{"paper_id":"1cc11a7c-169f-4d33-a5b4-c3d285c0c69c","body_text":"B A C D E F G S135  \n \n \nScientific Sessions \n(B) \nSession numbers are prefixed by SS. \nPresentation numbers are prefixed \nby the letter B. \nSessions and abstracts are listed \nby days. \n\u0011\u0011\u0017\u001e\u001b\u001c\u0014\u0012\u001f\u0002\u0001\u000f\u0012\u001b\u0013\u0017\u0001\n\n\u0001\u0001\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0001\u0001\u0005\u0005\u0007\t\n\u000e\u000e\u001b\u0018\u0014\u0012\u001f\u0002\u0001\u000f\u0012\u001b\u0013\u0017\u0001\u000b\u0001 \u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0001\u0005\r\u000b\n\u0010\u0012\u001d\u001e\u001b\u0014\u0012\u001f\u0002\u0001\u000f\u0012\u001b\u0013\u0017\u0001\f\u0001 \u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0001\u0006\b\r\n\u0010\u001e\u0019\u0014\u0012\u001f\u0002\u0001\u000f\u0012\u001b\u0013\u0017\u0001\r\u0001\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0001\u0006\u000b\u0007\n\u000f\u001a\u0019\u0014\u0012\u001f\u0002\u0001\u000f\u0012\u001b\u0013\u0017\u0001\u0005\u0004\u0001 \u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0001\u0007\u0004\u0004\nInsights Imaging (2014) 5 (Suppl 1):S135–S36  \nDOI 10.1007/s13244-014-0317-5\n\u001b\n\n \n \nB A C D E F G \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n \n \n\u0011\u0017\u001e\u001b\u001c\u0014\u0012\u001f\u0002\u0001\u000f\u0012\u001b\u0013\u0017\u0001\n\u0001\nS136  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n10:30 - 12:00 Room B  \nAbdominal Viscera  \nSS 101  \nPancreas and biliary system  \nModerators:  \nM. D'Onofrio; Verona/IT  \nD. Negru; Iasi/RO \nB-0001 10:30  \nAssessing the viability of human pancreas grafts using 31P MR \nspectroscopy  \nL. Carlbom, J. Weis, A. Biglarnia, O. Korsgren, H. Ahlström; Uppsala/SE \n(lina.carlbom@radiol.uu.se)  \nPurpose: In order to select pancreas suitable for transplantation an objective \nnon-invasive assessment of graft viability is desirable. 31P magnetic resonance \nspectroscopy ( 31P-MRS) has previously been applied for pancreas graft \nevaluation in animal models, with promisi ng results. The aim of this pilot study \nwas to investigate the feasibility of using 31P-MRS for assessment of human \npancreas graft viability prior to transplantation. \nMethods and Materials:  Pancreata from five human donors were included. \nImmediately after removal from the donor each pancreas was perfused with \nhistidine-tryptophan-ketoglutarate (HTK) solution and stored in hypothermic \ncondition (4oC). 31P-MRS was performed on a 1.5 T clinical MR scanner, using \nan ISIS sequence. Typical voxel size was ~5×5×14 cm 3. The first spectrum \nwas acquired 6-10 hours after HTK perfusion start. During the following 17-25 \nhours subsequent spectra were obtained by repeated examinations, while \npreserving the hypothermic environment. Thereafter the pancreas was \nexposed to room temperature for 24 hours and the last spectrum was \nmeasured. This spectrum served as a reference for non-viable tissue. The \nfollowing metabolites were fitted: phosphomonoesters (PME), inorganic \nphosphate (Pi), phosphodiesters (PDE), phosphocreatine (PCr), and \nadenosine triphosphate (ATP). \nResults: 3-ATP and 2-ATP lines decreased to the noise level within 2-4 hours \nafter the start of \n31P-MRS. PME, PDE and '-ATP levels gradually decreased \nand Pi increased. Non-viable pancreas tissue revealed dominant Pi and small \nPME and PDE intensities. \nConclusion: ( 3-ATP+2-ATP)/Pi, PME/Pi and PDE/Pi spectral intensity ratios \nobtained by \n31P-MRS are promising quantitative parameters for objective non-\ninvasive assessment of the viability of human pancreas grafts.  \nB-0002 10:39  \nUtility of DWI sequences in autoimmune pancreatitis before and after \nsteroid therapy  \nB. Pedrinolla, A. Cybulski, R. Negrelli, S. Mehrabi, R. Manfredi, R. Pozzi-\nMucelli; Verona/IT (beatrice.pedrinolla@gmail.com)  \nPurpose: To evaluate the utility of Diffusion Weighted (DWI) sequences in \nAutoimmune Pancreatitis (AIP) and to identify typical values of apparent \ndiffusion coefficients (ADC) before and after steroid therapy. \nMethods and Materials: Between February 2010 and April 2013 we evaluated \nretrospectively 35 Magnetic Resonance examination with Diffusion Weighted \nImaging (DWI) Sequences in 25 patients with diagnosis of AIP (19 men, 6 \nwomen, mean age 45.7 years). Ten out of 25 patients performed MRI before \nand after steroid therapy, 3/25 only before and 12/25 only after therapy. Two \nRadiologists separately analysed each exam, evaluating the signal ntensity of \nthe affected parenchyma in T1-weighted and DWI sequences and measuring \nADC values, through circular region of interest. \nResults: In the acute phase AIP appeared hypointense in T1 sequences in \n13/13 (100%) and hyperintense in 11/13 (84.6%) patients, with an ADC value \nof 1.12±0.19x10\n-3 mm2/s; after steroid treatment the signal intensity remained \nhypointense on T1 sequences in 16/22 (72.7%) and decreased in DWI in 17/22 \npatients (77.3%) with an ADC of 1.44 ±0.16x10\n-3 mm2/s, statistically \ndifferent from the acute phase value (p=0.0002). \nConclusion: AIP shows a low signal intensity on T1 sequences, an high signal \nintensity on DWI and a low ADC value in the acute phase. After steroid \ntreatment, signal intensity on T1 sequences remains low in the most of the \ncases, but intensity signal in DWI decreases and ADC value increases, \nreflecting disease activity. DWI and ADC are qualitative and quantitative \ncomplementary parameters in evaluation of response to treatment in AIP.  \n \n \n \n \n \nB-0003 10:48  \nStenosis of the main pancreatic duct in focal form of autoimmune \npancreatitis: imaging findings on MR-MRCP  \nR. Negrelli, E. Boninsegna, B. Pedrinolla, A. Ventriglia, C. Sozzi, S. Mehrabi, \nR. Manfredi, R. Pozzi-Mucelli; Verona/IT (ricky.negrelli@gmail.com)  \nPurpose: To retrospectively evaluate the MR imaging-MR \ncholangiopancreatographic (MRCP) findings of focal forms of autoimmune \npancreatitis (AIP) and to describe ductal system involvement at diagnosis. \nMethods and Materials:  MR examinations of 123 patients affected from AIP \nwere considered for inclusion. Out of these cases, we included 26 patients who \nsatisfied International Consensus Diagnostic Criteria and were suffering from \nfocal form of AIP. MRI was performed as a technique for the first diagnosis; all \nthe patients who underwent other imaging techniques were excluded. Image \nanalysis included: site of pancreatic parenc hymal enlargement, signal intensity \nabnormalities, pancreatic enhancement, main pancreatic duct (MPD) diameter, \nMPD stenosis, presence of upstream and side branches dilation. \nResults: signal intensity abnormalities were localised in the head in 10/26 \n(38.5%) patients, in the body-tail in 16/26 (61.5%) patients. Lesions showed \nhypointensity on T1-weighted images in all 26 patients, hyperintensity on T2-\nweighted images in 22/26 (84.6%) cases. The affected parenchyma was \nhypovascular during the arterial phase in 25/26 (96.2%) patients with contrast \nretention in all patients. MRCP study showed a single MPD stenosis in 12/26 \n(46.1%) patients and multiple stenoses in 14/26 (53.8%), without an upstream \ndilation of the MPD (mean value: 3.83 mm). \nConclusion: MR and MRCP are effective technique for the diagnosis of AIP, \nthrough the finding of indicative signs of the disease, such as the absence of \nthe physiological lobulation and the typical contrastographic appearance, \n(hypovascular during arterial phase with progressive retention of contrast). The \npresence of multiple stenoses at MRCP suggests the diagnosis of AIP.  \nB-0004 10:57  \nIndication to the use of secretin-enhanced MRCP: experience of a single \nlarge referral center  \nE. Boninsegna, R. Negrelli, B. Pedrinolla, S. Mehrabi, R. Manfredi, R. Pozzi-\nMucelli; Verona/IT (boninsegnae@gmail.com)  \nPurpose: To retrospectively evaluate the diagnostic utility of secretin-\nenhanced MR cholangiopancreatography (S-MRCP) in various pancreas \nconditions. \nMethods and Materials:  314 S-MRCP examinations performed on 299 \npatients in our center in 2012 were analysed. We evaluated the diagnostic role \nof S-MRCP in patients with suspected or diagnosed chronic pancreatitis, \nsevere acute pancreatitis, pancreatoduodenectomy, asymptomatic pancreatic \nhyperenzymaemia, suspected solid or cystic tumour. MRCP findings before \nand after Secretin administration were compared. \nResults: S-MRCP compared to MRCP found 34.2% (49/143) additional \npatients with mild-chronic pancreatitis ( P \n< 0.01); in 71 patients with already \ndiagnosed chronic pancreatitis secreti n was useful to assess pancreatic \nexocrine reserve (70% Sensibility, 95% Specificity) and to evaluate the \nefficiency of pancreatic sphincterotomy (performed in 16/71 patients, 22.5%); \nS-MRCP found pancreatic leakage in 12.5% of Patients (3/24) with acute \npancreatitis ( P=0.23); S-MRCP found anastomotic stenosis in 33.3% of \npatients with pancreatoduodenectomy (3/9, P=0.21); in the group with \nasymptomatic hyperenzymaemia S-MRCP showed mild-chronic pancreatitis in \n66.7% of patients (8/12, P \n< 0.01); in 17 patients with main pancreatic duct \nstenosis S-MRCP differentiated inflammatory pancreatic mass from pancreatic \ncarcinomas (100% Sensibility, 92% Specificity). In 19 patients with suspected \ncystic tumour S-MRCP was not diagnostically superior to MRCP. \nConclusion: Secretin-enhanced MRCP gives valuable information of the \nfunction and anatomy of the pancreas. It is useful to detect signs of mild-\nchronic pancreatitis, assess pancreatic exocrine reserve, demonstrate \npancreatic leakage, evaluate results of pancreatoduodenectomy and \nsphincterotomy, differentiate inflammatory pancreatic mass from pancreatic \ncarcinomas.  \nB-0005 11:06  \nPancreatic steatosis in a population-based study and its clinical \nrelevance determined by magnetic resonance imaging  \nF. Berthold\n1, J. Mayerle1, H. Völzke1, S.B. Reeder2, N. Hosten1, B. Mensel1, \nK. Hegenscheid1, P. Meffert1, J.-P. Kühn1; 1Greifswald/DE, 2Madison, WI/US \n(kuehn@uni-greifswald.de)  \nPurpose: To assess the pancreatic fat content and to investigate its clinical \nrelevance within a population-based study using a quantitative confounder-\ncorrected MRI method to measure tissue proton density fat-fraction (PDFF). \nMethods and Materials:  MRI was performed at 1.5 T including a multi-echo \nchemical shift-encoded sequence. PDFF-maps were calculated after correction \nfor T1-bias, T2*-bias, multi-peak spectral complexity of fat and noise bias. A fat \nphantom was constructed to evaluate the PDFF over the range from 0 to \nS137  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n100%. In addition, 1,367 asymptomatic volunteers, consistent of 633 men 743 \nwomen, with a median age of 50 years were grouped into non-diabetics \n(1083), prediabetics (208) and non-treated type 2 diabetics (76) following the \noral glucose tolerance test. PDFF was assessed in pancreatic head, body and \ntail for each subject. Multi-variate analysis was performed to compare PDFF \nwith demographic factors, behavioural factors and laboratory data associated \nwith the metabolic syndrome. \nResults: There was excellent agreement between fat content of phantom and \nPDFF (r2=0.989) with no differences in slope (p=0.471) and intercept \n(p=0.449). In volunteers, the mean-adjusted pancreatic fat content was 4.4% \n(head 4.6%; body 4.9%; tail 3.8%; being unequally distributed, p=0.0008). \nThere was no significant difference between non-diabetic, prediabetic and type \n2 diabetic subjects (p=0.757). Pancreatic PDFF was correlated with age, body \nmass index (BMI) and serum lipase activity, however (P < 0.001). \nConclusion: MRI is a useful tool to quantify the pancreatic steatosis. \nPancreatic fat is not related to prediabetes and diabetes, which implicates a \nlimited clinical relevance in the content of the glycaemic status.  \nB-0006 11:15  \nMDCT based volumetric analysis for evaluation of pancreas regeneration \nfollowing distal pancreatic resection  \nT. Zahel, V. Phillipp, H. Algül, E.J. Rummeny, M. Dobritz; \nMunich/DE (tinazahel@googlemail.com)  \nPurpose: To analyse pancreatic volume after distal pancreatic resection using \na semi-automatic volume software and MDCT-scans. \nMethods and Materials:  Residual pancreatic volumes of 25 patients who had \nundergone distal pancreatic resection (for benign and malignant reasons) were \ndetermined 2 weeks, 8 weeks, and 6 months after surgery. CT scans were \nobtained in the portal-venous phase (5 mm, 256-slice CT scanner). A semi-\nautomatic volume analysis software with\" tumor-tracking\" function was used. \nResults: Pancreatic volume was determined semi-automatically within \n5 minutes for one examination. Mean pancreatic volume of 25 patients (mean \nage 63.0 years) was 33.9 ml, 39.2 ml, and 40.5 ml; 2 weeks, 8 weeks, and 6 \nmonths after surgery, respectively. Si gnificant increase of pancreatic volume \nwas already seen 8 weeks after surgery (Wilcoxon's signed rank, p=0.001*). \nSix months after surgery pancreatic volume was significantly higher than 2 \nweeks after surgery (Wilcoxon's signed rank, p=0.002*). Thus, between 8 \nweeks and 6 months after surgery further volume increase was found \n(p=0.0004*).  \nConclusion: MDCT based volumetric analysis is a fast and suitable method \nfor evaluation of pancreas volume following distal pancreatic resection. \nFurthermore, pancreas volume shows a tendency to increase already 8 weeks \nafter surgery.  \nB-0007 11:24  \nDetection of active bile leak with Gd-EOB-DTPA-enhanced MR \ncholangiography: comparison of 20-25 min delayed and 60-180 min \ndelayed images  \nA. Cieszanowski, A. Stadnik, A. Lezak, E. Maj, K. Zieniewicz, \nK. Rowinska-Berman, I.P. Grudzinski, M. Krawczyk, O. Rowinski; Warsaw/PL \n(andrzej.cieszanowski@wum.edu.pl)  \nPurpose: To assess the value of contrast-enhanced magnetic resonance \ncholangiography (MRC) performed in different time delays after injection of \ngadoxetic acid disodium (Gd-EOB-DTPA) for the diagnosis of active bile leak. \nMethods and Materials:  This retrospective analysis included Gd-EOB-DTPA-\nenhanced MR images of 34 patients suspected of bile leak. Images were \nacquired 20-25 min after Gd-EOB-DTPA injection. If there was inadequate \ncontrast in the bile ducts, then delayed images after 60-90 min and 150-\n180 min were obtained. Results were correlated with intraoperative findings, \nERCP results, clinical data, laboratory tests, and follow-up examinations. \nResults: Gd-EOB-DTPA-enhanced MRC yielded an overall sensitivity of \n96.4%, specificity of 100% and accuracy of 97.1% for the diagnosis of an \nactive bile leak. The sensitivity of 20-25 min delayed MR images was 42.9%, of \ncombined 20-25 min and 60-90 min delayed images was 92.9% and of \ncombined 20-25 min, 60-90 min and 150-180 min delayed images was 96.4%. \nConclusion: Gd-EOB-DTPA-enhanced MRC utilising delayed phase images \nwas effective for detecting the presence and location of active bile leaks. The \nimages acquired 60-180 min post-injection enabled identification of bile leaks \neven in patients with a dilated biliary system or moderate liver dysfunction.  \n \n \n \n \n \n \n \n \nB-0008 11:33  \nXanthogranulomatous cholecystitis: which is the best image tool to \ndifferentiate it from gallbladder carcinoma?  \nE. Lee, J. Kim, I. Joo, J. Lee, J. Han, B. Choi; Seoul/KR \n(seraph377@gmail.com)  \nPurpose: To evaluate diagnostic performance and common findings of high-\nresolution ultrasound (HRUS), CT, MRI to differentiate xanthogranulomatous \ncholecystitis (XGC) from early flat-type gallbladder (GB) cancer. \nMethods and Materials:  From January 2000 to May 2012, patients with \nsurgically proven XGC (n=40) and early GB cancer (T1 or T2) with flat or \ninfiltrative type (n=46), who underwent at least one imaging study amongst the \nHRUS (combined low- and high-MHz transducers, n=43), CT (n=83), or MRI \n(n=34) were included this study. Two radiologists independently and \nretrospectively estimated the possibility of XGC or GB cancer in each imaging \nmodality using a five-point scale. They also evaluated the presence or absence \nof predefined abnormal findings of the gallbladder on HRUS, CT, and MRI. \nStatistical analyses were performed using ROC analysis and Fisher's exact \ntest. \nResults: AUCs of HRUS, CT and MR to differentiate XGC from GB cancer \nwere more than 0.8 in R1 and R2 with moderate to excellent agreement. \nStatistically common HRUS findings for XGC included diffuse and smooth wall \nthickening, intramural nodule, gallstone, and collapsed GB (p < 0.01). \nStatistically common CT findings for XGC included diffuse and smooth wall \nthickening, continuous mucosa, intramural nodule, heterogeneously thick \nsingle layer, transient hepatic atten uation difference, and pericholecystic \ninfiltration (p < 0.01). Statistically common MRI findings for XGC included \ndiffuse wall thickening, continuous mucosa, intramural nodule, \nheterogeneously thick single layer, and transient hepatic signal difference \n(p < 0.01). \nConclusion: All three modalities of HRUS, CT and MRI showed comparable \nperformance for distinguishing XGC from GB cancer using specific imaging \nfindings.  \nAuthor Disclosures: \nB. Choi: Consultant; Research Consultant, Samsung Electronics Co. Ltd. \nB-0009 11:42  \nDual-energy CT of the pancreas: improved carcinoma-to-pancreas \ncontrast with a novel mono-energetic reconstruction algorithm  \nR.W. Bauer, F. Fessler, J.M. Kerl, B. Schulz, C. Frellesen, T.J. Vogl, \nJ.L. Wichmann; Frankfurt a. Main/DE (ralfwbauer@aol.com)  \nPurpose: To evaluate a novel mono-energetic reconstruction algorithm with \nimproved noise reduction for dual-energy CT of the pancreas. \nMethods and Materials:  35 patients with suspected pancreatic carcinoma \nunderwent dual-source dual-energy CT with arterial phase. Images were \nreconstructed as virtual 120 kV series (M_0.6) and with the standard mono-\nenergetic application at 40 keV and 55 keV. Additional image series were \nreconstructed with the novel \"mono-energetic plus\" application promising \nimproved noise reduction (40+ and 55+). Image quality was compared \nbetween all series with respect to noise, pancreas signal, SNR and pancreas-\nto-lesion contrast. \nResults: 12 carcinomas were detected. Compared to the standard M_0.6 \nseries signal of healthy pancreas tissue was significantly higher for all mono-\nenergetic reconstructed images. With the standard mono-energetic algorithm \nnoise increased with lower energies (55: 20 HU; 40: 41 HU), while the novel \nalgorithm was able to keep the noise at a constantly low level (7 HU for 55+ \nand 40+) with no significant differences to the M_0.6 series (9 HU). SNR of the \npancreas was significantly superior in the 40+ and 55+ than in the 40 and 55 \nstandard series (35.5 and 20 vs. 7 and 8) and outperformed the M_0.6 series \n(9.5). Likewise, pancreas-to-lesion contrast was highest in the 40+ series (12) \nand thus significantly higher than in any of the other series (M_0.6: 2; 40: 1; 50: \n2; 55+: 5). \nConclusion: A novel algorithm for mono-energetic reconstructed dual-energy \nCT data can significantly improve image quality in the diagnosis of pancreatic \ncarcinoma.  \n \n \n \n \nS138  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0010 11:51  \nImaging findings of ischemic cholecystitis following transarterial \nchemoembolisation prior to liver transplantation for hepatocarcinoma  \nE. Danse, X. Pavard, J. Lerut, P. Goffette, P. Trefois, L. Annet, C. Dragean, \nN. Michoux; Brussels/BE (etienne.danse@uclouvain.be)  \nPurpose: To identify imaging features helping diagnose ischemic cholecystitis \n(IC) consecutive to transarterial chemoembolisation (TACE). \nMethods and Materials:  A retrospective review of TACE procedures prior to \ntreat hepatocarcinoma was performed including 46 patients (35 transplanted, 2 \ndied, 9 on the waiting list for liver transplantation). Post TACE US/MRI-derived \nfeatures were correlated to the final diagnosis based on pathologic analysis \n(35) or biological and clinical follow-up (11). Following were considered at \nUS/MRI: wall thickening (3 mm), gallbladder distension (short axis > 4 cm), \npericholecystic fluid and infiltration, striated wall, wall irregularities, at MRI: T1 \nhypersignal of the gallbladder wall on unenhanced sequence, T1 \nhyperattenuation of the gallbladder wall and/or of the adjacent liver \nparenchyma on Gd-enhanced sequence, at Sonography: Murphy sign, \nincreased colour Doppler signal of the gallbladder wall. Scott's pi was used to \nassess inter-modality agreement. A logistic regression was performed to \nidentify imaging features which contribute significantly to the prediction of IC. \nResults: IC was diagnosed in 12 patients. The most common features \n(frequency/Se/Sp) were wall thickening (91%/83%/91%), striated wall \n(82%/74%/96%), and wall irregularities (73%/75%/95%). Spontaneus \nhypersignal T1 signal of the gallbladder wall has a sensitivity and specificity of \n66 % and 100%, respectively. These features were significantly more present \nin positive patients (p < 0.005). Within a logistic model, they predict IC with a \ngood performance level (Youden index=0.91). Imaging-Pathology agreement \nwas good (pi=0.8) as well as US-MRI agreement (0.6< pi< 0.8). \nConclusion: A model based on three imaging features may allow predicting \nacute ischemic cholecystitis with US or MRI.  \n10:30 - 12:00 Room C  \nCardiac  \nSS 103  \nAcute chest pain, prognosis and risk \nstratification  \nModerators:  \nM. Gardarsdottir; Reykjavik/IS  \nS. Leschka; St. Gallen/CH  \nB-0011 10:30  \nChallenges in the use of a computed tomography imaging-based \ncardiovascular risk assessment tool in routine practice  \nP. Jairam, T. Blokhuis, H.M. Verkooijen, P.A. de Jong, F. Rutten, L. Leenen, \nW.P.T.M. Mali, Y. van der Graaf; Utrecht/NL (pjairam@umcutrecht.nl)  \nPurpose: Incorporation of a CT-based cardiovascular disease (CVD) risk \nscore into clinical practice may complement standard conventional risk factors-\nbased strategies in cardiovascular risk screening. The current study evaluates \nthe potential barriers to the introduction of the CT-based CVD risk score in \ndaily practice. \nMethods and Materials:  We conducted a pilot study among referring \nphysicians, radiologists and general practitioners (GP) involved in the \napplication of the CT based CVD risk score. Hundred traumatology patients \nwho underwent chest CT scanning in the UMC Utrecht were included. \nAdherence percentages of the referring physicians and radiologists to the \nregular and correct application of the CT based CVD risk score were assessed. \nAdditionally, the GPs attitudes towards follow-up of the CT based CVD risk \nscore result in primary prevention setting were evaluated. \nResults: Among the clinicians referring the patient for CT scanning 18% \nspecifically requested for CVD risk assessment and 42% conveyed the CVD \nrisk to the GP. Only 32% of the radiologists assessed the CVD risk score \nalthough it was specifically requested. Among the GPs 14% were negative \ntowards follow-up of the CVD risk score result in primary prevention setting. \nConclusion: In current daily practice, there are certain barriers that need to be \nreduced to make the implementation of the routine use of the CT based CVD \nrisk score realizable. Main deficiencies identified are: unfamiliarity and incorrect \napplication of the CT-based CVD risk score, unawareness about the \nsignificance of CVD risk prevention in general, financial- and time constraints.  \n \n \n \n \n \nB-0012 10:39  \nPrognostic significance of cardiac magnetic resonance Imaging in \npatients with acute chest pain, elevated cardiac enzymes and a negative \ncoronary angiogram  \nT. Emrich, M. Kros, N. Abegunewardene, T. Münzel, C. Düber, K.-F. Kreitner; \nMainz/DE (Tilman.Emrich@unimedizin-mainz.de)  \nPurpose: To assess the prognostic value of cardiac MRI in patients with acute \nchest pain, elevated cardiac enzymes and a negative coronary angiogram. \nMethods and Materials:  In a 51 months period, 152 patients allocated by the \nchest pain unit could be included in this study. Based on consensus reading of \nall available clinical, laboratory and imaging data, there were 54 patients with \nmyocarditis, 27 patients with dilative ca rdiomyopathy, 21 patients with ischemic \ncardiomyopathy, 15 patients with Tako-Tsubo cardiomyopathy and 17 patients \nwith a hypertensive cardiomyopathy. Furthermore we detected miscellaneous \nother cardiac diagnoses (e.g. tachymyopathy, hypertrophic cardiomyopathy or \nnon-compaction cardiomyopathy n = 18). CMRI enabled correct assignment of \ndiagnosis in 90 % of cases. All patients could be followed up either by \ntelephone call or by patients' medical record after a mean of 50 months. \nPrimary endpoints were the occurrence of MACE (death, stroke, heart failure, \nrecurrent hospitalisation), secondary endpoints were the initiation of an \ninterventional respectively operative procedure or a continuous medical \ntherapy. \nResults: Primary and secondary endpoints were reached most often in \npatients with dilative cardiomyopathy, non-compaction cardiomyopathy and \ntachymyopathy compared with all other diagnoses (p < 0.01), followed by \npatients with hypertensive heart disease. The most favorable prognosis had \npatients with Tako-Tsubo cardiomyopathy and patients with myocarditis. \nConclusion: CMRI helps establishing the final diagnosis in patients with acute \nchest pain, elevated cardiac enzymes and a negative coronary angiogram in \nthe vast majority of cases and is of prognostic significance.  \nB-0013 10:48  \nUsefulness of CT angiography in low and moderate cardiovascular risk \npatients with chest pain admitted to emergency room in multimodal \nhospital  \nP.T. Klimeczek, J. Jagas, W. Witkiewicz; Wroclaw/PL  \n(pklimeczek@gmail.com)  \nPurpose: The purpose of the study was to evaluate usefulness and safety \nangio-CT in patients admitted to the ER with chest pain. Angio-CT was \ngatekeeper to invasive procedures or non-invasive treatment. \nMethods and Materials:  The prospective study covered 206 patients (mean \nage 66 +/- 15, 109 F) admitted to the ER with chest pain and low to \nintermediate cardiovascular risk. Patients were randomly assembled into two \nsubgroups. Treatment in Group A comprised of risk assessment and invasive \ndiagnostics, if necessary (102 pts, 55 F). Group B (104 pts, 52 F) patients \nunderwent contrast CT-angiography with prospective ECG gating (triple rule \nout protocol) appended to the routine proceeding. \nResults: In group A, 104 DSCT were performed and subsequently 30 patients \nunderwent coronary angiography (24 PCI, 4 CABG, 2 muscular bridges). In 74 \ncases, coronary stenosis as a cause of chest pain was excluded and patients \nafter short clinical observation were discharged or relegated to another \nspecialist (due to additional findings). Among 1,096 coronary segments, 92 \n(8.3%) were nonevaluable (mostly distal  parts and small branches). Effective \nradiation dose was for DSCT 10.4+/4.2 mSv. In the period of follow-up (mean \n342+/-65 days), there were no hospitalisations due to bias in coronary \nassessment in CT. DSCT as a diagnostic procedure demonstrated \ndiscriminative value: area under ROC curve 0.977 for 0.95 confidence interval \nand p<0.002. Sensivity 100%, Specificity 95.4%, PPV 89% and NPV 100%. In \ngroup B: In 101 patients conventional coronary angiography and next 35 PCI \nand 6 CABG were performed. In 60 cases CCA was negative. \nConclusion: DSCT helps to avoid unnecessary invasive procedures due to \ncoronary stenosis exclusion.   \nB-0014 10:57  \nCoronary risk stratification in asymptomatic population: impact of \ncardiac CT  \nD. Caruso, S. Ferretti, D. Bellini, M. Spallone, G. Carlino, M. Rengo, A. Laghi; \nRome/IT (dcaruso85@gmail.com)  \nPurpose: To demonstrate the impact of cardiac CT (CTCA) in the stratification \nof cardiovascular risk in a population of asymptomatic patient with classic risk \nfactors for coronary artery disease (CAD) compared to the systematic coronary \nrisk evaluation (SCORE). \nMethods and Materials:  We included 123 asymptomatic patients (97 men/ 26 \nwomen; age 51.3 ±7.2) who underwent CTCA after clinical evaluation during \nwhich a risk for cardiovascular events in 10 years with the SCORE was \ncalculated. Calcium score was also evaluated. Three possible outcomes were \nhypotised: patient with no CAD, patients with non-significant coronary stenosis, \nS139  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nand patients with significant coronary stenosis. On the basis of CACA results, \nwe developed a simulation model to evaluate the effect on patient \nmanagement. \nResults: The pretest risk of cardiovascular events in the asymptomatic \npopulation was 1.06%. The average value of calcium score was \n56.48 ± 176.61 (moderate risk). We found 17 patients with significant coronary \nstenosis who underwent coronary revascularisation. Over 50 patients with non-\nsignificant coronary stenosis began a medical treatment with statins. The \naverage risk for cardiovascular events was 0.42 ± 0.66 after a cardiac CT \nexam. \nConclusion: We demonstrated an hypothetical reduction of the average risk \nfor cardiovascular events using cardiac CT.  \nB-0015 11:06  \nThe incremental prognostic value of dual-source computed tomography \ncoronary angiography in subjects with suspected or known coronary \nartery disease  \nT. Miszalski-Jamka, B. Kedzierski, T. Kuniej, A. Stoinska, P. Gac, R. Poreba, \nP. Jazwiec; Wroclaw/PL  \nPurpose: To assess incremental prognostic value of double-source computed \ntomography (DSCT) coronary angiography over clinical data in patients with \nknown or suspected coronary artery disease. \nMethods and Materials:  Clinical and DSCT data were analysed in 311 \nconsecutive patients who were scheduled for DSCT coronary angiography. \nDSCT angiograms were assessed for presence, luminal stenosis severity, \nlocation, and type (non-calcified, mixed or calcified) of coronary atherosclerotic \nplaques. 311 patients (164 males, mean age 54.0 ±8.1 years) were followed-up \nfor 18.3 ±4.0 months. Cardiac events (cardiac death, non-fatal myocardial \ninfarction (MI), revascularisation and cardiac hospitalisations were related to \nclinical and DSCT data. Cox proportional-hazards model was applied in \nstepwise forward fashion to identify predictors of outcome. \nResults: Coronary plaques were found in 197 patients. Cardiac events \noccurred in 25 patients (2 cardiac deaths, 3 MI, 8 revascularisations, 15 \nhospitalisations). Independent predictors of subsequent events were diabetes \nmellitus, prior MI, coronary plaque, and \u000150% left main stenosis. In sequential \nCox models predictive power of clinical model was strengthened by DSCT data \n(p < 0.05). \nConclusion: DSCT coronary angiography enhances prognostic value of \nclinical data in patients with suspected or known coronary artery disease.  \nB-0016 11:15  \nAnatomic vs functional testing in patients with chronic chest pain \nsyndrome: a cost-effectiveness analysis  \nA. Goehler1, T. Mayrhofer2, A. Pursnani2, S. Huber1, J. Bayley2, J. Nolte2, \nG. Gazelle2, B. Chow3, U. Hoffmann2; 1New Haven, CT/US, 2Boston, MA/US, \n3Ottawa, CT/CA (alexander.goehler@yale.edu)  \nPurpose: Improvements in Coronary CT angiography (CTA) have led to \ndebate about whether anatomic or functional testing is more cost-effective in \npatients with suspected obstructive coronary artery disease (CAD). We \nsimulated clinical outcomes and costs of CTA and functional testing. \nMethods and Materials:  We developed a Markov model to simulate CAD \nprogression and mortality in 3,719 patients from the Ottawa Cardiac CT \nRegistry. We compared no testing (SOC) to CTA (CTA), stress-EKG/stress-\necho/SPECT (in 20%, 50%, and 30% of the cases) (FT), FT followed by CTA \n(FT-CTA) and CTA followed by FT (CTA-FT). \nResults: In our population (age 58 years, 52% male, 68% moderate NCEP, \n9% high NCEP) the prevalence of CAD was 14% obstructive (54% non-\nobstructive). FT correctly identified 11% (13%) at costs of $848/patient; CTA \n12% (52%), CTA-FT 10% (52%), FT-CTA 10% (12%) at $892, $762, and $681 \nper patient, respectively. The model predicted an average remaining life \nexpectancy of 16.33 quality adjusted life years (QALY) for SOC and 16.44, \n16.46, 16.44 and 16.44 QALYs for FT, CTA, CTA-FT, and FT-CTA, \nrespectively. This resulted in incremental cost-effectiveness ratios (ICER) of \n$19,500/QALY for FT-CTA compared to SOC, and $24,300/QALY for CTA vs. \nFT-CTA; FT and CTA-FT were both dominated. When including treatment for \nnon-obstructive CAD, life expectancy increased by 0 to 0.6 QALYS depending \non the percentage of non-obstructive CAD diagnosed; CTA cost-effectiveness \nimproved to $5,000/QALY; the other strategies were dominated. \nConclusion: Preliminary analyses indicate th at CTA is cost-effective for initial \nevaluation of patients with chronic chest pain.  \n \n \n \n \n \n \n \nB-0017 11:24  \nPrognostic value of cardiac CT in a asymptomatic population: 2-years \nfollow-up  \nD. Caruso, M.M. Maceroni, F. Vecchietti, D. Bellini, L. Bertana, S. Ferretti, \nM. Rengo, A. Laghi; Latina/IT (dcaruso85@gmail.com)  \nPurpose: To evaluate the prognostic value of cardiac CT in a population of \nsymptomatic patients with intermediate risk of coronary heart disease. \nMethods and Materials:  One hundred twenty-three asymptomatic patients \nwith intermediate cardiovascular risk underwent CT coronary angiography \n(CTCA). Calcium score was also evaluated. Patients were classified in three \ngroups: patients with no CAD, patients with non-significant coronary stenosis, \npatients with significant coronary stenosis according to CTCA results. \nDevelopment of major cardiac events (cardiac death, non-fatal myocardial \ninfarction, and unstable angina requiring hospitalisation, coronary \nrevascularisations) or worsening of clinical conditions was evaluated for a 2-\nyear period. \nResults: None of the patients included in the \"no CAD\" group (51%) developed \nmajor cardiac events in 2 years. All patients (13.8%) with significant coronary \nstenoses underwent revascularisation within 6 months. Half of the patients with \nnon-significant coronary stenoses (17% of the initial population) developed \nsymptoms (70% stable angina, 30% unstable angina). The overall rate of major \ncardiac events (revascularuisation and unstable angina) was 23.8%. \nConclusion: Multislice CT showed a high prognostic value in patients with \nintermediate risk for coronary heart disease. In particular, the prognosis of \npatients with negative cardiac CT for coronary heart disease was excellent at \n2-years follow-up.  \nB-0018 11:33  \nResidents' performance in the interpretation of on-call \"triple-rule-out\" \nCT studies in patients with acute chest pain  \nA.J. Lewis, K.G. Garrett, U.J. Schoepf, J.R. Silverman, A.W. Krazinski, \nL. Geyer, P. Suranyi, F.G. Meinel, P. Costello; Charleston, SC/US \n(lewal@musc.edu)  \nPurpose: To evaluate the agreement between preliminary Radiology resident \nand final subspecialty attending interpretation of on-call, emergency \"Triple-\nRule-Out\" (TRO) CT studies in patients with acute chest pain. \nMethods and Materials:  The study was IRB-approved and HIPAA compliant. \nData from 617 on-call TRO studies were analysed. Dedicated software enables \nsubspecialty attendings to grade discrepancies in interpretations between \npreliminary trainee reports and their final interpretation as \"unlikely to be \nsignificant\" (minor discrepancies) or \" likely to be significant\" for patient \nmanagement (major discrepancies). The frequency of minor, major and all \ndiscrepancies was compared with 609 emergent non-ECG-synchronised chest \nCT studies using Pearson's 1\n2 test. \nResults: The total number of discrepancies was significantly higher in the TRO \ngroup (11.2%) compared to the control group (6.7%, p=0.008). Minor \ndiscrepancies occurred more often in the TRO group (9.1% vs. 3.9%, \np < 0.001), but there was no difference in the frequency of major discrepancies \n(2.1% vs. 2.8%, p=0.55). Minor discrepancies in the TRO group most \ncommonly resulted from missed extrathoracic findings with missed liver lesions \nbeing the most frequent. Major discrepancies mostly encompassed cardiac \nand extracardiac vascular findings. \nConclusion: On-call resident interpretation of TRO CT studies in patients with \nacute chest pain is congruent with final subspecialty attending interpretation in \nthe overwhelming majority of cases. The rate of discrepancies likely to affect \npatient management in this domain is not different from emergent non-ECG-\nsynchronised chest CT.  \nAuthor Disclosures: \nU.J. Schoepf: Consultant; Bayer, Bracco, GE, and Siemens. S140  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0019 11:42  \nAssessment of coronary plaque by coronary CT angiography in patients \nwith acute coronary syndrome non-ST segment elevation  \nS. Gaman, N. Barysheva, M. Shabanova, I. Merculova, M. Shariya; \nMoscow/RU (svgaman@yandex.ru)  \nPurpose: To evaluate plaque characteristics of culprit lesion in patients with \nacute coronary syndrome (ACS) non-ST segment elevation. \nMethods and Materials:  25 patients with ACS non-ST segment elevation \nunderwent coronary CT angiography (64-MSCT Aquilion, Toshiba, Japan; 100-\n120 ml intravenously contrast agent Ultravist 370 ,Bayer, Germany) within 24 \nhours after onset. The plaques were divided in 4 groups, namely, soft (Group \n1), mixed (Group 2), calcified (Group 3), obstructive (Group 4). The level was \nbetween 360-380 HU, the window between 1010-1030 HU.  We estimated  5 \ncriteria of culprit lesion: X-ray minimum density, length of plaque, spotty \ncalcification (diameter <  3 mm), remodeling index, rough contour, the ring-like \nenhancement. \nResults: We evaluated 25 coronary segments. Soft plaques were in 28% \n(n=7). Mixed plaques were in 52% (n=13). Calcified plaques were in 8% (n=2). \nObstructive plaques (with thrombotic component) were in 12% (n=3).  Mean \ndensity of plaque in Group 1 was 34.7+10.5 (18-60) HU, in Group 2 was \n51.2+24.2 (2-105) HU. Spotty calcification was in 57% (n=4) in Group 1. Rough \ncontour was identified in all plaques. Mean length of plaques was \n16.86+6.94 mm. Positive remodeling was in 88% (n=22). Mean remodeling \nindex was 1.28+0.13. The ring-like enhancement was in 24% (n=6). \nConclusion: Coronary CT angiography allows detect unstable plaque, \nsubsequently resulting in ACS.  \nB-0020 11:51  \nRight-to-left ventricle ratios on pulmonary CTA in patients with acute \npulmonary embolism: correlation of volumetric ratio, embolus burden \nand adverse outcome  \nB. Mensel, M. Holzinger, J.-P. Kühn, N. Hosten; \nGreifswald/DE (menselb@uni-greifswald.de)  \nPurpose: The  right-to-left ventricle ratio (RV/LV) is an important predictor of \nright heart dysfunction in patients with acute pulmonary embolism (APE). We \ncompared the correlation of volumetric RV/LV, embolus burden expressed by \nMastora score and adverse outcome (AO) of APE with diametrically and \nplanimetrically determined RV/LV on pulmonary CTA. \nMethods and Materials:  CTAs of 97 patients (median age, 63.5 years) were \nanalysed. For each patient, Mastora scoring was applied, the RV/LV was \ndetermined by semiautomated volumetry (vol), diametry (diam) in axial and 4-\nchamber views (4CH) and planimetry (plan) in axial and 4CH views. The time \nfor ratio measurements was taken. \nResults: Correlation coefficients (CC) for RV/LV\nvol vs. RV/LV plan4ch were \nr=0.678 (P < 0.001), vs. RV/LV plan: r=0.629 (P < 0.001), vs. RV/LV diam4CH: \nr=0.580 (P < 0.001) and vs. RV/LV diam: r=0.577 (P < 0.001). CCs for Mastora \nscores and RV/LV vol were r=0.663 (P < 0.001), RV/LV plan: r=0.645 (P < 0.001), \nRV/LVplan: r=0.606 (P < 0.001), RV/LV diam: r=0.574 (P < 0.001) and \nRV/LVdiam4CH: r=0.566 (P < 0.001). The median time needed for determination \nof RV/LV vol, RV/LV plan4CH, RV/LV diam4CH, RV/LV plan and RV/LV diam were \n16:48 min, 2:11 min, 1:26 min, 57 sec and 25 sec (P < 0.05). ROC analysis for \nevaluation of AO revealed an AUC for RV/LV plan4CH of 0.731 (P < 0.003) and \n0.700 (P < 0.01) for RV/LVplan. AUC for RV/LVvol was 0.786 (P < 0.001). \nConclusion: Determination of the RV/LV by planimetry is fast and better \ncorrelates with volumetry and the embolus burden than diametry. It is \ncomparable to volumetry in predicting AO.  \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n10:30 - 12:00 Room D  \nChest  \nSS 104  \nLung cancer screening and pulmonary \nnodule evaluation  \nModerators:  \nM. Regier; Hamburg/DE  \nE.J. Stern; Seattle, WA/US  \nB-0021 10:30  \nTobacco smoking and screen-detected lung cancer: does it matter \nbeyond 30 pack-years?  \nR. Aktay, P. Mazzone, T.E. Love; Cleveland, OH/US (re.aktay@gmail.com)  \nPurpose: To investigate whether smoking pack-years among high-risk \nindividuals incrementally improves prediction of screen-detected lung cancer. \nMethods and Materials:  National Lung Screening Trial (NLST) participants \n(n=53,452), each with smoking history of \u000330 pack-years were stratified by \npack-years into three groups ( \u000360 and \u0002 42 identifying high and low; \nmean±SD=83±23 and 37 ±4 respectively). For our analytic sample, we \nrandomly selected 6,000 individuals from the high (2,911) and low (3,089) \nstrata. We then estimated the propensity (PS) for high-smoker (exposure) \nusing multivariate logistic regressi on and 48 covariates, including socio-\ndemographics, occupational exposure, smoking status (former/current), family \nhistory, and medical and extra-pulmonary cancer history. An optimal pairwise \npropensity match produced 1,493 pairs of low- and high-smoker individuals. In \nthe matched sample, we estimated the association between high (vs. low-) \nsmoking and confirmed lung cancer (outcome), adjusting for PS and covariates \nstill imbalanced after matching, then compared these results to a model built \nfor all 6,000 individuals. \nResults: High-smokers were older (62 vs. 60 years), and had younger \nsmoking-onset age (16 vs. 18) than low-smokers. In our matched sample, \nlogistic regression estimated an odds ratio (OR) of 2.0 (95% CI:1.2 - 3.3; \np=0.008) for confirmed lung cancer, compared to 2.2 (CI:1.6 - 3.1; p < 0.0001) \nin the pre-match sample. \nConclusion: In NLST, lung cancer detection is significantly higher (OR=2.0) in \nsmokers with history of \u000360 pack-years as compared to \u000242 pack-years, even \nafter extensive covariate adjustment. Further analysis might suggest a new \nthreshold for pack-years as a screening selection criterion to reduce false-\npositives and cost.  \nB-0022 10:39  \nOverruling of screen test results in a CT lung cancer screening trial: \nvalue of radiologists' expertise  \nM.A. Heuvelmans\n1, R. Vliegenthart1, X. Xie1, P.A. De Jong2, W. P.T.M. Mali2, \nM. Oudkerk1; 1Groningen/NL, 2Utrecht/NL (m.a.heuvelmans@umcg.nl)  \nPurpose: To investigate the impact of radiologists' expertise on test result \ndecisions made in a CT lung cancer screening trial. \nMethods and Materials:  In the Dutch-Belgian randomised lung cancer \nscreening trial (NELSON), the baseline screen result was based on the lung \nnodule with largest volume. According to the protocol, nodule volume < 50 mm3, \n50-500 mm3 and >  500 mm3 led to a negative, indeterminate and positive \nscreen result, respectively. However, the NELSON protocol allowed \nradiologists to adjust the screen result. All participants in whom the baseline \nscreen result was based on a solid nodule were included. Baseline nodule \nvolume and screen result according to protocol were compared to the final \nscreen result. Nodules were followed for up to 6.8years. \nResults: In 3269 participants (2759 male, median age 58.0 years), the \nbaseline result was based on a solid nodule. In 189 participants (5.8%), the \ninitial result for the nodule was adjusted by the radiologist. Median follow-up \ntime of these nodules was 5.5years. The screen result was adjusted from \npositive or indeterminate to negative in two and 118 participants, respectively. \nNone of these nodules turned out malignant. The result was adjusted from \nnegative or positive to indeterminate in one and 64 participants, respectively. \nLung cancer was detected in two (3.1%) nodules with volume > 500 mm\n3 four \nyears later. In four participants the screen result was adjusted from \nindeterminate to positive; two nodules were malignant (50%). \nConclusion: In a baseline lung cancer screening study, the readers adjusted \nthe screen result in 5.8%. Radiologists' expertise can reduce false-positive and \nfalse-negative screen results.  \n \n \n \n \nS141  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0023 10:48  \nComparison of diameter and volume measurements for the estimation of \nnodule size for lung nodules detected in a CT lung cancer screening trial  \nM.A. Heuvelmans1, R. Vliegenthart1, N. Horeweg2, P.M.A. Van Ooijen1, W. \nP.T.M. Mali3, H.J. De Koning2, M. Oudkerk1; 1Groningen/NL, 2Rotterdam/NL, \n3Utrecht/NL (m.a.heuvelmans@umcg.nl)  \nPurpose: To compare congruity of estimation of lung nodule size in a lung \ncancer screening trial by calculating volume based on maximal and mean \ntransversal diameter measurements, and measurements from semi-automated \nvolumetric software. \nMethods and Materials:  The diameter and volume measurements of 7,914 \nsolid pulmonary nodules detected in 3,165 participants from the Dutch-Belgian \nrandomised lung cancer screening trial (Dutch acronym: NELSON) were \nevaluated. CT-scans were performed in low-dose setting. Nodule volumes \nwere obtained semi-automatically in the LungCARE software, and were \ncompared to volumes based on the maximal transverse diameter ( D) and the \nmean transversal diameter in x-y direction, without taking into account the \ndiameter standard deviation, and assuming a spherical shape of the nodule \n(formula: Volume=(1/6)*pi*D3). \nResults: Semi-automated software yielded a median nodule volume of \n37.5 mm3 (Interquartile Range (IQR): 23.8-67.7 mm 3). The median estimated \nnodule volume using maximal and mean transversal diameter, was 61.6 mm 3 \n(IQR: 38.8-130.9 mm3), and 47.7 mm 3 (IQR: 28.7-91.9 mm3), respectively. The \nuse of maximal diameter and mean diameter to estimate nodule size \noverestimated nodule volume by 55.6% (median, IQR: 25.3-96.1%) and 23.8% \n(median, IQR: 1.6-51.5%), respectively, compared to semi-automated \nvolumetry. This overestimation would res ult in an increase of positive test \nresults in a lung cancer screening setting based on diameter measurements. \nConclusion: Estimation of nodule volume based on maximal transversal \ndiameter measurements overestimates nodule size compared to semi-\nautomated volumetry. We recommend using nodule volume instead of \ndiameter to assess lung cancer probability and determine thresholds for \nscreening results.  \nB-0024 10:57  \nGround glass nodules: CT-epidemiological analysis of growth patterns  \nM. Silva1, F. Centra1, D. Colombi1, C. Rossi1, N. Sverzellati1, A.A. Bankier2; \n1Parma/IT, 2Boston, MA/US (mariosilvamed@gmail.com)  \nPurpose: To quantify growth patterns of solitary pure ground glass nodules \nand to relate these pattern to epidemiological factors. \nMethods and Materials: Between 2008 and 2011, 95 patients were diagnosed \non CT with solitary pure ground glass nodule (pGGN) at our hospital. CT \nfeatures of pGGNs were evaluated at an initial and a follow-up CT. pGGNs \nwere divided into \"persisting\" or \"resol ved\". Persisting nodules were further \nclassified according to potential changes in total or solid component diameter \ninto \"decreased\", \"unchanged\", and \"increased\". Clinical and demographic data \nwere recorded. Association of data with morphological pGGNs characteristics \nwere tested with Kruskall-Wallis test and logistic regression. \nResults: After a median follow-up of 16 months, 19/95 (20%) pGGNs resolved \nand 76/95 (80%) persisted. Of the persisting pGGNs, 51/76 (67.1%) were \nunchanged, 18/76 (23.7%) increased in size, and 7/76 (9.2%) decreased. \nGrowth was more likely with age \u0003  67 years and a diameter \u0003 10 mm (OR \n4.636; p = 0.016). No significant relation was found between pGGNs growth \nand gender, history of cancer, or pGGN location. pGGN resolution was more \nlikely with age < 67 (OR 3.28; p = 0.04). No difference in diameter was found \nbetween resolved and persisting pGGNs (p = 0.21). \nConclusion: As expected, persisting larger pGGNs were more likely to grow \nthan small pGGNs. However, solitary pGGNs were more likely to grow in older \nthan in younger patients. This observation could help to tailor future follow-up \nrecommendations for pGGNs with regard to the seemingly paradoxical \ninfluence of patient age.  \nB-0025 11:06  \nEvaluation of subcentimeter ground-glass nodule at very low dose CT: \nimpact of different levels of iterative reconstruction  \nK. Parekh, A.R. Seyal, R. Agrawal, T.H. Grant, A. Goodwin, V. Yaghmai; \nChicago, IL/US (rishi.agrawal@northwestern.edu)  \nPurpose: The purpose of our study was to determine the effect of different \nlevels of iterative reconstruction on the evaluation of ground-glass nodule at \nsignificantly reduced radiation doses. \nMethods and Materials:  An anthropomorphic chest phantom containing a \nsub-centimeter ground glass lung nodule was scanned at 80, 100 and 120 kV \nwith 10, 20, 40, 75 and 110 mA. Images were reconstructed with filtered back \nprojection (FBP) and sinogram-affirmed iterative reconstruction (SAFIRE) \nalgorithm using two different strengths of iterative reconstruction (3 and 5). \nForty-five image sets were randomised and shown to two chest radiologists \nindependently. For each image, both radiologists measured the largest lesion \ndiameter and evaluated lesion conspicuit y on a five-point scale. A score of 3 \nwas considered acceptable for lesion conspicuity. Data was analysed with \npaired t-test, Friedman test and Wilcoxon signed rank test. Kappa statistics \nwere used for inter-reader agreement. \nResults: The lowest radiation dose parameters with an acceptable score were \n80 kVp/10 mAs (0.098mSv) for IR-5 and 100 kVp/10 mAs (0.224 mSv) for FBP \nand IR-3. Mean lesion diameter was comparable between FBP, IR-3 and IR-5 \nfor effective doses above and below 1 mSv (p > 0.05). The diameter \nmeasurements were similar for both radiologists below 1 mSv for each \nreconstruction algorithm (p > 0.05). Inter-reader agreement for subjective \nassessment of lesion conspicuity was fair (k=0.259). Image noise, CNR and \nSNR were significantly different between the three reconstruction algorithms \n(p < 0.001). \nConclusion: Increasing the strength of iterative reconstruction may allow \ngreater dose reduction without compromising size and conspicuity of ground \nglass nodule.  \nAuthor Disclosures: \nK. Parekh: Research/Grant Support; Educational Grant Support from Siemens \nHealthcare. A.R. Seyal: Research/Grant Support; Educational Grant Support \nfrom Siemens Healthcare.  \nB-0026 11:15  \nUsefulness of alpha blending of maximum intensity projections or ray \nsums with segmented pulmonary nodules and vasculature for the \nevaluation of small nodules or ground glass opacity lesions  \nY. Nakano\n1, K. Maeda1, S. Kitahara1, T. Toyama1, T. Nakaguchi1, \nM. Kuwabara1, T. Kubo2; 1Kusatsu/JP, 2Kyoto/JP (ynakano@aurora.dti.ne.jp)  \nPurpose: There are many small lung nodules and ground glass opacity (GGO) \nlesions depicted on computed tomography (CT) scans that are difficult to \ndiagnose using chest computed radiograph y (CR) or a cine display of serial \nchest radiographs obtained with a flat-panel detector (FPD-SR). Alpha \nblending was used to display an alpha bitmap, which is a bitmap that has \ntransparent or semi-transparent pixels. We aimed to use the alpha-blended \nimages obtained from CT to support the diagnosis of pulmonary nodules. \nMethods and Materials:  Using alpha blending, thi ck slab, coronal maximum \nintensity projection (MIP), or ray sum images were overlaid with the segmented \npulmonary nodule and vasculature using various transparencies. In the \ncomparison of the detectability of pulmonary nodules on FPD-SR and chest \nCR, 18 patients with 20 nodules were included that were confirmed by CT and \nwere difficult to diagnose with FPD-SR and CR. For each patient, FPD-SR, CR, \nand CT with and without alpha-blended images were evaluated independently \nby four radiologists for a subjective image assessment of the diagnostic quality. \nResults: Alpha-blended images preserved the depth relationship between the \nnodule and the rib or pulmonary vasculature and prevented these small \nstructures from being obscured. Subjective image analysis illustrated a \nsignificant improvement when employing alpha blending for clinically relevant \ncriteria such as diagnostic confidence. \nConclusion: Alpha blending of thick slab MIP or ray sum images with \nsegmented pulmonary nodules and vasculature provides useful information \nconcerning the exact localisation of small lung nodules, including GGO, on \nFPD-SR and CR.  \nAuthor Disclosures: \nY. Nakano: Grant Recipient; Canon Inc.  \nB-0027 11:24  \nPulmonary adenocarcinoma presenting as part-solid ground glass \nnodule: is measuring solid component only appropriate in current \nstaging system?  \nE. Hwang, C. Park, S. Lee, J. Goo, Y. Ryu; Seoul/KR \n(ken921004@hotmail.com)  \nPurpose: To find out appropriate measurement for pulmonary \nadenocarcinoma presenting with part-solid ground glass nodule (psGGN), by \ncomparing disease-free survival (DFS) and overall survival (OS) with \nadenocarcinoma appearing as solid nodule (SN). \nMethods and Materials:  Our study included 501 patients (304 SN and 197 \npsGGN) who underwent curative surgery for pathologic stage I \nadenocarcinoma between 2002 and 2011. Maximal diameters of lesions were \nmeasured on axial preoperative CT images. For psGGN, maximal diameters of \nwhole lesions and solid components were separately measured on axial thin \nslice (\u00022 mm) images. DFS and OS were calculated from the date of surgery. \nTo find out significant factor for DFS and OS, Cox proportional hazard \nanalyses were performed. Afterwards, interaction term between solid \ncomponent size and nodule type was inserted to compare prognoses of SN \nand psGGN with same size of solid component. \nResults: The size of solid component was the only significant factor for DFS \nand OS in multivariate Cox analyses in psGGN group only (Hazard ratios 4.68 \nand 3.46 for DFS and OS, respectively, for 1 cm increase in size) and in whole \npatients group (Hazard ratios 1.81 and 1.73 for DFS and OS, respectively). \nComparing prognoses of psGGN and SN based on Cox-regression model with \nS142  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\ninteraction term, psGGN showed better DFS and OS when solid components \nwere \u00022 cm, but SN showed better prognoses when solid components were \nlarger. \nConclusion: Measuring solid component only might be an appropriate method \nto evaluate adenocarcinoma presenting as psGGN. However, psGGN and SN \nshowed different prognoses in same size of solid component  \nB-0028 11:33  \nDifferentiation of invasive pulmonary adenocarcinomas presenting as \npure ground-glass nodules from their preinvasive lesions by using \ncomputerised image feature analysis from multi-detector computerised \ntomography images  \nI. Hwang, C. Park, S. Park, S. Lee, J. Goo, H.-J. Lee; Seoul/KR \n(mit3000kr@gmail.com)  \nPurpose: To evaluate the diagnostic feasibility of three-dimensional \ncomputerised image feature analysis of multi-detector computerised \ntomography (MDCT) images to aid differentiation of invasive pulmonary \nadenocarcinomas (IPAs) presenting as a pure ground-glass nodules (PGGNs) \nfrom their preinvasive lesions. \nMethods and Materials: This retrospective study was finally included a total of \n38 patients with 40 pulmonary nodules presenting as PGGN on thin-section \n(\u00021 mm section thickness) MDCT without contrast enhancement from January \n2005 to February 2013. All of these nodules were pathologically confirmed and \ndivided into IPA group (n=9) and preinvasive group including atypical \nadenomatous hyperplasia (n=13) and adenocarcinoma in situ (n=18). Manual \nsegmentation was performed in each PGGN on every slice of CT images and \ncomputerised image features were quantitatively extracted using in-house \ndeveloped software. To identifying image features between IPAs and their \npreinvasive lesions, independent t-test and multivariate logistic regression \nanalysis were performed. \nResults: Between IPA group and preinvasive lesion group, patient's age (60.3 \nvs. 57.2years, respectively, P=.340) and lesion size (14.6 vs. 11.3 mm, \nrespectively, P=.441) were not significantly different. By independent t-test of \nimage features revealed that mean attenuation number (P=.043), standard \ndeviation of attenuation number (P=.016), 95percentile of attenuation number \n(P=.008), entropy (P=.008) and gray-scale co-occurrence matrix contrast \n(P=.036) were significantly different bet ween IPA and preinvasive lesion. \nHowever, multivariate logistic regression analysis including those image \nfeatures revealed that entropy was the only differentiating variable (P=.020). \nSensitivity and specificity were 22.2% (2/9) and 90.3% (28/31), respectively. \nConclusion: We suggest that entropy are specific image feature and may be \nhelpful in differentiating IPAs presenting as PGGN from preinvasive lesion.  \nB-0029 11:42  \nDynamic first-pass pulmonary perfusion area-detector CT for lung nodule \nassessment: comparison of dose reduction capability between adaptive \niterative dose reduction using 3D processing and filter back projection  \nY. Ohno\n1, S. Seki1, M. Nishio1, H. Koyama1, T. Yoshikawa1, S. Matsumoto1, \nY. Fujisawa2, N. Sugihara2, K. Sugimura1; 1Kobe/JP, 2Otawara/JP \n(yosirad@kobe-u.ac.jp)  \nPurpose: To directly compare the capability for radiation dose reduction on \ndynamic chest perfusion area-detector CT (ADCT) aiming lung and nodule \nperfusion assessments between adaptive iterative dose reduction using 3D \nprocessing (AIDR 3D) and filter back projection (FBP) methods. \nMethods and Materials:  36 consecutive patients with pulmonary nodules \nunderwent standard-dose perfusion ADCT (SDCT) using the following \nparameters: 320×0.5 mm collimation, 80 kVp, 120 mA, and 0.5 sec gantry \nrotation time. From SDCT raw data, low-dose perfusion ADCTs (LDCTs) at \n80 mA, 60 mA and 40 mA were computationally simulated. Then, SDCT and \neach LDCT were reconstructed by AIDR 3D and FBP methods. From each CT \ndata, perfusion map was computationally generated. Then, image noises of \nlung parenchyma and nodule, lung and nodule perfusions were evaluated by \nROI measurements. To determine the utility of AIDR 3D for radiation dose \nreduction, both image noises and perfusion parameters from all CT data were \nstatistically compared each other by using Tukey's HSD test. Correlations and \nthe limits of agreement on both perfusion parameters at each LDCT were \nstatistically evaluated. \nResults: When applied AIDR 3D, image noises of LDCT at 80 mA and 60 mA \nwere significantly lower than those by FBP (p < 0.05). Lung and nodule \nperfusions had significant and excellent correlations between SDCT and each \nLDCT (p < 0.001). The limits of agreement on each LDCT applied AIDR 3D \nwere smaller than that applied FBP. \nConclusion: AIDR 3D method has better potential for radiation dose reduction \nof chest perfusion ADCT than FBP method in routine clinical practice.  \nAuthor Disclosures: \nY. Ohno: Research/Grant Support; Toshiba Medical Systems Corporation, \nDaiichi-Sankyo, Co. Ltd., Bayer Pharma. S. Seki: None. M. Nishio: \nResearch/Grant Support; Toshiba Medical SystemsCorporation. H. Koyama:  \nNone. T. Yoshikawa: Research/Grant Support; Toshiba Medical Systems \nCorporation.s. Matsumoto: Research/Grant Support; Toshiba Medical \nSystems Corporation. Y. Fujisawa: Employee; Toshiba Medical Systems \nCorporation. N. Sugihara: Employee; Toshiba Medical Systems Corporation. \nK. Sugimura: Research/Grant Support; Daiichi-Sankyo Co. Ltd., Bayer \nPharma. \nB-0030 11:51  \nPrognostic value of spirometry and pulmonary CT biomarkers for \ncardiovascular events in a lung cancer screening setting  \nR.A.P. Takx1, R. Vliegenthart2, H.J. de Koning3, B. van Ginneken4, \nW.P.T.M. Mali1, M. Oudkerk2, T. Leiner1, P.A. de Jong1; 1Utrecht/NL, \n2Groningen/NL, 3Rotterdam/NL, 4Nijmegen/NL (richard.takx@gmail.com)  \nPurpose: To assess the prognostic value of spirometry and quantitative \npulmonary CT biomarkers for cardiovascular events. \nMethods and Materials:  3057 male lung cancer screening subject who \nunderwent spirometry and non-gated chest CT were analysed. Forced \nexpiratory volume in one second percent predicted (FEV1%predicted) and \nFEV1 divided by forced vital capacity (FVC) were obtained. Coronary artery \ncalcium volume, pulmonary emphysema (Perc15) and bronchial wall thickness \n(Pi10) were measured on the CT scans. The primary combined endpoint \nincluded fatal and non-fatal cardiovascular events. The ability of spirometry \nand pulmonary CT measures to predict events was evaluated by Cox \nproportional hazards analysis. Next, net reclassification improvement (NRI) and \nincremental C-indices were calculated. \nResults: Median follow-up was 2.9 (25p-75p 2.7-3.3) years and during that \nperiod 183 participants developed a cardiovascular event. Spirometry and \npulmonary CT biomarkers were associated with an increased risk of \ncardiovascular events. Age, smoking status and pack-years adjusted hazard \nratios were 0.992 (95%-CI 0.985-0.999) for FEV1%predicted, 1.001 (95%-CI \n0.987-1.015) for FEV1/FVC 1.014 (95%-CI 1.004-1.023) for perc15 per 10 HU \nand 1.264 (95%-CI 1.019-1.567) for pi10 per 1 mm. Incremental C-index \n(< 0.012) and NRI (0.22). In contrast, coronary artery calcium volume had an \nadjusted hazard ratio of 1.046 (95%-CI 1.034-1.058) per 100 mm3, a \nsignificant increase in C-index of 0.077 and an impressive NRI of 17.3% \n(P < 0.0001). \nConclusion: Spirometry and pulmonary CT biomarkers were significantly \nassociated with cardiovascular events, but did not provide relevant \nindependent prognostic information for cardiovascular events in a male lung \ncancer screening population.  \nAuthor Disclosures: \nH.J. de Koning: Advisory Board; Roche Diagnostics. T. Leiner: \nResearch/Grant Support; Bracco Diagnostics. Speaker; Philips Healthcare, \nBayer Healthcare.  \n10:30 - 12:00 Board Room B  \nEmergency Radiology  \nSS 117  \nImpact of radiology on emergency \nservices  \nModerators:  \nD. Nunez; New Haven, CT/US  \nF. Schwarz; Munich/DE  \nB-0031 10:30  \nHow does arm positioning of polytraumatised patients in the initial CT \naffect image quality and diagnostic accuracy?  \nJ. Kahn, M. Maurer; Berlin/DE (johannes.kahn@charite.de)  \nPurpose: To evaluate the influence of different arm positions on abdominal \nimage quality during initial whole-body CT (WBCT) in polytraumatised patients \nand to assess the risk of missing potentially life-threatening injuries due to arm \nartefacts. \nMethods and Materials: Between July 2011 and February 2013, WBCT scans \nof 203 patients with arms in the abdominal area during initial WBCT were \nanalysed. Six different arms-down positions were defined. 203 patients with \nelevated arms beside the head served as a control group. Two observers \njointly evaluated image quality of different organ regions using a 4-point-scale \nsystem. Follow-up CT-examinations were analysed to identify findings missed \nduring initial WBCT due to reduced image quality. \n \nS143  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nResults: Image quality was most severely degraded in patients with arms \ndown alongside the torso, followed by patients with arms crossed in front of the \npelvic area and patients with arms crossed in front of the upper abdomen, \nrespectively. Positioning with one arm up resulted in significantly better image \nquality than both arms down (p < 0.01). Overall, arms-up positioning showed \nsignificantly better image quality than arms-down positions (p < 0.01). In one \ncase, liver haemorrhage missed in the initial WBCT because of arm artefacts, \nwas revealed by follow-up CT. \nConclusion: In WBCT arms-down positioning significantly degrades \nabdominal image quality and artefacts might even conceal potentially life-\nthreatening injuries. If the patient's status does not allow elevation of both \narms, image quality can benefit from raising at least one arm. Otherwise, arms \nshould be placed in front of the upper abdomen instead of alongside the torso.  \nB-0032 10:39  \nIndication of whole-body multislice computed tomography in \npolytraumatised children  \nF. Wolfschmidt, I. Platzer, S. Manger, T. Wurmb, T. Bley, W. Kenn; \nWürzburg/DE (Wolfschmid_f@ukw.de)  \nPurpose: To retrospectively analyse the applicability of a triage protocol for the \nindication of whole-body MSCT as well as epidemiologic data from children \nwith suspected polytrauma. \nMethods and Materials: 72 children (49 male, aged 1 to 14 years) admitted to \na Level 1 trauma center with suspected polytrauma during 2004 to 2009 were \nenrolled. Whole-body MSCT (16-slice SIEMENS Somatom Sensation CT; \nsliding gantry) was indicated as in adult patients if one triage criteria basing on \nmechanism of injury, vital parameter and injury pattern was fulfilled. Data \nanalysis included under- and overtriage rates, Injury Severitiy Score (ISS), \nmechanism of injury, injury pattern, delayed diagnosis, lethality. ISS \u000316 \ndefined polytrauma. \nResults: The undertriage rate (ISS \u000316, no whole-body MSCT) was 26.3% \n(n=19), the overtriage rate (ISS < 16, whole-body MSCT) was 20.8% (n=15). All \npatients subject to undertriage underwent region specific MSCT. The mean \nISS was 26.5 (range 2-75). Typical mechanisms of injuries were motor vehicle \naccidents (59.7%) and falls from height (33.3%). Injuries to the head and face \nwere most common (52.8% and 25.0%), followed by extremitiy (51.4%), \nthoracic (36.1%) and abdominal (19.4%) injuries. Delayed diagnosis occurred \nin 3 cases. Lethality was 8.3%; in 4 of 6 patients trauma-related death was \ncaused by injuries to the head. \nConclusion: An adult triage rule for the indication of whole-body MSCT in \nchildren does not seem to be applicable due to high under- and overtriage \nrates. Knowledge of epidemiologic data can help to improve radiological \ntrauma algorithm in the multiple injured child emphasising modalities with low \nradiation exposure.  \nB-0033 10:48  \nFeasibility of a dual-room sliding gantry CT concept for initial evaluation \nof trauma patients  \nC. Frellesen, M. Böttcher, J. Kerl, J.L. Wichmann, T.J. Vogl, R.W. Bauer; \nFrankfurt a. Main/DE (c.frellesen@gmail.com)  \nPurpose: To evaluate the time-saving potential of a dual-room sliding gantry \nCT system in comparison with a routine single-room CT for initial assessment \nof patients in the trauma room. \nMethods and Materials:  We compared the mean amount of time between \ninitial admittance of the patient to the trauma room, start of the CT scan and \nend of initial trauma evaluation. 30 patients each were evaluated using a \ntraditional single-room CT and a novel dual-room sliding gantry CT. Statistical \nanalysis was performed using the Wilcoxon-Mann-Whitney-test and Fisher's \nexact test. \nResults: Patient groups were comparable as to sex, age and Injury Severity \nScore (p> 0.66). Median time from patient arrival to start of the diagnostic CT \nwas significantly shorter with sliding gantry CT (15.4 min vs. 21.2 min, \np < 0.001). Median time between trauma room admission and discharge was \nalso significantly shorter with the dual-room concept (41.3 min vs. 62.1 min, \np < 0.001). \nConclusion: The dual-room sliding gantry CT concept allows for significant \ntime savings in the initial evaluation of  trauma patients. Furthermore, it reduces \nnecessary patient transfer and manipulation of bearing devices.  \nB-0034 10:57  \nCT and MR track reconstruction of experimentally produced stab wounds  \nC. Giraudo1, P. Fais1, G. Cecchetto1, R. Boscolo-Berto1, M. Toniolo1, G. Viel1, \nF. Tagliaro2, D. Miotto1; 1Padua/IT, 2Verona/IT (chiara_giraudo@hotmail.it)  \nPurpose: To measure by computed tomography (CT) and magnetic resonance \n(MR) the length of stab wounds (SWs) experimentally produced on human \ncalves. Only a few data on the CT features of SWs are available in the clinical \nand forensic literature and, to the best of our knowledge, MR data are still \nmissing. \nMethods and Materials:  Ten SWs were inflicted on human legs surgically \namputated for medical reasons using a ceramic knife perpendicularly oriented \nto the skin (depth of SWs varying between 3.0 and 6.0 cm). CT and MR scans \nwere performed before stabbing; with the knife inside the wound track (only CT \nscans); and before/after filling each wound with the contrast medium (1:10 \ndilution of Omnipaque 300 GE Healthcare® with ultrasound gel). The depth of \nthe wound tracks was measured by an experienced radiologist (blind to the \nexperimental conditions) using Osirix (Open Source) software. \nResults: CT and MR measurements underestimated the depth of SWs injuries \nwith a mean error of 6.9% (range: -33.5%-17.4%) and 6.7%, respectively \n(range: -20.9%-14.4%). There was no statistical difference between CT and \nMR measurements. \nConclusion: Our preliminary results show that CT and MR investigations of \nSWs filled up with contrast medium provide consistent and reproducible data \non the depth of the inflicted injury. Further efforts will be made to improve the \ninjection modality of the contrast medium, in order to minimise underestimation \nerrors.  \nB-0035 11:06  \nImage quality of iterative reconstruction in cranial CT imaging: \ncomparison of model-based iterative reconstruction and adaptive \nstatistical iterative reconstruction  \nS. Notohamiprodjo, Z. Deak, F. Meurer, F. Mück, L. Geyer, M.F. Reiser, \nS. Wirth; Munich/DE (Susan.Notohamiprodjo@med.uni-muenchen.de)  \nPurpose: CCT is a frequent examination in emergency departments. Model-\nbased iterative reconstruction (MBIR) is the successor of adaptive statistical \niterative reconstruction (ASIR), promising a more effective reduction of image \nnoise and improved spatial resolution. In this study, we compare the effects of \nMBIR and ASIR in CCT. \nMethods and Materials:  100 trauma patients received CCT according to the \ninstitutional standard protocol (120 kV, 260 mAs, 20 mm detector collimation, \n0.984 pitch). Raw data sets and multiplanar reformations (MPRs) of 2.5 mm \nwere reconstructed with ASIR and MBIR. Two radiologists blinded to the \nreconstruction algorithm evaluated the depiction of anatomical structures and \namount of artefacts using a semi-quantitative scale (0:non-diagnostic, 1 \nimpaired, 2:sufficient; 3:good, 4:excellent). Data were analysed with Mann-\nWhitney U test and ANOVA. Mean attenuation values (MAV) and standard \ndeviation (SD) were measured for white matter (WM) and liquor space (LS). \nResults: MBIR significantly reduced streak artefacts better than ASIR. IQ of \nMBIR were rated significantly superior than ASIR images with median scores \nof 3 and 2, respectively. SD of WM especially in the posterior fossa was \nsignificantly lower in MBIR MPRs (4.86 ± 1.95; 4.79 ± 2.34) in comparison to \nASIR (5.53 ± 2.15; 5.91 ± 2.93); (p < 0.05). MAVs of WM were significantly \nhigher in ASIR than in MBIR. \nConclusion: Our results suggest significant improvement of IQ with MBIR \ncompared to ASIR in CCT of trauma patients. MBIR being a more accurate \nreconstruction algorithm could represent an effective method to decrease the \nradiation dose of CCT.  \nB-0036 11:15  \nDetection of blunt biliary injuries using hepatocyte-specific contrast-\nenhanced MR cholangiography  \nY.-C. Wong, L.-J. Wang, C.-H. Wu, H.-W. Chen, C.-J. Fu; Gueishan/TW \n(ycwong@cgmh.org.tw)  \nPurpose: We are to investigate the hepatocyte-specific contrast-enhanced \nmagnetic resonance cholangiography (HEMRC) for the detection of blunt \nbiliary injuries. \nMethods and Materials:  From May 2012 to September 2013, twelve patients \nof major blunt liver trauma consented to be enrolled in this study. The HEMRC \nwas acquired at 10, 20, 30 and 90 minutes respectively after intravenous \ninjection of hepatocyte-specific contrast medium (Gd-EOB-DTPA). We \ncompared the diagnostic performance of HEMRC of different acquisition times \nfor the detection of biliary injuries. Medical charts were reviewed for course of \ntreatments and final diagnosis. \nResults: MRI of all patients showed traumatic cysts in the injured liver. Among \nthem, HEMRC of nine patients detected biliary injuries evidenced by \nextravasation of biliary contrast medium. Biliary extravasation was first \ndetected at 10 minutes (n=1), 20 minutes (n=3), 30 minutes (n=2), 90 minutes \n(n=3). All were best visualised on HEMRC acquired at 90 minutes. Of the \ntraumatic cysts in three patients without biliary extravasation, two were \nhematomas, one was abscess. Of the nine patients with biliary injuries, four \nreceived catheter drainage, five were treated with observation. All had clinical \nimprovement and were discharged. \nConclusion: Blunt biliary injuries can be detected on HEMRC. The \nextravasated biliary contrast medium is best seen at a delayed hepatobiliary \nphase acquired at 90 minutes after intravenous injection of hepatocyte-specific \ncontrast medium (Gd-EOB-DTPA).  \nS144  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nAuthor Disclosures: \nY. Wong: Research/Grant Support; Chang Gung Medical Research Project. L. \nWang: Research/Grant Support; Chang Gung Medical Research Project. C. \nWu: Research/Grant Support; Chang Gung Medical Research Project. H. \nChen: Research/Grant Support; Chang Gung Medical Research Project. C. \nFu: Research/Grant Support; Chang Gung Medical Research Project. \nB-0037 11:24  \nClinical impact of chest and abdominal CT on emergency patients  \nM. Brambati, C. Messina, R. La Rocca, G. Togni, L.M. Sconfienza, \nF. Sardanelli; San Donato Milanese/IT (brambati@hotmail.it)  \nPurpose: To evaluate the impact of computed tomography (CT) examinations \nin determining a management change of patients admitted to the emergency \ndepartment (ED), quantifying therapeutic variation determined by CT scans. \nMethods and Materials:  We prospectively analysed thoracic/abdominal CT \nexamination requests from our ED, from October 2012 to March 2013. Before \neach CT, we asked the ED physicians to provide the most-likely diagnosis (12 \nchoices were offered, including a wide range of ED diseases) and the most \nappropriate foreseen management without CT scan information (admit to \nhospital, keep in observation, patient discharge). Once CT was performed, ED \nphysicians were asked to evaluate the concordance between therapeutic \nmanagement before and after CT, by evaluating CT report as following: not \nreliable, not confirming clinical diagnosis (l evel 1), confirming clinical diagnosis \nwithout (level 2) or with (level 3) new information, change of diagnosis (level 4). \nFurthermore, we defined as a major change the sum of level 1 and 4, and as a \nminor change the sum of level 0, 2 and 3. \nResults: We analysed 300 CT scans in 300 patients. CT examination was able \nto change the planned treatment in 202 cases (67%) and to confirm it in 98 \ncases (33%). Concerning score level on patients' management, a major \nchange in planned treatment was obtained in 112 cases (56%) and a minor \nchange in 90 cases (44%). \nConclusion: CT examination in ED patients permitted a planned treatment \nchange in 67% of cases and in 56% of cases determined a major variation. CT \nrepresents a predictor for hospital ED admission or discharge.  \nB-0038 11:33  \nWhole-body CT-based imaging algorithm for multiple trauma patients: \nradiation dose and time to diagnosis  \nS. Gordic, S. Hodel, H.-P. Simmen, G. Wanner, K. Sprengel, H. Alkadhi; \nZurich/CH (sonja.gordic@usz.ch)  \nPurpose: To determine the number of radiological investigations, associated \nradiation dose, and time to diagnosis in multiple trauma patients before and \nafter introduction of whole-body CT (WBCT) as primary diagnostic tool in early \ntrauma care. \nMethods and Materials:  120 consecutive patients assessed before the \nintroduction and 120 consecutive patients assessed after the introduction of \nWBCT into our hospitals' trauma algorithm were compared regarding number \nand types of CT, X-ray and FAST examinations, radiation dose, and time to \nprimary trauma-related diagnosis. \nResults: In the WBCT cohort the number of CT studies of the head, cervical \nspine, chest and abdomen was significantly (P <.001) higher as compared to \nthe non-WBCT cohort. In contrast, the number of X-ray examinations of the \ncervical spine, chest and pelvis and the number of FAST was significantly \n(P <.001) higher in the non-WBCT cohort. There were no significant (P=.56 \nand P=.30) differences between cohorts regarding the number of X-rays of \nupper and lower extremities. We found significantly (P <.001) higher effective \ndoses in the WBCT as compared to the non-WBCT cohort but also significantly \n(on average 29.5mSv vs 15.9mSv per patient, P <.001), but less additional \nimaging studies were needed in the WBCT cohort (P <.001). Additionally, the \ntime to primary trauma-related diagnosis was significantly shorter in the WBCT \ncohort (on average 0.19h vs 1.24h per patient, P <.001). \nConclusion: After introduction of WBCT into our trauma algorithm, overall \nradiation doses were higher in patients, but less additional imaging studies \nwere needed and the time to obtain the primary trauma-related diagnosis was \nshorter.  \nB-0039 11:42  \nRisk factors for non-compliance with recommendations by emergency \nradiologists  \nJ.O. Johnson, W. Shuaib; Atlanta, GA/US  (waqas.shuaib@emory.edu)  \nPurpose: To identify risk factors associated with non-compliance of \nrecommendations made by emergency radiologists. \nMethods and Materials:  Between March 2012-August 2012, we reviewed \n20000 consecutive emergency department patients receiving imaging at two \nuniversity hospitals to assess how often emergency radiologists made \nrecommendations, how often they were followed and what factors were \nassociated with non-compliance. The data was extracted from medical records \nand the hospital information system: recommendation in imaging report, age, \nsex, race, insurance status, primary care contact, distance from the hospital to \npatient residence, and primary language. Recommendations were categorised: \n1_immediate follow-up; 2_follow-up 1-4 weeks; 3_follow-up 1-3 months; \n4_follow-up 4-6 months; 5_follow-up 7-12 months and 6_clinical correlation. \nResults: We identified 1650 recommendations (1650/20000=8.25%). Using a \none to one logistic regression analys is, the following factors were significant \n(p < 0.05) when evaluating non-compliance: increasing age, no primary care \nphysician, lack of insurance, increased distance from hospital and extended \nfollow-up interval. Primary language was not a significant factor in non-\ncompliance. \nConclusion: Emergency radiologists rarely make recommendations. \nImmediate and short-term interval follow-up recommendations are more likely \nto be followed. Decreased compliance is associated with extended interval \nfollow-up recommendations. The risk factors for non-compliance are \nmultifactorial and include age, primary care physician status, insurance and \ndistance. Primary and/or referring physicians should take notice of these \ncompliance trends and mitigating factors; adopt systematic safety measures to \nensure compliance to counsel and educate patients about the importance of \nimaging recommendations.  \nB-0040 11:51  \nCan CT oesophagography reliably diagnose penetrating oesophageal \ninjury in the trauma population? Preliminary data  \nW. Conradie, F. Gebremarium; Bloemfontein/ZA (wjcon2@gmail.com)  \nPurpose: To measure the sensitivity and specificity of CT oesophagography \n(CTE) in diagnosing penetrating oesophageal injury. To determine the \ndiagnostic confidence of the radiologist in detecting these injuries with the use \nof CTE only. Finally, to determine if CTE can be used as the only imaging \nexamination in penetrating neck trauma to exclude oesophageal injury. \nMethods and Materials:  Prospective, cross-sectional analytical study was \ndone at Pelonomi Tertiary Hospital in Bloemfontein, South Africa, between \nDecember 2012 and November 2013. All adult trauma patients with suspected \npenetrating oesophageal injuries, who required emergency CTA, were \nconsidered for the study. An oral contrast solution was administered before the \nCTA study. All CT findings were confirmed by other imaging methods. Images \nwere evaluated separately by two independent general departmental \nradiologists. \nResults: Sixty (60) patients qualified for the study. Fifty-four (90%) were male. \nKnife wounds were the mechanism of injury in 83% of patients. Fourteen (14) \nconfirmed injuries (8 oesophageal and 6 in the hypopharynx) were all detected \nby CTE. One hypopharyngeal injury diagnosed intra-operatively was missed by \nCT and fluoroscopic esophagography (C TE sensitivity of 93%). CTE specificity \nwas 82% (8 false positives) and 91% (4  false positives) respectively. The two \nradiologists were positive to very confi dent of their findings in 80 and 88% of \ncases respectively. \nConclusion: Good sensitivity and specifici ty were achieved by both \nradiologists using CTE. Preliminary data suggests that CTE is reliable in \ndetecting penetrating oesophageal injuries and that general radiologists will be \nconfident in using this examination.   \n10:30 - 12:00 Room E1  \nMusculoskeletal  \nSS 110  \nShoulder and wrist  \nModerators:  \nS. Morozov; Moscow/RU  \nM. Reijnierse; Leiden/NL  \nB-0041 10:30  \nThe Mick Jagger position: a new manoeuvre for the intra-articular biceps \nultrasound visualisation  \nG. Azulay\n1, P. Omoumi2, G. Aguilar1, J. Monres3, M. Brandao4; \n1Buenos Aires/AR, 2Lausanne/CH, 3Goiania/BR, 4Ribeirao Preto/BR \n(guillermoazulay@yahoo.com.ar)  \nPurpose: To demonstrate the feasibility of a new dynamic ultrasound \nmanoeuvre, consisting in abduction and ex ternal rotation, for the visualisation \nof the intra-articular course of the long biceps tendon above the humeral head \nto its insertion on the glenoid. \nMethods and Materials: A cadaveric study was performed to demonstrate the \ncourse of the tendon, as well as the presence of an acoustic window between \nthe acromion and the coracoid process during the manoeuvre. A prospective \nstudy was performed on 40 asymptomatic subjects of various age, as well as \n10 patients referred for shoulder pain, in whom a correlation to MRI was also \nS145  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nobtained. Two observers graded the presence of an acoustic window, as well \nas the visibility of the biceps tendon on a scale from 1 to 4. \nResults: The visibility of the biceps tendon was diagnostic in 83% (n=36) 33 of \nthe 40 asymptomatic subjects. In the 10 pathologic shoulders, the biceps \ntendon was visible in its intra-articular course in all patients. Ultrasound \ndemonstrated 4 cases of tendinosis (tendon hypertrophy and/or loss of fibrillar \npattern) and 1 synovitis surrounding the  intra-articular biceps tendon, in \ncorrelation with MRI. \nConclusion: The manoeuvre in abduction external rotation allows the \nevaluation of the biceps tendon in its intra-articular course to its insertion on \nthe glenoid in up to 83% of subjects.  \nB-0042 10:39  \nA new dynamic manoeuvre to differentiate complete vs. partial distal \nbicep tears at ultrasound  \nG. Azulay\n1, I. Rossi1, P. Omoumi1, M. Brandao2; 1Buenos Aires/AR, \n2Ribeirao Preto/BR (lanacharossi@gmail.com)  \nPurpose: To demonstrate the feasibility and to assess the diagnostic value of \na dynamic ultrasound manoeuvre for the diagnosis of complete vs. partial tears \nof the distal biceps tendon at the elbow. \nMethods and Materials:  A cadaveric study on four specimens was performed \nto demonstrate the movements of the di stal biceps tendon during passive \nprono-supination of the forearm, before and after the creation of partial (50%) \nand complete (100%) tears of the tendon, with integrity of the lacertus fibrosus. \n15 patients, including 4 patients with a complete tendon tear, 1 patient with a \npartial tendon tear and 10 normal tendons were studied independently by two \nobservers. Before the examination following a conventional technique, the \ndynamic passive prono-supination manoeuvre was performed while the tendon \nwas examined in the transverse plane by the observers, blinded to the final \ndiagnosis. \nResults: The cadaveric study showed that the manoeuvre lead to an \nanteroposterior movement of the distal biceps tendon in normal and partially \ntorn tendons, but not in completely torn tendons. The manoeuvre allowed \naccurate diagnosis of complete vs. partial tendon tears in 100% of cases, with \nsurgery as a reference. \nConclusion: A manoeuvre of passive prono-supination of the forearm is useful \nfor the ultrasound diagnosis of complete vs. partial tears of the distal biceps \ntendon.  \nB-0043 10:48  \nUltrasound-guided block of suprascapular nerve as a treatment of \nadhesive capsulitis: indications, technique and early results  \nC. Martini1, F. Lacelli2, A. Romani1, N. Gandolfo1, G. Serafini1; 1Genoa/IT, \n2Pietra Ligure/IT (chiarapio@libero.it)  \nPurpose: Adhesive capsulitis (AC) is characterised by pain and stiffness in \nexternal rotation and abduction of the upper limb; physiatric rehabilitation (PR) \nis often difficult.The suprascapular nerve (SN) supplies 70% of shoulder \nsensitive innervation. US visualises the SN at the level of the spine of the \nscapula.The purpose of this work is to show that SN block makes a more \nlasting pain decrease than the intra-articular treatment of capsulitis and makes \nthe PR easier. \nMethods and Materials:  20 patients with clinical diagnosis of adhesive \ncapsulitis were randomised in 2 groups (A=10 F, y=45 ±3.2; B=10 F, y=44±3.6). \nGroup A was treated with US-guided intra-articular injection of 5 cc of \nhydrocloride mepivacaine 2%, 40 mg of methylprednisolone and 6 ml (90 mg) \nof hyaluronate. In group B, the US-guided perineural (at the level of the spine \nof the scapula) injection of 5 cc of hydrocloride mepivacaine 2% was added to \nthe treatment. All patients began PR the day of treatment. All patients \nunderwent clinical (VAS scale and ROM index) both before than immediately \nafter the treatment, at 1 week and 1 month. \nResults: VAS before: 8.9 (A), 9.1 (B); immediately after: 5.0 (A), 4.8 (B); at 1 \nweek: 6.2 (A), 4.5 (B); at 1 month: 6.1 (A), 4.0 (B) (p < 0.01). ROM before: \n100°(A), 95°(B); immediately after: 120°(A, B); at 1 week: 130°(A), 150°(B); at \n1 month: 135°(A), 170°(B). We had not complications, in particular no deficit of \nmotion. In all patients of group B, we visualised the SN by ultrasound. \nConclusion: The role of physiatry in rehabilitation and reduction of pain is \nfundamental.The SN block associated with intra-articular treatment allows an \nimprovement of PR.The SN block has a more lasting effect than intra-articular \ntreatment.  \n \n \n \n \n \n \n \n \nB-0044 10:57  \nCapsular laxity in atraumatic multidirectional instability of the shoulder: \nvalue of MR arthrography including abduction and external rotation \nimages  \nC. Schäffeler\n1, S. Waldt2, J.S. Bauer2, C. Kirchhoff2, B. Haller2, E.J. Rummeny2, \nA.B. Imhoff2, K. Woertler2; 1Chur/CH, 2Munich/DE (schaeffeler@me.com)  \nPurpose: To evaluate diagnostic signs and measurements for capsular laxity \non MR arthrography (MR-A) of the shoulder including abduction/external \nrotation (ABER) images in patients with atraumatic multidirectional instability \n(MDI). \nMethods and Materials:  Twenty-one MR-A including ABER position of 21 \npatients (mean age: 27 years; 4 males, 16 females) with clinically diagnosed \nMDI and 17 patients (mean age: 31 years; 12 males, 5 females) without \ninstability were retrospectively assessed by three radiologists. On ABER \nposition MR-A, the presence of a layer of contrast between the humeral head \n(HH) and the anteroinferior glenohumeral ligament (AIGHL) (crescent sign) and \na triangular-shaped space between HH, AIGHL and glenoid (triangle sign) \nwere evaluated; centering of the HH was measured. On standard imaging \nplanes anterosuperior herniation of the rotator interval (RI) capsule and glenoid \nversion were determined. \nResults: The crescent sign showed a sensitivity of 57%/62%/48% (observers \n1/2/3) and a specificity of 100%/100%/94% in the diagnosis of MDI. For the \ntriangle sign, sensitivity was 48%/57% /48%, specificity was 94%/94%94%. \nPresence of either sign showed high sensiti vity (86%/90%/81%) and specificity \n(94%/94%/94%). A positive triangle si gn was significantly associated with \ndecentering of the HH (; < 0.000). Measurements of RI herniation, RI width, \nand glenoid version were not significantly different between both groups. \nConclusion: Combined assessment of laxity signs on ABER position MR-A is \naccurate in the diagnosis of capsular laxity in patients with atraumatic MDI, \nwhereas measurements on standard imaging planes appear inappropriate.  \nB-0045 11:06  \nDiagnostic value of arthro-MRI in the long head of biceps tendon \ninstability due to biceps pulley lesion of the shoulder  \nS. Mariani, A. La Marra, F. Arrigoni, A. Mancini, A. Barile, C. Masciocchi; \nL'Aquila/IT (abarile0@sirm.org)  \nPurpose: To evaluate the added value of the internal and external rotation \nduring arthro-MRI in identifying the LHBT instability and the possible \ndevelopment of an antero-superior impingment (ASI). \nMethods and Materials: We retrospectively analysed MRI exam of 70 patients \nwho underwent arthro-MRI (1.5 T) and arthroscopy within the following 7-45 \ndays. Patients had clinical suspicion of biceps pulley lesions. The shoulder was \nstudied (with dedicated coil) in neutral position, in internal and external rotation \nand ABER in 12 patients. \nResults: Patients were divided in 4 gro ups (Habermayer classification) and \nevaluated for an unstable LHBT:10 patients had superior gleno-humeral \nligament (SGHL) tear (Type I),16 patients SGHL and supraspinatus (SSP) \ntendon tears (Type II),21 patients SGHL and subscapularis (SSC) tendon tears \n(Type III) and 23 patients SGHL, SSP and SSC tears (Type IV). At arthroscopy \n2 patients were negative,8 patients had Type I,16 patients Type II,19 patients \nType III and 25 patients Type IV lesions. MRI internal and external rotation \nshowed an initial anteromedial subluxation of the LHBT in 8 patients with Type \nII lesion and an anteromedial subluxation of the LHBT in all patients with Type \nIII and Type IV lesions.The dynamic tests during arthroscopy, confirmed LHBT \ninstability and ASI features in patients with Type III and Type IV lesions. \nConclusion: Only high grade lesions of biceps pulley can be associated with \nLHBT instability. MRI external and internal rotation led to a better identification \nof structures of the biceps pulley and the detection of LHBT instability could \nsuggest the presence of ASI.  \nB-0046 11:15  \nUltrasound-guided percutaneous treatment of rotator cuff calcific \ntendinitis: randomised comparison between one- and two-needle \nprocedure  \nG. Ferrero\n1, E. Fabbro1, D. Orlandi1, L.M. Sconfienza2, F. Lacelli3, G. Serafini3, \nE. Silvestri1; 1Genoa/IT, 2San Donato Milanese/IT, 3Pietra Ligure/IT \n(giulio.ferrero@gmail.com)  \nPurpose: US-guided percutaneous treatment of RCCT has been \ndemonstrated to be effective using one or two needles,but direct comparison \nbetween the two methods has never been performed.Our aim was to compare \nthe technical and one-year clinical outcome of these two approaches. \nMethods and Materials:  IRB approval and patients' informed consent were \nobtained.100 patients to be treated for RCCT (77females,mean age \n46years,range 32-70y)were randomised into two groups.GroupA (50 \npatients;mean visual analogue scale[ VAS]=7.8)was treated using an US-\nguided 16G double-needle technique (local anesthesia,washing with warm \nsaline,intrabursal steroid),while groupB (50patients;mean VAS=7.4)was treated \nS146  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nusing a 16G single-needle technique.Calcification appearance at \nUS (fluid,soft,hard),procedure time and ease of calcium \ndissolution (subjectively scored as easy=1,intermediate=2,difficult=3)were \nrecorded.VAS follow-up was performed at 1.3,6 and12 months.Complication \nrate was noted.Mann-Whitney U and Chi-square statistics were used. \nResults: No immediate or delayed major complications were \nencountered.Overall procedure duration in group A (489± 88s)was significantly \nshorter (P <.001)than duration in group B (684 ±187s).Difference in procedure \nduration and ease of calcium dissolution wa sn't significant when dealing with \nfluid deposits (P=.683;P=.849),whereas it was significant for soft and hard \ndeposits (P=.006 and P <.001;P=.004 and P <.001,respectively).Post-\nprocedure bursitis occurred in 4/35 patients after 61± 10days in group A and in \n5/35patients after 56 ±7days in group B (P=.874).In group A,VAS was 3.1 ±0.2 \nat 1 month,1.8± 0.3 at 3 months,1.4 ±0.2 at 6 months,1.0 ±0.3 at 1 year,while it \nwas 3.0±0.1.1.9±0.4.1.3±0.5.1.1±0.5 in group B (P\u0003.244). \nConclusion: One- and two-needle procedures are equally effective in treating \nRCCT with no major complications.Two-needle procedure allows for \nsignificantly reducing treatment time  and appears to be much easier when \ndealing with soft and hard calcium deposits.  \nB-0047 11:24  \nImaging-guided therapeutic shoulder injections: prospective study \ncomparing the lateral extension of the acromion on conventional \nradiographs with patients' outcomes  \nT.J. Dietrich, B.K. Moor, G.J. Puskas, C.W.A. Pfirrmann, J. Hodler, \nC.K. Peterson; Zurich/CH (tobiasjdietrich@gmail.com)  \nPurpose: To compare the lateral extension of the acromion on conventional \nradiographs with patient improvement in pain and shoulder function after \nsubacromial and glenohumeral injections. \nMethods and Materials: Institutional review board and informed consent were \nobtained. Totally 307 patients were prospectively included after therapeutic \nfluoroscopy-guided subacromial (n= 148 patients) or glenohumeral injections \n(n= 159 patients) with local anaesthetics (lidocaine 2%) and long-acting \ncorticosteroids (40 mg of triamcinolone). Post-interventional outcomes were \nassessed by the patient's global impression of change (PGIC) and visual \nanalogue scale (VAS) pre-injection and at 1 week and 1 month post-injection. \nTwo observers quantified the lateral extension of the acromion by the critical \nshoulder angle (CSA) and the acromion index (AI) on anteroposterior \nconventional radiographs. ANOVA and Chi-squared test served for statistics. \nResults: Relevant 'improvement' one month after subacromial injection was \nobserved in 63% of patients compared to 64% of patients after glenohumeral \njoint injection. Comparing the three CSA categories after subacromial injection \nshowed a higher percentage of 'improved' patients at 1 week (68.2% versus \n45.1%) and significantly lower pain levels on the VAS scale at 1 month \n(2.2 ± 1.9 versus 3.4 ±  3.0, p = 0.027) in patients with a short lateral extension \nof the acromion. No significant association was noted between the clinical \noutcome (PGIC and VAS scale) and the lateral extension of the acromion \n(CSA & AI) after glenohumeral joint injections. \nConclusion: Shorter lateral extensions of the acromion were related with \nbetter clinical outcomes in subacromial injections but not in glenohumeral \ninjections patients.  \nB-0048 11:33  \nUltrasound-guided percutaneous injection for De Quervain's disease \nusing three different techniques: preliminary results of a randomised \ncontrolled trial  \nD. Orlandi\n1, G. Ferrero1, E. Fabbro1, G. Serafini2, E. Silvestri1, \nL.M. Sconfienza3; 1Genoa/IT, 2Pietra Ligure/IT, 3San Donato Milanese/IT \n(theabo@libero.it)  \nPurpose: De Quervain's disease is a painful stenosing tenosynovitis of the first \ndorsal compartment of the wrist, caused by a thickening of the retinaculum. \nUltrasound-guided intracompartmental steroid injections reported pain relief in \nup to 97% of patients at 6 months follow-up with a rate of symptoms \nrecurrence up to 20%. We compared the efficacy and the outcome at 6 months \nfollow-up of three different ultrasound-guided treatment options for De \nQuervain's disease. \nMethods and Materials:  Excluding women with pregnancy-related disease, a \nconsecutive series of 26 patients who presented at our institution to be treated \nfor De Quervain's disease under ultrasound guidance entered our study. \nBaseline and follow-up (1, 3, 6 months) evaluation included US measurement \nof first dorsal compartment retinaculum maximum thickness, pain assessment \n(VAS) and disability assessment (quickDASH). All procedures were performed \nunder US guidance with axial scan over the first extensor compartment, and \nusing a medial-to-lateral approach. Patients were randomised into three \ngroups: 1 ml metilprednisolone acetate (group 1; 8 patients, mean age \n39±10years, mean baseline thickness= 1.6 mm, mean baseline VAS=6.4, mean \nbaseline quickDASH=53), 1 ml triamcinolone acetonide+15-day-delayed 2 ml \nsaline 0.9% (group 2; 8.44 ±9.1.3.6.0.56), and 1 ml triamcinolone \nacetonide+15-day-delayed 2 ml low-weight sodium hyaluronate (group 3; \n10.43±12.1.7.6.4.55). \nResults: No adverse reactions occurred. At 1-month follow-up we found: group \n1, mean thickness=0.5 mm,  mean VAS=1 .5, mean quick DASH=22; gr oup 2, \n0.6.1.4.23; group 3, 0.5.1.2.21. At 3-month follow-up: 0.5.1.1.21; 0.6.1.2.21; \n0.4.1.1.21. At 6-month follow-up: 0.8.3.4.32; 0.6.2.1.26; 0.5.1.0.19. VAS and \nquickDASH are graphically represented in Figure 1. \nConclusion: Ultrasound-guided intracompartment injection of triamcinolone \nacetonide+sodium hyaluronate seems to represent a promising approach to \ntreat De Quervain's disease, reducing symptoms recurrence up to 6 months.  \nAuthor Disclosures: \nD. Orlandi: Research/Grant Support; This research was partially founded by \nthe Young Researchers Grant 2013 awarded by the European Society of \nMusculoskeletal Radiology.  \nB-0049 11:42  \nUltra high-resolution C-arm CT arthrography: initial results in- and ex-\nvivo  \nC. Von Falck, B. Meyer, F. Wacker, H. Rosenthal; \nHannover/DE (c.v.falck@gmx.de)  \nPurpose: To report on initial results of direct C-arm CT arthrography using a \n1x1 binning ultra high-resolution detector read-out. \nMethods and Materials:  Direct bi- or tricompartmental arthrography of the \nwrist was conducted according to standard procedures under fluoroscopic \nguidance in 5 patients and 5 cadavers using an iodinated contrast agent \n(Imeron 300, 1:1 dilution with NaCl) for C-arm CT or a mixture of an iodinated \nand a gadolinium-based contrast agent (Imeron 300, Bracco and Magnevist \n2 mmol/l, Bayer, 1:1) for combined CT/MRI. C-arm CT images were acquired \non a monoplanar angiography unit (Artis Q, Siemens, Erlangen, Germany) \nusing a 1x1 binning detector read-out with a field-of-view of 22 cm. Subjective \nand objective image quality and patient workflow were compared with \nconventional thin-collimated MDCT (ex-vivo) and 3 T MRI (in-vivo), \nrespectively. \nResults: Image quality of C-arm CT arthrography was rated significantly higher \nas compared to MDCT/MRI arthrography with respect to the delineation of \nintrinsic ligaments, TFCC, cartilage, subchondral bone plates and trabecular \narchitecture. However, MRI added supplemental information on (teno-\n)synovitis, bone marrow edema and soft-tissue injury. C-arm CT considerably \nimproved the patient workflow by enabling joint injection and CT scan at a \nsingle modality as compared with the traditional two-step procedure. \nConclusion: Ultra high-resolution C-arm CT arthrography shows superior \ndepiction of intraarticular structures and improves patient workflow as \ncompared to MDCT/MRT arthrography.  \nAuthor Disclosures: \nC. Von Falck: Research/Grant Support; Visage Imaging. B. Meyer:  \nResearch/Grant Support; Visage Imaging, Siemens Healthcare. F. Wacker: \nResearch/Grant Support; Visage Imaging, Siemens Healthcare.  \nB-0050 11:51  \nMetallic artefacts from internal scaphoid fracture fixation screws: \ncomparison between C-arm flat-panel, cone-beam and multi-detector CT  \nT. Finkenstaedt, F. Morsbach, M. Calcagni, M. Vich, C. Pfirrmann, H. Alkadhi, \nG. Andreisek, R. Guggenberger; Zurich/CH  (tim.finkenstaedt@usz.ch)  \nPurpose: To systematically compare artefact degree and image quality from \nscaphoid fracture fixation screws between different CT modalities and radiation \ndose protocols. \nMethods and Materials:  CT acquisitions were acquired from six cadaveric \nwrists with scaphoid screws in two different scanning positions (45° and 90°) \nwith MDCT, C-arm-based flat-panel (FP) and cone-beam (CB) CT, the latter \ntwo with low- and standard radiation dose protocols each. Two radiologists \nmeasured the mean cartilage attenuation and metal artefact-induced absolute \nHU changes (=artefact extent) and evaluated different kinds of image quality \ncriteria, e.g. visualisation of the screw bone interface and artefacts degree, \nusing a five-point Likert-scale. Interreader-agreements were calculated (ICCs; \nCohen's Kappa) and mean absolute HU changes and ratings compared using \nFriedman and Wilcoxon signed-rank tests. \nResults: ICC and Kappa for Interreader-agreement were 0.58 and 0.51, \nrespectively. Mean cartilage attenuation di d not differ significantly among \nmodalities and no significant differences in artefact extent among different \nscrew types and scanning positions were noted (p>  0.05). In CBCT low- and \nstandard-dose acquisitions, significantly higher artefact extent emerged \ncompared to MDCT and FPCT (p < 0.05). Image quality was significantly better \n(p < 0.05) and artefact degree significantly lower (p < 0.001) in MDCT \ncompared to both other modalities. Screw bone interfaces were better visible in \nFPCT compared to CBCT (p < 0.05). \n \n \nS147  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nConclusion: MDCT has shown less metal-induced artefacts and better overall \nimage quality than FPCT and CBCT. However, FPCT and CBCT still provide \nsufficient image quality to serve as low-radiation-dose alternatives for \npostoperative scaphoid bone imaging in future.  \n10:30 - 12:00 Room E2  \nBreast  \nSS 102a  \nContrast and spectral mammography  \nModerators:  \nI. Pereira; Ourém/PT  \nF. Thibault; Paris/FR  \nB-0051 10:30  \nTumour size: dual-energy contrast-enhanced digital mammography \n(CEDM) versus breast MRI  \nI. Leconte, M. Teodorescu, N. Michoux, L. Fellah; Brussels/BE \n(marian.teodorescu@uclouvain.be)  \nPurpose: Evaluation of the tumour size in patients with breast tumors using \ndual-energy contrast-enhanced digital mammography and MRI. \nMethods and Materials:  Twenty-two patients with 30 breast tumours (29 \nmalignant, 1 benign) underwent contrast-enhanced digital mammography \n(CEDM) and MRI before surgery. Images were read twice by two senior \nradiologists. Inter-observer agreement and inter-technique agreement (mean \nmeasurement from both observers) with regard to the size of the lesions were \nassessed based on the intraclass correlation coefficient ICC (two-way model \nfor an absolute agreement where systematic differences are relevant) and its \n95% confidence interval. \nResults: Median size of the lesions at histology was 12 mm [4 mm; 200 mm]. \nInter-observer agreement was excellent for both modality (ICC\nMRI = 0.995 \n[0.987 - 0.998], ICC CEDM = 0.997 [0.994 - 0.999]). Inter-technique agreement \nwas excellent between CEDM and histopathology (ICC = 0.943 [0.882 - 0.972]) \nand slightly superior to the one observed between MRI and histopathology \n(ICC = 0.850 [0.707 - 0.927]). \nConclusion: Both CEDM and MRI offer reliable means of evaluation of tumour \nsize with an excellent reproducibility of measurements. CEDM is at least as \nefficient as MRI for evaluating tumour size.  \nB-0052 10:39  \nCan contrast-enhanced spectral mammography replace magnetic \nresonance imaging in the detection and staging of breast cancer?  \nM.H. Helal, R.M. Kamal, R. Essam, I. Godda, S.M. Mansour, N. Alieldin, \nN.M. Khalifa, N. ElSaid, A.A.I. El-Shaarawy; Cairo/EG \n(sahar_mnsr@yahoo.com)  \nPurpose: To evaluate the diagnostic performance of contrast-enhanced \nspectral digital mammography (CEM) versus dynamic contrast-enhanced \nmagnetic resonance imaging (DCE-MR) in the detection and staging of breast \ncancer. \nMethods and Materials: In this institutional ethics approved prospective study, \nwe compared the performance of CEM with MRI on 70 patients. Standard \ndigital mammogram was done in the mediolateral oblique and craniocaudal \nprojections followed by low (22-33 kVp) and high (44-49 kVp) energy \nexposures in the same projections. DCE-MR was set in the axial orientation \nand post processed using maximum intensity projection and multiplanar \nreconstruction images. Both examinations performed by IV injection of non-\nionic contrast agent. Outcomes of the surgi cal specimen or ultrasound guided \ncore biopsy were the gold standard of reference. \nResults: The study included 33 benign (47%) and 37 (53%) malignant breast \nlesions. The areas of contrast uptake had been correlated with abnormalities \nseen on the conventional mammography. Both CEM and MRI were individually \nassessed in the same group of cases. Multi centric and multifocal carcinomas \nwere detected by contrast mammograms in 29.7% (n=11) of malignant cases, \nwhen only unifocal carcinoma was reported on conventional mammograms. In \nthe contest of malignancy, both modalities stood on the same land. \nEnhancement detection of some benign lesions (n=5) was limited in CEM. \nStatistical analysis yielded a sensitivi ty, specificity and accuracy of 93.7%, \n66.6% and 80.6% compared to 93.7%, 86.6% and 90.3% for CEM and MRI, \nrespectively. \nConclusion: CEM is non-inferior to breast MRI in the detection and \ncharacterisation of breast malignancy.  \n \n \nB-0053 10:48  \nContrast-enhanced spectral mammography in women referred from the \nbreast cancer screening programme  \nM. Lobbes, U.C. Lalji, J. Houwers, P. Nelemans, M. Smidt, E. Heuts, \nJ.E. Wildberger; Maastricht/NL (marc.lobbes@mumc.nl)  \nPurpose: Previous results showed that contrast-enhanced spectral \nmammography (CESM) could increase diagnostic performance of \nmammography. Diagnostic performance of CESM in a population with low \ndisease prevalence (30%) was not evaluated before. \nMethods and Materials:  Women referred from breast cancer screening \nunderwent CESM. Two radiologists blinded for diagnosis provided BI-RADS \nclassifications for conven tional mammography and CESM. Statistical \nsignificance of differences between ma mmography and CESM was calculated \nusing McNemar's test and receiver operating  characteristic (ROC) curves were \nconstructed for both imaging modalities. Bland-Altman plots were created to \nevaluate agreement between tumour diameter as measured by CESM, MRI, \nand pathology. \nResults: 113 women were included (age 49-73 years). When compared with \nconventional mammography, CESM increased sensitivity to 100.0% (+3.3%), \nspecificity to 87.7% (+45.7%), PPV to 76.2% (+36.5%) , and NPV to 100.0% \n(+2.9%). Differences between conventional mammography and CESM were \nhighly significant (p \n< 0.0001). A similar trend could be observed for the ROC \ncurve. For conventional mammography, the AUC was 0.779. With CESM, AUC \nincreased from 0.197 to 0.976 (p \n< 0.0001). Excellent agreement between \ntumour diameter measured by CESM and breast MRI was observed, with a \nmean difference of 1.0 mm with 95% limits of agreement of 8.3 mm. Excellent \nagreement was also observed for the comparison of tumour diameter \nassessed by CESM and histopathology, with a mean difference of 1.4 mm, but \nwith larger 95% limits of agreement of 25.0 mm. \nConclusion: CESM significantly increases the diagnostic performance of \nconventional mammography, even in patient cohorts with a low prevalence of \nbreast cancer.  \nB-0054 10:57  \nRadiation exposure of contrast enhanced spectral mammography \ncompared to conventional mammography  \nC.R.L. Jeukens, U.C. Lalji, E.J. Meijer, M. Lobbes; Maastricht/NL \n(cecile.jeukens@mumc.nl)  \nPurpose: Contrast-enhanced Spectral Mammography (CESM) shows \npromising initial results, but comes at the cost of an increased dose as \ncompared to conventional mammography (Mx). Dromain reported a dose \nincrease of 20%, it being the only study adressing this issue. As CESM could \nsubstitute Mx, our purpose is to assess dose increase of CESM with respect to \nMx. \nMethods and Materials:  We retrieved radiation exposure related data (kV, \ncompressed breast thickness, glandularity, Average Glandular Dose (AGD)) for \n60 CESM and 344 Mx patients. All examinations were performed on the same \nmammograph (GE Senograph Essential/Senobright). The CESM examination \nexists of a low (kV=26-31 kV, Mo/Rh or Rh/Rh) and high energy (kV=45-49, \nMo/Cu or Rh/Cu) exposure after administering iodine contrast. A conventional \n(low-energy) as well as a contrast-enhanced (high-energy) mammogram are \nobtained. Radiation dose values reported by the mammograph were validated \nby phantom measurements. \nResults: Dose values reported by the system were in accordance with our \nmeasurements. Mean ± SD AGD for a single low and high energy CESM \nexposure was 2.12 ±0.68 mGy and 0.68 ±0.22 mGy, respectively. The AGD \ndepends on compressed breast thickness and glandularity. Combined radiation \nexposure was 2.80 ±0.88 mGy. Mean AGD for a single Mx exposure was \n1.55±0.48 mGy, which is significantly lower than the low energy CESM \nexposure (p < 0.001). \nConclusion: Compared to Mx, total radiation exposure of CESM is \nsignificantly increased by 63%. This increase is different from previously \nreported finding and presumably caused by differences in automatic exposure \ncontrol settings between CESM and Mx.  \nB-0055 11:06  \nThe added value of dual-energy contrast-enhanced digital mammography \nin breast cancer diagnosis  \nA. Chalazonitis, S. Liopiris, E. Feida, D. Goutzamanis, Z. Antoniou; Athens/GR \n(red-rad@ath.forthnet.gr)  \nPurpose: To determine the benefit of dual-energy contrast-enhanced digital \nmammography (CESM) performance in breast cancer diagnosis. \nMethods and Materials:  120 women, aged from 28 to 85 years (median age \n56.4 years), with suspicious finding (s) in conventional digital mammography, \nbreast ultrasonography, or breast MR, underwent dual-energy CEDM in our \nRadiology Department. The evaluation of the low-energy image was based on \nmorphology of the lesion (s). High-energy image evaluation was based on the \nS148  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nstrength of contrast enhancement intensity, according to a qualitative scale of \ncontrast enhancement intensity, categorised in 4-steps. Type 0= no \nenhancement, type 1= very low enhancement, type 2= moderate \nenhancement, type 3= intense enhancement. Type 0 and type 1 findings were \nconsidered to be probably benign, while type 2 and type 3 findings were \nconsidered to be probably malignant. Histopathological analysis of the suspect \nbreast lesions was performed in all patients, after core or surgical biopsy. \nResults: Histopathology confirmed 58 malignant and 62 benign lesions. There \nwas excellent correlation between proven breast malignancy and moderate or \nintense lesion enhancement (53 of 68), as well as between benign lesions and \nno, or very low enhancement (47 of 62). According to our findings, the positive \npredictive value of the method is 78% the negative predictive value is 90%, the \nspecificity is 77% and the sensitivity is 91%. \nConclusion: Dual-energy CEDM can be used as a useful adjunctive tool and a \nproblem-solving method to diagnosti c conventional mammography in every-\nday practice.  \nB-0056 11:15  \nContrast-enhanced digital mammography: is it useful in detecting lesions \nin oedematous breast?  \nN.A.E. ElDeib, N.M. Khalifa, S.M.S. Sharaf, M.H.H. Helal, O.M.M.N. Nada, \nE.N. Nasr, O.M. Magdy, S. Farouk, E. Abbas; Cairo/EG \n(nohasaid.rad@hotmail.com)  \nPurpose: To investigate the potential of using intravenous contrast material \nwith full-field digital mammography to facilitate the detection and \ncharacterisation of lesions in the oedematous dense breast. \nMethods and Materials: The study included 36 Egyptian patients (age ranged \nfrom 37 to 62 years, mean = 49.5 years) presenting by swollen breasts or \ncoming for follow-up after treatment either by chemotherapy or conservative \nbreast surgery. They underwent both conventional mammography and high-\nenergy post-contrast digital mammography and ultrasound breast examination. \nResults: Two radiologists analysed the presence and pattern of contrast \nuptake. Enhancement was detected in 23 cases and no detectable \nenhancement in 13 cases. Two false negative cases were detected (one \ninvasive carcinoma post chemotherapy and one duct carcinoma in situ). Two \nfalse positive cases were also detect ed (one diffuse granulomatous mastitis \nand one diffuse interstitial mastitis). The calculated sensitivity, specificity, \npositive and negative predictive values of CEDM were 93.9%, 89.6%, 93.9% \nand 89.6%, respectively, as compared to 85.6%, 55.1%, 76.3% and 69.3% for \nFFDM. \nConclusion: Dual-energy contrast-enhanced digital mammography is a useful \ntechnique in identification of lesions in mammographically dense oedematous \nbreasts and capable of demonstrating lesions that are not visible at standard \nmammography. CEDM is useful in follow-up of cases presenting by edema \nafter conservative breast surgery and chemotherapy.  \nB-0057 11:24  \nCharacterisation of breast lesions with spectral mammography: results \non tissue specimens and first clinical cases  \nF. Kilburn-Toppin\n1, P. Willsher2, K. Erhard3, E. Fredenberg4, E. Moa4, \nD. Dance5, M.G. Wallis2; 1Bury St Edmunds/UK, 2Cambridge/UK, \n3Hamburg/DE, 4Solna/SE, 5Guilford/UK (fleurkt@doctors.org.uk)  \nPurpose: Round lesions are a common mammographic finding; techniques to \nimprove characterisation at screening may reduce recalls. Our study aims to \ndetermine x-ray attenuation of solid breast lesion specimens to establish \nwhether they could be distinguished fr om cystic lesions by spectral imaging \n(SI). \nMethods and Materials:  73 fixed tissue samples of solid breast lesions, 50 \nsamples of cyst fluid and 50 of water were imaged on a prototype Philips \nMicroDose SI mammography system. Energy dependent x-ray attenuation was \nmeasured from the photon counts in the high and low-energy images and \nmapped to equivalent thicknesses of aluminium and polymethyl methacrylate. \nIn addition, 40 cysts and 26 solid lesions in 56 women have been imaged and \ncharacterised in vivo on a CE-marked clinical SI system following delineation of \neach lesion by a radiologist. \nResults: 25 fixed tissue samples were excluded (DCIS/benign/technical \nreasons). Attenuation of the remaining 48 biopsy proven malignant samples \nwas significantly different from cyst attenuation at 95% significance level. \nStandard deviation of the attenuation of tumours was 2-4 times larger than cyst \nsamples, and 7-14 times larger than water samples. 2 of the fixed tumour \nsamples overlapped with the distribution of cyst fluid samples. On the clinical \nsystem, our initial algorithm has correctly predicted all solid lesions. \nConclusion: Results demonstrate large sample variability but only small \noverlap between attenuation of cyst fluid and fixed tumour samples, suggesting \nit may be possible to distinguish cystic from solid lesions. Initial clinical results \nare promising, justifying continuing a clinical study.  \nAuthor Disclosures: \nK. Erhard: Employee; Philips. E. Fredenberg: Employee; Philips. E. Moa: \nEmployee; Philips. M. Wallis: Grant Recipient; Philips. \nB-0058 11:33  \nAdded value of contrast-enhanced spectral mammography (CESM) as \npart of a one stop breast unit  \nA.-M. Tardivel, C.S. Balleyguier, S. Canale, S. Delaloge, C. Mazouni, \nM.-C. Mathieu, C. Dromain; Villejuif/FR (am_tardivel@hotmail.com)  \nPurpose: To assess the added value on treatment management of contrast-\nenhanced spectral mammography (CESM) in adjunct to mammography and \nultrasound in breast cancer in One Stop Breast unit. \nMethods and Materials: 152 women with a suspicious or undetermined breast \nlesion on mammogram ± ultrasound underwent bilateral CESM in a one shot \nbreast post-screening unit between September 2012 and June 2013. CESM \nimages were blindly retrospectively revi ewed by two radiologists, to estimate \nBI-RADS categories and probability of malignancy (7 categories scale). Each \nlesion was confirmed histologically or by fol low-up for typical benign lesions. \nDiagnostic performances were estimated. Changes of medical and surgical \nstrategy were recorded. \nResults: 223 lesions were detected including 174 malignant lesions (137 \ninfiltrative ductal carcinoma, 19 lobular infiltrative carcinoma, 8 ductal \ncarcinoma in situ) in 124 / 152 patient s (82%). CESM sensitivity, specificity, \npositive predictive value and negative predictive value were 94%, 71%, 92% \nand 76%, respectively, with 14 false-posi tive and 11 false-negative findings. \nCESM changed diagnostic and treatment strategy in 33 (22%) patients, \ndetecting additional malignant lesions in 22 patients, with a more extensive \nsurgery (n=21) and neoadjuvant chemotherapy (n=1). A biopsy was avoided in \n11 patients with negative CESM, for whom a benign lesion was confirmed by \nfollow-up. Diagnostic and treatment changes according CESM were \nindependent from breast density, tumour type and mammographic/sonographic \nfindings. \nConclusion: CESM may be performed easily in One Stop Breast unit and may \nchange significantly the diagnostic and treatment strategy in breast cancer \nstaging.  \nB-0059 11:42  \nSecond-look digital breast tomosynthesis (SL-DBT) in assessing \nincidental findings (IFs) at contrast-enhanced magnetic resonance \nimaging (CE-MRI) in patients with newly diagnosed breast cancer  \nP. Clauser\n1, A. De Nicolò1, V. Londero1, R. Girometti1, C. Zuiani1, \nM. Bazzocchi1, F. Sardanelli2; 1Udine/IT, 2San Donato Milanese/IT \n(clauser.p@hotmail.it)  \nPurpose: To test if SL-DBT, i.e. the re-evaluation of DBT images after CE-\nMRI, helps assessing IFs at CE-MRI in patients with newly diagnosed breast \ncancer. \nMethods and Materials:  Two experienced readers in consensus \nretrospectively reviewed the examinations of 43 patients who underwent DBT \nand CE-MRI from May 2012 to January 2013, looking for a DBT correlate of \nIFs at CE-MR. Standard of reference was histology for CE-MRI suspicious \nfindings (ACR-BIRADS-3-5) and imaging follow-up for CE-MRI non-suspicious \nfindings (ACR-BIRADS-1-2). Fisher exact test was used. \nResults: A total of 32 CE-MRI IFs were detected in 24 patients: 18 BIRADS-2 \nand 14 BIRADS-3-5. A DBT correlate was found in 12/24 IFs (38%) overall, \n8/14 (57%) MR-BIRADS-3-5 and 4/18 (22%) MR-BIRADS-2 IFs, with \nborderline significance (p=0.080). Maligna ncy was histologically confirmed for \n10/14 CE-MRI IFs; 6 of these 10 additional malignancies (60%) had a DBT \ncorrelate with suspicious features: 3 in vasive lobular; 2 ductal carcinoma in \nsitu; and 1 invasive ductal. A significantl y lower rate of DBT correlate (6/22, \n27%), was found for non-suspicious CE-MRI IFs, all with benign features \n(p=0.005). \nConclusion: A DBT correlate was more frequent for malignant than for benign \nCE-MRI IFs. SL-DBT has the potential to confirm more than 50% of suspicious \nCE-MR IFs. However, the absence of a DBT correlate does not warrant to \navoid MR-guided biopsy.  \nB-0060 11:51  \nThe 3D mammography: the imaging of the future?  \nR. Ferré1, C.S. Balleyguier2, P. Goumot3, B. Mesurolle1; 1Montreal, QC/CA, \n2Villejuif/FR, 3Paris/FR (kn638@yahoo.fr)  \nPurpose: To assess the benefit of real three-dimension mammogram \n(3DSDM) in diagnosis improvement and cancer detection in comparison with \n2D digital mammography. \nMethods and Materials:  The 3DSDM is processed by an additional low-dose \nimage acquired with a 4-degree angulation compared to cranio-caudal \nacquisition. This acquisiti on time takes 1 minute more and the dose is 30% \nlower. The resolution is 50 8m. Both images are treated as a stereo-pair in the \n3DSDM system. Monitor allows magnification, and 2D and 3D can be switched \nas well. 1110 mammograms were performed from March 2012 until April 2013, \nincluding 1075 patients whose mean age was 60 (21.91). The study was \nprospective and board-approved. 3 radiologists who were blinded to each other \nS149  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nresults read 2D then 3D mammograms and evaluated 3D benefit with a 3-level \nscale : 0 for no benefit, 1 for moderate and 2 for excellent. All cases of cancers \nwere histologically proven and were also evaluated. \nResults: For 958 mammograms (86%), the readers had the same opinion \nabout the benefit of 3DSDM : grade 0, 1 & 2 were quoted in 8, 52 and 26% of \ncases. Discordance was not influenced by BIRADS classification (heterogenity \ntest : p = 0.55) neither with microcalcification or masses (heterogenity test : p = \n0.80). The readers had the same opinion of cancers in 96% of cases with a \nmoderate and excellent benefit (50% and 42% respectively). \nConclusion: 3DSDM is a new helpful tool to interpret mammograms and \nparticularly in a significantly higher cancer detection rate.  \n10:30 - 12:00 Room F1  \nOncologic Imaging  \nSS 116  \nImaging in response assessment: \nmethodology and clinical results  \nModerators:  \nK.S. Lee; Seoul/KR  \nM. Nadrljanski; Belgrade/RS  \nB-0061 10:30  \nCorrelation of radiological presentation and response to TKI targeted \ntherapy in EGFR mutant and ALK rearranged advanced lung \nadenocarcinomas patients  \nN. Moussa, C. Leduc, L. Faivre, J. Pignon, B. Besse, C. Dromain, \nC. Caramella; Villejuif/FR (ndi.moussa@gmail.com)  \nPurpose: Amongst caucasian patients with lung adenocarcinoma, around 15% \nexhibit epidermal growth factor receptor mutation (EGFRm) or anaplastic \nlymphoma kinase rearrangement (ALK+). These tumours are associated with a \nhigh response rate to specific targeted treatments, but the impact of the \nradiological presentation on the treatment benefit is poorly known. \nMethods and Materials:  We retrospectively reviewed patients with advanced \nnon-small cell lung cancer harbouring EGFRm and/or ALK+ that were included \nin a clinical trial at Gustave Roussy (MSN trial). A central review of all the \nbaseline clinical characteristics and CT images was performed to assess initial \ntumour volume (volumetry software program LungVCAR, GE Healthcare), \nnumber and type of metastatic lesions (brain, lung, adrenal, liver, bone). \nEGFRm tumours were treated with gefitinib or erlotinib, and ALK+ tumours with \ncrizotinib. Multivariate statistical analyses were performed to correlate with \nprogression-free survival (PFS). \nResults: Between june 2006 and january 2013, 405 patients were included in \nthe MSN. Amongst them, 97 patients were eligible, 80 EGFRm, 14 ALK+, 3 \nwith both. There was no statistically significant difference between \noligometastatic (< 3 sites) and polymetastatic patients and according to volume \ntumour ( < 35, 36-75 and > 75 cm\n3). None of the clinical characteristics of the \nmetastatic site had a detrimental effect on PF S, including 43 patients with brain \nmetastasis. \nConclusion: In patients with EGFRm or ALK+ lung cancer under targeted \ntherapy, the initial tumour burden or the presence of brain metastases was not \ncorrelated with a poorer benefit.  \nB-0062 10:39  \nRadio-pathological correlation in HCC treated by transarterial \nchemoembolisation: comparison between RECIST, mRECIST and EASL \ncriteria  \nM. Dioguardi Burgio\n1, M. Ronot2, O. Bruno2, C. Francoz2, V. Paradis2, \nF. Durand2, L. Castera2, J. Belghiti2, V. Vilgrain2; 1Palermo/IT, 2Clichy/FR \n(marco_dioguardi@hotmail.it)  \nPurpose: To compare the performances of RECIST1.1, mRECIST, and EASL \ncriteria for tumoural necrosis evaluation in a consecutive series of patients \ntreated with transarterial chemoembolisation (TACE) before liver \ntransplantation (LT) for hepatocellular carcinoma (HCC). \nMethods and Materials:  Between 2006 and 2012, all patients treated with at \nleast one session of TACE before LT for HCC were identified. Response to \ntreatment was evaluated by 2 independent readers on the last CT before LT \naccording to RECIST1.1, mRECIST, and EASL criteria. Imaging response was \ncompared to the tumoral necrosis assessed by pathology on the liver explant. \nInter-reader agreement for the tumoural response was evaluated by the kappa \nstatistic. Factor associated with a major ( > 90%) necrosis were tested by \nmultivariate analysis. \nResults: Population included 58 patients with 88 HCC treated with 94 TACE \nsessions. 51 nodules (58%) showed major necrosis. Among them, lesions \nwere classified as complete response according to RECIST1.1, mRECIST and \nEASL in 2 (4%), 47 (92%) and 47 (92%) for reader 1, respectively, and 1 (2%), \n45 (88%) and 45 (88%) for reader 2, respectively. Despite similar \nperformances with mRECIST and EASL, only mRECIST was correlated with \nmajor necrosis on multivariate analysis for both readers (p < 0.0001). Inter-\nobserver agreement was substantial for RECIST1.1 (k=0.65 ± 0.08), mRECIST \n(k=0.78 ± 0.07), and EASL (k=0.75 ± 0.07). \nConclusion: mRECIST and EASL criteria showed better correlation with major \ntumoural necrosis than RECIST1.1. mRECIST showed better correlation with \ntumoural major necrosis and should be used to evaluate response to TACE.  \nB-0063 10:48  \nInvestigating changes in tumour volumes for defining limits for stable \ndisease by total tumour volumetry criteria in therapy response \nassessment of hepatocellular carcinoma  \nA. Singh, W. Cai, S. Saini, G. Harris; Boston, MA/US (ahsingh@partners.org)  \nPurpose: Limits for stable disease according to total tumour volumetry (TTV) \ncriteria have been set between -65 and +73% change in total tumour volume \nafter treatment and is basically derived from extrapolation of bi-dimensional \nRECIST-based measurements lacking validation for specific tumour groups. \nOur aim is to generate receiver-operating-characteristic (ROC) curves for \ndefining a more reliable limit for stable disease for assessing therapy response \nin Hepatocellular carcinoma's (HCC) with total tumour volumetry criteria. \nMethods and Materials: Consecutive pre-treatment and post-treatment MDCT \ndatasets of 63 consecutively treated HCC patients were obtained for estimation \nof interval change in total tumour volume (TTV) using semi-automated 3D \nsegmentation techniques. Area-under-curve (AUC) was generated for various \nthresholds ( ±20%, ± 30%, ± 40%, ± 50%, ± 60%, ±70%) along with the current \nproposed TTV stable disease inclusion limits (-65 to +73% change). \nProgression-free survival time from start of treatment was used as dependent \nvariable. \nResults: The stable limit range for total tumour volumetry criteria \nbetween ±50% revealed a better AUC [AUC=0.727; 95%CI=0.60-0.83] \ncompared to other set limits for stable disease. The stable range set at ±60% \nwas also closer to most optimum (AUC=0.707). The ROC-AUC for existing \nTTV criteria for stable disease (-65 to +73%) was less than the above two \nranges (AUC=0.688). \nConclusion: Better prediction of therapy response in HCC by TTV criteria was \nachieved by setting limits of stable disease between ±50 and ±60% in this \nstudy compared to currently proposed limits of -65 to +73%, thus necessitating \nfurther validation on larger cohort.  \nAuthor Disclosures: \nA. Singh: Grant Recipient; NIH/NCI Proton beam federal share grant (PI) 2012 \n& 2013; Sarcoma Foundation of America 2010 Grant -PI; RSNA 2009 fellow \ngrant -PI. Research/Grant Support; RSNA fellow grant 2009; NIH/NCI Proton \nBeam Federal Shre Grant. S. Saini: Consultant; GE HEALTHCARE, PHILIPS, \nBRACCO. G. Harris: Advisory Board; Fovia Inc. \nB-0064 10:57  \nWhat does FDG-PET activity tell us about morphological changes in \ncolorectal liver metastasis treated with bevacizumab?  \nA.R. Seyal, F.D. Gonzalez-Guindalini, K. Parekh, P. Nikolaidis, V. Yaghmai; \nChicago, IL/US (v-yaghmai@northwestern.edu)  \nPurpose: To evaluate correlation of FDG-PET uptake with morphological \nchanges of colorectal liver metastases treated with bevacizumab. \nMethods and Materials: This HIPAA compliant study was IRB approved. Fifty-\nfour colorectal liver metastases in 22 patients treated with bevacizumab were \nevaluated. For each patient, pre- and post-therapy CT scans and post-therapy \nFDG-PET scan were evaluated. Based on FDG-PET, lesions were classified in \ntwo groups: Responder (no uptake) or non-responder (positive uptake). Two \nexperienced abdominal radiologists blinded to FDG-PET results analysed the \nCT images for changes in tumor morphology and categorised them as \nresponders (sharp margin) and non-responders (irregular margin). \nResults: The mean interval time between the post therapy CT and FDG-PET \nwas 8 days. Based on tumor morphology, 12/54 (22.2%) lesions were \nclassified as responders and 42/54 (77.8%) lesions as non-responders. The \nnumber of responder and non-responder lesions based on FDG-PET uptake \nwere 20/54 (37%) and 34/54 (63%), respectively. FDG-PET and tumor \nmorphology were concordant for response category in 40/54 (74.1%) \nmetastases. 3/54 (5.6%) metastases were classified as responders based on \nmorphology but demonstrated FDG-PET uptake after therapy, while 11/54 \n(20.3%) metastases classified as non-responders based on morphology \nshowed no uptake on post treatment FDG-PET. The FDG-PET sensitivity, \nspecificity, PPV and NPV to predict response based on tumor morphology \nwere 75%, 73.8%, 45% and 91.2%, respectively. FDG-PET predicted tumor \nmorphology (odds ratio: 8.45; 95% C: 1.93-37.03; P=0.005). \nConclusion: Changes in colorectal liver metastasis morphology and FDG-PET \nuptake show high concordance in patients treated with bevacizumab.  \n \nS150  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nAuthor Disclosures: \nA.R. Seyal: Research/Grant Support; Educational Grant from Siemens \nHealthcare. K. Parekh: Research/Grant Support; Educational Grant from \nSiemens Healthcare.  \nB-0065 11:06  \nVery high-resolution ultrasound and elastography in melanoma lesion: \nUS-pathological correlations  \nC. Botar-Jid, R. Cosgarea, S. Ienil\u0015, S.D. Bolboac\u0015, M. Lenghel, D. Vasilescu, \nS.M. Dudea; Cluj-Napoca/RO (inabotar@yahoo.com)  \nPurpose: The aim of this study was to evaluate the very high-resolution \nultrasound (US) in assessment of preoperative melanoma, especially by \ncorrelation between US thickness of melanoma and the histopathological \nthickness (Breslow index), being known that Breslow index positively correlates \nwith the probability of lymph node involvement and the risk of distant \nmetastasis. \nMethods and Materials:  The study included 28 melanoma lesions identified \non 25 patients. A Ultrasonix equipment with 20-40 MHz linear transducer was \nused for US evaluation. The relation between values obtained by 2D US \nevaluation of the lesions (thickness and elastographic appearance) and value \nobtained by histopathological examination (Breslow index) was investigated. \nResults: The mean age of the investigated subject was of 57 ±15 years old. \nMost investigated lesions were localised at lumbar region (17.86%, 95%CI \n[7.27-35.59], where CI = confidence interval) and had a hypoecogen \nhomogenous 2D US aspect in 71% of cases (95%CI [50.13-85.59]). The \nelastographic aspects of lesions were low or medium intensity in 43% and 39% \nrespectively. The US thickness (2.38 ±1.41 mm) proved significantly correlated \nwith Breslow index (2.61 ±1.19 mm) (r=0.9335, p=8.14•10-11). Furthermore, \nthe elastographic appearance of the lesion significantly correlated to both US \nthickness (;=-0.490, p = 0.008) and Breslow index ( ;=-0.440, p=0.036). \nConclusion: The strong linearity between US thickness and Breslow index \nobtained in our study and significant relation between elastographic \nappearance of the lesion and Breslow index sustain the usefulness of US and \nelastography in the assessment of skin melanoma lesions.  \nB-0066 11:15  \nThe tumour response assessed with CT at 8 weeks from start of first-line \nchemotherapy correlates with overall survival in metastatic colorectal \ncancer  \nC. Suzuki\n1, L.C.O. Blomqvist1, T.K. Guren2, K.M. Tveit2, B. Glimelius3; \n1Stockholm/SE, 2Oslo/NO, 3Uppsala/SE (Chikako.Suzuki@ki.se)  \nPurpose: To study the relationship between early tumour response assessed \nby computed tomography (CT) eight weeks from baseline and overall survival \n(OS) in patients receiving first-line chemotherapy for metastatic colorectal \ncancer (mCRC). \nMethods and Materials:  A total of 520 patients who received bolus 5-\nfluorouracil/folinic acid and oxalipla tin (Nordic FLOX), with or without \ncetuximab, as first-line treatment for CRC in a randomised multicenter trial \n(NORDIC VII, n=566), were eligible for this sub-study. Radiological response \nwas analysed according to response evaluation criteria in solid tumours \n(RECIST 1.0). The relationship between the percentage change in sum of \ntumour diameters from baseline to the first CT response evaluation and OS \nwas investigated by using Cox proportional hazards multiple regression model \nand Kaplan-Meier survival analyses. \nResults: Forty percentage decrease or more in the sum of tumour diameters \nwas a positive prognostic factor for OS. Any other magnitude of change in size, \neven 20% or more increase (corresponding to progressive disease by RECIST \n1.0) did not indicate shorter OS. A patient who had appearance of new \nlesion (s) or progression of non-target lesion (s) had a significantly shorter OS \nin both uni- and multivariate analyses. \nConclusion: Radiological tumour response assessed by CT at eight weeks \nwas related to outcome; a more than 40% decrease in tumour size was \nassociated with long OS, while appearance of new lesion (s) or progression of \nnon-target lesion (s) was a strong negative prognostic factor.  \nB-0067 11:24  \nNeoadjuvant radiochemotherapy response evaluation with MR and FDG-\nPET/CT in rectal cancer: predictive value of combined quantitative \nparameters of ADC and SUV compared with tumour regression grade at \nhistology  \nD. Ippolito, P.A. Bonaffini, D. Fior, C. Capraro, C. Trattenero, S. Sironi; \nMonza/IT (davide.atena@tiscalinet.it)  \nPurpose: To determine the clinical value of functional imaging,combining \nquantitative parameters of ADC and SUVmax,before and after chemo-radiation \ntherapy,in prediction of tumor response of patients with rectal cancer,correlated \nwith tumor regression grade at histology. \n \nMethods and Materials:  A total of 45 patients with biopsy proven diagnosis of \nrectal carcinoma were enrolled in our study.All patients underwent whole body \n18-FDG-PET/CT scan and a pelvic MR examination before (PET 1,MR 1) and \nafter neoadjuvant chemoradiation therapy (PET2,MR2).MR \nscanning,performed on 1.5T magnet (Philips,Achieva),comprised T2-weighted \nmultiplanar imaging and in addition DW images with b-value of 0 and \n1000 mm²/sec.On PET/CT the SUVmax of rectal lesion were calculated in \nPET1 and PET2.The percentage decrease of SUVmax ( ,SUV) and \nADC (,ADC) value,from baseline to presurgical scan,were assessed and \ncorrelated with pathologic response classified as tumor regression \ngrade (Mandard's criteria;TRG 1=complete regression,TRG5=no regression). \nResults: At histology,according to Mandard's criteria,29 tumors (68%) showed \ncomplete or subtotal regression (TRG1-2) and were classified as \nresponders;16 tumors (32%) were classified as non-responders (TRG3-\n5).Considering all patients,the mean values of SUVmax in PET 1 was higher \nthan mean value of SUVmax in PET2 (p < 0.001),whereas mean ADC values \nwas lower in MR 1 than MR2 (p < 0.001).The best predictors for TRG response \nwere SUV2 (threshold of 4.4) and ADC2 (1.28x10-3 mm2/s),but combining in a \nsingle analysis median quantitative value,the PPV in predicting different group \ncategory response,related to TRG system,presented an overall AUC of 96%, \nhigher than DWI (88.2%) or SUVmax (93.3%). \nConclusion: In era of PET/MRI scanner,combination of DWI and PET/CT \nrepresents the most feasible method to evaluate LARC patients,with accuracy \nvalues higher than those reported for other imaging technique.  \nB-0068 11:33  \nComparison between portal phase CT attenuation values and dynamic \ncontrast enhanced ultrasonography in the early evaluation of metastatic \nrenal cell carcinoma patients treated with anti-angiogenic treatment  \nM.-R. El Bejjani\n1, L. Rocher2, M.-F. Bellin2, S. Koscielny1, B. Benatsou1, \nN. Lassau1; 1Villejuif/FR, 2Kremlin-Bicêtre/FR (marierose.bejjani@gmail.com)  \nPurpose: Our objective was to compare the evaluation using DCE-US at one \nmonth and the CT-scan with calculation of density at 2 months for the \nprediction of response in patients treated by tyrosine kinase inhibitors for \nmetastatic renal cell carcinoma. \nMethods and Materials: We performed DCE-US in one target at baseline and \nD30. We selected patients with contrast-enhanced portal phase CT at baseline \nand after 2 months to calculate PFS. Response assessment using the \nResponse Evaluation Criteria in Solid Tumors and the modified Choi criteria (a \nregion of interest encompassing drawn with Global Imaging software) was \nperformed in 5 targets including the DCE-US tumor. Results were correlated to \nthe PFS. \nResults: A total of 81 patients were analysed. All had DCE-US at baseline and \none month. Forty four patients had CT-scan with contrast media injection for \nChoi criteria analysis. The median of follow-up was 18 months. For DCE-US, \nthe decrease of 90 % of AUC at D 30 was correlated to the PFS (p =0.01). The \ndifference of PFS between the groups defined by this cut-point was 4 months \n(bad responders) and 14 months (good responders). For the Choi criteria, the \npreliminary results seem to be efficient to predict PFS. \nConclusion: RECIST is not reliable to early identify good responders. DCE-US \nat one month could select patients with a poor PFS (p < 0.01) in order to \nchange treatment. Tumor density analysis at 2 months seems to be a good \nindicator and will be confirmed with the final analysis.  \nB-0069 11:42  \nComparing accuracy of dimensional and attenuation based criteria in \npredicting clinical outcome in patients with renal cell cancer treated with \nantiangiogenetic targeted therapy  \nC. Vancini, A. Spina, M. Totaro, V. Pollastri, N. Murri Dello Diago, E. Raisi, \nA. Rocchi, A. Carnevale, M. Giganti; Cona/IT (vanci10@libero.it)  \nPurpose: Aim of the study was to compare the accuracy of different response \nassessment criteria in the early evaluation of patients with metastatic renal cell \ncancer (RCC) on antiangiogenic targeted therapy. \nMethods and Materials:  44 patients with advanced RCC were studied. \nStandard contrast-enhanced CT (CECT) studies acquired before and three \nmonths after the onset of tyrosine-kinase inhibitor therapy were retrospectively \nevaluated. For each patient, response assessment to targeted therapy was \nevaluated using: Mass, Attenuation, Size and Structure (MASS) criteria; Size \nand Attenuation CT (SACT) criteria; modified Choi criteria (mChoi) and \nResponse Evaluation Criteria in Solid Tumo rs (RECIST); sensitivity, specificity \nand accuracy were evaluated for each response criteria using as old standard \nthe clinical outcome at 250 days from baseline. \nResults: Identifying patients with a progression free survival at 250 days \nMASS and SACT ha d a sensitivity of 95.23% while mChoi and RECIST had a \nsensitivity of 100%; the specificity was respectively of 52.17%, 56.52%, \n56.52%, 60.86%, and the accuracy of 72.72%, 75%, 77.27%, 79.54%. The \nnegative predictive value (progression free disease at 250 days) was 92.3% for \nMASS, 92.85% for SACT and 100% for mChoi and RECIST, while the positive \nS151  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\npredictive value was MASS 64.51%, SACT 66.66%, mChoi 67.74% and \nRECIST 70%. \nConclusion: Assessment of metastatic RCC target lesion on CECT, in a \ncohort of 44 patients treated with antiangiogenic targeted therapy, using \ndimensional and attenuation based methods shows in our casistic comparable \npredictive value performances, with slightly better results for RECIST, for a \ntime to progression free cut-off of 250 days.  \nB-0070 11:51  \nGrowth curves of renal masses from patients with von Hippel-Lindau \ndisease  \nG. Gennaro, C. Dal Bosco, G. Opocher, P. Muzzio, F. Pomerri; Padua/IT \n(gisella.gennaro@ioveneto.it)  \nPurpose: To analyse the progression curves of renal masses (RMs) in patients \nwith von Hippel-Lindau disease (VHL), and propose some changes in their \nmanagement. \nMethods and Materials:  This retrospective study included 26 VHL patients \nwho underwent periodical magnetic resonance imaging (MRI) examinations as \nfollow-up for renal masses. Thirty-one of total 60 RMs (51.7%) were classified \nas solid tumours (STs), and remaining 29 of 60 (48.3%) as complex cysts \n(CCs). For each lesion, the volume was estimated at each MRI occurrence \nusing the ellipsoid approximation, and i ndividual growth curves were traced. \nVariations in volume over time were analysed, and the mean growth rates \n(MGRs) calculated. MGRs were used to compare STs and CCs. \nResults: In cases for which several imaging occurrences were available, the \nanalysis of growth curves showed that solid tumours had an initial fast growth, \nfollowed by slower growth, according to the Gompertzian model. Otherwise, \ncomplex cysts showed some fluctuating progression curves, with spontaneous \nregressions in volume. Medians of the MGRs were 1.28 cm\n3/y for STs and \n0.37 cm3/y for CCs, respectively, leading to statistically significant difference \n(P=0.0023), and indicating a growing process substantially slower for CCs than \nfor STs. \nConclusion: This study showed that short-term MRI follow-up and multiple \nlesion volume measurements in VHL patients, would allow a more accurate \nestimation of the tumour growth curve, providing useful information to possibly \npostpone the lesion treatment. Less aggressive approach seems to be \npossible for complex cysts versus solid tumours.  \n10:30 - 12:00 Room F2  \nBreast  \nSS 102b  \nElastography and breast interventions  \nModerators:  \nA. Athanasiou; Paris/FR  \nR. Sinnatamby; Cambridge/UK  \nB-0071 10:30  \nWhich ultrasound shear wave elastography parameter gives the highest \ndiagnostic accuracy for solid breast lesions?  \nK. Skerl, K. Thomson, P. Whelehan, S.J. Vinnicombe, A.J. Evans; Dundee/UK \n(kskerl@dundee.ac.uk)  \nPurpose: Shear wave elastography (SWE) shows promise in refining benign-\nmalignant differentiation of solid breast masses during ultrasound \nexaminations. However, published results show varying diagnostic \nperformances of the SWE features, and it is still unclear which of the three \nnumerical parameters obtained (maximum, mean and standard deviation of the \ntissue elasticity measurements within a region of interest) gives optimal \ndiagnostic accuracy. \nMethods and Materials:  The shear wave parameters of 1,152 solid breast \nmasses were recorded prospectively prior  to histological examination. Four \nimages were obtained in two orthogonal planes using the Aixplorer device \n(SuperSonic Imagine).The values (generated using an ROI of 2 mm placed \nover the area of highest Emean) from the four images were averaged. \nSuggested thresholds from the literature (50 kPa for Emean, 80 kPa for Emax \nand 7 for SD) were used to calculate the diagnostic accuracy. Differences were \nevaluated using the chi-squared test. \nResults: The masses studied consisted of 791 cancers and 361 benign \nlesions. 63% of lesions were symptomatic (mean US size 20 mm) while 37% \nwere screen detected (mean US size 13 mm). The diagnostic accuracy (the \ncombination of sensitivity and specificity for cancer) for Emean was 84%. This \nwas significantly higher than the diagnostic accuracy using EMax (81%, \np=0.03) or SD (79%, p=0.001). \nConclusion: In this study the Emean measurements gave the highest \ndiagnostic accuracy of the three shear wave parameters known to be of \ndiagnostic value.  \nAuthor Disclosures: \nK. Skerl: Research/Grant Support; I am a PhD student partly founded by \nSuperSonic Imagine.  \nB-0072 10:39  \nShearwave elastography improves the diagnostic accuracy in the \ncharacterisation of benign and malignant breast lesions  \nW. Ng, K. Rahmat, F. Fadzli, C. Westerhout, A. Vijayananthan, Y. Abdul Aziz; \nKuala Lumpur/MY (katt_xr2000@yahoo.com)  \nPurpose: Shear wave (SW) elastography is an ultrasound technique based on \ntissue stiffness and provides quantitati ve information of breast lesions \nelasticity. We aim to investigate the diagnostic value of breast SW \nelastography in differentiating between benign and malignant lesions. \nMethods and Materials:  One hundred and sixty-six lesions in a total of 161 \npatients were examined by conventional ultrasound and SW elastography \nusing Aixplorer® (SuperSonic Imagine, France). The lesions were assessed \nusing B-mode and SW parameters were recorded (mean, maximum, and \nminimum elasticity of stiffe st portion of lesion and surrounding tissue; lesion-to-\nfat elasticity ratio; size ratio of SW  elastographic-to-B-mode lesion). SW \nelastography measurements were correlated with histopathology of core or \nsurgical biopsy diagnosis. \nResults: Final analysis comprised of 92 benign and 74 malignant lesions. The \nmaximum stiffness (Emax) with a cut-off point based on ROC curve of 58.0 \nkPa provided sensitivity of 90.0%, specific ity of 91.3%, positive predictive value \nof 97.3%, negative predictive value of 91.3% and accuracy of 94%. Applying a \ncut-off point of 42.0 kPa for SW elastographic mean stiffness (Emean), \ngenerated sensitivity of 86.7%, specificity  of 97.6%. For SW elastographic ratio \n(E ratio), the value of 2.2 was found to be optimal, yielding sensitivity of 72% \nand specificity of 97%. \nConclusion: Shearwave elastography provid es highly specific and sensitive \nquantitative values which is beneficial in  the characterisation of breast lesions. \nOur results showed that Emax is the most accurate parameter for \ndifferentiating benign from malignant lesions.  \nB-0074 10:48  \nCan we reduce the number of MR-guided biopsies? Application of an \nalgorithm that increases specificity  \nP.A.T. Baltzer, K. Pinker-Domenig, M. Bernathova, T.H. Helbich; Vienna/AT  \nPurpose: MR-guided biopsy is a useful but expensive technique which is \nroutinely performed on suspicious breast lesions which are apparent only on \nMRI. Our aim was to apply a classificati on algorithm assess its efficacy in \npredicting benign and malignant disease in lesions. \nMethods and Materials:  This IRB-approved retrospective study investigated \n385 consecutive patients (mean age 51.6, SD 12.8) undergoing MR-guided \nvacuum biopsy of suspicious (BI-RADS 4) breast lesions only visible on MRI. \nAn experienced radiologist blinded to histological diagnoses applied a \npreviously published classification algorithm (Eur Radiol 23 (8):2051-60) based \non five morphologic and dynamic criteria to all lesions. ROC analysis was \nperformed in order to measure diagnostic performance for lesion \ndifferentiation. \nResults: Of 399 biopsied lesions, 79 (19.8%) were malignant. The \nclassification algorithm show ed an accuracy of 87.2% (P < 0.001). 282 of 399 \n(70.7%) lesions could be classified as benign with a negative predictive value \nof 94.3% (266/282). In 89 of 399 lesions (22.3%), a benign histopathologic \nresult could be predicted with 100% accuracy. In the remaining 117 of 399 \nlesions, malignancy could be predicted wi th a positive predictive value of 36.2-\n100% (average 53.8%). \nConclusion: Application of a simple classi fication algorithm proved its \ndiagnostic use when applied to BI-RADs 4 lesions only visible on MRI. \nAccording to our results, at least 22.3% of all biopsies could be omitted.  \nB-0075 10:57  \nUltrasound guided HIFU treatment of breast fibroadenoma  \nM.M. Abehsera\n1, J.-N. Gugliemina1, J.I. Stoinov2, E. Poncelet3, N. Laurent3, \nL. Boulanger4, A. Dana1, C. Tibi1, R.D. Kovatcheva2; 1Neuilly/FR, 2Sofia/BG, \n3Valenciennes/FR, 4Lille/FR (marc.abehsera@orange.fr)  \nPurpose: The objective of our clinical study is to demonstrate the feasibility, \nthe safety and the efficacy of ultrasound-guided HIFU (USg-HIFU) in the \ntreatment of the breast fibroadenoma. \nMethods and Materials:  To date, 51 breast FA in 42 patients has been \ntreated by HIFU in 4 European sites. Patients mean age was 32 [16-52]. All \nFAs were confirmed by histology analysis after a core needle biopsy. The HIFU \ntreatment was performed as an outpatient procedure using neurolept \nanalgesia. The mean baseline volume of the FA was 3.89 cc [0.34 - \n19.7 cc].To evaluate potential acute effects, the first follow-up examination was \nperformed at 7 days after HIFU, and the next follow-up visits were performed \nwith an Echo Doppler every month from M1 to M6, and from M9 to M24. \n \nS152  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nResults: The average treatment time was around 1h12 [0h26-2h33]. A 27 \nyears old patient who became pregnant one month after the HIFU treatment, \nshowed a reduction of volume of 73% at M12 despite hormonal impregnation \ndue to pregnancy. One patient reviewed at M 11 had a volume reduction of \n93%. The Mean Volume Reduction was up to 77.6 % at M24. \nConclusion: HIFU treatment is a non-invasive method, well tolerated by \npatients. For all patients, the volume of the FA declined progressively. \nPreliminary results are encouraging and show that HIFU could be an \ninteresting alternative treatment.  \nB-0076 11:06  \nNon-biopsy or follow-up of presumed fibroadenomas in patients under 30 \nyears of age: is it safe? Four years experience in a single unit and review \nof European practice  \nK. Taylor, H. Vandersluis, P. Britton, M.G. Wallis; Cambridge/UK \n(kathryn.taylor@addenbrookes.nhs.uk)  \nPurpose: In women under 30 years; fibroadenomas (FA) are the commonest \nBIRADS 3 lesion and breast cancer is infrequent. On the basis of a 9-year \naudit in 2009, we implemented strict imaging and clinical criteria such that \nwomen< 30 with presumed FAs could safely be discharged without needle \nsampling or follow-up. Four years after protocol implementation, we report on \nits accuracy, effect on biopsy workload and potential for influencing European \npractice. \nMethods and Materials:  All women < 30 attending the breast unit between \n1.2.09 and 31.1.13 were retrospectively identified from our clinical database; \ntheir management audited and followed up to 31.6.13. In addition, a survey \nassessing European practice was completed by 32 centres from 19 countries. \nResults: 1571 women< 30 attended the breast unit. 6 aged 25-29 (BIRADS \u00034) \nwere diagnosed with breast cancer. Of 332 women scored BIRADS3; 266 (84 \naged 25-29) met the non-biopsy criteria and were discharged, 66 were outside \nthe criteria and underwent biopsy (54 FAs, 7 phyllodes tumours, 1 cancer). 14 \nwomen re-attended with increased lesion size, none biopsied but 5 excised at \nthe patients request. The protocol reduced biopsies by 78% in women \u000320 and \nby 72% in women aged 25-29. No cancers developed in discharged patients, \nmedian follow-up 2.3 yrs (range 0.4-4.4). The European survey indicates 29% \nof respondents routinely sample FAs in women \u000320, 55% in women \u000325. Of non \nUK respondents, 84% follow-up FAs regardless of patient age, 65% regardless \nof biopsy history. \nConclusion: Our non-biopsy protocol appears safe, reduces biopsy workload \nand justifies a discharge policy.  \nB-0077 11:15  \nSonographically guided biopsy with 14 Gauge vacuum assisted probe: \nfalse-negative and underestimation rate  \nV. Girardi, G. Carbognin; Brescia/IT (giravero@yahoo.it)  \nPurpose: To determine the diagnostic accuracy of US-guided 14-gauge \nvacuum assisted biopsy for breast lesions. \nMethods and Materials:  Seven hundred forty-five cases of sonographically \ncore needle biopsies using a 14-gauge vacuum assisted probe were performed \nconsecutively. We assessed the false-negative rate and the underestimation \nrate. The false-negative rate was defined as pathologically proved cancer for \nwhich US-guided biopsy results were benign findings. The underestimation \nrate was defined as an upgrade of a high-risk lesion (atypical ductal \nhyperplasia (ADH), lobular carcinoma in situ, intraductal papilloma and \npapilloma with atypia, radial scar, phyllodes tumor) or ductal carcinoma in situ \n(DCIS) at US-guided biopsy to malignancy at surgery. The gold standard were \nsurgical examination or stability during clinical and imaging follow-up ( > 12 \nmonths). \nResults: False-negative finding was founded in 1 (1.34‰) of 745 cases and \nthe false-negative rate was 6.71‰ (1 of 149 malignancies). In 3 (3.1%) of 96 \nhigh-risk lesions there was upgraded to malignancy at surgical excision (1 \ninvasive lobular carcinoma, 1 DCIS, 1 DCIS with microinvasion). At Vacuum \nAssisted Biopsy, these lesions were ADH, papillary lesions and papilloma with \natypia. In 3 (33.3%) of 9 cases with a DCIS lesion at US-guided 14-gauge \nVAB, surgical excision showed invasive carcinoma (2 invasive carcinomas, 1 \nDCIS with microinvasion). \nConclusion: Use of 14-gauge vacuum-assisted demonstrated good accuracy \nfor false-negative findings (1.34‰). Lesion underestimation was more likely \nwhen US-guided 14-Gauge Vacuum Assisted Biopsy revealed DCIS (33.3%) \nrather than high-risk lesion (3.1%). \n \n \n \nB-0078 \n11:24  \nVacuum-assisted breast biopsy using computer-aided 3 T-MRI guidance: \na preliminary experience  \nI. Baglio, L. Camera, G. Barbazeni, C. Cavedon, Q. Piubello, S. Montemezzi; \nVerona/IT  \nPurpose: To test the feasibility of MRI-guided vacuum-assisted breast biopsy \nfor diagnosis of suspicious breast lesions detected at 3.0 Tesla. \nMethods and Materials:  Between October 2011 and June 2013, 45 \nsuspicious breast lesions detected with a 3.0 T MR scanner underwent a \ncomputer-aided MRI-guided (Dynacad) vacuum-assisted biopsy with post-and \npillar technique. All lesions biopsied were classified as BI-RADS 4 or 5. A \nseven-channel breast array coil equipped for biopsy and a dedicated \ndiagnostic workstation were used for the localisation of the target lesion. After \ncalculating the localisation co-ordinates on the dedicated workstation, a MR-\ncompatible needle (11G or 8G) inserted in the coaxial cannula was placed in \nthe planned position. Post-procedure MRI scans were used to confirm the \ncorrect localisation of a marker left in the site of the biopsy. \nResults: The mean lesion size was 13.5 mm (range: 5-32 mm). On \nhistopathological examination, 13 were malignant (8 DCIS, 1 mixed carcinoma, \n1 tubular carcinoma, 1 invasive lobular carcinoma, 2 invasive ductal \ncarcinoma); 9 were high-risk lesions (3 papilloma, 1 LIN 2, 1 LIN, 1 ADH, 2 DIN \n1b, 1 radial scar) and 23 were benign lesions. All malignant and high-risk \nlesions were sent to surgery (wide local excision or mastectomy), benign \nlesions were sent to follow-up (6-12 months). Examination of surgical \nspecimens confirmed the results of vacuum-assisted biopsy in all malignant \nlesions. \nConclusion: Our preliminary experience revealed that 3-T MRI-guided \nvacuum-assisted biopsy is a safe and effective interventional method that \nenables accurate biopsy of lesions, especially for small lesions.  \nB-0079 11:33  \nIs galactography still state of the art in patients with nipple discharge? \nAn online survey among german breast care centers and a review of the \nliterature  \nK. Scheurlen, A. Schnitzer, J. Krammer, C. Kaiser, S.O. Schönberg, \nK. Wasser; Mannheim/DE (Klaus.Wasser@umm.de)  \nPurpose: Since methods such as high-resolution ultrasound (US) and MR-\nMammography (MRM) have been established in modern breast imaging the \nmandatory usage of galactography in patients with nipple discharge is worth \nquestioning. \nMethods and Materials:  An anonymous online survey was carried out \nnationwide, opened to 342 radiologic units of certified German centers. 2) A \nliterature search was performed in PubMed and Cochrane for studies reporting \non the diagnostic value of galactography, US and MRM. \nResults: 1) 177 units (52%) participated. 13% generally do not provide \ngalactographies. 57% conduct a maximum of 5-10 galactographies per year, \n18% 11-20, 8% 21-50 and 5% 51-100. Only 4% use galactography initially. \n85% give fist priority to US, then followed by galactography (53%) or MRM \n(32%) in a stepwise diagnosis. 2) A total of 19 studies were found, 14 with \nresults on galactography, 10 on ultrasoundand 5 on MRM. Almost all studies \nare retrospective. Due to a very variable number of cases and differing \ninclusion criteria the studies are only comparable to a limited extent and the \nresults on the diagnostic values show a very wide range. \nConclusion: Today galactography is a rarely used method for the vast majority \namong german breast care centers. Thus, galactography is no longer seen as \nstate of the art within a modern multimodal imaging concept. Furthermore, \nthere is no evidence in the literature for a mandatory usage of galactography. \nOverall, galactography, US and MRM show a weak evidence and the \nsuperiority of one method cannot be derived from the literature.  \nB-0080 11:42  \nFast migration of breast biopsy marker placement during stereotactic \ncore needle biopsy  \nK. Buch, M.M. Qureshi, A. Jain, A.E. Hirsch, C. Jaffe, D. Georgian-Smith, \nN. Hines, N.B. Bloch; Boston, MA/US (karen.buch@bmc.org)  \nPurpose: The accurate placement of stereotactic biopsy clips is not only \nimportant for localising breast lesions undergoing surgical excision, but also \ndefining the biopsy sites on subsequent mammographic follow-up in lesions \nnot requiring excision. The purpose of this study was to examine marker \nmigration on follow-up biopsy mammograms. \nMethods and Materials:  A total of 275 SecurMark (Hologic, Bedford, MA) \nstereotactic biopsy clips were placed in 265 patients undergoing uncomplicated \nstereotactic biopsies using a 9-gauge vacuum-assisted device from August \n2010 to July 2013. Follow-up mammograms on lumpectomy specimens that \nconfirmed marker placement were used to measure the amount of marker \nmigration. Patients with a marker migration of greater than 1 cm were \nS153  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nrecorded. Descriptive statistics were ca lculated and comparisons between two \ngroups were made with the unpaired t-test \nResults: Of the 275 stereotactic biopsy clips, 35 (12.7%) clips had migrated at \nleast 1 cm from the intended biopsy cavity. The range of marker migration was \n1-6 cm with a mean ( ± standard deviation) marker migration of 2.40 ± 1.25 cm. \nOf the 35 migrated biopsy markers, 9 (25.7%) had a migration of 3.5 cm or \ngreater. There was no difference in the amount of migration in the right \n(2.25 ± 1.02 cm) versus left (2.53 ± 1.42 cm) breast, p=0.513 \nConclusion: In this patient cohort, approximately 13% of markers had \nmigrated at least 1 cm from the original biopsy cavity. Marker migration may \nlead to diminished accuracy of lesi on location on radiographic follow-up. \nFurther study is warranted to assess clinical correlations.  \n10:30 - 12:00 Room G/H  \nGenitourinary  \nSS 107  \nProstate cancer: diagnosis and PIRADS \nscoring  \nModerators:  \nO. Nikolic; Novi Sad/RS  \nM.M. Otero-García; Vigo/ES  \nB-0081 10:30  \nA novel 68Ga-PSMA PET ligand in patients with biochemical recurrence \nof prostate cancer using PET/CT and PET/MR imaging  \nM. Eiber, T. Maurer, A. Beer, M. Souvatzoglou, K. Holzapfel, H.-J. Wester, \nE.J. Rummeny, M. Schwaiger; Munich/DE (matthias.eiber@gmx.de)  \nPurpose: Prostate-specific membrane antigen (PSMA) is a cell surface protein \nwith high expression in prostate cancer. Recently, Glu-NH-CO-NH-Lys-(Ahx)-\n[(68)Ga (HBED-CC)] as a new 68Ga-labelled PSMA ligand (68Ga-PMSA) has \nbeen developed. Preliminary data show a high and specific uptake prostate \ncancer. The aim of this study was to investigate the detection rate of 68Ga-\nPSMA PET/CT and PET/MR imaging patients with a biochemical recurrence. \nMethods and Materials:  107 patients (mean age 63.8 ±7.9) were included in \nthe analysis. Median PSA level was 1.9 ng/ml (range 0.2-45 ng/ml). After \ninjection of 122 ±17 MBq 68Ga-PSMA, 62 patients underwent contrast-\nenhanced PET/CT and 45 fully diagnostic PET/MR (including multiparametric \nprostate MR). Images were reviewed by one nuclear medicine physician and \none radiologist. Findings were rated as suspicious or highly suggestive for \nrecurrent prostate cancer. \nResults: 92 of 107 (85.9%) patients showed a pathological 68Ga-PSMA \nuptake. For PET/CT and PET/MR, respectively, the detection rates were 97.6% \n(40/41) and 100.0% (13/13) for PSA value \u00032 ng/ml, 91.7% (11/12) and 88.9% \n(8/9) for a PSA value 2-3 ng/ml, 66.6% (6/9) and 56.6% (13/23) for a PSA \nvalue < 1 ng/ml. Especially in cases with PSA values < 1 ng/ml, the diagnostic \ncertainty was considerably higher when combining 68Ga-PSMA with \nmultiparametric MR compared to PET/CT. Findings were rated as suspicious \nvs. highly suggestive in 5/9 vs. 1/9 patients in PET/CT and 2/23 vs. 11/23 \npatients in PET/MR. \nConclusion: 68Ga-PSMA PET imaging shows a higher of positive findings for \npatients with recurrent prostate cancer than reported for other tracers \nespecially at low PSA values. PET/MR should be preferred in patients with \nPSA < 1 ng/ml as multiparametric MR provides additional information \nincreasing the diagnostic certainty.  \nB-0082 10:39  \nNon-Gaussian water diffusion kurtosis imaging of prostate cancer  \nS. Suo, X. Chen, L. Wu, Y. Fan, Q. Yao, J. Xu; Shanghai/CN \n(shtsuo@gmail.com)  \nPurpose: To assess the non-Gaussian water diffusion properties of prostate \ncancer (PCa) and to determine the diagnostic performance of diffusion kurtosis \n(DK) model for distinguishing PCa and benign tissues within the peripheral \nzone (PZ). \nMethods and Materials:  Nineteen male patients (mean age 68 years, range \n51-81 years; mean preoperative PSA level 16.9 ng/ml, range 3.26-115 ng/ml; \nmean postoperative Gleason score 7, range 6-9) who were pathologically \nconfirmed with prostate carcinoma were enrolled in this study. All patients \nunderwent a prostatic MR protocol on a 3 Tesla MR scanner using a body \nphased-array coil including T1-weighted imaging, T2-weighted imaging and \naxial multi-b DW imaging (b-values= 0, 500, 800, 1200, 1500, 2000 sec/mm2). \nRegion of interests (ROIs) were placed on prostate cancer according to \npathological findings and benign tissues within PZ for comparison. K, D and \nADC values of the ROIs were calculated. Differences between K values of \nbenign PZ and PCa were assessed using paired t-tests. Correlation between \nparameters D and K in PCa was assessed using Pearson's correlation \ncoefficient. \nResults: ADC and D were significantly (p < 0.001) lower in PCa \n(0.79±0.14 8m\n2/ms and 1.56 ±0.23 8m2/ms, respectively) than in benign PZ \n(1.23±0.19 8m2/ms and 2.54 ±0.24 8m2/ms, respectively). K was significantly \n(p < 0.001) greater in PCa (0.96 ±0.20) than in benign PZ (0.59 ±0.08). The \ncorrelation between parameters D and K in PCa was strongly negative \n(Pearson correlation coefficient = -0.7291; p < 0.001). \nConclusion: The DK model appears to provide more parameters for PCa \ndetection. K potentially offers a new metric for assessment of PCa.  \nB-0083 10:48  \nMRI features of chronic prostatitis and differentiation from co-existant \nprostate cancer  \nK. Buch, A. Jain, M.M. Qureshi, C. Jaffe, D. Wang, R. Babayan, J. Henderson, \nC. Andry, N.B. Bloch; Boston, MA/US (karen.buch@bmc.org)  \nPurpose: Chronic prostatitis is a common histopathologic finding on total \nprostatectomy specimens; however, imaging features are not well established. \nPrior reports describe significant overlap in perfusion characteristics between \nprostate cancer and chronic prostatitis with no difference in perfusion between \nlow-grade cancer and chronic prostatitis. The purpose of this study was to \ndifferentiate T2 and enhancement characte ristics of chronic prostatitis from \ncancer using contrast-enhanced MRI (CE-MRI). \nMethods and Materials:  Following IRB approval, 55 prostate pre-operative \nCE-MRIs were performed from January 2012 to July 2013 on a 1.5-T scanner \nin consecutive prostate cancer patients who underwent prostatectomy. MRI \nfindings suggestive of chronic prostatitis were compared to prostatectomy \nspecimens. \nResults: Imaging features most suggestive of chronic prostatitis include late-\nenhancing pseudoseptations with fine, linear striations in a centrifugal pattern \nirrespective of rapid wash-in within area s with preserved pseudoseptations on \ndynamic CE-MRI. Of 55 patients, 47 had chronic prostatitis by histopathologic \ncriteria; 50 had MRI findings suggestive of chronic prostatitis with 3 false \npositives. These findings had a sensitivi ty of 100%, specificity of 62.5%, PPV \nof 93.8%, and NPV of 100%. \nConclusion: The key distinction between chronic prostatitis and cancer is the \npersistent enhancement of fine, centrifug al striations in chronic prostatitis \ncompared to nodular, confluent enhancement without preserved \npseudoseptations in cancer. CE-MRI has a high sensitivity, PPV, and NPV for \ndiagnosing coexistent chronic prostatitis in prostate cancer patients. These \ndistinctive imaging features are of high clinical value as they may decrease \nover-estimation of prostate cancer size and lead to more accurate MRI staging \nof prostate cancer.  \nB-0084 10:57  \nRole of multiparametric magnetic resonance imaging using T2-weighted, \ndiffusion-weighted and 4D perfusion contrast-enhanced MRI in prostate \ncancer at 3 T  \nE. Karaarslan, D. Gürbüz, Ö.S. Ulus, Ö.B. Argun, A.R. Kural; Istanbul/TR \n(defnegurbuz@yahoo.com)  \nPurpose: We aim to emphasise the importance of a relatively new \nmultiparametric MR imaging method performed at 3 T using T2-weighted, \ndiffusion-weighted and 4D perfusion dynamic contrast-enhanced MR imaging \nin diagnosing prostate cancer and de tecting biological characteristics of the \ntumour. \nMethods and Materials:  Multiparametric MR imaging findings of 21 patients, \nwith no previous treatment, diagnosed to potentially have prostate cancer due \nto palpable prostatic nodules and/or elevated serum PSA levels (average of \n10.26 ng/ml) are evaluated retrospectively. Multiparametric MR imaging \nsequences were obtained using multi-channel pelvic phase array coil on 3 T \nSiemens Skyra device. We performed statistical analysis to define the \nrelationship between multiparametric MR imaging parameters and \nhistopathological findings. \nResults: 87 foci were positive for pros tate cancer with histopathological \nfindings in 12 patients. Pairwise t-test results show that K-trans (ADC) values \nare significantly higher (lower) in the tumour tissues compared to the normal \nones and regression analysis shows a significant relationship (p-value=0.016, \nsignificance level=5%) between th e ratio of K-trans values of the tumour \ntissues to that of normal tissues and the Gleason score. A unit increase in this \nratio contributes to an average increase of 0.25 in the Gleason score. \nConclusion: We conclude that the T2-weighted morphological imaging \nmethod, when used together with functional MR imaging methods such as \ndiffusion-weighted and 4D perfusion dynamic contrast-enhanced MRI, is \neffective in diagnosing prostate cancer. It  also has the potential of providing \nreliable information regarding biological characteristis of the tumour and the \nprognosis of the patients.  \n \nS154  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0085 11:06  \nProspective impact of the additional use of an endorectal coil for 3 T \nprostate MRI on image quality and cancer detection rate  \nJ. Otto, G. Thörmer, M. Reiss-Zimmermann, N. Garnov, L.-C. Horn, M. Do, \nT. Kahn, M. Moche, H. Busse; \nLeipzig/DE (josephin.otto@medizin.uni-leipzig.de)  \nPurpose: To prospectively compare the impact of an additional endorectal \nreceive coil (ERC) on the quality of prostate MR images within the same \npatients and to determine the corresponding rates for the detection of prostate \ncancer (PCa). \nMethods and Materials: Prior to radical prostatectomy, 41 patients underwent \nT2- and diffusion-weighted imaging at 3 T using surface coils only (SC) or in \ncombination with an ERC. Two blinded readers (A and B with 70 and 160 \nprostate readings, respectively) randomly evaluated all image data in two \nseparate sessions. Image quality scores for localisation and staging were rated \non a five-point scale (1: very poor, 2: poor, 3: moderate, 4: good, 5: very good). \nCancer-suspicious lesions were classified according to their PI-RADS (prostate \nimaging reporting and data system) score (1-5). Standard of reference was \nprovided by whole-mount histopathologic section analysis. \nResults: Mean scores of image quality with ERC were significantly (p < 0.001) \nhigher than those without. PI-RADS \u00033 was assigned in 62 (ERC) vs. 49 (SC) \ncases (A) and 64 vs. 48 (B). Detection rates per lesion were similar for (A), \n76% (47/62, ERC) vs. 78% (38/49, SC), and significantly (p < 0.05) higher for \n(B), 88% (56/64) vs. 71% (34/48). Per patient, PCa was correctly identified in \n88% (A) vs. 98% (B) of all ERC cases and in 78% (A) vs. 73% (B) without. \nConclusion: Diagnostic performance in terms of the number of cancer-\nsuspicious as well true cancer foci was high er when an additional ERC was \nused for 3-T prostate MRI.  \nB-0086 11:15  \nProstate cancer diagnosis using MR imaging: does PI-RADS better than \nconventional methods?  \nW. Xia, X. Chen, H. Li; Zhengzhou/CN (51380696@qq.com)  \nPurpose: To compare the value of prostate imaging reporting and data system \n(PI-RADS) with conventional methods on diagnosing the prostate cancer. \nMethods and Materials:  166 patients (91 prostate cancers, 75 benign \nprostatic lesions) with integrated clinical data were enrolled in the study. All \npatients underwent 3.0 T MR prostate scanning, including T1WI, T2WI, DCE-\nMRI, DWI and MRS sequences. First, two radiologists who analysed the \nimages in conventional methods, then PI-RADS method was used to analysis \nT2WI, DCE-MRI, DWI and MRS. The accuracy, sensitivity and specificity were \ncalculated and compared. \nResults: The accuracy, sensitivity and specificity using conventional methods \non diagnosing prostate cancer were 81.32% (135/166), 82.41% (75/91), \n80.00% (60/75), respectively. ROC curve was used to analysis PI-RADS score, \narea under the curve (AUC) was 0.91, the sensitivity and specificity were 88% \nand 85% if taking 13 points as threshold. Taking 13 points as threshold, \namongst 91 prostatic cancer, 84.62% (77/91) PI-RADS score \u0003 13 points, \nwhilst amongst 75 benign lesions 13.33% (10/75) PI-RADS score \u0003 13 points. \nThe accuracy was 85.54 % (142/166). \nConclusion: Compared with conventional diagnostic methods, the application \nof PI-RADS can improve the accuracy. Taking PI-RADS =13 points as \nthreshold to identify prostate cancer ha s higher sensitivity and specificity.  \nB-0087 11:24  \nValidation of MRI sequences for PI-RADS scoring based on targeted MR-\nguided in-bore biopsy  \nL. Schimmöller\n1, M. Quentin1, C. Arsov1, C. Buchbender1, \nA. Seif Amir Hosseini2, R. Rabenalt1, P. Albers1, G. Antoch1, D. Blondin1; \n1Düsseldorf/DE, 2Göttingen/DE (lars.schimmoeller@med.uni-duesseldorf.de)  \nPurpose: This study retrospectively validates the ESUR scoring system (PI-\nRADS) in regard to the accuracy of the different MRI sequences at 3 T using \nMR-guided in-bore prostate biopsies as the reference standard. \nMethods and Materials:  492 different lesions in 218 consecutive patients \n(65.7 ± 7.9 years) with diagnostic 3 T prostate MRI consisting of T2-weighted, \ndiffusion-weighted, and dynamic contrast-enhanced imaging (T2WI, DWI, \nDCE-MRI) were scored according to the PI-RADS score. Histology of all \nlesions was obtained by targeted MR-guide d in-bore biopsy. Statistical analysis \nincluding ROC analysis was completed on all data. \nResults: In 159 lesions (98 patients) MR-guided biopsy was positive for \ntumour (Gleason grade 6 or higher). ROC analysis for each MRI-sequence \nleads to an area under the ROC curve (AUC) value of 0.683 for T2WI, 0.775 \nfor DWI, and 0.704 for DCE-MRI. For a combination of two sequences, the \nAUC was 0.789 for T2WI + DWI, and 0.751 for T2WI + PWI. All three MRI-\nsequences together achieved an AUC value of 0.787 (T2w+DWI+DCE-MRI). \nFor clinical significant prostate cancer (Gleason grade 7b and higher), the AUC \nvalue was 0.852 for T2WI + DWI, 0.839 for T2WI + PWI, and 0.72 for T2WI + \nDWI + DCI-MRI. \nConclusion: The summed PI-RADS score of T2WI, DWI, and DCI-MRI \nachieves the highest testing accuracy in our patient collective, especially in \npatients with clinical significant prostate cancer. A usage of only two or less \nMRI sequences leads to a lower AUC.  \nG. Antoch: Speaker; Siemens AG, Bayer AG, BTG Röntgen GmbH.  \nB-0088 11:33  \nEvaluation of multiparametric MRI PI-RADS scores for the detection of \nprostate cancer  \nT. Durmus1, T. Franiel2, A. Maxeiner1, E. Kilic1, A. Huppertz1, B. Hamm1, \nA.D.J. Baur1; 1Berlin/DE, 2Jena/DE (tahir.durmus@charite.de)  \nPurpose: To evaluate the magnetic resonance prostate imaging-reporting and \ndata system (PI-RADS) for the detection of prostate cancer. \nMethods and Materials:  113 lesions of 55 patients who had undergone MRI-\nguided biopsy of the prostate were retrospectively matched with the \ncorresponding images in previously acquired endorectal multiparametric MR \nimaging (T2-TSE, DWI, and DCE-MRI) at 1.5 Tesla. Blinded to the results of \nbiopsy two readers evaluated each biopsied lesion according to the PI-RADS \nscoring system. ROC analysis was performed for statistical analysis. \nResults: PI-RADS scores of DCE-MRI revealed a lower AUC (0.76) compared \nto T2 (0.88; p=0.0619) and DWI (0.93; p=0.0043). Sum scores of T2, DWI, \nDCE-MRI and of T2 and DWI, only, yielded an AUC of 0.93 and 0.95, \nrespectively. In central gland lesions T2 showed a numerically higher AUC \ncompared to DWI (0.98 and 0.95) whilst in peripheral zone lesions DWI was \nsignificantly superior (AUC of 0.93 and 0.73; p=0.041). An approach assigning \nthe PI-RADS score of T2 to central gland lesions and the score of DWI to \nperipheral zone lesions yielded the highest AUC (0.96) compared to any \nsequence alone and combined sum scores. \nConclusion: The PI-RADS scoring system for the detection of PCa has a good \ndiagnostic performance. However, scores of DCE-MRI seem to add significant \nvalue when evaluated according to the recommended criteria. Assigning the \nscore of T2 to central gland lesions and of DWI to peripheral zone lesions \nmight be sufficient for stratification of patients for further diagnostic workup.  \nAuthor Disclosures: \nA. Huppertz: Employee; Siemens AG. B. Hamm: Board Member; Deutsche \nRöntgengesellschaft, European Congress of Radiology, European Society of \nUroradiology, ESMRMB, European School of Radiology, Deutsche \nForschungs-gemeinschaft. Consultant; Bayer Schering Pharma, Toshiba. \nOther; Abbott, Actelion, Bayer Schering Pharma, Bayer Vital, BRACCO Group, \nBristol-Myers Squibb, Charité research organisation GmbH, Deutsche \nKrebshilfe, Dt. Stiftung für Herz- forschung, Essex Pharma, EU Programmes, \nFibrex Medical Inc., Focused Ultrasound Surgery Foundation, Fraunhofer \nGesellschaft, Guerbet, INC Research, InSightec Ltd., IPSEN Pharma, Kendle/ \nMorphoSys AG, Lilly GmbH, Lundbeck GmbH, MeVis Medical Solutions AG, \nNexus Oncology, Novartis, Parexel CRO Service, Perceptive, Pfizer GmbH, \nPhilipps, sanofis-aventis S.A, Siemens, Spectranetics GmbH, Terumo Medical \nCorporation, TNS Healthcare GMbH, Toshiba, UCB Pharma, Wyeth Pharma, \nZukunftsfond Berlin (TSB). \nB-0089 11:42  \nESUR scoring system for prostate cancer detection: how to derive the \noverall PI-RADS score from different single modality scores?  \nD. Junker, F. Aigner, J. Bektic, W. Horninger, W.R. Jaschke; Innsbruck/AT \n(daniel.junker@uki.at)  \nPurpose: To evaluate different ways to derive the overall PI-RADS score (1-5) \nfrom different single modality scores. \nMethods and Materials: Retrospective: The 3 T multiparametric MRI (mpMRI) \ndatasets of 143 consecutive patients were evaluated. Diffusion-weighted \nimaging, T2-weighted imaging and dynamic contrast-enhanced imaging were \nperformed. 73 patients underwent mpMRI-ultrasound image fusion guided re-\nbiopsy. After scoring these 3 PI-RADS single modalities (1-5), a summation \nscore (3-15) was calculated and 3 different ways to generate an overall PI-\nRADS score were compared: One approach, which generates the overall PI-\nRADS from the radiologist's impression after evaluating the single modalities, \nwas compared to different approaches, which derive the overall PI-RADS by \ndivision from the summation score. \nResults: For calculation of the overall PI-RADS score, a mathematical \napproach derived from the summation score, as presented by Roethke et al., \nshowed the highest reliability: The threshold of \u000310 (PI-RADS 4) showed high \nsensitivity (90%) and specificity (62%) for tumour incidence and that of \u000313 (PI-\nRADS 5) high sensitivity (80%) and specificity (86%) for the presence of high \nrisk disease (gleason \u00034+3). Overall, the single and summation scores \ncorrelated well with tumour incidence (AuC of 0.86, 95% CI 0.78 to 0.94) and \ngrading (AuC 0.84, 95% CI 0.68 to 0.99). \n \nS155  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nConclusion: A mathematical approach that derives the Overall PI-RADS score \n(1-5) from the summation score proved to be reliable. Therefore our data \nsuggest a threshold of \u000310 for PI-RADS 4 and \u000313 for PI-RADS 5.  \nB-0090 11:51  \nInterobserver agreement of the PI-RADS score for prostate cancer \ndiagnosis on multiparametric MRI  \nE.H.J. Hamoen\n1, L.C. Thompson2, F. Witjes1, M.M. Rovers1, J.O. Barentsz1; \n1Nijmegen/NL, 2Brisbane/AU (e.hamoen@rad.umcn.nl)  \nPurpose: To study the interobserver agreement of the proposed Prostate \nImaging Reporting and Data System (PI-RADS) of the ESUR for structured \nreporting of mp-MRI of the prostate. \nMethods and Materials: We conducted an institutional review board-approved \nsingle cohort prospective clinical trial. We included 223 men who were \nsuspected of having prostate cancer because of an elevated PSA or abnormal \ndigital rectal examination, without prior transrectal ultrasound-guided biopsies \n(TRUSGB) of the prostate. All men underwent a 3 T mp-MRI, which included \nT2-weighted (T2WI), diffusion weighted imaging (DWI), and dynamic contrast \nenhanced (DCE) MRI. Histology of all lesions was obtained by in-bore MR-\nguided biopsy followed by standard TRUSGB in MR-positive men, or only \nstandard TRUSGB in MR-negative men. All MRI sequences were co-read \nindependently by 2 investigators. Any discrepancies were resolved by \nconsensus. Inter-observer variability was calculated using percentages of \nagreement and intraclass correlation coefficients (ICCs) based on a per-patient \nanalysis. \nResults: The overall percentage of agreement for the different PI-RADS \ncategories was 75.8% (169/223). When cl assified to consequence (i.e, whether \nto perform a biopsy or not; PI-RADS 1-2 vs. PI-RADS 3-5), the percentage of \nagreement was 91.9% (205/223). Inter-reader agreement was good with an \nICC of 0.89 (95% CI, 0.86-0.92). ICCs of the different modalities were \nmoderate, varying from 0.65 (95% CI, 0.56-0.72) for DCE and 0.66 (95% CI, \n0.58-0.72) for DWI to 0.67 (95% CI, 0.60-0.74) for T2WI. \nConclusion: The ESUR PI-RADS score shows good to moderate inter-\nobserver agreement and enables standardised evaluation of mp-MRI for \nprostate cancer detection.  \n10:30 - 12:00 Room I/K  \nNeuro  \nSS 111  \nNovel applications of MRI techniques  \nModerators:  \nI.N. Pronin; Moscow/RU  \nW. Van Hecke; Antwerp/BE  \nB-0091 10:30  \nFirst-in-human trial of glutamine PET metabolic imaging: preliminary \nresults in glioma  \nC. Pressl\n1, M. Dunphy2, I. Mellinghoff2, A. Omuro2, S. Venneti2, J. Lewis2, \nH. Kung3, C. Thompson2; 1Vienna/AT, 2New York, NY/US, 3Philadelphia, \nPA/US (cpressl@gmx.at)  \nPurpose: To study the pharmacokinetics, metabolism, biodistribution and \nradiation dosimetry of [F-18] 4-L-Fluoroglutamine ( 2S, 4R ), a radiolabelled \nglutamine analogue, in glioma patients. \nMethods and Materials:  IRB-approved trial protocol and US FDA-approved \nexploratory IND. All patients provided signed informed consent. Main eligibility \ncriteria: > 21 years; tumour evident on clinical imaging; serum liver and renal \nindices within specified range; no diabe tic medications. Patients fasted 8 \nhours. \u0002222 MBq Fluoroglutamine tracer dose ( < 100 \u0001g) injected peripheral \nIV. PET scans 0, 1, and 3h post-injection. Se rial blood sampling for activity and \nmetabolite assays. MIRD formalism and OLINDA software used for dosimetry \nanalyses of PET-derived and blood time-activity data. \nResults: 5 glioma patients to-date, including 5 low-grade tumors and 1 \ntransformed high-grade tumour. High-grade glioma evident on Fluoroglutamine \nPET with rapid, sustained tumour fluoroglutamine concentration. All low-grade \nglioma PET-negative. Dosimetry favourable. No adverse events due to \nfluoroglutamine tracer. \nConclusion: This is the first human trial of a glutamine-analogue imaging \nagent to our knowledge. Our results demonstrate the feasibility of detecting \nhigh-grade glioma in human subjects by PET imaging with [F-18] 4-L-\nFluoroglutamine (2S, 4R) and encourage testing of Fluoroglutamine PET as a \nmuch-needed non-invasive biomarker for distinguishing aggressive high-grade \nglioma from benign low-grade glioma.  \n \nB-0092 10:39  \nMotor function recovery prediction in patients with acute ischemic stroke \nusing diffusion tensor imaging  \nT. Popova, R. Konovalov, E. Seliverstova, M. Krotenkova, M. Maksimova; \nMoscow/RU (Taisia3452@rambler.ru)  \nPurpose: Define possibility of diffusion tensor imaging (DTI) for assessing \ncorticospinal tracts (CST) to predict functi onal outcomes in patients with acute \nisChemic stroke (IS). \nMethods and Materials:  47 patients (19 women, mean age 61) with primary \nhemispheric IS were examined at 1, 14, 21 days since stroke onset. Fractional \nanisotropy (FA) of CST was measured on two levels in both hemispheres: \nposterior limb of internal capsule (PLIC) and cerebral peduncle (CP). Patients' \nneurological status was assessed using NIHSS and mRS on the 1 st and 2 1 st \ndays and BI on the 2 1st day. \nResults: Patients were divided in two groups: with satisfactory (group A, n=22) \nand unsatisfactory (group B, n=25) outcomes of motor function recovery by the \nend of acute period of IS. Following values of CST FA in ipsilateral side in PLIC \nin group B were achieved: 1 st day-0.708, 14 th day-0.485, 2 1 st day-0.41. \nFollowing values of CST FA in ipsilateral side in CP in group B were achieved: \n1st day-0.746, 14th day-0.554, 2 1st day-0.473. Thereby, significant decrease of \nCST FA was determined in group B in PLIC and CP on the 14 th and 2 1st days \n(Mann-Whitney Test B< 0.05). \nConclusion: DTI allows to assess changes in conduction tracts beyond the IS \nzone during acute period of IS. Signific ant alterations of CST are identified \nusing DTI on the 14 th day from onset in patients with unsatisfactory recovery of \nmotor function. Thereby, DTI can be applied for predicting of motor function \nrecovery in patients with acute IS.  \nB-0093 10:48  \nMR spectroscopy and FLT-PET: voxel-by-voxel comparison differentiates \ntumorous tissue in high-grade glioma  \nJ. Keller, J. Votrubová, I. Latnerová, F. Jír &, J. Kukal, J. Vymazal; Praha/CZ \n(keller.public@gmail.com)  \nPurpose: Aim of study was to evaluate the diagnostic accuracy of MR \nspectroscopy (MRS) and 18 F-fluorothymidine-PET (FLT) in high-grade-\ngliomas. \nMethods and Materials:  Twelve patients underwent FLT-PET, MRI and MRS \non 1.5 T (2D chemical shift imaging (CSI), voxel 10x10 mm, slice thickness \n15 mm, matrix 16x16 interpolated to 32x32, covering enhancing part of tumour \nand healthy tissue, analysed using jSipro with LCModel). Combination of \nglycerophosphocholine+phosphocholine (GPC+Pch), Creatine, Lactate and N-\nacetylaspartate (NAA) concentrations were analysed, excluding values with \nerrors over 50%. After FLT-PET to CSI coregistration, mean uptake in each \nCSI voxel was stored. Tumorous/normal tissue was segmented in contrast-\nenhanced transversal T1-weighted images, values were normalised to the \nmean of healthy tissue of each patient. Equality of median values in \ntumorous/normal tissue was tested with Wilcoxon-Mann-Whitney test, \ndependency of mean value of FLT on given descriptor was assessed by \nSpearman correlation coefficient, both on significance level of 0.05. \nResults: Comparing tumour and healthy tiss ue, mean FLT is significantly \nhigher in the tumour (p=3.718e-004). The ratios of NAA over \nGPC+Pch (Wilcoxon p=4.119e-020/Spearman,rho=-0.36,p=2.133e-008) and \nCreatine over GPC+PCh (p=7.904e-023/rho=-0.35,p=7.327e-008) significantly \ndiffer, being higher in tumour and correlate with FLT. The same results were \nobtained for NAA/Creatine (p=1.64e-017/rho=0.37,p=1.272e-008). GPC+PCh \nis higher in tumor tissue (p=4.734e-009). On contrary, GPC+Pch/Lactate ratio \nis lower in the tumour (p=1.334e-002). \nConclusion: To the best of our knowledge, we present the first voxel-based \ntechnique for comparison of FLT-PET and MRS. Both FLT (mean value in the \nvolumes of MRS voxels) and MRS (GPC+Pch/NAA, \nGPC+Pch/Creatine,Creatine/NAA,GPC+PCh and GPC+PCh/lactate) \ndifferentiate tumour and healthy tissue. Supported by IGA MZCR \nNT11328,NT12094/2011.00023001IKEM,PRVOUK P34.  \nB-0094 10:57  \nMicrostructural brain tissue damage in metabolic syndrome  \nM. Sala, A. de Roos, A. van den Berg, I. Altmann-Schneider, E. Slagboom, \nR. Westendorp, M. van Buchem, A. de Craen, J. van der Grond; Leiden/NL \n(M.L.Sala@lumc.nl)  \nPurpose: We investigate the association between metabolic syndrome risk \nfactors and brain tissue integrity, as assessed by magnetic resonance imaging. \nMethods and Materials:  From the Leiden Longevity Study, which is a \ncommunity-based study of long-lived subjects, their offspring and partners \nthereof, 130 subjects (61 men, mean age 66 years) were included. A metabolic \nsyndrome score was computed by summing the individual number of \ncomponents according to the Adult Treatment Panel III criteria. We performed \nlinear and logistic regression analysis and used standardised 2  values to \nS156  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nassess the association between metabolic syndrome and brain macrostructure \n(brain volume and white matter lesion load, lacunar infarcts, and cerebral \nmicrobleeds) and microstructure [mean magnetisation transfer ratio (MTR), \nMTR histogram peak height, fractional ani sotropy, and mean diffusivity (MD)]. \nLinear and stepwise regression analysis was performed to identify the \nindividual contribution of one metabolic syndrome parameter adjusting for the \nfour other parameters. Models were adjusted for age, gender, and relation to \nlong-lived family. \nResults: Brain macrostructure was not associated with metabolic syndrome. In \ncontrast, metabolic syndrome was associated with decreased gray (p=0.001) \nand white matter peak height (p=0.002) and increased gray matter MD \n(p=0.01). Serum HDLC ( 2=0.22, p=0.012), triglycerides ( 2=-0.25, p=0.002), \nBMI (2=-0.2, p=0.014), and diastolic blood pressure ( 2=-0.17, p=0.047 and 2=-\n0.23, p=0.009 for gray and white matter, respectively) were independent \nfactors in these changes in brain microstructure. \nConclusion: In early manifest metabolic syndrome, brain tissue decline can be \ndetected. Serum HDL cholesterol, trigly cerides, BMI, and diastolic blood \npressure were independent factors in brain tissue integrity.  \nB-0095 11:06  \nExperimental study on correlation of histopathological changes and \nevaluation of MRI in rat spinal injury  \nE.-J. Lin; Huangpu/CN (linej@mail.sysu.edu.cn)  \nPurpose: To confirm how the impairments of neural functions and \nhistopathological changes in spinal cord are correlated to the FA value and \nADC value assessed by MRI. \nMethods and Materials:  48 SD rats were randomly assigned to the sham-\noperated group and the model group. Animals in the model group were given a \nsurgery to expose the spinal cord and an absorbent polyurethane chip was \nimplanted between cervical laminae and cervical vertebral plate, both groups \nwere subdivided into four groups receiving different timing of injury: 4 h, 24 h, \n72 h, 1 w, ADC and FA value were measure for data analysis, rats were killed \nto histological assessment after BBB scoring and MRI scan. Number of motor \nneurons in the anterior horn of cervical cord in HE-stained sections and the \nfibre density in the posterior funiculus  of cervical cord in LFB-stained sections \nwere measured. The statistical analyses of data were performed by one-way \nANOVA and Person correlation analysis. \nResults: The correlation analysis demonstrated that the neuron number in the \nanterior horn of cervical cord was positively correlated to the FA value (0.772) \nwhile it was negatively correlated to the ADC value (-0.864); the fibre density in \nposterior funiculus of cervical cord was positively correlated to the FA value \n(0.84) while it was negatively correlated to the ADC value (-0.76). \nConclusion: Our experimental data provide valuable evidence for clinical \ndoctors on detecting histopathology and severity of CNS impairments directly \nusing imaging examination.  \nB-0096 11:15  \nA possibility of clinically using the unenhanced arterial spin-labeled MR-\nperfusion in the diagnostics of acute non-haemorrhagic stroke  \nA.A. Khromov, S.E. Semenov, I.V. Moldavskaya, A.N. Khromova, \nE.A. Zhuchkova; Kemerovo/RU (sts63@list.ru)  \nPurpose: To determine a possibility of clinically using the unenhanced arterial \nspin-labelled perfusion MRI (ASL) in the diagnosis of non-haemorrhagic stroke \nin acute period. To study and describe the MR-semiotics of acute non-\nhaemorrhagic stroke with different genesis according to ASL data as compared \nto the perfusion CT (PCT) as a reference method. To determine the \ncharacteristic signs of damage according to ASL data in acute period. \nMethods and Materials:  The sample group consisted of the patients with \nclinically and instrumentally verified diagnosis of non-haemorrhagic ischaemic \nstroke (n=30), and cerebral venous thrombosis (n=23) in the first day of onset \n(acute phase). Exclusion criteria: disease duration more than 24 h, history of \ncerebrovascular disorders, oncopathology. For all patients, native CT, PCT \n(Iopromide-370 mg/ml), MRI in modes T2WI, FLAIR, DWI, ASL have been \nperformed. \nResults: Reduced ASL signal in stroke zone corresponding to decrease in \nCBF, CBV has been observed in 100% cases (mean rASL=0.81 ±0.17). The \nperifocal increasing of ASL signal corresponding to increase in CBF, CBV was \nnoted in 30.19% cases in average, and it was characteristic for the venous \nstroke in 75% with r ASL=1.21 ±0.19 and for the arterial ischaemic stroke in \n25% with r ASL=0.93±0.26. \nConclusion: The ASL MR-method allows to detect not only stroke nucleus but \nalso perifocal high-signal zone as hyperaemia sign more often caused by the \ncerebral venous thrombosis then arterial ischaemia in acute stage, and this \ncan be used for different genesis (arterial and venous) of stroke.  \n \n \nB-0097 11:24  \nMOBILE pO2 brain mapping in sub-acute ischaemic stroke  \nF.G. Colliez, J. Magat, M. Maia Safronova, B. Jordan, A.F. Peeters, B. Gallez, \nT.P.J. Duprez; Brussels/BE (martasafronova@gmail.com)  \nPurpose: To assess the clinical applicability of brain oxygenation mapping \nusing the MOBILE (mapping of oxygen by imaging lipid enhancement) \ntechnique in sub-acute ischaemic stroke patients. \nMethods and Materials:  11 sub-acute (2-3 days) ischaemic stroke patients \nunderwent a standardised MR protocol on a clinical 3 T MR system including \nmorphological and diffusion-weighted im aging together with sequences aimed \nat measuring water relaxation rate R1 (with R1=1/T1), lipids R1 (MOBILE) and \nR2* (=1/T2*). Regions of interest (ROIs) contouring infarcted areas and mirror \ncontralateral ROIs within unaffected brai n tissue were drawn on diffusion \nimages and overlaid on water R1, lipids R1, and R2* mapped images. \nComparison of the medians of the water R1, lipids R1 and R2* values within \ndiseased areas versus mirror ROIs was performed using paired t test. \nHistogram analysis of the ROIs was also performed. Values obtained within \npatients' unaffected mirror-ROIs were compared to those obtained in 12 \nhealthy volunteers. \nResults: Nine infarcts were included into final analysis. Decreased R1 values \nwere recorded within infarcts when compared to unaffected brain tissue, with \nhigher statistical power for lipids R1 (0.408s-1; p < 0.0001) than for water R1 \n(0.154s-1; p=0.027). Decreased values for R2* were recorded within ischaemic \nbrain. All three parameters within unaffected mirror ROIs tightly matched those \nobtained in healthy volunteers (p> 0.08). \nConclusion: Selective analysis of lipids R1 has a better performance than that \nof water R1 for MR-based pO2 brain mapping using the relaxation effect of \nmolecular oxygen as an endogenous contrast agent.  \nB-0098 11:33  \nSWAN (susceptibility-weighted angiography) visualises hypoxia in \ncerebral veins  \nM. Patzig, B. Feddersen, K. Mees, G. Fesl; \nMunich/DE (Maximilian.Patzig@med.uni-muenchen.de)  \nPurpose: To evaluate the influence of hypox ia on the depiction of cerebral \nveins in the SWAN (susceptibility weighted angiography) sequence. \nMethods and Materials:  Healthy men (aged 20 - 28) were studied on MRI \nunder normal breathing conditions, short-term - hypoxia (7 minutes before and \nduring the MRI scan) and long - term hypoxia (8.5. hours before and during the \nMRI scan). Two blinded readers compared the three scans of each participant \nand graded the SWAN source images and minimum intensity projections \n(MinIP) according to the size, number and signal intensity of the cerebral veins. \nSignal intensities (SI) of deep cerebral veins were measured and SI \nproportions of deep cerebral veins to different parenchymal brain regions were \ncalculated. Continuous pulse oximetry was performed. \nResults: Nine subjects were included. In all of them, both readers correctly \ndistinguished the two hypoxia scans from the baseline scan, grading the \nSWAN images acquired under hypoxic conditions as visualising cerebral veins \nmore pronouncedly. Mean SI values measured in the internal cerebral vein \nwere 860.6 (baseline), 580.1 (short - term hypoxia) and 626.4 (long - term \nhypoxia), respectively. Overall, all mean SIs and SI proportions were \nsignificantly lower in the hypoxia scan s. No significant differences between \nshort - term and long - term hypoxia were found on visual inspections and SI \nmeasurements. These findings correlated with oxygen saturation \nmeasurements. \nConclusion: It was shown under experimental conditions that SWAN is \nsensitive to oxygen saturation changes in cerebral venous blood. Possible \nclinical implications of this finding include stroke and tumour imaging.  \nB-0099 11:42  \nThe DTI tractography challenge for neurosurgical planning  \nS. Pujol1, A. Golby1, G. Gerig2, W. Wells1, M. Styner3, L. Chauvin1, \nC. Pierpaoli4, A. Nabavi5, R. Kikinis1; 1Boston, MA/US, 2Salt Lake City, UT/US, \n3Chapel Hill, MD/US, 4Bethesda, MD/US, 5Kiel/DE (spujol@bwh.harvard.edu)  \nPurpose: The purpose of this paper is to present the Diffusion Tensor Imaging \n(DTI) Tractography Challenge, an international initiative to provide a \nstandardised evaluation of the performance of tractography algorithms for \nneurosurgical planning. \nMethods and Materials:  Twelve tractography teams reconstructed the \ncorticospinal tract from a common set of data acquired on 8 neurosurgical \ncases with lesions in and near the motor cortex, in the first two editions of the \nDTI Tractography Challenge workshop at the MICCAI 2011&2012 \nconferences. The datasets included pre-operative DWI,T1 and T2 volumes \nwith pre-segmented tumor and edema regions. Quantitative evaluation of the \nvariability among tractography results included the degree of bundle overlap \nand the distance between tracts. A panel of neurosurgeons and DTI experts \nS157  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nassessed the anatomical correctness and depi ction of the spatial relationship \nbetween the tracts and the tumor using a set of standardised review criteria. \nResults: The 476 tractography reconstructions of the corticopsinal tract \ngenerated by 21 different tractography methods showed large inter-algorithm \nvariability (average Dice coefficient of overlap: 0.22; average Hausdorff \ndistance between tracts:6.1 mm). The majo rity of the visualised tracts failed to \nreach some clinically significant parts of the motor cortex, such as the hand \nand face motor areas. Improvement in the tractography results from year 1 to \nyear 2 indicate that this collaborative effort is a learning experience for the \ncommunity \nConclusion: DTI tractography has a unique potential for non-invasive white \nmatter mapping. The DTI Challenge aims to provides a benchmark for the \nstandardised evaluation of tractography methods on neurosurgical data.  \nB-0100 11:51  \nEvaluation of the use of chemical shift gradient echo in and opposed \nphase sequences in 3 T MRI in the detection of H-MRS visible lipids and \ngrading of gliomas  \nN. Ramli, A. Mohd Khairy, K. Rahmat, L.K. Tan; Kuala Lumpur/MY \n(norlisahramli@gmail.com)  \nPurpose: To evaluate the values of 3-Tesla MRI chemical shift gradient echo \n(GE) in and opposed-phase sequence in discriminating between different \ngrades of brain glioma. \nMethods and Materials:  A total of 18 patients aged between 15 and 71 years \nold were enrolled (13 males, 5 females). Nine patients were diagnosed with \ngrade II glioma, three patients were grade III glioma and six patients were \ngrade IV glioblastoma multiforme (GBM). Additional in/opposed-phase and \nsingle voxel spectroscopy sequences were done. The signal loss ratios (SLR) \nwere obtained from solid portion of the tumour in the in-phase and opposed-\nphase. Lipid subtype concentrations were quantified by LC Model. \nResults: In clinical application of glioma, the SLR in-oppose phase done on \nsolid component of the tumour of 0.074 allowed classification of low from high \ngrade with 100% sensitivity and specificity, higher than the lipid quantification \nin MRS which gave highest sensitivity of 66.7% and specificity of 100%. \nConclusion: Chemical shift gradient echo in and opposed phase sequence \ncause significant signal loss in diffe rent grades of gliomas with very high \nspecificity and sensitivity at differentiating low and high grade glioma. This \nempirical finding provides new discovery that this sequence have the ability to \ngrade the glioma.  \nAuthor Disclosures: \nN. Ramli: Research/Grant Support; High Impact Research (HIR) Grant (J-\n20518-73808). \n10:30 - 12:00 Room L/M  \nPhysics in Radiology  \nSS 113  \nAdvances in CT technology and \napplications  \nModerators:  \nC. Leidecker; Forchheim/DE  \nM. Onu; Bucharest/RO \nB-0101 10:30  \nFully integrated CT detector technology: evaluation of dose reduction \npotential  \nC. Schabel, M. Bongers, S. Mangold, D. Ketelsen, C.D. Claussen, C. Thomas; \nTübingen/DE (christoph.schabel@med.uni-tuebingen.de)  \nPurpose: A recently introduced novel, fully integrated design of CT detector \ntechnology (IDT) promises low electronic noise levels compared to \nconventional detector technology (CDT). The purpose was thus to evaluate the \nincrease in efficiency of IDT compare d to CDT and its potential radiation dose \nreduction. \nMethods and Materials:  Three anthropomorphic phantoms of different \ndiameters (19.8.27.4 and 31.6 cm) were scanned on a dual-source CT scanner \n(Somatom Definition Flash) shortly before and after IDT installation \n(Stellar,Siemens,Forchheim,Germany). Phantoms were constructed from \ndifferent-sized barrels cont aining water and a centred syringe filled with \ncontrast media of identical dilution. Phantoms were scanned using standard \nclinical protocols and at additional tube current levels of 40.70,130 and 160% \nof the standard tube current. Scans were repeated for different tube potentials \n(80,100 and 140 kV). All other scan parameters were kept constant. Analysis \nof acquired image data was performed with a custom written MATLAB tool, \nwhich facilitated multiple identical noise and contrast measurements within the \nsyringe. Contrast to noise ratios were calculated. \n \nResults: CNR increase measured was up to 24.1% and depending on tube \npotential (6.1-24.1% for 80 kV,2.7-19.4% for 100 kV and 0.6-12.0% for 140 kV) \nand phantom size (S 9.2-24.1%;M 0.6-16.8%;L 2.8-23.1%). It was found that \nextreme combination benefit the most (S & L;40 and 160%) indicating a wider \nrange of good detection. Curve fitting analysis revealed that a potential \nradiation dose reduction of 1.1-35.4% is possible while receiving equal CNR. \nConclusion: IDT proves to increase CNR up to 24.1% and holds out the \nprospective to reduce the radiation dose up to 34.1% while acquiring images of \ncomparable quality.  \nB-0102 10:39  \nOptimal image-based material decomposition with energy-selective \ndetectors in spectral CT in comparison to dual energy CT (DECT)  \nS. Faby1, S. Kuchenbecker1, D. Simons1, H.-P. Schlemmer1, M. Lell2, \nM. Kachelrieß1; 1Heidelberg/DE, 2Erlangen/DE (sebastian.faby@dkfz.de)  \nPurpose: To minimise dose and maximise image quality in spectral CT when \nthe number of spectral energy bins B is larger than the number of materials M \nto decompose into. \nMethods and Materials:  Energy-selective detectors receive increasing \nattention in CT since first prototypes are available. For most spectral CT \ndetectors, the number of energy bins B is larger than the number of materials \nM one desires to separate. M=2 is of interest as it allows to distinguish soft \ntissue and contrast agent. We propose a new statistics-based method to \ncombine the images of B >M bins into M material images that minimises the \nimage noise and therefore patient dose. For evaluation of our proposed \nmethod, a CT system with energy-selective detectors is simulated with B \u00028 \nand compared to DECT. Virtual non-contrast (VNC) imaging is used to quantify \nour results. \nResults: An ideal energy-selective detector with B=4 allows to use 29% lower \ndose than DECT in the VNC image while significantly improving the iodine \noverlay image. Simulating a realistic non-ideal detector, however, would \nrequire 57% more dose than DECT, which is required to keep the VNC image \nat the same image quality. \nConclusion: It is shown that an ideal photon-counting detector could lead to a \npatient dose reduction of up to 29% or more while still achieving a significantly \nimproved iodine image. In a more realistic scenario, however, the current \ndetector technology is not yet able to outperform DECT in the case considered \nhere.  \nAuthor Disclosures: \nM. Lell: Grant Recipient; Siemens AG. Speaker; Siemens AG.  \nB-0103 10:48  \nVisualisation of energy-dependent attenuation properties in vitro and in \nvivo using polar coordinates in dual-energy computed-tomography data  \nL. Havla, M. Peller, C. Cyran, K. Nikolaou, M.F. Reiser, O. Dietrich; \nMunich/DE (lukas.havla@med.uni-muenchen.de)  \nPurpose: Dual-energy computed-tomography (DECT) examination with two \ndifferent x-ray spectra at the same time allows for material decomposition of \ncalcium and iodine. The purpose of the present study was to evaluate a new \nDECT post-processing approach based on the transformation of dual-energy \ndata into polar coordinates to ease analysis and differentiation between kind of \nmatter and concentration. \nMethods and Materials:  Given two corresponding DECT (80 kV/140 kV with \n1 mm tin filter) images, the attenuation data (ai (U1), ai (U2)) in Hounsfield \nunits of both energies (U1, U2) are transformed to polar coordinates, i.e., the \ndistance, ri, of every data point i to the coordinate origin and its angle, )_i, to \nthe abscissa is calculated. This approach was evaluated in a phantom \ncontaining different substances and in vivo in N=10 rats after application of \niodine contrast agent. \nResults: For phantom data, evaluation of the parameter map )(x,y) (x,y: \nimage coordinates) yields mean values of ) of 60.7° ±0.3°, 62.9°± 0.6°, \n66.7°±0.5°, and 71.5°±0.7° for calcium, gadolinium, copper, and iodine. In vivo, \nmean values of ) were 62.3°±0.4° and 71.5°±0.5° for calcium and iodine. \nConclusion: The evaluated data sets demonstrated clearly different polar-\nangle ranges for different substances in vitro and in vivo. Polar-coordinate \npost-processing of DECT data, thus, allows (1) to display the energy \ndependence of the attenuation coefficient in a function of a single variable, the \npolar angle ), (2) to select materials by characteristic polar angles, and (3) to \nplot the spatial distribution  of specific materials in an image with preserved \nanatomic and morphologic structure ( ) maps).  \n \nS158  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0104 10:57  \nMonochromatic imaging in dual energy CT (DECT): metal artifact \nreduction with acceptable image quality?  \nS. Kuchenbecker1, S. Faby1, S. Schüller1, M. Lell2, M. Kachelrieß1; \n1Heidelberg/DE, 2Erlangen/DE (stefan.kuchenbecker@dkfz.de)  \nPurpose: To analyse pseudo-monochromatic DECT imaging with respect to \nimage quality of images with metal implants. \nMethods and Materials:  Today's clinical DECT systems provide pseudo-\nmonochromatic imaging, a linear combination of the reconstructed low and \nhigh kV images. The linear blending factor is typically expressed as a photon \nenergy (in keV) and the method is called monochromatic imaging instead of \nlinear blending. The method is able to reduce metal artifacts under certain \npatient-specific conditions. True virtual-monochromatic imaging, in contrast, \nrequires rawdata-based processing. We compare pseudo- vs. virtual-\nmonochromatic imaging and quantify image quality of both approaches. \nTherefore we performed simulations of the Forbild abdomen phantom and \nmeasured a semi-anthropomorphic phantom containing iodinated contrast \nagent and metal inserts in a clinical dual source DECT with 100 kV and 140 kV \nSn tube voltage. In each case the reconstructed images were combined \nlinearly to minimise artifacts or to maximise the contrast-to-noise-ratio (CNR). \nResults: Pseudo-monochromatic imaging reduces metal artifacts in some \ncases, at cost of reduced CNR (50% and more). A dataset of the phantom \nscanned in the clinical DECT system showed a CNR of 4.9 in the low energy \nimage and 3.7 in the high energy image. The pseudo-monochromatic image at \nthe energy E \u0004139keV yields a CNR of 1.9 while the rawdata-based material \ndecomposition preserves the CNR=4.5 in the low energy image and CNR=3.5 \nin the high energy image. \nConclusion: The image-based pseudo-monochromatic imaging is a simple but \nlimited method to reduce metal artifacts which goes along with a significant \nCNR reduction.  \nAuthor Disclosures: \nM. Lell: Grant Recipient; Siemens AG. Speaker; Siemens AG. \nB-0105 11:06  \nSuppression of the CT beam hardening streak artefact using predictive \ncorrection on detector data  \nJ.G. Stowe, K.M. Curran; Dublin/IE (john.stowe@ucd.ie)  \nPurpose: To develop an automated program incorporating a predictive artefact \ncorrection technique (PACT) to correct for the signal deviations from metal \nbeam hardening artefacts in computed tomography (CT) detector raw data. \nMethods and Materials:  A thin-slice sequential CT scan was performed on a \ndosimetry head phantom using a Somatom Sensation 16 scanner to establish \na ground truth image. Metal pins were then affixed to either side of the \nphantom at the three and nine o'clock positions to generate streak artefact \ndetector raw data and a streak image. The program automatically detected the \nextent of the overlap peaks in the detector raw data causing the artefact. It \nprofiled a correction using adjacent projections so that the peak error could be \ncorrected rather than simply being removed or smoothed by interpolation. The \nPACT algorithm-modified raw data were then reconstructed on a SYNGO CT \nreconstruction workstation. This image was then compared against base truth \nand that produced by commercially available metal artefact reduction (MAR) \nsoftware. \nResults: Qualitative results illustrate superior suppression of streak artefact in \nimages using PACT when compared directly to commercial MAR software. \nRecovery of voxel data underlying the streak is also demonstrated to be \nsuperior with PACT versus MAR when referenced to the original ground truth \nimage. \nConclusion: The experiment demonstrates the feasibility of this predictive \nartefact correction technique in detecting and correcting beam hardening \nartefact without recourse to expensive additional options such as iterative \nreconstruction or dual energy that are not so commonly available in the clinical \nsetting.  \nB-0106 11:15  \nMetal artefact removal: single and dual-source CT approaches  \nT.R.C. Johnson, K. Hellbach, F.G. Meinel, M.F. Reiser, F. Bamberg; \nMunich/DE (thorsten.johnson@med.uni-muenchen.de)  \nPurpose: The aim of this study was to investigate the feasibility of a single-\nsource CT approach for the reduction of metal artefacts with spectral \nextrapolation. Additionally, the effici ency was to be compared to established \ndual-source CT-based methods. \nMethods and Materials:  A phantom comprising implants and osteosynthetic \nhardware of variable thickness and alloys of titanium or \nchromium/moleybdenum/vanadium were scanned on three CT scanners, i.e. a \nSiemens Flash DSCT (at filtered Sn140 and 100 kVp spectra), an Edge and a \nSensation 64 (both at 140, 100 and 80 kVp). Postprocessing was optimised to \neliminate metal artefacts by energetic extrapolation as far as possible. For \nFlash and Edge, the vendor's software was used, and for the Sensation64 data \na DICOM-based custom-written software. Artefact removal was graded on a 5-\npoint scale. \nResults: Metal artefact removal was effective in titanium prostheses and steel \nhardware up to 1 cm thickness. The filtered spectra of the Flash scanner \nprovided most effective elimination of artefacts (rating 4.1/5) and could handle \na little thicker steel. The effectivity of the Edge with the vendor's software and \nthe Sensation64 with the custom-written software was equivalent (equivalent \nrating of 3.6/5). \nConclusion: Dual-energy CT is an efficient approach of metal artifact \nreduction. DSCT with filtered spectra achieves the best results. However, \nsingle-source CT with two separate scans represents another efficient \napproach which provides a significant improvement without exceptional \nhardware.  \nAuthor Disclosures: \nT.R.C. Johnson: Patent Holder; Dual Energy CT related patents. \nResearch/Grant Support; from Siemens and Bayer. Speaker; for Siemens.  \nB-0107 11:24  \nAssessment of CT-based thermometry during laser interstitial \nthermotherapy ablation of swine pancreases  \nF. Giurazza, R. Del Vescovo, F. Siano, E. Schena, B.B. Zobel; Rome/IT \n(francescogiurazza@hotmail.it)  \nPurpose: Laser interstitial thermotherapy (LITT) is employed to destroy tumour \nin organs; its outcome strongly depends on temperature distribution inside \ntissues. \nMethods and Materials:  We evaluated temperature influence on the \nattenuation coefficient obtained by Hunsfi eld Unit (HU) modifications of CT \nscan examinations performed during LITT on pancreatic tissue. We performed \nCT scans examinations of 6 ex vivo swine pancreases while undergoing LITT \n(Nd: YAG laser, 6=1064 nm, laser energy= 600 J, power= 3 W, treatment \ntime= 200 s) and then we measured density changes placing two regions of \ninterest (ROI) of 0.4 cm\n2: the former, localised just upward the applicator, \npresented a temperature increase and a HU decrease during LITT; the second, \nat high distance from applicator, shows constant temperature and constant HU \nduring LITT. We have analysed HU variations on 19 consecutive scans with an \ninterval time of 9 seconds. \nResults: Tissue density calculated in the first ROI close to the applicator \nshows a decrease during LITT due to temperature rise from about 57 HU \nbefore the treatment to 35 HU when the laser is stopped; it presents a linear \ndependence with the procedural time (R2=0.8187). In the second ROI \npositioned distant from the applicator, where temperature rise is negligible, the \ntissue density does not show significant changes. The HU decreases as a \nfunction of temperature, showing a nonlinear trend with a mean thermal \nsensitivity of \u00030.50 HU \u0003C\u00031. \nConclusion: Temperature estimation by density variation observed at CT scan \ncould be a suitable mini-invasive tool  to choose optimal laser settings to \nproduce a controlled ablated volume.  \nB-0108 11:33  \nUrinary stone disease: dose and image quality in low dose CT with and \nwithout automatic tube current modulation, with and without iterative \nreconstruction  \nO. Soenen, F. Zanca, C. Balliauw, L. De Wever, R. Oyen; Leuven/BE \n(soenen.olivier@gmail.com)  \nPurpose: To compare dose and image quality (IQ) of a standard low-dose CT \nvs. a right-dose CT, i.e. with automatic tube current modulation (TCM), in \npatients with suspected urolithiasis and to assess the value of iterative \nreconstruction. \nMethods and Materials:  A CT-examination was performed on 193 patients \n(Siemens Definition Flash), 103 standard low-dose (120 kV, fixed 45 mAs) and \n90 right-dose (120 kV, TCM with 30 mAs reference). Filtered backprojection \n(FBP) reconstruction was used for both protocols and Sinogram Affirmed \nIterative Reconstruction (SAFIRE) for the right-dose only. A first-years resident \nchecked the standard protocol FBP images. Dose and conclusiveness were \nassessed. Two experienced radiologists re-examined all cases were no stones \nwere found in terms of ureter stones, subjective noise, visibility of the (pelvic) \nureter and diagnostic confidence, using respectively a 3 and 4-point scale \n(1=insufficient; 3/4=excellent). Unpaired t-test, Wilcoxon and Mann-Whiteny \ntest were used for statistical significant differences. \nResults: A decrease of 22% in mean effective dose was determined \n(p < 0.001) for the right-dose protocol and conclusiveness was better than for \nthe standard protocol: 96.2% and 78.7% respectively. The right-dose protocol \nalso showed an improved visibility of the pelvic ureter with respect to the \nstandard (median score 2 vs 1, p=0.02). For the other criteria no statistical \nsignificant difference was found (p > 0.05). SAFIRE did not show improved IQ \n(p=0.09). \n \nS159  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nConclusion: The use of TCM for urolithiasis CT allows for a dose reduction \nwhile preserving overall IQ and improving the visibility of the pelvic ureter. \nSAFIRE seems not to improve IQ.  \nB-0109 11:42  \nComparing the image quality of a mobile flat-panel CT and a \nmultidetector CT: a phantom study  \nJ. Neubauer\n1, J. Voigt2, M. Fiebich2, M. Langer1, E. Kotter1; 1Freiburg/DE, \n2Gießen/DE  \nPurpose: To compare the image quality of a compact mobile flat-panel CT \n(FPCT) capable of extremity imaging and a multidetector CT (MDCT) in \nexaminations with the same radiation dose. \nMethods and Materials:  Monte Carlo simulations were used to calculate \nequivalent dose settings for the FPCT and the MDCT. Simulations were based \non and validated by dose measurements. Homogeneity, geometric distortion, \nartifacts, accuracy of Hounsfield values, contrast and spatial resolution were \nevaluated in different imaging phantoms. Whitney Mann U Test and \nSpearman's rho were used for statistical analysis. \nResults: Homogeneity reached 2.5% for the FPCT and 0.5% for the MDCT. \nHounsfield values were more accurate and contrast to noise ratios (CNRs) \nwere higher for the MDCT than the FPCT. The MDCT depicted more rod \ninserts than the FPCT. No geometric distortion was detected in either modality. \nThe FPCT was more prone to artifacts around Krischner wires with 2 mm \ndiameter, whereas the MDCT showed a higher amount of artifacts around \nwires with a diameter of 0.8 mm. Spatial resolution was 1 lp/mm (xy), 1.7 \nlp/mm (z) for the FPCT and 1 lp/mm (xy), < 1 lp/mm (z) for the MDCT. \nConclusion: We compared a mobile FPCT and a 320-row MDCT by using the \nsame radiation dose for scans. We found the spatial resolution to be higher in \nthe FPCT. Hounsfield units were more accurate, homogeneity and contrast \nresolution were better in MDCT. The MDCT was also less prone to artifacts \nfrom thick Kirschner wires but showed comparably more artifacts around thin \nwires.  \nAuthor Disclosures: \nE. Kotter: Board Member; Editorial Board Member Thieme RadBase. \nB-0110 11:51  \nRadiation burden from modern 256-slice CT imaging for suspected \npulmonary embolism during pregnancy: Is lung scintigraphy still more \ndose efficient?  \nK. Perisinakis\n1, A. Tzedakis1, I. Seimenis2, A. Papadakis1, J. Damilakis1; \n1Iraklion/GR, 2Alexandroupolis/GR (Kostas.Perisinakis@med.uoc.gr)  \nPurpose: To a) determine normalised data on absorbed radiation dose to \nmaternal radiosensitive organs and embryo/fetus from 256-slice CT pulmonary \nangiography (CTPA) in pregnant patients suspected for pulmonary embolism, \nfor different maternal sizes and stages of gestation and b) provide reliable \nmaternal effective dose and fetal dose estimates from 256-slice CTPA for \ncomparison with lung scintigraphy. \nMethods and Materials:  Monte Carlo methods and mathematical \nanthropomorphic phantoms, generated to simulate adult females of varying \nbody-size at conception and at 3\nrd, 6th and 9th month of gestation, were used to \nsimulate standard and low-dose 256-slice CTPA examinations. Normalised \ndose data were derived for exposures at 80, 100 and 120 kV. Slim, average-\nsize and overweight pregnant patients were considered to be scanned with \n80 kV-350 mAs, 100 kV-250 mAs and 120 kV-200 mAs, respectively. Mean \nmaternal and fetal doses were determined for 76 pregnant women considered \nto be subjected to CTPA. \nResults: The dose to the embryo/fetus from the standard 120 kV 256-slice CT \nscan was found to be below 0.5 mGy for all stages of pregnancy. The \ncorresponding values for 80 kV and 100 kV 256-slice CT scans were 2-5 times \nlower. Maternal effective dose from CTPA was 0.9, 1.5 and 3.2mSv for slim, \naverage-sized and overweight pregnant females, respectively. \nConclusion: The maternal effective dose and the radiation dose to the \nembryo/fetus from modern 256-slice CTPA studies may be lower than the \ncorresponding typical values for lung scintigraphy. Current results may cancel \nthe rationale of present recommendations regarding the use of lung \nscintigraphy rather than CTPA in pregnant patients suspected for pulmonary \nembolism.  \n \n10:30 - 12:00 Room N/O  \nVascular  \nSS 115  \nNew trends  \nModerators:  \nF. Fanelli; Rome/IT  \nD.L. Tarnoki; Budapest/HU  \nB-0111 10:30  \nFusion image guidance in endovascular peripheral artery interventions  \nA.M.H. Sailer, M.W. de Haan, R. de Graaf, W.H. van Zwam, J.E. Wildberger, \nG.-W.H. Schurink, M. Das; Maastricht/NL (anni.sailer@mumc.nl)  \nPurpose: To evaluate the clinical applicability, geometrical accuracy and value \nof endovascular guidance by means of live fluoroscopy image fusion with \nmagnetic resonance angiography (MRA) and computed tomography \nangiography (CTA). \nMethods and Materials:  Fusion image guidance was evaluated in twenty \nendovascular peripheral artery interventions (PAI) in seventeen patients. \nFifteen patients had received pre-interventional diagnostic MRA and two \npatients had received CTA. Time for manually performed image co-registration \nwas documeted. Fluoroscopy with MRA/CTA fusion road-map accuracy was \nevaluated by overlay error in millimetres. Contrast-enhanced angiogram series \n(CEAS) which were not performed due to fusion guidance and total procedural \niodinated contrast media (CM) were recorded. Subjective additional value (AV) \nof the fusion road-map was scored by the interventional radiologists (0 = no \nAV; 1 = AV in terms of guidance; 2 = AV in terms of guidance and CM \nreduction). \nResults: Image co-registration was successful in all procedures within \napproximately five minutes. Overlay error was less than 2 mm in nine \nprocedures and between 2 and 4 mm in eight. Extended patient movements \nhindered fusion road-mapping in three procedures. Average CM saved per \nprocedure was 9 ±9 cc (range 0-30 cc) which accounted for on average \n17±18% of total procedural CM (mean ±standard deviation). AV in terms of \nguidance (1) was registered in six procedures and in terms of guidance and \nCM reduction (2) in ten procedures. \nConclusion: Fusion-image guidance is a promising alternative to conventional \nangiogram road-mapping in routine PAI, potentially reducing CM and \nconsecutively enhancing procedural safety for patients.  \n \nB-0112 10:39  \nBrain structural and haemodinamic changes caused by methcathinone \n(ephedron) abuse  \nF. Todua, D. Gachechiladze, M. Okujava, D. Miminoshvili; Tbilisi/GE \n(doudanag@hotmail.com)  \nPurpose: To assess the brain structural and haemodinamic findings in \nmethcathinone chronic users. This addicti ve psychoactive substance is derived \nvia the oxidation of ephedrine with potassium permanganate. \nMethods and Materials:  41 patients (mean age 41 years) with chronic \nintravenous use of methcathinone were investigated; All patients underwent \nbrain MRI (1.5 T, 3 T), MR-tractography, MR-angiography and Colour Doppler \nof extra-intracranial vessels, neurologi c and neuropsychological examinations, \ncerebrovascular reactiviry (CVR) TCD test. \nResults: In majority of abusers 32 (78%) extrapiramidal disorders similar to \nParkinson`s disease: bradikinesia, postural disturbance, araxia, tremor, \nmuscular distonia was noted. Pseudobulbar syndrome or personal \nabnormalities was comparatively rare. Two cases of stroke was diagnosted. In \n34-year-old male patient, severe dissection and thrombosis of the ICA was \nmarked, and in 41-year-old male, thrombosis of the MCA. MR images revealed \nT1 hyperintense lesions in 35 (85%) cases, predominantly in globus pallidum \n(30/74%), substantia nigra (28/68%), nuclei dentatus of cerrebulum (23/55%), \nanteriot pituitary lobe (16/40%). Clinical picture was correlated with white \nmatter fractional anisotropy. The development of brain changes were \nsignficantly associated with duration of abuse. At MRA moderate to severe \nvessel irregularity consistent with vasoconstriction and vasodilation was \npresent in 28 (68%) case. TCD revealed reduced blood flow, increased \npulsatility index (PI) values and impaired CVR. \nConclusion: MRI demonstrate systematic brain structural deficits in \nmethcathinone abusers. DTI identifies areas of disruption in white matter \ntracts. Slowed cerebral blood flow velocity with increased pulsatility and \nimpaired CRV in abusers indicate increased cerebrovascular resistance due to \nvasoconstriction of small cortical vessels.  \nS160  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0113 10:48  \nRespiratory variation of the length of the vena cava: implications for IVC \nfilters  \nT. Hashimoto, J. Koizumi, K. Yamamoto, T. Ichikawa, Y. Imai; Isehara/JP \n(k168062@is.icc.u-tokai.ac.jp)  \nPurpose: We evaluated the respiratory change of the length and diameter of \nthe vena cava using magnetic resonance imaging (MRI) in relation with \ntransjugular temporary filter migration. \nMethods and Materials: Twenty healthy patients were evaluated with MRI; the \nlength and diameter from the right brachiocephalic vein (BCV) to the pararenal \ninferior vena cava (IVC) were measured. \nResults: The lengths of the BCV, superior vena cava (SVC), RA, suprarenal \nand pararenal IVC during expiration vs. inspiration were 32.7 ±7.3 mm vs. \n43.0 ±8.0 mm, 44.6± 9.6 mm vs. 58.5 ±12.7 mm, 77.8± 12.4 mm vs. \n98.9±10.0 mm, 104.6 ±19.1 mm vs. 85.0 ±14.9 mm, and 49.0 ±8.7 mm vs. \n33.8±9.7 mm respectively. The distances from the BCV to the RA, from BCV to \nthe upper confluence of RV, and from BCV to the lower confluence of RV \nduring expiration vs. inspiration were calculated as 155.2 ±18.5 mm vs. \n200.34 ±20.1 mm, 255.6 ±  27.7 mm vs. 285.6 ±23.9 mm, and 308.7± 31.6 mm \nvs. 319.1± 24.9 mm. The diamaeter of the SVC, the suprarenal IVC, the \ninfrarenal IVC during expirati on vs. inspiration were 18.6 ±2.89 mm vs. \n16.4 ±3.0 mm, 15.9± 4.6 mm vs. 14.6 ±5.23 mm, and 14.9 ±4.8 mm \nvs.18.0±4.4 mm, respectively. There were statisti cally significant differences in \nboth vena cava lengths and diameters except the diameter of the suprarenal \nIVC between expiration and inspiration. \nConclusion: This study demonstrates that the distance from the BCV to the \nRA, the upper and lower confluences of RV was 4.5 cm, 2.6 cm and 1.0 cm \nlonger at inspiration than at expiration. These respiratory-associated changes \nof the vena cava length should be considered to prevent transjuglar temporary \nfilter migration.  \nB-0114 10:57  \nStudy for percutaneous transluminal angioplasty for dysfunctional \nfemoral haemodialysis graft fistula  \nE. Oh\n1, Y. Kim1, D. Goo1, S. Yang2; 1Seoul/KR, 2Gumi/KR \n(sophiaoes@naver.com)  \nPurpose: To analyse the radiologic features of dysfunctional femoral \narteriovenous graft and to evaluate various predictors of graft patency rates \nafter percutaneous transluminal angioplasty (PTA). \nMethods and Materials:  A retrospective analysis was performed to 45 \npatients who underwent femoral arteriovenous graft placement for \nhaemodialysis and who were referred for PTA for dysfunction between 2005 \nand 2012. The primary and secondary patency rates after PTA was evaluated. \nDifference of the primary patency rates according to the presence of diabetes \nmellitus, graft age from the time of creation to the first intervention ( < 12 \nmonths or \u000312months), presence of thrombus, shape of graft (U shape or \nstraight shape), anastomosis type of graft (femoral-femoral vs femoral-\nsaphenous), location of stenosis (central vs peripheral), length of \nstenosis (< 2 cm vs \u00032 cm), degree of stenosis severity (<  70% vs \u000370%), and \nstent insertion or not were estimated. \nResults: A total of 124 PTA were performed. For femoral arteriovenous graft, \npost-PTA primary and secondary patency rates at 3, 6, and 12 months were \n84.8%, 63.6%, 24.2%, and 95.2%, 95.2%, 85.7%, respectively. The average \npost-PTA primary and secondary patency rates were 13.2 months and 35.7 \nmonths, respectively. Metallic stents were inserted in nine of 124 proceducres. \nThere were no significant difference of the primary patency rates for various \npredictors except between stent insertion group and no insertion group. \nConclusion: PTA is safe and effective treatment modality to treat \ndysfunctional femoral haemodialysis gr aft fistula. There was statistically \nsignificantly low patency rate in the group of patients by inserting a stent.  \nB-0115 11:06  \nVisceral fat accumulation is a risk factor for atherosclerosis of the aorta  \nM. Hrabak Paar, R. Štern-Padovan; Zagreb/HR (maja.hrabak.paar@mef.hr)  \nPurpose: To evaluate the relationship between the amount and distribution of \nabdominal adipose tissue with development of atherosclerotic changes of the \naorta. \nMethods and Materials: MSCT angiography of the entire aorta was performed \nin 94 patients (68 men and 26 women; age range 40-85 years). In all patients \nsignificant aortic disease was excluded using CT examination. Total, visceral \nand subcutaneous abdominal fat areas were measured on a single axial CT \nscan at the level of umbilicus. Aortic diameter and wall thickness of different \naortic segments was measured, and atherosclerotic plaques of all aortic \nsegments were semi-quantitatively graded. Correlation analysis between \nabdominal fat areas and aortic diameters, wall thickness and plaque grades \nwas performed. \nResults: We found statistically significant correlation between diameter of all \naortic segments and visceral fat area, that was mostly pronounced in the aortic \narch (r=0.42, p < 0.05). Aortic wall thickness was associated with visceral fat \narea, this relationship was strongest at the level of descending thoracic aorta \n(r=0.32, p < 0.05). We also found positive corr elation between the visceral fat \narea and the grade of the largest atherosclerotic plaque of all aortic segments, \nwith the strongest correlation at the level of descending thoracic and abdominal \naorta (rs=0.32, p < 0.05). We did not find any correlation between \nsubcutaneous fat area and aortic wall thickness and atherosclerotic plaque \ngrade. \nConclusion: Visceral fat accumulation accelerates vascular aging, with \nconsequent increase of the risk for future cardiovascular events. The effect of \nsubcutaneous fat tissue on development of aortic atherosclerosis is negligible.  \nB-0116 11:15  \nAcute basilar artery occlusion: a safety and efficacy single-centre study  \nF.X. Zarco, A. Lopez, M.F. Werner, L. San Roman, J. Blasco, S. Amaro, \nÁ. Chamorro, L. Oleaga, J.M. Macho; Barcelona/ES \n(federico.zarco@yahoo.com)  \nPurpose: The purpose of this study was to evaluate the safety and efficacy of \nmechanical thrombectomy in subjects with acute basilar artery occlusion. \nMethods and Materials:  This retrospective single-center study includes 25 \nconsecutive patients with acute basilar artery occlusion treated within 24 hours \nafter symptoms onset with mechanical thrombectomy. Recanalisation rates, \ntime to treatment, duration of the procedure, hemorrhagic transformation, \nclinical outcome and mortality rate at 90 days were collected. \nResults: The mean age of patients was 61± 19 years, and the median \nprethrombectomy NHISS score was 20 (IQR 11-30). The mean time to \ntreatment was 354.54 ±212.40 minutes, and the mean endovascular treatment \ntime was 88.22 ±46.52 minutes measured from needle to final angiogram. \nSuccessful recanalisation (TICI 2b/3) was achieved in 22 patients (88.9%). No \npatients suffered parenchymal hematoma (0%) as a complication of the \nprocedure. A favorable outcome (0-2mRS) at 3 months was observed in 36.4% \nof the patients (8/22), and the mortality rate was 40.9%(9/22). \nConclusion: Our preliminary results show better results in terms of rate of \nsuccessful revascularisation (88.9%vs53-65%), funcional \noutcome (36.4%vs20-24%) and mortality rate (40.9%vs50-56%) than \npreviously published reports for intravenous or intra-arterial thrombolysis. The \nrecanalisation rates (88.9%), functional outcome rates (36.4%)are comparable \nto those obtained in other reports. However, our mortality rate (40.9%) is \nslightly higher than other series (21-35.7%), probably because we have \nmissing data in 3 month follow-up. Mechanical thrombectomy in acute basilar \nartery occlusion is feasible and effecti vely contributes to a high-rate of \nrecanalisation and improves funcional outcom e in patients wi th ABAO with a \nlow complication rate. These preliminary results must be confirmed in \nprospective studies.  \nB-0117 11:24  \nEndothelial function assessed by ultrasound flow-mediated dilatation in \npatients with haematologic malignancies subjected to high-dose \nchemotherapy in the course of haematopoietic stem cell transplantation  \nM. Poreba, R. Poreba, P. Gac, L. Usnarska-Zubkiewicz, W. Pilecki, \nK. Kuliczkowski, G. Mazur, M. Sobieszczanska; Wroclaw/PL \n(pawelgac@interia.pl)  \nPurpose: Examine endothelial function in patients with haematologic \nmalignancies subjected to high-dose chemotherapy (HSCT) in the course of \nhaematopoietic stem cell transplantation by means of ultrasound flow-mediated \ndilatation (FMD). \nMethods and Materials:  The studies were conducted on 43 consecutive \npatients qualified for HSCT following high-dose chemotherapy based on the \ncurrent standards. Evaluation of endothelial function by means of ultrasound \nFMD was conducted in 43 patients with haematological malignancies before \nHSCT (test A) and after HSCT (test B). We accepted the FMD value \u0003 7% as a \nnorm. \nResults: Brachial artery diameter 2 minutes after 5-minute vasoconstriction \nperiod, change in brachial artery diameter, and FMD were significantly lower \nafter HSCT as compared to the results obtained before the transplantation \n(p < 0.05). Before HSCT procedure normal FMD was present in 92.11% of \npatients. After HSCT procedure normal FMD was found significantly less \nfrequently, in 36.84% of patients (p < 0.05). The multifactorial step-wise \nbackward regression analysis indicated that administration of fludarabine and \ncytarabine and higher concentrations of blood creatinine represented risk \nfactors for the impairment of endothelial function expressed as decreased FMD \nvalue. \nConclusion: In patients with haematopoietic malignancies treated with HSCT, \nendothelial function assessed by the ultrasound flow-mediated dilatation was \nimpaired after chemotherapy and stem cells administration.  \nS161  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0118 11:33  \nAssessment of intrarenal flow Doppler parameters in patients before and \nafter pheochromocytoma tumour removal  \nM. Januszewicz, I. Pruszynska, O. Rowinski; Warsaw/PL (januszew@o2.pl)  \nPurpose: Pheochromocytoma is a neuroendocrine tumour derived from \nchromaffin cells in the medulla or adrenal glands. Secretion of norepinephrine \nor epinephrine may have an effect on the flow of blood in the arterial vessels. \nThe Doppler study was performed to assess potential changes of intrarenal \nflow presented by resistance indexes. \nMethods and Materials: 116 patients treated for pheochromocytoma (56 men, \nmean age 50.2y ±19.59) were divided into two groups: before (80) and after \n(35) adrenalectomy, and according to gender. The control group consisted of \n121 patients (79 men, mean age 47y ±14.82). Doppler examinations were \nperformed with Philips HD11 and HD22 (Philips Andover, MA, USA) equipment \nusing convex transducer 2-4Mhz.The renal size, resistive and pulsality (RI,PI) \nindexes and acceleration time (At) were measured in intra-lobar arteries of \nupper and lower parts of the kidney. Analysis of variance (ANOVA) was used \nwhen possible, if not possible U te st was conducted. Multiple regression \nanalysis was used in tests including quantitative values. \nResults: Control and study groups demonstrated a significant correlation \n(p < 0.05) of RI with age and gender of the patient. Conducted tests failed to \ndemonstrate a significant correlation between any of the indicators and the \nstate before and after surgery. \nConclusion: The impact of age on measured values was significantly visible in \nstudy and control groups. Adrenalectomy did not significantly change values of \nRI, PI and At. The Doppler study does not show the influence of \ncatecholamines secretion on renal flow.  \nB-0119 11:42  \nHypoplasia of the vertebral artery: impact on cerebellar blood flow and \nperfusion characteristics  \nK.M. Thierfelder, L. von Baumgarten, F.G. Meinel, M. Armburster, K. Nikolaou, \nM.F. Reiser, W.H. Sommer; \nMunich/DE (kolja.thierfelder@med.uni-muenchen.de)  \nPurpose: Hypoplasia of the vertebral artery (VAH) is a common vascular \nvariant and a risk factor for posterior circulat ion ischemia. The aim of our study \nwas to determine whether VAH leads to a perfusion deficit in the dependent \nPICA-territory. \nMethods and Materials:  Vertebral artery diameter was measured in the V4 \nsegment of 934 consecutive patients who underwent multimodal CT due to \nsuspected stroke. VAH was defined by a V4 diameter of up to 2 mm in the CT-\nangiography. Patients with posterior circulation ischemia, hemorrhagic stroke \nor other vertebrobasilar pathologies were excluded. The study was designed \nas a case-control study with a ratio of cases to control patients without VAH of \n1:2. Two readers evaluated four different perfusion maps for perfusion deficits \nin the cerebellum of all patients. \nResults: VAH was found in 15.6% with a right sided preponderance (61.6% \nright VAH). A perfusion deficit in the PICA-territory was present in up to 37.9% \nof patients with VAH. Time-to-drain (TTD) was the most sensitive map with \nregard to VAH (sensitivity of TTD 37.9%), followed by mean transit time \n(35.6%), and cerebral blood flow (34.5%). Cerebral blood volume was not \naffected in any patient. Cerebellar perfusion deficits were significantly more \nfrequent in patients with VAH than in the control group (7.6%, p < 0.001). \nConclusion: VAH can lead to a perfusion deficit in the cerebellum. CT \nperfusion readers have to be aware of this vascular variant. Its hemodynamic \nconsequences must not be mistaken for acute ischemia.  \nB-0120 11:51  \nEvaluation of computational wall stress analysis as an additional \ncharacterisation tool of small infrarenal abdominal aortic aneurysms  \nT. Nguyen-Kim, L. Jost, T. Pfammatter, T. Frauenfelder; Zurich/CH \n(thidanlinh.nguyen@usz.ch)  \nPurpose: To evaluate the impact of computational wall stress analysis in \ncomputed tomography (CT) of ruptured and not-ruptured small infrarenal \nabdominal aortic aneurysms (AAA) with a diameter of approximately 55 mm as \nan additional predictor for rupture. \nMethods and Materials:  24 patients (median age 72years) with small \ninfrarenal AAA (mean diameter 52.92 ±5.2 mm) underwent CT-angiography of \nthe abdomen. Two groups were formed: group1 (9 patients with acute clinical \nsymptoms and ruptured AAA), group2 (15 patients without clinical symptoms \nand not-rupture d AAA). Using dedi cated software (A4clinics VASCOPS) \nstructural analysis of the infrarenal AAA with the finite element method was \nperformed evaluating exterior and luminal diameter, intraluminal thrombus (ILT) \nthickness, vessel-, luminal- and ILT-volume, peak wall stress (PWS), peak wall \nrupture risk (PWRR). Additionally the mi ses-stress and rupture risk-index in the \nILT were calculated. Non parametric tests were used for comparison of the two \ngroups. \nResults: The maximum exterior diameter, mean total vessel-volume and ILT-\nthickness did not significantly differ between both groups (group1: \n53.6±6.1 mm, 133.3± 38.5 cm3, 11.3 ±9.1 mm; group2: 53.3 ±5.2 mm, \n123.3±52.2 cm\n3, 14.9 mm ±8.3 mm,(p> 0.11)). The maximum luminal-diameter \nand luminal-volume was significantly lower for group2 (group1:47.9 ±21.9 mm, \n70.9±27.4 cm3; group2:39.2 ±7.5 mm, 54.6± 21.7 cm3,p\u00020.046), whereas the \nILT-volume was significantly higher \n(group1:42.0±32.1 cm\n3,group2:51.9±34.1 cm3,p=0.047). In group1 ILT \nmean/maximum mises-stress (group1:6.3 ±2.4kPa/24.5±12.5kPa; \ngroup2:5.6±0.4kPa/20.1±5.2kPa) and maximum rupture risk-index \n(group1:0.41±0.2; group2:0.32 ±0.08) were significantly higher (p < 0.041). \nMean PWS and PWRR were lower in group2 (group1:105.9 ±24.1kPa, \n0.24±0.09; group2:101.4±35.3kPa; 0.28±0.07), but not significantly different. \nConclusion: In patients with equal small AAA diameters the ILT-volume and \nthe finite element analysis may serve as additional predictors for risk-\nstratification.  \n10:30 - 12:00 Conf. Room M3  \nInterventional Radiology  \nSS 109  \nNew IR techniques and animal studies  \nModerators:  \nJ.M. Lee; Seoul/KR  \nC. Rosenberg; Greifswald/DE  \nB-0121 10:30  \nEarly experience of a commercial available robot (Maxio) for CT-guided \nradiofrequency ablation of liver tumours  \nB.J. Abdullah\n1, C.H. Yeong1, K. Goh1, B. Yoong1, G. Ho1, A. Kulkarni2; \n1Kuala Lumpur/MY, 2Florence, OR/US (basrij@ummc.edu.my)  \nPurpose: To assess the accuracy of needle placement, radiation dose and \nperformance level during robotic-assisted radiofrequency ablation (RFA) of \nliver tumours using a CT-guidance robotic system. \nMethods and Materials:  19 patients were treated with RFA with the \nassistance of a robotic system (Maxio, Perfint Healthcare, USA). All the \nprocedures were performed under general anaesthesia. Following baseline CT \nscans, the lesions were identified. The treatment was planned on the Maxio \nworkstation. The accuracy of needle placement, number of readjustments and \ntotal radiation dose to each patient were recorded. The performance level was \ndocumented for each procedure on a five-point scale (5-1: excellent-poor). The \nradiation doses and readjustments were compared against 30 RFA patients \ntreated without robotic assistance. \nResults: RFA was successfully completed in all the patients. All the lesions \nwere targeted successfully with the guidance of robot. Performance levels \nwere all 5 except in one patient (4). The total radiation dose (CTDIvol) of the \nrobotic-assisted RFA was 411.37+-239.22 mGy, whereas the conventional \nRFA was 597.10+-437.63 (p < 0.05). The fluoroscopic dose (DLP) for the \nrobotic and non-robotic assisted RFA were 596.11+-360.16 mGy.cm and \n832.23+-642.80 mGy.cm, respectively (p < 0.05). There were no immediate \ncomplications noted in either group. \nConclusion: Robotic-assisted RFA improves the accuracy of needle \nplacement, reduce number of needle passes, and significantly reduce the total \nradiation dose to the patients.  \nAuthor Disclosures: \nB.J. Abdullah: Equipment Support Recipient; Perfint. Investigator; Publication. \nSpeaker; worshop.  \nB-0122 10:39  \nElectromagnetically navigated TIPS procedure: phantom and in vivo \nevaluation  \nP. Isfort1, H.-S. Na1, T. Penzkofer1, C. Wilkmann1, S. Osterhues1, A. Besting2, \nT. Schmitz-Rode1, C.K. Kuhl1, P. Bruners1; 1Aachen/DE, \n2Herzogenrath/DE (isfort@ukaachen.de)  \nPurpose: To evaluate the feasibility of electromagnetic tracking (EMT) \ntransjugular intrahepatic portosystemic shunt (TIPS) placement in a phantom \nand in vivo setting. \nMethods and Materials: A custom-designed TIPS set consisting of a stainless \nsteel stylet, a polypropylene catheter and a stainless steel outer canula was \ndeveloped. In the tip of both stylet and outer canula, coils were integrated to \nallow tip detection through an electromagnetic tracking system (Aurora, \nNorthern Digital, Waterloo, Canada). For navigation of the TIPS set, a software \nprototype was developed that allows visualisation of both the stylet and the \nouter canula tip position in a previously acquired C-arm CT dataset. The EMT-\nTIPS procedure was performed in a custom made gel-wax phantom (n=80 \ntrials) and in 8 domestic pigs. Domestic pigs were chosen as an animal model \nS162  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nfor challenging TIPS procedures. Time/number of punctures aiming at the \nportal vein was recorded. \nResults: In the phantom setting intervention time to cannulate the portal vein \n(PV) was 144.0 ± 62.8 s. A mean of 1.2 ± 0.4 punctures was needed for PV \ncannulation. In the in vivo trials, the TIPS procedure was successfully \nperformed in 5 out of 8 animals. Time for the complete TIPS procedure \nincluding prosthesis placement ranged from 40 to 562 minutes with a notable \nlearning curve between the trials. \nConclusion: EMT guidance of TIPS placement proved to be feasible in vitro \nas well as in vivo. The system holds promise to substantially facilitate \nchallenging TIPS procedures.  \nB-0123 10:48  \nLaser-assisted transjugular intrahepatic portosystemic shunt: an \nexperimental study  \nJ. Koizumi1, C. Itou1, N. Mori1, T. Hashimoto1, H. Shiozaki2, T. Sekiguchi1, \nT. Ichikawa1, Y. Imay1, B. d'Othée3; 1Isehara-City/JP, 2Tokyo/JP, 3Baltimore, \nMD/US (jkoizumi@is.icc.u-tokai.ac.jp)  \nPurpose: Transjugular intrahepatic portosystemic shunt (TIPS) is widely \napplied to prevent rebleeding of esophag eal varices or to control refractory \nascites. However, it is sometimes difficult to reach portal vein due to rigid \nhepatic parenchyma, acute angle between hepatic and portal vein, etc. Thus, \nwe introduced a laser probe instead of conventional needles. \nMethods and Materials:  For normal porcine liver, 15 J/cm (Group A) vs. 150 \nJ/cm (Group B) were directly delivered each ten times by a 980 nm of diode \nlaser probe in a saline bath. Each traverse area of the vaporided holes, \ncoagulation and carbonised tissues was measured in both groups. TIPS was \nattempted after guidewire negotiation of the hole created by a laser fiber via a \nRosche-Uchida set. \nResults: In group A, 0.36 ± 0.14 mm2 of holes with surrounding 3.9 ± 1.6 mm2 \nof coagulation were observed, while carbonization was not identified. In group \nB, 5.5 ± 2.6 mm2 of carbonization surrounded by 57.8 ± 23.7 mm2 of \ncoagulation were identified without definite holes. The coagulation areas of \ngroup A were significantly (p < 0.01) smaller than the ones of group B. After \nTIPS creation in group A, the coagulation was negligible due to the extended \ntissue by a stent. \nConclusion: For TIPS creation, low energy laser is feasible to open holes to \nallow passage of a guidewire instead of conventional needles.  \nB-0124 10:57  \nImage-guided periarterial ethanol sympathicolysis for renal denervation: \na feasibility study in pigs  \nF. Streitparth, A. Walter, N. Stolzenburg, P. Freyhardt, B. Gebauer, B. Hamm, \nR.W. Günther; Berlin/DE (florian.streitparth@charite.de)  \nPurpose: The aim of this study was to evaluate the feasibility and efficacy of \nimage-guided periarterial ethanol injection as an alternative to transluminal RF \nablation. \nMethods and Materials:  Unilateral renal periarterial ethanol injection was \nperformed under general anaesthesia in 6 pigs with the contralateral kidney \nserving as control. All interventions were performed in an open 1.0-T MRI \nsystem using real-time multiplanar guidance. The injected volume was 5 ml \n(95% ethanol labelled marked MR contrast medium) in 2 pigs and 10 ml in 4 \npigs. Four weeks post-treatment the pigs underwent MRI including MRA and \nwere killed. Norepinephrine (NE) concentration in the renal parenchyma served \nas a surrogate parameter to analyse the efficacy of sympathetic denervation. In \naddition, the renal artery and sympatheti c nerves were examined histologically \nto identify evidence of vascular and neural injury. \nResults: In pigs treated with 10 ml ethanol, treatment resulted in neural \ndegeneration. We found a significant reduction of NE concentration in the \nkidney parenchyma of 53% (p < 0.02) compared with the untreated \ncontralateral kidney. In pigs treated with 5 ml ethanol, no significant changes in \nhistology or NE were observed. There was no evidence of renal arterial \nstenosis in MRI, macroscopy or histology in any pig. \nConclusion: MR-guided periarterial ethanol injection was feasible and efficient \nfor renal sympathetic denervation in a swine model. This technique may be a \npromising alternative to the catheter-based approach in the treatment of \nresistant arterial hypertension.  \nB-0125 11:06  \nChemosaturation with percutaneous hepatic perfusions (PHP) of \nmelphalan for hepatic metastases: experience at two European centers  \nT.J. Vogl\n1, J.-E. Scholtz1, S. Zangos1, J. Trojan1, K. Zacharowski1, F. Orsi2, \nP. Ferruci2; 1Frankfurt a. Main/DE, 2Milan/IT (t.vogl@em.uni-frankfurt.de)  \nPurpose: Chemosaturation with percutaneous hepatic perfusion (PHP; \nHepatic CHEMOSAT® Delivery System; Delcath Systems Inc, USA) is a \nminimally invasive, repeatable regional therapy for unresectable hepatic \nmetastases. It uses a system of catheters and filters to isolate hepatic venous \nblood from the systemic circulation, allowing delivery of high-dose \nchemotherapy to the hepatic artery. Effluent hepatic venous blood is filtered \nbefore returning it to the systemic circulation, thereby reducing exposure to \nchemotherapy. We describe our experiences with chemosaturation-PHP at 2 \nEuropean centres. \nMethods and Materials:  Fourteen patients presented with unresectable \nhepatic metastases from solid tumours; 13 received 1-3 sessions of \nchemosaturation-PHP. Melphalan 2.0 (n=1) or 3.0 (n=12) mg/kg was given as \na 30-minute infusion into the hepatic artery. Twelve patients were evaluable for \ntumour response. \nResults: One complete (cholangiocarcinoma, n=1) and 6 partial responses \n(ocular, n=3 or cutaneous melanoma, n=3) were observed; 5 patients had \nstable disease (ocular melanoma, n=3; breast cancer, n=1; gastric cancer, \nn=1). Mild to moderate filter-related toxicity (i.e. thrombocytopenia, anaemia) \nwas observed immediately post-procedure. Grade 3/4 melphalan-related \npancytopenia developed after 1-2 weeks. All haematological events were \nmanaged effectively with transfusions and/or other supportive measures. The \nnew high-efficiency filter showed milder toxicity and faster recovery. In one \ncase, chemosaturation-PHP was abandoned prematurely due to heparin-\ninduced vaginal-bleeding, and one patient died due to retroperitoneal \nhaemorrhage from heparin anti-coagulation. \nConclusion: Chemosaturation-PHP for non-resectable liver metastases is a \nfeasible treatment option when performed by an experienced multi-disciplinary \nteam. It may be a promising regional therapy for patients with no effective \ntreatment options.  \nB-0127 11:15  \nFluoroscopy-guided infiltration for pain reduction in patients with \nBaastrup disease: clinical experience and results  \nG. Velonakis, D. Filippiadis, A. Mazioti, A. Malagari, E. ALexopoulou, \nN. Kelekis, A.D. Kelekis; Athens/GR (giorvelonakis@gmail.com)  \nPurpose: Baastrup disease refers to degenerative changes of adjacent \nspinous processes with resultant back pain. Purpose of this study is to assess \nsafety and efficacy of percutaneous, fluoroscopy-guided infiltrations in a \nconsecutive series of patients suffering from Baastrup disease (diagnosed \nclinically and by imaging findings). \nMethods and Materials:  During the last 4 years, 55 patients suffering from \nBaastrup disease (diagnosed clinically and by imaging findings) underwent \npercutaneous, fluoroscopy-guided infiltration. The position of the needle (22 \nGauge spinal needle) was fluoroscopically verified at the level of interspinous \nligament. Then a mixture of long acting glucocorticosteroid with local \nanaesthetic (1.5/1 cc) was injected. A questionnaire with NVS scale helped \nassessing pain relief degree, life quality and mobility improvement. \nResults: In the patients of our study a total of 67 sessions was performed. In \n12/55 patients (21.8%) a second infiltration was performed within 7-10 days \napart from the first one. Comparing the pain scores prior (mean value \n8.18±1.44 NVS units) and after (mean value 0.62 ±0.93 NVS units) there was a \nmean decrease of 7.56 ±1.686 NVS units (p < 0.001) on terms of pain \nreduction, effect upon mobility and life quality. There were no clinically \nsignificant complications noted in our study. \nConclusion: Fluoroscopy-guided infiltrations seem to be a feasible, efficacious \nand safe approach for pain reduction and mobility improvement in patients with \nBaastrup disease.  \nB-0128 11:24  \nNext generation multimodal visible embolisation particles: feasibility \nstudy in rabbit and pig animal models  \nJ. Budjan, E. Appel, T. Nguyen, S. Diehl, S.O. Schönberg, C. Reis, \nS.H. Bartling; Mannheim/DE (johannes.budjan@umm.de)  \nPurpose: Aim of this study is to produce and test next generation, multimodal \nvisible (X-ray, CT, MRI), embolisation pa rticles with a narrow particle size \ndistribution and synthesised in a new automated process under 100% quality \ncontrol. Aim of the study is to assess the visibility, manageability and ability to \nperform controlled, selective embolisation with the particles in vivo. \nMethods and Materials:  Particles with a diameter of 200 \u0001m and a narrow \nparticle size distribution ( ± 5% deviation in diameter) are synthesised in a \nclosed-loop automated process. An optimised monomer blend of an iodine \ncontaining monomer with an additional cross-linker is polymerised. The \nmonomer blend contains superparamagnetic iron oxide particles. A kidney \nembolisation model was used. A total of 4 rabbits and 2 pigs were embolised in \nan X-Ray angiography/Dyna-CT-Setup (Siemens Artis Zeego) under live image \ncontrol. The animals were examined in clinical MRI (Siemens Magnetom Trio, \nT1 VIBE, T2* and T2) and CT (Siemens Somatom Definition, 120 kV, 260 mAs, \n0.6 mm collimation) scanners directly before and after embolisation. \nResults: The particles were visible in CT, MRI and during embolisation in X-\nRay/Dyna-CT. A controlled segmental kidney embolisation could be achieved. \nPeriinterventional imaging demonstrated particles in all 3 imaging modalities \nand in positive correlation to histology which showed proper thrombogenesis. \nS163  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nConclusion: The automated synthesis process allows the creation of high \nquality MR, CT and X-Ray visible embolisation particles with a narrow particle \nsize distribution, that will allow, novel, approaches to personalised treatment \nconcepts and therapy monitoring.  \nB-0129 11:33  \nUtility of cone beam computed tomography and ablation planning \nsoftware for monitoring of ultrasound-guided microwave ablation of liver \nmalignancies  \nC. Floridi, G. Carrafiello, A. Ierardi, E. Macchi, F. Fontana, C. Fugazzola; \nVarese/IT (chiara.floridi@gmail.com)  \nPurpose: To prospectively evaluate the utility of C-arm Cone Beam Computer \nTomography (CBCT) and ablation planning software for monitoring of \nultrasound-guided microwave ablation (MWA) of liver malignancies and report \non feasibility and short-term outcome. \nMethods and Materials:  Between November 2012 and September 2013 \nfourteen patients (11 men, 3 women; mean age, 68.5 years) underwent MWA \nof 15 liver lesions (10 hepatocellular carcinomas, 5 metastatic tumours; mean \nsize 25.3 mm) using a C-arm CBCT. Intra-procedural dual-phase CBCT \n(arterial and venous) after intravenous contrast administration was performed \nto determine optimal approach to the lesion (s) using dedicated ablation \nplanning software. MW antennas were positioned under ultrasound guidance \nand non-enhanced CBCT was performed after deployment. CBCT acquired \nbefore and after antenna deployment was registered to evaluate tumour \ntargeting. Diagnostic contrast-enhanced CT was used in case CBCT did not \naccurately depict lesions. CBCT lesion detection accuracy and number of \nneedle re-positioning on the basis of CBCT and software information were \nrecorded. Clinical success was measured on follow-up contrast-enhanced CT. \nResults: All procedures were completed without complications. C-arm CBCT \ndetected 14 of the 15 lesions (93.3%) and registration with diagnostic CT was \nrequired in 1 (6.7%). MW antennas were repositioned on the basis of CBCT \nand software in 10 lesions (76%). Clinical success was achieved in 12 \nablations (80%) while 3 (20 %) presented with local recurrence on follow-up. \nConclusion: Monitoring of ultrasound-guided MWA of liver tumours using C-\narm CBCT and ablation planning software is feasible and leads to needle re-\npositioning in the majority of cases.  \nB-0130 11:42  \nIrreversible electroporation (IRE) in an acute porcine liver model: effect of \nprevious transarterial embolisation with iodised oil (TAEio) on technical \nparameters, CT 3D rendering of the electroporation zone, and histology  \nC.M. Sommer\n1, D.F.J. Vollherbst1, S. Zelzer1, M.F. Wachter1, S. Aulmann1, \nU. Stampfl1, P.L. Pereira2, H.-U. Kauczor1, B.A. Radeleff1; 1Heidelberg/DE, \n2Heilbronn/DE (cmsommer@gmx.com)  \nPurpose: To evaluate the effect of previous transarterial embolisation with \niodised oil (TAEio) on technical pa rameters, CT 3D rendering of the \nelectroporation zone, and histology after IRE in an acute porcine liver model. \nMethods and Materials:  In five landrace pigs, two IREs of the right liver (RL) \nand two IREs of the left liver (LL) were performed with identical system \nparameters. Before IRE, a selective transarterial embolisation of the left liver \nwas performed with iodised oil until stasis. CT examinations were performed \nnon-enhanced and contrast-enhanced to assess the extent of the \nelectroporation zone. After IRE, animals were killed, and livers harvested. \nMean resulting voltage and amperage were assessed during IRE. For CT 3D \nrendering of the electroporation zone, parameters for size and shape (e.g. \nshort axis, volume, and sphericity  index) were analysed. Histological \ndifferences were assessed. \nResults: Mean resulting voltage and amperage were 2545.3 ±66.0V and \n26.1±1.8 A for RL, and 2537.3± 69.0V and 27.7 ±1.8 A for LL without significant \ndifferences. Short axis, volume and sphericity index were 16.5 ±4.4 mm, \n8.6±3.2 cm3 and 1.7 ±0.3 for RL, and 18.2± 3.4 mm, 9.8± 3.8 cm3 and 1.7± 0.3 \nfor LL without significant differences. For RL and LL, the electroporation zone \nconsisted of severely widened hepatic sinusoids containing numerous \nerythrocytes, and showed homogeneously apoptosis. For LL, iodised oil could \nbe detected histologically in the center and at the rim of the electroporation \nzone. \nConclusion: In this acute porcine liver model, there was no adverse effect of \nprevious TAEio on technical parameters, CT 3D rendering of the \nelectroporation zone, and histology after IRE.  \nAuthor Disclosures: \nC.M. Sommer: Grant Recipient; AngioDynamics Research Grant \n10:30 - 12:00 Board Room A  \nRadiographers  \nSS 114  \nConventional radiography: exposure \nindices, image quality and patient dose  \nModerators:  \nE. Atalar; Ankara/TR  \nD. Pekarovic; Ljubljana/SI  \nB-0131 10:30  \nA European collaborative investigation into the impact of additional \ncopper filtration upon dose and image quality for adult chest \nexaminations  \nN. Mekiš1, L.A. Rainford2, T. Starc1, G. Paulo3, S. Foley2, J. Santos3; \n1Ljubljana/SI, 2Dublin/IE, 3Coimbra/PT  \nPurpose: To investigate the impact of additional copper (Cu) filtration upon \nradiation dose received and image quality during adult chest examinations. \nMethods and Materials:  Chest examination protocols across Slovenian \nclinical sites (n=10), detailing: kV, FFD, AEC selection; DR/CR technology, X-\nray beam filtration levels were identified. Experimental protocols (n=36) were \nformulated with referral to Portuguese protocols (n=4) currently employing \nadditional Cu filtration, parameters tested included: 125-150 kVp; 150 cm FFD \n(AEC:R) and 180 cm FFD (AEC:R+L); 2.5 mmAl with additional filtration levels \nof 0.1-0.3 mm Cu. A Whole Body PBU-60 phantom was imaged in a postero-\nanterior chest position. DAP measurements and dose at the thyroid, thorax \nsurface (position of the right breast) and superior breast surface were \nrecorded. Image quality evaluation, incorporating CEC anatomical structure \nscoring, was performed by radiologists from Slovenia and Portugal (n=6) using \nViewdex software, 3MP Barco monitors and ambient lighting levels < 40 lux. \nVGC analysis compared preset protocols with experimental copper filtration \nfindings. \nResults: Application of up to 0.3 mm Cu additional filtration resulted in DAP \nreductions of 33%. VGC findings identified optimal combinations of 180 cm \nFFD, 125 kV and 0.2 mm Cu, resulting in a 24% DAP reduction and 150 cm \nFFD, 145 kV and 0.3 mm Cu recording a 30% DAP decrease. Additional \ncopper filtration reduced dose by up to 57%, 40% and 20% for the thyroid, the \nsuperior and inferior breast surfaces respectively. \n \nConclusion: Reductions in DAP values of up to 33% were identified for \nincreased copper filtration levels, whilst image quality maintenance was \nquantified using VGC analysis for 180 and 150 cm FFD parameters.  \nB-0132 10:39  \nVisual evaluation of target exposure index and deviation index on chest \nx-ray image using digital radiography system  \nS. Fujimoto\n1, M. Shimada1, T. Kata1, E. Kidoya1, Y. Hasegawa1, T. Adachi1, \nH. Kimura1, Y. Mochizuki2, Y. Kitanaka3; 1Yoshida-gun/JP, 2Saitama-shi/JP, \n3 Minato-ku/JP (sfuji@u-fukui.ac.jp)  \nPurpose: The purpose of this study is to examine visual evaluation of target \nexposure index (EIt) and deviation index (DI) specifically for chest X-ray image \nusing digital radiography (DR) system based on the methods of EI and DI \ndefined by IEC and AAPM. \nMethods and Materials: At various EI settings, Chest X-ray images with mimic \ntumours on the back of the chest phantom (KYOTO KAGAKU) were examined \nwith DR system (Philips). For evaluating the EI range under proper image \nquality, sensory test (Scheffe's paired comparison) was performed by 10 \nradiological technologists focusing on noise  of the mimic tumours. In addition, \nobservation ratio on contrast-detail phantom (KYOTO KAGAKU)-examined \nvarious EI values were evaluated by the same radiological technologists. \nResults: No significant difference was found under EI range between \napproximately 400 and 800 by the sensory test. Also EI values of 400 and 800 \nshowed high observation ratio of approximately 95% and 97%, respectively. \nHowever, 150 and 1400 EI showed approximately 90% and 98% observation \nratio, respectively, were considered under and over exposure, respectively. \nConclusion: Considering EI range obtained by the results of both sensory test \nand observation ratio on the contrast-detail phantom, it was indicated that \nproper image quality would be given under EI range between 400 and 800. We \nconclude that EIt and DI for chest X-ray image using DR system is 550 and -\n1.5 to +1.5, respectively. In addition, this method is able to adapt for estimating \nEIt and DI of various parts of X-ray images.  \nAuthor Disclosures: \nS. Fujimoto: Research/Grant Support; Philips Electronics Japan, Ltd.  \nS164  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0133 10:48  \nThe distribution of effective dose and its association with body mass \nindex and dose-area product in abdominal radiographic examinations  \nJ. Jang, J.-H. Park, Y. Cho; Seoul/KR (jsjang@amc.seoul.kr)  \nPurpose: To indentify the distribution of e ffective dose and its association with \nbody mass index (BMI) and dose area product (DAP) in abdominal \nradiographic examinations. \nMethods and Materials:  We analysed data from 57 patients undergoing \nabdominal radiographic examinations in the supine and standing position. The \neffective dose according to the weighting factor published in ICRP 103 was \ncalculated on the basis of patient information such as height, weight and \nexamination condition, including peak  kilovoltage and focus-skin distance, \nusing a Monte Carlo program simulation. The Pearson correlation coefficient \nand linear regression analysis were used to identify the correlation among \neffective dose, BMI and DAP. \nResults: The mean effective dose was 0.208 mSv and 0.273 mSv in the \nsupine and standing position, respectively. DAP correlated very well with \neffective dose in the supine (r=0.973, R\n2=0.946, p=0.000) and standing \nposition (r=0.991, R 2=0.982, p=0.000), respectively. BMI was also significantly \nassociated with effective does in the supine (r=0.821, R 2=0.675, p=0.000) and \nstanding position (r=0.806, R 2=0.649, p=0.000), respectively. The effective \ndose tended to increase as BMI and DAP increased. \nConclusion: BMI and DAP have a large influence in effective dose. Therefore, \nconsidering effective dose and its association with BMI and DAP, the use of \nautomatic exposure control (AEC) and condition of radiation exposure might be \ncontrolled to prevent excessive dosage to patients with high BMI.  \nB-0134 10:57  \n10 kVp rule - an anthropomorphic pelvis phantom imaging study using a \nCR system: impact on image quality and effective dose using AEC and \nmanual mode  \nL.J.O.C. Lanca\n1, L. Franco2, A. Ahmed3, M. Harderwijk4, C. Marti2, S. Nasir3, \nJ. Ndlovu3, M. Oliveira1, A. Santiago1, P. Hogg3; 1Lisbon/PT, 2Lausanne/CH, \n3Salford/UK, 4Groningen/NL (luis.lanca@estesl.ipl.pt)  \nPurpose: This study aims to investigate the influence of tube potential (kVp) \nvariation in relation to perceptual image quality and effective dose for pelvis \nusing automatic exposure control (AEC) and non-AEC in a computed \nradiography (CR) system. \nMethods and Materials:  To determine the effects of using AEC and non-AEC \nby applying the 10 kVp rule in two experiments using an anthropomorphic \npelvis phantom. Images were acquired using 10 kVp increments (60-120 kVp) \nfor both experiments. The first experiment, based on seven AEC combinations, \nproduced 49 images. The mean mAs from each kVp increment were used as a \nbaseline for the second experiment producing 35 images. A total of 84 images \nwere produced and a panel of 5 experienced observers participated for the \nimage scoring using the 2 AFC visual grading software. PCXMC software was \nused to estimate the effective dose. \nResults: A decrease in perceptual image quality as the kVp increases was \nobserved both in non-AEC and AEC experiments, however no significant \nstatistical differences (p > 0.05) were found. Image quality scores from all \nobservers at 10 kVp increments for all mAs values using non-AEC mode \ndemonstrates a better score up to 90 kVp. Effective dose results show a \nstatistical significant decrease (p=0.000) on the 75\nth quartile from 0.3 mSv at \n60 kVp to 0.1 mSv at 120 kVp when applying the 10 kVp rule in non-AEC \nmode. \nConclusion: No significant reduction in perceptual image quality is observed \nwhen increasing kVp whilst a marked and significant effective dose reduction is \nobserved.  \nB-0135 11:06  \nDecision making and variation in radiation exposure factor selection by \nradiographers: an eye-tracking study  \nS. Darcy, L.A. Rainford, R. Toomey; Dublin/IE (sarah.darcy@ucdconnect.ie)  \nPurpose: The goal of radiographic imaging is to produce a diagnostically \nuseful image while minimising patient radiation dose. This study aimed to \nreview variations in exposure factor sel ection by radiographers for virtual \npatients with varying body mass index characteristics. Patient dose is impacted \nupon by a number of exposure parameters including: kVp, mAs, source to \nimage receptor distance (SID) and anti-scatter grids. \nMethods and Materials: Eleven radiographers were asked to assign exposure \nparameters (kVp; mAs; SID; grid) to forty computer-generated patient images, \nwhich represented five BMI categories - underweight; healthy weight; \noverweight; obese; super-obese. There were four examination categories: \nantero-posterior (AP) shoulder; AP lumbar; lateral lumbar; AP ward chest. As \nparticipants assigned exposures their visual patterns were recorded by a Tobii \n® TX300 eye-tracker. \nResults: Significant (p < 0.05) correlation was found between radiographer \nage/experience and assignment of mAs for AP shoulder, and lumbar \nexaminations. Greater age/experience correlated with higher mAs for the AP \nshoulder exam, but with lower values for lumbar examinations. Strong linear \ncorrelation between times to first fi xations on relevant anatomical areas and \nkVp/mAs values existed for the AP portable chest examination. \nConclusion: Exposure selection differences related to age/experience \nhighlight inconsistencies in the practice of exposure parameter setting. The \nreasons for these inconsistencies requires further investigation, and how to \naddress deficiencies in practice requires consideration to optimise safe patient \ncare. Due to the small sample size used, further research into the relationship \nbetween visual factors and individual  examinations is suggested, following the \nfindings regarding the AP portable chest examination.  \nB-0136 11:15  \nAn investigation into the impact of lead shielding application on \nradiographic image quality during lumbar spine examination of obese \npatients  \nJ. Lowe, E. Cronin, L.A. Rainford; Dublin/IE  (joanna.lowe@ucd.ie)  \nPurpose: To determine whether the use of lead shielding (LS) aides in raising \nimage quality levels during lumbar spine examinations of clinically obese \npatients. \nMethods and Materials:  Antero-posterior and lateral lumbar-spine \nradiographs were obtained an anthropomorphic phantom using a kVp range of \n80-110 (projection dependant) with LS appli ed in clinically relevant positions. \nThe phantom was manipulated to achieve 'apple' and 'pear' body shaped body \nhabitus and obesity classes I and II status with application of pre-measured fat \npackets. Diagnostic Imaging lecturers (n=3), with experience in visual grading \nanalysis (VGA), evaluated the phantom images (n=144), scoring CEC \nanatomical criteria under controlled am bient lighting viewing conditions of 25-\n40 lux. Images were displayed using Microsoft power-point on HPL1702 \nmonitors. Statistical analysis of the mean image-quality scores (IQS) was \nperformed to determine if the position of LS and kVp levels influenced resultant \nradiographic image quality. \nResults: Findings indicated no significant impact on the IQS following \nplacement of LS for either body shape variations or obesity classes. \nRadiographs obtained at the lowest kVp levels received the highest IQS. The \nuse of raised kVp levels from normal presets did not significantly impact upon \nIQS with the exception of obesity class II images combined with the 'pear' body \nshape which returned unacceptable VGA findings. \nConclusion: Results indicate that the use of LS did not influence image quality \nduring lumbar spine examinations of the obese phantom models. Optimal \nimage quality was identified following lower kVp application, however, \nacceptable VGA findings were noted at higher kVp levels.  \nB-0137 11:24  \nImage quality and dose analysis in PA chest x-ray: comparison between \nAEC and manual mode acquisition using the 10 kVp rule  \nC.S.D. Reis\n1, J. Gonçalves1, C. Klompmaker2, A. Bárbara1, C. Bloor3, \nR. Hegarty3, T. Lagrange4, N. Temming2, M. Sønnesyn5, H. Røkeness5, \nA. Yamasathien4, P. Hogg3; 1Lisbon/PT, 2Groningen/NL, 3Salford/UK, \n4Lausanne/CH, 5Oslo/NO (claudia.reis@estesl.ipl.pt)  \nPurpose: To compare image quality and effective dose when the 10 kVp rule \nis applied with manual and AEC mode in PA chest X-ray. \nMethods and Materials:  A total of 68 images (with and without lesions) were \nacquired of an anthropomorphic chest phantom in a Wolverson Arcoma X-ray \nunit. The images were evaluated against a reference image using image \nquality criteria and the 2 alternative forced choice (2 AFC) method by five \nradiographers. The effective dose was calculated using PCXMC software using \nthe exposure parameters and DAP. The exposure index (lgM) was recorded. \nResults: Exposure time decreases considerably when applying the 10 kVp \nrule in manual mode (50%-28%) compared to AEC mode (36%-23%). \nStatistical differences for effective dose between several AEC modes were \nfound (p=0.002). The effective dose is lower when using only the right AEC \nionization chamber. Considering image quality, there are no statistical \ndifferences (p=0.348) between the different AEC modes for images with no \nlesions. Using a higher kVp value the lgM values will also increase. The lgM \nvalues showed significant statistical differences (p=0.000). The image quality \nscores did not present statistically significant differences (p=0.043) for the \nimages with lesions when comparing manual with AEC modes. \nConclusion: In general, the dose is lower in the manual mode. By using the \nright AEC ionising chamber the effective dose will be the lowest in comparison \nto other ionising chambers. The use of the 10 kVp rule did not affect the \ndetectability of the lesions.  \n \n \n \nS165  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0138 11:33  \nDose reduction with PA projection in sacroiliac joint imaging  \nN. Mekiš; Ljubljana/SI  \nPurpose: To investigate the impact of the PA projection instead of the \nstandard AP projection for sacroiliac joint (SIJ) imaging on the entrance skin \ndose (ESD), testicular dose and image quality. \nMethods and Materials:  The study was conducted both, on an \nanthropomorphic phantom and on 50 male patients, randomly divided into two \nequal groups. In the first group the SIJ imaging was conducted in the AP \nprojection, whereas in the second group the imaging was conducted in the PA \nprojection. The dose was measured by thermoluminescent dosimeters (TLD) \nplaced at the centre of the image field and on the testicles. Image quality \nevaluation by using CEC anatomical structure scoring was performed by two \nradiologists and by three senior radiographers. \nResults: When using the PA projection the ESD was reduced from \n7.01±3.59 mGy to 5.21± 2.57 mGy (p=0.046). The testicular dose was reduced \nfrom 27.92 ±22.07 \u0001Gy to 5.64 ±4.26 \u0001Gy (p < 0.001). However, the image \nquality was better in the AP projection (p=0.012). \nConclusion: The results have shown that the ESD and testicular dose in SIJ \nimaging were lower in PA projection. The image quality performed on patient \nimaging was lower in PA projection compared to the AP projection, but they \ncould still be used for diagnostics. Therefore the PA projection can be \nrecommended as a method of choice in SIJ imaging.  \nB-0139 11:42  \nThe effect of breast shielding in panoramic dental imaging  \nN. Mekiš, N. Dove\u0013ar; Ljubljana/SI  \nPurpose: To investigate the impact of lead  shielding and its position on breast \ndose in adult panoramic dental imaging. \nMethods and Materials:  The study was conducted on an anthropomorphic \nphantom. The breasts were simulated by breast implants of two different sizes \n340 ml and 500 ml. Shield coat and gonadal apron of 0.5 mm lead equivalent \nwere used. The measurements were performed without the use of lead \nshielding and then with three different positions of shielding: coat for the whole \nbody, gonad apron at the rear of the phantom and gonad apron at the front of \nthe phantom. The dose was measured by EDD-30 placed at the centre of the \nbreast, on the top of the breast and on the top of the lungs. \nResults: Using the lead coat shielding reduced the dose at the centre of the \nright breast (500 ml) from 2.3 8Gy to 0.6 \u0001Gy and the dose at the centre of left \nbreast (340 ml) from 2 8Gy to 0.2 8Gy. Dose reduction to the breasts when \nusing gonadal apron at the back of the phantom was on average 1% and an \naverage of 70% was achieved when using it at the front. The dose reduction at \nthe top of the lungs was from 20.5 8Gy to 1.6 8Gy when the lead coat shielding \nwas used. \nConclusion: Based on the results, we can conclude that the use of coat lead \nshielding is recommended in the panoramic dental radiography. Despite the \nlow-dose exposure even without shielding, the dose can be further reduced.  \nB-0140 11:51  \nVariation of lumbar and pelvis Agfa exposure index in different \nradiography equipment's  \nR. Lopes\n1, J. Santos2; 1Vila Nova de Foz Côa/PT, 2Coimbra/PT \n(rogeriolopes87@gmail.com)  \nPurpose: The exposure index (EI) is a useful tool to estimate patient dose \nbased on detector exposure. Agfa systems described EI as logarithmic value \n(IgM), that corresponds to 1.96 bels in standard Speed Class. The increase of \n0.3 in lgM value corresponds to twice of the detected dose. The aim of this \nstudy was analyse the Agfa exposure index variation during lumbar and pelvis \nradiographies. \nMethods and Materials:  Random anthropomorphic phantom was exposed to \nlumbar (frontal and lateral view) and pelvis radiographies in ten different \ncentres. Experimental test with exposure parameters according to the \nrecommendations were performed, with and without automatic exposure \ncontrol (AEC). Unfors Patient Skin Dosimeter (PSD) was used to quantify \npatient dose and lgM was directly obtained on Agfa workstations. \nResults: The lgM mean value with AEC was 1.90 bels with mean patient dose \nof 75.15\u0001Sv and without AEC was 2.06 bels with 68.68 \u0001Sv. For lumbar frontal \nand lateral view, with the same exposure parameters, the major lgM value \ndifferences were 27% and 33%, respectively. For pelvis the major difference \nwas 29%. Despite lgM variation the PSD obtained values per body region were \nsimilar across the centres. \nConclusion: The lgM value revealed a large variation during lumbar and pelvis \nexposures in different radiography equipment's.  \n \n \n \n \n10:30 - 12:00 Room P  \nComputer Applications  \nSS 105  \nTrends in reporting, image managment \nand mobile computing  \nModerators:  \nU.W. Engelmann; Dossenheim/DE  \nA. Simisker; Tartu/EE  \nB-0141 10:30  \nFirst experience with a novel time-saving method for automatic labelling \nand curved multiplanar reconstructions for spinal CT  \nJ.-E. Scholtz, J.L. Wichmann, M. Kaup, C. Frellesen, M. Beeres, T. Lehnert, \nT.J. Vogl, J. Kerl, R.W. Bauer; Frankfurt a. Main/DE (jan-erik.scholtz@kgu.de)  \nPurpose: To evaluate a novel method for automatic labeling and curved \nmultiplanar reconstructions of spinal CT and to investigate its potential for time \nsavings and workflow improvement. \nMethods and Materials:  77 patients (28 women, 49 men, mean age \n65.3±14.4 years) with known spinal disease including degenerative changes of \nneuroforamina or spinal canal (n=32), disc herniation (n=36) or traumatic \nvertebral fractures (n=9) were examined usi ng 64-slice MDCT. Required time \nfor automatic labeling and curved multiplanar reconstructions of the examined \nvertebral column was compared with manual reconstructions. Error rate and \nadditional time for manual error correction during automatic labelling was \nassessed. Both curved multiplanar reconstructions were assessed by two \nobservers regarding evaluation of anatomical structures. \nResults: Correct automatic labelling was achieved in 72 patients (93.5%) with \nan error rate of 6.5% (n=5), which could be manually corrected in all cases \nwithin 16.0 ±6.6 seconds. Automatic processing of the whole vertebral column \nwas significantly faster (p < 0.05) than manual reconstruction (266.3 ±6.8 \nseconds vs. 286.7 ±9.7 seconds, p < 0.05). Automatic reconstructions were \npreferred by both observers in 52 cases (67.5%). In 25 cases (32.5%), both \nobservers stated that both reconstruction methods allowed an equally good \nevaluation of anatomical structures of the spine. There was no interobserver \ndisagreement. \nConclusion: The presented automatic labelling and curved multiplanar \nreconstruction method for evaluation of vertebral column CT is time saving and \nmight improve the workflow in routine clinical practice as it rarely requires \nmanual adjustment. Furthermore, automated curved reconstructions were \npreferred in 2/3 of cases and potentially facilitate evaluation of spinal anatomic \nstructures.  \nAuthor Disclosures: \nJ. Kerl: Speaker; Siemens Healthcare, CT Division. R.W. Bauer:  Speaker; \nSiemens Healthcare, CT Division. \nB-0142 10:39  \nOptimising RECIST reading using dedicated software  \nA. René1, S. Aufort2, S. Si Mohamed2, B. Gallix1; 1Montpellier/FR, \n2Castelnau-Le-Lez/FR (amandine.rene@intrasense.fr)  \nPurpose: The purpose of the study was to evaluate the reading time and \nreliability improvement using dedicated oncology software in comparison with \nmanual determination of RECIST response. \nMethods and Materials: 40 patients who underwent a CT-scan follow-up have \nbeen evaluated according to RECIST criteria using a standard viewer and \ndedicated software with 3D elastic targ et matching and automatic calculation of \ntumoral response (Myrian® XL-Onco, Intrasense). The medical database \ncontained thoracic and abdominal images. Readings were performed by two \noperators both with distinct degrees of experience. Reading times, inter and \nintra-operator reproducibility of measurements and response misclassifications \n(PD, SD, PR, CR) were evaluated. \nResults: Reading times and reproducibility were not affected by the operator \ndegree of experience. In average, the reading time was reduced by 49.7% \nusing dedicated software (mean manual reading time: 106.3 sec., mean \nsoftware reading time: 50.2 sec., p < 0.05). When stratifying results by target \nlocalisation, the decrease in reading time was 36.1% for hepatic targets (mean \ntarget size: 45.5 mm) and 63.4% for pulmonary targets (mean target size: \n18.7 mm). Inter and intra-operator reproducibility of measurements according \nto each method was identical (r=0.99). Using dedicated software prevented \nfrom misclassifications on 10 readings out of 120 (8 were due to calculation \nerrors). \n \nS166  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nConclusion: The use of dedicated oncology software optimises RECIST \nevaluation, decreasing significant ly reading times and response \nmisclassifications.  \nAuthor Disclosures: \nA. René: Employee; Intrasense Employee (CIFRE).  \nB-0143 10:48  \nRECIST management at investigator sites: evaluation of a cloud-based \nquality control of imaging evaluations in clinical trials  \nN. Sueoka-Aragane1, N. Kobayashi1, E. Bonnard2, C. Charbonnier3, E. Oubel3, \nJ. Yamamichi4, H. Mizobe4, S. Kimura1; 1Saga/JP, 2Nice/FR, 3Valbonne/FR, \n4Tokyo/JP (sueokan@cc.saga-u.ac.jp)  \nPurpose: Imaging evaluation in oncology depends on readers performances. \nIn order to standardise RECIST (Response Evaluation Criteria in Solid Tumors) \napplication at investigator sites, this study tested a cloud-based quality control \nof response evaluations. \nMethods and Materials: 11 cancer patients with chest CT scans available at 3 \ntime points were retrospectively selected. Images were reviewed following \nRECIST 1.1 criteria by two oncologists (Japan and Scotland) and one \nradiologist (France). They used cloud solutions (MEDIAN Technologies) \nhosted by a data center (Canon, Japan) ensuring centralisation and quality \ncontrol of both images and evaluations. A quality control of evaluations \nconsisted for the radiologist in checking \noncologists' baseline evaluation and establishing a consensus for the choice of \ntarget lesions. The impact of this consensus was analysed by measuring the \nmean inter-observer agreement on evaluations. \nResults: The agreement rate between the oncologists and the radiologist for \nthe target lesions choice increased from 59% (13/22 baselines) to 82% (18/22) \nbefore and after consensus. Justifiable differences in images interpretation \nprevented from having 100%. An agreement rate of 82% (36/44 evaluations) \nwas observed for response evaluations before and after consensus. The rate \nwas higher than in a previous pilot study without consensus (40%, 8/20). The \nquality control solved all non-conformities to RECIST (18%, 4/22 baselines). \nConclusion: The study shows the feasibility of a cloud-based quality control of \nimaging evaluations in multi-center international clinical studies that ensured \n100% of compliance with RECIST criteria. An improved agreement in the \nchoice of target lesions was accomplished in conformity to RECIST.  \nB-0144 10:57  \nMobile DICOM viewing applications facilitate multicenter radiology  \nI. Reicht, D. Simons, M. Fangerau, H.-P. Meinzer, A. Sassenberg, K. Yen, \nH.-P. Schlemmer; Heidelberg/DE (i.reicht@dkfz.de)  \nPurpose: Mobile communication via tablet devices and smartphones has \nincreasingly entered the healthcare sector. Continuous improvements in the \nresolution of tablet devices have made them interesting for radiological image \nviewing. However, integrating mobile applications into radiological workflows is \ndifficult since major investments for extending IT infrastructure are often \nrequired. Here we introduce an economical approach to easily integrate \nradiological infrastructures, facilitate multicenter networking and establish a \nsophisticated base for target-oriented procedures of forensic medicine based \non mobile applications. \n \nMethods and Materials:  Feasibility of integrating the CT infrastructure of the \nInstitute of Forensic Medicine, University of Heidelberg, and the Department of \nRadiology, German Cancer Research Center (DKFZ), Heidelberg was \nevaluated with a forensic-radiological workflow. This included acquiring CT \nimages, radiologists viewing images to generate pre-reports and furthermore \nforensic pathologists viewing images al ong with radiologists' pre-reports at \nautopsy. To view and access images the application MITKpocket, developed \nby the Department of Medical and Biological Informatics at DKFZ, was used \nwhich allows offline image processing on tablet computers. \nResults: Inter-department communication in the case of forensic imaging \npurposes was facilitated. The CT infrastructures were integrated by virtual \nprivate network (VPN) while MITKpocket supported radiologists and \npathologists to access and process images. Hence no cost-intensive \ninvestments to extend modify and maintain the previously existing radiological \ninfrastructures were needed. \nConclusion: A practical approach to integrate mobile radiological applications \ninto multicenter workflows was best achieved by offline capable applications of \nteleradiology. Even limitations of wireless IT infrastructure could be fully \ncompensated within the forensic-radiological workflow.  \n \nB-0145 11:06  \nDICOM-SandBox, an open communication platform for collaborative \nresearch  \nN. Roduit, T. Strgar, O. Ratib; Geneva/CH  \nPurpose: The goal of our project is to develop a secure portal for exchange of \nlarge sets of medical images between professionals. Unlike existing DICOM-\nbased teleradiology systems intended for clinical data, we elected to design an \nopen system that allows researchers to exchange anonymised image data in a \ndecentralised peer-to-peer architecture based on social networking paradigm. \nThis project is an exploratory initiative of the ESR eHealth and informatics \nsubcommittee. \nMethods and Materials: The file exchange platform was developed around an \nOpen Source framework called \"ownCloud\" (www.owncloud.org), allowing \nuniversal data and file exchange through web interface or WebDav that \nenables users to use existing cloud-based storage services though a single \nportal. The system handles the management of social networks of a \ncommunity of users supporting notificati on and data exchange between users \nor groups. The open \"plug-in\" architecture allowed us to extend its \nfunctionalities with specific features for management and display of DICOM \nfiles. Hierarchical storage and thumbnail preview of image series are part of \nthe added features. Special interface modules were developed for seamless \nintegration of existing Open-Source DICOM viewers including OsiriX and \nWeasis (www.osirixviewer.com). The system relies on existing cloud-storage \nservices such as DropBox and Google drive, allowing each user to use his own \nstorage service. \nResults: A prototype system was developed and tested among different \nacademic institutions for exchange and communication of anonymous DICOM \nfiles. \nConclusion: The DICOM-SandBox system provides an Open-Source solution \nfor convenient and efficient exchange and communication of DICOM files \namong academic and research teams.  \nB-0146 11:15  \nComparison of a tablet-PC with a high-resolution display and a dedicated \nPACS worsktation in emergency MDCT interpretation  \nS. Tewes, T. Rodt, S. Marquardt, E. Evangelidou, F. Wacker, C. von Falck; \nHannover/DE (c.v.falck@gmx.de)  \nPurpose: To compare a tablet-PC with a high-resolution display (iPad 3) and a \ndedicated 3D PACS workstation for the interpretation of emergency CT \nexaminations \nMethods and Materials:  The detectability of early signs of cerebral infarction \nand subtle pulmonary embolism in 40 CCT and 40 CTPA examinations was \nscored by three readers using both, a tablet-PC with a high-resolution display \n(iPad 3, Apple Inc., USA) running a radiology app (Visage Ease, Visage \nImaging GmbH, Berlin, Germany) and a 3D PACS workstation (Visage 7.1, \nVisage Imaging GmbH, Berlin). Diagnostic confidence was evaluated on a 5-\npoint-Likert scale. Statistics included Wilcoxon rangsum test, Spearman's \ncorrelation and Cohen's kappa. \nResults: For all readers, there was no significant difference in the median \nscore between iPad 3 and PACS for the CCT and the CTPA, respectively \n(p> 0.05). The mean Spearman's correlation coefficients were 0.46 ( ±0.2) / \n0.69 (±0.16) for the comparison between the iPad and the PACS, 0.41 ( ±0.16) / \n0.68 ( ±0.06) for observer agreement using the iPad and 0.35 (± 0.05) / 0.68 \n(±0.10) for observer agreement using the PACS for CCT and CTPA, \nrespectively. Mean kappa values were 0.52 ( ±0.17) / 0.67 ( ±0.19) for the \ncomparison between iPad and PACS, 0.33 ( ±0.16) / 0.69 ( ±0.08) for observer \nagreement using the iPad and 0.32 (± 0.16) / 0.60 ( ±0.14) for observer \nagreement using PACS. The differences were not considered statistically \nsignificant (p> 0.05) \nConclusion: There is no significant difference from interobserver agreement in \nthe interpretation of typical emergency CT examinations between the iPad 3 \nand a dedicated PACS workstation.  \nAuthor Disclosures: \nT. Rodt: Research/Grant Support; Visage Imaging. F. Wacker: \nResearch/Grant Support; Visage Imaging, Siemens Healthcare. C. von Falck: \nResearch/Grant Support; Visage Imaging, Siemens Healthcare. \n \nS167  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0147 11:24  \nQuality control in radiology reporting: experience in a private setting  \nT. Laswad1, D. Fournier1, H. Brat1, M. Deac2, O. Deriaz1; 1Sion/CH, \n2Morges/CH (tarek_laswed@yahoo.com)  \nPurpose: The aim of this study is to set up quality criteria of our radiology \nreports, to present a quality control model for reporting, to identify the most \nfrequent errors in our reporting and to suggest corrective actions of \nimprovement. \nMethods and Materials:  32 quality criteria of radiology reports have been \ndefined and adapted by the radiologists in a group of private clinics covering \nthe main imaging modalities. Five pairs of radiologists evaluated 250 structured \nanonymous reports independently. A consensual review and discussion was \nperformed for all reports foor both analytical and educational purpose. A \nscoring system of the various criteria was made to depict the weak points in \nthe reports. We only studied the reports, not the imaging details. \nResults: We identified our most frequent reporting errors (global and individual \nanalysis). The most frequent reporting errors were: wrong study title, unclear \nindication, vague conclusion and not answering the clinician's question. We set \nup a pertinent checklist of quality criteria of our structured reports. We present \ntypical examples of conformity, consistency and the most frequent errors in \nreporting. This project enhanced the aware ness of radiologists about their most \nfrequent reporting errors. Peer review was appreciated by radiologists as it \nhelps to share knowledge. \nConclusion: Improvement of the quality of the report depends mainly on the \nawareness and involvement of radiologists to apply quality standards. Quality \nimprovement of structured reporting must be a continuous process of \ncorrection and implementation (continuous quality improvement principle).  \nB-0148 11:33  \niPad-based primary 2D reading of CT angiography examinations of \npatients with suspected gastrointestinal bleeding: performance \ncomparison with a conventional workstation  \nL. Faggioni\n1, E. Neri1, I. Bargellini1, P. Scalise1, F. Calcagni1, G. D'Ippolito2, \nC. Bartolozzi1; 1Pisa/IT, 2São Paulo/BR (lfaggioni@sirm.org)  \nPurpose: To evaluate the effectiveness of the iPad for 2D reading of CT \nangiography studies performed for suspected acute gastrointestinal bleeding. \nMethods and Materials:  Twenty-five CT angiography (CTA) examinations of \npatients with suspected acute gastrointestinal bleeding either confirmed (20/25, \n80%) or ruled out (5/25, 20%) by digital subtraction angiography (DSA) were \nretrospectively reviewed by four independent readers. Two readers evaluated \nsource axial CTA images on a commercial workstation (Advantage Windows \n4.5, General Electric, Milwaukee, WI), whereas the others assessed the same \nimages on an iPad with Retina Display™ (64GB model, Apple Inc, Cupertino, \nCA). All CTA images had been wirelessly transferred on the iPad in JPEG \nlossless format using the Bonjour™ protocol. The time needed to complete \nreading of every CTA examination on the iPad and the workstation, detection \nof arterial blush, and suspected bleeding arteries as assessed on both devices \nwere recorded. \nResults: The time needed to complete reading of every CTA study was \nsignificantly shorter on the iPad than on the workstation (171 ±84 vs 227 ±91 \nseconds, respectively; p < 0.002). Sensitivity and specificity for arterial blush \ndetection were 85% and 60% for the workstation and 90% and 80% for the \niPad, respectively. Inter-reader agreement for workstations and iPads was \ngood (Cohen k=0.70) and very good (k=0.88), respectively. Agreement of \nworkstation and iPad vs DSA on bleeding arteries was very good (k=0.82 and \n0.89, respectively). \nConclusion: iPad-based preliminary 2D reading of CT angiography studies of \npatients with suspected acute gastrointe stinal bleeding is feasible and \nsignificantly faster compared with a conventional workstation.  \nB-0149 11:42  \nAdaptive support for PACS interface customization  \nW. Jorritsma, F. Cnossen, P.M.A. van Ooijen; Groningen/NL \n(w.jorritsma01@umcg.nl)  \nPurpose: To evaluate the usefulness of adaptive customization support in the \nPicture Archiving and Communication System (PACS) user interface. \nMethods and Materials:  Adaptive support was given in the form of \ncustomization suggestions, generated based on behavioural user data, which \nparticipants could choose to accept or ignore. Twelve radiologists worked with \nthe standard adaptable version of the PACS for six weeks, during which their \nactions on the PACS interface were logged. Based on these logging data, \ncustomization suggestions were generated for each specific participant. Half of \nthe participants received these suggestions and half did not. After the \nsuggestions, logging continued for another six weeks. Participants' \ncustomization behaviour and performance, measured as the average time \nneeded to review a radiography study, were compared between the groups. \nSubjective responses to the customization process were also measured. \nResults: Participants accepted most of the customization suggestions and all \nparticipants indicated that the suggesti ons were useful. Participants who \nreceived customization suggestions used the customizable elements of the \nPACS's interface more frequently than participants who did not receive the \nsuggestions. There were no effects in the performance data, possibly because \nthe performance measure we used was not sensitive enough. Subjective \nresponses did show that participants judged the adaptive support as improving \ntheir efficiency. \nConclusion: Adaptive customization support is a valuable addition to the \nstandard adaptable PACS interface, because it allows radiologists to \ncustomize their interface more effectively and can thereby increase the \nefficiency with which they interact with the PACS.  \n \nB-0150 11:51  \nWeb-based interactive 3D visualisation of CT image data on tablet \ncomputers for educational purposes  \nR. Unterhinninghofen1, S. Doll2, F. Rengier2, R. Talanow2, J. Kirsch2, \nR. Dillmann1, H.-U. Kauczor2, F.L. Giesel2; 1Karlsruhe/DE, \n2Heidelberg/DE (roland.unterhinninghofen@kit.edu)  \nPurpose: Volume rendering of CT image data is a 3D visualisation technique \nwell known from commercial workstations where it supports diagnostics and \ntherapy planning. In order to render these appealing views available for \neducational purposes, we developed dedicated software solution \nAnatomyMap. \nMethods and Materials:  Since tablet computers usually do not provide \nsufficient computational power to render 3D visualisation at interactive rates, \nwe created a client-server solution based on in-house developed software \nframework MEDIFRAME. A high-performance server performs rendering on \ndemand and streams the resulting views via internet to the client, e.g. a tablet \ncomputer. Users find a common display with 2D and 3D views of the CT data \nthat may be scrolled, rotated, zoomed, or panned interactively. For educational \npurposes labels may be displayed for selected anatomical structures. Also, for \neach structure an appropriate view is predefined that can be reached in an \nanimated flight. In exercise mode users assign names to empty labels using \ndrag and drop. \nResults: 30 CT datasets of different body parts, including head, neck, thorax, \nabdomen, and extremities were manually labelled with (normal) anatomical \nstructures. Additionally, 12 CT datasets we re labelled with specific pathological \nstructures. The software has been experimentally used in an online course with \n10 users located at different places in Europe. All users were able to run the \nweb-based software and perform the required exercises. Depending on \nindividual internet bandwidth overall experience with interactive rendering was \ngood. \nConclusion: AnatomyMap has been found a prac ticable tool and motivating \nextension to the anatomical atlas.  \n14:00 - 15:30 Room B  \nAbdominal Viscera  \nSS 201a  \nAdvanced imaging of pancreas  \nModerators:  \nL. Grzycka-Kowalczyk; Lublin/PL  \nC. Triantopoulou; Athens/GR  \nB-0151 14:00  \nIncidental hypervascular pancreatic lesions: prevalence and imaging \nfeatures on MDCT  \nP. Allegranza, D. Ippolito, F. Leone, P.A. Bonaffini, S. Sironi; Monza/IT \n(pietroallegranza@gmail.com)  \nPurpose: To assess frequency of hypervascular pancreatic lesions (HPL) \nincidentally detected on multidetector CT (MDCT) and to evaluate \nmorphological features that can allow their characterisation. \nMethods and Materials:  From August 2012 to February 2013, we \nretrospectively reviewed on the Institution's electronic database 3827 \nconsecutively contrast-enhanced abdominal MDCT performed both on a 256 \n(iCT, Philips) or 16-row CT scanner (Brilliance, Philips). The inclusion criterion \nwas the incidental detection of hypervascular pancreatic lesions in patients \nwith no symptoms related to the lesion itself. We evaluated several CT findings \nincluding lesion location, size, morphol ogy, presence of calcification and \nvascular pattern. Then, we correlated imaging findings with available clinical \ndata. \nResults: We detected 28 solid HPL (prevalence 0.4%) in 14 patients (9 male, \n5 female; age range 67-83, mean 76). Sizes ranged from 3 to 58 mm, (mean \n13 mm; median 9 mm); most common site of the lesion was the pancreatic tail \nS168  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n(11/28). A final diagnosis was reached in all cases by medical history or \nhistopathological analysis: pancreatic neuroendocrine tumour (11/28), \nintrapancreatic accessory spleen (1/28), and renal cell tumour (RCC) \nmetastases (16/28). Main pancreatic duct obstruction without parenchymal \natrophy was found in 1 patient (RCC lesion). Symptoms were present in 2/14 \n(14%) patients; reported symptoms were SIADH (1 case) and abdominal pain \n(1 case). Dimensional growth during follow-up was observed in 21/28 cases \n(16/21 were RCC multiple pancreatic metastases). \nConclusion: Incidental HPL are uncommon findings on MDCT. When multiple \nlesions are present, MEN I syndrome and presence of RCC should be \nconsidered.  \nB-0152 14:09  \nDiagnostic accuracy of 256-detector row computed tomography in \ndetection and characterisation of incidental pancreatic cystic lesions: a \nlarge population series  \nP. Allegranza, D. Ippolito, P. Bonaffini, F. Leone, D. Fior, A. Casiraghi, \nS. Sironi; Monza/IT (pietroallegranza@gmail.com)  \nPurpose: To assess the diagnostic value of 256-detector row MDCT in \ncharacterisation of incidentally detected pancreatic cystic lesions in a large \npopulation of patients. \nMethods and Materials:  We retrospectively reviewed 6389 examinations \nperformed on a 256-row detector scanner (iCT, Philips, 120 kV, automated \ncurrent modulation) between January 2011 and February 2013 for incidental \ndetection of pancreatic cysts. 192 patients (99 females, 93 males; age range \n31-90) were enrolled. Images were evaluated by two radiologists referring to \nstandardised morphologic features and predictive signs of malignancy: lesion's \nlocation, multifocality, size, communication with main pancreatic duct (MPD), \nMPD size, inner septa, wall thickening and mural enhancing nodules. \nResults: We evaluated 292 cysts in 192 patients (prevalence 2.05%). \nDiagnosis was established by histopathology or by imaging analysis: solitary \nbranch type IPMN (48.4%), multifocal branch-type IPMN (14.1%), main type \nIPMN (13%), mixed IPMN (10.4%), pseudocysts (2.6%), mucinous (7.3%) and \nserous cystoadenoma (3.7%), metastases (0.5%). Solitary cysts were found in \n145/192 (75.5%), two lesions in 27/192 (14.1%) and more than two in 20/192 \npatients (10.4%). Size ranged from 3 to 145 mm (mean 15 mm); lesions were \nmostly located in pancreatic body (87/292; 29.8%). We detected septa in \n52/292 lesions, wall thickening > 2 mm in 13/292, wall enhancement in 15/292, \nmural enhancing nodules in 12/292, communication with ductal system in \n25/292 and MPD dilatation in 10/292. \nConclusion: MDCT provide important diagnostic features for characterisation \nof pancreatic cystic lesions, incidentally discovered with increased frequency \ndue to the widespread use of cross-sectional imaging.  \nB-0153 14:18  \nEffect of incidental pancreatic cystic lesions on all-cause mortality and \nincidence of pancreatic adenocarcinoma and ductal carcinoma  \nV. Chernyak, M. Flusberg, L. Haramati, A.M. Rozenblit, E. Bellin; Bronx, \nNY/US (vichka17@hotmail.com)  \nPurpose: To assess effect of incidental pancreatic cysts (IPC) on all-cause \nmortality and incidence of pancreatic adenocarcinoma (AdenoCA) and \npancreatic ductal carcinoma (DCA). \nMethods and Materials:  Cyst cohort included cases with CT/MR reports done \nbetween 11/1/01 and 11/1/11 describing IPC. No-cyst cohort was frequency-\nmatched on age decade, modality and year of initial study from pool of patients \nwithout reported IPC. Cases diagnosed with pancreatic cancer within 5 years \nof initial CT/MR were excluded. Charlson 2 scores within 2 months of index \ndate were recorded. 10-year cumulative mortality and 10-year cumulative \nincidence of AdenoCA/ DCA were compared between the cohorts. Cox Hazard \nmodels were constructed with all-cause mortality and incidence of \nAdenoCA/DCA as outcome events, adjusting for age, sex, imaging modality \nand Charlson 2 score. \nResults: There were 1,337 cases in Cyst cohort and 3,993 cases in No-cyst \ncohort with mean age of 70.6 (± 15.4) and 70.0 ( ±15.6) years, respectively \n(p=0.304). 10-year cumulative all-cause mortality was 13.0% (95% CI 10.2-\n16.5) in Cyst cohort and 11.7% (95% CI 10.1-13.4) in No-cyst cohort. 10-year \ncumulative incidences of AdenoCA/DCA were 1.6% (95% CI 0.8-3.3) in Cyst \ncohort and 0.3% (95% CI 0.1-0.6) in No-cyst cohort (p < 0.001). For all-cause \nmortality, IPC had HR of 1.74 (95%CI 1.14-2.64) in subjects < 70 years and HR \nof 0.9 (95% CI 0.69-1.18) in those \u000370 years. For AdenoCA/DCA, IPC had HR \nof 4.22 (95%CI 1.65-10.8). \nConclusion: Incidental pancreatic cysts on CT/MR are associated with 4.2 \ntimes higher risk of pancreatic AdenoCA /DCA and with 1.7 times higher all-\ncause mortality in subjects < 70 years.  \n \n \n \nB-0154 14:27  \nArterial hypervascular solid-looking serous cystadenoma of the \npancreas: differential diagnosis with neuroendocrine tumours  \nH. Park, S. Kim, S. Park, S.-M. Hong, S. Lee, J. Byun, J. Kim, H. Kim, \nM.-G. Lee; Seoul/KR (hesoni86@gmail.com)  \nPurpose: To describe imaging findings of arterial hypervascular solid-looking \nserous cystadenoma (SCN) of the pancreas on CT and MR and to find imaging \nfeatures which differentiate it from neuroendocrine tumour (NET). \nMethods and Materials: Among 211 patients with surgically proven SCNs, we \nretrospectively identified 15 arterial hypervascular solid-looking SCNs. We \nrandomly chose size-matched 30 NETs from 80 pancreatic NETs. Two \nradiologists evaluated available CT and MR images in consensus. On CT, the \nreviewers assessed the size, location, shape, margin, CT attenuation and \nenhancement grade relative to the adjacent pancreatic parenchyma on the \nnon-enhanced and dynamic phases. On MR, signal intensity characteristics of \nthe tumour on T1-, T2-weighted images and ADC maps were evaluated. These \nfeatures and measurements were compared using the Fisher exact test and \nthe Mann-whitney test. \nResults: The frequency of arterial hypervascular solid-looking SCNs was 5.1% \namongst all SCNs. The mean size was 25.8 mm (range, 8.4-80 mm). CT \nfindings were similar between the two tumours: location, shape, margin, and \nenhancement patterns the dynamic phases. However, SCNs were significantly \nhypodense on non-contrast CT images than NETs (P=.03). They differed \nsignificantly on MR: bright signal intensity on T2-weighted images were more \ncommon in SCNs than NETs (P=01). All SCNs showed restricted diffusion on \nADC map, while none of NETs did (P <.01). \nConclusion: It is often difficult to differentiate arterial hypervascular solid-\nlooking SCNs from NETs, since they share similar imaging features. \nHypoattenuation on non-contrast CT images, bright signal intensity on T2-\nweighted MR images, and diffusion restriction can facilitate the differentiation.  \nB-0155 14:36  \nAdded value of diffusion-weighted imaging to conventional MR imaging \nin the preoperative detection of small pancreatic carcinoma  \nS. Kwon, Y. Kim, D. Choi, W. Lee, W.-K. Jeong, J. Min, M. Cha, C. Jeong; \nSeoul/KR (soyi.kwon@samsung.com)  \nPurpose: To evaluate the benefit of adding diffusion-weighted (DW) imaging \ninto the conventional MR imaging in the preoperative detection of small \npancreatic carcinoma (\u0002 2.0 cm). \nMethods and Materials:  The study included 83 patients (56 men, 27 women) \nwith surgically confirmed pancreatic adenocarcinoma (n= 53 \u0002 2.0 cm; n=30 \n2.1-3.0 cm) and 12 patients with histologi cally proven focal pancreatitis who \nunderwent gadoxetic acid-enhanced MR imaging and DW imaging between \nAugust 2010 and November 2012. Two observers independently reviewed two \nimage sets: 1) conventional MR imaging set including MR \ncholangiopancreatography and 2) combined image set including DW imaging \nto evaluate the circumferential tumour conspicuity using receiver operating \ncharacteristic curve analysis. Contrast ratios of each tumour and proximal or \ndistal pancreatic parenchyma to tumour on T1- and T2-weighted image, arterial \nand portal phase, and b-800 DW imaging were also calculated. \nResults: On b-800 DW imaging, most tumours were completely (n=32, 38.6%) \nor partially (n= 59.0%) delineated. For each observer, A\nZ values for tumour \ndetection were 0.852 and 0.884 for the conventional image set, and 0.975 and \n0.978 for the combined set (P =0.003; 0.04). For detecting 53 tumours ( \u0002 \n2.0 cm), the combined set (96.2%[51/53]; 94.3%[50/53]) yielded better \nsensitivity than the conventional image set (67.9%[36/53]; 71.7%[38/53])  \n(P=0.001; P=0.008), although no significant difference was found between the \ntwo image sets for detecting tumour > 2.0 cm ( P> 0.05). Contrast ratio of \ntumour on b-800 image was significantly higher than those of other images \n(P \n< 0.0001). \nConclusion: In preoperative evaluation of small pancreatic adenocarcinoma, \nthe addition of DW imaging to the conventional MR-imaging could improve \nsensitivity in tumour detection.  \nB-0156 14:45  \nComparison of 320-row perfusion CT-angiography with endoscopic \nsonography in preoperative diagnostic of isulinomas  \nE. Mukhamatullina, S. Kondrashin, S. Ternovoy; Moscow/RU \n(elzilaur@mail.ru)  \nPurpose: To compare the accuracy of preoperative detection of insulinomas \nbetween perfusion CT-angiography and endoscopic sonography. \nMethods and Materials:  A total of 90 patients, main group 45 patients with \nspecific clinical symptoms and Wipple's tri ad and control group of 45 patients \n(43.4± 2.8 years) underwent perfusion CT-angiography. Endoscopic \nsonography was performed for main group of patients. Patients were scanned \non 320-detector row CT scanner with following parameters: dynamic volume \nscan mode, gantry rotation 0.5 sec, scan coverage 10-16 cm, tube voltage \nS169  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n100 kV and tube current 150 mA, slice thickness 0.5x320 mm. IV injection of \n60 ml contrast media (320-350 mgI/ml) with flow rate of 5 ml/s was used. The \nprotocol for dynamic pancreas-imaging consisted of 19 intermittent images. \nImage datasets were reconstructed with 0.5-mm slice thickness and a total of \n6,400 images for the entire examination. Analysis of dynamic pancreas images \nwas performed in MPR, MIP projections using 4D cine mode. Respiratory \nmisregistrations were compensated with the software. Perfusion was \ndetermined with the gradient relationship technique. Contrast time-density \ncurves and perfusion maps were generated. \nResults: Endoscopic sonography was performed in 45 patients and allowed \ncorrect localisation of 50/ 66 tumours. Detection rate of perfusion angiography \nwas higher than for endoscopic sonography 61/66 (92.4%). Arterial flow was \nraised in patients with isulinoma in normal parenchyma comparing to control \ngroup (p < 0.05). \nConclusion: 320-row perfusion CT-angiography significantly improves \ndiagnostic confidence as compared to endoscopic sonography. Perfusion \nimaging carries the potential to improv e detection of insulinomas due to the \nsignificant perfusion differences.  \nB-0157 14:54  \nPancreatic neuroendocrine tumours: correlation between histogram \nanalysis of apparent diffusion coefficient MRI maps and tumour grade  \nJ. Sousa Pereira1, E. Rosado2, M.A. Bali3, T. Metens3, S.-L. Chao3, \nP. Demetter3, C. Matos3; 1Lisbon/PT, 2Amadora/PT, 3Brussels/BE \n(josepereira1985@hotmail.com)  \nPurpose: To explore the role of histogram analysis of apparent diffusion \ncoefficient (ADC) MRI maps based on entire tumour volume data in \ndetermining pancreatic neuroendocrine tumour (PNT) grade. \nMethods and Materials:  Retrospective evaluation of 22 patients with PNTs, \nincluding low-grade (G1; n=15), intermediate-grade (G2; n=4) and high-grade \n(G3; n=3) tumours. Regions of interest containing the lesion were drawn on \nevery section of the ADC map containing the tumour and summated to obtain \nhistograms for entire tumour volume. Calculated histographic parameters \nincluded mean ADC (mADC), 5\nth percentile ADC (ADC5), 10 th percentile ADC \n(ADC10), 25 th percentile ADC (ADC25), 50 th percentile ADC (ADC50), 75 th \npercentile ADC (ADC75), 90 th percentile ADC (ADC90) and 95 th percentile \nADC (ADC95), skewness and kurtosis. Histogram parameters were correlated \nwith tumour grade by repeated measures analysis of variance with Tukey-\nKramer post hoc comparisons. \nResults: The mADC, ADC75, ADC90 and ADC95 were significantly higher in \nG1 tumours (1283± 267; 1404 ±300; 1495 ±318; 1562 ±347 x 10-6 mm2/s) \ncompared to G2 (892 ±390; 952±381; 1036±384; 1072±374 x 10-6 mm2/s) and \nto G3 tumours (733± 225; 864± 284; 1008± 288; 1152 ±192 x 10-6 mm2/s) (p-\nvalue< 0.05). Skewness and kurtosis were significantly different between G1 \n(0.041±0.466; 2.802± 0.679) and G3 (1.01 ±1.140; 5.963 ±4.008) tumours (p-\nvalue< 0.05). Tumour volume (ml) was significantly higher on G3 (55 ±15.7) \ncompared to G1 (1.9± 2.7) and G2 (4.5± 3.6) tumours (p-value < 0.05). In this \nsmall sample size, we did not detect statistically significant parameters \nbetween G2 (n=4) and G3 (n=3) tumours. \nConclusion: Histographic analysis of ADC maps based on the entire tumour \nvolume can be useful in differentiating histologic grades of PNTs.  \nB-0158 15:03  \nPreoperative assessment of the pancreatic fat fraction and fibrosis in \npatients who underwent pancreatectomy using breath-hold, T2* corrected \ntriple-echo Dixon water-fat separation and diffusion weighted imaging \nusing intravoxel incoherent motion model  \nJ. Yoon\n1, J. Lee1, K. Lee1, B. Kiefer2, M. Kang1, J.-Y. Jang1, S.-W. Kim1, \nJ. Han1, B. Choi1; 1Seoul/KR, 2Erlangen/DE  \nPurpose: To evaluate diagnostic performance of triple-echo Dixon technique \nand intravoxel incoherent motion (IVIM)-diffusion weighted imaging (DWI) for \npancreatic steatosis and fibrosis in the patients who underwent \npancreatectomy, and to determine correlation between pancreatic fat, fibrosis \nand incidence of postoperative pancreas fistula (POPF). \nMethods and Materials:  This retrospective study was approved by our \ninstitutional review board and informed consent was waived. One hundred sixty \ntwo patients (M:F=92:70, mean age 62 years) underwent MRI at 3.0 T \npreoperatively and pancreatectomy. Fat fraction and IVIM-DWI parameters on \nMR were compared with fat fraction and fibrosis degree (F0-3) of the \nspecimen. In addition, fat fractions and IVIM-DWI parameters were compared \nin groups with and without POPF. Presence of POPF was determined based \non postoperative imaging, lab findings, and contents of surgical drain tubes. \nResults: In 162 patients, fat fraction on MR and that of specimen showed a \nstrong relationship (r=0.77). Among the IVIM-DWI parameters, only perfusion \nfraction was significantly different between F0-1 and F2-3 (30 ±10% vs. \n23.3±9.2%, p < 0.005). Fat fraction of the specimen did not show significant \ncorrelation with presence of POPF, either. \nConclusion: Pancreas fat and fibrosis can be quantified on preoperative MR \nbut the relationship with POPF and imaging parameters was unclear yet.  \nAuthor Disclosures: \nJ. Lee: Advisory Board; Bayer Schering Pharma. B. Kiefer: Employee; \nSiemens AG Healthcare sector. B. Choi: Consultant; Samsung. \nB-0159 15:12  \nPancreatic adenocarcinoma: comparison of six MRI sequences including \ndiffusion-weighted imaging for tumour conspicuity  \nF.-X. Arnaud, L. Legrand, E. Sibileau, I. Boulay, M. Zins; Paris/FR \n(fx.arnaud@yahoo.fr)  \nPurpose: To assess the best MR sequences for pancreatic adenocarcinoma \nconspicuity. \nMethods and Materials:  Our local institutional review board approved this \nretrospective study and waived the informed consent requirement. 54 \nconsecutive patients with pathologically proven pancreatic adenocarcinoma \nunderwent MRI (1.5 T, n=27 or 3 T, n=27). Fat-supressed (FS) T1-weighted \ngradient-echo (GRE), FS T2-weighted, 3D FS dynamic T1-weighted \ngadolinium-enhanced GRE during arterial, portal and delayed phases and \ndiffusion-weighted imaging (DWI) with b values of 0 and 600 or 800 sec/mm2 \nwere obtained. For each sequence, two gastrointestinal radiologists \nindependently assessed the subjective vi sual conspicuity using a four-point \nrating scale (0 to 3). They designated the sequence with the best visual \nconspicuity. The study coordinator perf ormed a quantitative analysis, placing \nregions of interest for tumor-to-pancreas contrast (either proximal or distal). \nThe visual conspicuity scores were compared using Fischer's test, and the \ntumor-to-pancreas contrasts were compared using paired Wilcoxon or t-tests. \np-values were considered statistically significant at p < 0.05. \nResults: 96% of Pancreatic adenocarcinomas appeared hypointense on 3D \nFS T1 GRE arterial phase, which was the best sequence for tumor conspicuity \n(2.6±0.7), followed by portal phase (2.2 ±1.0) and DWI (2.0± 1.0)(p < 0.01). The \narterial phase was designated as the best sequence in 50% of cases versus \n20% for DWI. Greatest tumor-to-pancreas contrast was noticed on the arterial \nphase. DWI was not useful for delineating 61% of tumors. \nConclusion: 3D FS T1 GRE arterial phase is the best sequence for pancreatic \nadenocarcinoma conspicuity. DWI is limited for clear delineation of the tumor.  \nB-0160 15:21  \nIs MDCT capable of detecting perineural invasion in pancreatic head \ncancer?  \nE. Kasatkina, V.K. Lyadov, I. Shrayner, S. Bogomazova, E. Mershina, \nV.E. Sinitsyn; Moscow/RU (ekkasatkina@gmail.com)  \nPurpose: The aim of study was to find whether MDCT is capable to detect \nextrapancreatic perineural invasion (EPI) pre-operatively in resectable \nadenocarcinoma of pancreatic head. To our knowledge, accuracy for \ndiagnosing carcinoma invasion into extrapancreatic neural plexus has not been \nestablished. \nMethods and Materials: Preoperative-CT-series of 38 patients with resectable \nadenocarcinoma of pancreatic head were evaluated by two independent \nobservers retrospectively. EPI was iden tified as confluent tissue of similar \nattenuation to primary PC extending along neural plexuses pathways. Plexus-\nPancreaticus-Capitalis-II (PLX-II:area along inferioposterior pancreatoduodenal \nartery (IPDA) and jejunal trunk) was assessed as this area is more susceptible \nfor extrapancreatic invasion of pancreatic head cancer. Two patterns of \nperipancreatic spread were established: confluent tumour spread (Pattern 1) \nand infiltration (Pattern 2) along known pathway or in retropancreatic adipose \ntissue. \nResults: All patients underwent Whipple-procedure, histologically \nadenocarcinoma of pancreatic head was confirmed in all patients. EPI was \nfound in 26 patients (68.4%), 19 of them showed intrapancreatic perineural \ninvasion. EPI was more prominent in lager tumours. All 26 patients with \npositive PLX-II-invasion were correctl y diagnosed on preoperative CT-scans by \nboth observers. Interobserver agreement was 92% (Pa=0.922) with Kappa \nvalue=0.63, which represents good agreement between two observers. \nPattern1 was found in 16 patients, Pattern2 in 10 patients. Sensitivity of MDCT \nwas 99%, specificity 59%, diagnostic accuracy 81%. \nConclusion: MDCT provides sufficient diagnostic information to detect PLX-II-\ninvasion on preoperative CT-series in patients with adenocarcinoma of \npancreatic head. Preoperative detection of EPI, which is significant cause of \npositive surgical margin and tumour recurrence, can influence clinical \nmanagement of patient-choice to perform surgical treatment or neoadjuvant \ntherapy.  \n \nS170  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n14:00 - 15:30 Room D  \nCardiac  \nSS 203  \nMyocardial ischaemia and late \nenhancement: MRI  \nModerators:  \nG. Bastarrika; Pamplona/ES  \nA.M. Taylor; London/UK \nB-0161 14:00  \nCombined assessment of stress myocardial perfusion MRI and iterative \nsuper-resolution whole-heart coronary MR angiography in detecting \ncoronary artery disease  \nM. Uno, M. Ishida, R. Nakayama, T. Ito, Y. Goto, Y. Ichikawa, M. Nagata, \nK. Kitagawa, H. Sakuma; Tsu, Mie/JP (ishidamasaki1@gmail.com)  \nPurpose: Stress myocardial perfusion MRI is useful for the detection of \ncoronary artery disease (CAD). Whole-heart coronary MR angiography \n(WHCMRA) permits non-invasive visualisation of coronary stenoses. However, \nthe additive value of WHCMRA to stress perfusion MRI is not well known. \nRecently, we have newly developed a super-resolution (SR) technique \noptimised for WHCMRA. The purpose of this study was to evaluate the value \nof combined assessment of stress perfusion MRI and SR-WHCMRA for \ndetecting CAD. \nMethods and Materials:  43 consecutive patients (71 ±10 years) with \nsuspected CAD who underwent both coronary angiography (CAG) and cardiac \nMRI including stress perfusion MRI, LGE and WHCMRA within 1 month were \nstudied. High-resolution WHCMRA was generated by iterative SR technique. \nThe observers recorded the presence of abnormality representing significant \nCAD for stress perfusion MRI, WHCMRA and the combination of both using 4-\npoint scale, respectively. Stenoses \u000370% was considered significant on CAG. \nResults: 129 coronary territories were eligible for the analysis including 20 \nterritories with previous stent implantation. Stress perfusion MRI was \ndiagnostic in all territories. WHCMRA was diagnostic in all coronary trees \nexcept for stent segments. On vessel-based analysis, diagnostic performance \nassessed by area under the ROC curve (AUC) was significantly higher with \ncombined assessment of SR-WHCMRA and stress perfusion MRI (AUC 0.892; \nsensitivity 87.0%; specificity 83.1%) than with stress perfusion MRI only (AUC \n0.741; sensitivity 60.9%; specificity 79.5%) (p=0.0005). \nConclusion: Iterative SR-WHCMRA combined with stress perfusion MRI can \nprovide excellent diagnostic performance for the detection of CAD.  \nB-0162 14:09  \nEvaluation of cirrhotic cardiomyopathy in end stage virus C hepatitis by \ndelayed myocardial enhancement  \nN.H. Behairy, D. Omran; Cairo/EG (nohabehairy@gmail.com)  \nPurpose: This study aims to evaluate functional and morphological myocardial \nchanges in hepatitis C virus patients with end stage liver disease listed for liver \ntransplantation by cardiac magnetic resonance. \nMethods and Materials:  Twenty-eight patients with end stage liver disease \nsecondary to hepatitis C virus listed for liver transplantation were enrolled in \nthis study. The mean patient's age was 55 ±8 years. The mean model for end-\nstage liver disease score was 25.5 ± 6.3. All patients were subjected to routine \nlaboratory investigations, upper gastrointestinal endoscopy, abdominal \nultrasound, 2D-echocardiography and cardiac magnetic resonance. \nResults: All patients showed adequate left ventricle contractility with normal \nwall motion and thickness. Patients showed  a normal range of ejection fraction \nfrom 55 to 80% with mean 65.5 ±11.8. We found variable degrees of delayed \nmyocardial enhancement in 21 (84%) of our patients. A significant negative \ncorrelation was found between the percentage of delayed myocardial \nenhancement and the ejection fraction, cardiac output, cardiac index and \nserum albumin level. \nConclusion: We conclude that severe liver cirrhosis secondary to hepatitis C \nvirus causes functional and morphological changes within the myocardium \nwhich could be accurately evaluated by cardiac magnetic resonance.  \nB-0163 14:18  \nRelevance of small areas of myocardial ischemia in adenosine stress MR  \nF. Longaretti, M. del Corral, M. Bocciolone, B. Nardi, V. Lisignoli, L. Balzarini, \nL. Monti; Rozzano/IT (lorenzo.monti@humanitas.it)  \nPurpose: To compare the clinical relevance of reporting all the areas of \nischemia observed at visual interpretat ion of stress perfusion (\"radiologic\" \napproach: method 1), versus the hypothesis of reporting only mild-to-moderate \nareas of ischemia, i.e. > 6% of LV mass (\"cardiologic\" approach: method 2). \nMethods and Materials:  Retrospective re-analysis of a series of stress MR, \nwith perfusion acquired after 4' of adenosine infusion at 140 mcg/Kg/min, 3 \nslices every heart beat allowing a 16 myocardial segments evaluation. MR \nadenosine stress was reported as positive : In method 1 in the presence of any \narea of subendocardial perfusion defect, and in method 2 only if at least 2 \nsubendocardial regions (2 half segments in the 16 segments model). \nResults: We analysed a series of 274 stress MR, finding out 75 patients with a \ncoronary angiography < 3 months after the diagnostic test. Prevalence of \ndisease among the studied population wa s 73.3%. Method 1: sensitivity 89.1%, \nspecificity 45%, PPV 81.6% (95%CI :70 to 89); NPV 60% (95% CI 35.7 to \n80.2), global accuracy of 77.33%. Method 2: sensitivity78.2%, specificity 75%, \nPPV 89.6% (95% CI 77.8 to 95.5), NPV (95% CI 37.3 to 72.4), global accuracy \nof 73.3%. \nConclusion: Exclusion of small areas of ischemia doubled the number of false \nnegative results from 6 to 12. The global accuracy of the exam did not changed \nbetween the 2 reporting methods. Therefore, also small areas of myocardial \nischemia should be reported in a stress MR report.  \nB-0164 14:27  \nNo reflow as predictor of adverse outcome in patients with acute \nmyocardial infarction: the role of cardiac magnetic resonance (CMR) and \ncoronary angiography  \nG. Benedetti, F. De Cobelli, A. Esposito, A. Damascelli, M. Cava, A. Colombo, \nA. Margonato, P.G. Camici, A. Del Maschio; Milan/IT \n(giulietta.benedetti@gmail.com)  \nPurpose: No reflow (NR) is a phenomenon due to microvascular obstruction \n(MVO), with partially known implication in STEMI patient's outcome. The best \ntools to assess the presence of NR are CMR and angiography. The aim of our \nstudy is to assess CMR superiority, compared to angiography, to detect MVO \nand predict patient's outcome. \nMethods and Materials:  All STEMI patients enrolled in our study underwent \npercutaneous coronary intervention (PCI) and CMR within 5 days from the \nacute event. We correlated the occurrence of MVO with the incidence of \nadverse cardiac events at 1 and at 6 months. \nResults: Forty patients (age 61±  10 yrs) were enrolled in the study, 30 of \nwhom have been followed up for 6 months. Twenty-seven patients had \nevidence of MVO (4.9 ± 4.5%) at CMR, while angiography detected only 14. \nThree pts experienced events in the 1\nst month and there was a significant \ncorrelation between early events and MVO% (p=0.006), but not with LE \nextension (p=0.34). Pts with MVO were also hospitalised for a longer period \n(p=0.06). Among the 30 pts with 6 months follow-up, we recorded events in 9 \npatients (1 reinfarction, 7 target lesion revascularisation 8 (TLR), 3 new PCI, 2 \nCABGs). Patients with MVO at CMR presented a higher incidence of TLR \n(p=0.06). The same correlations were not found for angiographic NR. \nConclusion: These data confirm that CMR is more powerful than angiography \nin MVO identification. MVO at CMR may help to identify pts with higher \nincidence of adverse events and TLR need.  \nB-0165 14:36  \nImpact of age-related differences on myocardial salvage (MS), micro-\nvascular obstruction (MVO) and left ventricular remodelling (LV-R) \nfollowing primary percutaneous coronary intervention (PCI): insights \nfrom cardiac magnetic resonance (CMR)  \nI. Iacucci, I. Carbone, M. Mancone, D. Gianluca, C. Catalano, M. Francone; \nRome/IT (ilaria.iacucci@gmail.com)  \nPurpose: Elderly population is the most represented in acute coronary \nsyndromes; however, only few studies investigated impact of age on \nmyocardial damage in patients presenting with STEMI undergoing primary PCI. \nOur aim was to evaluate whether differences in terms of MS, MVO and LV-R \nemerged among different tertiles of age in a population of STEMI patients \nundergoing CMR. \nMethods and Materials:  Ninety STEMI patients, subcategorised into 3 tertiles \n(33-50, 51-65, 66-80 years old, group I, II, III, respectively) according to age, \nunderwent CMR within 5 days after successful PTCA (time-to-reperfusion: 12 \nhrs within symptom onset) and at 6 months follow-up. Reversible and \nirreversible myocardial injury indexes of LV-R were quantified and compared \namong groups. \nResults: Infarct size (IS), MVO, LV end-systolic and end-diastolic volumes \n(ESV; EDV) were larger in group.i. as compared to group III (respectively, \np=0.006, p=0.0001, p=0.019, p=0.004) and were associated with more \nsignificant acute global systolic dysfunction in the same group (mean ejection \nfraction: 41.6%; p=0.018). MS was significantly higher in group.i. rather than \ngroup III (p=0.039). Positive LV-R was observed at 6 months follow-up only in \ngroup III patients (LV-ESV > 20%; p < 0.001). \nConclusion: Our preliminary CMR data suggest that age-related differences \nexist in acute STEMI patients regarding main indexes of myocardial injury and \nare characterised by larger extent of IS and larger micro-vascular damage in \nyounger patients and adverse remodelling at follow-up in elderly, likely \nS171  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nreflecting an extreme heterogeneity of early response and late adaptation to \nmyocardial necrosis  \nB-0166 14:45  \nHow microvascular obstruction impacts on left ventricle remodelling: a \ncardiac magnetic resonance (CMR) study  \nA. Damascelli, F. De Cobelli, A. Esposito, G. Benedetti, M. Cava, A. Durante, \nA. Colombo, P.G. Camici, A. Del Maschio; Milan/IT (damascelli.anna@hsr.it)  \nPurpose: The role of CMR in the prognostic stratification of patients with ST-\nelevation myocardial infarction (STEMI) is still under investigation. Great focus \nhas recently been given to the no reflow phenomenon, caused by \nmicrovascular obstruction (MVO). The aim of this study is to evaluate how \nCMR parameters progressively change after infarction and how MVO impacts \non left ventricle (LV) remodelling. \nMethods and Materials:  In this ongoing prospective study, 43 consecutive \nSTEMI patients, admitted to our ER and treated with PCI, were enrolled and \nunderwent a first CMR study (1.5 T magnet) within 5 days from the infarction. A \nsubgroup underwent a second CMR after 6 months. The main morpho-\nfunctional parameters were assessed on both CMRs. End-diastolic volume \nmodification between the second and the first CMR ( \u0005EDV) was used to \nevaluate LV remodelling. The criteria for MVO were a subendocardial lack of \nenhancement on first-pass perfusion sequence and/or the presence of a \nhypointense region, within the late-enhancement (LE) area. \nResults: A group of 14 patients (age 61 ±9 years) underwent both CMR \nstudies. There was a significant increase in EDV only in the group with MVO as \ncompared to the group without MVO ( \u0005EDV=32 ±27 ml; p=0.005 vs \n\u0005EDV=4.5±16 ml; p=0.6). MVO, LE and perfusion defects showed a direct \ncorrelation with \u0005EDV, with a significant relationship at regression analysis \n(MVO%: p=0.001; R2=0.6; LE%: p=0.005, R-squared=0.5; perfusion defect%: \np=0.01; R-squared=0.6). At multivariate analysis only MVO% presented a \nsignificant relation with \u0005EDV (p=0.02). \nConclusion: These preliminary data suggest that MVO is involved in LV \nremodelling after myocardial infarction.  \nB-0167 14:54  \n3D free-breathing cardiovascular 3 T MRI: late gadolinium enhancement \ncompared to breath-hold 2D imaging  \nM.B. Bizino, Q. Tao, J. Amersfoort, R.J. van der Geest, H.J. Lamb; Leiden/NL \n(h.j.lamb@lumc.nl)  \nPurpose: Clinical 3D cardiovascular magnetic resonance imaging (CMR) is \ndesirable, since it allows post-acquisition reformatting in any desired imaging \nplane. 3D-CMR is hampered by long breath-hold duration, introducing patient \ndiscomfort and technical limitations. These limitations can be overcome by \napplication of respiratory navigator techniques, for example to perform late \ngadolinium enhanced (LGE) CMR. This 3D approach allows to: (1) perform 3D-\nCMR during free-breathing; (2) increase image resolution; (3) average out \nheart rate variability by using a phase sensitive inversion recovery sequence \n(PSIR); (4) improve myocardial nulling, especially relevant at higher MR field \nstrength such as 3 T. Therefore, the purpose of the present study was to \ndevelop and clinically test free-breathing 3D-LGE-CMR using a respiratory \nnavigator approach at 3 T in comparison to standard 2D breath-hold. \nMethods and Materials: Between May 2012 and June 2013, 3D and 2D-PSIR \nsequences were acquired after administration of Dotarem (Guerbet). \nRetrospectively, 26 patients with LGE were selected for analysis (21 men; \nmean age ± standard deviation: 62.2 ±7.8). Myocardial scar tissue (ml), SNR, \nCNR and edge sharpness (ES) of scar tissue were quantified. Parameters \nwere compared with a paired t-test. \nResults: Myocardial scar tissue volume (3D: 27.11 ±17.94; 2D: \n29.50±15.43 ml; p = 0.49), SNR (3D: 100.88± 31.97; 2D: 89.92± 18.57; p=0.06) \nand CNR (3D: 3.96 ±1.84; 2D: 3.55 ±0.68; p=0.25) were not significantly \ndifferent between 3D and 2D sequences. ES was significantly higher for 3D \nCMR (3D: 0.051±0.0072; 2D: 0.048±0.0085; p=0.019). \nConclusion: Free-breathing 3D-LGE-CMR enables reliable myocardial scar \ntissue assessment with improved image resolution as compared to standard \n2D breath-hold imaging.  \nB-0168 15:03  \nCardiac magnetic resonance imaging findings and the risk of \ncardiovascular events in patients with recent myocardial infarction or \nsuspected or known coronary artery disease: a systematic review of \nprognostic studies  \nH. El Aidi\n1, A. Adams1, K. Moons1, H. den Ruijter1, P. Doevendans1, E. Nagel2, \nS. Schalla3, M. Bots1, T. Leiner1; 1Utrecht/NL, 2London/UK, 3Maastricht/NL \n(t.leiner@umcutrecht.nl)  \nPurpose: The purpose of this study was to investigate the association \nbetween CMR findings and future cardiovascular events by systematically \nreviewing the current literature. \nMethods and Materials:  Cohort studies published before 2013 identified by \nsystematic MEDLINE and EMBASE searches and citation tracking were \nevaluated. Studies evaluating associations between CMR findings (left \nventricular ejection fraction [LVEF], wall motion abnormalities [WMA], \nmyocardial perfusion, microvascul ar obstruction [MVO], late gadolinium \nenhancement [LGE], edema, and intramyocardial haemorrhage [IMH]), and \nhard events (all-cause mortality, cardiac death, cardiac transplantation, \nmyocardial infarction) or major adverse cardiovascular events (MACE) were \nincluded. \nResults: Of the 3,040 (MEDLINE) and 656 (EMBASE) articles retrieved, 56 \nmatched our selection criteria (n=25,497 patients). For patients with a recent \nmyocardial infarction, no relation was found between CMR findings and hard \nevents, but late MVO (adjusted hazard ratio (HR)-range: 1.03-10.4, 668 \npatients) and IMH (adjusted HR-range: 1.17-2.80, N=749) were independently \nassociated with MACE. In patients with suspected/known CAD, inducible WMA \n(adjusted HR-range: 1.87-2.99, N=2,863), and inducible perfusion defects \n(adjusted HR-range: 3.02- 7.77, N=4,012) were independently associated with \nhard events. Inducible perfusion defects were also associated with MACE \n(adjusted HR-range: 1.76-3.21, N=2,392). For other CMR findings, either no \nassociation was found or few studies were available. \nConclusion: Among patients with a recent myocardial infarction, late MVO and \nIMH are independently associated with MACE. In patients with \nsuspected/known CAD presence of inducible WMA are associated with hard \nevents and inducible perfusion defects are associated with hard events and \nMACE.  \nB-0169 15:12  \nSize of late gadolinium enhancement in patients with hypertrophic \ncardiomyopathy in correlation with serum MMP9 as an indicator of \nmyocardial fibrosis  \nM. Avanesov, M. Patten, J. Münch, P. Bannas, D. Sähring, E. Tahir, G. Adam, \nG. Lund; Hamburg/DE (m.avanesov@uke.de)  \nPurpose: We compared size of late gadolinium enhancement (LGE) obtained \nby cardiac magnetic resonance (CMR) imaging in patients with hypertrophic \ncardiomyopathy (HCM) with serum MMP9, which is a marker of myocardial \nfibrosis. \nMethods and Materials:  CMR was performed in 50 patients with HCM (mean \nage: 54.9 ±14.1 years, 27 women) using a 1.5 Tesla scanner (Achieva, \nPhilips). Size of fibrosis was quantified in percent of total myocardium on \ninversion-recovery images after injection of 0.2 ml/kg gadolinium using the \nHeAT software and compared with levels of serum MMP9. A serum level of \n> 46 ng/ml was regarded as increased. \nResults: Nine out of 50 patients with HCM (18 %) showed no fibrosis on LGE-\nCMR. In the remaining 41 patients, mean size of fibrosis was 13.3 ±10.3% on \nLGE-CMR. In all patients, the mean MMP9 level was 54.4 ±35.2 ng/ml. Size of \nfibrosis on LGE-CMR strongly correlated with MMP9 levels (R2=0.557, \nPearson's r= 0.75, p < 0.01). In the 9 patients with no LGE, MMP9 was with \n29.6 ± 14.2 ng/ml significantly lower compared to the 41 patients with LGE and \nlevels of 59.8 ± 36.2 ng/ml (p =0.01). \nConclusion: Size of fibrosis on LGE-CMR strongly correlated with the serum \nfibrosis marker MMP9 in patients with HCM. However, 2% of patients revealed \nno LGE despite increased MMP9 levels. These patients may have a diffuse \nmyocardial fibrosis which is not detectable by standard LGE-CMR.  \nB-0170 15:21  \nDo left ventricular volumes correlate with late enhancement in \nhypertrophic cardiomyopathy?  \nG. Muscogiuri1, M. Di Girolamo1, C.N. De Cecco2, S. Fierro1, D. Magrì1, \nV. David1; 1Rome/IT, 2Latina/IT (g.muscogiuri@hotmail.it)  \nPurpose: To correlate left ventricular volumes and late enhancement (LE) \nmass in patients with hypertrophic cardomyopathy. \nMethods and Materials:  We retrospectively evaluated 85 patients with HCM \ndiagnosis. All patients were studied with a 1.5 T MR. The study protocol \nincluded cine True-Fisp sequences (TR:3.09 ms,TE:1.3 ms, FA:80,thick:8 mm) \nfollowed by inversion recovery Turbo-Flash sequences for LE evaluation \n(TR:8 ms,TE:4 ms,TI:250-340 ms,thick:8 mm) acquired 10-15 minutes after iv \nadministration of 0.2 mmol/kg of Gadolinium. Left end-diastolic volume (EDV), \nend-systolic volume (ESV), stroke volume (SV), ejection fraction (FE) and LE \nmass was measured on short axis by manual planimetry using a dedicated \nsoftware. LE was considered as an area with SI > 6SD from normal tissue. \nPatients were divided in two different subgroup with LE (Group 1) and without \nLE (Group 2). For statistical analysis we used Spearman's correlation. \nResults: The following results were observed respectively in Group 1 and 2: \nLE mass 12±16 g, EDV 121±37 ml, ESV 39 ±21 ml, SV 87±23 ml, EF 72±9% in \nGroup 1 and EDV 115 ±29 ml, ESV 31 ±18 ml, SV 84 ±20 ml, EF 76 ±9% in \nGroup 2. Patient with LE presented higher EDV, ESV, SV and lower EF in \ncomparison to patients negative for LE. Significant correlation was not \nobserved between LE mass and EDV (p=0.6) and SV (0.25) while statistical \nS172  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nsignificant correlation was observed between LE mass, ESV (0.01) and EF \n(0.0001). \nConclusion: This study show that an increase of LE mass is correlated with a \ndecrease of left ventricle EF and increase of ESV.  \n14:00 - 15:30 Board Room B  \nHead and Neck  \nSS 208  \nPathologies of the orbit and temporal bone  \nModerators:  \nT. Rodt; Hannover/DE  \nB.F. Schuknecht; Zurich/CH  \nB-0171 14:00  \nExploration of orbital and orbital soft-tissue volume changes with gender \nand body parameters by using magnetic resonance imaging  \nM.F. Erkoç\n1, A. Okur2, B. Öztoprak1, C. Gümü\u000e1; 1Sivas/TR, 2Yozgat/TR \n(drerkoc@gmail.com)  \nPurpose: Understanding the volumetric values of eyeball and changes with \nage and gender will allow us to solve serious clinical implications. This study \naimed to examine the total orbital volume (TOV) and total orbital fat expansion \n(TOFE) in normal people with three different age groups and to find the \ncorrelation of these measurements due to age, gender and body parameters \n(height and weight) by MRI. \nMethods and Materials:  MRI data were acquired retrospectively. Total of \n1453 subjects were included and were divided into three age groups: 481 \nsubjects in 20-30 years age (240 males and 241 females), 521 subjects in 40-\n60 years age (253 males and 268 females) and 451 subjects in 60-70 years \nage (212 males and 239 females). The TOV and TOFE were measured using \nT1-weighted MR images for each subject, and clinical information's (age, \ngender, height and weight) were also obtained. \nResults: The measurements showed that TOV decreased by age and the \nvolume was larger in men than in women. While both weight and height \nshowed positive correlations with TOV in male and female subjects in their 20s \nand 40s, only weight showed a positive correlation with TOV in female subjects \nin their 60s. On the other hand, TOFE increased by age in all groups and the \nincrement was larger in women than men. \nConclusion: These results provide basic information about the effect of age, \ngender, and body parameters on TOV and TOFE. The variations in TOV are \nassociated with orbital soft tissues changes rather than with TOFE.  \nB-0172 14:09  \nOrbital colour Doppler ultrasound assessment in patients affected by \nLeber's hereditary optic neuropathy and dominant optic atrophy  \nC. Colantoni, M. Venturini, E. Borrelli, M. Cascavilla, P. Barboni, \nA. Del Maschio; Milan/IT (colantoni.caterina@hsr.it)  \nPurpose: To investigate the vascular dysfunction in patients with Leber's \nhereditary optic neuropathy (LHON), and with dominant optic atrophy (DOA), \nthat are genetic diseases which cause visual loss due to microvascular \ndisorders. \nMethods and Materials:  Six asymptomatic LHON patients (cLHON), 2 acute \npatients (aLHON), 8 chronic patients (chLHON), 6 patients with DOA, and 10 \ncontrol subjects underwent a complete ophthalmologic examination including \nenhanced depth imaging--optical coherence tomography, and OCDUS \nperformed with a ATL-Philips IU-22, and a 5-12 MHz linear probe. Patients \nwere examined with closed eyelids in supine position. Peak systolic velocity \n(PSV), end-diastolic velocity (EDV), and resistive index (RI) of ophthalmic \nartery (OA), central retinal artery (CRA), central retinal vein (CRV), short \nposterior ciliary arteries (SPCA). \nResults: In cLHON: SPCA EDV (cm/s)=5.0 ±1.4, SPCA RI=0.64 ±0.16, OA \nRI=0.59±0.06, in controls, respectively: 2.4 ±0.6 (P=0.001), 0.76 ±0.03 (P=0.02) \nand 0.75± 0.04 (P=0.001); SPCA in aLHON: EDV=7.1 ±2.1, PSV \n(cm/s)=21.3±4.5, RI= 0.67± 0.03, in controls, respectively: 2.4 ±0.6 (P < 0.001), \n10.3±2.8 (P=0.001) and 0.76 ±0.03 (P=0.005); CRA PSV: in chLHON= 8.6 ±2.3 \n(P=0.04), in aLHON=15.4 ±0.9, in controls=12.9 ±3.0; SPCA RI in \naLHON=0.67±0.03, in chLHON=0.80 ±0.0 (P=0.002); SPCA PSV: in DOA= \n7.2±1.6, in controls=10.3±2.8 (P=0.01). A significant PSV increase of both CRA \nand SPCA in aLHON, compared to cLHON and to controls, and a subsequent \nreduction in the chronic phase and in DOA was found. \nConclusion: OCDUS can be a useful diagnostic tool to investigate the \nvascular involvement, probably related to the microangiopathy, of LHON and \nDOA at different stages of the disease, providing quantitative and reproducible \ndata: in the future, OCDUS could monitor the response to treatment.  \nB-0173 14:18  \nFeasibility of 3 T IDEAL MR of the orbits for imaging of Graves' \nophtalmopathy: correlation between quantitative evaluation of \nextraocular muscle size and proptosis value  \nD. Guerrieri, G. Panzironi, M. Guida, C. Di Paola, F. De Cristofaro, L. Garau; \nRome/IT (d.guerrieri@gmail.com)  \nPurpose: To investigate the feasibility of 3 T MR iterative decomposition of \nwater and fat imaging (IDEAL) sequences for imaging of Graves' \nophtalmopathy, assessing extraocular muscle size and proptosis value. \nMethods and Materials:  3 T IDEAL MRI was performed on 56 patients with \nsymptoms of Graves' orbitopathy. Coronal and axial T2-weighted IDEAL fast \nspin-echo sequences were acquired in all patients; axial scans were obtained \nin the neuro-ocular plane. Since IDEAL sequences permit fast and accurate \nwater-fat separation with a single acquisition, we measured maximum cross-\nsectional area of extraocular muscles (EOM) on coronal T2 sequences after a \nvisual comparison between water-only and fat-only images with a free-hand \nROI. Proptosis value was quantified on axial images with Hertel Index, i.e. the \ndistance from the interzygomatic line and the apex of the globe; correlation \nwas measured with the Pearson correlation coefficient. \nResults: We found a moderate correlation ( p \n< 0.05) between Hertel index and \nareas of EOM (right: r=45-59, left: r=40-52); this association was stronger for \ninferior, medial and superior rectus mu scles and even stronger combining all \nareas for each orbit (right: r=60; left: r=56). \nConclusion: Orbital 3 T IDEAL MR imaging is a fast and useful procedure in \nthe evaluation of patients with Graves' ophtal mopathy. In a single acquisition, \nthis technique provides excellent water and fat separation, thus permitting an \naccurate and reproducible quantification of muscle hypertrophy and proptosis \nvalue; in facts artifacts deriving from incomplete or wrong fat suppression with \nconventional techniques are markedly reduced.  \nB-0174 14:27  \nDynamic contrast-enhanced magnetic resonance imaging of ocular \nmelanoma  \nJ. Xuyuan\n1, P. Asbach2, G. Willerding2, M. Dulce2, K. Xu3, M. Taupitz2, \nB. Hamm2, K. Erb-Eigner2; 1Shenyang/CN, Berlin/DE, 2Berlin/DE, \n3Shenyang/CN (Katharina.Erb@charite.de)  \nPurpose: Dynamic contrast-enhanced magnetic resonance imaging (DCE \nMRI) is used for assessment of microvasculature in several tumours. We \naimed to assess the contrast signal enhancement characteristics of ocular \nmelanoma. \nMethods and Materials:  Forty patients with ocular melanoma were \nprospectively investigated with ocular MRI including DCE sequences during a \n13-month period. A region-of-interest analysis of the images was performed to \ncalculate the time to achieve the maximum enhancement (Tmax), the washout-\nratio (WR), the enhancement ratio (ER) and the maximum rise slope (SL) \nwithin 106 seconds of the ocular melanoma in all patients. Ocular melanomas \nwere grouped with respect to their enhancement curve pattern. \nResults: In 39 patients (98%), the ocular melanomas showed an early strong \nsignal enhancement after contrast injection, resulting in a mean Tmax of 49 \nsec. The mean WR of the ocular melanoma was 21.3%. In 30 patients (75%), \nthe peak enhancement was followed by a washout of more than 10%. In 9 \npatients (23%), the washout was less than 10 % resulting in a plateau pattern. \nConclusion: Ocular melanoma demonstrates signal enhancement \ncharacteristics of hypervascular neoplasms. This study provides baseline curve \npattern data that may be useful for assessing changes in vascularity, e.g. \nduring therapy response.  \nB-0175 14:36  \nContrast-enhanced ultrasound in the quantitative assessment of uveal \nmelanoma response to gamma knife radiosurgery: do changes in tumour \nvascularisation precede thickness variation at ultrasound?  \nC. Colantoni, M. Venturini, G. Modorati, A. Colucci, M. Di Nicola, G. Agostini, \nF. De Cobelli, F. Bandello, A. Del Maschio; Milan/IT (colantoni.caterina@hsr.it)  \nPurpose: To prospectively analyse CEUS in the quantitative assessment of \nUM response to GKR, investigating if changes in tumour vascularisation \nprecede thickness variation, the conventional US response parameter, which \non average occurs at 12 months. \nMethods and Materials:  Ten patients (7 males, 3 females; mean age ±SD, \n66.2±12.62 years) with UM were treated with GKR. US and CEUS were \nperformed (SonoVue, Bracco ) with iU-22 ATL (Philips) and a 5-9 MHz linear \nprobe at baseline, 3, 6, and 12 months after treatment. UM transverse \ndiameter, thickness, and different quantitative parameters, such as area-under-\nthe-curve in the wash-in-phase, wash-in-perfusion-index, peak-enhancement, \nand wash-in-rate, were calculated using a dedicated software (Sonotumor, \nBracco). \nResults: At US the mean tumour thickness (mm) after GKR was: at baseline= \n8.3, 3 months after= 7.4 (P=ns), 6 months after= 6.6 (P =0.031), 12 months \nS173  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nafter= 5.8 (P=0.024). At CEUS, the parameters at baseline, 6 months and 12 \nmonths after treatment resulted respectively: peak-enhancement (a.u). = 2*10 7, \n8*105 (P=.018), 4*10 1 (P=.028); wash-in rate (a.u). = 4*10 6, 8*10 4 (P=.028), \n7*100 (P=.028); wash-in perfusion index (cm 3/sec) = 6*10 7, 2*10 6 (P=.028), \n1*102 (P=.043); area under the curve (a.u). = 9*10 8, 3*10 7 (P=ns), 1*10 3 \n(P=.028). At 6 months after treatment, tumour thickness decreased in 6/10 \npatients, while UM enhancement in 10/10. \nConclusion: CEUS showed an early UM enhancement reduction at 6 months \nafter GKR. A larger population is needed to investigate if CEUS could be either \nan additional tool to conventional US or the first choice technique to monitor \nUM response to GKR.  \nB-0176 14:45  \nImaging of perilymph fistulae of the round and oval windows in the \nabsence of a fracture  \nZ. Aloraini, F. Veillon, S. Riehm, J.-F. Matern, B. Rock, A. Charpiot, C. Debry, \nP. Hemar; Strasbourg/FR (dr.alorainiziad@gmail.com)  \nPurpose: To evaluate reliability of CT and MRI in diagnosing perilymph fistulae \n(PLF) of the round window (RW) and oval window (OW), in the absence of a \nfracture. \nMethods and Materials:  Amongst all patients (n = 101) clinically suspected of \nFPL, 61 have a CT, 40 MRI (including 31 CT + MRI) studied by three \nradiologists (two seniors, one junior) with reference to a normal population in \nCT (n = 30). \nResults: The sensitivity and specificity for the FR in MRI are better than CT: \nrespectively 94.4%(IRM), 90.3% (TDM) et 95.5% (IRM)/93.3 % (TDM). CT and \nMRI produce the same results for the sensitivity analysis of the FO: 92.3 % \n(IRM)/85.7 % (TDM). However, the specificity for the FO in CT (97.9%) is \nhigher than that of MRI (96.3%). By combining the two techniques, the \nsensitivity was 90%, positive predictive value (PPV) was 100%. False positive \ncases were explained by difficulty differentiating between inflammatory and \nperilymphatic fluid, false negatives by intermittent flow fistulae. \nConclusion: CT and MRI can play a key role in diagnosing PLF. \nB-0177 14:54  \nFunctional MSCT of temporal bone as a new standard in differential \ndiagnostics of a conductive hearing loss  \nI.V. Bodrova, L.A. Kulakova, N.V. Gagarina, E.V. Fominykh, S. Ternovoy; \nMoscow/RU (iv-bodrova@mail.ru)  \nPurpose: to assess possibilities of fMSCT in evaluation of ossicular mobility in \npatients with conductive hearing loss in comparison with healthy individuals. \nMethods and Materials:  75 persons (107ears) have been examined by \naudiologic tests, fMSCT: 13 healthy adult volunteers and 62 patients with \nconductive hearing loss. CT was performed on 320-detector CT with dynamic \nscan mode with simultaneous exposure of sound signal. 46 patients (56ears) \nwere underwent otosurgery. \nResults: We evaluate 6 main criteria of normal ossicular mobility in healthy \nvolunteers. In patients' group we revealed the follow pathology: 17 patients \nwith otosclerosis had restriction or absence of motility of stapes footplate; 10 \npatients with adhesive otitis media had decrease degree of motion of ossicles \nchain; 4 patients with tympanosclerosis had absence of motility of malleus; 3 \npatients had absence of motion due to rupture of incudostapedial joint and one \npatient with hypoplasia of ossicular chain had loss of motion. From the group of \n27 patients with previous stapedoplasty we observed 11 cases of prosthesis \ndysfunction due to: compression by otosclerotic focus (5 cases), the loop of \nprosthesis slid off the long limb of at movement (2 cases), the loop was opened \nand adjoined an tympanic membrane (2 cases), fracture of the long limb of \nincus (2 cases). All CT-findings were compare with otosurgery results and \ncorrelation were 98%. \nConclusion: FMSCT is a new noninvasive diagnostic method for evaluation of \nossicular mobility, that helps to choose  an optimal surgical approach in patient \nwith conductive hearing loss.  \nB-0178 15:03  \nSize of the membranous inner ear in different ages and sexes: volumetric \nassessment using three dimensional reconstructed high resolution MRI \nof the inner ear  \nN.N.N. Naguib, A. Morgan, N.-E.A.N. Mohammed, T. Lehnert, T. Gruber-Rouh, \nI. Burck, M. Harth, T.J. Vogl; Frankfurt a. Main/DE (nagy3n@yahoo.com)  \nPurpose: Volumetric assessment of the membranous inner ear in different \nages and to check the differences in volume among both sexes and between \nboth sides in the same patient using three dimensional (3D) reconstruction of \nthe high-resolution MR-Imaging (HR-MRI). \nMethods and Materials:  350 patients with a mean age of 48.5year were \nincluded. HR-MRI was performed using a T2-weighted SPACE sequence with \n0.6 mm slice thickness. 3D-reconstructions were performed using Advantage \nWorkstation. Volumetric assessment was manually performed for each side in \nall patients. The difference between different ages was tested using Pearson-\nlinear-regression test. The difference between both sides and sexes was \ntested using student T-test and Wilcoxon-Mann-Whitney test respectively. \nResults: The mean volume of the left inner ear in all patients was 0.526 mm3 \n(SD:0.097, Range:0.300-0.870). On the right side it was 0.520 mm3 (SD:0.010, \nRange:0.270-0.910). The mean volume of the inner ear was 0.520 mm3 \n(SD:0.099, Range:0.300-0.870) and 0.527 mm3 (SD:0.098, Range:0.270-\n0.910) in females and males respectively. No statistically significant difference \nwas noted between both sides in the same patient (p=0.37) or between both \nsexes (p=0.48). A statistically significant reduction in the volume of the inner \near with increased age was noted (p < 0.0001). The volume of the inner ear is \nsignificantly reduced by 0.0017 mm3 every year of age. \nConclusion: The volume of the inner ear is significantly reduced with \nincreased age at a rate of 0.0017 mm3/year of age. There is no significant \ndifference in volume between both sexes or both sides in the same patient.  \nB-0179 15:12  \nOrbital Colour-Doppler Ultrasound (OCDUS) and Spectral-Domain Optical \nCoherence Tomography (SD-OCT) assessment in brittle type 1 diabetic \n(T1D) patients after timely percutaneous intraportal pancreatic islet \ntransplantation (PIPIT)  \nS. Margari, M. Venturini, L. Pierro, P. Maffi, R. Lattanzio, F. De Cobelli, \nA. Secchi, A. Del Maschio; Milan/IT (sergio.margari.983@gmail.com)  \nPurpose: PIPIT is a less invasive alternative to pancreas transplantation. \nDiabetic retinopathy (DR) represents the major cause of visual loss in T1D \npatients. OCDUS and SD-OCT are fast/non-invasive examinations: the first \nquantifies the peak systolic velocity of central retinal artery (PSV-CRA), the \nsecond allows high-resolution cross-secti onal retinal images. Our aim was to \nassess the clinical relationship between retinal blood flow and morpho-\nstructural retinal changes after PIPIT. \nMethods and Materials:  Eight T1D patients, 5 affected and 3 unaffected by \nDR, were submitted to OCDUS and SD-OCT before and after PIPIT. DR, \nbased on fundus biomicroscopy, PSV-CRA with OCDUS, macular thickness \nand presence of micropseudocysts (MPCs) with SD-OCT, C-peptide (Cp), as a \nbiomarker of islet function, were assessed at baseline and at 1, 2, 3, 4, 5 years \nfrom PIPIT. Statistical analysis was performed by Mann-Whitney U Test. \nResults: PSV-CRA, in patients with and without DR, respectively, was as \nfollows: before PIPIT 7.86 ± 1.38 cm/s vs 8.06 ± 1.50; after PIPIT \n8.39 ± 1.01 cm/s vs 12.61 ± 2.73 (p < 0.05). SD-OCT showed a retinal \nthickness \u0002250 microns, but the presence of MPCs in 2 patients with DR. Cp, \nin patients with and without DR, respectively, was as follows: before PIPIT \n0.76 ± 0.48 ng/ml vs 0.62 ± 0.48; after PIPIT 0.72 ± 0.51 ng/ml vs 1.32 ± 1.21. \nConclusion: A timely PIPIT in brittle T1D patients, still unaffected by DR, \ndetermines a restoration of islet function and a beneficial effect on the retinal \nmicrocirculation, improving PSV-CRA and Cp values.  \nB-0180 15:21  \nVolumetric assessment of the cochlea in patients with long-standing \nunilateral sensorineural hearing loss: comparison with the normal side  \nN.N.N. Naguib, A. Morgan, T. Lehnert, T. Gruber-Rouh, I. Burck, M. Harth, \nR. Hammerstingl, T.J. Vogl; Frankfurt a. Main/DE (nagy3n@yahoo.com)  \nPurpose: To compare the cochlear volume of the diseased side in patients \nwith long-standing unilateral hearing loss with the cochlear volume of the \nnormal side using three di mensional (3D) reconstr uction of the high-resolution \nMR-Imaging (HR-MRI) sequences. \nMethods and Materials:  81 patients with a mean age of 45.2 years were \nincluded. All patients had long-standing unilateral hearing loss. HR-MRI was \nperformed using a T2-weighted SPACE sequence with 0.6-mm slice thickness. \n3D reconstructions were performed using Advantage Workstation. The \ndifference between the cochlear volume of the normal and the diseased side \nwas tested for statistical significance using the two-sample t test. \nResults: Unilateral hearing loss affected the right side in 35 patients and the \nleft side in 46 patients. The mean cochlear volume in all patients and both \nsides was 0.1721 mm\n3 (Standard deviation (SD): 0.0303, range: 0.1000 - \n0.2800 mm3). The mean volume of the cochlea in the diseased side was \n0.1717 mm3 (SD: 0.0287, range: 0.1000 - 0.2700 mm 3). The mean volume of \nthe cochlea in the normal side was 0.1725 mm 3 (SD: 0.0320, Range: 0.1100 - \n0.2800 mm3). There was no statistically significant difference between the \nvolume of the cochlea on the diseased side and the normal side (p = 0.87). \nConclusion: There is no statistically signi ficant difference in the cochlear \nvolume between the diseased side and the normal side in patients with \nunilateral long-standing sensorineural hearing loss.  \n \n \n \n \n \n \nS174  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n14:00 - 15:30 Room E1  \nMusculoskeletal  \nSS 210  \nKnee, ankle and foot  \nModerators:  \nC. Faletti; Turin/IT  \nJ. Renoux; Paris/FR  \nB-0181 14:00  \nTreatment of non-traumatic posteromedial knee pain due to \nsemimembranosus tendinopathy: a study assessing the efficacy of \nultrasound guided injections in 92 patients  \nW. Bashir\n1, D.P. Baghla2, A. Musah3, J. Bell2, D.A. Connell4; 1Birmingham/UK, \n2London/UK, 3Nottingham/UK, 4Melbourne/AU  \nPurpose: Assess effectiveness of ultrasound (US) guided steroid injections in \nthe management of posteromedial knee pain due to semimembranosus \ntendinopathy (SMT). \nMethods and Materials:  92 (42 male, 50 female) patients (mean age 42 \nyears) referred for MRI over a 5 year period with medial knee pain had a \ndiagnosis of semimembranosus tendinopathy made. The patients were \nsubsequently referred for US confirmation after which an US-guided injection \nof 40 mg triamcinolone and 2 ml 0.5% Bupivacaine was administered. Patients \nwere reviewed at 1 week, 4 weeks, 3 and 6 mont hs. VAS pain sco res were \nrecorded pre-procedure and post procedure. \nResults: MRI showed tendon thickening with intratendinous high SI and fluid in \nthe adjacent bursa on fat saturated images. Sonography confirmed thickening \nof the tendon with varying degrees of hypoechogenicity ± inflammatory \nchanges in the adjacent bursa. Significant VAS pain score reduction was \nobserved after injection when compared to that at presentation. US also \nshowed improvement in tendon fibrillar morphology. \nConclusion: Semimembranosus tendinopathy (SMT) should be actively \nsought as a potential aetiology when revi ewing an MRI of the knee, especially \nin patients presenting with medial knee pain as it is a frequent and easily \ntreatable cause of knee pain. SMT has been described in the past as being \nsecondary to a compensatory biomechanical mechanism in patients with \nsignificant intra-articular pathology but our study shows that it can also be \nfound in young individuals suffering from non-traumatic medial knee pain. \nUltrasound can confidently confirm the diagnosis, guide injections and monitor \nchanges of SMT.  \nB-0182 14:09  \nTotal knee arthroplasty: early post-surgical malrotation  \nM. Ereno Ealo, E. Pastor Ausin, B. Sancho Garaizabal, E. Montejo, \nF.M. Labayru Echevarrria; Galdacano/ES  (mjereno@gmail.com)  \nPurpose: Pain after TKA Surgery: CT showing early malrotation and benefits \nof correction. \nMethods and Materials:  35 knee arthroplasty revisions were performed in \npatients with a persistent pain after an uncomplicated TKA. Cases of \ncomponent loosening or infection were excluded. The component rotation \nmeasurement was based on the technique described by Berger et al. Femoral \ncomponent rotation: angle between the trans epicondylar axis and the posterior \ncondylar axis. (0-3º in women and 3-5º in men). Tibial component rotation: 3 \nslices at different levels were analysed including the tip of the tubercle. (neutral \nn 18º and internally rotated when larger). Knee Society Prosthesis Score, Knee \nSociety Function Score, Oxford Scores, Range of motion, Laxity, Patellar \nmaltracking and Pain were evaluated pre and post-surgery in all patients. \nResults: Mean preoperative femoral rotation was -2.6º. Mean preoperative \ntibial rotation was -4.3º. Mean preoperative femoral and tibial rotation was -\n6.8º. Knee Society Prosthesis Score: 42.3 (10-62) in pre revisions and 78.8 \n(65-95) in post surgery revisions. Knee Society Function Score: 37.7 (5-60) in \npre-revisions and 48.9 (10-85) in post-surgery revisions. Range of motion: 85.9 \n(50-125) in pre-revisions and 105.9 ( 85-135) in post-surgery revisions. In all \ncases p value < 0.001 \nConclusion: These was a significant improvement experienced by patients \nafter TKA revision for malrotation. The CT is recommended in the evaluation of \npatients with early painful TKA and no evidence of infection.  \nB-0183 14:18  \nThe clinical impact of leukoscan imaging in managing peri-prosthetic \njoint infection  \nT.J. Gordon, R. Govinda Rajoo, V. Prakash; Chertsey/UK \n(tom.gordon@doctors.org.uk)  \nPurpose: Three phase bone scintigraphy followed by Leukoscan imaging is a \npopular investigative cascade for the diagnosis of infected total hip and knee \nreplacements. This study analyses how the use of Leukoscans in a UK \nsecondary hospital setting impacts on the management of suspected peri-\nprosthetic joint infection. \nMethods and Materials:  Case based analyses were performed covering a 24 \nmonth period (2010-2012), inclusive of clinical follow-up. Patients had triple \nphase bone scintigraphy followed by a Leukoscan. The corresponding clinical \naction, inclusive of further investigations and management, was examined. \nFurther investigations included a 24-hour repeat of the Leukoscan and joint \naspiration for microbiological confirmation of infection. Management was \ncategorised into the following broad categories: no action, conservative \nmanagement, and surgery. \nResults: 55 patient cases were analysed. Triple phase bone scintigraphy was \npositive in 89% and negative in 11%. Leukoscans yielded positive results for \ninfection in 55% and negative in 45%, with 22% of patients receiving a 24-hour \nrepeat Leukoscan. Microbiological confirmation was sought in 47% in which all \ncultures of joint aspirate were negative. The result of the Leukoscan prompted \na change in management in 66%, in which 33% received conservative \nmanagement and the remaining 33% underwent revision surgery. No change \nin management was observed in 34%. \nConclusion: Triple phase bone scintigraphy is best used as a screening test. \nWhen negative it confidently rules out disease. Accuracy of isolated \nLeukoscans remains controversial. This study suggests that there is no robust \ncorrelation between the results of a Leukoscan and the resultant clinical action.  \nB-0184 14:27  \nMR findings in asymptomatic volunteers at the calcaneal attachment of \nthe plantar fascia  \nC. Ehrmann, M. Maier, B. Mengiardi, C.W.A. Pfirrmann, R. Sutter; Zurich/CH  \nPurpose: To assess MR findings at the calcaneal attachment of the plantar \nfascia in asymptomatic volunteers. \nMethods and Materials:  The study was approved by the institutional review \nboard and informed consent was obtained. MR examinations of 77 \nasymptomatic volunteers (40 women, 37 men; mean age 48.0 years, range 23-\n83 years) were obtained. Two msk fellowship trained radiologists analysed \nsignal characteristics and thickness of the m edial, central and lateral fascicle of \nthe plantar fascia were assessed. Moreover, the presence of soft tissue \noedema, bone marrow oedema and bony spur formation at the attachment of \nthe plantar fascia was noticed. \nResults: Mean thickness of the plantar fascia was 4.0 mm (central fascicle), \n0.6 mm (medial fascicle), and 2.3 mm (lateral fascicle). Increased signal \nintensity in the plantar fascia was seen in 16 volunteers (20.8%) in the T1w \nsequence, in 6 volunteers (7.8%) in the T2w sequence and in 5 volunteers \n(6.5%) in the STIR sequence. Soft tissue oedema above the plantar fascia was \nseen in 5 volunteers (6.5%) and below the plantar fascia in 16 volunteers \n(20.8%). A calcaneal spur was noted in 15 volunteers (19.5%). Calcaneal bone \nmarrow oedema was present in 4 volunteers (5.2%). \nConclusion: Soft-tissue oedema below the plantar fascia as well as calcaneal \nspurs are common findings in asymptomatic volunteers and should be used \nwith caution for diagnosing plantar fasciit is. Increased signal on fluid sensitive \nsequences within the plantar fascia is less frequent in asymptomatic \nvolunteers.  \nB-0185 14:36  \nHigh-volume image-guided injection with or without steroid for achilles \ntendinopathy: a prospective study  \nH. Abdulhussein\n1, D. Morrissey1, O. Chan2; 1Harrow/UK, 2London/UK \n(ha09215@qmul.ac.uk)  \nPurpose: High-volume image-guided injections (HVIGI's) have been shown to \nimprove outcomes in Achilles tendinopathy patients. The injection traditionally \ncontains Hydrocortisone Acetate, however this prospective cohort study was \nthe first to assess the injection with no steroid, just saline. Aiming to ascertain \nany difference in the outcomes of pain, function, symptoms and return to \nsporting activity between patients receiving a HVIGI with steroid, and without. \nMethods and Materials:  Patients were recruited consecutively from the \nLondon Independent Hospital. 21 patients (24 tendons) were injected with a \nHVIGI of either 10 Mils of Marcaine 0.5% mixed with 25 mg of hydrocortisone \nplus 40 Mils of Normal Saline (with steroid) or 50 Mils of Saline plus local \nanaesthetic (without steroid). All patients were placed on an eccentric loading \nexercise (ELE) programme. The Victorian Institute of Sports Assessment - \nAchilles tendon (VISA-A) questionnaire was the primary outcome measure, \nsecondary outcome measure was a VAS scale. \nResults: VISA-A scores improved significantly in both groups, from a pre-\ninjection mean of 39.3 to 60.7 in steroid cohort, and from 42.0 to 73.5 in the \nnon-steroid group at final follow-up. Improvements in VAS scores were seen in \nboth groups. No statistically significant difference in VISA-A scores between \nthe two groups at any point (p=0.703). \nConclusion: HVIGI without steroid shows similar trends in pain reduction and \nfunctional improvement in comparison to currently used HVIGI with steroid. \nS175  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nFurther research with imaging outcomes and longer follow-ups is necessary, \nhowever these findings suggest a non-steroid injection is a viable option.  \nB-0187 14:45  \nA new protocol of MRI evaluation of two different techniques in anterior \ncruciate ligament recontruction  \nM. Busacca, D. Capannelli, C. Tetta, R. Buda, E. Ferranti Calderoni, \nU. Albisinni; Bologna/IT (diana.capannelli@yahoo.it)  \nPurpose: The aim of this study is to evaluate integration and maturation of \nautologous graft in anterior cruciate ligament (ACL) reconstruction with \nmagnetic resonance imaging (MRI) and to evaluate correlation between MRI \nfindings and clinical outcome at 6-month follow-up. \nMethods and Materials:  40 patients (range 17-49 yrs, M/F 35/5) treated with \nACL reconstruction were evaluated with MRI 6 months after surgery. 20 were \ntreated with \"all-inside\" technique (half femoral tunnel HFT) and 20 with \"over \nthe top\" technique (complete femoral tunnel CFT). A new sequence protocol \nwas optimisated for the analysis of the graft structure including DP with and \nwithout fat saturation on sagittal and coronal sequences and FSE-T2-3D ±FS. \nFigueroa scoring scale was used to evaluate integration (presence of synovial \nfluid at tunnel-graft interface), ligamentati on (graft signal pattern: hypointense, \nisointense or hyperintense) and characterisation of the graft (poor or \nadeguate). IKDC score, KOOS and Tegner scale were collected. \nResults: Synovial fluid at tunnel-graft interface was present in 6 cases with \nHFT and in 7 cases with CFT. The graft signal pattern was iso-hypointense in \n13 cases with HFT and 13 cases with CFT, whereas it was hyperintense in 7 \ncases with HFT and 7 cases with CFT. The characterisation of the graft was \npoor in 3 patients with HFT and no cases were observed in CFT group. \nConclusion: MRI findings at 6-month follow-up demonstrate no statistically \nsignificant differences between two groups in terms of integration assessment \nand graft maturation (ligamentation), whereas \"all-inside\" technique has a \nbetter clinical outcome.  \nB-0188 14:54  \nQualitative and quantitative assessment of vastus medialis muscle \natrophy at MR imaging in asymptomatic patients after anterior cruciate \nligament reconstruction  \nM. Marcon\n1, B. Ciritsis2, C. Laux2, T. Nguyen-Kim2, M.A. Fischer2, \nG. Andreisek2, E. Ulbrich2; 1Udine/IT, 2Zurich/CH (magda.marcon@gmail.com)  \nPurpose: To quantitatively and qualitatively assess the vastus medialis \nmuscle, an important clinical indicator for postoperative knee function, at MR \nimaging in asymptomatic patients with anterior cruciate ligament (ACL) \nreconstruction. The non-operated leg served as internal control. \nMethods and Materials:  Prospective IRB approved study with written \ninformed patient consent. Thirty-five asymptomatic patients (men, 23; women, \n12) with ACL-reconstruction underwent MR imaging of both legs using an axial \nT1-weighted and a 3D spoiled dual gradient-echo (LAVA FLEX) sequences. \nMuscle volume and fat-signal-fraction (FSF) of the vastus medialis muscles \nwere determined. Additionally, two readers evaluated fatty muscle atrophy \nusing the Goutallier classification. Studen t t test was used to test significant \nmuscle volume, muscle FSF, and fatty atrophy differences between the \noperated and non-operated legs. A p-value <.125 indicated statistical \nsignificance. \nResults: The vastus medialis muscle volume was significantly smaller in the \noperated (mean ±SD, 430.6 ±119.6 cm3; range, 197.3-641.7 cm3) compared to \nthe non-operated leg (mean ±SD, 479.5 ±124.8 cm3; range, 261.4-658.9 cm3) \n(p.&gt125). The mean±SD percentage side-to-side difference in muscle volume \nwas 10.2 ±8.5% (range, -7.1- 30.1%) and in FSF 5.8 ±22.6% (range, -38.9-\n40.1%). Qualitative assessment of muscle atrophy revealed no significant \ndifferences between the operated and non-operated leg (p=.30 for reader 1; \np=.20 for reader 2). \nConclusion: In asymptomatic patients with ACL-reconstructions, a significant \natrophy of the vastus medialis muscle exists, but without fatty degeneration.  \nB-0189 15:03  \nMagnetic resonance imaging findings after lateral ankle trauma in injured \nand contralateral ankles  \nN. van Putte-Katier\n1, J. van Ochten2, S.M.A. Bierma-Zeinstra2, \nM. van Middelkoop2, E.H.G. Oei2; 1Dordrecht/NL, 2Rotterdam/NL \n(nkatier@yahoo.com)  \nPurpose: To determine the prevalence of structural MRI abnormalities after \nlateral ankle trauma in injured and contralateral asymptomatic ankles to identify \nlesion types that may be preexistent \nMethods and Materials:  195 patients (mean age 37.5 years; 43% male) \nincluded in an observational case-control study on persistent symptoms after \nlateral ankle trauma completed a questionnaire and MRI (1.5 T) of both ankles \n6-12 months after visiting their general practitioner for an inversion ankle \ntrauma. Prevalence of ankle lesions was compared between injured and \ncontralateral ankles. Multivariable anal ysis was performed to investigate the \nassociation between lesions frequently seen in both ankles (i.e. anterior \ntalofibular (ATFL) and calcaneofibular ligament (CFL) lesions) and recent \ntrauma, previous trauma, age, gender, BMI and osteoarthritis. \nResults: Bone marrow edema, joint effusion, soft tissue edema and peri-\narticular calcifications were found in both ankles, but significantly more \nfrequently in the injured ankle. Peroneal tendon lesions were rarely seen in \nboth ankles. Anterior and posterior tibi ofibular ligament lesions, deltoid \nligament lesions and signs of talona vicular osteoarthritis were almost \nexclusively found in the injured ankle. ATFL and CFL lesions were frequently \nfound in both ankles, in 55.9% and 37.4% of the injured ankles, respectively \nand in 17.9% and 5.6% of asymptomatic contralateral ankles, respectively. \nATFL lesions were related to recent trauma, gender and age, CFL lesions were \nrelated to recent trauma and gender. \nConclusion: The prevalence of structural MRI abnormalities in injured and \nasymptomatic ankles is high, suggesting that some lesions (especially ATFL \nand CFL lesions) are pre-existent.  \nB-0190 15:12  \nLigamentous injury patterns and risk of associated tissue damage in \nathletes with ankle sprain  \nF.W. Roemer1, N. Jomaah1, J. Niu2, E. Almusa1, B. Roger1, P. D'Hooghe1, \nJ. Tol1, C. Geertsema1, A. Guermazi1; 1Doha/QA, 2Boston, MA/US \n(frank.roemer@klinikum-augsburg.de)  \nPurpose: To describe retrospectively the structural injury pattern in athletes \nthat were referred to MRI for evaluation of acute ankle sprain and to assess the \nrisk of associated traumatic tissue damage beyond lateral and syndesmotic \nligament involvement. \nMethods and Materials:  261 ankle MRIs of athletes with acute ankle sprain \nwere evaluated with regard to lateral and syndesmotic ligament injury. As \nconcomitant injuries the deltoid and spri ng ligaments, sinus tarsi, peroneal, \nflexor and extensor retinacula and tendons, traumatic bone changes and joint \neffusion were assessed. Six exclusive injury patterns were defined based on \nlateral and syndesmotic ligament involvement. Risk for associated injuries was \nestimated using logistic regression. \nResults: Athletes were on average 22.5 years old and mean interval from \ninjury to MRI was 5.7 days. 103 (39.5%) had a complete anterior talofibular \nligament injury and no syndesmotic injury and 53 (20.3%) had syndesmotic \ninvolvement. Acute lateral osteochondral lesions of the talar dome were seen \nin 20 (7.7%) ankles and chronic lateral osteochondral lesions in 3 (1.1%). Risk \nfor associated deltoid ligament injury was increased for ankles with lateral \nligament injury (aOR 4.04, 95% confidence interval (CI) 1.99-8.22). Risk for \ntalar bone contusions was increased for ankles with any syndesmotic injury \n(aOR 3.43, 95% CI 1.72-6.85). \nConclusion: About 20% of athletes referred for MRI after suffering an acute \nankle sprain have evidence of syndesmotic injury, whilst about 40% have \nevidence of lateral ligament injury without syndesmotic involvement. \nConcomitant talar osseous and deltoid ligament injuries are common.  \n14:00 - 15:30 Room E2  \nGI Tract  \nSS 201b  \nAdvances in small bowel imaging  \nModerators:  \nP. Soyer; Paris/FR  \nV. Vandecaveye; Leuven/BE  \nB-0191 14:00  \nDynamic contrast-enhanced magnetic-resonance imaging (DCE-MRI) of \nsmall bowel and MR flow analysis of mesenteric vessels in patients with \nParoxistic Nocturnal Haemoglobinuria (PNH) with and without abdominal \npain  \nG. Pezzetti, F. De Cobelli, S. Margari, A. Esposito, G. Ironi, A. Del Maschio; \nMilan/IT (pezzetti.giulio@hsr.it)  \nPurpose: We aimed to assess if DCE-MRI of small bowel wall and flow \nanalysis of mesenteric vessels may identify early ischaemic signs in PNH \npatients, with (AP) and without (NAP) abdominal pain, which exact \npathogenesis has never been determined by in vivo imaging studies. \nMethods and Materials:  Six AP and six NAP PNH-fasted patients were \nscanned using a 1.5 T MRI with a phased-array coil, after ingestion of PEG \nsolution and during Gadobutrol i.v. injection. Mean flow (MF) and stroke \nvolume (SV) of superior mesenteric vein (SMV) and artery (SMA) with ECG-\ngated phase-contrast flow-mapping sequences were assessed. Areas under \nthe curve at 60 (AUC\n60) and 90 seconds (AUC 90) and k-trans in six locations of \nS176  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nsmall bowel wall with perfusion sequences were calculated. Statistical analysis \nwas performed with Mann-Whitney test. \nResults: All the parameters above were lower in AP than in NAP: AUC 60: \n84.81 1/s ± 4.99 vs. 131.73 ± 18.47; p = 0.002; AUC 90: 102.33 ± 5.76 vs. \n152.58 ± 23.11; p = 0.002; k trans: 0.0240 ml / ml*min ± 0.0019 vs. \n0.0369 ± 0.0009 (p=0.093 duodenum, 0.009 jejunum, 0.004 ileum). SMV: MF \n4.67 ml/s ± 0.85 vs. 8.32 ± 2.14; p = 0.002; SV 3.85 ml ± 0.76 vs. 6.55 ± 1.57; \np = 0.015. SMA: MF 6.95 ± 2.61 vs. 11.2 ± 2.32; SV 6.52 ± 2.19 vs. \n8.78 ± 1.63; p = 0.065. \nConclusion: Small intestine blood-supply impairment could be an early and \nreliable MRI marker of mesenteric ischaemia in PNH patients with abdominal \npain.  \nB-0192 14:09  \nTraining readers to improve their accuracy in grading luminal Crohn's \ndisease activity on MRI  \nJ.A.W. Tielbeek, S. Bipat, T.N. Boellaard, C.Y. Nio, J. Stoker; Amsterdam/NL \n(j.a.w.tielbeek@amc.uva.nl)  \nPurpose: To prospectively evaluate if training with direct feedback improves \ngrading accuracy of inexperienced readers in determining luminal Crohn's \ndisease activity on MR imaging. \nMethods and Materials:  Thirty-one readers (14 radiologists, 17 residents) \nwithout prior experience participated in a structured MR training program with \nindividual hands-on training. All re aders assessed 100 MR examinations of \npatients with Crohn's disease, randomly assigned to four sets of 25 cases and \nreceived direct feedback. An expert panel determined disease activity per case \nfor determining the reference standard. To determine the effect of training with \ndirect feedback, the proportions of grading accuracy, understaging and \noverstaging per set were compared using logistic regression analyses. Mean \nreading times and confidence scores (scale 0-10) were calculated and \ncompared by t-test. \nResults: Grading accuracy of all trainees was 51% (95%CI:41-60%), 60% \n(95%CI:51-69%), 63% (95%CI:52-72%) and 75% (95%CI:66-81%) in the four \nconsecutive sets, respectively. Grading accuracy increased after 75 cases with \ndirect feedback (P < 0.001). Understaging decreased, from 23% (95%CI:15-\n33%) to 7% (95%CI:3-14%) (P < 0.001). Overstaging did not change \nsignificantly. \nThe accuracy for grading none, mild, moderate and severe CD in the last set \nwas 75% (95%CI:62-84%), 70% (95%CI:55-82%), 63% (95%CI:54-71%) and \n87% (95%CI:62-96%), respectively. Mean reading time decreased from 6:37 to \n4:35 minutes (P <  0.001). Mean confidence increased from 6.90 to 7.65 \n(P < 0.001). \nConclusion: Grading accuracy, reading time and confidence of inexperienced \nreaders in evaluating Crohn's disease activi ty on MR improved during training \nwith feedback. Inexperienced readers need training with at least 75 cases \nbefore achieving the accuracy as reported in literature.  \nB-0193 14:18  \nMR enterography in the study of patients with Crohn's disease: which \nfindings of MRE are more likely to change the gastroentologist's \nmanagement of the patient?  \nS. Rajabi, L.A. Stein, C. Reinhold, T. Bessissow, I. Dupuis, A. Prucha, \nA. Benmassaoud; Montreal, QC/CA (shadi.rajabi@mail.mcgill.ca)  \nPurpose: To determine which signs of Crohn's Disease (CD) on magnetic \nresonance enterography (MRE), are most likely to change patient-\nmanagement. \nMethods and Materials:  Data on 63 CD patients were collected at McGill \nUniversity Hospitals. 22 signs of CD were shown on MRE for these patients. \nManagement post-MRE were stratified as: 1) no change, 2) change in \nmedication dose, 3) change in medication, and 4) surgery and/or \nhospitalisation. Data concerning disease location, behaviour (Montreal CD \nclassification), previous surgery and recent CRP prior to MRE were retrieved. \nLogistic regression (univariate/multivariate analyses) was used to determine \nwhich MRE and clinical signs were associated with management change. \nResults: Of the 22 MRE signs, the most common were circumferential-wall-\nthickening (60.3%), and wall-enhancement post-Gadolinium (52.9%). 55.6% of \npatients had management changed (35 patients, with some overlap in groups \n2.3,4) versus 44.4% with no change (group1). Logistic regression performed \non clinical and MRE data showed: high CRP values, mesenteric engorgement, \nand bowel-wall-thickening had significant relationship with change of \nmanagement vs. no change (group1). Circumferential-wall-thickening, and \nenhancement post-gadolinium had a significant relationship with change in \nmedication (group3). Disease behaviour, CRP, tethering of bowel loops, \nspiculated mesenteric disease, and ileocolic disease were shown to have a \nsignificant relationship with the deci sion to perform surgery/hospitalise a \npatient (group4). Ordinate outcomes analysis, where the 4 different categories \nof management change were assumed to be different levels of change, \nshowed patients with decreased motility to have higher odds of more severe \nchange of management. \nConclusion: The information obtained here can guide radiologists as to which \nsigns of CD are more important to look for on MRE from a patient-management \nperspective.  \nB-0194 14:27  \nStaging of Crohn's disease activity using CT, MRI, US and scintigraphy: a \nmeta-analysis  \nC.A.J. Puylaert, J.A.W. Tielbeek, S. Bipat, J. Stoker; Amsterdam/NL \n(c.a.puylaert@amc.uva.nl)  \nPurpose: To assess the role of computed tomography (CT), magnetic \nresonance imaging (MRI), ultrasonography (US) and scintigraphy (SG) in \nstaging Crohn's disease (CD) activity. \nMethods and Materials:  MEDLINE, EM BASE and Co chrane databases were \nsearched for studies evaluating CT, MRI, US and SG in staging CD activity as \ncompared to (ileo)-colonoscopy or histology as the reference standard. Two \nindependent reviewers assessed the data. Three by three tables (none, mild, \nfrank disease) were constructed for all studies and overall diagnostic \naccuracies were calculated/summarised by fixed or random-effects models. \nResults: Our search yielded 8347 articles, from which 20 articles were \ndetermined eligible for inclusion. A total of 577 patients were included. On per-\npatient basis: 2, 13, 1 and 1 datasets were available for respectively CT, MRI, \nUS and SG. Data were not pooled for US and SG and showed accuracy values \nof 44% (95%CI:26-62%) and 40% (95%CI:12-74%) in the available datasets. \nCT and MRI data were pooled and showed similar overall grading accuracy \nestimates of 86% (95%CI:75-93%) and 84%(95%CI:68-93%), respectively \n(P=0.78). On per-segment basis: 2, 2, 2 and 3 datasets were available for \nrespectively CT, MRI, US and SG. The overall grading accuracy estimates \nwere respectively 74% (95%CI:68-80%), 78% (95%CI:72-82%), 66% \n(95%CI:52-78%) and 80% (95%CI:75-85%). US had the lowest accuracy. CT, \nMRI and SG had comparable accuracy (P > 0.05). \nConclusion: US has the lowest accuracy for grading CD. SG showed mixed \nresults for per-patient and per-segment data. CT and MRI showed comparable \nhigh accuracy values both on per-patient and per-segment analysis.  \nB-0195 14:36  \nDoes HRCT allow the prediction of oesophageal involvement in systemic \nsclerosis?  \nT. Nguyen-Kim, B. Maurer, P. Nyffenegger, O. Distler, T. Frauenfelder; \nZurich/CH (thidanlinh.nguyen@usz.ch)  \nPurpose: To correlate oesophageal diameters measured on CT with \nmanometry-findings in patients with systemic sclerosis (SSC). \nMethods and Materials:  148 patients with SSc underwent HRCT for SSc-\nassessment. From all patients information about dysphagia, dyspepsia, globus-\nsensation, odynophagia, heartburn, regurgi tation was obtained. All patients \nfulfilling the ACR-Criteria, and underwent manometry were included (n=53, \n41female, median-age 59, range 28-80). Based on manometry, two groups \nwere defined (group1:pathologic manometry (n=39), group2: normal \nmanometry (n=14)). Esophageal diameter,area and perimeter were measured \nby two independent readers on CT-images at following levels: largest diameter \nabove and below the aortic arch, respectively on level of carina, \npulmonalvenous confluens and 1 cm above right diaphragm. ROC-curves \nregression analyses were applied to correlate CT-measurements with \nmanometry and clinical symptoms. \nResults: Mean maximal diameter/area/perimeter was for group1 \n13.1 mm/106.8 mm2/36.2 mm (level of \ncarina),11.6 mm/75.7 mm2/31.9 mm (level  of pulmonalvenous confluens), \n9.8 mm/77.9 mm2/27.8 mm (level 1 cm above right diaphragm) and for group2 \n7.5 mm/37.6 mm2/24.1 mm (level of carina), 11.1 mm/91.2 mm2/33.7 mm \n(level of pulmonalvenous confluens), 7.9 mm/66.7 mm2/26.9 mm (level 1 cm \nabove right diaphragm). The largest mean diameter/area/perimeter above and \nbelow the aortic arch were 11.7 mm/101.2 mm2/33.7 mm and \n17.0 mm/149.4 mm2/47.2 mm for group1 and 7.7 mm/34.6 mm2/21.5 mm, \nrespectively 10.8 mm/59.6 mm2/28.7 mm for group2. The maximal diameters \ndid not differ significantly between both groups. Interreader-variability was \ngood (k=0.69). On level of carina, a cut-off perimeter of 31.2 mm allowed to \ndifferentiate between group1 and group2 with a sensitivity of 71% and a \nspecificity of 87% (area under the curve 0.77). No correlations were found \nbetween CT-measurements and clinical findings. Significant correlations were \nfound between CT-measurements and manometry on level of carina (p \u00020.02) \nand below the aortic arch (p\u00020.01). \nConclusion: HRCT allows to predict pathologic manometry-findings in patients \nwith SSc using a cut-off perimeter of 31.2 mm on level of carina with a positive \npredictive-value of 98%.  \n \nS177  \n\n \n \nB A C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0196 14:45  \nSmall bowel motility measurements in MRI using 2D coronal slices: does \nthe intrasegmental location matter? (a pilot study)  \nS. Bickelhaupt, J.M. Froehlich, M.A. Patak; Zurich/CH (sebabick@gmx.de)  \nPurpose: Small bowel motility analyses using dynamic MRI acquisition in \ncoronal plane are of increasing clinical interest. The aim of this study was to \nevaluate if quantitative results of small bowel motility analyses in coronal plane \nare influenced by the positioning of the 2D cross-section measurement point \nwithin the small bowel`s lumen. \nMethods and Materials:  44 small-bowel motility measurements in 6 \nparticipants (male; mean 37.8years) were included in this IRB approved, \nprospective study. MRI (3.0-T,Ingenia-Philips) was performed after \nstandardised preparation. 3D-motility sequences (Dixon-dynFFE;TR 2.508;TE \n11.254; slice thickness 3 mm; temporal resolution 1 sec) covering the \nileocaecal region were acquired in breathhold over 42-56 sec. Motility was \nanalysed measuring 2D cross-section diameters of the small-bowel lumen in \nthree different locations (ventral, central and dorsal) of the same segment \nusing a motility-assessment software. Curve characteristics (diameter, \namplitude, extent of luminal occlusion during contractions) were compared for \nall three locations using ANOVA and paired student`s t test. \nResults: Mean luminal diameter was 11.82 mm (SD ±5.02) in the ventral, \n13.49 mm (SD ±4.44) in the central and 10.57 mm (SD ±3.92) in the dorsal \ncompartment of the bowel lumen without significant difference between the \ncompartments (p> 0.05). Contraction amplitudes (ventral: 10.47 mm, SD ±2.61; \ncentral: 10.89 mm, SD ±2.93; dorsal: 10.55 mm,SD ±3.21) did not differ \n(p=0.878) as well as the extent of luminal occlusion during the contractions \n(p=0.11) (ventral:0.97,SD±0.29; central:0.88,SD±0.28; dorsal:1.04,SD±0.25). \nConclusion: Quantitative motility parameters are not substantially influenced \nby the choice of cross-sections on the coronal planes as long as the segment \nis visible throughout the measurement.  \nB-0197 14:54  \nIs mesenteric panniculitis truely a paraneoplastic phenomenon? A \nmatched pair analysis  \nÖ. Gögebakan\n1, T. Albrecht1, M.A. Osterhoff2, A.J. Reimann1; 1Berlin/DE, \n2Nuthetal/DE (oeslemg@googlemail.com)  \nPurpose: Mesenteric panniculitis (MP) is an underdiagnosed inflammatory \ncondition of mesenteric adipose tissue. Prior studies suggested an association \nof MP with malignancy. To reassess this hypothesis, we performed the first-\nmatched case-control study comparing prevalence of malignancy and other \ndisease in patients with and without MP. \nMethods and Materials:  With a keyword search, we identified CT \nexaminations of MP patients between 2010 and 2012. Each MP patient was \nmatched with two control patients for age, gender, abdominal diameter and CT \nprotocol. Manifestation and extent of mesenteric panniculitis was classified \nindependently by two investigators according to established criteria. \nConcomitant disease, laboratory parameters and follow-up CTs were recorded \nand analysed for all patients. \nResults: 77 of 13485 CT patients were diagnosed with MP (prevalence \n0.58%). 50.6 % of MP patients suffered from malignancy vs. 60.2% in the \ncontrol group (p = 0.157). Over up to 4 years of follow-up in 35 of these 77 MP \npatients, no association between development of MP and the course of tumour \ndiseases could be identified. There was also no significant difference in the \nrate of frequent concomitant diseases, such as hypertension, diabetes or \nprevious surgery between the two groups. \nConclusion: In this first case-control study, we could show that, contrary to \nprevious reports, mesenteric panniculitis is neither paraneoplastic nor it is \nassociated with other diseases.  \nB-0198 15:03  \nAssessment of acute intestinal graft versus host disease by abdominal \nmagnetic resonance imaging at 3 Tesla  \nJ. Budjan, H.J. Michaely, U.I. Attenberger, S. Haneder, D. Heidenreich, \nS. Kreil, W.-K. Hofmann, S.O. Schönberg, S.A. Klein; \nMannheim/DE (johannes.budjan@umm.de)  \nPurpose: After allogeneic stem cell transplantation (SCT) a reliable \ndifferentiation between acute graft versus host disease (aGvHD) and its \ndifferential diagnoses is esse ntial for an early and successful treatment. Aim of \nthis study is to assess intestinal aGvHD by magnetic resonance imaging (MRI). \nMethods and Materials:  As part of our routine preparation prior to allogeneic \nSCT 78 consecutive patients underwent abdominal MRI examination after \ninformed consent on a 3 T MR-scanner (Magnetom Skyra, Siemens) including \naxial and coronal T2w sequences with and without fat-saturation and a three-\ndimensional dynamic T1w, contrast-enhanced sequence with a spatial \nresolution of 0.9x0.9x0.9 mm3. After SCT patients with suspected aGvHD \nreceived a second MRI as well as endoscopic examination with multiple \nbiopsies for histologic investigation. \nResults: Nine patients (aGvHD-group) suffered from histologically proven \nintestinal aGvHD. In ten control-group patients, no intestinal aGvHD was \ndiagnosed. In all aGvHD patients characteristic MRI findings with long-segment \nbowel wall thickening - always involving the terminal ileum - with profound \nsubmucosal edema were detected. The bowel wall was significantly thickened \nin patients with intestinal aGvHD in comparison with control group patients \n(mean wall thickness of the small intestine: aGvHD-group 8 mm, control-group \n3 mm, p < 0.001; large intestine: aGvHD-group 9 mm, control-group 3 mm, \np < 0.001). Bowel perfusion spared the submucosa while demonstrating strong \nand patchy mucosal hyperemia. Free abdominal fluid was seen in the majority \nof aGvHD patients. \nConclusion: In intestinal aGvHD, a characteristic MR-appearance can be \ndetected. This MRI pattern might facilitate an early and non-invasive diagnosis \nof intestinal aGvHD.  \nB-0199 15:12  \nRole of oral contrast medium in x-ray defecography  \nF. Testa, D. Fraire, C. Nyffenegger, M. Baigi, M. Lo Bello; Bra/IT \n(frates@gmail.com)  \nPurpose: Oral contrast medium in x-ray defecography is not required in all \nprocedures, but is mandatory to detect enterocele. To consider administering \nan oral contrast to all patients who undergo the procedure. \nMethods and Materials:  We reviewed our consecutive series of 139 \nprocedures in last 4 years on patients suffering from disorders in the \nevacuation. For each procedure we have considered the presence or absence \nof enterocele and, if present, its extent. All our procedures were made with oral \ncontrast medium administred to the patient one hour before the exam. \nResults: 139 defecographies in 131 female patients and 8 male patients \n(mean age 61.6 years, median age 62 years) showed an amount of 52 \nenteroceles (37.4%), classed in 32 mild enteroceles (61.5 %, not interfering \nwith the evacuation) and 20 severe enteroceles (38.5 %, interfering with the \nevacuation). No signifiant difference was recognised in efficacy between \nbarium and iodinated contrast media. \nConclusion: The high rate of enterocele suggests the opportunity of use of an \noral contrast in all patients who undergo defecography. The choice between \nbarium and iodinated contrast media can be accomplished on the basis of the \npatient's clinical history.  \nB-0200 15:21  \nPrevalence of significant findings on magnetic resonance enterography \n(MRE) beyond Crohn's  \nP.M. Yeap, M. Budak, J. Weir-McCall, M. Szewczyk-Bieda, I. Zealley; \nDundee/UK (pheymingyeap@gmail.com)  \nPurpose: Magnetic resonance enterography (MRE) is increasingly used for \nevaluation of the small bowel in patients with Crohn's disease. Occasionally \nother pathologies unrelated to Crohn's may be sought, or be identified when \nCrohn's is suspected. We aimed to determine the frequency of significant \nincidental findings detected by MRE in patients with suspected or known \nCrohn's disease, which may have important impact on clinical management. \nMethods and Materials:  Single centre study of 807 MRE performed between \nJanuary 2004 and March 2013. Clinical details of study population and their \nrespective MRE reports were obtained from local Computerised Radiology \nInformation System and were retrospectively reviewed. Significant incidental \nfindings were defined as enteric or extra-enteric findings unrelated to Crohn's \nthat may account for presenting symptoms or requiring further investigation. \nResults: Of 807 MRE, 98% were performed for suspected or known Crohn's. \nOnly 2% were performed for more esoteric diagnosis particularly in young or \npregnant patients. 38 (4%) of MRE had signif icant incidental findings, of which \n58% (n=22) were bowel pathologies and 42% (n=16) were extra-enteric. Extra-\nenteric pathologies included gynaecological (n=7), mesenteric (n=3), urinary \ntract (n=2), biliary tree (n=1), neural crest (n=1), retroperitoneum (n=1), and \nvascular (n=1). Bowel findings were mainly of adhesion (23%), obstruction \n(18%), and intussusception (9%). \nConclusion: Although only a small proportion of patients have significant \nincidental findings at MRE, it is desi rable that radiologists are aware of the \nMRE appearances of diseases affecting the small bowel other than Crohn's, \nand of extra-enteric diseases that may hav e similar clinical presentation to \nCrohn's.  \n \n \n \n \n \n \n \n \n \nS178  \n\n \n \nBA C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n14:00 - 15:30 Room F1  \nOncologic Imaging  \nSS 216  \nNew imaging biomarkers and decision-\nmaking in oncology  \nModerators:  \nG.P. Schmidt; Munich/DE  \nC.A. Cuénod; Paris/FR  \nB-0201 14:00  \nBreast MRI as a potential biomarker to predict occurrence of metastasis: \nis there any additional value compared to classical prognostic factors?  \nM. Dietzel1, R. Zoubi2, C. Jerowski3, W.A. Kaiser3, P.A.T. Baltzer4; \n1Erlangen/DE, Jena/DE, 2Bielefeld/DE, Jena/DE, 3Jena/DE, 4Vienna/AT, \nJena/AT  \nPurpose: There is increasing evidence that breast-MRI could be used as a \nnon-invasive prognostic-biomarker. However, most previous investigations \naddressed surrogates of outcome as endpoint, i.e. tumour-grading, steroid-\nreceptors, etc., instead of direct endpoints such as distance-metastasis. \nFurthermore, the additional value of breast-MRI compared to classical \nprognostic-factors remains poorly investigated. Accordingly, we aimed to \ninvestigate the additional value of breast-MRI compared to conventional \nprognostic-factors to predict occurrence of distance metastasis. \nMethods and Materials: Patients with newly diagnosed invasive breast cancer \nreceiving pre-therapeutic breast-MRI at our institution were eligible \n(standardised protocol according to EUSOBI-recommendations; 1.5 Tesla). \nClassical prognostic-factors included nodal-status, T-stage, typing, tumour-\ngrading, in situ components, steroid-receptors and herceptin-receptor-status. \nAll patients were followed-up according to national-guidelines and occurrence \nof distant-metastasis was documented. Breast-MRI was analysed semi-\nautomatically by a commercial CAD-system (computer-assisted-diagnosis). It \nallows to semi-quantitatively assess characteristic enhancement-parameters \n(n=15) of the breast-cancer. Logistic-regression was used to identify accuracy \nof classical prognostic-factors alone and in combination  with breast-MRI to \npredict occurrence of distant-me tastases (ROC: receiver-operating-\ncharacteristics; AUC: area-under-the-ROC-curve; inter-AUC-comparison). \nResults: During a mean follow-up of 55 months, 38 out of 251 women (15.8%) \nwere diagnosed with distant-metastasis. If used separately, breast-MRI \n(AUC=78.8%) and classical prognostic-factors (AUC=80.0%) showed \nmoderate accuracy to predict distant-metastases without significant difference \n(P=0.8). Yet, the combined use of breast-MRI and classical prognostic-factors \nsignificantly increased overall accuracy to AUC=87.1% (P <  0.001). \nConclusion: Breast MRI has a major potential as a non-invasive biomarker. \nAccording to our data it adds significant prognostic value to classical \nprognostic factors to predict distance metastasis in breast cancer.  \nB-0202 14:09  \nComparison between MRI and CT in prediction of peritoneal \ncarcinomatosis index in patients undergoing peritoneal surgery in \nrelation to the radiologist's experience  \nM. Torkzad\n1, N. Casta2, A. Bergman2, H. Ahlström2, H. Mahteme2; \n1Sollentuna/SE, 2Uppsala/SE (michael.torkzad@gmail.com)  \nPurpose: To compare CT and MRI for assessment of total PCI and tumour \nburden per site and assessments made by the radiologists. \nMethods and Materials: In 19 prospective cases of peritoneal carcinomatosis, \nMRI of the abdomen (with T1-weighted TSE, T2-weighted TSE, 3D T1-\nweighted fat saturated images before and contrast enhancement with Gd, and \ndiffusion-weighted images with b 1000) and contrast-enhanced CT (portal \nvenous phase) was used within two days and maximum one week before \nsurgery. An inexperienced radiologist and an experienced (MRI and CT) \nabdominal radiologist evaluated the image s separately on different occasions \nand blinded to clinical data. The agreement between the radiologists' \nassessment and surgical findings in total and per site were measured and \ncompared. \nResults: Total PCI: experienced radiologist assessed total tumour burden \ncorrectly on both CT and MRI (kappa = 1.0). The inexperienced radiologist \nassessed CT better (kappa = 0.73) than MRI (kappa = 0.58). Different sites: \nExperienced radiologist showed higher agreement per location with kappa = \n0.77 for MRI and 0.80 for CT. The same figures were 0.39 and 0.60 for the \ninexperienced radiologist. The best results of experienced radiologist for \nassessment of the small intestine and its mesentery were seen with CT while \nfor pelvis, upper abdomen and the flanks the best agreement was seen on \nMRI. \nConclusion: Degree of experience influences assessment of PCI more than \nchoice of modality. The difference between CT and MRI results is partially \nrelated to experience and tumour site for the inexperienced radiologists.  \nB-0203 14:18  \nRemaining malignant lymph nodes in good responders after \nchemoradiotherapy for rectal cancer: where are they located?  \nL.A. Heijnen, D.M. Lambregts, M.H. Martens, M.J. Lahaye, M. Maas, \nG.L. Beets, R.G.H. Beets-Tan; Maastricht/NL (d.lambregts@mumc.nl)  \nPurpose: Minimally invasive treatments may be an option in rectal cancer \npatients showing a good or complete tumour response after \nchemoradiotherapy (ypT0-2). However, regardless the primary tumour \nresponse, remaining metastatic lymph nodes withhold a risk for recurrence. \nKnowledge on the presence and location of these ypN+ nodes may help guide \ntreatment intensification (boost radiotherapy) to further sterilize the nodes. Aim \nof this study was to investigate location patterns of remaining ypN+ nodes in \ngood/complete tumour responders. \nMethods and Materials:  211 locally advanced rectal cancer patients \nunderwent chemoradiotherapy, which resulted in downstaging to ypT0-2 in 134 \npatients, who constituted the final study group. For the patients with a ypT0-\n2N+ status, a lesion-by-lesion MR-histologic analysis was performed on the \nlocation of the individual ypN+ nodes. \nResults: 8/134 ypT0-2 patients (6%) had a yp2N+ status. 47% of the ypN+ \nnodes were located at the same height as the tumour, the other 53% were \nlocated proximal to the tumour at a distance of 1.2-6.5 cm above the tumour \nlevel (40% within < 5 cm from the tumour; 60% > 5 cm above the tumour, in the \npresacral area). In the axial plane, 71% of the nodes were located near (within \n< 1 cm from) the tumour/rectal lumen. \nConclusion: The incidence of remaining malignant nodes in case of good \ntumour response after CRT is very low. Remaining nodal metastases are solely \nlocated at the same level or proximal to the tumour. The majority of N+ nodes \nare located near the tumour/lumen.  \nB-0204 14:27  \nPreoperative evaluation of rectal cancer with MR: how to increase \ndiagnostic accuracy of N staging?  \nM. Gatti, R. Faletti, M. Benedini, S. Stola, A. Rapellino, A. Dominguez, \nA. Grasso, P. Fonio, G. Gandini; Turin/IT (marcogatti17@gmail.com)  \nPurpose: To evaluate the accuracy of magnetic resonance (MR) on loco-\nregional staging of rectal cancer focus on nodes, and compare the results to \nhistologic findings, considered as standard reference. \nMethods and Materials:  Between July 2011 and March 2013, 61 patients, 31 \n(52.5%) males, age 66.75 ±13.77, with rectal cancer, were staged \npreoperatively with MR and had surgical resections performed. Two \nradiologists blinded to the pathology results performed the MR evaluation \nindependently. Nodal size, border contour, signal intensity and localisation \nwere considered on 265 nodes for N malignant score (p1, p2, p3). The ADC \nvalues of N were measured in regions of interest. Comparison between \nimaging and histopathologic findings was ca rried out with different approaches: \nChi-square test, analysis of variance (ANOVA), Kruscal-Wallis' test, Cohen's \nkappa coefficient and ROC curve. \nResults: MR accuracy for T-stage was Kw= 0.87 ±0.06, interoperator variability \nwas not statistical significant (Kw=0.62 ±0.08). Nodes were divided into p1=198, \np2=17, p3=50. Accuracy on node defined suspicious (p3) was kw=0.62 ±0.08. \nADC values for nodes were p1=1.227 ±0.298 mm2/s, p2=1.120 ±0.306 mm2/s \nand p3=0.818 ±0.168 mm2/s. We defined a threshold ADC value of 1 mm2/s \nand the correlation with malignant node was strong (AUC=0.88). The \npercentage of malignant nodes [p3/(p1+p2)] is higher in the external iliac lymph \nnodes than pre-sacral and meso-rectal ones (55.6% vs. 17.5 and 17.6%). \nConclusion: Magnetic resonance imaging is an accurate imaging method in \nstaging of rectal cancer. Prediction of nodal involvement could be improved \nusing ADC value, which is a reliable and reproducible evaluation.  \nB-0205 14:36  \nPre-operative MRI in early stage cervical cancer may predict the need of \nadjuvant therapies: a single-center experience  \nS.A. Angileri, S. Rizzo, S. Maccagnoni, G. Calareso, F. Landoni, S. Raimondi, \nE. Pasquali, R. Lazzari, M. Bellomi; Milan/IT (ang.alessio@yahoo.it)  \nPurpose: To determine whether MRI and DWI may predict which patients are \ncandidate to adjuvant therapies in early-stage cervical cancer. \nMethods and Materials:  Data about adjuvant therapies, minimum uninvolved \nstroma, maximum stromal involvement, positive lymph nodes were collected in \n217 patients operated for early-stage cervical cancer (FIGO IA1-IIB). ADC \nmaps were avaible in 51/217 patients. Measures from pathological reports \nwere used as reference standard. P-values < 0.05 were considered significant. \nResults: 113/217 (54%) patients underwent adjuvant therapies (9 \nchemotherapy; 21 radiotherapy; 83 radio-chemotherapy). Sensitivity, \nS179  \n\n \n \nBA C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nspecificity, positive/negative predictive  values and accuracy of MR imaging in \nevaluating minimum thickness of uninvolved  cervical stroma were respectively \n88%, 75%, 70%, 90% and 80% while for pelvic positive lymphnodes were \n64%, 85%, 65%, 84% and 78%. MR and pathological results were concordant \nabout maximum depth of stromal invasion in 207/217 patients (95%). Depth of \nstromal invasion was strongly related to positive nodal status (p < 0.001). DWI \nshowed no correlation with histological type, grade or presence of lymph node \nmetastasis. \nConclusion: Pre-surgical MR evaluation can predict the need of adjuvant \ntherapies because of the high accuracy in measuring the minimum thickness of \nuninvolved stroma and the maximum depth of stromal invasion. MR accuracy \nin detection of positive lymph nodes was 78%. Depth of stromal invasion was \nstrongly related to the presence positive lymph nodes.  \nB-0206 14:45  \nFive-year results of prostate cancer permanent brachytherapy: the \nimportance of postimplant CT-based quality control  \nO. Apolikhin, A. Sivkov, B. Oschepkov, D. Roshin, A. Koryakin; Moscow/RU \n(vatatava@ya.ru)  \nPurpose: Brachytherapy is a high-tech method, which arose from Radiology \nand Minimally Invasive Urology as the result of the accumulation of significant \nexperience in radiation therapy and the latest knowledge of radiation biology \nand dosimetry. However, the real seed distribution doesn`t always match the \npreplan. The main purpose of the study was to asses the long-term results \ndepending on the postimplant dosimetry. \nMethods and Materials:  Single-centre results of brachytherapy with 125I \nsources in 117 prostate cancer patients of low and intermediate-risk group \n(according to the D `Amico criteria) with an average follow-up of 5 years, \noperated in FSBI Institute of Urology from 2000 to 2013. In the postoperative \nperiod (on the 30\nth day) patients underwent CT-based PDA (postimplantation \ndosimetric analysis), which restated the basic dosimetric parameters - one of \nthe most important - D90 (dose that is received by 90% of the prostate gland). \nResults: According to our data, the 5-year disease-free survival was \nsignificantly higher in the patients who received radiation dose D90 > 140 Gy, \nthan in patients with dose < 140 Gy: 93.2% and 77.6%, respectively (p 140 \nGy), but statistically signi ficant differences between the groups were obtained \nonly in the incidence of dysuria: 58.6% and 42.4%, respectively (p < 0.05). \nConclusion: Along with the stage of disease, tumor grade, and preoperative \nPSA, PDA plays important role in the prognosis of the disease. In patients with \nhigher D90 biochemical control was better, although the frequency of dysuria in \nthis group of patients was more common.  \nB-0207 14:54  \nIonizing radiation exposure as a result of diagnostic imaging in patients \nwith Hodgkin and non-Hodgkin lymphoma  \nM.P. Crowley, S.B. O'Neill, D.C. O'Neill, B. Bird, O. Flanagan, M.M. Maher, \nM.R. Cahill, D. O'Shea, K. O'Regan; Cork/IE  \nPurpose: Exposure to ionizing radiation has been linked to an increased risk \nof malignancy. An increasing majority of patients with lymphoma achieve long-\nterm survival. Late complications of treatment have emerged as a significant \ncause of death/morbidity. Long-term survivors are at risk for developing second \nmalignancies due to treatment. Ionizing radiation exposure through diagnostic \nimaging may increase this risk. \nMethods and Materials:  Retrospective review of 486 consecutive patients \nwith biopsy-proven Hodgkin/non-Hodgkin lymphoma that discussed at a \nmultidisciplinary lymphoma meeting between January 2009 and July 2012 was \nconducted. The number/type of radiological procedures were obtained from the \nradiology databases in each of 5 participating centres. The cumulative effective \ndose (CED)was calculated using standardised procedure-specific radiation \ndose levels. \nResults: Mean (SD) age at diagnosis was 59 (17) with 15% (n=73) under 40 \nyears. 59% percent were men. 16% (n=78) had Hodgkin lymphoma; 84% \n(n=408) had Non-Hodgkin lymphoma. The median estimated total CED (IQR) \nper subject was 69.4mSv (42-118). 46% had a total CED >  75mSv and 14% \nhad a total CED >  150mSv. CT contributed 89% of the CED and PET-CT \ncontributed 8%. Patients aged under 40 had a median (IQR) CED of 89.44mSv \n(55.42-123.94). Patients who underwent a stem cell transplant had a median \n(IQR) CED at 161.94mSv (135.11-224.68). 59% of this group went on to have \nradiotherapy as part of their treatment protocol. \nConclusion: This study highlights the considerable ionizing radiation exposure \nfrom radiological imaging in lymphoma patients, especially in young patients \nconsidered the most radiosensitive and at highest risk for secondary \nmalignancies.  \n \n \nB-0208 15:03  \nThe role of baseline 18 F-FDG PET/CT maximum SUV in predicting \ntreatment outcome of patients with multiple or oligometastatic breast \ncancer  \nH. Zagloul\n1, Y. Assiri1, Y.E. Almalki2, S. El badawy1; 1Dammam/SA, 2Riyadh/SA \n(yaser_21@yahoo.com)  \nPurpose: To evaluate pretreatment (SUVmax) of (18 F-FDG PET-CT) as a \npredictor of progression free survival (PFS), and overall survival (OS) in \nmultiple and oligometastatic breast cancer patients. \nMethods and Materials: We retrospectively analysed metastatic breast cancer \npatients (MBC) who had pretreatment 18 F-FDG PET-CT from January 2010 to \nDecember 2012. We examined the association between the highest \npretreatment (SUVmax) in metastatic sites and the treatment outcomes. The \n(PFS), and (OS) were calculated by the Kaplan-Meier method, and log rank \ntest. \nResults: We identified 70 MBC patients with pretreatment 18 F-FDG PET-CT. \nOligometastasis to bone was observed in 20 patients while 50 patients had \nmultiple organs metastases. The receiver-operating characteristic curve (ROC) \ndemonstrated a SUVmax 7.7 to be the cutoff in multiple MBC for predicting \nPFS which was significantly higher in patients with pretreatment SUVmax \u0002 7.7 \ncompared to > 7.7 (P \n< 0.0001). On multivariate analysis (MVA), the SUVmax \ncategory was the only factor correlated with both PFS (Hazard ratio (HR)) = \n4.5, 95% C I 3-6.8, P < 0. 0001 ) and OS (HR = 3.2, 95% C I 2.2-4.9, \nP < 0.0001). Additionally, the ROC cut off SUVmax in oligometastatic patients \nwas 4.4 with significantly higher PFS in patients SUVmax \u0002 4.4 compared to \n> 4.4 ( P =0.001 ). On MVA, the SUVmax category was the only factor \nassociated with PFS ((HR) = 8.4, 95% C I 1.2-54.8, P < 0. 026) and but not OS \n(P=0.99). \nConclusion: The pretreatment 18 F-FDG PET-CT SUVmax is an independent \nprognostic predictor of clinical outcomes in MBC patients.  \nB-0209 15:12  \nThe malignant proliferation of MDT meetings: can radiology departments \ncontinue to support them all?  \nR. Balasubramaniam, M. Subesinghe, J. Smith; Leeds/UK \n(ravivarmabalasub@gmail.com)  \nPurpose: To quantify the increase in workload associated with multidisciplinary \nteam meetings for radiologists working in a tertiary referral centre over a 5-year \nperiod. \nMethods and Materials:  Information regarding volume of MDT cases from \n2008 to 2012 was acquired from the radiology information system (CRIS\nTM) \nand through structured interviews of indi vidual consultant radiologists. Data \nobtained included the number of MDT meetings involved with, type of MDT \nmeeting (oncological or non-oncological), time allocated for preparation and \nperceived deficiencies in the current MDT meeting. \nResults: The annual number of cases discussed in an MDT meeting in 2008 \nwas 13049. In 2009, this had grown to 24610, by 2010 it was 26864, in 2011 a \npeak of 28603 cases and in 2012 there were 26984 entries. This demonstrates \nthat the volume of cases has more than doubled over five years. Consultant \nradiologists were responsible for a median of 2 MDT meetings per week (range \n1-5). 66% (31/47) of consultant radiologists were part of an oncological MDT \nmeeting and 60% (28/47) prepared for at least part of their MDT meeting out of \ncontracted working hours. The most frequently stated deficiencies in the \ncurrent MDT meeting included insufficient clinical information (40%) and a lack \nof clerical support/funding (32%). \nConclusion: The MDT approach is the standard of care in the delivery of \noptimal oncological patient management in the UK. The radiologist's workload \nassociated with MDT meetings has more than doubled in the last 5 years. The \nMDT meeting is under resourced and without change unsustainable.  \nB-0210 15:21  \nMultidisciplinary meetings and radiologist workload: a retrospective and \nprospective review in a tertiary university centre in Ireland  \nE. Aherne, H. Moriarty, M. Egan, L. Lawler; Dublin/IE \n(emily.aherne@gmail.com)  \nPurpose: In recent years multidisciplinary meetings (MDMs) have become a \npart of the standard of care for many patients with cancer. The number and \ncomplexity of imaging studies presented continues to expand rapidly. These \nmeetings are an important forum for discussion and decision-making regarding \nchallenging cases and for clinical teaching but have put increasing pressure on \nradiology departments in their demand for time and resources. \nMethods and Materials:  Data was retrospectively gathered from April 2012 to \nSeptember 2012 regarding the number of MDMs held and type of imaging \nreviewed. A five-week prospective study was performed from 22/10/2012 to \n25/11/2012 inclusive to examine the workload in further detail. \nResults: Retrospectively, 199 meetings were held with 2253 clinical cases \nreviewed over 26 weeks. Prospectively, 52 meetings were held over 5 weeks \nS180  \n\n \n \nBA C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nfor 13 clinical specialty areas. There were 1038 clinical case discussions. \nThere were a total of 2122 documented individual imaging studies reviewed: \n563 CT studies (27%), 446 ultrasound studies (21%), 411 mammogram \nstudies (19%), 264 MRI studies (12%), 113 PET studies (5%). Specialist \nregistrar preparation time was 55 hours (11 per week). Consultant preparation \ntime was 67.75 hours (13.55 per week). Delivery time was 57.25 hours (11.45 \nper week). \nConclusion: MDMs are becoming a standard of care for cancer patients. Due \nto the rapid increase in the number of meetings and the volume and complexity \nof cases discussed, MDMs now represent a significant proportion of the \nradiologist workload and reduce the time dedicated to other activities within the \ndepartment.  \n14:00 - 15:30 Room F2  \nBreast  \nSS 202  \nDifferent ways to evaluate treatment \nresponse  \nModerators:  \nP.A.T. Baltzer; Vienna/AT  \nG.I. Kirova-Nedialkova; Sofia/BG  \nB-0211 14:00  \nEvaluation of T1/T2 ratios obtained by quantitative MRI in a pilot study as \na potential biomarker to monitor response to treatment of biopsy-proven \nmalignant breast lesions and assessment tool for involvement of \ncontralateral breast.  \nM.A. Malikova\n1, J.N. Tkacz1, A. Aakil1, P.J. Slanetz1, C.-Y. Guo2, H. Jara1, \nC.-Y. Guo2; 1Boston, MA/US, 2Tainan/TW (mmalikov@bu.edu)  \nPurpose: To study a potential role of quantitative MRI (qMRI)using T1/T2 \nratios to assess contralateral breast involvement and monitor response to \ntreatment. \nMethods and Materials:  In a pilot study, 28 women with known breast lesions \nwere scanned post-treatment with the mixed-TSE pulse sequence and T1/T2 \nmaps were obtained. qMRI assessment of contralateral breast without known \ncancerous lesion was performed and compared to the breast lesion subjected \nto chemotherapy and/or radiation therapy to monitor treatment response. \nResults: T1/T2 means of 6.73 ± 2.55 were observed for biopsy-proven \nmalignant lesions treated prior to qMRI with chemotherapy and/or radiation as \ncompared to contralateral breast with T1/T2 ratio means of 3.37 ± 1.68. \nRecurrent disease with contralateral breast involvement was confirmed by \nhistophatology in two cases and elevated T1/T2=11.5 for previously treated \nlesion (contralateral breast T1/T2 = 8.1) and T1/T2= 9.1 (contralateral breast \nT1/T2= 6.9) were detected. The higher stage of cancer determined by \nhistopathology was strongly associated with higher T1/T2 ratio ( p= 0.0093). \nEstrogen, progesterone and HER2/neu receptors triple-negative status were \nassociated with higher T1/T2 ratio and more poor response to treatment \n(p=0.0065). Larger size of lesion showed significant correlation with elevated \nT1/T2 ratio and poor response to treatment with chemotherapy alone \n(p=0.0427) as compared to combination regimen with chemotherapy and \nradiation. \nConclusion: The T1/T2 ratios provide measures that strongly correlate with \nhistopathology. This quantitative information can provide basis for \nimprovement of diagnostic breast imaging and serve as a tool to assess \nresponse to treatment and contralateral breast involvement.  \nB-0212 14:09  \nRole of pre-treatment apparent diffusion coefficient in the prediction of \nresponse to neoadjuvant chemotherapy in locally advanced breast \ncancer patients  \nA. Cipriani, E. Bufi, P. Belli, M. Costantini, M. Di Matteo, P. Rinaldi, L. Bonomo; \nRome/IT (antocipriani@tiscali.it)  \nPurpose: Being still no consensus in the literature about this topic, we \naddressed the diagnostic reliability of apparent diffusion coefficient (ADC), \nobtained before treatment, in the prediction of response to neoadjuvant \nchemotherapy (NAC) in locally advanced breast cancer (LABC) patients. \nMethods and Materials:  Two hundred fifty-five consecutive LABC patients \n(mean age 47.7± 10.0 years, range 24-74 years) underwent a 1.5 T MRI \nexamination of the breast before and after NAC, prior to surgery, including \ndimensional assessment of target lesi ons (according to RECIST criteria) and \ndiffusion-weighted imaging (DWI), with ADC calculation (b values 0 and 1000 \nsec/mm2). Response to treatment was assessed according to the TRG (tumour \nregression grade) classification. Pre-treatment ADC and increase in ADC \nvalues ( ,ADC) following NAC of responders and non-responders were \ncompared. \nResults: Following NAC, pathological complete response (TRG1) was \nobserved in 17% of cases, partial response (TRG2-3) in 42% and no response \n(TRG4-5) in the remaining 41%. ADC was capable of differentiating each \nspecific tumour subtype before treatment (anova, p=0.022). No difference was \nobserved between pre-treatment ADC of patients with partial or complete \nresponse to treatment (TRG1-2-3) and non-responders (TRG4-5, p=0.581). \nOtherwise, post-treatment ADC of responders was statistically higher than non-\nresponders (p < 0.001). Both final ADC and ,ADC inversely correlated with the \nTRG class (Spearman's rho -0.373 and -0.315, respectively, p < 0.001). \nConclusion: In our experience, pre-treatment ADC does not predict response \nto NAC in LABC patients. Otherwise, final ADC and ,ADC negatively correlate \nwith response to treatment and should be taken into consideration when \nestablishing it.  \nB-0213 14:18  \nDiffusion-weighted imaging to quantify the residual tumour post-\nneoadjuvant chemotherapy in locally advanced breast cancer: in \ncomparison with dynamic contrast-enhanced MRI  \nS. Poyyamoli; Coimbatore/IN (psan26@yahoo.co.in)  \nPurpose: Quantification of breast carcinoma after neoadjuvant chemotherapy \nis essential to triage a locally advanced breast cancer (LABC) patient into \nbreast conservation. Diffusion-weighted imaging (DWI) is evaluated for residual \ntumour assessment in comparison with dynamic contrast-enhanced MRI (DCE \nMRI). \nMethods and Materials:  Thirty-six patients with LABC were studied with DWI \nand DCE MRI, before and after neoadjuvant chemotherapy. Tumour size and \nApparent Diffusion Coefficients (ADC) were recorded. The residual tumour \nsizes measured at DWI and DCE MRI were compared with the size at post-\nsurgical pathology, which was considered gold standard, using Pearson \ncorrelation. The pre-treatment ADCs of the tumour were compared between \nthose with pathological complete response (pCR) and those with residual \ndisease (non-pCR). \nResults: The sensitivities and specificities for detection of residual tumour \nwere similar for both DWI and DCE MRI, at 100% and 80%, respectively. Both \nDWI (r=0.94, p < 0.001) and DCE MRI (r=0.93, p < 0.001) had significant \ncorrelation with tumour size at pathology with no significant difference between \ntheir strengths of correlation (z=0.12, p=0.9045). DW MRI (z=0.797, p=0.425) \nand DCE MRI (z=0.88, p=0.379) fared equally well among focal and nonfocal \nlesions. There was no significant difference (p=0.5527) in the pre-treatment \nADCs between the pCR and non-pCR groups. \nConclusion: DWI is as accurate as DCE MRI in quantifying the presurgical \nresidual disease in patients with locally advanced breast cancer who undergo \nneoadjuvant systemic therapy. It can be of use in patients with end-stage renal \ndisease. ADC analysis is not useful in tumour response prediction.  \nB-0214 14:27  \nThe hypervascularity paradox: can asymmetric increase in breast \nvascularity predict the response of neoadjuvant chemotherapy and the \nfollow-up outcome in locally advanced breast cancer?  \nM. Di Matteo, E. Bufi, A. Cipriani, M. Costantini, P. Belli, L. Bonomo; Rome/IT  \nPurpose: To investigate the relationship between asymmetric increase in \nbreast vascularity (AIBV) and the pathological and molecular profiles of breast \ncancer. To address the prognostic performance of AIBV and of vascular maps \nreduction after NAC (Neoadjuvant Chemotherapy) in predicting pathological \ncomplete response (pCR) at surgery and outcome at follow-up. \nMethods and Materials:  Two-hundred-nineteen patients with unilateral locally \nadvanced breast cancer (LABC) underwent MRI before and after NAC. Axial, \nsagittal and coronal MIPs were obtained to allow a subjective comparative \nevaluation. Asymmetrical vs. symmetrical breast vascularity was defined \nthrough a combination of vessels number, di ameter and signal intensity. An \naverage 31.4 ± 18 months follow-up was available for 82 patients. \nResults: AIBV ipsilateral to the LABC was observed in 62.5% of cases \n(p < 0.001). AIBV was also significantly associated with IDC, G3, Triple \nNegative, HER2+, and Hybrid phenotypes (p < 0.001). pCR was higher among \nthe LABC with ipsilateral AIBV (24%) than those with symmetrical breast \nvascularity (6%) (p= 0.001; t=-3.395). After NAC, vascular map in the breast \nwith LABC was significantly reduced, particularly in patients with pCR \n(p < 0.001; t=-4.803). At follow-up, a 22% recurrence-rate was observed (6.1% \nmortality). AIBV after NAC was significantly associated with worse overall \nsurvival at follow-up (Kaplan-Meier analysis). \nConclusion: LABC with ipsilateral AIBV before NAC is associated with more \naggressive clinical, pathological and molecular profiles. Nonetheless, it is more \nsensitive to NAC and shows a higher frequency of pCR. Consistently, the \npresence of AIBV after NAC entails a worse late prognosis and should prompt \nmore aggressive therapeutic strategies.  \nS181  \n\n \n \nBA C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0215 14:36  \nAccuracy of 3 T magnetic resonance imaging (3 T MRI) with a high-\nrelaxivity contrast agent in assessing treatment response in patients \nundergoing neoadjuvant chemotherapy (NAC)  \nM. Telesca, F. Pediconi, S. Ursu, M. Luciani, V. Casali, E. Miglio, C. Catalano; \nRome/IT (marianna.telesca@uniroma1.it)  \nPurpose: To assess the accuracy of 3 T MRI in evaluating residual disease \nafter NAC in patients with advanced breast cancer. \nMethods and Materials:  Between March 2010 and March 2013, 47 women \nwith advanced breast cancers underwent 3 T MRI before and after NAC. The \nMRI protocol comprised precontrast FSE T2w IDEAL sequence and VIBRANT \n3D T1w sequence acquired before and after administration of gadobenate \ndimeglumine (MultiHance®) at 0.1 mmol/kg bodyweight. Tumour size was \ndetermined before and after NAC. MRI evaluation of treatment response was \nclassified with RECIST criteria. Pat hologic complete response was defined as \nwhen there were no residual invasive cancer cells. Residual tumour size at \nMRI was compared with pathological findings. \nResults: 50 lesions were evaluated. The overall sensitivity, specificity, PPV, \nNPV and accuracy for diagnosing of invasive residual disease at MRI were \n70%, 76%, 85%, 57% and 72%, respectively. The presence of residual tumour \nat MRI was overestimated in 4 cases (in 2 cases histology showed only DCIS \ncomponent) and underestimated in 10 cases (histology showed scattered \nresidual invasive foci). We found a statisti cally significant correlation between \nMRI and pathology measurements (Spearman Rho = 0.639; P value < 0.0001). \nThe tumour size was underestimated in 11 cases, in all of these the \nhistological size was less than 4 mm. \nConclusion: The presence and size of residual disease in breast patients \ntreated with NAC could be accurately evaluated using 3 T MRI and high-\nrelaxivity contrast agent. Both overes timation and underestimation can be \nobserved and might have important clinical impact.  \nB-0216 14:45  \nLocally advanced breast cancer response to neoadjuvant chemotherapy: \ncorrelation between RECIST, positive enhancement integral values and \ntumour vascularity  \nM. Nadrljanski, R. Maksimovic, V. Plesinac-Karapandzic, M. Nikitovic, \nB. Markovic-Vasiljkovic, Z. Milosevic; Belgrade/RS \n(dr.m.nadrljanski@gmail.com)  \nPurpose: To prospectively assess tumour size, vascular score, positive \nenhancement integral (PEI) on MRI and their correlation in patients with locally \nadvanced breast cancer (LABC). \nMethods and Materials:  Thirty patients were assessed initially, after four \ncycles of anthracycline-based regimen and upon NACT (paclitaxel, 4 cycles) \nwith 1.5 T unit, on Gd-DTPA postcontrast series. The following was analysed: \ntumour size (RECIST), number of vessels (30 mm or longer, 2 mm or larger) \nand PEI values (mean±SD), correlated to RECIST. \nResults: Tumour size change is significant before and after four cycles \n(4.7±1.5 cm vs. 3.2 ±1.1 cm, p <  0.001) and upon NACT (4.7 ±1.5 cm vs. \n1.9±0.9 cm, p < 0.0001). The same applies to vascularity after four cycles \n(4.0±1.1 vs. 3.2 ±1.1, p < 0.001) and upon NACT (4.0 ±1.1 vs. 2.2 ±0.9, \np < 0.0001) and to PEI after four cycles (779.6 ±97.2 vs. 662.6±91.3, p < 0.001) \nand upon NACT (779.6± 97.2 vs. 566.2 ±97.1, p < 0.0001). The correlation \nbetween RECIST and vascularity/PEI is weak after four cycles (0.36 and 0.22 \nrespectively) and moderate upon NACT (0.61 and 0.50 respectively). Upon \nNACT, the correlation between vascularity and PEI is weak (0.33), unlike the \nstrong correlation of tumour size after four cycles and upon NACT (0.80). \nConclusion: Tumour size, vascularity and PEI significantly change during and \nupon NACT. Change in tumour size after four cycles and upon NACT strongly \ncorrelates. There is moderate positive correlation between RECIST and \nvascularity/PEI upon completion of NACT, but not before paclitaxel was \nintroduced. To our knowledge, this is the first trial testing PEI in NACT.  \nB-0217 14:54  \nBreast MRI: factors affecting accuracy in the evaluation of residual \ndisease after neoadjuvant chemotherapy  \nS. Gigli, F. Di Pastena, S. Tardioli, M. Mancini, G. D'Amati, M. Monti, \nL. Ballesio; Rome/IT (adrenalina_1@hotmail.it)  \nPurpose: After Neoadjuvant Chemotherapy (NACHT)some changes occur in \nthe tumoral bed,reducing MRI accuracy in evaluating residual disease.We \naimed to analyse the causes of under/overestimation of lesions size in MR \nimages. \nMethods and Materials:  We reviewed MRI exams of 69 patients with locally \nadvanced breast cancer and we measured the longest diameter of each lesion \non MR images obtained before and after NACHT.The response rate was \nexpressed in percentage and compared to the tumor size on the histological \nspecimen (expressed in percentage according to Miller and Payne).In absence \nof residual tumor we classified the case as pathological complete response \n(pCR). We used Pearson correlation and T-test to relate MRI and pathological \nresponse rate.We stratified differences based on the histological changes in \nthe surgical specimen (fibrosis or necrosis).We also considered MRI \nfindings (mass/non mass like enhancement, hi gh T2 signal intensity) and tumor \nbiological features. \nResults: 23/69 patients achieved pCR.MRI identify pCR in 21/23 cases,in two \ncases overestimate disease.We observed a good correlation (0.67)between \nMRI and pathology ( t=6.1169; df  =46; p \n< 0.005).In the other cases MRI \noverestimates the residual lesions.Size discrepancy was greater in case of \ndiffuse fibrosis on the surgical specimen.Other causes were large \nlesions (> 2.5 cm),non mass-like enhancement,Triple Negative cancers and \nhigh T2 signal intensity. \nConclusion: MRI is a valid tool in evaluating pCR but tends to overestimate \nlesions size in case of residual tumor.MRI accuracy in estimating tumor size \nafter NACHT depends on the presence of fibrous tissue,still vascularised,which \ncan enhance after contrast.It's very important to consider tissue changes \ncaused by chemotherapy in order to improve MRI accuracy.  \nB-0218 15:03  \nRole of MRI in predicting the response of neoadjuvant chemotherapy and \nthe follow-up outcome in patients with different breast cancer \nphenotypes  \nE. Bufi, M. Di Matteo, P. Belli, L. Nardone, B. Diletto, L. Bonomo; Rome/IT  \nPurpose: We addressed the diagnostic reliability of conventional MRI vs. \nDiffusion Weighted Imaging (DWI) according to different tumor subtypes, \nincluding HER2+/HR+ (Hybrid phenotype) and in the prediction of outcome at \nfollow-up. \nMethods and Materials:  Two-hundred-twenty-five patients underwent MRI \nbefore and after NAC, including morphological assessment (RECIST \nclassification) and DWI with ADC. The complete pathological response - pCR \nwas assessed (Mandard classification). An average 31.4 ± 18 months follow-up \nwas available for 82 patients. \nResults: Tumor phenotypes were Luminal (63.6%), Triple Negative (16.4%), \nHER2+ (7.6%) or Hybrid (12.4%). After NAC, pCR was observed in 17.3% of \ncases. Average ADC was statistically higher after NAC (p < 0.001) among \npatients showing pCR vs. those who had not pCR. The RECIST classification \nshowed adequate performance in predicting the pCR in Triple Negative (area \nunder the ROC curve, AUC=0.9) and in the HER2+ subgroup (AUC=0.826). \nLess accurate performance was found in the Luminal and Hybrid subgroups \n(AUC 0.693 and 0.611, respectively). In the latter two, the ADC criterion \nyielded an improved performance (AUC=0.787 and 0.722, respectively). At \nfollow-up, a 22% recurrence-rate was observed (6.1% mortality); no recurrence \nwas observed among pCR patients. None of the above-mentioned MRI criteria \npredicted disease-free survival (Kaplan-Meier survival analysis). \nConclusion: The diagnostic reliability of MRI in predicting the pCR to NAC \ndepends on the tumor phenotype, particularly in the Luminal and Hybrid \nsubgroups. In these cases, the ADC value may facilitate the diagnosis. \nNonetheless, disease-free survival at follo w-up can be predicted through final \nhistopathological results only.  \nB-0219 15:12  \nMRI evaluation for residual diseases after the lumpectomy of malignant \nbreast tumours  \nL. Wang, D. Wang; Shanghai/CN (wangjun.124@163.com)  \nPurpose: To determine the utility of breast magnetic resonance imaging (MRI) \nin detecting residual diseases at the prior lumpectomy site. \nMethods and Materials:  From September 2009 to June 2013, 87 consecutive \npatients who underwent lumpectomy and were pathologically confirmed as \nmalignant tumours were retrospectively reviewed. All the patients underwent \nMRI before re-excision surgery. All scans were evaluated according to BI-\nRADS criteria of MRI for post-surgery. \nResults: Of the 87 patients, residual diseases were pathologically confirmed in \n28 (32.2%) patients. Forty-two patients had BI-RADS 2 or 3 category, among \nof which, 4 (9.5%) had residual lesions and 50% (21/42) patients had \nundergone breast conservation therapy; Forty-five patients had BI-RADS 4 or 5 \ncategory, among of which, 24 (53.3%) had residual lesions and 8.9% (4/45) \npatients had undergone breast conservation therapy. The sensitivity, \nspecificity, positive predictive value a nd negative predictive value of MRI for \nprediction of residual cancer were 85.7% (24/28), 64.4% (38/59), 53.3% \n(24/45) and 90.4% (38/42), respectively. Among the MRI findings, ductal \nenhancement, segmental enhancement and masslike enhancement had a \npositive predictive value of 77.8%, 71.4% and 54.5%, respectively. \nConclusion: BI-RADS categories of MRI were useful in estimating the residual \nlesions after lumpectomy. Ductal enhancement, segmental enhancement and \nmasslike enhancement were most predictive of malignancy.  \n \nS182  \n\n \n \nBA C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0220 15:21  \nImage-guided breast lesion excision biopsy versus vacuum-assisted \nbreast biopsy for suspicious non-palpable breast lesions  \nN.M. Abdel Razek, M. Shaalan, O. Yousef, O.S. Omar, S. Naguib, O. Soliman; \nGiza/EG (naglaabdelrazek@yahoo.com)  \nPurpose: To compare the diagnostic efficiency of BLES to VAB in diagnosis of \nsmall non-palpable suspicious breast lesions. \nMethods and Materials: This is a prospective study included 380 patients with \nsmall suspicious non-palpable breast lesions (BIRADS 4 & BIRADS3 with \npositive family history).190/380 were performed using the BLES &190/380 \nwere performed using the VAB.The histopathology results were analysed and \ncompared to the results of open surgery in the malignant cases. \nResults: Group 1 included 190 suspicious lesions were removed using the \nBLES ,20%(55/190)were diagnosed after histopathology as benign including \nfibrocystic disease,sclerosing adenosis ,radial scars and papillomas without \natypia.31.6%(60/190)were diagnosed as high risk lesions including papillomas \nwith atypia,ALH,ADH&39.4 (75/190)were diagnosed as malignant including \nDCIS, LCIS,IDC&ILC.All histopathologically proven malignant lesions were \nexposed to Re-surgery.there was no underestimation encountered by the \nBLES.The margin was free in 68% of cases (51/75 malignant lesions)and the \nmargin was flushed in 32%(24/75)of malignant cases.Group 2 included another \n190 suspicious lesions removed using the VAB,33.7%(64/190) were \nbenign,30.0%(57/190)were high risk lesions & 36.3 %(69/190)were malignant \nlesions.All malignant lesions were exposed to re-surgery.Underestimation after \nVAB was encountered in 20.5% (39/190) of cases.Underestimation of DCIS \ndiagnosed by VAB was found in (12/25)48.0%. \nConclusion: BLES & VAB are used as the primary method for histopathology \ndiagnosis of suspicious small&borderline lesions.BLES is favored in high risk \nlesions & DCIS considering the relativ e high underestimation rate associated \nwith VAB and not found with the BLES. Moreover, BLES offers complete lesion \nremoval with available margin evaluation offe ring good results similar to that of \nopen surgery.  \n14:00 - 15:30 Room G/H  \nGenitourinary  \nSS 207  \nUterus: imaging and intervention  \nModerators:  \nT.J. Kroencke; Berlin/DE  \nI. Thomassin-Naggara; Paris/FR  \nB-0221 14:00  \nMRI in cancer of the corpus uteri staging: possibilities and limitations  \nA. Proshin, J. Proshina, T. Berezovskaya; Obninsk/RU \n(al.proshin@yandex.ru)  \nPurpose: To prospectively assess the diagnostic capabilities of magnetic \nresonance imaging (MRI) in the detection of local extent of endometrial \ncarcinoma (EC) and to determine the causes of errors in evaluation of depth of \nmyometrial invasion. \nMethods and Materials:  72 consecutive patients with a histologically proven \nEC underwent preoperative MR imaging. 1.5 Tesla unit (Symphony Maestro \nClass, Siemens, Erlangen, Germany) was used with a multichannel phased-\narray body coil. High-resolution T2-WI in three planes were obtained, followed \nby T1-WI after intravenous contrast administration in 30 patients. MR findings \nwere compared with surgical staging. \nResults: Total accuracy of MRI for EC staging was 84%. For deep myometrial \ninfiltration, a sensitivity of 56%, specificity of 92%, PPV of 69% and NPV of \n87% were reached. Accuracy for contrast-enhanced scans and T2 sequences \nshowed no statistically significant difference. Accuracy of MRI for cervical \ninvolvement detection was 95%. Errors in evaluating myometrial invasion were \nretrospectively divided into three groups. Cases of misdiagnosis associated \nwith methodological errors (motion artefacts, wrong slice positioning, MRI \nperformed in early period after curettage) were combined into the first group. \nOther errors were associated with concomitant pathologies (adenomyosis and \nleiomyomas) and age-related changes of the corpus uteri. Tumour-related \nfactors (large polyploid tumours, tumours located in the uterine cornu, some \nhistological types of tumour) were combined into the third group. \nConclusion: MR imaging is an effective technique for preoperative evaluation \nof EC. A number of errors must be taken into consideration to avoid \nmisdiagnosis.  \n \n \nB-0222 14:09  \nThe preserved fundal circumferential contour sign: a new and simple \nsign on 2D ultrasound to differentiate septate uterus from other double \nuterine cavity anomalies  \nR.M.K.E. Fouad, S.T. Hamed, I. Faker; Cairo/EG (rashaakamal@hotmail.com)  \nPurpose: To compare between the circumferential contour sign (CCS) and the \nfundal contour sign (FCS) in the diagnosis of septate uterus. \nMethods and Materials:  This study included 96 patients. Inclusion criteria \nincluded the presence of duplicated uterine cavity on ultrasound study. The \nCCS was assessd in axial images taken at the level of the fundus on 2D \nultrasound. Patients were classified into 2 groups. Group A showed a \npreserved CCS, with no external indentations. The postulated diagnosis was \n'septate uterus'. Group B included patients with disrupted CCS with a figure of \n8 configuration. Findings were then correlated with the FCS on T2 W MRI \ncoronal images and laparoscopy. Accuracy measures were calculated and \ncompared. \nResults: Group A (56 cases, 58.3%) included 49 (51%) true positive septate \nuteri and 7 (7.3%) false positive cases. Group B (40 cases, 41.7%) included 36 \n(37.5%) true negative cases and 4 (4.2%) false negative cases. Ultrasound \ndiagnosis based on the circumferential contour sign showed significant \ncorrelation with the laparoscopy diagnosis of the patients (p: 0.00). Calculated \nsensitivity, specificity, positive and nega tive predictive values and accuracy of \nultrasound in reference to the CCS were 92.4%, 83.7%, 87.5%, 90% and \n88.5%, respectively, as compared to 100%, 81.8%, 86.6%, 100% and 91.6% to \nFCS. \nConclusion: 2D ultrasound was considered inaccurate in investigating \nduplicated uterine cavity anomalies due to its inadequacy in viewing the uterus \nin the coronal plane. The CCS assessed on the axial images has upgraded the \nperformance of 2D ultrasound to compete efficiently with MRI and 3D \nultrasound.  \nB-0223 14:18  \nAccuracy of MR imaging in the diagnosis of invasive placenta  \nL.J. Bour, V. Place, S. Bendavid, Y. Fargeaudou, D. Sebag-Ffez, E. Vicaut, \nA. Dohan, P. Soyer; Paris/FR (jlaurence.bour@gmail.com)  \nPurpose: The purpose of our study was to evaluate the accuracy of MR \nImaging in the diagnosis of invasive placenta. \nMethods and Materials:  The MR imaging examinations of 32 women with \nsuspected invasive placenta were blindly reviewed by four independent \nobservers. Eleven morphological MR criteria were evaluated using logistic \nregression analysis. Final diagnosis obtained with MR imaging and diagnosis \nconfidence were investigated for each reader. Final diagnosis was established \nby intraoperative findings or histopathological analysis. \nResults: Sixteen women (16/32; 50%) had invasive placenta. Sensitivity, \nspecificity and accuracy of reviewers ranged between 76%-93%, 78%-83% \nand 78%-88%, respectively. Overall sensitivity, specificity and accuracy of MR \nimaging were respectively 80% [95%CI: 66%-93%], 84% [95%CI: 75%-94%] \nand 82% [CI95% 78%-88%]. Overall interobserver correlation coefficient was \nfair ( 5appa =.40). At univariate analysis, 5 morphological MR criteria were \nsignificantly associated with the diagnosi s of invasive placenta (interruption of \nthe uteroplacental interface, p <.0001; interruption of the inner layer of the \nuteroplacental interface on T2-weighted images, p=.0004; loss of the normal \nuterine pear shape, p=.0004; intraplacental dark bands on T2-weighted \nimages, p=.0023; and placenta previa, p=.0131). At logistic regression \nanalysis, interruption of the uteroplacental interface was the single criteria that \nwas significantly associated with the diagnosis of invasive placenta (p=.0006; \nOR=11.8). \nConclusion: MR imaging has acceptable degrees of sensitivity and specificity \nfor the diagnosis of invasive placenta, although it is associated with a fair \ninterobserver agreement. Interruption of the uteroplacental interface is the \nsingle independent discriminating criteria for the diagnosis of invasive placenta.  \nB-0224 14:27  \nNulliparous vs caesarean-scarred uteri: in-vivo analysis of myometrial \nuterine fibres with 3 T-magnetic resonance with diffusion tensor imaging \n(MRDTI)  \nF. Fiocchi, E. Petrella, S. Currà, L. Nocetti, F. Facchinetti, P. Torricelli; \nModena/IT (federica.fiocchi@gmail.com)  \nPurpose: To investigate fibre architecture of in-vivo human uterus in \nnulliparous and caesarean-scarred (CS) women by 3 T-MRDTI with 3D \ntractography. Quantitative results regarding fibres number, Fractional \nanisotropy (FA) and Apparent Diffusion Coefficient (ADC) were compared. \nMethods and Materials:  In-vivo 3 T-MRDTI was performed in 56 volunteers \n(12 nulliparous, I group; 44 CS, II group). Main diffusion directions reflecting \nfibres orientation were investigated using sense-SSEPI sequence with \ndiffusion-sensitized gradients (b=600 mm2/s) along 16 directions within 24-\nmonths after delivery. A fibre-tracking post -processing algorithm was used to \nS183  \n\n \n \nBA C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nanalyse quantitatively uterine structure. Fibres running through anterior \nisthmus, site of suture, were compared to those running through posterior wall; \nFA and ADC of whole uterus and of anterior isthmus were measured. \nResults: 3 T-MRDTI with 3D tractography reconstruction shows fibre disarray \nat scar level. In group II significant reduction of longitudinal myometrial fibres of \nanterior isthmus was found respect to posterior wall at the same level in \ncomparison to group I, p < 0.0004 (median with IQ range: -46%; -71%-29% \nversus -2%; -27%22%). FA and ADC of whole uterus were similar (p > 0.1) in \ngroup.i. and group II, respectively 0.406 ±0.025 versus 0.39± 0.038 and \n3.364±0.456 x10-3 mm2/s versus 3.332 ±0.309 x10-3 mm2/s. Regarding \nanterior isthmus region, ADC was higher in group.i. respect to group II, \nalthough not statistically significant (p=0.1) as well as FA (p > 0.1). \nConclusion: 3 T-MRDTI with fibre tracking adds in-vivo evaluation of uterine \nmuscular structure, quantifying fibre scar disarray. Further data and follow-up \nwill define how this up-to-date technique could impact in the clinical \nmanagement of VBAC delivery.  \nB-0225 14:36  \n3 T-magnetic resonance diffusion tensor imaging (MRDTI) of caesarean \nscar: morphological and quantitative evaluation - what can we add to \ntransvaginal ultrasound?  \nF. Fiocchi, E. Petrella, S. Currà, L. Nocetti, T. Costi, G. Ligabue, F. Facchinetti, \nP. Torricelli; Modena/IT (ffiocchi@sirm.org)  \nPurpose: To investigate the potential value of 3 T-MRDTI with fibre-tracking \ncompared to Transvaginal Ultrasound (TVU) in caesarean scar (CS) evaluation \nin women with one or two caesarean deliveries. \nMethods and Materials:  3 T-MRDTI and TVU were performed in 44 \ncaesarean-scarred volunteers within 24 months after delivery (29 with one CS, \ngroup I, and 15 with two CS, group II). Main diffusion directions reflecting fibres \norientation were investigated using a sense-SSEPI sequence with diffusion-\nsensitized gradients (b=600 mm2/s) al ong 16 directions. CS was classified \nliner or retracting on the basis of MR (linear if endometrial profile was \nconserved; retracting if myometrial reduction/endometrial dehiscence were \nfound). A fibre-tracking post-process ing algorithm was used to analyse \nquantitatively fibres of anterior isthmus compared to those of posterior wall. \nResults: According to 3 T-MR, 21 CS were classified as linear and 23 as \nretracting with TVU global agreement of 54.5%. Uterine isthmocele was found \nin 8 women (4 each group; agreement 75%). 3 T-MRDTI fibre-tracking analysis \nof myometrial fibres running through CS in anterior isthmus respect to posterior \nwall showed no significant difference in fi bre disarray between group.i. and II (-\n55%,IQ-32%-74% versus-42%,IQ-31%-58%,p > 0.4). Among uteri with \nretracting CS, fiber reduction was significantly higher compared to those with \nlinear CS (-55%,IQ-37%-83% versus -40%,IQ-4%-61%, p < 0.001). At \nfollow-up, 7 women of group.i. had vaginal delivery; median fibre reduction was \n-43%, lower respect to the median of group.i. (p=0.1). \nConclusion: 3 T-MRDTI with fibre-tracking approach adds quantitative data at \nmorphological analyses of TVU, relying on evaluation of residual fiber muscle \nat scar level.  \nB-0226 14:45  \nQuantitative dynamic contrast-enhanced MRI in symptomatic uterine \nfibroids and normal uterus  \nS. Majd, B.J. Abdullah, S. Ahmad Sarji, N. Mat Adenan, C. Yeong; \nKuala Lumpur/MY (greenpalm010@gmail.com)  \nPurpose: Quantitative dynamic contrast-enhanced MRI (DCE-MRI) is an \nimaging technique to measure permeability and vascularity of the tissues. The \naim of this study was to compare the Ktrans, Kep and Ve of normal \nmyometrium with the fibroids. \nMethods and Materials:  16 normal subjects underwent DCE-MRI study of the \npelvis. After routine pelvis MRI protocol DCE-MRI was done using T1 \nvolumetric (LAVA) sequence. The data were post-processed by DCE-MRI \nsoftware and parameters [K-trans: volume transfer between the blood plasma \nand extracellular fluid, Kep: Rate constant between the EES and blood plasma, \nVe: EES fractional volume] were determined for the myometrium, endometrium \nand cervix. 16 patients with clinical diagnosis of uterine fibroids were examined \nusing the same DCE-MRI protocol. Hysterectomy was performed after MRI and \nuterine fibroids were confirmed by histopathology results. The Ktrans, Kep and \nVe of normal myometrium and fibroids were compared. \nResults: The mean ktrans in myometrium and endometrium were 0.45 min-1, \n0.40 min-1 in cervix and 0.80 min-1 in fi broids. There is significant difference (P \nvalue < 0.05) between the K-trans of fibroid tissue and normal myometrium. \nThere was no significant difference between k-trans, Kep and Ve of \nmyometrium, endometrium and cervix. \nConclusion: The significant difference (P value < 0.05) between the K-trans of \nfibroid tissue and normal myometrium indicates that the permeability of fibroid \ntissue is higher than normal myometrium. It also supports the role of DCE-MRI \nin functional assessment of tumour microcirculation. These findings may \nprovide the foundation for interpretation of results of uterine DCE-MRI studies.  \nB-0227 14:54  \nMagnetic resonance-guided focused ultrasound (MRgFUS) in women \naffected by uterine fibroids: outcomes on symptoms, quality of life, non-\nperfused volume ratio and size reduction over 12 months  \nF. Ciolina, F. Zaccagna, F. Boni, B. Cavallo Marincola, F. Sandolo, \nL. Bertaccini, A. Napoli, C. Catalano; Rome/IT  (federica.ciolina@gmail.com)  \nPurpose: To investigate the efficacy of MR-guided acoustic ablation in \nsymptoms relief and volume reduction over time. \nMethods and Materials:  120 fibroids in 95 symptomatic women (average age \n40.8) were ablated using MRgFUS. Treatment is done using the ablative \nproperties of the HIFU system under 3 T MRI guide. Symptoms and quality of \nlife were scored using Severity Score (SS) and the Uterine Fibroids Score \nQuality of Life Score (UFS-QOL). Pre-treatment measurements of leiomyoma \nvolume were obtained on pre-treatment MR images and immediately after \ntreatment non-perfused Volume (NPV) was calculated from T1-w contrast-\nenhanced MR sequences. The average volume of treated fibroids was \n84.76 ± 84.78 mm3. Follow-up images were obtained 3, 6 and 12 months after \ntreatment and served to determine leiomyoma shrinkage. Qualitative and \nquantitative relations between fibroid volume, NPV ratio at treatment, 3, 6 and \n12-months shrinkage were measured. \nResults: MRgFUS treated patients results in a significant change in USF-QoL \nscore: mean SS score values were 48.6 ± 13.4 (pre-treatment), 25.1 ±  8.9 \n(three-months follow-up), 22.1 ± 7.5 (six-months follow-up) and 19.3 ± 6.8 \n(twelve-months follow-up). Fibroids volume changed from 84.76 ± 84.78 mm3 \n(before treatment) to 54 ± 66.1 mm3 (at 12 months follow-up). We encountered \na statistically significant difference be tween the two values (p = 0.001). Mean \npost-treatment VNP was 59.90±56.47 mm3 (p=0.001). \nConclusion: Patients treated using MRgFUS therapy showed a significant \nrelief of symptoms and significant fibroi d ablation. The procedure is performed \nin a totally non-invasive manner and with a high safety profile.  \nB-0228 15:03  \nRetrospective evaluation of uterine fibroids treated using MRgFUS: \nelements that can predict short and long-term results  \nF. Ciolina, F. Boni, F. Zaccagna, V. Noce, L. Bertaccini, B. Cavallo Marincola, \nA. Napoli, C. Catalano; Rome/IT (federica.ciolina@gmail.com)  \nPurpose: To retrospectively analyse predictive elements to obtain an optimal \ntreatment of uterine fibroids in patients treated using magnetic resonance-\nguided focused ultrasound (MRgFUS). \nMethods and Materials:  75 fibroids (52± 18 mm) in 68 symptomatic women \n(age average 41 ±5) were treated using MRgFUS (ExAblate 2100) combined \nwith a 3 T MR unit (GE). T2 SI of fibroids and T1 SI were measured on pre-\ntreatment examination before and after administration of gadolinium (Gd-\nBOPTA, Bracco); also the distance between center of myoma and skin, skin \nthickness, maximum diameter and volume of fibroids were recorded. The day \nof treatment the non-perfused volume (NPV) was recorded at the end of the \ntreatment. All parameters were related to final NPV and volume shrinkage at \n12 months to established short and long term outcomes of treatment. \nResults: Difference between T1 SI of the fibroids and healthy myometrium \nsignificantly correlates with volume shrinkage (45%) and NPV (60%, r=0.85). \nT2 SI on pre-treatment studies, distance between skin surface and center of \nmyoma (53±19 mm) and skin thickness (13 ±7 mm) show a mild correlation with \nvolume reduction at 12 months (36+18 mm, respectively r=-72.5 p=0.047 and \nr=69.7 p=0.03). Each sonication was of 20 ±2 s (2540± 1095 J/sonication) and \nmean average duration of treatment was of 125 ±30 min. Moreover, there was \npositive correlation between measured parameters, sonication duration and \nenergy necessary to obtain a > 50% NPV (70±15%, r= 62.8, p=0.021). \nConclusion: SI ratio on T1w of uterine fibroids and myometrium on screening \nMRI should be considered as predictor of positive outcome for MRgFUS.  \nB-0229 15:12  \nValue of parametric maps in the assessement of uterine lesions by \ncombination of DWI and semi-quantitative perfusion dynamic contrast-\nenhanced (DCE) MRI  \nA.C. Cadonici, D. Ippolito, O. Minutolo, P. Bonaffini, C. R.G.L. Talei Franzesi, \nS. Sironi; Monza/IT (a.cadonici@gmail.com)  \nPurpose: To investigate the value of combined diffusion-weighted imaging and \nDCE-MRI in the assessement of benign and malignant uterine lesions. \nMethods and Materials: We enrolled 50 patients with endometrial cancer who \nunderwent pre-operative MR examination on 1.5 T magnet: scanning protocol \nincluded multiplanar T1- and T2-weighted TSE,10 dynamic gadolinium-\nenhanced T1-weighted GE sequences (overall time 5 min, 66 sec) and DWI \nsequences (b value: 0.1000 mm 2/s). ADC and perfusion maps were generated \non dedicated workstation and regions of interest (ROIs) were manually drawn \non each identified uterine lesion and on normal myometrium. Mean ADC, \nrelative enhancement (RE, %), maximum enhancement (ME, %), maximum \nS184  \n\n \n \nBA C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nrelative enhancement (MRE, %) and time-to-peak (TTP, sec) were calculated \nand statistically analysed. \nResults: Post-operative histological ex amination confirmed the presence of \nendometrial cancer in all the patients and the presence of 23 miomas. The \nfollowing parameters were obtained for neoplastic tissue: ADC \n916.05 mm²/sec± 313.8 x10-3; RE 72.25% ± 33.9; ME 976.8% ± 331.7; MRE \n90.9% ± 24.1; TTP 192.1sec ± 100.6, in miomas: ADC \n1025.5 mm²/sec ± 436.1; RE 95.1% ± 48.6; ME 1357.3% ± 798.7;MRE \n107.4% ± 47; TTP 233.8 sec ± 126.3 and in normal myometrium: ADC \n1548.9 mm²/sec ± 277.6; RE 163.3% ± 34.2; ME 2010.1% ± 291.7; MRE \n170.7% ± 31.2; TTP 242.8 sec ± 121.5. Mean ADC, RE, ME and MRE were \nsignificantly lower ( p> 0.05) both in neoplasms and in miomas than in normal \nmiometrium, no significant difference was found between miomas and \nneoplastic lesions. \nConclusion: Combined DWI and DCE-MRI offer in vivo information that can \nbe useful in depiction and characterisation of uterine lesions.  \nB-0230 15:21  \nDiagnostic value of ontrast-enhanced perfusion MR imaging in the \nassessment of tumour grading in patients with endometrial carcinoma by \nusing quantitative analysis of microvascular changes: preliminary results  \nO. Minutolo, D. Ippolito, A. Cadonici, C. R.G.L. Talei Franzesi, P.A. Bonaffini, \nS. Sironi; Monza/IT (orazio.minutolo@hotmail.it)  \nPurpose: To determine diagnostic value of dynamic contrast-enhanced \nperfusion-MRI in detection and characterisation of endometrial \ncancer,correlated with tumor grading,being the histopathological analysis the \nstandard of reference. \nMethods and Materials:  From January 2011 to July 2012.80 patients with \nhistologically proven endometrial ca rcinoma underwent dedicated pelvic MRI \nexamination by using pelvic phased array multicoil.Each patient scan consists \nof multiplanar T2 and T1 sequences and dynamic contrast enhanced \nTHRIVE,using a 1.5 T MRI system (Achieva,Philips).Philips's workstation was \nused to generate color permeability maps showing perfusion of enhancing \ntumors.After the placing of regions of interests (ROIs)on the site of maps which \nbest corresponded to enhanced regions of lesion,the following parameters \nwere calculated:Relative Enhancement,Maximum Enhancement,Maximum \nRelative Enhancement and Time to Peak. \nResults: Pathological results of all patients were obtained postoperatively and \ncompared with DCE-MRI perfusion parameters.At histological examination 21 \npatients had G1 tumor,44 had G2 tumor,14 had G3 tumor,and 1 had \nsquamous cell carcinoma.Tumor locations visualised on T2w MRI and DSCE-\nMRI were consistent with histopathologi cal findings and the quantitative \nanalysis showed the following values for endometrial \ncancer:RE (%)61.4±36.4;ME (%)829.4±418.8;MRE (%)69.4±42.2 and \nTTP (sec)179.5±27.4.Corresponding values calculated in normal endometrium \nwere:RE (%)157.1±61.3;ME (%)1634.5±625.7;MRE (%)128.8±51.6 and \nTTP (sec)193.6±23.8.A significant (p < 0.001)decrease of RE,ME and MRE in \nthe area of tumor lesion in all of the patients examinated in comparison with \nthe normal myometrium was observed.Furthermore a significant higher \nvalues (p < 0.001)of RE,ME,MRE was obtained for G1 tumours (less \naggressive)in comparison with those with G2 or G3 grading. \nConclusion: Conventional MRI combined with perfusion DCE represents a \nfeasible technique that provide non-invasively quantitative and qualitative \ninformation about biological characteristi cs of endometrial cancer,related to \ntumor aggressiveness.  \n14:00 - 15:30 Room I/K  \nNeuro  \nSS 211  \nStroke imaging  \nModerators:  \nA.K. Firat; Malatya/TR  \nM.M. Thurnher; Vienna/AT  \nB-0231 14:00  \nSwirl sign is a robust predictor of spot sign on CTA and poor outcome in \nultra-early ICH patients  \nC. Ovesen, I. Havsteen, A. Christensen, C. Krarup, H. Christensen; \nCopenhagen/DK (seestein@gmail.com)  \nPurpose: Computed tomography angiography (CTA) spot sign signifies active \nbleeding and poor outcome in intracerebral haematoma (ICH) patients. CTA is \nnot as available as non-contrast CT (NCCT). NCCT swirl sign is a less well-\ndescribed marker of active bleeding. We investigate if swirl sign predicts spot \nsign and poor outcome in ultra-early ICH patients? \nMethods and Materials:  We included spontaneous ICH patients admitted \nwithin 4.5 hours from symptom onset April 2009-January 2013. Standard \nworkup included NCCT and CTA. Swirl sign was defined as hypo- or isodense \nregions within the hyperdense haematoma with brain parenchyma as \nreference. Outcome was assessed as 90-day modified Rankin Scale (mRS). \nResults: 35 of 137 patients (25.5%) showed swirl sign and 27 (77%) had \nconcomitant spot sign. This yields a high specificity (0.92) and negative \npredictive value (0.86) but slightly lower sensitivity (0.66) and positive \npredictive value (0.77). Swirl sign independently predicted presence of spot \nsign (OR 15.5 CI: 5.6-42.8) adjusted for admission haematoma volume and \ntime to scan. Swirl sign was associated with poorer median [IQR] 90-day mRS \n(5 [4-6] vs. 3 [2-5], p < 0.0001). Swirl sign emerged as independent predictor of \npoor outcome (mRS 5-6) (OR 3.28 CI: 1.15-9.34) adjusted for age, admission \nNIHSS, and admission haematoma volume. Concurrent spot and swirl sign did \nnot add to the prediction of poor outcome. \nConclusion: Swirl sign predicts spot sign presence and entails poor outcome \nirrespective of other predictors. Further studies are needed to evaluate the \nswirl sign's value in clinical decision-making and trials.  \nB-0232 14:09  \nIntramural haematoma detection by susceptibility weighted image in \nintracranial vertebral artery dissection  \nY. Lee, H. Choi, S. Jung, K.-J. Ahn, B.-s. Kim, T.-W. Kim; Seoul/KR \n(yoondori5678@gmail.com)  \nPurpose: We aimed to evaluate accuracy of intramural haematoma sign on \nsusceptibility weighted image (SWI) in vertebral artery dissection (VAD). \nMethods and Materials:  We retrospectively analysed patients with ischaemic \nstroke in the vertebral artery territory from 2010 to 2012. We divided the \npatients into VAD group and non-dissection group. Intramural haematoma sign \nwas considered positive if the patient had (a) eccentric or concentric \nhypointense signal lesion in vertebral  artery on SWI and (b) this signal should \nbe hyperintense on phase map and no evidence of calcification on the brain \nCT suggesting blood products other than calcification. The accuracy of \nintramural haematoma sign on SWI was evaluated. Phase value, demographic \nand clinical data were compared between VAD and non-dissection group. \nResults: Thirty-nine patients were included. Ten patients were VAD group and \n29 patients were non-dissection group. Among 10 cases of VAD group, the \n\"Intramural haematoma sign on SWI\" was positive in 9, and positive in 1 out of \n29 cases in the non-dissection group. The intramural haematoma sign on SWI \nwas significantly associated with VAD (p < 0.001) and showed sensitivity of \n90%, specificity of 96.6%. Mean phase values of intramural haematomas (n=9) \nwere all positive and those of calcified lesions (n=13) were all negative \n(0.45±0.17 radian vs. -0.42±0.28 radian, p < 0.001). \nConclusion: The intramural haematoma sign on SWI was significantly \nassociated with VAD and the phase values were higher in intramural \nhaematomas compared with atherosclerotic calcifications.  \nB-0233 14:18  \nHigh-resolution MR imaging in patients with symptomatic middle cerebral \nartery dissection  \nJ. Byon, H.-S. Kwak, S. Hwang, K. Jung; Jeonju/KR  \n(miaow_mew@hanmail.net)  \nPurpose: To investigate the findings of high-resolution magnetic resonance \nimaging (HRMRI) and clinical features in patients with acute symptomatic \nmiddle cerebral artery (MCA) dissection. \nMethods and Materials:  Ten patients with acute symptomatic MCA dissection \nunderwent HRMRI within 3 days after initial clinical onset and routine brain MR \nimaging. HRMRI examinations include time-of-flight (TOF) MR angiography, \nT2-weighted, T1-weighted, proton-density (PD)-weighted, and three-\ndimensional magnetization-prepared rapid acquisition gradient-echo \n(MPRAGE) sequences. MR angiography and/or cerebral angiography were \nused as the reference standard to establish the diagnosis of MCA dissection. \nWe analysed the angiographic findings and HRMRI findings such as string \nsing, peal and string sign, intimal flap, double lumen, and intramural \nhematoma. \nResults: All patients presented with cerebral ischaemia (median NIHSS score \n= 2, range = 0 - 18). Nine patients excluded one with traumatic event, did not \nhave any history of trauma. The main site of the lesions was Lt M1 portion. On \nTOF MR angiography and/or cerebral angi ography, string sign was seen in five \npatients. However, intimal flap and double lumen findings were seen in all \npatients on HRMRI. High signal lesion on MPRAGE sequences around the \ndissection lumen due to intramural haematoma, was seen in three patients. \nConclusion: HRMRI can be able to easily detect the wall structure of MCA \nsuch as the intimal flap and double lumen in patients with acute symptomatic \nMCA dissection. MPRAGE can detect haemorrhage in the false lumen of MCA \ndissection.  \n \nS185  \n\n \n \nBA C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0234 14:27  \nClinical significance of intraluminal contrast enhancement in patients \nwith spontaneous cervical artery dissection: an in vivo MRI study  \nE. Coppenrath1, O. Lenz1, N. Lummel1, J. Linn1, F. Bamberg1, M. Dichgans1, \nT. Pfefferkorn2, M.F. Reiser1, T. Saam1; 1Munich/DE, \n2Ingolstadt/DE (eva.coppenrath@med.uni-muenchen.de)  \nPurpose: Recent studies have suggested that intraluminal thrombi show \nstrong contrast enhancement on carotid black-blood MRI. The aim was to \nevaluate the significance of intraluminal contrast enhancement (iCE) on \nsymptom status in patients with spontaneous cervical artery dissection (sCAD). \nMethods and Materials:  33 consecutive patients (19 men) with sCAD \nreceived a brain MRI (DIFF, T2w, T2*w, FLAIR, TOF) and a multi-sequence \n3 T-MRI with fat-saturated high-resolution black-blood T1w-sequences pre- \nand post-contrast, MRA, T2w- and TOF images of both carotid and vertebral \narteries. Presence or absence of iCE, vessel occlusion and vessel wall \nhaematoma (VWH) were analysed by two radiologists in consensus decision \nwho were blinded to all clinical information and the brain MRI. \nResults: 44 of 132 analysed vessels had a VWH, consistent with sCAD. In 17 \nof 44 dissected vessels an acute ischaemic stroke was found in the territory of \nthe corresponding vessel. 16 of 17 (94.1%) vessels ipsilateral to ischaemic \nstroke demonstrated iCE, compared to 9 of 44 (20.4%) dissected vessels \nwithout stroke in the corresponding vessel territory (Fisher´s Exact test \nP < 0.001). The presence/absence of iCE for ischaemic stroke in dissected \nvessels resulted in a sensitivity, specific ity, positive and negative predictive \nvalue and accuracy of 0.94, 0.67, 0.64, 0.95, and 0.77 and an odds ratio of \n32.0 (95% confidence interval = 3.64 - 281). \nConclusion: iCE, suggestive of intraluminal thrombus formation, is strongly \ncorrelated with ischemic symptoms in patients with sCAD. Future studies will \nhave to determine whether patients with iCE are at greater risk of recurrent \nstroke.  \nB-0235 14:36  \nCT-verified leukoaraiosis as risk factor for post-thrombolytic \nsymptomatic haemorrhage  \nL. Willer, I. Havsteen, A. Christensen, H. Christensen; Copenhagen/DK \n(seestein@gmail.com)  \nPurpose: Is CT-verified leukoaraiosis a risk factor for symptomatic post-\nthrombolystic haemorrhage? \nMethods and Materials:  1) Retrospective analysis of single-centre \nconsecutive TPA-treated patients within 4.5 hours from symptom onset. \nStandard work-up included baseline non-contrast CT (NCCT) and CT \nangiography and next day follow-up NCCT. Baseline NCCT leukoaraiosis was \ngraded using Fazekas' score and dichotomised as absence (Fazekas 0) or \npresence (Fazekas 1-3). Haemorrhagic transformation was rated using ECASS \ncriteria. Symptomatic intracerebral haemorrhage (sICH) was defined as \nhaemorrhage and deterioration oh NIHSS \u00034 within 36 hours from symptom \nonset. EVT-treated patients were excluded. 2) Pooled analysis with 1312 TPA-\ntreated patients from literature. \nResults: 311 TPA-treated were included April 2009 - July 2012. Leukoaraiosis \nwas present in 113 (36%). 23 (7%) showed haemorrhagic transformation (HT). \nLeukoaraiosis positive patients had significantly higher haemorrhagic \ntransformation frequency (11.5%, p=0.04). Leukoaraiosis doubled HT risk (OR \n2.4, 95% CI 1.4-5.8). Only 4 patients developed sICH, 3 with leukoaraiosis. \nLeukoaraiosis was not an independent risk factor for haemorrhagic \ntransformation (p=0.2). Pooled analysis of 1623 patients in total, hereof 479 \nleukoaraiosis positive patients, showed significantly higher sICH frequency in \n35 (7.3%) leukoaraiosis positive than 44 (3.8%) leukoaraiosis negative \npatients, (p=0.005) and doubled sICH risk in leukoaraiosis positives (OR 1.97, \n95% CI 1.22-3.19). \nConclusion: Leukoaraiosis is a risk factor for post-thrombolytic haemorrhagic \ntransformation and symptomatic haemorrhage.  \nB-0236 14:45  \nAnalysis of association between carotid artery plaque volume and \ncerebral microbleeds  \nL. Saba1, R. Montisci1, R. Sanfilippo1, M. Piga1, J. Suri2, E.A. Genovese1; \n1Cagliari/IT, 2Roseville, CA/US (lucasaba@tiscali.it)  \nPurpose: Cerebral microbleeds (CMBs), have become increasingly recognised \nwith the widespread use of MRI techniques that are sensitive to iron deposits. \nOur purpose was to explore the association between carotid plaque volume \nand CMBs. \nMethods and Materials:  82 consecutive (males 59; median age 64) patients \nwere prospectively analysed. Carotid arteries were studied using a 16-detector \nrow CT scanner whereas brain was explored with a 1.5 Tesla system. CMBs \nwere studied using a T2*-weighted gradient-recalled echo (GRE) sequence. \nMicrobleeds were classified as absent (grad e 1), mild (grade 2; total number of \nmicrobleeds, 1-2), moderate (grade 3;total number of micro-bleeds,3-10), and \nsevere (grade 4;total number of microbleeds, > 10). Component types of the \ncarotid plaque were defined according HU values. Plaque volumes of each \ncomponent was calculated. Chi-square, multiple logistic regression analysis as \nwell as ROC was calculated. \nResults: The prevalence of CMBs was 35.3%. A statistically significant \ndifference was observed between symptomatic (40%) and asymptomatic (11%) \npatients (p value = 0.001; OR = 6.07). Linear regression analysis demonstrated \nan association between the number of CMB and the symptoms (p = 0.0018). A \nstatistically significant correlation was observed between the increase of the \nvolume of the fatty component and CMBs (rho = 0.89; p = 0.001). \nConclusion: Results of this study confirm the association between CMBs and \nsymptoms and that there is an increased number of CMBs in symptomatic \npatients. Moreover, we found that an increased volume of the fatty component \nis associated the presence and number of CMBs.  \nB-0237 14:54  \nSymmetrical plaque progression rates in bilateral carotid atherosclerosis: \nthe impact of local plaque factors  \nH.-S. Kwak, G.-H. Chung; Jeonju/KR (kwak8140@jbnu.ac.kr)  \nPurpose: The purpose of this study was to evaluate the symmetry of \nprogression or regression of bilateral carotid atherosclerosis during a seven \nmonth follow-up period. \nMethods and Materials:  As the placebo arm of a multi-center clinical trial, 54 \nsubjects with 16-79% carotid stenosis by ultrasound and presence of a lipid \ncore on baseline MRI underwent follow-up carotid MRI at seven months. Wall, \nlipid core, and plaque components such as intraplaque hemorrhage (IPH) and \nulcer were assessed on both sides on the baseline and follow-up scans. \nProgression between bilateral carotid plaques was calculated as changes \nwithin the common coverage between scans. \nResults: Forty-three (79.6%) of the subjects were on lipid-lowering therapy. \nBilateral wall volume progression or regression was found in 31 subjects \n(57.4%) and unilateral IPH was present in six (11.1%) subjects at baseline. In \nthe sample as a whole, there was little correlation in wall volume progression \nbetween sides (r=-0.02, p=0.883). However, progression was significantly \ncorrelated between sides in the group without IPH (r=0.31, p=0.034) and was \nsignificantly different (p=0.011) than in  the group with unilateral IPH (r=-0.60, \np=0.208). In those with IPH, mean progression was 29.9 ± 55.7 mm\n3 on the \nside with IPH and -26.9 ± 29.3 mm3 on the non-IPH side (p=0.131). \nConclusion: In the absence of intraplaque hemorrhage, carotid atherosclerotic \nlesion volume tends to change in the same direction bilaterally, potentially due \nto systemic processes.  \nB-0238 15:03  \nDiagnostic accuracy of whole-brain CT perfusion imaging in small-\nvolume infarctions  \nK.M. Thierfelder, L. von Baumgarten, A.C. Löchelt, F.G. Meinel, K. Nikolaou, \nS.E. Beyer, M. Patzig, M.F. Reiser, W.H. Sommer; \nMunich/DE (kolja.thierfelder@med.uni-muenchen.de)  \nPurpose: The aim of this study was to determine the diagnostic accuracy of \nwhole brain CT perfusion (WB-CTP) in small ischemic brain infarctions and to \nidentify factors influencing the detection rate. \nMethods and Materials:  Out of a cohort of 1380 subjects who underwent \ninitial WB-CTP due to suspected stroke, we selected all patients with a \nsupratentorial MRI-confirmed ischemic infarction with a volume of \u0002 8 ml. The \nstudy was designed as a case-control study with a ratio of cases to controls \nwith no infarction in follow-up MRI of 1:3. Two blinded readers independently \nevaluated four different CT perfusion parameter datasets per subject with \nrespect to presence and localisation of a perfusion deficit. \nResults: A total of 113 subjects met the inclusion criteria for the patient group. \nOverall, WB-CTP reached a sensitivity of 43.4% and a specificity of 92.9%. \nAmong these, cortical infarctions were detected in 31 of 49 cases (69%), while \nsubcortical infarctions were detected only in 18 of 64 cases (28%), p < 0.05. \nMean final infarction diameter (17.3 mm) and volume (1.9 ml) of infarctions \ndetected on CTP were significantly larger than that of infarctions not detected \n(12.4 mm and 0.8 ml, respectively; p < 0.001). Time from symptom onset did \nnot differ significantly between infarctions that were detected or not (204 vs. \n189 min; p=0.75). \nConclusion: The detection rate of WB-CTP in small infarctions highly depends \non infarction localisation and final size, while time from symptom onset does \nnot seem to influence diagnostic accuracy.  \n \n \n \nS186  \n\n \n \nBA C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0239 15:12  \nDynamic CT angiogram in acute stroke: a complementary look at \nperfusion  \nS. Chakraborty, S. Patro, R. Glikstein, G. Stotts; Ottawa, ON/CA \n(santanoo@gmail.com)  \nPurpose: CT angiogram and CT perfusion have been established as an \nimportant tool for evaluation of the acute stroke patients. With the advent of \n320 slice whole brain CT scanner, we are able to generate whole brain \nperfusion and time resolved dynamic CT angiogram (dCTA) images that \nprovide temporal flow information. \nMethods and Materials: Retrospective assessment of 53 consecutive patients \npresenting with acute stroke was performed. The dynamic CT angiogram 3D \nMIP data are interpreted with documentation of the time of arrival of contrast at \nthe supraclinoid ICA, M1, M2 and distal corti cal branches at equivalent position \non each side. The filling of cortical branches is also analysed for antegrade or \nretrograde flow. \nResults: Correlation between the final volume infarct on follow-up CT scan \nwith the delay in appearance of contrast between sides at different vascular \nlevels was calculated using Pearson correlation coefficient. This was significant \nat the cortical level (r= 0.7 p < 0.0001). Retrograde flow in cortical branches \nwas noted in 8 subjects. Most important observation in this study was the \nexclusion of any significant infarct in presence of a symmetric dynamic CTA. \nThe smallest infarct size in presence of a delay in filling was 10.2 ml. In \npatients with smaller infarcts, the dynamic CTA was symmetric. \nConclusion: dCTA is complementary to perfusion maps and enables us direct \nvisualisation of intracranial flow. Symmetric dynamic CTA is an excellent \npredictor of very small or no infarct.  \nB-0240 15:21  \n20 minutes' door-to-needle time in acute ischaemic stroke is achievable \nin a radiology-neurology team structure  \nS. Henriksen, L. Jeppesen, A. Christensen, H. Christensen; Copenhagen/DK \n(hchr0039@regionh.dk)  \nPurpose: We aimed at reducing our median door-to-needle-time (DTN) to \nbelow 20 minutes by improving the org anisational structure of our acute stroke \nevaluation while accepting no increase in bleeding complications. \nMethods and Materials:  A team including radiologist, neurologist, stroke \nnurse and radiographer set up a structured patient admission process based \non trauma team principles and experience with fibrinolysis. The team in a \ndedicated room within radiology department receives the patients with \nimmediate access to both CT and MRI; standard work up is CT plus CTA. \nDuring a 3-month registration period in 2013 an external person registered all \ncases of acute stroke evaluation. For comparison, data from 2012 was used. \nResults: A total of 148 patients was registered and was characterised by a \nmedian age of 67 years and 53.4% males. Forty-seven patients (31.8%) \nreceived fibrinolysis. The overall median DTN was 16 minutes 58 seconds. For \npatients receiving fibrinolysis, the DNT was 20 minutes 58 seconds and for \npatients not receiving treatment the median ti me to decision was 15 minutes, \n50 seconds. No symptomatic intracranial haemorrhages or other significant \nbleeding complications occurred during the study period. Median DTN in 2012 \nwas 49 minutes; and costs were neutral. \nConclusion: DTN-time can safely be reduced to 20 minutes by organisational \ninterventions, in particular changing the auspice from neurological to \nradiological. NNT is reduced by 1 with every 20 minutes reduction in DTN; \nthereby this intervention has a clinically significant impact on stroke outcome.  \nAuthor Disclosures: \n S. Henriksen: None. L. Jeppesen: None. A. Christensen: None. H. \nChristensen: None. \n14:00 - 15:30 Room L/M  \nPhysics in Radiology  \nSS 213  \nOptimising image quality and patient \nexposure in CT  \nModerators:  \nP.E. Colombo; Milan/IT  \nW. Stiller; Heidelberg/DE  \nB-0241 14:00  \nReconstruction of organ doses in paediatric CT performed in the 90-thies \nin Norway  \nH.M. Olerud1, B. Toft2, S. Flatabø1, A. Jahnen3, C. Lee4, I. Thierry-Chef5; \n1Østerås/NO, 2Gjøvik/NO, 3Luxembourg/LU, 4EPS Rockville, MD/US, 5Lyon/FR \n(hilde.olerud@nrpa.no)  \nPurpose: A large epidemiological study (EPI-CT) aims to provide knowledge \nabout the risk of leukemia and brai n cancer associated with pediatric CT, \nhttp://epi-CT.iarc.fr/. New computational human phantoms and software have \nbeen developed to provide estimates of the organ doses. The aim was to \nreconstruct organ doses from CT examinations done in the 1990s with the new \nsoftware; to sort out the probable range of doses as input to uncertainty \nestimates in EPI-CT. \nMethods and Materials:  We used local typical scan protocols in Norway from \nCT scanners used in the 1990s, and a beta version of the new software \nprovided for EPI-CT. \nResults: A one year old child could have received 54 (17-77) mGy to the brain, \nand 21 (7-31) mGy to active marrow from a head CT scan. From CT of the \nchest, a newborn could have received 14 (10-21) mGy to active marrow. From \nan abdominal CT scan, 10 year old children could have received doses of 10 \n(6-17) mGy to active marrow. These doses are considerably higher than the \nage-adjusted protocols nowadays. \nConclusion: The doses children received from CT during the 1990s are of \nsuch a magnitude that they might show statistically significant health effects in \nthe EPI-CT project. In Pre-PACS time there may be lack of knowledge about \nthe size of the child, the CT scanner model used, or the scan parameters used. \nAll these parameters result in differences in organ doses by a factor of 2 - 3.  \nAuthor Disclosures: \nI. Thierry-Chef: Research/Grant Support; EU (FP7/2007-2013) under grant \nagreement number 269912 - EPI-CT. \nB-0242 14:09  \nDose reduction with dual-energy body CT: feasib ility of concurrent \nspectral analysis and dose modulation  \nI.S. Leichter, M.H. Gabbai, Z. Romman, J. Sosna; Jerusalem/IL  \n(zachilei@gmail.com)  \nPurpose: Dose modulation (DOM) reduces patient dose by minimising x-ray \ntube current according to patient size. The effectiveness of DOM is limited in \ndual-energy CT (DECT) systems based on two tubes producing different \nenergies or energy-switching in one tube. Spectral-detector CT (SDCT) \ntechnology uses only one x-ray beam separated into two energies by \ninnovative dual-layer detectors and should enable effective DOM. The purpose \nof this study was to evaluate the feasibility of dose reduction in an SDCT \nprototype. \nMethods and Materials:  Following IRB approval and informed consent, 37 \npatients (mean age 56.6 years) were scanned with a novel-SDCT prototype \n(Philips Healthcare, Cleveland, OH, USA). Eleven patients were scanned with \nan abdomen/pelvis protocol, 14 with chest/abdomen/pelvis protocol, and 12 \nwith a chest protocol. Scanning parameters were 120 kVp, mAs ranging from \n59 to 259. Dose length product (DLP) and CT dose-index (CTDI\nVOL) were \nanalysed for each patient to estimate dose savings (EDS). \nResults: The estimated dose savings (ESD) was highest in chest scans \n(22.4%), resulting in the lowest DLP and CTDI VOL values (363.6 mGy \u0002cm \n,11.36 mGy, respectively). In chest/abdomen/pelvis scans dose saving was \nlower (21.4%), resulting in 786.1 mGy \u0002cm and 13.2 mGy, respectively, and in \nabdomen/pelvis scans it was lowest (14.8%), resulting in 807.0 mGy \u0002cm and \n14.9 mGy, respectively. Dose saving was significantly higher for chest scans \nand chest/abdomen/pelvis scans compared to abdomen/pelvis scans (p < 0.05 \nand p < 0.04, respectively). \nConclusion: SDCT can concurrently reduce patient dose substantially by \neffective tube current modulation and enable full benefits of spectral analysis.  \nAuthor Disclosures: \nZ. Romman: Employee; Philips. J. Sosna: Grant Recipient; Philips. \nS187  \n\n \n \nBA C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0243 14:18  \nShould automatic exposure control be used in CT imaging of pregnant \npatients?  \nA. Papadakis, K. Perisinakis, J. Damilakis; Iraklion/GR \n(apapadak@edu.med.uoc.gr)  \nPurpose: To assess the effect of maternal body size at different stages of \ngestation on maternal effective dose and embryo dose in routine abdomen and \npelvis CT imaging of pregnant patients using automatic exposure control \n(AEC). \nMethods and Materials:  The adult anthropomorphic Rando phantom was \nused to simulate an average pregnant individual at the 1 st trimester of \ngestation. The abdominal slices of the phantom were appropriately devised \nusing Lucite material to simulate pregnancy at the 2 nd and 3 rd trimester. Each \nphantom was scanned with fixed mA and with the AEC-activated, using a 16-\nrow CT scanner. Thermoluminescent dosimeters were used to determine \nabsorbed dose at all maternal radiosensitive organs and embryo. Maternal \neffective dose was calculated based on the ICRP 103. \nResults: Maternal effective dose and embryo dose in fixed mA acquisitions \nwere 7.1 mSv and 18.6 mGy at the 1\nst, 7.3 mSv and 17.7 mGy at the 2 nd, and \n7.5 mSv and 15.4 mGy at the 3 rd trimester of gestation. The corresponding \nvalues in AEC-activated acquisitions were 3.6 mSv and 7.5 mGy, and 3.9 mSv \nand 8.8 mGy, and 4.2 mSv and 7.9 mGy, respectively. \nConclusion: AEC efficiency is not hampered by the increased abdominal size \nof pregnant individuals. The AEC may substantially reduce maternal effective \ndose and embryo dose even at the 3 rd stage of gestation when abdomen has \nreached its maximum size. AEC should thus be activated without caution in \npregnant patients referred to abdomen and pelvis CT imaging.  \nB-0244 14:27  \nSize-specific dose estimates (SSDE) for the evaluation of individual \npatient dose in CT protocol for renal colic  \nL. Waszczuk, M. Guzi\u001bski, A. Czarnecka, J. Bladowska, M. S \u0017siadek; \nWroclaw/PL (lukasz.waszczuk@reagan.com)  \nPurpose: To evaluate the effects of an institutional unenhanced CT protocol \nfor renal colic on image quality and radiation dose reduction using size-specific \ndose estimates (SSDE). \nMethods and Materials:  52 consecutive patients with acute renal colic \nunderwent CT with reduced radiation dose (120 kVp; NI, 59.1; pitch, 0.984:1). \nThe evaluated radiation dose descriptors were SSDE (mGy), CTDI (mGy). \nSignal-to-noise ratio (SNR), contrast-to-noise atio (CNR). Subjective image \nassessment by two radiologists were performed. Visibility of abdominal, pelvic \nparts of ureters, ureterovesical junctions and overall subjective image quality \nwere evaluated. The control group comprised 52 consecutive patients who \nunderwent routine CT on the same scanner. \nResults: SNR of aorta, spleen, fat and psoas muscle were significantly smaller \nin the renal colic group than the control (1.1 vs. 2.0; 1.8 vs. 3.0; 5.1 vs. 7.5; 2.0 \nvs. 3.1; respectively; p < 0.001). However, no statistically significant differences \nin SNR of bladder and liver, and CNR of liver-spleen, liver-fat, aorta-muscle \nand muscle-fat pairs were noted. Subjective image quality was better in the \ncontrol group (2.8 out of 3 possible points vs. 2.4). Differences in the visibility \nof all 3 parts of ureters were not statistically significant (2.8 vs. 2.9; 2.2 vs. 2.4; \n2.4 vs. 2.7). Significant radiation dose reduction in the renal colic group was \nachieved (SSDE, 8 ±4 mGy vs. 22 ±8 mGy; CTDI, 7.5 ±4.8 mGy vs. \n19.1±10.2 mGy, p < 0.001). \nConclusion: The institutional renal colic CT protocol provides a clinically good \nimage quality. Ureters' visibility and SNR/CNR values show that this protocol \nshould replace standard CT protocol.  \nB-0245 14:36  \nHigh correlation between CT radiation dose estimates obtained by fast \nmonte carlo computation and solid-state metal-oxide semiconductor \nfield-effect transistor measurements in physical anthropomorphic \nphantoms  \nP. Prinsen\n1, J. Wiegert1, S. Trattner2, R. Pieniazek2, T.L. Morton3, E. Gerland4, \nC.M. Thompson5, S. Halliburton5, A.J. Einstein2; 1Eindhoven/NL, 2New York, \nNY/US, 3Highland Heights, OH/US, 4Haifa/IL, 5Cleveland, OH/US \n(peter.prinsen@philips.com)  \nPurpose: Accurate, patient-specific estimati on of radiation dosimetry for CT \nprotocols is critical to optimise radiation doses and balance dose against image \nquality. While MC simulation is often used to estimate doses from CT, few data \ncompare such estimates against experimentally measured doses in \ncontemporary CT scanners. We aimed to compare radiation dose estimates \nfrom a MC approach to doses measured using MOSFETs in a 256-slice \nvolume scanner. \nMethods and Materials:  50 MOSFETs were placed inside a modified ATOM \n(CIRS, Norfolk, VA) tissue-equivalent anthropomorphic phantom. The phantom \nwas then scanned using an iCT scanner (Philips, Cleveland, OH) with a chest \nprotocol (helical scan, 120 kVp, 360 mAs). MC computations were performed \non voxelised CT images of the phantom with a MC tool developed specifically \nfor diagnostic X-ray energies (DiPhoS, Philips Research, Eindhoven, The \nNetherlands). \nResults: In the directly irradiated section of the phantom the ratio of the \nMOSFET measurements and the MC computations was 0.99 ±0.06 (30 data \npoints) and 0.97 ±0.03 (26 data points) for the female and male version of the \nphantom, respectively. For comparison, the error bar on the individual ratios, \nmainly composed of measurement uncertainties, was 0.06. In the region \nreceiving only scattered radiation dose ratios were also consistent with a value \nof 1. \nConclusion: Radiation dose estimation using a MC method is strongly \ncorrelated with experimental measurements. The availability of dose \ndistribution estimates based on actual reconstructed patient CT images may \noffer the potential for accurate patient-specific CT dosimetry.  \nAuthor Disclosures: \nS. Trattner: Research/Grant Support; Philips Healthcare. C.M. Thompson: \nResearch/Grant Support; Philips Healthcare. S. Halliburton: Research/Grant \nSupport; Philips Healthcare. Speaker; Philips Healthcare. A.J. Einstein: \nResearch/Grant Support; Philips Healthcare, GE Healthcare. \nB-0246 14:45  \nUse of CT dose notification and alert values in routine clinical practice  \nC.H. McCollough, M. Howard, S. Leng, L. Yu, M. Bruesewitz, K. Grant; \nRochester, MN/US \nPurpose: The purpose of this investigation was to assess the impact on \nworkflow of the use of notification and alert values in our practice and to \nprovide baseline data for quality improvement initiatives. \nMethods and Materials:  Five diagnostic, clinical CT scanners were \nprogrammed with the notification and alert values recommended by the \nAmerican Association of Physics in Medicine. Retrospective analysis was \nperformed on log files to assess the frequency of and reason for notification \nand alert events. \nResults: Between February and September of 2012, 11,384 patients were \nscanned on the five systems. One alert occurred due to the use of bolus \ntracking in a morbidly obese patient, where the pre-scan cumulative CTDI\nvol for \nthe exam exceeded the recommended alert value of 1000 mGy. Only \n1.2 ± 0.6% of patient scans triggered a notification. Notifications were mainly \ntriggered due to bolus tracking and/or la rge patient size. Protocols triggering \nnotifications most often included CT angiography of the chest for pulmonary \nemboli. \nConclusion: Because only a small percentage of performed patient \nexaminations triggered a notification or alert event, the impact on workflow of \nadopting these features was negligible. Evaluation of the logs identified trends \nin reasons for which notification events  were triggered; these primarily included \nlarge patient size and bolus tracking. Additionally, specific protocols were \nidentified where adjustment of notification values was deemed necessary.  \nAuthor Disclosures: \nC.H. McCollough: Grant Recipient; research support from Siemens \nHealthcare, outside the submitted work.  \nB-0247 14:54  \nThe assessment of effective dose and organ dose taking tube current \nmodulation into account  \nX. Lopez Rendon, H. Bosmans, R. Oyen, F. Zanca; Leuven/BE \n(xochitl.lopezrendon@uzleuven.be)  \nPurpose: To evaluate the effect of including longitudinal tube current \nmodulation (TCM) versus using the average mAs on organ dose and effective \ndose (E) calculations. \nMethods and Materials:  97 consecutive adult patients (46 female, 51 male) \nunderwent thorax/abdomen scans performed with TCM (CareDose 4D, \nSiemens Definition Flash) at 120 kVp, 110 (thorax) and 200 (abdomen) \nreference mAs. Body mass index (BMI) of all patients was registered. Doses to \nfully irradiated organs (breasts, lungs, stomach, liver and ovaries) and E were \ncalculated using two versions of CT-Expo: v.2.0, which uses the patient \naverage mAs and the new version 2.2, which includes an approximation of the \nlongitudinal modulation. Student t-test was used to asses statistical \nsignificance. \nResults: We found a significant difference (p < 0.001) for E, on both thorax \nand abdomen CT exams, with E being overestimated on average by 3.3% \nwhen no TCM is simulated. Also for organ doses a significant difference \n(p < 0.001) was found with an average overestimation of 13.7% for the breast, \n7.3% for the lungs, 9.1% for the liver and 8.5% for the stomach but an \nunderestimation of 11.5% for the ovaries when no TCM is used. No trend was \nobserved as a function of patient BMI for the difference between both methods. \nConclusion: The new version of CT-Expo that accounts for TCM showed \nstatistical significant differences in terms of E and organ doses when compared \nS188  \n\n \n \nBA C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nto the previous version using only the average mAs. Future development could \nuse patient specific TCM profiles and pati ent size specific conversion factors.  \nB-0248 15:03  \nEfficacy of lens protection systems in cranial CT-scans: dependency on \ndifferent scanning techniques  \nN. Guberina, M. Schlamann, B. Mukherjee, A. Ringelstein; \nEssen/DE (nika.guberina@uk-essen.de)  \nPurpose: The purpose of this phantom study was to evaluate the potential \ndose-attenuation of different eye lens protectors for patients undergoing \nvarious cranial CT-scans at different scanners. \nMethods and Materials: Radiation exposure of the eye lens of seven common \nCT-Algorithms at 2 different CT-scanners (SOMATOM® Definition AS (CT 1) \nand SOMATOM® Definition Flash (CT 2) was measured with \nthermoluminescence dosimeters (TLD-500, '-Al2O3:C) using two different lens \nprotectors (Somatex (SOM) and Medical-Imaging-Systems (MIS)). \nResults: Dose attenuation accomplished by the different lens protectors is \nsummarised as follows: for CT 1 (a) unenhanced CT (nCT) with gantry \nangulation: SOM (0%), MIS (0%); (b) CT-angiography (CTA): SOM (37%), MIS \n(9%); (c) CT-perfusion (CTP): SOM (61%), MIS (64%); for CT 2 (d) nCT \nwithout gantry angulation: SOM (19%), MIS (9%); (e) CTA Safire®: SOM \n(61%), MIS (26%); (f) dual-energy-CTA without Safire®: SOM (31%), MIS \n(7%); (g) CTP: SOM (56%), MIS (31%). Depending on the CT protocol but \nindependent from the scanner used, lens protector SOM attenuated the dose \nup to 1.9 times more effectively compared to MIS. Physical analysis revealed \nthat the two lens protectors differ with respect to their density and thickness. \nConclusion: The efficacy of the two evaluated lens protectors differs widely \ndue to various material properties but is also highly dependent on the applied \nCT-protocol. Lens protectors are most effective in CTA protocols when \nreducing direct dose exposure. Considering both CT protocol and material of \nthe lens protectors is mandatory to reduce radiation exposure of the eye lens \nof patients undergoing CT-scans.  \nB-0249 15:12  \nOne-stop-shop myocardial 256-slice CT examination: what about the \ncumulative radiation risk?  \nK. Perisinakis\n1, I. Seimenis2, A. Tzedakis1, K. Pagonidis1, A. Papadakis1, \nJ. Damilakis1; 1Iraklion/GR, 2Alexandroupolis/GR \n(Kostas.Perisinakis@med.uoc.gr)  \nPurpose: To determine a) individual-specific estimates of radiation burden and \nassociated radiogenic cancer risks associated with myocardial 256-slice \ncoronary CT angiography (CCTA), dynamic CT perfusion (CTP) and delayed \nenhancement CT (DECT) scans, and b) the total life attributable risk (LAR) of \nradiation-induced cancer in individuals subjected to cardiac one-stop-shop \n256-slice CT examination. \nMethods and Materials: The typical 256-slice CCTA, dynamic CTP and DECT \nscans were simulated using Monte Carlo methods on sixty-two adult \nindividuals using an advanced simulati on software, dedicated for patient CT \ndosimetry. Radiation absorbed doses were determined to primarily exposed \nradiosensitive organs from each scan. Organ/tissue-specific radiogenic cancer \nrisk factors were used to derive indivi dual-specific LARs of cancer. The mean \ntotal LAR from the CCTA+CTP+DECT scans' sequence was estimated and \ncompared to nominal intrinsic risk of cancer. \nResults: The mean cumulative risk of radiogenic cancer associated with the \ncomplete one-stop-shop cardiac 256-slice CT examination was found to \nmarginally increase the intrinsic risk for cancer induction by less than 0.6% in \nfemales and less than 0.1% in males. The CTP scan was found to be the main \ncontributor to cumulative radiation burden from the 256-slice \nCCTA+CTP+DECT scan-sequence. The 256-slice CTP+DECT scan \ncombination was found to be more dose-efficient compared to radionuclide \nmyocardial perfusion imaging. \nConclusion: The theoretical radiation cancer risks associated with the one-\nstop-shop myocardial 256-slice CT examination may be considered low. \nNevertheless, every effort should be made towards acquisition protocol \noptimisation for the dynamic CTP study which is the main contributor to patient \nradiation burden.  \n \n \n \n \n \n \n \n \n \n \n \n \n14:00 - 15:30 Room N/O  \nVascular  \nSS 215  \nDevelopments in CT imaging  \nModerators:  \nM. Das; Maastricht/NL  \nK. Nikolaou; Munich/DE  \nB-0250 14:00  \nFoot perfusion CT in patients with peripheral arterial occlusive disease \ntreated with prostanoid drug: a pilot study  \nM. Nestola, R. Iezzi, M. la Torre, A. Contegiacomo, E. Antonuccio, L. Bonomo; \nRome/IT (massimiliano.nestola@libero.it)  \nPurpose: To evaluate the effectiveness of treatment with prostanoid drug \n(iloprost) in patients with PAOD using foot perfusion multidetector-row \ncomputed tomography (MDCT) technique. \nMethods and Materials: After institutional review board approval and informed \npatient consent were obtained, 10 patients with PAOD, older than 65 years, \nwere prospectively enrolled. All patients underwent dynamic foot 64-row-CT \nexaminations before and after daily iloprost infusion for one week, acquiring 8 \ncontiguous 5-mm reconstructed sections, with 1-second gantry rotation time \nand 60-second acquisition time, during injection of 40 mL of contrast medium \n(Iomeprol 400 mgI/mL, @ 4 mL/sec). Data were analysed by two experienced \nblinded readers using a dedicated software to calculate perfusion parameters, \nsuch as blood flow (BF), blood volume (BV), mean transit time (MTT), and \npermeability-surface area product (PS), before and after medical therapy. \nInterobserver and intraobserver agreement of perfusion CT analysis were \nassessed by Bland-Altman analyses. Perfusion parameters changes after \nprostanoid therapy were assessed by Wilcoxon's test, compared to clinical and \nlaboratoristic evaluation. \nResults: A good interobserver and intraobserver agreement of perfusion CT \nanalysis was obtained in all patients ( > 0.89). By comparing perfusion \nparameters after prostanoid treatment, a significantly shorter MTT was \nobtained, with good concordance with clinical results. \nConclusion: Foot CT perfusion, by providing the functional foot \nmicrovasculature, could be an useful method to evaluate the effectiveness of \nprostanoid therapy in patients with PAOD.  \nB-0251 14:09  \nVirtual monochromatic spectral image reconstruction in dual energy CT \nangiography and its use to reduce iodine load  \nS. Suntharalingam, K. Nassenstein; \nEssen/DE (Saravanabavaan.Suntharalingam@uk-essen.de)  \nPurpose: To quantify the benefits concerning image quality of dual energy CT \nangiography (DECTA) with virtual monochromatic spectral (VMS) image \nreconstruction in comparison to standard CT angiography (CTA), and to test if \nthese benefits can be used to reduce iodine load. \nMethods and Materials:  Ninety patients were randomised to three CT \nprotocols: CTA with injection of 100 ml contrast media with 350 mg/ml iodine, \nDECTA with the same iodine load, and DECTA with reduced (75%) iodine \nload. Nine series of VMS images were reconstructed (40-120keV). Signal \nintensity (SI) and noise were measured in the aorta, musculature and fat, and \nSNR and CNR values were calculated. \nResults: Image reconstruction at 80 keV revealed best SNR and CNR values. \nDECTA with 350 mg/ml iodine and image reconstruction at 80keV showed \nhigher SNR and CNR values compared to standard CTA (SNR aorta: 11.05 vs. \n8.2; CNR aorta-fat: 16.8 vs. 11.9; p < 0.05). Image reconstruction of DECTA \nwith reduced iodine load at 80 keV showed higher SNR and CNR values \ncompared to CTA (SNR aorta: 12.7 vs. 8.2; CNR aorta-fat: 20.0 vs. 11.9; \np < 0.05), but significant lower SI values of the aorta (215.1 vs. 270.7). Image \nreconstruction of DECTA with reduced iodine load at 70 keV showed similar SI \nvalues of the aorta (272.3 vs. 270.7) but still higher SNR and CNR values \n(SNR aorta: 11.4 vs. 8.2; CNR aorta-fat: 17.1 vs. 11.9; p < 0.05) compared to \nCTA. \nConclusion: DECTA with VMS image reconstruction allow to improve CNR \nand SNR, and to reduce iodine load compared to standard CTA.  \n \n \n \n \n \n \n \nS189  \n\n \n \nBA C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0252 14:18  \nFlash-4D CT angiography in aortic dissection  \nC.-Y. Lu1, Y.-K. Diao1, Y.-Q. Guo1, X. Zhang2, Z.-L. Li1; 1Chengdu/CN, \n2Shanghai/CN (yz1756@163.com)  \nPurpose: To assess feasibility and diagnostic value of Flash-4D CT \nangiography (CTA) for aortic dissection (AD). \nMethods and Materials:  18 consecutive patients with known or suspected AD \n(age:30-76 years) referred for aortic CTA were scanned on a dual-source CT \nscanner (Somatom Definition Flash, Siemens) using a high-pitch mode (pitch = \n3.0) with an automatic selection of kilovoltage that proposes optimised kV and \nmA settings according to planned examination type (Care KV; Siemens \nHealthcare) for multiphasic image acquisition (range from the entrance of bony \nthorax to the plane of symphysis pubis, time resolution 12s, 4 phases). CT \ndensities were measured in the aortic lumen and renal parenchyma. \nResults: In all cases Flash-4D CTA can exactly display the true and false \nlumen, intimal flap, the entry tear and the involvement of branches of AD. \nMean radiation dose was 11.6 ± 1.61 mSv. CT density of true lumen peaked at \n407.6 ± 89.1 HU, signal-to-noise ratio was 17.2 ±7.83. Compared to standard \ntri-phasic protocol (un-enhanced, arterial and portal scans), additional \ndiagnostic information was also obta ined as followed: enhancement delay \nbetween true and false lumen (n=18); the degree of membrane oscillation \n(n=16); perfusion delay in arteries originating from the false lumen (n=9) and \nquantitative assessment of renal perfusion asymmetry (n=3). \nConclusion: Flash-4D CTA covering the entire aorta is feasible and can \nexactly reveal pathological and anatomical features of AD with relative low \nradiation dose. Compared to standard tri-phasic protocol, it can provide more \ndiagnostic information, which can be helpful for the selection of treatment \nmethods.  \nAuthor Disclosures: \nX. Zhang: Employee; Siemens Shanghai Medical Equipment Ltd.  \nB-0253 14:27  \nImpact of the hybrid iterative reconstruction technique on image quality \nof low-tube-voltage CT pulmonary angiography  \nA. Laqmani1, M. Regier1, S. Veldhoen2, A. Backhaus1, S. Sehner1, H.D. Nagel3, \nG. Adam1, F.O. Henes1; 1Hamburg/DE, 2 Würzburg/DE, \n3Buchholz/DE (f.henes@uke.de)  \nPurpose: To determine the impact of a hybrid iterative reconstruction (HIR) \ntechnique (iDose, Philips Healthcare) on image noise and image quality in low-\ntube-voltage and dose-reduced CT pulmonary angiography (CTPA) in \ncomparison to filtered back projection (FBP). \nMethods and Materials:  50 patients (mean body weight, < 80 kg) with \nsuspected pulmonary embolism (PE) underwent CTPA with 80 kV protocol \n(Brilliance iCT; means: CTDIvol 2.3 mGy; DLP: 73.1 mGy*cm; effective dose: \n1.2mSv). Raw data were reconstructed using FBP and three HIR levels (2, 4 \nand 6). Two radiologists assessed image quality and noise on a scale of 1 \n(poor) to 5 (excellent). Conspicuity of PE was assessed in central, segmental \nand subsegmental arteries using a three-point scale (1, subtle; 2, sufficient; 3, \nexcellent). CT attenuation of pulmonary arteries, objective image noise (OIN) \nand background signal was measured, contrast-to-noise ratios (CNR) were \ncalculated. Statistical analysis was performed using a random intercept model. \nResults: With each HIR level, a significant decrease in subjective and \nobjective noise was achieved. In comparison with FBP, the lowest OIN was \nachieved with HIR level 6 (means: 36.7 HU vs. 23.1 HU, respectively). CNR \nsignificantly increased with application of HIR whilst CT attenuation in \npulmonary arteries maintained constant. Image quality was rated significantly \nhigher at HIR 2, 4 and 6 (means: 3.8, 4.7 and 4.7, respectively) compared to \nFBP (mean: 3.3). Conspicuity of central and segmental PE improved with use \nof HIR. \nConclusion: The HIR technique reduces image noise, improves image quality \nand conspicuity of PE in 80 kV CTPA protocols.  \nB-0254 14:36  \nAcute limited dissection (class 3) of the aorta diagnosed with EKG-gated \nCT angiography: a 10-year single center experience  \nA.S. Chin, A. Kino, G. Berry, D.C. Miller, D. Fleischmann; Stanford, CA/US \n(annechin@stanford.edu)  \nPurpose: Limited dissection (LD) is notoriously difficult to diagnose \nprospectively, reported to elude all cross-sectional imaging techniques. ESC \nTask Force classifies LD as \"class 3\" aor tic dissection, but this entity remains \nlargely unknown to radiologists. We have identified LDs at our institution on \nECG-gated CTA prospectively with surgical/pathologic confirmation. Our aim is \nto evaluate the ability of state-of-the-art CTA to detect LD in the clinical setting \nof acute aortic syndrome (AAS) and describe CTA imaging characteristics. \nMethods and Materials:  CTAs from Jan 1, 2002 - Dec 31, 2012 in patients \npresenting with AAS were retrospectively reviewed by two cardiovascular \nradiologists. LD was diagnosed accor ding to ESC classification and \nSvensson's 1999 original angiographic desc ription \"subtle aortic contour bulge \nwithout frank dissection flap.\" Additio nal post-processing was performed to \nincrease lesion conspicuity. \nResults: Incidence of LD was 4.9% (25 LD, 291 classic dissection, 123 IMH, \n29 penetrating atherosclerotic ulcer, 7 ia trogenic, 3 mycotic and 33 rupturing \naneurysm). Of 25 acute LDs, there were 17 type A and 8 type B (2 arch, 6 \ndescending aorta). There was 100% surgical/pathological concordance with \npre-operative CTA diagnosis in 10/17 type A LDs who underwent urgent \nsurgery. One type B LD was \"missed\" on initial review. \nConclusion: Accurate detection of LD is possible using ECG-gated CTA, \nalthough lesion awareness and meticulous dataset review is required; \nadditional post-processing increases lesion conspicuity. This is a first report of \nprospective CTA diagnosis of LD, and the first to report type B LD using CTA.  \nB-0255 14:45  \nFeasibility study of CT-angiography with low kV settings and ultra low-\ncontrast medium volume in the assessment of thoracic and abdominal \naorta disease  \nC.R.G.L. Talei Franzesi, D. Ippolito, P.A. Bonaffini, D. Fior, O. Minutolo, \nS. Sironi; Monza/IT (ctfdoc@hotmail.com)  \nPurpose: To assess the diagnostic quality and the radiation dose exposure of \nlow-kV CT angiography study (100 kV),by using ultra low-contrast medium \nvolume (40 mL), for thoracic and abdominal aorta evaluation. \nMethods and Materials:  From July 2011 to march 2013, 81 patients (31 \nwomen; mean age 65.4 years; range, 35-83 years; BMI < 30),with thoracic or \nabdominal aortic disease, were prospectively examined with 256-MDCT scan \n(Brilliance iCT; Philips) using low-dose protocol (100 kV; automated tube \ncurrent modulation) and ultra low-contrast volume (40 mL; 4 mL/s; \n350 mgI/mL). For the evaluation of ascending aorta, an ECG-gated \nretrospective protocol was performed. A control group of 56 patients (20 \nwomen; mean age 67.2 years; range, 34-86 years) who underwent on the \nsame scanner standard CT-angiography protocol (120 kV; 350 mAs), with \nstandard contrast volume (100 mL) was also evaluated. Density \nmeasurements were performed manually drawing a region of interest (ROI) on \nlumen of ascending aorta, arch, descending and abdominal aorta, renal \narteries and common iliac arteries. The radiation dose exposure (dose-length \nproduct, DLP) was also calculated for both groups. Then, the obtained data \nwere compared and statistically analysed. \nResults: In all CT studies, we could correctly visualise and evaluate main \nbranches of thoracic and abdominal aorta. No significant difference of density \nmeasurements was achieved between low-kV protocol (mean attenuation \nvalue of thoracic aorta 310 HU, abdominal aorta 337 HU and renal arteries \n329 HU) and the control group (mean value of thoracic aorta 316 HU, \nabdominal aorta 331 HU and renal arteries 307 HU).The radiation dose \nexposure was significantly lower (p < 0.05) in low-kV protocol (mean DLP \nthoracic 490 mGy*cm; abdominal 335 mGy*cm) than in control group (mean \nDLP thoracic 625 mGy*cm; abdominal 952 mGy*cm), with an overall reduction \nof 22% in the thoracic and 65% for abdominal study. \nConclusion: Low-kV protocol provides a diagnostic performance comparable \nto standard protocol, decreasing significantly the radiation dose exposure as \nwell as the contrast material volume, reducing also the risk of contrast-induced \nnephropathy.  \nB-0257 14:54  \nCTA imaging characteristics of rupturing thoracic aortic aneurysm in \nacute aortic syndrome: a 10-year single center experience  \nA.S. Chin, A. Kino, D. Fleischmann; Stanford, CA/US \n(annechin@stanford.edu)  \nPurpose: The incidence of leaking or rupturing thoracic aortic aneurysm is \nlargely unknown as many succumb before coming to medical attention. Our \naim is to evaluate the incidence of leaking/rupturing aortic aneurysm \npresenting as acute aortic syndrome  (AAS) and describe CTA imaging \ncharacteristics. \nMethods and Materials:  CTAs from Jan 1, 2003 - Dec 31, 2012 in patients \nwith AAS were retrospectively reviewed by two cardiovascular radiologists. \nLeaking/rupturing aneurysm was diagnosed based on aortic diameter greater \nthan 40 mm AND (1) contrast extravasation, (2) pseudoaneurysm formation, or \n(3) other imaging finding indicating acute aortic injury including periaortic \nhematoma, intramural hematoma or mediastinal hemorrhage. \nResults: 511 patients were diagnosed with AAS with 6.5% incidence of \nrupturing thoracic aneurysm (291 classic dissection, 123 IMH, 25 limited \ndissection, 29 penetrating atherosclerotic ulcer, 7 iatrogenic, 3 mycotic and 33 \nrupturing aneurysm). There was 87.9% (29/33) descending involvement. 20/33 \npatients underwent surgical or endovascular treatment with 15% in-hospital \nmortality versus 38.5% in-hospital mortality with conservative management. \nConclusion: Leaking or rupturing thoracic aneurysm represents a significant \nportion of patients presenting with AAS, comparable to penetrating \natherosclerotic ulcer in our series, an d most frequently involves the descending \naorta.  \nS190  \n\n \n \nBA C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0258 15:03  \nLow-dose 256-MDCT angiography of the carotid arteries: effect of hybrid \niterative reconstruction technique on noise, artefacts, and image quality  \nE. Kondratyev, G.G. Karmazanovsky, V. Shirokov, N. Tarbaeva, \nA. Vishnevskaia; Moscow/RU (evgenykondratiev@gmail.com)  \nPurpose: To evaluate the effect of hybrid iterative reconstruction on qualitative \nand quantitative parameters at low-dose carotid CTA \nMethods and Materials:  44 consecutive patients were enrolled in the study. \nFirst group (n=22) was examined under 120 kV 250 mAs and second group \n(n=22) under 100 kV 250 mAs. CT images in first group were reconstructed \nonly with the filtered back projection (FBP). CT data in second group were \nreconstructed both with FBP and three levels of hybrid iterative reconstruction \nalgorithm (iDose). We compared quantitative and qualitative parameters \namong the two groups and among four different reconstructions in second \ngroup. \nResults: Effective dose in 120 kV and 100 kV group was 7.18 ±1.19 mSv and \n4.14±1.03 mSv, respectively (p < 0.0001). Mean arterial attenuation was about \n25% higher in second group (236.5 ±46 vs. 302.6±32.7 HU; p < 0.0001). Image \nnoise at the level of humeral belt was 32.5 ±12.5 in 100 kV group and \n26.3±13.3 in 120 kV (p=0.115. Average noise decreased when using 3 levels \nof iDose up to 23.6 ±6.4, 17.7± 5.6, 13.7 ±5.1, respectively (p=0.00001). Mean \nCNR increased to 10.38 ±3.87, 14.5 ±5.21, 18.32± 8.61, respectively (p < 0.05). \nThe presence of artifacts on the level of humeral belt in 120 kV group was \n14%, in 100 kV - 41% (p=0.002). The difference in visual scores between \nstandard and low-dose protocol was significant (p=0.008). When applying \niterative reconstruction, the frequency of streak artifacts decreased \ndramatically (p < 0.0001). Most studies had excellent quality with no artefacts \nwhile using highest level of iDose. \nConclusion: Low-dose MDCT angiography using hybrid iterative \nreconstruction may provide sufficient image quality and allows for significant \nreduction of patient dose.  \nB-0259 15:12  \nComparison between CT venography at 320 multi-detector row scanners \nwith conventional angiography in patients with failed arteriovenous axis \nfor haemodyalysis  \nY. Ragab\n1, H. Hamza2, A. El Marakby1, F. Zeinhohm1; 1Cairo/EG, \n2Doncaster/UK (hosnyhamza71@gmail.com)  \nPurpose: To compare CT venography at 320 multi-detector row scanners with \nconventional angiography in patients with failed arteriovenous axis for \nhaemodyalysis. \nMethods and Materials:  retrospective study including 50 ptients with failed \narteriovenous axis for haemodyalysis (37 men, 13 women) who underwent 320 \nmulti-detector CT venography of the thoracic inlet prior to angioplasty. Findings \non CT angiograms, including CT scans, maximum intensity projections, and \nthree-dimensional volume-rendered images, were used to evaluate the site \nand cause of axis failure. \nResults: Among the 50 patients initially treated with venous angioplasty, 56 \nvenous occlusions were identified. In 94% of cases, concordant findings were \nobserved with both modalities (CTV and conventional venography). In five \n(6%)cases, CT could not be used to identify precisely the site of venous \nobstructions. In 5% cases, CT depicted venous tight stenoses that could not be \ntackled by angioplasty. Three-dimensional images were found to be superior to \n2D CT angiogrphic in depicting the anatomical venous anomalies which \nenabled the interventional radiologist s to perform successful angioplasty after \ndirect catherization. \nConclusion: CT venography using 320 multi-detector systems provides more \naccurate depiction of the venous anatomy of the thoracic inlet prior to \nconventional venography and angioplasty.  \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n14:00 - 15:30 Conf. Room M3  \nInterventional Radiology  \nSS 209  \nMR-guided high-intensity focused \nultrasound  \nModerators:  \nN. Grenier; Bordeaux/FR  \nC.M. Sommer; Heidelberg/DE  \nB-0260 14:00  \nReintervention rate and symptom improvement following volumetric MR-\nguided high-intensity focused ultrasound versus uterine artery \nembolisation for uterine fibroids: a multicenter study  \nM.E. Ikink1, R.J. Nijenhuis1, H.M. Verkooijen1, P.N.M. Lohle2, \nM.A.A.J. van den Bosch1; 1Utrecht/NL, 2Tilburg/NL (m.ikink@umcutrecht.nl)  \nPurpose: To assess the effectiveness of MR-guided High-Intensity Focused \nUltrasound (MR-HIFU) for treatment of uterine fibroids in comparison to Uterine \nArtery Embolisation (UAE). \nMethods and Materials:  Between January-2011 and January-2013, 51 \nwomen with symptomatic fibroids underwent MR-HIFU in the UMC Utrecht. \nClinical and imaging data were compared to 68 women treated with UAE in the \nSt.Elisabeth Hospital Tilburg, those who would theoretically been eligible for \nMR-HIFU based on fibroid size ( \u000212 cm) and number ( \u00025), absence of \ninterposed intestines and other pelvic diseases. We compared reintervention \nwithin 12-months following treatment; symptom severity (tSSS) and quality of \nlife (HRQoL) scores 3-months after initial treatment. Logistic regression was \nperformed to calculate the adjusted Odds-ratio of clinically relevant symptom \nimprovement (defined as 3-months tSSS \u000220) of women treated with MR-HIFU \nversus UAE. Cox regression was applied to calculate the adjusted risk of \nreintervention between both groups. \nResults: After MR-HIFU, the median tSSS improved from 53.1 (IQR \n[40.6.68.8]) at baseline to 34.4 (IQR [21.9.46.9]) after 3-months (p < 0.001). \nAfter UAE, median tSSS improved from 65.3 (IQR [56.3.74.2]) to 21.9 (IQR \n[9.4.34.4]; p < 0.001). For both groups, HRQoL improved significantly from \nbaseline to follow-up (p < 0.001). Compared to UAE, women treated with MR-\nHIFU were less likely to develop adequate symptom improvement (OR=0.07; \n95%-CI [0.02.0.29]; p < 0001). At 12-months, patients treated with MR-HIFU \nhad a 7.11 (95%-CI [2.00.25.3]; p=0.002) times higher risk of reintervention. \nConclusion: Women with symptomatic uterine fibroids had a higher probability \nof adequate symptom improvement and a lower risk of reintervention if treated \nwith UAE as compared to MR-HIFU.  \nB-0261 14:09  \nNew fronteers for the multiple uterine fibroids therapy: combined \ntreatment using MRgFUS and uterine artery embolisation  \nF. Ferrari, A. Miccoli, F. Arrigoni, S. Carducci, A. Giordano, G. Mascaretti, \nC. Masciocchi; L'Aquila/IT (fabianaferrari@hotmail.it)  \nPurpose: To evaluate the combination between magnetic resonance-guided \nfocused ultrasound (MRgFUS) and uterine artery embolisation (UAE) to \nincrease the number of patients, affected by multiple uterine fibroids, treatable \nby non-surgical therapy. \nMethods and Materials: From December 2012 to September 2013, 6 patients \nwith multiple uterine fibroids, aged between 36 and 51, were first treated by \nMRgFUS and after 1 month using UAE. Each patient presented more than 3 \nfibroids, measuring between 3 and 14 cm. Four patients had 4 fibroids, 1 of \nthese was treated using MRgFUS and the others with UAE. Two patients \npresented 3 fibroids, 2 treated by MRgFUS and the others using UAE. The use \nof UAE after MRgFUS caused an increase of the necrotic area in fibroids \nalready treated, improving the treatment efficacy, and allowing the treatment of \nfibroids otherwise untreatable by MRgFUS. Each patient was subjected to \nclinical evaluation using the severity-score-questionnaire. \nResults: We obtained a good response in both treatments, without any \ncomplication. The \"non perfused volume\" showed a mean value of 86.5% in \nfibroids treated with MRgFUS, and a mean value of 90% for fibroids treated \nwith UAE. The symptomatic score showed a reduction of about 90%, if \ncompared to the pre-treatment score. \nConclusion: These combined treatments imply minimal hospitalisation and \ncomplications preserving uterus integrity when the invasive surgery would be \nthe only therapeutic possibility.  \n \n \nS191  \n\n \n \nBA C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0262 14:18  \nOsteoid osteoma: magnetic resonance-guided high intensity-focused \nultrasound for entirely non-invasive treatment: a prospective \ndevelopmental study  \nA. Napoli, M. Anzidei, F. Boni, L. Bertaccini, G. Brachetti, C. Catalano; \nRome/IT (alessandro.napoli@uniroma1.it)  \nPurpose: To determine the efficacy of MR-guided focused ultrasound \n(MRgFUS) treatment of symptomatic osteoid osteomas. \nMethods and Materials:  This prospective, IRB approved study involved 15 \nconsecutive patients (11 m, 4 f, mean age 21) with clinical and imaging \ndiagnosis of osteoid osteoma, all patients underwent MRgFUS ablation \n(ExAblate, InSightec). Lesions located in the vertebral body were excluded, \nwhile lesions in proximity to joints or neurovascular bundles were included. \nTreatment success was determined at clinical and imaging follow-up at 1, 6 \nand 12 months post-treatment. A visual analogue pain score was used to \nassess changes in symptoms. Bone changes at nidus site were evaluated on \nthe basis of CT and dynamic ce-MR imaging (Gd-Bopta; Bracco) pre- and post-\ntreatment. \nResults: Treatment was carried out using a variable sonications number \n(4±1.8) with a mean energy deposition of 866 ±211 J. There were no treatment \nor anesthesia-related complications. A sta tistically significant difference \n(p=0.001) was noted between pre- and post-treatment VAS scores (8.3 ±1.6 vs \n0.6±1.5, respectively). Two treatments were conducted in patients with prior \nCTgRFA failure and needed two different sessions to achieve complete clinical \nsuccess. At imaging, edema and hyperemia gradually disappeared in all \nlesions. No apparent relationship between nidus vascular extinction and \nsuccessful outcome was found. Variable reabsorption degree of sclerotic \nreaction was observed with nidus disappearance in 4 cases (27%). \nConclusion: Treatment of osteoid osteoma using MRgFUS can be performed \nsafely with high rate of success and without treatment-related morbidity. Our \nresults also indicated a positive trend to bone rearrangement after treatment.  \nB-0263 14:27  \nOur experience of non-invasive treatment of epiphyseal benign bone \nlesions using MRgFUS: can it really be a definitive solution?  \nF. Arrigoni, L. Gregori, A. La Marra, A. Conchiglia, L. Zugaro, A. Barile, \nC. Masciocchi; L'Aquila/IT (abarile0@sirm.org)  \nPurpose: To evaluate the role of MRI-guided focused ultrasound (MRgFUS) in \nthe treatment of epiphyseal benign bone lesions in which the surgery would be \ntoo demolitive. \nMethods and Materials:  From March 2011 to August 2013 we treated 12 \nepiphyseal benign bone lesions: seven fibro-osteitis (four of the humerus; two \nof the foot; one of the knee), two periosteal chondroma of the femoral neck, \ntwo fibromixomas of the knee and one osteoblastoma of the femoral neck. All \npatients were studied by CT and MRI and evaluated by VAS scale, for the \nclinical symptoms before and after (6 and 12 months) treatment. The nature of \nall the lesions was confirmed by biopsy. \nResults: After the treatment all patients, except one, showed regression in \npainful symptomatology with mean VAS that decreased from 7.8 to 2.5. In the \npatient with periosteal chondroma of the femoral neck no improvement in \nsymptomatology was observed. At the MRI and CT evaluation after treatment, \nin no case a progression of disease was described. No substantial changes \nwere found in the CT images of controls. Instead, in the MRI evaluations, in all \nthe lesions, there was the reduction of bone edema around the lesion already \nto the first control at 6 months. In no case major complications were observed. \nConclusion: Though further and larger studies are needed our experience \nshows that the use of MRgFUS is a safe and effective treatment for those \nlesions in which the surgery would be too invasive in relation with the grade of \nlesions.  \nB-0264 14:36  \nMagnetic resonance-guided focused ultrasound surgery (MRgFUS) \ntreatment of painful bone metastases: can ADC value predict the clinical \noutcome?  \nF. Boni, F. Zaccagna, A. Napoli, V. Noce, L. Bertaccini, C. Catalano; Rome/IT \n(fabrizioboni00@gmail.com)  \nPurpose: To evaluate the role of ADC values in the assessment of bone \nmetastasis' response after MR-guided focused ultrasound surgery (MRgFUS), \nand to correlate these modifications with clinical outcomes. \nMethods and Materials:  23 patients with bone metastases underwent \nMRgFUS treatment (ExAblate2100,InSightec). Lesion's size and locations \nwere determined using CT and MRI; all MRI scans were performed with a 3 T \nunit paired with the ExAblate system. Treatments were performed under \ngeneral anaesthesia or subarachnoid spinal block. Follow-up examinations \nwere performed 1, 3 and 6 months after treatment; pain severity and pain \ninterference were evaluated using a Visual Analogue Scale, meanwhile \nimaging assessment was performed by comparing pre- and post-treatment \nADC values. \nResults: All patients well tolerated the treatment and no heating-related \nadverse events were recorded. The VAS score decreased from baseline \n7.09±1.8, to 2.65±1.36 at first follow-up and 1.04 ±1.91 at third month follow-up; \nat sixth month, it was stable (1.09 ±1.99). ADC values increased of +48.9% at \nfirst month follow-up (p < 0.001), and it was stable in the following \nexaminations (43.3% at 3 months and 42.8% at 6 months). Moreover, there \nwas a statistically significant negative correlation between ADC and VAS ( ;=-\n0.684; p=0.03). \nConclusion: Preliminary data showed that an increment in ADC values is \nstrongly associated with pain relief after MRgFUS treatment in patients with \nbone metastases; moreover, we also demonstrated a different percentage of \nincrease in ADC values according to response assessment. Therefore, in \nconclusion, ADC value could play an important role in outcome prediction in \npatients undergoing MRgFUS for painful bone metastasis.  \nB-0265 14:45  \nPrimary pain palliation and local tumour control in bone metastases \ntreated with MR-guided focused ultrasound  \nF. Zaccagna, B. Cavallo Marincola, A. Napoli, F. Boni, G. Brachetti, \nL. Bertaccini, C. Catalano; Rome/IT (f.zaccagna@gmail.com)  \nPurpose: To evaluate the clinical performance of MRgFUS in the primary \ntreatment of painful bone metastases and to explore the potential of this \ntechnique in achieving local control. \nMethods and Materials:  26 consecutive patients (female/male 12/14; age: \n64.7±7.5) with painful bone metastases were enrolled in this study. Before and \n3 months after MRgFUS treatment, pain severity and pain interference scores \nwere assessed according to Brief Pain Inventory-Quality of Life (BPI-QoL) \ncriteria and patients underwent both CT and MRI. Local tumour control was \nevaluated according to lesion size, density and perfusion at CT, dynamic \ncontrast enhancement at MRI (Discovery 750HD, GE; Gd-Bopta, Bracco) and \nmetabolic activity at PET or scintigraphy. Patients were classified into \nresponders and non-responders. \nResults: No treatment-related adverse events were recorded during the study. \nA statistically significant difference bet ween baseline and follow-up values for \nboth pain severity and pain interference scores was observed (p < 0.05). \nIncreased bone density was observed in 9/26 (34.6%) patients. Non-perfused \nvolume values ranged between 20% and 92%. There was no difference in NPV \nvalues between responders and non-responders (46.7 ±24.2% [25 - 90 %] vs. \n45±24.9% [20 - 93 %]; p=0.7). In 6 patients (5 prostate and 1 breast primary \ncancer), there was nearly absence of metabolic activity after treatment (mean \nSUV=1.2). \nConclusion: MRgFUS can be safely and effectively used as the primary \ntreatment for pain palliation in patients with bone metastases; our experience \ndemonstrated also a potential role for the MRgFUS in local tumour control as \nconfirmed by metabolic analysis.  \nB-0266 14:54  \nMagnetic resonance-guided focused ultrasound surgery (MRgFUS) \ntreatment of primary pancreatic and hepatic cancer: preliminary \nexperience in tumour control  \nF. Zaccagna, F. Boni, L. Bertaccini, V. Noce, M. Anzidei, A. Napoli, \nC. Catalano; Rome/IT (f.zaccagna@gmail.com)  \nPurpose: Hepatic tumours (HCC) and pancreatic cancer represent two of the \nmost challenging abdominal tumours due to their vascular relationship and to \nthe poor prognosis. Both these cancers have been successfully treated with \nfocused ultrasound under conventional US guidance. Magnetic resonance-\nguided focused ultrasound surgery (MRgFUS) introduces the advantage of \nreal-time monitoring, allowing a more precise lesion's ablation and a more \naccurate in-treatment patient management. This technique has been widely \nused in other applications while its use to treat HCC and pancreatic cancer is \nstill in its preliminary phase. Therefore, our purpose was to evaluate safety and \neffectiveness of high-intensity MR-gui ded focused ultrasound treatment in \npancreatic and HCC. \nMethods and Materials:  5 patients with pancreatic cancer and 1 with \nunresectable right lobe HCC underwent MRgFUS treatment (ExAblate2100, \nInSightec). Treatments were done in a single ambulatory session. To evaluate \ntumour control, perfusion T1w images after contrast medium administration \nwere obtained pre- and post-treatment. Follow-up examinations were \nscheduled at 1, 3, 6 and 12 months. \nResults: All patients well tolerated the treatment and no heating-related \nadverse event was recorded. Immediately after treatment, all patients showed \ncoagulative necrosis with a mean non-perfused volume of 65.4 ±16.6 [45 - 90]. \nAll patients with pancreatic cancer showed a significant decrease of pain. At \nfollow-up, no local progression was recorded; after MRgFUS 2 patients with \npancreatic cancer underwent RT meanwhile another one required a second \nMRgFUS treatment. \nS192  \n\n \n \nBA C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nConclusion: Our preliminary experience indicates that MRgFUS could be a \npromising non-invasive treatment modality in patients with unresectable \npancreatic cancer and HCC.  \nB-0267 15:03  \nRole of magnetic resonance-guided high intensity focused ultrasound \n(MRgFUS) surgery as non-invasive treatment of breast cancer in patients \nwith focal disease  \nA. Napoli, V. Noce, L. Di Mare, M. Anzidei, F. Pediconi, L. Bertaccini, \nC. Catalano; Rome/IT  \nPurpose: To assess safety and feasibility of 3 T MR-guided focused \nultrasound (MRgFUS) ablation of invasive ductal breast cancer (stage T1 M0 \nN0) prior to surgical resection and sent inel lymph node biopsy. As secondary \noutcome, we evaluated MRI accuracy in the assessment of residual disease. \nMethods and Materials:  Eleven patients with unifocal biopsy-proven IDC, \nscheduled for lumpectomy and sentinel lymph node biopsy, underwent \nMRgFUS treatment. Pre-treatment imaging was performed on a 3 T MRI unit to \nlocalise the enhancing lump and to evaluate treatment's feasibility according to \nits size ( < 2 cm) and location. All patients underwent MRgFUS treatment \n(ExAblate 2100; InSightec) in a day-surgery setting. Immediately after the \ntreatment, a contrast-enhanced MRI (CE-MRI) was performed to evaluate \ntreatment response; post-surgery pathological evaluation was considered as \nreference standard to assess treatment's efficacy. \nResults: All patients well tolerated the treatment and no heating-related \nadverse event was recorded. At post-treatment CE-MRI, no enhancing lesion \nwas seen in 9 patients; in these patients, post-surgery pathological evaluation \ndemonstrated an area of necrosis with 5-mm margins of normal breast tissue \nand no foci of residual disease. In the remaining 2 cases, treatment was \ninterrupted due to a transducer's malfunction; CE-MRI demonstrated a fainting \nenhancement and post-surgery pathological evaluation showed a 15% of \nresidual tumour in the ablated area. Post-treatment CE-MRI assessment of \nresidual tumour was strongly correlated to post-surgery pathological evaluation \nof treatment response. \nConclusion: MRgFUS is an innovative and totally non-invasive treatment \nmodality for unifocal breast cancer that allows a safety and efficacy treatment \ndue to MR guidance.  \nB-0268 15:12  \nNon-invasive focal therapy of organ confined prostate cancer: phase-I \nstudy using magnetic resonance guided focused ultrasound technology \nand excision pathology for efficacy assessment  \nD. Pier Luigi, A. Napoli, F. Zaccagna, G. Cartocci, F. Boni, V. Noce, V. Noce, \nC. Catalano; Rome/IT (f.zaccagna@gmail.com)  \nPurpose: To assess safety and effectiveness of non-invasive MR-guided \nfocused Ultrasound Surgery (MRgFUS) treatment of localised prostate cancer \nin a phase-I, treat and resection designed exploratory study. \nMethods and Materials:  11 patients with biopsy proven focal T2 prostate \ncancer (low-to-intermediate risk: PSA < 12 and Gleason < 3+4), confirmed on a \nprevious multiparametric MRI including dynamic contrast enhanced (DCE) \nimaging (Gd-BOPTA, Bracco), underwent MRgFUS ablation (ExAblate, \nInSightec). All patients were scheduled to radical laparoscopic prostatectomy. \nMRgFUS treatment was carried out on the MR identifiable lesion ( < 2) using a \npatient specific energy (3000-8500 J) and real- time MR thermometry. Non-\nperfused volume (NPV) in the post-treatment MRI was compared with excision \npathology for necrosis assessment. \nResults: No significant complications were observed in all subjects during or \nimmediately after the procedure. Treatment was validated by pathological \nexaminations, which demonstrated extensive coagulative necrosis at the site of \nsonication surrounded by normal pros tatic tissue with inflammatory changes; \nthese features were positively correlated with the immediate post-treatment \nMRI scan and NPV values. At histology, 10 patients were free of residual \nviable tumour within the treated area; in the remaining patient, 10% of residual \ntumour was observed within the NPV. There was a variable amount of isolated \ncancer tissue (Gleason<  6, 3+3) within non-treated parenchyma that was \nneither identifiable at MRI nor at biopsy. \nConclusion: Results of our Phase-I study suggest that MRgFUS is a safe and \neffective modality to determine a > 90% necrosis of identifiable prostate \ncancer; other prospective studies are needed to extend success rate in larger \ncohort.  \n \n \n \n \nB-0269 \n15:21  \nImage-guided high-focused ultrasound for renal sympathicolysis: a \nfeasibility study in pigs  \nP. Freyhardt, L. Heckmann, A. Beck, N. Stolzenburg, J. Schnorr, \nJ.-L. Rinnethal, R.W. Günther, F. Streitparth; \nBerlin/DE (patrick.freyhardt@charite.de)  \nPurpose: To evaluate feasibility, safety and efficacy of MR-guided high-\nfocused ultrasound (MRgHiFUS) for renal sympathetic denervation in pigs. \nMethods and Materials:  Renal periarterial MRgHiFUS was performed under \ngeneral anaesthesia in 10 pigs (unilaterally in 9 pigs, sham treatment in 1 pig). \nBlood pressure measurements and MRI of the kidneys, renal arteries and \nsurrounding structures were acquired immediately pre- and post-intervention \nand after 4 weeks. Hereafter, all animals were killed to histologically examine \ninduced neural degeneration and to assess efficacy of the procedure by \ndetermining norepinephrine (NE) concentration in the renal parenchyma. \nResults: On average, 10.5 ±2.9 sonifications with a mean energy of 2671 ±446 \nJoule were applied. Post-interventional MRI revealed a periarterial oedema on \nthe treated side in three pigs, corresponding histologic changes were found in \none pig. Renal NE was lower (-8 to -27 %) on the treated side than on the \nuntreated side in 5 of 7 unilaterally treate d pigs. A significant difference in the \naverage NE level between the treated (392 ng/g) and untreated kidneys \n(430 ng/g) of all unilaterally treated animals was not found. Post-interventional \nMRI indicated that special anatomic features led to ultrasound energy \nabsorption at the transverse process and fascia. \nConclusion: MRgHiFUS did not induce significant renal sympathicolysis in a \npig model, probably due to insufficient pe riarterial energy deposition. Since a \nHiFUS treatment in humans is expected to be easier to perform due to a better \naccess to renal sympathetic nerve fibres, further studies of this method are \ndesirable.  \n14:00 - 15:30 Board Room A  \nRadiographers  \nSS 214  \nQuality improvement in screening and \nsymptomatic mammography services  \nModerators:  \nC. Mandel; East Melbourne/AU  \nD. O'Leary; Dublin/IE  \nB-0270 14:00  \nMammographic positioning quality of newly trained vs experienced \nradiographers in the Dutch breast cancer screening programme  \nC.G.C.M. van Landsveld-Verhoeven, J.M.H. Timmers, M.J.M. Broeders, \nG.J. den Heeten; Nijmegen/NL (c.vanlandsveld-verhoeven@lrcb.nl)  \nPurpose: To compare mammographic positioning quality of new (NR) versus \nexperienced screening radiographers (ER). \nMethods and Materials:  Radiographers must complete an initial education \ncourse before starting to work in the Dutch breast screening programme. This \ncourse consists of a theoretical part (4 days) and a practical training period (6 \nweeks). A portfolio of 50 mammograms, randomly selected from screening \npractice, is part of the examination. Audits are part of the quality assurance \nprogramme and a review of positioning quality of screening mammograms is \none of the activities performed. We analysed 7079 views from portfolios and \n14896 audit views. All mammograms were reviewed based on pre specified \ncriteria, e.g. depiction of the inframammary angle and nipple in profile. \nResults: Positioning was more adequate for NR than ER (CC views: 96.5% \nversus 86.4%, p=0.00; MLO views: 91.9% versus 84.5%, p=0.00). \nMammograms from ER were more often poor, because the errors were more \nsevere. For the CC views, the NR scored better for most of the criteria: they \nhad less problems with bucky height (5.6% versus 9.2%, p=0.00) and less \nlateral and medial folds compared to ER (10.4% versus 15.6%, p=0.00). On \nthe contrary, for MLO views, NR encountered more difficulties, especially with \nthe symmetry (12.0% versus 5.7%, p=0.00) and depiction of the inframammary \nangle without folds (68.3% versus 58.8%, p=0.00). \nConclusion: Overall, NR perform better than ER. These results stress the \nneed for continuous auditing and training in breast cancer screening \nprogrammes to keep positioning skills up to date.  \nAuthor Disclosures: \nG.J. den Heeten: Founder; Co-founder of Sigmascreening a spin off company \nof the Academic Medical Centre Amsterdam. \nS193  \n\n \n \nBA C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0271 14:09  \nReject analysis for digital mammography (2D) including 2D plus \ntomosynthesis in high volume mammography screening  \nR. Hammond1, R. Gullien1, B. Østerås1, I. Hauge2; 1Oslo/NO, 2Østerås/NO \n(robham@ous-hf.no)  \nPurpose: Reject rates and reasons for rejected images between digital \nmammography (2D) compared with 2D plus tomosynthesis in high volume \nmammography screening. \nMethods and Materials:  Reject analysis for an 18 month period included a \ntotal of 95,976 mammography images, 22,772 from 2D examinations and \n73,204 from 2D plus tomosynthesis. For 2D plus tomosynthesis, one image is \ndefined as both 2D and a tomosynthesis acquisition. Rejection rate was \ncalculated on per image basis, presented with 95% Confidence Intervals (CI) \nestimated using the Wilson score method. Rejected images were assigned into \ncategories for reasons: 1) positioning, 2) x-ray equipment failure, 3) patient \nmotion, 4) artifacts and 5) others \nResults: Total rejection rate for 2D was1.62% [CI: 1.46-1.79] (368/22772) and \n2D plus tomosynthesis1.28% [CI: 1.20 - 1.37] (939/73204). Stratified rejection \nrate for categories: 1)positioning: 0.82% [CI: 0.71 - 0.95] vs. 0.69% [CI: 0.63 - \n0.75]; 2)x-ray equipment failure: 0.60% [CI: 0.51 - 0.71] vs. 0.37% [CI: 0.33 - \n0.42]; 3)patient motion: 0.066% [CI: 0.040 - 0.11] vs. 0.089% [CI: 0.070 - 0.11]; \n4)artifacts: 0.022% [CI: 0.0094 - 0.051] vs. 0.041% [CI:0.029 - 0.058]; 5)others: \n0.11% [CI: 0.071 - 0.16] vs. 0.092 % [CI: 0.072 - 0.12] for 2D and 2D plus \ntomosynthesis, respectively. Overall rejection rate was significantly higher for \n2D compared with 2D plus tomosynthesis. Most common reasons for rejections \nwere: Positioning and X-ray equipment failure. \nConclusion: Positioning is the most common reason for rejections. \nTomosynthesis may be implemented in a high volume breast cancer-screening \nprogram without an increase in rejected images.  \nAuthor Disclosures: \nR. Hammond: Advisory Board; Hologic, Inc. 2012. Other; Travel costs 2012, \nHologic, Inc. R. Gullien: Other; Travel costs 2012, Hologic, Inc.  \nB-0272 14:18  \nTomosynthesis in mammography screening: invited women's attitude \nregarding radiation health effects and pain experience  \nR. Gullien, R. Hammond, J. Andersen, P. Skaane; Oslo/NO \n(uxraul@ous-hf.no)  \nPurpose: Comparing participants and non-participants responses when \noffered tomosynthesis in addition to 2D mammograms based on informed \nconsent in a screening program. \nMethods and Materials:  From Sept.28 th to Dec.12 th 2012, 4609 women aged \n50-69 attended a population-based screening program. 2922 women voluntary \nanswered a questionnaire including questions about concern of radiation \nhealth effects and pain experience. Both participants and non-participants were \nasked to reply. Most questions were identical for both groups. 34 incomplete \nquestionnaires were excluded. \nResults: 82% (2367/2888) of participants and 18% (521/2888) of non-\nparticipants replied. There was no difference regarding level of education, self-\nassessment of knowledge of radiation, and previously history of mammography \nbetween the groups. 780 (33%) of participating and 133 (26%) of non-\nparticipating women had heard about tomosynthesis (p < 0.05). Of all repliers, \n93.5% (2700/2888) were not/slightly concerned about radiation health effects. \nAmong participants, 96% (2254/2367) were not/slightly concerned about \nradiation effects compared with 86% (446/521) among non-participants \n(p < 0.05). 75% (2178/2888) of all repliers experienced no/little pain during the \nexamination, 77% (1821/2367) vs. 68% (357/521) for participants and non-\nparticipants, respectively. Of wom en receiving tomosynthesis, 75% \n(1785/2367) experienced no difference, 6% less, and 8% more pain compared \nwith previous mammography. 91% (2148/2367) felt the examination-time was \nthe same, and 91% (2144/2367) believed to have received a better \nexamination. \nConclusion: The majorities of women choosing tomosynthesis had a low level \nof anxiety for adverse radiation health effects and believed they received a \nbetter examination. They didn't find tomosynthesis more painful or longer than \na standard 2D mammogram.  \nAuthor Disclosures: \nR. Gullien: Other; Travel costs and fees for one lecture in 2012, Hologic, \nInc. R. Hammond: Advisory Board; Hologic, Inc. 2012. Other; Travel costs and \nfees in 2012 by Hologic, Inc. P. Skaane: Equipment Support Recipient; \nHologic, Inc. Research/Grant Support; Financial support when overtime \nreading was necessary by Hologic, Inc. \nB-0273 14:27  \nReject analysis in high-volume mammography screening: comparison of \nimage quality between rejected and replaced images  \nR. Hammond, R. Gullien, J. Andersen, P. Skaane; Oslo/NO \n(uxraul@ous-hf.no)  \nPurpose: Compare image quality of retained images from multiple sets of \nrejected and repeated images using the classification system PGMI (Perfect, \nGood, Moderate, Inadequate). \nMethods and Materials:  From October 2011-December 2012, a total of 544 \nimages were rejected by radiographers with the reason \"positioning\". 18 \nimages were excluded due to incomplete information. All rejected and repeated \npaired images were given a PGMI score separately by an PGMI-radiographer. \nPGMI score for each image set was compared and placed into one of three \ncategories, depending on the score of the retained image: Higher (H), Same \n(S) or Lower (L) PGMI score. For category S and L, further analysis were done \non reasons for repeating an image. \nResults: 67% (351/526) of the repeated had a higher PGMI score than the \nrejected images; 30% (159/526) had the same PGMI score; 3% (16/526) had a \nlower PGMI score. For category \"S\" rejected images: 9% (15/159) were CC \nand 91% (144/159) were MLO images. Category \"L\": 13% (2/16) of rejected \nimages were CC and 87% (14/16) were MLO. Of the rejected images within \ncategories \"S\" and \"L\", a total of 90% (158/175) were MLO. They were rejected \nfor the reasons: a) pectoral muscle not to the nipple level 35% (56/158), b) \nfolds in the inframammary fold 19% (30/158), c) nipple not in profile 13% \n(21/158), d) inframammary fold not visible 9% (15/158), e) others 3% (23/158). \nConclusion: Two thirds of the repeated images show improved image quality, \nbut there is potential for improvement of rejected images.  \nAuthor Disclosures: \nR. Hammond: Advisory Board; Hologic, Inc. 2012. Other; Travel costs and \nfees in 2012, Hologic, Inc. R. Gullien: Other; Travel costs and fees for one \nlecture in 2012, Hologic, Inc. P. Skaane: Equipment Support Recipient; \nHologic, Inc. Research/Grant Support; Financial support when overtime \nreading was necessary by Hologic, Inc. \nB-0274 14:36  \nFailure on clinical image quality criteria in digital mammography: how \ncan radiographers do better?  \nC.S.D. Reis1, M.F. Oliveira2, A. Pascoal3, A. Pascoal3, J. Alves2; 1Lisbon/PT, \n2Sacavém/PT, 3London/UK (claudia.reis@estesl.ipl.pt)  \nPurpose: To assess image quality using PGMI (perfect, good, moderate, \ninadequate) scale in digital mammography examinations acquired in DR \nsystems. Identify the main failures and propose corrective actions. Evaluate \nthe most typical breast density. \nMethods and Materials:  Clinical image quality criteria were evaluated \nconsidering mammograms acquired in 13 DR systems and classified according \nto PGMI scale using the criteria described in European Commission guidelines \nfor radiographers. The breast density was assessed according to ACR \nrecommendations. The data were collected on the acquisition system monitor \nto reproduce the daily practice of the radiographer. \nResults: The image quality criteria were evaluated in 3044 images. The \ncriteria were fully achieved in 41% of the images that were classified as \nP (perfect), 31 % of the images were classified as M (moderate), 20% G (good) \nand 9% I (inadequate). The main cause of inadequate image quality was \nabsence of all breast tissue in the image, skin folders in the pectoral muscle \nand in the infra-mammary angle. The higher number of failures occurred in \nMLO projections (809 out of 1022). The most represented (36%) breast type \nwas type 2 (25-50% glandular tissue). \nConclusion: Incorrect radiographic technique was frequently detected \nsuggesting potential training needs and poor communication between the team \nmembers (radiographer and radiologists). Further correlations are necessary to \nidentify the main causes for the failures, namely specific education and training \nin digital mammography and workload.  \nB-0275 14:45  \nScreening mammograms rejected due to positioning: does radiographer \nexperience and type of employment matter?  \nR. Hammond\n1, K. Pedersen2, R. Gullien1, S. Sebuødegård1, P. Skaane1; \n1Oslo/NO, 2Østerås/NO (robham@ous-hf.no)  \nPurpose: Examine the dependence of rejection rate on experience and \nemployment type. \nMethods and Materials:  From October 2011 to December 2012, a total of \n85740 images were aquired. Of these images, 544 (0.63 %) were rejected for \npositioning reasons. Indivi dual reject rates for 25 radiographers were \ncalculated. Experience in mammography, less or more than five years, and \ntype of employment, full time or part time, was registered. Seven radiographers \nhad less than, and 18 had more than five years of experience. Nine worked full \ntime and 16 part-time. Using logistic re gression, the odds for rejecting images \nS194  \n\n \n \nBA C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nwas modeled among radiographers with different experience and employment \nstatus. \nResults: The crude odds ratio for rejecting images is 1.20 (95% CI: 1.01-1.43) \nfor the full-time employed compared to the part-time employed radiographers, \nand 0.53 (95% CI: 0.44-0.65) for the experienced radiographers compared to \nthe less experienced ones. Adjusting for these two factors results in a reduced \neffect of type of employment from 1.20 to 1.05 (95% CI: 0.88-1.25). The effect \nof experience remains constant when adjusting for type of employment \n(OR=0.54, 95% CI: 0.44-0.66). \nConclusion: The reject rate was higher among the less experienced \nradiographers and was not significantly influenced by type of employment.  \nAuthor Disclosures: \nR. Hammond: Advisory Board; Hologic, Inc. 2012. Other; Travel costs 2012, \nHologic, Inc. K. Pedersen: Advisory Board; Hologic, Inc. 2012. R. Gullien: \nOther; Travel costs 2012, Hologic, Inc. P. Skaane: Equipment Support \nRecipient; Hologic, Inc. Research/Grant Support; Financial support when \novertime reading was necessary by Hologic, Inc. \nB-0276 14:54  \nDICOM metadata-mining in PACS for computed radiography X-Ray \nexposure analysis: a mammography multisite study  \nM.R.D. Santos, A. Silva, N. Rocha, P.S. Couto; Aveiro/PT (mrs@ua.pt)  \nPurpose: Extract DICOM Metadata from disperse Picture Archiving and \nCommunication Systems using the Dicoogle (www.dicoogle.com) system for \nthe x-ray exposure variation analysis in Computed Radiography \nMammographic studies. \nMethods and Materials: DICOM metada stored in several PACS sites were \nextracted after Dicoogle user validation. Retrieved tag-value data elements \nwere used to objectively assess X-ray exposure. Due to its generalised \navailability, the DICOM attribute \"Sensitivity\" was chosen as the main exposure \nrelated parameter that was used to instance our approach in a mammographic \nmulti-site study spanning 2008-11 data. The Kruskal-Wallis statistical test was \nused to characterise exposure variation patterns both for intra-site and inter-\nsite assessments. \nResults: With the indexed retrieval process we efficiently assembled 8087 \nimages, from 2047 studies belonging to 1757 patients. The detector x-ray \nexposure values (S Value) analysis exhibited a reduction of radiation exposure \nover time in institution B. In institution  A a sharp increase was identified during \n2009 and 2010 and a decreased during 2011. The variation of the exposure \nvalues is statistically significant (p < 0.001). High standard deviation values, \nassociated with a high exposure levels, are themselves significant and may \nresult from mammographic studies performed with an x-ray overexposure or \nunderexposure. \nConclusion: The developed exposure assessment methodology shows that \nthe efficient mining of DICOM metadata , stored over disperse PACS archives \nof radiology departments is possible and, may definitely contribute to quality \ncontrol initiatives at radiology departm ents, namely in radiation protection and \nprotocol optimisation scope.  \nB-0277 15:03  \nVisibility of cancer mimicking lesions in a polyvinyl alcohol breast \nphantom using mammographic imaging: relationship between phantom \nthickness and lesion visibility  \nM.S. Ossati, K. Szczepura, A.M. Marono, G.G. Wåde, J. Wilkinson, K. Boerma, \nP. Sanderson, S. Kramer, S.S. Evensen, P. Hogg; Salford/UK \n(M.S.Ossati@edu.salford.ac.uk)  \nPurpose: To determine the relationship between lesion visibility and phantom \nbreast thickness in mammographic imaging. \nMethods and Materials:  Two PVAL phantoms, each containing a contrast-\nenhanced lesion, were evaluated. The mechanical and x-ray attenuation \nproperties of the phantoms/lesions were similar to fatty breast tissue and \nmalignant disease. Images were obtained , under different thicknesses, using \nFFDM. Lesion visibility was assessed using visual analysis of the sharpness \nand contrast using a 2 alternative forced choice (2 AFC). The lesion size was \nmeasured and the contrast to noise ratio (CNR) was calculated. \nResults: All results demonstrated a non-linear relationship between phantom \nthickness and lesion visibility. The initial thickness was 45 mm. The average \n2 AFC score in phantom 1 and phantom 2 ranged from 3.43 to 6.29 and 3.86 \nto 6.86, respectively, with the highest value at a thickness reduction of 40% in \nphantom 1 and 62% in phantom 2. The CNR in phantom 1 and phantom 2 \nranged from 3.00 to 9.68 and 4.29 to 10.69, respectively, with the highest value \nat a thickness reduction of 62% in Phantom 1 and 49% in phantom 2. linear \nrelationship was shown between thickness reduction and the area of the \nlesion. \nConclusion: For the deformable phantom, using 2 AFC, lesion visibility \nincreases as thickness reduces to a certain point, beyond which lesion visibility \ndeteriorates. Further research is necessary to understand why visibility \ndeteriorates.  \n \nB-0278 15:12  \nRadiographers practice concerning breast compression in \nmammography: gradual versus no gradual  \nM. Bule, C.S.D. Reis; Lisbon/PT (claudia.reis@estesl.ipl.pt)  \nPurpose: Evaluate the type of breast compression (gradual or no gradual) that \nprovides less discomfort to the patient. \nMethods and Materials:  The standard projections were simulated \n[craniocaudal/(CC) and mediolateral-oblique/(MLO)] with the two breast \ncompressions in 90 volunteers women aged between 19 and 86. The women \nwere organised in groups according to the breast density. The intensity of \ndiscomfort was evaluated using the sc ale that have represented several faces \n(0-10) proposed by Wong Baker in the end of each simulation. It was also \napplied an interview using focus group to debate the score that were attributed \nduring pain evaluation and to identify the criteria that were considered to do the \nclassification. \nResults: The women aged between 19-29y (with higher breast density) \nclassified the pain during no gradual compression as 4 and the gradual \ncompression as 2 for both projections. The MLO projection was considered the \nmost uncomfortable. During the focus group interview applied to this group was \nhighlighted that compression did not promoted pain but discomfort. They \nconsidered that the high expectations of pain did not correspond to the \ndiscomfort that they felt. Similar results were identified for the older women (30-\n50y; > 50y). \nConclusion: The radiographers should considerer the technique for breast \ncompression. The gradual compression was considered for the majority of the \nwomen as the most comfortable regardless of breast density. The MLO \nprojection was considered as uncomfortable due to the positioning (axila and \ninclusion of pectoral muscle) and due to the higher breast compression \ncompared to the CC projection.  \n \n14:00 - 15:30 Room P  \nComputer Applications  \nSS 205  \nComputer applications and dose reduction  \nModerators:  \nF.H. Barneveld Binkhuysen; Soest/NL  \nM. Müller-Eschner; Heidelberg/DE  \nB-0279 14:00  \nLesion size is a potential confounder for tumour heterogeneity assessed \nwith first order histogram features entropy and uniformity  \nM. Benndorf, M. Soschynski, S. Bucher, M. Windfuhr-Blum, M. Langer, \nE. Kotter; Freiburg/DE (matthias.benndorf@uniklinik-freiburg.de)  \nPurpose: To investigate whether tumour heterogeneity measured with first \norder histogram features depends on lesion size. Measurement of tumour \nheterogeneity is considered to be an em erging tool for lesion stratification \naccording to histopathological type and survival prognosis. \nMethods and Materials:  68 consecutive breast MRI mass lesions (24 benign, \n44 malignant) were retrospectively analysed. Tumours were manually \nsegmented in early contrast enhanced subtraction images that showed the \nlargest axial tumour diameter. For each tumour, mean, standard deviation, \nskewness, kurtosis, empirical Shannon entropy [-1* -p (a)*log (p (a))] and \nuniformity [-p (a)^2] were calculated. \nResults: Malignant lesions showed higher entropy values (mean: 4.671) and \nsmaller uniformity values (mean: 0.012) than benign lesions (mean: 4.098 and \n0.019, respectively, P < 0.01 each). Mean signal intensity was significantly \nhigher in malignant lesions, no difference was observed for standard deviation, \nskewness and kurtosis of the tumours' si gnal intensity histograms. Receiver-\nOperating-Characteristic (ROC) analysis yielded an AUC for entropy as \ndiagnostic variable of 0.792. However, benign lesions were in average smaller \nthan malignant lesions (P < 0.01, 9 mm versus 17 mm). Lesion size measured \nin voxels per tumour yielded an AUC of 0.790 if used as diagnostic variable. \nThe DeLong method showed no significant difference of the ROC curves \n(P=0.94). There was a strong correlation between entropy and lesion size \n(Spearman correlation coefficient: 0.92). \nConclusion: Lesion size, since correlated with the independent variable \nentropy and the outcome variable, is iden tified as a potential confounder for \nstudies that derive diagnostic thresholds for entropy and uniformity as \nmeasures for tumour heterogeneity.  \n \n \nS195  \n\n \n \nBA C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0280 14:09  \nVessel probe reconstructions and 3D analysis software in the CT \ncharacterisation of incidentally detected breast lesions  \nM. Moschetta, M. Telegrafo, A. Scardapane, V. Lorusso, L. Rella, G. Angelelli, \nA. Stabile Ianora; Bari/IT (marco.moschetta@gmail.com)  \nPurpose: To evaluate the potential benefits of 320-row MDCT in the \nevaluation and differential diagnosis of incidentally detected breast lesions by \nusing Vessel probe in MPR mode reconstructions and 3D analysis software \nwith net enhancement value. \nMethods and Materials:  62 breast lesions in 46 patients who underwent 320-\nrow chest CT examination because of different clinical issues were \nretrospectively evaluated. CT scans were assessed searching for presence, \nlocation, number, morphological features and density of breast nodules. NET \nenhancement was calculated by subtracting pre-contrast density from the \ndensity obtained by post-contrast values. Sensitivity, specificity, positive \npredictive value (PPV), negative predictive value (NPV) and diagnostic \naccuracy of CT were calculated firstly for morphological features and then for \ndynamic behaviour. \nResults: 30/62 lesions were found to be malignant at histological examination. \n32 nodules were found to be benign at histological examination. By considering \nmorphological features, sensitivity, specificity, accuracy, positive predictive and \nnegative predictive values were 87%, 100%, 88%, 100% and 50%, \nrespectively, for CT. Basing on NET enhancement, CT obtained sensitivity, \nspecificity, accuracy, positive predict ive and negative predictive values of \n100%, 94%, 97%, 94% and 100%, respectively. \nConclusion: MDCT allows to recognise breast lesions and to suggest a \ndifferential diagnosis of benign from ma lignant lesions basing on morphological \nand dynamic features. Net enhancement can also be proposed as an \nadditional accurate CT feature.  \nB-0281 14:18  \nThe impact of a novel iterative model-based reconstruction algorithm on \nprosthetic heart valve related artifacts at reduced radiation dose \nmultidetector-row CT  \nD. Suchá\n1, M.J. Willemink1, P.A. de Jong1, A.M.R. Schilham1, T. Leiner1, \nP. Symersky2, R.P.J. Budde1; 1Utrecht/NL, 2Amsterdam/NL \n(D.sucha@umcutrecht.nl)  \nPurpose: Prosthetic heart-valve (PHV) assessment with computed \ntomography (CT) is thriving, but remains hampered by PHV-related artefacts \nand high radiation-dose. The impact of a hybrid and prototype model-based \niterative-reconstruction method and dose reduction on PHV-related artefacts \nand image quality (IQ) were assessed. \nMethods and Materials:  One transcatheter (Edwards-Sapien) and two \nmechanical (St. Jude, Medtronic-Hall) PHVs were embedded in diluted \ncontrast and imaged with retrospectively-ECG-gated CT. Eight scans were \nacquired of each PHV at 120 kV, 600 mAs (routine) and 150 mAs (reduced-\ndose). Data were reconstructed with filtered back-projection (FBP), hybrid \niterative-reconstruction (IR, iDose4) and model-based iterative-reconstruction \n(IMR, Philips-Healthcare). Hypodense and hyperdense artefact-volumes were \nmeasured by two threshold-filters. Signal-to-noise (SNR) and contrast-to-noise \n(CNR) ratios were calculated. Statistical analysis was done with the Friedman-\ntest (significance: P < 0.05). \nResults: Artefact-volumes differed significantly between reconstruction \nalgorithms for all PHVs and scans (P < 0.004). Compared to FBP, overall \nhypodense and hyperdense artefact-volumes decreased by 4% and 1% (IR) \nand 1% and 4% (IMR) at 600 mAs; and 53% and 20% (IR) and 67% and 23% \n(IMR), respectively, at 150 mAs. Iterative-reconstruction increased SNR and \nCNR at all doses (P < 0.001). At 150 mAs median SNR and CNR increased \nfrom 5 and 5 (FBP) to 7 and 7 (IR) and 33 and 38 (IMR), respectively \n(P < 0.001). Even at reduced dose, IMR resulted in higher IQ than routine dose \nFBP and IR. \nConclusion: Iterative-reconstruction significantly reduced PHV-related artifacts \nand improved IQ. With 75% reduced-dose IMR IQ was higher than with routine \ndose FBP and IR. Thus, IMR allows for more radiation dose reduction than IR \nwhile maintaining high IQ.  \nAuthor Disclosures: \nR.P.J. Budde: Research/Grant Support; This study was supported by a grant \nof The Dutch Heart Foundation [2009B014]. The department of Radiology, \nUniversity Medical Center Utrecht received Research Support from Philips \nHealthcare. \nB-0282 14:27  \nInfluence of 4th generation iterative reconstruction system on image \nquality in computed tomography in adults with acute appendicitis  \nM. Karul\n1, S. Fokuhl1, S. Veldhoen2, H.D. Nagel3, M. Regier1, G. Adam1, \nJ. Yamamura1; 1Hamburg/DE, 2 Würzburg/DE, \n3Buchholz in der Nordheide/DE (m.karul@uke.de)  \nPurpose: To define image quality of an iterative reconstruction (IR) system in \nlow-dose abdominal computed tomography (CT) in patients with \nhistopathologically proven appendicitis in an intraindividual comparison to \nfiltered back projection (FBP) and to evaluate dose reduction capability. \nMethods and Materials:  12 patients (mean BMI 23.6 kg/m 2) with appendicitis \nunderwent a preoperative reduced-dose 256-CT (RDCT) scan (Brilliance iCT; \n80 eff. mAs; mean CTDI vol: 8.9 mGy). The raw data were reconstructed using \nFBP and IR system (iDose4™, Philips, Best, the Netherlands) with two iteration \nlevels (4: 50% iteration; 6: 70% iteration). 12 other patients (mean BMI \n24.1 kg/m2) with appendicitis who had undergone standard-dose CT (SDCT) \nwith FBP reconstructed images (mean exposure 140 mAs; mean CTDI vol: \n632.8 ± 509.8 mGy; range 415-1193 mGy) served as reference standard. Two \nblinded radiologists rated subjective im age quality and signs of appendicitis on \nCT. Additionally, the objective image noise (OIN) was assessed. \nResults: In RDCT iDose level 6 leads to a decrease in OIN (FBP vs. iDose: \npsoas major muscle 64.4 vs. 49.3 HU), providing also significant improvements \nin image quality and noise reduction compared to RDCT FBP images. The \ndetection of appendicitis signs e.g. periapp endiceal fat attenuation was limited \nin RDCT FBP images. RDCT with iDose4™ level 6 was determined to be of \nequivalent image quality as SDCT with FBP. \nConclusion: These pilot data propose that iDose4™ has potential to \nremarkably improve image quality in reduced-dose abdominal CT in the \ndiagnosis of appendicitis while simultaneously reducing image noise.  \n \nB-0283 14:36  \nEvaluation of the effectiveness of rigid and deformable motion-correction \nalgorithms with regard to CT-perfusion measurements in abdominal \norgans affected by breathing motion  \nS. Skornitzke, F. Fritz, M. Klauß, G. Pahn, L. Grenacher, H.-U. Kauczor, \nW. Stiller; Heidelberg/DE (Stephan.Skornitzke@med.uni-heidelberg.de)  \nPurpose: To evaluate the effectiveness of different motion-correction \nalgorithms and their effect on CT-perfusion map calculation in abdominal \norgans affected by breathing motion. \nMethods and Materials:  CT-perfusion sequences were dynamically acquired \nover 51s (34 acquisitions every 1.5s) in five patients with recurrent pancreatic \ncarcinoma. Image data were motion-corrected throughout the dynamic \nacquisition using commercially availa ble CT-perfusion software (BodyPCT, \nSiemens Healthcare, Forchheim, Germany) or custom-developed deformable \nregistration (demons algorithm). Afte r motion-correction, perfusion maps were \ncalculated using a combined Maximum-Slope/Patlak-model (BodyPCT); R²-\nvalue and residual of the perfusion model fit were determined. Two blinded \nexperienced radiologists rated motion-correction quality in terms of \"in-plane\" \nand \"out-of-plane\" correction and \"overall quality\", and resulting perfusion \nmaps in terms of \"vessel correction\", \"validity of perfusion values\", and \"overall \nquality\" on a five-point scale (1=worst, 5=best). \nResults: Deformable registration scored higher (rating-criteria averaged mean \nscore 3.8) than BodyPCT (3.0) and a control group without motion-correction \n(3.1; all p < 0.0001) in all motion-correction categories. BodyPCT and control \ngroup did not differ significantly (p >= 0.09). Perfusion maps were not affected \nby choice of motion-correction method (p >= 0.09); average mean scores were \n3.5 (deformable), 3.1 (BodyPCT), 3.0 (control). Average R² of deformably \nregistered images was higher (0.76/0.51/0.66) and residual lower \n(0.033/0.079/0.044) than for rigid (BodyPCT) or without registration. \nConclusion: Deformable registration for motion-correction in abdominal \norgans improves spatial alignment of the target region throughout the time \ncourse of dynamic CT sequences, resulting in increased accuracy of perfusion \nmodel fits. However, larger sample sizes are necessary for quantification of \nmotion-correction effects on perfusion maps.  \n \n \n \n \n \nS196  \n\n \n \nBA C D E F G \nThursday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0284 14:45  \nDenoising of HRpQCT scans via dicitionary learning for improved spatio-\ntemporal morphometry analysis  \nM.D. DiFranco, A. Valentinitsch, L. Fischer, C. Schueller-Weidekamm, \nF. Kainberger, G. Langs; Vienna/AT (matthew.difranco@meduniwien.ac.at)  \nPurpose: High-resolution quantitative CT (HRpQCT) images have shown \npromise in studying in-vivo bone microarchitecture at the ultradistal extremities. \nHRpQCT produces isotropic volumetric images at a resolution of 82 \u0001m. \nStandard scans cover 9 mm of the distal radius or tibia and last 3 minutes with \na radiation dose < 3 \u0001Sv. Spatio-temporal morphometry (S TM) of longitudinal \nHRpQCT scans involves rigid registration of baseline and follow-up scans, \nsegmentation of mineralised bone regions, and estimation of the magnitude \nand directionality of local microarchitectural changes. However, noise in \nHRpQCT images contributes errors at each step. \nMethods and Materials:  We propose a 3D dictionary learning (DL) approach \nto HRpQCT image denoising to improve S TM. DL enables sparse approximation \nof image data through linear combinations of representative image patches \n(the dictionary) in a two-step optimisation process. Radius HRpQCT scans \nwere acquired from a set of 23 cadaver arms. Parameters for 3D DL included \npatch shape (cubic or spherical), patch size (3 to 7 voxels), dictionary size (128 \nto 640 elements), and the optimisation technique. \nResults: Peak signal-to-noise ratio (PSNR) between the original and denoised \nimages was used to compare results. Patch size was found to be the most \nrelevant variable, with smaller patches leading to higher PSNR for both cubic \nand spherical patches. PSNR, measured as decibels (dB), was seen with cubic \npatches of size 3 (33.4±1.19) and spherical patches of diameter 5 (32.5 ±1.12). \nConclusion: We have assessed 3D dictionary learning as a method for \nminimising noise while preserving fine structures in HRpQCT images.  \nB-0285 14:54  \nUNSCEAR survey system: a software platform to support the global \nsurvey of medical radiation usage and exposures  \nA. Jahnen1, C. Moll1, F. Shannoun2; 1Luxembourg/LU, 2Vienna/AT \n(andreas.jahnen@tudor.lu)  \nPurpose: The United Nations Scientific Committee on the Effects of Atomic \nRadiation (UNSCEAR) established by the United Nations General Assembly in \n1955 to assess and report levels and effects of all sources of ionizing radiation \nconducts regular surveys on medical radiation exposure. A new web-based \nplatform with adequate software tools to support UNSCEAR's survey was \ndeveloped and will be presented. \nMethods and Materials:  The software platform is composed of a web portal \naccessible at http://survey.unscear.org that serves as a interface to \nparticipating countries. National co ntact persons (NCP) need to register \nthemselves on the platform to be able to access it. After validation, the NCP \nwill have access to the countries private area, where they find specific \ntemplates for Diagnostic Radiology, Interve ntional Radiology, Nuclear Medicine \nand Radiotherapy. Only NCP are eligible to submit official countries data, \nwhich will then undergo another validation step by scientific experts. The \nnational data will then inserted in the last component of the system, the \nUNSCEAR Database for further processing and analysis. \nResults: The UNSCEAR Survey System is composed of three major \ncomponents: the user portal that manages the collected data and the \nparticipants, the dedicated spreadsheets that are used to provide the national \ndata and the UNSCEAR Database that store the data and the results of the \nevaluation. \nConclusion: The new UNSCEAR Survey System will facilitate the data \ncollection and management process that will have a positive impact on the \noutcomes of UNSCEAR's next Global Survey of Medical Radiation Usage and \nExposures.  \nB-0286 15:03  \nAssessment of the diagnostic value of virtual mono-energetic images \ngenerated by a novel spectral-detector CT (SDCT) prototype  \nM.H. Gabbai, I.S. Leichter, Z. Romman, J. Sosna; Jerusalem/IL \n(nuchaline@hotmail.com)  \nPurpose: To compare diagnostic value of virtual mono-energetic 120 kVp \nimages with \"conventional\" abdominal CT images, generated by a single \nspectral-detector CT (SDCT) acquisition. \nMethods and Materials:  Following IRB approval and informed consent, \nabdominal CT images of 30 patients (mean age 59) were acquired with a novel \nSDCT prototype (Philips Healthcare, Cleveland, OH). The SDCT acquisition \nparameters were 120 kVp and 59-259 mAs. For each SDCT study, \n\"conventional\" CT images, comparable to those obtained by a standard MSCT \nsystem, are generated along with virtual mono-energetic images in the range \n40 keV to 140 keV. Two qualified radiologists assessed the overall diagnostic \nvalue of mono-energetic images at 65 keV, compared to \"conventional\" SDCT \nimages using a scale of 1 to 4. Scores 3-4 indicated the mono-energetic image \nshowing reduced image artifacts and/or enhanced image contrast. The one \nsample proportion test was applied. \nResults: All reconstructed mono-energetic SDCT images at 65 keV were \ndiagnostic. Compared to conventional SDCT images, the mono-energetic \nimages were ranked as markedly better for 25 patients (83.3%), better for 3 \n(10%), and equivalent for 2 (6.7%), with a confidence level of 95%. Differences \nbetween mean HU values for ROIs of the 65 keV virtual mono-energetic \nimages and conventional SDCT images at 120 kVp were 5.3 ±1.3 HU in the \naorta, 21±3.0 HU in cortical bone, 6.2 ±1.2 HU in the liver and 6.0 ±2.2 HU in fat \n(p> 0.1). \nConclusion: Mono-energy images in most cases demonstrated improved \nimage quality with enhanced image contrast and artefact suppression \ncompared to conventional-SDCT abdominal images.  \nAuthor Disclosures: \nZ. Romman: Employee; Philips. J. Sosna: Consultant; Actiview. \nB-0287 15:12  \nAccuracy of coronary plaque detection using a semiautomatic plaque \nanalysis software in computed tomography coronary angiography  \nA. Laqmani1, T. Klink2, M. Quitzke1, D.D. Credner1, G. Adam1, G. Lund1; \n1Hamburg/DE, 2Berne/CH (a.laqmani@uke.de)  \nPurpose: To assess the accuracy of coronary plaque detection with a \nsemiautomatic plaque analysis software in computed tomography coronary \nangiography (CTCA) with a 256-MSCT scanner. \nMethods and Materials:  Ten patients undergoing prospectively ECG-\ntriggered, axial CTCA on a 256-MSCT scanner (Brilliance iCT; tube \nvoltage,120 kVp; tube current-time product, 250 mAs; collimation, 2 x 128 x \n0.625 mm, reconstructed slice thickness, 0.9 mm) were enclosed in this study. \nAll plaques were evaluated with a dedicated semiautomatic plaque analysis \nsoftware \"Comprehensive Cardiac Analysis\" (Extended Brilliance Workspace, \nPhilips Healthcare, Best, The Netherlands). After semiautomatic coronary \nartery extraction automatically detected lesions are marked by the software as \nplaques. The observers evaluated, if these automatically marked lesions \ncorresponded with visually detectable plaques. Potential reasons for a false-\npositive plaque detection were analysed. \nResults: The software automatically identified 114 structures as plaques. 32 \n(28%) of the automatically marked lesions complied with plaques (true-\npositive). 82 (72%) of the lesions did not correspond with visually detectable \nplaques (false-positive). 20 plaques were manually detected by observers but \nnot by the software (false-negative). For 82 false-positive detected plaques, the \nfollowing potential reasons were noticed by the observers: high density in \npericoronary fat (59%), vessel ramification (24%), contrast in adjacent veins \n(6%), artery kinking (4%) and falsely contoured vessel (7%). \n \nConclusion: The evaluated semiautomatic plaque analysis software \ndemonstrates a very high false-positive detection rate of coronary plaques. A \nrevision of the software marked lesions as plaques is indispensable.  \nB-0288 15:21  \nCoronary CT angiography using 2° generation iterative reconstruction vs \nfiltered back projection: evaluation of image quality and radiation dose \nsaving potential. A validation study  \nC. Martini, L. Buttarelli, E. Rossi, M. De Filippo; Parma/IT \n(chiaramartini10@gmail.com)  \nPurpose: To compare IQ of iterative reconstruction (SAFIRE) settings vs. \nfiltered back projection (FBP) in CT Coronary Angiography (CTCA). \nMethods and Materials:  Twenty consecutive patients underwent CTCA for \nsuspected or known Coronary Artery Disease (CAD) with Dual-Source CT (CT \nFlash, Siemens). Datasets were reconstructed using two standard FBP (B26-\nB46) kernels and three comparable SAFIRE settings (S2, S3, S4). Vascular \nattenuation and noise were measured.  CT vascular attenuation values were \nmeasured in: ascending aorta (Ao), right (RCA) and left (IVA) coronary artery, \nrespectively. Results were compared with ANOVA and Pearson's r correlation \ncoefficient. S/N and C/N were calculated. A p-value of 0.05 was considered \nsignificant. \nResults: We didn't find significant differences between attenuation values of \nFBP and SAFIRE, except for the noise (p < 0.05). Infact, noise was 15, 12, 10, \n9 HU in B26, S26-2,-3 and -4, respectively, and was 27, 20, 17, 16 HU in B46, \nS46-2,-3 and -4, respectively. Comparing FBP with corresponding SAFIRE's \nsetting, ANOVA test showed significant differences in both RCA and IVA (B26 \nvs. S46-2,-3,-4, and B46 vs. S26-2,-3,-4). Lowest noise was found for SAFIRE \nusing S26-4 (9.6 HU) and I46-4 (15.6 HU). SAFIRE can provide S/N and C/N \nsignificantly higher with increasing ke rnel sharpness. Moreover, the best S/N \nand C/N was found for S26-3 and S46-4. \nConclusion: In CTCA, SAFIRE settings at medium (S3 in B26) and slowly \nhigh strength (S4 in B46) can be used in clinical routines and may have more \npotential than FBP for CAD evaluation improving diagnostic accuracy and/or \nholding the potential for radiation dose reduction.  \n \nS197  \n\n \n \nBA C D E F G \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n \n\u000e\u001b\u0018\u0014\u0012\u001f\u0002\u0001\u000f\u0012\u001b\u0013\u0017\u0001\u000b\u0001\nS198  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n10:30 - 12:00 Room C  \nCardiac  \nSS 503  \nCardiac imaging: new horizons  \nModerators:  \nT.R.C. Johnson; Munich/DE  \nJ.-F. Paul; Le Plessis Robinson/FR  \nB-0289 10:30  \nIntegrated and quantitative comparison of PET and MRI in acute \nmyocardial infarction  \nF. Nensa\n1, T. Poeppel1, E. Tezgah1, P. Heusch2, K. Nassenstein1, \nT. Schlosser1; 1Essen/DE, 2Düsseldorf/DE (felix.nensa@gmail.com)  \nPurpose: To quantitatively compare positron emission tomography (PET) and \nlate gadolinium-enhancement (LGE) in the assessment of acute myocardial \ninfarction. \nMethods and Materials:  Simultaneous cardiac PET/MRI (Biograph mMR, \nSiemens Healthcare) with 18 F-fluorodeoxyglucose (18 F-FDG) was performed \nin 25 patients with an acute occlusion of a coronary artery and interventional \nrecanalisation. Cine, T2-weighted and LGE images were acquired in parallel to \nan ECG-gated PET scan. Infarcts were categorised into 1-25%, 26-50%, 51-\n75% and 76-100% transmurality in LGE images. Short-axis LGE and PET \nimages were processed and transformed into co-registered polar (bull's eye) \nplots using dedicated software developed in-house. Segment wise (90 \nsegments/slice; 630-990 segments/scan) inter-method correlation was \ncalculated with weighted Pearson's product-moment correlation coefficients. \nBinary inter-method agreement in infarct delineation was calculated as Cohen's \nkappa. \nResults: Median correlation coefficient was -0.16 ±0.21, -0.48±0.14, -0.73±0.08 \nand -0.79± 0.10 for 1-25%, 26-50%, 51-75% and 76-100% transmurality, \nrespectively. Median kappa was 0.04± 0.19, 0.34 ±0.19, 0.77 ±0.16 and \n0.81±0.14 for 1-25%, 26-50%, 51-75% and 76-100% transmurality, \nrespectively. Mean infarct size in LGE images was 32.2 ±14.3 ml and \n41.7±31.1 ml in PET images. In 11 patients with visually conclusive agreement \nbetween PET and LGE, the defect was significantly (p=0.03) larger in PET \nimages. In 6 patients no LGE but a clearly reduced 18 F-FDG uptake was \nfound in the perfusion territory of the occluded coronary artery. \nConclusion: Concordance between PET and LGE was dependent on infarct \ntransmurality and therefore associated with high agreement in transmural and \nrelatively poor agreement in subendocardial infarcts. However, reduced 18 F-\nFDG uptake seemed to correspond with the area-at-risk.  \nB-0290 10:39  \nComparison of cardiac function in synchronously acquired Hybrid PET-\nMRI data  \nC. Lücke, P. Werner, T. Jochimsen, I. Eitel, M. Grothoff, H. Barthel, O. Sabri, \nM. Gutberlet; Leipzig/DE (luec@med.uni-leipzig.de)  \nPurpose: To determine and compare the cardiac function in synchronously \nacquired Hybrid PET-MRI data sets. \nMethods and Materials:  In 10 patients (8 male, 2 female, mean age 48 ± 18 \nyears), who underwent a [18 F]-FDG-PET-CT due to a non-cardiac indication \nand showed a homogenous cardiac FDG uptake, a synchronous PET-MRI \n(Biograph mMR, Siemens, Erlangen, Germany) was performed with the \nresidual activity of the previous invest igation. The PET acquisition time was \n15 min, while simultaneously standard cine sequences were acquired in short \naxis, two- and four-chamber orientation. PET and MRI data were evaluated by \ntwo investigators blinded to the results of the other method. The left ventricular \nend-diastolic volume (EDV) and end-systolic volume (ESV), ejection fraction \n(EF) and left ventricular myocardial mass (MM) were measured and mean \ndifferences (MD) were calculated. Pearson correlation coefficients ( r) were \ndetermined and a Bland-Altman analysis was conducted. \nResults: The comparison showed a good correlation of cardiac function \nparameters (EDV: r = 0.94; ESV: r =0.88, MM: r =0.71, EF: r=0.72). The MD of \nEDV was 5 ±8 ml in favor of the PET, ( p=0.67), ESV was measured the same \nsize (MD 0 ± 7 ml, p=0.99). EF showed with a MD of 1 ± 7%, no significant \ndifference between the two methods ( p=0.78). The MM was measured \n19 ± 15 g (p \n< 0.05) greater with PET than with MRI. \nConclusion: In simultaneously acquired cardiac PET/MR data EDV, ESV and \nEF show a very good agreement. Only the left ventricular wall mass shows a \nstatistically significant difference in favor of the PET.  \n \nB-0291 10:48  \nValidation of coronary CT angiography-derived fractional flow reserve \nwith catheter-based fractional flow reserve  \nA. Coenen, A. Kurata, A. Dedic, M. Lubbers, M.L. Dijkshoorn, M. Ouhlous, \nR. van Geuns, G.P. Krestin, K. Nieman; Rotterdam/NL \n(adriaancoenen@gmail.com)  \nPurpose: Catheter-based fractional flow reserve (FFRCath) has become the \nreference standard to determine the functional severity of angiographic \ncoronary artery disease (CAD). The feasibility of non-invasive estimations of \nfunctional severity from anatomical coronary CT angiography (CCTA) images \nusing computational fluid dynamics has recently been reported. In this study, \nwe investigate the performance of CCTA-derived fractional flow reserve \ncalculation (FFRCT) compared with FFRCath and determine the incremental \ndiagnostic value of FFRCT over CCTA. \nMethods and Materials:  We evaluated the diagnostic performance of a novel \nFFRCT algorithm (Siemens Medical Solutions, Forchheim, Germany) that can \nbe performed on-site without transfer of data. Based on the left ventricular \nmass, coronary anatomy derived from CCTA and several hemodynamic \nparameters, FFRCT can be computed. In this study, we included 101 patients \nwho underwent a CCTA followed by a FFRcath within 50 days. FFRCT and \nFFRcath results are compared using Spearman's coefficient and Bland-Altman \nanalysis. In addition, the incremental value of FFRCT over CCTA will be \ndetermined using C-statistics. \nResults: Baseline characteristics: mean age 62 years, 79% male, 17% with \nhistory of diabetes and average calcium score 744. In these 101 patients, 181 \nvessels were interrogated with an FFR catheter, of which 77 vessels were \nconsidered haemodynamically obstructed (FFRCath \u0002 0.80). We preformed \nCCTA-derived coronary artery lumen segmentations in all 101 patients. At the \ntime of abstract submission, FFRCT analysis with the latest iteration of the \nwork-in-progress software was ongoing. \nConclusion: We will report the diagnostic performance of a new algorithm for \nCCTA-based FFRCT.  \nAuthor Disclosures: \nK. Nieman: Research/Grant Support; Grant from Siemens Medical Solution, \nfor a previous unrelated study. \nB-0292 10:57  \nA virtual two-dimensional cardiac phantom for calculation of regional left \nventricular strain using non-rigid image registration  \nS.A. Sorrentino1, M.J. Peperhove1, T. Kaireit1, J. Strehlow2, J. Ruehaak2, \nF. Wacker1, J. Vogel-Claussen1, H.-o. Shin1; 1Hannover/DE, \n2Lübeck/DE (sorrentino.sajoscha@mh-hannover.de)  \nPurpose: To evaluate a non-rigid image registration algorithm for left \nventricular (LV) strain measurements on a virtual LV phantom and to establish \na method to compute circumferential and radial strain using cine-gated, non-\ntagged MR images. \nMethods and Materials:  A two-dimensional virtual LV phantom was \ndeveloped, recreating a series of twen ty-nine circular masks simulating the \nmidventricular plane of short-axis cine MR images of the left ventricle. Non-\nrigid image registration was performed, using the resulting deformation field for \nquantification of circumferential and radial strains (\" virtual tagging\"). The virtual \nLV phantom was further divided in four segments. Statistical analysis was done \nusing Pearson correlation coefficient calculations. \nResults: Strain values from virtual tagging were highly correlated with the real \nvalues. Overall peak circumferential strain determined by virtual tagging \ndiffered 1.6% from real values (r\n2 = 0.97; P < 0.0001). Overall peak radial strain \ndetermined by virtual tagging differed 0.8% from real values (r 2 = 0.98; \nP < 0.0001). When dividing the phantom into four segments, circumferential \nstrain determined by virtual tagging differed 4.4 - 6.3% from real values (r 2 = \n0.95; P < 0.0001) and radial strain differed 1.2 - 2.9 % from real values (r 2 = \n0.95; P < 0.0001). \nConclusion: Circumferential and radial strain values computed from non-rigid \nregistration followed by analysis of the resulting deformation field (virtual \ntagging) correlate significantly with real  values of a virtual LV phantom, making \nit a promising tool to compute strains using cine-gated, non-tagged MR \nimages.  \nS199  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0293 11:06  \nEvaluation of epicardial adipose tissue using CT angiography: evaluation \nof a prototype software  \nJ.V. Spearman, F.G. Meinel, U.J. Schoepf, A.W. Krazinski, P. Apfaltrer, \nA.D. McQuiston, C. Canstein, C.N. De Cecco, L.L. Geyer; Charleston, SC/US  \n(jvspearman@gmail.com)  \nPurpose: This study evaluated the performance of a novel automated software \ntool for epicardial fat volume (EFV) quantification compared to a standard \nmanual technique at coronary CT angiography (cCTA). \n \nMethods and Materials:  cCTA data sets of 70 patients (58.6 ±12.9years, 33 \nmen) were retrospectively analysed using two different post-processing \nsoftware applications. Observer 1 perform ed a manual single-plane pericardial \nborder definition and EFVM segmentation (manual approach). Two observers \nused a software program with fully-automated 3D pericardial border definition \nand EFVA calculation (automated approach). EFV and time required for \nmeasuring EFV (including software processi ng time and manual optimisation \ntime) for each method were recorded. Intra-observer and inter-observer \nreliability was assessed on the prototype software measurements. T test, \nSpearman's rho, and Bland Altman plots were used for statistical analysis. \nResults: The final EFVA (with manual border optimisation) was strongly \ncorrelated with the manual axial segmentation measurement (60.9 ±33.2 mL \nvs.65.8±37.0 mL, rho=0.970, P < 0.001). A mean of 3.9 ±1.9 manual border \nedits were performed to optimise the automated process. The software \nprototype required significantly less time to perform the measurements \n(135.6±24.6s vs. 314.3±76.3s, P0.9). \nConclusion: Automated EFVA quantification is an accurate and time saving \nmethod for quantification of EFV compared to established manual axial \nsegmentation methods  \nAuthor Disclosures: \nU.J. Schoepf: Grant Recipient; Bayer, Bracco, GE, Medrad, Siemens. C. \nCanstein: Employee; Siemens.  \nB-0294 11:15  \nFeasibility study of free-breathing diffusion tensor imaging in porcine \nacute myocardial infarction model  \nJ.-W. Kang1, S. Choi2, W. Lee1, T.-H. Lim1; 1Seoul/KR, 2Ulsan/KR \n(joonwon.kang153@gmail.com)  \nPurpose: To evaluate the feasibility of in vivo DT-MRI without breath-hold with \nregard to changes in direction-dependent wa ter diffusivity refl ecting alterations \nin tissue integrity such as apparent diffusion coefficients (ADC), fractional \nanisotropy (FA), and fiber length. \nMethods and Materials:  Acute myocardial infarction (AMI) was induced by \nligation of mid segment of left anterior descending coronary artery (LAD) in \nsixteen pigs. DT-MRI using a SENSE-based echo-planar imaging technique \nwas acquired using a 1.5-tesla MR scanner with free-breathing state using \nnavigator sequence. With a b-value of 300 s/mm\n2, the diffusion tensor images \nwere obtained for 6 diffusion-sensitizing gradient directions at infarcted zone at \nthe mid-ventricular level. Image quality of the acquired DTI was evaluated. The \nADC, FA, and the fiber length were measured for quantitative analysis. \nResults: Image quality was good in 3 pigs, fair in 2 pigs, and poor in 2 \npigs.The infarct zone showed significantly increased ADC than that of the \nremote zone (8.097 ± 3.741 × 10\n-3 mm2/sec versus 5.894 ± 2.985 × 10 -\n3 mm2/sec, P=0.018). The FA of the infract zone was seen to be also \nsignificantly lower than that of remote zone (0.393 ± 0.972 versus \n0.485 ± 0.145, P=0.018). The fiber length in the infarct zone was seen to be \nsignificantly shorter than the remote zone (17.57 ± 5.46 mm versus \n24.84 ± 9.79 mm, P=0.018). \nConclusion: In vivo DT-MRI's of post-infarct myocardium with fair or good \nimage quality can be acquired and the results correlated well with those of ex-\nvivo and breath-hold studies.  \nB-0295 11:24  \nNew micro angiographic system for evaluation therapeutic effects of C-kit \npositive cardiac stem cells  \nC. Tanaka; Isehara-city, Kanagawa/JP (chitty@is.icc.u-tokai.ac.jp)  \nPurpose: Recently, the number of heart failure by ischaemic disease is \nincreasing. Tissue engineering is hopeful, however, the evaluating tools are not \nsufficient. We developed microangiographic system, and assessed therapeutic \neffects. \nMethods and Materials: The system we developed has a cerium anode which \nhas characteristic X-ray around 34.6 Kev. It is close to K-edge of contrast \nmaterials (Iodine and Barium), therefore, the system can detect tiny amount of \niodine. C-kit positive cardiac stem cells (CSCs) were isolated and cultivated by \nleft auricles of dogs. Acute myocardial infarction (AMI) was made at the apex, \nand the cultured autologous CSCs were injected directly to the cardiac wall of \nthe ischaemic area in 5 dogs (CSCs group). One month later, the hearts were \nexcised and the coronary artery was full-filled with barium. Then, they were \nradiated by the system. In other five dogs, the cardiac wall of the ischaemic \narea was injected with saline (saline group). \nResults: We lost 2 dogs in CSCs group and 3 dogs in saline group due to \nlethal arrhythmia. In CSCs group, a lot of newly formed vessels were visualised \nat the apex. They were meandering with irregularities. The minimum diameter \nof vessels was 50 8m. The new vessels were visualised in all dogs in CSCs \ngroup. Besides, avascular area was visualised at the apex without new vessels \nin saline group. \nConclusion: The therapeutic effects of CSCs for ischaemic disease were \nevaluated by visualising newly formed vessels. Our microangiographic system \nis useful for the evaluation.  \nB-0296 11:33  \nFeasibility of an ultra-low dose CT for left atrium and pulmonary veins \nimaging using VEO (model-based iterative reconstruction)  \nA.D. Annoni, A. Formenti, G. Pontone, E. Nobili, M. Petullà, S. Mushtaq, \nG. Ballerini, M. Pepi, D. Andreini; Milan/IT (andrea.annoni@ccfm.it)  \nPurpose: To evaluate the feasibility of ultra-low dose CT for left atrium and \npulmonary veins imaging using VEO (model-based iterative reconstruction). \nMethods and Materials:  120 patients with persistent or intermittent atrial \nfibrillation before catheter ablation were enrolled in our study. Patients were \nrandomised into 2 groups: Group 1 (60 pts, MDCT with VEO, no ECG \ntriggering, 100 kV and 60 mA, irrespective of patient BMI) and Group 2 (60 pts, \nMDCT with standard acquisition, ECG triggering, ASIR, kV and mA tailored on \npatient BMI). The image quality (graded as good, adequate and poor) was \nevaluated by two reviewers. The CT-attenuation, image noise, signal-to-noise \nratio (SNR), contrast-to-noise ratio (CNR) of left atrium and every pulmonary \nvein branch and Effective Dose (ED) were evaluated and compared between \ntwo groups. \nResults: No differences were found between two groups in terms of gender \nand BMI and image quality score. No significant differences were found in CT-\nattenuation of left atrium and pulmonary veins between two groups but \nstatistically significant differences were found between Group 1 and Group 2 in \nSNR, CNR and noise of left atrium (26.2 ±7.6 versus 14.1±4.4, p < 0.00001 and \n23.06±7.09 versus 12.06 ±3.8, p < 0.00001, respectively) and of pulmonary \nveins. Group 1 patients showed a significantly lower mean ED in comparison \nwith Group 2 (0.5±0.05 versus 5.07±3.3 mSv). \nConclusion: The CT for left atrium and pulmonary veins imaging using VEO is \nfeasible and allows to perform the examination with very low radiation \nexposure and good image quality.  \nB-0297 11:42  \nMagnetic resonance imaging at 1.5 Tesla in patients with a subcutaneous \nimplantable cardioverter-defibrillator (S-ICD)  \nJ. Keller\n1, P. Neu\u0001il1, J. Vymazal1, J. Weichet1, M. Janotka1, J. Brada1, \nR. \u0001á\u0013ek1, V.Y. Reddy2; 1Praha 5/CZ, 2New York, NY/US \n(keller.public@gmail.com)  \nPurpose: The aim of our study was to evaluate the safety of imaging in \npatients with a new type of implantable cardioverter-defibrillator called the S-\nICD in a 1.5 T MRI scanner. With the increasing number of patients with \ncardiac implantable devices who are indicated for MRI, there is a growing need \nfor establishing MRI compatibility of cardiac implantable devices. We present \nthe first cohort of patients implanted with an S-ICD and safely scanned with a \n1.5 T MRI. \nMethods and Materials:  Patients with implanted S-ICD systems underwent \nMRI scan of one or more anatomical area. The S-ICD were programmed off \nand patients were monitored by ECG throughout the imaging procedure. \nDevice function was evaluated pre and post-scan. A thermistor probe was \nused to monitor temperature changes in the area above the subcutaneous \npocket with SICD and patients were asked to report immediately any pain, \ntorqueing movement or heating sensation in the area of either the pocket or \nelectrode. \nResults: Thirteen patients underwent a total of 17 examinations at 1.5 T. \nScans included brain, spine and cardiac imaging. Two patients were re-\nscanned due complaints of heating over the pocket during lumbar scans, \ncaused by a thermistor probe placed on the skin to measure skin temperature. \nRescan without the probe and all the remaining scans were performed without \nincident. No evidence of device malfunction was obversed. \nConclusion: MRI of patients with the implanted S-ICD can be performed \nsafely under controlled conditions. This study was supported by Research \nProject Charles University in Prague, PRVOUK P34.  \n \n \nS200  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0298 11:51  \nNoninvasive measurement of coronary flow velocity reserve by phase-\ncontrast cine MRI at 3 T in the detection of stenosis in the major three \ncoronary arteries  \nT. Higashigawa\n1, Y. Ichikawa1, M. Ishida2, D. Izumi1, T. Kouiji1, K. Matsuoka1, \nK. Kitagawa2, T. Hirano1, H. Sakuma2; 1Matsusaka/JP, 2Tsu/JP \n(higashikawat@clin.medic.mie-u.ac.jp)  \nPurpose: Coronary flow velocity reserve (CFVR) can be noninvasively \nmeasured by phase-contrast cine MRI (PC-MRI). To date, CFVR measurement \nhas been studied with 1.5 T system and mainly limited to LAD artery. With 3 T \nsystem, however, PC-MRI may allow reliable flow quantification not only in \nLAD artery but also in RCA and LCX artery due to improved spatial and \ntemporal resolution. The purpose of this study was to evaluate the feasibility of \n3 T MR measurement of CFVR for detecting significant stenosis in three major \ncoronary arteries. \nMethods and Materials:  Sixteen patients (71 ±9 years) with suspected \nmoderate coronary stenosis on CT angiography were included. CFVR was \nmeasured perpendicular to the coronary arteries (total 26 vessels [RCA, 11; \nLAD, 10; LCX, 5]) using breath-hold PC-MRI at rest and during adenosine \ntriphosphate (ATP)-induced hyperemia with 3 T MR system (Ingenia 3 T, \nPhilips) by two observers. Measurements were compared with quantitative \ncoronary angiography (QCA). \nResults: CFVR was successfully determined in 25/26 (96%) vessels. \nModerate inverse correlation was found between CFVR and coronary stenosis \non QCA (r=-0.57, p=0.002). Using a threshold of 1.5 for CFVR, the sensitivity, \nspecificity, and positive and negati ve predictive value for detecting \u000350% \nstenosis on QCA was 83%(5/6), 85%(17/20), 63%(5/8), 94%(17/18), \nrespectively. Intra-class correlation coefficient between CFVR measurements \nby two observers was 0.82, showing a good inter-observer reproducibility. \nConclusion: CFVR can be determined in three major coronary arteries with a \nhigh success rate by using breath-hold PC-MRI at 3 T, and has a great \npotential for noninvasive assessment of physiologic significance of coronary \narterial stenosis.  \n10:30 - 12:00 Room D  \nChest  \nSS 504  \nVascular imaging and thromboembolic \ndisease  \nModerators:  \nB. Feragalli; Chieti/IT  \nT. Frauenfelder; Zurich/CH  \nB-0299 10:30  \nUltra-low dose CT pulmonary angiography reconstructed with a model-\nbased iterative reconstruction: comparison with standard CT pulmonary \nangiography. A prospective non-inferiority trial  \nX. Montet, A.-L. Hachulla, A. Neroladaki, D. Botsikas, C.D. Becker; Geneva/CH \n(xavier.montet@hcuge.ch)  \nPurpose: To compare quantitative and qualitative image quality and radiation \ndose between CT pulmonary angiography (CTPA) reconstructed with filtered \nback projection (FBP) and ultra-low dose CTPA reconstructed with model-\nbased iterative reconstruction (MBIR). \nMethods and Materials:  This prospective study was approved by the \ninstitutional review board and each patients provided written informed consent. \nEighty-two patients were scanned with an ultra-low dose CTPA (100 kV, \n20 mA) and eighty-two patients were scanned with a classical CTPA (100 kV, \n250 mA). Region of interests were drawn in nine pulmonary vessels; signal-to-\nnoise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. A five-\npoint scale was used to subjectively evaluate the quality of CTPA and ultra-low \ndose CTPA. \nResults: Compared to standard CTPA, ultra-low dose CTPA (reconstructed \nwith MBIR) showed no differences in density measured in 9 pulmonary \nvessels, higher SNR (p < 0.0001) and higher CNR (p < 0.0001) despite a dose \nreduction of 93 % (p < 0.0001). \nConclusion: Ultra-low dose CTPA reconstructed with MBIR allows a \nsignificant dose reduction while improving SNR and CNR in the pulmonary \nvessels, as compared with classical CTPA reconstructed with FBP.  \nB-0300 10:39  \nIterative reconstruction in single source dual-energy CT pulmonary \nangiography: Is sufficient to achieve a radiation dose as low as state-of-\nthe-art single-energy CTPA?  \nM. Ohana, M.-Y. Jeung, A. Labani, S. El-Ghannudi, C. Roy; Strasbourg/FR \n(mickael.ohana@gmail.com)  \nPurpose: Single-source dual-energy CT pulmonary angiography (DE-CTPA) \ninduces an increase of radiation dose going up to 40% when compared to a \nsingle-energy examination. Our goal wa s to cancel this increase by using \niterative reconstruction (ASIR). \nMethods and Materials:  Fifty patients (60% men, 65.8 yo ±15.4, \nBMI=25.9±4.6) were prospectively included and underwent single-source DE-\nCTPA with following acquisition parameters: 80/140 kV, 0.6 s rotation time, \n275 mA fixed tube current, 50% ASIR. Parameters were tweaked to target a \nradiation dose similar to a 100 kV single-energy CTPA (DLP of 250 mGy.cm). \nThirty patients (46% men, 64.4 yo ±18.6, BMI=26 ±4.6) from a previous \nprospective study on DE-CTPA (375 mA fixed tube current, no ASIR) were \nused as the reference group. Subjective image quality was scored by two \nradiologists using a 5-level scale. Meas ures of signal intensity and noise on 65 \nkeV monochromatic reconstructions were used to calculate signal-to-noise \n(SNR) and contrast-to-noise (CNR) ratios. \nResults: All examinations were of diagnostic quality (score \u00033). Compared with \nthe reference DE-CTPA protocol, ASIR effectively achieved a spectacular dose \nreduction (DLP of 243 mGy.cm VS 388, p < 0.01), with a preserved image \nquality (4.4/5 VS 4.6, p=0.23) and an equivalent SNR (16.4 VS 14.9, p=0.27) \nand CNR (14.1 VS 12.7, p=0.28). SNR, CNR and image quality were \nnegatively correlated with Body Mass Index, which could therefore be used to \nadjust radiation dose to the patient's morphology. \nConclusion: Thanks to iterative reconstruction, single-source DE-CTPA can \nbe achieved at diagnostic quality with a radiation dose no greater than a single-\nenergy examination (DLP of 243 mGy.cm).  \nB-0301 10:48  \nCombined MR imaging of acute pulmonary embolism and deep vein \nthrombosis: diagnostic accuracy of unenhanced balanced steady-state \nfree precession and contrast-enhanced 3D gradient echo sequences  \nN. Karabulut, F. Kaya, I. Yilmaz, D. Herek; Denizli/TR \n(nkarabulut@yahoo.com)  \nPurpose: To evaluate diagnostic performance of combined MR imaging in \npulmonary embolism (PE) and deep vein thrombosis (DVT). \nMethods and Materials:  Combined pulmonary and lower extremity MR \nimaging and Doppler sonography were performed in 29 patients (18 men, 11 \nwomen) within 72 hours after computed tomography angiography (CTA). MR \ntechnique included two sequences: unenhanced balanced steady-state free \nprecession (SSFP), and contrast-enhanced three-dimensional (3D) gradient-\necho (GRE). Two reviewers analysed CT angiography and each MR sequence \nand recorded the presence of emboli in pulmonary arteries and thrombi in \nlower extremity veins. Diagnostic accuracy of each MR technique was \ncalculated using CTA (in chest) and sonography (in lower extremities) as the \nreference standard. \nResults: A total of 210 emboli were detected in 18 (62%) patients on CTA. \nDVT was detected in 21 (72%) on sonography. Sensitivities for SSFP vs 3D \nGRE MR respectively in PE detection were 52% vs 62% on a per-embolus \nbasis, and 52% vs 94% on a per-patient basis. \nSensitivities for SSFP vs 3D GRE MR respectively in DVT detection were 73% \nvs 80% on a per thrombus basis, and 85% vs 93% on a per-patient basis. Five \n(28%) patients without PE showed DVT, whereas two patients without DVT \nhad PE. \nConclusion: Combined MR imaging of acute PE and DVT is a one-stop-\nshopping examination and may be considered a second-line modality in \npatients with contraindications to CTA. Unenhanced SSFP can be used for \ndiagnosing PE or DVT in pregnant patients.  \nB-0302 10:57  \nDecreased left atrial volume predicts higher mortality in patients with \nacute pulmonary embolism  \nE. Soikher, S. Adam, H. Shmueli, S. Berliner, Y. Sagi, A. Meilik, Y. Amitai, \nU. Bendet, G. Aviram; Tel Aviv/IL (soikher@gmail.com)  \nPurpose: To investigate the association between the volumes of the right and \nleft cardiac ventricles and atria with adverse prognosis in acute pulmonary \nembolism (PE) using CT pulmonary angiography (CTPA). \nMethods and Materials:  We retrospectively analysed 450 consecutive \npatients diagnosed with acute PE by non-gated CTPA between 1.1.2009 and \n31.12.2010. Each CTPA was investigated by measuring the right ventricular \n(RV) and left ventricular (LV) diameter ratio, and by a novel volumetric analysis \nsoftware which provides the volumes of the LV, RV, right atrium (RA) and left \natrium (LA) automatically. The association with 30 days mortality was \nanalysed. \nResults: Seventy-nine (17.5%) patients were excluded due to technical and \npatient-related factors. Out of 371 patients that were included in the final study \ngroup, 39 (10.5%) died within 30 days. Mortality was significantly associated \nwith reduced LA volumes (odds ratio =1.49, P=0.016 for 20 ml decrease) and \nS201  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nhigher ratios between the volumes of RA/LA (odds ratio =1.91, P=0.031). No \nsignificant association was found between mortality and RV/LV diameters, RV, \nLV and RA volumes, age and gender. Analysis of the influence of various \nmeasurements on mortality revealed that RA/LA volume ratio was the best \npredictor, with a mortality of 19.8% for the 111 patients with the RA/LA volume \nratio \u00031.315, and of 6.5% among the 260 patients with RA/LA volume ratio \n< 1.315 (P=0.003). \nConclusion: RA/LA volume ratio \u00031.3 is associated with higher mortality in 30 \ndays. Volumetric analysis of the heart using CTPA data may be useful for risk \nstratification in acute PE.  \nAuthor Disclosures: \nG. Aviram: Research/Grant Support; Philips Healthcare. \nB-0303 11:06  \nDual-energy CT perfusion and angiography in chronic thromboembolic \npulmonary hypertension: diagnostic accuracy and concordance with \nradionuclide scintigraphy  \nG. Dournes, D. Verdier, M. Montaudon, A.-L. Riviere, C. Dromer, F. Picard, \nM.-A. Billes, F. Laurent, M. Lederlin; Bordeaux/FR (gdournes@yahoo.fr)  \nPurpose: To evaluate the diagnostic accuracy of dual-energy computed \ntomography (DECT) perfusion and angiography versus ventilation/perfusion \n(V/Q) scintigraphy in chronic throm boembolic pulmonary hypertension \n(CTEPH), and to assess the per-segment concordance rate of DECT and \nscintigraphy. \nMethods and Materials:  Forty consecutive patients with proven pulmonary \nhypertension underwent V/Q scintigraphy and DECT perfusion and \nangiography. Each imaging technique was assessed for the location of \nsegmental defects. Diagnosis of CTEPH was established when at least one \nsegmental perfusion defect was detected by scintigraphy. Diagnostic accuracy \nof DECT perfusion and angiography was assessed and compared with \nscintigraphy. In CTEPH patients, the per-segment concordance between \nscintigraphy and DECT perfusion/angiography was calculated. \nResults: Fourteen patients were diagnosed with CTEPH and 26 with other \naetiologies. DECT perfusion and angiography correctly identified all CTEPH \npatients with sensitivity/specificity values of 1/0.92 and 1/0.93, respectively. At \na segmental level, DECT perfusion showed moderate agreement ( 5=0.44) with \nscintigraphy. Agreement between CT angiography and scintigraphy ranged \nfrom fair ( 5=0.31) to slight ( 5=0.09) depending on whether completely or \npartially occlusive patterns were considered, respectively. \nConclusion: Both DECT perfusion and angiography show satisfactory \nperformance for the diagnosis of CTEPH. DECT perfusion is more accurate \nthan angiography at identifying the segmental location of abnormalities.  \nB-0304 11:15  \nImpact of perfusion imaging on the assessment of peripheral chronic \npulmonary thromboembolism (CPTE): clinical experience in 62 patients  \nF. Molinari, J. Le Faivre, F. Pontana, K. Yasunaga, J. Remy, M. Remy-Jardin; \nLille/FR (martine.remy@chru-lille.fr)  \nPurpose: To evaluate the impact of perfusion imaging on the detection of \nperipheral chronic pulmonary thromboembolism (CPTE). \nMethods and Materials:  62 patients with CPTE underwent a dual-source, \ndual-energy CT angiographic examination with (a) reconstruction of diagnostic \n(i.e., averaged images from both tubes) and pulmonary blood volume (PBV) \nimages; (b) enabling separate depiction of peripheral chronic CPTE on \ndiagnostic images and perfusion defects on MPRs of PBV images. On \ndiagnostic scans, the CT features of peripheral CPTE included stenosed \narterial branches and/or endoluminal filling defects within segmental and \nsubsegmental arteries. On PBV images, pulmonary embolism-type defects \nconsisted of triangular, pleural-based and sharply marginated hypoattenuated \nareas which were recorded at a segmental level (20 segments/patient; total: \n1240 segments). The readings of diagnostic and perfusion images were \nindependently performed by two readers. \nResults: On diagnostic images: (a) the analysis of segmental arteries depicted \nCT features of CPTE within 476 segments; (b) the analysis of both segmental \nand subsegmental arteries depicted CT features of CPTE within 872 \nsegments. PBV imaging de picted: (a) 313 segments with perfusion defects at \nthe level of which segmental arteries had not been diagnosed with CPTE, \nincreasing the number of segments affected by CPTE by 66% (313/476); (b) \n66 segments with perfusion defects at the level of which subsegmental arteries \nhad not been diagnosed with CPTE, increasing the number of segments \naffected by CPTE by 7.5% (66/872). \nConclusion: The reading of PBV im ages enables depiction of a greater \nnumber of segments involved in peripheral CPTE.  \n \nB-0305 11:24  \nCorrelation between DE-CTPA-based iodine map defect extensions and \nclinical parameters in patients with chronic thromboembolic pulmonary \ndisease detected at DECT: an initial experience  \nM. Paoletti, C. Capone, D. Stoppa, A. Valentini, E.M. Bassi, M. Morsolini, \nV. Grazioli, A.M. D'Armini, R. Dore; Pavia/IT  \nPurpose: To determine if perfusion-based iodine map generated by \npostprocessing of DE-CTPA (dual-energy computed tomography pulmonary \nangiography) data can correlate wi th mPAP (mean pulm onary arterial \npressure) and PVR (pulmonary vascular resistance) and the extension of \nvascular disease in patients with chronic thromboembolic pulmonary disease. \nMethods and Materials:  33 consecutive patients with chronic thromboembolic \npulmonary disease (18 men and 15 women, mean age 56) underwent DE-\nCTPA. Patients were divided into two groups: group A: 12 pts, \nmPAP < 25 mmHg, NYHA 2-4; group B: 21 pts, mPAP \u0003 25 mmHg, NYHA 2-4. \nPostprocessing was used to generate iodine-distribution maps. A two-\noperators-based subjective evaluation and a semi-automatic quantification of \nperfusion defects were performed. A modified Qanadli score was performed to \nassess the vascular obstruction in the pulmonary vascular tree in the whole \npopulation and in the two groups. The parenchymal density assessment was \nperformed by a dedicated software. \nResults: There was a statistical significant difference between the two groups \n(p < 0.01) considering the subjective perfusi on quantification and the vascular \nobstruction score. The study also s howed a moderate positive correlation \nbetween the subjective perfusion score and both mPAP and PVR; a moderate \nnegative correlation was present between the obstruction score and mPAP. No \nclear correlation was evident comparing mPAP and PVR with the parenchymal \ndensity and the semi-automatic perfusion quantification. \nConclusion: Subjective perfusion quantification and the modified Qanadli \nscore demonstrated a greater disease degree in the group with mPAP \u0003 \n25 mmHg. A correlation exists between the clinical parameters and the \nsubjective perfusion quantification.  \nB-0306 11:33  \nComplex contrast injection protocol reduces inflow streak artefacts at the \ncervico-thoracic junction during computed tomography of the thorax  \nC. Saade, M. Hourani; Beirut/LB (charbel.saade@aub.edu.lb)  \nPurpose: To investigate enhancement of thoracic vasculature during \ncomputed tomography (CT) of the thorax using a complex injection contrast \nprotocol. \nMethods and Materials:  300 patients underwent routine post-contrast thorax \nCT using a 64 channel CT scanner. Patients were allocated to one of two \ncontrast protocols: Protocol A, the depar tment's standard protocol, consisting \nof a caudocranial scan direction with 100 mL of contrast intravenously injected \nas a single bolus; Protocol B, involving a caudocranial scan direction and \n100 mL of contrast using a complex injection protocol. Each protocol employed \na dual barrel injector with 100 mL of saline and a fixed scan delay of 70 sec \nprior to acquisition. Attenuation profile s of the thoracic arteries and veins were \nmeasured with the arteriovenous contrast ratios (AVCR) calculated. Receiver \noperating characteristic (ROC) analysis was performed using DBM \nmethodology. \nResults: Arterial attenuation was up to 24% (p < 0.03) higher following \nregimen B compared with A. Attenuation in the veins were significantly lower in \nregimen B than in regimen A with a maximum reduction of up to 84% \n(p < 0.0001). With Regimen B, there were significant (p < 0.002) improvements \nin AVCR at a variety of anatomical sites. The ROC analysis demonstrated a \nsignificantly higher Az score for the novel protocol compared with Regimen A \n(p < 0.05) with inter-reader agreement increasing from poor to excellent. \nConclusion: Significant improvements in visualisation of thoracic vasculature \ncan be achieved at the cervico-thoracic junction using a complex injection \ncontrast protocol.  \nB-0307 11:42  \nDual-energy CT with reduced iodine load: a new option for standard \nchest CTA in patients with superior vena cava syndrome  \nS. Bendaoud, O. Vanaerde, F. Molinari, A. Simeone, E. Algeri, J. Remy, \nM. Remy-Jardin; Lille/FR (martine.remy@chru-lille.fr)  \nPurpose: To evaluate the possibilities of dual-energy CT in the context of \nsuperior vena cava syndrome (SVCS). \nMethods and Materials: 41 patients underwent a dual-source, dual-energy CT \nangiographic examination with administration of a low-concentrated contrast \nagent (160 mg iodine /mL) and reconstruction of 3 series of images (i.e., the 2 \npolychromatic series acquired at 80 and 140 kV; the fused images from both \ntubes, equivalent to images acquired at 120 kV). The following parameters \nwere analysed: (a) the CNR and SNR within the SVC, pulmonary arteries and \naorta; (b) the presence of streak artifacts at the level of 3 nodal stations (i.e., \n2R, 4R, 10R). \nS202  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nResults: Fused images provided (a) good to excellent opacification within the \nSVC (n=40; 98%) without artifacts at the level of 2R (n=26; 63%), 4R (n=40; \n98%) and 10 R (n=41; 100%); (b) analyzability of pulmonary arteries down to \nthe subsegmental level (n=31; 76%); and (c) good to excellent opacification of \nthe aorta (n=35; 85%). In 29 patients (29/41; 71%), averaged images alone \nprovided optimal evaluation of all vascular compartments; in 12 patients \n(12/41; 29%), they had to be completed by images at 140 kV (n=6) to suppress \nartifacts at the level of the nodal station 2R and/or images at 80 kV (n=10) to \nimprove the CNR at the level of subsegmental pulmonary arteries and/or the \naorta. \nConclusion: Dual-energy CT enables combination of optimal evaluation of \nSVCS and diagnostic image quality at the level of the other thoracic \ncirculations.  \nB-0308 11:51  \nImpact of iterative reconstruction on CNR and SNR in a 256-slice MDCT \nlow-dose triple-rule-out angiography  \nB.M. Gramer, V. Phi van, M. Rasper, E.J. Rummeny, A. Huber; Munich/DE  \nPurpose: To evaluate the ability of a new iterative reconstruction algorithm \n(IR), iDose4, for the improvement of quantitative image quality (IQ) in triple-rule-\nout (TRO) angiography in emergency patients and to investigate the feasibility \nof radiation dose reduction. \nMethods and Materials: ECG-gated 256-slice MDCT TRO angiography scans \nwere performed in 52 patients at 120 ± 0 kVp and 120 ± 0 mAs. Data were \nreconstructed with a conventional standard filtered back projection (FBP) and \nwith seven different levels (L) of iterative reconstruction (IR (L1 - L7)). Image \nnoise, contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were \nevaluated for all data. In addition, the results of the emergency TRO-\nexamination were investigated. \nResults: Noise was reduced from 34 ± 7 (FBP) to 16 ± 4 (IR Level 7). IR \nimproved SNR (34 ± 7.3 with FBP) up to 18.1 ± 15.9 (IR Level 7). Likewise, \nCNR increased from 8.9 ± 0.5 (FBP) to 18.8 ± 2.47 (IR Level 7). With the TRO-\nexamination in 14 % it was found a pulmonary embolism, in 6 % a coronary \ndisease and in 2 % a aortic dissection. \nConclusion: IR improves SNR and CNR compared to FBP, thus a reduction of \n30% radiation dose seems feasible. In futu re, several investigations concerning \nthe comparison between low-dose, high-dose protocols need to be further \nevaluated.  \n10:30 - 12:00 Board Room B  \nOncologic Imaging  \nSS 516  \nTrends in CT  \nModerator  \nA. Gogbashian; Middlesex/UK  \nG. Petralia; Milan/IT  \nB-0309 10:30  \nIntegrated metabolic-perfusion assessment of non-small cell lung cancer \nusing 18 F-FDG PET/CT and perfusion-CT  \nL. Calandriello, A. del Ciello, A. Larici, L. Leccisotti, A. Giordano, L. Bonomo; \nRome/IT (lcalan@hotmail.it)  \nPurpose: To assess the correlation between metabolic and perfusion \nparameters in patients with non-small-cell lung cancer (NSCLC) who \nunderwent 18 F-FDG-PET/CT and perfusion-CT. \nMethods and Materials:  20 patients with clinically resectable (stage Ia-IIIa) \nNSCLC underwent PET/CT and whole-tumor perfusion-CT within 2 weeks \nbefore surgery. Peak standardised uptake value (SUVpeak), SUVmean and \nmetabolic tumor volume (MTV) calculated using manual (mMTV) and \nautomated (aMTV) contouring method with a threshold of 40% of the maximum \nSUV, were used as metabolic parameters. Blood Flow (BF) was determined as \nperfusion parameter. Patients were divided into two subgroups according to \nmaximum lesion diameter (\u000230 mm or > 30 mm). We assessed the correlation \nbetween perfusion and metabolic parameters in overall population and within \neach subgroup. The difference of each parameter within subgroups was \ncalculated. Pearson coefficient and Mann-Whitney test were used for statistical \nanalysis; a p-value \u00020.05 was considered significant. \nResults: No correlation was found between perfusion and metabolic \nparameters in overall population. After dividing Patients into two groups, a \nstatistically significant negative correl ation was found between volumetric \nmetabolic parameters mMTV/aMTV and BF in Patients with tumor maximum \ndiameter > 30 mm (p:0.04 for both). A significant difference of BF, SUVpeak, \nSUVmean, aMTV and mMTV was found between subgroups \n(p:0.001;p:0.04;p:0.02;p:0.001;p:0.001): in bigger lesions BF tends to decrease \nwhile metabolic parameters tend to increase. \nConclusion: Volumetric metabolic parameters correlate with perfusion \nparameters depending on tumor size. PET/CT and Perfusion-CT parameters \ncannot be considered equivalent in the assessment of NSCLC but their \ncombined evaluation can provide a better tumor characterisation with possible \nfuture application.  \nB-0310 10:39  \nCT perfusion parameters as a prognostic biomarker in patients with non-\nsmall-cell lung cancer  \nL. Calandriello, A. Larici, M. Occhipinti, A. Infante, G. Petrone, L. Bonomo; \nRome/IT (lcalan@hotmail.it)  \nPurpose: To correlate CT perfusion parameters with histopathological \nprognostic factors in Patients with clinically operable early stage (Ia - IIIa) \nNSCLC and to assess the correlation between these parameters and \nrecurrence in our study population \nMethods and Materials:  25 patients with clinically resectable NSCLC \nunderwent perfusion CT examination using 64 row CT and contrast medium \ninjection (50 ml, @ 5 ml/sec) before surgery. CT perfusion parameters \nconsidered were: Blood Flow (BF) and Blood Volume (BV). Maximum tumor \ndiameter was also measured. Histopathological factors assessed were: tumor \nstage and grade, extent of necrosis ( \u000210% or > 10%) and microvessels density \n(MVD). After surgery Patients underwent clinico-radiological follow-up. Pearson \ncorrelation, Anova test, T Student test and Chi-squared test were used for \nstatistical analysis. A p value < 0.05 was considered significant \nResults: BF values were correlated with pathological stage (p:0.008). BF and \nBV values were statistically lower in tumors with maximum diameter > 3 cm \n(p:0.001; p:0.05) and with necrosis >  10%(p:0.01; p:0.05). In addiction BV \nvalues were statistically associated with MVD (p:0.04). No correlation was \nfound between perfusion parameters and tumor grading. Mean follow-up was \n15 months with recurrence disease occurred in 7 Patients. Pathological stage \n(p:0.04), maximum tumor diameter (p:0.01) and BF values (p:0.05) were \nsignificantly associated with the risk of recurrence \nConclusion: Perfusion parameters in Pts with early stage (IIa-IIIa) clinically \noperable NSCLC correlate with hist opathological prognostic factors and may \nserve as pre-treatment prognostic biomarker of risk of recurrence  \nB-0311 10:48  \nClinical application of dual-phase C-arm CT with a single injection to \ndetect hepatocellular carcinoma and metastasis during hepatic \narteriography  \nJ. Wang\n1, K.-Y. Huang1, Z.-G. Zhuang1, J.-C. Chi1, J.-J. Cheng1, J. Beilner1, \nY. Deuerling-Zheng2; 1Shanghai/CN, 2Forchheim/DE  \nPurpose: To investigate the feasibility of using existing 3D-DSA acquisition to \nperform dual-phase C-arm CT with a single contrast injection for the detection \nof tumour lesions and blood supply during TACE. \nMethods and Materials: 10 cases were collected from July 2012 to May 2013, \nwho received dual phase C-arm CT (Artis Zeego, Siemens, Germany) during \nTACE. We injected 48 ml (diluted to 33%) contrast media at a rate of 4 ml/s \nthrough a 5 F catheter placed in the celiac trunk, manually triggered 3D-DSA \nscan protocol was used to obtain arterial  and portal venous phase images. \nFirst run was initiated 2 seconds after contrast media injection. Second run \nwas triggered 2 seconds after the C-arm rotates back to initial position. CT-like \nimages in sagittal, transversal and coronal orientation were reconstructed \nusing 10 mm-thick maximal intensity projection (MIP) to visualise small vessels \nand lesions. \nResults: Out of the 10 cases, image quality of 2 cases found to be insufficient \nfor diagnosis due to metal and motion art efacts. 50% (5 of 10 patients) lesions \nwere found in both phases; 20% more lesions were detected in portal venous \nphase and 10% more in arterial phase. Ring-enhancement could be seen for \nmetastases in venous phase. \nConclusion: Application of intra-procedural dual-phase C-arm CT for TACE \ncould visualise hepatic lesions more clearly at least in one phase. It could \npotentially offer a more accurate real-time planning for super-selective \nembolisation. Moreover, sequential TACE and portal vein embolisation could \nbe considered in cases lesions were only detected in portal venous phase.  \nAuthor Disclosures: \nK. Huang: Consultant; Siemens. J. Beilner: Consultant; Siemens. Y. \nDeuerling-Zheng: Consultant; Siemens. \nS203  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0312 10:57  \nSelection of colon cancer patients for neoadjuvant chemotherapy by \npreoperative CT  \nA. Nørgaard, C. Dam, S.R. Rafaelsen; Vejle/DK \n(Soeren.Rafael.Rafaelsen@rsyd.dk)  \nPurpose: Preoperative staging is essenti al to plan correct treatment of colon \ncancer and calls for objective, accurate methods with sufficient reproducibility. \nThis is a prerequisite for the introduction of neoadjuvant chemotherapy, which \nrepresents a new treatment option. The aim was evaluate the diagnostic \naccuracy of multislice computed tomography (CT) in local staging of colon \ncancer correlated with histopathological parameters, including criteria for \nadjuvant chemotherapy. \nMethods and Materials:  A total of 74 patients were included. All had \npreoperative CT scans and surgical resection of their colon tumours. Tumour \nstage (T-stage), extramural tumour invasion (ETI), nodal stage (N-stage), \nextramural venous invasion (EVI), and the distance from tumour to nearest \nretroperitoneal fascia (DRF) were assessed on the CT scan and compared \nblindly with the results of the patholog ical examination, which also included \nevaluation of the criteria for adjuvant chemotherapy. Advanced tumours were \ndefined as T3 with ETI \u0003 5 mm or T4. \nResults: Sixty-nine percent of the tumours were correctly T-staged by CT, 7% \nwere overstaged and 24% were understaged. As to correct recognition of ETI \non the CT scan, the observer was 70% accurate compared with histopathology \n(sensitivity 64%; specificity 78%). N-stage, EVI, and DRF had poor accuracy: \n53%; 55% and 63%. All patients with advanced tumours on CT fulfilled the \ncriteria for adjuvant chemotherapy. PV+ value: 100% (95% CI: 88.0-100). \nConclusion: CT has a potential as the imaging modality of choice in the \npreoperative selection of advanced tumours suitable for neoadjuvant \nchemotherapy. This can be done without overtreatment of low-risk patients.  \nB-0313 11:06  \nVertebral marrow enhancement in chest MDCT studies of oncology \npatients without superior vena cava obstruction  \nA.J. Villanueva Marcos\n1, M. Paramo1, R. Zalazar1, P. García-Barquín1, \nJ. Etxano1, J. Larrache1, G. Bastarrika2, J. Pueyo1; 1Pamplona/ES, 2Toronto, \nON/CA (avillanueva@unav.es)  \nPurpose: VM is a transient contrast vertebral opacification that may be \nmistaken for metastases in oncology patients with SVC obstruction. Our aim \nwas to demonstrate that VM can be found in patients with thoracic venous \ncollateral vessels (VC) without SVC obstruction. \nMethods and Materials:  Chest MDCT exams of 56 patients with VC without \nVCS obstruction were evaluated. Two groups based on the presence of VC \ndue to venous thrombosis (VT) at the brachiocephalic and/or subclavian and \naxillary veins (group 1, n=28) or due to anatomical compression of the \nsubclavian vein, without VT (group 2, n=28) were formed. MDCT exams were \nperformed with arms in upright position, af ter injection of 100 ml of Iohexol at \n2 ml/s in the arm with VT/compression. VC was classified in shoulder, \nmediastinal, anterior chest wall, neck and posterior paravertebral according \ntheir distribution. One point was assigned for each anatomical area. Intensity of \nVC was defined by the summation of these points. Images were compared with \na normal follow MDCT of the same patient. Fisher's test and Chi square of \nPearson test were performed. \nResults: Nine patients of group 1 showed 49 VM, whereas no patient of group \n2 had VM (p= 0.002). Patients with VM had VC in posterior paravertebral \nareas, mediastinum or neck more frequently than those without VM (p=0.005, \np=0.000, p=0.017). 66.6 % of patients with VM presented 3 or more VC \nintensity points, whereas 19.14% of patients without VM showed that intensity \n(p=0.008). \nConclusion: VM was found only in oncology patients with VC and VT of the \nbrachiocephalic and/or subclavian-axillary veins without VCS obstruction.  \nB-0314 11:15  \nDual source dual-energy CT in patients with advanced gastrointestinal \nstromal tumour: image quality and accuracy of hepatic metastasis \ndetection with virtual monoenergetic imaging  \nS. Sudarski\n1, P. Apfaltrer1, J.W. Nance2, M. Meyer1, C. Fink3, S.O. Schönberg1, \nT. Henzler1; 1Mannheim/DE, 2Baltimore, MD/US, \n3Celle/DE (sonja_sudarski@gmx.de)  \nPurpose: To compare in dual-energy CT (DECT) conventionally reconstructed \npolyenergetic images (PEI) at 120 peak kilovoltage (kVp) to virtual \nmonoenergetic images (MEI) at different kiloelectron volt (keV) levels for \nevaluation of gastrointestinal stromal tumor (GIST) hepatic metastases with \nregard to objective (IQob) as well as subjective (IQsub) image quality and \ndiagnostic accuracy in metastasis detection assessed by readers of varying \nexperience. \n \n \nMethods and Materials:  From 50 examinations of 17 GIST patients \nundergoing abdominal dual-source DECT for staging and follow-up, PEI and 9 \nMEI in 10-keV intervals from 40-120 keV were reconstructed. Liver contrast-to-\nnoise ratios (CNR) and metastasis-to-liver ratios were calculated. MEI \nreconstructions with the highest IQob were compared to PEI for IQsub and \ndiagnostic accuracy by one experienced (ER) and one inexperienced reader \n(IR). \nResults: MEI at 70 keV had highest IQob with equal liver CNR and metastasis-\nto-liver ratio compared to PEI. The ER rated 70 keV MEI and PEI equally high \n(median 4), whereas the IR rated IQsub best in 70 keV MEI (median 5). \nDiagnostic accuracy was equal in 70 keV MEI and PEI for ER (AUC= 1.00) and \nbetter in 70 keV MEI than in PEI for IR (AUC= 0.98 and 0.96, p > 0.05). \nConclusion: MEI at 70 keV provided an IQob equivalent to PEI. Regarding the \nIR, IQsub was impoved in 70 keV MEI compared to PEI and a tendency \ntowards higher diagnostic accuracy was seen. Therefore, inexperienced \nreaders might improve their diagnostic confidence in the detection of hepatic \nGIST metastases by evaluating MEI reconstructions at 70keV.  \nB-0315 11:24  \nIterative reconstructions safire applied to dual-energy CT images for \nincreasing detectability of small low-contrast hypoattenuating liver \nmetastases  \nE. Faietti, L. Berta, L. Mascaro, M. Ravanelli, R. Maroldi; Brescia/IT  \n(elena1487@alice.it)  \nPurpose: To optimise DECT protocols with Sinogram Affirmed Iterative \nReconstruction (SAFIRE) algorithms in order to improve detection of small \nhypodense liver metastases. \nMethods and Materials: A DECT portal-phase acquisition of two healthy livers \nwas reconstructed using standard filtered-back-projection (FBP) and four \nSAFIRE reconstruction schemes obtained by combining two iterative medium-\nsmooth filters (I26,I30) and two different strengths (S3,S5). SAFIRE \nreconstructions were performed on both whole-dose (DE-composition 0.5) and \nhalf-dose 80 kVp images, while FBP reconstructions were applied to DE-\ncomposition images only, resulting in 9 reconstructions per patient. Eight 6-mm \nspherical lesions were simulated in random positions for each series, resulting \nin 144 simulated lesions. A -26 HU lesion-to-liver contrast (LLC) was selected \nfor DE-composition images and a -33.8 HU for 80 kVp images, according to \nthe results of a preliminary study on 29 colorectal cancer liver metastases \ndemonstrating a 30% increased LLC in 80 kVp images compared to DE-\ncomposition. Four expert radiologists performed a detectability test and rated \nthe overall quality, noise and sharpness (5-point scale) in all images. \nResults: FBP reconstructions allowed only 13% lesions to be detected. Best \nperformance was obtained with S5 reconstructions on DE-composition series \n(47% and 61% lesions detected with I26 and I30 kernels, respectively). 80 kVp \nseries provided worse performances compared to DE-composition series. \nContrary to expectations within DE-composition series, S5 image quality \nratings proved to be worse than S3 and FBP, while 80 kVp series resulted the \nworst in all. \nConclusion: SAFIRE has the potential to increase sensitivity for small low-\ncontrast hypodense liver lesions.  \nB-0316 11:33  \nAssessment of early treatment effects of targeted tumour therapy by CT: \nsystematic comparison of dual-energy CT, conventional contrast-\nenhanced CT and dynamic contrast-enhanced CT  \nG. Jost, G. Knobloch, A. Huppertz, H. Pietsch; \nBerlin/DE (gregor.jost@bayer.com)  \nPurpose: Comparison of dual-energy computed tomography (DE-CT), \ndynamic contrast-enhanced CT (DCE-CT) and conventional contrast-enhanced \nCT (CE-CT) in the assessment of early treatment response after targeted \ntumor therapy in a preclinical setting. \nMethods and Materials:  A rat GS9L glioma model was examined with \ncontrast-enhanced dynamic DE-CT measurements (dual source CT, \n80 kV/140 kV) before and on days 1 and 4 after start of daily regorafenib (n=8) \nor placebo (n=8)treatment. Based on that DE-CT (60s p.i., 80/140 kV) derived \niodine maps and the DCE-CT (0-30s p.i., 80 kV) based parameters maps for \nblood flow (BF), blood volume (BV), and vascular permeability (PMB) were \ncalculated and compared to conventional CE-CT (60s p.i., 80 kV). \nResults: The regorafenib group exhibited a significantly lower tumor iodine \nconcentration and a significantly lower PMB in the tumor on day 1 and 4 \ncompared to baseline, which was not observed for the placebo group. CE-CT \nshowed a significant decrease in tumor density on day 4 but not on day 1. The \nDE-CT derived iodine concentrations correlated well with CE-CT tumor \nattenuation and PMB but not with BV or BF. \n \n \n \n \n \nS204  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nConclusion: DE-CT derived tumor iodine concentrations allow an early \ntreatment monitoring of targeted tumor therapy in good agreement with the \nDCE-CT parameter PMB. Both methods DE-CT and DCE-CT showed a \nsuperior performance compared to single energy CE-CT based measurement \nof tumor attenuations.  \nAuthor Disclosures: \nG. Jost: Employee; Bayer AG. A. Huppertz: Employee; Siemens AG. H. \nPietsch: Employee; Bayer AG. \nB-0317 11:42  \n4th generation iterative reconstruction algorithm in low dose whole-body \nCT in comparison with standard dose examination for follow-up of \noncologic patients  \nA. Casiraghi, D. Ippolito, P.A. Bonaffini, C. R.G.L. Talei Franzesi, D. Fior, \nS. Sironi; Monza/IT (casiraghi.ale@gmail.com)  \nPurpose: To compare radiation dose and image quality of low dose protocol \nwith iterative reconstruction algorithm (iDose4) with standard dose protocol CT \nexamination for follow-up of oncologic patients. \nMethods and Materials:  51 patients (32 male; mean age 69.5 ±10.5 years, \nmean BMI 24.9 ±4.1) with malignant disease underwent, during follow-up, low-\ndose whole-body CT scan in a single venous phase (256-row CT, Brilliance, \nPhilips, iDose4 modulation) with the following parameters: 120 kV, variable \nmAs (with dose modulation), slice thickness 2 mm. The patients underwent \nalso standard dose examination on 16-rows CT scan (Philips), with 120 kV, \n200-400 mAs (depending on patient weight), slice thickness 2 mm. Image \nnoise, sharpness and diagnostic quality were evaluated using a 4-point scale. \nDose-length product (DLP) was calculated and data from both examinations \nwere compared and statistically analysed. \nResults: Total DLP was significantly (p < 0.001) lower in low-dose \nexaminations as compared to standard-dose CT studies \n(1010.0±375.1 mGy*cm vs 1404.9 ±281.6), with an overall dose reduction of \n29%. Density values in liver and vessels were higher in low-dose images (liver \n111.7±17.2 HU vs 101.7± 16.6; aorta 164.8± 17.8 vs 149.6 ±22.7, p < 0.001). \nQualitative analysis didn't reveal significant difference in image noise and \ndiagnostic quality of the two groups. \nConclusion: iDose4 reconstruction algorithm allows significant reduction \n(29%) of radiation dose without loss of diagnostic quality representing an \nuseful technique to reduce dose exposure in oncologic patients.  \nB-0318 11:51  \nFiltered back projection vs adaptive statistical iterative reconstruction in \nstaging-CT: comparison of dose and image quality in NET-patients  \nG. Böning, M.-L. Schäfer, U. Grupp, J. Kahn, D. Renz, T. Denecke, B. Hamm, \nM. Pavel, F. Streitparth; Berlin/DE (georg.boening@charite.de)  \nPurpose: The purpose of this study was to investigate, if dose reduction via \nadaptive statistical iterative reconstruction (ASIR) affects image quality and \ndiagnostic evidence in patients with neuroendocrine tumour (NET). \nMethods and Materials:  This prospective, single-center study was performed \nwith a 64-section CT-scanner (LightSpeed VCT; GE Healthcare), updated with \nASIR technology. 16 patients with histologically proven NET underwent \nstaging-CT (thorax and abdomen) with filtered back projection (FBP) (protocol \nA) and with ASIR 40% (protocol B) in follow-up, by using identical scan \nparameters. To evaluate image quality, SNR and CNRs were calculated. In \naddition, subjective 5-grade scoring (1 insufficient to 5 excellent) was \nperformed by two experienced and blinded readers. \nResults: Our results show that, with matched scan length (596± 75 mm [A], \n609±38 mm [B]), protocol B reduced the DLP by 35.7% \n(1053.1±404.8 mGy*cm [A], 676.9 ±248.5 mGy*cm [B]). Protocol B increased \nSNR (9.8±2.7 [A], 12.9 ±4.5 [B]) and CNR (complete tumor-to-liver, 3.2± 2.1 [A], \n4.3±2.7 [B]). There were no significant differences in subjective image quality \nscoring: noise (4.2 ±0.8 [A], 4.0 ±0.8 [B]), contrast (4.4 ±0.7 [A], 4.1 ±0.8 [B]), \nvisibility of small structures (4.4 ±0.7 [A], 4.2±0.8 [B]), visibility of suspect lesion \n(4.8±0.4 [A], 4.8 ±0.4 [B]), artefacts (5.0 ±0 [A], 5.0 ±0 [B]) and diagnostic \nconfidence (5.0±0 [A], 5.0±0 [B]). \nConclusion: In clinical practice, ASIR can be used to reduce radiation dose \nwithout decreasing objective image quality and diagnostic confidence in NET-\npatients.  \n \n10:30 - 12:00 Room E1  \nMusculoskeletal  \nSS 510  \nSpine: osteoporosis, malignancy and \nspondylarthropathy  \nModerators:  \nM.P. Aparisi Gomez; Valencia/ES  \nC. Van Kuijk; Amsterdam/NL  \nB-0319 10:30  \nAutomatic detection of osteoporotic vertebral fractures in routine \nthoracic and abdominal MDCT  \nT. Baum1, J.S. Bauer1, T. Netsch2, T. Klinder2, M. Dobritz1, E.J. Rummeny1, \nP.B. Noël1, C. Lorenz2; 1Munich/DE, 2Hamburg/DE (thbaum@gmx.de)  \nPurpose: To develop an automatic spine segmentation algorithm for routine \nthoracic and abdominal MDCT and use this algorithm to automatically detect \nosteoporotic vertebral fractures. \nMethods and Materials:  We retrospectively identified patients older than 45 \nyears of age, who underwent routine contrast-enhanced thoracic and \nabdominal MDCT. Cross-sectional M DCT images of 71 patients including 8 \nmen and 9 women with osteoporotic vertebral fractures were selected to \ninvestigate the performance of our automa tic spine segmentation algorithm to \ndetect these fractures. Furthermore, the algorithm was applied to baseline and \nfollow-up MDCT images of 9 patients (4 men and 5 women) with incidental \nvertebral fractures in the follow-up MDCT. The algorithm localised and \nidentified the vertebrae T5-L5. Each ve rtebra was automatically segmented by \nusing corresponding vertebrae surface shape models that were adapted to the \noriginal images. Anterior, middle, and posterior height of each vertebra was \nautomatically determined, and anterior-posterior-ratio (APR) and middle-\nposterior-ratio (MPR) were computed. As gold standard, two radiologists \ngraded vertebral fractures from T5 to L5 according to the Genant classification \nin consensus by using the sagittal reformations. \nResults: Using ROC analysis to differentiate vertebrae without versus with \nprevalent fracture, AUC values of 0.84 and 0.83 were obtained for APR and \nMPR, respectively (p < 0.001). The longitudinal changes in APR and MPR \nwere significantly different between vertebrae without versus with incidental \nfracture ( ,APR: -8.5% ±8.6% versus -1.6% ±4.2%, p=0.002; , MPR: -\n11.4%±7.7% versus -1.2%±1.6%, p < 0.001). \nConclusion: The presented algorithm may support radiologists to report \ncurrently underdiagnosed osteoporotic vertebral fractures, so that appropriate \ntherapy can be initiated.  \nAuthor Disclosures: \nJ.S. Bauer: Research/Grant Support; Deutsche Forschungsgemeinschaft \n(DFG BA 4085/1-2). T. Netsch: Employee; Philips. T. Klinder: Employee; \nPhilips. C. Lorenz: Employee; Philips. \nB-0320 10:39  \nPitfalls in previous dual energy x-ray absorptiometry scans: adherence to \nInternational Society of Clinical Densitomery 2007 guideline  \nC. Messina1, M. Bandirali1, L.M. Sconfienza1, R. Spairani1, F. Ulivieri2, \nF. Sardanelli1; 1San Donato Milanese/IT, 2Milan/IT (carmelomex@gmail.com)  \nPurpose: Dual-energy X-ray absorptiometry (DXA) is the standard of care for \ndiagnosing osteoporosis and monitoring patients. Inaccurate DXA exams may \nlead to different mistakes (known as \"pitfalls\") resulting in erroneous data \ninterpretation and equivocal reports. We evaluated rate and type of errors in \nprevious DXA of patients coming to our institution for a new DXA exam. \nMethods and Materials:  We prospectively evaluated 2,476 patients who \npresented at our institution to perform DXA. We excluded patients without \nprevious DXA and those who performed the previous examination at our \ninstitution. Two radiologists with 4 ye ars of experience in DXA re-evaluated \nprevious DXA of 498 patients (38 males, 447 females; mean age 68 ±9 years), \naccording to International Society of Clinical Densitometry (ISCD) 2007 \nguidelines. Errors were classified in four categories: patient-positioning (PP), \ndata-analysis (DA), artefacts, demographics. When available, previous \ncomparisons among outsource DXA were analysed also for technical errors. \nResults: Previous outsource DXA were performed at 37 different centers, with \n13±8 patients (mean ± standard deviation) per center. Out of 485 DXA, 451 \n(93%) had at least one error for a total of 558 errors: 441 (79%) were DA, 66 \n(12%) PP, 39 (7%) artefacts, and 12 (2%) demographics. Only 42 (9%) had a \nprevious DXA for comparisons, for a total of 57 errors: 31 (54%) were DA, 17 \n(30%) PP, and 9 (16%) scan mode discrepancies. \nConclusion: More than 90% of previous DXA presented at least one error. \nISCD guidelines are very poorly adopted.  \n \nS205  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0321 10:48  \nEarly detection of sacroiliitis using DW imaging  \nL. Miu; Timisoara/RO (oprealuminitaoana@yahoo.com)  \nPurpose: This study proposed to evaluate the value of diffusion-weighted MRI \nto detect active inflammatory changes in the sacroiliac joints of patients with \nearly axial spondyloarthritis. \nMethods and Materials:  36 patients with chronic low back pain underwent \nclinical and MRI evaluation for axia l spondyloarthritis or early ankylosing \nspondylitis. STIR, contrast-enhanced T1-weighted, fat-saturated T2-weighted, \nand diffusion-weighted b value1,000 s/mm 2 images were obtained. The \npresence of subchondral bone marrow oedema, subchondral fatty marrow \ninfiltration, or contrast enhancement in the sacroiliac joints or adjacent \nenthesitis sites was considered a marker for active inflammatory changes. All \nMRI sequences were evaluated for the presence of acute inflammatory \nchanges. Mean apparent diffusion coeffici ent values of diffusion-weighted \nimages were calculated from normal and involved iliac and sacral bones of \nsacroiliac joints. \nResults: ADC values measured from the lesions at b value of 1,000 s/mm2 in \npatients with sacroiliitis n = 13 were signi ficantly higher than values measured \nfrom iliac and sacral bones in patients with low back pain of mechanical origin \nn = 29. DWI showed sensitivity for detecting acute lesions in early sacroiliitis \nsimilar to that of T1-weighted gadolinium images 89.3%DWI vs 91.3%T1+c. \nConclusion: DWI is a sensitive, fast sequence and does not require a contrast \nagent, which makes it a good and cost-effective alternative for imaging \nsacroiliac joints. DWI also offers the possibility of quantifying diffusion \ncoefficients of the lesions, which helps to discriminate between normal and \ninvolved subchondral bone.  \nB-0322 10:57  \nEffects of recent lung transplantation on cortical and trabecular \nmicroarchitecture and bone strength in men and women  \nL. Fischer, A. Valentinitsch, M.D. DiFranco, C. Schueller-Weidekamm, \nD. Kienzl, T. Gross, F. Kainberger, G. Langs, J.M. Patsch; Vienna/AT \n(janina.patsch@meduniwien.ac.at)  \nPurpose: Organ transplant recipients often suffer from severely impaired bone \nstrength arising of pre-existing osteoporosis and bone disease aggravation due \nto immunosuppressive treatment after surgery. Lung transplant recipients are \nunder an intense post-transplant drug regimen and fracture rates are high. \nDespite, low bone mineral density and altered states of bone turnover have \nbeen reported, bone microarchitecture status has been scarcely analysed. \nMethods and Materials:  After recovery from surgery, 61 patients (female: \nn=31, male: n=30; mean age: 45.9± 14.9), and 60 healthy, age and gender-\nmatched controls (Co) underwent high resolution peripheral quantitative \ncomputed tomography (HR-pQCT; SCANCO Medical AG) of the ultradistal \nradius. Volumetric bone mineral density, trabecular and cortical bone \nmicroarchitecture and bone strength were assessed. ANCOVA was used to \ncompare mean differences between female and male LuTX patients and Co. \nResults: Female transplant recipients exhibited larger and more \nheterogeneous cortical pores (+13.3%, p=0.009; +16.7%, p=0.029), greater \ntrabecular heterogeneity (+80%, p=0.044) and lower mid-trabecular BMD (-\n17.9%, p=0.049) than healthy women. Male transplantation recipients had \nlower cortical area (-21.3%, p=0.001), global BMD (-19.5%, p=0.002), \ntrabecular BMD (-22.2%, p=0.003), BV/TV (-23%, p=0.002), trabecular number \n(-13%, p=0.006), trabecular thickness (-12.5%, p=0.023), stiffness (-21%, \np=0.001), failure force (-21%, p < 0.001), overall bone strength (-24%, \np < 0.001) and larger trabecular separation and network heterogeneity \n(+25.6%, p=0.015; (+50%, p=0.036) than healthy men. \nConclusion: Male and female patients with recent lung transplantation exhibit \nrelevant deficits in trabecular and cortical bone quality and bone strength. \nFurthermore, they exhibited major disturbances in gender-specific bone \ncharacteristics.  \nB-0323 11:06  \nBone microarchitecture in thalassaemia  \nJ. Yamamura1, R. Grosse1, B. Schönnagel1, S. Keller1, C. Berliner1, \nP. Nielsen1, G. Adam1, R. Fischer2; 1Hamburg/DE, 2Oakland, CA/US \n(j.yamamura@uke.de)  \nPurpose: To assess the microarchitecture of the bone density of patients with \nthalassaemia using HR-pQCT and compared to DXA. \nMethods and Materials: In 17 patients with beta-thalassaemia major (n=10), -\nintermedia (n=6), and CDA-II (n=1), the bone marrow density (BMD) of lumbar \nspine (LS) and total hip was measured by DXA. BMD Z-scores were \ncalculated; volumetric BMD and the trabecular architecture of the non-\ndominant distal radius and tibia by HR-pQCT were assessed. Liver iron \nconcentration and endocrinological parameters were determined. Non-\nparametric statistical analysis was used. \n \nResults: In 15 patients, low BMD values (LS Z-score range: -1.1 to -3.1) \nmeasured by DXA were significantly correlated with total volumetric density \n(p=0.002) measured by HR-pQCT at the distal radius. In 6 patients with latent \nhypogonadism, the trabecular inhomogeneity parameter at the distal radius \ndeviated by more than 100% from the upper normal value. Patients with \nhypogonadism (n=9) were significantly different from normals with respect to \nradial TbSp SD (p=0.02), but not to LS Z-score. Patients with fractures (n=5) \nhad lower total densities (p=0.02) and trabecular TbSp SD (p=0.02) at the tibia \nand started blood transfusions (Tx-age) at a higher age (p=0.023). Z-scores did \nnot reflect the fracture risk in this patient group (p=0.11). Only the trabecular \nthickness of the tibia seems to be correlated with the Tx-age (Rs=0.62, \np=0.007). Liver iron was mainly correlated with tibial TbSp SD (Rs=0.54, \np=0.025). \nConclusion: In thalassaemia, BMD Z-scores seem to underestimate fracture \nrisk because a normal cortical thickness and density may conceal a porous \ntrabecular structure.  \nB-0324 11:15  \nDurie-Salmon plus vs international staging system: the impact of MRI in \nthe staging of multiple mieloma  \nG. Filonzi, P. Spinnato, E. Salizzoni, G. Battista, U. Albisinni, A. Bazzocchi; \nBologna/IT (giacomo.filonzi@gmail.com)  \nPurpose: The Durie Salmon Plus (DDS+) is a recently developed staging \nsystem for Multiple Myeloma (MM), based on the number of bone lesions \ndetected with MRI or FDG PET/CT and on few clinical parameters. Given that \nthe DSS+ has not been validated yet, the aim of our study is to compare the \nInternational Staging System (ISS), a widely used system for MM that \nevaluates only laboratory parameters, with the DSS+, according to patients' \nsurvival rates and response to therapy. \nMethods and Materials:  We retrospectively enrolled 52 patients, diagnosed \nwith MM during 2004-2008, who underwent contrast-enhanced MRI (1.5 T)in \nour department at the time of diagnosis. Patients were staged with both ISS \nand DSS+ and the two systems were then compared according to survival rate, \nresponse to therapy and disease-free survival (Student's-T test, COX and \nKaplan-Meier analysis), during a 5-year follow-up. \nResults: From ISS to DSS+ 22 patients have been upstaged, 11 have been \ndownstaged and 19 have been staged the same. After therapy 40/52 patients \n(76.9%) achieved a complete response, with a mean free-disease survival of \n49.5 months. During the follow-up 4/52 patients (7.7%) have died; according to \nDSS+ all these 4 patients were at stage III, only one according to ISS. No \nstatistically significant difference was found between the two staging system \nconsidering response to therapy. \nConclusion: Our data indicate that DSS+ has a great potential in staging MM \npatients, for survival and therapy efficacy prediction. To our knowledge, this is \nthe first study designed to compare these two staging systems.  \nB-0325 11:24  \nAssociation of osteolyses with vertebral fractures in patients with \nmultiple myeloma  \nJ. Borggrefe1, S. Giravent2, J. Pena1, A. Wulff2, M. Heller2, C.C. Glüer2; \n1Cologne/DE, 2Kiel/DE (Jan.Borggrefe@uk-koeln.de)  \nPurpose: In patients with multiple myeloma (MM), computed tomography is \nwidely used for staging and to detect fractures. We investigated the association \nof prevalent vertebral fractures in MM patients with clinical and radiological \nfeatures of the disease. \nMethods and Materials: 128 MM patients underwent whole body low-dose CT \nin clinical routine with 1.5-mm slice thickness, 120 kVp and approximately \n100 mAs. Two radiologists reported on following parameters based on \npredefined criteria: vertebral fractures, general fracture risk, osteopenia, \ntrabecular sclerosis, extramedullary MM manifestations, osteolyses up to a size \nof 8 mm and larger than 8 mm. Age-adjusted multivariate logistic regression \nmodels were calculated to describe the association of these parameters with \nprevalent fractures. \nResults: The prevalence of vertebral fractures was 49%. Patients with \nfractures were comparable in age to patients without fractures (63 vs 64 years \nof average, p > 0.6). In age-adjusted logistic regression, the OR for prevalent \nvertebral fractures in women showed the strongest association to the \nprevalence of osteolytic lesions, regardless of size. In both women and men, \npatients with larger osteolyses did not show a higher prevalence of fractures. In \nmen, the osteopenia showed the strongest association to fracture risk with an \nOR of 2.8 (1.6 -4.7). Suspected fracture risk was associated to fractures with \nan OR of 2.3 (1.6 - 3.8). \nConclusion: The prevalence of vertebral fractures in myeloma patients is \nassociated with osteopenia and osteolytic changes. Prevalence of larger \nosteolyses did not show a higher association to fractures than patients with \nsmaller osteolytic changes.  \n \nS206  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0326 11:33  \nDetermination of the best combination of b-values for ADC-based \nassessment of benign and malignant vertebral body fractures with a \ndiffusion-weighted ssTSE sequence  \nT. Geith, G. Schmidt, A. Biffar, O. Dietrich, H.-R. Dürr, M.F. Reiser, \nA. Baur-Melnyk; Munich/DE (tobias.geith@med.uni-muenchen.de)  \nPurpose: Finding the best combination of b-values for apparent-diffusion-\ncoefficient (ADC)-based assessment of acute benign and malignant vertebral \nbody fractures using a ssTSE-sequence. \nMethods and Materials: 26 acute benign (mean age 69, 31.5-86.2 years) and \n20 malignant vertebral fractures (mean age 63.4, 24.7-86.4 years). Standard \nmorphological sequences and a diffusion- weighted (DW) single-shot turbo spin \necho (ssTSE) sequence at different b-values (100, 250, 400, 600 s/mm²) were \nacquired at 1.5 T. ADCs were determined based on regions of interest (ROIs), \nmanually adapted to hyperintense areas on STIR in the fractured vertebral \nbodies. Combinations of two to four b-values were used to calculate the ADC, \nusing a least-squares algorithm. Statistically significant differences were \ndetermined with the Student's t-test and Mann-Whitney-U test. ROC analysis \nand the Youden-index were used to determine cut-off values with the highest \nsensitivity and specificity. \nResults: Benign fractures had significantly higher ADCs than malignant \nfractures (except for the combination of b=400 s/mm\n2 and b=600 s/mm 2). \nHigher b-values resulted in lower ADCs than calculated with low b-values. \nADCs calculated with b=100 and 400 s/mm 2 had the highest AUC (0.85). The \nsecond highest AUC (0.829) showed the ADCs calculated with b=100, 250, \nand 400 s/mm 2. The Youden-index with equal weight given to sensitivity and \nspecificity suggests to use an ADC calculated with b=100, 250, and 400 s/mm 2 \n(cut-off ADC< 1.7 ×10-3 mm2/s) to best diagnose malignancy (sensitivity=85%, \nspecificity=84.6%). \n \nConclusion: The combination of low to intermediate b-values \n(b=100,250,400s/mm2) provides the best diagnostic capability for ADC-based \ndifferentiation of acute benign and mali gnant vertebral body fractures using a \ndiffusion-weighted ssTSE sequence.  \nB-0327 11:42  \nAssessing structural changes in axial spondyloarthritis using a low-dose \nbiplanar imaging system (EOS)  \nA. Molto1, V. Freire1, A. Feydy1, W.P. Maksymowych2, M. Benhamou1, \nF. Rannou1, M. Dougados1, L. Gossec1, J.-L. Drapé1; 1Paris/FR, 2Edmonton, \nAB/CA (antoine.feydy@cch.aphp.fr)  \nPurpose: Patients with axial spondyloarthritis (SpA) experience repeated \nspine imaging. EOS is a new low-dose imaging system with significantly lower \nirradiation than conventional radiography (CR). The objective was to explore \nthe EOS performances compared to CR, for the classification and follow-up of \nSpA. \nMethods and Materials:  Observational prospective single-center study, \nincluding SpA patients (definite diag nosis by expert opinion) and control \npatients [definite chronic mechanical low back pain (cLBP)]. All patients \nunderwent pelvic and frontal and lateral CR of the entire spine, and 2D EOS \nimaging on the same day. Images were blindly assessed for sacroiliitis \n(modified New York criteria, mNY), and for ankylosis of the spine (modified \nStoke Ankylosing Spondylitis Spinal Score, mSASSS). Global ease of \ninterpretation was rated 0-10. The primary outcome was inter-modality \nagreement, with an a priori defined non-inferiority limit of 0.7. Inter-observer, \nintra-observer and inter-modality agreement were measured by kappa, \nweighted kappa, intra-class correlation coefficient, and Bland-Altman plots. \nResults: 48 SpA patients [mean age 47.6 ± 14.9 years, symptom duration \n21.4 ± 13.3 years, 35 (70%) men] and 48 cLBP controls (mean age 49.1 ± 10.7 \nyears; 9 (22.5%) men] were included. Inter-modality agreement between EOS \nand CR was 0.50 (0.26-0.75) and 0.97 (0.95-0.98), for sacroiliitis and \nmSASSS, respectively. Ease of interpretation was greater for CR (8.2 ±0.9) as \ncompared to EOS (7.2±0.8, p < 0.0001). \nConclusion: Our results suggest that EOS could replace CR for the \nclassification and follow-up of the structur al damage of the spine, but its place \nin the classification of sacroiliitis remains unclear.  \nB-0328 11:51  \nReading of the sacroiliac joints on plain radiographs in undifferentiated \nspondyloarthropathies: agreement between local reading and trained \ncentral reading in a cohort of 708 patients  \nR. van den Berg\n1, G. Lenczner2, A. Feydy2, D. van der Heijde1, M. Reijnierse1, \nA. Saraux3, P. Claudepierre4; 1Leiden/NL, 2Paris/FR, 3Brest/FR, 4Créteil/FR \n(antoine.feydy@cch.aphp.fr)  \nPurpose: In daily practice, local radiologists/rheumatologist judge sacroiliac \njoints on X-rays (X-SI), while in cohorts the scoring is done by trained readers. \nOur aim was to compare the local scores to centralised scores. \nMethods and Materials:  Patients with back pain from the 25 participating \ncenters were included in the DESIR cohort ( n=708). Baseline X-SIs were \nscored by the local reader, according to a scoring method derived from the \nmodified New York (mNY) criteria1 (local score). Grade 2 and 3 from the \noriginal mNY were pooled together in one combined grade 'DESIR-2'. \nSacroiliitis was defined by at least unilateral grade \u0003DESIR-2. In addition, two \ncentralised readers independently scored all X-SIs according to the original \nmNY criteria. In case of disagreement, a radiologist experienced in SpA \nimaging served as adjudicator. An X-SI was marked positive for sacroiliitis if \n2/3 readers agreed on bilateral \u0003mNY-2 or unilateral \u0003mNY-3. \nResults: Inter-reader agreement between the two centralised readers was \nmoderate (Kappa 0.54), while percentage agreement (84.3%) was good. \nHowever, the adjudicator needed to score 108/689 (15.7%) X-SIs because of \ndisagreement among the two centralised readers. Overall, more radiographs \nwere scored positive by the local readers ( n=184) than by the centralised \nreaders ( n=145). In 77 patients, the X-SI was scored positive by the local \nreader but negative by the centralised readers. \nConclusion: Agreement between the centralised score and local score, also \nthe inter-reader agreement between the two centralised readers, was \nmoderate. The role of X-SI as diagnostic criterion for axial SpA should be re-\nevaluated.  \n10:30 - 12:00 Room F2  \nBreast  \nSS 502  \nTomosynthesis, digital mammography and \nscreening  \nModerators:  \nL.A. Carbonaro; San Donato Milanese/IT  \nA. Evans; Dundee/UK  \nB-0329 10:30  \nPerformance of one-view breast tomosynthesis versus two-view \nmammography in breast cancer screening: first results from the the \nMalmö breast tomosynthesis screening trial  \nS. Zackrisson, K. Lång, P. Timberg, I. Andersson; Malmö/SE \n(sophia.zackrisson@med.lu.se)  \nPurpose: The combination of 2-view BT and 2-view DM in breast cancer \nscreening has been evaluated in three recent studies. The Malmö Breast \nTomosynthesis Screening Trial (MBTST) was designed to assess the efficacy \nof 1-view BT versus 2-view DM in breast cancer screening. We now report \npreliminary results from the interim analysis of 7,500 screened women. \nMethods and Materials:  MBTST is a prospective, single-armed, paired study \nwith a planned inclusion of 15,000 screening participants aged 40-74 years. In \naddition to the regular screening mammogram a 1-view BT with reduced \ncompression is acquired with a Siemens Mammomat Inspiration unit. BT and \nDM images are read independently with double reading. BI-RADS ratings of 1-\n5 is reported and women with >= 3 are routinely recalled for work-up. Breast \ncancer detection rate, recall rate and other performance indicators will be \npresented. \nResults: Sixty-five breast cancers were detected, 46 by both BT and DM, 18 \nonly by BT and one only by DM. The detection rate with 1-view BT was \n8.5/1000 women screened versus 6.3/1000 with 2-view DM. The recall rate \nafter arbitration was 2.2% with 2-view DM versus 3.3% with 1 view-BT. Further \nrefined data will be presented. \nConclusion: One-view BT alone increased breast cancer detection rate with \napproximately 40%. Our preliminary results suggests that 1-view BT as a \nsingle screening modality might be feasible.  \nAuthor Disclosures: \nS. Zackrisson: Equipment Support Recipient; Siemens AG. Speaker; \nSpeaker's fees and travel support from Siemens AG, Germany. K. Lång: \nSpeaker; Speaker's fees and travel support from Siemens AG, Germany. P. \nTimberg: None. I. Andersson: Speaker; Speaker's fees and travel support \nfrom Siemens AG, Germany. \nB-0330 10:39  \nComparison of FFDM with DBT in a UK retrospective reading study  \nF.J. Gilbert1, L. Tucker1, S. Nagarajan1, P. Willsher1, S. Astley2, K.C. Young3, \nS. Duffy4; 1Cambridge/UK, 2Manchester/UK, 3Guildford/UK, 4London/UK \n(fjg28@cam.ac.uk)  \nPurpose: To compare digital breast tomosynthesis (DBT) with full field digital \nmammography (FFDM) in the UK NHS Breast Screening Programme. \nMethods and Materials:  Women recalled following screening were consented \nto have additional DBT imaging at th e time of their assessment. We had DBT \nand FFDM reading data on 1087 women whose final diagnosis was cancer, \nS207  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nand 4514 whose final diagnosis was normal or benign. We had synthetic two-\ndimensional image (2D) reading data on 1032 cancers and 4137 non-cancers. \nData was collected prospectively for each case. Histopathology from core \nbiopsy or surgical excision was used as the gold standard to confirm cancer. \nThe sensitivity and speci ficity of the different imaging combinations was \ncompared in a retrospective reading study. Each case was read three ways \n(FFDM alone, FFDM with DBT and synthetic 2D image with DBT) by three \ndifferent experienced screen readers who were not from the site where the \ncase originated. Statistical analysis used McNemar methods. \nResults: FFDM+ DBT showed a small but borderline significant (p=0.05) \nimprovement in sensitivity over FFDM alone- 88% (955/1087) vs 85% \n(929/1087). FFDM+DBT showed substantially and significantly (p < 0.001) \ngreater specificity than FFDM alone- 67% (3045/4514) vs 55% (2474/4514). \nNo significant difference in sensitivity was noted for FFDM vs synthetic 2D plus \nDBT (p=0.9), but there was a highly signi ficant difference in specificity- 67% \n(2774/4137)for synthetic 2D plus DBT vs 55% (2270/4137) for FFDM alone. \nConclusion: Digital breast tomosynthesis in combination with FFDM confers a \nsubstantial improvement in specificity, and may confer a small improvement in \nsensitivity.  \nB-0331 10:48  \nAdded value of one-view breast tomosynthesis combined with digital \nmammography according to reader experience  \nI. Thomassin-Naggara, N. Perrot, S. Dechoux, J. Chopier, C. De Bazelaire; \nParis/FR (isabelle.thomassin@gmail.com)  \nPurpose: To retrospectively evaluate the added value of one-view breast \ntomosynthesis when combined with mammography to characterise breast \nlesions. \nMethods and Materials: One hundred fifty-five women (mean age, 51.3 years, \nrange: 24-92 years) who systematically underwent mammography and breast \ntomosynthesis with subsequent percutaneous biopsy were analysed. Four \nradiologists (two seniors, R1 and R2, and two juniors, R3 and R4) \nindependently reviewed exams in 2 steps: mammography alone and \nmammography with tomosynthesis. The lesions in the cohort included 39.3% \n(61/155) cancers and 60.6% (94/155) benign lesions. \nResults: There was almost perfect agreement irrespective of reader \nexperience for the reading of the combination of mammography and \ntomosynthesis, whereas agreement was poor between junior and senior \nreaders for the reading of mammography alone. Area under the ROC \n(AUROC) values for the combination of mammography and tomosynthesis \nwere significantly better than AUROC values for mammography alone for all \nreaders except the most experienced, for whom only a tendency was noted. \nThe proportion of cancers undiagnosed by mammography alone that were well \ndiagnosed by the addition of breast tomosynthesis was 6.5% (4/61), 13.1% \n(8/61), 27.8% (17/61) and 26.2% (16/61) for Readers 1, 2, 3 and 4, \nrespectively. The proportion of false positi ve cases induced by the addition of \nbreast tomosynthesis to mammography was 2.1% (2/94), 2.1% (2/94), 9.5% \n(9/94) and 12.7% (12/94) for Readers 1, 2, 3 and 4, respectively. \nConclusion: Adding breast tomosynthesis to mammography improved \nsensitivity and negative predictive value for all readers except for the most \nexperienced one.  \nB-0332 10:57  \nDigital mammography vs digital breast tomosynthesis in an enriched \nsample  \nP. Martínez Miravete\n1, M. Paramo2, R. Salazar2, J. Etxano2, L. Apesteguia2, \nL.J. Pina Insausti2; 1Zaragoza/ES, 2Pamplona/ES \n(paulamartinezmiravete@yahoo.es)  \nPurpose: To evaluate the sensitivity and s pecificity of digital mammography \n(DM) versus digital breast tomosynthesis (DBT) in an enriched sample. \nMethods and Materials: A sample of 504 patients with both DM and DBT was \nretrospectively evaluated by two blinded experts. The mean age was 48.4 y/o \n(21-88). Only 32 (6.3%) showed ACR I density pattern and 230 (45.6%) had \ndense patterns (III & IV). Clinical and ultrasound studies were not available. \nThe enriched sample included 61 cancers (12.1%) and 112 biopsy proven \nbenign lesions (22.2%). The remaining 331 cases were normal or benign (1-\nyear follow-up). COMBO mode (DM and DBT) was used. The patients were \ncategorised as negative (BI-RADS cat 1&2) or positive (BI-RADS 3-5). \nMultifocal/multicentric were not consid ered. Data were analysed by using the \nSPSS (15.0) and PEPI softwares to calculate the concordance between the \nreaders and to compare the sensitivity and specificity. \nResults: The concordance between the readers for the BI-RADS classification \nwas moderate for DM (kappa= 0.49) as well as for DBT (kappa=0.58). DBT \nsignificantly increased the sensitivity of both readers compared with DM alone \n(reader 1: DM 82%, DBT 95.1%; p < 0.05; Reader 2: DM 72.1%, DBT 80.3%; \np < 0.05). Regarding the specificity, there were no significant differences for \nreader 1 (DM 69.5%, vs DBT 69.0%; p > 0.05) and for reader 2 (DM 67.6 % vs \nDBT 68.3%; p> 0.05). \nConclusion: The concordance between the readers was moderate in this \nenriched sample. DBT significantly increas ed the sensitivity of both readers but \nthere were no significant changes regarding the specificity.  \nB-0333 11:06  \nFirst experience with the new generation low-dose digital breast \ntomosynthesis: can 2D synthetic image replace digital mammography in \ncombination with digital breast tomosynthesis?  \nM. Locatelli\n1, M. Tonutti2, A. Trianni3; 1Gorizia/IT, 2Trieste/IT, 3Udine/IT \n(martiloc@yahoo.it)  \nPurpose: Digital breast tomosynthesis (DBT) is a new promising technique, \nexpected to improve digital mammography (DM) interpretation by reducing \ntissue superimposition. DBT acquisition provides plane images focused at \ndifferent depths of the breast. Moreover, synthetic 2D (2Dtomo) images \nanalogue to DM images can be reconstructed. The aim of this study is to \nevaluate 2Dtomo associated with DBT, compared with DM associated with \nDBT in terms of added diagnostic value and dose received by the patient. \nMethods and Materials:  DBT was performed on 78 patients (symptomatic or \nscreening-recalled) after DM examination with the new generation GE system \n(Senographe Essential). A total of 89 exams underwent double-blinded review \nby two experienced breast radiologists. The diagnosis was then confirmed by \nultrasound, biopsy, magnetic resonance or contrast enhanced spectral \nmammography. For all exams, dosimetric information was also collected. \nResults: Inter-observer accordance was in 90% of DBT images and 87% of \n2Dtomo images. DBT findings were concordant with the final diagnosis in 98% \nof the cases and 2Dtomo in 73%. 2Dtomo is a synthetic image obtained \nprocessing the information of DBT without additional dose. The combination \n2Dtomo/DBT would reduce the patient dose of about 50%. In addition, 2Dtomo \nimproves the negative predictive factor (NPV). But this is only an apparent \nimprovement, since 2Dtomo actually demonstrated really low sensitivity. \nMoreover, 2Dtomo significantly decreases the conspicuity of details compared \nwith DM and DBT, independently from the final diagnosis and from breast \ndensity. \nConclusion: The combination of 2Dtomo plus DBT cannot, at present, replace \nDM in screening workflow.  \nB-0334 11:15  \nImproved detection of architectural distortion in digital mammography \nusing distortion-weighted image (DiWI): a new mathematical image-\nfiltering technique by the pinwheel-framelet processing method  \nT. Ueda, H. Tsunoda, H. Arai, E. Morishita, G. Akaike, S. Arai; Tokyo/JP \n(takueda@luke.or.jp)  \nPurpose: To investigate the usefulness distortion-weighted image (DiWI) that \nis processed by the new pinwheel-framelet processing method specific to \nenhance architectural distortion in digital mammography. \nMethods and Materials:  The institutional review board approved the \nretrospective study. A total of 100 pairs of digital mammograms in CC and \nMLO views in half with and in half without architectural distortion were selected \nfor the study. The diagnosis of a board-certified breast radiologist with 20 years \nexperience was used as the gold standard. Original mammograms were \nprocessed to DiWI, a digitally-filtered image using the pinwheel-framelet \nprocessing method that is newly developed by our group based on the \nmathematical modelling of human visual processing. A board-certified breast \nradiologist (R1) who has 10 years experience and a radiology-resident (R2) \nwho has 1 year experience of mammography assessed original digital \nmammograms with and without DiWI independently for the presence and the \ngrades of distortion of mammogram. The result was assessed by area under \ncurve (AUC) using receiver operating characteristic analysis. \nResults: The AUC without DiWI by R1 and R2 were 0.96 and 0.81 and the \nAUC with DiWI were improved to 0.98 and 0.89, respectively The AUC by R1 \nwas significantly lower than that by R2 (p < 0.01) but showed no significant \ndifference with DiWI (p=0.25). \nConclusion: DiWI improved the diagnostic accuracy to assess architectural \ndistortion of digital mammography, especially in less-experienced reader.  \nB-0335 11:24  \nOpportunistic breast cancer screening in the Netherlands  \nE. Paap1, J.M.H. Timmers1, H.M. Zonderland2, M.J.M. Broeders1, \nG.J. den Heeten1; 1Nijmegen/NL, 2Amsterdam/NL (e.paap@lrcb.nl)  \nPurpose: To compare the demand and indications for opportunistic breast \ncancer screening of women who are part of the target population of the Dutch \norganised programme (50-75) to women who are not invited for screening. \nMethods and Materials:  The study was conducted at the radiology \ndepartment of the Academic Medical Centre, Amsterdam, The Netherlands. A \ntotal of 1,000 randomly selected women were included: 500 in the age group \n40-49, and 500 in the age group 50-59. All included women were referred to \nthe hospital by their general practitioner and received a mammographic \nexamination between 1 January 2006 and 22 May 2011. Indications for referral \nS208  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nwere retrieved from medical records. Based on these indications, \nmammographic examinations were classified into three groups: opportunistic \nscreening, screening for women with increased familial risk and diagnostic \nexaminations. The proportion of opportunistic screening was compared \nbetween both age groups using the Chi-squared test. \nResults: There was no difference in the proportion of opportunistic screening \nin both age groups (28% versus 25% in the age groups 40-49 and 50-59, \nrespectively; p=0.549). Screening for women with increased familial risk (8% \nversus 7%) and diagnostic examinations (65% versus 68%) showed similar \nresults as well. \nConclusion: In contrast to our expectations, the proportional opportunistic \nscreening in the age group not invited for screening was similar to that in the \nage group invited for screening. A linkage with the screening register could \nimprove the assessment of opportunistic screening in the age group above 50.  \nAuthor Disclosures: \nG.J. den Heeten: Advisory Board; former member of the medical advisory \nboard of Matakina. \nB-0336 11:33  \nDoes a false positive recall for assessment deter women from \nsubsequent breast screening?  \nR. Sinnatamby1, A. Herbert2, S. Garnett3, C. Beattie4, J. Lavelle5, I. Lyburn6, \nA.J. Maxwell7; 1Cambridge/UK, 2London/UK, 3Preston/UK, 4Liverpool/UK, \n5Lancaster/UK, 6Cheltenham/UK, 7Manchester/UK \n(ruchi.sinnatamby@addenbrookes.nhs.uk)  \nPurpose: Potential harms of breast screening  include possible psychological \nmorbidity of recall and workup for benign or normal outcome. We have \nevaluated the subsequent failure to attend screening as a surrogate for this \npotential adverse effect. \nMethods and Materials:  A cohort of 253,017 women screened in 5 \ngeographically and demographically di fferent centres within a national \nprogramme were studied. Subsequent re-attendance rates in those who \nreceived a normal result were compared with those who were recalled for \nassessment with normal or benign outcome. Data was extracted from the \nnational database to assess effects of age, biopsy at workup and type of \nscreen, prevalent or incident. \nResults: Following a prevalent round screen, women were slightly but \nsignificantly more likely to re-attend after false positive recall than after a \nnormal examination (87.7% vs. 86.0%; 95% CI: 0.54% to 2.62%). Following \nincident round screens overall re-attendance was higher than in prevalent \nrounds (92.4% vs. 86.2%), with no signific ant difference after false positive \nrecall. However, women who underwent needle sampling or open biopsy were \n12% and 60% less likely to re-attend than women with a normal screen \n(p < 0.001). Odds of re-attendance decreased significantly with increasing age. \nConclusion: This study suggests that any psychological morbidity resulting \nfrom breast screening assessment does not deter most women from \nsubsequent attendance. Nevertheless invasive workup, particularly open \nbiopsy but also percutaneous biopsy, does have a deleterious effect on re-\nattendance and should be used prudently. \nResults from this study have been published online: J Med Screen, Aug 2013  \nAuthor Disclosures: \nR. Sinnatamby: Research/Grant Support; National Institute for Health \nResearch, Cambridge Biomedical Research Centre. A.J. Maxwell: \nResearch/Grant Support; NHS North West. \nB-0337 11:42  \nContralateral breast cancer: incidence according to ductal or lobular \nprimary phenotype: a large dual cancer registry-based study  \nN. Sharma1, F. Langlands1, J. White1, O. Kearns2, S. Cheung2, R. Burns2, \nK. Horgan1, D. Dodwell1; 1Leeds/UK, 2Birmingham/UK \n(fiona.langlands@nhs.net)  \nPurpose: Historically there has been an association between invasive lobular \ncarcinoma ILC and an increased risk of developing a contralateral breast \ncarcinoma. We aimed to identify any differences in the incidence of \ncontralateral breast cancer between patien ts with primary tumour diagnosis of \ninvasive ductal carcinoma (IDC) and ILC. \nMethods and Materials:  Data from the Northern & Yorkshire Cancer Registry \n& Information Service (NYCRIS) and the West Midlands Cancer Intelligence \nUnit (WMCIU) from 1998 - 2003 for all registered cases of invasive breast \ncancer of either pure ductal or pure lobular reported histology were obtained. \nThe invasive status of the contralateral tumour diagnosis and tumour \nmorphology was collected. Chi-Square tests were undertaken to examine the \ndifferences in contralateral rates for both registries and univariate analysis to \nascertain which predictors affected contralateral breast cancer risk in WMCIU. \nResults: A total of 38132 patients were studied, 32735 (86%) with IDC and \n5397 (14%) with ILC. There was no significant difference between the numbers \nof contralateral breast cancers according to original cancer histology, 901 \n(2·8%) patients with IDC vs 166 (3·1%) patients with ILC, p=0·169. The \nanalysis of WMCIU cases showed no association between original histology, \nage at diagnosis, tumour grade, use of radiotherapy for the primary cancer or \nuse of systemic therapy and development of a contralateral breast cancer. \nConclusion: There is no apparent increase in risk of developing a \ncontralateral breast cancer according to the primary cancer histology either \nIDC or ILC.  \nB-0338 11:51  \nIn the context of overdiagnosis, does size matter?  \nS. Bhuva, I. Haigh, M. McMahon, B. Dall, D. Dodwell, N. Sharma; Leeds/UK \n(shaheel.bhuva@gmail.com)  \nPurpose: The Marmot review showed that although breast screening saves \nlives, it is harmful through overdiagnosis; treating cancers that would not \notherwise have ever become clinically apparent. Currently, no size threshold \nexists for recalling screening patients with calcifications. Our aim was to assess \nwhether a minimum size threshold would reduce overdiagnosis. \nMethods and Materials:  We conducted a retrospective review of 375 \nscreening patients with microcalcifications over 24 months. We assessed all \npatients with pure calcifications \u000210 mm documenting core biopsy, final \nhistology and treatment. \nResults: 61 cases of microcalcifications \u000210 mm: 8 benign, 40 in situ cancers \nand 13 invasive cancers. This group was subcatagorised into calcifications: \n0\u00025 mm (24 patients) and 5 \u000210 mm (37 patients). In the '0 \u00025 mm' group, there \nwere 16 in situ (low grade 1; intermediate grade 7; high grade 8) and 2 \ninvasive cancers (G2 ductals ER/PR+Her2- node negative). In the '5 \u000210 mm' \ngroup, there were 24 in situ (low grade 3; intermediate grade 12; high grade 9) \nand 11 invasive cancers (4 G1ER+Her2- node negative; 6 G2: (5 ER+Her2-, 1 \ntriple negative). 1 of these 6 cases was node positive (micrometastasis) and 1 \nG3ERPR+Her2- node negative). All underwent wide local excision, and all but \none patient with invasive carcinoma received radiotherapy. \nConclusion: Recalling focal clusters of microcalcifications ( < 10 mm) identified \na high rate of cancers: 66%(40/61) in situ and 21% (13/61) invasive. Regarding \noverdiagnosis: 51% (27/53) of cancers were low/intermediate grade DCIS or \nG1 invasive and 49% (26/53) were high-grade DCIS or invasive G2/3. \nTherefore, size is not a key factor in reducing overdiagnosis.  \n10:30 - 12:00 Room G/H  \nGenitourinary  \nSS 507  \nProstate cancer: diagnosis, extension and \nrecurrence  \nModerators:  \nT. Durmus; Berlin/DE  \nJ. Richenberg; Brighton/UK  \nB-0339 10:30  \nMR accuracy for the diagnosis of prostate cancer  \nA.P. Moffa, R.L. Cazzato, R. Del Vescovo, B.B. Zobel; Rome/IT \n(angelomoffa@gmail.com)  \nPurpose: To determine the accuracy of mp-MRI for prediction of extracapsular \nextension (ECE) in patients with prostate cancer (PCa) classified as \"low risk\". \nMethods and Materials:  Thirty-one patients with biopsy-proved PCa \nunderwent endorectal MRI prior to radiation therapy. Histological features \nevaluated were Gleason score, affected lobe, greatest percentage of cancer in \nall core biopsy specimens, and percentage of cancer-positive core specimens \nin all core biopsy specimens. The likelihood of ECE was assessed \nretrospectively on the basis of MR five- points scale, where patients are divided \ninto two groups, A and B (Group A MR score <  3; Group B MR score \u00033). \nGroup B scores were considered suggestive for ECE. Pearson's chi-squared \ntest and t Student were used to correlate histological and clinical data with MR \nparameters for ECE. All the statistics were developed in the environment of \nMATLAB® (Math Works, Inc). A difference with P \n<.05 was considered \nsignificant. \nResults: In Group B serum PSA levels, percentage of cancer-positive core \nspecimens in all core biopsy specimens, and ADC values were predictors of \nECE ( P <.05). There is a trend of correlation between ADC values and PSA \nlevels (p=0.55); percentage of cancer-positive core specimens in all core \nbiopsy specimens and greatest percentage of cancer in all core biopsy \nspecimens (p=0.48); and ADC values and greatest percentage of cancer in all \ncore biopsy specimens (p= 0.11). \nConclusion: Detection of locally advanced disease improved substantially \nwhen MRI was added to routine clinical staging; mp-MRI is able to assess ECE \nin 39% of cases in ''low risk'' PCa patients.  \n \nS209  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0340 10:39  \nThe role of learning curves as a function of the expertise in the prostate \nMRI  \nF. Barchetti, V. Panebianco, C. Zini, V. Forte, I. Elena, C. Catalano; Rome/IT  \nPurpose: To evaluate the changing of sensitivity in detecting prostate cancer \n(PC) assessing the learning curves with the advance of experience. \nMethods and Materials:  900 patients who underwent a Mp-MRI examination \nof the prostate were independently retrospectively evaluated by 2 readers: \nreader A (R.A) and reader B (R.B). \nResults: 170 patients out of 900 were originally assessed negative for the \npresence of PC. R.A in 69 out of 170 patients detected subsequently an \naltered focus and 2 further suspecious areas in 30 men, while R.B detected a \nsuspecious lesion in 63 patients. 330 patients out of 900 in the first reading \nwere considered positive for an alte red focus: in the second reading R.A \ndiscovered a further area of suspiciuos malignancy in 157 patients, while R.B \nin 104 patients detected a further lesion. In 350 patients out of 900 initially \nwere estimated two suspicious zones: in the second reading, R.A discovered a \nfurther zone of suspected malignancy in 180 patients, while R.B in 121 patients \ndetected a further lesion. 50 patients ori ginally were considered positive for 3 \nsuspected areas: in the second reading session R.A discovered a further zone \nof suspected malignancy in 11 patients, while R.B in 5 patients. All in the \nsensitivity of R.A in detecting foci of mo rpho-functional changings increased \nfrom 61% to 97% and for R.B from 49% to 89%. \nConclusion: The sensitivity in detecting suspicious areas of PC increases \nsubstantially with the advance of the expertise reaching a detecting rate \nstatistically significant (P < 0.05).  \nB-0341 10:48  \nUtility of exponential apparent diffusion coefficient for evaluating \nperipheral zone prostate cancer at 3 T: preliminary experience  \nS. Park, C. Kim, B. Park, M. Cha; Seoul/KR (minjae.cha@samsung.com)  \nPurpose: To investigate the utility of exponential apparent diffusion coefficient \n(eADC) derived from diffusion-weighted imaging (DWI) in evaluating peripheral \nzone (PZ) prostate cancer at 3 T. \nMethods and Materials: 74 patients who had PZ cancers of 0.5 cm 3 or greater \non surgical specimens and performed DWI at 3 T were enrolled in this \nretrospective study. The eADC and ADC maps were obtained from DWI data, \nrespectively. Based on radiologic-patho logic correlation, both eADC and ADC \nvalues (×10\n-3 mm2/s) for cancers and benign PZ tissues were measured by two \nindependent radiologists, and the results  were compared. Contrast-to-noise \nratio (CNR) and signal-to-noise ratio (SNR) were measured on eADC and ADC \nmaps. The correlation between eADC or ADC values of cancers and Gleason \nscore was also assessed. Statistical analyses were performed using Wilcoxon \nsigned rank test, intraclass coefficient (ICC), Bland-Altman test, and Spearman \ncorrelation analysis. \nResults: The median eADC (0.48) and ADC (0.73) values of cancers were \nsignificantly different as compared with those of benign PZ (0.19 and 1.64, \nrespectively) (P < 0.001). For cancers, eADC showed good interreader \nagreement (ICC= 0.758) and interreader variability of 1.1%. The SNR was \nsignificantly greater in eADC than ADC (P < 0.001), while the CNR was similar \nbetween eADC and ADC (P= 0.241). A moderate correlation between eADC \n(rho= 0.690) and ADC (rho= -0.694) of cancers and Gleason score was seen, \nrespectively. \nConclusion: Our preliminary results suggest that eADC may be a useful \nimaging tool in evaluating PZ prostate cancers, with improved SNR compared \nwith ADC.  \nB-0342 10:57  \nPreoperative MRI improves the surgical outcome in patients with non-\npalpable prostate cancer in a randomised study  \nE. Rud, D. Klotz, K. Rennesund, A. Svindland, E. Baco, L. Eri, H.B. Eggesbø; \nOslo/NO (h.b.eggesbo@medisin.uio.no)  \nPurpose: The aim of this study was to evaluate whether MRI prior to \nprostatectomy improved the surgical outcome. \nMethods and Materials:  Prospective study including 411 patients randomised \nto MRI or not prior to prostatectomy (age: 63 ±8 years and PSA: 8.0±5.6 ng/ml). \nGleason score in biopsy were 6: 34%, 7a: 38%), 7b: 11%, 8: 15%, and 9: 2%. \nClinical T classification were: cT1: 54%, cT2: 43% and cT3: 3%. The MRI \nincluded high-resolution axial T2w images a nd DWI. Surgical excision was uni- \nor bilateral nerve sparing (UNS or BNS) or non- nerve sparing (NNS). Positive \nsurgical margins (sm+) was defined as extension of tumor into the cut surface. \nResults: The overall rate of sm+ (no MRI vs. MRI) was 23% vs. 20% (p=0.39). \nIn cT1, the rate of sm+ was 27% vs. 16% (p=0.05). No difference was found in \npatients with cT2 and cT3. The sm+ rate according to the surgical procedure \n(no MRI vs. MRI); BNS: 19% vs. 12% (p=0.33), UNS: 21% vs. 19% (p= 0.74), \nNNS: 30% vs. 25% (p=0.57). In pT2 and pT3, the rate of sm+ (no MRI vs. MRI) \nwas 8% vs. 5% (p=0.40) and 39% vs. 32% (p=0.36). In low, intermediate and \nhigh risk d'Amico groups, the rate of sm+ was 13% vs. 6% (p=0.32), 24% vs. \n23% (p=0.90) and 32% vs. 30% (p=0.77). \nConclusion: Preoperative MRI reduces the risk of positive surgical margins \nafter RALP in patients with non-palpable prostate cancer.  \nB-0343 11:06  \nIs there a role for functional MR techniques for the assessment of \nextracapsular extension in prostate cancer? A preliminary analysis with \nhistopathologic correlation  \nU.I. Attenberger\n1, S.O. Schönberg1, D. Hausmann1, A. Weidner1, \nJ.N. Morellini2, D.J. Dinter1, A. Haecker1, M. Sertdemir1; 1Mannheim/DE, \n2Texas, TX/US (ulrike.attenberger@umm.de)  \nPurpose: The presence of extracapsular extension (ECE) has significant \nimpact for treatment options in prostate cancer (PC). T2-w MRI-sequences are \nmost commonly used for preoperative assessment of ECE, with variable \naccuracy. The aim is to evaluate the diagnostic accuracy of T2w-imaging vs. \nquantitative DWI-MRI (ADC) and DCE-MRI parameters (plasma flow (PF), \nmean transit time (MTT)) for detection of capsular invasion (CI) and ECE. \nMethods and Materials:  Triplanar T2w-sequences of 34 patients with PC \nwere analysed prior prostatectomy by two blinded/experienced readers. DCE- \nand DWI-MRI were analysed by a third radiologist, in concordance to the \nhistopathological analysis. Sensitivity (SS) and specificity (SP) of T2w, ADC, \nPF and MTT for prediction of CI/ECE were determined by area-under-the-\nreceiver-operating characteristics analysis. ADC-, PF- and MTT-values were \nnormalised by the PC/normal tissue ratio. \nResults: By histopathologic analysis, 14/34 pa tients had ECE, 11/34 patients \nhad only CI and 9/34 patients had no ECE/CI. The interobserver agreement for \ndetection of ECE/CI of T2w-sequences was poor ( 5=0.1), SS/SP for detecting \nECE was 28/50%. PF-, MTT- and ADC-ratios in ECE differed significantly \n(p < 0.001) from cases without ECE. The AUC and SS/SP of ECE for PF-/MTT-\n/ADC-ratios was 0.98/92%/95%, 0.92/100%/80 and 0.69/86%/50%, \nrespectively. PF- and MTT-ratios between CI and without CI/ECE differed \nsignificantly (PF, p < 0.0001; MTT, p=0.0134), SS/SP, 84%/89% for PF and \nSS/SP, 52%/100% for MTT-ratios, no significant differences regarding ADC-\nratios could be identified. \nConclusion: ECE and CI can be assessed by quantitative DCE-MRI analysis \nwith great diagnostic confidence. Moreover, quantitative PF- and MTT-values \ndetect ECE/CI with greater specificity than ADC-value analysis.  \nB-0344 11:15  \nUsefulness of additional apparent diffusion coefficient (ADC) values to \nmorphologic MR imaging in predicts extracapusular extension (ECE) of \nprostate cancer  \nT. Manabe, M. Oda, E. Arai, Y. Kanai, M. Miyake, M. Komiyama, H. Nakanishi, \nM. Kusumoto, Y. Arai; Tokyo/JP (tmanabe@ncc.go.jp)  \nPurpose: In our previous study, we found that ADC values of prostate cancer \nwith ECE are significantly lower than those of without ECE. The purpose of this \nstudy was to assess the predictive value for ECE of prostate cancer of MRI \nusing morphologic (T2-weighted imaging [T2WI] and diffusion-weighted image \n[DWI]) alone and combined with ADC values. \nMethods and Materials:  This retrospective study included 230 patients who \nunderwent 3.0-T MRI before total prostatectomy. We reviewed morphologic \nMRI and graded the likelihood of ECE on a five-point scale. ROIs were placed \nin the dominant cancerous area.ADC values were calculated by at least square \n(b=0, 800, 1500).We consider the possibility of ECE is higher when the ADC \nvalues were lower, but it limited to the auxiliary role of the morphologic MRI. \nWe graded the likelihood of ECE on a five-point scale using additional ADC \nvalues to morphologic MRI. Diagnostic performance (area under receiver \noperating characteristic [ROC] curve: AUC), accuracy, sensitivity, specificity, \npositive predictive value (PPV), and negative predictive value (NPV) were \nevaluated. \nResults: AUC improved significantly after additional ADC values; AUC=0.8044 \n(MRI alone), AUC=0.8494 (MRI+ADC value), (p=0.0003). Morphologic MRI \nalone showed accuracy, sensitivity , specificity, PPV, and NPV of 73.5%, \n68.0%, 77.4%, 68.6% and 76.9%, respectively. Additional ADC values showed \naccuracy, sensitivity, specificity, PPV, and NPV of 79.1, 73.2%, 83.5%, 76.3% \nand 81.0%, respectively. \nConclusion: Additional ADC values to morphologic MR imaging improve the \npredictive value of ECE of prostate cancer.  \nS210  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0345 11:24  \n3 T diffusion tensor imaging (DTI) in the evaluation of periprostatic nerve \nbundle before and after radiation therapy  \nC. Zini, F. Barchetti, V. Forte, D. Musio, C. Catalano, V. Panebianco; Rome/IT \n(zini.chiara@gmail.com)  \nPurpose: To assess diffusion tensor imaging (DTI) at 3 T for evaluating the \nperiprostatic nerve bundle in terms of neuranatomical distribution, density and \nrelationship with the capsule before and after radiation therapy (RT). \nMethods and Materials:  63 patients were enrolled. All underwent a \nmultiparametric-MRI examination of the prostate at 3 T magnet (Discovery \nM750, GE) equipped with an endorectal and a surface coil, before and after 2 \nmonths of radiation treatment (35 cycles). Scan protocol included: a \nmorphological study obtained with TSE high-resolution T2-weighted sequences \non multiple plans, a dynamic study with contrast medium for localisation of the \nlesion, a diffusion study (DWI) with different b values (500.1000,3000) and DTI \ntechnique (fiber tracking) using a b value of 1000 with 16 directions. \nResults: In all cases, before RT it has been possible to display the \nperiprostatic nerve bundle in terms of anatomical distribution, density and \ndistance of the nerve fibers from the capsule; after RT we observed, \nrespectively, superposition of the findings in  27 patients, partial integrity of the \nfibers in 31 patients (loss of nerve fibers ranging from 19% to 35%, mean \n26.3%) and massive rarefaction of the nerve fibers in 5 patients (loss of nerve \nfibers ranging from 42% to 59%, mean 47.8%). These results compared with \nthe IIEF-5 test showed a statistically significative correlation (p < 0.05). \nConclusion: DTI technique allows a complete visualisation of the periprostatic \nnerve bundle and plays an important role in the evaluation of nerve fibers \ndamage in patients who underwent RT.  \nB-0346 11:33  \nPreoperative lymph node staging in patients with primary prostate cancer \nusing diffusion-weighted magnetic resonance imaging and [11C] choline \nPET/CT: which method is better?  \nT. Vag, M. Heck, A. Beer, M. Schwaiger, M. Souvatzoglou, M. Eiber; \nMunich/DE (tibor.vag@tum.de)  \nPurpose: Lymph node staging in primary prostate carcinoma using \nconventional Magnetic Resonance Imaging (MRI) and Computer Tomography \n(CT) relies on size measurements, in ove rall exhibiting low sensitivity and \nspecificity. New promising techniques including diffusion weighted imaging \n(DWI) and [11C]choline PET/CT can give additional functional information. The \naim of this study was to compare diagnostic performance of DWI and \n[11C]choline PET/CT in the assessment of preoperative lymph node status in \npatients with primary prostate cancer. \nMethods and Materials:  33 patients with primary prostate carcinoma \nunderwent DWI and [11C]choline PET/CT prior to radical prostatectomy and \nextended pelvic lymph node dissec tion. Functional parameters including \nmaximum standardised uptake value (SUVmax) and apparent diffusion \ncoefficient (ADC) of identified lymph nodes were measured and correlated with \nhistopathology. Performance of both modalities was compared by calculation \nof receiver operator characteristic (ROC) curve using histopathology as \nstandard of reference. \nResults: A significant difference between malignant and benign lymph nodes \nwas observed for mean ADC (1.16 vs. 0.93 mm2/s) and SUVmax (1.95 vs. \n4.31). ROC curve analysis revealed optimal ADC threshold of 1.01 mm2/s for \ndifferentiating benign form malignant lymph nodes with a corresponding \nsensitivity/ specificity of 77.41%/ 77.05% and an Area under the Curve (AUC) \nof 0.810. The optimal threshold for SUVmax was 2.66 with corresponding \nsensitivity/ specificity of 74.19%/ 80.49% and an AUC of 0.819. \nConclusion: DWI and [11C]choline PET/CT reveal a similar diagnostic \nperformance for pre-operative lymph-node staging of prostate cancer.  \nB-0347 11:42  \nDiscrimination of benign and malignant lymph nodes in prostate cancer: \ndiameter measurement vs DWI, ADC mapping or signal intensity at T2w-\nSTIR?  \nM. Regier, C. Seiwerts, F.O. Henes, H. Kooijman, G. Sauter, G. Adam, \nL. Budaeus; Hamburg/DE (mregier@uke.de)  \nPurpose: To determine the accuracy of quantitative MRI using diffusion-\nweighted MRI (DWI) and signal intensity measurement at T2w STIR in prostate \ncancer to compare these to histopathology. \nMethods and Materials:  59 consecutive patients at high-risk following \nD´Amico criteria underwent pelvic MRI one day before prostatectomy. A \nstandardised T2w STIR and DWI sequence were applied (b-values: \n0.25.75,100,200,500 and 900). Short (SAD) and long axis diameters (LAD) and \nmean and maximum signal intensity of pelvic nodes were recorded at T2w \nSTIR. ADC calculation was performed and mean (ADCmean) and minimum \nADCs (ADCmin) were determined. 1393 lymph nodes were removed and \nhistopathologic workup was performed. Sensi tivity, specificity, positive- and \nnegative-predicitve-values for the discrimination of benign and malignant \nnodes were calculated using Wilcoxon and chi-square test. \nResults: Histopathology revealed malignant nodes in 21 patients. In these \nnodes, the mean SAD and LAD were 8.3 mm (range, 3-14.2 mm) and 12.3 mm \n(range 4-27 mm). Applying a threshold of 0.98x10-3 mm2/s for the ADCmean \nonly 2 false positive findings were noted. The ADCmin was the most accurate \ndiscriminator allowing for correct identification of malignant nodes in all patients \nwith 100% specificty if a threshold of 0.74x10-3 mm2/s was applied. \nDetermination of mean (p=0.62) and maximum (p=0.07) signal intensities at \nT2w STIR did not proof any statistical significance for the discrimination of \nnodes. \nConclusion: Although the sensitivity rates of diameter measurement and DWI \nwere equivalent, assessment of the ADCmin proofed to be the superior \ndiscriminator with an accuracy of 100%. Signal intensity measurements at T2w \nSTIR have limited capability of detecting malignancy.  \nB-0348 11:51  \nThe role of combined 3 T DWI with MRS in the differentiation of loco-\nregional recurrence from residual glandular tissue after radical \nprostatectomy  \nC. Zini, F. Barchetti, V. Forte, M. Bernieri, V. Panebianco, C. Catalano; \nRome/IT (zini.chiara@gmail.com)  \nPurpose: To distinguish between loco-regional recurrence and residual \nglandular healthy tissue using 3 T DW I and MRS after radical prostatectomy \n(PR). \nMethods and Materials:  60 patients who underwent RP with persistence of \nminimum PSA values or modest rise of PSA values within 6 months (range \nbetween 0.2 ng/ml and 1.5 ng/ml) were enrolled for 3 T multiparametric-MRI \nexamination. The protocol included: a morphological study with high-resolution \nT2-weighted sequences, a dynamic study with T1-weighted GRE sequences \nacquired after intravenous administration of contrast medium, a diffusion-\nweighted (DWI) study with exponential b-values (0, 500, 1000, 3000) and \nthree-dimensional multivoxel spectroscopic sequence (MRS). Each patient was \nevaluated independently by two radiologists. MRI results were validated by \ntransrectal ultrasound biopsy. \nResults: In all cases, a solid tissue (size between 8 mm and 23 mm) was \nidentified in T2 morphological images. In 49 patients (81%) DWI and MRSI \ndemonstrated features of malignancy (ADC values ranging from 0.3 to \n1.1 mm2/s and a choline-plus-creatine-to-citrate ratio CC/C in at least 3 \nadjacent voxels > 0.8. In the remaining 11 patients (19%) DWI and MRS \nshowed benign features (ADC values > 1.2 mm2/s and a CC/C in at least 3 \nadjacent voxels < 0.5. All MRI findings were confirmed by histological Results: \n39 patients had loco-regional recurrence and 11 patients had residual \nglandular tissue. \nConclusion: The combination of DWI and MRS is proved to be a very reliable \ntool for distinguish beetween loco-regional recurrence and residual glandular \ntissue after RP.  \n10:30 - 12:00 Room I/K  \nNeuro  \nSS 511  \nPaediatric neuroimaging and \ndevelopmental anomalies  \nModerators:  \nV. Mendes Pereira; Geneva/CH \nA. Rovira-Cañellas; Barcelona/ES  \nB-0349 10:30  \nHigh-resolution MRI using orbit surface coils vs conventional MRI in the \nevaluation of metastatic risk factors in children with retinoblastoma  \nS. Sirin, M. Schlamann, K.A. Metz, N. Bornfeld, M. Holdt, B. Schweiger, \nF. Nensa, P. Temming, S.L. Goericke; Essen/DE (selma.sirin@uk-essen.de)  \nPurpose: Conventional MRI is a well-accepted, non-invasive imaging modality \nfor the evaluation of tumor extension in children with retinoblastoma. First \nstudies using high-resolution MRI with orbit surface coils were promising. The \naim of this study therefore was to assess if high-resolution MRI using orbit \nsurface coils is superior to conventional MRI regarding the depiction of \nmetastatic risk factors in children with retinoblastoma. \nMethods and Materials:  66 children (25 female, 41 male, mean age 18.9 \nmonths, 67 enrolled eyes) underwent conventional MRI using a standard head \ncoil on 1.5 T. After the administration of Gadolinium additional high-resolution \nT1-weighted sequences were acquired with orbit surface coils. Two reviewers \nevaluated both Gadolinium-enhanced T1-weighted sequences regarding the \npresence of metastatic risk factors (postlaminar optic nerve infiltration, \nS211  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nchoroidal invasion, orbital fat invasion). Histopathologic evaluation after \nenucleation served as reference standard. \nResults: Depiction of metastatic risk factors increased with high-resolution MRI \nusing orbit surface coils: Sensitivity and specificity for the detection of \npostlaminar optic nerve infiltration were 70.0%/87.7% with high-resolution MRI \nusing orbit surface coils and 40.0%/86.0% using conventional MRI. High-\nresolution MRI using orbit surface coils additionally increased the detection \nrate of choroidal invasion (sensitivity/specificity 73.7%/93.8% vs. \n31.6%/93.8%). There was one patient with orbital fat invasion in the patient \ngroup, which was only detected in the images acquired with the orbit surface \ncoil. \nConclusion: High-resolution MRI using orbit surface coils is superior to \nconventional MRI using a standard head coil for the evaluation of metastatic \nrisk factors in children with retinoblastoma.  \nB-0350 10:39  \n\"White matter choking signs\" for diagnosis of focal cortical dysplasia on \n3 T MR imaging: retrospective analysis of 165 cases with multi-modality \nmetabolic imaging and radio pathological correlation  \nR. Vadapalli, S. JS, M. Panigrahi; Hyderabad/IN (rammohanvsv@yahoo.com)  \nPurpose: To describe two new signs called \"White Matter Choking Sign\" and \n\"WM Choking extended\" useful for diagnosis of FCD. \nMethods and Materials:  165 patients in age group of 6-44 years with \nrefractory epilepsy were included in the retrospective study imaged using Both \nTLE and ETLE (extra temporal lobe epilepsy) protocols on a 3 T MRI system \n(Achieva ,Philips Health care, Netherlands) with a 3D T1, 3D T2, 3D T2 FLAIR \nfor detection of occult dysplasia. The data was viewed and post-processed \nusing a Philips Portal Work station and Advantage Windows (GE health care \nsystem) to generate 3D corticographs of normal, abnormal areas and \ncorrelated with multimodal imaging and pathology. \nResults: Three patterns emerged in our series of histopathologically proved \nFCD. The FCDS analysed were as follows: 1B (56), IIA (33), IIB (27), III (39). \nSudden truncation or choking of sub-cortical white matter with blurring of \ninterface (White Matter Choking sign) has positively correlated with Focal \ncortical dysplasia in 82%, WM choking sign underlying a cortical laminar \narchitectural abnormality (White Matter  choking Extended sign) has positively \ncorrelated with type IB and Type IIA- 92%, abnormal Medullary Spike Pattern \nwas seen in Cingulate gyral FCD (n=4), Para sagittal Cortical Ribbon dysplasia \nof type IB (n=7). Type 1B and IIA: sensiti vity 92%, specificity 81%, Type IIB \nsensitivity 92%, specificity 70%; specificity of type IIB improved with presence \nof trans mantel sign (n=27) to 95%. \nConclusion: White Matter Choking Sign and White Matter choking Extended \nsign offer optimal sensitivity and specificity for MRI detection of FCD.  \nB-0351 10:48  \nIsolated craniosynostoses: is cranial sutures ultrasonography helpful?  \nS. Bernardo, P. Sollazzo, V. Vinci, M. Saldari, P. Cascone, G. Saponaro, \nL. Manganaro; Rome/IT (silviabernardo@live.it)  \nPurpose: The aim of this study is to demonstrate the effectiveness of the use \nof ultrasound as a diagnostic and follow-up tool in newborn children affected by \ncraniostenoses. \nMethods and Materials:  Between May 2011 and July 2012, 23 children aged \nbetween 1 month and 8 months were referred to our operative unit for \nabnormal head shape or small head diameter. We selected 17 children, whose \nclinical findings were clinically suggestive for craniostenosis or head molding. \nAll patients underwent an ultrasound examination and, those positive for \ncraniostenosis or with an uncertain diagnosis also underwent CT scan \nexamination; US scan and CT scan were performed within one week from \nclinical examination. \nResults: Five infants had normal appearance of the cranial sutures on US. In \n12/17 infants, US identified premature closure of one or more cranial sutures. \nIn one case, US was not able to determine the real closure of right coronal \nsuture and a six months follow-up was needed. \nConclusion: In our experience ultrasound examination has shown to be an \neffective, fast, inexpensive and nonrisky method for diagnosis and \nassessments in children with craniostenoses, and was able to detect the \npresence of synostosis in all patients affected with a 100% match with CT scan \nexamination.  \nB-0352 10:57  \nPrenatal detection of abnormal hippocampal development in \nlissencephaly  \nB. Kunzendorf, E. Schwartz, G. Langs, D. Prayer, G. Kasprian; Vienna/AT \n(n0742368@students.meduniwien.ac.at)  \nPurpose: To detect and quantify differences in the hippocampal morphology \nbetween normal foetuses and cases with lissencephaly. \nMethods and Materials:  Standardised coronal T2-weighted foetal MR (1.5 \nTesla) sequences of 19 cases with the neuropathological/follow-up imaging \ndiagnosis of lissencephaly were compared to 36 normal foetuses (age range \n20-39 gestational weeks - GW). The boundaries of the hippocampi were \nsegmented using ITK Snap in order to define 4 lines, using 4 characteristic \nhippocampal landmarks and 3D Slicer. 4 angles between these lines were \nmeasured. A midline served as a reference to assess the positioning of the \nhippocampus as a whole. \nResults: Normal age-related reduction of hippocampal angles (r²=0.387;.000) \ncould not be observed in lissencephaly cases (r²=.010;.674). In lissencephaly, \nthe angles were significantly wider than in normal age matched controls \n(p=.000; Welch's Test). Only two angles were sufficient to discriminate healthy \nfrom lissencephaly fetuses with a sensitivity of 80% and a specificity of 94.4%. \nNormals showed left/right differences in one angle (p=0.009; paired t-test), \nwhereas in lissencephaly cases, 3 angles were asymmetric (p=.031;.021;.045; \npaired t-test). The rotation of the main axis from vertical to horizontal was less \npronounced in lissencephaly on the right side (p=.005; Welch's Test). \nConclusion: Geometrical 2D analysis provides insights into normal and \nabnormal patterns of prenatal hippocampal morphology and adds valuable \nquantitative data to detect and characterise fetal brain pathologies. \nInterhemispheric differences have to be taken into account.  \nB-0353 11:06  \nFoetal cortical pattern analysis in commissural dysgenesis  \nG. Kasprian, E. Schwartz, G. Langs, P. Brugger, D. Prayer; Vienna/AT \n(gregor.kasprian@meduniwien.ac.at)  \nPurpose: To detect and describe abnormalities and differences in cortical \nfolding patterns of foetuses with commissural dysgenesis (CD). \nMethods and Materials:  Three orthogonal T2-w sequences (1.5 Tesla, slice \nthickness 4.4 mm, FOV 230 mm, TE=140 ms) of 12 foetuses with isolated, \npartial and associated forms of CD were retrospectively analysed. 2D pattern \nanalysis consisted of cortical contour delineation (coronal plane) and 2D shape \nmodelling using a multivariate Gaussian model. For 3D modelling axial, coronal \nand sagittal sequences were combined in to isotropic volumes (resolution 0.78-\n1.02 mm) using intra-slice motion correction and super-resolution \nreconstruction. In these, the shape of the manually delineated cortical contour \nwas described using a 3D Gaussian model. Results were compared to 12 age-\nmatched foetuses with normal cerebral development. \nResults: Hemispheric asymmetry patterns are less pronounced in the acallosal \ngroup of foetuses as demonstrated by 2D pattern analysis. Hemispheric \nasymmetries were less pronounced in the perisylvian brain regions in CD \ncases. 3D modelling could readily visualise the dynamic cortical folding \npatterns in CD foetuses and could detect sublte differences to normal controls. \nConclusion: 2D and 3D modelling and pattern analysis are computerised, \nquantitative methods to detect even sub tle differences of atypical cortical \nfolding patterns of foetuses with CD. In future, these tools may be further \nsuitable to differentiate cases of isolat ed CD with adverse neurodevelopmental \noutcome from those with close to normal development.  \nB-0354 11:15  \nUnexpected brain MRI findings in research volunteers  \nP.A. Rowley, A. Field, E. Simcock, A. Munoz Del Rio, H.A. Rowley; Madison, \nWI/US (hrowley@uwhealth.org)  \nPurpose: Brain MRI scans performed in neuroscience studies have revealed a \nrange of unexpected findings in normal volunteers. The incidence and types of \nabnormalities have not been well established in a large population, and best \npractice for dealing with such findings is  controversial. We undertook this study \nto analyse abnormalities discovered by expert MRI readers in a large group of \nchildren and adult research volunteers. \nMethods and Materials:  6441 consecutive subjects ( < 1 to 94 years) were \nrecruited from a single institution, referred from over 100 IRB-approved brain \nresearch studies. All scans were uploaded to PACS and interpreted by \nNeuroradiologists using an on-line structured report. Research technologists \nand staff were also prospectively asked to document concerns discovered \nwhile scanning or processing. \nResults: On formal neuroradiologic review, normal results were found in \n5205/6441 (80.8%). Among 1236 abnormals, 982/6441 (15.2%) were \ncategorised as follow-up not mandatory; and in 254/6441 (3.9%) follow-up was \nrecommended. Less than 1% of the abnormalities were prospectively correctly \nflagged by research staff. No correlations were established between abnormal \nresults and either gender or age. When volunteers were contacted regarding \nabnormal findings, they were almost universally grateful for the information, \nand opted for additional clinical evaluation. \nConclusion: Potentially clinically significant abnormalities are seen in nearly \n4% of children and adults who volunteer for research brain MRI scans, and \nthese are only rarely accurately identified by research staff. Routine expert \nRadiologic review of all such scans can help facilitate clinical referral when \nindicated.  \nAuthor Disclosures: \nH. Rowley: Consultant; GE, Bracco, Guerbet, Gore, Genentech, and \nLundbeck. \nS212  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0355 11:24  \nNormal variations of the falx cerebri shape based on MR data  \nA.-A. Al-Jebaly, M.A. Alkubayyer, I. Alorainy; Riyadh/SA  \nPurpose: Evaluation of the normal variations of falx cerebri shape based on \nMR data. \nMethods and Materials:  We retrospectively reviewed 2313 consecutive brain \nMR exams done in 2012. Falx cerbri and supratentorial compartment were \nmanually traced on the mid-sagittal contrast-enhanced T1WI. The falx shape \nwas assessed by evaluation of falx height and area. Falx height was measured \nfrom the highest point at its inferior edge to a reference line (RL) drawn from \njunction of the inferior sagittal and straight sinuses to crista galli. Falx area was \nmeasured in reference to the entire supratentorial compartment area. \nStatistical analysis was performed using ANOVA and Chi-square test. \nResults: 170 exams satisfied our inclusion crit eria (adults with exams including \ncontrast-enhanced sagittal T1WIs of slice thickness 1.5 mm or less). We \nidentified three falx shapes. Type-I with D/RL ratio less than 0.33, type-II with \nratio (0.33 - 0.67), and type-III with ratio more than 0.67. These types were \nseen in 3%, 68%, and 29% of the cases, respectively. There was significant \ndifference in the height between the three types (p=0.025). No significant \ndifference was observed in the absolute falx area (p=0.592), however, a \nsignificant difference in the percentage of falx area to the entire supratentorial \ncompartment area (p=0.019) was noted. \nConclusion: Falx cerbri shape can be clustered into 3 types. The percentage \nof falx area to the entire supratentorial compartment area is different in these \ntypes. This finding may guide future studies to develop a biomarker of \nsubfalcine herniation risk depending on the falx shape type.  \nB-0356 11:33  \nModality specific activations in working memory in children treated for \ncerebellar medullobastoma: an fMRI study  \nD. Hoang, A. Pagnier, E. Cousin, K. Guichardet, I. Schiff, F. Dubois-Teklali, \nA. Krainik; Grenoble/FR (hoang_ducha@yahoo.fr)  \nPurpose: Children treated for a cerebellar medulloblastoma demonstrated \ncognitive disorders in working memory  (WM), especially visuospatial WM, \nleading to an impairment of school performance. The purpose of recent study \nis to describe the cerebellar involvement in specific cognitive deficits observed \nin these children. \nMethods and Materials:  Nine healthy volunteers children (11.1 ± 2.2 yo), were \ncompared to 5 patients treated for cerebellar medulloblastoma (12.1 ±0.6 yo). \nAll subjects were native French speakers, right-handed, with a global IQ of 70-\n130. The participants were examined through 4 block-design 1-back tasks in \nthe sensorial modality (visual/auditory) and the nature of the cues \n(verbal/nonverbal), using BOLD fMRI. Data was analysed by ANOVA with 2x2 \nfactorial design, using SPM8 and SUIT (spatially unbiased infra-tentorial and \ncerebellar template). \nResults: 4/5 patients had a WM deficit following a resection of the left posterior \ncerebellar lobe (CrusI/II, lobule VIIb/VIII/IX) and inferior part of vermis; the only \npatient without WM deficit was the only one without this region resection. \nBOLD activations for visual vs. auditory  and nonverbal vs. verbal contrast were \nfound in the left posterior cerebellar lobe of healthy subject group. \nConclusion: The cerebellum plays the same role in WM in children as that has \nbeen previously described in adults. The left posterior cerebellar lobe may \ninvolve the visuospatial WM.  \nB-0357 11:42  \nValue of DSA in the diagnostic workup of pulsatile tinnitus  \nC. Deuschl, S. Göricke, G. Lehnerdt, O. Kastrup, O. Müller, M. Forsting, \nM. Schlamann; Essen/DE (cornelius.deuschl@uk-essen.de)  \nPurpose: Pulsatile tinnitus is a rare complaint, which can be a symptom of \nseveral pathologies, e.g. dural arteriovenous fistula (DAVF), arteriovenous \nmalformation (AVM), intracranial stenosis or glomus tympanicum \nparaganglioma. The current diagnostic pathway includes an extensive \nneurological examination, cranial MRI and diagnostic digital subtraction \nangiography (DSA) as gold standard in imaging. This retrospective study \nevaluates the additional diagnostic impact of DSA for diagnostic workup in \ncomparison to MRI. \nMethods and Materials:  Fifty-four consecutive patients with pulsatile tinnitus \ntreated in our institution between 2002 and 2013 were included in this \nretrospective study. All patients had a diagnostic workup including DSA and \ncerebral MRI. MRI examinations were blinded for DSA results and \nretrospective analysed by two experienced neuroradiologists ( > 10y) in \nconsensus. All MRI sequences were analysed separately. \nResults: DSA revealed pathologic findings in 37 of the 54 patients. 26 patients \nhad DAVF, two patients had AVM, two patients a galeal AV fistula, four \npatients glomus tympanicum paraganglioma, two patients carotid-sinus-\ncavernosus-fistula and three patients had other pathologies. All pathologies, \nwhich caused the pulsatile tinnitus were detected by MR imaging. \nConclusion: In our study DSA revealed no further information in patients \nwithout any detectable MRI pathology. We suggest that cranial MRI-protocol \nshould contain a time-of-flight-angio graphy (fistula, stenosis), a contrast-\nenhanced-angiography of the supraaortal  vessels (fistula, stenosis), a fat-\nsaturated, contrast-enhanced T1-weighted sequence of the skull base \n(paraganglioma) and a T2-weighted sequence (fistula, paraganglioma). DSA is \nonly recommended when MRI is suspicious for pathology. For the grading of \nfistula DSA is still mandatory.͒͒   \nB-0358 11:51  \nPostmortal developing of ADC measured with ex vivo DWI of the brain: a \ncomparison study of in vivo and ex vivo  \nJ. Yamamura1, S. Keller1, B. Schönnagel1, T.M. Schmidt1, R. Fischer2; \n1Hamburg/DE, 2Oakland, CA/US (s.keller@uke.de)  \nPurpose: Changes in water diffusion can be quantified by diffusion-weighted \nMR imaging; for example, to diagnose ischemic stroke. However, there are \nonly few works about changes in post-mortem brain. The aim of this study was \nto examine for a typical developing of ADC after death and to compare the \nvalues to in vivo brain. \nMethods and Materials: 21 corpses were scanned (13 male, 8 female). Mean \nage was 75.5 ± 0.7 years and mean weight 74.2 ± 18.3 kg. All died a natural \ncause of death. They were scanned with a 1.5 T MRT (Siemens Magnetom \nSymphony; Erlangen, Germany). Scans were repeated in time lags of 1 h. \nDiffusion-weighted imaging (DWI) was performed with b values of 0 and 100. \nAn ADC-mapping was calculated in thalamus, cerebrum and cerebellum. The \nso-obtained values were then statistically compared to healthy volunteer ( n=5) \nand to the literature. Student t test was performed for statistical analyses. \nResults: The ADC in the three examined regions (cerebrum, cerebellum, \nthalamus) decreased during the examination in a characteristical way. The \nallocation of ADC values between ex vivo and in vivo is significantly different \nand can be described by a Gaussian distribution ( p \n< 0.005). \nConclusion: Ex vivo ADC values are signific antly different to the in vivo \nliterature values. Post-mortem DWI of the brain may be able to help to assess \nthe time of death.  \n10:30 - 12:00 Room L/M  \nAbdominal Viscera  \nSS 501  \nMRI of diffuse liver disease  \nModerators:  \nT. Denecke; Berlin/DE  \nN. Papanikolaou; Iraklion/GR  \nB-0359 10:30  \nIntravoxel incoherent motion diffusion-weighted imaging for staging \nhepatic fibrosis  \nS. Ichikawa, U. Motosugi, H. Morisaka, K. Sano, T. Ichikawa; Chuo-shi, \nYamanashi/JP  \nPurpose: To investigate the relationships between the degree of hepatic \nfibrosis and parameters calculated using intravoxel incoherent motion (IVIM) \nimaging of the liver. \nMethods and Materials:  We included 100 patients, divided into 3 groups: \ngroup A, without hepatic fibrosis (n=41); group B, with chronic liver disease (F1-\nF3) (n=20); group C, with cirrhosis (n=39). IVIM imaging was used to acquire \ndiffusion-weighted images at 11 b values (0, 10, 20, 30, 40, 50, 80, 100, 200, \n500, and 1000 s/mm 2). The diffusion coefficient of pure molecular diffusion (D), \ndiffusion coefficient of micro circulation or perfusion-related diffusion (D*), \nperfusion-related diffusion fraction (f), and apparent diffusion coefficient (ADC) \nwere compared among the 3 groups. Receiver operating characteristic curve \nanalysis was also performed to determine the optimal cut-off value and \naccuracy of IVIM and MR elastography (MRE) for staging hepatic fibrosis. \nResults: Only mean D* value was significantly different amongst the 3 groups \n(group A, 76.0 × 10 -3 mm2/s; group B, 64.2 × 10 -3 mm2/s; group C, 57.9 × 10 -\n3 mm2/s; P < 0.0001). There were no significant differences in the D (P = \n1.0000), f (P = 0.1563), and ADC values (P = 0.3435). The Az values for \ndiagnosing the degree of hepatic fibrosis  were as follows (D* value vs. MRE): \n\u0003group B, 0.9649 vs. 0.9801 (p = 0.3741); \u0003group C, 0.9606 vs. 0.9871 (P = \n0.1765). \nConclusion: As hepatic fibrosis progresses, the hepatic perfusion reduced, \nand was effectively detected by IVIM imaging. IVIM is reliable technique for \nevaluating hepatic fibrosis as well as MRE.  \n \n \n S213  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0360 10:39  \nUtility of hepatobiliary phase in the Gd-EOB-DTPA-enhanced MR imaging \nin the differentiation of simple steatosis and nonalcoholic steatohepatitis.  \nM. Takechi, T. Tsuda, G. Koiwahara, H. Tanaka, T. Mochizuki; Ehime/JP  \nPurpose: To evaluate the utility of hepatobiliary phase in the gadolinium \nethoxybenzyl diethylenetriaminepentaacetic acid-enhanced MR imaging (EOB-\nMRI) in differentiating SS (simple steatosis) from NASH (nonalcoholic \nsteatohepatitis). \nMethods and Materials:  From August 2009 to March 2013, histologically \nproven 27 patients (11 SS and 16 NASH) who underwent both EOB-MRI and \nin-phase/out-of-phase imaging were enrolled. The liver-to-spleen contrast ratio \n(L/S ratio = signal intensity of the hepa tic parenchyma/signal intensity of the \nspleen) and liver-to-muscle signal intensity ratio (LMSIR = signal intensity of \nthe hepatic parenchyma / signal intensity of the paraspinal muscle) were \ncalculated in the hepatobiliary phase of EOB-MRI, signal intensity loss on out-\nof-phase T1-weighted images (fat fraction), which were compared between SS \nand NASH groups. The correlations between histological stage/grade and L/S \nratio or LMSIR were explored. \nResults: The L/S ratio and LMSIR in NASH were significantly lower than those \nin SS (p = 0.01, 0.008). There was no difference in fat fraction between SS and \nNASH groups (p = 0.767). In SS and NASH groups, the L/S ratio (r = -0.515, p \n= 0.007) and LMSIR (r = -0.476, p = 0.014) were significantly correlated with \nthe fibrosis stage. Fat fraction in NASH was strongly correlated with the \nsteatosis score (p < 0.0001, r = 0.876). \nConclusion: In SS and NASH groups, the L/S ratio and LMSIR in the \nhepatobiliary phase of EOB-MRI were useful imaging markers to differentiate \nSS from NASH, showing significant association with fibrosis stage.  \nB-0361 10:48  \nEffect of extended delay time on the degree of liver enhancement on Gd-\nEOB-DTPA-enhanced MRI in patients with parenchymal liver disease  \nY. Esterson, M. Flusberg, S. Oh, F. Mazzariol, A.M. Rozenblit, V. Chernyak; \nBronx, NY/US (vichka17@hotmail.com)  \nPurpose: To compare hepatic parenchymal enhancement on the hepatobiliary \nphase (HBP) obtained at 20 vs 30 minutes delay in patients with parenchymal \nliver disease (PLD). \nMethods and Materials:  This retrospective study included subjects with PLD \nwho underwent Gd-EOB-DTPA-enhanced MRI of abdomen from May until \nAugust 2013, where HBP was obtained at both 20 and 30 minutes delay. For \neach case, presence of biliary opacification with Gd-EOB-DTPA and signal \nintensity (SI) of the liver, main portal vein (PV) and spleen were recorded on \npre-contrast, 20 and 30 minutes HBP. The following indices were calculated for \nboth 20 and 30 minutes HBP: liver relative enhancement (LRE) = (SI\nHBP - \nSIpre)/SIpre, liver/spleen index (LSI) = (SI liver/SIspleen)HBP/(SIliver/SIspleen)pre, liver/PV \nindex (LPI) = (SIliver/SIPV) HBP/(SIliver/SIPV)pre. \nResults: There were 64 subjects, 34 (53.1%) men, mean age 58.8 years \n(±11.7), median MELD score 40.9 (IQR 9.0 - 44.9). Biliary opacification was \npresent in 56 (87.5%) of 64 subjects on 20 minutes HBP and in 62 (96.9%) of \n64 subjects on 30 minutes HBP (p < 0.05). Mean LRE  were 0.46 ( ±0.3) at \n20 minutes and 0.48 (± 0.3) at 30 minutes, p < 0.03. Mean LSI were 1.27 (±0.3) \nat 20 minutes and 1.35 ( ±0.4) at 30 minutes, p < 0.0001. Mean LPI  were 1.11 \n(±0.4) at 20 minutes and 1.18 (±0.4) at 30 minutes, p < 0.0001. \nConclusion: Extending delay time of HBP to 30 minutes improves degree of \nliver enhancement and rate of biliary opacification in patients with PLD.  \nB-0363 10:57  \nSuccess rate of three MRI protocols for liver iron measurements  \nJ.H. Runge, E.M. Akkerman, A.J. Nederveen, J. Stoker; Amsterdam/NL \n(j.h.runge@amc.uva.nl)  \nPurpose: Several MRI-methods with particular benefits and drawbacks are in \nuse for measuring liver iron concentration (LIC). Examples include MR-\nrelaxometry (R2 and R2*) and the Gandon-method. We assessed the success \nrate of these three methods. \nMethods and Materials:  All patients undergoing LIC-measurements in our \ncentre between January 2008 and December 2012 were retrospectively \nincluded. LIC-measurements consisted of the Gandon-, R2- and R2*-methods. \nRegions-of-interest were drawn by one observer. R2 and R2* were calculated \nusing bi- and monoexponential signal  decay functions, respectively. Rician \nnoise bias was approximated by the pythagorean addition of an extra fit \nparameter to these functions. Gandon-data were converted online to a LIC-\nvalue in \u0001mol/g, which has an upper detection limit of 340 \u0001mol/g. All iron \nlevels above this limit are given as > 350 \u0001mol/g. The relationships between \nmethods were assessed with Spearman's correlation coefficient (r\ns). \nResults: A total of 122 LIC-measurements were performed in 99 patients. \nGandon-, R2*- and R2-data were successfully acquired in 90/99 (91%), 98/99 \n(99%) and 59/99 (60%) baseline measurements, respectively. Correlations r\ns \nbetween Gandon-R2*, Gandon-R2 and R2*-R2 for LIC < 350 \u0001mol/g were near \nperfect at 0.97 (P < 0.001, n=77), 0.88 (P < 0.001, n=47) and 0.91 (P < 0.001, \nn=51), respectively. LIC was > 350 \u0001mol/g in 14 subjects. For these R2* and \nR2 correlated at rs=0.73 (P=0.04, n=8). \nConclusion: Our data suggest that the Gandon- and R2*-methods are \npreferable over the R2-method for LIC-measurement in terms of success rate. \nGiven that R2* is also sensitive for iron detection in subjects with LIC > 350 \n\u0001mol/g, R2* seems the method of choice.  \nB-0364 11:06  \nThe role of iron in elevation of liver enzyme levels in steatosis: a non-\ninvasive assessment in general population by magnetic resonance \nimaging  \nA. Radmard, M. Dadgostar, A. Yoonessi, A. Hashemi Taheri, H. Poustchi, \nS. Merat, R. Malekzadeh; Tehran/IR (amir.radmard@gmail.com)  \nPurpose: To investigate whether hepatic iron content can affect liver enzyme \nlevels in subjects with non-alcoholic fatty liver disease (NAFLD) and non-\nalcoholic steatohepatitis (NASH) using non-invasive assessment by MRI. \nMethods and Materials:  The study was carried out on 207 subjects randomly \nselected from general population, aged 50-77 years, who underwent liver MRI \nincluding in-phase/opposed-phase and multiechoT2*-weighted sequences. \nDiagnosis of steatosis was made by a combination of ultrasound and MRI. \nQuantitative T2*maps of entire cross-sectional area of liver was calculated on a \npixel-by-pixel basis using a semi-automated software to measure meanT2* of \nwhole liver. \nResults: The mean T2*values were significantly lower in fatty liver group \ncompared with normal individuals (p=0.02). Male subjects with NASH had \nstatistically lower T2* than NAFLD group in multivariate analysis (OR 0.71, \n95% CI 0.53-0.95), while this was not demonstrated in female subjects. Unlike \nwomen, there was negative significant correlation between ALT level and \nT2*values in men with NASH and NAFLD (r=-0.77vs. r=-0.45, respectively). \nEvery 1 IU/ml increment in ALT was associated with 9.07 milliseconds \ndecrease in T2* (95% CI, 3.8-14.3, p=0.003) in men with NASH. \nConclusion: Estimated hepatic iron content in MRI is directly correlated with \nliver enzyme level in men, which may support the role of iron in possible \nprogression to NASH in simple steatosis. In contrast, lack of such correlation in \nwomen could be attributed to relatively lower liver iron storage.  \nB-0365 11:15  \nAccuracy of liver fat quantification by CT, MRI and US: a prospective \ncomparison with magnetic resonance spectroscopy (MRS)  \nH. Kramer\n1, P.J. Pickhardt2, M.A. Kliewer2, D. Hernando2, G.-H. Chen2, \nS.B. Reeder2; 1Munich/DE, 2Madison, WI/US (harald.kramer@med.lmu.de)  \nPurpose: The hallmark feature of non-alcoholic fatty liver disease (NAFLD) is \nthe accumulation of triglycerides within hepatocytes (steatosis), which causes \ninflammation, fibrosis, and cirrhosis. MR-spectroscopy (MRS) is regarded as \nthe non-invasive standard for quantification of tissue triglycerides. The purpose \nof this study was to evaluate the accuracy of quantitative chemical shift-\nencoded MRI, dual-energy CT (DECT) and ultrasound (US) to quantify \nsteatosis. \nMethods and Materials:  25 patients (56 ±5 years, 10m/15f) scheduled for CT-\ncolonography (CTC) were recruited. All underwent CTC, MRS, MRI and US \nwithin 2 hours. 3 MRS voxels were placed throughout the liver; DECT, MRI and \nUS measurements were subsequently co-localised. For CT, Hounsfield Units \n(HU) as well as fat density (FD) derived from DECT were recorded. For MRI, \nproton density fat-fraction (PDFF) measured from the chemical shift-encoded \nmethod (IDEAL-IQ), and for US, shear-wave velocity, SNR and attenuation \nwere recorded. Data were analysed using linear regression for each technique \ncompared to MRS. 2-sided Student t-tests (0.05 significance level) were used \nwith the hypothesis that the slope coefficient is zero. \nResults: There was excellent correlation between MRS-PDFF vs MRI-PDFF \n(r\n2=90.57-98.46, p < 0.05) and CT-HU (r 2=89.97-92.38, p < 0.05). CT-FD \nshowed moderate correlation with MRS-PDFF (r 2=50.75-59.14, p < 0.05). None \nof the US based metrics showed reliable correlation with MRS-PDFF \n(r2< 20.32, p> 0.05). \nConclusion: We evaluated different non-invasive modalities to serve as \nbiomarkers for evaluation of NAFLD. Quantitative chemical shift MRI-PDFF \nand CT-HU showed excellent correlation to MRS-PDFF. Material \ndecomposition with DECT (CT-FD) did not improve the accuracy of fat \nquantification. US was not accurate for liver-fat quantification.  \nAuthor Disclosures: \nH. Kramer: Grant Recipient; UW Madison Radiology R&D. P.J. Pickhardt: \nGrant Recipient; NIH. Research/Grant Support; NIH. M.A. Kliewer: \nResearch/Grant Support; NIH. D. Hernando: Research/Grant Support; NIH. G. \nChen: Research/Grant Support; NIH. S.B. Reeder: Grant Recipient; NIH. \nResearch/Grant Support; Bracco Diagnostics. \nS214  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0366 11:24  \nComparison of modified dixon-sequences and H1-spectroscopy for \nquantitative assessment of liver steatosis in patients with gestational \ndiabetes  \nN.N. Kammer, C. Lütke Daldrup, E. Coppenrath, A. Lechner, U. Ferrari, \nM.F. Reiser, S. Wirth, T. Saam, H. Hetterich; \nMunich/DE (holger.hetterich@med.uni-muenchen.de)  \nPurpose: Patients with gestational diabetes have a substantial increased risk \nfor the development of type-2 diabetes. Liver steatosis has been identified as \nan independent risk factor for diabetes. H1-spectroscopy is an established \nmethod to measure liver fat content but is restricted to small voxel elements, \nlong acquisition time and complicated  post-processing. Fast-modified Dixon \nsequences (mDixon) have been shown to be an alternative for liver fat \nassessment. Aim of this study was to compare mDixon with H1-spectroscopy \nfor quantitative assessment of liver fat content. \nMethods and Materials:  Patients with a history of gestational diabetes within \nthe last 6 months underwent both H1-spectroscopy (STEAM, TE 10 ms, TR \n2000 ms, FA 90, voxel size 1.5x1.5x1.5 cm³) placed in segment VII of the liver \nand mDixon imaging (TE first 1.5 ms/second 2.7 ms, TR 4.1 ms, FA 10) at a 3 \nTesla scanner. \nResults: 54 patients (mean age 28.5 ±4.1 years, mean BMI 27 ±3.7) were \nincluded. H1-spectroscopy (average acquisition time 8 minutes) and mDixon \nsequences (average acquisition time 30 seconds) were successfully \nperformed. Liver fat content was significantly higher in the mDixon sequences \ncompared to H1-spectroscopy (5.1 ±6.5% vs. 2.4 ±5.7%, p < 0.001). Correlation \nbetween both techniques was excellent (Pearsons' R 0.96). Inter-reader \nagreement was excellent for both acquisition techniques, with an intraclass-\ncorrelation coefficient of 0.97 and 0.96, respectively. \nConclusion: This study demonstrated an excellent correlation between \nmDixon and H1-spectroscopy for measurements of liver fat content. However, \nabsolute values are higher with the mDixon sequence. Other fat compartments \nsuch as abdominal fat can also be assessed by mDixon within the same \nsequence.  \nB-0367 11:33  \nAre MR diffusion-weighted, hepato-specific contrast-enhanced and \nsusceptibility-weighted imaging surrogate markers for advanced liver \nfibrosis detection in chronic liver disease patients?  \nD.S. Feier\n1, C. Balassy2, N. Bastati2, A. Ba-Ssalamah2; 1Cluj-Napoca/RO, \n2Vienna/AT (diana.feier@gmail.com)  \nPurpose: To assess whether apparent diffusion coefficients (ADC) using \ndiffusion-weighted imaging (DWI), signal intensity measurements on \nsusceptibility-weighted imagines (SWI), and measurements of gadoxetic acid-\nenhanced liver parenchyma intensity correlate with histologically proven \nfibrosis, and to compare their diagnosti c value as non-invasive methods for \nliver fibrosis staging. \nMethods and Materials:  Seventy-six patients underwent a 3 T MRI \nexamination [including DWI, gadoxetic acid-enhanced T1-weighted MRI, and \nSWI sequences] and liver biopsy. Fibrosis was staged using the Metavir \nscoring system: F0 (n=17, 21.2%); F1 (n=10, 12.5%); F2 (n=12, 15%); F3 \n(n=11, 13%); and F4 (n=26, 37.5%). Signal intensity (SI) of the liver was \ndefined using region-of-interest measurements to calculate the mean ADC \nvalues, the relative enhancement (RE) in the hepatobiliary phase (20 minutes \nafter gadoxetic acid administration), and the liver to muscle ratio (LMR) \nmeasurements for SWI. The diagnostic performance of the three parameters \nfor distinguishing F0-F2 (no to moderate fibrosis) from F3-F4 (severe fibrosis) \nwas assessed using receiver operating characteristics (ROC) analysis. \nResults: Liver fibrosis correlated strongly with SWI LMR (r=-80, p < 0.0001) \nand moderately with RE (r=-61, p < 0.000) and mean ADC (-0.58, p < 0.0001). \nThe best diagnostic performance in detecting severe liver fibrosis was obtained \nfor LMR SWI measurements, with an AUROC of 0.90 (Se=98%, Sp=69.4%). \nRE measurements and DWI performed comparably, with an AUROC of 0.85 \n(Se=88.2%, Sp=91.3%), and 0.77 (Se=67.3%, Sp=85.7%), respectively. \nConclusion: The diagnostic performance of DWI, gadoxetic acid-enhanced \nMRI, and SWI to identify patients with severe liver fibrosis was comparable in \nour cohort, but the AUROC values favour SWI as the best diagnostic modality.  \nB-0368 11:42  \nComparison of mDixon sequences and T1-weighted images in the \ndetermination and quantification of adipose tissue compartments with \nwhole-body 3 T-MRI  \nH. Hetterich, C. Lütke Daldrup, E. Coppenrath, A. Lechner, U. Ferrari, S. Wirth, \nT. Saam, N.N. Kammer; Munich/DE (holger.hetterich@med.uni-muenchen.de)  \nPurpose: T1-weighted (T1w) images can quantify fat distribution patterns, \nwhich have a predictive value for the development of chronic diseases like \ntype-2 diabetes. Modified Dixon sequence (mDixon) can generate fat only \nimages with high contrast between fat and lean tissue. Aim of this study was to \nevaluate mDixon for assessment of fat-distribution in whole-body MRI using \nT1w as reference standard. \nMethods and Materials:  Ten healthy volunteers (6 female; age: 24 ±3 years; \nBMI 22.3±3.8) had a whole-body MRI at 3 Tesla using axial T1w and mDixon \nsequences. Bodies were divided into five anatomic regions (upper extremity, \nhead/neck, thorax, abdomen, lower extremity) and subcutaneous, visceral and \nwhole body fat was determined using a dedicated software analysis tool. \nImage quality and image contrast, specifically the ability to differentiate fat from \nsurrounding tissue, were assessed using a visual analogue scale from 1-5 \n(VAS, 5=best). \nResults: 50 anatomical regions were evaluated in each sequence. There was \nno significant difference in relative total body and relative visceral fat content in \nmDixon and T1w (total: 30.7 ±6.4% vs. 30.7 ±6.3%, p=1.0, visceral: 6.6 ±2.7% \nvs. 6.7± 3.1%, p=0.82). All measurements showed an excellent correlation \n(total: Pearson's R=0.99 for total and R=0.88 for visceral body fat). The VAS \ndisplayed a significant better image quality and contrast of the mDixon both for \nsubcutaneous (3.6 ±0.5 vs. 4.3 ±0.6, p=0.001) and visceral fat (3.0± 0.0 vs. \n4.7±0.5 > p=0.001). \nConclusion: mDixon provides better tissue contras t for the quantification of \nadipose tissue compared to conventional T1w and quantitative results do not \ndiffer significantly between these two sequences.  \n10:30 - 12:00 Room N/O  \nVascular  \nSS 515  \nDevelopments in MR imaging  \nModerators:  \nD. Brisbois; Liege/BE  \nR.N. Planken; Amsterdam/NL  \nB-0369 10:30  \nNon-contrast-enhanced quiescent interval single-shot MR angiography at \n3 Tesla in patients with advanced peripheral arterial occlusive disease  \nK.M. Thierfelder1, G. Meimarakis1, K. Nikolaou1, W.H. Sommer1, P. Schmitt2, \nM.F. Reiser1, D. Theisen1; 1Munich/DE, \n2Erlangen/DE (kolja.thierfelder@med.uni-muenchen.de)  \nPurpose: The aim of this study was to assess the diagnostic performance of \nnon-contrast-enhanced ECG-gated quiescent interval single-shot (QISS) \nmagnetic resonance angiography at 3 Tesla in patients with advanced \nperipheral arterial occlusive disease (PAOD). \nMethods and Materials:  A total of 21 consecutive patients with advanced \nPAOD (Fontaine stage IIb and higher) referred for peripheral magnetic \nresonance angiography (MRA) were included. Imaging was performed on a 3 T \nwhole body MR scanner. Image quality and stenosis diameter were evaluated \nin comparison to contrast-enhanced continuous table and TWIST MRA (CE-\nMRA) as standard of reference. QISS images were acquired with a thickness \nof 1.5 mm each (high-resolution QISS, HR-QISS). Two blinded readers rated \nthe image quality and the degree of stenosis for both HR-QISS and CE-MRA in \n26 predefined arterial vessel segments on 5-point Likert scales. \nResults: With CE-MRA as the reference standard, HR-QISS showed high \nsensitivity (94.1%), specificity (97.8%), positive (95.1%), and negative \npredictive value (97.2%) for the detection of significant ( \u0003 50%) stenosis. \nInterreader agreement for stenosis assessment of both HR-QISS and CE-MRA \nwas excellent ( 5-values of 0.951 and 0.962, respectively). As compared to CR-\nMRA, image quality of HR-QISS was significantly lower for the distal aorta, the \nfemoral and iliac arteries (each with p < 0.01), while no significant difference \nwas found in the popliteal (p = 0.09) and lower leg arteries (p = 0.78). \nConclusion: Non-enhanced ECG-gated HR-QISS performs very well in \nsubjects with severe PAOD and is a good alternative for patients with a high \nrisk of nephrogenic systemic fibrosis.  \nB-0370 10:39  \nMagnetic particle imaging (MPI): direct quantification of vascular stenosis  \nJ. Haegele1, J. Rahmer2, R.L. Duschka1, C. Schaecke1, N. Panagiotopoulos1, \nJ. Tonak1, J. Borgert2, J. Barkhausen1, F.M. Vogt1; 1Lübeck/DE, \n2Hamburg/DE (julian.haegele@uksh.de)  \nPurpose: Purpose of this study was to visualise and quantify different vascular \nstenoses using Magnetic Particle Imaging (MPI). \nMethods and Materials:  Nine standardised stenosis-phantoms were used, \neach featuring a circular lumen of 10 mm diameter. The lumen narrowed \nconically to different circular stenose s of 1 mm diameter amounting to 99% of \nthe cross section, 2 mm/96%, 3 mm/91%, 4 mm/84%, 5 mm/75%, 6 mm/64%, \n7 mm/51%, 8 mm/36% or 9 mm/19%, respectively. For MPI, the phantoms \nwere filled with a dilution of 5% Resovist (Bayer Pharma). Images were \nacquired using a pre-clinical MPI-demonstrator (Philips Research, Hamburg, \nS215  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nGermany). For comparison, the same stenosis-phantoms were evaluated with \ncontrast-enhanced CT and MRI (Siemens Definition AS64, 12% Imeron 300 \n(Bracco Imaging); Philips Achieva 1.5 T, 3% Gadovist (Bayer Vital)). \nResults: MPI was able to visualise all stenoses accurately but the highest \n(1 mm/99%; spatial resolution of about 1x3x3 mm^3). CT exhibited the highest \nspatial resolution, followed by MRI, both modalities were able to visualise all \nstenoses. MPI was able to detect the residual lumen of the 1 mm/99% stenosis \nusing signal quantific ation. Furthermore, it was possible to reliably quantify the \nextent of the stenoses down to 5 mm/75%. Higher grade stenoses were \nunderestimated, the stenosis of 84% was measured as 75%, 91% as 79%, \n96% as 81% and 99% as 90%. \nConclusion: Direct quantification of vascular stenoses using MPI is possible. \nIn current experimental MPI-systems, signal interferences can aggravate the \nMPI-signal of smaller objects, thus distorti ng their quantification. However, MPI \nis still able to detect small structures like residual lumina in high grade vascular \nstenosis using the raw MPI-signal.  \nAuthor Disclosures: \nJ. Rahmer: Employee; Philips Research.  \nB-0371 10:48  \nHigh-resolution TOF MRA at 7T versus DSA for assessment of \narteriovenous malformations  \nL. Umutlu, K. Wrede, C. Moenninghoff, P. Dammann, S. Johst, M. Forsting, \nM. Schlamann; Essen/DE (Lale.Umutlu@uk-essen.de)  \nPurpose: The aim of this trial was to compare the diagnostic competence of \nhigh-resolution 7 Tesla TOF MRA with digital subtraction angiography (DSA) \nfor assessment of AVM. \nMethods and Materials: 15 patients with known AVM prospectively underwent \npretreatment DSA and a 7 Tesla MRA (Magnetom 7T, Siemens Healthcare) \nobtaining a high-resolution Time-of-flight MRA (voxel size of 0.2 x 0.2 x \n0.2 mm3). Two readers in consensus evaluated the delineation of the AVM (1) \nnidus, (2) feeder, (3) drainer, and (4) relationship between AVM and the \nadjacent brain structures (5) vessel-tissue contrast as well as (6) artifact \nimpairment for both datasets using a 5-point scoring system. \nResults: Both imaging modalities provided high-quality vessel delineation. \nDSA yielded excellent ratings for assessment of AVM related features (e.g. \nmean nidus 4.7; mean feeder vessel 4.9). 7T TOF MRA approached equally \nhigh scoring for evaluation of AVM related items (mean nidus 4.6; mean feeder \nvessel 4.8). Furthermore, 7T TOF MRA allowed for assessment of the \nrelationship between AVM and adjacent brain structures. Only minor \nimpairments due to signal variations were noted for MR imaging (mean 4.5). \nConclusion: Based on the increased spatial resolution and high-quality \nvessel-tissue contrast, ultra-high-field TOF MRA enables superior assessment \nof AVM and its associated vessel structures.  \nB-0372 10:57  \nNon-contrast-enhanced T1w MRA of the lower extremity vessels at 7 \nTesla  \nA. Fischer, S. Maderwald, S. Johst, S. Orzada, M.E. Ladd, K. Nassenstein, \nT.C. Lauenstein, L. Umutlu; Essen/DE (anja.fischer@uk-essen.de)  \nPurpose: Investigation of the feasibility of non-contrast-enhanced (NE) T1-\nweighted MRA of the lower extremity arteries at 7 Tesla (T) and comparison to \ncontrast-enhanced (CE) MRA at 1.5 T. \nMethods and Materials: 12 healthy volunteers were examined on a 7T whole-\nbody MR-system utilising a custom-built 16-channel transmit/receive coil and a \nmanually positionable AngioSURF table for multi-station imaging. T1w NE-\nTurbo-FLASH imaging with phonocardiogram gating was acquired covering the \nvasculature from pelvis to feet. 7 subjects underwent a concomitant ce-MRA at \n1.5 T (1M-gadobutrol 0.1 mmol/kg BW). Qualitative image analysis and \npresence of artifacts were assessed using a five-point scale in the (1) iliacal, \n(2) femoral, (3) popliteal, (4) tibiofibular and (5) foot segment. Contrast-ratios \n(CR) of the analysed arterial segments and adjacent soft tissue were obtained \nfor quantitative assessment. \nResults: Both MRA techniques provided an overall high-quality conspicuity of \nthe arterial vasculature, with 7T Turbo-FLASH imaging yielding a \nhomogeneously hyperintense delineation of the non-enhanced arteries. While \n7T NE-MRA showed slight artifact impairment in all assessed arterial segments \n(e.g. iliacal 4.21, feet 4.6), 1.5 T ce-MRA only showed focal minor impairment \nof the foot segment (4.7). Quantitative analysis revealed equivalent contrast \nratios for most assessed segments in both MRA techniques, with superior \nmean values for 1.5 T ce-MRA for the iliacal (NE-7T 0.50, ce-1.5 T 0.86) and \nfemoral (NE-7T 0.66, CE-1.5 T 0.78) arteries. \nConclusion: Our results demonstrate high-quality imaging of the lower \nextremity arteries with 7 Tesla non-contrast-enhanced T1w MRA, yielding \ncomparable image quality to 1.5 T CE-MRA.  \nAuthor Disclosures: \nL. Umutlu: Consultant; Bayer AG. \nB-0373 11:06  \nNon-enhanced T1-weighted imaging of the visceral arteries at 7 Tesla  \nA. Fischer, O. Kraff, S. Maderwald, K. Beiderwellen, T.C. Lauenstein, \nL. Umutlu; Essen/DE (anja.fischer@uk-essen.de)  \nPurpose: Aim of the study was to assess the feasibility of different non-\ncontrast-enhanced T1-weighted (w) sequences for imaging of the visceral \narteries of the upper abdomen at 7 Tesla. \nMethods and Materials: 10 healthy volunteers were examined on a 7T whole-\nbody MR-system utilising a custom-built 8-channel transmit/receive coil. The \nfollowing non-enhanced sequences were acquired: T1w 2D_FLASH, T1w \n3D_FLASH and Time of flight (TOF)-MRA in transversal orientation. The \ndelineation of the following visceral arteries was evaluated: right and left \ncommon hepatic artery, coeliacal and splenic artery, superior and inferior \nmesenteric artery. For qualitative analysis, image quality and the presence of \nartifacts were assessed using a five-point scale. Contrast ratios of the above \nnamed arteries in correlation to adjacent liver tissue or psoas muscle were \ncalculated for quantitative assessment. \n \nResults: All three sequences provided a homogenous hyperintense \ndelineation of the assessed visceral arteries. TOF-MRA provided best overall \nimage quality (TOF 4.17, 2D_FLASH 3.42, 3D_FLASH 3.46) and highest mean \nvalues for image quality for all analysed vessel segments as well as least \nimpairment due to artifacts (overall artifacts TOF 4.08, 2D_FLASH 3.50, \n3D_FLASH 3.46). Quantitative image analysis confirmed the superiority of the \nTOF sequence showing significant higher CR values for all visceral arteries \ndue to an effective suppression of background signal (e.g. right hepatic artery \nTOF 4.25, 2D_FLASH 3.54, 3D_FLASH 3.33; p < 0.05). \nConclusion: Non-contrast-enhanced T1w imaging in general and, TOF-MRA \nin particular, appear to be promising techniques for good quality assessment of \nvisceral arteries without the need of contrast media at 7T.  \nAuthor Disclosures: \nL. Umutlu: Consultant; Bayer AG. \nB-0374 11:15  \nContrast enhanced MR angiography of renal arteries in living kidney \ndonors - comparison with CT-angiography  \nK. Sulkowska, P. Palczewski, M. Sawicka, M. Golebiowski; Warsaw/PL  \n(zlakasia@tlen.pl)  \nPurpose: CT angiography (CTA) is regarded the gold standard in noninvasive \nassessment of abdominal arteries, however it has a burden of ionizing \nradiation. The purpose of our study was to assess the quality of images of \nrenal arteries in living kidney donors acquired with MR angiography (MRA) and \ncompare them with CTA. \nMethods and Materials:  40 potential living kidney donors were examined. \nCTA was performed on a 64-row scanner (Aquilion, Toshiba, Japan). 150 ml of \ncontrast medium was administered in a triphasic automatic injection. MRA was \nperformed on 1.5 T unit (Ingenia, Philips, The Netherlands). Contrast medium \nin a dose of 0.2 ml/kg body weight was injected at a rate of 2 ml/s. The MRA \nimages were acquired with T1 3D sequence. The number and size of renal \narteries were assessed in both studies. The quality of renal artery images in \nMRA was assessed with a four-point scale (very good, good, bad, vessel not \nvisualised). \nResults: CTA showed 108 arteries supplying 80 kidneys. In MRA, 107 arteries \nwere visualised - one 2 mm extra artery was not detected. The quality of \nimages was very good in 93 cases (87%), good in 8 (7.5%), and bad in 6 \n(5.5%). Features of fibromuscular dysplasia were not detected in one artery in \nMRA. In 45% of arteries, 1-2 mm underestimation of diameter occurred in \nMRA. In the remaining cases, the measurements were concordant. \nConclusion: MRA shows a good agreement with CTA, however \nunderestimation of arterial diameter may lead to serious discrepancies in \nselected cases.  \nB-0375 11:24  \nContrast paramagnetic enhancement of coronary atherosclerotic lesions \nas extension of CE-MRI of the heart  \nW.Y. Ussov, E.E. Bobrikova, E.A. Vusik, A.A. Bogunetsky, P.I. Lukyanenok, \nS.G. Goltsov; Tomsk/RU (wolfussov@yandex.ru)  \nPurpose: We evaluated the CE-MR imaging of atherosclerotic plaques in \npatients with coronary atherosclerosis and recent myocardial infarction. \nMethods and Materials:  22 patients with verified coronary atherosclerosis \nwere studied, 10 with predominantly right coronary artery disease and 12 with \nstenosis of the left circumflex coronary artery. The CE MRI study of the heart \nwas carried out using T1-w scan with end-diastolic ECG gating obtaining 7 mm \nslices of the whole heart. TR was 450 ms, TE = 15 ms, matrix 256 E 256, with \nvoxel 0.1 _ 0.12 mm. Paramagnetic was injected as 2 ml of 0.5 M solution per \n10 kg of BW. For the atherosclerotic plaque itself and arterial wall outside the S216  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nplaque, the index of image enhancement was calculated as ratio of intensities \non T1-w.SE scan. \nResults: When analysed visually the T1-w CE-MR scan provided sure \ndelineation of stenoses of coronary arteries due to uptake of paramagnetics to \nthe plaque. In patients of control group, the RCA IE was 1.08 ± 0.06, and LCA \nIE 1.09 ± 0.07. The atherosclerotic plaque in infarction-dependent LCA \ndemonstrated IE as high as 1.54 ± 0.22, whereas in infarction-dependent LCA \nthe plaque was enhanced with IE=1.42 ± 0.18. Also the areas of infarction-\ndependent arteries far from plaques demonstrated mild enhancement with IE in \nranges 1.16-1.18. No significant correlation was revealed between IE and \ndegree of stenoses or LV contractility indices. \nConclusion: CE-MRI of coronary atherosclerotic plaques can be suggested as \naddition to CE myocardial studies for better depiction of atherosclerosis.  \nB-0376 11:33  \n3D non-contrast-enhanced, ECG-gated MR angiography of the lower \nextremities at 3.0 T: comparison with contrast-enhanced MR angiography  \nM. Rasper, M. Wildgruber, M. Settles, H.-H. Eckstein, C. Reeps, \nA. Zimmermann, E.J. Rummeny, A. Huber; \nMunich/DE (michael.rasper@tum.de)  \nPurpose: To determine objective and subjective image quality and diagnostic \nconfidence of non-contrast-enhanced ECG-gated MR angiography (NE-MRA) \nof the lower extremities compared to gadolinium-enhanced MR angiography \n(CE-MRA) at 3.0 Tesla. \nMethods and Materials:  27 patients with PAOD underwent multistep, ECG-\ngated 3D T2-weighted TSE NE-MRA (TRANCE, TR=1000 ms, TE=75 ms, \nvoxel size 1.7x1.7x4 mm). Systolic and diastolic datasets were acquired after \nindividual planning of the diastolic acquisition window. After subtraction, MIP \nprojections were calculated. CE-MRA was performed within the same \nexamination at a 3.0 T MR system (Ingenia, Philips). CNR was determined for \nthe iliacal, femoral and popliteal arteries. Subjective image quality (5-point-\nscale), sensitivity and specificity for detection of arterial stenoses and \nocclusions (1: no stenosis, 2: 1-49%, 3: 50-74%, 4: 75-99%, 5: occlusion) was \ndetermined. \nResults: CNR was 25.7 ± 1.4 for NE-MRA and 28.4 ± 1.6 for CE-MRA (p=ns). \nSubjective image quality was 4.4 ± 0.1 vs. 4.7 ± 0.1 for NE-MRA and CE-MRA \n(p=ns). Lesions (grade 3-5) were detected with a sensitivity and specificity of \n98.4% and 93.4% compared to CE MRA. The degree of stenosis was \noverestimated in 24.7% and underestimated in 3.5% by NE-MRA. \nConclusion: NE-MRA of the lower extremities at 3.0 T is a promising method \nin patients with severe renal dysfunction (risk of nephrogenic systemic fibrosis). \nAlthough providing slightly inferior subjective image quality and a lower CNR \ncompared to CE-MRA, NE-MRA (TRANCE) offers an alternative MR \nangiography method for patients with PAOD and renal failure with acceptable \nhigh diagnostic accuracy.  \nB-0377 11:42  \n7T vs 1.5 T TOF MRA for assessment of intracranial aneurysms: the more \nTesla, the better?  \nL. Umutlu, K. Wrede, C. Moenninghoff, S. Johst, P. Dammann, M. Forsting, \nM. Schlamann; Essen/DE (Lale.Umutlu@uk-essen.de)  \nPurpose: Aim of this trial was to compare the diagnostic ability of 1.5 versus 7 \nTesla TOF MRA for assessment of intracranial aneuryms. \nMethods and Materials:  17 subjects were examined on a 1.5 Tesla \n(Magnetom Aera, Siemens Healthcare) and Time-of-flight MRA with a voxel \nsize of 0.7x0.7x0.7 mm3 was obtained. Subsequently all subjects underwent a \n7 Tesla examination (7T whole-body MR system; Magnetom 7T, Siemens \nHealthcare) with a voxel size of 0.2 x 0.2 x 0.2 mm3. Two radiologists in \nconsensus assessed the delineation of the (1) aneurym dome, (2) neck, (3) \nparent vessel, (4) vessel tissue contrast and (5) image impairment due to \nartifacts. For qualitative analysis a 5-point scale was used (5= excellent \ndelineation; 1= non-diagnostic). Contrast ratios (CR) of all aneurysms and \nadjacent parenchyma were calculated. A Wilcoxon rank test was performed for \nanalysis of statistical significance. \nResults: According to qualitative analysis 7 Tesla TOF MRA yielded \nsignificantly superior delineation of dome (mean 7T:=4.5; mean 1.5 T= 3.2; \np < 0.5) and neck (mean 7T=4.6; mean 1.5 T=3.3; p <.05) over 1.5 MRA. \nBased on increased signal alterations, 7T MRA showed slightly decreased CR \nof aneuryms to adjacent parenchyma (mean 0.60) over 1.5 MRA (CR mean \n0.66; p < 0.05), also reflected in increased image impairment of subjective \nratings (mean 7T=3.8; mean 1.5 T=4.5). \nConclusion: High-resolution 7T TOF MRA may bear the potential to provide \nsuperior assessment of the aneurysms and their related vessel-features based \non high-quality vessel-tissue contrast and imaging at improved spatial \nresolution.  \n \nB-0378 11:51  \nWhole brain 3D-black-blood 3 T-MRI for the diagnosis of CNS vasculitis: a \nfeasibility study  \nN.N. Kammer1, E. Coppenrath1, H. Kooijman2, M.F. Reiser1, T. Saam1; \n1Munich/DE, 2Hamburg/DE (nora.kammer@med.uni-muenchen.de)  \nPurpose: Although 2D-T1w black-blood sequences are able to detect \natherosclerotic and inflammatory changes of intracranial vessels they are time \nextensive and thus limited to a small field-of- view. We sought to evaluate a \ncommercially not available isotropic 3D whole-brain-black-blood T1w-TSE \nsequence with variable flip angles (3D-BB-VISTA) for the diagnosis of cerebral \nvasculitis. \nMethods and Materials:  10 patients with suspected vasculitis and 15 tumor \npatients without any evidence of vascular disease received a standardised \nprotocol (T1w pre- and post contrast, TOF, DIFF, T2, FLAIR) and a T1w 3D-\nBB-VISTA sequence pre- and post contrast (resolution=0.8 mm isotropic, scan-\ntime 4:56 minutes). Left and right arteries of the anterior and posterior \ncirculation (100 arterial segments) were evaluated by two experienced readers \nin consensus decision for the presence of stenosis and contrast enhancement \nof the vessel wall. \nResults: 3 out of 40 (7.5%) arterial segments in patients with suspected \nvasculitis showed focal contrast enhancement and luminal narrowing (1x left \nvertebral artery, 2x left middle cerebral artery). These findings were found in \nthree distinct patients in which vasculitis was clinically confirmed. One patient \nwith sickle-cell disease had a stenosis and concentric wall thickening without \ncontrast enhancement. None of the 60 arterial segments of the tumor patients \nshowed any signs of contrast enhancement or luminal narrowing. \nConclusion: Whole-brain-black-blood MRI is feasible in less than 10 minutes \nscan time and allows to accurately diagnosing CNS vasculitis. Future studies \nwill be necessary to evaluate the utility of this sequence for other vascular \npathologies, such as arterial dissection and atherosclerosis.  \n10:30 - 12:00 Conf. Room M3  \nInterventional Radiology  \nSS 509  \nTransarterial chemoembolisation (TACE)  \nModerators:  \nK. Malagari; Athens/GR  \nK. Zelenak; Martin/SK  \nB-0379 10:30  \nExperimental study on transarterial administration of VEGF siRNA \ncombined with transarterial chemoembolisation in rats with \nhepatocellular carcinoma  \nT.J. Vogl\n1, J. Qian2, E. Oppermann1, U. Imlau1, A. Tran1, H. Korkusuz1, \nW.O. Bechstein1; 1Frankfurt a. Main/DE, 2 Wuhan/CN \n(t.vogl@em.uni-frankfurt.de)  \nPurpose: To evaluate the effects of transarterial administration of vascular \nendothelial growth factor siRNA (VEGF siRNA) combined with transarterial \nchemoembolisation (TACE) vs. TACE alone for the treatment of hepatocellular \ncarcinoma (HCC) in rats. \nMethods and Materials:  Subcapsular implantation of a solid Morris-hepatoma \n3924 A in the liver was carried out in 20 male ACI rats (day 0). Tumor volume \n(V1) was measured by MRI (day 12). After laparotomy and retrograde \nplacement of a catheter into the gastroduodenal artery, the following agents of \ninterventional treatment were injected into the hepatic artery (day 13): (A) \nTACE (0.1 mg mitomycin+0.1 ml lipiodol+5.0 mg degradable starch \nmicrospheres)+2.5nmol VEGF siRNA (n=10); (B) TACE alone (control group, \nn=10). Tumor volume (V2) was assessed by MRI (day 25) and tumor growth \nratio (V2/V1) was calculated. Western blot analysis was performed to assess \nthe protein expression level of VEGF in each treatment. Quantization of \npositive VEGF tumor cells was carried out by immunohistochemical \nexamination in all rats. \nResults: The mean tumor growth ratios (V2/V1) were 1.2853 ±0.1568 in group \nA (TACE+VEGF siRNA) and 3.0239 ±0.2098 in group B (TACE alone). Group A \nshowed significant inhibition of tumor growth ( P \n< 0.01) compared with the \ncontrol group B. There were significant  differences in VEGF expression levels \nbetween group A and group B by Western blot analysis ( P < 0.01). Lower \nexpression of VEGF in HCC was observed in group A vs. group B by \nimmunohistochemical examination (P < 0.05). \nConclusion: Combined TACE and transarterial administration of VEGF siRNA \nis more effective than TACE alone for growth inhibition of HCC in rats.  \nS217  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0380 10:39  \nImportance of supply of right inferior phrenic artery to segment VIII \nhepatocellular carcinoma for trans-arterial chemoembolisation  \nH. Saleem, A.I. Rana, M. Jehangir, E.M. Kiani; Islamabad/PK  \n(dr.hassan173@gmail.com)  \nPurpose: The purpose of the study is to evaluate arterial supply by the right \ninferior phrenic artery (RIPA) of segment VIII hepatocellular carcinoma (HCC) \nand its importance in trans-arterial chemoembolisation (TACE). \nMethods and Materials:  From July 2011 to August 2013, 176 patients \nunderwent TACE for hepatocellular carcinoma. Pre- and post-\nchemoembolisation liver dynamic studies done on 320-slice CT scanner and \ndigital subtraction angiograms were retrospectively reviewed for tumor location, \ntumor feeding vessels, technical success of chemoembolisation and tumor \nresponse based on Modified Response Evaluation Criteria In Solid Tumors \n(mRECIST) guidelines. \nResults: Segment VIII HCC was identified in 47 (26%) of 176 cases. \nChemoembolisation of RIPA was done in 18 (10%) cases, out of which 11 \ncases had HCC in segment VIII. In 3 out of these 11 cases, disease \nprogression was recognised on follow-up CT; therefore, on subsequent TACE \nsessions chemoembolisation of RIPA was done after which they showed \ncomplete or partial response on further follow-up. In rest of 36 cases of \nsegment VIII HCC, there was an indirect evidence of RIPA supplying segment \nVIII HCC; in 3 cases, RIPA was not chemoembolised and progression of \ndisease was evident on follow-up, and furthermore 6 cases had CT evidence of \nRIPA supplying segment VIII HCC when analysed retrospectively. \nConclusion: Routine selective chemoembolisation of right inferior phrenic \nartery is necessary in all segment VIII hepatocellular carcinomas as significant \nnumber (42%) of segment VIII HCC in our study had an evidence of additional \nblood supply from right inferior phrenic artery.  \nB-0381 10:48  \nUtility of cone-beam computed tomography and Emboguide software for \nplanning and monitoring of transarterial catheter embolisation (TACE) of \nhepatocellular carcinoma (HCC)  \nC. Floridi, G. Carrafiello, F. Fontana, A. Ierardi, C. Fugazzola; Varese/IT \n(chiara.floridi@gmail.com)  \nPurpose: To prospectively evaluate the utility of C-arm cone-beam computer \ntomography (CBCT) and Emboguide software for planning and monitoring of \ntransarterial catheter embolisation (TACE) of HCCs and report on feasibility \nand short-term clinical outcome. \nMethods and Materials:  Between November 2012 and September 2013, 35 \npatients (25 men, 10 women, mean age 76.4 years) underwent TACE of HCC \nnodules (67 nodules, mean nodule size 27.5 mm). Intra-procedural dual-phase \nCBCT (arterial and venous) after intra-arterial contrast administration was \nperformed to visualise the HCC nodules and to determine the nodule arterial \nfeeders using dedicated Emboguide software. TACE was performed with \ndoxorubicine mixed with lipiodol and non-enhanced CBCT was performed after \nTACE. CBCT images acquired before and after TACE were registered to \nevaluate drugs tumour filling. CBCT lesion detection accuracy, tumour arterial \nfeeders detection accuracy and number of catheter re-positioning on the basis \nof CBCT and Emboguide software information were recorded. Clinical success \nwas measured as lack of enhancement on follow-up CT. \nResults: All procedures were completed successfully without complications. \nIntra-procedural C-arm CBCT detected of the 67 lesions (100%). The TACE \ncatheters were repositioned on the basis of CBCT and Emboguide software in \n25 lesions (37.3%). Clinical success was achieved in 55 of the lesions (82.1%), \nwhile 12 (17.9%) presented with local recurrence on follow-up imaging. \nConclusion: Planning and monitoring of HCC nodule TACE using C-arm \nCBCT and Emboguide software is feasible and leads to establish the correct \nHCC arterial feeders allowing to perform a selective TACE.  \nB-0382 10:57  \nTranscatheter intra-arterial MRA for accurate guidance of TACE in \npatients with HCC  \nA. Massmann, M. Wolska-Krawczyk, R. Seidel, P. Fries, G.K. Schneider, \nA. Buecker; Homburg a.d. Saar/DE (Alexander.Massmann@uks.eu)  \nPurpose: Evaluation of transcatheter intra-arterial MRA (TI-MRA) with \nconventional digital subtraction angiography (DSA) for accurate guidance of \nselective transarterial chemoembolisation (TACE) of hepatocellular carcinoma \n(HCC). \nMethods and Materials:  26 patients with unresectable HCC underwent 57 TI-\nMRA procedures. Prior to embolisation, a catheter was inserted into HCC \nsupplying sub-/segmental arteries under x-ray fluoroscopy-guidance. Contrast-\nenhanced TI-MRA (20 ml Gadolinium-DOTA 5% Dotarem, Guerbet, France) \nwas performed using either FLASH3D- or VIBE-sequences (Siemens \nMagnetom Aera 1.5 T) for acquisition of tumour perfusion. CT after \nchemoembolisation by injection of lipiodol/doxorubicin from identical catheter \nposition was used to determine the perfused liver area, which was matched to \nthe area seen by TI-MRA. \nResults: TI-MRA confirmed initial correct catheter positioning in 94% of \npatients and led to catheter repositioning in three patients. One erroneous \nadrenal gland embolisation and two embolisations of wrong liver-segments \nwere avoided. Additional collateral tumour supply was evident in four cases \nbecause of incomplete perfusion of HCC in TI-MRA via a single catheter \nposition. Additionally, new HCC-nodules were identified; TI-MRA depicted two \npatients with two satellite HCC-nodules, which were later visible in follow-up \nstaging MRI. Mean SNR for tumour depicted VIBE in arterial and venous \nphase superior to FLASH3D (p < 0.02, resp. p < 0.01)]. CNR was statistically \nnot different. \nConclusion: TI-MRA proved beneficial to detect correct catheter positioning \nand prevented erroneous/insufficient tumour embolisation. VIBE was \nfavourable to FLASH3D. Compared with an IR-angiosuite with DynaCT \nfunctionality, TI-MRA lacks ionizing radiation exposure but requires time-\nconsuming patient transfer between IR/MRI unit.  \nB-0383 11:06  \nCaudate lobe hepatocellular carcinoma treated with selective \nchemoembolisation: usefulness of C-arm CT performed at the proper \nhepatic artery or equivalent  \nW. Choi, H.-C. Kim, S. Hur, J. Chung; Seoul/KR (kchoipro@gmail.com)  \nPurpose: To evaluate the usefulness of C-arm CT performed at the proper \nhepatic artery or equivalent in patients with caudate lobe hepatocellular \ncarcinoma (HCC) for detection of the tumour-feeding artery during \nchemoembolisation \nMethods and Materials:  From July 2009 to June 2012, 1069 patients with \nHCC underwent C-arm CT, and caudate lobe HCCs were found in 69 patients. \nAmong 69 patients, 17 patients was excluded because of size less than 1 cm \n(n=6), hypovascular HCC (n=7), and presence of portal vein thrombosis (n=4). \nFinally 52 patients were included. Two radiologists reviewed the C-arm CT \nfindings and treatment response on the first enhanced follow-up CT. And then \ncumulative local recurrence rate was calculated \nResults: Among 52 cases, we could find tumour-feeding arteries and their \norigin in 48 individuals (92.3%). Sele ctive chemoembolisation via tumour-\nfeeding arteries was succeeded in 42 patients (87.5%). The cumulative local \nrecurrence rates at 6 months, 1 year, and 3 years were 19.4%, 32.8%, and \n35.8%, respectively. The cumulative local recurrence rates was significantly \nlower in the patients who have single tumour-feeding artery and treated with \nselective chemoembolisation. In the multivariate Cox model for cumulative \nlocal recurrence rates, selective chemoembolisation of the tumour-feeding \narteries was a significant important factor in lower local recurrence rates \n(hazard ratio, 0.255; 95% CI: 0.089.0.731; P=0.011) \nConclusion: C-arm CT obtained at the proper hepatic artery or equivalent \nlevel can demonstrate most of the tumour-feeding arteries supplying HCCs in \nthe caudate lobe  \nB-0384 11:15  \nImproved stability of lipiodol-drug emulsion for TACE of HCC results in \nimproved pharmacokinetic profile: proof of concept using idarubicin  \nM. Boulin\n1, A. Schmitt1, J.-P. Cercueil1, M. Wendremaire1, D.-C. Imbs1, \nE. Delhom2, M.-A. Pierredon-Foulongne2, B. Guiu2; 1Dijon/FR, 2Montpellier/FR \n(b-guiu@chu-montpellier.fr)  \nPurpose: We recently demonstrated that idarubicin was the most cytotoxic \ndrug amongst eleven anticancer drugs on three hepatocellular carcinoma \n(HCC) cell lines. We aimed to select the most stable idarubicin-lipiodol \nemulsion and test the hypothesis that a better emulsion stability results in a \nlower systemic exposure of the drug after transarterial chemoembolisation \n(TACE) for HCC. \nMethods and Materials:  Nine emulsions with doxoru bicin 50-mg or idarubicin \n10-mg and lipiodol 10-mL were prepared using the pumping method. Emulsion \nstability was evaluated by measuring the separation between phases \n(aqueous, emulsion and oil) at 37 °C. The approval of the institutional review \nboard was obtained to evaluate the pharmacokinetics of the most stable \nemulsion (amongst the 9 tested) after intra-arterial injection and bland \nembolisation (250 \u0001m calibrated microspheres) in eight unresectable HCC \npatients. Blood samples were obtained in all patients at 0, 5, 15, 30, 120 min \nand 24 hours after TACE to determine Cmax and area under the curve (AUC). \nResults: The emulsion idarubicin 2 mg/mL + lipiodol (1:2 v:v) was the most \nstable emulsion (no phase separation at 48 hours). After injection of the \nemulsion, mean Cmax was 12.5 ng/mL. An estimation of the bioavailability \nshows that about 40% of administered idarubicin was not found in the blood \nand thus, remained in the liver. Compared to doxorubicin-lipiodol emulsion, \nrelative Cmax and AUC were 10 times lower using idarubicin. \nConclusion: Idarubicin-lipiodol emulsion is  very stable over time and was \nassociated with a much better pharmacokinetic profile than doxorubicin-lipiodol \nfor TACE of HCC.  \nS218  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0385 11:24  \nQuantitative evaluation of CT perfusion map as indicator of tumor \nresponse to transarterial chemoembolisation and radiofrequency ablation  \nD. Fior, D. Ippolito, P.A. Bonaffini, M. Colombo, C. R.G.L. Talei Franzesi, \nS. Sironi; Monza/IT (davidefior85@gmail.com)  \nPurpose: To assess if different interventional treatments (RFA and TACE) may \ninfluence the evaluation of perfusion parameters obtained with CT-p. \nMethods and Materials:  Thirty-three consecutive cirrhotic patients candidates \nto TACE orRFA were included. CT-p study was performed on 16 \nmultidetectorCT (Brilliance 16,Philips,NL)¸dose exposure was 120 Kv, \n120 mAs.In all cases bolus injection of 50 ml of non ionic contrast \nagent (350 mgI/ml) at a flow rate of 6 ml/sec was performed and forty dynamic \nscans were acquired at a fixed table positi on.A dedicated perfusion software \nwhich generated a quantitative map of arterial and portal perfusion by means \nof colour scale was employed.The following perfusion parameters were \nassessed before and after TACE:Hepatic perfusion (HP),Arterial \nperfusion (AP),Blood Volume (BV),Hepatic perfusion Index (HPI),Time To \nPeak (TTP). \nResults: A complete treatment was obtained in 16 cases and incomplete \ntreatment in the remaining cases.The following perfusion data were obtained in \npartially treated lesions:HP 43.2 ±15.1 ml/sec/100 gr;AP 38.7 ±8.8 ml/min; BV \n20.7±9.5 ml/100 mg;TTP 24± 3.7 sec; HPI 61.7 ±7.5%.Corresponding value \ncalculated in patients without residual tumor were: HP 10.2 ±6.3; AP 10.4±7;BV \n4.05±4.8; TTP 38.9± 4.2;HPI 9.9 ±9.2.While in normal liver the found \nparameters were:HP 13.2 ±4;AP 12.3±3.4;BV 11.8±2.8; TTP 43.9± 2.9 and HPI \n17.1±9.8.A significant difference (p < 0.001) was found for all parameters \nbetween residual viable tumor tissue (p < 0.001)compared to successfully \ntreated lesion,due to the presence of resi dual arterial vascular structures in \nviable portion of treated HCC. \nConclusion: According to our results, CT-p evaluation is not influenced by \nTACE or RFA treatments, thus representing a feasible technique that allows a \nreproducible quantitative evaluation of treatment response in HCC patients  \nB-0386 11:33  \nHCC treated by TACE with iodised oil: is one-month follow-up with MDCT \npredictive of treatment efficacy? A correlation with longer follow-up  \nG.A. Zamboni, M. Ambrosetti, F. Lombardo, A. Contro, G. Mansueto, R. Pozzi-\nMucelli; Verona/IT (gzamboni@hotmail.com)  \nPurpose: To compare the results of one-month follow-up MDCT after TACE \nwith iodised oil in patients with HCC with those of further follow-up, to confirm \nthe clinical value of routine one-month follow-up. \nMethods and Materials:  We reviewed the 64-row MDCT scans performed 4 \nweeks after TACE with iodised oil (Lipiodol, Guerbet) on 29 patients with HCC \n(26M, 3 F; mean age 67 years): unenhanced, arterial phase, portal-venous \nphase and equilibrium phase images were available. Up to 2 nodules were \nanalysed per patient, and complete treatment of each nodule was diagnosed \nbased on the absence of residual enhancement. The results were compared \nwith those of subsequent contrast-enhanced imaging (MDCT, MRI or CEUS), \nwith a lesion-by-lesion analysis. Sensitivity, specificity, PPV and NPV for the \none-month follow-up were calculated by means of Fisher's test, using the later \nfollow-up as a gold-standard. \nResults: A total of 40 nodules were analysed (mean diameter 27 mm). Further \nfollow-up was at an average of 6 months (2-26 months). When the nodule was \ndiagnosed as completely treated at one-month follow-up MDCT, this had 100% \nsensitivity, 80 % specificity, 94% PPV and 100% NPV compared with \nsubsequent follow-up contrast-enhanced imaging. \nConclusion: Contrast-enhanced multiphasic CT is commonly used for the \nfollow-up of HCC after TACE. The results at one-month follow-up are \nconfirmed by later follow-up imaging.  \nB-0387 11:42  \nCombination of Sorafenib and transarterial chemoembolisation (TACE) vs \nTACE vs Sorafenib protocol alone in advanced stage hepatocellular \ncarcinoma (HCC): retrospective study at three German liver centers  \nT.J. Vogl\n1, J. Trojan1, M. Göller1, M. op den Winkel2, E. Schott3, M.-W. Welker1, \nS. Zangos1, W. Bechstein1, S. Zeuzem1; 1Frankfurt a. Main/DE, 2Munich/DE, \n3Berlin/DE (t.vogl@em.uni-frankfurt.de)  \nPurpose: To compare combined Sorafenib and transarterial \nchemoembolisation (TACE), TACE alone and Sorafenib alone for treatment of \npatients with advanced hepatocellular carcinoma (HCC) according to \nBarcelona Clinic Liver Cancer (BCLC) stage C. \nMethods and Materials:  In this retrospective multicenter cohort study 185 \npatients with BCLC stage C treated with Sorafenib and TACE (group A, n=50), \nTACE alone (group B, n=59) or Sorafenib alone (group C, n=76) were \nretrospectively analysed for comparison from January 2007 to October 2012. \nPortal vein infiltration, extrahepatic metastases, time-to-progression and overall \nsurvival were evaluated. For patients of group A adverse events were also \ndocumented. \nResults: Portal vein infiltration was documented in 32% of patients in group A, \n36% in group B, and 37% in group C. Extrahepatic metastases were present in \n60% (group A), 34% (group B), and 49% (group C). Median time-to-\nprogression was 6.3 months in group A, 5.4 months in group B and 3.5 months \nin group C. Median overall survival was 17.0 months in group A, 11.0 months \nin group B and 9.0 months in group C. The most common adverse events in \nthe combined Sorafenib and TACE treatment were diarrhea (54%), hand-foot-\nskin reactions (40%) and fatigue (36%). Due to adverse events, the Sorafinab \ndose was reduced in 86% of patients in group A and stopped in 6%. \nConclusion: Combined Sorafenib and TACE treatment seems to be a \npromising treatment option in patients with HCC in BCLC stage C, especially \nwhen extrahepatic metastases are present. However, further prospective or \nrandomised studies are necessary.  \nB-0388 11:51  \nComparison between transcatheter arterial chemoembolisation (TACE) \nand transcatheter arterial chemoembolisation combined with \npercutaneous radiofrequency ablation (TACE-RFA) for treatment of \nintermediate hepatocellular carcinoma  \nE. Antonuccio, R. Iezzi, M. la Torre, A. Guerra, M. Nestola, L. Bonomo; \nRome/IT (gabrieleantonuccio@hotmail.it)  \nPurpose: To compare safety, tolerability, influence on liver function and \nefficacy of TACE and single-step balloon-occluded RFA combined with TACE \n(boRFA+TACE) in patients with unresectable multinodular HCC. \nMethods and Materials:  30 patients with HCC treated with boRFA+TACE \n(Group A) were individually matched according to tumour type, age, sex and \nliver disease stage with a group of 15 patients treated only with TACE (Group \nB). The two groups were compared in terms of liver function, major \ncomplications, time of hospitalisation, treatment efficacy (1, 6 and 12 months \nCT, mRECIST criteria) and overall survival (OS). \nResults: Hepatic liver function and Child-Pugh score did not significantly differ \namongst the two groups at 1 month. Technical success, defined as complete \nor partial devascularisation during the arterial phase of all nodules obtained on \n1-month CT, was achieved in 25/30 patients (83.3%) in A and 12/15 patients \n(80%) in B, respectively. At 6-month CT, local recurrence was developed in \n10/30 (33.3% A) and 5/15 (33.3% B). During one year follow-up, a mean \nnumber of procedures per patient of 1.28 and 1.86 were obtained, respectively \n(P <.05). No significant differences were found in terms of OS amongst the two \ngroups (median survival: 392±62 days, A; 487±38 days, B). \nConclusion: Both procedures were safe, well tolerable, not deteriorating liver \nfunction, with good results in terms of efficacy and overall survival, without \nsignificant differences. However, the use of combined therapy could be more \nfavourable than TACE alone in terms of cost-effectiveness in patients with \nmultinodular unresectable HCC, allowing to reduce the repeated number of \ntreatments.  \n10:30 - 12:00 Board Room A \nHead and Neck  \nSS 508  \nHead and neck oncology  \nModerators:  \nC. Czerny; Vienna/AT  \nR. Kohler; Sion/CH  \nB-0389 10:30  \nPET/MR and PET/CT in follow-up of head and neck cancer patients  \nM.A. Queiroz, P. Veit-Haibach, G. von Schulthess, M. Hüllner, F. Kuhn, \nS. Kollias, G. Huber, C. Meerwein; Zurich/CH \n(Marcelo.AraujoQueiroz@usz.ch)  \nPurpose: Positron Emission Tomography (PET)/Magnetic Ressonance \nImaging (MRI) is the emerging hybrid imaging modality. The aim of this study \nwas to assess contrast enhanced (ce) PET/MRI compared to \ncePET/Computed Tomography (CT) in patients with suspected recurrence of \nHNC. \nMethods and Materials: Eight-seven patients were enrolled in this prospective \nstudy. All patients underwent PET/CT-MRI in a tri-modality setup. Diagnostic \naccuracy concerning detection of recurrent HNC was evaluated for cePET/CT \nand cePET/MRI, as well as image quality, presence of unclear FDG uptake \nand diagnostic advantages of use of gadolinium. \nResults: CePET/MRI showed no statistically significant difference in diagnostic \naccuracy compared to cePET/CT (91.5% vs 90.6%). Artefacts grade was \nsimilar in both methods, while their location was different. CePET/CT artefacts \nwere primarily located in the supra-hyoid area, while cePET/MRI, artefacts \nS219  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nwere more equally distributed among the supra and infra-hyoid neck regions. \nBoth methods showed 34 unclear FDG uptake, of those eleven could be \nsolved by cePET/MRI and five by cePET-CT. The use of gadolinium in \nPET/MRI didn't yield higher diagnostic accuracy, but helped to define tumour \nmargins in 6.9% of patients. \nConclusion: CePET/MRI might be slightly superior compared to cePET/CT to \nsolve unclear FDG uptake related to possible tumour recurrence in patients \nwith follow-up after HNC. It might also be the imaging tool of choice for \nevaluation of the oropharynx and the oral  cavity based on a higher incidence of \ntechnical artefacts in cePET/CT in this area. However, overall there is no \nstatistically significant difference concerning diagnostic accuracy of the two \nmethods.  \nAuthor Disclosures: \nP. Veit-Haibach: Grant Recipient; Bayer Healthcare and Siemens Medical \nSolution. Speaker; GE Healthcare. G. von Schulthess: Speaker; GE \nHealthcare.  \nB-0390 10:39  \nUse of DWI in PET/MRI for head and neck cancer evaluation  \nM.A. Queiroz, P. Veit-Haibach, G. von Schulthess, M. Hüllner, F. Kuhn, \nS. Kollias, G. Huber, C. Meerwein; Zurich/CH \n(Marcelo.AraujoQueiroz@usz.ch)  \nPurpose: The novel method 18 F-fluorodeoxy-D-glucose (FDG) positron \nemission tomography / magnetic resonance imaging (PET/MRI) is an attractive \nalternative to PET/Computed Tomography (CT) on imaging evaluation of head \nand neck cancers (HNCs). Defining MR protocol is a challenge, since there are \nmany different sequences and acquisition time should not be too long. The aim \nof this study is analyse whether DWI adds significant information to PET/MRI \non lesion detection for HNCs. \nMethods and Materials:  Seventy patients were enrolled in this prospective \nstudy. All patients underwent sequential contrast enhanced (ce)PET/CT and \ncePET/MRI using a tri-modality PET/CT-MR setup. First, all the lesions were \nassessed by PET/MRI with conventional sequences and, in a second step, the \nPET/MRI with DWI sequence. The PET values (Standardised Uptake Value-\nSUV) and DWI values (Apparent Coefficient Diffusion-DC and B value) of all \nFDG positive lesions were also evaluated. \nResults: One hundred and eighty-eight lesions were found, in which 118 were \nmalignant and 70 were benign. DWI detected 120 lesions, while PET/MRI \nidentified 48 more lesions. DWI showed 20 lesions not seen on PET/MRI. \nHowever, those additional lesions did not change the overall staging. SUV \nmaximum and mean were higher in malignant lesions than in benign lesions, \nbut DWI values were not statistically different. \nConclusion: PET/MRI is superior to DWI alone and thus, DWI is not needed in \nPET-MRI protocols for HNC detection.  \nAuthor Disclosures: \nP. Veit-Haibach: Research/Grant Support; Bayer Healthcare and Siemens \nMedical Solution. Speaker; GE Healthcare. G. von Schulthess: Speaker; GE \nHealthcare.  \nB-0391 10:48  \nDiffusion-weighted MRI in advanced oropharyngeal carcinoma treated by \nexclusive chemoradiation therapy: prognostic value of histogram-derived \nparameters  \nM. Plebani, M. Ravanelli, L. Costa, V. Kengni Fondjie Legrand, D. Farina, \nR. Maroldi; Brescia/IT (mauroplebani83@hotmail.it)  \nPurpose: To assess the prognostic value of histogram parameters extracted \nfrom diffusion-weighted (DW) pre-treatment MRI in patients treated by \nexclusive chemoradiation therapy (CHRT) for advanced oropharyngeal \ncarcinoma. \nMethods and Materials:  Pre-treatment DW-MRI datasets from patients who \nunderwent CHRT for advanced oropharyngeal carcinoma from October2007 to \nNovember2011 were retrospectively reviewed and analysed. Histogram \nanalysis was performed on Apparent Diffusion Coefficient (ADC) maps for \nprimary tumour (T), peritumour ring and largest nodal metastasis (N), resulting \nin the following parameters: ADC mean, max and min, histogram skewness \nand kurtosis. Kaplan-Meier analysis was performed to test prognostic value \n(overall survival, OS; progression-free survival, PFS). \nResults: DWI datasets from 27 patients were reviewed by an expert radiologist \nblinded to clinical outcome. Analysis at T,  peritumour and N site was feasible in \n23, 23 and 16 patients. Maximum ADC and skewness of T were significantly \nhigher in good responders (n=14) than in poor responders (n=9) (p 0.004 and \n0.005, respectively). Multiplying ADC max and skewness, a novel parameter \n(skew*max) was obtained. At Kaplan -Meier analysis, ADC max, skewness and \nskew*max, categorised by median split, did correlate with OS, with hazard \nratios of respectively 3.47 (p0.02), 6.57 (p0.005) and 15.45 (p0.0004). Similar \nresults were obtained for PFS, being disease progression and mortality strictly \nassociated. Nine out of 11 patients with low skew*max values did relapse \nduring follow-up; only one recurrence was observed in 12 high skew*max \npatients (p0.002). \nConclusion: Skew*max derived from ADC histograms is a promising \nprognostic indicator for advanced oropharyngeal carcinoma treated by \nexclusive CHRT.  \nB-0392 10:57  \nCharacterisation of head and neck tumors using dynamic contrast \nenhanced MRI  \nG. Léránt, P. Sárközy, L. Jávor, C. Szalay, A. Lévai, M. G \u001edény; Budapest/HU \n(lerger@freemail.hu)  \nPurpose: To assess the diagnostic value of dynamic contract enhanced MRI \n(DCE-MRI) in differentiation between malignant and benign head and neck \n(HN) lesions, and between changes caused by radiation therapy. \nMethods and Materials:  150 patients with HN tumor were examined using \nDCE-MRI sequences (Fast Spoiled Gradient Echo FSPGR, 80 phases), beside \nroutine head neck (HN) imaging protocol. The examinations were performed \non a 3 Tesla wide bore clinical MR scanner (General Electric Discovery 750w, \nMilwaukee, USA). As contrast agent gadobenate dimeglumine (Multihance©, \nBracco, Italy) were applied. The time intensity curves (TIC) were extracted from \nthe region of interests (ROI) specified by experienced HN radiologists. The \nTICs were used to acquire time-to-peak (TTP), relative maximum \nenchancement (RME), relative wash-out (RWO) and other parameters. The \nparameters were analysed using univariate tests and multivariate models in \nSPSS 17 to identify predictors that can be used to infer tumor malignancy and \npost-irradiation status. \nResults: Multiple parameters of curve characteristics are significantly different \nin case of malignant vs. post-irradiation status, and also in case of malignant \nvs. benign tumors. We investigated the per formance of logistic regression to \nidentify the status of a tumor, and found multiple significant (p < 0.05) \npredictors for both benign/malignant status as well as pre- and post-irradiation \nstatus. \nConclusion: This large cohort of data supports the increasing role of DCE-MRI \nin HNT differentiation.  \nB-0393 11:06  \nDynamic contrast enhanced MRI for differentiation of major salivary \nglands neoplasms, a 3-T MRI study  \nL. Aghaghazvini, H. Sharifian, F. Salahshur, N. Yazdani, M. Shakiba, \nS. Kooraki; Tehran/IR (la_ghazvini@yahoo.com)  \nPurpose: Evaluate the role of dynamic contrast-enhanced MRI (DCE) for \ndifferentiation between malignant, Warthin and benign non-warthin (BNW) \nneoplasms of major salivary glands. \nMethods and Materials:  46 salivary gland neoplasms underwent preoperative \nDCE. Postoperative histopathologic evalua tion was performed for a definite \ndiagnosis. (30 BNW, 6 Warthin, 10 malignant) TIC (Time-signal intensity \ncurves) were categorised as (A) Tpeak > 43s and WR180 < 4.6%. \n(B)Tpeak> 43s and WR180:4.6-22% (C) Tpeak < 43s and WR> 22%. \nResults: Accuracy of Tpeak was 98.9% for differentiation between BNW and \nWarthin, 83.7% between BNW and malignant and 80% between malignant and \nWarthin. All warthins showed Tpeak \u000243s, while one BNW had Tpeak < 43s. A \nTpeak< 63.5s differentiated 8/10 (80%) of malignant tumors from BNW, while \n4/30 of BNW had a Tpeak < 63.5s. Two malignant tumors had Tpeak < 43s. \nWR180 had an accuracy of 100% for differentiation between warthin and BNW, \n87.3% between BNW and malignant and 93.3% between warthin and \nmalignant tumors. 29 out of 30 (96.7%) BNW had a washout < 4.60%, while \n8/10 (80%) of malignant tumors had a washout > 4.60%. All warthins had a \nWR180> 22%, while two malignant tumors had a WR180 > 22%. According to \nTIC curves, 29/30 of BNW demonstrated TIC curve type A and one \ndemonstrated type B. 6/10 of malignant tumors had TIC type B, 2 had TIC type \nA and 2 type C. All warthin were categorised in Type C. \nConclusion: This study showed DCE could assist in preoperative \ndifferentiation of salivary gland neoplasms; especially regarding discrimination \nbetween warthin and BNW tumors.  \n \n \n \n \n \n \n \n \n \n \n \n \n \nS220  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0394 11:15  \nAssesment of global and locoregional heterogeneity of primary \nsquamous cell carcinoma of the head and neck: association with \ntreatment response and clinical outcome  \nI. Sowemimo, M. Siddique, S. Connor, M. McGurk, C. Yip, T. Guerrero-Urbano, \nS. Gourtsoyianni, G. Cook, V.J. Goh; London/UK (ivica.sowemimo@kcl.ac.uk)  \nPurpose: Our aim was to assess the relationship between CT and MRI \nevaluation of whole tumour heterogeneity with response to treatment and \nclinical outcome. We hypothesised that image heterogeneity may reflect \nunderlying tumour biology. \nMethods and Materials: Following IRB approval, the imaging heterogeneity of \ncontrast enhanced MDCT (ceCT), contrast enhanced T1-weighted 1.5 T-MRI \n(ceMRI), and T2-weighted 1.5 T-MRI (T2MRI) of 33 patients (21 men, mean \n62.7 years) with primary squamous cell carcinoma of the head and neck were \nevaluated using global and locoregional methods: first-order statistics; second-\norder co-occurrence matrices; higher-order run length (GLRL) and \nneighbourhood grey-tone difference (NGTDM); and model-based fractal \nanalysis (FA). Parameters were compared with Stage, treatment outcome and \nsurvival using Mann Whitney and Kaplan Meier statistics. \nResults: There was a difference in ceCT and T2MRI parameters between \nearly and advanced cancers (p < 0.01). Higher-order locoregional GLRL and \nNGTDM may better reflect clinical outcome in primary head and neck cancer \nwith a difference between treatment responders/non-responders as well as \npatients with recurrence/no recurrence (p < 0.05). There was a borderline \nassociation between ceCT kurtosis and overall survival (log rank p=0.046) in \ncomparison to tumor size where there was no difference, using an optimal 'cut-\noff' threshold. \nConclusion: While findings are preliminary, assessment of global and \nlocoregional imaging heterogeneity may augment current imaging practice with \nrespect to clinical outcome.  \nB-0395 11:24  \nThe role of magnetic resonance spectroscopy for differentiation between \nmajor salivary glands neoplasms  \nL. Aghaghazvini, H. Sharifian, S. Omidi, N. Yazdani, S. Kooraki; Tehran/IR \n(h_sharifian_md@yahoo.com)  \nPurpose: To assess the role of magnetic resonance spectroscopy (MRS) for \npreoperative differentiation between benign non-Warthin (BNW),Warthin and \nmalignant neoplasms of major salivary glands. \nMethods and Materials:  43 major salivary gland neoplasms (25 BNW, 7 \nWarthin and 11 malignant) underwent preoperative MRS. Final diagnosis was \nconfirmed with postoperative histopathologic evaluation. MRS was performed \nwith echo times (TE) of 135 and 270 at 3 Tesla. Spectra was analysed to \ndetermine peak amplitude of choline (Cho), creatine (Cr) and cho/cr ratio. ROC \ncurve was used to determine optimal cutoff points. \nResults: Mean cho/cr at TE135 was 1.84 ±2.05, 1.16 ±0.64 and 3.90± 3.23 in \nBNW, Warthin and malignant neoplasms, respectively. Mean cho/cr at TE270 \nwas 1.66 ±1.85, 0.97 ±0.47 and 3.18± 1.53 in BNW, Warthin and malignant \nneoplasms, respectively. Cho/cr had an accuracy of 78.9% at TE135 (best \ncutoff point 1.92 with 81.8% sensitivity and 88% specificity) and 81.5% at \nTE270 (best cutoff point 1.92 with sensitivity of 81.8% and specificity of 84%) \nfor differentiation between BNW and malignant tumours. MRS was powerful for \ndifferentiation between Warthin and malignant neoplasms showing a cho/cr \naccuracy of 87% and 92.2% at TE135 and TE270, respectively. Cutoff points \nof 1.59 at TE135 (sensitivity 81.8%, specificity 85.7%) and 1.25 at TE270 \n(sensitivity 90.9%, specifici ty 85.7%) were powerful in differentiation between \nmalignant and Warthin neoplasms. MRS wa s not powerful for differentiation \nbetween BNW and Warthin tumours. \nConclusion: This study showed that MRS is helpful in preoperative \ndiscrimination of major salivary gland neoplasms.  \nB-0396 11:33  \nTo evaluate the efficacy of MRI in detection of cartilage invasion and \nsubmucosal space involvement in laryngeal cancer for accurate \npretherapeutic staging  \nS. Priya, S. Mehra; New Delhi/IN (sarvpriya1985@gmail.com)  \nPurpose: To evaluate the efficacy of MRI in detection of cartilage invasion for \naccurate pretherapeutic staging. \nMethods and Materials:  33 patients with endoscopically diagnosed laryngeal \nmasses were included in a prospective study. CECT and CEMR were \nperformed to assess cartilage invasion. The median age group was 51-60 \nyears with 29 males and 4 females. 19 patients underwent total laryngectomy \nwith histopathology of the resected specimen. CT was performed on Philips \nBrilliance 40-slice spiral scanner. CEMRI was performed on Siemens 1.5 T \nscanner using surface neck coils (slice thickness of 3-4 mm and 1 mm \nintersection gap). \nResults: CT: 14 masses were characterised as T4, 10 as T3, 5 as T2 and 4 as \nT1. Diagnostic accuracy of CECT was 73% for staging and for cartilage \ninvasion was 78% for thyroid and cricoid and 79% for arytenoid. MR: 15 \nmasses were characterised as T4, 5 as T3, 6 as T2 and 3 as T1 with \ndiagnostic accuracy of 89% for staging. MR had higher accuracy in detecting \ncartilage invasion with 89% accuracy for thyroid, 78% for cricoid and 84% for \narytenoid cartilage. Histopathology: There were 2 false positive MR results for \nthyroid and arytenoid each and 4 for cricoid cartilage invasion. CECT had \nlower diagnostic accuracy for staging and for cartilage invasion with 3 false \nnegative results for thyroid cartilage and 2 for arytenoid and cricoid cartilage. \nConclusion: CEMR has higher sensitivity and accuracy in detecting cartilage \ninvasion. MR should be used as first line imaging modality for laryngeal tumour \nevaluation.  \nB-0397 11:42  \nThe value of ultrasonographic criteria for the differential diagnosis \nbetween benign and malignant cervical lymph nodes  \nL.M. Lenghel, G. B\u0015ciu#, A. Bojan, C. Botar-Jid, D. Vasilescu, D. Feier, \nS.M. Dudea; Cluj-Napoca/RO (manu_2416@yahoo.com)  \nPurpose: The aim of the study is to explore th e diagnostic value of grey scale, \nDoppler and sonoelastographic criterias for the differentiation between benign \nand malignant lymph nodes of the neck. \nMethods and Materials:  Over a period of 42 months (October 2009 - April \n2013) the patients examined routinely for the assessment of superficial cervical \nlymph nodes in the department of ultrasound were recorded in a database \ncontaining grey-scale, Doppler and sonoelastographic information and images. \nThe images of 30 benign and 60 malignant (20 lymphomas and 40 metastatic) \nlymph nodes obtained were chosen. The images obtained at real-time \nelastography were scored according to a new scoring system using 6 patterns, \ncomparing the sonoelastographic appearence with bidimensional images. \nResults: In the multivariate analysis, none of the bidimensional criaterias \nproved to be independent predictors of malignancy. From the Doppler \nparameters, the vascular pattern was an indepedent predictor of malignant \nlymph nodes. It was analysed the diagnostic value of the vascular pattern with \narea under the ROC curves (AUROC) = 0.89,p < 0.0001, sensibility = 90%, \nspecificity= 83.3% and sonoelastographic scores area under the ROC curves \n(AUROC) = 0.86,p < 0.0001, sensibility = 78.3%, specificity= 90%. \nConclusion: In this study, the vascular pattern assessed on Doppler images \nand the sonoelastographic scores are the most important predictors of \nmalignancy, with a very good sensibility and specificity.  \nB-0398 11:51  \nUltrasound-guided transcutaneous tru-cut biopsy of laryngo \nhypopharyngeal lesions  \nG. Conte, E. De Fiori, E. Perucchini, L. Preda, L. De Benedetto, M. Ansarin, \nM. Bellomi; Milan/IT (giorgio.conte@ieo.it)  \nPurpose: To evaluate the performance of ultrasound-guided transcutaneous \ntru-cut biopsy (USGTCB) in patients with untreated or previously treated \nsuspicious laryngo-hypopharyngeal masses, who have relative or absolute \ncontraindications for microlaryngoscopy. \nMethods and Materials:  From August 2004 to April 2013, we prospectively \nenrolled 62 patients (47 males, 15 females; age 44-95 years), for total of 64 \nUSGTCBs scheduled: 37 USGTCBs were performed for an untreated mass \nsuspicious of malignancy and 27 for suspicious recurrence of malignancy. \nBiopsies were performed with the free-hand technique by a single radiologist \nafter the preliminary assessment by US of the mass. \nResults: USGTCB diagnosed 47 squamous cell carcinomas, 6 other malignant \nlesions and 11 benign lesions (true positi ve); no false positives and five false \nnegatives were reported: two in patients with untreated lesions, two in patients \npreviously treated with radiotherapy and one in a patient previously treated \nwith endoscopic laser surgery. Overall, the sensitivity of the technique was \n91.4%; the specificity was 100%; positive  and negative predictive values were \n100% and 54.5%, respectively. Sensitivi ty, specificity, po sitive and negative \npredictive value and accuracy for the procedures performed in previously \nradio-treated patients were 84.6%, 100%, 100%, 71.4%, respectively. \nConclusion: Although biopsy under microlaryngoscopy remains the \"gold-\nstandard\" technique for histological diagnosis of both primary and recurrent \nlaryngo-hypopharyngeal masses, USGTCB is a cost-effective procedure that \ncould be applied in patients contraindicated for general anaesthesia or those \nwith a risk of tracheotomy due to intubation difficulties. The performance of \nUSGTCB is adequate even in previously radio-treated patients to differenatiate \nrecurrence of malignancy from radio-necrosis.  \n \n \n \n \n \nS221  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n14:00 - 15:30 Room A  \nGI Tract  \nSS 601a  \nNew insights into colorectal cancer  \nModerators:  \nC. Hoeffel; Reims/FR  \nP. Wylie; London/UK  \nB-0399 14:00  \nDiagnostic accuracy of MR vs rigid rectoscopy in assessing the \nextraperitoneal location of rectal cancers  \nM. Revelli, C. Puppo, F. Paparo, R. Piccazzo, D. Astengo, L. Bacigalupo, \nA. Pascariello, G.A. Binda, G.A. Rollandi; Genua/IT \n(matteorevelli@gmail.com)  \nPurpose: Our purpose was to compare the diagnostic accuracy of rigid \nrectoscopy and MR in assessing the extra or intraperitoneal location of rectal \ncancers, using surgical exploration as reference standard. \nMethods and Materials:  Patients with surgically proven primary rectal \nadenocarcinoma were retrospectively identified and all patients who underwent \npreoperative rectoscopy and MR were enrolled. Patients with a complete \nresponse to chemoradiation therapy were excluded. All MR examinations were \nreviewed by two abdominal radiologists in consensus, determining the intra or \nextraperitoneal location of tumour's inferior edge. Three different cut-off \nmeasurements were used to define the diagnostic accuracy of rectoscopy: \n< 8 cm, < 10 cm and < 12 cm. \nResults: 54 patients (32 male, 22 female, mean age 69.2 years) with surgically \nproven primary rectal adenocarcinoma (47 extra and 7 intraperitoneal tumours) \nwere included. MR showed a sensitivity  and specificity of 95.74% and 100%, \nrespectively. Rigid rectoscopy showed a sensitivity and specificity of 93.75% \nand 66.67% at 8 cm, 97.87% and 57.14% at 10 cm and 100% and 14.29% at \n12 cm (p = 0.007). \nConclusion: MR, due to the direct visualisation of the anterior peritoneal \nreflection, showed higher specificity  than rectoscopy in defining the \nextraperitoneal location of rectal cancers.  \nB-0400 14:09  \nTumour volumetry on diffusion-weighted MRI for identification of \ncomplete tumour responders to preoperative chemoradiotherapy in rectal \ncancer: a multicenter validation study  \nD.M. Lambregts\n1, S. Sassen2, S.-X. Rao1, M.H. Martens1, L.A. Heijnen1, \nG.L. Beets1, R.A. Vliegen2, R.G.H. Beets-Tan1; 1Maastricht/NL, 2Heerlen/NL \n(d.lambregts@mumc.nl)  \nPurpose: Retrospective studies have shown that tumour volumetry using \ndiffusion-weighted imaging (DWI) may help i dentify rectal cancer patients with \na complete tumour response after neoadjuvant chemoradiotherapy (CRT). This \nstudy aims to prospectively validat e the diagnostic value of previous \nretrospectively determined volume-thresholds in a larger and multicentric \npatient cohort. \nMethods and Materials:  119 patients from two different centres underwent \nMRI (1.5 T) including standard T2W-MRI and DWI (highest b-value b1000-\n1100), both pre- and post-CRT. An experienced reader placed free hand ROIs \naround the tumour area on each tumour-containing slice to determine pre-CRT \nand post-CRT volumes (cm3) on T2W-MRI and DWI and calculate \u0005volume \n(=[pre-volume - post-volume]/[pre-volume]*100%). T2W and DWI thresholds \n(retrospectively determined in previous studies) for pre-volume, post-volume \nand \u0005volume were tested to prospectively assess their diagnostic values in \nidentifying patients with a complete tumour response. \nResults: Twenty-one patients had a complete response. Areas under the \nROC-curve for the pre-/post-/ ,-volumes were 0.73/0.80/0.69 for T2W-MRI and \n0.75/0.86/0.78 for DWI. For T2W-volumetry, sensitivity and specificity using the \npredefined thresholds were 62% and 74% for pre-volume, 52% and 92% for \npost-volume and 38% and 86% for \u0005volume. For DWI-volumetry, sensitivity \nand specificity were 62% and 77% for pre-volume, 62% and 91% for post-\nvolume and 71% and 80% for \u0005volume. \nConclusion: Previously determined DWI volume-thresholds can be \nreproduced with good results in a prospective and multicenter setting. Post-\nCRT DWI-volumetry provides the best results for discriminating complete \nresponders with an AUC of 0.86 and - prospectively tested - sensitivity of 62% \nand specificity of 91%  \n \n \n \n \n \nB-0401 14:18  \nDiffusion-weighted images in differentiation of granulation tissue from \nminimal portion of residual tumour in the cases of the assumption of \ncomplete response after chemoradiotherapy of patients with rectal \ncancer  \nK.B. Puzakov, N.A. Rubtsova, I.V. Droshneva, D.V. Sidorov, \nO.A. Mainovskaya; Moscow/RU (fetobizuar@mail.ru)  \nPurpose: The aim of the study was to determine the differentiation of epithelial \ngranulation from residual tumour in cases of the assumption of complete \nresponse after chemoradiotherapy. \nMethods and Materials:  The study included 86 patients with rectal cancer. \nStudies were performed on 1.5 T MR imaging with a flexible 4-channel body \ncoil. Analysis was used in the ADC by one section outlined with hand-rendered \nall parts of the tumor. Maps ADC automatically generated upon completion of \nDWI sequences. Evaluation ADC of rectal tumors was carried out on the stage \nprior to the n-CRT and 4-6 weeks after. In all cases, MRI and histology data \nare compared. Scanning protocol includes multiplanar T2 and T1WI with \nintrarectal contrasting agent and in DWI with b-factor (0 and 800 mm²/sec). \nResults: There were 12 complete responders according to pathomorphological \ndata with no tumour growth among fibrotic mass. According to MRI data (T2WI \n+ DWI), there were considered only 8 complete responders, but 1 (1.2%) case \nwas false-negative because of microfocus (small groups of adenocarcinoma \ncells) of the tumor which has no chance of MRI detection, there were 7 (8.1%) \ntrue-negative cases of complete response. In 5 (5.8%) cases, granulation \ntissue was wrongly defined as tumor fa lse-positive results. Sensitivity, \nspecificity, accuracy, PPV, NPV were 98.7%, 58.3%, 93%, 93.6% and 87.5%, \nrespectively. \nConclusion: After the retrospective analysis, we found no statistically \nsignificant differences between the ADC of the small residual tumour and the \ngranulation epithelial tissue (1.329x10 \n-3 mm 2/s and 1.387x10 -3 mm 2/s, \nrespectively). This caused a lack of specifici ty with the method in this difficult \ngroup of patients. Therefore, this issue needs further study.  \nB-0402 14:27  \nPreoperative 3 T MR imaging of rectal cancer: local staging accuracy \nusing 2D T2-weighted FSE sequence and diffusion-weighted MRI with b-\nmultiple SE-EPI  \nP. Boraschi, F. Donati, E. Marciano, R. Balestri, G. Gherarducci, F. Pacciardi, \nE. Neri, F. Falaschi, C. Bartolozzi; Pisa/IT (p.boraschi@do.med.unipi.it)  \nPurpose: To evaluate the image quality and diagnostic performance of 2D \nT2w FSE sequence and Dw-MRI with b-multiple SE-EPI in the local staging of \nrectal cancer at 3 T. \nMethods and Materials:  Forty patients with biopsy-proven rectal cancer \nunderwent MRI at 3 T-device (GE-DISCOVERY MR750; GE Healthcare) using \n8-channel phased-array body coil. MR imaging protocol included high-\nresolution 2D T2w FSE images in sagittal, coronal, axial and axial-oblique \nplanes. Dw-MRI was performed using axial spin-echo echo-planar sequence \nwith multiple b -values (150,500.1000,1500 sec/mm²) in all diffusion directions. \nTwo experienced radiologists separately reviewed the 2D T2w imaging data-\nset alone and the combined set of T2w and Dw-MR images. The reviewers \nassessed the radiologic T staging with regard to tumor extension to the \nmuscularis propria and perirectal fat invasion and performed image quality \nassessment of data-sets using a five-point scale. \nResults: Thirty-two patients who underwent a total mesorectal excision (TME) \nwere enrolled in the imaging analysis; the remaining 8 patients were excluded \nbecause they were classified as stage T1 (two cases) and stage T4 (six \ncases). The overall sensitivity, specificity and accuracy for prediction of \nperirectal fat invasion in rectal cancer using the combined set of T2w and Dw-\nMR images and the T2w imaging data-set alone were 94%, 78%, 87.5% and \n77%, 57%, 68.7%, respectively. Image quality analysis was performed in all 40 \npatients and was excellent on T2w images and good on Dw-MRI. \nConclusion: Diffusion-weighted MR imaging in addiction to T2-weighted MR \nimaging can improve the local staging of rectal cancer at 3 T.  \nS222  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0403 14:36  \nDiagnostic performance of kinetic parameters derived from dynamic \ncontrast-enhanced MRI for the selection of good responders after \nchemoradiation for rectal cancer  \nM.H. Martens, S. Subhani, L.A. Heijnen, D.M. Lambregts, M. Maas, R.G. Riedl, \nG.L. Beets, E. Kluza, R.G.H. Beets-Tan; Maastricht/NL \n(milou.martens@mumc.nl)  \nPurpose: Response assessment after chemoradiotherapy (CRT) in rectal \ncancer remains difficult. The aim of this  study was to investigate if kinetic \nparamters derived from dynamic contrast-enhanced (DCE) MRI, using the \nblood-pool contrast agent gadofosveset, can identify good responders after \nCRT. \nMethods and Materials:  Twenty-five patients with locally advanced rectal \ncancer received DCE-MRI both before and 8 weeks after CRT. The kinetic \nparameters i.e., the initial slope, initial peak, late slope, and area under the first \n60, 90, and 120s of the enhancement curve (AUC 60, AUC 90, AUC 120) were \ndetermined from relative signal enhan cement-time curves. Receiver operating \ncharacteristics (ROC) curves were used to assess the diagnostic performance. \nGood responders (n=11) were defined as patients with a tumour regression \ngrade (TRG) of 1 or 2 at histopathologic assessment after resection. Poor \nresponders were defined as patients with a TRG of 3 to 5 (n=14). \nResults: Before neo-adjuvant CRT, the late slope was significantly lower for \nthe good responders (-1.61x10\n-3) compared with the poor responders (5.18x10 -\n3, p=0.004). Post-CRT the initial peak, AUC 90, and AUC 120 were significantly \nlower in the good responders compared with the poor responders (1.20vs1.53, \n102vs128, 145vs181 and p=0.017, 0.028, 0.023 respectively). All parameters \nexcept the late slope changed significantly more post-CRT in the good \nresponders compared with the poor responders. ROC-curves ranged from 0.73 \nto 0.83. \nConclusion: Kinetic parameters derived from dynamic contrast-enhanced MRI \nare a promising tool for prediction and assessment of response after \nchemoradiotherapy in patients with rectal cancer.  \nB-0404 14:45  \nDifferentiation of poorly differentiated colorectal adenocarcinomas from \nwell- or moderately differentiated colorectal adenocarcinomas at \ncontrast-enhanced multidetector computed tomography  \nJ.E. Kim\n1, J.M. Lee2, J.H. Baek2, S.K. Moon2, J.K. Han2, B.I. Choi2; 1Jinju/KR, \n2Seoul/KR (wldmsrla80@hanmail.net)  \nPurpose: To describe the CT findings of poorly-differentiated (PD) colorectal \nadenocarcinoma (CRAC) and to identify the features that differentiate it from \nwell- (WD) or moderately-differentiated (MD) CRAC. \nMethods and Materials: One-hundred and thirteen patients with pathologically \nproved PD (n = 26), WD (n = 35), or MD (n = 52) CRACs who had undergone \npreoperative contrast-enhanced multidetector CT (MDCT) imaging were \nincluded in this study. Analysis of CT fi ndings included determination of the (a) \nlocation and shape of the tumour; (b) enhancement pattern and degree, and \nmaximal wall thickness of the tumour; (c) pericolic fat infiltration; (d) size and \nenhancement degree of the regional lymph nodes (LNs); and (e) presence of \ndirect invasion, colonic obstruction, and distant metastasis. The significance of \nthese findings was determined with the x \n2 test. \nResults: ignificant features in the differentiation of PD CRACs from WD or MD \nCRACs included bulky shape, heterogeneous enhancement, the same or lower \nattenuation compared with muscle within the tumour, nodular pericolic fat \ninfiltration, regional LNs being more than 10 mm in short axis diameter, \nregional LNs with the same or lower attenuation compared with muscle, and \npresence of distant metastasis (P < 0.05). When at least two of these seven \nimaging features were used in combination, sensitivity and specificity in the \ndiagnosis of PD CRACs were 88% and 70%, respectively. \nConclusion: By using characteristic CT features, one can differentiate PD \nCRAC from WD or MD CRAC with a high degree of accuracy at contrast-\nenhanced MDCT.  \nB-0405 14:54  \nComparison between CT with multiplanar reconstructions and MRI for \nprediction of neoadjuvant therapy in rectal cancer  \nM. Jaffro, S. Lagarde, S. Collot, P. Otal, H. Rousseau, F.-Z. Mokrane; \nToulouse/FR (mokrane_fatimazohra@yahoo.fr)  \nPurpose: The objective of this study was to compare the multidetector-row CT \n(MDCT) with multiplanar reconstructions and MRI in the decision of \nneoadjuvant therapy in rectal cancer. \nMethods and Materials: During a 4-year period, all patients who were enrolled \nin this study had biopsy-proven rectal carcinoma, CT of the abdomen and \npelvis and MRI of the pelvis. Two radi ologists, an expert and a junior reviewed \nall examinations independently. They were blinded one from the other, from \nthe findings of the other modality, and from clinical information. Only T3 \ntumours, staged using MRI by the expert were analysed. Agreement between \nMRI and MDCT, inter-observer agreement concerning neoadjuvant therapy \ndecision and all tumor characteristics were calculated. \nResults: Among the 62 studied patients, the neoadjuvant radiochemothrapy \nwas indicated in 56 patients (90.3%). In the prediction of neoadjuvant \nradiochemotherapy by CT, the agreement between the two modalities was \n0.73, the sensitivity was about 98%, t he specificity was about 75%, the PPV \nwas about 98% and the NPV was about 75%. Inter-observer agreement was \n0.73 for the MRI and 1.00 for the CT. Agreement between MDCT and MRI \nwas: for mesorectal fascia characteristics 0.73, for nodes status 0.53, for \nvascular invasion 0.19, for tumour deposit 0.48, for tumour spread into \nmesorectum 0.14, and for size 0.49. Inter-observer agreement were ranged \nfrom 0.40 to 1.00 for the CT and from 0.56 to 1.00. \nConclusion: Our findings suggest that MDCT with multiplanar reconstructions \ncan replace MRI for the prediction of neoadjuvant therapy.  \nB-0406 15:03  \nDoes tumour size matter? Correlation of rectal tumour volumes with \noncological outcomes in low rectal cancers  \nM. Tayyab1, M. Subhani2, R. Karim2, E.T. Razia3, A. Razack1; 1Cottingham/UK, \n2Carmarthen/UK, 3Barrow/UK (subhani@doctors.org.uk)  \nPurpose: The relationship between tumour volume and oncological outcome \nhas been reported in cases of brain, nasopharyngeal, lung, hepatocellular and \nprostate cancers. There is paucity of similar data in rectal cancer. The aims of \nthis study were to determine whether tumour volume and mesorectal volume \nevaluated by magnetic resonance imaging (MRI) have effects on oncological \noutcomes of rectal cancer. \nMethods and Materials:  Volumetric analysis of rectal tumours was performed \nfrom the MRI images and then correlated with oncological outcomes. The \nstudy was based on a clinical and radiological database of patients who \nunderwent rectal cancer surgery in a tertiary teaching centre during the year \n2004. \nResults: 35 patients underwent rectal cancer surgery after staging with MRI \nduring the study period. Of these, seven could not have their MRI images \nretrieved and were, therefore, excluded from further analysis. 3 further patients \nhad metastases identified at diagnosis and were also excluded. Tumour \nvolume (TV) was a significant predictor of overall survival HR (95%CI); 5.8 \n(1.2-29), (P=0.03). Mesorectal volume (MRV) and TV/MRV did not show any \ncorrelation with oncological outcomes. LNR, TME and inadvertent perforation \nwere other independent predictors of oncological outcomes following APER. \nConclusion: Tumour volume showed a direct relationship with overall survival \nand this may be used to stratify rectal tumours for neoadjuvant therapy; \nhowever, a larger prospective study is required to prove this correlation.  \nB-0407 15:12  \nPreliminary study of low-tube voltage scan in evaluation of T-staging of \nrectal cancer with dual-source CT  \nG. Shi, Y.-N. Wang; Shijiazhuang/CN (gaofengs62@sina.com)  \nPurpose: The purpose of this study was to investigate the effect of low tube \nvoltage in evaluation of T-Staging of rectal cancer with dual-source CT. \nMethods and Materials:  Forty patients (25 men ,15 women) underwent \ncontrast-enhanced abdominal DSCT. Data were reconstructed as three \ngroups: group A, fused image reconstructed with D30 (filter back projection \nFBP) ;group B, 80 kV image reconstructed with D30 and group C ,80 kV image \nreconstructed with I30 (iterative reconstruction IR). The mean CT numbers, \nnoise and SNR of organs and lesions were assessed quantitatively in each \ngroup. Diagnostic accuracy was statistically compared related with pathologic \nstaging between three groups. \nResults: Noise of group A and C had no difference (P > 0.05), while lower than \ngroup B (P < 0.05). Mean CT value of external iliac vessels at group B and C \nhad no difference (P > 0.05), while higher than group B (P < 0.05). SNR of \nexternal iliac vessels at group A and B had no difference (P > 0.05), while lower \nthan group C (P < 0.05). Mean CT value of rectal cancer at three groups had \nno difference (P > 0.05), while SNR of rectal cancer at group A and C higher \nthan group B (P < 0.05).The diagnostic accuracy of group A and C had no \nstatistical difference (P> 0.05), while higher than group B (P < 0.05). \nConclusion: Obtained with 80 kV (with iterative reconstruction) is feasible and \nthe images are satisfactory for T-Staging of rectal cancer.  \nB-0408 15:21  \nMR tumour volumetry for tumour response evaluation after neo-adjuvant \nchemoradiation- in rectal cancer: a prospective validation study  \nM.H. Martens, R.C. Dresen, D.M. Lambregts, L.A. Heijnen, T.J. Hua, W. Mok, \nG.L. Beets, R.G.H. Beets-Tan; Maastricht/NL (milou.martens@mumc.nl)  \nPurpose: The assessment of tumour response after chemoradiation (CRT) in \nrectal cancer remains difficult. Morphologic evaluation on T2-weighted MRI is \nnot accurate to predict tumour downstaging. Studies have suggested that \nassessment of tumour volume may improve the accuracy, but this has only \nS223  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nbeen tested retrospectively. Aim of this study was to prospectively determine \nthe value of tumour volumetry by testing previously reported volume thresholds \nin a new cohort of locally advanced rectal cancers treated with CRT. \nMethods and Materials: Seventy-three patients with a cT3-4 locally advanced \nrectal tumour were included. Tumour volume (estimated as height x length x \nwidth) was analysed before and after CRT. The reduction in tumour volume \n(%) was calculated. The primary tumour volume and volume reduction after \nCRT was compared between responders (ypT0-2) and non-responders (ypT3-\n4) using Mann Whitney U test. Sensitivity, specificity, positive predictive value \n(PPV), and negative predictive value (NPV) were calculated using a predefined \ncut-off of > 75% reduction in tumour volume (according to previous reports). \nResults: The volume of the primary tumour was significantly smaller in de \nypT0-2 group compared to ypT3-4 tumours (97.0 vs 172.8 cm 3, p=0.008). \nVolume reduction rates were significantly higher in ypT0-2 than in ypT3-4 \ntumours (86.7 vs 72.4%, p < 0.001). Applying the criterium of >  75% reduction \nresulted in a sensitivity of 88%, specificity 59%, PPV 65%, and NPV 85% for \ndetecting ypT0-2. \nConclusion: This study has prospectively confirmed that a reduction in tumour \nvolume of > 75% MRI can predict tumour downstaging to yT0-2 with a high \nsensitivity and moderate specificity.  \n14:00 - 15:30 Room B  \nAbdominal Viscera  \nSS 601b  \nEfficacy and diagnostic performance  \nModerators:  \nF. Caseiro-Alves; Coimbra/PT  \nS. Haneder; Mannheim/DE  \nB-0409 14:00  \nThe correlation study of visceral fat area and non-alcoholic liver disease \nin hepatocellular carcinoma  \nK. Weng, I.-H. Lao, C. Mak, W. Tzeng; Tainan/TW (smallt@gmail.com)  \nPurpose: Visceral fat area (VFA) is a qua ntitative measurement of visceral fat \nin CT images. Increased VFA has been postulated as the cause of non-\nalcoholic fatty liver disease (NAFLD) in NAFLD-related hepatocellular \ncarcinoma (HCC). So far, no study has directly validated the hypothesis. \nMethods and Materials:  43 HCC patients with pre-treatment abdominal CT in \nJan/2009-April/2011, without chronic viral hepatitis or alcoholism, were \nincluded. VFA elevation ( > 100 cm\n2 at umbilicus level) and fatty liver is \ndetermined in CT images. Prevalence of increased VFA, liver function test \n(LFT) at HCC diagnosis, Child-Pugh score, the Cancer of the Liver Italian \nProgram (CLIP) score, and HCC-related mortality were compared between \npatients with and without NAFLD. Further, CLIP staging was compared \nbetween patients with and without elevated VFA. \nResults: No statistically significant difference existed in the prevalence of \nincreased VFA, HCC-related mortality, Child-Pugh score and LFT at HCC \ndiagnosis, between patients with and without NAFLD. The distribution pattern \nof CLIP score was statistically signifi cantly different between NAFLD group and \nnon-NAFLD group (more CLIP 2, 3 patients in NAFLD group, p=0.047) but not \nbetween HCC patients with and without VFA elevation. The mortality rate in \nnon-NALFD group is higher than NAFLD group but not statistically significant \n(p=0.101). \n \nConclusion: The results from our study did not support that increased VFA \nwas associated with LFT, severity of NAFLD, and several prognostic factors in \nHCC patients. The difference in mortality and distribution pattern of CLIP stage \nin patients with and without NAFLD suggested different prognoses and may \nworth further investigation.  \nB-0410 14:09  \nThe use of bolus tracking, high flow or slow flow contrast injection rate in \nGd-EOB-MRI of the liver and its influence on SNR and truncation artifacts \non arterial phase  \nG. Perucca, P. Demaria, R. Faletti, D. Righi, P. Fonio, G. Gandini; Turin/IT \n(giuliaperucca@yahoo.it)  \nPurpose: To evaluate signal to noise ratio (SNR) and presence of truncation \nartifacts (TA) on arterial phase images in gadoxetic acid-DTPA (Gd-EOB-\nDTPA)-enhanced magnetic resonance imaging (MRI) of the liver with and \nwithout fluoroscopic triggering technique using high or slow-rate contrast \ninjection. \nMethods and Materials:  176 MR examinations for liver disease were \nretrospectively reviewed. Three Gd-EOB-DTPA injection methods were \nevaluated: 1) fluoroscopic triggering and high-rate injection (2.0 ml/s); 2) \nfluoroscopic triggering and slow-rate injection (0.8 ml/s); 3) no fluoroscopic \ntriggering, high-rate injection and double arterial phase acquisition (2.5 ml/s). A \nqualitative analysis was performed, evaluating presence of TA and giving a \nscore to set the image quality (0: no TA; 1: TA with no diagnostic impairment; \n2: TA with diagnostic impairment). As a quantitative analysis, SNR ratio on \narterial phase images was calculated placing ROIs in three liver parenchyma \nregions. To evaluate the appropriateness of the arterial phase, mean intensity \nvalues were calculated on abdominal aorta, and compared to values in non-\nenhanced phase. T-Student test and ANOVA test were performed for statistical \nanalysis. \nResults: The presence of TA was significantly lower in groups 2 and 3 if \ncompared to group 1. SNR of liver parenchyma on arterial phase was \nsignificantly higher in groups 2 and 3, in comparison with group 1. The \nappropriateness of the arterial phase was similar across groups. \nConclusion: High rate contrast injection without fluoroscopic triggering \ntechnique and double arterial phase acquisi tion is a valid choice for Gd-EOB-\nDTPA MR imaging of the liver.  \nB-0411 14:18  \nUsefulness of \"controlled aliasing in parallel imaging results in higher \nacceleration\" (CAIPIRINHA) in gadoxetic acid-enhanced liver MRI to \nclarify the hepatic arterial phase  \nY. Park, C. Lee, K. Kim, J. Choi, J. Lee, C. Park; Seoul/KR \n(pys797979@naver.com)  \nPurpose: To determine whether CAIPIRINHA could improve the image quality \nin the hepatic arterial phase of gadoxetic acid-enhanced liver MRI. \nMethods and Materials:  A total of 320 patients underwent gadoxetic acid-\nenhanced liver MRI: a conventional protocol (fixed scan delay and 2 mL/s \ninjection) using standard 3-T MR (group A); an optimised protocol (bolus \ntracking and 1 mL/s injection) using standard 3-T MR (group B); an optimised \nprotocol using new 3-T MR (group C); and an optimised protocol and \nCAIPIRINHA using new 3-T MR (group D). An image quality in the hepatic \narterial phase was reviewed and assigned using a 4-point rating scale from 1 \n(no artifacts) to 4 points (nondiagnostic images with severe artifacts). The \ndifferences in image quality scores among 4 groups were evaluated. \nResults: The median score of image quality was 2 in groups A and B and 1 in \ngroups C and D. Scores of 4 points were observed in groups A (n = 7), B (n = \n5), and C (n = 3), but not in group D. From groups A to D, the median score of \nimage quality decreased significantly ( P = 0.0001). The median score of image \nquality of group D was significantly lower than those of groups A and B ( P = \n0.0001 and 0.001, respectively), while there was no significant difference \nbetween groups D and C (P = 0.656). \nConclusion: CAIPIRINHA technique improved the image quality of hepatic \narterial phase imaging with gadoxetic acid, reducing the number of \nnondiagnostic arterial phase studies.  \nB-0413 14:27  \nReal-time elastography: role in the assessment of hepatic fibrosis in \npatients with liver iron-overload  \nL. Cevasco, F. Paparo, M. Revelli, C. Puppo, E. Aleo, L. Bacigalupo, G. Forni, \nG. Rollandi; Genoa/IT (dott.luca.cevasco@gmail.com)  \nPurpose: Our purpose was to determine the diagnostic accuracy of real-time \nelastography (RTE) in assessing hepatic fibrosis stage in a heterogeneous \ncohort of patients with liver iron-overload using transient elastography (TE) as \nreference standard. \nMethods and Materials: 67 patients with MRI-detectable hepatic iron-overload \n(T2*< 6.3 ms) were enrolled. All TE and RTE examinations were performed by \nexperienced operators: the informations provided by the elastograms were \nconverted in quantitative data by calculating the elastic ratio, which represents \nthe strain distribution in two selected ROI (one positioned in the liver \nparenchyma and the other in a homogeneously soft region of the diaphragm). \nResults: 60 patients were included; 7 patients were excluded because of \ninvalid TE or RTE examinations. The cohort of patients included 37 adults with \nthalassaemia major, 13 patients with thalassaemia intermedia, 6 patients with \nprimary haemochromatosis and 4 patients with myelodysplastic syndromes. A \nsignificant increase in el astic ratios was observed with increasing stiffness \nvalues measured by TE (r= \u00030.645, 95% CI 0.468-0.772, P < 0.0001). The \nmean elastic ratios for each METAVIR group were as follows: F0/1=1.9± 0.4; \nF2=2.2±0.4; F3=2.9±0.5; F4=3.2±0.4. The diagnostic accuracy of RTE for F \u00032 \nevaluated by AUC-ROC analysis was 0.798 (95% CI 0.674-0.890). The \ndiagnostic accuracy of RTE for F \u00033 was 0.909 (95% CI 0.806-0.968). At a cut-\noff \u00032.75, RTE showed a sensitivity of 70% (95% CI 45.7-88.1) and a \nspecificity of 97.5% (95% CI 86.8-99.9). \nConclusion: RTE allows to discriminate between F0/1-F2 and F3-F4 with a \nreasonable diagnostic accuracy in patients with MRI-detectable liver iron-\noverload.  \n \n \nS224  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0414 14:36  \nThe impact of field strength and contrast administration on liver \nhaemodynamics at k-t accelerated 4D flow MRI  \nZ. Stankovic, M. Markl, E. Semaan, M. Wasielewski, M. Carr, A. Barker, \nJ. Carr, J. Collins; Chicago, IL/US (zoran.stankovic@northwestern.edu)  \nPurpose: To evaluate influence of contrast administration and field strength on \nvisualisation and quantification of arterial and portal venous (PV) liver \nhaemodynamics at 4D flow MRI in healthy volunteers. \nMethods and Materials:  Liver haemodynamics were evaluated on n=38 4D \nflow MRI datasets acquired in 5 healthy volunteers (55 ±9 yrs) at 1.5 T and 3 T \nwith a spatial resolution of 2.1x2.5x3.0 mm 3. Scans were performed before and \nafter administration of gadofosveset trisodium (Ablavar©). Measurements were \nperformed with venc=50 and 100 cm /sec. K-t GR APPA was applie d with an \nacceleration factor R=5. Qualitative 3D blood flow visualisation was based on \nparticle-traces and streamlines. Quantitative analyses were performed with \nretrospective extraction of time-resolved peak velocities and net flow over the \ncardiac cycle based on 10 analyses planes. Bland Altman (BA) analyses \ncompared peak velocities and net flow. \nResults: 4D flow MRI visualisation was successful in all datasets. Qualitatively, \nincreased noise was seen for the PV system evaluation for a venc of 100 cm/s. \nQuantitative analyses at 1.5 vs. 3 T revealed similar values for peak velocities \n(BA:0.02±0.12 cm/s) and net flow (BA:0.2 ±3.4 ml/cycle). Flow quantification \nbefore and after contrast offered similar values for peak velocities \n(BA:0.01±0.05 cm/s), while net flow values were increased with a mean \ndifference of (BA:-0.6±1.3 ml/cycle) post-contrast. \nConclusion: 4D flow MRI enables visualisation of the liver haemodynamics, at \nboth 1.5 and 3 T, with and without contrast. While quantitation of peak \nvelocities was similar across field strengths and independent of contrast \nadministration, statistically signific ant differences were noted in net flow \nquantification, likely due better delineation of vessel margins with contrast.  \nAuthor Disclosures: \nJ. Carr: Speaker; Lantheus Speaker Bureau.  \nB-0415 14:45  \nDiagnostic capabilities of dual-energy x-ray absorptiometry in the \ndiagnostic algorithm of the metabolic syndrome in patients with \nsteatohepatitis  \nD. Venidiktova, A.V. Borsukov, M.V. Borsukova; Smolensk/RU  \n(darya.venidiktova@gmail.com)  \nPurpose: To determine the informational content of x-ray absorptiometry and \nnon-invasive bioimpedance in patients with mixed origin steatohepatitis. \nMethods and Materials:  In 2012, 63 patients with obesity were examined \n(men - 38 women - 25) with steatohepatitis: Group 1 (n = 18) - non-alcoholic \nfatty liver disease, group 2 (n = 21) - steatohepatitis in patients with 2-type \ndiabetes, group 3 (n = 24) - alcoholic steatohepatitis. The patients underwent a \nbioimpedance and the whole body research with dual energy absorptiometry \n(DXA-StratosDR). \nResults: At the 1\nst stage, the body mass index (BMI), the results of \nbioimpedance and densitometric analysis in the system \"fat - water\" and \"fat - \nlean mass\" of the human body were compared. The diagnostic efficacy of \ninstrumental methods is 38.6 % higher than BMI information content in all \npatients. On the 2\nnd stage, the set of measures to reduce weight was hold. In \nthe first month of the 2 nd stage, with DXA and BIM the water sector of the \norganism was decreased in 1 gr. by 18.5 % of the original; in 2 gr. by 27.1%; in \n3 gr. by 7.8 %. DXA in 2\nnd stage: sensitivity 97.5%, specificity 95.2%; \ninformative content of BIM was: sensitivity 74.7%, specificity 66.3%. \nConclusion: The method for DXA-\"whole body\" is more informative in the \ndiagnosis of metabolic syndrome.  \nB-0416 14:54  \nMRI-based estimation of liver function: post-Gd-EOB-DTPA T1 \nrelaxometry of 3 T vs the MELD-Score  \nM. Haimerl, N. Verloh, C. Fellner, F. Zeman, C. Stroszczynski, P. Wiggermann; \nRegensburg/DE (michael.haimerl@ukr.de)  \nPurpose: To determine the ability of T1 mapping of liver on Gd-EOB-DTPA-\nenhanced MR imaging (MRI) for estimating liver function and to compare the \nestimated liver function to the Model for End-Stage Liver Disease (MELD) \nscore. \nMethods and Materials:  168 patients underwent Gd-EOB-DTPA-enhanced \nMRI on a 3 T system. Patients were classified into three groups: MELD-Score \n\u0002 10 (n = 128), MELD-Score 11 - 18 (n = 33) and patients with MELD-Score \n> 18 (n = 7). Two TurboFLASH sequences (TI = 400 ms, 1000 ms) were \nacquired before and 20 minutes after Gd-EOB-DTPA administration to obtain \nT1 maps. Reduction rate of T1 relaxation time between pre- and postcontrast \nenhancement and T1 relaxation times were determined and correlated to the \nMELD-score. \n \nResults: T1 relaxation time for non-enhanced MRI showed no significant \ndifferences (p = 0.644) between the 3 different groups (MELD \u0002 10, \n762.62 ms ± 140.28 ms; MELD 11- 18, 783.31 ms ± 169.47; MELD > 18, \n802.11 ms ± 204.14 ms). After administration of Gd-EOB-DTPA a significant \ndifference of patient groups could be shown (MELD \u0002 10, \n297.72 ms ± 88.41 ms; MELD 11- 18, 430.16 ms ± 134.99; MELD > 18, \n561.95 ms ± 90 ms; p \u0002 0.001) \nConclusion: Patients with advanced liver disease showed significantly lower \nchanges in T1 mapping. Therefore, evaluation of changes in T1 mapping of the \nliver parenchyma may serve as a useful method to determine whole liver \nfunction, to improve the estimation of segmental liver function and finally to \ndefine the grade of liver disease.  \nB-0417 15:03  \nThe application research of CT single energy image fusion technology in \nhypervascular liver small lesions  \nM.Y. Wang, B.J. Gao, J.P. Lv; Zhengzhou/CN \n(wangmingyue.xxmu@163.com)  \nPurpose: To evaluate the applied value of CT single energy image fusion \ntechnology in hypervascular liver small lesions in arterial phase. \nMethods and Materials: 30 patients who were accepted energy spectra of CT \nscans in arterial phase, a total of 48 sma ll rich blood supply of the liver lesions \n(炩3 cm), were retrospectively analysed. CT browser binding energy spectrum, \nyielding 40keV, 70keV, QC groups, as well as (40+70) keV integration set of \nfour images. The noise ratio (CNR) and image noise of four groups were \ncompared using one-way analysis of variance. The lesion detection and the \noverall image quality were compared using 5 point method and using \nnonparametric tests. \nResults: There were no significant differences between the CNR of (40+70) \nkeV group (6.39 ±4.21) and that of 40keV Group (4.15 ±3.97) (P> 0.05), but the \nCNR of (40+70) keV group was significantly higher than that of 70keV Group \n(3.28 ±3.02) (p=0.009) and that of QC group (3.23 ±3.41) (p=0.008).The image \nnoise of (40+70) keV group (25.44 ±6.74) is significantly lower than that of \n40keV (46.37 ±9.16) (P < 0.001), but higher than that 70keV Group \n(19.33±6.70) (P=0.009) and QC group (16.61 ±3.60) (p 炩0.001). There were \nno significant differences between the lesions detection capacity score of \n(40+70) keV group (3.36 ± 0.51) and that of 40keV Group (3.5 ± 0.66), but the \nlesions detection capacity score of (40+70) keV group was significantly higher \nthan that of 70keV Group (2.94 ± 0.45) (P=0.016) and that of QC group \n(3.06 ± 0.416) (P=0.049). The overall image quality score of the (40 +70) keV \ngroup (3.61 ± 0.53) was significantly higher than that of the other three group \n(P < 0.02). \nConclusion: CT single energy image fusion technology which combines the \nadvantages of high CNR of the low keV image with the advantages of the low \nnoise of high keV image without compromising image quality, improve the \nlesion detection capability.  \nB-0418 15:12  \nCost-utility analysis of nonalcoholic steatohepatitis screening  \nE. Zhang, C. Wartelle, L. Lepanto, A. Tang; Montreal, QC/CA \n(eric.zhang@umontreal.ca)  \nPurpose: Nonalcoholic fatty liver disease (NAFLD) is the leading chronic liver \ncondition in Western countries. No studies have examined the cost-\neffectiveness of screening for nonalcoholic steatohepatitis (NASH), its \nadvanced form. We performed a cost-utility analysis of noninvasive screening \nand intervention strategies using third-party payer perspective. \nMethods and Materials:  A Markov model was created simulating NAFLD \nprogression in a general population. We compared the most validated \nnoninvasive techniques for NASH or significant fibrosis ( \u0003F2) detection: \ntransient elastography (TE); acoustic radiation force impulse (ARFI); NAFLD \nfibrosis score (NFS); cytokeratin-18 (CK-18); magnetic resonance elastography \n(MRE), and sequential algorithms. Liver biopsy and MRE were compared as \nconfirmation methods. Model parameters were derived from literature review \nand uncertainties tested in sensitivity analyses. Costs were calculated in \nCanadian dollars adjusted for inflation and discounted at 3%. Incremental cost-\neffectiveness ratio (ICER) of $C50,000 or less was considered cost-effective. \nResults: Compared with no screening, screening with NFS alone and with \nNFS/TE/CK-18 algorithm were most cost-effective with ICERs of $C4,330 and \n$C18,200 per quality-adjusted life year (QALY) gained, respectively. Screening \nwith NFS/ARFI/CK-18 algorithm was dominated with an ICER of $C61,876 per \nQALY gained. Compared with biopsy, MRE confirmation for fibrosis staging \nwas more cost-effective with ICER of $C18,715 vs. $C44,033. Sensitivity \nanalyses revealed ARFI became more cost-effective than TE in the sequential \nalgorithms if TE unreliability rates exceeded 21% or when TE price increased \npast $C108. \nConclusion: Our model suggests that NASH screening in the general \npopulation can be cost-effective with NFS alone or with a sequential \nNFS/TE/CK-18 algorithm.  \nS225  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n14:00 - 15:30 Room C  \nComputer Applications  \nSS 605  \nCAD and image segmentation  \nModerators:  \nO. Pianykh; Newton Highlands, MA/US  \nP. Sögner; Feldkirch/AT  \nB-0419 14:00  \nDouble reading improves detection of small lung tumours in chest \nradiographs: can a computer aided detection system replace the second \nreader?  \nS. Schalekamp\n1, C.M. Schaefer-Prokop2, N. Karssemeijer1, B. van Ginneken1; \n1Nijmegen/NL, 2Amersfoort/NL (steven.schalekamp@gmail.com)  \nPurpose: To investigate whether or not a computer aided detection (CAD) \nsystem could replace a second human reader in a double reading process. \nMethods and Materials:  We selected 300 posteroanterior and lateral digital \nchest radiographs (CXR), including 111 with a solitary CT proven pulmonary \nnodule with an average diameter of 16 mm. Twelve radiologists read the CXRs \nhaving bone suppressed images available. Readers marked and scored \nsuspicious regions on a continuous scale from 0 to 100. All images were also \nprocessed by a CAD system (ClearRead+Detect 5.2, Riverain Technologies) \nthat also provided a score between 0 and 100 for each suspicious location it \nidentified. Location based ROC analysis was used to measure nodule \nlocalisation performance. Mean sensitivity in a false positive fraction range \nbetween 0 and 0.2 was used to compare reader performance. Double reading \nwas evaluated by combining the findings of two readers: scores of findings at \nthe same location were averaged while findings that were not identified by the \nsecond observer were averaged with 0. CAD results were treated similarly to \nevery observer for simulated double reading. A paired t-test was used to \ncalculate differences. \nResults: The mean sensitivity was 64.0% for single reading (range 45.5%-\n78.2%). Combining the readings of two observers improved lung nodule \ndetection on average to 73.1% (range 58.3%-83.8%; p=0.001). Performance \nwith CAD as the second reader increased to 67.8% (range 58.1%-81.1%; \np=0.02). \nConclusion: Use of CAD as the second reader significantly improves \ndetection of lung nodules, although it is not yet as good as double reading by \ntwo human readers.  \nAuthor Disclosures: \nS. Schalekamp: Research/Grant Support; Riverain Technologies. C.M. \nSchaefer-Prokop: Advisory Board; Riverain Technologies. N. Karssemeijer: \nResearch/Grant Support; Riverain Technologies.  \nB-0424 14:09  \nVisceral fat quantification using routine abdominal CT data  \nM. Pop, R. Pop; Tg.Mures/RO (pop.marian@gmail.com)  \nPurpose: Quantitative assessment of body fat is important for the diagnosis \nand treatment of diseases related to obesity. The standard evaluation methods \ndo not measure body fat quantitatively. Computed tomography (CT) is \nbecoming the standard procedure for measuring the abdominal fat distribution, \nvarious methods and software being used. \nMethods and Materials:  The retrospective study included 111 inpatients, who \nunderwent routine abdominal CT exams (SOMATOM AS 64 MDCT). MPR \nlinking the posterior-inferior aspect of L4/L5 intervertebral disc and the \numbilicus were processed using custom written MATLAB R2009b software. \nImageJ was used for tracing the contour of visceral fat area (VFA).Patient data \n(including blood glucose, cholesterol an d triglycerides) were statistically \nanalysed using MO Excel and GraphPad Inprism5. \nResults: The Visceral Fat percentage varied in population from 14.59-\n68.69 (SD= 11.83) with significant difference between sexes (male vs. female, \n46.98vs.31.62, p 220 mg% and triglycerides > 150 mg% are significantly \nassociated with the VF percent (p < 0.05).Overall there is a weak correlation \nbetween the lab variables and the measured fat, the strongest one being \nbetween TG and the VFA (r=+0.23). However, when looking at certain samples \nthere is a higher positive correlation between age and VFA percentage. \nConclusion: The technique used decreases the human error in marking of the \nfat areas providing a good estimation of the VF and VF percentage. Visceral fat \nmeasured by CT relates with certain lab variables. Further analysis, including \ndifferent blood tests and clinical data are required for a better understanding of \nthe CT role in obesity related pathology diagnosis and treatment.  \n \nAuthor Disclosures: \nM. Pop: Grant Recipient; Internal Research Grant- Tg.Mures University of \nMedicine and Pharmacy, Romania. R. Pop: Grant Recipient; Internal Research \nGrant- Tg.Mures University of Medicine and Pharmacy, Romania. \nB-0420 14:18  \nApplication of artificial neuronal networks for the assessment for the \nassessment of early, non-invasive breast cancer  \nM. Dietzel1, W.A. Kaiser2, P.A.T. Baltzer3; 1Erlangen/DE, Jena/DE, 2Jena/DE, \n3Vienna/AT, Jena/AT  \nPurpose: Accurate diagnosis of breast cancer at an early, non-invasive stage \nis crucial for favourable patient outcome. Breast-MRI provides significant \npotential to solve this task. However, eve n upon breast-MRI differentiation of \nnon-invasive breast cancer from benign fibrocystic breast changes remains \nchallenging. Artificial neuronal networks (ANN) are able to automatically \nclassify highly sophisticated imaging data. Accordingly, we evaluated the \npotential of ANN for the diagnosis of early, non-invasive breast cancer based \non MRI imaging patterns. \nMethods and Materials:  Patients were recruited from a cross-sectional \ndatabase containing consecutive, histological ly verified breast lesions imaged \nby breast-MRI (standardised protocols; ethical-board approval). All non-\ninvasive breast cancer (DCIS: ductal carcinoma in situ) or benign findings \n(FBC: fibrocystic breast changes) were included into the dataset of the study. \nIn a next step, imaging patterns of FBC and DCIS were prospectively \nevaluated by two experienced radiologists in consensus using 17 standardised \ndescriptors. Finally, non-supervised ANN we re applied to classify each lesions \nas \"benign\" or \"malignant\" based on the breast-MRI descriptors. To further \noptimise the ANN performance, topology and network-architecture were \noptimised using dedicated heuristics in  a randomly selected training sample. \nDiagnostic accuracy of the ANN was then prospectively evaluated in a \nseparate test sample (AUC: Area under the curve). \nResults: 288 patients were included into the dataset. 69 were diagnosed with \nDCIS. Diagnostic accuracy was highest, if a multilayer perceptron type ANN \nwas used (AUC= 86.2%). \nConclusion: Artificial neuronal networks provide high diagnostic accuracy for \nthe assessment of breast cancer at an early non-invasive stage.  \nB-0421 14:27  \nReal time and accurate segmentation of mammographic \nmicrocalcifications  \nN. Arikidis, P. Sakellaropoulos, S. Skiadopoulos, A. Karahaliou, K. Vassiou, \nL. Costaridou; Patras/GR (skiado@upatras.gr)  \nPurpose: Morphology of individual microcal cifications contributes in the \ncharacterisation of microcalcification clusters in mammography. Precise \nsegmentation is thus essential for the development of computer-aided \ndiagnosis (CAD) schemes. The purpose of this study is the development of a \nmethod for fast and accurate segmentation of individual microcalcifications, \nfulfilling requirements of a content-based image retrieval CAD scheme. \n \nMethods and Materials: A two-stage segmentation method was developed. \nInitially, the grey-level value corresponding to the maximum radial gradient \nindex (RGI) is estimated in polar coordinates, providing initial contour pixel \nestimates. The RGI contour is then defined in Cartesian coordinates using a \nfirst-order polynomial fitting of the contour pixel estimates. Finally, the contour \nis optimised by iterative region growing, allowing curve evolution from inside \nthe lesion. The proposed method was compared with a radial gradient-based \nsegmentation method. Segmentation accuracy was quantitatively evaluated \nemploying the area overlap measure, by comparing automated segmentations \nto expert manual delineations of 158 indi vidual microcalcifications originating \nfrom 24 clusters of the DDSM database. Microcalcifications spanned a wide \nrange of shapes and sizes and background mammographic parenchyma. The \nmethod functionality was qualitatively assessed by incorporating it in a home-\ndeveloped GUI. \nResults: The proposed method achieved an area overlap of 0.66 ±0.20, \noutperforming statistically significantly ( p \n< 0.001) the radial gradient-based \nmethod (0.44 ±0.17), and fulfilled radiologists' requirements for accurate and \nreal-time segmentation of microcalcifications. \nConclusion: The proposed segmentation method is time-efficient and non-\nparametric, performing accurately in case of microcalcifications of varying \nshape and size, even in presence of dense parenchyma.  \nS226  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0422 14:36  \nAutomatic detection of prostate cancer by computer-aided multi-\nparametric magnetic resonance imaging  \nS. Mazzetti, V. Giannini, A. Vignati, F. Russo, D. Regge, M. Stasi; Candiolo/IT  \nPurpose: A computer-aided diagnosis (CAD) system was developed, to \nincrease objectivity and reproducibility of prostate cancer (PCa) interpretation \nin multi-parametric (mp) magnetic resonance imaging (MRI). T2-weighted (T2-\nw), diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) \nparameters were combined to calculate a pixel-wise probability of PCa \npresence. \nMethods and Materials:  20 men with PSA > 4 ng/ml with biopsy proven PCa \nunderwent MRI at 1.5 T using an endorectal coil, followed radical \nprostatectomy within 3 months of imaging. Each prostate was cut into axial \nsections of the same thickness and orientation as the axial MRI. Foci of cancer \nwere contoured on each slide with ink by the pathologist to create the standard \nof reference. A radiologist compared imaging with histopathology and reported \nboth malignant and benign regions of interest on T2-w images. After the \nregistration between T2-w, DW and DCE datasets, each pixel was represented \nlike a vector containing scalar values such as T2-w signal intensity, the \napparent diffusion coefficient and quanti tative physiological parameters (e.g. \nkep, Ktrans) obtained from DCE-MRI datasets. All these parameters were fed \ninto a support vector machine (SVM) classifier, and a parametric color-coded \nmap of the cancer's presence probability for each pixel of the prostate was \ncreated. \nResults: The area under the ROC curve for the SVM classifier was equal to \n0.93, sensitivity 0.84 and specificity 0.85. \nConclusion: The application of a CAD system based on MRI information that \nautomatically highlights cancer suspicious regions will improve the diagnostic \naccuracy of the radiologist, reducing reader variability and speeding up the \nreading time.  \nB-0423 14:45  \nAutomatic segmentation of atherosclerotic plaque components in \ndifferent carotid MRI protocols  \nA. van Engelen1, A.C. van Dijk1, M.T.B. Truijman2, R. van 't Klooster3, \nA. van der Lugt1, W.J. Niessen1, M.E. Kooi2, M. de Bruijne1; 1Rotterdam/NL, \n2Maastricht/NL, 3Leiden/NL (a.vanengelen@erasmusmc.nl)  \nPurpose: To automatically segment carotid atherosclerotic plaque \ncomponents in MR image data from two hospitals with a difference in MRI \npulse sequences and MRI scanners. Additionally, to evaluate whether a \nmethod trained on data obtained with one imaging protocol can be used to \nsegment data that is obtained with another protocol. \nMethods and Materials:  Multi-sequence MRI (T1w, T2w, IR-TFE or SPGR, \nTOF or FSPGR, postcontrast-T1w) of 19 patients from center 1 and 20 from \ncenter 2 (stenosis 30-69%) were acquired. Observer 1 manually annotated all \n39 images; observer 2 only those of center 1. Using the annotations of \nobserver 1, linear discriminant classifiers for calcification (C), lipid or \nintraplaque haemorrhage (L+IPH) and fibrous tissue (F) were trained with 2 \nmethods: M1) using only same-center data and M2) using only different-center \ndata. Evaluation was performed using leave-one-patient-out experiments. \nResults: ICC-values (volume per vessel) of F, L+IPH and C, were for M1 0.98, \n0.90 and 0.60 (center-1) and 0.96, 0.91 and 0.94 (center-2), and for M2 0.87, \n0.89 and 0.09 (center-1) and 0.97, 0.94 and 0.81 (center-2). Interobserver-ICC \nfor center 1 was 0.91, 0.53 and 0.63. Kappa for IPH-detection was 0.80 and \n0.89 (M1), 1.00 and 0.71 (M2), and 0.78 between observers. \n \n \nConclusion: Automated segmentation of atherosclerotic plaque components \nwas similar to the interobserver variability. Using an algorithm trained on data \nfrom a different center reduced accuracy for calcification and, for center 2, IPH \ndetection. Either standardised imaging protocols, or advances in image \nprocessing to deal with different image acquisitions, are recommended.  \nAuthor Disclosures: \nA. van Engelen: Research/Grant Support; CTMM, the Center for Translational \nMolecular Medicine (www.ctmm.nl), project PARISk (grant 01C- 202), and the \nDutch Heart Foundation. A.C. van Dijk: Research/Grant Support; CTMM, the \nCenter for Translational Molecular Medicine (www.ctmm.nl), project PARISk \n (grant 01C- 202), and the Dutch Heart Foundation. M.T.B. Truijman: \nResearch/Grant Support; CTMM, the Center for Translational Molecular \nMedicine (www.ctmm.nl), project PARISk (grant 01C- 202), and the Dutch \nHeart Foundation. R. van 't Klooster: Research/Grant Support; CTMM, the \nCenter for Translational Molecular Medicine (www.ctmm.nl), project PARISk \n(grant 01C- 202), and the Dutch Heart Foundation.  \nB-0425 14:54  \nComputer-assisted diagnosis (CAD) in multiparametric neuroimaging: \nyou only have to push the button?  \nM. Dietzel1, S. Lang1, P.A.T. Baltzer2, B. Volbers1, S. Lettmaier1, R. Fietkau1, \nT. Struffert1, T. Engelhorn1, A. Dörfler1; 1Erlangen/DE, 2Vienna/AT  \nPurpose: Multiparametric magnetic-resonance neuroimaging is increasingly \nused in clinical practice. From theory, it provides quantitative measures for \ntissue characterisation and might - beside many other benefits - potentially \nreduce observer related bias. Yet, currently available CAD-software requires \nnumerous user-interactions. Consequently, relevant observer-related bias on \nfinal results can not be excluded. We  aimed to systematically address this \nmatter using a state of the art MR protocol and a CAD-software, specifically \ndesigned for this purpose. \nMethods and Materials:  A series of fifteen patients with brain tumours was \ninvestigated using one clinical MR unit (Siemens Magentom Aera, B\n0=1.5T) \nincluding DTI (Diffusion tensor imaging), DWI (Diffusion weighted imaging) as \nwell as DCE sequences (dynamic contrast enhanced; 6 ml Gadovist @2 ml/s). \nMultiparametric analysis was done by one experienced neuroradiologist using \na commercially available semi-automatic CAD-software. Postprocessing was \nrepeated independently several times resulting in serial measurements of FA \n(DTI), ADC (DWI), k\ntrans, k ep and V e (DCE). Variability within serial \nmeasurements was assessed by reproducibility (concordance correlation-\ncoefficient), precision (Pearson ;), accuracy (Bias correction-factor/Cb), \nreliability (intraclass correlation-coefficient) and systematic bias (Bland-Altmann \nplot: regression-coefficient/Rc). \nResults: Overall variability of multiparametric analysis was low. \nReproducibility, precision, reliability and accuracy showed a range from 0.94 to \n0.99. Best results were identified for DCE-parameters (reproducibility, \nprecision, reliability and accuracy: 0.99). In all series, Bland-Altmann plot \nexcluded presence of systematic bias. \nConclusion: Computer-assisted multiparametric Neuroimaging was a robust \nmeasure for tissue characterisation. Despite  significant user interaction during \nthe CAD-analysis, we identified excellent reproducibility, precision and \nabsence of systematic bias.  \nB-0426 15:03  \nAn enterprise class computer aided detection platform scalable from \nlaptop to cloud  \nM. Hinton\n1, O. Kubassova1, M. Boesen2; 1London/UK, 2Copenhagen/DK \n(mark.hinton@imageanalysis.org.uk)  \nPurpose: To achieve efficiency in analyzing medical images many utilise cloud \nbased image storage and computer aided detection (CAD) techniques. The \nproblem is keeping calculations and image overlays up to date whilst providing \ngood user experience across uncontrolled bandwidths. To support clinical \ndevelopments the architecture of the software should support easy integration \nof new algorithms without compromising performance. Here is a novel \napproach to a multi-tier architecture, Dynamika, which has addressed these \nproblems and been validated in radiology practices. \nMethods and Materials:  Dynamika uses a back end framework of Spring and \nHibernate to give robust server scaling and performance. It uses Spring \nWebflow to control the path through the application. Webflow has been \nenhanced for tightly controlled batch processing, utilised in clinical trials, \nroutine analysis, and investigations. The front end uses Google Web Toolkit to \ngive high performance, desktop like behavior through AJAX and the power of \nHTML5. 3D is with WebGL. \n \nResults: We have benchmarked against a workstation for user experience and \ndevelopment efficiency. The cloud arch itecture has comparable performance to \nthe workstation in scrolling through images with complex overlays. Time to \nimplement new algorithms (coding and testing) was up to 10 times less in \nDynamika. Dynamika supports collaboration and can be used from any device. \nConclusion: Dynamika has addressed challenges of handling large datasets \nin real-time. Validation in clinical practice has shown Dynamika gives better \nperformance than a workstation. It supports multi-center collaboration and data \nsharing. There are low costs to deploy updates and development time is less.  \n \nAuthor Disclosures: \nM. Hinton: Employee; Image Analysis. O. Kubassova: CEO; Image Analysis. \nM. Boesen: Advisory Board; Independant non paid member Image Analysis \nLTD. Consultant; Radiologist. \nS227  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0427 15:12  \nAutomatic assessment of the occlusal plane on panoramic radiographs.  \nP.A. Regulski, K. Szopi\u001bski, K. Nowi\u001bski; Warsaw/PL (pregulski@interia.pl)  \nPurpose: Objective assessment of the curvature of occlusal plane with the use \nof an automatic computer algorithm. \nMethods and Materials:  100 panoramic radiographs were selected and \ndivided by two observers into two equinumerous groups (Kappa = 1): a correct \nocclusal plane position (x-ray meets quality criteria) and an incorrect occlusal \nplane position (x-ray does not meet quality criteria). The segmentation \nalgorithm based on clustering methods with adaptive thresholding was \nperformed to find region of interest (teeth and space between them). This \nregion constituted starting points for watershed segmentation. Skeletonization \nwas carried out on segmented surfaces. Lines and points of the skeleton were \nsmoothed with polynomial interpolation. For each x-ray, parametric angle of \nocclusal plane was calculated by usi ng the mean of the derivatives in \nequidistant points located on the interpolated line. \nResults: Magnitudes of parametric angles formed two Gaussian curves: one \nfor panoramic radiographs meeting quality criteria (average = 15.97, standard \ndeviation = 7.81), the other for ones the does not (average = 28.96, standard \ndeviation = 9.21). By that means the thresholding value was obtained ( ' = \n22.83, p < 0.05). \nConclusion: Automatic assessment of the curvature on orthopantomograms of \nocclusal plane is feasible and the objective  thresholding value of this curvature \nis 22.83.  \nB-0428 15:21  \nEnhancing ground glass nodule interpretation through the interactive \nunification of 2D and 3D visualisations  \nP. Kocsis, V. Demers, F. Chandelier, L.A. Stein; Montreal, QC/CA \n(virginie.demers@mail.mcgill.ca)  \nPurpose: To demonstrate the advantage of a Novel visualisation technique \nthat interactively blends 2D and 3D renderings for the interpretation of ground \nglass opacity nodules (GGO). We hypothesise that using such technique for \nGGO examination will allow an improvement in image accuracy in terms of \ndiagnostic information when compared to  traditional thick-slab multiplanar \nvisualisation (SLAB). \nMethods and Materials:  13 patient datasets were obtained from The Cancer \nImaging Archive (http://cancerimagingarchive.net/) sponsored by the Cancer \nImaging Program, DCTD/NCI/NIH. Interactive screen capture images of \nnodules were collected for both visualis ation paradigms. Our primary objective \nwas to evaluate the discriminative power of light intensity values within a given \nregion of interest to best segregate GGO from its environment. The signal to \nnoise ratio (SNR) was determined for all images and compared to a Rose \nCriterion (RC) that represents the 100% certainty threshold for identification of \nimage details (corresponding to RC (SNR) \u0003 5). \nResults: The SNR of GGO exceeded the Rose Criterion (SNR \u0003 5) in 92.3% \nand 46.2% of the patient datasets during the Novel and SLAB visualisation \nconditions respectively. Qualitative inspection of the GGO in the former \nensured that vessels were not included in nodule volume assessments. \nConclusion: The Novel visualisation technique increases accuracy of image \ndetails, by providing an interactive environment integrating traditional SLAB \nvisualisation and advanced 3D rendering . This facilitates radiologist's \ninterpretation while characterising GGO nodules. Such results will be \ninvestigated during a prospective clinical study.  \nAuthor Disclosures: \nP. Kocsis: Employee; Cadens Medical Imaging. F. Chandelier: Employee; \nCadens Medical Imaging.  \n \n \n14:00 - 15:30 Room D  \nChest  \nSS 604  \nRadiation dose and techniques in chest CT  \nModerators:  \nP. Vock; Spiegel/CH  \nN.N. \nB-0429 14:00  \nAre chest radiographs outdated in tuberculosis screening? Low dose CT \n(LDCT) as an alternative  \nS. Notohamiprodjo, U.G. Mueller-Lisse, H. Schulze-Koops, M.F. Reiser, \nT. Saam; Munich/DE (Susan.Notohamiprodjo@med.uni-muenchen.de)  \nPurpose: To rule out tuberculosis before initiation of immunosuppressive \ntherapy with biologicals, chest X-ray (cXR) is routinely used in rheumatic \npatients. We evaluated the diagnostic value  of cXR in the detection of pleural \nscarring (PS) and postspecific changes (PC) compared to Low-Dose-CT \n(LDCT) of the chest as gold standard. \nMethods and Materials:  We retrospectively included 80 patients having erect \ncXR and LDCT of the chest performed within 2 weeks between 2009 and \n2013. One blinded radiologist evaluated the presence/absence of PS and PC \nin LDCT independently from a second blinded radiologist who evaluated the \ncXR. Cohen´s kappa, Sensitivity (SN), specificity (SP), positive predictive value \n(PPV) and negative predictive value (NPV) and accuracy (AC) were calculated. \nDose parameters were recorded. \nResults: For detection of PS cXR result ed in SN, SP, PPV, NPV and AC of \n53.7%, 96.6%, 92.3%, 27% and 77.9%, respectively. For detection of PC cXR \nresulted in SN, SP, PPV, NPV and AC of 50%, 98.3%, 90%, 86.6% and 87%, \nrespectively. Agreement between cXR and LDCT was moderate with a \nCohen's kappa value of 0.53. The average effective dose was 0.08 mSv in XR \nand 0.55 mSv in LDCT. \nConclusion: Our study showed that a substantial number of PC and PS are \nmissed on conventional chest X-rays which might pose a potential risk for \npatients receiving immunosuppressive therapy. LDCT can reveal such post-\nspecific changes at acceptable radiation dose and might therefore be an \nalternative imaging method to rule out postspecific changes.  \nB-0430 14:09  \nThoracic lymph node delineation at contrast-enhanced MDCT: \ncomparison of protocols with greatly reduced dose ( << 1mSv) and \nstandard dose  \nM. Paolini, K. Weber, M.F. Reiser, A. Tufman, R. Huber, U.G. Mueller-Lisse; \nMunich/DE (Marco.Paolini@med.uni-muenchen.de)  \nPurpose: To determine differences in the delineation of mediastinal and hilar \nlymph nodes at contrast-enhanced MDCT between a dose-reduced ( < 1mSv, \nLDCT) and a standard-dose (SDCT) protocol. \nMethods and Materials:  Based on the international-association-for-the-study-\nof-lung-cancer (IASLC) grouping of thoracic lymph nodes, two independent \nradiologists (respective post-graduate work experience, 3 and 20 years) \nretrospectively assessed lymph-node delineation (\"measurable\" vs. \"non-\nmeasurable\") in intravenously contrast-enhanced (average, 70 ml at 3 ml/s, \nwith 350 mg-of-iodine/ml) MDCT-scans of the chest (64 rows, 120KVp, dose \nmodulation, filtered back projection, reformatted axial slice thickness, 5 mm), \nincluding 9 subsequent LDCTs (effective-tube-current-time-product, \n< 30 mAs/slice, effective-dose, < 1mSv) and 36 matched SDCT controls \n(average, 100 mAs/slice, with matching for gender, age, chest/lung diameters, \nand clinical history) that were obtained during the 4\nth quarter, 2012. Fisher's \nexact test (p < 0.05) and Cohen's kappa statistics were applied. \nResults: Inter-observer agreement was substantial to perfect (kappa: 0.75 - \n1.0) for all thoracic lymph node groups (upper mediastinal, aortopulmonary, \nsubcarinal, lower mediastinal, hilar, peripheral). Overall, LDCTs delineated 47 \nof 54 (87%) lymph node groups (positive inter-observer agreement), while \nSDCT delineated 174 of 216 (81%). There were no significant differences in \nindividual lymph node groups (p=0.08 to 1.0). Measurable lymph nodes did not \ndiffer significantly in size between cases and controls. \nConclusion: Delineation of mediastinal and hilar lymph node groups was \nsimilar despite greatly reduced-dose at LDCT of the chest-CT when compared \nwith standard dose chest-CT. Patients with non-malignant lung disease, \nunclear chest-X-ray findings, or the need for follow-up CT scans may therefore \nbenefit from contrast-enhanced LDCT.  \n \n \nS228  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0431 14:18  \nModel based iterative reconstruction: its efficacy in CT assessment of \ncystic fibrosis and dose reduction  \nK.K.-P. Lau1, D. Jackson1, N. Ardley1, T. Lau2; 1Melbourne/AU, 2Brisbane/AU \n(kenkplau@gmail.com)  \nPurpose: There is lack of a precise correlation between the chest radiographic \n(CXR) findings and the clinical manifest ations of cystic fibrosis (CF). CT chest \nis contrarily more sensitive and specific, but routine use is limited by higher \nradiation dose (RD). Recent advent of the CT model-based iterative \nreconstruction (MBIR) technique improves low contrast detectability and \nreduces artifacts at significantly lower radiation dose. This prospective study \nwas to evaluate the efficacy of MBIR in CT assessment of cystic fibrosis at \nmuch reduced RD. \nMethods and Materials:  CT chest at 100 kVp and 4 mAs were undertaken on \nconsecutive acute adult CF patients. RD's were recorded. MBIR was used to \nproduce CT images in standard formats. These images and CXR were \nindividually read by 2 blinded radiologists. Results were compared. \nResults: 82 patients (M:F=35:47, mean age of 34) were recruited. 29.3% \npatients had follow-up CT's. Images were generally 'noisy' but adequate. The \nRD's ranged between 0.042 to 0.07mSv which were comparable to one chest \nx-ray dose. CT demonstrated bronchiectasis and peribrochial thickening in \n100%, mucous plugging in 82.9%, consolidation and tree-in-bud appearances \nin 54.8%, collapse in 4.8%, scarring in 42.6%, pneumothorax in 1.2% and \npulmonary abscess in 3.65% of these patients. CXR only detected 68.3%, \n4.9%, 14.6%, 1.2%, 24.3%, 1.2% and 0% of these abnormalities \ncorrespondingly. Follow-up CT's accurately monitoring abnormalities. \nConclusion: Gene therapies being developed for CF require detailed lung \nevaluation. MBIR helps lowering CT chest RD to that of CXR. CT may become \nthe preferred imaging tool in CF assessment.  \nB-0432 14:27  \nSources of variability in the quantification of CT perfusion of the lung in \npatients with idiopathic pulmonary fibrosis (IPF)  \nC.J. Rofe, E.J.R. van Beek, N. Hirani, J.T. Murchison, A. Nania, M. Connell, \nS. Mirsadraee; Edinburgh/UK (christopherrofe@hotmail.com)  \nPurpose: To assess sources of variability of lung perfusion quantified by \nmeans of dynamic CT perfusion. \nMethods and Materials:  : Two dynamic pulmonary CT perfusion (DCTP) \nscans were obtained in 8 patients with IPF during breath-hold using a Toshiba \nAquilion-One. Perfusion was quantified by maximum-slope technique. Mean \nperfusion values were compared between 2 scans on identical regions of \ninterest in each lung at three pre-determined levels. Intraobserver and \nintramodality variability was assessed. < 30% variation was determined as \nclinically acceptable. \nResults: Observed means in the 16 scans ranged from 57 to \n537.3 mls/100 g/min. There was intraobserver agreement (variability < 10%; r2 \n= 0.98 - 0.74). Clinically acceptable intramodality variations were observed in 5 \nof 8 patients. Clinically unacceptable variation was seen in 3 patients (up to \n98% difference in mean values). Breathing motion artefact was a major source \nof intramodality variation. Adjusting for breathing artefact reduced variations in \nobserved means (reducing the maximum variation by 4% and the average \nvariation by 22%). Changes in the characteristics of the input function (e.g. \nhigh pulmonary time-density  baseline values and different curve slope) were \nalso sources of measurement bias. Effect of lung density change due to \ndifferent depth of breath-hold was minimal. Despite significant variation \nbetween the patients 2 scans, the ratio of values between the 2 lungs in both \nscans remained relatively constant. \nConclusion: DCTP provides a physiological mean to assess pulmonary \nperfusion. Post-processing analysis of the results is challenging and \nawareness of the pitfalls is necessary to apply the tests in clinical trials.  \nB-0433 14:36  \nEffectiveness of an automated tube potential selection tool in contrast \nenhanced thoracic staging CT examinations  \nC. Schabel, M. Bongers, S. Mangold, C.D. Claussen, C. Thomas; \nTübingen/DE (christoph.schabel@med.uni-tuebingen.de)  \nPurpose: To evaluate a novel automated scanogram-based voltage selection \ntool (AkV) combined with automated tube current adaptation for thoracic \ncomputed tomography in terms of objective image quality and potential \nradiation dose reduction. \nMethods and Materials:  Three months after AkV (CAREkV, Siemens, \nForchheim, Germany) was introduced into clinical routine in our institution, \npatients who had received a previous thoracic CT examination with 120 kV and \na follow-up exam using AkV were retrospectively included. Besides AKV, all \nother scanning parameters were kept constant. Contrast dose was individually \ndetermined. Patients with identical tube potentials in both examinations were \nexcluded. Contrast-to-noise ratios (CNR) were assed in multiple slices within \nthe thoracic aorta at identical levels with in each patient. Cross-sections were \nmeasured to document patients cross sectional areas. The effective radiation \ndose (ED) was estimated as the product of the dose-length product (DLP) and \na chest specific conversion coefficient (k=0.014 mSv/(mGy*cm)). \nMeasurements were statistically treated as paired samples. \nResults: Forty-eight patients (35 female, 51.0 ±14.0 years) were included. In \narterial phase thoracic imaging, CNR was constant for AkV vs. 120 kV in the \ndescending aorta (18.8 ±5.6 vs. 19.3 ±6.1; p=0.56) and pulmonary artery \n(21.0±6.2 vs. 21.8 ±6.2; p=0.33). ED was significantly lower using AkV \n(3.15±1.3mSv vs. 4.1 ±1.3mSv; p < 0.001). Cross-sections (2346 ±509 cm^2 vs. \n2343±498 cm^2; p=0.91) and volume of contrast media (86.25 ±12.8 ml vs. \n89.4±16.3; p=0.15) did not differ significantly. \nConclusion: Compared to standard 120 kV-protocols, AkV leads to a relevant \nradiation dose reduction in contrast enhanced thorcic CT examinations while \nCNR of both techniques remains equal.  \nB-0434 14:45  \nArtefact reduction of dual-energy lung perfusion image using a tin filter: a \nphantom study and evaluation on clinical images  \nT. Kawai, Y. Ozawa, T. Suzuki, K. Ohashi, Y. Shibamoto; Nagoya/JP \n(tatsuyakawai@gmail.com)  \nPurpose: To investigate the reliability of lung perfusion blood volume (PBV) \nimages created by dual-energy CT (DECT) equipped with or without a tin filer, \nfocusing on its accuracy adjacent to high attenuation areas. \nMethods and Materials:  A columnar phantom made of hollow resin clay \ncontaining 4.0 mgI/cm^3 with agarose gel containing 50 mgI/mL in the center \n(73 and 18 mm in diameter, respectively) was used to simulate contrast-\nenhanced lung parenchyma and central veins, respectively. It was scanned by \nDECT at 80/140 kVp with or without a tin filer and examined the area of \nenhancement decline adjacent to the central high-attenuation gel on the lung \nPBV images. In the clinical  study, 40 patients (mean age, 65; range, 16 to 93 \nyears) without apparent pulmonary embolism were included. They underwent \nDECT with (n = 20) or without (n = 20) the filter and the degrees of artifact - \npulmonary enhancement defect and pseudo-enhancement in the trachea \nadjacent to the vena cava were evaluated using a four-point scale (0 = minimal \nto 3 = prominent). \nResults: In the phantom study, the areas with less than 95% enhancement \ncompared to the maximum values were 87.6 and 162 mm^2 with and without \nfilter, respectively. In the clinical study, the mean degrees of artifact with vs. \nwithout filter were 0.85 ±0.58 vs. 2.0 ±0.8 (p < 0.0001) and 1.1 ±0.5 vs. 2.2 ±0.7 \n(p < 0.0001) for pulmonary enhancement defect and pseudo-enhancement in \nthe trachea, respectively. \nConclusion: The quality of dual-energy lung perfusion image will be improved \nby using the tin filter technique.  \nB-0435 14:54  \nMinimising dose in test bolus CT pulmonary angiography (CTPA): can \ntube potential be routinely lowered to 80 kVp during contrast monitoring?  \nJ.C.L. Rodrigues, D. Joshi, S. Lyen, I. Negus, N.E. Manghat, M. Hamilton; \nBristol/UK (jonrodrigues@doctors.org.uk)  \nPurpose: Technological advances have dramatically reduced CTPA dose. \nHowever, the monitoring phase represents increased proportion of overall \ndose. We aimed to determine whether monitoring in test-bolus CTPA can be \nroutinely performed at 80 kVp to minimise dose without affecting diagnostic \nquality. \nMethods and Materials:  Retrospective analysis of two test bolus CTPA \nprotocols was performed. Fifty consecutive patients scanned with protocol A \n(low monitoring kVp: 80 kVp and 45 mAs) were compared to fifty consecutive \npatients scanned with protocol B (standard monitoring kV: 100 kVp and \n45 mAs). Diagnostic phase parameters were the same for both (100 kVp and \n150 reference mAs). Scans were assessed for quality (mean attenuation, \nsignal to noise (SNR) and contrast to noise (CNR) in the main pulmonary artery \n(MPA), percentage of diagnostic scans ( > 200 HU in MPA) and number of \nrepeated monitoring scans). Mean effective dose was calculated. \nResults: No difference in mean MPA attenuation (415.5 ±35.8 HU vs \n410.1±29.9 HU, P=0.820), SNR (11.0 ±0.9 vs 10.8 ±0.9, P=0.819) or CNR \n(9.1±0.9 vs 9.0 ±0.9, P=0.855) between protocols. Diagnostic rates (96% vs \n100%, P=0.741) and number of repeated monitoring scans (0% vs 0%) were \nsimilar. Mean monitoring phase dose was significantly lower (0.07 ±0.01 mSv \nvs 0.15±0.02 mSV, P \n< 0.0001) for protocol A, accounting for 3.2% of the total \nCTPA study dose compared with 6.8% in Protocol B. \nConclusion: Monitoring should be performed at 80 kVp in test bolus CTPA to \nsignificantly lower dose, without compromising diagnostic quality. Increased \nimage noise can be tolerated because the monitoring images are not required \nfor diagnosis and contrast kinetics can still be reliably determined.  \n \nS229  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0436 15:03  \nSubmSv CT imaging of pulmonary arteries using an iterative model \nreconstruction algorithm  \nD. Muenzel1, T. Koehler2, B. Brendel2, K. Brown3, S. Zabic3, A. Fingerle1, \nE.J. Rummeny1, M. Dobritz1, P.B. Noel1; 1Munich/DE, 2Hamburg/DE, \n3Cleveland, OH/US  \nPurpose: To investigate the improvement in diagnostic quality of iterative \nmodel reconstruction (IMR) algorithm for submSv computed tomogr aphy \nangiography of the pulmonary arteries (CTA). \nMethods and Materials: Eighteen patients with CTA were included, 8 with and \n10 without pulmonary artery embolism. All scans were performed at 120 kVp \n(average effective doses 4.34 ±1.99mSv). Acquisitions with reduced radiation \nexposure were simulated from the original CT data to 15% of the tube current, \nresulting in a submSv average dose of 0.65 ±0.30mSv. Filtered backprojection \n(FBP) was used to reconstruct the original data (protocol A); submSv data \nwere reconstructed using FBP (protocol B) and IMR (protocol C). Image \nquality, image noise and contrast tonoise ratio (CNR) were assessed. Two \nblinded readers determined subjective image quality and assessed the \ndetectability of pulmonary artery embolism. \nResults: With IMR noise could be subjectively removed, while the image \ntexture of these images differed from FBP reconstructions. Specifically, with \nIMR, the noise was significantly reduced by a factor up to 20 (B vs. C). CNR \nand image quality were improved with a median image quality score of 3 \n(IMR,B) vs. 1 (FBP,C),p < 0.05. With respect to diagnostics protocol A and C \nwere identical, while B was worse: To detect pulmonary artery embolism in \nIMR and FBP low dose images, the sensitivity was 100% for IMR and 62.5% \nfor FBP while specificity was 100% for both protocols. \nConclusion: This simulation study indicates that by using IMR, pulmonary \nartery embolism can be detected accurately in scans with submSv dose levels.  \nAuthor Disclosures: \nT. Koehler: Employee; Philips. B. Brendel: Employee; Philips. K. Brown: \nEmployee; Philips. S. Zabic: Employee; Philips.  \nB-0437 15:12  \nPulmonary CT angiography: evaluation of high concentration contrast \nmedium protocols for radiation dose reduction  \nP. Heusch\n1, R.S. Lanzman1, J. Aissa1, L. Schimmöller1, G. Antoch1, M. Krix2, \nP. Kröpil1; 1Düsseldorf/DE, \n2Konstanz/DE (patric.kroepil@med.uni-duesseldorf.de)  \nPurpose: A high iodine delivery rate (IDR) yields a high signal in CT \nangiography (CTA), potentially compensating for a reduced radiation dose. The \npresent study evaluates the combination of a high IDR with a low tube current \ntime product for pulmonary CTA. \nMethods and Materials:  One-hundred nineteen consecutive patients \nundergoing pulmonary CTA for suspected pulmonary embolism were included \nand imaged on a 128-row CT scanner at 100 kVp using highly concentrated \ncontrast material (85 ml Iomeprol; 400 mg iodine/ml). The protocol entailed a \nflow rate of 5 ml/s and 90 mAs for group A, 3.5 ml/s and 135 mAs for group B, \n5 ml/s and 135 mAs for group C, and 3.5 ml/s and 90 mAs for group D. SNR \nand CNR were determined for the pulmonary artery. Subjective image quality \n(IQ) was rated on a 5-point-scale (1_non-diagnostic IQ - 5_excellent). \nResults: CNR did not differ significantly between group A (43.7 ±27.7), B \n(34.5±17.9) and C (38.9 ±13.8) as well as between group B and D (29.9 ±11.2). \nCNR in group A and C was higher than in group D (p < 0.02). Subjective IQ in \ngroup A (4.7± 0.47) was higher than in group B (4.33 ±0.76) and D (4.41 ±0.5) \n(p < 0.05). \nConclusion: A high IDR (highly concentrated contrast material combined with \na high flow) permits a mAs-reduction of approximately 33% without \ncompromising image quality in pulmonary CTA. Therefore the concept of \"high \nIDR - low mAs\" can be recommended in patients with suspected pulmonary \nembolism.  \nAuthor Disclosures: \nM. Krix: Employee; 2 Bracco Imaging, Global Medical & Regulatory Affairs, \nKonstanz, Germany.  \n \nB-0438 15:21  \nBone suppressed images improve pulmonary fungal infection detection \nin chest radiographs  \nS. Schalekamp\n1, I.A.H. van den Berk2, I.J.C. Hartmann3, M.M. Snoeren1, \nA.E. Odink3, S.A.H. Pegge4, L.J. Schijf4, N. Karssemeijer1, \nC.M. Schaefer-Prokop4; 1Nijmegen/NL, 2Amsterdam/NL, 3Rotterdam/NL, \n4Amersfoort/NL (steven.schalekamp@gmail.com)  \nPurpose: To assess the effect of bone suppression images (BSI) on observer \nperformance in detecting pulmonary fungal infections (PFI) on chest \nradiographs. \nMethods and Materials:  105 frontal (bedside or PA) chest radiographs (CXR) \nof suspects for PFI were collected from four institutions. Presence or absence \nof disease was determined by an expert radiologist and a clinical researcher in \nconsensus, using CT as reference standard. Radiographs could contain single \nor multiple sites of infection, and were classified into four categories of subtlety. \nBSI were generated by ClearRead BSI 3.2 (Riverain Technologies, Ohio). Five \nradiologists and two residents participate d in an observer study. Evaluation \nwas done on a per lung basis, resulting in 78 diseased lungs and 132 normal \nlungs. Observers scored the lungs on a continuous scale (0-100), and marked \nthe most suspicious lesion, if present. Area under the ROC curve (AUC) served \nas performance measure. P-values were calculated using the Dorfman-\nBerbaum-Metz method. Sensitivity and speci ficity were calculated considering \nonly the lungs with a suspiciousness score over 50 to be positive. \nResults: AUC without BSI was 0.815, and increased to 0.853 with BSI \n(p=0.01). Six of the seven observers increased their performance, four of them \nsignificantly. Sensitivity increased from  49% to 66%. Specificity dropped from \n95% to 90%. Significant improvement of performance was seen in the group of \nvery subtle cases (p < 0.001). \nConclusion: BSI significantly improved detection performance of PFI in chest \nradiographs, especially for very subtle abnormalities. BSI improved the \nsensitivity of the CXR examination, outwei ghing the smaller loss in specificity.  \nAuthor Disclosures: \nS. Schalekamp: Research/Grant Support; Riverain Technologies. N. \nKarssemeijer: Research/Grant Support; Riverain Technologies. C.M. \nSchaefer-Prokop: Advisory Board; Riverain Technologies. \n14:00 - 15:30 Board Room B  \nMusculoskeletal  \nSS 610b  \nInflammatory diseases  \nModerators:  \nF. Becce; Lausanne/CH  \nF. Kainberger; Vienna/AT  \nB-0439 14:00  \nDynamic contrast-enhanced low-field (0.25T) MRI wrist in rheumatoid \narthritis compared with high-field (3.0 T) MRI  \nK. Lee, J.F. Griffith, J.H.Y. Leung, D. Wang, L. Shi, L. Tam; Hong Kong/HK \n(joysleung@gmail.com)  \nPurpose: The volume of enhancing synovial tissue and degree of perfusion by \ndynamic contrast-enhanced MRI is helpful in determining response to \ntreatment. This has not been assessed on low-field MRI. The aim of this study \nis to compare assessment of wrist synovitis severity, enhancing synovial \nvolume and synovial perfusion indices of low-field (0.25T) MRI in patients with \nrheumatoid arthritis with high-field (3.0 T) MRI. \nMethods and Materials:  Prospective study of 21 patients (F:M = 16:5, mean \nage 50.0 ± 9.8 years) with active rheumatoid arthritis. Dynamic contrast-\nenhanced MRI examination of the most severely affected wrist was performed \non both 0.25T (G-SCAN, Esaote, Italy) and 3.0 T (Achieva TX-series, Philips \nMedical Systems, Best, Netherlands) whole-body imaging systems. Three MRI \nparameters [synovitis severity (RAMRIS grade), active synovitis volume (ml\n3), \nand synovial perfusion indices (maximum enhancement (%,) enhancement \nslope (%/sec))] were compared. \nResults: Comparing 0.25T and 3.0 T MRI, there was excellent agreement for \nsemi-quantitative assessment (r:0.97, p < 0.00001) and quantitative \nassessment (r:0.94, p < 0.00001) of enhancing synovial volume. Good \nagreement of Emax (r:0.6, p= 0.002) and fair agreement (r:0.5, p=0.02) for \nEslope were identified. \nConclusion: 0.25T MRI yields excellent synovial volume assessment and fair \nto good perfusion parameters to 3 T MRI and can be used to assess \ntherapeutic response in rheumatoid arthritis patients.  \n \nS230  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0440 14:09  \nUnenhanced and dynamic contrast enhanced (DCE) MRI in assessment \nof scaphoid fracture non-union revisited: role in pre-operative planning  \nS. Janardhan, S. Withey, S. Tan, S. Choudhary; Birmingham/UK \n(seemajanardhan@doctors.org.uk)  \nPurpose: Accurate pre-operative assessment of proximal pole vascularity aids \nin appropriate surgical planning for treatment of non union of scaphoid \nfractures. Our study aims to evaluate the usefulness of DCE-MRI in pre-\noperative assessment and surgical planning in treatment of scaphoid non-\nunion. \nMethods and Materials:  A retrospective study between Jan 08-May 13 \nidentified 20 patients who underwent pre-operative dynamic Gadolinium-\nenhanced wrist MRI on 3 T. Time interval between initial injury and MRI study \nwas recorded. Using Siemens Mean curve software, a contrast enhancement \ncurve was generated on dynamic contrast enhanced T1 images with regions of \ninterest defined in the proximal, distal scaphoid poles and radial styloid. The \nsteepest upslope of gadolinium enhancement curve was assessed to \ndetermine the degree of vascularity. Results were graded as normal, impaired \nvascularity and avascular necrosis (AVN). Unenhanced T1 signal of proximal \npole and subjective assessment of its enhancement pattern were also \nanalysed. Intra-operative findings were used as gold standard. \nResults: 14/20 (70%) scans corresponded to intra-operative findings of the \nproximal pole vascularity. 5/20 (25%) had discordant results of which 4/5 cases \nhad time interval of > 7 months between injury and scans. 1/20 had no intra-\noperative confirmation. Sensitivity, specificity and accuracy of the DCE-MRI \nwere 64%, 100% and 74% respectively. In 7/20 confirmed AVN cases, fat \nsignal was demonstrable on unenhanced T1 images making it a non-specific \nfinding \nConclusion: Dynamic contrast enhanced MRI is a reliable tool for pre-\noperative assessment of proximal pole vascularity and surgical planning. \nHowever MRI results may be confounded if the fracture is old ( > 7 months).  \nB-0441 14:18  \nHybrid 18 F-FDG PET-MRI of the hand in rheumathoid arthritis  \nF. Miese1, H. Hautzel1, H. Herzog2, B. Ostendorf1, P. Sewerin1, C. Schleich1, \nC. Buchbender1, A. Scherer3, G. Antoch1; 1Düsseldorf/DE, 2Jülich/DE, \n3Aachen/DE (dr.miese@gmx.de)  \nPurpose: 18 F-FDG-PET is highly sensitive to inflammatory activity in \nrheumatoid arthritis (RA). However, MRI is most sensitive of joint damage in \nRA due to its high soft tissue contrast. The purpose of the present study was to \ntest the feasibility of true hybrid PET-MRI of the hand in RA and to compare \nthe assessment of synovitis in PET and MRI. \nMethods and Materials: True hybrid 18 F-FDG PET-MRI was acquired in four \npatients (all female; average age: 48 years, range 24-58). Two presented with \nearly therapy-naive RA, two presented prior to therapy escalation. PET-MRI \nwere acquired on a APD-based magnetoinsensitive BrainPET Detector \n(Siemens, Erlangen, Germany) in a 3 T MRI scanner (Magnetom Trio, \nSiemens). The MRI data were evaluated according to the RAMRIS synovitis \ncriteria. The PET of the same joints was categorised semiquatitatively. \nAdditional findings, not included in the RAMRIS were recorded. \nResults: All patients were positive for synovitis in MRI and PET. On a joint \nlevel, 21/26 (81%) of joints were MRI-positive, and 18/26 (69%) were positive \non PET. In three joints that demonstrated synovitis on MRI, glucosis utilisation \nwas normal (14%). Synovitis severity as measured in PET and MRI correlated \nsignificantly (r = 0.672; P < 0.001). In 6/10 additional abnormal findings, there \nwas concordance between MRI and PET. \nConclusion: The results point towards the validity of 18 F-FDG PET-MRI of \nthe hand in RA. 18 F-FDG PET-MRI may possibly be a tool for further research \nand therapy monitoring of both, inflammatory activity as well as joint \ndestruction in RA.  \nAuthor Disclosures: \nG. Antoch: Speaker; Siemens Medical Solutions, Bayer Healthcare, BTG. \nB-0442 14:27  \nBiochemical MRI with glycosaminoglycan chemical exchange saturation \ntransfer imaging of finger joint cartilage in rheumatoid arthritis  \nF. Miese, C. Schleich, A. Müller-Lutz, H.-J. Wittsack, B. Ostendorf, P. Sewerin, \nM.J. Schneider, G. Antoch; Düsseldorf/DE (dr.miese@gmx.de)  \nPurpose: Rheumathoid arthritis (RA) frequently involves finger joint. gagCEST \nhas been demonstrated to visualise biochemical alterations of cartilage in knee \njoints following cartilage repair surgery as well as in intervertebral discs. The \npurpose of our study was to test the feasibility of gagCEST in finger cartilage in \nhealthy volunteers and patients with RA. \n \n \n \n \nMethods and Materials:  Six volunteers (mean age 33; range: 21-45 years) \nand four patients (age 58; range: 52-64 years) were examined at a 3 T MR \nscanner. For gagCEST imaging, CEST effects were prepared by a train of \nGaussian RF pulses followed by signal readout with a 3D RF spoiled GRE \nsequence. The CEST curves were calculated for each pixel and were shifted \nfor the water resonance to appear at 0 ppm of the Z-Spectrum. The MTR \nasymmetry curves were determined. The CEST effect of the cartilage was \nmeasured with the glycosaminoglycan saturation transfer [ST = CEST \n(+1.3 ppm) - CEST (-1.3 ppm)/CEST (+1.3 ppm)]. Joint space width (JSW) was \nmeasured. \nResults: Cartilage ST values were significantly lower in patients compared to \nhealthy volunteers (13.58 ± 6.11 vs. 27.38 ± 4.52; p=0.011). CEST curves \nshowed a decrease between 1.2 and 2.2 ppm, corresponding to the resonance \nfrequency of hydroxyl protons of glycosaminoglycans. There was no significant \ndifference in JSW. \nConclusion: CEST imaging revealed alterations in finger cartilage of RA \npatients compared to healthy controls in the absence of cartilage thinning. The \ndecreased CEST effect in the spectral range of glycosaminoglycan resonances \npoints towards depletion of glycosaminoglycans in RA.  \nAuthor Disclosures: \nG. Antoch: Speaker; Siemens Medical Solutions, Bayer Healthcare, BTG. \nB-0443 14:36  \nCharacterisation of metacarpal and radial bone in rheumatoid arthritis \nusing high-resolution peripheral quantitative CT  \nH. Yang, A. Yu, A. Burghardt, T. Link, X. Li; San Francisco, CA/US \n(frankyang119@126.com)  \nPurpose: 1) To develop a standardised method of quantifying BMD and \nmicroarchitecture in the hand and wrist bones of patients with rheumatoid \narthritis (RA) using HR-pQCT; 2) to compare quantified bone parameters of \ncontrols to those of RA and post-menopausal osteopenic (PM-OP) subjects, \nand 3) to correlate quantified bone parameters at the distal radius and \nmetacarpal heads of RA subjects. \nMethods and Materials:  HR-pQCT imaging of the dominant hand and wrist \nwas performed in 12 female RA patients and 20 healthy female controls. BMD \nand trabecular parameters for the 2-12% head region of the metacarpals were \ncalculated and compared between RA and controls. Bone parameters were \nalso calculated for the distal radius in RA patients and compared to data from \ncontrols and 44 PM-OP women. Clinical evaluations of RA patients were \nexamined for correlation to bone parameters. \nResults: Compared to controls, RA patients had significantly decreased BMD, \ntrabecular volume and number, and increased trabecular heterogeneity.There \nwere no significant differences in the bone parameters between RA patients \nand PM-OP women, except trabecular number. Trabecular BMD in the third \nmetacarpal and in the distal radius were significantly correlated ( ;=0.918, \np < 0.0001) in RA patients. \nConclusion: This study established a standardised method for quantifying \nbone density and trabecular properties in the hand and wrist bones of RA \npatients using HR-pQCT. Deterioration of bone structure in RA patients was \nfound comparable to that in osteopenic women, and trabecular bone loss near \naffected joints was found to be correlated with bone loss away from joints.  \nB-0444 14:45  \nUltrasound findings in hand joints involvement in patients with psoriatic \narthritis and its correlation with clinical DAS 28 score  \nP.M. Naranje, M. Prakash, A. Sharma, S. Dogra, N. Khandelwal; \nChandigarh/IN (priyanka11sh@gmail.com)  \nPurpose: To evaluate the ultrasound findings in hand joints in patients with \npsoriatic arthritis and correlate grayscale and power Doppler ultrasonography \nfindings with Disease Activity Score 28.  \nMethods and Materials:  This prospective study was performed in 30 patients. \nUltrasound evaluation of 28 joints of both hands was undertaken and findings \nwere recorded including synovial hypertrophy, power Doppler abnormality, soft \ntissue thickening, tendonitis, joint effusion, periosteal reaction and erosions. \nComposite ultrasound scores and Diseas e Activity Score 28 were calculated \nand compared. \nResults: Ultrasound detected more abnormalities in the hand joints than did \nclinical examination. The frequency of ultrasound abnormalities:Synovial \nhypertrophy in 100%, power Doppler abnormality suggesting hypervascularity \nin 36.7%,soft tissue thickening in 66.7 %,periosteal reaction in 33.3%,erosions \nin 30% (mostly in DIP and PIP joints) and flexor tendonitis in 6.7% of patients. \nSignificant correlation was found between Disease activity score 28 and gray-\nscale joint score (GSJS) (Spearman's ;: 0.499, P: 0.005),gray-scale joint count \n(GSJC)(;: 0.398, P: 0.029) and power Doppler joint score (PDJS) ( ;:0.367, \nP:0.046). There was a statistically signif icant difference between remission and \nlow disease activity group, and moderate disease activity group in terms of \nGSJC, GSJS, PDJC and PDJS (P < 0.05). These ultrasound measures were \nhigher in moderate disease activity zone patients. \n \nS231  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nConclusion: Ultrasound is a useful modality for the objective assessment of \npsoriatic arthritis, which can detect joint inflammation to a larger extent than \nclinically expected. Ultrasound including power Doppler can be used as a \nmodality for assessment of severity of psoriatic arthritis as it correlates with the \nclinical scoring.  \nB-0445 14:54  \nRole of MRI in evaluation of asymmetric undifferentiated inflammatory \nhand arthritis: can it help change the diagnosis?  \nR.K. Paruchuri, L. Rajashekhar; Hyderabad/IN (rakheekumar@gmail.com)  \nPurpose: The ACR/EULAR 2010 criteria is a cl inical tool that aids the clinician \nin identifying patients of undifferentiated arthritis who require early aggressive \ntherapy. MRI can increase its sensitivity by identifying patients with disease \nmore progressed than thought of clinically thus altering the treatment. \nMethods and Materials: MRI was performed for 25 patients with ACR/EULAR \nscore of \u00026/10. Bilateral wrists, metacarpophalangeal and proximal \ninterphalageal joints were evaluated for evidence of bone erosions, bone \noedema, synovitis, tenosynovitis and effusions. Presence of synovitis and \nerosions or oedema was categorised as rheumatoid arthritis (RA) while \nabsence of synovitis but presence of other findings was categorised as \nprobable RA. \nResults: The female to male ratio was 3:1 and average age was 43 years. \nBased on the MRI findings, a diagnosis of RA was given in 12 cases (48%) \nand probable RA in 7 cases (28%) giving a total of 19 cases (76%). 5 patients \nwere still labeled as undifferentiated arthritis (20%) and 1 as post viral \nsequelae. Bone erosions were the commonest finding in these 19 patients, \nseen in 18 (94%)cases, followed by effusions 78%, synovitis (63%), \ntenosynovitis (52%) and bone oedema (47%). \nConclusion: Studies have shown that a significant number of patients \npresenting with undifferentiated arthritis will progress to RA and early \ntherapeutic intervention delays or halts the disease. We successfully identified \npatients with more advanced disease than clinically thought of. Thus, the \naddition of MR imaging-based joint area involvement (clinically normal) may \nenhance the performance of the ACR/EULAR 2010 RA criteria.  \nB-0446 15:03  \nAssessment of radiographic progression in rheumatoid arthritis patients \nusing Sharp/van der Heijde scoring method: comparison with plain \nradiography and tomosynthesis  \nM. Fujii, T. Aoki, S. Kinoshita, H. Oki, Y. Hayashida, K. Saito, Y. Tanaka, \nY. Korogi; Kitakyushu/JP  \nPurpose: Sharp/van der Heijde scoring method is commonly used for the \nevaluation of radiographic progression in adult rheumatoid arthritis (RA) \npatients. The purpose of this study is to compare tomosynthesis with plain \nradiography of the wrist and hand for the applicability of radiographic \nprogression assessment using Sharp/van der Heijde scoring method. \nMethods and Materials:  Twenty consecutive patients with established \ndiagnosis of RA were included in this study. Plain radiography and \ntomosynthesis of the bilateral hand and wrist were undergone within a week at \nboth baseline and follow-up. The mean total dose of radiography and \ntomosynthesis was 0.13 mGy and 0.25 mGy, respectively. Sharp/van der \nHeijde score on images from the 2 modalities was independently reviewed by 2 \nradiologists (23 and 6 years of experience in interpreting musculoskeletal \nradiography). Interobserver agreement for the Sharp/van der Heijde scores \nwas analysed by computing the intraclass correlation coefficient (ICC). The \nreading time per case for each modality was also recorded. \nResults: Significantly higher Sharp/van der Heijde scores were revealed with \ntomosynthesis than with plain radiography (P <.01). Interobserver agreement \non baseline Sharp/van der Heijde scores were excellent for both plain \nradiography and tomosynthesis (ICC=0.95, 0.98 respectively). Agreement on \nchange assessment was excellent for tomosynthesis (ICC=0.93) but moderate \nfor plain radiography (ICC=0.71). The reading time with tomosynthesis was not \nsignificantly different from plain radiography. \nConclusion: Tomosynthesis is more reliable for Sharp/van der Heijde scoring \nmethod in RA patients than radiography, and may be suitable for the reference \nmethod.  \nB-0447 15:12  \nUltrasonographic diagnosis in rheumatoid arthritis: should only \nsymptomatic joints be scanned?  \nY. Volokhina, S. Beck, A. Chien; Loma Linda, CA/US  (yvolokhina@llu.edu)  \nPurpose: To investigate the validity of reduced joint counts for \nultrasonographic (US) assessment of joint inflammatory activity by scanning \nonly symptomatic joints in patients with known or suspected rheumatoid \narthritis (RA). \nMethods and Materials: 129 patients seen in rheumatology clinic received US \nscans of bilateral hands. Clinical symptoms (joint pain, swelling, warmth) and \nUS findings (synovial hypertrophy, hyperaemia, erosions) were recorded in the \nscanned joints of bilateral wrists, first th rough fifth metacarpophalangeal and all \ninterphalangeal joints. Assuming two different levels of disease activity of US \nfindings, hyperaemia > synovial hypertrophy >erosions (H >SH>E) vs. \nhyperaemia>erosions>synovial hypertrophy (H >E>SH), each patient was \nanalysed for correlation of US and clinical findings. \nResults: 36 patients had known diagnosis of RA, and 83 patients had \nquestionable diagnosis of RA. Out of 36 patients with known RA, scanning only \nsymptomatic joints while assuming the H >SH>E level of disease activity, 9 \npatients with positive US findings w ould have been underreported (75% \nsensitivity), while 11 patients with positive US findings would have been \nunderreported (69% sensitivity) if the accepted level of disease activity were \nH>E>SH. Out of 83 patients with questionabl e diagnosis of RA, scanning only \nsymptomatic joints while assuming the H >SH>E level of disease activity, 28 \npatients with positive US findings w ould have been underreported (66% \nsensitivity), while 29 patients with positive US findings would have been \nunderreported (65% sensitivity) if the accepted level of disease activity were \nH>E>SH. \nConclusion: Scanning only symptomatic joints in patients with both known and \nsuspected diagnosis of RA would underreport the disease activity.  \nB-0448 15:21  \nComputer-aided and manual quantifications of MRI synovitis, bone \nmarrow oedema, erosion and cartilage loss in rheumatoid arthritis  \nH. Yang, J. Rivoire, M. Hoppe, T. Link, X. Li; San Francisco, CA/US \n(frankyang119@126.com)  \nPurpose: To investigate the reliability and validity of multiple computer-aided \nand manual quantifications and semi-qua ntifications for MRI synovitis, bone \nmarrow oedema, erosion and cartilage loss of wrist in rheumatoid arthritis (RA). \nMethods and Materials:  Wrist MRI was performed at 3 T in 16 RA patients \nand 3 controls. Synovitis volume and perfusion, bone marrow oedema (BME) \nvolume, signal intensity and perfusion , and erosion dimension were measured \nby in-house developed software, and correlated with OMERAC-RAMRIS. A \nsemi-quantitative MRI cartilage loss score system was developed. Intra-class \ncorrelation coefficients (ICCs) were used to test reproducibility of these \nquantifications and semi- quantifications. Spearman correlation coefficients \nwere calculated between lesion quantifications and RAMRIS, and between \nMRI cartilage score and radiographic Sharp score. \nResults: The intra- and inter-observer ICCs were excellent for synovitis, BME \nand erosion quantifications and cartilage loss grading (all > 0.89). The synovitis \nvolume, BME volume and signal in tensity, and erosion dimension were \nsignificantly correlated with corresponding RAMRIS (r = 0.727 to 0.900, \np < 0.05). Synovitis perfusion parameter maximum enhancement (E) was \nsignificantly correlated with synovitis RAMRIS (r = 0.798), but steepest slope \n(S) was not. BME perfusion E and S were not correlated with RAMRIS. \nCartilage loss grading was significantly correlated with the Sharp joint space \nnarrowing score (r = 0.635, p = 0.008). \nConclusion: Multiple computer-aided and manual and semi-quantitative \nmethods can be used to evaluate MRI pathologies in RA with excellent \nreproducibility. Quantitative evaluation can be more sensitive for detecting \ndisease activity or subtle changes duri ng follow-up than conventional scoring \nsystem.  \nB-0449 15:30  \nBiochemical cartilage MRI and synovitis severity in rheumatoid arthrits: \ncorrelation of cartilage damage and inflammatory activity  \nF. Miese, C. Schleich, C. Buchbender, C. Nowak, P. Kröpil, B. Ostendorf, \nR. Lanzman, H.-J. Wittsack, G. Antoch; Düsseldorf/DE (dr.miese@gmx.de)  \nPurpose: To test for a correlation between cartilage composition and \ninflammatory activity on an individual joint level in early, therapy-naïve \nrheumatoid arthritis (RA). \nMethods and Materials:  Metacaropophalangeal joints in 27 patients with RA \nwere examined (22 females, five males, mean age 54 years). Delayed Gd-\nenhanced MRI of the cartilage (dGEMRIC) of MCP joints was acquired on a \n3 T scanner. dGEMRIC index was determined as measure of cartilage \nglycosaminoglycan content. Inflammatory activity was assessed using the \nsynovitis-subscore according to the RAMRIS-criteria on coronal T1-weighted \nimages acquired prior to and following Gd-administration and on post-contrast \naxial T1-weighted images with fat suppression. \nResults: Synovitis severity was 0 in three cases, grade 1 in six cases, grade 2 \nin eight cases and grade 3 in ten cases. Average dGEMRIC index was \n408 ms ± 145 ms. There was a significant correlation between dGEMRIC index \nand synovitis severity (Spearman rho= -0.49; p = 0.009). \nConclusion: Decreased glycosaminoglycan content was significantly \nassociated with inflammatory activity in i ndividual metacarpophalangeal joints \nin early, therapy-naïve RA. The correlation was only moderately close \nsuggesting concurrent cartilage damaging factors.  \nAuthor Disclosures: \nG. Antoch: Speaker; Siemens Medical Solutions, Bayer Healthcare, BTG. \nS232  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n14:00 - 15:30 Room E1  \nMusculoskeletal  \nSS 610a  \nSpine  \nModerators:  \nE.J. Ulbrich; Zurich/CH  \nF.M.H.M. Vanhoenacker; Antwerp/BE  \nB-0450 14:00  \nLumbar spine MRI findings predicting instability: a comparative study \nusing flexion-extension radiography  \nJ.P.M. Vrouwe\n1, G.K. Thawait1, M. Reijnierse2, D.B. Cohen1, L.H. Riley1, \nK.M. Kebaish1, U. Thakur1, R. Rao1, J.A. Carrino1; 1Baltimore, MD/US, \n2Leiden/NL (j.p.m.vrouwe.2@umail.leidenuniv.nl)  \nPurpose: Lumbar spine MRI is performed in supine position and interpretation \noften occurs without radiographic comparison. The purpose of this study was \nto identify lumbar spine MRI predictors for radiographic instability. \nMethods and Materials:  Institutional review board approval was obtained for \nthis retrospective study. 970 lumbar sp ine levels of 194 patients [mean age \n58.8; range 19-87; 109 (56.1%) female] were reviewed in flexion-extension \nradiographs as well as T1,T2 and STIR weighted MRI. Excluded were patients \nwith a history of spinal problems. MRIs were assessed for the qualitative \npresence of high intensity zone (HIZ), Modic change and facet joint bone \nmarrow oedema (BME); disc degeneration, facet joint osteoarthritis (FJOA), \ndisc contour appearance, muscular atrophy (MA) and central stenosis (CS) \nwere rated semi-quantitatively. Quantitative data were collected for facet joint \neffusion/widening (FJE), facet angles (FA) and interfacet distance (IFD). Data \nwere analysed by odds ratio calculation and using 2-sided independent t-test. \nResults: Of the 970 levels, 177 (18.2%) levels had radiographic evidence of \ninstability; these cases were female in 59.3%(105/177), controls in \n55.5%(440/793). MRI showed 120 levels of listhesis. Odds ratios were \ncalculated for: HIZ-1.32 (0.91-1.93) p=0.143; Modic change-2.39 (1.71-3.32) \np <.01; and BME-2.61 (1.62-4.20), p < 0.01. Comparison of the semi-\nquantitative findings showed higher degrees of disc degeneration (p < 0.01), \nFJOA (p=0.001), abnormality in disc contours (p=0.001), MA (p < 0.001), and \nCS (p <.001) in cases than in controls. Processing of numeric ratings showed a \nmean FJE of 1.76 mm in cases and 1.29 mm in controls (p=0.001); mean FA \nwas 55° and 54°, respectively (p=0.68); mean IFD was 3.56 cm and 3.42 cm, \nrespectively (p=0.14). \nConclusion: Several degenerative changes on MRI are more frequently \npresent with radiographic instability.  \nB-0451 14:09  \nA clinical epidemiological imaging study of spinal segment variants in a \nnon-symptomatic population  \nJ.P.M. Vrouwe1, G.K. Thawait1, M. Haider1, S.K. Thawait1, A. Chhabra2, \nJ.A. Carrino1; 1Baltimore, MD/US, 2Dallas, TX/US \n(j.p.m.vrouwe.2@umail.leidenuniv.nl)  \nPurpose: Spinal variances may lead to confusion and inaccurate numbering of \nthe vertebral segments. The purpose of this abstract is to determine the \nprevalence of spinal segmental variants  in an asymptomatic population. \nMethods and Materials:  Institutional review board approval was obtained for \nthis retrospective study. Review of whole body isotropic Computed tomography \n(CT) of 450 patients (males 171; mean age 31, age range17-45) without back \npain was performed. Vertebral numbering was performed and the presence of \ncervical ribs, thoracolumbar transitional vertebra (TLTV); and lumbosacral \ntransitional vertebra (LSTV) was documented. Cervical ribs and variances were \nnoted. TLTVs were defined as presence of hypoplastic ribs (HR) or non-fused \ntransverse apophyses (NFA) at the level of lowest rib-bearing segment. LSTVs \nwere characterised as per Castellvi. \nResults: 450 cases were reviewed and the number of presacral segments was \naccounted for as: 22 in 0.2%(1/450), 23 in 1.8%(8/450), 24 in 93.3%(420/450) \nand 25 in 4.7%(21/450). Presence of cervical ribs was seen in 4.2%(19/450) \nand elongated C7 transverse process in 2.7%(12/450) of the study population. \nTLTV was found in 23.3%(105/450) with HR in 9.6%(43/450) and NFA in \n13.8%(62/450). LSTV was noted in 26.4%(119/450) of the population and they \nwere classified based on Castellvi's classification as: Type Ia in 3.8%(17/450), \nType Ib in 2.2%(10/450), Type IIa in 6.9%(31/450), Type IIb in 6.4%(29/450), \nType IIIa in 1.1%(5/450), Type IIIb in 3.8%(17/450) and Type IV in \n2.2%(10/450). \nConclusion: This study provides a clinical epidemiological approximation for \nprevalence of spinal segmental variability and highlights the large variability of \nsegmental anatomy relevant to spine imagers and clinicians.  \nB-0453 14:27  \nThe effect of active referral guideline implementation on the number and \njustification of spine radiographs in municipal health centres in one city  \nP. Tahvonen, H. Oikarinen, J. Niinimäki, O. Tervonen; Oulu/FI \n(pirita.tahvonen@lshp.fi)  \nPurpose: To determine the effects of active implementation of referral \nguidelines on the number and justification of spine radiographs requested by \npractitioners in municipal health centres in one city. \nMethods and Materials:  Specified guidelines for spine radiographs were \ndistributed, first time with an educational cover letter, by e-mail to referring \npractitioners and the staff of the radiology department altogether three times \nduring the study period. Educational lectures were also provided. The number \nof spine radiographs (patients aged \u000316 years) during similar 6-month periods \nin the year preceding the interventions and the following 2 years was analysed. \nFurthermore, justification of 450 different spine radiographs performed during \nthese years was assessed by using requests and corresponding patient files. \nDifference between the total numbers of examinations was calculated using \n\u0001²goodness of fit test and changes in proportions of justified cases using \nindependent samples \u0001²test. \nResults: After interventions, the total number of spine radiographs decreased \nby 48% (9.53/1000 citizens vs. 4.98/1000, p < 0.001) and that of the cervical \nspine by 46%(2.29/1000 vs. 1.23/1000, p < 0.001), thoracic spine by 53% \n(1.22/1000 vs. 0.58/1000,p < 0.001) and lumbar spine by 47% (6.02/1000 vs. \n3.18/1000, p < 0.001). The results persisted after 1-year follow-up. Before \ninterventions, 24% (12/50) of the cervical, 46% (23/50) of the thoracic and 32% \n(16/50) of the lumbar spine radiographs were justified. After interventions only \njustification of the lumbar spine radiogr aphs improved significantly, 64% being \njustified (p=0.005). \nConclusion: The number of spine radiographs decreased significantly. The \nlevel of justification was low and only justification of the lumbar spine \nradiographs improved significantly.  \nB-0454 14:36  \nSignal intensity of the cervical spine  \nF. de Bruin1, S. ter Horst1, H. Bloem1, K. Fagerli2, R. Landewé3, \nM. van Oosterhout4, D. van der Heijde1, M. Reijnierse1; 1Leiden/NL, 2Oslo/NO, \n3Amsterdam/NL, 4Gouda/NL (f.de_bruin@lumc.nl)  \nPurpose: Disc degeneration in the cervical spine has not been described so \nfar. No classification system for the cervical spine exists. Therefore, we applied \nthe Pfirrmann classification to the cervical spine. \nMethods and Materials:  Patients (n = 260) from the SPondyloArthritis Caught \nEarly (SPACE) cohort were included with back pain \u0003 3 months, \u0002 2 years, \nonset < 45 years. Cervical T1 and STIR MR sagittal images were scored on the \nPfirrmann classification sc ale by two readers, a third acted as adjudicator. The \nPfirrmann classification describes degener ative changes of intervertebral discs \nin the lumbar spine on a 5-points scale: class 1 normal, class 5 collapsed disc \nspace. \nResults: 1300 intervertebral discs were scored (C2-C3 though C6-C7). 499 \n(38%) discs had a Pfirrmann score of 1, 664 (51%) discs were scored as class \n2, 128 (10%) discs were scored as class 3, 8 (1%) as class 4 and 1 (0%) as \nclass 5. Frequencies of class 2 and up were highest on levels C2-C3 and C3-\nC4, 168 (65%) and 178 (68%). In 126 (48%) patients, the first 4 intervertebral \ndiscs were scored as class 2 or higher. \nConclusion: Over half of all cervical discs were inhomogeneous without loss \nof height (Pfirrmann 2), 11% of discs were grey to black and had loss of height \nto some degree (Pfirrmann 3 or higher). The upper levels of the cervical spine \nwere most frequently affected. The Pfirrmann class of the cervical spine \nappears higher than the lumbar spine and might be a normal variant.  \nB-0455 14:45  \nDeterminants of evolution of endplate and disc degeneration in the \nlumbar spine: a multifactorial perspective  \nN. Farshad-Amacker, A. Hughes, A. Aichmair, R.J. Herzog, M. Farshad; \nNew York, NY/US (nadja.farshad@yahoo.com)  \nPurpose: Radiographic progression of disc and endplate degeneration of the \nlumbar spine is thought to be multifactorial. The aim of this study was to find \nthe strength of influence and interaction of the factors and their interaction in \norder to understand which are the most important determinants in evolution or \nprogression of lumbar spinal degeneration. \nMethods and Materials:  Patients (n=90) who underwent two lumbar MRI \nexams with an interval of at least four years and without any spinal surgery \nwhere retrospectively included. Disc degeneration was scored according to the \nPfirrmann classification and endplate chan ges according to Modic in 450 levels \non both MRIs. Potential variables for degeneration such as age, gender, BMI, \nscoliosis and sagittal parameters were compared between patients with and \nwithout evolution or progression of degenerative changes in their lumbar spine. \nS233  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nA multivariate analysis aimed to separate the most important variables for \nprogression of disc and endplate degeneration, respectively. \nResults: While neither age, gender, BMI, sacral slope or presence of scoliosis \ncould be identified as progression factor for disc degeneration, a higher \nlordosis was observed in subjects with no progression (49.2 ±11.0 vs \n43.2±11.7,p=0.017). Progression or evolution of endplate degeneration was \nonly associated with higher degree of scoliosis (9.5 ±10.4 versus 5.9 ±9.0; \np=0.0078) and not to any of the other variables. \nConclusion: While a scoliotic deformity of the lumbar spine is associated with \nevolution or progression of endplate degeneration, a higher lumbar lordosis \nseems protective for radiographic progression of disc degeneration.  \nB-0456 14:54  \nComparison of lumbar disk height measurements between EOS system \nand digital radiography  \nV. Freire, A. Feydy, M. Benhamou, S. Poiraudeau, J.-L. Drapé; Paris/FR \n(antoine.feydy@cch.aphp.fr)  \nPurpose: Biplane slot scanning systems are used by clinicians in daily \npractice, based on two low-dose simultaneous digital anteroposterior and \nlateral radiographs, avoiding the magnification presented in digital radiography \n(DR) images. The aim of this study was to compare lumbar disk height (LDH) \nbetween a biplane slot scanning system (i.e. EOS system) and a DR system, \nshowing that biplane slot scanning systems provide more accurate \nmeasurements. \nMethods and Materials: (a) In-vivo: 50 patients [41 women, 9 men, age: mean \n(SD): 49.4 (10.7)] presenting chronic low back pain were included. Lateral \nradiographs of the spine were obtained with the EOS system and a DR \nsystem. Two senior clinicians measured the LDH between L3-L4, L4-L5 and \nL5-S1. Mean (SD) of the measurements, reproducibility (ICC coefficient) \nbetween both readers, as well as image quality (from 0 to 10) were calculated. \n(b) In-vitro: we used a phantom apparatus to perform five vertical \ndisplacements of 2 mm on two dry vertebrae. LDH was measured for each \ndisplacement with EOS and DR. \nResults: (a) In-vivo: Image quality was equivalent for both systems, as well as \nreproducibility. LDH measured (in mm) by DR was systematically higher as \ncompared to EOS system [Reader 1- EOS:7.3 (1.9), DR: 8.9 (2.6), Reader 2 - \nEOS:7.3 (1.5), DR: 10.1 (1.9)]. (b) In-vitro: Mean (SD) differences between true \nand measured LDH for EOS [0.4 (1.1) mm], and DR [2.1 (1.4) mm] were \nstatistically significant (Student's t test p < 0.05). \nConclusion: Biplane slot scanning systems provide reliable measurements of \nthe LDH while reducing the radiation dose.  \nB-0458 15:03  \nAssociation of low-back pain with modic type endplate changes and disc \ndegeneration using a detailed MRI-classification  \nK. Luoma, L. Kerttula, T. Vehmas, M. Grönblad; Helsinki/FI \n(katariina.luoma@hus.fi)  \nPurpose: Modic type 1 signal abnormality in bone marrow (M1) may have \nimpact on treatment decisions for low-back pain (LBP) patients. M1 is \nassociated with rapidly progressing bony endplate lesions (EPL) and disc \ndegeneration (DD). The association of LBP with M1s, EPLs and DD was \nstudied with a more detailed grading method than conventional Pfirrman and \nModic classification. \nMethods and Materials:  49 patients with chronic nonspecific LBP and large \nM1 had  a follow-up MRI (1.0 T) after one year. Severity of LBP (VAS) on \nnumerical scale 0-10 and of disability (ODI) on scale 0-100 was questioned \nand size of M1, severity of adjacent EPLs and of DD was visually classified in \nconsensus at baseline and follow-up. Change in VAS and ODI was non-\nparametrically correlated with change in M1 size and grade of EPLs and DD \nseparately (Pearson correlation, 2-tailed). \nResults: Increase of pain (VAS) correlated with increase of M1 (p < 0.01) and \nof EPLs (p=0.02) and with increase of signal intensity of nucleus pulposus \n(DSI) in discs with decreased height (p=0.01). ODI correlated with increase of \nDSI (p=0.03) and with increase of M1 (p=0.07). \nConclusion: In addition to signal abnormalities in subchondral bone marrow, \ndefects and irregularities in endplate region and increase of signal intensity in \nnucleus pulposus may be at least as important as conventionally classified \nModic changes and degenerative disc cha nges in explaining nonspecific LBP. \nDetailed classifying separate changes in subchondral bone marrow, disc and \nendplate may promote MRI-diagnosti cs of the pathologic, progressive \ndegenerative disc disease.  \n \n \n \nB-0459 \n15:12  \nImage quality optimisation of spinal exams with metal artifacts using \niterative reconstruction in combination with monoenergetic extrapolation  \nH. Haubenreisser1, M. Hahn1, J.W. Nance2, P. Apfaltrer1, M. Sedlmair3, \nB. Schmidt3, S.O. Schönberg1, T. Henzler1; 1Mannheim/DE, 2Baltimore, \nMD/US, 3Forchheim/DE (Holger.Haubenreisser@medma.uni-heidelberg.de)  \nPurpose: To evaluate the effectiveness of spectral CT in combination with \niterative reconstruction (IR) in the raw data space in reducing metal artifacts \ncaused by pedicle-screws in patients with dorsal spinal fusion. \nMethods and Materials: 10 consecutive patients with dorsal spinal fusion with \na total of 57 pedicle-screws referred for dual-energy CT (DECT) of the spinal \ncolumn were prospectively included in the study. Data was acquired at 80 and \n140 kVp. Each DECT dataset was reconstructed with traditional filtered back \nprojection (FBP) as well as IR, after which monoenergetic image sets ranging \nfrom 60keV to 180keV were generated at 10keV intervals. Both objective \n(quantitative artifact and image noise measurements) and subjective \nevaluation (diagnostic quality, depicti on of pedicle-screws and surrounding \nstructures) were performed. \nResults: Image quality of monochromatic images in the range from 80 keV to \n120keV was rated superior to both the conventional polychromatic images as \nwell as the monochromatic sets at lower energies. In addition, even though IR \nhad no significant impact on the presence of artifacts (p=0.841-0.998), both \nobjective (p < 0.001) and subjective (p < 0.001) image quality parameters of \nsets reconstructed with IR were consistently better than the FBP sets. \nInterobserver agreement was good to excellent (Cohen's K=0.74). \nConclusion: Compared to conventional polychromatic images, monochromatic \nimages acquired from DECT provided superior image quality with reduced \nmetal artifacts in patients with spinal fusion. Optimal energy range was at \naround 110 keV. IR was found to further improve both subjective and objective \nimage quality, especially of the surrounding tissue.  \nAuthor Disclosures: \nM. Sedlmair: Employee; Siemens Medical Solutions. B. Schmidt: Employee; \nSiemens Medical Solutions. \n14:00 - 15:30 Room F2  \nBreast  \nSS 602  \nBeyond B-mode ultrasound  \nModerators:  \nG. Forrai; Budapest/HU  \nA. Linda; Udine/IT  \nB-0461 14:00  \nEvaluation of breast lesions with a spiculation and retraction severity \nindex (SRSI) on coronal reconstructions of automated breast ultrasound \nimproves differentiation between benign and malignant lesions  \nJ.C.M. van Zelst\n1, B. Platel1, M. de Jong2, T. Tan1, M. Rutten2, R.M. Mann1, \nN. Karssemeijer1; 1Nijmegen/NL, 2's-Hertogenbosch/NL \n(j.vanzelst@rad.umcn.nl)  \nPurpose: To investigate the value of a spiculation and retraction severity index \n(SRSI) in coronal reconstructions of ABUS to improve the differentiation \nbetween benign and malignant breast lesions. \nMethods and Materials:  96 ABUS scans from 96 patients were obtained. All \nscans contained a biopsy-proven lesion (36 malignant, 60 benign). Each scan \nwas presented to 5 breast radiologists (ABUS experience 0-3 years). First, only \nthe transversal acquisition was shown. Readers were asked to classify the \nmost suspicious lesion in the scan using the BI-RADS lexicon. A likelihood-of-\nmalignancy (LOM) score (0-10.0) was requested. Thereafter, the coronal \nreconstruction was shown. Readers were asked to rate spiculation and \nretraction in the coronal plane on the SRSI, a 5-point semi-continuous index. \nSubsequently, LOM-scores could be adjusted. The differentiating capacity of \nSRSI between benign and malignant lesions was assessed using ROC-\nanalysis. Reader agreement for SRSI was computed with the intraclass \ncorrelation coefficient (ICC). AUCs based on LOM-scores prior to and after \nevaluation of the coronal scans were calculated using multi-reader-multi-case \nROC-analysis. \nResults: The SRSI is highly discriminative between benign and malignant \nlesions with AUCs ranging from 0.796-0.883. The ICC shows substantial \nagreement between readers in assessing SRSI (0.605, p < 0.001). All readers \nimproved their performance after evaluation of the SRSI with an overall \nincrease in AUC from 0.82 to 0.87 (p=0.01). Moreover, readers downgraded \n3%-18% benign cases to BI-RADS 2 avoiding unnecessary biopsies. \n \nS234  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nConclusion: Evaluating spiculation and retraction patterns on coronal \nreconstructions of ABUS using SRSI, improves radiologists' performance in the \ndifferentiation between malignant and b enign breast lesions significantly.  \nB-0462 14:09  \nThe impact of real-time virtual sonography in the surgical management of \nbreast cancer: a single-institution review  \nM. Yoshida, S. Nakano, K. Fujii, J. Kousaka, Y. Shiomi, R. Tetsuka, T. Andou, \nT. Imai, T. Fukutomi; Aichi/JP (miwyoshi@aichi-med-u.ac.jp)  \nPurpose: Real-time virtual sonography (RVS) synchronises ultrasonographic \nimages and MR images of the same section in real time. The aim of this study \nwas to evaluate the impact of RVS in the surgical management of breast \ncancer. \nMethods and Materials:  A total of 108 breast cancer patients were identified \nas candidates for breast-conserving surgery (BCS) based on conventional \nassessments and underwent a preoperative breast MRI. When the additional \nlesion was detected by MRI, it was preoperatively assessed by second-look \nultrasonography (US) and, if needed, US-guided needle biopsy. If the \nadditional MRI lesion was undetectable by conventional US, we performed a \nsecond-look US assessment with the use of RVS. \nResults: In 46 out of the 108 affected breasts, 49 additional ipsilateral MRI \nlesions were detected. The detection rate of the additional MRI lesions by \nconventional second-look US was 45%, while the rate went up to 92% when \nusing RVS. In 40 of the 46 breasts, on the basis of second-look US/RVS \nassessments, we had increased the extent of resection (BCS with wider \nmargins 18, Mastectomy 22). As a result, the rate of positive margins after BCS \nwas 13% and the presence of invasive component on the margin was only 1%. \nConclusion: Our results suggest that the improved detection rate of the \nadditional MRI lesions by second-look US with RVS can lead to the reduction \nof positive margins after BCS.  \nB-0463 14:18  \nPredictive value of posterior acoustic features in the biological behaviour \nof breast tumours  \nY. Fernandez Nuñez, R. Medina, R. Revert Espi; Valencia/ES \n(fernandezyinet@gmail.com)  \nPurpose: To evaluate the association between the sound-attenuating \nproperties of breast cancer with tumor grade, hormone receptors expression, \nERRB2 oncogene and ki -67 marker, as well as to assess the predicting value \nof these features. \nMethods and Materials:  The posterior acoustic properties of 138 breast \ncancer ultrasound images obtained between January and December 2012 \nwere reviewed and correlate with tumor grade, estrogen/progesterone receptor \nexpression, ki-67 and ERRB2 receptor status. These posterior acoustic \nfeatures were classified into shadowing, enhancement, mixed pattern and no \nchange. \nResults: Of the 22 CDI with grade III, 77.3 % had posterior enhancement, \nwhile 13.6% had posterior shadowing. There were 23 lesions with negative \nestrogen receptors, of which 87.0 % had posterior enhancement and 8.7 % \nhad posterior shadowing, with statistically  significant difference. Also, of the 32 \npatients with negative progesterone receptors there was observed a higher \nproportion of lesions with posterior enhancement (65.6 %) and only 15.6 % had \nposterior shadowing. Of the 18 lesions with high expression of ki-67, 72.2% \nhad posterior enhancement and 11.1% had posterior shadowing. There were \nno significant differences between tumor grades I and II and acoustic features, \nnor with ERRB2 oncogene. \nConclusion: The presence of posterior enhancement is strongly associated \nwith a higher tumor grade and higher risk of being estrogen and progesterone \nreceptor negative as well as greater expression of Ki -67 marker.  \nB-0464 14:27  \nRole of targeted-ultrasonography in further assessing incidentally \ndetected breast lesions at dynamic magnetic resonance imaging  \nR.O. Stroie, V. Londero, A. Gualano, R. Girometti, C. Zuiani, M. Bazzocchi; \nUdine/IT (rstroie@yahoo.com)  \nPurpose: To investigate the role of targeted-ultrasonography (targeted-US) in \nidentification and characterisation of inci dental enhancing lesions on breast \ndynamic-Magnetic Resonance Imaging (dynamic-MRI). \nMethods and Materials: We retrospectively reviewed 2500 consecutive breast \ndynamic-MRI during a 2-year period, identifying 142 incidental enhancing \nlesions categorised as 3, 4, 5 on BI-RADS MRI lexicon. Correlations between \nMRI lesion characteristics, histopathologic findings and US detection rate were \nanalysed. The reference standard was histopathologic examiantion after \nneedle biopsy or surgical excision in 102 of 142 (72%) lesions and follow-up \n(\u000324 months) in 40/142 (28%). Statistical analysis used Chi-square test.  \nResults: US correlation was made in 104/142 (73%) lesions. Higher US \ndetection rate was observed for masses (84/104 [81%]) rather than non-\nmasses (12/21 [57%]) (p=0.04), for MRI BI-RADS category 4-5 (51/62 [82%]) \nrather than category 3 (53/80 [66%]) (p=0.036). Targeted-US equally identified \nmalignant and benign lesions [46/63 (73%) and 58/79 (73%)]. 8 of the \nmalignancies were assessed as MRI BI-RADS 3 and 38 as MRI BI-RADS 4-5, \nin concordance to the presumed US suspect pattern. Sonographic correlation \nwas also higher in invasive (39/50 [78%]) compared to non-invasive (7/13  \n[54%]) malignancies (p=0.15) although an y statistically significant difference. \nSensitivity, specificity, positive and negative predictive values regarding the US \nsecond-look, were respectively, 82%, 69%, 68% and 83%. \nConclusion: Targeted-US identifies most of the incidental enhancing breast \nMRI lesions, especially those assessed as masses with a high grade of \nsuspicion that necessitate further characterisation with US-guided needle \nbiopsy. The lack of an US correlate does not obviate the need for biopsy.  \nB-0465 14:36  \nCan transmission-ultrasound tomography detect small lesions in dense \nbreasts?  \nV.Z. Marmarelis; Los Angeles, CA/US (vzm@usc.edu)  \nPurpose: To examine whether the novel 3D diagnostic imaging technology of \ntransmission-ultrasound tomography (TUT) can detect small lesions ( < 10 mm) \nin dense breasts of 112 BI-RADS 4 volunteers (ACR 3 or 4). \nMethods and Materials:  The TUT system performs 3D tomography of the \npendulant breast using transmission ultrasound (distinct from conventional \necho-mode ultrasound) in a fixed-coordinate system. Design details were \npresented in ECR 2011 and 2012. TUT constructs multiple images for each \ncoronal slice, using measurements of refractivity and frequency-dependent \nattenuation and dispersion, which are combined to form the composite index \n(CI) of each tissue voxel. High values of CI index are used for detection and \ndifferentiation of breast malignant lesi ons. Initial results were published in \nEuropean Radiology (Feb. 2013). This study is focused on dense breasts of \n112 BI-RADS 4 female volunteers (ages 36-78) and examines the CI values of \n34 malignant and 78 benign lesions (sizes 2-10 mm, median of 6.2 mm) \nconfirmed by histopathology of biopsy samples. \nResults: The CI values of malignant lesion voxels were above 1.04, which is \nthe cut-off point in the distribution of CI values of normal breast tissue and \nbenign lesion voxels, whilst 99.9% of normal tissue voxels had CI values \n< 0.56. This allows detection and differentiation of breast lesions with high \nstatistical significance. \nConclusion: Initial results indicate the potential of TUT to detect and classify \nsmall breast lesions ( < 10 mm) in women with dense breasts at high statistical \nsignificance level. Further testing of this promising result is suggested.  \nAuthor Disclosures: \nV.Z. Marmarelis: Founder; Marmarelis. Patent Holder; Marmarelis. \nShareholder; Marmarelis. \nB-0466 14:45  \nTechnical quality assurance in mammasonography within the Austrian \nmammography-screening pilot project: concept and first results  \nS. Wildner1, R. Mittasch2, F. Semturs1, C. Kollmann1; 1Vienna/AT, 2 Wels/AT \n(sonja.wildner@meduniwien.ac.at)  \nPurpose: Ultrasound quality assurance is often regarded as not efficient or too \ncost-intensive among radiologists. As part of the Mammography Screening \nProgram starting in Austria, ultrasound is  included in primary diagnostics which \nis unique for European Mammography Screening Programs. Hence, Technical \nQuality Assurance has to be performed for ultrasound devices as well as for \nmammography devices. While mammography TQA follows certain protocols \nand guidelines especially designed for this purpose, no such documents exist \nfor ultrasound so far. \nMethods and Materials:  A quality assurance test protocol for screening \npurposes was developed. Within this protocol simple and fast tests on a \nmonthly basis should guarantee an optimal image quality and transducer \nperformance. Only a few test images are acquired and evaluated by in-house \nsoftware to quantify loss of elements, signal-to-noise-ratio, and penetration \ndepth. \nResults: Preliminary results obtained during the pilot phase of the program \nshow that within 40 institutions comprising 49 ultrasound devices and 53 \ntransducers 7 (13.5%) severe transducer failures were found which were not \nrecognised by the radiologists. \nConclusion: We can prove that even without sophisticated and expensive aids \nsuch as phantoms it is possible to detect failures and thus improve image \nquality by using just simple settings. Technical quality assurance is essential in \nultrasound diagnostics and need not be cost-intensive or complicated.  \n \nS235  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0467 14:54  \nReview of 3000 automated breast ultrasound scanners in dense-breasted \nwomen: analysis of results in the detection of benign and malign lesions  \nA. Domingo, F. Gras, C. Cusidó, X. Salvador; Tarragona/ES \n(angelsdc@yahoo.com)  \nPurpose: Our aim was to evaluate the use of automated 3D breast ultrasound \nin the detection of benign and malign lesions. \nMethods and Materials:  Four breast radiologists (experience range 9-35 \nyears) reviewed 3,000 automated 3D ultrasound breast scanners in breast-\ndensed women, who also underwent screening mammography. Patients with \nhistory of known breast cancer were excluded. A standardised scanning \ntechnique was performed by well-trained radiographers, thus allowing a \ndecrease in undesired technical artefacts. \nResults: 80% of the reviewed scanners were classified as benign or probably \nbenign (BI-RADS 1 to 3) and 20% were classified as suspicious or malign (BI-\nRADS 4 and 5). Malign lesions were histologically proven. Multiplanar views \nallowed better characterisation of lesions:  anatomical precise location (nipple \nand skin distance), clock position, shape, margins, ecogenicity, surrounding \ntissue changes and size. ABVS lessens interobserver variability when \nmeasuring lesions. Radiographers performed the scans, shortening the \nradiologist's reporting time (mean time 10 minutes per study). \nConclusion: Rate detection of benign and malign lesions using ABVS is \nsimilar to hand-held ultrasound. However, the use of multiplanar \nreconstructions allows better characterisation of lesion size and exact location, \nespecially useful in follow-up of benign lesions. ABVS is a promising diagnostic \nmethod with good interobserver reliability. It increases breast cancer detection \nrate in breast-densed women when combined with adjoint mammography.  \nB-0468 15:03  \nDiagnostic performance of breast acoustic radiation force impulse \nimaging in the clinical setting  \nP. Kapetas\n1, P.A.T. Baltzer1, P. Clauser2, O. Abeyakoon3, K. Pinker-Domenig1, \nM. Bernathova1, R. Woitek1, T.H. Helbich1; 1Vienna/AT, 2Udine/IT, 3London/UK \n(panagiotis.kapetas@meduniwien.ac.at)  \nPurpose: To evaluate quantitative breast acoustic radiation force impulse \n(ARFI) imaging in the clinical setting. \nMethods and Materials:  Fifty-eight patients (age range 21-82, mean age \n51.7) receiving ARFI imaging (Virtual Touch, Siemens Acuson S3000, 9 MHz \ntransducer) as part of their diagnostic ultrasound workup were investigated \nbetween june and september 2013. Two ARFI measurements of identified \nlesions were performed independently by two out of a pool of five different \nradiologists experienced in breast imaging. The measurement itself took 4 \nseconds. Regions of Interest (ROI) were placed into the lesion and the \nadjacent fatty tissue. The overall exam ination time was below 1 minute. ROC \nanalysis was used for calculating diagnostic performance of ARFI \nmeasurements. The reference standard was either established by \nhistopathology or imaging findings. \nResults: There were 22 malignant and 36 benign lesions. Both ARFI \nmeasurements showed equal diagnostic performance as measured by the \narea under the ROC curve (0.780 and 0.783, respectively; P > 0.05). A cut-off \nvalue of ~3m/s revealed a sensitivity and specificity of 81.8/77.8% \n(measurement 1) and 85.3/61.1% (measurement 2). \nConclusion: ARFI provides quantitative data valid for differentiation between \nbenign and malignant breast lesions. ARFI measurements are fast and can \nthus be implemented into routine ultrasound workup of breast lesions.  \nB-0469 15:12  \nAcoustic radiation force impulse imaging value in differentiating benign \nand malignant breast nodules  \nM. Magalhaes\n1, P. Belo Oliveira1, J. Casalta-Lopes1, Y. Costa2, M. Gonçalo1, \nP. Gomes1, F. Caseiro-Alves1; 1Coimbra/PT, 2Faro/PT \n(mafaldatmagalhaes@gmail.com)  \nPurpose: To evaluate the role of acoustic radiation force impulse imaging \n(ARFI) for the differential diagnosis between benignancy and malignancy of \nbreast tumors. \nMethods and Materials:  The authors performed B-mode US and ARFI in 83 \npatients with breast lesions, subsequently characterised by percutaneous \nbiopsy. Shear wave velocity (SWV) was obtained within the lesion and in the \nsurrounding parenchyma (m/s). SWV measurements and lesion-to-\nparenchyma ratio (LTPR) were calculated. For differentiation between \nbenignancy and malignancy receiver operating characteristic (ROC) curves \nwere plotted for each parameter and cut-off values determined according to \nYouden's Index. Statistical significance was achieved if p < 0.05. \nResults: A total of 92 breast lesions were included, (57 benign and 35 \nmalignant nodules). Intra-lesional SWV was significantly higher for malignant \nneoplasms compared to benignancy (average of 9.14m/s vs. 3.45m/s; \np < 0.001). LTPR was also significantly higher for malignant lesions (3.046 vs. \n1.443; p < 0.001). No difference in parenchymal SWV was registered among \ngroups (p=0.071). ROC curves revealed significant discriminative power for \nintra-lesional SWV [area under curve (AUC)=0.980; p < 0.001] and LTPR \n(AUC=0.950; p < 0.001). A cut-off value of 6.595m/s has a sensitivity and \nspecificity of 88.6% and 96.4%, respectively. For LTPR a cut-off of 2.181 was \nfound, providing a sensitivity of 88.6% and specificity of 91.1%. \nConclusion: Quantitative elasticity measurements may be used as a potential \nbiomarker for characterisation of breast lesions reducing the number of \nunnecessary biopsies.  \n14:00 - 15:30 Room G/H  \nGenitourinary  \nSS 607  \nGynaecological and bladder tumours  \nModerators:  \nC.D. Alt; Heidelberg/DE  \nR. Manfredi; Verona/IT  \nB-0470 14:00  \nSemi-quantitative dynamic contrast-enhanced (DCE) MRI in preoperative \nstaging of patients with cervical carcinoma: preliminary results  \nA.C. Cadonici, D. Ippolito, P. Bonaffini, O. Minutolo, V. Besostri, S. Sironi; \nMonza/IT (a.cadonici@gmail.com)  \nPurpose: To assess the value of semiquantitative DCE parameters in cervical \ncancer to find any difference between neoplastic tissue and normal cervical \ntissue, being tumour grade the standard of reference. \nMethods and Materials:  Thirty patients with cervical cancer were enrolled in \nour study. Scanning protocol included multiplanar T1- and T2-weighted TSE \nand 10 dynamic T1-weighted GE sequences obtained during the administration \nof contrast medium (overall time: 5 minutes and 66 s). Perfusion colour maps \nwere generated on a dedicated software and two regions of interest (ROIs) \nwere manually drawn on the tumour and on normal cervical tissue to generate \ntime-signal intensity curves. Relative enhancement (RE%), maximum \nenhancement (ME%), maximum relative enhancement (MRE%) and time to \npeak (TTP) were calculated and statistically analysed both for neoplastic and \nnormal cervical tissues. \nResults: Semi-quantitative analysis showed  the following perfusion values for \ncervical cancer: RE: 92.26% ±49.34; ME: 1123.96% ±679.70; MRE: \n96.48%±58.29; TTP: 201.91s ±79.79. Corresponding values calculated in \ncervical tissue were: RE: 148.31% ±52.39; ME: 1620.23% ±470.05; MRE: \n148.54%±52.43; TTP: 235.24s ±72.04. RE, ME and MRE were significantly \n(p < 0.05) lower in neoplastic tissue compared to cervical tissue. ME, MRE and \nRE were also higher in G1 than in G2-G3 tumours. \nConclusion: Perfusion parameters differ significantly between cervical cancer \nand normal cervix; moreover, tumour perfusion parameters proved to decrease \naccording to tumour grade.  \nB-0471 14:09  \nValue of diffusion-weighted imaging in predicting parametrial invasion in \nstage Ia2-IIa cervical cancer  \nC. Jeong\n1, J. Park1, C. Kim1, S. Park1, B. Park1, B. Kim2, S. Kwon1, M. Cha1, \nH. Kim1; 1Seoul/KR, 2Rochester, MN/US (iamhis27@gmail.com)  \nPurpose: We investigated the value of diffusion-weighted imaging (DWI) in \nevaluating parametrial invasion (PMI) in sta ge IA2-IIA uterine cervical cancer. \nMethods and Materials:  A total of 117 patients with stage IA2-IIA uterine \ncervical cancer who underwent preoperative MRI and radical hysterectomy \nwere included. Preoperative clinical variables such as age, serum squamous \ncell (SCC) antigen level, FIGO stage, and biopsy results and MRI variables \nincluding tumor size, tumor ADC, presence or absence of PMI or lymph node \nmetastases were analysed and compared between the groups with and without \npathologically proven PMI. \nResults: Pathologic PMIs were identified in 32% of patients (37/117). All \nvariables except age were significantly different between patients with and \nwithout pathologic PMI (all P \n< 0.05). All variables except serum SCC antigen \nwere also significantly correlated with pathologic PMI on univariate analysis (all \nP \n< 0.05). Multivariate analysis indicated that PMI on MRI ( P < 0.001) and \ntumor ADC ( P= 0.029) were independent predictors of pathologic PMI. The \narea under the curve of PMI on MRI increased significantly from 0.793 to 0.872 \nwhen combined with tumor ADC ( P= 0.002). The false negative rate (FNR) of \nPMI on MRI was 10.1% (7/69). When samples were further stratified with tumor \nADC, the FNR decreased to 2.0% (1/49). \nConclusion: In stage IA2-IIA cervical cancer, tumor ADC and PMI on MRI \nseem to be independent predictors of pathologic PMI. Combining the two \npredictors improved the diagnostic performance of the identification of patients \nat low-risk for pathologic PMI.  \nS236  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0472 14:18  \nComparison of magnetic resonace imaging and transvaginal ultrasound \nin the staging of invasive cervical cancer  \nF. Moloney, D. Ryan, M. Twomey, M. Hewitt, J. Barry; Cork/IE \n(fiachramoloney@hotmail.com)  \nPurpose: The aim of this prospective study was to compare the diagnostic \naccuracy of transvaginal ultrasound (TVS) with magnetic resonance imaging \n(MRI) in the staging of invasive cervical cancer using surgical histology as the \ngold standard. \nMethods and Materials:  This was a prospective, operator-blinded, \ninterdisciplinary study conducted at a national centre for gynaecological \ncancer. We enrolled consecutive patients diagnosed with invasive carcinoma \nof the cervix during the period January 2011 to July 2013 (47 patients). All \npatients underwent MRI and TVS according to a standardised protocol. \nResults: TVS correlated strongly with MRI in the assessment of tumor size. \nSensitivities and specificities for the detection of stromal invasion were 100% \nand 55% and 100% and 65% for MRI and TVS respectively. No significant \ndifference was detected (p value = 0.48). MRI had a false positive rate of 22% \nin the assessment of parametrial invasion with TVS correctly down staging 6 \npatients from stage IIb to Ib. \nConclusion: Accurate staging of cervical cancer is essential as it directs both \ntreatment strategies and guides prognosis. TVS offers the advantages over \nMRI of being relatively inexpensive, non-invasive and potentially widely \navailable. We have shown TVS to have a similar diagnostic accuracy to MRI \nand suggest that transvaginal ultrasound could be used as a first-line imaging \nmodality to stage invasive cervical cancer. TVS performed by a dedicated \ngynaecological radiologist can be a fe asible and economic imaging modality \nwith a diagnostic accuracy comparable to that of MRI.  \nB-0473 14:27  \nMRI of endometrial carcinoma: comparison between T2-weighted, \ncontrast-enhanced T1-weighted and diffusion-weighted sequences  \nM. Bonatti\n1, J. Stuefer1, G. Schifferle1, N. Oberhofer1, R. Manfredi2, G. Bonatti1; \n1Bolzano/IT, 2Verona/IT (matteobonatti@hotmail.com)  \nPurpose: To compare the accuracy of T2-weighted, contrast-enhanced T1-\nweighted and diffusion-weighted MR images (T2-WI, CET1-WI and DWI) in the \nassessment of myometrial and cervical stromal infiltration by endometrial \ncarcinoma (EC). \nMethods and Materials:  Fifty patients with histologically proven EC who \nunderwent preoperative MRI and surgery at our Institution over a 30-month \nperiod have been included in our retrospective study; informed consent was \nwaived. Two radiologists independently evaluated T2-WI, CET1-WI and DWI of \neach patient and assessed: depth of myometrial invasion (more/less 50%) and \npresence of cervical stromal infiltration (Yes/No); a pathologist reviewed \nhistological specimens by considering th e same variables. Radiological \nfindings have been compared with path ological ones by means of Fisher's \nexact Test. \nResults: At histology, myometrial infiltration was 50% in 17/50 (34%); at MRI, \nmyometrial infiltration was correctly assessed in 43/50 (86%) of the cases \nwhen evaluating T2-WI, in 43/50 (86%) when evaluating CET1-WI and in 45/34 \n(90%) when evaluating DWI (P > 0.05). At histology, cervical stromal infiltration \nwas present in 9/50 (18%) of the cases and absent in 41/50 (82%); at MRI, \ncervical stromal infiltration was correctly assessed in 46/50 (92%) of the cases \nwhen evaluating T2-WI, in 46/50 (92%) when evaluating CET1-WI and in \n46/50 (92%) when evaluating DWI (P > 0.05). \nConclusion: No statistically significant differences have been found in the \naccuracy of T2-WI, CET1-WI and DWI in evaluating myometrial and cervical \nstromal infiltration by endometrial carcinoma; therefore, DWI may replace \nCET1-WI, always in addition to the more \"anatomical\" T2-WI, for \"T\" staging of \nendometrial carcinoma.  \nB-0474 14:36  \nConventional MR imaging combined with perfusion and diffusion \nweighted imaging in the pre-operative assessment of endometrial cancer  \nA.C. Cadonici, D. Ippolito, O. Minutolo, P. Bonaffini, M. Colombo, S. Sironi; \nMonza/IT (a.cadonici@gmail.com)  \nPurpose: To assess the role of semiquantitative DCE and quantitative DWI \nparameters in patients with endometrial cancer for the evaluation of tumour \naggressiveness, being tumour grading the standard of reference. \nMethods and Materials:  60 patients with biopsy-proven endometrial cancer \nwho underwent 1.5 T MR staging examination were prospectively enrolled. \nImaging protocol included multiplanar T1 and T2 weighted TSE sequences,10 \ndynamic T1 weighted gradient echo sequences during the administration of \nGadolinium (overall time:5 minutes and 66 seconds)and DWI sequences (b \nvalues:0 and 1000 mm2/sec).Colour perfusion and ADC maps were generated \nusing a dedicated software.Relative Enhancement (RE %),Maximum \nEnhancement (ME %),Maximum Relative Enhancement (MRE %),Time To \nPeak (TTP %)and mean ADC values were calculated by manually drawing a \nregion of interest (ROI)on neoplastic tissue and normal myometrium and then \nstatistically analysed. \nResults: Histopathological analysis confirmed the presence of endometrial \ncarcinoma in all the patients.According to Wilcoxon signed rank test,neoplastic \ntissue showed significantly lower (p < 0.001) values of \nRE (64.57 %± 36.27);ME (889, 67 % ± 449.96) and MRE (77.60% ± 38.13) as \ncompared to normal myometrium (RE 153.39% ± 55.56; ME \n1817.01% ± 707.22;MRE 159.89 % ± 53.49).TTP was significantly higher in \nneoplastic lesion than in normal myometrium (375.84 s ± 1588.86 vs \n195.72s ± 76.74). Mean ADC value of neoplastic tissue was 781.60 ± 233.09 x \n10-3 mm2/s, significantly lower (p < 0.001) than in \nmyometrium (1594.20 ± 375.0 x 10-3 mm2/s).Moreover ME and RE showed \nhiger perfusion values in G1 tumors than in less differentiated lesions. \nConclusion: Perfusion parameters and mean ADC differ significantly between \nendometrial cancer and normal myometrium, potentially reflecting their \ndifferent micorscopical features.  \nB-0475 14:45  \nAssessment of aggressiveness of epithelial ovarian cancers: correlation \nof apparent diffusion coefficient with histologic grade and clinical stage  \nJ.-W. Oh, S. Rha, J. Byun; Seoul/KR (fromentin@naver.com)  \nPurpose: The purpose of this study was to correlate the apparent diffusion \ncoefficient (ADC) value of an epithelial ovarian cancer with histologic grade \nand postsurgical stage. \nMethods and Materials:  Forty-three patients with pathologically proven \nepithelial ovarian cancers, including well-differentiated carcinomas (WDC; n = \n7), moderately differentiated carcinomas (MDC; n = 27), and poorly \ndifferentiated carcinomas (PDC; n = 9) were enrolled in this study. All patients \nunderwent preoperative pelvic MRI including diffusion-weighted images with b \nvalue of 0 and 1000 s/mm\n2 at 3.0-T unit. The mean ADC values of the solid \nportion of ovarian tumours were measured by two radiologists. Histologic grade \nand postsurgical stage were assessed. The mean ADC values of ovarian \ncancers were compared among the different histologic grades using one-way \nANOVA. Independent sample t-test was used for the comparisons of ADCs \nbetween early stage tumour (FIGO stage I) and advanced tumour (FIGO stage \nII, III, and IV). \nResults: The mean ADC values of the solid portion of epithelial ovarian \ncancers significantly differed between those of WDC and MDC (p=0.013), \nWDC and PDC (p=0.010). However, there was no significant difference \nbetween those of MDC and PDC (p=0.983). A significant difference was found \nin the mean ADC values between early stage cancers and advanced cancers \n(p=0.011). The mean ADC values showed significant correlation with histologic \ngrade (rho=-0.446, p=0.003) and postsurgical stage (rho=-0.425, p=0.005). \nConclusion: The mean ADC values of the solid portion of epithelial ovarian \ncancers strongly correlate with histologic grade and postsurgical stage.  \nB-0476 14:54  \nImpact of ADNEXMR SCORING system on the clinical management of \nadnexal masses  \nI. Thomassin-Naggara, E. Aubert, M. Ballester, M.-F. Carette, E. Darai, \nM. Bazot; Paris/FR (isabelle.thomassin@gmail.com)  \nPurpose: To retrospectively apply the MRI scoring system (ADNEXMR \nSCORING system) designed for characterisation of indeterminate adnexal \nmasses to assess its value in clinical practice. \nMethods and Materials:  Our study population comprised 394 women (mean \nage:45, range:18-88) having 497 adnexal masses, who underwent MRI \nbetween January 2008 and October 2010. Surgical pathology or at least a one-\nyear imaging follow-up for each patient was recorded. Blinded to final \ndiagnosis, patients were stratified into five categories according the \nADNEXMRSCORE. According to the ADNEXMRSCORE, patients classified as \nADNEXMRSCORE2 and 3 would have been managed with follow-up scans \nwhereas patients classified as ADNEXMR SCORE 4 and 5 would have been \noperated. This theoretical ADNEXMRSCORE management was compared to \nthe routine clinical management performed for each patient. \nResults: Among patients scored as 2 or 3 (n=317), no cancer was found in \nmasses larger than 6 cm. Excluding all patients with formal indication of \nsurgical removal (symptomatic women (n=97), infertile (n=19) or personal \nhistory of ovarian malignancy (n=3)), surgery would have been avoided in \n20/198 (10.1%), 29/198 (14.5%), and 44/198 (22.2%) women having adnexal \nmasses lower than 4 cm, 5 cm and 6 cm, respectively. Among patients scored \n4 or 5, treatment planning would have been changed in only 3/77 (3.9%) \nwomen who would undergo surgery for benign lesions. \nConclusion: Our study suggests that an optimal management could be \nachieved in patients with indeterminate adnexal masses when using \nADNEXMR SCORING system, allowing a significant decrease (10%) of \nsurgical recourse. A prospective study is required to confirm these data.  \nS237  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0477 15:03  \nHistogram analysis of apparent diffusion coefficient in urinary bladder \nlesions: correlation with pathological findings  \nS. Suo, X. Chen, Y. Fan, L. Wu, Q. Yao, J. Xu; Shanghai/CN \n(shtsuo@gmail.com)  \nPurpose: To determine if histogram analysis of apparent diffusion coefficient \n(ADC) can help differentiate bladder benign lesions from malignant lesions and \ndistinguish bladder tumours of different T stages. \nMethods and Materials:  In all, 52 patients with bladder lesions, including \nbenign lesions (n = 7) and malignant lesions (n = 45; T1 stage or less, 23; T2 \nstage, 7; T3 stage, 8; T4 stage, 7), were retrospectively evaluated. ADC maps \nwere obtained at two b-value combinations (b = 0, 700 s/mm 2 and 0, 1500 \ns/mm2). Parameters of histogram analysis of ADC included mean, kurtosis, \nskewness and entropy. The correlations between these parameters and \npathological results were revealed. \nResults: Significant differences were found in mean ADC values obtained at \nboth b-value combinations among patients of different pathological groups \n(P < 0.001). For ADC maps obtained at b-value combination of 0 and 1500 \ns/mm2, there were also statistically signi ficant differences in kurtosis (P = \n0.009) and skewness (P = 0.039), and the area under the receiver operating \ncharacteristic curve (AUC) for mean ADC was statistically significant in the \ndifferentiation of benign lesions and malignant lesions (AUC, 0.87; P < 0.05), \nand in the differentiation of T stages (AUC, 0.77-0.90; P < 0.05 for all \ncomparisons). Kurtosis ADC was helpful for classifying stage T4 (AUC, 0.85; \nP < 0.05). \nConclusion: A combination of mean ADC and kurtosis ADC at b-value \ncombination of 0 and 1500 s/mm2 is more accurate for assessment of bladder \nlesions of different pathological groups when compared with mean ADC alone.  \nB-0478 15:12  \nEstimation of bladder carcinoma histologic grade with diffusion-weighted \nMR imaging  \nH. Wang, Y. Guo, S. Li; GuangZhou/CN (huanjun.wang@gmail.com)  \nPurpose: To compare the diagnostic efficacy of the apparent diffusion \ncoefficient (ADC) versus a normalised ADC (nADC) value in estimation of \nbladder urothelial histologic grade and to identify an optimal reference standard \nfor nADC values in bladder tissue.  \nMethods and Materials:  Thirty patients who underwent standard preoperative \nbladder DW-MRI examination (b=0.1000 s/mm\n2) were recruited into the study \nbetween November 2011 and May 2013. In all cases urothelial carcinoma was \nconfirmed by histopathology. ADC was obtained for each tumour. Reference \ntissues from urine in bladder lumen, the obturator internus and gluteus \nmaximus were used to evaluate nADC which was calculated as: ADC (tumour \nlesion)/ADC (reference standard). A receiver operating characteristic curve \n(ROC) was constructed for each of the three nADC tissues and their ability to \ndifferentiate between high- and low-grade bladder carcinoma were compared \nto identify an optimal reference standard for nADC calculation. \nResults: The ADC (mean ±SD) for low- and high-grade bladder carcinoma \nwere 1.112 ±0.159 and 0.772 ±0.091, respectively (P < 0.001). The area under \nthe ROC curve of the ADC were 0.985, 0.995, 0.960 and 0.945, respectively in \nbladder tumour, urine, obturator internus and gluteus maximus (P < 0.001). \nConclusion: DW-MRI can be used to non-invasively estimate the histological \ngrade of bladder urothelial carcinoma. Urine in bladder lumen can be used as \nan ideal reference standard for nADC calculation. The differential diagnostic \nefficacy of nADC is superior to that of the ADC value.  \nB-0479 15:21  \nValue of MDCT in the detection of lymph node metastases in patients \nwith carcinoma of the urinary bladder: correlation of imaging and \nhistopathological findings in 274 patients  \nT. Zahel, T. Maurer, T. Horn, E.J. Rummeny, K. Holzapfel; \nMunich/DE (tinazahel@googlemail.com)  \nPurpose: To evaluate multi-detector computed tomography (MDCT) in the \ndetection of lymph node metastases in patients with urothelial carcinoma of the \nurinary bladder. \nMethods and Materials:  Two-hundred and seventy-four patients with \nurothelial carcinoma of the bladder were preoperatively scanned by MDCT \n(sensation 64, siemens; portal venous phase of abdomen and pelvis). Based \non anatomical levels, a 12-field-based approach was used independently by \ntwo radiologists to analyse the presence of lymph node metastases on CT \nscans. Lymph nodes were classified using a 5-point scale (1: definitely benign \n2: most likely benign 3: uncertain 4: most likely malignant 5: definitely \nmalignant). Results from radiological analysis were correlated with findings of \nhistopathological results after radical pelvic lymphadenectomy in all patients. \nCorrelations were performed on a field and patient basis. \n \nResults: In 65 of 274 patients (24%), lymph node metastases were confirmed \nby histopathological analysis. On a patient basis, sensitivity, specificity, positive \npredictive value (PPV), negative predictive value (NPV), and accuracy of \nMDCT in the detection of lymph node metastases were 65%, 93%, 90%, 73%, \nand 79%, respectively. Using the field-based method, 1983 fields of 274 \npatients could be evaluated. Of these, 140 fields (7%) included lymph node \nmetastases. Sensitivity, specificity, PPV, NPV, and accuracy were 52%, 98%, \n96%, 67%, and 75%, respectively, with this method. \nConclusion: MDCT was not sensitive, but highly specific in the detection of \nlymph node metastases in patients with urothelial carcinoma of the bladder.  \n14:00 - 15:30 Room I/K  \nNeuro  \nSS 611  \nBrain tumour staging and therapy  \nModerators:  \nK. Ahlström Riklund; Umea/SE  \nS. Bisdas; Tübingen/DE  \nB-0480 14:00  \nDiffusion kurtosis imaging in grading of brain glioma malignancy  \nA. Tonoyan1, I.N. Pronin1, L. Fadeeva1, D. Pitskhelauri1, E. Farrher2, \nF. Grinberg2, V. Kornienko1; 1Moscow/RU, 2Juelich/DE (atonoyan@nsi.ru)  \nPurpose: Diffusion kurtosis imaging (DKI) has been introduced as an \nadvanced extension of diffusion tensor imaging (DTI). DKI characterises the \ndiffusion deviation degree from the Gaussian model. The goal of this study is to \nassess the diagnostic efficacy of DKI in glioma grading. \nMethods and Materials:  29 patients with cerebral gliomas underwent imaging \nwith a 3-T MR scanner. A spin-echo EPI sequence was used to acquire DKI \nusing b values of 0, 1000 and 2500 s/mm² and 60 gradient directions. The DT \nparameters (mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), \nfractional anisotropy (FA), relative anisotropy (RA)) and the DK parameters \n(mean kurtosis (MK), axial kurtosis (AK), radial kurtosis (RK), kurtosis \nanisotropy (KA)) were compared in the solid parts of 14 low-grade gliomas \n(LGG), and 15 high-grade gliomas (HGG) (P < 0.05 significance level, t-test). \nResults: MK, AK, RK, KA for HGG and LGG were 0.677 ±0.309, 0.613±0.239, \n0.718±0.390, 0.115 ±0.113 and 0.462 ±0.117, 0.442 ±0.108, 0.447 ±0.174, \n0.039±0.017, respectively. DK parameters significantly differed between \ngliomas grades (MK, P=0.02; AK, P=0.02; RK, P=0.025; KA, P=0.02). MD, AD, \nRD, FA, RA for HGG and LGG were 1.382 ±0.577 (×10-3 mm2/sec), \n1.564±0.593 (×10-3 mm2/sec), 1.168± 0.606 (×10-3 mm2/sec), 0.151 ±0.112, \n0.090±0.070 and 1.867 ±0.394 (×10-3 mm2/sec), 2.040 ±0.437 (×10-\n3 mm2/sec), 1.780 ±0.379 (×10-3 mm2/sec), 0.083± 0.042, 0.053 ±0.022, \nrespectively. FA significantly increased with higher malignancy (P=0.04), \nwhereas MD, AD and RD significantly decreased with that (P=0.01, 0.02, \n0.003, respectively). The highest sensitivity  and specificity for discriminating \nbetween HGG and LGG were found for MK (93% and 94%, respectively). \nConclusion: DKI demonstrated a promising potential to differentiate among \nglioma grades and provides added value in comparison with conventional DTI.  \nB-0481 14:09  \nGlioma grading based on perfusion MRI: a normalised blood volume \nhistogram metrics quantification study  \nK. Nikiforaki1, V.K. Katsaros2, G. Manikis1, K. Marias1, G. Strantzalis2, \nN. Papanikolaou1; 1Iraklion, Crete/GR, 2Athens/GR (nikiforakik@gmail.com)  \nPurpose: To compare the diagnostic accuracy of normalised Blood Volume \n(nBV) histogram metrics to differentiate low from high grade gliomas. \nMethods and Materials:  Forty nine patients (22 female, 27 male) with \nhistologically confirmed gliomas were included. Group A comprised 13 patients \nwith low grade gliomas (all grade II) while group B comprised 36 patients (4 \ngrade III and 32 grade IV). Three-dimensional tumor segmentation was based \non intensity level clustering in T2 FLAIR for the non enhancing lesions or post \ncontrast T1 weighted images for the enhancing lesions. Dynamic Susceptibility \nContrast (DSC) perfusion was applied in all patients. Leakage corrected nBV \nmaps were created from all pixels included in the tumor volume. Minimum, \nmaximum, mean, standard deviation, median, 5%, 30%, 70% and 95% \npercentiles, as well as, normalised peak height of the nBV histograms were \ncalculated for both groups. Resulting nBV histograms were analysed for each \npatient to calculate the area under the curve of receiver operating \ncharacteristics (AUROC) for the above mentioned histogram metrics. \n \n \n \n \nS238  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nResults: Both V30 (threshold value: 0.478) and Median (threshold value: \n0.671) histogram metrics were resulted in 86.11% sensitivity and 100% \nspecificity, to discriminate high form low grade gliomas, however the \nV30 AUROC was higher than that of Median (0.949 and 0929, respectively). \nConclusion: Normalised Blood Volume histogram analysis is an accurate \nmethod for the differentiation between low and high grade gliomas.  \nAuthor Disclosures: \nK. Nikiforaki: Employee; N. Papanikolaou & Associates. N. Papanikolaou: \nCEO; N. Papanikolaou & Associates. Founder; N. Papanikolaou & Associates. \nB-0482 14:18  \nPrognostic value of apparent diffusion coefficient (ADC) values and its \ncorrelation with methylguanine-DNA-methyltransferase (MGMT) promoter \nmethylation status on glioblastoma multiforme (GBM)  \nR. Zalazar, M.D. Hernández, M. Páramo, P. Slon, M. Millor Murunzabal, \nJ. Solorzano Rendon, M. Ribelles, J. Zubieta, M. Garcia de Eulate; \nPamplona/ES (lzalazar@unav.es)  \nPurpose: To analyse whether apparent diffusion coefficient (ADC) values \ncorrelate with survival and with methylguanine-DNA-methyltransferase \n(MGMT) promoter methylation status on glioblastoma multiforme (GBM). \nMethods and Materials:  57 patients with untreated GBM before surgery were \nanalysed. Patients were followed-up for at least 12 months or until death. A \nROI were drawn on ADC-map in the highest restriction region of the tumor and \non the normal-appearing contralateral white matter (NCWM). ADCmin-values \nwere evaluated as well as ADC-index defined as a ratio between tumoral \nADCmin and NCWM-ADCmean. MGMT-status, tumoral volume, residual \nvolume, progression-free survival (P FS) and overall survival (OS) were \nevaluated. Three groups were analysed, Group1=ADC-index > 0.7 and MGMT-\nmethylated-status, Group2=ADC-index < 0.7 and MGMT-non methylated-\nstatus, and Group3=MGMT-non-methyltaed-status independent of ADC-index. \nKaplan-Meier and Cox-regression model were performed. \nResults: 57 patients were evaluated. 46 patients had complete resection. \nPresurgical tumoral volume (mean=42.4 cm\n3) and post-surgical volume \n(mean=0.57 cm3) had no association with survival. MGMT-status (n=53) was \nnot methylated in 26. On Kaplan-Meier analyses MGMT-status correlated \nbetter with PFS (p=0.002), while ADC-index correlate better with OS \n(p < 0.001). Group1 had better prognosis than Group2 in PFS (p=0.014) and \nOS (p < 0.001). In Group3, ADC-index > 0.7 had better OS than ADC-\nindex< 0.7 (p=0.027). Patients with MGMT-methylated-status and \nADCindex< 0.7 had worse OS than patients with ADCindex > 0.7 (p < 0.001). \nThe ADC-index value of 0.7 represents the best cut-off value for predicting OS. \nADC-index was a significant predictor variable on Cox regression model \n(p0.003). \nConclusion: The combined use of ADC-index and MGMT-status are stronger \npredictors than using separated in GBM. ADC-index value is a new prognostic \nparameter in GBM.  \nB-0483 14:27  \nMGMT promoter methylation status is associated with specific imaging \nfeatures and MR imaging quantitative parameters in high-grade gliomas  \nT. Jiang; Shanghai/CN (laijiangtaotao@163.com)  \nPurpose: To retrospectively evaluate the relationship between the MGMT \nmethylation status and the quantitative imaging parameters of MR in HGGs. \nMethods and Materials:  24 patients whose MGMT promoter methylation \nstatus was available were enrolled retrospectively. MR examinations were \nperformed before surgery. ADC and FA from DTI, and the regional cerebral \nblood parameters from PWI and parameters from IVIM were measured for \nenhancing tumours. \nResults: ADC values tended to be higher in the methylated HGGs than in the \nunmethylated HGGs (p M=M0.055), the ADC ratio was significantly higher in the \nmethylated tumours versus the unmethylated tumours (p M=M0.032). The FA and \nFA ratio showed significantly lower values in the methylated HGGs as \ncompared with those in the unmethylated HGGs (p M=M0.006 and pM=M0.007). The \nf values of methylated HGGs (0.156 ± 0.039 [standard deviation]) were \nsignificantly larger than those of unmethylated HGGs (0.066 ± 0.031) (P \n=.003). The D* values of unmethylated HGGs (21.99 x 10-3 mm2/sec ± 19.01) \nwere significantly smaller than those of methylated HGGs (42.64 x 10-\n3 mm2/sec ± 20.17) (P =.022). Regarding imaging features, only ill-defined \nmargin was seen more frequently in the methylated group than in the \nunmethylated group (45.5% versus 7.7%, respectively, pM=M0.048). \nConclusion: MGMT promoter methylation status is associated with a specific \nimaging feature (an ill-defined margin) and several imaging parameters (a \nhigher ADC, lower FA and higher perfusion parameters) of HGGs.  \n \nB-0484 14:36  \nComparison of diffusion tensor, dynamic susceptibility contrast MRI and \n99mTc-Tetrofosmin brain SPECT for the detection of recurrent high-grade \nglioma  \nA. Zikou, G. Alexiou, S. Tsiouris, A. Goussia, P. Kosta, S. Vourgaris, \nP. Tsekeris, A. Fotopoulos, M.I. Argyropoulou; Ioannina/GR \n(anzikou@cc.uoi.gr)  \nPurpose: Treatment-induced necrosis is a relative frequent finding in patients \ntreated for high-grade gliomas. Differentiation by imaging modalities between \nglioma recurrence and treatment-induced necrosis is not always \nstraightforward. Herewith, we compared diffusion tensor, dynamic susceptibility \ncontrast MRI and \n99mTc-Tetrofosmin brain SPECT for the differentiation of \nglioma recurrence from treatment-induced necrosis. \nMethods and Materials:  We prospectively studied 30 patients who were \ntreated for high-grade glioma and had a suspicion of recurrent tumour on \nfollow-up MRI. All patients received surgical resection of the tumour, followed \nby postoperative standard radiotherapy with chemotherapy. No residual tumour \nhad been found in the imaging follow-up immediately after initial treatment. All \npatients underwent brain MRI and within a week underwent \n99mTc-Tetrofosmin \nbrain SPECT. \nResults: Both 99mTc-Tetrofosmin brain SPECT and dynamic susceptibility \ncontrast MRI could discriminate the two clinical entities with 100% sensitivity \nand 100% specificity. An ADC ratio cut-off value of 1.27 could differentiate \nrecurrence from treatment-induced necrosis with 65% sensitivity and 100% \nspecificity and a FA ratio cut-off value of 0.47 could differentiate recurrence \nfrom treatment-induced necrosis with a 57% sensitivity and 100% specificity. A \nsignificant correlation between \n99mTc-Tetrofosmin uptake ratio and rCBV was \nfound (P=0.002). A significant negative correlation was also found between \n99mTc-Tetrofosmin uptake ratio and ADC ratio (P=0.031). \nConclusion: Dynamic susceptibility contrast MRI and brain SPECT with 99mTc-\nTetrofosmin had the same accuracy and may be used to detect recurrent \ntumour. DTI also showed promise for the detection of recurrent tumour, but \nwas inferior to both dynamic susceptibility contrast MRI and brain SPECT.  \nB-0485 14:45  \nDifferential diagnosis of therapy-related changes and recurrent \nintracranial tumours using perfusion MRI and methionine PET  \nR.S. Romanos-Zapata, T. Danfors, J. Wikström, R. Raininko; Uppsala/SE \n(romina.solangel.romanos.zapata@akademiska.se)  \nPurpose: Irradiation and chemotherapy may cause contrast enhancing tissue \nchanges difficult to differentiate from a recurrent tumor. We evaluate the value \nof perfusion MRI and methionine PET in di fferential diagnosis of neoplastic and \nnon-neoplastic changes. \nMethods and Materials:  21 patients, treated earlier for an intracranial \nneoplasm, were recruited in the study after development of a new contrast \nenhancement. They underwent standard brain MRI and perfusion study with \nDSC technique at 1.5 T, and \nC11methionine PET. The diagnosis was confirmed \nhistologically or with a long time follow-up. Patients with insufficient follow-ups \nor inconclusive final diagnosis (stabl e lesions in patients receiving \ntemozolomide during follow-up) were excluded. The final material consisted of \n16 patients who had 19 lesions. Ten of the lesions were neoplastic (all \nhistologically confirmed) and nine lesions were non-neoplastic. The lesion was \nrecorded as neoplastic on perfusion MRI if the RBV ratio of the lesion/the same \narea in the healthy side was > 2 and on PET if the lesion/normal cortex ratio \nwas \u00032.0. \nResults: 14/19 lesions (74%) were correctly diagnosed on perfusion MRI and \n15/19 lesions (79%) on PET. Sensitivity and specificity for neoplastic lesions \nwere 80% and 67% on perfusion MRI and 100% and 56% on methionine PET, \nrespectively. Diagnosis was correct or false with both methods in 11 and 1 \nlesions, respectively, and discrepant in 7 lesions. \nConclusion: Accuracy of both methods is roughly the same. Methionine PET \nis highly sensitive for recurrent tu mors but produces a lot of false positive \ndiagnoses.  \nS239  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0486 14:54  \nDifferentiation of true recurrence from delayed radiation therapy-related \nchange of primary brain tumors using advanced MR imaging  \nD. Kim, S. Choi, J.-H. Kim, C.-H. Sohn; Seoul/KR (phemuto_45@naver.com)  \nPurpose: To compare dynamic susceptibility contrast imaging, diffusion \nweighted imaging and susceptibility weighted imaging (SWI) for the \ndifferentiation of tumor recurrence and delayed radiation therapy (RT)-related \nchange in patients treated with RT for primary brain tumors. \nMethods and Materials:  We enrolled 24 patients treated with RT for varoius \nprimary brain tumors, who showed newly appeared enhancing-lesions 1year \nafter completion of RT on follow-up 3 T brain MRI. The enhancing-lesions were \nconfirmed as recurrence (n=14) or RT-change (n=10) based on \nradiological (n=11) or pathologic (n=13) findings. We calculated the mean \nvalues of normalised CBV (nCBV),ADC (apparent diffusion coefficient),and \nproportion of dark signal intensity on SWI (proSWI) for enhancing lesions. All \nvalues between two groups were compared using unpaired t-test. A \nmultivariable logistic regression mode l was used to determine the best \npredictor of differential diagnosis between two groups. The cutoff value of the \nbest predictor obtained from receiver-operating characteristic curve analysis \nwas applied to the differentiation of RT-change and recurrence,and we \nobtained the sensitivity,specificity,and accuracy for the diagnosis. \nResults: The mean nCBV values were significantly higher in recurrence group \nthan RT-change group (2.64vs1.06;P=.004),and mean proSWI were \nsignificantly lower in recurrence group (4.37vs43.92;P <.001). However, no \nsignificant difference was observed in mean ADC values between two \ngroups (P=.419). Results of multivariable logistic regression analysis showed \nthat proSWI was the only variable that could be used to independently \ndifferentiate true recurrence from RT-change (P=.001); the \nsensitivity,specificity,and accuracy were 78.6%(11of14),100%(10of10),and \n87.5%(21of24), respectively. \nConclusion: We found that the proSWI was the most promising parameter for \nthe differentiation of newly developed enhancing-lesions more than 1year after \nRT completion in brain tumor patients.  \nB-0487 15:03  \nEvaluation of microvascular permeability with dynamic contrast-\nenhanced MRI for the differentiation of primary CNS lymphoma and \nglioblastoma: radiologic-pathologic correlation  \nP. Kickingereder, F. Sahm, B. Wiestler, S. Heiland, H.-P. Schlemmer, W. Wick, \nA. von Deimling, M. Bendszus, A. Radbruch; \nHeidelberg/DE (philipp.kickingereder@med.uni-heidelberg.de)  \nPurpose: Dynamic contrast-enhanced (DCE) MRI can provide in vivo \nassessment of the microvasculature in intracranial tumours. The aim of the \npresent study was to evaluate the diagnostic performance of DCE-MRI derived \nvascular permeability parameters, including the volume transfer constant K\ntrans, \nthe volume (V e) of extravascular extracellular space (EES), and the flux-rate \nconstant Kep between EES a nd plasma, for the differentiation of primary CNS \nlymphoma (PCNSL) and glioblastoma (GB). \nMethods and Materials:  Sixty GB and ten PCNSL were included. Pre-\ntreatment DCE-MRI with a 3D T1-weighted spoiled gradient-echo sequence \nwas performed using Dotarem on a 3 T MRI scanner. Perfusion parameters \n(K\ntrans, K ep, and V e) were measured based on the Tofts-Kernmode model. \nMann-Whitney-U test and receiver-operating characteristics (ROC) analysis \nwere used to compare those parameters between PCNSL and GB. \nHistopathological correlation of DCE-M RI findings was performed using Tibor-\nPap impregnation and CD31 immunohistochemistry. \nResults: Median K\ntrans and K ep values were significantly higher in PCNSL \n(0.148±0.060 and 0.401 ±0.089) than in GB (0.064 ±0.020 and 0.224 ±0.058) \n(p < 0.01, respectively). Median V e values did not differ significantly between \nPCNSL (0.429 ±0.174) and GB (0.319± 0.101). On ROC analysis, K trans had the \nbest discriminative value for differentiating PCNSL and GB (threshold: 0.093, \nsensitivity: 90.0%, specificity: 95.0%). Histopathological evaluation revealed \nintact vascular integrity in GB despite endothelial proliferation, whereas PCNSL \ndemonstrated destructed vessel architecture, thereby promoting vascular \ndisintegrity. \nConclusion: PCNSL demonstrated significantly higher K\ntrans and K ep values \ncompared with GB, implying a higher vascular permeability in PCNSL. These \nfindings correlate with underlying histopathological features, and may be useful \nin distinguishing PCNSL from GB.  \nB-0488 15:12  \nMultiparametric characterisation of a rat model of glioblastoma by using \nMRI and 18 F-FDG PET/CT images  \nM. Vieira-Leite, P. López-Larrubia; Madrid/ES (mariaceciliavll@hotmail.com)  \nPurpose: Glioblastoma is the most frequent primary brain tumour that carries a \nvery bad prognosis despite the advances in treating human malignancies. This \nstudy aimed to characterise a rat model of glioma by MRI and PET/CT, the two \nversatile tools used in neuroimaging. \nMethods and Materials:  Male Wistar rats (N=19) implanted with C6 cells in \ntheir right caudate-putamen and Sham animals (N=5) were used and studied \nwith MRI using a 7T system to acquire a T2, T2* and T1-weighted images to \nyield relaxation time maps, diffusion tension imaging-DTI to obtain mean \ndiffusivity-(MD) and fractional anisot ropy-(FA) maps, and magnetisation \ntransfer-(MT) to determine MT ratio maps. Colour-based maps were computed \nusing a home-made software developed in Matlab. ROIs were drawn in the \ntumoural tissue (TT), contralateral hem isphere (CH) and healthy tissue (HT). \nSix animals were also submitted to an 18 F-FDG-PET/CT, analysing ROI's in \nthe T, CH and liver. \nResults: TT compared with Sham showed significantly different values of \nMTR, T1, T2 and T2*. TT compared to CH was also significant on MTR, MD, \nT1, T2 and T2* measurements. When comparing TT and HT, there were \nsignificant differences on MT,FA, T1 and T2. PET/CT showed significantly \nhigher SUVs on the TT than on CH. Correlation between SUVs and MRI \nparameters could not be found. \nConclusion: There are significant differences in MRI parameters related to \ninflammation, oedema and hypoxia between TT, CH and HT. 18 F-FDG-\nPET/CT provided new information to the MRI. Tumour characterisation can \nimprove the selection of patients who will benefit from tailored therapies and \ntheir follow-up.  \nB-0489 15:21  \nResection probability maps for quality assessment of glioma surgery \nwithout brain location bias  \nP.C. de Witt Hamer\n1, E.J. Hendriks1, E. Mandonnet2, F. Barkhof1, \nA.H. Zwinderman1, H. Duffau3; 1Amsterdam/NL, 2Paris/FR, 3Montpellier/FR \n(hendriks.eef@gmail.com)  \nPurpose: Intraoperative brain stimulation mapping reduces permanent \npostoperative deficits and extends tumour removal in resective surgery for \nglioma patients. Successful functional m apping is assumed to depend on the \nsurgical team's expertise. In this study, g lioma resection results are quantified \nand compared using a novel approach, so-called resection probability maps \n(RPM), exemplified by a surgical team comparison, here with long and short \nexperience in mapping. \nMethods and Materials:  Adult patients with glioma were included by two \ncenters with two and fifteen years of mapping experience. Resective surgery \nwas targeted at non-enhanced MRI extension and was limited by functional \nboundaries. Neurological outcome was compared. To compare resection \nresults, we applied RPMs to quantify and compare the resection probability \nthroughout the brain at 1 mm resolution. Considerations for spatial \ndependence and multiple comparisons were taken into account. \nResults: The senior surgical team contributed 56, and the junior team 52 \npatients. The patient cohorts were comparable in age, preoperative tumour \nvolume, lateralization, and lobe localisation. Neurological outcome was similar \nbetween teams. The resection probability on the RPMs was very similar, with \nnone (0%) of 703,967 voxels in left-sided tumours being differentially resected, \nand 124 (0.02%) of 644,153 voxels in right-sided tumours. \nConclusion: RPMs provide a quantitative volumetric method to compare \nresection results, which we present as standard for quality assessment of \nresective glioma surgery because brain lo cation bias is avoided. Stimulation \nmapping is a robust surgical technique, because the neurological outcome and \nfunctional-based resection results using stimulation mapping are independent \nof surgical experience.  \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nS240  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n14:00 - 15:30 Room L/M  \nCardiac  \nSS 603a  \nFunctional MR imaging: myocardium and \nventricles  \nModerators:  \nD. Maintz; Cologne/DE  \nF. Molinari; Lille/FR  \nB-0490 14:00  \nAssessment of sub-clinical acute cellular rejection after heart \ntransplantation: comparison of cardiac imaging and endomyocardial \nbiopsy  \nC. Krieghoff, M. Barten, L. Hildebrandt, M. Grothoff, L. Lehmkuhl, C. Lücke, \nC. Andres, S. Nitzsche, M. Gutberlet; Leipzig/DE (c.krieghoff@freenet.de)  \nPurpose: Comparing the diagnostic value of multi-sequential cardiac magnetic \nresonance imaging (CMR) with endomyocardial biopsy (EMB) for detection of \nsub-clinical cardiac allograft rejection. \nMethods and Materials:  146 examinations in 73 Patients (mean age 53 ±12 \nyears, 58 male) were performed using a 1.5-Tesla scanner and compared to \nEMB results. A multi-sequential protocol was used including T2-weighted short \ntau inversion recovery (STIR) for calculation of the oedema ratio (ER), T1-\nweighted spin-echo sequence for assessment of global relative enhancement \n(gRE) and inversion-recovery sequences to visualise late gadolinium \nenhancement (LGE). Cut-off values were defined as <= 2 for ER and <= 4.5 for \ngRE. The presence of LGE was assessed qualitatively. A histological grade \n> 1B was considered as relevant rejection in which all patients received anti-\ninflammatory medical treatment. \nResults: One-hundred and twenty-seven (127/146=87%) EMBs demonstrated \nwith no or mild signs of rejection (grades <= 1 A) and 19/146 (13%) with a \nrelevant rejection (grade >= 1B). Sensitivity, specificity, positive predictive \n(PPV) and negative predictive value (NPV) for rejection grade 1B or higher \nwere as follows: ER: 63%, 78%, 30% and 93%; gRE: 63%, 70%, 24% and \n93%; LGE: 68%, 36%, 13% and 87%; with the combination of ER and gRE \nwith at least 1/2 positive: 84%, 57%, 23% and 96%. A receiver operator \ncharacteristic analysis revealed an area under the curve of 0.724 for ER and \n0.659 for gRE. \nConclusion: CMR parameters for myocarditis were also useful to detect sub-\nclinical acute cellular rejection after heart transplantation. Comparable results \nto myocarditis could be achieved, with a combination of ER and gRE.  \nB-0491 14:09  \nMyocardial engraftment assessment of mesenchymal stem patches on \nserial high-resolution in vivo cardiac MR in chronic heart failure  \nE. Blondiaux1, L. Pidial1, G. Autret1, D. Balvay1, E. Audureau2, C. Whilhelm1, \nH. Ducou le Pointe1, P. Menasché1, O. Clément1; 1Paris/FR, 2Créteil/FR \n(eleonore.blondiaux@trs.aphp.fr)  \nPurpose: To determine whether the efficiency of epicardial deposit of human \nbone marrow-derived mesenchymal stem cells (BMSC) fibrin patch on \nchronically-infarcted rat hearts occurred through integration of stem cells from \nthe patch to the recipient myocardium. \nMethods and Materials:  BMSC were labeled with iron oxide nanoparticles \n(BMSC*, n=12) or unlabeled (BMSC-, n=10). Patches were applied to region of \nischemia. No patch was applied to control group hearts after myocardial \ninfarction and median sternotomy (SHAM, n=7). In vivo cardiac MR imaging \nwas performed on a 4.7 Tesla scanner before, 8 days and 21 days after \ntransplantation. Therapeutic efficacy was evaluated on cine flash MRI \nsequences with left ventricular ejection fraction (LVEF). Cell migration into the \nmyocardium was evaluated on in vivo T2*-weighted sequences. The results \nwere compared with histology for the evaluation of iron labeled cells (Perls) \nand immunohistochemistry for the presence of human cells (Lamin A/C). \nResults: At day 8 and 21 after transplantati on, a statistically significant \ndifference was found between the LVEF of BMSC* and BMSC- compared with \nSHAM (p=0.02 and p=0.03 respectively). Persisting human cells were \nidentified in the grafted area 21 days after transplantation. Location of dark \nareas identified on T2*-weighted MR images corresponded with spatially MR-\nmatched histological sections and demonstrated that no BMSC* integrated in \nthe myocardium. \nConclusion: The absence of integration BMSC into the recipient myocardium \nand the presence of persisting human cells at day 21 suggest that the \nefficiency of these constructs is more closely related to the paracrine effects of \nBMSCs.  \nAuthor Disclosures: \nE. Blondiaux: Research/Grant Support; Société Française de Radiologie. \nB-0492 14:18  \nMyocardial MR spectroscopy (MRS) as early indicator of athlete's heart \nand hypertrophic cardiomyopathy  \nF. Secchi, R. Spairani, M. Petrini, C. Messina, F. Cartia, G. Di Leo, \nF. Sardanelli; Milan/IT (francescosecchimd@gmail.com)  \nPurpose: To evaluate myocardial energetic metabolism with 31P-MRS and \n1H-MRS in order to define early metabolic modifications in athlete's heart. \nMethods and Materials: We prospectively performed a cardiac 1.5-T MR in 30 \nsubjects: 15 athletes (A), 7 HCM patients (H) and 8 healthy volunteers (V). \nECG-triggered true-FISP and 1H-MRS point resolved spectroscopy sequence \nwere performed. For the 1H-MRS, a single voxel was placed into the septum. A \n31P-MRS multivoxel chemical shift imaging sequence was acquired. 1H-MRS \nspectra were processed using jMRUI software; 31P-MRS spectra using \nSpectroscopy-Argus. Kruskal-Wallis and Jonckheere-Terpstra tests were used. \nResults: Ejection fraction (%), indexed end-diastolic volume (ml/m\n2), end-\nsystolic volume (ml/m 2), mass (g/cm 2) and septal thickness (mm) were 65, 84, \n31, 70 and 10 for group A, respectively; 68, 73, 20, 81 and 18 for group H, \nrespectively; 63 (p=0.939), 78 (p=0.058), 29 (p=0.481), 45 (p=0.013) and 6 \n(p < 0.001) for group V, respectively. Creatine phosphate (PCr), 3ATP and \ninorganic phosphate (Pi) were 29, 5.5, 0.4 for group A, respectively; 22, 5.4, \n0.4 for group H, respectively; 24 (p=0.281), 5.7 (p=0.877), and 0.0 (p=0.066) \nfor group V, respectively. PCR/ 3ATP was 5.1 in group A, 3.7 in group H and \n4.6 in group V (p=0.441); total creatine was 0.4, 0.6, and 0.0, respectively \n(p=0.050); lipids were 0.1, 1.8, and 0.0, respectively (p=0.078). \nConclusion: A reduction of PCR/3 ATP ratio and an increase of lipids are \nconfirmed in group H. A reduction of PCR/ 3ATP associated with an increase of \nlipids could represent an indicator of early stage of HCM.  \nB-0493 14:27  \nLeft ventricular non-compaction: pathological or normal variant?  \nJ. Weir-McCall, A. Dawson, K. Fitzgerald, C. Papagiorcopulo, M. Lambert, \nR.D. White, S. Gandy, A.M. Struthers, J.J.F. Belch, J.G. Houston; Dundee/UK \n(jweirmccall@doctors.net.uk)  \nPurpose: There is considerable overlap between Left Ventricular Non \nCompaction and other cardiomyopathies, and it has been reported in up to \n18% of athletes raising the question whether it is a distinct pathological entity. \nTo further understand this unusual phenotype we assessed its prevalence in a \nhealthy population using cardiac magnetic resonance (CMR). \nMethods and Materials:  5000 volunteers >  45 yrs with no history of \ncardiovascular (CV) disease and a 10 year risk of CV disease less than 20% \nas assessed by the ASSIGN score were recruited to the Tayside Screening for \nCardiac Events (TASCFORCE) study. Those with a B-type natriuretic peptide \n(BNP) level greater than their gender specific median were invited for a whole \nbody cardiovascular MRI. From this group, 500 CMR were assessed, and \nLVNC ratios measured on the horizontal long axis and vertical long axis \nbSSFP sequences. Non compaction ratio was recorded at end diastole in the \nsection with the greatest ratio of compacted to non compacted myocardium. \nResults: The average non compacted:compacted LV myocardium was 1.79 \n(IQR 1.38-2.1) with the anterior wall of the mid LV the most common location of \nmaximmum non compaction. 80 (16%) had a non compaction ratio of > 2.3 (the \ncurrent proposed threshold for LVNC diagnosis). Of these the average non \ncompaction ratio was 2.83 (IQR 2.45-3.05), with an average of 4 segments \ninvolved (IQR 3-6) using the AHA 17 segment model. \nConclusion: The current CMR criteria appears to over diagnose LVNC in \nhealthy individuals and more stringent diagnostic criteria is required.  \nB-0494 14:36  \nAssessment of left ventricular functional and morphological adaptation in \nprofessional soccer players using cardiac MR  \nM. Regier, E. Tahir, J. Schmidt-Holz, C. Behzadi, R.P. Marschall, \nP. Catala-Lehnen, K. Müllerleile, G. Adam, G.K. Lund; \nHamburg/DE (mregier@uke.de)  \nPurpose: To investigate the effects of intensive daily training related to \nprofessional soccer on morphological and functional parameters of the left \nventricle assessed by cardiac magnetic resonance imaging (CMRI) and to \ncompare these to the observations in non-athletic healthy volunteers. \nMethods and Materials:  In 16 male professional soccer players from the \nGerman Bundesliga team squad of the Hamburger SV and six sedentary \ncontrols CMRI was performed at 1.5 T during active season. For quantitative \nCMRI, an electrocardiographically triggered steady-state free precession \n(SSFP) cine sequence (TR/TE, 3.2/1.6 ms; pixel-size, 1.7 mm×1.7 mm) was \nperformed in short- and long-axis views. Quantitative analysis included the \nend-diastolic (EDV) and end-systolic volume (ESV), the stroke volume (SV), \nleft ventricular ejection-fraction (EF) as well as the end-diastolic (EDMM) and \nend-systolic myocardial mass (ES MM). Statistical evaluation included \nSpearman`s correlation coefficient (CC) and the Wilcoxon test. \nS241  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nResults: In professional soccer players the EDV (230.8 ±20 ml vs. \n168.99±42.48 ml; p <  0.02), ESV (101.1 ±16.65 ml vs. 68.28 ±15.81 ml; \np=0.002) and SV (129.73± 15.73 ml vs. 100.71 ±27.26 ml; p <  0.05) were \nsignificantly higher than in non-athletic volunteers. Furthermore, the myocardial \nmass was significantly higher in professional soccer players at the end-\ndiastolic (152.28 ±37.72 g vs. 100.88 ±35.71 g; p=0.015) as well as the end-\nsystolic (163.4 ±37.8 g vs. 114.4 ±39.3 g; p < 0.03) state whereas the ejection-\nfraction was similar in both collectives. At rest, the athlete`s heart rate was \nsignificantly lower (50 vs. 61 beats/min; p=0.01). \nConclusion: Left ventricular adaptations in professional soccer players are \ncharacterised by an increase in functional parameters and myocardial mass. \nCMRI allows for an objective quantitative assessment and might help to \ndifferentiate cardiac adaptations from hypertrophic cardiomyopathy.  \nB-0495 14:45  \nCardiac MRI in elite athletes: \u0005an it be a final step in the eligibility for \ncompetitive sport after suspicious ultrasonography?  \nO. Larina, E. Mershina, V.E. Sinitsyn, E. Sidorenko, V. Preobrazhenskiy; \nMoscow/RU (Larina-Olga@yandex.ru)  \nPurpose: To evaluate usefulness and efficacy of CMR in young athletes with \nsuspicious or inconclusive ultrasonography referring for their eligibility to \ncompetitive sport. \nMethods and Materials:  29 athletes (high league football and hockey players, \nathletics; age 24± 5; 27/2 men/women) were examined in 2009-2013. All \nathletes had suspicions to cardiac abnormalities according to the results of \nechocardiography, ECG and functional examination. CMR was performed with \n1.5 T-scanner to detect/rule out LV hypertrophy, arrhythmogenic \ncardiomyopathy, myocarditis or congenital heart diseases. \nResults: >MR didn't confirm cardiac pathology or found minor non-significant \nabnormalities in 16 cases (55.2%). In 5 cases (17.2%) CMR demonstrated the \npresence of bicuspid aortic valve with non -significant regurgitation. In 2 cases \n(6.9%) athletes had deep myocardial trabeculations without criteria of non-\ncompaction cardiomyopathy. These athletes kept on doing competitive sports \nunder the care of cardiologists. In 3 cases (10.3%) CMR revealed LV \nhypertrophy, which exceeded criteria established for the \"athlete's heart\". In 1 \ncase of apical LV hypertrophy with focus of late-enhancement was found. \nThese athletes were recommended to disco ntinue professional sport activities. \n2 sportsmen (6.9%) were referred to cardiac surgeon: the first one had patent \nductus arteriosus (Qp:Qs = 1.35:1), the second one - the complex cardiac \npathology - non-compacted myocardium, ventricular septal and inferior wall \naneurism, atrial septal defect (Qp:Qs = 1.35:1). \nConclusion: CMR provides significant contribution for medical decision-\nmaking in athletes eligibility for professional sport due to its possibilities in the \nassessment of ischemia and viability, evaluation of non-ischemic \ncardiomyopathies, myocarditis, pericardial disease, congenital heart disease \nand cardiac masses.  \nB-0496 14:54  \nMR 4D flow-based estimation of pulmonary arterial wedge pressure  \nU. Reiter, G. Reiter, G. Kovacs, A. Schmidt, H. Olschewski, M.H. Fuchsjäger; \nGraz/AT (ursula.reiter@medunigraz.at)  \nPurpose: To evaluate if time-resolved three-directional magnetic resonance \nphase contrast imaging (4D-MR-PCI) derived left atrial in- and out-flow patterns \ncan be employed to estimate pulmonary arterial wedge pressure (PAWP). \nMethods and Materials:  60 patients with suspected pulmonary hypertension \n(PH) underwent right heart catheterization for determination of pulmonary \nhaemodynamics and 4D-MR-PCI of the left atrium. MR-PCI data were \nvisualised with dedicated software and evaluated for peak velocities v\nS and v D \nof S- and D-wave of pulmonary veins at the pulmonary venous-left atrial \njunctions as well as for the peak velocity v\nE of the E-wave at the left atrial-\nventricular junction. Relations between peak  velocities, left atrial acceleration \nindex defined as a LA=2·vE/(vS+vD) and PAWP were analysed by means of \ncorrelation and linear regression analysis. \nResults: Whereas no single peak velocity (mean v S=34±12 cm/s, mean \nvD=32±8 cm/s, mean vE=50±16 cm/s) correlated strongly with PAWP (r=-0.57, -\n0.16 and 0.62 for v S, v D and v E, respectively), the correlation coefficient \nbetween aLA (mean a LA =1.7±0.9) and PAWP was r=0.92. Linear regression of \nPAWP on a LA did not depend on the presence of PH (p=0.61 for the intercept, \np=0.87 for the slope) and the standard deviation from the regression line \nPAWP=-3.6+8.5·aLA (in mmHg) was 2.0 mmHg. \nConclusion: 4D MR-PCI-derived left atrial acceleration index allows an \naccurate estimation of PAWP in patients with suspected PH and might, \ntherefore, be employed as non-invasive marker for the pre- or post-capillary \nnature of cardiovascular disorders in general, and PH in particular.  \nAuthor Disclosures: \nG. Reiter: Employee; Siemens AG.  \nB-0497 15:03  \nTowards non-invasive haemodynamic assessment of pulmonary \nhypertension  \nG. Reiter, U. Reiter, G. Kovacs, A. Schmidt, H. Olschewski, M.H. Fuchsjäger; \nGraz/AT (gert.reiter@siemens.com)  \nPurpose: Mean pulmonary arterial pressure (mPAP), pulmonary arterial \nwedge pressure (PAWP), and transpulmonary pressure gradient (TPG) are \nhaemodynamic key parameters for defini tion and classification of pulmonary \nhypertension (PH). The purpose of the present study was to analyse, if blood \nflow patterns derived from time-resolved three-directional magnetic resonance \nphase contrast imaging (4D-MR-PCI) can be used to estimate these \nparameters in patients with PH. \nMethods and Materials:  33 patients with PH underwent right heart \ncatheterisation providing mPAP, PAWP and TPG, as well as 4D-MR-PCI of the \nmain pulmonary artery and the left atrium. Velocity fields resulting from 4D-MR-\nPCI were visualised with dedicated software and evaluated for (1) the duration \nof vortical blood flow (t\nvortex) in the main pulmonary artery and (2) the left atrial \nacceleration index a LA=2·vE/(vS+vD) determined from three-dimensional peak \nvelocities of systolic (v S) and diastolic (v D) pulmonary venous inflow and left \natrial outflow (v E). Relationships between invasively and non-invasively \ndetermined parameters were analysed by correlation, linear regression and \nBland-Altman analysis. \nResults: Strong correlations were  found betw een mPAP and t\nvortex (r=0.96) as \nwell as between PAWP and a LA (r=0.93). Linear regression equations \nmPAP=15+0.66·tvortex and PAWP=-3+8·a LA (both in mmHg) estimated mPAP \nand PAWP with standard deviations of 4 mmHg and 2 mmHg, respectively. \nThe difference of estimated mPAP and PAWP strongly correlated with TPG \n(r=0.96) and resulted in a standard deviation of 4 mmHg between invasive and \nnon-invasive assessment. \nConclusion: 4D-MR-PCI allows an accurate, non-invasive determination of the \nhemodynamic key parameters mPAP, PAWP and TPG in patients with PH.  \nAuthor Disclosures: \nG. Reiter: Employee; Siemens AG.  \nB-0498 15:12  \n4D flow and cardiac MRI to estimate pulmonary arterial pressure: \ncomparison with right-heart catheterisation in patients with pulmonary \nhypertension  \nH. Ota, K. Sugimura, K. Nochioka, S. Tatebe, M. Miura, K. Satoh, K. Takase, \nH. Shimokawa, S. Takahashi; Sendai/JP (h-ota@rad.med.tohoku.ac.jp)  \nPurpose: Non-invasive method to estimate pulmonary artery (PA) pressure \nremains to be developed. We examined whether several parameters driven by \n4D flow and cardiac MRI parameters allowed the estimation. \nMethods and Materials: We enrolled 22 patients with pulmonary hypertension \n(pulmonary arterial hypertension, 5, chronic thromboembolic pulmonary \nhypertension, 17) and 4 normal volunteers for 4D flow and cardiac MRI. Using \n4D flow MRI, the degree of vortex flow in the main PA flow was measured. \nCardiac MRI parameters, including, right ventricular ejection fraction (RVEF), \nRV end-diastolic and end-systolic volume index, RV cardiac index, main PA \ndiameter, and ratio of main PA to ascending aorta diameter (ratio PA) were \ndocumented. MRI findings were compared with catheter-driven mean PA \npressure (mPAP) in the 22 patients. \nResults: Vortex flow in the main PA was observed in all patients, but not in the \nvolunteers. In the patients, the mean ± SD of mPAP and degree of vortex flow \nwere 37.6 ± 11.0 mmHg and 67.0 ± 9.4%, respectively. The degree of vortex \nflow (Pearson's r=0.81, P < 0.01), ratio PA (r=0.51, P=0.02) and RVEF (r=-\n0.44, P=0.04) was correlated with mPAP. Other parameters were not \ncorrelated. Multivariate linear regression analysis demonstrated the degree of \nvortex flow was significantly associated with mPAP (coefficient=12.5, 95%CI, \n4.7, 20.2, P < 0.01) but the remaining parameters were not. \nConclusion: Among several MRI parameters, the degree of vortex flow in the \nmain PA demonstrated significant association with mPAP. 4D flow MRI was \nuseful to estimate mPAP in patients with pulmonary hypertension.  \nS242  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0499 15:21  \nThe prevalence of potentially serious incidental findings on cardiac MR \nimaging: a systematic review  \nL.M. Gibson, L. Paul, C.L.M. Sudlow; Edinburgh/UK (lornagibson1@nhs.net)  \nPurpose: To perform a systematic review to estimate the prevalence and \ntypes of incidental findings on cardiac magnetic resonance (MR) imaging to \ninform the design of the UK Biobank multi-modal imaging study of 100,000 \nmiddle-aged participants. \nMethods and Materials:  We searched authors' files, Medline and Embase for \nstudies published in any language by June 2013 which reported the prevalence \nof incidental findings on cardiac MR in  adult patients or apparently healthy \nvolunteers. We defined serious incidental findings as those likely to threaten \nlifespan, quality of life or major body functions. One reviewer selected studies \nfor inclusion and a second independently checked 10% of the references. We \nextracted data on incidental findings, participant characteristics and imaging \nvariables. \nResults: In 16 studies, 4,089 of 17,138 people (mean age 51 years, 42% \nfemale, 22% patients) had incidental findi ngs, which were potentially serious in \n699 (4.1%, 95% confidence interval 3.8-4.4%) including 415 suspected \nmalignancies. The commonest non-maligna nt potentially serious incidental \nfindings were pleural effusion (n=144), non-specific major parenchymal lung \nabnormality (n=23) and pulmonary consolidation (n=17). Potentially serious \nincidental findings were detected more frequently in studies using contrast \ncompared to non-contrast imaging (5.6% versus 1.5%). One study (n=132) \nused a 3 T scanner, and the remainder used 1.5 T scanners.  \nConclusion: Potentially serious incidental  findings are common on cardiac \nMR. Over half are suspected malignancies. The potential for such findings \nshould be discussed with research participants and patients when seeking \ninformed consent. Investigators should design systems for evaluating \nincidental findings and referring patients to healthcare providers.  \nAuthor Disclosures: \nL.M. Gibson: Research/Grant Support; Received funding from UK Biobank to \nattend educational meetings. C.L.M. Sudlow: Other; UK Biobank Chief \nScientist. \n14:00 - 15:30 Conf. Room M3  \nInterventional Radiology  \nSS 609  \nTrends in occlusive and aneurysmal \ndisease  \nModerators:  \nE. Dosa; Budapest/HU  \nD.K. Tsetis; Iraklion/GR  \nB-0500 14:00  \nThe effect of sustained delivery of sirolimus on neointimal hyperplasia \nand the local thrombotic environment after angioplasty  \nY. E\n1, N. He2; 1Baoding/CN, 2Tianjin/CN (eyajun@hotmail.com)  \nPurpose: To explore the effect and potential problems of local sustained \ndelivery of sirolimus for restenosis prevention after PTA. \nMethods and Materials:  Experimental common carotid artery injury model \nwas established in the rat. Pluronic F-127 gel containing sirolimus was applied \nto the exposed adventitial surface of the injured carotid artery, and the effects \nof local sustained delivery of sirolimus for restenosis prevention after \nangioplasty were evaluated by haematoxylin and eosin staining and \nimmunohistochemistry staining. \nResults: 15 and 30 days after injury, compared to controls the neointimal \nthickness and area, the ratio of intimal area to medial area and the stenotic \nrate were significantly decreased in both high concentration (600 8g/100 8l) \nand low concentration (300 8g/100 8l) experimental groups ( P \n< 0.01); \nCompared to controls, 15 and 30 days after injury local sustained delivery of \nsirolimus in both experimental groups enhanced the expression of the TF and \nPAI-1 in neointima (P \n< 0.05), however, the expression of t-PA in neointima \nwas decreased in both high and low concentration groups ( P < 0.05). \nConclusion: Local sustained delivery of sirolimus not only suppressed the \nneointimal hyperplasia effectively, but also induced the high expression of TF \nand PAI-1 and low expression of t-PA in neointima, and the imbalance \nexpression of TF, tPA and PAI-1 could play an important role in late thrombosis \nformation after DES (drug eluting stent) placement.  \n \nB-0501 14:09  \nCalcium assessment and impact on drug eluting balloons in peripheral \narterial disease  \nF. Fanelli, A. Cannavale, M. Corona, P. Lucatelli, A. d'Adamo, A. Wlderk, \nF.M. Salvatori; Rome/IT (alessandro.cannavale@hotmail.com)  \nPurpose: To assess the effect of calcium on the efficacy of DEB during \nrevascularisation of steno-obstructive SFA lesions. \nMethods and Materials:  Sixty patients with de-novo lesions of the superficial \nfemoral artery (SFA) underwent endovascular treatment with DEB. A pre-\ndilatation with conventional undersized (- 1 mm RVD) angioplasty balloon was \ndone. DEB were selected according to vessel reference diameter (1:1) and \nkeep inflated for 60 seconds. In case of residual stenosis > 50% or flow-limiting \ndissection a post-dilatation with conventional  balloon or provisional stenting \nwas done. Ankle-brachial index (ABI), late lumen loss (LLL), target lesion \nrevascularisation (TLR), primary (PP) and secondary (SP) patency, major \nadverse events (MAE) and Rutheford shift were evaluated after a minimum \nfollow-up of 1 year. Patients were divided in eight groups according to the \namount of calcium: degree from 0° to 360°; length 3 cm. \nResults: Recanalisation was done success fully in all cases. Flow-limiting \ndissection occurred in 5 cases (8.3%) with higher degree of calcium. It was \nsolved with post dilatation in 3 cases and provisional stenting in the other 2. A \nless effect of DEB was observed in those patients with higher degree of \ncalcium ( > 270° vs. < 90°): ABI 0.71 ±0.07 vs. 0.92± 0.07; LLL 0.75 ±0.21 vs. \n0.45±0.10; PP 50% vs. 100%; SP 50% vs. 100%; TLR 25% vs. 0%; MAE 25% \nvs. 0%. According to the length of calcium, results were similar. \nConclusion: Calcium represents a barrier for optimal drug absorption. \nCircumferencial distribution seems to be the most influencing factor with worst \neffect noted in 360° calcium presence.  \nB-0502 14:18  \nEfficacy of drug eluting balloon percutaneous transluminal angioplasty to \ntreat recurrent carotid in-stent restenosis: long-term results  \nC. Del Giudice, R. Gandini, V. Da Ros, S. Altobelli, E. Salvatori, E. Pampana, \nG. Simonetti; Rome/IT (costantino.delgiudice@gmail.com)  \nPurpose: To evaluate the potential role, safety and efficacy of drug eluting \nballoon for treatment of carotid in-stent restenosis (ISR). \nMethods and Materials:  856 consecutive patients underwent carotid artery \nstenting from May 2002 to January 2008. In 41 patients a significant ISR \n(> 80% stenosis) occurred. Nine of these were affected by the onset of \nrecurrent restenosis after multiple treatments within a short period of time. \nThese patients were treated with DEB angioplasty to treat internal carotid \nartery ISR. An ultrasound controlwas performed at 1, 3, 6 and yearly after the \nprocedure with mean follow-up time 36.6 ±2.7 months. \nResults: A technical success was obtained in 100% of cases. A distal filter \ndevice was used in all cases. No major periprocedural neurological or \nmyocardial events were recorded. Angiographic stenosis decreased from \n87%±4% to 6± 4%. Peak systolic velocity (PSV) decreased significantly after \nthe procedure from 4.7 ±1.5 to 1.3±0.5 m/s. PSV maintained under a significant \nvalues during the follow-up except in one patient, who developed a significant \nISR 3 years after the procedure. TVR was 9% at 36 months follow-up. No \nneurological or myocardial events were recorded during the follow-up. 1 patient \ndied at 3 months follow-up. \nConclusion: DEB may have a potential role, improving outcomes of patients \ntreated for carotid ISR.  \nB-0503 14:27  \nAn echo-color-doppler analysis - carotid endarterectomy vs stenting: \ndoes the flow really change?  \nP. Lucatelli1, F. Fanelli1, A. Cannavale1, C. Cirelli1, M. Corona1, A. d'Adamo1, \nC. Catalano1, F.M. Salvatori1, L. Saba2; 1Rome/IT, 2Cagliari/IT \n(pierleone.lucatelli@gmail.com)  \nPurpose: To assess potential hemodynamic differences after Carotid \nEndArterectomy (CEA) and Carotid Artery Stenting (CAS) and their eventual \nimpact on clinical management. \nMethods and Materials:  Between 2010 and 2011 two groups of 30 patients \nreferred for CAS or CEA were prospectively enrolled. Pre-procedural imaging \nwas performed with ECD and CTA. ECD was repeated within 24 hours, at one, \nsix and twelve months from the procedures. PSV and EDV were assessed at 2 \nstandard site: CCA and distal ICA. \nResults: Twenty-four hours findings highly differs between populations.CCA \nPSV in the CEA and CAS group were respectively 44.88 ±9.16 cm/sec and \n69.20±20.04 cm/sec (p= 0.002);CCA EDV were 16.11± 2.29 cm/sec and \n19.13±6.42 cm/sec (p=0.065);ICA PSV were 46.11 ±7.9 cm/sec and \n94.02±57.7 cm/sec (p=0.0012);ICA EDV were 20.22 ±4.33 cm/sec and \n30.47±18.33 cm/sec (p= 0.025).One month, six months and one year follow-up \nconfirmed the different trend in the findings of two cohorts; in particular at one \nyear:CCA PSV were 50.94 ±12.44 cm/sec and 60.59 ±26.84 cm/sec (p= \nS243  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n0.181);CCA EDV were 17.11± 3.46 cm/sec and 19 ±16.35 cm/sec \n(p=0.634);ICA PSV were 51.66 ± 10.1 cm/sec and 70.86 ± 20.64 cm/sec \n(p=0.014);ICA EDV were 25.05 ±8.65 cm/sec and 32.66± 13 cm/sec (p= \n0.0609). \nConclusion: ECD follow-up is mandatory for these patients, allows to reduce \nfalse positive re-stenosis diagnosis, to choose the best anti-aggregation \ntherapies. Within the first month from CEA patient benefits of a lower risk \ncondition compared to CAS patient, due to a significant faster drop of the PSV; \nmoreover long-term CEA CCA PSV could be used as a surrogate marker of \nneointima formation.  \nB-0504 14:36  \nPaclitaxel-coated balloon-angioplasty for central-venous re-stenosis in \npatients with haemodialysis fistulas  \nA. Massmann\n1, P. Fries1, K. Obst-Gleditsch1, R. Shayesteh-Kheslat1, \nM. Katoh2, A. Buecker1; 1Homburg a.d. Saar/DE, \n2Krefeld/DE (Alexander.Massmann@uks.eu)  \nPurpose: Retrospective evaluation of standard (POBA) and Paclitaxel-coated \nballoon angioplasty (PCBA) for central venous re-stenoses in patients with \nimpaired haemodialysis fistulas. \nMethods and Materials: 27 patients (male 15, female 12, mean 66 ±14 [39-90] \nyears) with 32 non-malignant central venous stenoses confirmed by \nsonography, MRI or venography were treated initially by POBA. In case of \nsymptomatic re-stenoses re-intervention was done by POBA in 5 patients of \nwhom 2 patients underwent 11 or 5 POBA treatments. PCBA was performed in \n13 patients after single or repetitive POBA. All Paclitaxel-coated balloons \n(Elutax SV, AachenResonance, Germany) (diameter 6-14 mm) were custom-\nmade. \nResults: Central venous stenosis included the axillary (11), subclavian (6), \nbrachiocephalic (12) and/or superior caval vein (3). 3 patients had a \ncombination of 2, 1 patient of 3 central venous stenoses. Overall primary \ntechnical (residual stenosis < 30%) and clinical (shunt function) success of \ninitial and re-angioplasty was 100%. Re-interventions (POBA n=32; PCBA \nn=20) due to re-stenosis were necessary in 15 (55.6%) patients. Kaplan-Meier \nanalysis revealed PCBA significantly superior to POBA. Median freedom from \nTLR after PCBA was 12 months vs. 5 months after POBA (p=0.03; Log-rank \n(Mantel-Cox), Gehan-Breslow-Wilcoxon test). Re-re-stenosis intervals were \nsignificantly prolonged by PCBA (mean 9.5 ±1.9 months) vs. POBA (mean \n5±4.9 months) (p=0.01; unpaired t-test). No minor/major procedure-associated \ncomplications occurred. \nConclusion: Paclitaxel-coated balloon-angioplasty of central-venous re-\nstenosis yields a significantly longer freedom from TLR in patients with \nhaemodialysis shunts and therefore should be the primary treatment approach.  \nB-0505 14:45  \nPaclitaxel-coated balloons vs. plain balloon angioplasty for the failing \nfistula: final 1-year results of the randomised controlled trial  \nP.M. Kitrou\n1, S. Spiliopoulos1, K. Katsanos2, M. Kyriakopoulou1, \nD. Karnabatidis1, D. Siablis1; 1Patras/GR, 2London/UK \n(panoskitrou@gmail.com)  \nPurpose: /o report the final 1-year results of a prospective randomised \ncontrolled trial investigating paclitaxel-coated balloon (PCB) vs. plain balloon \n(PB) angioplasty for the treatment of failing arterio-venous fistulae (AVF). \nMethods and Materials: From May 2011 to September 2012, 40 patients were \nrandomised to undergo either PCB dilation (Group PCB, n=20) or PBA (Group \nPB, n=20). Enrollment criteria included a clinical and angiographic diagnosis of \ndysfunctional AVF circuit due to at least one stenotic lesion. Regular \nangiographic follow-up was scheduled every 2 months. Study primary \nendpoints included technical success (defined as residual stenosis of the \ntreated lesion < 30% without any significant dissection) and primary patency of \nthe treated site (defined as angiographic visualisation of a patent lesion with \n< 50% restenosis and no need for any additional repeat procedure within the \npreviously treated lesion due to failing access). \nResults: Baseline variables were equally distributed among the two groups. \nTechnical success was 100% for both the groups. Interim calculation of the \nprimary endpoint outcome showed a significantly superior primary patency in \ngroup PCB compared to group PB at 6 months (65.0% vs. 30%, respectively; \np=0.04). \nConclusion: Six-month interim results show that PCB angioplasty could be a \nvalid solution in to our armamentarium for the treatment of failing AVF. Long-\nterm 1-year final data will be announced.  \n \n \n \n \n \n \nB-0506 14:54  \nSingle center prospective randomised study to evaluate treatment of \nsuperficial femoral artery chronic in-stent occlusion with combined laser \natherectomy and drug eluting balloon angioplasty in patients with critical \nlimb ischemia  \nC. Del Giudice, R. Gandini, S. Merolla, D. Morosetti, E. Pampana, \nG. Simonetti; Rome/IT (costantino.delgiudice@gmail.com)  \nPurpose: To compare efficacy and safety of laser debulking (LD) and drug \neluting balloon (DEB) angioplasty to treatment with DEB angioplasty alone in \npatients affected by critical limb ischemia (CLI) and superficial femoral artery \n(SFA) chronic stent occlusion. \nMethods and Materials:  From December 2009 to March 2011, 48 patients (of \n448 CLI patients)underwent endovascular treatment of a SFA chronic stent \nocclusion. The patients were randomly sub divided in two groups: LD combined \nwith DEB angioplasty was used in 24 patients (Group 1) and 24 patients were \ntreated with DEB angioplasty alone (Group 2). The patency rate at 12 months \nfollow-up was the primary endpoint. Secondary endpoints were target lesion \nrevascularisation (TLR) and clinical success at 12 months follow-up. \nResults: In Group 1, the patency rate was significantly higher than in Group 2 \nat 6 and 12 months follow-up (respectively 91.7% and 66.7% in group 1 and \n58.3% and 37.5% in group 2, p=0.01). TLR at 12 months follow-up was 16.7% \nin group 1 and 50% in group 2 (p=0.01). Two patients (8.3%) needed major \namputations in group 1 while 11 patients (45.8%) in group 2 at 12 months \nfollow-up (p=0.003). \nConclusion: The combined treatment with LD and DEB angioplasty is \ncorrelated with better outcomes in CLI patients with SFA stent occlusions.  \nB-0507 15:03  \nEvaluation of local thrombolysis for thrombosis of total implantable \nvenous access devices (port-systems)  \nA. Massmann, M. Wolska-Krawczyk, T. Probst, P. Minko, G.K. Schneider, \nA. Buecker; Homburg a.d. Saar/DE (Alexander.Massmann@uks.eu)  \nPurpose: Evaluation of local thrombolysis for thrombosis of total implantable \nvenous access devices (venous port-systems). \nMethods and Materials: 101 patients (15-81 years) with port-dysfunction were \nreferred for angiography. Thrombosis of the port-catheter was treated by local \nthrombolysis with injection of 3-5 mg rt-PA directly into the port system. Port \nfunction was re-evaluated by re-angiography the next working day. \nResults: Port-dysfunction was obvious due to  impossible blood aspiration in \n59 ports. Injection of saline solution was impossible or only with unusual high \npressure achievable in 41 ports. 3 patients reported local pain during injection. \nAngiography depicted port-catheter thrombosis in 46 ports. 41 patients agreed \nto a local thrombolysis treatment. Re-angiography on the next working day \n(time interval 16 hours-3 days) confirmed a successful procedure in 37 (90%) \npatients. 5 ports showed residual thrombosis but working port-function. Re-\nthrombosis occurred in 3 patients after 5 days (n=1) and 3 months (n=2). \nUnsuccessful thrombolysis was observed in 4 patients with extensive \nthrombosis extending into the subclavian and jugular veins. Complete \ndislocation or disruption with consec utive malfunction of the TIVAD was \ndetected in 15 (15%) patients. 4 TIVAD-catheters dislocated into the vena cava \nor right heart and were successfully retrieved. 17 mal-functioning ports showed \nmisplaced catheter-tips. 16 were corrected interventionally yielding complete \nrestored port function. No patient was referred for a second repositioning. \nConclusion: Port-catheter thrombosis related dysfunction can easily and \nsafely treated by local thrombolysis.  \nB-0508 15:12  \nIncidence and management of visceral artery aneurysms (VAA)  \nM.B. Pitton, E. Dappa, R. Kloeckner, S. Schotten, G.M. Wirth, A. Lollert, \nF. Jungmann, J. Doering, C. Dueber; \nMainz/DE (Michael.Pitton@unimedizin-mainz.de)  \nPurpose: Visceral artery aneurysms (VAA) are rare but imply an risk for acute \nrupture. We analysed the institutional data base for diagnosis and \nmanagement of VAA over a period of 10 years. \nMethods and Materials: 239 patients were identified suffering from VAA. VAA \nwere analysed with respect to location, size, true aneurysm or false aneurysms \nafter surgery/intervention, rupture status, management, and clinical follow-up. \nResults: VAA were located in splenic artery (n=81), celiac trunk (n=46), renal \nartery (n=42), hepatic artery (n=37), superior mesenteric artery (n=15), \ngastroduodenal artery (n=10) and others (8). Mean follow-up was 42.9 ±34.9 \nmonths. 181 of 239 patients were monitored conservatively. 58 cases were \ntreated with transarterial intervention (n=47, embolisation, stentgrafting, or \ncombinations) or surgery (n=11), 40 patients were diagnosed at rupture and \nwere treated on an emergency basis. There was no significant difference in \nsize between ruptured and non-ruptured VAA (15.2 ± 8.4 mm vs. \n16.3 ± 10.1 mm). The 30-day mortality in ruptured cases was 8.3% after S244  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\ninterventional treatment compared to 0% in elective cases. Conservatively \ntreated patients presented a 30-day mortality of 6.1%. \nConclusion: The clinical impact of VAA remains unclear. There was no \ndifference in size in ruptured and non-ruptured aneurysms. Interventional \ntreatment seems to offer a beneficial approach compared to surgery.  \nB-0509 15:21  \nSingle-center experience in endovascular treatment of visceral artery \naneurysms and pseudoaneurysms with Viabahn covered stent: technical \naspects, success rate, complications and MDCT follow-up  \nM. Orsi, M. Venturini, F. Morelli, M. Colombo, C. Sallemi, F. De Cobelli, \nM. Salvioni, S. Cappio, A. Del Maschio; Milan/IT (orsi.marcello@hsr.it)  \nPurpose: To report our single-center experience in endovascular treatment of \nvisceral artery aneurysms/pseudoaneurysms with Viabahn covered stent. \nMethods and Materials:  From 2005 to 2013, 13 patients were treated with 16 \nself-expandable covered stents (Viabahn, Gore; diameter from 5 to 8 mm; \nlength from 2.5 to 5 cm): 11 in the hepatic artery, 4 in the splenic artery, 1 in \nthe renal artery. 6/13 patients were trea ted for aneurysms (3 splenic, 2 hepatic, \n1 renal); 7/13 for post-surgical bleeding pseudoaneurysms (5 of the \ngastroduodenal artery, 1 of hepatic artery, 1 of the splenic artery). A \ntransfemoral approach was performed in 11/13, left-transaxillary in 2/13 due to \nthe unfavourable angle of the celiac trunk. Double antiplatelet therapy was \nadministered for 6 months after stent placement. A triphasic contrast-enhanced \nMDCT was performed before, 1 day and 6 months after the procedure. \nResults: All covered stents were properly placed in their targeted vessels. \nSuccessful treatment without complications was achieved in 10/13 patients. In \n3/13 patients, complications were recorded: 1 post-stenting stenosis of the \nproper hepatic artery, resolved with PTA; 1 stent occlusion in the common \nhepatic artery, without liver ischaemia because of the blood supply from the \ngastroduodenal artery; 1 minimal splenic infarction after stent placement in the \nsplenic artery without clinical consequences. At 6 months, MDCT showed stent \npatency in 12/13 cases. \nConclusion: Endovascular treatment of visceral aneurysms/pseudoaneurysms \nusing a very flexible, self-expandable, Viabahn covered stent represents an \neffective, less invasive, more conservati ve alternative to surgery/embolisation.  \n14:00 - 15:30 Board Room A  \nCardiac  \nSS 603b  \nCongenital heart disease and cardiac \nmasses  \nModerators:  \nJ. Glowacki; Zabrze/PL  \nM. Kantarci; Erzurum/TR  \nB-0510 14:00  \nRight ventricular myocardial fibrosis detection using cardiac MR in \nrepaired tetralogy of fallot: correlation between functional and clinical \nmarkers  \nN. Galea, V. Noce, V. Sorrentino, M. Francone, C. Catalano, I. Carbone; \nRome/IT (vinc.noce@hotmail.it)  \nPurpose: To assess correlations between right ventricular myocardial fibrosis, \ndetected by late gadolinium enhancement (LE) on cardiac magnetic resonance \n(CMR), bi-ventricular function and clinical data after surgical correction of \ntetralogy of fallot (rToF). \nMethods and Materials: Study population included a retrospective selection of \n15 patients with rToF undergone to a complete CMR assessment including: \ncineMR steady-state free precession (SSFP) sequences to assess bi-\nventricular volumes, myocardial mass and peak filling/ejection rates, T2 STIR \nsequences and T1-weighted inversion-recovery images after 0.1 mmol/kg Gd-\nBOPTA injection to detect right ventricular late enhancement (RVLE). A clinical \ndataset at the time of CMR scan was built up for each patient, including NYHA \nclass, exercise tolerance, history of arrhythmias and syncope. \nResults: 9/15 patients presented RVLE, localised at RV insertions points (7/9) \nand amongst RV trabeculations (2/9). On the basis of RVLE finding, we divided \nour cohort into positive and negative grou ps for statistical analysis (difference \nbetween means assessed with student's t test independent sample, correlation \nassessed with Spearman/Pearson analyses). We determined that RVLE \npresence correlates with reduction of RV ejection fraction (47.2 ±5.6%, \np < 0.001) and end-systolic volume index increases (57.3 ±7.2 ml/m2, \np < 0.001). Moreover, a negative correlation was found between RVLE \npresence and both NYHA class and exercise tolerance (mean exercise \nduration 778±47 min, p < 0.001). \nConclusion: Our study exposed a high prevalence of RVLE in rToF patients, \ndetermined by LGE CMR. RVLE presence was correlated to RV functional \ndecline and clinical deterioration. No correlation between RVLE and left \nventricular function parameters was showed.  \nB-0511 14:09  \nDiagnostic value of dual source CT angiography in congenital heart \ndiseases: comparison with transthoracic echocardiography and \nangiography  \nM.A. Karimi, F. Sedaghat, M. Motevalli, H. Pouraliakbar; Tehran/IR \n(mkarimidr@yahoo.com)  \nPurpose: Dual-source CT angiography (DSCTA) is a new imaging method \nwith high spatial and temporal resolutions that provides valuable information \nabout detailed structures of heart. The aim of this study was to determine \ndiagnostic value of DSCTA in cardiac diseases. \nMethods and Materials:  Parameters of diagnostic value (sensitivity, \nspecificity, positive predict ive value [PPV], negative predictive value [NPV] and \ndiagnostic accuracy) of DSCTA were determined in 36 patients with congenital \nheart diseases (median:8.5 month [neonate to 35 y]; 21 male) who underwent \nsurgery in Shahid Rajaei Hospital from September 2010 to March 2011, and \ncompared with that of angiography and transthoracic echocardiography (TTE). \nSurgery was gold standard. \nResults: Total 105 cardiac anomalies were diagnosed. Sensitivity, specificity, \nPPV, NPV and accuracy of DSCTA were 98.25%, 97.9%, 98.1%, 99.07%, and \n98.2%, respectively. These values were 95.04%, 98.7%, 97.8%, 98.1%, and \n98%, respectively, for angiography, and 93.5%, 96.2%, 94.4%, 96.3%, and \n95.4%, respectively, for TTE. There was no statistically significant difference \nbetween three methods. Only, one ASD and 2 PDA were missed in DSCTA. \nAngiography missed 2 ASD and 2 PDA, and TTE missed 7 ASD, one VSD, \nand 3 PDA. DSCTA also provided important findings (n=38) about intrathoracic \nor abdominal organs. \nConclusion: DSCTA has a diagnostic value similar to angiography for \ncongenital heart diseases and can obviate the need for invasive diagnostic \nmodalities. DSCTA also can provide important information about detailed \nanatomic structures of heart, vessels, lungs and intra-abdominal organs.  \nB-0512 14:18  \nThe relationship of location of patent foramen ovale with severity of \nstroke: a life-saving radiological approach  \nM.F. Erkoç\n1, Ö. Örsçelik1, B. Öztoprak1, A. Okur2, M. Kantarcı3, Y. Kızrak3; \n1Yüceyurt/TR, 2Yozgat/TR, 3Erzurum/TR (drerkoc@gmail.com)  \nPurpose: Patent foramen ovale (PFO), is a common developmental anomaly \nthat causes paradoxical embolus and may be found in approximately 25% of \nadults. In literature, PFO and stroke is well associated as PFO causes for up to \n40% of all ischaemic strokes. However, percutaneous closure of PFO for the \npatients with/without stroke is controversial. The aim of this study is to \ninvestigate the relationship of the location of PFO with severity of stroke and to \nhelp identify the patients who would benefit from percutaneous PFO closure \nbefore ischaemic stroke appears; which is vital. \nMethods and Materials:  17 patients with stroke and echocardiographically \nproven PFO were classified according to the severity of stroke by cranial MRI; \nand the locations of PFO were determined as superior and inferior based on an \nimaginary line that separates the interatrial septum into two equal parts by \ncardiac CT. Paired statistical analysis was applied. \nResults: 4 patients (47%) revealed mild, 5 patients (30%) severe and 8 \npatients (23%) moderate according to their severity of stroke. Based on the \nPFO locations, there were 13 (77%) patients with superiorly (group I), and 4 \npatients (23%) with inferiorly located PFO (group II). Statistically, there was a \nstrong correlation between the patients presenting with moderate and severe \nstroke with group.i. (p < 0.005). \nConclusion: Superiorly located PFO patients have a greater risk for stroke \nand may face different neurological problems in their rest of life, percutaneous \nclosure of superiorly located PFOs when detected will provide a life-saving \nprocess.  \nB-0513 14:27  \nTwo methods for quantification of cardiovascular shunts by cardiac \nmagnetic resonance (CMR) in patients with atrial septum defects (ASD)  \nE. Pershina, M.A. Glazkova, E. Mershina, V.E. Sinitsyn; Moscow/RU \n(pershina86@mail.ru)  \nPurpose: To compare velocity-encoded phase-contrast (VENC) MRI and \nvolumetric analysis of shot-axis imag es for quantification of cardiovascular \nshunts in patients with atrial septum defect (ASD). \nMethods and Materials:  31 patients (16/15-f/m, mean age 36, 7± 16, 7 years) \nwith ASD underwent 1, 5 CMR to determine the size and localisation defects, \nto quantify shunts between systemic (Q s) and pulmonary (Qp) circulation. 25 \nS245  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\npatients had ostium secundum defects (11 of them - small multiple defects), 5 \nsinus venosus and 1 ostium primum defect. A typical CMR protocol included \nlong- and short-axis cine steady-state free-precession images and VENC \nimages. VENC images acquired perpendicular to the ascending aorta and \nmain pulmonary artery for measuring Qs and Qp. Using volumetric analysis, \nshunt volume and shunt fraction were calculated as the difference between left \nventricle and right ventricle stroke volumes (SV). Semiautomatic \npostprocessing was used for calculating Qp:Qs with both methods. \nResults: The ratio Qp:Qs ranged from 1:1.1 to 1:4 (mean 2.1 ±0.96). Patients \nwith Qs:Qp > 1.5 were recommended for cardiac surgery consultation. \nCorrelation between Qp:Qs mesuared with VENC and SV difference was very \nstrong (p=0.99). In small left-to-right shunts (Qp:Qs < 1, 3), the cardiac \nchambers were not significantly enlarged and the pulmonary vasculature was \nusually normal. In patients with large (Qp:Qs > 2.0), right atrial and right \nventriculars volumes were increased and signs of pulmonary hypertension \nwere found. \nConclusion: Volumetric analysis of short-axis images could be an alternative \nto VENC method for quantification of cardiovascular shunts in patients with \nASD.  \nB-0514 14:36  \nRole of 256-MDCT in evaluation of image quality and radiation dose in \nprospective gating in congenital heart diseases in infants  \nA.K. Sharma; Delhi/IN (shokie10@hotmail.com)  \nPurpose: To evaluate image quality and radiation dose in prospectively ECG \ngated 256 Slice MDCT angiography in infants with congenital heart diseases. \nMethods and Materials:  From May 2011 to May 2013, 60 infants with \ncongenital heart disease referred for pre-operative or post-operative CT were \nincluded. All were scanned with 256 MDCT Somtom Definition Flash Siemens \nDual source Unit utilising a low dose protocol. \nResults: No serious reactions noted. A total 184 cardiac anomalies were \nconfirmed by surgery or heart catheteri sation.The sensitivity of MDCT for \ncardiac anomalies was 97.1%, specificity 98.4%, and accuracy 95.2%. The \nmean heart rate during scan was 126/min. Mean scan length was 115.3 mm. \nMean volume CT dose was 2.1mGY. Diagnostic quality images were obtained \nand viewed by two radiologists independently. \nConclusion: Low dose prospectively gated CT in infants with CHD is the ideal \nmodality with comprehensive 3D evaluation including coronary arteries with \nminimal mean volume CT dose.  \nB-0515 14:45  \nDelayed myocardial enhancement in pediatric idiopathic hypertrophic \ncardiomyopathy  \nN.H. Behairy, W. El Mozy; Cairo/EG (nohabehairy@gmail.com)  \nPurpose: To detect the presence of myocardial fibrosis in paediatric age group \nand whether there is a certain age of which fibrosis may be suspected. \nMethods and Materials:  We prospectively studied 20 patients diagnosed as \nidiopathic hypertrophic cardiomyopathy clinically and by echocardiography as \nwell as laboratory methods. Patients were between 1.5 yrs up to 16 years. All \npatients were subjected to MRI and echocardiography. MRI was performed on \n(ACHIEVA, 1.5 T Philips Medical Systems,Netherlands). Balanced FFE in 2, 4 \nchambers as well as short axis images were taken in 20 cardiac phases along \nwith delayed enhancement after 5-10 min with triple inversion recovery after \nperforming look locker to determine the best time of delay. Q flow was done to \ndetect the presence of obstruction at the aortic valve region. Images were \nanalysed for volumetric measurements, functional analysis and myocardial \ntissue characterisation. The presence, pattern and site of ventricular \nenhancement were studied. \nResults: Fifteen patients (75%) showed presence of patchy midwall \nmyocardial enhancement. 25% of patients did not show any enhancement. \nSome of the patients with evident myocardial enhancement were as small as \n1.5 years. Myocardial thickness ranged from 15 to 24 mm. Enhancement was \npresent in the area of most hypertrophy. Ejection fraction ranged from 55 to \n72%. \nConclusion: Myocardial fibrosis may be present in paediatric hypertrophic \ncardiomyopathy with no cut-off value for age.  \nB-0516 14:54  \nDetection and characterisation of myocardial fatty foci in patients \naffected by tuberous sclerosis complex using high-resolution computed \ntomography: a new diagnostic criteria?  \nS. Tresoldi, P. Magistrelli, G. Pompili, L. Rahali, G. Cornalba; Milan/IT \n(silvia.3soldi@gmail.com)  \nPurpose: To evaluate prevalence and characteristics of MFF in TSC patients \nundergoing HRCT. \nMethods and Materials: All consecutive TSC patients who underwent 64-slice \nHRCT (1.25x1.25 mm) for suspected lymphangioleiomyomatosis (LAM) \nbetween January 2010 and August 2013 were retrospectively selected. Image \nevaluation was performed (in double blind trial) by two radiologists with \ndifferent experience in cardiac imaging using both axial and multiplanar \nreformation (MPR) images even on cardiac axis (short axis, long axis and 4-\nchamber view) to detect MFF (well-circumscribed areas with homogeneous fat \nCT density within the myocardium). MFF presence, number, site, size and \nshape were evaluated. In doubtful cases (e.g. artefacts due to hearth \npulsation), the patient was considered free of foci. Information about other \norgans involvement (brain; kidneys; liver; lung) were obtained. Descriptive \nstatistics were used and correlation between MFF and other organs' \ninvolvement was estimated. \nResults: Study population resulted composed of 39 patients (35 females; \nmean age 34.5 years; range 18-52 years). MFF were identified in 51.3% \n(20/39) of patients 7 of whom (35%) had TSC multiorgan involvement. MFF \nwere more often linear and identified more frequently in the apical \ninterventricular septum; MFF size range was 8-50 mm. Other organ \ninvolvement was as follows: kidneys 84.6% (33/36) of patients; lung 79.4% \n(31/39); brain 66.6% (26/39), liver 46.1% (18/39). Only 2 patients with \nmultiorgan involvement had no MFF. \nConclusion: Prevalence of MFF in TSC patients is high and it is often \nassociated to other organ involvement  \nB-0517 15:03  \nIsolated left ventricular non-compaction: relationship between MRI \ncriteria for non-compaction and clinical events  \nK. Warin-Fresse, D. Marrest, L. Le gloan, C. Defrance, B. Delasalle, M. Caza, \nP. Guerin; Nantes/FR  \nPurpose: Isolated ventricular non-compaction (LVNC) is characterised by a \ncompacted epicardial band and a non-compacted endocardial layer. \nComplications are ventricular dysfunction, arrhythmias and thromboembolic \nevents. The aim of the study was to look for a potential relationship between \nMRI's non-compaction extension criteria and clinical events. \nMethods and Materials:  Between 2004 and 2013, 99 patients were included \nin a retrospective study reviewing MRI with LVNC. MRI diagnosis criteria for \nLVNC was the ratio of the thickness of non-compacted (NC) to compacted \nmyocardial layers superior to 2.3, in the diastolic phase. LV ejection fraction, \nvolumes, global LV mass, compacted and NC LV mass, number of NC \nsegments and non-compaction score (NCS) were measured. A LV remodelling \nindex (LVRI) defined as the ratio between LV compacted mass and LV end-\ndiastolic volume was calculated. \nResults: There were no statistical relationships between LVEF alteration and \nNCS (p=0.57) and the number of NC segments (p =0.97), between stroke \nincidence and NCS (p=0.22) and the number of NC segments (p=0.96) and \nbetween ventricular arrhythmias and NCS (p=0.59) and the number of NC \nsegments (p=0.59). There was a significant inverse relation between LVEF and \ncompacted mass (p < 0.0001) and between stroke and compacted mass (p = \n0.007), but not for ventricular arrhythmias (p = 0.95). There was no statistical \nrelationship between LVRI and LVEF, arrhythmias or stroke. \nConclusion: This study did not show any association between MRI NC \nextension criteria and clinical events, but showed a relationship between \ncompacted mass and LVEF dysfunction and stroke incidence.  \nB-0518 15:12  \nDifferences in CMR characteristics between pulmonary hypertension \nassociated to congenital heart disease and other precapillary pulmonary \narterial hypertension subgroups  \nS.-A. Mouratoglou\n1, A. Kallifatidis1, G. Giannakoulas1, V. Kamperidis1, \nI. Grapsa2, G. Pitsiou1, I. Stanopoulos1, S. Hadjimiltiades1, H. Karvounis1; \n1Thessaloniki/GR, 2London/GR (alexandros.kallifatidis@yahoo.gr)  \nPurpose: To compare CMR parameters between patients with pulmonary \narterial hypertension associated to congenital heart disease (CHD-PAH) with \nthose of patients classified in the rest of precapillary pulmonary arterial \nhypertension subgroups (pPAH). \nMethods and Materials:  All patients underwent cardiac magnetic resonance \n(CMR),(Siemens Avanto 1.5T) for the determination of right ventricular (RV) \nfunction and pressure overload and echocardiographic study for the \nassessment of tricuspid annular plane systo lic excursion (TAPSE) on the same \nday. \nResults: Our study included 6 patients with CHD-PAH (mean age \n40.3±13.9years) and 8 with pPAH (mean age 51.4 ±11.5years). Patients in both \nstudy groups retained mildly reduced but similar RV function, as expressed by \nTAPSE (1.7 ±0.2 cm in CHD-PAH and 1.8 ±0.3 cm in pPAH, p > 0.05) and RV \nejection fraction (46.8 ±10.9% in CHD-PAH and 48.2 ±11.6% in pPAH, p>  0.05), \nalthough CHD-PAH patients had higher RV diastolic pressure overload (as \nexpressed through RV eccentricity index in diastole: 2.3 ±0.3 and 1.7 ±0.2 \nrespectively, p=0.002). Pulmonary artery (PA) was more severely dilated in \nCHD-PAH than in pPAH [as expressed by PA diameter in systole (5.1 ±0.5 cm \nS246  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nand 4.2± 0.5 cm, p=0.01) and in diastole (4.9 ±0.5 cm and 4.0 ±0.5 cm, \np=0.009)]. \nConclusion: Although patients with CHD-PAH have more severely pressure \noverloaded right ventricle, they manage to retain similar RV function when \ncompared to pPAH patients. This may reflect the progressive RV adaptation to \nchronic increase of RV blood flow and pressure occurring before the \ndevelopment of elevated pulmonary vascular resistance and fixed PAH. PA \ndilatation is another compensatory mechanism in CHD-PAH patients and may \nexplain their greater risk of in situ thrombosis.  \nB-0519 15:21  \nIntracardiac thrombus and masses in patients with CAD: CMR versus \nTTE  \nW. Staab\n1, L. Bergau1, M. Dorenkamp2, S. Obenauer3, R. Hinojar4, J. Lotz1, \nC. Sohns1; 1Göttingen/DE, 2Berlin/DE, 3Düsseldorf/DE, 4London/UK \n(wieland.staab@med.uni-goettingen.de)  \nPurpose: Transthoracic echocardiography (TTE) is widely used for patients \nwith coronary artery disease (CAD) and suspected intracardiac mass. This \nstudy aimed to assess the current role of cardiac MRI (CMR) to differentiate \ncardiac masses from thrombus formation in comparison to TTE. \n \nMethods and Materials:  171 patients (89 male, aged 34-89 years, median \n60.8±10.7) with known CAD who had been referred to TTE for evaluation of \nknown or suspected intracardiac mass, underwent additional 1.5-Tesla CMR. \nTTE and CMR were independently evaluated for thrombus formation or \nintracardiac mass and related size, shape, signal characteristics and \nmorphology. \nResults: TTE depicted intracavitary thrombus formation in 40/171 patients \n(23.4%) and intracardiac mass in 12/171 patients (7.0%). All masses detected \nin TTE were correctly seen on CMR. However, CMR showed 15 subsequent \nthrombi and 3 additional intracardiac masses (p= 0.001) that were not detected \nin TTE. Patients with impaired systolic function (LVEF < 30%) showed \nmisleading results when referred to TTE (19 vs. 27 masses detected, p < 0.01). \nConclusion: TTE depicted intracavitary thrombus formation in 40/171 patients \n(23.4%) and intracardiac mass in 12/171 patients (7.0%). All masses detected \nin TTE were correctly seen on CMR. However, CMR showed 15 subsequent \nthrombi and 3 additional intracardiac masses (p= 0.001) that were not detected \nin TTE. Patients with impaired systolic function (LVEF < 30%) showed \nmisleading results when referred to TTE (19 vs. 27 masses detected, p < 0.01).  \nB-0520 15:30  \nThe application of dual source CT in complex congenital heart disease of \ntetralogy of Fallot  \nS. Ou, F. Long, S. Ou, K. Cai, B. Li, G. Qiao; Guangzhou/CN \n(oushanxing@sina.com)  \nPurpose: To investigate the clinical value and accuracy of DSCT in the \nassessment of patients with Tetralogy of Fallot (TOF). \nMethods and Materials:  70 patients suspected or known complex congenital \nheart disease of tetralogy of Fallot underwent DSCT. A combination of \nrestruction with images of end-systole, including maximum intensify projection, \nmulti-planar reconstruction, volume rendering, and so on. Seek the \ncardiovascular malformation according to the Van Praagh Segment analytical \nmethod. Two radiologists with 5 years expe rience in the field of cardiovascular \nimaging diagnosis assessed the imagi ng. The DSCT imaging diagnosis was \ncompared with echocardiography (ECHO) or operation results. Analyse the \naccuracy of DSCT and the ECHO results compared with surgery. Descriptive \nstatistics was used to compare efficacy. \nResults: 51 patients had surgery in all 70 patients. 255 places of malformation \nwere proved by operation, including 91 intracardiac malformations and 164 \nextracardiac malformation. \nThe diagnostic accuracy of intracardiac \nmalformations were 94.5% (86/91) and 97.8%(88/91) respectively by DSCT \nand ECHO. There were no significant differences between DSCT and \nechocardiography ( <2=1.051,P> 0.05). The diagnostic accuracy of \nextracardiac malformations were 97.8% (160/164) and 71.95% (118/164) \nrespectively by DSCT and ECHO. There were significant differences between \nDSCT and echocardiography ( <2=40.649, P < 0.01). For all the 255 places of \ncardiovascular malformation, the diagnostic accuracy of DSCT, \nechocardiography were 96.47% and 81.17%, respectively. There were \nsignificant differences between DSCT or echocardiography for assessment of \ncardiovascular malformation (P < 0.01). \nConclusion: DSCT is superior to echocardiography for quantitative \nassessment of extracardiac malformations in patients with complicate \ncongenital heart disease of TOF, which is significant for clinical surgery.  \n \n \n \n \n14:00 - 15:30 Room P  \nMolecular Imaging  \nSS 606  \nTranslational studies  \nModerators:  \nC.C. Cyran; Munich/DE  \nJ. Grimm; New York, NY/US  \nB-0521 14:00  \nDetection of early precursor lesions of pancreatic cancer using \nhyperpolarised [1-13C]pyruvate  \nE.C.P.M. Serrao\n1, M.I. Kettunen1, T.B. Rodrigues1, P. Dzien1, F.A. Gallagher1, \nD. Tuveson2, K. Brindle1; 1Cambridge/UK, 2New York, NY/US \n(carolinapms@yahoo.com)  \nPurpose: Pancreatic ductal adenocarcinoma (PDA) is the fourth leading cause \nof cancer-related deaths worldwide. Improvements in mortality may only be \npossible by early diagnosis of pancreatic precursor lesions (i.e. PanIN), \nhowever this is still challenging clinically due to the lack of sensitive and \nspecific biomarkers. The aim of this study was to identify metabolic signatures \nassociated with the different stages of PDA progression using 13C magnetic \nresonance spectroscopic imaging of hyperpolarised [1-13C]pyruvate in a \ngenetically engineered mouse model of pancreatic cancer. \nMethods and Materials:  LSL-KrasG12D/+-p48Cre/+(KC) mice with mPanIN, \nLSL-KrasG12/D+;LSL-Tpr53R172H/+;Pdx-1-Cre (KPC) mice with spontaneous \npancreatic cancer and control mice were used. KPC and C57BL/6 mice were \nused as models of established tumour and normal tissue, respectively. MRI \nwas performed at 7T using a 13C/1H volume coil/20-mm diameter 13C-surface \ncoil combination. A chemical shift image was acquired from a single 4-8 mm \naxial slice covering the pancreas 20 sec after injection of 0.3 mL (82 mM) \nhyperpolarised [1-13C]pyruvate. [1-13C]Pyruvate, [1-13C]lactate (lac) and [1-\n13C]alanine (ala) signal intensities in the pancreas were analysed. 1H-NMR \nspectra of tissue extracts were obtained at 14.1T (TR 12.5s) and Lac and Ala \nconcentrations calculated. Tissues were evaluated histologically. \nResults: Progressive reduction of [1-13C]Ala/[1-13C]Lac ratio was observed \nwith increasing disease progression. No changes were observed in control \nmice.1H-NMR spectra of tissue extracts revealed the same Ala/Lac signature. \nConclusion: [1-13C]Pyruvate metabolism and the ratio of the subsequently \nformed [1-13C]Ala and [1-13C]Lac may form useful probes for detecting and \nfollowing progression of panIN lesions, before any mass-forming lesion \n(tumour) can be detected by conventional imaging. This may offer an improved \ndiagnostic tool in high-risk populations.  \nAuthor Disclosures: \nE.C.P.M. Serrao: Research/Grant Support; General Electrics. M.I. Kettunen: \nResearch/Grant Support; General Electrics. T.B. Rodrigues: Research/Grant \nSupport; General Electrics. P. Dzien: Research/Grant Support; General \nElectrics. F.A. Gallagher: Research/Grant Support; General Electrics. D. \nTuveson: None. K.M. Brindle: Research/Grant Support; General Electrics. \nB-0522 14:09  \nEvaluation of anti-angiogenic therapies using molecular MRI and DCE-US \nin kidney tumour xenograft  \nI. Leguerney1, L. De Rochefort2, M. Poirier-Quinot2, S. Robin1, \nS. Pitre-Champagnat1, X. Violas3, P. Robert3, N. Lassau1; 1Villejuif/FR, \n2Orsay/FR, 3Roissy/FR (ingrid.leguerney@gustaveroussy.fr)  \nPurpose: To study the interest of molecular MRI-targeted ':23 compared to \nDCE-US and to evaluate several anti-angiogenic drugs in xenografted kidney \ncancer. \nMethods and Materials:  24 mice were xenografted (3.106 cells A498). We \nperformed imaging evaluations in 4 groups, 1 control and 3 treated with \nantiangiogenic drugs: monoclonal anti-body (bevacizumab), thyrosine kinase \ninhibitor (sunitinib) and m-Tor inhibitor (everolimus). MR acquisitions were \nperformed on a 1.5 T Achieva system (Philips), using a conventional surface \ncoil. Susceptibility MRI was done after injection of an USPIO-RGD-based \nnanoemulsion binding ':23 (P04000 Guerbet). DCE-US was performed with \nToshiba Aplio XV using high-frequency probe and microbubbles (Sonovue, \nBracco). Molecular MRI and DCE-US were performed at the same days: \nbaseline and D3. We evaluated R2* in the tumour 1 hour after P04000 with \nMRI and blood volume using AUC for DCE-US. \n \nS247  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nResults: Tumor size wassignificantly differ ent between control and treated \ngroups at D3 ( p=0.0099). AUC calculated with DCE-US at D3 was significantly \nlowest for bevacizumab group ( p=0.008) and not significant for the two other \ntreatments. R2* quantification at D3, 1 hour after P04000 injection, is reduced \nfrom 23.1±4.6 s-1 in the control group to 7.9 ±4.8 s-1 (p < 0.007) for everolimus \n13.5±7.9 s-1 (p < 0.047) for bevacizumab and not significant for sunitinib. \nConclusion: Molecular imaging with ':2 3-targeting contrast agent is \ncomplementary or even more sensitive than blood volume determination by \nDCE US to detect effects of antiangiogenic drugs with different mechanism of \naction.  \nAuthor Disclosures: \nX. Violas: Employee; Guerbet. P. Robert: Employee; Guerbet.  \nB-0523 14:18  \nOptimisation of combination of peptide receptor radionuclide therapy \n(PRRT) and temozolomide therapy using SPECT/CT and MRI in mice  \nS.M. Bison, J.C. Haeck, S.J. Koelewijn, M. Melis, M.R. Bernsen, M. de Jong; \nRotterdam/NL (s.bison@erasmusmc.nl)  \nAim: \nTreatment of patients with somatostatin receptor (SSTR)-overexpressing \nneuroendocrine tumours (NET) with the SST-analogue Lutetium-177-labelled \noctreotate (PRRT) or the chemotherapeutic agent temozolomide (TMZ) is \nsuccessfully being applied. Their combination might result in additive effects. \nUsing MRI and SPECT/CT we studied tumour characteristics and therapeutic \nresponses after different administration schemes in a murine tumour model in \norder to identify the optimal treatment schedule for PRRT plus TMZ. \nMethods and Materials: \nWe performed molecular imaging studies in mice bearing SSTR-expressing \nH69 tumours after single i.v. administration of 30 MBq \n177Lu-octreotate or TMZ \n(oral 50 mg/kg daily for 14d). Weekly tumour perfusion was evaluated by DCE-\nMRI, whereas tumour uptake of \n111In-octreotide was quantified using \nSPECT/CT until d40. Based on these results, seven different 177Lu-octreotate \nand TMZ treatment schemes were evaluated, varying the order and time \ninterval of the two therapies besides single treatment. \nResults: \nPRRT or TMZ resulted in reduced tumour size, accompanied by significant \nchanges in MRI characteristics such as intrinsic T2, T2* values and enhanced \ntumour perfusion. Moreover, TMZ treatment also resulted in increasing uptake \nof \n111In-octreotide until d15. In the subsequent therapy study 90% of animals \nreceiving PRRT at d15 after TMZ treatment showed complete response; \nindeed the best anti-tumour results compared to single and other combination \ntherapies. \nConclusions \nMolecular imaging studies indicated that PRRT after TMZ treatment could \nachieve optimal therapeutic effect because of enhanced tumour uptake of \nradioactivity, which was confirmed in the therapy study. Therefore TMZ \nadministration prior to PRRT might increase tumour responses in NET patients \nas well.  \nB-0524 14:27  \nA multimodal quantitative molecular imaging protocol for kidney tumor \nmouse model characterisation using targeted contrast agents  \nM. Poirier-Quinot\n1, L. de Rochefort1, I. Leguerney2, S. Robin2, \nS. Pitre-Champagnat1, X. Violas3, P. Robert3, N. Lassau2; 1Orsay/FR, \n2Villejuif/FR, 3Roissy-Charles-de-Gaulle/FR (marie.poirier-quinot@u-psud.fr)  \nPurpose: Comparison of two molecular imaging techniques (US and MRI) \nusing targeted ':23 contrast agents in a xenograft tumor model. \nMethods and Materials:  Dynamic contrast-enhanced DCE-US and dynamic \nsusceptibility contrast DSC-MRI with ':23-targeted contrast-agents (CA) were \napplied. Mice were xenografted with a human kidney tumor: cells (3.106 cells \nA498) were injected subcutaneously to 13 nude mice. At day 20-22 after \ninjection, mice were anesthetised (isoflurane+O2) and imaged. MR and US \ntargeted and non-targeted CA were injected at 2 days intervals. Apparent \nDiffusion Coefficient (ADC) and DCS-MR acquisitions were done at 1.5 T \n(Philips Achieva, micro23 coil). DSC were done using a USPIO-based \nnanoemulsion targeted with RGD binding ':23, as well as a control \nnanoemulsion (Guerbet). Molecular US acqui sitions were performed on a small \nanimal dedicated system (Visualsonics VEVO-2100, 20 MHz probe MS-250), \nusing MicroMarker\nTM ':23-targeted and control (IgG) \u0001bubbles. Data were co-\nlocalised, ROIs were drawn for analysis of: tumor size, ADC, contrast \nenhancement and relaxivity R2* quantification. \nResults: US and MRI tumor sizes correlated well, R=0.99 (p < 0.001 Pearson \ntest). ADC values and US signal enhancement on hypo- and hyper-\nvascularised area correlated with R=0.73 (p=0.006 Pearson test). Targeted vs \nnon-targeted injections gave significantly different 1) contrast modifications for \nDCE-US (p=0.0051, paired student's t-test) and 2) R2* modifications for DSC-\nMRI (p=0.0286, Mann-Whitney test). \n \nConclusion: Multimodal evaluation of targeted CA and various imaged-derived \nbiomarkers for preclinical oncology may be used to follow-up treatment \nresponse. The use of clinical imaging set-up here could allow the fast transfer \nof this methodology into the clinics.  \nB-0525 14:36  \nMR imaging and targeting of a specific alveolar macrophage \nsubpopulation in COPD animal model using antibody conjugated \nmagnetic nanoparticles  \nA. Al Faraj, A. Sultana Shaik, B. Al Sayed, R. Halwani; Riyadh/SA \n(aalfaraj@ksu.edu.sa)  \nPurpose: MR Imaging of macrophages offers a promising noninvasive \napproach for better assessment of the pathophysiological impairments in \nCOPD. Inside the body, different environmental conditions will orient \nmacrophages to have either proinflammatory-M1 or immunomodulator-M2 \nprofile. The purpose of this study was to characterise the in-vivo effect of \nmagnetic nanoparticles (MNP) intrapulmonary administration on macrophages \npolarization in COPD and to specifically target and monitor one subpopulation \nusing MRI. \nMethods and Materials:  C O P D  m i c e  w e r e  e x p o s e d  t o  P E G y l a t e d  d e x t r a n -\ncoated MNP. Surface membrane receptor expression, iNOS vs Arginase1 \nproduction and gene expression profile were performed to have an in-depth \ncharacterisation of macrophages polarization. CD86- or CD206-antibodies \nwere then conjugated to maleimide MNP to specifically target and image either \nM1 or M2 macrophages using ultra-short echo time (UTE) sequence on a 4.7T \nmagnet. The polarization profile of antibody-MNP targeted subpopulations was \nfinally assessed using immunohistochemistry and flow cytometer. \nResults: While a continuum balance in macrophages subpopulations was \nidentified during COPD, MNP intrapulm onary administration did not affect their \npolarization profile. M1 and M2 macrophages were successfully targeted using \nCD86- and CD206-conjugated MNP respectively. MR imaging using UTE \nsequence allowed successful detection  of hyper-intensity regions \nhomogenously distributed in COPD lung using TE=1 ms and co-localisation of  \neither CD86- or CD206-conjugated MNP targeted to macrophages \nsubpopulations as hypo-intensity void signal due to macrophages aggregates \nusing TE=0.4 ms. \nConclusion: Coupling of MNP with a specific antibody targeted to a particular \nmacrophages subpopulation could offer a promising strategy for an early and \nbetter diagnosis of pulmonary inflammatory diseases using noninvasive MRI.  \nB-0526 14:45  \nSpatially resolved ex vivo quantification of a gadolinium-containing MR \nagent by matrix-assisted laser desorption ionization imaging: correlation \nto in vivo MRI  \nM. Wildgruber\n1, M. Aichler2, K. Huber2, K. Kosanke1, E.J. Rummeny1, \nA.K. Walch2; 1Munich/DE, 2Oberschleissheim/DE (moritz.wildgruber@tum.de)  \nPurpose: To evaluate MALDI imaging for spatially resolved ex vivo \nquantification of a gadolinium-based magnetic resonance agent in correlation \nto in vivo magnetic resonance imaging. \nMethods and Materials:  In vivo deposition of a Gadofluorine M was \ninvestigated in a mouse model of myocardial infarction. Mice were investigated \nby in vivo MRI at 7T at 6h, 24h and 48h after injection of 0.2 mmol/kg \nGadofluorine M. Delayed enhancement was detected in the infarct scar using a \nconventional FLASH technique and quanti fied by calculating signal- and \ncontrast-to-noise ratios. In addition, T1 mapping studies were performed using \na snapshot technique. Animals were killed after each time point and hearts \nwere prepared for quantitative assessment by MALDI imaging. \nResults: Delayed enhancement imaging revealed signal enhancement in the \nmyocardial scar beginning at 6h after Gadofluorine M injection with peak \nenhancement at 24h hours and residual enhancement at 48h post injection. \nContrast-to-noise ratios were highest at 24h post injection due to high agent \naccumulation in the infarct and low signal from the blood. T1 values in the \ninfarct were shortest at 6h and steadily increased to 24h and 48h post \ninjection. MALDI Imaging was able to corroborate the in vivo imaging results \nand enabled in situ quantification of the in vivo applied Gadolfuorine M with \nhigh-spatial resolution. \nConclusion: MALDI Imaging is able to provide a mass-specrometry-based \nquantification of gadolinium-containing cont rast agents in situ with high-spatial \nresolution. The results of MALDI Imaging correlate with in vivo MRI. For the \nfirst time, quantitative ex vivo validation of in vivo contrast agent distribution is \npossible.  \n \n \n \n \n \n \nS248  \n\n \n \nBA C D E F G \nFriday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0527 14:54  \nOptoacoustic imaging and staging of rheumatoid arthritis  \nC. von Schacky1, N. Beziere1, Y. Kosanke1, M. Kimm1, M. Aichler2, \nE.J. Rummeny1, V. Ntziachristos1, R. Meier1; 1Munich/DE, \n2Neuherberg/DE (c.schacky@tum.de)  \nPurpose: The purpose of our study was to evaluate multispectral optoacoustic \ntomography (MSOT) in a murine model to visualise the extent of the \ninflammation in vivo through a L- and P-selectin targeting contrast agent. \nMethods and Materials:  Collagen-induced arthritis mice were used as a \nrheumatoid arthritis model of the limb. Optoacoustic imaging was performed \nusing a L- and P-selectin targeting contrast agent (dPGS-NIR provided by \nMivenion, Germany) to increase contrast of the arthritic joint, and signal \nintensity ratios between healthy and arthritic legs were calculated. Contrast-\nenhanced MRI imaging as well as clinical observation, lymphocyte and \ngranulocyte count and histology served as references. \nResults: MSOT using an inflammation targeting contrast agent allowed for \naccurate spatial diagnosis of inflammation in the mouse joints and for \nsignificant differentiation of inflamed to healthy joints (P = 0.023). The arthritis \nfindings on the MSOT images were c onfirmed by clinical observation, blood \nanalysis, contrast-enhanced MRI and ex vivo histology. \nConclusion: The combination of inflammation targeting contrast agent and \noptoacoustic tomographic imaging presents a reliable and accessible method \nto assess rheumatoid arthritis in respect to diagnosis and staging. Considering \nthe current development of the imaging technology, it is to be expected that \nthese approaches will be translated into clinical application as a fast and cheap \nway for imaging of rheumatoid arthritis.  \nAuthor Disclosures: \nV. Ntziachristos: Shareholder; Ithera Medical GmbH.  \nB-0528 15:03  \nAu@Fe3O4 Janus particles as an innovative contrast agent for future \nmulti-modal imaging  \nL. Haslauer1, P. Ernst1, I. Schick2, O. Köhler2, I. Hilger1, W. Tremel2; 1Jena/DE, \n2Mainz/DE (Lisa.Haslauer@med.uni-jena.de)  \nPurpose: Based on their magnetic and op tical properties, asymmetric Janus \nparticles (JPs) display high versatility as multi-modal imaging tools or as drug \ntarget delivery systems. Due to poor data available on their impact on \nbiological systems, we investi gated newly developed Au@Fe 3O4 JPs with \nvarying position of amino groups on cells in culture. \nMethods and Materials:  JPs consist of gold at a silica-PEG-FITC coated iron \noxide domain with thiole-groups attached to the gold part. We investigated \nbiocompatibility via ATPLite, ROS, H2 A.X and comet assay and uptake by \nmicroscopy on endothelial cells and monocytes. \nResults: Au@Fe\n3O4 JPs mainly exhibit a better biocompatibility up to 50 \u0001g/ml \nFe (II)/(III) (85.35% viability, 72 h) compared to their spherical counterparts. \nJPs with NH 2-functionalization decreased viability to 10.6%. Fe 3O4 \nnanoparticles induced a high release of ROS compared to Au@Fe 3O4 \n(189.23 % vs. 18.67%). 60%-70% of the JPs were internalised independently \nfrom the position of amino groups at the JP domains. JP associated DNA \ndamage (10% higher vs. untreated cells) and a high amount of phosphorylated \nhistone H2 A.X (fluorescence intensity (treated/untreated): 42996 vs. 31587) \nwas independent from the effects on the cellular ATP levels (96% vs. control). \nConclusion: JPs offer a better biocompatibility compared to their spherical \ncounterparts due to antioxidative effects of the gold domain. In the view of \napplications in vivo,  Au@Fe\n3O4 particles would be preferred towards the \nAu@MnO variants because of their lower impact on cell metabolism. \nCombining good biocompatibility and the known imaging properties, JPs are \nvery attractive for future biomedical applications.  \nB-0529 15:12  \n\"To serve and protect\" - enzyme inhibitors as radiopeptide escorts \npromote tumour targeting  \nB.A. Nock1, T. Maina-Nock1, E.P. Krenning2, M. de Jong2; 1Athens/GR, \n2Rotterdam/NL (m.hendriks-dejong@erasmusmc.nl)  \nPurpose: Radiopeptide drugs like radiolabelled octreotide analogues are \nsuccessfully being applied for tumour visualisation and treatment. However, \ntranslation of this paradigm to other r adiopeptide ligands has been severely \nhampered by their often poor metabolic stability. We hypothesised a novel \napplication - co-injection of a single en zyme inhibitor - to improve peptide \nbioavailability and hence tumour uptake in vivo. We co-injected radiopeptides \nand phosphoramidon (PA), a potent (IC\n50 34 nM) and reversible competitive \nneutral endopeptidase (NEP)-inhibitor, to explore our hypothesis. \nMethods and Materials: Co-injection of PA (0.3 mg) with 111In-labeled \nsomatostatin, gastrin and bombesin radiopeptides was tested in different \nmouse models (healthy mice as well as tumour-bearing SCID and nude mice).  \nAt 4 and 24 h post-injection, animal SPECT/CT imaging was performed \nfollowed by biodistribution measurements. \nResults: We could provoke a remarkable and very significant rise (up to 40 \ntimes the control values) in the percentage of circulating intact 111In-labelled \nsomatostatin, gastrin and bombesin radiopeptides in healthy mice after PA co-\ninjection. Most importantly, this strategy resulted in a spectacular increase of \nradiolabel accumulation (up to 14 times the control values) in different types of \ntumours xenografted in the mice. The improved tumour uptake could be clearly \nvisualised by SPECT/CT as well. \nConclusion: Our findings open exciting new op portunities for the application of \nbiodegradable peptide-drugs of either natural or synthetic origin as well as for \nthe rationale design of in vivo stable analogues. They also provide a versatile \ntool for elucidating enzyme-peptide interactions.  \nB-0530 15:21  \nCamelid reporter gene imaging: a generic method for in vivo cell tracking \nof fluorescent/luminescent cells  \nL.R.Y. Goethals\n1, G.-J. Allemeersch1, T.J. Bos2, J. de Mey1, T. Lahoutte1; \n1Jette/BE, 2La Jolla, CA/US (Lode.Goethals@vub.ac.be)  \nPurpose: To combine the sensitivity of bioluminescent imaging (BLI) with the \n3D and quantitative properties of SPECT/micro-CT, we generated cell lines \nexpressing a Yellow-Fluorescent-Protein and Gaussia Luciferase fusion protein \n(YFP/GLuc). For in vivo SPECT detection of this YFP/GLuc, a nanobody, \nbinding yellow and green fluorescent proteins (anti-YFP-Nb), was labelled with \n99mTc. \nMethods and Materials:  10E5 HEK 293 T-cells were transduced with \nYFP/GLuc containing vector: both membrane-targeted (MT-YFP/GLuc) and \nnon-targeted (YFP/GLuc) fusion proteins were developed. These were \ncompared against a cell line expressing Green-Fluorescent-Firefly Luciferase \n(GFP/Fluc) and cells expressing Red Fluorescent Protein in combination with a \nGaussia Luciferase (Red/GLuc). Transduction efficiencies were scored by \nfluorescence microscopy; cells were enriched by FACS. Luciferase \nfunctionality was tested in vitro by BLI. Subsequently, cells were transplanted \nsubcutaneously in athymic mice (MT-YFP/GLuc: n=4, YFP/GLuc: n=6, \nGFP/Fluc: n=6, Red/GLuc: n=4). After transplantation, in vivo BLI was \nperformed. Labelling efficiency of anti-YFP-Nb was measured using ITLC. One \nweek after transplanation, 99mTc labelled anti-YFP-Nb was injected \nintravenously and SPECT/micro-CT was performed. \nResults: Cells containing MT-YFP/GLuc were positive on fluorescent \nmicroscopy, with fluorescent signal confined to the cell membrane. Transduced \ncells were assayed by BLI and showed a significantly higher light output both in \nvitro and in vivo. Anti-YFP-Nb labelling efficiency was 98% and SPECT/Micro-\nCT demonstrated higher transplant to muscle ratio for both the MT-YFP/GLuc \nand YFP/GLuc groups, compared with the GFP/FLuc and Red/GLuc group. \nConclusion: This study provides a proof-of-principle for a nanobody-based cell \ntracking method, using a YFP/Gluc fusion protein and anti-YFP-Nb.  \n \n \nS249  \n\n \n \nBA C D E F G \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n \n \n\u0010\u0012\u001d\u001e\u001b\u0014\u0012\u001f\u0002\u0001\u000f\u0012\u001b\u0013\u0017\u0001\f\u0001\nS250  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n10:30 - 12:00 Room C  \nAbdominal Viscera  \nSS 901a  \nLiver tumours: CT and MRI  \nModerators:  \nD.M. Lambregts; Maastricht/NL  \nN.C. Tarhan; Ankara/TR  \nB-0531 10:30  \nHepatocellular carcinoma (HCC) is more advanced at diagnosis in HIV-\nHCV (human immunodeficiency virus-hepatitis C virus) co-infected than \nin HCV mono-infected cirrhotic patients  \nM. Lewin\n1, M. Gelu-Simeon1, R. Sobesky1, M. Ostos1, E. Teicher2, L. Meyer2, \nO. Seror3, J.-C. Trinchet3, J.-C. Duclos-Vallée1; 1Villejuif/FR, \n2Le Kremlin-Bicêtre/FR, 3Bondy/FR (maite.lewin@pbr.aphp.fr)  \nPurpose: To characterise the imaging of HCC in HIV-HCV co-infected cirrhotic \npatients compared to mono-infected HCV cirrhotic patients. \nMethods and Materials:  HCCs from a multi-centric cohort of 35 HIV-HCV \ncirrhotic patients (32 males, median age  50 years old [43-65], median CD4 \ncount: 345 cells/mm 3 [24-1121], median duration from cirrhosis to HCC \ndiagnosis: 4.5 years) and from a control group of 35 HCV cirrhotic patients (29 \nmales, median age 56 years old [41-83]) were retrospectively included. CT or \nMRI image analysis was focused on the detection of nodular or infiltrative \nforms with evaluating the number and size of the nodules, evidence for \nvascular invasion and signs of portal hypertension. Fisher and Wilcoxon tests \nwere used for statistical analysis. \nResults: An infiltrative form was found in 8/35 HIV-HCV versus 0/35 in HCV \npatients (22.9% and 0%, respectively, p=0.002). Other HCCs were nodular in \nnature. A single nodule was found in 20/35 HIV-HCV (57%) and in 19/35 HCV \npatients (54%). The largest nodules had a median diameter of 25 mm [12-130] \nin HIV-HCV versus 21 mm [13-90] in HCV patients. Tumour portal thrombosis \nwas found in 10/35 HIV-HCV (including 5 infiltrative form) versus 0/35 in HCV \npatients (28.5% and 0%, respectively, p=0.028). Portal hypertension signs \nwere seen in 29/35 (83%) HIV-HCV patients and in 22/35 (63%) HCV patients. \nConclusion: Compared to HCV mono-infected reference patients, HCC in \nHIV-HCV co-infected patients revealed to be at a more advanced stage at \ndiagnosis with a significantly higher occurrence of infiltrative form and of \ntumour portal thrombosis.  \nB-0533 10:39  \nPreoperative T-Staging of gallbladder carcinoma using gadoxetic acid-\nenhanced MR imaging: emphasis on usefulness of the hepatobiliary \nphase  \nE. Oh, J. Hwang, Y. Kim, S. Hong; Seoul/KR (sophiaoes@naver.com)  \nPurpose: To evaluate diagnostic performance of gadoxetic acid-enhanced MR \nimaging with an emphasis on the usefulness of hepatobiliary phase (HBP) in \nthe preoperative T-staging of gallbladder carcinoma. \nMethods and Materials:  Sixty-six patients with surgically confirmed \ngallbladder carcinoma underwent MR imaging. Two radiologists independently \nreviewed two sets of gadoxetic acid-enhanced MR imaging without HBP and \nwith HBP. Local tumour spread was evaluated according to the T-staging, and \nthe results were compared with pathologic findings. The diagnostic \nperformance of two image sets to differentiate each T-stage was compared. \nResults: The sensitivities of MR imaging with HBP to differentiate T1 versus \u0003 \nT2 lesions, \u0002 T2 versus \u0003 T3 lesions, and \u0002 T3 versus T4 lesions were 96.3%, \n85.7%, and 100% for observer 1, and 92.6%, 95.2%, and 100% for observer 2, \nrespectively (P < 0.0001). By adding HBP, the sensitivities to differentiate \u0002 T2 \nversus \u0003 T3 lesions were increased from 66.7% to 85.7% for observer 1 and \nfrom 81.0% to 95.2% for observer 2, although there was no significant \ndifference (P > 0.05). The overall accuracies for T-staging were increased from \n80.3% to 86.4% for observer 1, a statistically significant degree (P = 0.046), \nand from 83.8% to 87.9% for observer 2 (P > 0.05). The k value for the two \nobservers indicated excellent agreement. \nConclusion: Gadoxetic acid-enhanced MR imaging provided acceptable \ndiagnostic performance for the preoperative T-staging of gallbladder \ncarcinoma. Addition of HBP aid in the detection of liver invasion.  \n \n \n \n \n \n \n \nB-0534 10:48  \nThe prevalence of potentially serious incidental findings on abdominal \nmagnetic resonance imaging: a systematic review  \nL.M. Gibson, L. Paul, C.L.M. Sudlow; Edinburgh/UK (lornagibson1@nhs.net)  \nPurpose: To perform a systematic review to estimate the prevalence and \ntypes of incidental findings on abdominal magnetic resonance (MR) imaging to \ninform the design of the UK Biobank multi-modal imaging study of 100,000 \nmiddle-aged participants.  \nMethods and Materials:  We searched authors' files, Medline and Embase for \nstudies published in any language by June 2013 which reported the prevalence \nof incidental findings on abdominal MR in adult patients or apparently healthy \nvolunteers. We defined serious incidental findings as those likely to threaten \nlifespan, quality of life or major body functions. One reviewer selected studies \nfor inclusion and a second independently checked 10% of the references. We \nextracted data on incidental findings, participant characteristics and imaging \nvariables \nResults: We included 11 studies of 85,322 participants (mean age 51 years, \n42% female). The largest (n=79,121 patients) only assessed incidental \nabdominal aortic aneurysms (0.94% (95% confidence interval [CI] 0.8-1.1%). \nOf the remaining 6,201 participants, 3,959 had incidental findings which were \npotentially serious in 413 (6.7%, 95% CI 6.1-7.3%), including 104 suspected \nmalignancies. The most frequent non-malignant serious findings were \npancreatic cysts (n=154), ascites (n=76) and pleural effusion (n=21). \nPotentially serious incidental findings were detected more frequently in studies \nwhich used contrast compared to non-contrast imaging (23% vs 2%). One \nstudy (n=132) used a 3 T scanner, and the remainder used 1.5 T scanners. \nConclusion: Potentially serious incidental findings are common on abdominal \nMR and will often require further investigations. This should be discussed with \nresearch participants and patients when seeking informed consent.  \nAuthor Disclosures: \nL.M. Gibson: Research/Grant Support; unding from UK Biobank to attend \neducational meetings. C.L.M. Sudlow: Other; UK Biobank Chief Scientist. \nB-0535 10:57  \nQualitative analysis of small (\u00012 cm) regenerative nodules, dysplastic \nnodules and well-differentiated HCCs with gadoxetic acid MRI  \nM. Di Martino1, R. Di Miscio1, C.V. Lombardo1, L. Saba2, C. Catalano1; \n1Rome/IT, 2Cagliari/IT (dimase81_6@hotmail.com)  \nPurpose: To evaluate radiological findi ngs and diagnostic accuracy of \ngadoxetic acid magnetic resonance imaging (MRI) in the evaluation of small \n(\u00022 cm) regenerative nodules (RN), dysplastic nodules (DN) and well-\ndifferentiated hepatocellular carcinomas (HCCs). \nMethods and Materials:  Sixty-two cirrhotic patients, with 107 focal liver \nlesions were prospectively recruited. MR examinations were performed with a \n3 T magnet (Discovery MR750; General Eletric Systems). The MRI study \nprotocol included T1-weighted and T2-weighted pre-contrast sequences and \n3D-spoiled gradient-echo T1-weighted post-contrast sequences Gd-EOB-\nDTPA-enhanced obtained during the arterial, portal-venous and equilibrium \nphases \u000425 s, 70 s 180 s and after 20 m. All lesions (33 RN, 29 DN and 45 \nHCCs) were pathologically confirmed. One radiologist not involved in the \ndatasets analysis reported the signal intensity characteristics of each lesion. \nTwo radiologists blinded to clinical and pathological information evaluate \nradiological dataset images. Sensitivity, specificity and diagnostic accuracy \nwere considered for statistical analysis. \nResults: Regenerative nodules usually show enhancement during the arterial \nphase without wash-out sign during portal-venous and delayed phase. \nDysplastic nodules tend to do not show enhancement during the arterial phase \nand present wash-out on delayed phase. Well-differentiated HCCs very often \nshow typical vascular pattern (wash-in and wash-out) and low-signal intensity \nduring the hepatobiliary phase. According to the AASLD radiological diagnosis \nthe mean sensitivity, specificity and di agnostic accuracy in the diagnosis of \nHCC were, respectively (76.4%, 80%, 0.84). \nConclusion: Gadoxetic acid MR imaging is a reliable tool in the \ncharacterisation of well-differentiated HCC from dysplastic and regenerative \nnodules.  \n \n \nS251  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0536 11:06  \nComparison of PET fused with MR, PET/CT and MR alone in \ncharacterising hepatic lesions  \nE.B. Uglow, A. Parsai, Y. Bouchareb, T. Szyszko; London/UK \n(elizabethuglow906@hotmail.com)  \nPurpose: To compare PET fused with MR (fused-PET/MR), PET/CT and MR \nwith gadolinium ± diffusion weighting for detecting and characterising hepatic \nlesions. \nMethods and Materials: This is a retrospective review of 36 hepatic lesions in \n20 patients (mean age 58 years ±14 yrs). All patients had both a PET/CT and \nMR scan. The mean time between scans was 42 days ± 30 days. PET/CT and \nMR scans were fused using the HERMES® software and reviewed by 2 \nreaders, who used a scale of 1-5 to characterise lesions as benign (1), \nmalignant (5) or indeterminate (3). The final diagnosis was determined by \nhistopathology or follow-up imaging. PET/CT and MR alone were later \nreviewed independently to avoid bias. \nResults: 36 lesions were detected using fused-PET/MR and MR alone. 28/36 \nwere detected with PET/CT alone. 26/36 were benign lesions and 10/36 were \nmetastatic hepatic lesions. All lesions were correctly characterised as benign \nor malignant by PET/ MR. 31/36 lesions were correctly characterised by MR \nalone. All 28 lesions detected by PET/CT alone, were correctly characterised. \n5 indeterminate lesions on MR were correctly characterised by the addition of \nPET/CT \nConclusion: MR has a high sensitivity (100% ) for detecting hepatic lesions, \nhowever, it correctly characterises only 86% of these lesions. PET/CT has a \nlower sensitivity for detecting lesions (78%), however, it correctly characterised \n100% of those lesions detected. Fused-PET/MR is able to correctly \ncharacterise those lesions indeterminate on MR alone. Fused-PET/MR \nprovides optimal sensitivity and characterisation of hepatic lesions.  \nB-0537 11:15  \nInterest of shear wave elastography in the determination of malignancy \nfor focal liver lesions  \nW. Ben Hassen, M. Wagner, L. Chami, S. Egels, J.-M. Correas, O. Lucidarme; \nParis/FR  \nPurpose: To assess the stiffness of various focal liver lesions (FLL) using \nSupersonic Shearwave Elastography (SSE). \nMethods and Materials:  SSE were performed in 115 patients (mean age:56.2 \nyears; range 21-89) with 121 FLL (79 benign, 42 malignant, mean size: \n27.4 mm). Final diagnosis was assessed wi th pathological examination in all \ncases of malignant and atypical benign lesions, and with CT or MRI when \ntypical patterns of hemangiomas or focal nodular hyperplasia (FNH) were \nfound. Three consecutives measurements in kilopascals were performed in the \ncenter of each lesion and in surrounding normal parenchyma. Average values \nand the ratio between values of elasticity in FLL and values of elasticity of \nnormal liver were then computed. \nResults: 79 benign lesions (40 hemangiomas, 23 FNH, 6 adenomas, and 10 \nothers benign lesions), and 42 malignant lesions (16 hepatocellular carcinomas \nand 26 metastases) were analysed. Malignant lesions exhibited a mean \nstiffness value of 52.78kPa± 32.85, whereas benign lesions had an elasticity \nvalue of 25.03kPa ±18.9; P < 10-4). The ratio between FLL and surrounding \nnormal liver was more important in malignant lesions (5.8± 4.3) than for benign \nones (3.8 ±2.95; P < 0.002). Mean stiffness values differed significantly \nbetween the three groups of lesions (benign lesions, HCC and metastases: \nMetastases exhibited the highest values of stiffness (P < 10-4) and highest \nstiffness ratio (P < 10-4). Hepatic hemangiomas showed the lowest values of \nstiffness compared to the other lesions (P < 10-4). \nConclusion: SSE provides addi tional information that po tentially could help in \nliver lesion characterisation with US, particularly to differentiate benign lesions \nfrom HCC and metastases.  \nB-0538 11:24  \nPattern of HCC recurrence after liver transplantation: time to modify the \ncurrent follow-up imaging modalities?  \nM. Dioguardi Burgio1, M. Ronot2, D. Fuks2, F. Dondero2, F. Cauchy2, \nV. Paradis2, F. Durand2, J. Belghiti2, V. Vilgrain2; 1Palermo/IT, 2Clichy/FR \n(marco_dioguardi@hotmail.it)  \nPurpose: To analyse the imaging characteristics of hepatocellular carcinoma \n(HCC) recurrence following liver transplantation (LT) in order to determine \nwhether the current follow-up imaging modalities are relevant in the detection \nof these recurrences. \nMethods and Materials: Among 336 cirrhotic patients undergoing LT between \n2000 and 2011, 25 (7.4%) experienced HCC recurrence. Their pre-LT \ncharacteristics, long-term outcome and imaging characteristics of recurrences \nwere retrospectively analysed. \nResults: All patients were males [median age 54 (41-64) years]. Before LT, 13 \n(52%) patients had lesions outside the M ilan criteria. Median time to HCC \nrecurrence was 13.8 (1-75) months following LT and 8 (32%) patients \nexperienced recurrence > 24 months after LT. Recurrences were detected \nusing routine US follow-up in only 7 (28%) patients, and CT/MRI imaging in 18 \n(72%) of the patients including 5 (20%) based on alpha-fetoprotein elevation. \nThe most frequently involved organs were the lungs in 13 (52%) cases and the \nbones in 9 (36%) cases. Recurrent HCC involved > 1 organ in 11 (44%) \npatients. Recurrences were limited to the liver in one (4%) patient, were \nexclusively extrahepatic in 18 (72%) patients and were both intrahepatic and \nextrahepatic in six (24%) patients. \nConclusion: Routine US examination alone failed to detect most HCC \nrecurrences. Because HCC recurrence may occur even in patients with \nfavourable prognostic factors, is mainly extra-hepatic, may be delayed, and is \nrarely identified using US examination, we suggest performing regular whole-\nbody imaging during follow-up visits 2 years or more after LT.  \nB-0539 11:33  \nAlignment of abdominal organs in a sequential PET/MRI  \nC. Rubbert1, A.A. Kohan2, J.L. Vercher-Conejero2, K.A. Herrmann2, \nR.R.F.J. Muzic2, P.R. Ros2, P.F. Faulhaber2; 1Düsseldorf/DE, 2Cleveland, \nOH/US (christian.rubbert@med.uni-duesseldorf.de)  \nPurpose: A commonly discussed disadvantage of sequential PET/MRI is the \neffect of spatially and temporally disp laced PET and MRI acquisitions. This \nstudy aims to quantitatively evaluate automatic image fusion of upper \nabdominal organs, which are subject to breathing movement. \nMethods and Materials:  11 patients with PET and MRI acquisitions of the \nupper abdomen were evaluated under an IRB-approved PET/CT (Philips \nGemini TF) and PET/MRI (Philips Ingenuity TF) protocol. Volumes of interest \n(VOIs) were defined in a unified coordinate system for the liver, spleen and \nkidneys. Dice coefficients were used to evaluate the overlap of corresponding \nVOIs in PET and CT from PET/CT. The same procedure was performed for \nimage fusion of PET with the best-matching MRI, PET and the worst-matching \nMRI, as well as both MRI sequences fused. Dice coefficients were interpreted \nanalogously to Kappa statistics (0.61-0.8 = good, > 0.8 = excellent). \nResults: Overlap of VOIs in PET/CT was excellent for the liver (0.84 ±0.08) and \ngood for the spleen (0.75 ±0.06) and each kidney (0.74 ±0.12, 0.79±0.05). PET \nand best MRI overlap was excellent in liver (0.85 ±0.03) and spleen (0.80 ±0.06) \nand good in each kidney (0.75 ±0.07, 0.78±0.07). The results were comparable \nwith the worst-aligned PET/MRI. Overlap was excellent in all organs when \ncomparing fused MRI sequences. \nConclusion: Despite sequential PET and MRI acquisitions, organ overlap in \nPET/MRI has been found robust and comparable to PET/CT.  \nAuthor Disclosures: \nC. Rubbert: Other; CWRU Fellowship 2012/13 funded, Koninklijke Philips \nElectronics NV. A.A. Kohan: Other; Fellowship funded, Koninklijke Philips \nElectronics NV. J.L. Vercher-Conejero: Other; Fellowship funded, Koninklijke \nPhilips Electronics NV. K.A. Herrmann: None. R.R.F.J. Muzic: \nResearch/Grant Support; Koninklijke Philips Electronics NV. P.R. Ros: \nInvestigator; Koninklijke Philips Electronics NV. P.F. Faulhaber: Investigator; \nKoninklijke Philips Electronics NV. \nB-0540 11:42  \n64-row perfusion CT of hepatocellular carcinoma with the axial shuttle \ntechnique and adaptive statistical iterative image reconstruction: \npreliminary experience  \nL. Faggioni\n1, E. Neri1, G. D'Ippolito2, F. Pancrazi1, B. Ginanni1, R. Sacco1, \nG. Bresci1, C. Bartolozzi1; 1Pisa/IT, 2São Paulo/BR (lfaggioni@sirm.org)  \nPurpose: To assess the feasibility of CT perfusion imaging (pCT) of \nhepatocellular carcinoma (HCC) on a 64-row scanner with extended lesion \ncoverage and adaptive statistical iterative image reconstruction. \nMethods and Materials:  Nineteen patients (total 24 HCC) underwent pCT on \na high-definition 64-row CT scanner (Discovery CT750 HD, General Electric) \nwith z-axis coverage of 8 cm obtained through continuous table toggling (axial \nshuttle) and an adaptive statistical iterative reconstruction algorithm (ASiR™). \nAll pCT examinations were performed using a low-dose protocol (tube voltage \n80 kV, current 200 mA, rotation time 0.4 s) and 40% ASiR at 5 mm slice \nthickness. Blood flow (BF), blood volume (BV), mean transit time (MTT), \nhepatic arterial fraction (HAF), and permeability-surface product (PS) were \ncomputed in HCC and in the surrounding liver parenchyma. The rate of non-\nassessable HCC lesions and dose-length product (DLP) values were \ncompared with those of 14 patients (total 23 HCC) previously evaluated on a \n64-row scanner with standard filtered backprojection (FBP) and 4 cm \ncoverage. \nResults: BF, BV, HAF, and PS were higher, and MTT lower in HCC than in the \nsurrounding liver parenchyma (p < 0.01). The rate of non-assessable lesions \nand DLP were lower with the 8 cm coverage, ASiR scanner than with the 4 cm \ncoverage, FBP scanner (11% vs 26%, p=0.015 and 215.8 ±77.1 vs \n598.2±135.4 mGy\u0002cm, p < 0.01, respectively). \n \nS252  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nConclusion: Compared with a standard pCT protocol, 64-row pCT of HCC \nlesions with extended lesion coverage and adaptive statistical iterative \nreconstruction can yield a significantly higher rate of assessable lesions with a \nlower radiation dose.  \n \n10:30 - 12:00 Room D  \nChest  \nSS 904  \nInterstitial lung disease, lung function and \ninfection  \nModerators:  \nE. Castañer; Sabadell/ES  \nA.P. Parkar; Bergen/NO  \nB-0541 10:30  \nComparison of HRCT data in idiopathic pulmonary artery hypertension \n(IPAH) and normals using fractal dimension analysis  \nM.A. Arshad\n1, L. Howard1, E. Chan2, S. Giannarou1, G.-Z. Yang1, S. Copley1; \n1London/UK, 2High Wycombe/UK (mubarik@doctors.org.uk)  \nPurpose: To investigate if a difference exists in the lung microstructure on \nhigh-resolution CT (HRCT) images between patients with idiopathic pulmonary \nartery hypertension (IPAH) and normal individuals using fractal dimension (FD) \nanalysis (an index of complexity). \nMethods and Materials:  A retrospective analysis was performed on 42 \npatients (mean age 51.8, range 21-84 years, sex 15 males, 27 females) \nconfirmed with IPAH and 16 normals (mean age 41.5, range 21-75 years, sex \n7 M, 9 F). The IPAH group underwent HRCT and concurrent right heart \ncatheterisation. The normals undertook HRCT and pulmonary function testing. \nPulmonary regions of interest were assessed with FD analysis. The minimum, \nmaximum and mean fractal values were compared for the two groups. The \nfractal values for the IPAH group were correlated with the following \ncatheterisation parameters: mean arterial pressure (MAP), pulmonary vascular \nresistance (PVR) and pulmonary vascular resistance index (PVRi). \nResults: Significant differences in the fractal  values between the two groups \nwere observed. Comparing IPAH with normals, the minimum (34.3 ± 9.43 vs \n49.3 ± 6.40), maximum (78.5 ± 9.34 vs 103 ± 12.9) and mean (56.4 ± 9.37 vs \n76.2 ± 7.33) fractal values were all significantly less (p < 0.0001) in the IPAH \ngroup. However, no significant correlation was found between the fractal \nvalues and the MAP, PVR and PVRi in the IPAH group. \nConclusion: The lung parenchyma of patients with IPAH has significantly \ndifferent CT complexity compared with normal individuals. This may provide a \nuseful non-invasive marker for screening and monitoring treatment response.  \nAuthor Disclosures: \nE. Chan: Employee; Janssen-Cilag Ltd, Johnson & Johnson.  \n \nB-0542 10:39  \nQuantitative CT in the follow-up of functionally stable lung transplant \nrecipients  \nM. Silva1, D. Kienzl2, C. Mueller-Mang2, P. Jaksch2, W. Klepetko2, \nA.A. Bankier1; 1Boston, MA/US, 2Vienna/AT (mariosilvamed@gmail.com)  \nPurpose: To quantify lung parenchymal changes in functionally stable lung \ntransplant recipients using combined inspiratory and expiratory CT. \nMethods and Materials:  Twenty patients after double lung transplantation, all \nof which were stable with regards to clinical presentation and lung function \n(i.e., no evidence of graft rejection), underwent yearly combined inspiratory and \nexpiratory CT examinations over 5 years. Lung parenchymal densitometric and \nquantitative airway metrics were calculated with dedicated software. The \nlongitudinal evolution of the metrics was compared within individual patients, \nand relative changes were compared betwe en individuals. Comparisons were \nperformed using analyses of variance for repeated measurements, and linear \nregression analyses were used for data modeling. \nResults: Over the 5-year study period, CT measured lung weight and \nhistogram peaks showed statistical ly significant (p = 0.012 and p < 0. 001, \nrespectively) decreases. Moreover, mean lung density (MLD) significantly \ndecreased (p = 0.029), with regression lines showing similar slopes between \npatients (F = 2.69; p = 0.036). Simultaneously, MLD on expiratory CT \nexaminations also significantly decreased (p  = 0.001), while quantitative airway \nmetrics such as wall thickness, wall area percentage and Pi10 did not \nsignificantly change over time. \nConclusion: On quantitative CT, functionally stable lung transplant recipients \nshow a consistent pattern of longitudinal tissue loss, combined to increasing \ngas trapping. None of these changes are detected by the lung function test \ncurrently used as reference standard for following these patients.  \n \nB-0543 10:48  \nImpact of iterative reconstructions on detection of systemic sclerosis \n(SSc): related interstitial lung disease: clinical experience in 55 patients  \nF. Pontana, A.-S. Billard, K. Yasunaga, S. Bendaoud, J.-B. Faivre, \nM. Remy-Jardin; Lille/FR (fpontana@gmail.com)  \nPurpose: To evaluate the impact of iterative reconstructions on the depiction \nof SSc -related lung infiltration. \nMethods and Materials:  55 patients were enrolled in a study comparing \nreduced-dose and full-dose images simultaneously available from the same \ndataset acquired on a dual-source CT unit with (a) both tubes set at similar \nenergy (120 kVp); (b) the total reference mAs (i.e., 110 mAs) split up in a way \nthat 40% was applied to tube A and 60% to tube B. Two series of images were \ngenerated: (a) full-dose images (generated from both tubes), reconstructed \nwith FBP (Group 1) (i.e., the reference standard); (b) reduced-dose images \n(generated from tube A; 60% dose reduction) reconstructed with SAFIRE \n(Group 2). \nResults: In Group 1: (a) the mean level of objective noise was 26.23 ±9.40 HU; \n(b) CT features of lung infiltration were depicted in 38 patients (69.1%) in \nwhom the following findings were seen: fine reticular opacities (38/55; 69.1%); \nmild ground glass opacities (GGO) (38/55; 69.1%); \nbronchiectasis/bronchiolectasis (27/55; 49.1%) and honeycombing (17/55; \n30.9%). Comparing Group 2 and Group 1: (a) despite dose reduction, the \nobjective noise was significantly reduced (22.02 ±6.94 HU; p < 0.001); (b) there \nwas a similar detection of interstitial  lung disease in 38 patients (p=1); (c) \nsimilar subjective depiction of bronchi ectasis/bronchiolectasis (p=0.776) and \nhoneycombing (p=1); (d) improved visual depiction of fine reticular opacities \nand GGO (p=0.0186); and (e) similar good interobserver agreement (k > 0.8). \nConclusion: The image quality and diagnostic value of reduced-dose images \nreconstructed with SAFIRE is comparable to that of full-dose FBP images.  \nB-0544 10:57  \nImpact of scanning conditions in the evaluation of pulmonary blood \nvolume with dual-energy CT: results in 42 subjects  \nF. Molinari, P. Felloni, F. Pontana, N. Tacelli, T. Santangelo, M. Remy-Jardin; \nLille/FR (martine.remy@chru-lille.fr)  \nPurpose: To evaluate the characteristics of pulmonary blood volume (PBV) on \ndual-energy CT examinations. \nMethods and Materials:  42 patients were eligible to this study on the basis of \n(a) the absence of respiratory disease after a diagnostic work-up including a \ndual-source, dual-energy chest CT angiographic examination; (b) that was \nrated with an excellent image quality. Qualitative analysis was based on visual \nassessment. Quantitative analysis measured the (a) iodine concentration per \nlung (IPIPE software; Siemens) and (b) regional distribution of iodine after \nsemi-automatic division of each lung into 18 areas (OSIRIX). \nResults: The iodine (I) concentration di d not significantly differ between the \nright (R) (1.54 ±0.43 mg I/mL) and left (L) (1.53 ±0.41 mg I/mL) lungs with a \nmean attenuation of 41.35 HU (R lung) and 41.14 HU (L lung) (p=0.49). Three \nregional gradients of attenuation were observed : (a) infero-superior \n(p < 0.001), linked to the conditions of examination (mean \u0005 : -6.23 in the R \nlung; -5.96 in the L lung); (b) postero-anterior (p < 0.001) due to gravity (mean \n\u0005 : 11.92 in the R lung; 15.93 in the L lung) et (c) cortico-medullary (p < 0.001) \n(mean \u0005: -9.35 in the R lung; -8.37 in the L lung). The intensity of the postero-\nanterior (r=0.42; p < 0.001) and cortico-medullary (r=0.58; p < 0.0001) \ngradients was correlated to the overall iodine concentration. 7% of segments \n(59/840) showed artifacts hampering perfusion analysis, related to beam-\nhardening (RS1; RS2) or cardiac motion (RS5, LS5) artifacts. \nConclusion: Distribution of PBV is influenced  by physiological gradients and \nscanning conditions.  \nB-0545 11:06  \nIn vivo visualisation of pulmonary emphysema using grating-based x-ray \ndark-field imaging  \nK. Hellbach\n1, A. Yaroshenko2, A. Velroyen2, F. Bamberg1, K. Nikolaou1, \nM.F. Reiser1, F. Pfeiffer2, A.Ö. Yildirim3, F.G. Meinel1; 1Munich/DE, \n2Garching/DE, 3Neuherberg/DE (katharina.hellbach@med.uni-muenchen.de)  \nPurpose: Conventional chest radiographs have a limited sensitivity for the \ndetection of mild to moderate emphysema. The purpose of this study was to \nassess whether grating-based x-ray dark-field imaging can be used to visualise \npulmonary emphysema in vivo in a small-animal model. \nMethods and Materials:  To generate a murine model of pulmonary \nemphysema, three female C57BL/6N mice were treated with a single \norotracheal application of porcine pancreatic elastase (100 U/kg body weight) \ndissolved in phosphate-buffered saline (PBS). Three control mice received \nS253  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nPBS. Mice were imaged in vivo using a prototype grating-based small animal \nscanner. The anaesthetised mice were breathing freely during the image \nacquisition. The resulting images were processed using Fourier decomposition \nto obtain transmission images (equivalent to a conventional radiograph) and x-\nray dark-field images. In vivo pulmonary function tests were performed before \nsacrificing the mice and analyzing the lungs by histopathology. \nResults: Pulmonary function tests and histopathology confirmed that mice in \nthe elastase group but not in the PBS group had developed emphysema after \n21 days. Specifically, histopathology demonstrated diffuse airspace widening \nand loss of normal alveolar architect ure. Tissue elastance was significantly \nlower in the emphysema group than in the control group (18 vs. \n34 cmH2O/mL). The dark-field signal intensity of the lung parenchyma was \nsignificantly lower in the emphysema group compared to the control group \nallowing for a clear discrimination between healthy and emphysematous mice. \nConclusion: X-ray dark-field projection images can be used to diagnose \npulmonary emphysema in living mice.  \nB-0546 11:15  \nImaging of pulmonary emphysema: correlation of FEV1% with \nquantitative volumetric CT analysis of pulmonary volume and \nemphysema  \nF. Doellinger\n1, R.-H. Huebner1, J.-M. Kuhnigk2, N.F. Schreiter1, C. Haberstroh1, \nV. Froeling1, A. Poellinger1; 1Berlin/DE, \n2Bremen/DE (felix.doellinger@charite.de)  \nPurpose: FEV1/FVC ratio (FEV1%) is an important clinical parameter in the \nevaluation of patients with COPD and pulmonary emphysema (PE). The aim of \nthis study was to assess correlations between FEV1% and parameters of \nquantitative volumetric CT analysis. \nMethods and Materials:  33 patients with confirmed COPD GOLD IV and PE \nwere evaluated with inspiratory and expiratory chest CT. We performed \ncomputerised quantitative analysis of lung parenchyma to detect total lung \nvolume and proportionate emphysema. The used software MeVisPULMO 3D \n(v3.42, Fraunhofer MEVIS, Bremen, Germany) can detect lung areas with a \nphysical density below -950 HU and determine the ratio of normal and \nemphysematous lung parenchyma (i.e. emphysema score). We calculated the \nrelative differences of lung volumes and emphysema scores between \ninspiration and expiration. \nResults: FEV1% ranged from 12.0 to 42.0% (mean 26.50%). The relative \ndifferences of lung volumes between inspi ration and expiration ranged from \n67.38 to 99.71% (mean 85.62%). There was a strong statistical correlation of \nlow FEV1% and small differences of lung volumes (p <.005). The relative \ndifferences of emphysema scores between inspiration and expiration ranged \nfrom +11.94 to -45.21% (mean -20.95%). There was a strong statistical \ncorrelation of low FEV1% and small differences of emphysema scores (p \n=.026). \nConclusion: Small relative differences of lung volumes and emphysema \nscores between inspiratory and expiratory CT show a significant correlation \nwith low FEV1% in patients with COPD GOLD IV and PE.  \nB-0547 11:24  \nDigital tomosynthesis vs radiography in detection of fungal pneumonia: a \ncomputer simulated clinical trial  \nR.M. Edwards, G. Kicska; Seattle, WA/US (edwards5@uw.edu)  \nPurpose: Compare simulated digital tomosynthesis (sim-DTS) to radiography \nin the detection of fungal pneumonia, using chest computed tomography (CT) \nas the gold standard. \nMethods and Materials:  52 patients with fungal pneumonia and 13 normal \ncontrols were identified that had undergone unenhanced chest CT and chest \nradiograph within a 7 day period. Fungal pneumonia was confidently identified \non CT, the gold standard, but was marginally detectable on radiography. Sim-\nDTS images were created from the CT examination. Four cardiothoracic \nradiologists with minimal tomosynthesis experience reviewed the images and \nrated likelihood of fungal pneumonia on a 1 to 10 point scale. Diagnostic \nperformance was evaluated by ROC analysis. Area under the curve (AUC) and \nspecific performance was compared for both modalities. \nResults: All cases of fungal pneumonia demonstrated pulmonary nodules. \nMedian largest nodule size was 18 mm. Observer performance for all readers \nshowed area under the curve (AUC) of 0.83 for tomography (95% CI: 0.78-\n0.89) and 0.79 for radiography (95% CI: 0.72-0.85). There is no statistically \nsignificant difference between tomography and radiography (p-value = 0.28) \nperformance in fungal pneumonia detection. When considering a desired \nsensitivity of 90%, specificity was 29% for tomography (95% CI:30-43) and \n36% for tomography (95% CI:25-58). \nConclusion: This study suggests that digital tomosynthesis performs as well \nor better than radiography, despite being interpreted by radiologists with \nminimal or no tomosynthesis experience. When interpreting studies to \nmaximise sensitivity, tomosynthesis may have higher specificity, which would \nsignificantly reduce unnecessary CT exams in neutropenic patients who are \nroutinely screened for infection.  \nAuthor Disclosures: \nG. Kicska: Grant Recipient; General Electric. \nB-0548 11:33  \nThe development of diagnostic accuracy and search pattern behaviour in \nthe interpretation of chest radiographs  \nB.S. Kelly, L.A. Rainford, E.C. Kavanagh, R. Toomey; Dublin/IE \n(brendanskelly@me.com)  \nPurpose: To investigate the development of radiological image interpretation \nskill through medical training by measuring both diagnostic accuracy and eye \nmovements during visual search. \nMethods and Materials:  Five Consultant Radiologists, deemed the reference \nexpert group, four Radiology Registra rs, five Senior House Officers (SHOs) \nand six Interns formed four clinician groups. Participants were shown 30 chest \nradiographs, 14 of which had a pneumothorax and were asked to give their \nlevel of confidence as to whether a pneumothorax was present. Receiver \noperating characteristic (ROC) analysis was carried out on diagnostic \ndecisions. Eye movements were recorded by a Tobii TX300 eye tracker. Four \nEye-tracking metrics were analysed. Variables were compared to identify any \ndifferences between groups. \nResults: All data were compared using the Friedman non-parametric method. \nThe average area under the ROC Curve for the groups increased with \nexperience (p=0.009). Statistically significant difference in diagnostic accuracy \nwas found between Consultants and Registrars (p=0.046). All four eye-tracking \nmetrics reduced with experience, this was statistically significant for Registrars \ncompared with SHOs. The total reading time reduced with experience; \nsignificantly for Registrars compared to SHOs (p=0.046) and between SHOs \nand Interns (0.025). \nConclusion: Reader performance increased with experience. The level of \nexperience at which there was a statistically significant difference was higher \nfor diagnostic accuracy than for eye-tracking metrics. This data would suggest \nthat specific training is needed to improve radiology expertise and that the \ndevelopment of an \"expert\" search pattern predates the development of \n\"expert\" levels of diagnostic accuracy.  \nB-0549 11:42  \nComparison study of chest radiography, digital tomosynthesis and low-\ndose MDCT to detect ground-glass nodules: an anthropomorphic chest \nphantom study  \nK. Doo\n1, E.-Y. Kang1, H. Yong1, S.-Y. Ham1, K. Lee2, J. Choo2; 1Seoul/KR, \n2Asan/KR (kwdoo@korea.ac.kr)  \nPurpose: The purpose of this study was to evaluate the comparison of \ndiagnostic performance of chest digital tomosynthesis (DT), chest radiography \n(CR) and low-dose CT (LDCT) for the detection of ground-glass opacity (GGO) \npulmonary nodules, using an anthropomorphic chest phantom. \nMethods and Materials:  Artificial pulmonary nodul es (diameter: 5 and 8 mm, \nCT densities: -630 and -800 HU) were placed in a phantom and total 40 \nsamples of different nodule settings underwent CR, DT and LDCT. The images \nwere randomly read by 3 blinded radiologists. Free-response receiver-\noperating characteristic (FROC) were used to compare the differences in \ndetection accuracy between CR, DT and LDCT. \nResults: The figures of merit for the FROC curves averaged for the observers \nwere 0.41, 0.37, and 0.76 for CR, DT and LDCT, respectively. FROC analyses \nrevealed significantly better performance (P \n< 0.05) of LDCT than CR and DT \nfor the detection of GGO nodules. The detectability difference between CR and \nDT was not statistically significant (P=0.73). The inter-observer agreements \nbetween three readers were 0.176, 0.510 and 0.719 for CR, DT and LDCT. \nConclusion: The diagnostic performance of DT for the detection of GGO \npulmonary nodules was not significantly different to CR, and LDCT showed \nsignificantly better performance than CR and DT. DT may not be an alternative \nmethod to CT for the detection of GGO nodules, and LDCT is preferred to \ndetect GGO nodules.  \nB-0550 11:51  \nTrachea morphology on CTPA: correlation with extent and distribution of \nadipose tissue  \nD. ap Dafydd, S.R. Desai, F. Gordon, S. Copley; London/UK \n(derfelapdafydd@hotmail.com)  \nPurpose: Excessive expiratory tracheal collapse on CT is associated with \ntracheomalacia. However, other factors such as obesity may also contribute to \nthis feature. We aim to evaluate the rel ationship between thoracic adiposity \nand tracheal collapse in a nonselected group of patients. \nMethods and Materials:  A consecutive group of non-selected patients \nundergoing CT pulmonary angiograms (CTPAs) over a four-month period for \nsuspected pulmonary embolus were retrospectively analysed by two thoracic \nradiologists. Exclusion criteria include d intubation and mediastinal masses. \nUsing an adapted scoring system, the morphology of the trachea was \nevaluated as normal or demonstrating anterior bowing of the posterior wall to a \nS254  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nmild, moderate or severe degree. The cross-sectional area of the trachea at its \nnarrowest point was also recorded. Addi tionally, measurements of adiposity \nwere taken, including anterior mediastinal fat thickness, sagittal thoracic \ndiameter and subcutaneous fat thickness. The data was analysed using \nmultinomial logistical regression. \nResults: 296 patients were included. Both moderate and severe bowing of the \nposterior trachea were significantly correlat ed with sagittal thoracic diameter \n(p < 0.0001) and with mediastinal fat thickness (p < 0.005). Tracheal cross-\nsectional area was inversely correlated with subcutaneous fat thickness \n(p=0.005). Tracheal cross-sectional area was lower in females than in males \n(p < 0.0001). \nConclusion: These findings demonstrate a statistically significant relationship \nbetween thoracic adiposity and trachea morphology in a large nonselected \npopulation being evaluated for pulmonary embolus. Therefore, the CT \ndiagnostic criteria for tracheomalacia may vary with body habitus.  \n10:30 - 12:00 Board Room B  \nHead and Neck  \nSS 908  \nImaging techniques  \nModerators:  \nK.S.S. Bhatia; Shatin/HK  \nH.B. Eggesbø; Oslo/NO  \nB-0551 10:30  \n70 kV ultra-low dose computed tomography of the paranasal sinus: \ndiagnostic image quality and radiation dose  \nB. Bodelle, B. Schulz, J.L. Wichmann, N. Klotz, T.J. Vogl; \nFrankfurt a. Main/DE (bbodelle@googlemail.com)  \nPurpose: To evaluate diagnostic image quality and radiation dose of 70 kV CT \nlow-dose technique of the paranasal sinus. \nMethods and Materials:  CT of the paranasal sinus was performed on 3x40 \nage- and sex-matched patients at different tube voltages and currents \n(70 kV/75 mAs, 100 kV/40 mAs [standard low dose protocol], 120 kV/40 mAs \n[standard protocol]). CTDIvol, DLP, attenuation, image noise and SNR were \ncompared between the groups using Mann-Whitney U test. Subjective \ndiagnostic image quality was compared using a 5-point scale (1 = worst, 5 = \nbest, 2 readers in consensus) and Cohen's weighted kappa analysis for inter-\nobserver agreement. \nResults: Radiation dose was significantly lower in 70 kV than 100 and 120 kV \n(DLP: 32 mGycm vs. 52 mGycm vs. 82 mGycm; CTDI 2.3 mGy vs. 4.0 mGy \nvs. 6.3 mGy, p < 0.05). Mean SNR (120 kV: 0.13; 100 kV 0.20; 70 kV 0.37, \np < 0.05) and organ attenuation increased statistically significantly with lower \nkV, while image noise decreased (mean: 120 kV: 82 ±11 HU; 100 kV 81± 37; \n70 kV 191± 26, p < 0.05). All examinations showed diagnostic image quality. \nSubjective diagnostic image quality was higher in standard protocols than in \n70 kV protocol (120 kV: 5.0; 100 kV 4.5; 70 kV 3.5, p < 0.05) and was not rated \nsignificantly differently with good inter-observer agreement (k > 0.59). \nConclusion: 70 kV ultra-low dose CT of the pa ranasal sinus allows significant \ndose reduction of -61%, better attenuation of organ structures in comparison to \nstandard protocol while remaining diagnostic image quality with a slight \nreduction in subjective image quality.  \nB-0553 10:39  \nApplication of IDEAL T2- and postcontrast T1-weighted fat-suppressed \nFSE imaging in head and neck at 3 T: evaluation of quality improvement  \nJ. Hong, H. Lee, Y. Kang, M. Lim, M. Kim, S. Cho; Incheon/KR \n(ifiamyou82@naver.com)  \nPurpose: To compare fat-suppressed MRI quality using iterative \ndecomposition of water and fat with echo asymmetry and least-squares \nestimation (IDEAL) with that using frequency selective fat-suppresion (FSFS) \nT2- and postcontrast T1-weighted fast spin-echo images in extracranial head \nand neck at 3 T. \nMethods and Materials:  This prospective, single-center study was institutive \nreview board approved. MRI was performed in 28 individuals of a routine \npatient collective. The axial T2- and postcontrast T1-weighted imaging with \nIDEAL and FSFS were compared. Visual evaluation of following items was \nperformed by two experienced, independent readers: 1) artifacts around oral \ncavity, airway, paranasal sinus, and hea d-neck junction, 2) uniformity of fat \nsuppression, 3) image sharpness, 4) contrast of pathologies and lymph nodes \nto surrounding tissue. Statistical evaluati on was done by using the Wilconxon's \nsinged rank test. \nResults: Both IDEAL T2- and postcontrast T1-weighted imaging significantly \nreduced artifacts around airway, paranasal sinus, and head-neck junction, and \nsignificantly improved uniform fat suppression (p < 0.05, respectively). IDEAL \nsignificantly decreased artifacts around oral cavity on T2-weighted images, and \nsignificantly improved lymph node-to-tissue contrast on postcontrast T1-\nweighted images (p < 0.05, respectively). However, no significant improvement \nwas found on lesion-to-tissue contrast. \nConclusion: IDEAL T2- and postcontrast T1-weighted imaging improves \nimage quality by reducing the degree of artifacts around airway, paranasal \nsinus, and head-neck junction, and providing uniform fat saturation of the head \nand neck.  \nB-0554 10:48  \nInner ear CT imaging: influence of iterative reconstruction techniques on \ndose and image quality  \nF. Zanca\n1, W. Coudyzer1, I. Bosmans2, A.-S. Delabie2, K. Op de beeck1, \nR. Hermans1; 1Leuven/BE, 2Brussels/BE (federica.zanca@uzleuven.be)  \nPurpose: To assess dose reduction potential using Sinogram Affirmed \nIterative Reconstruction (SAFIRE) relative to filtered backprojection (FBP) on \ntemporal bone computed tomography (CT). \nMethods and Materials: Two cadaver heads were scanned on 128-slice multi-\ndetector-row CT (SOMATOM Definition Flash) using the standard-of-care \nprotocol (140 kV, 220 fixed mAs) and dose reduced protocols at 200, 180 and \n160 mAs (10, 20, 30% dose reduction, respectively). In addition, the standard-\nof-care with lower potential (120 kV) but higher mAs (250) (30% dose \nreduction) was also used. Data were reconstructed with FBP and SAFIRE \n(strength 5), using very sharp filters. Objective noise and Hounsfield units were \nmeasured in the native axial (0.4 mm slice, 0.2 mm increment) and reformatted \ncoronal and axial (0.8 mm slice, 1 mm increment) images. Signal to noise ratio \n(SNR) was calculated and the two techniques were compared (Student t-test). \nTwo neuroradiologists assessed the images for visibility of ear structures and \nfor diagnostic image quality, using a 5- point scale (1=insufficient; 5=excellent). \nResults: Objective noise was significantly lower for SAFIRE with respect to \nFBP for the native images (117 ±6.6 vs 132± 8.1, p < 0.05). SNR followed the \nsame trend. Subjective image quality analysis was significantly better for FBP \n(p-value< 0.001, SAFIRE median score 3 vs 4 for FBP). \nConclusion: Compared with FBP, SAFIRE enabled significant reduction of \nobjective image noise for the high-resolution native images which also yield a \nmore confident evaluation of very small structures (e.g. the ossicular chain). \nHowever, overall image quality was significantly better for FBP, possibly \nbecause of the extreme strength of 5 for SAFIRE.  \nB-0555 10:57  \nReduction of MR imaging artefacts caused by cochlea implants: a \nphantom study  \nA. Pomschar, F. Dirr, J. Müller, M.F. Reiser, B. Ertl-Wagner; \nMunich/DE (Andreas.Pomschar@med.lmu.de)  \nPurpose: To evaluate the effect of an advanced metal artefact suppression \nMR sequence (warp), which combines view angle tilting (VAT), increased \nbandwidth and slice-encoding metal artefact correction (SEMAC), on magnet-\ninduced artefacts caused by cochlea implants in an experimental setup. \nMethods and Materials:  Measurements were performed on a phantom in a \n3 T MRI scanner (Magnetom Skyra, Siemens Healthcare). The phantom \nconsisted of a plastic grid cube of 15x15x15 cm, 1 cm grid, immersed in a \ncopper sulphate solution with a cochlear implant, placed at 1 cm depth. 3D T1-\nweighted images were acquired with and without \"warp\" technology, with VAT \nset to 50 and 100%, respectively. Signal void penetration into the grid cube \nwas measured from the bottom of the CI receiver to the maximum depth of the \nsignal void. Signal void area around the CI receiver was measured in the plane \nof the CI receiver. \nResults: Signal void on T1-weighted sequences without metal artefact \nsuppression showed a penetration depth of 8.2 cm and an in-plane area of \n167 cm². With activated \"warp\" technique and 50% VAT, penetration depth was \nreduced by 41% to 4.8 cm and area by 72% to 47 cm², with 100% VAT, depth \nwas reduced by 49% to 4.2 cm and area by 76% to 40 cm². \nConclusion: An advanced metal artefact suppression algorithm combining \nVAT, SEMAC and increased bandwidth significantly reduces susceptibility \nartefacts caused by cochlear implants at 3 T. It has the potential to increase \nthe diagnostic value of cranial imaging in patients with CI.  \nAuthor Disclosures: \nA. Pomschar: Equipment Support Recipient; The Syngo\"warp\" sequence was \nprovided by SIEMENS Healthcare.  \nS255  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0556 11:06  \nMR tractography of the intraparotid facial nerve  \nA. Attye, I. Troprès, A. Karkas, C. Righini, G. Bettega, A. Krainik; Grenoble/FR  \nPurpose: Identifying the facial nerve (VII) after the stylomastoïd foramen \nremains a modern imaging challenge. We attempt to visualise the VII up the \nproximal facial nerve division (FND) am ong patients admitted for parotid lesion \nwith diffusion tensor imaging (DTI). Then, we attempt to validate this method \nby comparison with the surgeon findings. \nMethods and Materials:  DTI was performed on a 3 T Philips Achieva ® MRI \nScan with a 32 channels array head coil. We used both the Philips navigational \nsoftware Fibertrack ® and free software MRtrix ® to obtain facial nerve fiber \ntracking with the single Region of Interest method. The fraction of anisotropy \nhas been set to 0.05 and the maximal angle change to 80°. The location of the \nFND in relation to the tumour was correlated with the data of the DTI during the \ntumour resection by the surgeon. The correlation study included a visual \nanalysis and use of a monitoring of the VII (Avalanche® device). \nResults: We performed a DTI study of the facial nerve among 16 patients with \nfocal parotid lesion before surgery. Fibres corresponding to the course of the \nmain trunk of the VII were identified with the DTI-based fiber tracking technique \nin all patients. The visualisation of the FND allows us to define two parts of \nparotid gland, superficial and deep, and to successfully locate the process into \nin all cases in relation with the surgeon findings. \nConclusion: DTI study of the VII up the FND seems to be feasible and \npotentially useful before management of focal parotid lesion.  \nB-0557 11:15  \nNormal variation of hypoglossal canal  \nM. Osawa, T. Kanda, T. Kiritoshi, K. Toyoda, H. Oba, S. Furui; Tokyo/JP \n(funimarun@gmail.com)  \nPurpose: Double hypoglossal canal and size laterality of the hypoglossal canal \nare major normal variations of the canal, but the true incidences of these \nvariations, or sex and laterality differences are not known. We investigated the \nnormal variation of the hypoglossal canal using 64-slice CT and MRI. \nMethods and Materials:  596 consecutive patients (mean age, 61 years: \nrange, 15-94 years: 257 male, 339 female) underwent CT. 2 radiologists \nindependently reviewed their CT images and counted the canal number on \neach side. If the canal was single, the hypoglossal canal size was measured. \n61 patients who had undergone MRI, were checked for the hypoglossal nerve. \nSteel-Dwass test was used, and statistical  significance was established at a p-\nvalue of < 0.05. \nResults: The incidence of double hypoglossal canal was 16.9%. Right double \nhypoglossal canal of women was significantly rarer than that of men or that of \nthe left side. Bilaterally, double hypoglossal canal was significantly rarer in \nwomen than in men. In single hypoglossal canal patients, left side predominant \nlaterality was observed in 31.9% of patients and right side predominant \nlaterality in 12.1%. In the 61 patients who had undergone MRI the hypoglossal \nverve existed within all hypoglossal canals. \nConclusion: Both double hypoglossal canal and size asymmetry of \nhypoglossal canal are common. Right side double hypoglossal canal of women \nwas significantly rarer than that of men or that of the left side.  \nB-0558 11:24  \nFacial asymmetry and temporomandibular joint  \nR. Oca Pernas, E. Santos, N. Silva, A. Fernández, A. Grande, A. Bustos; \nVigo/ES (roqueoca@hotmail.com)  \nPurpose: 1). To evaluate mandibular ramus length and condyle size in \npatients with facial asymmetry. 2). To determine if the diagnose of facial \nasymmetry is a conditioning for the development of degenerative changes in \ntemporomandibular joint (TMJ). \nMethods and Materials:  25 non-contrast facial CT of patients referring from \nMaxillofacial Surgery Department with clinical diagnosis of facial asymmetry \nwere retrospectively analysed; 25 non-contrast facial CT for preoperative \nassessment of unerupted molar teeth extraction were chosen as controls. \nMandibular ramus length and axial diameters (minor and major) of condyles \nwere measured. Degenerative changes of TMJ were evaluated independently \nby two blinded radiologists with quantitative scale of 4 points (0: no \ndegenerative changes; 3: advanced joint destruction). In case of disagreement, \na consensus reading was conducted. Anatomic differences and degenerative \nchanges were analysed. Interobserver reliability was calculated. \nResults: 1). Short mandibular ramus length was 57.6 and 64.1 mm for patients \nand controls, respectively (p=0.002). There  were no statistical differences in \nlong mandibular ramus length between both groups. 2). Mandibular condyles \ndiameters, either in short or long ramus sides, were smaller in patients with \nfacial asymmetry (p=0.015 and p=0.013). 3). TMJs presented more severe \ndegenerative changes in patients (p < 0.001), being more extensive in short \nramus side condyle (p=0.014). 4). Interobserver reliability was 0.84 and 0.86 \nfor long and short ramus sides. \nConclusion: 1). Patients with facial asymmetry show shorter mandibular \nramus length and smaller condyles. 2). TMJ degenerative changes are more \nsevere in patients with facial asymmetry, mainly in short mandibular ramus \nside.  \nB-0559 11:33  \nMandibular incisive canal (MIC): visibility and path of the intramandibular \ncourse using cone beam computed tomography (CBCT)  \nD. Di Salvo, A. Borghesi, R. Bettini, D. Farina, R. Maroldi; Brescia/IT \n(diegodisalvo@gmail.com)  \nPurpose: The interforaminal mandibular region is considered a safe zone for \nimplant surgery; nevertheless literature reports neurosensory disturbances of \nthe lower lip from 7% to 24% of cases after implant placement in this area. The \naim of this retrospective study was to assess the visibility and path of \nintramandibular course of MIC using CBCT. \nMethods and Materials:  140 patients (280 hemimandibles) were included in \nthis study. The visibility, diameters and distances from anatomical landmarks in \nthe interforaminal region (root tips, buccal , lingual and inferior cortex of the \nmandible) were measured twice by two observers using CBCT in consensus. \nCoefficient of repeatability (CR) and limits of agreement were calculated by \nBland-Altman method. \nResults: CBCT identified MIC at root tips of first premolars, canines and lateral \nincisors in 70%, 46.1% and 15.4%, respectively. At the same landmarks, the \nmean diameters were 1.4 mm, 1.1 mm and 0.9 mm (CR range: 0.4-0.6 mm); \nthe mean distances from the root tips were 5.7 mm, 6.3 mm and 8 mm (CR \nrange: 0.7-1.2 mm); the mean distances from buccal cortex were 3.0 mm, \n5.0 mm and 5.1 mm (CR range: 0.7-1.2 mm); the mean distances from lingual \ncortex were 5.3 mm, 4.6 mm and 4.9 mm (CR range: 0.5-0.9 mm). \nConclusion: Even though the MIC is usually only partially corticalised, \ntherefore difficult to trace in some cases, the variability of measurements of \nMIC using CBCT was reasonably small, with the potential to improve the \nprecision of implant surgery planning in the interforaminal region.  \nB-0560 11:42  \nQuality assurance of dental digital imaging in Finland in health care \nfacilities having CBCT devices  \nE. Metsala, K. Holopainen, T. Parviainen; Helsinki/FI \n(eija.metsala@metropolia.fi)  \nPurpose: In October 2011, Radiation and Nuclear Safety Authority Finland \npublished a guide presenting the radiation safety requirements concerning \ndental x-ray practices and quality assurance procedures. The aim of this study \nwas to describe dental x-ray quality assurance procedures performed in \nFinland, and dental imaging staff's educational needs associated to them. \nMethods and Materials:  Target group of the study was all the health care \norganisations in Finland having the cone beam CT in their use. The data were \ncollected by a postal questionnaire during spring 2012 and 25/33 \nquestionnaires were returned. The questionnaire comprised 39 questions, out \nof which ten were open-ended, 23 structured and 6 half-structured questions. \nThe data were analysed by using PASW Statistics 18 program. \nResults: Dental health care quality assurance tests were well performed. The \nmost common quality assurance tests were mechanical and an emergency \nswitch tests. Almost all the respondents (22/25) had received some kind of life-\nlong education in dental digital imagi ng quality assurance (QA). However, only \n11 of them had received QA-education during their professional education. \nParticipators wanted continuous and regular training. They also wished \nrevision to basic radiation protection and pr actical training. There came also up \na wish for cone beam CT training for dental hygienists. \nConclusion: State of quality assurance in dental digital imaging in Finland is \nquite good. However, education of the topic is still needed. Most urgently is \nneeded education for the basic radiation protection issues and cone beam \nimaging quality assurance issues.  \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nS256  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n \n10:30 - 12:00 Room E1  \nMusculoskeletal  \nSS 910  \nTumours  \nModerators:  \nT. Bäuerle; Erlangen/DE  \nJ.L. Bloem; Leiden/NL  \nB-0561 10:30  \nDoes apparent diffusion coefficient values can be used for the \ndifferentiation of small-blue-round cell tumours from malignant non-\nsmall-blue-round cell tumours?  \nF.B. Ergen, G. Yildirim, I.C. Kose, J. Karakaya, B. Aydin, U. Aydingoz; \nAnkara/TR (bergen@delta-eur.com)  \nPurpose: The purpose of this study is to assess the ability of apparent \ndiffusion coefficient (ADC) values in differentiating small-blue-round cell \ntumours (SBRCT) and malignant non-small-blue-round cell tumours (NSBRCT) \nof the musculoskletal system. \nMethods and Materials:  For a period of 1.5 years, patients presented with \nSBRCT (n=10) and NSBRCT (n=8) who underwent conventional MRI and \ndiffusion-weighted imaging (DWI) were included to this study. None had \nreceived anti-neoplastic therapy and all were pathologically confirmed. For \neach mass, two observers independently measured 3 different ADC values \nfrom the areas that demonstrate the lowest diffusivity. The difference between \nthe medians of SBRCT and NSBRCT was assessed with Mann-Whitney test. \nThe optimal cut-off ADC value was determined with ROC analysis. \nResults: Eighteen patients (mean age, 54 years) with final diagnosis of \nEwing's sarcoma (n=7), Langerhans cell histiocytosis (n=2) multiple myeloma \n(n=1), PNET (n=1), osteosarcoma (n=4), mixoid liposarcoma (n=2), \nchondrosarcoma (n=1), were included. Median ADC values of SBRCT and \nNSBRCT were 0.57±0.18x10\n-3 and 1.03±0.61x10-3 mm2/sec for observer 1; and \n0.55 ±0.19x10-3 and 1.04± 0.58x10-3 mm2/sec for observer 2, respectively. We \nfound a statistically significant differ ence between the median ADC values for \nboth observers ( P=0.006). Intraclass correlation coefficient was 94% (95% CI, \n86.5%-98.0%). The area under ADC ROC curve was 0.88 (95% CI, 0.64-0.98). \nThe optimal cut-off point was 0.69 x10 -3 mm2/sec. For this cut-off point, \nsensitivity and specificity were 85.7% and 81.8%, respectively. \nConclusion: Apparent diffusion coefficient values can be used in \ndifferentiation of SBRCT from malignant NSBRCT in patients with \nmusculoskeletal tumours.  \nB-0562 10:39  \nImaging follow-up of large and symptomatic soft tissue lipomas  \nR. Balasubramaniam, H. Lyall, H. Gupta, P. Robinson; Leeds/UK \n(ravivarmabalasub@gmail.com)  \nPurpose: Lipomas > 5 cm, below deep fascia or symptomatic have malignant \npotential and UK national recommendati ons are for excision. However patient \nreluctance and anatomical location can make surgery unattractive. We \nprospectively studied patient outcomes for lipomas referred to a sarcoma \nservice for surgery but managed conservatively. \nMethods and Materials:  Prospective series of 80 patients referred to a \nsarcoma service with lipomas > 5 cm, deep to fascia, symptomatic and/or \nminor atypical imaging features initially managed conservatively. All lesions \nmeasured and interval growth defined as percentage increase from initial \ndimensions. Minor atypical imaging features defined as internal septal \nthickening/blood flow, heterogenous echo genicity on ultrasound or mild \nincomplete MRI fat suppression (not nodular). Clinical follow-up and imaging \nsurveillance was performed. \nResults: 26 lipomas were subcutaneous, 10 intra-fascial, 12 inter-muscular \nand 32 intra-muscular. Conservative management occurred because: location \n(20), co-morbidity (3), pregnancy (1), and patient choice (56). At presentation \n80 had ultrasound and 59 MRI. 8/59 had MRI atypical features (8 incomplete \nfat suppression, 2 septal enhancement) and another 8/80 ultrasound atypical \nfeatures (septation low blood flow or thickening). 46 were > 5 cm on MRI and \n54 on ultrasound. Mean follow-up was 12 months (range 8-32). No lesions with \natypical imaging showed significant interval growth. 9 lesions showing interval \ngrowth (range 7.1- 56%) all demonstrated stability on at least one subsequent \nscan and 3 cases underwent surgery with histology and cytogenetics \nconfirming lipoma. \nConclusion: This study demonstrates that large, deep or symptomatic lipomas \nwhere surgery is not immediately indicated can be safely followed up with \nMRI/Ultrasound.  \n \nB-0563 10:48  \nFrequency of MR parameters in soft tissue synovial sarcoma: \ncomparison between different histopathologic type  \nV. Vasilevska Nikodinovska1, K. Vilanova2, F.M.H.M. Vanhoenacker3, \nI.-M. Nöbauer-Huhmann4; 1Skopje/MK, 2Girona/ES, 3Brussel/BE, 4Vienna/AT \n(v_vasilevska@yahoo.com)  \nPurpose: To evaluate the frequency of the magnetic imaging (MRI) \nparameters in synovial sarcoma. To assess the correlations between MRI \nparameters and histopathological types of synovial sarcoma, as well as to \nselect specific MRI parameters that could possibly predict the histological type \nof synovial sarcomas. \nMethods and Materials:  MRI findings of 43 cases (23 males, 20 females, \nmedian age 40 years) of synovial sarcoma of the soft tissue were \nretrospectively analysed. Monophasic was 24 cases (56%), biphasic \n17 (39.5%) cases and two were low differentiated synovial sarcomas. Twenty-\nfour MRI parameters were evaluated. Besides descriptive statistics, Spearman \nrank-order correlations, Mann-Whitney U test and Multivariate regression \nanalysis were performed. \nResults: Deep and extracompartmental localisations were found in 79% of the \ncases. Most of the cases were with iso signal intensity (SI) in T1 and high and \ninhomogeneous SI in T2, with peripheral (53%) and inhomogeneous (88%) \nenhancement. Both cystic areas and necrosis were present in 53%. Mostly, \nhaemorrhage and fluid-fluid levels were absent. Multilocular configuration was \nobserved in 12 (28%) cases. Sixty three percent of the cases had well-\ndemarcated margins, and in the same percentage two different solid areas \nwere present. Bone and joint involvement was rare. Multiple regression \nanalysis showed that there were no MR parameters significantly predictive for \nthe histopathological type of synovial  sarcomas. There were no statistically \nsignificant differences between th e monophasic and biphasic synovial \nsarcomas for none of the evaluated parameters. \nConclusion: Evaluated MR parameters cannot reliably predict the \nhistopathologic types of synovial sarcoma.  \nB-0564 10:57  \nMyxoid containing tumours of soft tissues: MRI appearance with \nradiologic-pathologic correlation  \nN. Alberti, X. Buy, N. Frulio, M. Kind; Bordeaux/FR (nicolasalberti@aol.com)  \nPurpose: To identify specific MRI features and to correlate with pathology in a \nlarge series of histologically proven myxoid soft tissue tumours (STT). \nMethods and Materials:  63 patients with myxoid STT were included. All \npatients underwent MRI before surgery. Definite histological diagnosis was \nobtained after surgical resection in all cases. Following criteria were analysed: \nbefore contrast injection: tumour location relative to the fascia, lesion margin, \nsignal homogeneity, peritumoural oedema; presence of hyperintense T1 WI \nperipheral rim (fat split sign). After contrast injection: tumour enhancement; \npresence of tail sign. Correlation with pathology focused on: T2WI fluid-like or \nhypo-intensity areas compared to myxoid, necrotic and fibrotic tissue; loss of \nhyper-T1 signal on fat-sat sequence compared to adipose tissue. \nResults: Histopathology was low-grade fibromyxoid sarcoma (LGFMS), \nmyxofibrosarcoma (MFS), myxoid liposarcoma (MLPS), and myxoma in 8, 23, \n20 and 12 cases, respectively. All myxoma and LGFMS were intramuscular \nwhile all MLPS were intermuscular. 75% MFS invaded both fascial and deep \nstructures. ͒ Myxoid matrix was found in 75% MLPS and 90% myxoma; \nLGFMS and MFS showed heterogeneous mild T2 signal with fibrous tissue at \nhistology. When present, fatty T1 hypersignal was specific of MLPS and tail \nsign specific of MFS. \nConclusion: Myxoid STT are a heterogeneous group of mesenchymal \ntumours with characteristic imaging features. MR results give the basis of \ndecision-making by a multidisciplinary committee.  \nB-0565 11:06  \nAssessment of the preoperative chemotherapy of soft tissue sarcomas \nusing anatomical and functional methods of visualisation  \nY. Zamogilnaya, N. Kochergina, A. Bludov, A. Nered; Moscow/RU \n(yzamogilnaya@gmail.com)  \nPurpose: To increase and compare the informativeness of MRI, changes in \ntumor size and DCE-MRI in assessment of the preoperative chemotherapy of \nsoft tissue sarcomas (STS) by developing differential criteria (decisive rule - \nDR) of poor and good response (PR/GR) to treatment. \nMethods and Materials:  To develop the DR for different methods of \nvisualisation 74 patients with STS were analysed (74 with MRI, 37 with DCE-\nMRI). Plus MRI was used to estimate the changes in the tumor size according \nto RECIST criteria. The DR was created using multifactor analysis whereby \nstatistically significant radiological si gns acquired weight coefficients (WC), \nS257  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nwhich determined the frequency of occurrence of symptoms in a group of \npatients with GR and PR. \nResults: The sensitivity of DR for MRI was 65%, the specificity - 86%; for \nDCE-MRI - 100% and 84%, of RECIST criteria - 50% and 100%, respectively. \nThe most informative MRI and DCE-MRI signs with the highest WC were: \ndecrease of a proposed solid component, increase of the thickness of \npseudocapsule and disappearance of enhancement, type II of the curve of the \ntumor for GR; increase/appearance of cystic component, preservation of \nsurrounding edema and diffuse type of enhancement, type V of the curve of \nthe tumor for PR. \nConclusion: MRI (qualitative and RECIST criteria) with its higher specificity \nbetter predicts PR, DCE-MRI shows higher values of sensitivity associated with \nGR. The combination of anatomical and functional methods improves the \nquality of evaluation of the treatment in patients with STS (sensitivity - 100%, \nspecificity - 96%).  \nB-0566 11:15  \nPilomatricoma: radiologic findings of 17 cases  \nY. Hirokawa1, H. Kurokawa1, S. Ikeda1, R. Terasawa1, M. Kohzai1, T. Tsuno1, \nK. Ikeda2, N. Sakaida1, N. Tanigawa1; 1Shinmachi/JP, 2Moriguchi/JP \n(hirokawy@hirakata.kmu.ac.jp)  \nPurpose: The purpose of this study is to ev aluate the characteristic findings of \npilomatricoma on x-ray, CT, and MRI and to correlate the imaging findings with \nhistopathologic features. \nMethods and Materials:  We retrospectively reviewed X-ray (n=3), CT (n=8), \nand MR (n=8) findings of 17 cases in 171 consecutive patients pathologically \nconfirmed pilomatricomas during 2006-2012. The radiologic findings of various \ntissues within tumours were evaluated by x-ray, CT, and MRI. The study \npopulation included 10 men and 7 women with a mean age of 27.3 years \n(range 2-94 years). The lesions were located in the subcutaneous fat layer of \nthe head and neck (n=9), extremity (n=8). Imaging findings of all cases were \ncompared with histopathologic findings. \nResults: On MRI, in all cases, tumours showed isointensity compared with \nadjacent skeletal muscle on T1, T2WI. But on T2WI, 6 of 8 cases showed \nvarious degree of reticular and/or patchy hyperintense area. On CT, 6 of 8 \ncases showed isodensity compared with skeletal muscle. Four cases \ncombined low-density areas, partially . Seven of 8 cases had combined \ncalcification. Four cases showed fine and other 3 cases showed coarse \nnodular calcification. In comparison with pa thologic finding, isointensity areas \non T1, T2WI and iso- or high-density areas on CT compared with skeletal \nmuscle were corresponding to intercellular cement, granulation, fibrosis and \ncalcifications. And low-density areas on CT and reticular and amorphous high-\nintensity areas on T2WI were corresponding to basaloid cells and ghost cells \nwithin tumour. \nConclusion: Radiologic findings of pilomatricoma have some characteristic \nfindings which are fine and/or spotted cal cifications (X-ray, CT)and isointensity \ncompared with skeletal muscle combined funi cular or reticular high-intensity \narea (T2WI). These findings were useful for differential diagnosis.  \nB-0567 11:24  \nNeurovascular invasion by soft-tissue sarcoma: assessment with MR \nimaging in 174 cases  \nK. Holzapfel, J. Regler, H. Rechl, K. Specht, R. von Eisenhart-Rothe, \nR. Gradinger, E.J. Rummeny, K. Wörtler; \nMunich/DE (holzapfel@roe.med.tum.de)  \nPurpose: To evaluate MR imaging in the assessment of neurovascular \ninvasion by soft-tissue sarcoma. \nMethods and Materials:  MR images of 174 patients with soft-tissue sarcoma \nwho subsequently underwent resection/amputation were analysed by two \nreaders. To assess neurovascular invasion, extent of contact between tumour \nand neurovascular structures was classified using a five-point scale (no \ncontact, contact \u000290°, 91-180°, 181-270°, >  271°). Interobserver agreement in \nquantifying contact between tumour and neurovascular structures was \ncalculated using kappa coefficients. Imaging findings were correlated with \nintraoperative findings and/or results of histopathology. ROC analysis was \nperformed to determine the optimal threshold value to predict neurovascular \ninvasion. \nResults: Intraoperative evaluation/histopathology confirmed neurovascular \ninvasion in 25.3% of patients. Interobserver agreement in quantifying contact \nbetween tumour and neurovascular structures was excellent for arteries, veins \nand nerves (kappa: 0.85/0.89/0.89). ROC analysis revealed an optimal \nthreshold value of > 180° for the prediction of arterial, venous and neural \nInvasion for Reader1 and for arterial and venous invasion for Reader2, \nwhereas the threshold value for nerves was > 270° for Reader2. Using these \ncut-off values, sensitivities/specificities in diagnosing invasion of arteries, veins \nand nerves were 84.6%/97.5%, 84.6%/97.5% and 77.8%/93.2% for Reader1 \nand 84.6%/93.8%, 84.6%/94.7% and 72.2%/97.3% for Reader2. The areas \nunder the ROC curves for arteries, veins and nerves were 0.95/0.95/0.93 \n(Reader1) and 0.95/0.96/0.92 (Reader2). \nConclusion: MR imaging allows reliable and accurate assessment of \nneurovascular invasion by soft-tissue sarcoma. Neurovascular invasion should \nbe diagnosed, if contact between tumour and vascular/neural circumference \nexceeds 180°.  \nB-0568 11:33  \nUltrasound-guided biopsy in bone lesions: how and when it can be done. \nPreliminary results  \nS. Pozza\n1, A. De Marchi1, M. Boffano1, G. Biino2, R. Piana1, C. Faletti1; \n1Turin/IT, 2Pavia/IT (simona.pozza@gmail.com)  \nPurpose: Bone biopsy is usually under CT guidance. The aim of this study is \nto propose US guided biopsy in specified bone lesions with cortex interruption \nbut without soft tissue involvement. \nMethods and Materials:  From January 2012 to February 2013, thirteen \npatients underwent an US guided biopsy for a bone lesion. The lesions, always \ncharacterised by a cortex interruption, were located in the lower limb (3 cases), \nin the upper limb (4), in the chest (3), and in the pelvis (3). To assess the \ndiagnostic accuracy we evaluated agreement between the diagnosis made on \nbone tissue specimens from needle biopsy and either the final diagnosis or the \nclinical evolution (whether not further surgically treated) by means of Cohen's \nkappa. This coefficient is a statistical measure of inter-rater agreement for \ncategorical items. \nResults: In 10 cases out of 13 the diagnosis was obtained correctly. The \ndiagnosis were myeloma (3 cases), metastases of carcinoma (3), metastases \nof sarcoma (1), giant cell of the bone (2), Tietze's disease (1), not diagnostic \nbiopsy (3). On 13 patients 5 tumors types were diagnosed, so that 5 items \nwere considered for Kappa coefficient cal culation. In three patients insufficient \nmaterial was obtained to allow a histological diagnosis. In the remainder 10 \npatients a perfect agreement was observed (k=1, p < 0.05). \nConclusion: In accurately selected cases the biopsy of bone lesions can be \nperformed under US guide. This technique is eventually more time effective \nand does not use ionising radiation. Fu rther studies are needed to confirm our \nresults.  \nB-0569 11:42  \nMagnetic resonance guided focused ultrasound surgery for osteoid \nosteoma  \nA. Bazzocchi1, A. Napoli2, P. Spinnato1, D. Diano1, G. Facchini1, M. Busacca1, \nC. Catalano2, U. Albisinni1; 1Bologna/IT, 2Rome/IT (abazzo@inwind.it)  \nPurpose: This work presents the six months after and the preliminary \nexperience in the treatment of osteoid osteoma by magnetic resonance guided \nfocused ultrasound surgery (MRgFUS), at the Rizzoli Institute. \nMethods and Materials:  Six patients affected by osteoid osteoma were \ntreated by MRgFUS (ExAblate 2100, InSightec, Israel on 1.5 T Signa Twin \nSpeed MR-system, GE, USA), and were followed at 1, 3, and 6 months after \nthe procedure. Only osteoid osteomas with typical presentation, according to \nclinical and imaging findings, were recruited. Pain and function were scored \nbefore and after MRgFUS. \nResults: Patients were all males, ageing 18-46 years old (BMI 26.2 ±4.9, range \n19.3-34.5 Kg/m2) and presented with pain scoring 5 to 10 on a visual analogue \nscale basis [VAS - 0-10 scale]). All osteoid osteomas were located at femur \n(head/neck in 4, diaphysis in 2), and in one case a recurrence after \nradiofrequency ablation was treated. No intra- and post-procedure \ncomplications or adverse effects were observed. VAS immediately dropped to \n2.3±1.6 (0-5, at discharge) (p < 0.001), and flattened to 0 in all patients from \nthe 1-month check. At 6 months, no pain or function limitations were present. \nConclusion: MRgFUS is safe, and extremely effective in the treatment of \nosteoid osteoma. This interventional procedure pushes the front of treatment to \nan even less invasive approach, and this may represent a true competitor of \nany other method in today's clinical management of osteoid osteoma.  \nB-0570 11:51  \nMRgHIFU treatment in pain palliation of bone metastases: initial \nexperience from the Rizzoli orthopaedic institute  \nA. Bazzocchi\n1, A. Napoli2, P. Spinnato1, F. Ponti1, M. Busacca1, C. Catalano2, \nU. Albisinni1; 1Bologna/IT, 2Rome/IT (abazzo@inwind.it)  \nPurpose: Bone metastases are the most common cause of cancer-related \npain. The aim of this work was to assess the efficacy of MRgHIFU in the \ntreatment of pain caused by bone metastases, in the preliminary cohort of \npatients treated at our Institute. \nMethods and Materials:  From November 2012, 16 patients affected by bone \nmetastases were enrolled in the study. Pain and quality of life were scored \nbefore and after MRgHIFU (ExAblate 2100, InSightec, Israel on 1.5 T Signa \nTwin Speed MR-system, GE, USA). A clinical follow-up was performed at 1, 3 \nand 5 months. \nResults: Twenty lesions were treated in 16 patients (7 males, 9 females, age \nrange 47-83 years) with different primary cancers (4 breast, 4 kidney, 3 lung, 3 \nS258  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nthyroid, 1 colon, 1 rectum). The treated lesions were located as follows: 17 at \npelvis (85%), 2 at femur, 1 at rib. In five patients the bone lesion was single. \nTreatments were performed under spinal anesthesia in 14/16 patients, under \ngeneral anesthesia in 2/16. Two patients died during the follow-up \n(approximately 2 months after the treatment), while ten patients reached the 3-\nmonth check point, and five the 5-month one. According to visual analogue \nscale (VAS, 0-10 points) results, the average pain drop after 1 month \namounted to 57%, and this was 86% at both 3 and 5 months from baseline (all \np \n< 0.01), with 3 out of 5 patients presenting VAS=0. \nConclusion: Our preliminary experience shows the efficacy and the safety of \nMRgFUS in controlling the pain of bone metastases from different primary \ncancers.  \n10:30 - 12:00 Room F1  \nOncologic Imaging  \nSS 916  \nEmerging applications of diffusion-\nweighted MRI  \nModerators:  \nA. Luna; Jaen/ES  \nM.C. Roethke; Heidelberg/DE  \nB-0571 10:30  \nIs whole-body diffusion-weighted imaging all we need for detecting \nmetastases in melanoma patients?  \nG. Conte, G. Petralia, P. Summers, S. Alessi, A. Testori, M. Bellomi; Milan/IT  \n(giorgio.conte@ieo.it)  \nPurpose: To investigate whether whole-body diffusion-weighted imaging (WB-\nDWI) is adequate for detecting metastases in melanoma patients or must be \ncombined with contrast-enhanced WB magnetic resonance imaging (ceWB-\nMRI). \nMethods and Materials:  One-hundred and forty-seven WB-DWI and ceWB-\nMRI studies were performed quarterly in 23 patients with advanced melanoma. \nThe reference standard was biopsy, other imaging, or changes on follow-up. \nFindings of metastasis in separate WB-DWI and WB-DWI+ceWB-MRI readings \nwere compared using 5 statistics. \nResults: Eleven patients were metastatic by reference standard. At reading, \n14 patients were considered positive and 9 negative for metastases by WB-\nDWI: 9 proved to be TP, 5 FP, 7 TN and 2 FN. Fifteen patients were \nconsidered positive and 8 negative for metastases by WB-DWI+ceWB-MRI: 10 \nTP 5 FP, 7 TN and 1 FN. Both techniques failed to detect the presence of \nmetastasis in a patient with local recurrence, and WB-DWI failed in one with \ncase of brain metastasis. There was almost perfect agreement between \ntechniques for detection of patients with metastases ( 5M=M93.7 %, 95 % CI 81.5-\n100 %). A total of 21 metastatic findings were observed by reference standard, \nof which 16 were detected using WB-DWI (16 TP, 5 FN, 6 FP), and 19 using \nWB-DWI+ceWB-MRI (19 TP, 2 FN, 12 FP). Both techniques failed to detect a \nlung metastasis and a local recurrence, and WB-DWI did not detect three brain \nmetastases. \nConclusion: WB-DWI without additional WB-ceMRI sequences is promising \nfor detecting extracranial metastases in melanoma patients, but contrast-\nenhanced MRI is required for brain evaluation.  \nB-0572 10:39  \nPossibilities of diffusion-weighted magnetic resonance imaging in \ndetection of peritoneal dissemination in case of recurrent ovarian cancer  \nI. Sychenkova, N. Rubtsova; Moscow/RU (sichiu@rambler.ru)  \nPurpose: To determine the possibilities of DWI MRI in detection of \ndissemination on the peritoneum of abdomen and pelvis in patients with \novarian cancer, who underwent specialised antineoplastic therapy, with the \npresence of recurrence according to the results of oncomarker test. \nMethods and Materials: The study included 28 female patients (age range: 41 \nto 69 years) with the presence of recurrence according to the results of \noncomarker test. All the patients underwent MRI, whose data were \nsubsequently compared with the histopathological examination of remote \nspecimens. MRI was performed in two stages: the first one was carried out with \nthe use of a protocol that included Sg T2, Ax T2, Cor T2 FatSat, Obl-Ax T2, \nObl-Cor T2 and Co T1; the 2\nnd - with addition of DWI MRI to the standard \nprotocol. \nResults: The indicators of MRI diagnosti c effectiveness when using the \nstandard protocol were the following: accuracy 50%, sensitivity 48%, and \nspecificity 66%. The informativity measures when using the DWI MRI method \nincreased to: 92% for accuracy, 93% for sensitivity and 100% for specificity. \nConclusion: The use of DW MRI significantly increases the diagnostic \nefficiency measures of the technique in the diagnosis of recurrent ovarian \ncancer. Considering the high technique informativity, it is recommended to be \nobligatory included into the examination protocol for monitoring of patients, \nwho underwent specialised antitumour treatment for ovarian cancer.  \nB-0573 10:48  \nTo analyse whether values of ADC have a correlation with survival and \nwith epidermal growth factor receptor amplification in glioblastoma  \nR. Zalazar, M. Paramo, M. Hernandez, j. Etxano, P. Garcia Barquin, \nP. Dominguez, H. Quiceno Arias, E. Guillen, M. Garcia de Eulate; \nPamplona/ES (lzalazar@unav.es)  \nPurpose: To analyse whether values of appar ent diffusion coefficient (ADC) \nhave a correlation with survival and with epidermal growth factor receptor \n(EGFR) amplification in glioblastoma (GBM). \nMethods and Materials:  49 patients with untreated GBM were analysed and \nunderwent a diffusion-weighted imaging study before surgery (mean=6 days). \nMean follow-up (18.69 months-DS ± 10.3). A ROI was drawn on ADC map in \nthe highest restriction region of the tumor and on the normal-appearing \ncontralateral white matter (NCWM). ADC-min values were evaluated as well as \nADC-index defined as a ratio between tumoral ADC-min and NCWM-ADC \nmean. EGFR amplification, tumoral volume, residual volume, progression-free \nsurvival (PFS) and overall survival (OS) were analysed. Student t test, reciever \noperating curves (ROC), Kaplan-Meier and Cox regression model were \nperformed. \nResults: 30 patients had EGFR unamplified. 39 patients had complete \nresection. Presurgical tumoral volume (mean=42.1 cm 3) and postsurgical \nvolume (mean=0.65 cm 3) had no association with survival. Both ADC-values \nand ADC-index were not related with EGFR amplification. On Kaplan-Meier \nanalyses, EGFR amplification was correlated better with a decrease in PFS \n(p=0.029), while ADC-index > 0.7 correlates better with OS ( p < 0.001). EGFR-\nunamplifided patients with ADC-index < 0.7 had a significant decrease in PFS \n(p=0.002) and OS ( p < 0.01). Patients with EGFR amplification and ADC-\nindex> 0.7 had better OS than patients with ADC-index < 0.7 (p=0.028), without \ndifferences in PFS. The ADC-index value of 0.7 represents the best cut-off \nvalue for predicting OS. ADC-index was a significant predictor variable on Cox \nregression model (p=0.024). \nConclusion: The EGFR amplification is significantly correlated with PFS, while \nADC-index condition OS in GBM. EGFR and ADC-index could be strong \npretreatment predictors of survival in patients with GBM.  \nB-0574 10:57  \nPredicting treatment response in lymphoma: value of pretreatment \napparent diffusion coefficient and its early change during chemotherapy  \nS.A. Kharuzhyk, N.V. Sachivko; Minsk/BY (skharuzhyk@nld.by)  \nPurpose: To evaluate usefulness of pretreatment apparent diffusion coefficient \n(ADC) and its early change during chemotherapy to predict treatment response \nin lymphoma. \nMethods and Materials:  Whole body MRI with diffusion weighted imaging \n(b=0 and 800 s/mm 2) was performed in 19 patients (26-76 years) with \nmorphologically confirmed lymphoma before treatment and repeated at the \nlevel of target lesion (largest lymph node) after first, before and after second \ncycles of chemotherapy. ADC was measured on three adjacent slices and \naveraged to get target lesion ADC. Tumors were considered responding to \ntreatment if product of two maximal perpendicular diameters decreased by \nmore than 50%. \nResults: Pretreatment ADC was equal to 0.99×10 -3 mm2/c and increased by \n47%, 74% and 88% after first, before and after second cycles of \nchemotherapy. Product of tumor diameters before treatment was equal to \n3089 mm\n2 and decrease by 43%, 47% and 74% correspondingly. There was a \npositive correlation between pretreatment ADC and residual tumor size after \nfirst (r = 0.47, p = 0.057), before (r = 0.51, p < 0.03) and after second (r = 0.60, \np < 0.01) cycles. In ROC-analysis pretreatment ADC cut-off of 0.69×10 -3 mm2/c \npredicted tumor response after first cycle of chemotherapy with 50% sensitivity \nand 82% specificity (Az=0.63). Pretreatment ADC cut-off of 0.82×10 -3 mm2/c \npredicted tumor response after second cycle of chemotherapy with 60% \nsensitivity and 100% specificity (Az=0.85). \nConclusion: ADC increases early during treatment in parallel and does not \nprecede decrease in tumor size. Pretreatment ADC can predict tumor \nresponse after second cycle of chemotherapy.  \nS259  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0575 11:06  \nDiffusion-weighted MR imaging and volume measurements in \nassessment of early tumour response to antiangiogenic therapy  \nM.J. Schneider, K. Nikolaou, C. Cyran, M.F. Reiser, O. Dietrich; \nMunich/DE (Moritz.Schneider@med.uni-muenchen.de)  \nPurpose: To evaluate the combination of DW-MRI and volume measurements \nto classify placebo and therapy group in an experimental tumour model. \nMethods and Materials:  In 23 athymic nude rats, human colon carcinoma \nxenografts (HT-29) were implanted in the left flank. Animals were examined \nbefore and 7 days after treatment onset with regorafenib (n=12) or placebo \n(n=11) in a 3-Tesla whole-body system. For DW-MRI, a single-shot EPI \nsequence with 0.5×0.5×2 mm³ resolution and 9 b-values (10-800s/mm²) was \nused. The apparent diffusion coefficient (ADC) was calculated voxelwise by \nmonoexponential fitting. Multi-slice regions of interest were defined covering \nthe entire tumour, within which the median was taken as representative tumour \nADC. Tumor volume was determined using a T2-weighted turbo-spin-echo \nsequence with 0.3×0.3×1.5 mm³ resolution and TR/TE=9560/91 ms. Observed \nabsolute ADC and relative volume changes between first and second \nmeasurement were evaluated as classifiers by a receiver-operator-\ncharacteristic (ROC) analysis individually, followed by a Fisher's linear \ndiscriminant analysis (FLDA) combining both parameters. \nResults: Sensitivity, specificity, and accuracy of the ADC-based ROC analysis \nwere 0.875, 0.636, and 0.783, respectively (ADC-change cutoff: \n0.033 mm²/10³s, above=therapy), and for the volume 0.818, 0.818, and 0.826, \nrespectively (volume-change cutoff: 61.4%, below=therapy). The combined \nFLDA approach yielded a sensitivity of 0.833, specificity of 1 and accuracy of \n0.913. \nConclusion: The combination of both parameters slightly decreased the \nsensitivity compared to using ADC alone; however, a considerable increase in \nspecificity was achieved resulting in the highest diagnostic accuracy, thus \noutperforming the use of either ADC or tumour volume individually in the \ndifferentiation of therapy vs. placebo group.  \nB-0576 11:15  \nComparison between ADC and extravascular extracellular volume in \noncologic patients under chemio-radiotherapy: preliminary results  \nL. Natale\n1, C. Biagini2, M. Betti2, C. Biagini2, G. Izzo1, L. Cionini2; 1Rome/IT, \n2Sesto Fiorentino/IT (lnatale@rm.unicatt.it)  \nPurpose: To compare the apparent diffusion coefficient (ADC) changes, \nobtained by diffusion-weighted imaging (DWI) with the extravascular \nextracellular volume (Vee) changes, obtained by T1 perfusion imaging (DCE-\nMRI), in patients receiving chemo-radiotherapy. The rationale lies in the \ncommon micro-biological interpretation of both parameters, the tissue \"cell \ndensity\". Consequently, their change, obtained simultaneously with \nindependent methods, should correlate positively and linearly, within the \nexperimental errors. \nMethods and Materials:  12 consecutive patients with different tumours \nunderwent a baseline MRI and a second MRI after two weeks from the \nbeginning of the therapy, for early assessment of treatment efficacy. An \nexperienced radiologist contoured a region of interest (ROI) on DWI images to \nlocalise the lesion and to obtain the mean ADC value. After a post-processing \nwith dedicated software (Tissue4D, Siemens HealthCare, Erlangen), the same \noperator contoured a ROI on the considered lesion in DCE-MRI to obtain the \nmean Vee value. The relative variation of the two parameters, calculated as \n(X2weeks - Xbaseline)/Xbaseline was plotted. \nResults: Our measurements, although strongly affected by experimental error, \ndemonstrate an evident correlation between ADC and Vee: the variations of \nboth parameters show a positive and linear behaviour for almost all of the \npatients under study. Only in patients with prostate cancer, the variations of \nADC and Vee seem not follow any correlation. \nConclusion: ADC and Vee changes after chemo-radiotherapy appear to be \nclosely related, confirming their depende nce on cellular density, except in \npatients with prostate cancer in which a new interpretative paradigm seems to \nbe necessary.  \nB-0577 11:24  \nThe role of DWI as a marker of prediction of tumour grade in endometrial \ncancer: preliminary results  \nC.L. Piccolo, R. Del Vescovo, A. Ramaglia, E. Schena, F. Giurazza, \nR.F. Grasso, B. Beomonte Zobel; Rome/IT  (c.piccolo@unicampus.it)  \nPurpose: To evaluate the effectiveness of diffusion-weighted MRI (DW-MRI) in \nthe assessment of tumour grade in endometrial lesions. \nMethods and Materials:  54 endometrial lesions including 27 endometrial \ncancers and 27 benign lesions were enrolled in our prospective study. DWI \nwas performed with b factors values of 0, 500, and 1000 s/mm -2. The region of \ninterest was defined within the tumor on T2-weighted EPI image and then \nmanually copied to an apparent diffusion coefficient (ADC) map. Then, the \nADC value was obtained and the calculation of mean ADC value was \ncorrelated with histology. \nResults: The mean ADC values for histological grade 1 and 2 were 0.79 x10\n-\n3 mm2s-1 and 0.73 x10 -3 mm2s-1 for grade 3 endometrial lesions. There was no \nstatistically significant difference between tumour grades. The mean ADC \nvalue for endometrial carcinoma (grouping all types of tumors) was significantly \nlower (p < 0.01) than that of benign endometrial lesions. A cut-off mean ADC \nvalue of less than 1.01 x10 -3 mm2s-1 yielded a sensitivity, specificity and \naccuracy of 89.3%, 87.5% and 88.8% respectively. \nConclusion: ADC measurements can quantitatively differentiate between \nbenign and malignant endometrial lesions. However, tumor mean ADC is not \nuseful in the assessment of tumor grade.  \nB-0578 11:33  \nDW-MRI for the characterisation of focal liver lesions in cancer patients  \nR. Chojniak, M.L. Testa, L.S. Sene; São Paulo/BR \n(chojniak@accamargo.org.br)  \nPurpose: Most studies accessing the ability of DWI-MR to differentiate benign \nand malignant liver lesions included cysts in the analysis. Cysts are easy to \ndiagnose and have high ADC values what increases diagnostic accuracy of \nsuch studies. Comparison of the ADC values obtained for cysts, solid benign \nand metastatic liver lesions in cancer patients is presented. \nMethods and Materials:  ADC values of 325 liver lesions in 115 adult cancer \npatients were prospectively analysed. Lesions were diagnosed throughout \nimaging and clinical characteristics. On e hundred and five benign (42 cysts, 63 \nsolid benign) in 57 patients and 262 metastatic lesions in 58 patients were \nincluded. ADCs were obtained with 0.600 sec/mm² b values. ROC analysis \nwas conducted to evaluate ADC performance for metastasis diagnosis. \nResults: The mean ADC values were 2.3, 1.4 and 1.1 x 10-3 mm²/sec for \ncysts, solid benign and metastatic lesions. Benign and metastatic lesions \nADCs' were different when cysts were included (p < 0.0001) but not when only \nsolid benign lesions were analysed (p=0.10). The ADC cutoff value of 1.3 x 10-\n3 mm²/sec differentiates benign solid and metastatic lesions with an accuracy \nof 66%. \nConclusion: In cancer patients, ADC value cannot confidently differentiate \nsolid benign and metastatic liver lesions. Most studies that suggest that \napplication included cystic lesions in the evaluation and must have the results \nanalysed with caution.  \nB-0579 11:42  \nCorrelation between DWI-ADC values and histological cellularity in bone \nmarrow biopsy in patients affected by lymphoma  \nS. Carbone, I. Grazzini, A. Fausto, L. Leoncini, M. Mazzei, L. Volterrani; \nSiena/IT (fracarb@gmail.com)  \nPurpose: To investigate the relationship between crest bone marrow apparent \ndiffusion coefficient (ADC) and cellularity percentage obtained by bone marrow \nbiopsy (BMB) in a population of patients affected by lymphoma scheduled for \nwhole-body MR examination. \nMethods and Materials:  26 consecutive patients (age 44 ±16 years old) \naffected by Hodgkin Disease (HD, 15 cases) and non-Hodgkin lymphoma (9 \nDLBCL and 2 MCL) underwent whole body MR, for a total of 30 studies. Seven \nno-hematologic patients were used as normal controls. ADC was extrapolated \nfrom diffusion-weighted data set on pel vis by whole-body SE-EPI inversion \nrecovery imaging (b-value 800 sec/mm2), using a ROI-based method. All the \nhematologic patients underwent BMB (mean interval 86 days). \nResults: ADC was lower in controls than in patients with lymphoma \n(p < 0.0001) and it increased significantly with bone marrow cellularity with no \nlinear fit (p=0.002). Furthermore, ADC was significantly lower in low cellular \nmarrow (cellularity < 30%, p < 0.05). \nConclusion: ADC seems to be a potential biomarker of bone marrow \ncellularity in patients affected by lymphoma. A prospective study on a largest \npopulation could be useful to confirm this preliminary data and to evaluate \nclinical implications of these findings.  \nB-0580 11:51  \nOptimisation of b-values in MR diffusion-weighted acquisitions through \ninformation theory: a mathematical justification for consensus  \nA. Alberich-Bayarri, R. Sanz-Requena, G. García-Martí, L. Marti-Bonmati; \nValencia/ES (angel.alberich@quiron.es)  \nPurpose: To address the problem of b-value optimisation in DW-MR as a \nsignal compression problem in the frame of information theory and the \nproperties of the Fisher information matrix (FIM), focusing on 4 optimum b-\nvalues that contain most of the informati on of the signal and provide minimum \nestimation error of the diffusion parameters. \nMethods and Materials:  In order to analyse the amount of information of the \nbiexponential signal decay model, the FIM was calculated, which objectivises \nthe amount of information that an observation carries about unknown \nS260  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nparameters. To determine the typical biol ogical distributions of D, D* and f \nvalues through different organs and parenchyma, a systematic literature review \nof relevant intra-voxel incoherent motion (IVIM) DW studies in brain, breast, \nabdomen, pelvis and musculoskeletal tissues was performed. The \ndetermination of the 4 optimum b-values that achieved a proper fit of the IVIM \nmodel was performed by considering the b-value 0 in conjunction with the 3 b-\nvalue ranges providing the maximums of the 3 FIM diagonal elements. \nResults: The optimum b-values obtained for brain were 0, 15, 65 and \n682s/mm2; for breast 0, 8, 41 and 390s/mm2; for abdomen 0, 10, 50, 351 \ns/mm2; for pelvis 0, 25, 110, 674s/mm2; musculoskeletal 0, 24, 110, \n657s/mm2. \nConclusion: An optimum set of b-values according to information theory was \nobtained for different regions and biologic al situations in the body. The results \ntogether with a validation currently being performed with clinical data will add \nrelevant insight into consensus over a standardised b-value sampling scheme \nin DW-MR.  \n10:30 - 12:00 Room F2  \nBreast  \nSS 902  \nMRI  \nModerators:  \nU. Bick; Berlin/DE  \nJ. Veltman; Almelo/NL  \nB-0581 10:30  \nInfluence of background enhancement on the diagnostic accuracy of \nbreast MRI  \nM. Dietzel\n1, W.A. Kaiser2, P.A.T. Baltzer3; 1Erlangen/DE, Jena/DE, 2Jena/DE, \n3Vienna/AT, Jena/AT (dietzelmatthias2@hotmail.com)  \nPurpose: Background enhancement (BE) in breast MRI is often attributed to \nhormonal stimulation. Although strong BE is considered as a diagnostic \nchallenge in clinical practice, empirical evidence for this assumption is limited. \nThe present study aims to investigate the diagnostic accuracy of breast MRI \nstratified by the degree of background enhancement. \nMethods and Materials:  Consecutive patients undergoing breast MRI (1.5 T, \nunenhanced T2w and dynamic contrast-enhanced T1w sequences in \nconcordance with international recommendations) with subsequent histological \nsampling of imaging detected lesions were eligible for this IRB approved \nretrospective study. Breast MRI were read by two experienced radiologists \nblinded to histopathology results in consensus. Lesions were classified \naccording to BI-RADS. Furthermore, background enhancement (BE) was \ninvestigated and graded on an ordinal scale as \"distinct\" or \"not distinct\". \nFinally, diagnostic parameters were calc ulated and stratified by the grade of \nBE. \nResults: 664 lesions were included (423 malignant, 241 benign). BE was \n\"distinct\" in 78 (11.7%) and \"not distinct\"  in 586 cases (88.3%). Sensitivity and \nspecificity of breast MRI showed only slight differences between the \"not \ndistinct\" (93.0% and 81.7%) and \"distinct\" BE group (94.9% and 74.4%; all: \nP=n.s). However, the PPV (positive predictive value) was significantly lower in \nthe subgroup exhibiting \"distinct\" BE (78.7%) compared to the \"distinct\" BE \nsubgroup (90.6%; P=0.02). \nConclusion: Presence of \"distinct background enhancement\" leads to an \nincreased false positive rate, significantly decreasing the PPV of breast MRI.  \nB-0582 10:39  \nComparison of morphologic and dynamic characteristics of only MR-\nvisible lesions at 1.5 T vs. 3 T according to 425 MR-guided breast \nbiopsies  \nA. Malich\n1, J. Dvorak1, U. Teichgräber2, A. Kott1, J. Feger1; 1Nordhausen/DE, \n2Jena/DE (ansgar.malich@shk-ndh.de)  \nPurpose: To compare morphological features of only MR-visible lesions at \n1.5 T vs. 3 T according to the histopathology after MR-guided biopsy. \nMethods and Materials:  425 MR-guided biopsies were analysed. Lesions \nhomogeneity, margins, oedema, T2w-density, adjacent vessels, shape, etc. \nwere analysed and matched to histopathology. 354/71 interventions were \nperformed at 1.5 T/3 T (Philips Achieva/Ingenia). Mean lesion size was 6 and \n7 mm. \nResults: 285/354 and 62/71 biopsies were finished successfully (19.5% vs. \n9.8%). Most of 1.5 T interventions were aborted due to claustrophobia, lack of \nspace, the only reason for abortion at 3 T was lack of lesions visualisability. \n50.8%/42.2% were proven as B2 at 1.5 T/3 T; 14.4%/24.0% as in situ and \n15.3%/24.0% as malignancies. Oedema was observed more common at 3 T: \nbenign:13.3%; in situ: 29.4%; malignant: 11.8% at 3 T (10.6%;17.6%;13.0% at \n1.5 T). Spiculations were significantly more often visible at 3 T at all dignities \n(40.0%; 23.5%; 47.2% at benign, in situ, malignant lesions) vs. 21.7%; 25.5%; \n57.4% at 1.5 T. Adjacent vessels were observed in 17.2%; 11.8%; 27.8% at \n1.5 T vs. 20.0%; 23.5%; 29.4% at 3 T-based MR-guided biopsies. Ring \nenhancement was more common at 3 T (20.0%; 23.5%; 29.4% at 3 T vs. \n17.2%; 11.8%; 27.8% at 1.5 T). Unsharp edge was more common at \nmalignancies at 1.5; related spicul ations were more obvious at 3 T \n(malignancies; unsharp edge 57.4% vs. 29.4%; spiculations 18.5% vs. 52.9%). \nConclusion: Morphologic characteristics differ dignity-related (malignancies \nare spiculated, inhomogeneous, unsharp with ring enhancement, adjacent \nvessel and blooming) but also according to higher resolution of 3 T-MRI. \nLesion discrimination is more reliable at 3 T with a higher percentage of \n(pre)malignant histologies according to MR-guided biopsy. Biopsy procedure at \n3 T is more comfortable due to larger bore and better positioning opportunities.  \nB-0583 10:48  \nTime-to-peak tumor sub-volume in invasive carcinomas and \nfibroadenomas  \nM. Nadrljanski, R. Maksimovic, V. Plesinac-Karapandzic, M. Nikitovic, \nB. Markovic-Vasiljkovic, Z. Milosevic; Belgrade/RS \n(dr.m.nadrljanski@gmail.com)  \nPurpose: To assess the distribution of time-to-peak (TTP) intralesional signals \nand define the TTP tumor sub-volume (TTP Vol). in benign and malignant \nbreast lesions, as it is known that fibroadenomas (FA) have lower blood vessel \ndensity than invasive ductal carcinomas (IDC). \nMethods and Materials: Forty patients were assessed with 1.5 T unit on DCE-\nMRI examination with Gd-DTPA. Tumor volume (Tu Vol). was computed for \neach lesion, taking into consideration the three dimensions. TTP Vol. was \ncomputed for each lesion in the largest connected area of pixels at a set \nthreshold. The lesions were histologically  verified as FA (n=20) or IDC (n=20) \nand statistically analysed. TTP Vol./Tu Vol. ratio, as the relation between the \n'hot-spot' and the whole tumor, was calculated for all lesions. \nResults: The difference in Tu Vol. between the two subgroups (7.0 ±4.3 for IDC \nvs. 6.2 ±5.1 for FA, p=0.36), was not significant, unlike the difference in TTP \nVol. in two subgroups (5.3 ±3.1 for IDC vs. 3.4 ±3.2 for FA, p=0.02). The \ndifference in the TTP Vol./Tu Vol. ratio between the two subgroups (0.77 ±0.11 \nfor IDC vs. 0.52 ±0.14 for FA, p < 0.0001) was highly statistically significant. \nHighly significant correlation between the 'hot-spot' volume and the whole \ntumor volume was confirmed for IDC (r=0.92). \nConclusion: TTP Vol. was greater in IDC compared to FA, particularly if \nregarded as the 'hot-spot volume' to tumor volume ratio, pointing to the \ncorrelated vascular and tumor growth observed in IDC.  \nB-0584 10:57  \nBreast MRI in the evaluation of nipple discharge: less is more  \nR. Ramiro Gandía, J. Camps Herrero, A. Cervera Araez, J. Cano Gimeno, \nV. Ricart Selma, M. Forment Navarro, C. Martinez Rubio; Alzira/ES \n(rramiro@hospital-ribera.com)  \nPurpose: To analyse whether breast MRI in patients with pathologic nipple \ndischarge adds any valuable information. \nMethods and Materials:  Retrospective analysis in 123 consecutive patients \nwith a diagnosis of pathologic nipple discharge and breast MRI exams. US, \nmammography, cytology and galactography were performed in 93, 76, 74 and \n6.5% of all patients respectively. BMRI included a T2 FSE sequence and a 3D \ndynamic T1 GRE sequence (spatial resolution 0.7/0.7/2 mm). MRI was \nconsidered negative when no enhancement, ductal or glandular enhancement \nand probably benign lesions were seen. MRI was deemed positive when \nsegmental, irregular or nodular enhancement adjacent to the central ducts. \nInfluence of MRI was rated as: non existent, diagnosis of a lesion, change of \ntherapeutic approach, overdiagnosis and false negative lesions. Gold standard \nwas pathology. No pathology with a follow-up of greater than 24 months or a \nbenign lesion were considered negative. A diagnosis of papilloma or a \nmalignant lesion was considered positive. \nResults: MRI had no influence in 18.6%, influenced therapy in 20.3%, \ndiagnosed a lesion in 14.6%, showed a greater extent in 5.7%, FP in 9.7%, FN \nin 0.8% and non conclusive in 2 patients. Mean follow-up was 27.2 months. \nDiagnostic accuracy in showed a sensitivity, specificity, PPV and NPV of \n94.7%, 76%, 64.3% and 97% respectively. \nConclusion: MRI is very useful diagnostic tool for diagnosis in 20% and for \nexclusion of disease and therefore can potentially avoid further diagnostic and \nsurgical procedures in patients with a negative study due to its almost 100% \nNPV.  \nAuthor Disclosures: \nJ. Camps-Herrero: Advisory Board; Bayer. Research/Grant Support; Bayer. \nSpeaker; Bayer.  \nS261  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0585 11:06  \nBreast MRI in Pptients with unilateral hematic nipple discharge: \ncomparison with galactography  \nS. Gigli, F. Di Pastena, L. Ballesio, S. Tardioli, I. D' Ambrosio, L. Porfiri; \nRome/IT (adrenalina_1@hotmail.it)  \nPurpose: to assess the role of breast MRI in evaluating Patients with unilateral \nhematic or sero-hematic nipple discharge in comparison with galactography. \nMethods and Materials:  in this retrospective study we included 53 patients \nwith unilateral hematic/serohematic secretion who performed both \ngalactography and MRI. We evaluated the capability of both the techniques to \nidentify the presence/absence of ductal  pathology and to distinguish benign \nfrom malignant lesions.Lesions classified as BIRADS 1/2 underwent to \nfollow-up (performed with mammography, ultrasound or cytology)while the gold \nstandard to assess the type of pathology in lesions classified as BIRADS 3.4 \nand 5 was the histological examination after surgery. \nResults: after surgery and follow-up,8 patients had no pathology (15%),23 had \na diagnosis of papilloma (43%),11 of papillomatosis (21%),5 of Ductal Cancer \nIn Situ (10%)and 6 of papillary carcinoma (11%).Concerning the ability to \nidentify the presence/absence of pathology, both galactography and MRI \npresented a specificity of 100% while sensitivity was 98% for MRI vs 49% of \ngalactography.The ROC analysis was used to test the diagnostic ability of both \nthe modalities separately considered (Galactography and MRI) compared with \nhistological analysis. Considering MRI we found a statistically association \nbetween mass intraductal enhancement and the presence of papilloma \n(p < 0.001;AUC: 0.957; CI 0.888 -1.025),between papillomatosis and ductal \nenhancement (p < 0.001;AUC: 0.790; CI 0.623-0.958),between segmental \nenhancement and DCIS (p=0.007 AUC: 0.750; CI 0.429 -1.071,) and between \npapillary cancer and linear enhancement (p=0.011). \nConclusion: MRI can be considered a valid and alternative tool in detecting \nductal pathologies showing higher values of sensitivity and specificity in \ncomparison with galactography.  \nB-0586 11:15  \nMRI screening for silicone breast implant rupture: accuracy, inter- and \nintraobserver variability using explantation results as reference standard  \nM.C. Maijers, F.B. Niessen, E.F.H. Veldhuizen, M.J.P.F. Ritt, R.A. Manoliu; \nAmsterdam/NL (marikemaijers@hotmail.com)  \nPurpose: In Europe the recall of PIP silicone breast implants in 2010 was \nfollowed by recommendation to remove all ruptured implants. Consequently, \nlarge numbers of asymptomatic women underwent MRI. The accuracy and \ninterobserver variability of MRI is relevant when indications for surgery are \nchiefly based on MRI. Accuracy of MRI was not previously studied in a cohort \nof women, all of whom underwent explantation regardless of symptoms. \nMethods and Materials:  A prospective cohort study included 107 women with \n214 PIP silicone implants who underwent explantation preceded by MRI of the \nbreasts. Two radiologists independently reevaluated in 2013 all MRI \nexaminations being blinded for the previous diagnoses or the outcome at \nsurgery. A structured protocol was developed to describe the MRI findings. The \nex vivo findings served as reference standard. \nResults: In 208 of the 214 explanted prostheses, radiologists agreed \nindependently about the condition of the implants. In five of the six cases they \ndisagreed upon (2.6%), they subsequently reached a non-imposed consensus. \n158 implants were correctly diagnosed as intact and 40 as ruptured. A \nsensitivity of 93%, a specificity of 93%, a positive predictive value of 77% and a \nnegative predictive value of 98% was found. The interobserver agreement was \nexcellent with a Kappa value of 0.92. \nConclusion: MRI has a high accuracy in diagnosing rupture in silicone breast \nimplants. Considering the high Kappa value of interobserver agreement, MRI \nappears to be a consistent diagnostic test. A simple, uniform reporting protocol, \nmay improve communication between radiologist and plastic surgeon.  \nB-0587 11:24  \nPrepectoral oedema as a morphological sign in MR mammography  \nC. Kaiser1, M. Herold2, J. Krammer1, M. Dietzel2, P.A.T. Baltzer2, W.A. Kaiser2, \nS.O. Schönberg1, K. Wasser1; 1Mannheim/DE, \n2Jena/DE (Clemens.Kaiser@umm.de)  \nPurpose: To retrospectively evaluate the role of prepectoral oedema (PE) as a \nmorphological sign in the differential diagnosis of breast lesions. \nMethods and Materials:  Between 01/2005 and 10/2006, a total of 1109 \nconsecutive MRM exams have been performed in our institution. In this study, \nonly patients who would later be biopsied or operated in our own hospital were \nincluded. They had no previous operation, biopsy, intervention, chemotherapy, \nhormone replacement therapy or previous mastitis. In total, 162 patients with \n180 histologically correlated lesions were included. The evaluations were \nperformed by four experienced radiologists in consensus. \nResults: 180 evaluated lesions included 104 malignant lesions (93 invasive \nand 11 non-invasive cancers) and 76 benign lesions. PE was detected in 2.6 % \nof benign lesions (2/76), in none of the DCIS-cases (0/11) and in 25.8 % of \nmalignant lesions (24/93) (p < 0.000). PE were found significantly more \nfrequently in presence of malignant tumours above 2 cm in diameter [(47.1 %; \n16/34) vs. (13.8 %; 8/58)] (p < 0.001). PE was not statistically associated to \nmalignant tumour-type, presence or absence of additional DCIS, and number \nof lesions. This resulted in the following diagnostic parameters for PE as an \nindicator for malignancy: sensitivity of 19.3%, specificity of 97.3%, PPV of \n92.3%; NPV of 48%; accuracy 57.7%. \nConclusion: In case of occurrence, the \"Prepectoral Edema Sign\" seems to \nbe a specific indicator for malignant tumours with a high-positive predictive \nvalue, independent from its entity.  \nB-0588 11:33  \nAxillary node staging in patients with breast cancer on preoperative 3 T \nbreast MRI: a pilot study  \nB. Bresson, T. Dao, P. Beaussart, F. Pigneur, E. Meyblum, R. Bosc, \nY. Belkacemi, A. Rahmouni, A. Luciani; Creteil/FR (bert.bresson@gmail.com)  \nPurpose: To assess the accuracy of 3 T magnetic resonance imaging (3 T \nMRI) in detecting metastatic axillary lymph nodes on routine preoperative \nbreast MRI examination. \nMethods and Materials:  72 patients with histologically proven breast cancers \nreferred for breast MRI staging between July 2010 and June 2013 were \nretrospectively studied. MRI examinations were performed at 3 T, using a \ndedicated breast coil covering also bilateral  axillary area. MRI protocol included \nT1, T2 and 3D sequences after dynamic injection of gadolinium, with a 0.8 mm \nisotropic voxel. The detectability of axillary nodes, and the presence of specific \nMR criteria including size, signal and morphological criteria were assessed and \nconfronted to pathological post-operative findings. \nResults: A total of 21 full axillary lymph node dissections, 45 sentinel lymph \nnode dissections and 6 image-guided biopsy were available for pathological \nconfrontations. 14 patients showed metastatic axillary nodes. Using combined \nsize and morphological criteria, the detectability of axillary nodes on 3 T MRI \nwas 79% with sensitivity, 98% specificity, and 92% NPV. Overall 11/14 N+ \npatients were correctly identified on MRI. \nConclusion: Metastatic axillary lymph nodes can be suggested on routine \npreoperative 3 T breast MRI examinations with high specificity and NPV, with \nfigures close to those reported using dedicated axillary surface coils.  \nB-0589 11:42  \nPreoperative breast MRI: should BI-RADS 3 category be considered?  \nM. Páramo, R. Zalazar, L.J. Pina Insausti, F. Martinez Regueira, A. Elizalde, \nB. Olartecoechea, N. Rodriguez-Spiteri; Pamplona/ES (mparamo@unav.es)  \nPurpose: To compare the sensitivity (SE) and specifity (SP) of preoperative \nbreast MRI including BI-RADS 3 category lesions as positive for malignancy or \nnot. \nMethods and Materials:  51 consecutive patients with histologically proven \nbreast cancer and preoperative breast MRI were selected. 134 breast lesions \nwere evaluated. Preoperative MRI images were interpreted retrospectively by \ntwo breast radiologists blinded to the final diagnosis. BI-RADS 3 lesions were \nincluded as malignant in group 1 and as benign lesions in group 2. All the \nlesions were compared with the gold standard (histology or follow-up). The \nresults were collected using an excel table to calculate the sensitivity and \nspecificity, and the statistical significance was studied using the PEPI software. \nResults: Out of 134 breast lesions, 77 were histologically malignant and 57 \nwere benign. In group 1 the SE and SP of preoperative MRI were respectively: \nSE (98.7 %) and SP (5.3 %). In group 2 the SE and SP of preoperative MRI \nwere respectively: SE (92.2%) and SP (91.2%). The comparison between both \ngroups showed statistically significance for SP (5.3% vs 91.2%, p < 0.05) and \nshowed no statistically differences for SE (98.7% vs 92.2%, p > 0.05). Only 5 \nBI-RADS 3 lesions were finally malignant, all of them were separated from the \nmain tumour less than 15 mm. \nConclusion: Considering BI-RADS-3 category as benign in preoperative MRI \nincreases significantly the specificity without decreasing the sensitivity. All of \nthe malignant BI-RADS 3 lesions were close to the main tumour ( < 15 mm).  \nB-0590 11:51  \nBreast MRI as a problem-solving tool: systematic review and meta-\nanalysis  \nB. Bennani-Baiti, P.A.T. Baltzer; Vienna/AT  \nPurpose: To assess the validity of breast MRI as a problem-solving tool. \nMethods and Materials:  Two investigators independently performed a \nsystematic review using predefined search terms. Discrepancies were resolved \nby final consensus cross-evaluation. We selected only studies whereby breast \nMRI was used for problem-solving purposes i.e. inconclusive \nmammographic/sonographic findings. Studies that focused solely on assessing \nmammographic microcalcification malignancies were excluded. Standard of \nreference had to be established either by histopathology or follow-up \nS262  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nexaminations. Study design, technical parameters, number of true positives, \nfalse positives, false negatives and tr ue negatives were extracted from the \noriginal publications, and possible bias was determined using the QUADAS 2 \napplet. Statistical analysis included data pooling, forest plot construction, and \nheterogeneity testing. \nResults: 11 studies met our inclusion criteria. These comprised 1062 lesions, \nincluding 777 benign and 285 malignant le sions. The negative predictive alue \n(NPV) ranged from 87.5 to 100%, with a pooled NPV of 99.1%. A fixed effects \nmodel was applied due to low heterogeneity (P=0.129). The positive predictive \nvalue (PPV) was highly heterogeneous (P < 0.0001) ranging from 25 to 96.4%. \nBased on a random effects model, the pooled PPV was 53.2%. \nConclusion: This is the first meta-analytical study to demonstrate that breast \nMRI can reliably exclude malignancy when applied as a problem solving tool. \nThese Results: i. alleviate the controversy surrounding the use of breast MRI \nas a problem solving tool; ii. strongly supports its implementation as a problem-\nsolving tool and; iii. should impact the guidelines in breast imaging.  \n10:30 - 12:00 Room I/K  \nNeuro  \nSS 911  \nNeurodegenerative diseases  \nModerators:  \nS. Haller; Geneva/CH  \nT.A. Yousry; London/UK  \nB-0591 10:30  \nThe pattern of white matter alteration in patients with Parkinson's disease \naccording to cognitive status  \nS.-K. Lee, N. Shin; Seoul/KR (c0na@yuhs.ac)  \nPurpose: To assess the pattern of white matter alteration in patients with \nParkinson's disease (PD) according to cognitive status by using diffusion \ntensor imaging. \nMethods and Materials:  From August 2011 till September 2012, we enrolled \npatients with PD-intact cognition (PD-IC, n=10), PD-mild cognitive impairment \n(PD-MCI, n=15), PD with dementia (PDD, n=11), and healthy control subjects \n(n=15). Fractional anisotrophy (FA) map of patient groups was compared with \neach other and that of control subjects by using tract-based spatial \nstatistics (TBSS) where age and education were included as covariates in \nanalysis of covariance. \nResults: Compared with control subjects, FA values were significantly \ndecreased in many major tracts in patients with PD-MCI and more PDD as \nfollows: corpus callosum, bilateral su perior longitudinal fasiculi, bilateral \nanterior corona radiata, bilateral anterior limbs of internal capsule, bilateral \nexternal capsule, bilateral posterior thalamic radiation, bilateral cingulum, and \nleft inferior longitudinal fasciculus. Compared with patients with PD-IC, there \nwere significantly decreased FA values in the body of corpus callosum in \npatients with PDD. There were not significantly decreased FA values in \npatients with PD-IC compared with control subjects. PDD patients with shorter \ndisease duration before dementia ( < 5 years) showed greater decrease in FA \nvalues than those with longer disease duration ( \u00035 years). \nConclusion: These data suggest that white matter damage in PD exhibits a \ngreater extent with increasing levels of cognitive impairment. In addition, white \nmatter alteration responsible for PDD may differ according to disease duration \nof PD.  \nB-0592 10:39  \nIron load in genetic Parkinson's disease measured using MRI  \nN. Pyatigorskaya, J.-C. Corvol, M. Sharman, A. Brice, S. Lehericy; Paris/FR \n(nadya.pyatigorskaya@gmail.com)  \nPurpose: Although most cases of Parkinson's disease (PD) are sporadic, \ngenetic forms of PD exist. In idiopathic PD (IPD), iron load is increased in the \nsubstantia nigra (SN). The goal of this work is to measure the iron load in the \nSN and the basal ganglia (BG) of patients carrying genetic mutations \nassociated with PD. \nMethods and Materials:  Measurements of T2 and T2* relaxation times were \nperformed at 3 Tesla in 20 IPD patients, 20 subjects with LRRK2 or Parkin \nmutations related to PD (10 symptomatic patients and 10 non-symptomatic \ncarriers), and 20 control subjects. In all cases, R2* and R2 mean values for SN \nand BG were calculated. \nResults: R2* values were increased in IPD and mutation-carrying PD patients \nas compared to controls (p < 0.0001) and also in mutation-carrying PD patients \nas compared to IPD (p=0.0023). Asymptomatic mutation carriers showed R2* \nvalues higher than those of controls (p= 0.021), but not significantly different \nfrom those of IPD patients. No changes were observed for R2 values in SN \nand BG or R2* values in BG. \nConclusion: Iron load in the SN of the mutation-carrying subjects \n(symptomatic and asymptomatic carriers) was increased. Genetic PD patients \nshowed greater iron load increases than IPD patients. Iron load, analysed with \nR2* can be regarded as a biomarker of the nigrostriatal degenerative changes \nin mutation carriers associated with neurodegeneration. The role of iron load in \nneurodegeneration in mutation-carrying subjects, as well as its prognostic \nvalue has yet to be elucidated.  \nB-0593 10:48  \nIs there an association between leukoaraiosis volume and diabetes?  \nL. Saba, R. Montisci, R. Sanfilippo, M. Piga, E.A. Genovese; Cagliari/IT  \n(lucasaba@tiscali.it)  \nPurpose: The association between diabetes mellitus and leukoaraiosis is still \ndebated while the association with hypertension, age and carotid artery \nstenosis is widely demonstrated. In this work our purpose is to evaluate the \nassociation of white matter hyperintense lesion volume and diabetes in a \ncohort of patients who underwent an MRI of the brain at our institution. \nMethods and Materials:  Fifty-four consecutive patients (mean age 72 ± 9 \nyears, males 42) were prospectively recruited at our Institution before \nundergoing carotid endarterectomy. The patients were assessed for the \npresence of vascular risk factors, including diabetes mellitus, hypertension, \nhyperlipidemia. The patients underwent an admission MRI of the brain which \nincluded T2-FLAIR, T2-SE and DWI sequences. FLAIR-leukoaraiosis lesion \nvolume was performed by a neuroradiologist, blinded to the presence of risk \nfactors, using a semi-automated segmentation technique. ROC analysis was \nperformed to evaluate the AUC of FLAIR-leukoaraiosis lesion volume and \nnumber of lesions with respect to the vascular risk factors. \nResults: The ROC curve analysis showed an AUC of 0.725 (SE = 0.082 and \n95% CI from 0.593 to 0.873) with a statistically significant p value of 0.002 \nbetween the presence of diabetes mellitus and the FLAIR-leukoaraiosis lesion \nvolume. In the ROC curve analysis between the presence of diabetes mellitus \nand number of lesion the AUC was 0.715 (SE = 0.085 and 95% CI from 0.553 \nto 0.845) with a p value of 0.0119. \nConclusion: Our data demonstrate an association between diabetes mellitus \nand the volume of the cerebral white matter abnormality.  \nB-0594 10:57  \n3 Tesla brain MRI including quantitative diffusion tensor imaging to \ndifferentiate between Parkinson's disease and atypical parkinsonism  \nF.J.A. Meijer, A. Tuladhar, B. Bloem, B. Goraj; Nijmegen/NL \n(f.meijer@rad.umcn.nl)  \nPurpose: To evaluate 3 Tesla brain MRI in differentiating between Parkinson's \ndisease (PD) and atypical parkinsonism (AP) in patients presenting with \nparkinsonism but uncertain initial clinical diagnosis. The added value of \nquantitative diffusion tensor MRI (DTI) was evaluated. \nMethods and Materials: Prospective observational cohort study in 60 patients. \nAt baseline brain MRI including DTI was performed followed by mean clinical \nfollow-up of 18 months during which probable diagnoses could be made in 44 \npatients (26 PD, 18 AP). Brain MRI abnormalities were scored. DTI data were \nanalysed by the region of interest (ROI) method and the discriminative power \nof each ROI was evaluated by multivariate logistic regression. The area-under-\nthe-receiving-operating-curve (AUC) was used to evaluate the discriminative \npower of routine brain MRI and routine brain MRI combined with DTI ROI mean \ndiffusivity (MD) and fractional anisotropy (FA) values. \nResults: AUC of routine brain MRI in differentiating PD and AP was 0.75 (95% \nCI 0.60-0.91, sensitivity 89% and specificity 54%) when at least one \nabnormality was present; in case of at least two abnormalities AUC was 0.81 \n(95% CI 0.67-0.95, sensitivity 78% an d specificity 81%). When combined with \nMD values in the putamen or MD and FA values in the midbrain, the AUC \ncould be increased to 0.83 (95% CI 0.71-0.96)- 0.89 (95% CI 0.79-0.98). \nConclusion: In the work-up of parkinsonism with uncertain diagnosis, 3 Tesla \nbrain MRI can aid in differentiating between PD and AP which could be \nimproved by quantitative DTI-MRI, but the discriminative power depends on \ndefining imaging criteria.  \nAuthor Disclosures: \nB. Bloem: Board Member; Editorial Board member of Movement Disorders \n(earlier), Associate Editor for the Journal of Parkinson's disease (currently), \nPhysiotherapy Canada (currently). Consultant; Boehringer Ingelheim, Danone, \nGlaxo-Smith-Kline, Solvay. Grant Recipient; Alkemade Keuls fund, Michael J \nFox Foundation, Netherlands Organisation of Scientific Research, Prinses \nBeatrix Foundation, Stichting Internationaal Parkinson Fonds.  \nS263  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0595 11:06  \nDiffusion tensor imaging at 3-T MR for detection of patients with \ndepression and comorbid hypertension in depression  \nY. Liu, H. Yuan, X. Zeng, Z. Wang, H. Zhang; Beijing/CN (lyyulia@163.com)  \nPurpose: Diffusion tensor imaging (DTI) was used to investigate the \ndifferences of white matter impairment between depression and comorbid \nhypertension in depression. To evaluate the correlation between fractional \nanisotropy (FA) and degrees of depression. \nMethods and Materials:  Patients with depression (n=15) and comorbid \nhypertension in depression (n=27) were compared with age- and sex-matched \nhealthy control subjects (HC, n=26). Voxel-based analysis was used to analyse \nDTI data (SPM8, DTI studio). FA and mean diffusivity (MD) in patients with \ndepression and comorbid hypertension in depression were compared with HC \nrespectively. The correlation between FA and scores of Hamilton Depression \nScale (HAMD\n17) was evaluated. \nResults: 1.Compared to HC, FA decreased significantly in patients with \ndepression (P uncorrected < 0.001, F=3.18; cluster size > 50) in the right inferior \nfrontal gyrus, right precuneus, right lingual gyrus, left superior temporal gyrus \nand left cerebellum posterior lobes. 2. More cerebral regions of patients with \ncomorbid hypertension in depression were involved (P uncorrected < 0.001, \nF=3.18),including bilateral superior temporal gyrus, bilateral superior frontal \ngyrus, bilateral thalamus, bilateral caudate, right parahippocampal gyrus, left \nmiddle temporal gyrus, left cerebellum posterior lobes. 3. There were no \nsignificant differences in MD. 4. FA in left (r=-0.458) and right superior frontal \ngyrus (r=-0.474) and right superior temporal gyrus (r=-0.474) were negatively \ncorrelated with scores of HAMD17 (P=0.001). \nConclusion: Our results reveal underlying extensive white matter impairments \nin patients with depression. The different patterns of decrease in FA suggest \nhypertension may play a synergistic action in the progress of depression. FA \ncan reflect degrees of depression and is more sensitive than MD.  \nB-0596 11:15  \nDiffusion Kurtosis imaging at 3-T MR imaging for detection of individuals \nwith depression and comorbid hypertension in depression  \nX. Zeng, H. Yuan, Y. Liu, Z. Wang, H. Zhang; Beijing/CN \n(rainman304@126.com)  \nPurpose: Diffusion Kurtosis Imaging (DKI) was used to investigate the \ndifferences of white matter impairment between depression and comorbid \nhypertension in depression. \nMethods and Materials:  We used a voxel-based analysis method to analyse \nDKI data (SPM8, http://www.fil.ion.ucl.ac.uk/spm/software/spm8; DKE, \nhttp://academicdepartments.musc.edu/cbi/dki/DKE) in patients with depression \n(n=15; 3 males, 12 females) and comorbid hypertension in depression (n=27; 5 \nmales, 22 females) compared with age- and sex-matched no cognitive \nimpairment cases (NCI, n=26; 8 males, 18 females). \nResults: Compared to NCI, we found significant decrease in Mean Kurtosis \n(MK) of patients with depression (P\nuncorrected < 0.001, F=11.6; cluster size >  50) \nin the right inferior frontal gyrus, bilateral inferior and middle temporal gyrus, \nbilateral precuneus, midbrain and bilateral cerebellum posterior lobes; \nCompared to NCI, there are more cerebral regions of individuals with comorbid \nhypertension in depression involved according to the significant decrease in \nMK (P\ncorrected < 0.05, FWEp=26.52; cluster size > 50), including right inferior \nfrontal gyrus, bilateral superior frontal, bilateral inferior and middle temporal \ngyrus, bilateral thalami, bilateral limbic lobe uncus, bilateral parahippocampa \ngyrus, bilateral precuneus, bilateral posterior cingutate and bilateral cerebellum \nposterior lobes. \nConclusion: Our results revealed underlying extensive white matter \nimpairments in patient with depression. The different patterns of decrease in \nMK betweendepression and comorbid hypertension in depression suggest \nhypertension might play a synergistic action in the progress of depression. As \na potential biomarker, DKI could differentiate the patients from the healthy.  \nB-0597 11:24  \nValidation of an MRI rating scale for amyloid related imaging \nabnormalities  \nA. Bechten\n1, M.P. Wattjes1, D. Purcell2, E. Sanchez1, M. Daams1, H.M. Arrighi2, \nF. Barkhof1; 1Amsterdam/NL, 2San Francisco, CA/US (a.bechten@vumc.nl)  \nPurpose: MRI abnormalities in relation to amyloid-2  (A 2) lowering \nimmunotherapy with edema or effusion (ARIA-E) describes 3 different \nmanifestations, represented as parenchymal hyperintensity, sulcal \nhyperintensity and gyral swelling. The aim of our study is to validate the use of \na recently introduced MRI rating scale for ARIA-E in a larger patient group and \nmultiple raters. \nMethods and Materials:  We evaluated a group of 75 patients, 30 with known \nARIA-E and 45 without and we test the Inter-rater reliability between 5 \nneuroradiologists using intraclass correlation coefficient. All patients included in \nthis study were part of phase II multicenter, randomised, double blind, placebo-\ncontrolled multi ascending dose immunisation study by using Bapineuzumab. \nResults: Raters successfully applied the scale with a high agreement in the \nidentification of ARIA-E cases. We observed a high inter-rater agreement for \nscores of sulcal hyperintensity (ICC= 0.917; 95% CI, 0.86-0.96) and for the \ncombined scores of the 2 ARIA-E findings, parenchymal and sulcal \nhyperintensity (ICC = 0.881; 95% CI, 0.80 - 0.93). A slightly lower agreement \nfor parenchymal hyperintensity (ICC =0.681; 95% CI, 0.51-0.84) was observed. \nConclusion: There was a very high consensus between the raters to identify \nthe ARIA-E cases and for the scoring for the different ARIA-E findings. This \nrating scale is a very simple and effecti ve tool to evaluate the severity of this \nadverse event in patients recruited for A 2 lowering therapeutic trials. It allows \naccurate monitoring of this adverse event and could aid in dose adjustment.  \nAuthor Disclosures: \nD. Purcell: Consultant; Consulting Fee or Honorarium Janssen. H.M. Arrighi: \nEmployee; Janssen Alzheimer Immunotherapy Research & Development LLC. \nF. Barkhof: Consultant; Consulting Fee or Honorarium Janssen. \nB-0598 11:33  \nThe prevalence of cortical superficial siderosis in a memory clinic \npopulation  \nH.I. Zonneveld, J.D.C. Goos, M.P. Wattjes, N.D. Prins, P. Scheltens, \nW.M. van der Flier, J.P.A. Kuijer, M. Muller, F. Barkhof; Amsterdam/NL \n(f.barkhof@vumc.nl)  \nPurpose: Cortical superficial siderosis (SS) is a recently recognised \nmanifestation of cerebral amyloid angiopathy (CAA). The aim of this study was \nto determine prevalence, topography and severity of SS in a memory clinic \npatient cohort and its possible association with Alzheimer's disease (AD). \nMethods and Materials:  We included 809 patients (56%men, age 66 ±10 \nyears) from the Amsterdam Dementia Cohort between November 2010 and \nNovember 2012 scanned on a 3 Tesla MRI system. We analysed prevalence \nand topography of cortical SS according to demographic, clinical, and MRI \ndata. Agreement for SS detection between two neuroradiologists was \ncalculated by using Cohen's Kappa. \nResults: Agreement for detection of SS was excellent (unweighted 5 of 0.81). \nIn 17 patients (2.1%) cortical SS was found without a known cause. The \nprevalence of idiopathic SS differed according to diagnostic groups (p < 0.001): \nnearly 5% in AD patients (n=168) versus 2% of mild cognitive impairment \npatients (n=143), and 2.5% of other types of dementia (n=80). By contrast, SS \nwas not found in patients with subjective complaints (n=168) or those with \nother disorders (n=157). The presence of SS was associated with age, \ncognition, APOE J4, microbleeds and white matter hyperintensities (all \np < 0.05). \nConclusion: The prevalence of cortical SS in a memory clinic setting is higher \nthan reported in the general population, but lower than reported in CAA. The \nrelatively high prevalence of SS in AD and its clinical associations suggest that \nSS is a relevant radiological manifestation of amyloid pathology in AD. Further \nlongitudinal research is needed to investigate clinical relevance.  \nAuthor Disclosures: \nM.P. Wattjes: Consultant; Biogen-Idec. Other; lectures for: Biogen Idec, Bayer \nHealthcare, Roche and Janssen Cilag. N.D. Prins: Advisory Board; Boehringer \nIngelheim and Envivo. Grant Recipient; Vereniging AEGON. Research/Grant \nSupport; rain Foundation of the Netherlands and Alzheimer Nederland. \nSpeaker; Janssen and Novartis. P. Scheltens: Research/Grant Support; GE \nHealthcare, Danone Research and MERCK (for the istitution). Speaker; Lilly, \nGE Healthcare, Lundbeck, Danone and Jansen AI-Pfizer (paid to institution). F. \nBarkhof: Consultant; Bayer-Schering Pharma, Sanofi-Aventis, Biogen-Idec, \nTEVA, Merck-Serono, Novartis, Roche, Synthon BV, Jansen Research. \nResearch/Grant Support; Dutch MS Society and EU-FP7. \nB-0599 11:42  \nDiffusion tensor imaging of the hippocampus and posterior cingulate \nfasciculus in mild cognitive impairment and early Alzheimer's disease: \nour initial results  \nD. Grasso, C. Borreggine, D. Melchionda, E. Carapelle, L. Macarini, \nL.M. Specchio; Foggia/IT (daniela.grasso@hotmail.it)  \nPurpose: The aim of this study was to show the role of Diffusion Tensor \nImaging (DTI) as a potential tool in evaluating microstructural white matter \nalterations in patients with Mild Cognitive Impairment (MCI) and early \nAlzheimer's disease (AD). \nMethods and Materials:  Fifty five subjects (15 MCI; 20 AD; 20 controls) were \nenrolled. All patients were assessed using physical, neurological and \nneuropsycological tests. Conventional MRI sequences and DTI were acquired. \nFractional anisotropy (FA) and Apparent Diffusion Coefficient (ADC) values \nwere measured using the region of interest (ROIs) method in the bilateral \nhippocampal body, parahippocampal white matter and posterior cingulate. \nData were analysed using Statistical Package For Social Sciences software \n(ver 21.0; SPSS Inc, Chicago, IL, USA). \n \nS264  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nResults: In MCI and AD patients we observed a significant FA decrease and \nADC increase in the hippocampus, posterior cingulate and parahippocampal \nwhite matter compared to controls. Cognitive tests findings showed high \ncorrelation with DTI parameters, especially FA values in the hippocampus body \nand parahippocampal white matter. \nConclusion: Microstructural alterations in the hippocampus, parahippocampal \nwhite matter and posterior cingulate were detected by DTI technique in MCI \nand AD patients. DTI parameters in the hippocampus and parahippocampal \nwhite matter could be a potential tool to define microstructural damages in \nearly AD patients and seem to be more correlated with cognitive skills than DTI \nchanges in the posterior cingulate.  \nB-0600 11:51  \nGender and age aspects of hippocampal anatomy in MDD patients \ncompared to healthy volunteers using methods of MR morphometry  \nT. Rostovtseva, R. Ezhova, N. Ananieva; St. Petersburg/RU \n(rostovtsevat@mail.ru)  \nPurpose: Investigation of the hippocampal formation structural variants in \npatients with major depression disorder (MDD) compared to healthy \nvolunteers. \nMethods and Materials: 139 patients in the age from 18 to 50 were examined. \nThe first group of patients consisted of 101 healthy volunteer. The second \ngroup included 28 patients with MDD. All of the patients underwent MRI of the \nbrain on 1.5T Toshiba scanner using standard brain protocol with addition of \n3D MPRAGE sequence and following voxel morphometry ((FreeSurfer/ \nMassacyusetts General Hospital - URL.; http://surfer.nmr.harvard.edu). \nResults: Different structural variants of hippocampus were found either in \nhealthy volunteers or in patients with MDD. We haven't found significant age \ncorrelation of the hippocampal volume of healthy volunteers in the age before \n50 years. Hippocampal volume was certainly bigger in men than in women. \nEarly manifestation of MDD and high severity of the disease according to \nMontgomery-Asberg depression rating scale were found more often in patients \nwith hippocampal structural variants compared to patients with normal \narchitecture of hippocampus. \nConclusion: Morphological variants of the m ediobasal parts of temporal lobes \ncouldn't be, as we consider, the direct eti ological factor of major depression \ndisorder, but their presence could possibly be the sign of development failure \nof the brain, and in particular of the brain structures involved in formation of the \nemotions.  \n10:30 - 12:00 Room L/M  \nCardiac  \nSS 903  \nCoronary plaques and aorta  \nModerators:  \nA.J.B.S. Madureira; Porto/PT  \nP. Stolzmann; Zurich/CH  \nB-0601 10:30  \nState-of-the-art CT scanners from four different vendors do not \nsubstantially affect coronary artery calcium risk classification in a large \ncohort  \nM.J. Willemink\n1, R. Vliegenthart2, T. Leiner1, R.P.J. Budde1, R.L.A.W. Bleys1, \nM. Das3, M. Prokop4, N. Buls5, P.A. de Jong1; 1Utrecht/NL, 2Groningen/NL, \n3Maastricht/NL, 4Nijmegen/NL, 5Brussels/BE (m.willemink@umcutrecht.nl)  \nPurpose: Coronary artery calcification (CAC) scores assessed with CT have \nemerged as an important imaging biomarker for cardiovascular risk \nclassification. American Heart Association guidelines recommend CAC-scoring \nin asymptomatic adults with low-to-intermediate and intermediate \ncardiovascular risk, concerning approximately 40% of the United States adult \npopulation. Treatment strategies depend on CAC-scores, but state-of-the-art \nCT-systems from the major vendors have never been compared head-to-head. \nOur purpose was to determine the inter-vendor variability of CAC-scores ex \nvivo with state-of-the-art CT-scanners and to assess the effects of this \nvariability on risk-category reclassification in a large population-based cohort. \nMethods and Materials:  We evaluated the differences in CAC-scores \nbetween CT-scanners from four different vendors. Fifteen ex vivo human \nhearts were placed in a phantom resembling an average human adult. Hearts \nwere scanned at equal radiation dose settings for each vendor. CAC-scores \nwere quantified with clinically used semi-automatic software. The ex vivo CAC-\nscores were used to simulate the effects of different CT-scanners on \nreclassification of 432 ol der individuals from a population-based study at \nintermediate cardiovascular risk based on Framingham risk scores. \n \n \nResults: CAC-scores differed substantially between CT-scanners with median \nCAC-scores ranging from 332 (quartiles 114-1135) to 469 (quartiles 183-1381) \nbetween vendors (P < 0.05). Simulation showed that these differences resulted \nin cardiovascular risk-clas sification shifts in 0.5 to 6.5% of individuals at \nintermediate risk by using a CT-scanner from a different vendor. \nConclusion: Among individuals at intermediate cardiovascular risk, state-of-\nthe-art CT-scanners produce substantially different CAC-scores, which can \nresult in reclassification to high or low risk in up to 6.5% depending on the \nvendor.  \nB-0602 10:39  \nPhase-contrast computed tomography: coronary plaque characterisation \nby quantitative phase-contrast Hounsfield units  \nH. Hetterich\n1, M. Willner2, C. Habbel1, J. Herzen2, T. Saam1, F. Pfeiffer2, \nM.F. Reiser1, F. Bamberg1; 1Munich/DE, \n2Garching/DE (holger.hetterich@med.uni-muenchen.de)  \nPurpose: Poor contrast in low-absorbing materials limits accurate \natherosclerotic plaque characterisation by absorption-contrast computed \ntomography (ACT). Phase-contrast CT (PCT) is an experimental technique \nrelying on X-ray phase-shift, yielding a hi gher contrast in biological soft tissue. \nPhase-contrast Hounsfield units (HU-P) can be calculated using the refraction \nindex. We hypothesised that plaque components including fibrous (Fib), lipid-\nrich (Lip) and calcified tissue (Cal) can be differentiated based on HU-P. \nMethods and Materials:  Fifteen human coronary arteries were imaged at a \nlaboratory-based set-up using a conventional X-ray tube (35 kV) and grating-\ninterferometer. Tomographic images were reconstructed with a resolution of \n100 \u0001m and correlated with histopathology. In both ACT- and PCT-data, \nregions corresponding to Fib, Lip or Cal based on histopathology were \nmanually traced. Mean HU-A, HU-P and signal-to-noise ratios (SNR) were \ncalculated for analysed regions. \nResults: A total number of 316 cross-sections with 184 Fib, 56 Lip and 119 \nCal containing regions were assessed. Fib, Lip and Cal were associated with \nsignificant different mean HU-P (61.7± 18.5, 39.9 ±16.1 and 447.3 ±155.5; \np=0.00013) and HU-A (76.4 ±30.6, 41.5 ±97.5 and 4305.2 ±1276.6; p=0.0017). \nHowever, we observed a substantial overlap in HU-A between Fib and Lip, \nwhile there was little overlap in HU-P. The receiver operating characteristic \ncurve showed a significant higher area under the curve for HU-P (0.92) than \nHU-A (0.85). PCT was associated with an improved SNR in both Fib and Lip \n(p=0.0024). \nConclusion: PCT can reliably differentiate important components of \natherosclerotic lesions based on quanti tative HU-P, indicating its high potential \nfor improved assessment of coronary artery disease.  \nB-0603 10:48  \nInterobserver agreement of the quantitative computed tomography \nassessment of high-risk coronary plaque features in the ROMICAT II trial  \nP. Maurovich-Horvat1, S. Puchner2, M. Lu2, T. Liu2, T. Mayrhofer2, \nU. Hoffmann2, M. Ferencik2; 1Budapest/HU, 2Boston, MA/US \n(maurovich.horvat@gmail.com)  \nPurpose: Excellent reproducibility for CCTA plaque measurements is a \nprerequisite for quantitative plaque assessment in clinical practice and \nresearch trials. We explored interobserver variability of plaque measurements \nin the ROMICAT II trial. \nMethods and Materials:  Two readers independently evaluated 30 randomly \nselected CCTA exams from 473 patients enrolled in the ROMICAT II study. \nEach reader performed a qualitative assessment for the presence of calcified, \nnon-calcified plaque and the napkin-ring sign (plaque with low CT attenuation \nsurrounded by rim like higher CT attenuation). All plaques were assessed \nquantitatively using dedicated software (QAngio CT, MEDIS, Leiden, The \nNetherlands). For each plaque proximal, distal normal reference, minimal \nluminal area, remodelling index, plaque volume, % plaque burden, low \nattenuation plaque volume ( < 30 HU), and non-calcified plaque volume \n(< 130 HU) was determined. Kappa statistics was calculated to assess \ninterobserver agreement for binary variables and Pearson's linear correlation \ncoefficient continuous variables. \nResults: Interobserver agreement was excellent for all measures. Kappa \nvalues were 1.00 for the presence of the napkin-ring sign, 0.73 for the \npresence of positive remodelling, 0.83 for the presence of low HU plaque, and \n0.84 for the presence of plaque burden > 70%. We observed excellent \ncorrelation for plaque burden (R=0.94, mean difference 0 ±6%), minimal luminal \narea (R=0.98, mean difference 0.1 ±0.8 mm2), total plaque volume \n(1.1±5.7 mm3), non-calcified plaque volume (0.7 ±5.4 mm3), and low HU \nplaque volume (0.2±1.9 mm3). \nConclusion: Advanced quantitative CCTA assessment of coronary \natherosclerotic plaque including high-risk plaque features can be performed \nhighly reproducible in a multicenter multivendor setting of the ROMICAT II trial.  \nS265  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nAuthor Disclosures: \nP. Maurovich-Horvat: Grant Recipient; \"Nemzeti Kivalosagi Program\" TAMOP \n4.2.4.A/1-11-1-2012- 0001. U. Hoffmann: Grant Recipient; National Heart, \nLung, and Blood Institute (U01HL092040 and U01HL092022) and the National \nInstitutes of Health (UL1RR025758, K23HL098370).  \nB-0604 10:57  \nCan we evaluate the effect of genetic and environmental influences on \ncoronary anatomy and plaque characteristics? initial experience with \ncoronary CT angiography in twin pairs  \nP. Maurovich-Horvat\n1, A.L. Jermendy1, T. Horváth1, E. Nagy1, Á.D. Tárnoki1, \nD.L. Tárnoki1, P. Kitslaar2, B. Merkely1, G. Jermendy1; 1Budapest/HU, \n2Leiden/NL (maurovich.horvat@gmail.com)  \nPurpose: Twin studies provide a unique method for assessing the phenotypic \nimpacts of environmental and genetic factors through the comparison of \nmonozygotic (MZ) and dizygotic (DZ) twins. The heritability of coronary \nanatomy, which may influence plaque formation through local haemodynamic \neffects, and the heritability of plaque morphology were not yet studied. We \nsought to assess these parameters. Here, we report our initial experience. \nMethods and Materials:  In this classical twin study we plan to enroll 100 \nasymptomatic, adult twin pairs with no history of coronary artery disease. The \n%plaque burden, plaque volume and non-calcified plaque volume were \nassessed by coronary CT angiography (Philips 256-slice iCT, Best, The \nNetherlands). Plaque analysis was perfomed with a dedicated software \n(QAngio CT Research Edition, Medis B.V., Leiden, The Netherlands). \nResults: At this point, 30 twins (mean age 57 ±9 years, 22% male), 6 MZ and 9 \nDZ pairs, were enrolled. Dyslipidemia was present in 57%, hypertension in \n27%, diabetes in 10% of the twins and 33% of the twins were smokers. \nCoronary atherosclerosis was present in 12 subjects and 56 plaques were \ndetected. We observed a median total plaque burden of 40.3 (IQR:34.7-\n45.9)%; plaque volume of 39.6 (IQR:24.9-82.9) mm3 and a non-calcified \nplaque volume of 15.4 (IQR:8.6-30.2) mm3. \nConclusion: Our first impression is that CCTA of twins provides a valuable \ntool to assess heritability of coronary geometry and coronary plaque \nmorphology. To perform statistically robust analysis, the enrollment of 100 twin \npairs is warranted. The target completion date of the study is March 2014.  \nAuthor Disclosures: \nP. Maurovich-Horvat: Research/Grant Support; \"Nemzeti Kivalosagi Program\" \nTAMOP 4.2.4.A/1-11-1-2012- 0001 \nB-0605 11:06  \nComputed tomography characteristics of coronary artery atherosclerosis \nin subjects with lower extremity peripheral artery disease and no cardiac \nsymptoms  \nT. Miszalski-Jamka\n1, S. Licholai2, B. Laskowicz2, M. Konieczynska2, \nM. Trystula2, L. Slowik2, M. Urbanczyk2, M. Pasowicz2, P. Jazwiec1; \n1 Wroclaw/PL, 2Krakow/PL  \nPurpose: Computed tomography coronary angiography (CTCA) enables non-\ninvasive evaluation of coronary artery atherosclerosis. However, its value to \nassess coronary artery disease (CAD) in subjects with lower extremity \nperipheral artery disease (PAD) and no cardiac symptoms is unknown. The \nobjectives are to determine the value of CTCA to assess coronary artery \natherosclerosis and to evaluate the relationship between coronary artery \nplaque characteristics and severity of peripheral atherosclerosis in subjects \nwith lower extremity PAD and no cardiac symptoms. \nMethods and Materials:  Sixty-five individuals (45 males, 20 females, mean \nage 62.5 ±7.6 years) with lower extremity PAD and no cardiac symptoms \nunderwent CTCA. \nResults: CTCA revealed CAD in 56 subjects. Twenty-two had obstructive \nCAD. The mean ankle-brachial index (ABI) was 0.64 ±0.16. Twenty-six \nindividuals demonstrated abnormal carotid artery intima-media thickness (IMT). \nABI<median, if compared to ABI \u0003median was associated with higher proportion \nof obstructive multivessel to single vessel CAD (8:4 versus 1:9;p=0.01) and \nhigher number of coronary artery segments with mixed plaques (2.3 ±2.2 \nversus 1.2 ±1.3;p=0.02). Comparing patients with abnormal and normal IMT, \nthe former demonstrated higher proportion of obstructive multivessel to single \nvessel CAD (7:3 versus 2:10;p=0.01) and higher number of coronary artery \nsegments with non-calcified (1.9 ±3.2 versus 0.6 ±1.4;p=0.04) and mixed \nplaques (2.3±2.1 versus 1.3±1.7;p=0.049). \nConclusion: CTCA may be effective to detect CAD in subjects with lower \nextremity PAD and no cardiac symptoms. The low ABI and abnormal IMT are \nassociated with more extensive CAD and higher burden of high-risk coronary \nartery plaques.  \n \nB-0606 11:15  \nIterative reconstruction algorithms in coronary CT angiography for the \ncharacterisation of coronary atherosclerotic plaque: a comparison with \nhistology  \nS. Puchner\n1, M. Ferencik1, P. Maurovich-Horvat1, M. Nakano2, F. Otsuka2, \nH.-U. Kauczor3, R. Virmani2, U. Hoffmann1, C. Schlett1; 1Boston, MA/US, \n2Gaitherburg, MD/US, 3Heidelberg/DE (stefan.puchner@meduniwien.ac.at)  \nPurpose: To evaluate whether iterative reconstruction algorithms improve the \naccuracy of coronary CT angiography (CCTA) for coronary plaque \ncharacterisation compared to histology. \nMethods and Materials:  CCTA and histological data were acquired from the \ncoronary arteries of 3 ex-vivo hearts. CT images were reconstructed by using \nfiltered-back projection (FBPR) as well as adaptive-statistical (ASIR) and \nmodel-based (MBIR) iterative reconstruction algorithms. Cross-sectional \nimages were co-registered between CCTA and histology and a semi-\nautomated plaque assessment was performed for each reconstruction \nalgorithm. The results were then compared to histology. \nResults: Of 173 included cross-sections, presence of a lipid-core plaque (LCP) \nwas in 26 cross-sections based on histology. Plaque area < 60 HU was larger \nin cross-sections with LCP as compared to non-LCP (mean plaque area \n< 60 HU in FBPR 5.17vs.3.16,p <  0.0001;in ASIR 5.58vs.3.16,p < 0.0001;in \nMBIR6.49 vs.3.23,p < 0.0001, respectively). This translated into an area under \nthe curve (AUC) for detecting LCP by CTA of 0.803 for FBPR, 0.850 for ASIR, \n0.903 for MBIR. The AUC of MBIR was significant higher as for FBPR \n(p=0.01). In cross-sections with any calcification by histology, the plaque area \n> 180 HU in CCTA increased with increasing size of calcification in histology. \nAs compared to FBPR and ASIR, a reduced plaque area >  180 HU was \nobserved for MBIR (p=0.03 and 0.008,respectively). \nConclusion: Plaque area < 60 HU in CCTA was associated with LCP \nregardless of the reconstruction algorithm. However, MBIR demosntrated a \nhigher accuracy for LCP and degreased potential blooming of calcification \ncompared to ASIR and FBPR. This may improve the value of CCTA for patient \nrisk stratification.  \nB-0607 11:24  \nDistensibility of the ascending and descending aorta in patients with \naortic stenosis  \nL. M\u0002y\u001bska, C. Chin, L. Henderson, S. Semple, D. Newby, M. Dweck, \nS. Mirsadraee; Edinburgh/UK (lucja.mlynska@gmail.com)  \nPurpose: Patients with bicuspid valve disease and aortic stenosis commonly \ndevelop aortic dilatation that may relate to an associated aortopathy or \nmechanical stress. We sought to demonstrate whether these patients had \naltered aortic distensibility compared to those with a trileaflet valve and \nsubjects without stenosis. \nMethods and Materials:  We recruited 95 subjects (age 63 ±9 years) with \ndifferent aortic valve morphologies (23 bicuspid (BAV), 50 tricuspid (TAV) and \n21 non-stenotic). Distensibility on both ascending and descending aorta was \nmeasured on MRI as the change in cross-sectional aortic area per unit change \nin blood pressure. \nResults: Significant difference in distensibility is demonstrated between \nascending and descending aorta in both the stenotic groups (P < 0.05), which \nis not seen in non-stenotic patients ( > 0.05). Moreover, patients with BAV have \nhigher mean distensibility compared to patients with TAV although it was not \nstatistically different. The mean distensibility (mmHg -1) in the stenotic bicuspid \ngroup of the ascending aorta was 3.39± 1.9 x10 -3 and of the descending \n5.71±2.9 x10-3. For the stenotic tricuspid group values were 2.6 ±1.2 x10-3 in the \nascending and 4.16 ±2.3 x10-3 in the descending. The distensibility in controls \nwere 6.19±6.3 and 6.32±3.47, respectively. No association was found between \nthe severity of aortic stenosis and distensibility. \nConclusion: The study shows that there is a significant impact on the \ndistensibility ratio, of ascending to descending aorta, in patients suffering from \naortic stenosis.  \nB-0608 11:33  \nEvaluation of aortic valve calcium and feasibility of transcatheter aortic \nvalve implantation with first- and second-generation transcatheter heart \nvalves  \nM. Avanesov, M. Seiffert, L. Conradi, C. Lunau, J. Schirmer, G. Adam, \nS. Blankenberg, H. Reichenspurner, G. Lund; \nHamburg/DE (m.avanesov@uke.de)  \nPurpose: With the recent availability of several second-generation \ntranscatheter aortic valve implantation (TAVI) devices, a correlation between \naortic valve calcium load and paravalvular regurgitation remains to be \ninvestigated. We performed a retrospective CT based assessment of aortic \nvalve calcium in correlation with hemodynamic performance of different \ntranscatheter heart valves. \nS266  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nMethods and Materials:  In 156 patients preoperative contrast-enhanced CT \nscans with prospective ECG gating were available for retrospective analysis. \nThree-dimensional reconstruction of CT data was performed using the \n3Mensio software (3Mensio Medical Imaging, Bilthoven). After calibration for \ncontrast agent density, calcium load was quantified within the device-landing \nzone. Data were correlated with echocardiographic measurements. \nResults: Total aortic valve calcium was 2468 ±1685 mm3 with eccentric \ndistribution ( > 50% of calcium load at one cusp) in 26.3% and calcium \nprotruding into the left ventricular outflow tract in 41.7% of patients. Devices \nimplanted were the Edwards Sapien XT (n=52), Medtronic CoreValve (n=33), \nSymetis Acurate (n=25), JenaValve (n=20), and Medtronic Engager (n=26) \nvalves. Postprocedural paravalvular regurgitation was none or trace in 65.2% \nand mild in 34.8%. Although a trend towards a correlation of calcium load and \nparavalvular regurgitation was observed (p=0.054), no differences in \nhemodynamic performance with regard to different valve types and aortic valve \ncalcium could be demonstrated. \nConclusion: TAVI using first- and second-generation devices can be \nperformed with good hemodynamic results, irrespective of annular calcification. \nAortic valve calcium seemed to be associated with increased paravalvular \nregurgitation, however no relevant predictors of regurgitation for the different \ntranscatheter heart valve prostheses could be identified.  \nB-0609 11:42  \nTranscatheter aortic valve implantation (TAVI) for severe aortic stenosis: \nthe significance of non-vascular incidental pathology at CT angiography \nand the impact on outcome  \nJ.C.L. Rodrigues, P. Murphy, M. Hamilton, N.E. Manghat; Bristol/UK \n(jonrodrigues@doctors.org.uk)  \nPurpose: Untreated severe aortic stenosis (AS) has poor prognosis and is \ncommon amongst older patients with comorbidity who are at high risk for \ndefinitive aortic valve replacement. TAVI is a less invasive alternative but \napproximately 33% may have iliofemoral atherosclerosis precluding TAVI. The \nburden of incidental non-vascular pathol ogy (INVP) in pre-TAVI patients has \nnot been quantified before. \nMethods and Materials:  We reviewed 100 consecutive pre-TAVI CT \nangiography (CTA) scans. All CTAs were reported by Consultant \nCardiovascular Radiologists. The radiological reports were reviewed for the \ndocumentation of INVP which were stratified by clinical relevance. The \npresence of INVP in those managed conservatively was compared to those \nwho underwent TAVI. \nResults: INVP was documented in 88%, consisting of unsuspected possible \nmalignancy in 8%, progression of known malignancy in 1%, conditions \nrequiring acute treatment in 17% (e.g. pulmonary oedema) and indeterminate \nfindings present in 19% (e.g. lung nodules). However, no INVP was anticipated \nto have worse prognosis than severe AS. Of the 100 pre-TAVI patients who \nunderwent CTA, 40% proceeded to TAVI. A trend towards more incidental \nfindings requiring acute treatment was seen in conservatively managed \npatients (30% vs 60.5%, P = 0.15). Emphysema was present in significantly \nmore conservatively managed patients compared to TAVI patients (18.4% vs \n0%, P < 0.05). \nConclusion: INVP in patients undergoing CTA prior to TAVI are common and \npotentially clinically relevant. Less than 50% referred for CT (aorta) pre-TAVI \nactually underwent TAVI. The presence of emphysema on pre-TAVI CTA may \nbe a potential predictor of subsequent conservative management.  \nB-0610 11:51  \nCT-angiography of the aortic annulus for prosthesis sizing in TAVI: \ncomparison of predictive values of major anatomic parameters  \nF. Schwarz, D. Zinsser, P. Lange, M. Greif, M.F. Reiser, C. Kupatt, \nC.R. Becker; Munich/DE (florian.schwarz@med.lmu.de)  \nPurpose: To compare the predictive value of CT-derived annulus \nmeasurements prior to transcatheter aortic valve implantation (TAVI) for the \nselection of prosthesis size for two major valve models. \nMethods and Materials:  In 351 TAVI-patients (235: CoreValve, 116 Edwards \nSapien), optimal prosthesis size was determined during the TAVI procedure by \ninflation of a balloon catheter at the aortic annulus. All patients had previously \nundergone CTA of the bodytrunk at our institution. Two readers independently \ndetermined long and short axis as well as circumference and area of the aortic \nannulus. A nested cross-validation approach was used to estimate the \npredictive power of these parameters for the prosthesis size ultimately \nimplanted and to define optimal cut-off values. \nResults: There was excellent agreement between observers for the major \nanatomic parameters (ICC's > 0.85). Differences between patients who \nunderwent implantation of the small, medium or large prosthesis were \nsignificant for all evaluated param eters and both valve models (p's < 0.05). \nAnnulus area and circumference had equally high predictive power for \nprosthesis size (multi-class AUC's: 0.86, 0.87, 0.87, 0.88). Application of the \noptimal cut-off values for annulus circumference suggested by our cross-\nvalidation strategy (CV:7.7;8.9 cm; ES:7.2;8.8 cm) would have resulted in the \nselection of the size ultimately considered optimal in 87%(306/351) of cases. \nConclusion: CT-based annulus measurements permit good prediction of the \nprosthesis size considered optimal during TAVI. Applying the calculated cutoff \nvalues, identical prosthesis size would been selected in 87% of cases on the \nbasis of CT alone. Extending our model to the degree of calcification might \nfurther increase its predictive power.  \n10:30 - 12:00 Conf. Room M3  \nInterventional Radiology  \nSS 909  \nAortic and neuro interventions  \nModerators:  \nR.F. Dondelinger; Liege/BE  \nD. Filippiadis; Athens/GR  \nB-0611 10:30  \nEndovascular aneurysm repair (EVAR): is imaging surveillance robust \nand does it influence long-term mortality?  \nM. Waduud\n1, M. Ritchie1, R. Yadavali2, S. Lim2, R. Bhat3, W. Choong3, \nS. Ingram4, L. Cormack4, J. Moss1; 1Glasgow/UK, 2Aberdeen/UK, 3Dundee/UK, \n4Edinburgh/UK  \nPurpose: EVAR is the dominant treatment strategy for abdominal aortic \naneurysms. However, due to uncertainty regarding long-term durability an on-\ngoing imaging surveillance programme is required. The aim was to assess the \ndeliverability and its effect on all-cause and aneurysm-related mortality. \nMethods and Materials:  A retrospective analysis of all EVAR procedures \ncarried out in the four main Scottish Vascular Units. Patients were identified \nlocally and imaging data collected by manually searching a combination of \ndifferent databases. Complete imaging follow-up was defined as following the \nlocal protocol for each site and subsequent continuing annual imaging. \nOutcome measures included all-cause and aneurysm-related mortality. Cause \nof death was obtained from the death certificate. \nResults: Data were available for 569 patients from 2001 to 2012. All centres \nhad data for a minimum of 5 contiguous years. Follow-up period ranged from \n1.66 to 4.55 years (median 3.03). Overall 53% had complete imaging \nsurveillance, 43% partial and 7% none. For the whole cohort all-cause 5-year \nmortality was 33.5% and aneurysm-related mortality was 4.5%. All-cause \nmortality in patients with complete, partial and no imaging was 49.9%,19.1% \nand 47.2% and aneurysm-related mortality was 3.7%, 4.4% and 9.5%, \nrespectively. All-cause mortality was significant higher in patients with complete \nimaging surveillance (p < 0.001). No significant differences were observed in \naneurysm related mortality (p=0.2). \nConclusion: Only half of EVAR patients achieve complete long-term imaging \nsurveillance over a minimum 5-year period. However, incomplete imaging \ncould not be linked to any increase in mortality. This information may have \nimplications for the national screening programme.  \nB-0612 10:39  \nCTA with fluoroscopy image fusion guidance in endovascular complex \naortic aneurysm repair  \nA.M.H. Sailer, M.W. de Haan, A.G. Peppelenbosch, M.J.H.M. Jacobs, \nJ.E. Wildberger, G.-W.H. Schurink; Maastricht/NL (anni.sailer@mumc.nl)  \nPurpose: To evaluate the application and benefit of intraoperative guidance by \nmeans of live fluoroscopy image fusion with computed tomography \nangiography (CTA) in endovascular thoraco-abdominal aortic repair. \nMethods and Materials:  CTA with fluoroscopy image fusion road-mapping \nwas prospectively evaluated in pat ients with thoraco-abdominal aortic \naneurysms who underwent fenestrated and/or branched endovascular repair \n(FEVAR/BEVAR). C-arm cone beam computed tomography (CBCT) was \nperformed prior to the interventions and manually co-registered to patients' \noutpatient diagnostic CTA dataset. Radiation dose of CBCT in terms of dose \narea product (DAP, in mGym\n2) was registered. Total procedural iodinated \ncontrast material dose, overall procedure time and fluoroscopy time were \ncompared between the fusion group (n=31) and case controls (n=31). \nResults: Radiation dose of CBCT was 1.47 ± 0.41 mGym\n2 (mean±SD). Image \nco-registration was feasible in all patients within approximately five minutes. \nFusion image road-mapping was used for navigation and positioning of the \ndevices and catheter guidance during access to target vessels. Iodinated \ncontrast material dose and procedure time were significantly lower in the fusion \ngroup compared to case controls (159 cc (95% CI: 132 cc; 186 cc) versus \n199 cc (95% CI: 170 cc; 229 cc), p=0.037 and 5.2 hours (95% CI: 4.5 h; 5.9 h) \nversus 6.3 hours (95% CI: 5.4 h; 7.2 h), p=0.022). No significant differences in \nfluoroscopy time were observed. \nS267  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nConclusion: Image fusion guidance is a valuable addition in complex \nendovascular interventions. The technology supports accurate target vessel \ncanalisation and stentgraft placement. It contributes to reduce iodinated \ncontrast material dose and procedure time.  \nB-0613 10:48  \nA 10-year retrospective review of pelvic ischaemic complications due to \ninternal iliac artery embolisation prior to EVAR  \nJ.G. McGarry, A.O. Alenezi, F.P. McGrath, M.F. Given, A.N. Keeling, M.J. Lee; \nIreland/IE (mcgarryj@tcd.ie)  \nPurpose: Internal iliac artery (IIA) embolisation is frequently performed prior to \nendovascular aortic aneurysm repair (EVAR) when concomitant common illiac \naneurysms necessitate graft extension into the external iliac arteries (to \nprevent endoleaks via retrograde IIA flow). Because the safety of this \nprocedure remains questionable, we aimed to determine the incidence of \nassociated pelvic ischaemic complications, and to establish what parameters \nare predictive of increased patient risk. \nMethods and Materials:  A retrospective review of clinical records and pre-\nprocedural CT angiography was conducted for all patients undergoing IIA \nembolisation prior to EVAR from 2002 to 2012. Bivariate analysis (Spearman \ncorrelation tests: p < 0.05 significant) was used to test for differences between \ntwo groups, those with or without new-onset pelvic ischaemic complications \nduring follow-up. \nResults: Twenty-five patients underwent elective IIA embolisation average 23 \ndays prior to EVAR (average age 72.2; 22/25 male). 3/25 patients underwent \nbilateral embolisation, 22 unilateral. Overall, 7/25 patients (28%) experienced \nnew-onset pelvic ischaemic complications, including erectile dysfunction (1/25), \nbilateral leg paraesthesia (1/25), and buttock claudication (BC) (5/25). Long-\nterm persistence of BC could be confirmed definitively in only 2 of the 5 \npatients. A shorter time interval from embolisation to EVAR correlated \nstatistically with increased risk of pelvic ischaemic complications (p < 0.03). \nBilateral IIA embolisation was independently associated with BC (p < 0.032). \nNo patient risk factors or CT angiographic factors were predictive of increased \nrisk. \nConclusion: We conclude that by avoiding both a short-time interval from \nembolisation to EVAR, and bilateral IIA embolisation, the risk of persistent \nischaemic complications due to IIA embolisation can be significantly minimised.  \nB-0614 10:57  \nOutcomes of endovascular treatment for aortic pseudoaneurysm in \nBehcet's disease  \nS. Kim, D. Lee, M. Kim, J. Won; Seoul/KR (dinbe@yuhs.ac)  \nPurpose: To evaluate the effectiveness of endovascular stent-grafting for \nsurgical management of aortic pseudoaneurysm in patients with Behcet's \ndisease (BD). \nMethods and Materials: We present a single-institution retrospective cohort of \npatients with aortic pseudoaneurysm and BD treated with aortic stent-grafting. \nCT imaging was obtained preoperatively in all patients and once within two \nweeks postoperatively, and then annually. Clinical follow-up and erythrocyte \nsedimentation rate (ESR) were used to follow BD activity. Immunosuppressant \ntherapy was instituted prior to endovascular treatment unless a \ncontraindication existed. \nResults: From 1998 to 2012, 10 patients (eight male, two female; median age \n39) with BD and aortic pseudoaneurysm were treated with endovascular stent-\ngrafting at this institution. 90% of these patients received immunosuppressive \ntherapy before and after surgical treatment. The median follow-up period was \n57 months (interquartile range, IQR 43-72). The locations of the 12 \npseudoaneurysms treated in this cohort were infrarenal abdominal aorta \n(seven), descending thoracic aorta (four), and aortic arch (one). Median \npseudoaneurysm size was 4.5 cm (IQR 3.4-5.9). At long-term follow-up, \ncomplete resolution of the aortic pseudoaneurysm was noted in all patients. No \nendoleaks occurred. Newly developed pseudoaneurysm at the distal margin of \nthe stent-graft was noted in one patient 17 months after the stent-graft \nprocedure. One patient required a subsequent stent-graft placement for an \nexpanding pseudoaneurysm of the subclavian artery. No patient deaths \noccurred during the follow-up period. \nConclusion: Endovascular treatment of aortic pseudoaneurysm with stent-\ngrafting in patients with BD is safe and effective with long-term durability.  \nB-0615 11:06  \nAccurate fluoroscopy-guided fenestration of aortic dissections using a \nconventional reentry catheter: first clinical experiences  \nF. Wolfschmidt, I. Platzer, J. Goltz, W. Kenn, R. Leyh, T. Bley, R. Kickuth; \nWürzburg/DE (Wolfschmid_f@ukw.de)  \nPurpose: Evaluation of the feasibility and effectiveness of fluoroscopy-guided \nneedle insertion for gaining controlled target lumen reentry in fenestration of \naortic dissections. \nMethods and Materials:  Between 2009 and 2013, eleven consecutive \npatients (10 male patients, mean age 51 ± 14 years) with malperfusion \nsyndrome from aortic dissection (8 type B and 3 type A dissections) were \ntreated using the Outback LTD reentry catheter (Cordis, Miami Lakes, Florida). \nThis 6-F catheter is equipped with a curved, extendable coaxial needle that \nallows accurate real-time fluoroscopy-guided puncture of the target lumen. \nAfter successful reentry a 0.014\" guidewire may be directed through the \ncoaxial needle into the target lumen. Patients had developed renal (n=6), \nmesenterial (n=1), spinal (n=3) and iliofemoral (n=7) ischemia. Three patients \nunderwent stentgraft implantation prior to fenestration. Technical success, total \nprocedure time, clinical outcome, follow-up imaging (CTA and MRA including \nflow measurements) and complications were evaluated. \nResults: The technical success rate using this reentry catheter was 100%. \nTotal procedure time was 72 ± 30 minutes; range 32 - 139 minutes. 3 patients \nwith iliofemoral malperfusion syndrome required additional stent implantation. \nIn all patients a significant improvement of clinical symptoms occurred. \nFollow-up imaging (mean follow-up period 164 days) showed a stable \ndissection membrane. One patient with spi nal malperfusion died due to his bad \ngeneral condition during hospitalisation. \nConclusion: This conventional fluoroscopic-based reentry catheter is a \nreliable and safe tool for gaining controlled target lumen reentry in fenestration \nof aortic dissections with malperfusion syndrome.  \nB-0616 11:15  \nUncovered stent implantation in complicated acute aortic dissection type \nB  \nA. Massmann, T. Kunihara, P. Fries, G.K. Schneider, H.-J. Schäfers, \nA. Buecker; Homburg a.d. Saar/DE (Alexander.Massmann@uks.eu)  \nPurpose: To retrospectively evaluate the technical feasibility and mid-term \nresults of uncovered thoraco-abdominal bare metal stent placement in \ncomplicated acute aortic dissection Stanford type B (AADB). \nMethods and Materials:  Fourteen patients (3 female, range 44-71 years) with \nAADB suffering from apparent gastrointestinal malperfusion and claudication \nunderwent uncovered metal stent implantation (diameter 7-28 mm, length 40-\n100 mm) into the thoraco-abdominal aorta (n=23) and visceral arteries (n=5). \nResults: Stenting yielded considerable clinical improvement in 13 of 14 \npatients. More than one stent (up to four) was placed in seven patients (2 \nceliac, 1 mesenteric, 2 renal, 8 aorto-iliac). Follow-up CTA revealed collapse of \nfour aortic stents (diameter 9-25 mm, length 100 mm) after one week. \nCatheterisation and balloon dilatation of all four stents were possible, but re-\ncollapse occurred 1 month later in all cases. However, patients were \nasymptomatic; ultrasound and CTA show ed sufficient perfusion of the visceral \narteries in all patients. Follow-up ranged from 6 months to 5 years (average 2.5 \nyears). One patient required an iliaco-mesenteric bypass for treatment of \nchronic mesenteric ischaemia, one month after stent placement. No other \npatient required additional interventional or surgical therapy. \nConclusion: Thoraco-abdominal stent placement is a technically feasible \nminimally invasive therapy in complicat ed AADB yielding similar clinical results \ncompared to treatment by dedicated covered aortic stentgraft. Stent size \nshould be below the normal aortic diamete r to avoid possible stent collapse.  \nB-0617 11:24  \nFeasibility of the superselective test with propofol for determining \neloquent brain regions in the endovascular treatment of arteriovenous \nmalformations  \nJ.A. Jordan, J.C. Llibre; La Habana/CU (jjordan@infomed.sld.cu)  \nPurpose: The superselective test for determining eloquent brain areas, carried \nout prior to the embolisation treatment for AVMs, is a tool contributing to \nincrease the safety of endovascular procedures. Taking into account \namobarbital unavailability, it was decided to carry out the present study, aimed \nat demonstrating propofol's efficacy and safety as an alternative to the use of \namobarbital to perform this test. \nMethods and Materials:  A group of 58 patients that went through 91 \nembolisation sessions were treated for brain AVMs using endovascular surgery \nbetween February 2006 and February 2011. The superselective test was \nperformed prior to embolisation with Histoacryl, using the intra-arterial \nadministration of 20 mg of propofol through a microcatheter positioned near the \nAVM nidus. \nResults: 10 (7.8%) of the 128 superselective tests turned out positive. \nNeurological deficits appeared immediately after propofol administration, lasted \nfor a minute and disappeared after 5 minutes. Only one of the patients showing \na negative test result developed neurologi cal deficits after embolisation, for \n99.2% NPV. Despite their positive test results, six patients were embolised and \nfive developed postembolisation neurological deficits, for 83.3% PPV. The test \nshowed 83.3% sensitivity and 99.2% specificity. \nConclusion: The use of propofol to perform the superselective test during \nbrain AVM embolisation is a safe and effective alternative to the use of \namobarbital, and may predict the occurrence of post - embolisation ischemic \ncomplications.  \nS268  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0618 11:33  \nMechanical thrombectomies performed in acute ischaemic stroke \npatients in Paula Stradins Clinical University hospital during 2010. - 2013  \nA. Balodis, K. Kupcs, H. Kidikas, E. Miglane; Riga/LV \n(arturs.balodis7@inbox.lv)  \nPurpose: Evaluate safety and efficacy of endovascular thrombectomy as a \ntreatment method of acute ischaemic stroke during large artery occlusion. \nMethods and Materials:  This was a retrospective study of 96 patients with \nacute ischemic stroke hospitalised in Paula Stradins Clinical University hospital \nfrom 28.12.2010 till 01.08.2013 and treated by endovascular thrombectomies \ndue to large artery occlusions. Telephone interviews were performed 3 months \nafter thrombectomy using modified Rankin Scale (mRS). Paired samples T-test \nwas used. \nResults: There were 50 (52.1%) males and 46 (47.9%) females, mean age \nwas 67.13±10.22 (SD) years.The majority of thrombs were localised in anterior \ncirculation area - 77 (80.20%), in posterior circulation area - 19 (19.8%). Mean \ntime from stroke's onset to mechanical thrombectomy was 252.28 ±97.71 (SD) \nmin in anterior circulation area and 417.90 ±170.59 (SD) in posterior circulation \narea.Mean National Institutes of Health Stroke Scale (NIHSS) until \nthrombectomy was 16.58 ±6.51 (SD), mean NIHSS after was 8.91± 7.80 (SD). \nThe difference was statistically significant, p < 0.0001.MRS before \nthrombectomy - mRS 3 got 1 (1.0%) patient with mild disability, mRS 4-5 got \n95 (99.0%) patients with moderately severe and severe disability. At 3 months \nafter, 37 (38.5%) patients had good outcome mRS-2 and less, 19 (19.8%) \npatients had mild disability, 9 (9.4%) patients had severe disability, mRS 4-5. \nThere are no data about 9 (9.4%) patients. Total mortality after 3 months was \n22 (22.9%)-mRS 6. \nConclusion: Mechanical thrombectomy can signi ficantly improve neurological \noutcomes in patients with severe ischaemic stroke. Accurate patients' selection \nimproved the late neurological results compared to our previous study.  \nB-0619 11:42  \nTranscatheter embolisation of extracranial aneurysms using n-butyl \ncyanoacrylate  \nJ. Koizumi, C. Itou, N. Mori, T. Sekiguchi, T. Hashimoto, K. Myojin, T. Ichikawa, \nY. Imai; Isehara/JP (jkoizumi@is.icc.u-tokai.ac.jp)  \nPurpose: To clarify the efficacy of transcatheter embolisation using n-butyl \ncyanoacrylate (NBCA) for extracranial aneurysms. \nMethods and Materials:  For 18aneurysms (5splenic, 5internal iliac, 3hepatic \narteries, 1celiac, 1 gastroduodenal, 1renal, 1uterine artery, 1 thoracic aorta) in \n17 patients, embolisation using NBCA with Lipiodol (33-67%) was performed. \nThe etiology includes atherosclerosis (10), pseudoaneurysm (3), myocosis (3), \nand median arcuate ligament compression (2). In 13aneurysms, coils were \nused as frames or nests for subsequent glue injection. Flow control using a \nballoon catheter was applied in 5aneurysms and distal neck was embolised by \ncoils in 5aneurysms to prevent glue migration. The coil and glue packing \ndensities for the aneurysmal volumes were calculated. \nResults: For 8.2± 9.9 mL of aneurysm volumes, 1.9 ±2.0 mL of NBCA was \ninjected after framing by 0.2 ±0.2 mL of coil volumes; the coil packing density \nwas only 3.8 ±4.3%. In 2splenic aneurysms, glue was migrated to splenic \nparenchyma intentionally as partial splenic embolisation. In other two internal \niliac artery aneurysms, minor distal migration was observed without clinical \nsequels. Incomplete occlusion occurred in one aneurysm due to shortness of \nglue and recurrence occurred in two mycotic aneurysms. NBCA expanded \n4.4±3.9 times in the aneurysms. \nConclusion: Transcatheter embolisation using NBCA was useful in reducing \ncoil usage with a high success rate.  \nB-0620 11:51  \nEndovascular stenting of extra-cranial internal carotid artery or vertebral \nartery occlusions in the management of acute stroke  \nA. Sastry, S. Nayak; Stoke-on-Trent/UK (anandsas@gmail.com)  \nPurpose: Middle cerebral artery (MCA) embolic occlusion with concomitant \ncervical internal carotid artery (ICA) occlusion is associated with a low rate of \nrecanalisation and poor outcome after intravenous thrombolysis. The purpose \nof this study was to assess outcome of endovascular stenting of extra-cranial \ninternal carotid artery or vertebral artery tandem occlusions using NIHSS, \nmodified Rankin score (mRS) and thrombolysis in cerebral infarction (TICI) \nscores. \nMethods and Materials:  Retrospective analysis of our stroke thrombectomy \ndatabase identified 124 patients. In addi tion to mechanical thrombectomy, 15 \npatients underwent ICA stenting for tandem ICA/MCA occlusions and 3 \npatients had vertebral origin stenting for VA origin/basilar artery occlusions. We \nexamined neurological improvement defined by \u0003 10-point reduction of NIHSS \nscore, TICI and improved mRS = 2 & 3 score at 90 day. \nResults: 90-day follow-up data was available for 18 patients which showed \n47%(n=7) had a reduction in the NIHSS score by greater than 10 points and a \nmRS \u0002 2 at 90 days. 67%(n=10) had a good outcome with a mRS of either \n2or3. 87%(n=13) achieved TICI 2b or 3 signifying successful recanalisation. \nMortality was 26 %(n=4) with 3 deaths due to malignant MCA infarction and 1 \ndeath due to pneumonia. \nConclusion: There was significant improvement in NIHSS, mRS and TICI \nscores in our 18 patients who underwent endovascular stenting for extra-\ncranial internal carotid artery or vertebral artery tandem occlusions. Major \nStrokes due to ICA and VA origin/basilar occlusions can be successfully \ntreated by ICA/VA origin endovascular stenting in conjunction with mechanical \nthrombectomy.  \n10:30 - 12:00 Board Room A  \nRadiographers  \nSS 914  \nOptimisation of dose and image quality in \nCT  \nModerators:  \nE. Agadakos; Athens/GR  \nJ. Cabukovska-Radulovska; Skopje/MK  \nB-0621 10:30  \nOptimisation of paediatric head computed tomography examinations: an \nexperimental and clinical approach  \nJ. Santos\n1, S. Foley2, G. Paulo1, M. McEntee3, L.A. Rainford1; 1Coimbra/PT, \n2Dublin/IE, 3Sydney/AU (joanasantos@estescoimbra.pt)  \nPurpose: Optimisation of paediatric head Computed Tomography (CT) \nexaminations. \nMethods and Materials:  Preset protocols for head CT examinations, derived \nfrom three national Portuguese paediatric centres were applied to Catphan 600 \nand anthropomorphic phantoms (0, 5 and 10 years old). Current exposure \nparameters were manipulated to optimise radiation dose. OsiriX software \nbased on standard deviation pixel values was applied to measure image noise. \nCT scanner dose reports provided CT Dose Index (CTDIvol-mGy) and Dose \nLength Product (DLP-mGy.cm). The findings were discussed locally with the \nparticipating centres. Based on the results a CT system upgrade with tube \ncurrent and voltage modulation proceeded in one centre. Patient data pre/post \nupgrade was collated to review dose and image quality levels. Patient images \nwere presented in Viewdex software underwent Visual Grading Characteristic \n(VGC) image quality evaluation by paediatric neuro-radiologists (n=4), using \nanatomical criteria scoring. \nResults: Optimisation across participating centres resulted in dose reductions \nof between 13% and 65%. Post experimental optimisation similar image noise \nlevels to the preset were identified. The CT upgrade demonstrated a decrease \nin mean dose for head CT examinations of 42%, image quality evaluation is \non-going and will be presented. \nConclusion: Minor exposure parameter manipulations facilitated paediatric CT \ndose reduction with limited impact on image quality. The optimisation tests and \nthe system software upgrade promoted a dose reduction in children.  \nB-0622 10:39  \nLow-dose chest CT vs bedside chest x-ray in emergency patients  \nA. Latifi\n1, M. Torkzad2, M. Beckman3, A. Sundin3, F. Labruto4; 1Manchester/UK, \n2Sollentuna/SE, 3Stockholm/SE, 4Syndney/AU (michael.torkzad@gmail.com)  \nPurpose: In this prospective non-randomised study, the diagnostic yield of \nbedside chest X-ray (bCXR) with non-contrast-enhanced low-dose chest \ncomputerised tomography (LDCT) was compared. \nMethods and Materials:  16 subjects > 65 years planned for bCXR underwent \nLDCT immediately afterwards. bCXR was performed with AP (150 KV and \n2.5 mAs) and lateral (140 KV and 6 mAs) views, mean radiation dose of 0.7 \nmSv and LDCT (average radiation dose = 0.59 mSv). Each bCXR and LDCT \nexaminations were read on different occasions by three blinded radiologists \nindependently. The degree of general diagnostic confidence was scored (1-4). \nThe agreement between the results was assessed by intraclass correlation \ncoefficient, and Cohen's and weighted kappa. \nResults: The average confidence score was always higher or the same for \nLDCT compared to bCXR (mean 2.85 for reading bCXR and 3.83 for LDCT). \nThere was no discrepancy for diagnosis of pneumothorax on LDCT. On bCXR \nhowever, there were two false negative and two false positive cases. Objective \nmeasurements of atelectasis depth (ICC 0.64 vs. 0.36), depth of pleural \neffusion (0.74 vs. 0.27) and heart size dimension (0.82 vs. 0.43) always \nshowed better agreement on LDCT readings than bCXR readings, \nrespectively. The following were missed on bCXR: four pulmonary opacities, \nthree malignancies, two patients with free intra-abdominal air and one case of \nfracture. No extra finding was missed on LDCT compared to bCXR. \nS269  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nConclusion: Chest LDCT with less radiation dose than bCXR discloses more \ndiagnoses and shows higher reliability and reader confidence.  \nB-0623 10:48  \nPsychophysical evaluation of CT image quality using human observers \nand software analysis  \nF. Zarb1, L.A. Rainford2; 1Msida/MT, 2Dublin/IE (francis.zarb@um.edu.mt)  \nPurpose: Comparison of objective image quality characteristics obtained from \nhuman observer evaluations and software analysis of CT phantom images. \nMethods and Materials:  A Catphan®600 CT quality assurance phantom was \nscanned using protocols for four anatomical areas: posterior fossa; cerebrum; \nabdomen and chest on three different CT models as part of an optimisation \nstrategy. CT image data sets (n=24) obtained pre and post-optimisation were \nblindly evaluated by radiographers (n =8) identifying the number of distinctly \ndiscernible line pairs and contrast discs for each of the three supra-slice sets \nwithin the phantom's high-resolution and low-contrast modules, respectively. \nThe same CT data sets were also gauged using the web based service - \nImage Owl for the automatic analysis of Catphan®600 images. \nResults: Inter-observer reliability measured using Cronbach's ' between \nhuman observers and again including software analysis (9\nth observer) gave \n'=0.97 for both instances, indicating that internal consistency of the observer \ngroup, with and without software analysis was identical. \nThe results of a paired sample t-test showed no significant difference (p > 0.05) \nbetween human observers and software analysis in 37.5% of observations for \nline pairs and 37.5%; 12.5% and 50% for the three sets of contrast discs. \nConclusion: Combined use of human observers and software analysis for \nevaluation of image quality in CT using phantoms is recommended. However, \nthe sole use of software analysis methods may provide more detail than that \nobtained by human observers. Further research to measuring the clinical \nrelevance of such image quality findings is recommended.  \nB-0624 10:57  \nAn investigation into the application of optimised CT protocols for head \nexaminations across clinical centres in Malta and Denmark  \nF. Zarb\n1, S. Holm2, L.A. Rainford3; 1Msida/MT, 2Odense/DK, 3Dublin/IE \n(francis.zarb@um.edu.mt)  \nPurpose: To investigate dose and image quality differences between clinically \nadopted optimised Maltese head CT protocols and preset parameters applied \nin a Danish center for matched CT equipment. \nMethods and Materials:  A Danish clinical center with a GE BrightSpeed Elite \n16-slice CT scanner was approached to participate in the optimisation study. \nHead CT protocols were reviewed from the twinned Maltese and Danish \ncenters. Maltese head CT data sets (n=20) produced using previously \noptimised protocols were collated for image evaluation and combined with non-\noptimised Danish preset head data sets (n=20). All anonymised images \ncontained minimal abnormal pathology. VIEWDEX software was employed for \nimage display. Controlled ambient lighting of > 60 lux and 3MP primary class \nmonitors were employed. A radiology cohort stated their confidence in the \nidentification of CEC validated anatomic al structures. Image quality analysis \nwas performed using Visual Grading Characteristic (VGC) analyses and dose \ndata (CTDIvol and DLP) reviewed for the optimised (Maltese) and preset \noptions (Danish). \nResults: Optimised Maltese protocols had been previously found to reduce \nCTDIvol and DLP by 7.5% and 5.7% respectively when compared to the \noriginal manufacturer preset scanning parameters, whilst image quality was \nmaintained. Mean dose values for CT head examinations were noted: Maltese \nCTDIvol 33.12 mGy / DLP 461.45 mGycm and Danish CTDIvol 71.98 mGy and \nDLP 1047.26 mGycm. \nConclusion: Optimised head CT protocols demonstrated dose savings of 55% \ncompared to the current preset Danish imaging parameters. The Danish image \nevaluation is currently on-going and findings will be presented with the \ncompleted dose analysis.  \nB-0625 11:06  \nOptimisation of the CT kidney ureter bladder protocol  \nJ. Tabone1, D. Aquilina2, F. Zarb2; 1Sliema/MT, 2Msida/MT \n(jtabone@stjameshospital.com)  \nPurpose: Population radiation exposure due to increased use of CT KUB in \nrenal colic has become significant. Therefore, efforts should be directed to \noptimise CT scan parameters minimising radiation exposure whilst maintaining \ndiagnostic efficacy. \nMethods and Materials:  Optimisation of the local protocol on a Philips \nBrilliance 64 slice CT was performed in stages. Firstly, radiation dose and \nimage quality descriptors were established in a phantom experiment involving \nsystematic reduction of scan parameters on the Philips quality control \nphantom. Resulting images were visually scored by radiographers (n=10) in \nterms of spatial and contrast resolution identifying an exposure combination \ndetecting structures \u00032 mm in size, as smaller calc uli are clinically insignificant. \nSecondly, the resulting exposure combination was applied in a clinical trial \ninvolving 10 patients. The images produced were compared to a randomly \nselected retrospective image sample (n=10) acquired with the current protocol. \nRadiologists (n=5) visually graded t he image data sets based on a combination \nof CEC image quality criteria for CT KUB and the unenhanced abdomen. \nImage quality data was analysed using vi sual grading characteristics (VGC) \nand findings considered significant at the 95% confidence interval. \nResults: Mean radiation dose levels in terms of CTDIvol (1.76 mGy) and DLP \n(95 mGycm) post optimisation were significantly (p < 0.05) between images \nobtained from both protocols. \nConclusion: The optimised protocol was found to have similar diagnostic \nquality to the current protocol with a significant reduction (70%) in both CTDIvol \nand DLP.  \nB-0626 11:15  \nPreventable exposure in routine chest CT examinations: evaluation of \neffective dose beyond prescribed anatomical landmarks  \nA. Barbara, J. Ferreira, L.J.O.C. Lanca; Lisbon/PT  \nPurpose: To evaluate preventable exposure dose in routine chest CT \nexaminations beyond prescribed anatomical landmarks and estimate extra \ndose delivered to the patient. \nMethods and Materials: A sample of 102 routine adult chest CT examinations \n(53 male and 49 female) was retrospectively analysed. All the scans were \nacquired with a MDCT (8-slice). Using the CT-Expo software, organ effective \ndose (lungs, oesophagus, heart, bone, thyroid, kidneys and adrenal glands) \nwere estimated. A significance level of p < 0.05 was used for statistical analysis \nto test any statistical differences between the effective dose from the \nperformed CT scans and the desirable scans accurately planned and \nreferenced to the prescribed landmarks. \nResults: 93% of chest CT examinations were planned and acquired beyond \nthe prescribed anatomical landmarks. The mean effective dose in the 7 organs \nfor the acquired exam versus the desirable prescribed landmarks under the \nroutine scanning protocol was as follows: lungs (59.2 mSv vs 57.7 mSv); \noesophagus (56.2 mSv vs 57.3 mSv); heart (52.1 mSv vs 49.8 mSv); bone \n(43.0 mSv vs 42.2 mSv); thyroid (13.6 mSv vs 30.3 mSv); kidneys (37.0 mSv \nvs 12.2 mSv); and adrenal glands (42.8 mSv vs 29.2 mSv). Statistical \nsignificant differences in effective dose (p < 0.05) were found in all organs, \nwhere extra-coverage was found, except thyroid. Major differences were found \nin kidneys (24.8 mSv) and thyroid (-16.7 mSv) due the fact that those organs \nare located at the anatomical boundaries. \nConclusion: An accurate scanning protocol should be followed to avoid \nunnecessary dose delivered to the patient.  \nB-0627 11:24  \nDo radiographers' inform parents? An investigation into disclosure of \nradiation risks in paediatric CT in Ireland  \nK. Foley-Friel, L.A. Rainford, M.-L. Butler; Dublin/IE  \nPurpose: Computed tomography (CT) is widely regarded as a high radiation \ndose imaging modality and its use amongst the paediatric population is rapidly \nincreasing. Communicating the benefits and risks of CT with parents will allow \nan informed decision to be made in the child's best interest. The aim of the \nstudy was to establish current practice surrounding radiographers' disclosure of \nradiation risks to parents prior to paediatric CT examinations. \nMethods and Materials:  Postal questionnaires (n= 60) were distributed to the \nspecialised national paediatric centres (n=3) in Ireland and three regional \nhospitals performing both adult and paediatric examinations. Key topics in the \nquestionnaire included the practice of informing parents about radiation risks in \npaediatric CT and radiographers' opinions on discussing radiation risks. \nResults: A response rate of 67% was attained and of these, 20% indicated \nroutinely informing parents of radiation ri sks in paediatric CT, whilst 90% inform \nof scan duration and 95% inform about equipment movements. In addition, \n24% stated radiation risks should be discussed with parents, and 60% stated \nthis responsibility lies with the radiographer and referring clinician. \nRadiographer responses indicated that they believed parents wished to be \ninformed of CT radiation risks (n= 52%). \nConclusion: The majority of radiography responses indicated that they do not \nroutinely disclose radiation risks to parents (n=80%), despite over 50% of \nradiographers' opinion stating that parents wish to be informed of them. No \ndepartmental protocols related to the di sclosure of radiation risks for CT \nexaminations performed were identified.  \n \n \n \nS270  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0628 11:33  \nOperator dependency in protocol assignment could be suppressed if \ntuning the AEC strength curve from average to strong  \nF. Hastir1, D. Tack2; 1Ath/BE, 2Braine-L'Alleud/BE \n(Francois.Hastir@EpiCURA.be)  \nPurpose: To investigate the impact of tuning the Automatic Exposure Control \n(AEC) strength curve from \"average\" to \"strong\" on image quality, radiation \ndose, and operator dependency during lumbar spine CT examinations. \nMethods and Materials:  Two hospitals (H1 and H2), both using the same \nscanners, were considered for two time periods (P1, P2). During P1, the AEC \ncurve was \"average\" and radiographers had to select one of two protocols \naccording to the BMI: \"Standard\" if BMI 30.0 (140 KV-280 mAs). During P2, the \nAEC curve was changed to \"strong\" and all acquisitions obtained with one \nprotocol (120 KV and 270 mAs). Image quality was scored and patients' \ndiameters calculated. \nResults: Data of 497 examinations were analysed. There was no significant \ndifference in mean diameters according to hospitals and periods (P >.801), and \nin quality scores between periods (P >.172). There was a significant difference \nbetween hospitals regarding how often the \"large\" protocol was assigned \n(13/132 patients (10%) in H1, vs. 37/133 (28%) in H2) (P <.001). During P1, \nCTDIvol was higher in H2 (+13%; P =.050). In both hospitals, CTDIvol was \nreduced between periods (-19.2%, in H1, -29.4% in H2, P <.001). \nConclusion: An operator dependency in protocol selection, unexplained by \npatient diameters or by image quality scores can increase radiation dose \nduring lumbar spine CT. Tuning the AEC curve from average to strong enables \nsuppressing this operator dependency while reducing the dose and preserving \nimage quality.  \nB-0629 11:42  \nReference dose levels in head computed tomography: a pilot study \nperformed during traineeship in three Portuguese health institutions  \nC. Figueira, C. Vieira, D. Santos, D. Santos, J. Vale, M.R.D. Santos; Aveiro/PT \n(mrs@ua.pt)  \nPurpose: The main objectives of this study were to, during radiography \ninternship, verify if effective dose values associated with CT head scan were \nconsistent with ones referenced in the European Guidelines and to verify if the \nexposure parameters were adjusted to different groups of patients namely in \npaediatric examinations. \nMethods and Materials:  Data were obtained in three Portuguese medical \ninstitutions during Radiography internship. Dose-Length Product (DLP), age \nand sex of 239 patients were collected and were included all head \nexaminations without contrast, regardless of pathology. With the DLP values, \neffective dose (E= EDLP•DLP) was calculated using the normalised effective \ndose for adults (EDLP=0.0023mSv•mGy-1•cm-1) and children (EDLP = \n0.0040mSv•mGy-1•cm-1 - 5 years; EDLP = 0.0032mSv•mGy-1•cm-1 - 10 \nyears??). \nResults: The study sample is composed by 239 patients (53% female and \n47% male) divided into 2 groups one between 17 and 100 years and other, \npaediatric sample, composed of 8 cases aged between 5 and 16 years. Values \nof mean effective doses obtained for adults (4,55 ±1,50mSv) were higher than \nthe European Guidelines values (2,41 mSv). For paediatrics patients, we \nexpected to find lower values than for adults and that was not observed (5 \nyears category 4,62 ± 2,03 mSv; 10 years category 4,74±3,13 mSv). \nConclusion: Comparing with the European Guidelines we found that, for both \nadults and children, the effective dose values suggested the need to optimise \npractices in head CT studies.  \nB-0630 11:51  \nColorectal liver metastasis' changes during different systematic \nchemotherapy treatment  \nM. Kiss, B. Lombay; Miskolc/HU (kissmate20@gmail.com)  \nPurpose: Colorectal cancer is one of the most common cancer and the liver is \nthe most common site of colorectal metastases. There are several therapeutic \noptions - surgical, local or systemic chemotherapy - to manage metastases. \nThe statistical analysis is indispensable an d it gives very useful information to \nchange the best treatment. \nMethods and Materials:  Between 01.10.2008 and 01.07.2013 we examined \n2430 oncological patients with a known primary colorectal tumour. These \npatients underwent contrast-enhanced CT (a Siemens Somatom Definition \nAS+ 2x64 detector, row MDCT) and/or a contrast-enhanced liver MRI (a \nSiemens Magnetom Symphony 1.5 T and a Siemens Magnetom Verio 3 T). \nMATLAB software was used to made statistical analysis. We analysed the \nvisual appearance, the type of the chemotherapy treatment and studied how \nthey changed during the course of treatment. \nResults: We found liver metastases in 142 patients. We divided the patients \ninto 3 groups, based on the type of the systematic chemotherapy treatment. \nThe Folfox seemed to the best method: 23 regression (decreased the size, \nnumber of the mass and changed their structure) 12 unchanged status (no \nchange in the status of mass) 19 progression. De-Gramont: 6 regressions and \n34 progressions. Folfiri: 34 progressions, 2 unchanged status, 12 regressions. \nConclusion: The aims of chemotherapy in unresectable colorectal liver \nmetastases to prolong survival, decrease the size and control symptoms. \nThere is no universally accepted standard therapy. Statistical analysis is very \nimportant the clinical medicine, but it's not worth to based the treatment on \nthese analysis.  \nAuthor Disclosures: \n M. Kiss: None. B. Lombay: None. \n10:30 - 12:00 Room P  \nGI Tract  \nSS 901b  \nEsophageal and gastric neoplasms: new \ntrends  \nModerators:  \nM. Studniarek; Gdansk/PL  \nD.J.M. Tolan; Leeds/UK  \nB-0631 10:30  \nValue of oral effervescent powder administration for multidetector CT \nevaluation of oesophageal cancer  \nK.I. Ringe, S. Meyer, F. Wacker, H.-J. Raatschen; \nHannover/DE (ringe.kristina@mh-hannover.de)  \nPurpose: To assess the value of oral effervescent powder administration for \ndetection and staging of oesophageal cancer at contrast-enhanced CT. \nMethods and Materials:  84 patients without oesophageal pathology and 52 \npatients with histological confirmed diagnosi s of oesophageal cancer referred \nfor CT were included in this prospective IRB-approved study (99m/37f, mean \nage 61y). Half of the patients of each group were orally administered 3 g \neffervescent powder (EP) prior to image acquisition. Oesophageal distension \nwas assessed (proximal/middle/distal/tumour level) by volumetry of the inner \n(ID) and outer diameter (OD). Two blinded readers separately evaluated the \ndatasets regarding diagnosis of oesophageal cancer (yes/no) and staging (T0-\nT4), if applicable. Distension results were compared (T-Test). In patients with \ncancer sensitivity, specificity, negative (NPV) and positive (PPV) predictive \nvalues were calculated. Staging results were evaluated (Cohen-k). \nResults: ID and quotient ID/OD were significantly larger at all levels after EP \nas compared to the control (p < 0.05; mean ID:1.1 vs. 0.42, mean ID/OD:0.34 \nvs. 0.13). For both readers sensitivity, specificity, NPV and PPV for detection of \ncancer were as follows: 78%/78%, 98%/98%, 95%/95%, 87%/87% after EP; \n60%/68%, 98%/98%, 94%/94%, 80%/83% without EP. Staging after EP was \ngood (k=0.838/0.674) and moderate without EP (k=0.576/0.592). Interobserver \nagreement for detection and staging of tumour was very good (k=0.830) and \ngood (k=0.741) after EP, and good (k=0.774) and moderate (k=0.591) without \nEP, respectively. \nConclusion: Oral administration of effervescent powder at CT results in good \ndistension of the oesophagus, and improves detection and staging of \noesophageal cancer, as compared to studies without effervescent powder.  \nB-0632 10:39  \nDW-MRI in gastro-oesophageal cancer: can ADC be considered a \nprognostic biomarker and used for preoperative risk stratification?  \nF. Giganti, F. De Cobelli, E. Orsenigo, D. Chiari, E. Mazza, L. Albarello, \nA. Ambrosi, C. Staudacher, A. Del Maschio; Milan/IT \n(giganti.francesco@hsr.it)  \nPurpose: To investigate the role of apparent diffusion coefficient (ADC) as a \nbiomarker in the evaluation of the aggressiveness of gastro-oesophageal \ntumours. \nMethods and Materials:  Written informed consent was obtained from each \nPatient. 78 Patients (54 men - 24 women; mean age 64.6 years) with biopsy-\nproven disease (13 oesophageal, 13 gastro-oesophageal junction and 52 \ngastric cancer) were examined with a 1.5 T MR system including T1, T2 and \nDWI ( b values 0-600 s/mm\n2) sequences. 52/78 Patients (67%) were treated \nwith surgery while 26/78 Patients (33%) were submitted to neaodjuvant \ntherapy and then restaged with MR before surgery. All participants were \nfollowed up for a median of 18.33 months. The role of ADC, tumour site, post-\noperative T and N stage and histotype was investigated by univariate and \nmultivariate analysis using Cox regression model and Kaplan-Meier curves. \nResults: Of the 78 Patients, 62 (80%) were alive and 16 (20%) had died. \nMedian overall survival was 36 ± 8.59 months (C.I. 19.1-52.8). Considering all \nthe variables, our results showed that ADC values below 1.4 x 10\n-3 mm2/s can \nS271  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\npredict a negative prognosis both in t he total population (n=78; p=0.010) and in \nPatients directly treated with surgery (n=52; p=0.014). \nConclusion: Our study suggests the potential role of ADC as a quantitative \nbiomarker reflecting the aggressiveness of gastro-oesophageal lesions and \nmay be useful for pre-operative risk stratification considering the role of ADC \nas an independent prognostic factor.  \nB-0633 10:48  \nDual-energy CT: relationship between iodine concentration in perigastric \nadipose tissue and serosa invasion for gastric cancer  \nG. Shi, L. Yang; Shijiazhuang/CN (gaofengs62@sina.com)  \nPurpose: To investigate the relationship between iodine concentration (IC) in \nperigastric fat by dual-energy CT (DECT) and serosa invasion for gastric \ncancer using histopathologic result as reference. \nMethods and Materials:  48 patients with gastric cancer undergoing \npreoperative DECT and surgery were enrolled. The T staging according single-\nenergy venous phase images was compared with the pathological T stage. \nThe IC of perigastric adipose tissue was measured at arterial phase (AP) and \nportal venous phase (PVP), respectively. Receiver operating characteristic was \nused to determine the threshold of IC for detecting serosa invasion. The \neffective radiation dose of unenhanced, arterial and portal venous phase scan \nwas calculated. \nResults: The accuracy of T staging according single-energy venous phase \nimages was 58.33% (28/48). IC was significantly higher in serosa invasion \ngroup than that of uninvaded group (AP: 0.60 ±0.34 vs. 0.12 ±0.22 mg/ml, Z=-\n4.240,p=0.000; PVP: 0.83 ±0.41 vs. 0.29 ±0.23 mg/ml, Z=-4.292,p=0.000). With \na threshold of 0.25 mg/ml at AP, the sensiti vity and specificity for detecting \nserosa invasion was 84.4% and 81.2%. With a threshold of 0.45 mg/ml at PVP, \nthe sensitivity and specificity was 87.5% and 81.2%. The effective radiation \ndose of unenhanced, arterial and portal venous phase was 5.08 ±1.20, \n4.39±1.46, and 4.58±2.42 mSv, respectively. \nConclusion: DECT and iodine quantification in perigastric fat is an accurate \nmethod to detect serosa invasion for gastric cancer.  \nB-0634 10:57  \nComparison of computed tomographic perfusion and 18 FDG/PET-CT in \nthe diagnosis of primary oesophageal cancer  \nM. Kantarci1, B. Genc1, E. Orsal1, H. Ogul1, Y. Aydin1, B. Pirimoglu1, A. Okur1, \nA. Solak2, A. Eroglu1; 1Erzurum/TR, 2Izmir/TR (akkanrad@hotmail.com)  \nPurpose: To assess the relationship between PET/CT and CT perfusion \nperformed for staging of primary oesophageal cancer. \nMethods and Materials:  Nineteen patients undergoing PET/CT for \noesophageal cancer staging were enrolled. Subsequently, CT perfusion and \nthoracoabdominal CT with contrast were performed for the oesophageal \nmasses. Oesophageal tumour diameters were divided into three groups: 5-\n15 mm, 15-25 mm, and 25-35 mm. For each group, lymph node metastasis \nand distant metastasis, as well as the mean CT perfusion and SUVmax values, \nwere calculated. CT perfusion parameters of blood volume (BV), blood flow \n(BF), and permeability surface (BMP) were compared with the PET parameter \nSUVmax. Tumour diagnosis was confirmed histopathologically in all the \npatients. Correlation between the tumour grade, pathological cell types, and \nthe SUVmax and CT perfusion parameters calculated in tumour mass were \ncompared. \nResults: In all stages, no significant difference was found between CT \nperfusion and SUVmax values in oesophageal cancers with varying \nhistological types and tumour diameters (P > 0.05). There was no significant \ndifference between the CT perfusion parameters in the Stage 1, 2, and 3 \noesophageal cancers (P > 0.05). However, there was a significant difference \nbetween Stage 4 and the other stages with respect to the BF values \n(P < 0.0213). In Stage 1, no measurable FDG uptake was detected in four \ncases with a tumour diameter of 6 to 12 mm. However, CT perfusion values of \nwere measured in all cases. \nConclusion: The CT perfusion technique is a feasible method for evaluating \noesophageal cancers with small tumour diameters that are not amenable for \nassessment with PET/CT.  \n \n \n \n \n \n \n \n \n \n \n \n \nB-0635 11:06  \nA prospective trial for the evaluation of esophageal cancer patients: \nfluorodeoxyglucose (FDG) positron emission tomography \n(PET)/computed tomography (CT) vs contrast enhancement (c.e). CT vs. \nFDG PET/c.e.CT  \nL. Evangelista, A. Cervino, E. Scagliori, A. Panunzio, C. Castoro, P. Muzzio, \nV. Sileni Chiarion, F. Pomerri; Padua/IT (laura.evangelista@tin.it)  \nPurpose: We reported the preliminary data about the comparison of diagnostic \nperformance among PET/CT, c.e.CT and PET/c.e.CT in oesophageal cancer \npatients. \nMethods and Materials:  60 EC patients (46 male, 62 ±12 years) who \nunderwent basal PET/CT plus c.e.CT in a single session, were recruited. After \n60 min from the injection of FDG, a whole body PET/CT scan was acquired. At \nthe end of standard acquisition, a neck-thorax-abdomen c.e. CT was \nperformed; in particular, three c.e. phases for the liver evaluation were made. \nThree specialised physicians (two radiologists and two nuclear medicine \nspecialists) read the images, separately. The diagnostic performances of \nPET/CT, PET/c.e.CT and c.e.CT were evaluated by using the standard method \nand then compared with clinical staging (by patient-based analysis). \nResults: 60 patients performed both PET/CT and c.e.CT while 57 of them had \nall three scans. The imaging co-registration (PET and c.e.CT) was good in \n88% of patients, discrete in 7% and scarce in only 5%. The agreement among \nthe three scans was present in 35% of subjects. In the remnant 65% of \npatients, c.e.CT demonstrated more lymph node metastases than both \nPET/CT and PET/c.e.CT (15 and 11%, respectively), similarly PET/c.e.CT \nshowed more loco-regional/distant lymph nodes and distant metastases than \nPET/CT (increase in positive rate=30%). The clinical staging was recovered in \n28 (41%) patients. The positive predic tive value of PET/c.e.CT was higher than \nPET/CT and c.e.CT for the identification of loco-regional/distant lymph nodes \nand distant metastases (81 vs.78% and 70%, respectively). \nConclusion: In EC patients, FDG PET/c.e.CT represents an accurate and \nfeasible method for recognising a major number of pathological findings in \ncomparison with PET/CT and c.e.CT.  \nB-0636 11:15  \nDiagnostic performance of MDCT in preoperative assessment for \nlymphatic gastric cancer spread in the era of neoadjuvant treatment: is a \ndouble dimensional cut-off a reliable approach?  \nM.A. Mazzei, C. Pozzessere, S. Guerrini, P. Mercuri, A. Parrinello, \nN. Cioffi Squitieri, L. Righi, F.G. Mazzei, L. Volterrani; Siena/IT  \n(mamazzei@gmail.com)  \nPurpose: To validate the accuracy of MDCT in the pretreatment lymphonode \n(LN) definition in patients with Gastric Cancer (GC), using a double \ndimensional cut-off. \nMethods and Materials:  135 patients with primary GC, who underwent an \nMDCT staging scan followed by radical surgical treatment, were \nretrospectively, blindly and independently evaluated by a resident (reviewer1) \nand an experienced radiologist (reviewer2). All patients were staged according \nto the 3\nrd edition of Japanese Classification of Gastric Carcinoma (JCGC). \nRegional LNs were considered involved when the short-axis diameter (SaD) \nwas >/= 5 mm for nodes of level 1 and >/= 8 mm for those of the other level, \naccording to the distance of the LNs from the primary tumour. Cohen K test \nwas used to evaluate the inter-observer agreement. \nResults: LN invasion was found in 83 cases (66%). The N staging overall \naccuracy was 84% (reviewer1) and 90% (reviewer2). There was a statistical \nsignificant difference between the maxi mum SaD of pathological LNs of levels \n1 and 2 (p < 0.05), of intestinal and diffuse type (p < 0.01), intestinal and mixed \ntype (p < 0.05), and intestinal and diffuse/mixed type (p < 0.005). MDCT \ndiagnostic accuracy was maximised using a double dimensional cut-off, 5 mm \nfor LNs of level 1 and 7.7 mm for LNs of level 2. None of the T2 cases were \nunderstaged. \nConclusion: A double dimensional cut-off for level 1 and 2 according to the \ndistance of the LNs from the primary tumor encourage the use of MDCT as the \nonly technique sufficient to assess lymphatic cancer spread in the staging of \nGC.  \n \n \n \n \n \n \n \n \n \n \n \n \nS272  \n\n \n \nBA C D E F G \nSaturday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0637 11:24  \nDifferentiation of early gastric cancer with ulceration and advanced \ngastric cancer using multiphasic dynamic multidetector CT  \nD. Tsurumaru, M. Miyasaka, Y. Nishimuta, Y. Asayama, A. Nishie, Y. Kubo, \nH. Honda; Fukuoka/JP (tsuru-d@radiol.med.kyushu-u.ac.jp)  \nPurpose: Early gastric cancer with ulceration (EGC-U) mimics advanced \ngastric cancer (AGC) because they could have similar endoscopic findings with \nulceration. The purpose of this retrospective study was to determine whether \nenhancement at multiphasic dynamic multidetector row computed tomography \n(MDCT) can help differentiate EGC-U from AGC. \nMethods and Materials:  Seventy-four consecutive patients with pathologically \nproven EGC-U (Ul-II-IV) and AGC (T2-T4a) were enrolled. Preoperative MDCT \nimages were obtained 40s (arterial phase), 70s (portal phase) and 240s \n(delayed phase) after injection of nonionic contrast material. We compared the \nCT attenuation value of EGC-U and AGC using t test. We also performed \nreceiver operating characteristic (ROC) analysis to determine the optimal \nthreshold levels to differentiate EGC-U from AGC. \nResults: Of the 74 cases, 40 cases (16 EGC-U and 24 AGC) were detectable \nin all three phases, which were analysed. Mean enhancement of EGC-U and \nAGC peaked in the delayed and portal phase, respectively. The CT attenuation \nvalue of EGC-U was significantly lower than that of AGC in both the arterial \n(66 HU vs 107 HU, P <.0001) and portal (75 HU vs 115 HU, P <.0001) phases. \nThe sensitivity, specificity, and accuracy in differentiating EGC-U from AGC \nwere 81%, 88%, and 85%, respectively, for arterial phase and 88%, 100%, and \n95%, respectively, for portal phase. \nConclusion: Enhancement at multiphasic dynamic MDCT can help \ndifferentiate EGC-U from AGC.  \nB-0638 11:33  \nA comparison study with fluoroscopy: can CT scan predict anastomotic \nleaks after gastric surgery?  \nT. Kim, J. Kim, C.-I. Shin, S. Kim, J. Han, B. Choi; Seoul/KR \n(taiho17@gmail.com)  \nPurpose: To assess diagnostic performance of CT for detecting anastomotic \nleaks after gastric surgery comparison with fluoroscopy and to analysis clinical \nrole of immediate postoperative CT after gastric surgery. \nMethods and Materials:  Our study consisted of 179 patients who underwent \nCT and fluoroscopy after gastric surgery. We categorised patients as follows: \nGroup I, leak on fluoroscopy; Group II, possible leak on CT but negative on \nfluoroscopy; Group III, no leak. Two reviewers independently rated the \npossibility of leak on CT using a five-point scale. They evaluated presence or \nabsence of predefined CT findings. We also analysed the relationship between \nclinical data and different groups. ROC curve analysis, Chi-Square test and \nStudent t-test were used for statistical analysis. \nResults: AUC for detecting leak on CT was 0.886 in R1 and 0.668 in R2 with \nmoderate agreement ( @ = 0.482). Statistically common CT findings for leak \nincluded discontinuity at the anastomos is site, large amount of air-fluid, and \nwall thickening at anastomosis site (p < 0.05). Discontinuity at the anastomosis \nwas independently associated with the leak (p=0.0001). The hospitalisation \nperiod and postoperative fasting period was longer on Group.i. than Group II or \nGroup III (p < 0.05). Group II showed longer total recovery period than Group \nIII (p < 0.05). However, surgical type (laparoscopic vs. open surgery) showed \nno statistical difference on different groups. \nConclusion: Postoperative CT was useful for prediction of anastomotic leaks \nusing specific imaging findings. Also these CT findings can predict total \nrecovery period.  \nB-0639 11:42  \nMRI characteristics of anal carcinoma: analysis in a cohort of 51 patients  \nR. Sun, C. Durdux, P. Bauer, C. Bourillon, C.A. Cuenod; Paris/FR \n(roger.sun1988@gmail.com)  \nPurpose: The number of anal carcinoma is increasing and MR imaging is \nbecoming method of choice for staging and follow-up. The purpose of this \nstudy was to evaluate the primary MRI appearances of anal carcinoma in a \nlarge cohort of patients. \nMethods and Materials:  A review was performed on 51 biopsy-proven anal \ncarcinoma, where MRI was used for primary staging using T2-weighted images \n(T2WI), T1WI after gadolinium chelate injection, and diffusion WI. The size, the \nextent and the signal characteristics of the anal tumour, as well as the nodal \nspreading were recorded. The characteristics were compared according to the \nsex. \nResults: Relative to the internal anal sphincter, tumours appear with very high \nsignal intensity (SI) in all cases on diffusion WI, and with high SI in 80% of \ncases on T2WI (58% discrete, 22% frank high SI). On Gd-enhanced T1-WI \n(T1+Gd), 77% tumours showed low SI, with a peripheral rim of high SI in 37%. \nLymph node metastases showed slight high SI on T2WI, and frank high SI on \nT1+Gd. The median craniocaudal and circumference diameters were 4.5 cm \n(IC95% [3.8-5.3]) and 213° (IC95% [182-245]). At diagnosis, women were \nolder than men (62 vs. 54 yo) The circumferential involvement and the number \nof T4 was more important in women (360° in 37% vs. 6%, < 180° in 11% vs. \n44%, T4 in 49% vs. 13%) (p < 0.05). \nConclusion: MRI is an excellent means of assessing primary anal carcinomas, \nwhich appearances are different in older women than in young men.  \nB-0640 11:51  \nThe prognostic value of tumour volume and lymph node metastasis for \noesophageal carcinoma  \nG. Shi, Q. Xu; Shijiazhuang/CN (gaofengs62@sina.com)  \nPurpose: To investigate the relationship between tumour volume and lymph \nnode metastasis, and its prognostic value of oesophageal carcinoma. \nMethods and Materials:  Six hundred and seven patients (413 males 194 \nfemales,age range 26 - 78 years) received the radical resection of thoracic \noesophageal carcinoma were enrolled.  According to postoperative pathology, \nthe number of lymph node metastasis was 0 in 371 cases, 1 in 107 cases, 2 in \n51 cases, 3 in 35 cases, \u0003 4 in 43 cases. These patients' preoperative CT \nimages were used for tumour volume measurement. The patients were \nfollowed up for a duration ranged from 1 to 75 months (mean 39 months). The \nrelationship between tumour volume, number of lymph node metastasis and \npatient prognosis was investigated. \nResults: The tumour volume had significant difference between N0 and N1 \nstage (P < 0.001). The tumour volume had significant difference between 1 \nlymph node metastasis group and \u00034 lymph nodes metastasis group (P0.05). \nThe tumour volume had a positive correlation to lymph node metastasis \n(r=0.230,P < 0.001). The 1, 3, 5-years survival rates after the surgery date \nwere 83.32%, 53.33%, 36.02%, respectivel y. The survival rate was significant \ndifference between N0 and N1 stage (P < 0.001). Significant difference also \nexisted between 1 and \u00032 lymph nodes metastasis group (P < 0.01). Cox \nregression model showed that the independent prognostic factors are: tumour \nvolume, the number of lymph node metastasi s, pathological type, lesion region \n(P < 0.05). \nConclusion: Oesophageal carcinoma tumour volume is related to lymph node \nmetastasis with a positive correlation, and it is an independent prognostic \nfactor of post-surgery survival rate.  \n \nS273  \n\n \n \nBA C D E F G \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n \n \n\u0010\u001e\u0019\u0014\u0012\u001f\u0002\u0001\u000f\u0012\u001b\u0013\u0017\u0001\r\u0001\nS274  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n10:30 - 12:00 Room A  \nOncologic Imaging  \nSS 1316  \nTumour staging: whole-body MRI and \nMR/PET  \nModerators:  \nM. Mayerhöfer; Vienna/AT  \nA.G. Rockall; London/UK \nB-0641 10:30  \nOne-step TNM staging of high-risk prostate cancer during a single MR \nimaging session  \nV.P. Pasoglou, A. Larbi, L. Collette, L. Annet, F. Jamar, N. Michoux, \nB. Vande Berg, B. Tombal, F.E. Lecouvet; Brussels/BE \n(vasilikipas@gmail.com)  \nPurpose: Multiparametric MRI (mpMRI) is the standard for local (T)PCa \nstaging. Whole-body MRI (wbMRI) is effective for the metastatic screening. \nThis study assesses the feasibility and value of an \"all-in-one\" TNM staging \ncombining mpMRI and wbMRI. \nMethods and Materials:  30 patients with \"high-risk\" PCa (PSA > 20 ng/ml, \nGleason\u0003 8, or T stage \u0003 3a) underwent wbMRI including diffusion-weighted \nimaging (DWI) and prostate mpMRI in addition to the standard bone (M) and \nnode (N) screening [bone scintigraphy ± targeted x-rays if necessary \n(BS±TXR) and contrast CT]. A \"best valuable comparator\" (BVC) integrating all \ninitial and follow-up imaging, biological, and clinical data were used to \nadjudicate N and M metastatic status. \nResults: Local (T) staging was feasible in all patients using ESUR guidelines. \nBased on the BVC, 13 patients had metastases. Sensitivity of BS ±TXR and \nwbMRI for detecting bone metastases was 89% and 100%; specificity was \n90% and 100%, respectively. Sensitivity of CT and wbMRI for detecting node \nmetastases was 82% and 100%; specificity was 100% for both. Sensitivity of \nBS±TXR combined with CT and of wbMRI for detecting metastases was 85% \nand 100%; specificity was 88% and 100%, respectively. For the overall staging \nof the patients as being either N0M0 or havi ng disease extension beyond the \nprostate, wbMRI was superior to the BS ±TXR and CT combination \n[improvement in AUC by 13.6%, P=0.0392]. \nConclusion: TNM staging of PCa is feasible in less than one hour in an MRI \nsession combining mpMRI and wbMRI, outperforming BS ±TXR and CT for \ndiscriminating patients with or without metastasis.  \nAuthor Disclosures: \nV.P. Pasoglou: Grant Recipient; FNRS/TELEVIE GRANT. Research/Grant \nSupport; Fondation contre le cancer.  \nB-0642 10:39  \nContrast enhanced total spine MRI and DWI evaluation of disease activity \nin monoclonal gammopathy of undetermined significance and multiple \nmyeloma  \nP. Arcuri\n1, V. Arcuri1, S. Roccia2, M. Gigliotti1, S. Molica1, G. Fodero1; \n1Catanzaro/IT, 2Lamezia Terme/IT (arppaolo@alice.it)  \nPurpose: The aim of our study was to evaluate the diagnostic value of total-\nspine contrast -enhanced MRI and DWIBS (with high B-value) in the prognosis \nand assessment of therapy in Monoclonal Gammopathy of Undetermined \nSignificance (MGUS) and Multiple Mieloma (MM). \nMethods and Materials:  We studied, retrospectively, 56 patients affected of \nMGUS (38) and MM (18) before treatment and after induction chemotherapy. \nThe results were matched with hematologic values and bone-biopsy. Were \nused sequences pre- and post-contrast and DWIBS. The values were obtained \nby ROIs positioned on pathologic vertebral bodies. Post-treatment changes in \nROIs Signal Intensity were compared with clinical response to therapy and with \nbone-biopsy by using the Mann-Whitney U test. \nResults: Lower homogeneous signal intensities in T1 Weighted images \nassociated with a moderate enhancement after contrast administration and \nirregular high signal intensity in DWIBS were negative prognostic value in \nMGUS, then changed in symptomatic MM (P < 0.001). In patients affected of \nMM, the absence of significant enhancement in T1 SPIR sequence post-\ncontrast material injection (p < 0.002) and a low signal in DWIBS (p < 0.001), \nwere indicative for therapeutic efficacy. \nConclusion: The combined MRI study of MGUS patients by DWIBS and \ncontrast enhanced MRI of Total Spine is useful for early diagnosis and to \npredict the change in MM, then supply by bone-biopsy. In MM, treatment \nresponse patients correspond to absence of contrast enhancement and low-\nsignal in DWIBS.  \n \nB-0643 10:48  \nTumour load in patients with multiple myeloma: ß-2 Microglobulin levels \nvs whole-body MRI  \nM. D'Anastasi, M. Notohamiprodjo, M.F. Reiser, A. Baur-Melnyk; \nMunich/DE (melvin.danastasi@med.uni-muenchen.de)  \nPurpose: ß-2 microglobulin is a serum maker of tumor burden in hematologic \nmalignancies. We aimed to correlate serum ß-2microglobulin levels in patients \nwith multiple myeloma (MM) to tumor mass determined by whole-body-MRI \n(WBMRI) \nMethods and Materials:  We retrospectively included patients with a new \ndiagnosis of MM and a WBMRI prior to treatment at our institution between \n2003-2011. Patients with a GFR < 60 ml/min were excluded from further \nanalysis since ß-2 Microglobulin levels are increased in those patients. 30 \npatients without renal impairment could be included. WBMRI exams (T1-w TSE \n+ STIR) were assessed by two expert musculoskeletal radiologists in \nconsensus for focal lesions and for the presence of diffuse myeloma infiltration. \nThe grade of diffuse infiltration was confirmed by histology as gold standard. \nPatients were staged according to the Durie & Salmon PLUS Staging System. \nResults: According to WBMRI findings, 13 patients were classified as D&S \nPLUS Stage I (low-grade), 6 as Stage II (intermediate-grade) and 11 as Stage \nIII (high-grade). As expected, most of the stage I patients (12/13) had normal \nß-2 microglobulin levels (\u00023 mg/L). 5/6 patients in stage II and 5/11 patients in \nstage III showed normal ß-2 microglobulin levels. Thus 10/17 patients (58.8%) \nwith substantial infiltration in the bone marrow showed false negative ß-2 \nmicroglobulin levels. \nConclusion: ß-2 microglobulin levels as a marker of tumor load may be \nmisleading in a number of patients with substantial myeloma infiltration in the \nbone marrow. WBMRI may display the full tumor load and correctly show the \nextension of myeloma infiltrates.  \nB-0644 10:57  \nThe non-contrast-enhanced whole body magnetic resonance imaging in \nthe general population: the prevalence of abnormal findings in two age \ngroups  \nA. Cieszanowski, E. Maj, P. Kulisiewicz, I.P. Grudzinski, K. Jakoniuk-Glodala, \nI. Chlipala-Nitek, B. Kaczynski, O. Rowinski; Warsaw/PL \n(andrzej.cieszanowski@wum.edu.pl)  \nPurpose: To assess the incidence of abnormal findings detected during non-\ncontrast-enhanced whole body magnetic resonance imaging (WB-MRI) in \ngeneral population in two age groups: \u000250 years of age (yoa) and in older \npatients. \nMethods and Materials:  Analysis included 666 non-contrast-enhanced WB-\nMRIs performed on 1.5-T scanner between December 2009 and April 2013 in \nprivate hospital in 451 patients \u000250 yoa and 215 patients > 50 yoa. Following \nimages were obtained: T2-STIR (whole body-coronal plane), T2-STIR (whole \nspine-sagittal), T2-TSE with fat-saturation (neck and trunk-axial), T2-FLAIR \n(head-axial), 3D T1-GRE (thorax-coronal, axial), T2-TSE (abdomen-axial), \nchemical shift (abdomen-axial). Detected abnormalities were classified as: \nunimportant (type I), potentially signifi cant, requiring medical attention (type II), \nsignificant, requiring treatment (type III). \nResults: There were 3375 incidental findings depicted in 659 (98%) subjects: \n2997 type I lesions (88.8%), 363 type II lesions (10.8%) and 15 type III lesions \n(0.4%), including malignant or possibly malignant lesions in 7 subjects. The \nuppermost differences in the prevalence of abnormalities on WB-MRI between \npatients \u000250 yoa and > 50 yoa concerned: brain infarction (22.2%, 45%, \nrespectively), thyroid cysts/nodules (8 .7%, 18.8%), pulmonary nodules (5%, \n16.2%), significant degenerative disease of the spine (23.3%, 44.5%), extra-\nspinal degenerative disease (22.4%, 61.1%), hepatic steatosis (15.8% vs. \n24.9%), liver cysts/hemangiomas (24%, 34.5%), renal cysts (16.9%, 40.6%), \nprostate enlargement (5.1%, 34.2% of males), and uterine fibroids (16.3%, \n37.9% of females). \nConclusion: The incidental findings were detected in almost all subjects. WB-\nMRI demonstrated that the prevalence of most of abnormalities increases with \nage.  \nB-0645 11:06  \nDiagnostic accuracy of simultaneously acquired FDG-PET/MRI for the \ndetection of sentinel lymph node metastases in malignant melanoma \npatients  \nM.C. Herbrik\n1, T. Pöppel1, J. Grueneisen1, V. Hartung1, P. Heusch2, \nT.C. Lauenstein1; 1Essen/DE, 2Düsseldorf/DE (michael.herbrik@uk-essen.de)  \nPurpose: Sentinal lymph node (SNL) biopsy as an invasive procedure is still \nunder discussion in malignant melanoma staging. The aim of this study was to \nevaluate the diagnostic accuracy of simultaneously acquired FDG-PET/MRI for \nthe detection of sentinel lymph node metastases in patients with histologically \nproven malignant melanoma. \nS275  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nMethods and Materials:  30 consecutive patients with histopathologically \nconfirmed malignant melanoma and scheduled for FDG-PET/CT were \nprospectively enrolled for an additional, integrated whole-body PET/MRI scan \n(Biograph mMR, Siemens). The PET/MRI protocol comprised the following MR \nsequences: 1) T1w FLASH pre and post-contrast, 2) T2w HASTE, 3) DWI. All \npatients underwent SNL-biopsy serving as the standard of reference. \nSensitivity, specificity, PPV, NPV and accuracy of FDG-PET/MRI for the \ndetection of sentinel lymph node metastases was evaluated on a compartment \nbasis. \nResults: Sensitivity, specificity, PPV, NPV and accuracy of FDG-PET/MRI for \nthe detection of lymph node metastases was 33%, 100%, 100%, 80% and \n82%. In early stages, there was a high rate (6/30) of false negative results. \nConclusion: FDG-PET/MRI yields a relatively high diagnostic accuracy for the \ndetection of sentinel lymph node metastases. Results in early stages should be \nrated with caution due a high rate of false negative results.  \nB-0646 11:15  \nComparison of 18 F-FDG PET/MRI and MRI alone for whole body staging \nof female patients with recurrent pelvic malignancies  \nJ. Grueneisen, K. Beiderwellen, M. Heubner, R. Kimmig, T.C. Lauenstein, \nL. Umutlu; Essen/DE (johannes.grueneisen@uk-essen.de)  \nPurpose: To compare the diagnostic potential of integrated 18 F-FDG \nPET/MRI and MRI alone for whole-body staging of patients with recurrent \nmalignancies of the female pelvis. \nMethods and Materials:  20 patients with suspected recurrence of cervical or \novarian cancer were included in our study. All patients underwent whole-body \n18 F-FDG PET/MRI (Biograph mMR, Siemens). The MR protocol included 1) \nT1 2D FLASH pre and post contrast, 2) T2 HASTE and 3) DWI. Two readers \nevaluated separately the following datasets subsequently (A) 18 F-FDG \nPET/MRI, (B) whole-body MRI including DWI, regarding (1) lesion count, (2) \nlesion conspicuity (4-point ordi nal scale), (3) lesion dignity \n(benign/malignant/indeterminate) and diagnostic confidence (3-point ordinal \nscale). Wilcoxon's signed-rank test was applied to assess statistical \nsignificance. \nResults: Malignant lesions were present in 17 of 20 Patients. A total of 81 \nlesions, comprising 61 malignant and 20 benign lesions were detected. \nPET/MRI offered correct and superior identification of all 17 patients with \ncancer lesions, compared to MRI alone (15/17). Additionally, 18 F-FDG \nPET/MRI exhibited a significant hi gher conspicuity (PET/MRI: 3.91 ±0.28; \nMRI+DWI: 3.66 ±0.63) and diagnostic confidence (PET/MRI:2.79 ±0.43; \nMRI+DWI: 2.15 ±0.72) in the detection of malignant lesions (p < 0.01). 18 F-\nFDG PET/MRI also offered a superior conspicuity in the detection of benign \nlesions (MRI: 3.23±1.14; MRI+DWI: 3.13±1.24). \nConclusion: The results demonstrate the superiority of 18 F-FDG PET/MRI in \ndetecting malignant and benign lesions compared to MRI alone. Thus, whole \nbody PET/MRI seems to be a more powerful diagnostic modality for staging of \npatients with suspected pelvic malignancies.  \nB-0647 11:24  \nWhole-body [18 F]-FDG PET/MRI vs PET/CT in staging of recurrent \nmalignancies of the female pelvis: first results  \nK. Beiderwellen\n1, J. Grueneisen1, V. Hartung1, P. Heusch2, B. Aktas1, \nR. Kimmig1, S. Kinner1, T.C. Lauenstein1, L. Umutlu1; 1Essen/DE, \n2Düsseldorf/DE (karsten.beiderwellen@uk-essen.de)  \nPurpose: To evaluate the diagnostic potential of whole-body PET/MRI with \n[18 F]-FDG in recurrent ovarian and cervical cancer in comparison to whole-\nbody PET/CT. \nMethods and Materials:  19 patients with suspected recurrence of pelvic \nmalignancies (ovarian cancer, n=11; cervical cancer, n=8) scheduled for a \ncontrast-enhanced PET/CT with [18 F]-FDG (Biograph mCT 128, Siemens) \nwere enrolled for a subsequent whole body PET/MRI examination (Biograph \nmMR, Siemens). The protocol comprised: 1) T1 FLASH 2D ax. pre and post-\ncontrast, 2) T2 HASTE ax., 3) STIR cor., 4) DWI. The resulting datasets \n(PET/CT, PET/MRI) were rated by two radiologists with regard to lesion count, \nlesion conspicuity (4 point ordinal scale), dignity \n(benign/malignant/indeterminate) and diagnostic confidence (3 point ordinal \nscale). All available data (prior examinations, PET/CT, PET/MRI, clinical \nfollow-up) served as standard of reference. Mean values were compared using \nWilcoxon rank sum test. \nResults: Malignant lesions were present in 16 of 19 subjects. A total of 78 \nlesions (malignant, n = 58; benign, n = 20) were described. Both PET/CT and \nPET/MRI allowed for identification of all malignant lesions and provided \nequivalent conspicuity (PET/CT: 3.86 ±0.35 PET/MRI: 3.91± 0.28). Diagnostic \nconfidence was significantly higher for PET/MRI in malignant lesions \n(PET/CT:2.65±0.53; PET/MRI:2.78 ±0.44, p < 0.01) as well as benign lesions \n(PET/CT:1.74±0.72; PET/MRI:2.18±0.76, p < 0.05). \nConclusion: Both modalities offer an equivalently high diagnostic value for \nrecurrent pelvic malignancies. PET/MRI offers higher diagnostic confidence in \nthe discrimination of benign and malignant lesions. Considering the reduced \nradiation dose and superior lesion discrimination, PET/MRI may serve as \npowerful alternative to PET/CT in the future.  \nB-0648 11:33  \nThoracic staging in lung cancer: [18 F]-FDG-PET/MRI vs [18 F]-FDG-\nPET/CT  \nP. Heusch\n1, C. Buchbender1, J. Köhler2, T.A. Heusner1, F. Nensa2, B. Gomez2, \nH. Kühl2, V. Hartung2, G. Antoch1; 1Düsseldorf/DE, 2Essen/DE  \nPurpose: To compare a dedicated pulmonary [18 F]-FDG-PET/MRI protocol to \n[18 F]-FDG-PET/CT for primary and locoregional lymph node staging in \nNSCLC patients using histopathology as the reference. \nMethods and Materials:  Twenty-two NSCLC patients (mean age 65.1 ±9.1 \nyears) underwent FDG-PET/CT followed by a FDG-PET/MRI, including a \ndedicated pulmonary MRI protocol. T- and N-staging was performed according \nto the 7 th edition of the AJCC staging manual by two readers in separate \nsessions for FDG-PET/CT and FDG-PET/MRI, respectively. Histopathology \nwas used as the reference standard for T- and N-stage. The maximum \nstandardised uptake value (SUVmax) was measured. SUVmax obtained from \nFDG-PET/CT and FDG-PET/MRI were compared. Pearson correlation analysis \nand Bland-Altman plots were performed for quantitative comparison. \nResults: FDG-PET/MRI and FDG-PET/CT agreed on T-stages in 16/16 of \npatients (100%), all patients were staged correctly when compared to the \nreference standard. There was no statistically significant difference between \nFDG-PET/CT and FDG-PET/MRI for lymph node metastases detection \n(p=0.48). For definition of thoracic N-stages FDG-PET/MRI and FDG-PET/CT \nwere concordant in 20/22 patients (91%). FDG-PET/MRI and FDG-PET/CT \ndetermined the N-stage correctly in 20/22 patients (91%) and 18/22 patients \n(82%), respectively. The SUVmax of NSCLC was 12.0 ±5.7 for FDG-PET/MRI \nand 10.5± 5.3 for FDG-PET/CT. SUVmax values based on FDG-PET/CT and \nFDG-PET/MRI correlated well (R=0.86;p < 0.0001). Using Bland-Altman \nanalysis, the lower and upper limits of agreement between PET/CT and \nPET/MRI were \u00037.42 to 4.40 for SUVmax. \nConclusion: FDG-PET/MRI using a dedicated pulmonary MRI protocol and \nFDG-PET/CT are in excellent agreement on thoracic T- and N- stages and the \nSUVmax of the primary tumour.  \nB-0649 11:42  \nIntegrated 18F-FDG PET/MRI with a 16-channel breast coil for local and \naxillary breast cancer staging: initial results on PET imaging  \nS. Kinner, T. Pöppel, A. Bockisch, O. Hoffmann, J. Nagarajah; Essen/DE  \nPurpose: Until lately, no PET/MR mammography compatible breast coil was \ncommercially available. We conducted this study i) to evaluate the feasibility of \nFDG-PET/MRI mammography with a standard 16-channel RF breast coil and \nii) to estimate the coil influence on image quality of the FDG-PET in the setting \nof local and axillary staging in breast cancer patients. \nMethods and Materials:  42 women with histopathologically proven breast \ncancer underwent FDG-PET/MRM with a standard 16-channel RF breast coil \nsubsequent to a scheduled PET/CT. Both examinations were compared with \nrespect to lesion detection and staging, quan tification of lesional uptake, PET \nimage quality, as well as presence of artefacts. Analyses were performed both \nat patient and lesion level and correlated with body mass indexes (BMI). \nWilcoxon signed-rank test, Mann-Whitney U test as well as Spearman's rank \ncorrelation were applied if appropriate. \nResults: 47 lesions were detected with PET/CT vs. 46 with PET/MRM. Mean \nSUV\nmax determined with PET/CT for tumours and lymph nodes was 6.1 ±4.7 \nand 5.8± 4.8 vs. 3.4 ±1.7 and 3.5± 1.9 with PET/MRI (p=0.006/ p=0.23). All 42 \nexaminations were rated as sufficient for diagnosis with PET/CT vs. 31 \nexaminations with PET/MRI. Mean BMI of all patients with PET/MR images \nthat were sufficient for the assessment was 23.9 vs.30.6 for images that were \ninsufficient for assessment (p < 0.001). \nConclusion: Staging of breast cancer patients with integrated PET/MRI with a \nstandard 16-channel breast coil is feasible. PET/MR provides acceptable \nimage quality with similar staging information as compared to PET/CT. \nHowever, dedicated PET/MR breast coils are likely to improve the results, \nparticularly in overweight patients.  \n \n \n \n \n \n \n \n \n \n \n \nS276  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0650 11:51  \nQuantification of ADC and SUV values in tumours and lymph node \nmetastases of patients with cervical carcinoma in a simultaneous \nMR/PET system  \nP. Brandmaier, S. Purz, M. Reinhardt, H. Barthel, O. Sabri, T. Kahn, \nP. Stumpp; Leipzig/DE (philipp.brandmaier@medizin.uni-leipzig.de)  \nPurpose: Previous studies show discrepancies between standard uptake \nvalue (SUV) and apparent diffusion coefficient (ADC) parameters of different \ntumor entities with non simultaneous measurements on examination modalities \nsuch as PET-CT and MRI. The objective of this study was the quantitative \nevaluation of SUV and ADC values in patients with primary and recurrent \ncervical cancer and suspicious lymph nodes in a simultaneous PET-MRI \nsystem to deteriorate an expectable correlation \nMethods and Materials:  We included 17 patients with cervical carcinoma and \nlymph node metastases (34 lesions) who all underwent a simultaneous whole \nbody 18 F-fluorodeoxyglucose (FDG) PET-MRI including a dedicated pelvic \nexamination. Reader defined volume-of-interest (VOI) for ADC and SUV were \nplaced in suspicious lesions and FDG-positive lymph nodes in regions with \nmaximum FDG-uptake. ADC min, ADCmean, relative ADC value and SUV max, mean, \nmin was calculated with the M.gluteus maximus serving as reference tissue. \nCorrelation between multiple pairs were conducted via Pearson - correlation - \ntest. \nResults: Local tumor lesions and lymph nodes showed average SUV mean \nvalues of 12.7 (SE ± 1.63) and 9.4 respectively (SE ± 1.59); corresponding \nADCmean averages amounted to 1.020 x 10 -3 mm/s2 (SE ± 0.104) and 1.094 x \n10-3 mm/s2 (SE ± 0.12). Significant inverse correlation (p < 0.05) could be seen \nin ADC mean vs. SUV mean and ADC mean vs. SUVmax of tumors (-.613, -605). In all \nother pairs a negative inverse correlation tendency was seen (p > 0.05). \nConclusion: Values of ADC and SUV show a significant inverse correlation for \nADC mean vs. SUV mean and ADC mean vs. SUVmax.  \n10:30 - 12:00 Room D  \nChest  \nSS 1304  \nMalignancies and intervention  \nModerators:  \nS. Vadnjal Dzonlagic; Maribor/SI  \nJ.E. Wildberger; Maastricht/NL  \nB-0652 10:30  \nPerfusion CT: an evaluation of lung tumours following microwave \nablation  \nN. Parvizi, D. Chung, F. Gleeson, M. Anderson; Oxford/UK \n(nassim.parvizi@gmail.com)  \nPurpose: To assess changes in perfusion CT (pCT) parameters following \nmicrowave ablation (MWA) of lung tumours and determine the utility of direct \nvisualisation of perfusion maps and pCT parameters to confirm adequate \ntreatment and predict local tumour progression (LTP). \nMethods and Materials:  15 patients with (7 primary and 8 metastatic) lung \ntumours underwent pCT scans immediately pre and post MWA. The tumour \nmedian size was 23 mm (range 12-52 mm). Perfusion maps of the tumours \nwere constructed using CT perfusion 3 software (GE, Milwaukee, USA). \nRegions of interest were drawn on sequential axial sections to extract pCT \nparameters from the entire tumour volume. Data was analysed using Wilcoxon \nsigned rank and Mann-Whitney tests. Direct visualisation of perfusion maps \npre and post MWA was performed blinded to outcome. \nResults: A significant difference was only found in the median blood volume \npre and post MWA (3.59 vs 2.30 ml/100 mg, p=0.01). 3 patients developed \nLTP on follow-up imaging 6 months post MWA (mean size 38 mm vs. 23 mm in \nno recurrence, p=0.03). Comparison of median pCT parameters between \npatients with LTP and no recurrence pre and post MWA did not demonstrate \nany significant differences. Treatment adequacy was correctly categorised by \ndirect visualisation of the perfusion maps for 11 out of the 15 patients with \nsensitivity 67%, specificity 75%, PPV 40% and NPV 90%. \nConclusion: pCT is a useful assessment tool immediately following MWA of \nlung tumours. Direct visualisation of the perfusion maps may allow \nidentification of areas requiring further treatment at the time of the procedure.  \n \n \n \n \n \n \nB-0653 10:39  \nTwo-phase dual energy CT in lung carcinoma: possible contribution of \niodine uptake calculation in mediastinal lymph nodes with different \ntherapy response  \nJ. Baxa\n1, J. Ferda1, A. Vondrakova1, T. Flohr2, B. Schmidt2, B. Kreuzberg1; \n1Pilsen/CZ, 2Forchheim/DE (baxaj@fnplzen.cz)  \nPurpose: To find out potential contribution of iodine uptake change in lymph \nnodes (LN) therapy response assessment. \nMethods and Materials:  Retrospective analysis of 113 target LN (cross-\nsectional diameter > 10 mm) in 25 patients with non-small cell lung carcinoma, \nwho underwent staging and follow-up (interval 6-10 weeks; mean 8.3) dual-\nenergy CT in arterial and venous postcontrast phase, 2-4 cycles of \nchemotherapy was completed during interval. Segmentation of LN and iodine \nuptake quantification (mg/ccm) prior therapy and follow-up was performed in \nboth phases using prototype of application (syngo.IPEPE, Siemens). Statistical \ncomparison of the change of iodine uptake in progressed (RECIST diameter \nincreased by 20% and more) LN (55), stabilised or regressing (58). \nResults: The value of iodine uptake change in progressing LN in venous \nphase was significantly lower (-0.35 mg/ccm; p=0.003) comparing stabilised or \nregressing lymph nodes (0.05 mg/ccm). And also response of arteriovenous \nshift was significantly different in reference groups (-0.77 vs. 0.31 mg/cm2, \np < 0.001). The significant difference of iodine uptake response in arterial \nphase was not confirmed. (p=0.3) The direct correlation of iodine uptake \nparameters and concrete volume or RECIST response was not found. \nConclusion: Our results confirmed possible feasibility of iodine uptake \ndetermination from dual-energy CT in LN response assessment, significant \ndiscrepancy in change of iodine uptake in mediastinal LN differently (RECIST \ncriteria) responding to chemotherapy was confirmed. The decrease of venous \niodine uptake should correspond to limited interstitial space in not responding \nLN. Further study must confirm and specify  the possible contribution in therapy \nresponse prediction.  \nAuthor Disclosures: \nT. Flohr: Employee; Siemens Healthcare. B. Schmidt: Employee; Siemens \nHealthcare.  \nB-0654 10:48  \nTranscutaneous ultrasound examination of mediastinum in lung cancer  \nV.I. Kazakevich, L.A. Mitina; Moscow/RU  (julia-victor@yandex.ru)  \nPurpose: Transcutaneous chest sonography of the mediastinum in lung \ncancer is considered to be an uninformative method. However, atelectasis of \nthe upper lobe or of the entire lung creates an acoustic window that allows one \nto examine in detail the structure of the mediastinum and lung tumours to \ndetermine tumour involvement of the mediastinum. The objective of the study \nwas to determine the possibility of transcutaneous ultrasound examination of \nthe mediastinum in patients with lung cancer. \nMethods and Materials:  We have developed a technique of mediastinal \nultrasound and semiotics of the tumour ingrowth into the pericardium, large \nvessels and heart in patients with lung cancer with atelectasis of the upper lobe \nor entire lung. Using this procedure, 139 patients were examined. Surgery was \nperformed in 96 (69.1 %) of them. \nResults: Using the ultrasound technique described above, the sensitivity, \nspecificity, and accuracy of the diagnosis of lung tumour ingrowth into the \npericardium equalled 85.7 %, 94.1 % and 90.7%, into the superior vena cava - \n71.4 %, 100 % and 96 8%, into the pulmonary arteries - 93.8 %, 98.3% and \n96.7 %, into pulmonary trunk - 100%, 98.5% and 98.6%, into the pulmonary \nveins - 95.8 % 98.2% and 97.5 %, and into the heart - 80%, 98.7% and 97.6 %. \nConclusion: Transcutaneous chest sonography is an effective method for \ndiagnosing tumour involvement of organs and structures of the mediastinum in \npatients with lung cancer with atelectasis of the upper lobe or entire lung.  \nB-0655 10:57  \nTransthoracic core needle biopsy under CT scan for lung malignancies: \npredictive negative value and predictive factor of failure and \ncomplications  \nC. Fontaine-Delaruelle\n1, S. Couraud2, D. Gamondes3, E. Pradat2, \nA. De Leusse2, P.-J. Souquet2, G. Ferretti4; 1Lyon/FR, 2Pierre Bénite/FR, \n3Bron/FR, 4Grenoble/FR (gferretti@chu-grenoble.fr)  \nPurpose: Transthoracic core needle biopsy under CT-Scan (TTCNB) is \nfrequently used for the diagnosis of lung nodules. However, clinical value of \nnegative results was poorly investigat ed. This work aims to determine the \nnegative predictive value (NPV) of TTCNB as well as to investigate predictive \nfactors of false-negative results and complications. \nMethods and Materials:  Charts of all TTCNB performed in three centres \nbetween 2006 and 2012 were reviewed. Statistics includes binary logistic \nregression for multi-variables analysis. \nResults: Overall, 980 TTCNB were performed. Results were a malignant \ndisease in 79% (n=777), a non-malignant disease in 6% (n=54) and a negative \nS277  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n(or non-contributive) result in 15% (n=149). The complication rate was 34% \n(life-threatening complication in 6%). In multivariate analysis, predictive factors \nof complication were a target size \u000210 mm and a poor training of the performer. \nFor malignant disease diagnose, the negative predictive value was 51% and \nsensibility and specificity, were respectively 89% and 99%. The predictive \nfactors found in multivariate analysis were a poor training of the performer and \na FDG-uptake of the target in PET-CT (OR=8.5 [95%CI 2.3-31.9]; p=0.001). In \n25 cases, a second TTCNB was performed in the same target after. \nComplication rate was 33% and TTCNB lead to diagnosis in 95% with a 67% \nNPV. \nConclusion: Around half of the negative TTCNBs are falsely negative for \nmalignant disease, especially in case of FDG-uptake of the target nodule. \nHowever, an additional TTCNB at the same target do not increased rate of \ncomplication and leads to diagnosis.  \n \nB-0656 11:06  \nThree-dimensional analysis of advanced stage NSCLC: prognostic \nsignificance of volumetric measurements  \nD. Colombi1, S. Diciotti2, C. Manna1, I. Montermini1, E. Fontana1, C. Rossi1, \nM. Silva1, M. Tiseo1, N. Sverzellati1; 1Parma/IT, 2Firenze/IT \n(colombidavide@gmail.com)  \nPurpose: To evaluate the reproducibility of the three-dimensional (3-D) \nanalysis of advanced stage non-small cell lung cancer (NSCLC) using a semi-\nautomated computer software and to determine the value of volumetric CT \nmeasurements in predicting prognosis. \nMethods and Materials:  CT scans of 43 measurable NSCLCs were included \nin this study. Four observers independently measured the greatest diameter of \neach lesion by using the electronic caliper on baseline and follow-up (post first \ncycle chemotherapy) CT scans. In the same session, a semi-automated three-\ndimensional lung cancer segmentation software commercially available, was \napplied to assess both unidimensional and volumetric measurements of the \nsame lesions. The Bland and Altman test evaluated the interobserver variability \nfor each measuring system; in order to further compare reproducibility between \ndiameters and volumetric measurements, the latter were transformed into \nequivalent diameters by assuming the tumor as having a spherical-like shape. \nThe value of each CT measurement change between baseline and follow-up in \npredicting progression-free survival (P FS) was analysed by logistic regression \nand Cox proportional hazards regression model. \nResults: Volumetric measurements were the most reproducible \nmeasurements. The only significant indicators of lower PFS were the volume \nchange for two observers (greatest HR, 1.57; 95% CI: 1.04-2.38), and the \nmaximal diameter obtained through the software for one observer (HR, 3.58; \n95% CI: 1.18-10.9). \nConclusion: Our preliminary data suggests that the software-based \nassessment of the lesion size seems more reproducible than the manual one \nand of more prognostic value.  \nB-0657 11:15  \nConflicting or complementary role of computed tomography (CT) and \npositron emission tomography (PET)/CT in the assessment of thymic \ncancer and thymoma  \nE. Scagliori\n1, A. Panunzio1, L. Evangelista1, N. Nannini1, F. Calabrese1, \nF. Pomerri1, R. Polverosi2; 1Padova/IT, 2Venezia/IT (laura.evangelista@tin.it)  \nPurpose: To evaluate the role of CT and PET/CT in thymic cancer and \nthymoma patients at initial staging. \nMethods and Materials:  We retrospectively reviewed CT and PET/CT of 26 \npatients with a proven-diagnosis of thymic cancer (n=9)and \nthymoma (n=17).Chest CT findings docum ented were qualitative (calcification, \nperitumoral fat infiltration,pleural-pericardial effusion, degree of abutment of \nvessel circumference, et al)and quantitati ve (maximum axial and longitudinal \ndiameter and volume).Both qualitative and semiquantitative data (standardised \nuptake value, total lesion glicolysis-TLG, metabolic tumor volume-MTV)were \nrecovered by PET/CT.The outcome of all patients was retrieved by clinical \nchart or observational follow-up.The com parisons among histological entities, \noutcome and CT and PET/CT findings were evaluated using a non-parametric \nanalysis. \nResults: PET/CT resulted positive in 15 patients with thymoma.100%of \npatients with thymic cancer had a positive scan.CT was available in 5/9 \npatients with thymic cancer and in 3/17 subjects with thymoma.All quantitative \nCT parameters were significantly higher in patients with thymic cancer than \nthymoma (MAD:45vs.20 mm,MLD:69vs.21 mm and volume:77.91vs.4.52 ml;all \np < 0.05).Conversely, only MTV and TLG were significantly different in patients \nwith thymic cancer than the counterpart (126.53vs.6.03 cm3 and \n246.05vs.20.32,respectively;both p < 0.05).After a median follow-up of 17.45 \nmonths, four recurrences of disease occurred (three in patients with thymic \ncancer and one with a type B2 thymoma).Follow-up data were lost in three \nsubjects.CT volume in a patient with recurrent disease was 170.12 ml vs. a \nmedian value of 10.5 ml in seven disease-free patients.MTV was higher in \nrecurrent than disease-free subset (143.3vs.81.13 cm3),although not \nstatistically significant (p=0.075). \nConclusion: Both morphological and metabolic volume can be useful for \ndiagnostic and prognostic meaning in thymic cancer and thymoma patients.  \nB-0658 11:24  \nPosttransplantation lymphoproliferative disorder (PTLD) of the chest: CT \nand FDG-PET/CT features in twelve adults  \nG. Yoon, M. Kim, J. Huh; Seoul/KR (3770 ghwo@hanmail.net)  \nPurpose: To investigate chest CT and 18 F-FDG-PET/CT findings of \nposttransplantation lymphoproliferative disorder (PTLD) of the chest in adults. \nMethods and Materials:  This retrospective study was approved by the \nInstitutional Review Board. Informed consent was waived. From November \n2004 through February 2013, twelve patients (three female, nine male; age \nrange, 34-68 years; median age, 46 years) were retrospectively reviewed who \nwere histopathologically proved PTLD. Transplanted organs were kidney (n=6), \nliver (n=4), and heart, pancreas, bone marrow (n=1), respectively. We \ninvestigated the relationship with Epstein-Barr virus (EBV) infection and \npatients' outcomes. We evaluated the locations and characteristics of the \nimaging abnormalities on chest CT (n=12) and max SUV on 18 F-FDG-PET/CT \nscans (n=10). The lesions were classified into the following three patterns: 1) \nlymph node pattern; 2) pleural pattern; and 3) airspace pattern. \nResults: The interval between transplantation and PTLD onset was 2-128 \nmonths (median, 49). EBV infection found in 10 patients (83%). Outcomes \nshowed complete (n=8, 67%) or partial remission (n=3) and undetermined \n(n=1). The most common CT patterns were LN involvement in the mediastinal, \nsupraclavicular, or axillary area (n=10, 83%). The other findings were pleural \ninvolvement as effusion (n=4, 33%), and airspace involvement; necrotic \nconsolidative mass or nodules (n=3, 25%) with overlapped patterns in 5 cases. \nMax SUV on 18 F-FDG-PET/CT scans was 2.7~25.5 (median 7.7). \nConclusion: PTLD involving the chest manifests as three distinct patterns on \nLNs involvement, pleural effusion, and nodules or masses in order of \nfrequency on chest CT. All patients proved lesions demonstrate increased \nFDG uptake on 18 F-FDG-PET/CT.  \nB-0659 11:33  \nCardiac mortality and morbidity in breast cancer survivors after radiation \ntherapy - is coronary atherosclerosis the culprit?  \nP. Apfaltrer\n1, U.J. Schoepf2, J. Spears2, L. Pilz1, S.O. Schönberg1, T. Henzler1, \nR. Vliegenthart3; 1Mannheim/DE, 2Charleston, SC/US, 3Groningen/NL \n(paul.apfaltrer@umm.de)  \nPurpose: Breast cancer survivors after radiation therapy (RT) have increased \nrates of cardiac morbidity and mortality. We sought to investigate whether \naccelerated coronary artery disease (CAD) is to blame by comparing coronary \ncalcium scores (CCS) in breast cancer survivors with and without RT. \nMethods and Materials:  306 women with history of breast cancer were \nincluded. 67 patients underwent chest CT studies \u00036 months after the start of \nRT (RT-group), whilst 239 patients had a CT scan either prior to or without \nundergoing RT (noRT). Coronary calcium was quantified by applying a \nthreshold-based automated algorithm using a dedicated workstation. Statistical \nanalysis included the Fisher's exact test, Wilcoxon-Mann-Whitney Test, the \nSiegel-Tukey Test, and Cox-regression analysis. \nResults: Mean age at diagnosis for the noRT group was 57.1 ±11.9 years \nversus 58.4 ±12.9 years for the RT group (p > 0.05). The groups showed no \nsignificant differences in race, smoking history, laterality, or cancer stage. 61 \nnoRT patients (25.5%) had a CCS of 0, compared to 18 RT patients (26.9%, \np> 0.05). The median CCS for both groups was 0 (25\nth, 75th percentile: 0, 4; \np> 0.05). When adjusting for the time between diagnosis/RT and CT, RT \npatients had a significantly lower risk of a positive CCS compared to noRT \npatients. Results were similar after adjustment for age, race, smoking history, \nlaterality and stage. \nConclusion: Breast cancer survivors after RT are not more likely to show \ncoronary calcifications on subsequent CT imaging. Our preliminary results thus \ndo not support radiation-induced accelerated CAD as an explanation for higher \nrates of heart disease in this group.  \nAuthor Disclosures: \n U.J. Schoepf: Consultant; Bayer, Bracco, GE, and Siemens.  \nS278  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0660 11:42  \nMultidetector low-dose CT in assessment of predictive signs of \nmalignancy of undetermined lung nodules in staging of patients with \nknown lung cancer  \nA. Nasatti, D. Ippolito, P. Bonaffini, A. Casiraghi, D. Fior, S. Sironi; Monza/IT  \nPurpose: To assess the role of low-dose multidetector computed tomography \nstudy in the evaluation of undetermined nodules identified on patients with lung \ncancer, referred to CT staging. \nMethods and Materials:  A total of 32 patients (22 males, 10 females; mean \nage 67.7 years, range 30-80) with known lung cancer and undetermined \nconcomitant lung nodules were reviewed. All patients underwent multiple \nwhole body CT scan examinations, with a minimum follow-up of 12 months. All \nstudies were analysed in order to identify and characterise undetermined lung \nnodule (up to 3 cm in diameter) besides the primary lesion, according to their \nmaximum axial diameter, density and structure. \nResults: In 32 patients with lung cancer (31 NSCLC, 1 carcinoid) during a \nfollow-up period of at least 12 months (range 12-87), a total of 221 nodules \nwas found (mean 6.9 per patient, range 0-18). We classified 35/221 (15.8%) \nnodules in 17/32 patients as metastatic in relation to dimensional growth over \ntime or decrease in size after treatment (mean diameter at staging CT of \n6.05 mm, range 2.2-15.7 mm): 32/35 (91.4%) nodules were solid non-calcified; \n2 (5.7%) non-solid and 1 (2.9%) partially solid. A total of 186/221 (84.2%) \nnodules was considered as benign (mean diameter 4.3 mm, range 1.8-\n14.1 mm): 140/186 nodules were solid non-calcified (75.3%), 19 (10.2%) non-\nsolid, 3 (1.6%) partially solid and 24 (12.9%) calcified. No cut-off value in \ndiameter was found to discriminate benign from malignant nodules. \nConclusion: The assessment of dimensional growth during follow-up period \nremains the most reliable method to establish malignant nature of \nundetermined nodules in lung cancer patients.  \n10:30 - 12:00 Room E1  \nMusculoskeletal  \nSS 1310  \nCartilage and muscle: advanced imaging  \nModerators:  \nJ.S. Bauer; Munich/DE  \nL. Cerezal; Santander/ES \nB-0661 10:30  \nMR T1rho quantification of knee cartilage lesion: correlated with \narthroscopic evaluation  \nH. Yang, V. Pedoia, j. Rivoire, Y. Zhang, D. Kumar, T. Link, B. Ma, X. Li; \nSan Francisco, CA/US (frankyang119@126.com)  \nPurpose: To evaluate the capability of T1rho quantification identifying knee \ncartilage lesion confirmed by arthroscopy. \nMethods and Materials:  31 patients and 72 healthy controls were scanned at \n3.0 Tesla. 38 cartilage lesions in 31 patients were found by arthroscopy. \nWORMS was used for clinical MRI grading. T1rho value and z-scores value \n(T1rho normalised to control values in matched regions) in full thickness, deep \nand superficial layer cartilage were compared between compartments with and \nwithout lesions. Student t-test was compared of WORMS, T1rho and Z-score \nvalue between normal cartilage and cartilage lesion. ROC analysis was \ncompared the specificity and sensitivity of the three quantitative methods. \nResults: Compared to compartment without lesions, all of WORMS, T1rho and \nz-score values of cartilage significantly increased at the compartments with \nlesions (p < 0.01). The AUC were 0.734 (95% CI: 0.64, 0.83), 0.746 (0.64, \n0.85) and 0.775 (0.69, 0.86) among the WORMS, T1rho value and z-score \nquantification separately. The AUC of the full thickness, deep and superficial \nlayer cartilage of z-score value were 0.775 (95% CI: 0.69, 0.86) 0.654 (0.54, \n0.76), and 0.784 (0.68, 0.89) respectively. \nConclusion: T1rho quantification show a better diagnostic capability \ncompared clinical MRI grading in detecting cartilage lesion, especially when \nusing normalised z-score and laminar analysis.  \nB-0662 10:39  \nDelayed gadolinium-enhanced MRI of cartilage is superior to T1rho-\nmapping in measuring cartilage-sulphated glycosaminoglycan content: \npreliminary results of an in vivo validation study  \nJ. van Tiel, G. Kotek, M. Reijman, P.K. Bos, S. Klein, J.A.N. Verhaar, \nG.P. Krestin, H. Weinans, E.H.G. Oei; Rotterdam/NL (e.oei@erasmusmc.nl)  \nPurpose: T1rho-mapping has been proposed as a non-contrast-enhanced \nalternative to delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) to \nquantitatively measure cartilage-sulphated glycosaminoglycan (sGAG) content. \nHowever, no thorough validation studies comparing both techniques acquired \nin vivo against a tissue reference standard for sGAG have been performed. \nThe aim of this study was to assess the relation of dGEMRIC and T1rho-\nmapping with cartilage sGAG content in vivo in osteoarthritis patients. \nMethods and Materials:  We analysed data of 8 patients from an ongoing \nstudy in which knee osteoarthritis patients undergo T1rho-mapping and \ndGEMRIC at 3 T before total knee replacement (TKR). T1- and T1rho-values of \nboth scans were calculated in 6 cartilage regions (medial and lateral weight-\nbearing (WB) femoral condyles and tibial plateaus and non-WB cartilage of the \ncondyles). Femoral and tibial cartilage was harvested during TKR and \nrescanned with contrast-enhanced microCT (CE-uCT), which served as \nreference standard for sGAG since it has been shown to accurately measure \nsGAG content. We analysed the correlation between T1- and T1rho-values \nand CE-uCT outcomes with linear regression. \nResults: T1- and T1rho-values ranged between 280-834 ms and 32-48 ms, \nrespectively, for dGEMRIC and T1rho-mapping. dGEMRIC outcomes had a \nstrong negative correlation with CE-uCT (r=-0.78;p < 0.0001;95%CI=-0.88--\n0.63), while T1rho outcomes did not correlate with cartilage sGAG content (r=-\n0.01;p=0.94; 95%CI=-0.35--0.32). \nConclusion: Our preliminary results suggest that dGEMRIC can accurately \nmeasure articular cartilage sGAG content, whereas T1rho-mapping is not \nsuitable for this purpose. Therefore, despite the need to use a contrast agent, \nwe consider dGEMRIC to be superior to T1rho-mapping for quantitatively \nmeasuring cartilage sGAG content.  \nAuthor Disclosures: \nG.P. Krestin: Consultant; General Electric Healthcare. Grant Recipient; \nGeneral Electric Healthcare.  \nB-0663 10:48  \nCT arthrography of the human knee to quantitatively measure cartilage \nbiochemical composition: preliminary results of an in vivo validation \nstudy  \nJ. van Tiel, M. Siebelt, M. Reijman, P.K. Bos, J.H. Waarsing, J.A.N. Verhaar, \nG.P. Krestin, H. Weinans, E.H.G. Oei; Rotterdam/NL (e.oei@erasmusmc.nl)  \nPurpose: The ability of CT arthrography (CTa) to quantitatively measure \nhuman cadaveric knee cartilage composition in terms of sulphated \nglycosaminoglycan (sGAG) content has recently been demonstrated. Since a \nvalidation study comparing in vivo acquired CTa outcomes against reference \nstandards for cartilage composition has not been performed yet, the aim of the \npresent study was to perform such a validation in humans with knee \nosteoarthritis (OA). \nMethods and Materials:  We analysed data of 8 patients from an ongoing \nstudy in which knee OA patients (Kellgren and Lawrence grade 2-4) undergo \nCTa before total knee replacement (TKR). Mean X-ray attenuation values were \ncalculated in 6 regions of interest (ROI) of the articular cartilage (medial and \nlateral weight-bearing (WB) femoral condyles and tibial plateaus and non-WB \ncartilage of the condyles). Femoral and tibial cartilage was harvested during \nTKR and rescanned with contrast-enhanced microCT (CE-uCT), which served \nas surrogate reference standard for sGAG since it has been shown to \naccurately measure sGAG content. We analysed the correlation between CTa \nX-ray attenuation and CE-uCT outcomes with linear regression. \nResults: X-ray attenuation values of the different  ROIs in the tibiofemoral joint \nranged from 150 to 450 Hounsfield Units. Outcomes of CTa had a strong \ncorrelation with reference CE-uCT, representing sGAG content of cartilage \n(r=0.81;< 0.0001;r\n2=0.65). \nConclusion: Our preliminary results suggest that CTa can accurately measure \nsGAG content of articular cartilage in human knee joints in vivo. The coefficient \nof determination, however, is only moderate and therefore CTa outcomes are \nlikely to be also influenced other composites of cartilage, e.g. collagen.  \nAuthor Disclosures: \nG.P. Krestin: Consultant; General Electric Healthcare. Grant Recipient; \nGeneral Electric Healthcare.  \nB-0664 10:57  \nBiochemical imaging and morphological analysis of the lower extremity \njoint cartilages of 44 ultra-marathoners with a mobile MRI during a 4500 \nkm trans-continental-run  \nU.H.W. Schütz\n1, M. Ehrhardt1, D. Schoss1, A. Reiner1, S. Göd2, M. Brix1, \nS. Trattnig2, M. Beer1, C. Billich1; 1Ulm/DE, 2Vienna/AT \n(uwe.schuetz@rocketmail.com)  \nPurpose: The TransEuropeFootRace (TEFR) was one of the longest ultra-\nmarathons. The results on investigations on the cartilage layers of the lower \nextremity joints are shown in the progress of the TEFR, proofing the \nhypothesis, that running nearly 4,500 km alters the joint cartilage in an extent \ntowards relevant cartilage injury improving the risk of osteoarthritis. \nMethods and Materials: 44 TEFR-participants were accompanied by a mobile \n1.5 T MR-imager mounted on a 40-tonnes truck, when running 70.1 km per \nstage in 64 days. They got repeated MRI on knee, ankle and midtarsal joints in \nregular intervals. The protocols used were a TIRM, a PDw TSE fs and a T2* \nS279  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nGRE mapping sequence. ROIs were selected manually on T2* images. \nMorphological evaluation was done on the PDw and TIRM sequences. \nResults: Compared to start, there are significant increases of mean T2* values \ndetectable in all cartilage layers of all evaluated joints (except: femoropatellar \njoint) for all measurement intervals during the TEFR (p < 0.05). We found \nrelevant decreasing of mean T2*values in the cartilages of joints with axial \nloading after 2,000 km distance run. No relevant changes regarding \nmorphological criteria like thickness of carti lage layers were seen for any of the \ninvestigated joints. \nConclusion: It could be shown for the first time in vivo that after early \ndegradation human cartilage matrix is able to develop anabolic changes with \nde novo re-synthesis of glycosaminoglycanes under ongoing multistage \nultramarathon burden in axial loaded lower extremity joints. Therefore, there is \nno distance limit in running regarding human joint cartilages.  \n \nB-0665 11:06  \nQuantitative MR imaging of the ankle: the effect of axial traction on \ncartilage T2 relaxation times and cartilage diffusion values  \nP.M. Jungmann, T. Baum, C. Schaeffeler, M. Sauerschnig, A. Mann, \nC. Ganter, E.J. Rummeny, K. Woertler, J.S. Bauer; \nMunich/DE (pia.jungmann@tum.de)  \nPurpose: To assess the impact of axial traction during 3.0 T MR imaging of the \nankle on quantitative cartilage imaging parameters. \nMethods and Materials:  Ankle MR images were acquired in 8 volunteers with \nand without axial traction (6 kg). For morphological evaluation, coronal and \nsagittal T1-weighted (w) turbo spin echo (TSE) sequences with a DRIVE pulse, \nsagittal fat-saturated intermediate-w TSE sequences and 3D gradient echo \nsequences were acquired. For quantitative assessment of cartilage \ndegradation, segmentation was performed on three different sagittal \nsequences: 2D multislice-multiecho (MSME) SE T2-w, steady-state free-\nprecession (SSFP) T2-w and SSFP diffusion-weighted imaging (DWI). Paired t-\ntests were used for statistical analysis. Coefficients of variation (CV) were \ncalculated to assess reliability of two independent observers. \nResults: Cartilage surface delineation was superior with axial traction \n(P < 0.05), especially on coronal T1-w images. T2 differed significantly with and \nwithout axial traction (tibia, P=0.016; talus, P=0.007). While without traction, \ntibial and talar T2 was not significantly different (mean ±SEM, 43.5 ±1.6 ms \nversus 44.1 ±0.9 ms, P=0.658), with axial traction, T2 was lower at the tibia \n(40.0±1.6 ms versus 46.1 ±1.0 ms, P < 0.001). SSFP T2 was significantly \ndifferent between tibia and talus in MR scans with axial traction (20.3 ±1.7 ms \nversus 24.5 ±1.0 ms; P=0.005; normal scans, P=0.289). SSFP DWI values at \nthe talus differed significantly (P=0.035). Reproducibility was better for images \nwith axial traction (tibia T2, CV, intrareader 1.5% and 1.7% versus 1.7% and \n3.7%, interreader 3.4% versus 5.2%). \nConclusion: Axial traction of the ankle during MR imaging better visualised the \ncartilage surface, improved compartment discrimination and reproducibility of \nquantitative cartilage matrix degradation parameters.  \nB-0666 11:15  \nLongitudinal follow-up of changes regarding specific body tissue \ncomposition of 44 ultra-marathoners with a mobile whole body MRI \nduring a 4,500 km trans-continental-run \nU.H.W. Schütz\n1, C. Billich1, M. Beer1, J. Machan2; 1Ulm/DE, \n2Tübingen/DE (uwe.schuetz@rocketmail.com)  \nPurpose: The results of differentiated measurements of changes in body \ncomposition during the TranseuropeFootrace (TEFR) using a mobile whole-\nbody MR-imager are presented and the proposed influence of visceral and \nsomatic adipose and lean tissue distribution on performance tested. \nMethods and Materials:  22 participants were randomly selected for the \nrepeated MR-measurements (intervals: 800 km) with a mobile 1.5 Tesla MR \nscanner mounted on 40-tons truck during the 64-stage 4,486 km TEFR. A \nvalidated MRI protocol was used: T1w TSE, TE 12 ms, TR 490 ms, ST 10 mm, \nSD 10 mm. For topographic tissue, segmentation and mapping a modified \nfuzzy c-means algorithm was used. A semiautomatic postprocessing of whole \nbody MRI datasets allows reliable analysis of the following tissue \ncompartments: Total, somatic and visceral adipose (TAT,SAST,VAT) and lean \n(TLT,SLT,VLT) tissue. Adipose and lean tissue was also differentiated \nregarding trunk and extremities. \nResults: Adipose tissue showed a significant decrease at all measurement \ntimes for TAT, SAST and VAT. Lean tissues decreased until the end of the \nrace, but not significantly. The mean relative volume changes at the last \nmeasurement compared to the start were: TAT \u000341.3%, SAST \u000348.7%, \nVAT\u000364.5%, intraabdominal adipose tissue \u000367.3%, mediastinal adipose \ntissue \u000341.5%, TLT\u00031.2%, SLT\u00031.4%. \nConclusion: Even lean tissue volume (mainly skeletal muscle) decreased due \nto the unpreventable chronic negative energy balance during TEFR. VAT has \nthe fastest and highest decrease compared to SAST and lean tissue \ncompartments during the race. It seems to be the most sensitive morphometric \nparameter regarding the risk of non-finishing a transcontinental ultramarathon \nand shows direct relationship to prerace-performance.  \nB-0667 11:24  \nCorrelation between muscle cross-sectional area measurement and total \nvastus medialis volume in patients with anterior cruciate ligament \nreconstructions  \nM. Marcon\n1, B. Ciritsis2, C. Laux2, M.A. Fischer2, G. Andreisek2, E.J. Ulbrich2; \n1Udine/IT, 2Zurich/CH (magda.marcon@gmail.com)  \nPurpose: Vastus medialis atrophy is a clinical indicator for postoperative knee \nfunction in patients with anterior cruciate ligament (ACL) reconstructions. \nPurpose was to develop a simple estimation for total muscle volume in patients \nwith ACL-reconstructions. \nMethods and Materials:  Prospective IRB approved study with written \ninformed patient consent. Both thighs of thirty-four consecutive patients with \nACL-reconstructions (men, 22; women, 12) were imaged at 1.5 T using an \naxial T1-weighted as well as axial 3D spoiled dual gradient-echo (LAVA FLEX) \nsequences with automated reconstruction of pure fat-only and water-only \nimages. Total muscle volume of both vastus medialis muscles (n=68) was \ndetermined by one experienced reader on the water-only images, where \nmuscle borders were more clearly i dentifiable, using dedicated software \nfeaturing semi-automatic segmentation with linear interpolation (Myrian 1, \nIntrasense, France). In addition, the muscle`s cross-sectional area was \nmeasured on single slices at two different levels, 15 cm (CSA-Up) and 6 cm \n(CSA-Low) above the knee joint. The correlation between total muscle volume \nand both cross-sectional area measurements was evaluated using Pearson \ncorrelation-coefficient. p <.05 indicated statistical significance. \nResults: The vastus medialis' total muscle volume was 457.2 ±132.6 cm3 \n(mean±SD)(range, 197.3-771.2). The mean ±SD CSA-Up was \n2405.2±664.4 mm2 (range, 1241-3969) and the mean ±SD CSA-Low was \n1211.7±416.4 mm2 (range, 431-2199). Pearson correlation showed a weak \nlinear relationship between total muscle volume and CSA-Low (r=.347, \np=0.002), but a strong linear relationship between total muscle volume and \nCSA-Up (r=.949, p <.001). \nConclusion: Muscle cross-sectional area measurements 15 cm above the \nknee joint allow simple estimations of the total vastus medialis muscle volume.  \nB-0668 11:33  \nMRI muscle fat quantification with 3 point Dixon in 20 patients with \nmuscular dystrophy and its correlation with clinical scales  \nA. Guisasola Iñiguez, R. Fernández-Torron, J. Alustiza, E. Fernandez, \nD. Otaegui, J. Poza, A. Saenz, E. Salvador, A. Lopez de Munain; \nSan Sebastian/ES (aguisasola@osatek.net)  \nPurpose: Muscle magnetic resonance imaging (MRI) provides information on \nthe distribution and evolution of limb girdle muscular dystrophies (LGMD). In \nthe last years quantitative sequences like 3-point Dixon technique have been \ndeveloped to measure muscle fat fraction. \nThe aim of this study is to quantify muscle fat content in lower limb muscles of \nambulant patients with LGMD 2 A and to determine its correlation with \nfunctional scales. \nMethods and Materials:  Cross-sectional study of 20 ambulant patients with \nmolecularly confirmed LGMD2 A. Gardner-Meldwin-Walton and Vignos scales \nwere assessed by a neurologist to determine clinical severity. A 3-point Dixon \nsequence (TE 2.3-4.6-6.9 ms, FOV 375, matrix 376/384, thickness 2 mm, \nacquisition time: 5.10 minutes) was performed in a 1.5 T Achieva Philips \nscanner. Muscle fat fraction was calculated drawing a region of interest \ncovering cross-sectional area in three different slices per muscle bilaterally (ten \nmuscles in thigh, eight in calves). Correlations between clinical scales and \nmuscle fat fraction were determined with Spearman's rho coefficient. \nResults: Mean age was 24.30 ± 9.35 years. Mean clinical severity was \n4.65 ± 2 and 3.68 ± 1.87 in Gardner-Meldwin-Walton and Vignos scales. A \nsignificant correlation (p < 0.05) was detected between the mean fat muscle \ncontent of all muscles and Gardner-Meldwin-Walton (r-square 0.91) and \nVignos (r-square 0.86) scale. This correlation was also found separately in the \nmuscles of thigh (r-square 0.9) and calves (r-square 0.86). \nConclusion: Muscle fat content measured with 3-point Dixon provides a high \ncorrelation with clinical severity of ambulant LGMD2 A patients and could be a \nuseful biomarker.  \nAuthor Disclosures: \nR. Fernández-Torron: Grant Recipient; Rio Hortega Grant, Ministry of Health \nand Science. Research/Grant Support; SAIOTEK programme of Basque \nGovernment.  \nS280  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0669 11:42  \nReal-time elastosonography RTE contribution in assessing muscle \nspasticity in patients with spinal cord injury: preliminary report  \nP. De Petro, S. Pozza, A. De Marchi, F. Carlo, M. Actis, L. Romano, \nP. Balocco; Turin/IT (doc.lucaromano@libero.it)  \nPurpose: This study aims to present our experience of 9 cases of spinal cord \ninjury patients (SCI), using ultrasonography and real-time elastosonography \n(RTE) in assessing muscle spasticity versus fibrotic muscle component. \nMethods and Materials:  We examinates 9 patients with incomplete (2 \npatients) or complete (5 patientes) SCI, 2 women, 7 men using an ultrasound \nsystem with array tranducer F-75 Aloka Hitachi UST-5411, 2-18 MHz. We \ninvestigated intrinsic stiffness changes using RTE in the triceps sural muscle: \nthe relaxed muscle structures appear mostly soft (yellow-red), while contracted \nor degenerated muscle fibers appear hard (blue). Elastosonography findings \nwere converted in a semiquantitative measurement method (ratio) from 0 to 4 \n(increase stiffness to reduce stiffness respectively) between the area of interest \nand a reference area in our case standoff pad. Clinical and functional \nevaluations were performed (ROM, Ashworth scale, WHS). Statistical analysis \nincluded Pearson r calculation, and regression line analysis. \nResults: We observed, throughout statistical analysis, an opposite correlation \n(r= -0.595) between clinical data of ROM evaluation and RTE value of muscle \nflexibility (y = -0.039x + 4.902 R² = 0.354). \nConclusion: The muscle flexibility is an important component to quantify grade \nof spasticity in SCI patients. In this preliminary report, a decreased ROM \nmatches with an increased ratio (mostly soft muscle). It could be a fundamental \ncomponent to choose the best treatment for this typology of patients. For a \nbetter evaluation of muscle component (spastic or fibrotic) we need to continue \nwith a more representative and homogeneous sample.  \nB-0670 11:51  \nT1rho values and T2 mapping using 3.0-Tesla MRI and arthroscopic \nfindings correlations of hip joint cartilage in patients with early \nosteoarthritis caused by femoroacetabular impingement (FAI)  \nH. Goto\n1, S. Hashimoto1, Y. Iwama2, N. Kanzaki1, N. Aoyama1, Y. Ohno1, \nK. Sugimura1; 1Kobe/JP, 2Nishinomiya/JP (hjmgoto@hotmail.co.jp)  \nPurpose: The aim of this study was to examine correlations among the pain \nscore, the hip arthroscopic findings and to evaluate the sensitivity of T1rho and \nT2 mapping in the quantification of early damaged hip joint cartilage in FAI \npatients. \nMethods and Materials:  Twenteen patients with clinical signs of FAI (5 cam-\ntype and 7 mixed-type) were examined using 3.0-T magnetic resonance \nimaging (MRI). T2 mapping and T1rho values were calculated from sagittal-\noriented gradient-multi-echo sequences. Region of interest analysis was \nmanually performed on consecutive slices. Median T2 mapping values and \nT1rho values of both the superior damaged cartilage areas were compared. In \naddition, all patients underwent hip arthroscopy, and the Multicenter \nArthroscopy of the Hip Outcomes Research Network (MAHORN) score were \ncalculated and compared with T1rho and T2 mapping. The significance of \ndifferences between the T1rho values and the T2 mapping of cartilage were \ndetermined using a paired t-test and non-parametric regression analysis. P \nvalues < 0.05 were considered statistically significant. \nResults: The pain score was significantly correlated with T1rho values (r=0.96, \n*p < 0.01) but no significant correlation was observed with T2 mapping (r=-\n0.12,p=0.67). The cartilage delamination of MAHORN score was significantly \ncorrelated with T1rho values (normal cartilage vs injure cartilage; 85.22 vs \n102.42, *p=0.02) but no significant correlation was observed with T2 \nmapping (46.64 vs 50.10, p=0.78). \nConclusion: T1rho has the potential to evaluate the degree of degeneration of \nhip joint cartilage in patients with early osteoarthritis caused by FAI.  \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n10:30 - 12:00 Room E2  \nAbdominal Viscera  \nSS 1301  \nAdvanced imaging of liver neoplasms  \nModerators:  \nL.S. Guimaraes; Porto/PT  \nM. Laniado; Dresden/DE  \nB-0671 10:30  \nUsing gadoxetic acid-enhanced liver MR imaging to predict histologic \nfeatures and treatment response in liver metastasis from breast cancer: \nPreliminary results  \nM. Ku, C. Lee, J. Kim, Y. Park, J. Lee, J. Choi, K. Kim, C. Park; Seoul/KR \n(kheiemsci@naver.com)  \nPurpose: To retrospectively identify gadoxetic acid-enhanced MRI findings of \nliver metastasis from breast cancer that correlate with histologic factors of \nbreast cancer, and to evaluate the relationship between MRI findings and \ntreatment response. \nMethods and Materials:  This study was approved by our institutional review \nboard and the requirement for informed consent was waived. Thirty-four \nmetastatic lesions of 20 breast cancer patients with liver metastasis were \nincluded. Appearance on hepatobiliary phase (HBP) and T2WI, and arterial \nenhancement pattern were evaluated. \nHistologic factors including histologic subt ype (luminal A, luminal B, HER2, and \nbasal-like subtypes), mutation of p53, Ki67 labeling index, and tumor grade of \nbreast cancer were reviewed and analysed to identify histologic factors that \ncorrelate with MRI findings. \nIn 11 patients who had undergone chemotherapy for liver metastasis, sixteen \nmetastatic lesions were classified into \"responder\" and \"non-responder\", and \nalso analysed to evaluate correlation between treatment response and MRI \nfindings. \nADC value and lesion-to-liver SI ratio were measured for each lesion and \ncompared between different groups. \nResults: There was no histologic factor that significantly correlated with \ngadoxetic acid-enhanced MRI findings, and ADC value and SI ratio did not \ncorrelate with any histologic factors. \"Target\" appearance on HBP was more \nfrequent in \"non-responder\" than \"responder\"[11/12 (91.7%) vs. 1/4 (25%), \np=0.027]. ADC value and SI ratio were not significantly different between \n\"responder\" and \"non-responder\"(1.13 ±0.21 vs.1.02± 0.19×10\n-3 mm2/sec, \np=0.396, and 0.51±0.13 vs.0.55±0.14, p=0.865, respectively). \nConclusion: Metastatic lesions from breast cancer showing \"non-target\" \nappearance on HBP of gadoxetic acid-enhanced MRI tend to respond better to \nchemotherapy than those showing \"target\" appearance.  \nB-0672 10:39  \nAssessment of response to chemotherapy in patients with liver \nmetastases from colorectal cancer: value of diffusion-weighted MR \nimaging  \nT. Zahel, E.J. Rummeny, K. Holzapfel; \nMunich/DE (tinazahel@googlemail.com)  \nPurpose: To evaluate diffusion-weighted MR imaging (DWI) in assessing \nresponse to chemotherapy in patients with liver metastases from colorectal \ncancer. \nMethods and Materials:  Thirty-three patients (24 men, 9 women, mean age \n65.5 years) with liver metastases from colorectal cancer underwent MR \nimaging (1.5 T Magnetom Avanto, Siemens) before and after 8 weeks of \nsystemic chemotherapy. The MR imaging protocol comprised DWI using a \nsingle-shot echo-planar imaging sequence (TR = \u0001TE =69 ms, Matrix \n192x144, slice thickness 5 mm, iPAT factor = 2, b values 50, 300 und 600 \ns/mm²) combined with navigator echo technique. ADC (apparent diffusion \ncoefficient)-values of metastases were calculated before and after \nchemotherapy. Regions of interest entailed (a) the whole lesion and (b) the \nperiphery of lesions. Response of metastases to chemotherapy was assessed \nusing the Response Evaluation Criteria in Solid Tumors. \nResults: One-hundred-four metastases (72 responding and 32 non-\nresponding) were analysed using DWI. Responding (1.28 vs. 1.41) and non-\nresponding lesions (1.4 vs.1.46) had higher ADC-values after chemotherapy \nusing whole tumor regions of interest; these were only significant in responding \nlesions (p = 0.001; nonresponding lesions p =0.21). ADC-values in the \nperiphery of metastases showed a significant increase in responding lesions \n(1.01 vs. 1.20; p = 0.0116). ADC value increase of nonresponding lesions was \nnot significant (1.07 vs.1.16 p = 0.4586). \nConclusion: Following chemotherapy, responding lesions showed a \nsignificant increase of ADC values w hen measured as a whole region of \nS281  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\ninterest and also when measured in the periphery. Nonresponding lesions did \nnot show a significant difference.  \nB-0673 10:48  \nLiver lesion margin intensity slope to distinguish cysts, responder and \nnon-responder colorectal metastases following anti-angiogenic therapy  \nV. Yaghmai, A.R. Seyal, F.D. Gonzalez-Guindalini, K. Parekh, Y. Velichko, \nT. O'Donnell; Chicago, IL/US (v-yaghmai@northwestern.edu)  \nPurpose: To evaluate liver margin intensity slope (LMIS)as a potential imaging \nbiomarker for distinguishing responder and non-responder colorectal liver \nmetastases from cysts after anti-angiogenic therapy. \nMethods and Materials:  The HIPAA compliant study was IRB approved. Two \npatient cohorts were selected. First cohort comprised of 45 colorectal liver \nmetastases in 21 patients treated with bevacizumab with post-treatment \nabdominal CT and a FDG-PET scans. Second cohort comprised of fifteen \npatients with 19 liver cysts imaged by contrast-enhanced MDCT. Volumetric \nsegmentation of liver lesions was performed using semiautomated \nsegmentation software. Lesion margin intensity slope, a quantitative measure \nof margin sharpness, where sharper margins of low-density lesion result in \ngreater negative value, was measured for liver metastases and cysts. LMIS of \npost-treatment liver metastases was compared with their FDG-PET response \nand with LMIS of cysts. One-way analysis of variance was used for initial \nanalysis with Student-Newman-Keuls test for multiple comparisons. \nResults: Based on FDG-PET 34/45 (75.5%) lesions showed response and \n11/45 (24.4%) lesions were nonresponders. Mean LMIS values for \nnonresponders, responders and liver cysts were - 8.2 ± 4.3, - 19 ± 3.4 and - \n22.27 ± 4.8 HU/layer, respectively (p < 0.0001). On multiple comparisons, all \nthree groups were significantly different from each other though, responder \nlesions had less mean difference in LMIS value from cysts when compared \nwith nonresponders (11.52 HU/layer for responders vs. 18.9 HU/layer for \nnonresponders). \nConclusion: Integration of LMIS may help differentiate liver cysts from \nmetastases. It is a potential biomarker of response to antiangiogenic treatment \nin colorectal liver metastases.  \nAuthor Disclosures: \nA.R. Seyal: Research/Grant Support; Educational Grant Support from \nSiemens Healthcare. F.D. Gonzalez-Guindalini: None. K. Parekh: \nResearch/Grant Support; Educational Grant Support from Siemens \nHealthcare. Y. Velichko: None. T. O'Donnell: Employee; Siemens Medical \nSolutions. \nB-0674 10:57  \nDyna-CT vs MDCT in the evaluation and detection of hypervascular HCC  \nP. Lucatelli, M. Di Martino, E. d'Adamo, A. d'Adamo, M. Bezzi, M. Corona, \nF.M. Salvatori, C. Catalano; Rome/IT (pierleone.lucatelli@gmail.com)  \nPurpose: To evaluate the feasibility and the reproducibility of Dyna-CT in the \nevaluation of the contrast-to-noise ratio compared with MultiDetector-\nComputed Tomography (MDCT). \nMethods and Materials:  Twenty consecutive cirrhotic patients, scheduled for \ntransarterialchemoembolisation-(TACE), planned on the basis of MDCT, \nunderwent Dyna-CT immediately before treatment. 64-slice CT was performed \nwith 0.6×64 mm collimation, 3-mm section thickness, 250 mAs, 120 kVp. A \ntriple-phase protocol was utilised with scans initiated at 18s, 60s and 180s after \na trigger threshold of 150 HU above baseline was achieved in aorta. Dyna-CT \nwas performed after having positioned a Sim-1 catheter beyond the \ngastroduodenal artery. Injection rate and volume of contrast media were left to \nthe operator choice according to vascular anatomy. The contrant agent was \ndiluted up to 40% with saline. Intra-arterial injection lasted 12 sec (4 sec delay \n+8 sec of acquisition).Two radiologist in consensus evaluated two data sets of \nimages on a dedicated workstation (Leonardo; Siemens Medical Systems).The \nmean CT numbers of HCC nodules were assessed by manually placing \ncircular or ovoid ROIs, which were drawn to encompass as much of the lesion \nas possible. CNR was calculated for both technique as follow: ROIt - ROIl/ SDn \nwhere ROIt is the mean attenuation of the tumor, ROIl is the mean attenuation \nof the non-tumorous liver parenchyma, and SDn is the image noise. \nResults: No statistical significant differenc e was reported between MDCT and \nDyna-CT in the evaluation of HCC's CNR (p >.05). \nConclusion: Dyna-CT is feasible and reproducible compared to MDCT in the \nassessment of hypervascular HCC.  \n \nB-0675 11:06  \nVolumetric assessment by 7 Tesla liver magnetic resonance (MR) in mice \nto evaluate a novel therapy for colorectal cancer (CRC) metastases  \nP. Marra, A. Esposito, G. Sitia, M. Catarinella, T. Canu, L.G. Guidotti, \nF. De Cobelli, A. Del Maschio; Milan/IT (marrapaolo87@libero.it)  \nPurpose: Tie2-expressing monocytes (TEMs) are tumor-associated \nmacrophages with pro-angiogenic activity, normally recruited in primitive and \nmetastatic liver lesions with neo-angiogenesis. As interferon- ' (IFN') is known \nto play antitumoral effects, we engi neered TEMs to express and selectively \ndeliver IFN ' to liver metastases. Antitumoral efficacy was assessed by MRI \nvolumetric analyses in a mouse model of liver CRC metastases. \nMethods and Materials: Liver metastases were induced injecting 5x10 3 CT26-\nGFP cells through the splenic vein in 30 CB6 F1 mice: 14/26 were previously \ntransplanted with TEMs engineered to express IFN ' under the Tie2 promoter \n(IFN-group); 12/26 were transplanted with engineered TEMs expressing green-\nfluorescent-protein under the Tie2 promoter (Placebo-group); 4/26 control mice \nwere not manipulated before metastases induction (Control-group). At 14-21-\n34 and 54 days all mice underwent in-vivo 7-Tesla liver-MRI with hepatocyte-\nspecific contrast agent (EOB-DTPA) for the volumetric assessment of \nmetastases. \nResults: The incidence of liver metastases was lower in IFN-group than in \nPlacebo and Control groups both at 14 (0%vs57%vs50%; p < 0.05) and at 34 \ndays (11%vs100%vs100%; p=0.002) from CT26-GFP cells injection. 3 IFN-\nmice that developed metastases at day 21 were cured and presented no \nmetastases at day 54. Average tumor volume was significantly lower in IFN-\ngroup than in Placebo and Control groups with a mean value between time-\npoints respectively of 1.53vs128.86vs38.92 mm\n3 (p < 0.01). At day 54 all \nPlacebo- and Control-mice were dead vs only 11% of IFN-mice (p=0.001). \nConclusion: Hepatic deliver of IFN ' by engineered TEMs reduces the \nincidence and volume of CRC metastases at serial MRI analyses and improves \nsurvival in experimental mice.  \nB-0676 11:15  \nPreoperative assessment of colorectal liver metastases after \nchemotherapy: a combined approach of diffusion-weighted MR imaging \nwith b-multiple SE-EPI and Gd-EOB-DTPA MR sequences at 3 T-device  \nP. Boraschi, F. Donati, L. Urbani, R. Gigoni, G. Gherarducci, F. Pacciardi, \nG. Masi, F. Falaschi, C. Bartolozzi; Pisa/IT (p.boraschi@do.med.unipi.it)  \nPurpose: To determine whether diffusion-weighted MR imaging (DW-MRI) \nwith b-multiple SE-EPI could improve the diagnostic performance of Gd-EOB-\nDTPA-enhanced MRI (dynamic and hepato-biliary phase sequences) in the \npreoperative assessment of colorectal liver metastases in patients previously \nundergone chemotherapy. \nMethods and Materials:  Twenty patients with colorectal cancer and focal liver \nlesions underwent MR imaging at 3 T-device (GE DISCOVERY MR750;GE \nHealthcare) after preoperative chemotherapy. Three images sets were \nseparately reviewed by two observers in conference: 1, DW-MRI using a spin-\necho echo-planar sequence with multiple b values (150, 500, 1000, 1500 \nsec/mm²); 2, Gd-EOB-DTPA Lava-flex sequence including both dynamic and \nhepato-biliary phase; 3, combined DW-MRI and Gd-EOB-DTPA images. The \nMRI findings were correlated with surgery and histopathology, which was our \ngold standard. Only clear benign lesions at intraoperative ultrasound remained \nunresected. Statistical analysis was performed on a per-lesion basis. \nResults: A total of 146 hepatic lesions were detected; of these, 106 were \nmetastases (72.6%), whereas the remaining 40 (27.4%) were characterised as \nbenign lesions (cysts and hemangiomas). Image set 1 correctly identified 92 \nout of 106 metastases (sensitivity 86.7%, specificity 50%, diagnostic accuracy \n76.7%), image set 2 correctly detected 98 out of 106 metastases (sensitivity \n92.4%, specificity 70%, diagnostic accuracy 86.3%), and image set 3 correctly \ndiagnosed 104 out of 106 metastases (sensitivity 98.1%, specificity 95%, \ndiagnostic accuracy 97.2%). Differenc es were statistically significant \n(p < 0.001). \nConclusion: DW-MRI with b-multiple SE-EPI significantly increases the \ndiagnostic performance of Gd-EOB-DTPA-enhanced 3 T MRI in the \npreoperative assessment of colorectal liver metastases.  \n \n \n \n \n \n \n \n \n \n \n \n \nS282  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0677 11:24  \nPerformance of gadoxetic acid-enhanced MRI for the differentiation of \nFNH and HCA: a single centre experience  \nC. Perez Fernandez, T. Denecke, C. Grieser; \nBerlin/DE (carmen.perez-fernandez@charite.de)  \nPurpose: Evaluation of enhancement characteristics of focal nodular \nhyperplasia (FNHs) and hepatocellular adenomas (HCAs) with gadoxetic acid-\nenhanced magnetic resonance imaging (MRI). \nMethods and Materials: Eighty-six patients who underwent MRI at 1.5 T were \nretrospectively included. Examination protocol contained: T1-in- and opposed \nphase; T2-weighted UTSE and fat-saturated T1-weighted (WATS; LAVA) with \nand without contrast media (Gd-EOB-DTPA; arterial, portal venous, venous \nand hepatobiliary phase. Standard of reference was surgical resection (n=53) \nor biopsy (n=15) available for 114 lesions. All cases were read by two \nindependent radiologists in consensus. Lesi on intensity was visually compared \nwith the intensity of the surrounding liver parenchyma. Furthermore, relative \nsignal intensity (SI) values (%) in contrast to native SI values were recorded for \nthe different contrast phases. \nResults: 114 lesions (FNHs, n=44; HCAs, n=70) were evaluated. On \nunenhanced MRI, presence of fat (P < 0.001; accuracy=54%), haemorrhage \n(P=0.071; accuracy=57%) and \"wash-out'' were indicative for HCA (P < 0.001; \naccuracy=63%), whereas the presence of a central scar was indicative for FNH \n(P < 0.001; accuracy=85%). Regarding signal intensities on hepatobiliary \nphase images, an iso-/hyperintense appearance of FNHs and hypointensity of \nHCAs were the best discriminators between both entities (P < 0.001; \nacc=92%). \nConclusion: An iso-/hyperintensity of FNHs and hypointensity of HCAs on \nhepatobiliary phase images are highly accurate discriminators between both \nentities. In case of conclusive findings of FNH on gadoxetic-enhanced MRI, \nbiopsy may be dispensable.  \nB-0678 11:33  \nEvaluation of HCC and hypovascular nodules with gadoxetic acid-\nenhanced MRI and DWI  \nC. Briani, M. Di Pietropaolo, G. Federici, M. Marignani, P. Begini, E. Iannicelli; \nRome/IT  \nPurpose: To investigate the prognostic value of Diffusion Weighted imaging \n(DWI) compared to Gadoxetic Acid-enhanced MRI (Gd-EOB-DTPA enhanced \nMRI) both in the detection of HCC and hypovascular nodules hypointense on \nhepatobiliary phase images (HP), and in the assessment of its evolution. \nMethods and Materials:  Fifty-five patients underwent Gd-EOB-DTPA \nenhanced MRI including DWI sequences (b-values 50-400-800 s/mm²). We \nevaluated nodules size, vascular pattern on dynamic contrast-enhanced MRI \nand the signal intensity on HP and on DWI. Statistical differences in the \ndetection of HCC according to the size were compared by McNemar test. \nFisher's exact test was performed to analyse relationship between size of the \nhypovascular nodules and development of the hypervascularisation. \nResults: One hundred and five nodules were detected with Gd-EOB-DTPA-\nenhanced MRI. Sixty-five/105 nodules showed typical vascular pattern of HCC \non dynamic imaging; 63/65 lesions (96.9%) appeared hypointense on HP, \n35/65 HCCs (53.8%) were hyperintense on DWI at b=800 s/mm². Thirty-\nnine/105 hypovascular nodules appeared hypointense in the hepatobiliary \nphase images. On follow-up MR images 18/39 nodules (46%) showed a typical \nvascular pattern of HCC (high risk \u0003 10 mm in size p=0.012). Nine/39 (23%) \nhypovascular nodules showed hyperintensity on DWI at the first exam, 7 of \nthese developed into HCC during the follow-up period. \nConclusion: Gd-EOB-enhanced-MRI demonstrated highly accuracy in the \ndiagnosis of HCC and in the detection of hypovascular nodules with potential \nprogression to HCC.No significant add value of DWI compared to Gd-EOB-\nDTPA enhanced MRI was demonstrated, nevertheless hyperintensity of \nhypovascular nodules on high-b-value DWI seems to suggest high risk of \nmalignant transformation  \nB-0679 11:42  \nHepatocellular carcinoma: correlation between microvascular invasion \nwith image findings of gadoxetic acid-enhanced MR and [ 18F] FDG uptake \non PET/CT  \nS. Ahn, J.-M. Lee, I. Joo, E. Lee, J. Han, B. Choi; Seoul/KR \n(ddodola323@gmail.com)  \nPurpose: To analyse the correlation between microvascular invasion (MVI) \nwith image findings of gadoxetic acid-enhanced MR and [ 18F] FDG uptake on \nPET/CT in patients with hepatocellular carcinoma (HCC) who are undergoing \nliver transplantation. \nMethods and Materials:  51 patients with 78 HCCs underwent liver \ntransplantation after MR imaging and [ 18F] FDG-PET/CT. Tumor size, signal \nintensity and homogeneity on dynamic phase and hepatobiliary phase (HBP), \ntumor margin, peritumoral enhancement, tumor capsule and peritumoral \nhypointensity were analysed. To evaluate 18 F-FDG uptake, the SUVmax of \ntumor, the ratio of tumor SUVmax to normal-liver SUVmax \n(TSUVmax/LSUVmax), and the ratio of tumor SUVmax to normal-liver \nSUVmean (TSUVmax/LSUVmean) were analysed. The size, histologic grades, \nthe presence of MVI of the HCCs were evaluated on pathologic examinations. \nAssociation between the imaging findings with MVI were assessed by Fisher's \nexact test and logistic regression analysis. Independent t-test or Mann-Whitney \ntest were used to compare continuous variables between the positive and \nnegative MVI groups. \nResults: Inhomogeneity on HBP (Odds ratio [OR] = 3.57, p =.032) and \nirregular margin (OR = 3.1, p=.035) were predictable factors for MVI. \nSUVmax (MVI positive: 5.09 ± 2.39, negative 3.27 ± 1.41, p =.001), \nTSUVmax/LSUVmax (positive: 1.59 ±1.53, negative 0.81 ± 0.57, p =.007), and \nTSUVmax/LSUVmean (positive: 1.41 ± 1.28, negative 0.77 ±  0.54, p =.008) \nwere significantly higher in positive MVI groups. \nConclusion: Irregular margin, inhomogenity on HBP of MRI and increased \n18 F-FDG uptake on PET are factors that suggest MVI in HCC patients.  \nB-0680 11:51  \nDiagnosing MRI and CT in patients with colorectal liver metastases: \ndiagnostic performance and inter-observer agreement of four different \nqualified reviewers  \nM. Albrecht\n1, J.L. Wichmann1, C. Müller1, H. Ackermann1, S. Sakthibalan2, \nR. Hammerstingl1, W.O. Bechstein1, T. Schreckenbach1, S. Zangos1, \nT.J. Vogl1; 1Frankfurt a. Main/DE, 2London/UK (MoritzAlbrecht@gmx.net)  \nPurpose: To compare the diagnostic performance of four different qualified \nreviewers retrospectively diagnosing CT and MRI of patients with colorectal \nliver metastases (CRLM). \nMethods and Materials: 51 CT and 54 MRI of 105 patients with CRLM prior to \nhepatectomy were included. Segments were identified as CRLM positive or \nnegative using intraoperative findings/histopathology and served as the \nreference standard for a per-segment analysis. Four reviewers of varied \nexperience; (A,B,C: radiologists with respectively > 20, > 5, < 1 years of \nexperience and D: 5\nth year medical student) reported the frequency of CRLM \nand the segments affected. Per-segment sensitivity, specificity, Cohens Kappa \n(5) for diagnosed segments and intra-class correlation coefficients (ICC) for \nnumber of lesions were calculated. \nResults: CT sensitivity and specificity was for reviewer A 89.71%/94.41%, B \n78.50%/88.37%, C 63.55%/85.58% and D 84.11%/78.60%. MRI sensitivity and \nspecificity was for reviewer A 90.40%/95.43%, B 74.40%/90.04%, C \n60.00%/85.89% and D 65.60%/75.90%. In the analysis of diagnosed segments \n(5) and frequency of CRLM per patient (ICC), the overall inter-observer \nagreement was higher for CT ( 5=0.43, p < 0.001; ICC=0.75, p < 0.001) than \nMRI ( 5=0.38, p < 0.001; ICC= 0.65, p < 0.001). The experienced reviewers A \nand B achieved better agreement for MRI ( 5=0.54, p < 0.001; ICC =0.77, \np < 0.001) than CT ( 5=0.52, p < 0.00; ICC=0.76, p < 0.001) unlike the less \nexperienced (MRI 5=0.38, ICC=0.63 and CT 5=0.41, ICC=0.74, respectively, \np < 0.001). \nConclusion: MRI diagnosis of CRLM should be reserved primarily for expert \nradiologists. When compared to experienced radiologists, beginners can \nachieve better diagnostic performance with CT than MRI.  \n10:30 - 12:00 Room F1  \nRadiographers  \nSS 1314  \nOptimisation of imaging examinations  \nModerators:  \nJ.-F. Chateil; Bordeaux/FR  \nF. Zarb; Msida/MT  \nB-0681 10:30  \nVentricular function assessment using MRI: comparative study between \ncartesian and radial techniques of k-space filling  \nC. Ferreira\n1, P. Martins2, B. Graça1, F. Peixoto2, S. Monteiro2, S. Barbosa2, \nM. Castelo-Branco1; 1Coimbra/PT, 2Aveiro/PT (c_dferreira@yahoo.com)  \nPurpose: Radial k-space filling allows an acquisition less prone to movement \nartefacts. The aim of this study is to assess overall image quality and compare \ncardiac measures derived two k-space sampling techniques (cartesian and \nradial) in the evaluation of ventricular function. \nMethods and Materials:  Ten healthy volunteers were enrolled in this study. \nCardiac cine images ECG-gated were collected with a cine_SSFP sequence \n(standard short-axis orientation), with the two k-space sampling techniques. All \nimages were qualitatively assessed on a four-point scale (4-excellent, 1-non-\ndiagnostic). Statistical analysis was performed using Wilcoxon test. The \nS283  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\ndifferences in the assessment of LV volumes and EF between both k-sampling \ntechniques were tested using the Student's paired t-test. \nResults: Radial technique presented images with fewer artefacts than the \ncartesian technique, with overall good delineation of the endocardium. In the \nqualitative analysis, radial technique had a median value of 3.00 while the \ncartesian had 2.00 (p=0.0315). For quantitative analysis EDV was \n137.10±24.29 mL by the radial technique and 132.30 ±24.15 mL by the \ncartesian technique (p=0.182). The corresponding EF values were \n69.63±4.09% and 68.56±5.17% (p=0.321). \nConclusion: Ventricular function assessment is feasible with the use of radial \nk-space sampling with better overall image quality. Radial k-sampling holds \npromise in the evaluation of patients with  difficulties performing breath-hold \ntechniques.  \nB-0682 10:39  \nSonoelastography in differentiation of benign and malignant small sized \novarian tumours  \nA.E. Khalmukhamedova, V.E. Gazhonova, I.S. Belozerova, A.V. Zubarev; \nMoscow/RU (frish666@gmail.com)  \nPurpose: The objective of this study was to evaluate the diagnostic \npossibilities of sonoelastography (SE) to differentiate benign from malignant \nsmall sized ovarian tumours. \nMethods and Materials:  86 patients (aged 19-78 years) with ovarian tumours \nless than 3 sm were performed conventional TVU on HI VISION Preirus \n(Hitachi Medical Corporation). Modified Tsukuba sonoelastography \nclassification was used for evaluation of the elasticity score of the tumour. \nColour-Doppler and SE data were evaluated independently by two specialists. \nUS results were compared with surgical and hystomorphological data, MRI, \nCT, PET-CT data and abdominal fluid as piration results. Elasticity score \naccording to the degree and correspondingly distribution of the strain were \nestablished (5 point color scale: 1-3 benign, 4-5 malignant). Strain ratio was \ncalculated. Inter- and intraobserver variability was calculated. \nResults: Based on the data of sonoelastography, 38 hysterectomies, 25 \nisolated resections of the tumours and 26 ovariectomies were performed. 48 \nbenign and 41 malignant ovarian tumours were revealed by means of final \nhistopathology. Sonoelastography increased the sensitivity (from 81% to 97%) \nand accuracy (from 82% to 94%) of US scanning in diagnostic of ovarian \ncancer. Pathomorphological results were compatible to sonoelastography data \nin most of the cases (k=0.84, correlation 92%). In 36% cases \nsonoelastography increased diagnostic confidence and helped to change the \nfinal diagnosis. The method of sono elastography cannot itself determine the \ndiagnosis, but in 32% cases it helped differentiating the nature of the tumour. \nConclusion: Real-time sonoelastography is a valuable tool that increases \ndiagnostic confidence in differentiation small sized ovarian tumours.  \nB-0683 10:48  \nMagnetic resonance quantification of iron in basal ganglia using SWI \ntechnique  \nC.S.P. Rocha, G.A. Preira, M.M.C.P. Ribeiro, P. Sousa, R. Silva; Lisbon/PT \n(catia.rocha91@gmail.com)  \nPurpose: To verify the effectiveness of magnetic resonance (MR) measuring \nthe iron concentration in basal ganglia, using susceptibility weighted imaging \n(SWI); to optimise intrinsic parameters of SWI sequence, in order to highlight \nthe evidence of iron and compare those iron concentrations in basal ganglia \namong subjects, concerning age, gender and brain hemispheres. \nMethods and Materials:  30 healthy subjects were selected and stratified into \nfive aged groups, underwent a brain MR by a Magneton Avanto Siemens\nTM \n(1.5 T) system. Four SWI protocols were applied with different flip angle (FA) \nand slice thickness (TH); images were analysed by SPIN TM software, that \nallowed the ROIs drawing in phase images. The iron concentrations in \nmg/100 g of fresh tissue were measured in six bilateral basal-ganglia. \nResults: In males, higher iron concentrations (21.429 ±0.374 mg/100 g) were \nfound comparing to females (19.883± 0.416 mg/100 g). The same trend was \nfound in the left hemisphere (18.775 ±4.760 mg/100 g) and throughout \ndifferenced aged groups {[30-40[;[40-50[;[50-60[}; Substantia Nigra, Globus \nPallidus, and Putamen presented higher iron concentrations. \nConclusion: The protocol choice is determinant to assess the iron \nconcentration with high accurancy. In this study, the best protocol to highlight \nthe evidence of iron concentration has one with smaller FA and higher TH. Iron \nconcentration increase according to age increase, male's subjects and left \nhemisphere. The robust correlation between results and literature, lead to \nassume that iron concentration, measured by SWI, can be used as a \nbiomarker and can be used by radiographers in the screening and follow-up of \nneurodegenerative diseases as Alzheimer, Parkinson and Huntington.  \n \n \n \nB-0684 10:57  \nMeasurement of bone mass density: comparison of the absorptiometry \n(DEXA) and quantitative ultrasonometry methods  \nR. Patricio, M.C. Ribeiro; Lisbon/PT (margarida.ribeiro@estesl.ipl.pt)  \nPurpose: Osteoporosis, characterised by loss and hardiness of bone mass, \nleads to an increased risk of bone fractures. To use the QUS method, with \nreliability, in outpatients or some specific clinical settings such as elderly \nhomes, continuing care centers, primary care in ambulatory environment, or in \nscreening programs. This study aim to assess and to compare the values of \nbone mass density obtained through the QUS and DEXA methods and to verify \nif there is, or not, a constant variation in the obtained values from the same \nsubject, allowing the establishment of a linear variation pattern. \nMethods and Materials:  The sample had 50-86 years old (average=64.16; \nSD=12,003). The inclusion criteria were: female, post-menopause, without \nbone fractures diagnosed. The bone mass density was evaluated on a set of \n32 subjects, using the two methods cons ecutively. To data acquisition were \nused an Achilles InSight, System and a Norland both by GE®. Due the \ntechniques' specificity the QUS was app lied in the calcaneal region and the \nDEXA in the lumbar spine. \nResults: Using Pearson's correlation tests, were obtained T-score values with \nr= 0.556 and Z-score value of r=0.461. The Student's t-test, shown a Z-score \nwith p=0.005 and for the T-score p=0.466. \nConclusion: It was impossible to establish a trend or a linear variation value, \nbut there was a positive variation between the T-score values in both methods. \nEach method may be applied with reliability but may not be replaced one by \nthe other, being the QUS method informative and the DEXA diagnostic.  \nB-0685 11:06  \n3-point ultrasound for complete diagnosis of deep vein thrombosis of the \nlower extremities  \nA. Latifi\n1, F. Labruto2, A. Sundin3, M. Torkzad4; 1Manchester/UK, 2Sydney/AU, \n3Stockholm/SE, 4Sollentuna/SE (michael.torkzad@gmail.com)  \nPurpose: To investigate the accuracy of 3-point ultrasound for diagnosis of \nDVT in patients referred to radiology from the emergency department. \nMethods and Materials:  Consecutive and prospective patients referred for \nimaging of the lower extremities to rule out primary DVT were asked to enrol in \nthis study. Three points along the course of the veins were examined in the \nfollowing areas: the inguinal area, the popliteal area and the point of maximum \npain if and when identified by the patient's finger The reference tests were \nradiologic examinations and follow-up for six months. The radiologic \nexamination was either complete ultrasound examination of the lower \nextremities or ascending venography performed immediately after 3-point \nultrasound by a radiologist blinded to results of 3-point ultrasound. \nResults: 110 patients have been recruited thus far with complete data and \nfollow-up. No single case of false negative diagnosis has been detected. \nConclusion: With examination of three points along the course of lower \nextremity veins all cases of DVT were detected.  \nB-0686 11:15  \nDetermining the value of non-traditional approaches to conventional \nradiographic imaging of neonates in the post-mortem setting  \nN.P. Burke1, J. McNulty1, N. Pelletier2, T. Grgurich2, R. Lombardo2, \nB. Hennessy2, G. Conlogue2; 1Dublin/IE, 2Hamden, CT/US \n(niall.burke91@gmail.com)  \nPurpose: The number of autopsies carried out following sudden infant death \ncontinues to decline, and a stronger reliance on radiological imaging has been \nnoted in these cases. Despite the growth in the use of cross-sectional imaging \nin forensics, conventional radiography continues to play a prominent role in \npost-mortem imaging of neonates. This study aims to determine the best \ncombination of X-ray source, image receptor and kilovoltage peak for use in \nthe neonatal post-mortem setting where cross-sectional imaging is unavailable. \nMethods and Materials:  Rib fractures were simulated on a foetal pig model \nand imaged using high and low kVp exposures on CR plates and \nmammography film across a Toshiba Kalare X-ray unit, a Siemens Mammomat \n300 and a HP Faxitron 43807N cabinet system. A visual grading analysis \n(VGA) study was subsequently undertaken to determine which combination \nprovided the best resolution of the simulated fractures. \nResults: Use of mammography film in the cabinet X-ray system with a low kVp \nexposure provided the best demonstration of the simulated fracture of interest \n[mean image quality score (IQS) of 8.67]. This was closely followed by the \ncombination of the mammographic unit and digital CR plate---again using a low \nkVp exposure (mean IQS of 7.33). \nConclusion: Where cross-sectional imaging is not available or not widely used \nin the post-mortem imaging of neonates, it is important to take into account the \nalternative approaches of attaining conventional radiographs. The role of the \nradiographer in determining the most appropriate approach to imaging such \ncases should not be undervalued.  \nS284  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0687 11:24  \nIs contrast agent necessary for MR angiography?  \nD. Colson1, C. Cox1, S. Germonpré1, B. Caerts2; 1Brussel/BE, 2Turnhout/BE \n(dries.colson@telenet.be)  \nPurpose: Despite the ongoing evolution of non-contrast-enhanced MRA \ntechniques, contrast-enhanced MRA is still the standard for accurate diameter \ndetermination of the renal artery. But side effects and especially NSF are not \nnegligible. Can CE-MRA sequences be replaced by NCE-MRA sequences, \nespecially for patients with renal problems? \nMethods and Materials:  A self-made phantom was used to simulate the renal \nartery. The phantom consists of four small tubes made of glass, one without \nand three with stenosis (50, 67 and 75%). The data were acquired on an 1.5 T \nand 3 T scanner. The CE sequence was performed with a GE sequence with \nGadovist® and the NCE sequence with a PCA sequence. There were also \nsequences taken with Dotarem®, but only on the 3 T machine. The images \nwere evaluated by nine radiologists and nine radiographers. \nResults: In the non-stenotic phantom, the results of CE and NCE sequences \nwere similar. They were both capable of accurate measurement of the \ndiameter. In the phantoms with stenosis, the PCA sequence overestimated the \nstenosis. When the stenosis increased, the overestimation was larger. CE \nsequences provided an accurate diameter determination. Only with a severe \nstenosis (75%), there was an underestimation. A 1.0 molar contrast agent \nyielded superior results to a 0.5 molar contrast agent. \nConclusion: A PCA sequence can replace a CE sequence when there is no \nstenosis in the renal artery. When there is a stenosis, a CE sequence can \nadditionally be performed, especially when there is a severe stenosis. \nPreference should be given to a 1.0 molar contrast agent. More research is \nnecessary for b-SSFP, FSE and ASL.  \nB-0688 11:33  \nParallel MR imaging: technique and significance  \nM. Kiss, B. Lombay; Miskolc/HU (kissmate20@gmail.com)  \nPurpose: Parallel Acquisition Technique (PAT) is a special Magnetic \nResonance (MR) imaging tool, which take advantage of the spatial information \nand reduce the acquisition time. Parallel imaging become widely available. \nThere are different types of this technique and radiographers have a crucial \nrule to use this technique. \nMethods and Materials:  We applied a Siemens Magnetom Symphony 1.5 T, \nand a Siemens Magnetom Verio 3 T MR system. We examined 200 patients \nand use the PAT in different types of body part e.g. head, spine, abdomen, \nangiography, chest and cardiac. For the optimisation of the protocol and image \nquality we used different PAT (Grappa, mSense and Caipirinha). We analysed \nthe image quality, the signal-to-noise ratio (SNR) and the acquisition time. \nSome characteristic examples will be presented. \nResults: We found significant loss in SNR, and differences between the \nvarious parallel techniquesA few sequences are not good candidates for \nparallel imaging - when the SNR was too low. The Grappa technique was the \nbest method in every type of sequences. The Cipiriniha was useable only the \nabdominal imaging. The mSense was much noisier than the Grappa and \nCaipirinha in every examinations. We couldn't find significant differences \namong the different type of sequences when we applied the PAT. \nConclusion: The parallel imaging have a wide range of clinical applications, it \ncan be reduce the acquisition time and improved spatial resolution. The \ntechnique is attractive for cardiac-, abdomen and contrast enhancement MR \napplications. The main disadvantage to reduce the signal-to-noise ratio.  \nB-0689 11:42  \nImplementation of TraumaCad calibration ball in orthopaedic imaging in a \nradiology department: a multidisciplinary approach  \nJ. Jensen, B. Mussmann; Odense/DK (Janni.Jensen@rsyd.dk)  \nPurpose: TraumaCad® is digital templating software for pre-operative \northopaedic surgery planning. A correctly placed calibration ball (CB) in the X-\nray is crucial for sizing of orthopae dic implants and visualisation of fracture \nreduction. Approximately, 10% of the images need a CB. Positioning of the CB \nis time consuming, challenging and may result in retakes. The metallic CB \nintroduces artifacts possibly obscuring anatomic structures and pathology. The \npurpose of this study was to ensure the presence of a CB in all pre-operative \nX-rays as opposed to in all x-rays query fracture. \nMethods and Materials:  A three-step approach was adopted. 1. \nComprehensive guidelines were developed, introduced and made available at \nall X-ray rooms. 2. Multidisciplinary education involving radiographers, \nradiologists and orthopaedic surgeons were arranged to gain an \ninterdisciplinary understanding of the processes involved when placing the CB, \nreporting the X-ray and using TraumeCad. 3. Sessions, aimed specifically at \nradiographers, on how to identify fractures requiring surgery were held and \nrepeated. Subsequently audits were performed. \nResults: 270 consecutive patients were included, of which 24 needed surgery \nand 21 of those had a correctly placed CB. 246 patients did not need surgery, \nof those 225 were correctly identified as true negative and 21 had a CB in their \nX-ray. The sensitivity was 88% and the specificity 91%, with a positive \npredictive value of 50% and a negative predictive value of 98%. \nConclusion: The guidelines were successfully introduced and of the included \npatients, only three surgery-requiring fractures were missed potentially needing \nan additional CB image.  \nB-0690 11:51  \nEvaluation of the impact of specific training in the reduction of the \nradiography examination errors  \nA. Santos\n1, C. Blanco2, G. Paulo1; 1Coimbra/PT, 2Cuenca/ES \n(adelinosantos@estescoimbra.pt)  \nPurpose: A radiological protection system shoul d be grounded on justification, \noptimisation and limitation, which requi res the implementation of Quality \nAssurance Programs. Measure it is difficult with digital systems and as \nimportant changes in their analysis are evident we want to check the way a \nspecific training programme affects the repet ition rate of conventional digital \nradiographic studies. \nMethods and Materials: Data from one month was measured and analysed in \ntwo digital conventional radiology rooms and an observational study, of \nprospective nature and fixed cohort, was carried out followed by a training \nprogramme which had an impact on them. Later, an analysis was carried out \nagain in order to compare and evaluate the results. Thanks to the DICOM \nimage headers, dosimetric data was analysed and once the relative unit of \nvalue was calculated, the approximate economic saving was estimated. \nResults: The rejection rate have decreased 28% thanks to digital systems. It \nhas been shown that the accountability of the rejection rate lies with the \nRadiographer. With training and commitment it is possible to obtain a 31% of \nreduction rates. Such a decrease has an impact both on the patient dosage \nand related costs. \nConclusion: The rejection rate is a key indicator of the quality of Radiology \nfacilities and a clear tool which helps avoid unnecessary patient dose. The \nRadiographer must bring together and integrate knowledge to avoid repetitions \nespecially due to erroneous practices. Its application and accountability should \nhave straight results in dose reduction, contributing to facilitate high quality \nhealth care.  \n10:30 - 12:00 Room F2  \nBreast  \nSS 1302  \nMRI diffusion: update 2014  \nModerators:  \nC. Dromain; Villejuif/FR  \nF. Pediconi; Rome/IT  \nB-0691 10:30  \nCan quantitative diffusion-weighted imaging (DWI) predict elevated MIB-1 \nproliferation index in invasive breast cancer?  \nC. Molinari, V. Bertani, A. Gualano, E. Di Gaetano, R. Girometti, V. Londero, \nC. Zuiani, M. Bazzocchi; Udine/IT (molinari.cristina83@gmail.com)  \nPurpose: To investigate whether quantitative Diffusion-Weighted Imaging \n(DWI) parameters predict elevated levels of MIB-1 proliferation index in \npatients with breast cancer. \nMethods and Materials:  We retrospectively enrolled 52 patients with biopsy- \nand surgically-proven invasive cancers (n=52), who underwent preoperative \nbreast Magnetic Resonance imaging (MRI) on a 1.5 T magnet. MRI \nexamination included a Single Shot Echoplanar DWI sequence with b values of \n0 and 1000s/mm2. For each lesion, two experienced readers in consensus \nmeasured the apparent diffusion coefficient (ADC) (on the ADC maps) and \nlesion-to-background-ratio (LBGR) (on b=1000 s/mm2 images). Based on \nimmunohistochemistry results, we then compared mean ADC and LBGR \nvalues between MIB-1-positive ( > 14%) and MIB-1-negative ( \u000214%) patients \nusing the unpaired T-test. \nResults: Patients were assessed as MIB-1-positive and MIB-1-negative in \n23/52 (44.2%) and 29/52 (55.8%), respectively. ADC values were significantly \n(p < 0.05) lower in MIB-1-positive patients (0.86x10-3 s/mm2; 95%IC 0.80 - \n0.92) compared to MIB-1-negative ones (1.01x10-3 s/mm2; 95%IC 0.91-1.11). \nOn the contrary, we showed no significant difference in LBGR between MIB-1-\npositive (6.73; 95%IC 4.15-9.32) and MIB-1-negative (9.14; 95%IC 4.45-12.82) \nwomen. \nConclusion: Lower ADC values at DWI are associated with elevated MIB-1 \nproliferation index in patients with invasive breast cancer.  \nS285  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0692 10:39  \nEvaluation of apparent diffusion coefficient to predict grade, micro-\ninvasion and invasion in DCIS  \nH.M. Hussein, C. Chung, H. Moshonov, M. Naomi, S. Kulkarni, A. Scaranelo; \nToronto, ON/CA (heba.hussein@uhn.ca)  \nPurpose: To evaluate the role of apparent diffusion coefficient (ADC) in \ndistinguishing DCIS grades and identifying micro-invasive/invasive disease. \nMethods and Materials:  71 non-invasive/high-risk core-biopsy proven breast \nlesions were assessed preoperatively using diffusion weighted MRI. The ability \nof ADC values to distinguish DCIS gra des and predict the presence of invasion \nwas analysed. \nResults: On 3 T, mean ADC value was 1.20 ×10\u00033 mm2/s ± 0.48 (SD) (range, \n0.47 - 1.78 ×10 \u00033 mm2/s) for non-high grade DCIS, 1.23 x 10-3 mm2/s ± 0.40 \n(SD) (range, 0.26 - 1.77 ×10 \u00033 mm2/s) for high-grade DCIS, and 1.15 x 10-\n3 mm2/s ± 0.45 (SD) (range, 0.26 - 1.75 ×10 \u00033 mm2/s) for \ninvasive/microinvasive disease. On 1.5 T, mean ADC value was 1.04 x 10-\n3 mm2/s ± 0.41 (SD) (range, 0.15 - 1.85 ×10 \u00033 mm2/s) for non-high grade \nDCIS, 1.01 x 10-3 mm2/s ± 0.37 (SD) (range, 0.06 - 1.76 ×10 \u00033 mm2/s) for \nhigh-grade DCIS, and 1.11 x 10-3 mm2/s ± 0.30 (SD) (range, 0.64 - 1.76 \n×10\u00033 mm2/s) for invasive/microinvasive disease. Based on logistic regression \nanalysis, mean ADC value was not a significant predictor for invasiveness \nusing 1.5 T [OR = 2.6 (95% CI (0.409, 17.12)), p=0.3] or 3 T [OR = 0.4 (95% CI \n(0.076, 2.399)), p=0.3] \nConclusion: Mean ADC acquired using a 1.5 T or 3 T MRI was unable to \npredict high-grade or invasive disease in biopsy-proven DCIS lesions. Further \nwork is exploring voxel-based approaches that may better appreciate tumor \nheterogeneity and identify sub-regions of tumor with these higher risk features.  \nB-0693 10:48  \nApparent diffusion coefficient measurements of breast tumours at \nroutine breast magnetic resonance imaging: how reproducible are they?  \nS.J. Vinnicombe\n1, S. Waugh1, Z. Davis2, A.J. Evans1; 1Dundee/UK, \n2Edinburgh/UK (s.vinnicombe@dundee.ac.uk)  \nPurpose: Diffusion weighted imaging (DWI) is increasingly utilised for breast \nlesion characterisation and assessment of response to chemotherapy, but \nthere is little data on reproducibility of measurements of the apparent diffusion \ncoefficient (ADC). The purpose of this work was to analyse intra- and inter-\nobserver variability of ADC measurements on a series of newly diagnosed \nbreast malignancies. \nMethods and Materials:  IRB approval was waived for this retrospective study \nof anonymised data. 46 consecutive patients with biopsy-proven breast cancer \nwere included. Two experts and one non-expert observer identified index \nlesions on DW images (b value 800 or 1,000 s/mm\n2) and the corresponding \nADC map. A region of interest was drawn around the lesion manually for \nwhole-tumour ADC (ADC\nWT); for the minimum ADC value (ADC min), a 3 mm 2 \nROI was moved over the area of restricted diffusion. Expert observers \nrepeated the measurements after \u0003 1week. Intra and inter-observer variability \nwas analysed with intraclass correlation coefficients (ICC) and Bland-Altman \nplots with calculation of coefficients of repeatability (CoR, all units in mm 2/s). \nResults: For masses, reader agreement was high: ADC WT, ICC 0.751, CoR \n0.302; ADC min, ICC 0.806, CoR 0.241. For nml, agreement was good for \nADCWT (ICC 0.611, CoR 0.499) but not ADC min (ICC 0.289, CoR 0.578), unless \nthe inexperienced reader was excluded (CoR 0.079). Intra-reader repeatability \nwas excellent (ADC WT: ICC > 0.972, CoR < 0.220; ADC min: ICC > 0.976, \nCoR< 0.131). \nConclusion: ADC WT measurements are generally highly reproducible for \nexperts and non-experts. Reproducibility is higher for masses than nml, and for \nADCWT rather than ADC min, where tumour heterogeneity and artefact probably \nconfound inexperienced readers.  \nB-0694 10:57  \nQuantitative analysis of apparent diffusion coefficient maps for breast \ncancer diagnosis in 3 T diffusion-weighted MRI  \nA. Karahaliou\n1, K. Vassiou2, S. Skiadopoulos1, N. Arikidis1, I. Fezoulidis2, \nL. Costaridou1; 1Patras/GR, 2Larissa/GR (akarahaliou@upatras.gr)  \nPurpose: To investigate the feasibility of histogram analysis of ADC maps for \ndifferentiating malignant from benign breas t lesions in 3.0 T diffusion-weighted \nMRI (DW-MRI). \nMethods and Materials: Dataset analysed consists of 89 histologically verified \nbreast lesions (51 malignant, 38 benign) of patients who underwent DW-MRI at \n3.0 T (b-values 0, 900 s/mm 2). ADC maps were generated for a slice \nrepresentative of lesion largest diameter. An expert radiologist manually \ndelineated lesion contour on ADC map, defining the lesion region of interest to \nbe subjected to histogram analysis considering: mean, standard deviation, \nskewness, kurtosis, entropy, maximum, minimum and range of ADC values. \nThe discriminating ability of individual histogram features, as well as of feature \ncombinations, was investigated employing a least squares minimum distance \nclassifier. Classification performance was evaluated by means of the area \nunder receiver operating characteristic curve (Az). \nResults: Malignant lesions demonstrated statistically significant lower median \nvalue of ADC feature mean (0.94 x10-3 mm\n2/s) and maximum (1.43x10-\n3 mm2/s), as compared to benign lesions (mean: 1.49x10-3 mm 2/s and \nmaximum: 1.94x10-3 mm 2/s). Malignant lesions demonstrated increased \nentropy (5.82) reflecting increased ADC heterogeneity, as compared to benign \nones (5.62). Among individual features, best classification was achieved by \nADC feature mean (Az=0.87 ±0.04). The feature subset comprising of ADC \nmean, entropy and minimum demonstrated the highest classification \nperformance (0.91±0.03). \nConclusion: Histogram analysis of ADC maps allows for quantification of \nspecific lesion ADC heterogeneity properties, improving the potential of DW-\nMRI in differentiating malignant from benign breast lesions.  \nB-0695 11:06  \nBI-RADS 4 lesions only visible on contrast-enhanced MRI: can apparent \ndiffusion coefficient measurements differentiate benign from malignant?  \nP.A.T. Baltzer, K. Pinker-Domenig, M. Bernathova, T.H. Helbich; Vienna/AT \n(patbaltzer@gmail.com)  \nPurpose: Due to its high sensitivity, contrast-enhanced breast MRI detects \nsuspicious lesions otherwise not visible. Here, MRI-guided biopsy is applied. \nUnnecessary biopsies in benign lesions cause costs and patient inconvenience \nand should thus be avoided. This study investigates the use of apparent \ndiffusion coefficient (ADC) in lesions only visible on MRI. \nMethods and Materials:  A retrospective review of our single-center \nprospectively populated database revealed 101 patients (mean age 49.5, SD \n13.9, median 48, IQR 17 years) who underwent diffusion-weighted imaging at \n1.5 T. The patients showed 104 lesions visible on MRI only classified as BI-\nRADS 4 based on BI-RADS criteria and were scheduled for MRI-guided \nbiopsy. ADC values were measured by an experienced radiologist blinded to \nhistopathologic results. Diagnostic accuracy was investigated using ROC \nanalysis. \nResults: Histopathology revealed 20 malignant and 84 benign lesions. Lesions \nwere classified as mass in 61 (15 malignant, 24.6%) and non-mass in 43 (5 \nmalignant, 11.6%). At an ADC cut-off level of \u0002 1.258*10\n-3 mm2/s, ROC \nanalysis showed a sensitivity and specificity for ADC measurements of 80% \nand 79.8%, respectively. In mass lesions, sensitivity and specificity were \n93.3% and 82.6%. In non-mass lesions, lower sensitivity (80%) and specificity \n(65.8%) were observed. \nConclusion: ADC measurements can help to differentiate breast lesions only \nvisible on MRI and classified as BI-RADS 4 by BI-RADS criteria. Higher \nsensitivity and specificity are observed in mass lesions as compared to non-\nmass lesions was observed.  \nB-0696 11:15  \nImproving the accuracy of breast MRI: could diffusion-weighted imaging \n(DWI) overcome background parenchymal enhancement (BPE)?  \nM. Panzeri, C. Losio, G. Cristel, M. Rodighiero, S. Tacchini, F. De Cobelli, \nA. Del Maschio; Milan/IT  \nPurpose: BPE can limit the accuracy of breast-MRI similarly to what occurs in \nmammographically dense breast, requiring a short-term, expensive MRI-\nfollow-up. We evaluated if the adjunct of DWI could help in this difficult setting. \nMethods and Materials:  Out of 1757 MRI examinations performed from 2008 \nto 2013, 338 (19%) were reported of limited diagnostic value due to BPE; 84 \nincluding DWI and a minimum 1-year follow-up were considered. Four classes \nwere defined according to their BPE patterns: 40% (34/84) of women had \nminimal BPE, 38% (32/84) mild BPE, 14% (12/84) moderate and 7% (6/84) \nmarked. MRI alone and MRI+DWI were compared regarding diagnostic \nperformance, BI-RADS, biopsy rate, histopathology/follow-up. Agreement with \nhistopathology was assessed by the estimate of the Cohen's K statistic. \nResults: A higher number of BI-RADS 1-2 was found in patients with minimal \nBPE than in those with mild to marked (p=0.001). Out of 31 suspicious \nenhancements, 47% were confirmed as malignant (7 IDC, 3 ILC, 3 tubular and \n1 papillary carcinoma, 2 DCIS, 2 sarcoma). There was no significant difference \nin biopsy rate among various BPE patterns . The sensitivity, specificity, positive \nand negative predictive values were, respectively, 89%, 87%, 53% and 98% \nfor MRI alone, 93%, 84%, 70% and 97% for MRI+DWI. Agreement with \nhistopathology was improved by DWI (k=0.71 vs. k=0.59). \nConclusion: Compared to conventional breast-MRI, DWI significantly \nimproves the positive predictive value in case of BPE. However, since DWI \ndoes not increase the negative predictive value, all BPEs with negative DWI \nshould undergo a short-term follow-up.  \n \n \n \n \nS286  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0697 11:24  \nCan diffusion-weighted magnetic resonance imaging differentiate \nbetween metastatic and non-metastatic axillary lymph nodes in patients \nwith breast cancer?  \nF. Fornasa, S. Nencioni, A. Dibenedetto; S. Bonifacio/IT \n(francescafornasa@libero.it)  \nPurpose: To assess the accuracy of Diffusion-weighted Magnetic Resonance \nImaging (DWI) in differentiating between metastatic and normal axillary lymph \nnodes in patients with breast cancer. \nMethods and Materials:  250 patients with histolog ically proven breast cancer \nunderwent breast MRI (1.5 T; 4-channel coil) within two weeks prior to axillary \ndissection. The axilla ipsilateral to the tu mor was included into the field of view; \nif a lymph node was detected with morphological features (short axis = 7 mm \nor more) deeming malignancy likely, DWI (b values: 0 and 800 mm/sec2) was \nperformed and a lymph nodal Apparent Diffusion Coefficient (ADC) was \nobtained through the average of three different measurements. Patients were \nincluded if histology after axillary dissection demonstrated, in the lymph node \nevaluated with DWI, either a metastasis larger than 5 mm or the absence of \nmetastases. 43 patients (age range: 38-79 years) meeting the above \nmentioned criteria were included in this study. The Student's t-test was used. \nResults: At histology 19 patients had one lymph node with a metastasis larger \nthan 5 mm and 24 had not. The ADC values of the metastatic lymph nodes \n(mean: 0.878 mm2/sec; range: 0.30-1.20) were significantly lower (p < 0.001) \nthan those of the metastasis-free lymph nodes (mean: 1.494; range: 0.60-\n2.50). With a cutoff value of 1.09 mm2/sec (two false positive; one false \nnegative result) DWI proved 94.7% sensitive, 91.7% specific and 93.0% \naccurate in the diagnosis of lymph node metastasis. \nConclusion: DWI is able in differentiating between metastatic and metastasis-\nfree axillary lymph nodes in breast cancer.  \nB-0698 11:33  \nDiffusion-weighted imaging of breast lesions: a systematic review and \nmeta-analysis  \nM.D. Dorrius, H. Dijkstra, M. Oudkerk, P.E. Sijens; Groningen/NL \n(m.d.dorrius@umcg.nl)  \nPurpose: To evaluate the effect of the choice of b-values and prior use of \ncontrast medium on ADCs of breast lesions derived from DWI, and on the \ndiscrimination between benign and malignant lesions. \nMethods and Materials:  A literature search was performed of relevant DWI \nstudies. Meta-analysis focussed on ADC-values rather than true diffusion, not \navailable in the fast majority of studies acquired with just a few b-values. The \naccuracy of DWI to characterise lesions by using b-value \u0002600s/mm\n2 and b-\nvalue > 600s/mm2 was presented as pooled sensitivity and specificity. The \nADC was calculated for both groups. This choice of cut-off was motivated by \nearlier findings in a breast DWI study of healthy volunteers, demonstrating that \nat b-values smaller than 600s/mm\n2 the DW signal is monoexponential. Also, \nlesions were pooled as pre- or post-contrast DWI. \nResults: Of 317 articles, 26 met the inclusion criteria. Mean ADC was \nsignificantly higher (p < 0.001) for the group of b-values \u0002600s/mm2 compared \nto > 600s/mm2. The sensitivity (91% and 89%, respectively) and specificity \n(75% and 84%) were similar (p > 0.05) in both groups. Contrast media had no \nsignificant effects on the ADCs (p>  0.08). The contrast between benign and \nmalignant lesions was optimal (58.4%) for the combination of b=0 and \n1000s/mm2. \nConclusion: The wide variety of b-value combinations applied in different \nstudies significantly affects the ADC of breast lesions and therefore confounds \nquantitative DWI. If only a couple of b-values are used, those of b=0 and \n1000s/mm\n2 are recommended for the best improvement of contrast between \nbenign and malignant lesions.  \nB-0699 11:42  \nQuantitative diffusion-weighted imaging at 3 T for the detection of breast \ncancer: influence of ROI-selection on the diagnostic performance  \nH. Bickel, K. Pinker-Domenig, P.A.T. Baltzer, T.H. Helbich; Vienna/AT \n(hubert.bickel@meduniwien.ac.at)  \nPurpose: Diffusion-weighted imaging (DWI), using apparent diffusion \ncoefficient (ADC), is a powerful tool for the diagnosis of breast cancer. \nHowever, no consensus on which is the best way to measure ADC exists. \nThus, the aim of this study was to compare different approaches on region of \ninterest (ROI) selection and their influence on diagnostic performance. \nMethods and Materials:  3 T MRI-scans of 102 patients with breast lesions \n(BI-RADS 3-5) were evaluated by a blinded reader. T2-w, contrast-enhanced \nT1-w and DWI sequences were used for lesion identification. Manually drawn \nROIs were placed on the ADC maps: a two-dimensional (2D) ROI inside the \nlesion part with the lowest ADC values and a three-dimensional (3D) ROI \ncovering the whole lesion. Minimum, maximum and mean ADC was measured. \nAll lesions were histopathologically ve rified. Means were compared between \nbenign and malignant lesions and between the different measurement \napproaches. ROC-curves were drawn to compare diagnostic performance. \nResults: Mean ADC was significantly different between benign (n=20) and \nmalignant (n=82) lesions for both 3D and 2D ROIs in all measurements \n(p <.001). ROC curves showed comparable results (AUC between.97 and.993) \nfor all approaches except maximum ADC of the whole lesion (AUC.794). \nMaximum ADC in the region of the lowest ADC was best for differentiation of \nbenign and malignant lesions. \nConclusion: All measurement approaches except maximum ADC of the whole \nlesion performed excellently and are feasible for the differentiation of benign \nand malignant breast lesions.  \nAuthor Disclosures: \nT.H. Helbich: Consultant; Siemens AG, Hologic Inc. Grant Recipient; Siemens \nAG. \nB-0700 11:51  \nQuantitative diffusion-weighted imaging (DWI) of additional lesions at \npre-operative breast MRI: a practical tool to prevent overtreatment?  \nM. Panzeri, C. Losio, R. Cavallin, E. Venturini, G. Cristel, S. Tacchini, \nM. Rodighiero, F. De Cobelli, A. Del Maschio; Milan/IT \n(panzeri.marta@gmail.com)  \nPurpose: To assess the impact of DWI on the surgical management of \nadditional lesions depicted at pre-operative MRI. \nMethods and Materials:  Out of 150 patients undergoing breast MRI for \nlocoregional staging between 2008 and 2013, 50 directly underwent surgery. \nMRI examinations were classified based up on additional lesions features and \nlocation: no impact if no additional lesion was identified or if the additional \nlesion (s) didn't change surgery; good impact if additional malignant lesions \nwere correctly identified (extended surgery); bad impact when an additional \nsuspicious lesion was not confirmed at fi nal histopatology (incorrect extended \nsurgery). Additional lesions were classi fied according to their morpho-kinetic \nfeatures and DWI signal (BI-RADS). \nResults: Of the 46 additional findings  seen on MRI, 35 required a wider \nsurgery. In 29% (10/35) of these, malignancy was not confirmed at final \nhistopathology. The Apparent Diffusion Coefficient (ADC) measured with DWI \nwould have correctly diagnosed all the 25  additional malignancies, modifying \nthe multifocal/multicentric status. Dynamic-MRI alone had no impact on 31 \npatients (64%), good impact on 11 patients (22%) and bad impact on 8 \npatients (14%). The addition of ADC to dynamic-MRI would have lead to no \nimpact on 35 patients (70%), good impact on 14 patients (28%) and bad \nimpact on 1 patient (2%). \nConclusion: Quantitative DWI improves the performance of pre-operative \nBreast MRI in the characterisation of additional lesions, allowing a more \nconfident definition of multicentric and mu ltifocal disease. This feature can be \nhelpful in reducing the number of pre-surgical biopsies and unnecessary \nextended surgery induced by Breast-MRI.  \n \nS287  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n10:30 - 12:00 Room G/H  \nGenitourinary  \nSS 1307  \nRenal tumours: diagnosis and intervention  \nModerators:  \nT.M. Cunha; Lisbon/PT  \nR.S. Lanzman; Düsseldorf/DE  \nB-0701 10:30  \nMultiparametric magnetic resonance imaging to differentiate common \nsubtypes of renal tumours  \nE. Tricaud, F. Cornelis, N. Grenier; Bordeaux/FR (elise.tricaud@gmail.com)  \nPurpose: To retrospectively evaluate the ability of magnetic resonance (MR) \nimaging to differentiate common types of renal tumours using parameters \nderived from routinely performed sequences. \nMethods and Materials:  MR images from 100 pathologically proven solid \nrenal tumours without macroscopic fat (57 clear-cell, 16 papillary, 7 \nchromophobe renal cell carcinomas (RCCs), 16 oncocytomas and 4 minimal \nfat angiomyolipomas (AMLs)) treated at a single institution between 2009 and \n2012 were evaluated. Two radiologists blinded to pathology results reviewed \nindependently double-echo chemical shift, T1- and T2-weighted images, and \nADC maps. Signal intensity index (SII), tumour-to-spleen SI ratio (TSR), ADC \nratio, wash-in (WiI) and wash-out indices (WoI) between different phases \n(arterial, parenchymal or late) were calculated. Results were analysed with \nWilcoxon sum rank, Fisher's exact tests and receiver operating characteristics, \nand diagnostic accuracy estimated. A Bonferroni correction was applied to \ncorrect for multiple testing. \nResults: There were significant differences between papillary RCCs and other \nrenal tumours for arterial WiI (P < 0.001, area under the curve (AUC)=0.92), \ninitial WoI (P=0.006, AUC=0.72) and ADC ratio (P < 0.001, AUC=0.85); \nbetween chromophobe RCCs and oncocytomas for TSR (P=0.02, AUC=0.8), \nparenchymal WiI (P=0.03, AUC=0.74), late WiI (P=0.02, AUC=0.77), initial WoI \n(P=0.03, AUC=0.8) and late WoI (P=0.04, AUC=0.79); and between clear-cell \nRCCs and oncocytomas for SII (P=0.01, AUC=0.71) and parenchymal WiI \n(P=0.01, AUC=0.69). Multiparametric analysis distinguished papillary RCCs \nfrom other renal tumours (sensitivity: 37.5%, specificity: 100%) and \noncocytomas from chromophobe and clear-cell RCCs (sensitivity, specificity: \n25%, 100% and 18.7%, 94.2%, respectively). \nConclusion: Multiparametric MR imaging seems useful before deciding the \nmost appropriate therapeutic management.  \nB-0702 10:39  \nContribution of ADC value to histopathological differentiation of renal \ntumors  \nJ. Lisý, M. Chocholatý, K. Havlová, L. Mik \u0001ík, H. B ezinová, M. Schmidt; \nPrague/CZ (jilisy@yahoo.com)  \nPurpose: To evaluate ability of the apparent diffusion coefficient (ADC) value \nin differentiation of histological types of renal tumors. \nMethods and Materials:  MRI examination including DWI with b coefficients 0, \n400, 1000 was performed in 82 patients with renal tumor before surgery. Mean \nADC values in tumor lesion were correlated with histopathological finding after \nsurgery. Histopathological typing proved 61 cases of clear cell carcinoma \n(ccRCC), 8 papillary RCCs, 2 chromophobe RCCs, 5 oncocytomas, 3 \nangiomyolipomas, 2 urethelial carcinomas and 1 papillary adenoma. Results \nwere statistically correlated by t-test. \nResults: Mean ADC value in different renal tumors was: ccRCC 1.51 x 10 \n-\n3 mm2/s, papillary RCC 0.855 x 10 -3 mm2/s, chromophobe RCC 0.82 x 10 -\n3 mm2/s, oncocytoma 1,351 x 10 -3 mm2/s, angiomyolipoma 1.72 x 10 -3 mm2/s, \nurothelial carcinoma 1.1 x 10 -3 mm2/s, papillary adenoma 1,445 x 10 -3 mm2/s. \nCorrelation between different histopathological types of renal tumors and mean \nADC value was found (p < 0.05). Correlation between histological grading and \nmean ADC value in ccRCC was statistically significant (p < 0.03). \nConclusion: Mean ADC value is helpful in histopathological differentiation of \nrenal tumors.  \nB-0703 10:48  \nSmall clear cell renal carcinoma: correlation between CT findings and \nhistologic grade  \nS. Choi, D. Sung, S. Oh, N. Han, B. Park, M. Kim, S. Cho; Seoul/KR \n(sudengury@naver.com)  \nPurpose: To evaluate the correlation between CT findings and histologic \ngrade (Fuhrman grade) of small clear cell renal cell carcinoma (CCRCC), \nwhich is significant prognostic factor. \nMethods and Materials: We retrospectively reviewed 88 pathologically proven \nsmall ( \u00024 cm, pT1a), CCRCCs in 87 patients. Two radiologists independently \nanalysed tumour shape, margin, encapsulation, enhancement pattern and \nrelative enhancement to renal cortex on CT scan. Enhancement patterns were \ndefined according to the percentage of diffuse enhancement (pattern 1, \nhomogeneous \u000390%; pattern 2, relative homogeneous 75-90%; pattern 3, \nheterogeneous < 75%). Histologic grade was divided into two groups: low \n(Fuhrman grade 1 or 2) and high (3 or 4). \nResults: Sixty low-grade (68.2%) and twenty-eight high-grade (31.8%) small \nCCRCCs were assessed. We found a statistically significant correlation \nbetween enhancement pattern and the Furhman grade with good interobserver \nagreement. The lower grade RCCs tend to be more homogeneous \nenhancement (p < 0.001 and p=0.003, reader 1 and reader 2, 5=0.688). \nHyperattenuating tumour than adjacent normal renal cortex was exclusively \nfounded in the low-grade group (p=0.024 for both readers, 5=0.635). The \nprevalence of ovoid shape, indistinct ma rgin and absence of encapsulation in \nlow-grade RCCs were significantly greater than in high-grade group for reader \n1, but no significant difference was found for reader 2 (p=0.003, p=0.028, \np < 0.001, respectively for reader 1; p=0.895, p=0.680, p=0.674, respectively, \nfor reader 2). \nConclusion: Homogeneous tumoural enhancement and hyperattenuating \ntumour at contrast-enhanced CT were related to low-Fuhrman grade of small \nCCRCCs. These data may have implications for active surveillance of small \nCCRCCs.  \nB-0704 10:57  \nThe use of contrast-enhanced ultrasonography (CEUS) in classification \nof renal cystic lesions  \nJ. Foukal, M. Mechl; Brno/CZ (jfoukal@fnbrno.cz)  \nPurpose: To evaluate the classification of cystic renal lesions with CEUS and \nto compare the results with CT. \nMethods and Materials: The set consists of 112 lesion in 94 patients who had \nCT and CEUS with renal lesion that was cystic on at least one of the methods. \nLesions were evaluated by Bosniak classifi cation and either histologically \nverified or followed-up for at least 2 years. We assessed correlation between \nmethods, sensitivity and specificity for malignancy detection from the viewpoint \nof Bosniak classification, sensitivity for det ection of individual features used in \nBosniak classification and odds ratios of malignancy for this features. Data \nwere processed by ROC analysis. Stati stical significance was assessed by \nFisher's exact test. \nResults: Overall agreement between methods was 61%, with division to non-\nsurgical (category I, II, IIF) and surgical (III, IV, solid) groups agreement was \n90%. With this division sensitivity, s pecificity, PPV and NPV was 92.3%, \n90.9%, 57.1%, 98.9% for CEUS and 69.2%, 94.9%, 64.3%, 95.9% for CT. \nCEUS was more sensitive than CT in detecting septa (53% vs. 25% of lesions, \np < 0.001) and in detecting enhancement of septa (22% vs. 10% of lesions, \np < 0.001). Solid component enhancement was not significantly different, but \non CEUS this was more predictive factor for malignancy detection (increased \nlikelihood of malignancy 384 times on CEUS, 78 times on CT, p < 0.001). \nConclusion: Results of CEUS correlate with CT. Sensitivity of CEUS for the \ndetection of malignancy was higher than that of CT, specificity was slightly \nlower.  \nB-0705 11:06  \nThe accuracy and interobserver variability of multidetector computer \ntomography (MDCT) for T staging of renal cell carcinoma  \nA. Lebovici\n1, M. Buruian2, D.S. Feier1, A. Tamas-Szora1, M.D. Suciu1, \nS.A. Sfrangeu1; 1Cluj-Napoca/RO, 2Targu-Mures/RO \n(andrei1079@yahoo.com)  \nPurpose: To determine the accuracy and interobserver variability of \nmultidetector computer tomography (MDCT) for T staging of patients with renal \ncell carcinoma. \nMethods and Materials:  Two young readers, with three and six years of \nexperience in genitourinary imaging, independently and in consensus reviewed \nthe imaging and histology data of 113 patients (84 males, mean age 57.4 ±12 \nyears) with RCC (91-clear-cell, 15-chromophobe, 4-papillary, 2-collector duct, \n1-translocation). Patients underwent multiphase contrast enhanced 64-MDCT \nand partial or radical nephrectomy. Pathological analysis revealed 54 (47.8%) \nT1 lesions (25-T1a, 29-T1b), 10 (8.8%) T2 lesions (6-2a, 4-2b), 45 (39.9%) T3 \nlesions (34-3a, 11-T3b) and 4 (3.5%) T4 lesions. The accuracy of MDCT in T \nstaging of RCC was assessed using receiver operating curve (ROC) analysis. \nInterobserver variability was assessed using inter-rater agreement statistics \n(Kappa). \nResults: In consensus, MDCT performed best in predicting RCC stage T1 \n(AUROC=0.87, Se=92.6%, Sp=81.4%) and stage T4 (AUROC=0.87, Se=75%, \nSp=100%). The AUROC for stage T2 was 0.71 (Se=50%, Sp=93.2%) and for \nstage T3 was 0.78 (Se=66.7%, Sp=89.7%). Independently, the more \nexperienced reader performed better in T staging of RCC, in good agreement \nS288  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nwith the histology results (kappa=0.78), correctly classifying 50 patients with T1 \n(92%), 5 patients with T2 (50%), 30 patients with T3 (66%) and 3 patients with \nT4 (75%). The interobserver agreement was fairly good (kappa=0.61). \nConclusion: MDCT performs best in predicting early (stage T1) and advanced \nRCC (stage T4), with fairly good interobserver variability.  \nB-0706 11:15  \nNovel anatomic kidney segmentation in nephron sparing surgery: a \ncomprehensive CT-scan based reporting  \nP. Lodise, V. Panebianco, A. Cannavale, F. Barchetti, V. Forte, C. Catalano; \nRome/IT (pietro.lodise@gmail.com)  \nPurpose: Introduce a novel a segmental anatomy of the kidney with a \nstandardised radiological reporting method to describe renal masses ( < 7 cm) \nlocation and pathological features. \nMethods and Materials:  63 patients underwent multiphase MDCT scan with \n1 mm acquisitions. We divided the kidney into 3 zones and 12 segments. 2 \nradiologists blindly read all cases according to a standardised report method: \ntumour size, location in kidney's segments, exophityc growth, collecting \nsystem's relationship and tumour's feeding arteries (FA). Intra and inter-\nobserver reliability was assessed with k-statistic test. \nResults: 63 tumours were diagnosed. 10 (15.8%) were mono-segmental, 23 \n(36.5%) involved 2 segments, 18 (28.5%) involved 3 segments, and 12 \ntumours (19%) involved 4 segments. Mean exophytic percentage of the lesions \nwas 24.9%: 8.6 % of the tumours were > 2/3 exophytic, in 40 % of the tumours \nthe exophytic growth pattern was comprised between 1/3 and 2/3, 36.1% were \n< 1/3 exophytic and 15.2 % were completely endophytic. Dislocation and \ninfiltration of the collecting system was observed in 21 (28.5%) and 16 (25.4%) \ntumours, respectively. In the remaining 26 tumours, mean distance from the \ncollecting system was 7.7 mm. In 39 tumours, one FA was detected; in 15 \ntumours, two FAs were detected and in 9 tumours 3 or 4 FAs were detected. \nIntra and inter-observer reliability resulted as k=0.95 and 0.91, respectively. \nMean reporting time was 16±4 mins. \nConclusion: Kidney segmentation and standardised radiological report are an \nexhaustive manner to describe small renal masses location and provide \ninformation for clinical practice.  \nB-0707 11:24  \nEarly antiangiogenic effects of multikinase inhibitors in patients with \nmetastatic renal cell cancer using dynamic contrast enhanced CT: initial \nresults of a pilot study  \nA. Sterzik, M. Staehler, J. Casuscelli, M. Karpitschka, F. Schwarz, M.F. Reiser, \nA. Graser; Munich/DE (alexander.sterzik@med.uni-muenchen.de)  \nPurpose: To correlate early changes of tumor perfusion assessed by DCE-CT \nin mRCC patients under MKI with available preliminary data of clinical \nresponse. \nMethods and Materials:  40 patients (29 males, 11 females, 68 ±7 years) with \nmRCC underwent perfusion CT imaging of representative metastatic lesions \non a dual-source CT scanner (10 cm z-axis coverage, acquisition time 43 sec, \n100 kVp (abdomen), 80 kVp (chest), 100 mAs). Two subsequent DCE-scans \nwere performed before and 7 days after start of treatment with Sunitib (n=30) \nor Pazopanib (n=10). Blood flow (BF), blood volume (BV) and permeability-\nsurface area product (PS) were calculated for the entire tumor volume. Results \nwere correlated to RECIST-based response and progression-free interval \n(PFI). \nResults: Comparing baseline and follow-up scan, perfusion CT showed a \nprofound reduction of mean BF, BV and PS 7 days after therapy initiation \n(range -44% to -31%; all p-values < 0.001). Responders (n=15) - defined by \ntheir best overall response according to RECIST - showed a significantly \ngreater reduction of mean BF and BV-values on day 7 than Non-Responders \n(= patients with stable/progressive disease, n=25): -53% ±26% vs. -32% ±28% \nfor BF and -51% ±20% vs. -33% ±25% for BV, all p-values < 0.05. Mean BF-\nreduction in patients with a PFI > 7 months (n=24) was more pronounced than \nin patients with a PFI < 7 months (-57% ±29% vs. -32% ±23%; p=0.029). PS-\nperfusion indices were not found predictive for therapy response. \nConclusion: Early changes in DCE-parameters of tumor perfusion in patients \nwith mRCC under MKI might yield the potential to predict biologic response to \nantiangiogenic drugs.  \nAuthor Disclosures: \nA. Sterzik: Grant Recipient; Bayer Healthcare. M. Staehler: Consultant; \nNovartis, Pfizer. Speaker; Novartis, Pfizer. A. Graser: Consultant; Siemens \nHealthcare, Bayer Healthcare. Speaker; Bayer Healthcare, Siemens \nHealthcare. \nB-0708 11:33  \nBeyond RECIST criteria: the role of MR perfusion in evaluating response \nto anti-angiogenic therapy in patients with metastatic renal cancer  \nM.G. Bernieri, F. Barchetti, V. Forte, E.L. Indino, C. Catalano, V. Panebianco; \nRome/IT (mariagiulia.bernieri@gmail.com)  \nPurpose: To determine the role of MRI perfusion technique for evaluating \nresponse to anti-angiogenic therapy in patients with metastatic renal cell \ncarcinoma (RCC) using as criteria the dimensional changes and the \nvascularisation degree. \nMethods and Materials:  46 patients (108 lesions) with primitive and/or \nmetastatic RCC were evaluated with MRI before and during anti-angiogenic \ntherapy (at 0, 4, 8 weeks); we assessed the lesion changes of dimension \naccording to RECIST guidelines and vascularisation degree through perfusion \nvolume (VP) evaluation; to obtain this parameter, we used a T1-weighted GRE \nsequence acquired after intravenous administration of contrast medium and an \nediting software (Functool 7.4). \nResults: After 4 weeks, we observed a response to therapy (complete or \npartial: CR/PR) in 67.7% of lesions considering the size criteria and 77.6% \naccording to VP; stable disease (SD) in 6.5% considering RECIST and 3% \naccording to VP; progression of disease in 25.8% according to RECIST and in \n19.4% considering VP. After 8 weeks, we reached a CR/PR in 74% of the \nlesions taking into account RECIST and in 80% considering VP, SD in 6% \naccording to RECIST and in 0% taking into account VP, PD in 20% of the \nlesion considering both methods of analysis (RECIST and VP). \nConclusion: Functional MRI is a valid method for evaluating neoangiogenesis \nin primary and/or metastatic RCC; considering VP rather than dimensional \nchanges allows to assess early anti-angiogenic therapy effectiveness to \ndetermine a proper use.  \nB-0709 11:42  \nRadiofrequency ablation of sporadic cystic renal masses: mid-term \noutcomes  \nH. Kim, M. Cha, B. Park, J. Park, S. Park, C. Kim; Seoul/KR \n(haejin0324.kim@samsung.com)  \nPurpose: To retrospectively investigate the mid-term outcomes of \nradiofrequency ablation (RFA) for sporadic Bosniak III or IV masses. \nMethods and Materials:  Between May 2003 and May 2013, 27 patients \n(mean, 55 years; range, 22 - 77 years) with 27 sporadic cystic renal masses \n(mean, 2.8 ± 0.2 cm; range, 1.1 - 4.8 cm) underwent percutaneous RFA and \nfollow-up CT or MRI was performed for 6 months or longer (mean, 23.4 ± 3.5 \nmonths; range, 6 - 65 months). Renal masses consisted of 18 Bosniak III and 9 \nBosniak IV lesions. The mean ablation duration, number of session, technical \nsuccess rate, primary and second effectiveness rates, cancer-specific and \noverall survival rates, complications, and estimated glomerular filtration rate \n(eGFR) were analysed. The Kaplan-Meier survival curve and Wilcoxon Signed-\nrank test were used for the statistical analysis. \nResults: The mean ablation duration and number of session were \n20.5 ± 18.7 min (range, 5 - 78 min) and 1.1 ± 0.3 (range, 1 - 2), respectively. \nThe technical success rate was 100% (27/27). The primary and secondary \neffectiveness rates were 88.9% (24/27) and 100% (3/3), respectively. The 2-\nyear cancer-specific and overall survival rates were 100% and 95.5%, \nrespectively. The major and minor complication rates were 3.7% (1/27) and \n25.9% (7/27), respectively. The median eGFR had decreased slightly 1 - 6 \nmonths after the RFA (pre-RFA, 80.5 mL/min/1.73 m\n2; post-RFA, \n74.8 mL/min/1.73 m2; p < 0.001). \nConclusion: RFA has potential to effectively treat sporadic Bosniak III or IV \nmasses in poor surgical candidates.  \nB-0710 11:51  \nModified renal score: quantitative criteria predicting the complexity of \nradiofrequency ablation of renal tumours  \nR. Betari, A. Mejean, C. Elie, M.-O. Timsit, S. Richard, V. Delmas, O. Helenon, \nJ.-M. Correas; Paris/FR  \nPurpose: To develop and test a predictive score for complications (including \ntherapeutic failure) of radiofrequency ablation (RFA) of renal tumours. \nMethods and Materials:  442 consecutive RFA procedures were \nretrospectively evaluated between 2005 and 2012. We collected and analysed \neach of the following data on imaging regarding the tumour to determine their \nclinical relevance separately and as a score: depth, diameter, size of the \nendophytic portion, distance between the tumour and the closest critical \nanatomical structure, distance between the tumour and a perpendicular line to \nthe renal sinus, distance between the tumour and the digestive tract or the \ndiaphragm, tumour enhancement. We defined two groups using the Clavien-\nDindo scoring system (CD) and the therapeutic outcome of the procedure \n(CD< 2 and success vs. CD \u00032 or failure). Data were analysed using the \nStudent t test and Wilcoxon test. \nS289  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nResults: Five criteria were useful to predict the complexity of a procedure. \nDepth (p=6.55.10e-5), diameter (p=2.79.10e-8), endophytic extension \n(p=6.01.10e-9), distance to the closest critical anatomical structure \n(p=1.21.10e-9), distance to the digestive tract (p=0.029). Thresholds were \nfound for the first three criteria (respectively 85, 26, 20 mm). There was no \nstatistically significant difference between the two groups for the other criteria. \nConclusion: A new predictive score using relevant criteria can be proposed to \nassess a renal tumour before a RFA. Complications or therapeutic failure is \nless likely to happen after a procedure if the tumour is less than 26 mm, \nsuperficial, mainly exophytic, distant to  the digestive tract, located far from a \ncritical organ.  \n10:30 - 12:00 Room I/K  \nNeuro  \nSS 1311  \nEndovascular treatment  \nModerators:  \nA. Dörfler; Erlangen/DE  \nI.Q. Grunwald; Oxford/UK  \nB-0711 10:30  \nThrombus-length pedicts outcome in patients with cerebral artery \nocclusion treated with intravenous fibrinolysis  \nC. Ovesen, K. Hansson-Lundblad, I. Havsteen, C.R. Trampedach, \nC. Musaeus, H. Christensen, A. Christensen; Copenhagen/DK \n(hchr0039@regionh.dk)  \nPurpose: The length of a cerebral artery occlusion has been suggested to \naffect the efficacy of intravenous fibrinolysis in facilitating reperfusion. We \ninvestigated the association between thrombus-length and short- and long-\nterm outcome. \nMethods and Materials:  We included patients admitted within 4.5 hours after \nonset of stroke and a computed tomography angiography (CTA) demonstrated \nmiddle cerebral artery occlusion. All patients had intravenous tissue \nplasminogen activator as only reperfusion therapy. Thrombus-length was \nmeasured on CTA. Short-term outcome was measured as difference between \nNational Institute of Health Stroke Scale on admission and day-2 ( ,NIHSS). \nLong-term outcome was measured as 90-days modified Rankin Scale (mRS). \nResults: We included 70 patients. Mean (SD) thrombus-length was 22.0 mm \n(10.0 mm). The median (IQR) NIHSS on admission was 14 (9-18) and 9 (3.5-\n16) on day 2; 90-days median (IQR) mRS was 3 (1-5). There was a good \ncorrelation between admission NIHSS and thrombus-length (r\ns = 0.312; p = \n0.009) as well as 90-day mRS and thrombus-length (r s = 0.262; p = 0.034). No \ncorrelation was observed between ,NIHSS and thrombus-length (r s= -0.139; p \n= 0.255). Increasing thrombus-length was a univariate predictor of good (mRS \n0-3) and poor (mRS 5-6) outcome (OR 0.94 CI: 0.90-0.99 and OR 1.17 CI: \n1.01-1.14 per mm increase, respectively). When adjusting for NIHSS and age, \nthe effect of thrombus-length on good outcome was removed however the \neffect on poor outcome remained (OR 1.09 CI: 1.01-1.16 pr. mm) \nConclusion: Thrombus-length covariates with stroke severity and predicts \npoor outcome. Thrombus-length is not associated with early remission after \nfibrinolysis.  \nB-0712 10:39  \nMR angiographic and clinical long-term follow-up after intracranial \nmechanical thrombectomy using solitaire FR device  \nF. Eugene1, H. Raoult1, J. Gentric2, G. Mineur1, B. Carsin1, T. Ronziere1, \nA. Stamm1, J. Ferre1, J. Gauvrit1; 1Rennes/FR, 2Brest/FR \n(dadanepitbull@gmail.com)  \nPurpose: Little is known about consequences of arterial wall damages \npossibly due to mechanical endovascular thrombectomy (MET). Our aim was \nto perform angiographic and clinical long-term follow-up (FU) of patients \ntreated with MET using Solitaire FR. \nMethods and Materials:  Forty-five stroke patients treated during August 2010 \nto February 2012 were prospectively evaluated. Angiographic imaging was \nperformed on a 3 T MRI and included intracranial arteries TOF-MR \nangiography (MRA) and supra-aortic arteries gadolinium-enhanced MRA. \nImages were assessed to detect arterial anomalies (stenosis, occlusions, and \ndilatation) in comparison post-MET final run.Clinical evaluation was performed \nwith the modified Rankin Scale score (mRS), compared with 3-month mRS, \nand the quality of life SF-36 scale. \nResults: Thirty-four patients were assessed at the mean term of 449 days \n(median 451; range 196-677), 4 were lost to follow-up and 7 died. MRA \nshowed 5 delayed intracranial arterial anomalies in 4 patients, 4 stenosis and 1 \ndilatation, 4 pre-existing intracranial arterial stenosis and 1 pre-existing cervical \narterial stenosis. These all patients remained asymptomatic during FU period. \nA significant clinical improvement was observed between 3 months and long-\nterm FU (p L0.0001), with a good outcome (mRS \u0002 2) achieved from 54.5% to \n61% of patients. Health-related quality of life was better than that of unselected \npatients with stroke. \nConclusion: Long-term FU of patients treated with Solitaire shows \nasymptomatic arterial anomalies and fu rther clinical improvement, suggesting \nthat MET entails a systematic long FU including MRA.  \nB-0713 10:48  \nSafety and efficacy of a new device for the treatment of wide neck \nbifurcation aneurysms: preliminary experience  \nM. Aguilar-Pérez, W. Kurre, S. Fischer, H. Bäzner, H. Henkes; \nStuttgart/DE (martaaguilarperez@yahoo.es)  \nPurpose: Wide neck bifurcation aneurysms (WNBA) are considered to belong \nto the subgroup of aneurysms with increased difficulty and risks. Balloon- and \nstent-remodelling are known techniques for their treatment. pCONus is a self-\nexpanding, completely retrievable, electrolytically detachable device with a \nproximal shaft, 4 distal petals and a nylon cross in the distal end of the shaft. \nThe device is made to bridge the orifice of WNBA in order to allow better \ncontrol of the coil occlusion. It combines elements of \"waffle cone\" stent \ndeployment and the no longer available TriSpan Device. Our purpose was to \nevaluate the safety and efficacy of this device for the treatment of WNBA. \nMethods and Materials:  25 consecutive patients underwent endovascular \ntreatment of WNBA using pCONus between February 2012 and May 2013. \nTarget vessels included the anterior circulation in 19 (76%) and the posterior \ncirculation in 6 (24%). 8 patients were treated in the setting of acute \nsubarachnoid haemorrhage (32%). \nResults: Neither technical failure nor rupture was encountered. Acute thrombi \nformation was observed in one patient (4%), which resolved after \nadministration a body weight adapted bolus dose of eptifibatide (Integrilin). \nAfter the initial procedure, total occlusion was achieved in 7 (28%) patients and \na neck remnant was evident in 9 (36%). Follow-up angiography was available \nin 21 patients and demonstrated complete occlusion in 13 (61.9%). Evident coil \ncompaction requiring re-treatment was observed in three patients. pCONus \nalso assisted re-coiling. \nConclusion: pCONus allows controlled coil occlusion of WNBA, both ruptured \nand unruptured. Major complications are rare.  \nAuthor Disclosures: \nM. Aguilar-Pérez: Consultant; Phenox, Covidien, ab medica. W. Kurre: \nConsultant; phenox. H. Henkes: Consultant; Phenox, Covidien, Codman, Balt. \nFounder; co-founder of phenox. \nB-0714 10:57  \nLeptomeningeal collaterals in patients with proximal middle cerebral \nartery occlusion are associated with shorter thrombus length and lower \nthrombus burden  \nC.R. Trampedach, C. Ovesen, A. Christensen, H. Christensen; \nCopenhagen/DK (ctramp111@yahoo.com)  \nPurpose: Proximal middle cerebral artery occlusions (M1 occlusion) are often \nbut not always associated with severe stroke and poor outcome. The presence \nof leptomeningeal collaterals can potentially reduce the acute ischemia and \nthus reduce stroke severity. Occlusions and collaterals can be assessed using \ncomputed tomography angiography (CTA). We assessed if leptomeningeal \ncollaterals covariate with the length of the thrombus and a thrombus burden \nscore. \nMethods and Materials:  Eighty-one patients - subsequently diagnosed with a \nM1 occlusion on CTA - were admitted within 4.5 hours after symptom onset \nbetween May 2009 and December 2011. Occlusions and leptomeningeal \ncollaterals were evaluated on CTA; collaterals were scored according to the \namount of collateral supply filling the occluded middle cerebral artery territory. \nResults: Eighty-one patients with a single M1 occlusion were included into the \nanalysis (60.5% female, 39.5% male, mean age 69 years, range 29-93 years). \nThere was no correlation between age and collateral score. Median thrombus \nlength at time of admittance was 15 mm (range 2-33), which correlated to the \ncollateral score (R= -0.376, p < 0.001). Median thrombus burden score was 4 \n(range 0-8) and a correlation with the collateral score was present (R=0.446, \np < 0.001). \nConclusion: Leptomeningeal collaterals on CT angiography relate to a shorter \nproximal middle cerebral artery occlusion and a lower thrombus burden score.  \n \nS290  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0715 11:06  \nLeptomeningeal collaterals in patients with proximal middle cerebral \nartery occlusion are associated with milder stroke and better functional \noutcome after fibrinolysis  \nC.R. Trampedach, C. Ovesen, A. Christensen, H. Christensen; \nCopenhagen/DK (ctramp111@yahoo.com)  \nPurpose: Proximal middle cerebral artery occlusions (M1 occlusion) are often \nassociated with severe stroke and poor outcome. The presence of \nleptomeningeal collaterals can potentially reduce the acute ischemia and thus \nreduce stroke severity. Occlusions and collaterals can be assessed using \ncomputed tomography angiography (CTA). Collaterals were scored according \nto the amount of collateral supply filling the occluded middle cerebral artery \nterritory. We assessed the hypothesis that leptomeningeal collaterals \ncovariates with National Institutes of Heal th Stroke Scale (NIHSS) at time of \nadmission and with 3 month outcome after acute ischaemic stroke. \nMethods and Materials:  Fifty-eight patients - subsequently diagnosed with a \nM1 occlusion on CTA - were admitted within 4.5 hours after symptom onset \nbetween May 2009 and December 2011. All patients were scored according to \nNIHSS on admittance by a stroke-neurologist. Occlusions and leptomeningeal \ncollaterals were evaluated on nonenhanced CT and CTA. All patients received \nfibrinolysis. Outcome was assessed by modified Rankin Scale (mRS) at 3 \nmonths. \nResults: Fifty-eight patients with a M1 occlusion were included (57% female, \n43% male, mean 70 years, range 42-93 years). There was no correlation \nbetween age and collateral score. Median NIHSS at time of admittance was 15 \n(range 3-25), which correlated to the collateral score (R=-0.422, p < 0.001). \nMedian mRS at 3 months was 3 (range 0-6) and a correlation with the \ncollateral score was present (R=-0.361, p=0.007). \nConclusion: Leptomeningeal collaterals on CT angiography relate to lower \nNIHSS on admission as well as less handicap after 3 months.  \nB-0716 11:15  \nPredictors of neurological deficit after endovascular treatment of cerebral \narteriovenous malformations and functional repercussion in prospective \nfollow-up  \nJ.C. Llibre, J.A. Jordan; La Habana/CU (pereraelianne@infomed.sld.cu)  \nPurpose: Endovascular therapy is a well established approach to treatment of \ncerebral arteriovenous malformations (AVMs). The objective of this study was \nto determine predictive factors of neurol ogical deficit following its application. \nMethods and Materials:  71 patients with cerebral AVMs, having undergone \n147 embolisation sessions from 2006 to 2011 were followed up prospectively \n(average of 31, 1 ± 17, 5 months). Functional neurological condition was \ndocumented by means of the modified Rankin scale. \nResults: Factors found to be predictors of neurological deficit were the partial \nobstruction of drainage veins (OR=197.6; IC=2.76-1416.0; P=0.015), a positive \nresult in the Propofol test (OR=50.2; IC=6.18 - 566.5; P=0.000), AVM diameter \nunder 3 cm (OR=21.3; IC:1.71-265.6; P=0.018), the presence of intranidal \naneurysms (OR=11.2; IC=1.09 -114.2; P = 0.042), the absence of \npostprocedure hypotension (OR=10.2; IC=1.35-77.7; P=0.003), deep venous \ndrainage (OR=7.14; IC=1.15 - 44.4; P =0.035), and devascularisation in excess \nof 40% per session (OR=3.3; IC=1.11 - 16.8; P=0.056). 56 patients (78, 9%) \ndid not experience changes in their neurological condition after the treatment \nand 13 patients (18, 3%) showed a new neurological deficit related to the \ntreatment. 95.8 % of the patients did not show significant long term incapacity. \nConclusion: Partial obstruction of drainage veins, small AVMs, intranidal \naneurysms, faulty hemodynamic control and extensive devascularisation were \nfound to be predictors of neurological defi cit. A significant number of patients \nwith neurological deficit improved in the long term.  \nB-0717 11:24  \nAngiographic reconstructions from whole-brain perfusion CT for the \ndetection of large vessel occlusion and recanalisation in acute stroke  \nJ. Zhang, D. Geng; Shanghai/CN (zhj81828@163.com)  \nPurpose: The aim of this study is to assess the value of angiographic thin-slice \nvolume perfusion CT reconstructions for the detection of intracranial large \nvessel occlusion and recanalisation after receiving intravenous thrombolytic \ntherapy in patients with stroke. \nMethods and Materials:  Twenty-five patients with acute cerebral infarction \ntreated by recombinant tissue plasminogen activator (rt-PA) were enrolled in \nthis study. They all underwent admission and 24-hour whole-brain perfusion \nCT. All images were obtained on a 256-slice multidetector CT scanner. \nDynamic 3D CT angiographic images (4-dimensional CTA) generated from \nperfusion source data were obtained in all patients. Images were assessed for \nthe presence of intracranial vessel recanalisation. The cerebral hemodynamics \nchanges in distribution of ischemic lesions were analysed on perfusion \nparameter maps. \nResults: Of 25 patients with an infarct on follow-up imaging, 19 had infarcts in \nthe middle cerebral artery territory, 5 had infarcts in the posterior cerebral \nartery territory, and 1 had an infarct in the internal carotid artery territory. \nAverage image quality scoring of baseline CT angiography (CTA) was the \nsame as one of 24-hours volume perfusion CTA (VPCTA) ( P> 0.05), 4 cases \nwith middle cerebral artery occlusion and one case with internal carotid artery \nreceived partial recanalisation on 24-hours VPCTA. \nConclusion: In acute stroke, whole-brain PCT may be an optimal method to \nevaluate patients for thrombolysis, detect intracranial arterial recanalisation of \ncerebral arteries after receiving intravenous thrombolytic therapy, and have the \npotential to decrease radiation dose and contrast media by substituting for \nintracranial CTA in stroke CT.  \nB-0718 11:33  \nTRICKS MRA in the follow-up of coiled aneurysms: preliminary \nevaluation  \nC. Sicignano, V. Piscitelli, M. Ferraioli, G. Buono, A. Generali, L. Delehaye; \nNaples/IT (carmine.sicignano@gmail.com)  \nPurpose: To evaluate the clinical utility of Time-Resolved Imaging of Contrast \nKineticS (TRICKS) in MR for the follow-up of patients that underwent \nendovascular treatments for intracranial aneurysms. \nMethods and Materials:  From June 2008 to December August 2013 156 \npatients (with 161 aneurysms endovascularly treated) underwent simultaneous \nTOF (Time Of Flight) and TRICKS MRA (Magnetic Resonance Angiography) \nas follow-up of endovascular treatment of intracranial aneurysms (mean: 8 \nmonths after treatment, range: 3 to 17 months); DSA (Digital Subtraction \nAngiography) was performed too, as gold standard (range: 1 to 9 months, \nmean: 5 months, after MRA). MRA images were analysed independently by 2 \nsenior radiologists and DSA by other two different radiologists. Findings were \nassigned to 1 of 3 categories: complete obliteration (class 1), residual neck \n(class 2) and recanalisation (class 3). \nResults: TRICKS MRA showed a significantly higher agreement with DSA \ntechnique in detecting aneurysm recanalisation compared to TOF-MRI \n(agreement of 93% vs 75%). \nConclusion: Dynamic MRA in the form of TRICKS is relatively new imaging \nmodality with great potential; if compared to DSA, as in this report, it may \nrepresent an efficient option to follow- up patients with intracranial aneurysms \ntreated by endovascular techiniques.  \nB-0719 11:42  \nIdentification of risk groups in mechanical thrombectomy using the \npRESet stent-retriever: are there risk groups for procedure-related \ncomplications?  \nT. Zoubi, R. Dziewas, J. Minnerup, W. Heindel, W. Schwindt, T. Niederstadt; \nMünster/DE (zoubitar@ukmuenster.de)  \nPurpose: Mechanical thrombectomy is an established method of \nrecanalisation in patients with acute stroke. Stent-retriever represents a new \nkind of device. Our purpose was to identify patients with higher risk of \nperiinterventional complications. \nMethods and Materials: In our database of 159 interventional treated strokes, \nwe identified 52 patients (ø66±17 yrs) with acute thrombembolic occlusion of \nMCA who underwent mechanical thrombectomy using the pRESet device \n(Phenox, Bochum, Germany). In all patients NECT, CTA and PCT were \nperformed immediately before intervention. Grade of recanalisation was \nmeasured using the TICI score. Duration of interventional procedure was \nrepresented by the time from first diagnostic angiography to revascularisation. \nResults: Successful recanalisation (TICI 2b or higher) was achieved in 46 \npatients (88.5%). 3 patients suffered from vasospams during intervention. In 4 \npatients thrombembolic complications occurred. Lower density of the occluding \nthrombus led significantly more often to periinterventional complications \n(57±5HE vs 66± 23HE, p=0.015). Thrombembolic complications occurred \nsignificantly more often, if the patients age was \u000375yr (p=0.01). Angio-to-\nrecanalisation time tended to be longer in patients with higher vascular risk \nscore but did not show significance (p=0.086). Thrombus length, number of \npasses of the device and vascular risk score had no influence on the number \nof complications. \nConclusion: Mechanical thrombectomy using the pRESet stent-retriever \ndevice is an effective method of recanalisation in patients with acute \nthrombembolic occlusion of MCA. Complications associated with \nthrombectomy occur, in our study significantly more often in patients with \nhigher age or lower density of thrombus. The dependence of thrombus density \nand complication rate may originate from thrombus composition.  \n \n \nS291  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0720 11:51  \nCan a negative orbital-colour-Doppler-US examination avoid a diagnostic \ncerebral angiography in patients with a clinical suspect of anterior-\ndraining intracranial-arterio-venous-fistulas?  \nG. Cristel, M. Venturini, S. Bianchi Marzoli, F. Simionato, G. Agostini, \nA. Del Maschio; Milan/IT  \nPurpose: Digital subtraction angiography (DSA) represents the gold standard \ntechnique to diagnose and treat IAVF. Orbital-colour-Doppler-ultrasound \n(OCDUS) has already revealed itself to be useful in detecting dilated superior \nophthalmic vein (SOV) in patients with IAVF. We investigated whether a \nnegative OCDUS could avoid an invasive diagnostic cerebral angiography in \npatients with clinical suspect of IAVF. \nMethods and Materials:  Twenty-two consecutive patients with ophthalmic \nsigns suspecting IAVF were submitted to ophthalmologic examination, OCDUS \nand DSA. Both eyes were studied with OCDUS (ATL-Philips HDI-5000/IU22, 5-\n12-MHz linear-probe), performed by the same experienced operator. IAVF \ndiagnosis with OCDUS was based on the finding of SOV with reversed, \narterialised, and low-resistance (RI < 0.5) blood flow. Sensibility, specificity, \nPPV, NPV and accuracy of OCDUS were calculated considering either number \nof patients and total eyes (total=43), using DSA as gold standard. \nResults: Considering the patients, 18/22 were positive at both OCDUS and \nDSA (DSA demonstrated 18 dural and 2 carotid-cavernous-sinus-fistulas, 2 \npatients with bilateral involvement) and 4/22 were negative at both; hence, \nsensibility, specificity, PPV, NPV, and accuracy of OCDUS were all of 100%. \nConsidering the eyes, 24/43 were positive at OCDUS and out of them a IAVF \nwas confirmed in 20/24 cases; 19/43 were negative at both OCDUS and DSA. \nNo false negatives were recorded at OCDUS. Therefore, sensibility, specificity, \nPPV, NPV, and accuracy of OCDUS, respectively, were 100, 83, 83, 100, and \n91%. \nConclusion: Our findings suggest that a negative OCDUS could avoid an \ninvasive DSA in patients with clinical suspect of IAVF.  \n10:30 - 12:00 Room L/M  \nCardiac  \nSS 1303  \nMyocarditis, storage diseases and \ndiabetes  \nModerators:  \nJ. Bremerich; Basle/CH  \nT. Miszalski-Jamka; Kraków/PL  \nB-0721 10:30  \nPost-myocarditis scars underlying ventricular tachycardia: \ncorrespondence between delayed-enhanced CMR or MDCT imaging and \nelectroanatomic mapping  \nA. Palmisano, A. Esposito, C. Colantoni, G. Maccabelli, F. De Cobelli, \nP. Della Bella, A. Del Maschio; Milan/IT (a.palmisano@live.it)  \nPurpose: The success of catheter ablation guided by electro-anatomic \nmapping (EAM) in patients with recurrent ventricular tachycardia (VT) depends \non the effective identification of myocardi al scars. Preablation endocardial EAM \nwith bipolar voltages identifies with high accuracy post-ischemic scars. The \nidentification of post-myocarditis scars at EAM is challenging. The aim of the \nstudy was to compare scars at different EAM approaches (bipolar-endocardial, \nbipolar-epicardial, unipolar-endocardial, unipolar-epicardial) with late \nenhancement at imaging. \nMethods and Materials: Nineteen patients (pts) with post-myocarditis VT were \nenrolled. 15 pts underwent CMR including post-gadolinium IR-T1w sequences; \n4 pts with ICD underwent MDCT including a delayed low-energy (80 kV) scan \nfor scars identification. Scar' site, extension and transmural distribution \n(subendocardial, mid-wall, subepicardial, transmural) were evaluated at \nimaging and compared with low voltages suggestive for scars at bipolar and \nunipolar maps with endocardial and epicardial approach. \nResults: 19/19 pts had myocardial scars at LE imaging: in 9 pts, scars \ninvolved myocardial wall from epicardium to midwall; in 10 pts, scars involved \nonly subepicardium. Segment per segment correspondence of LE scar \nlocalisation with scars at EAM demonstrated that unipolar mapping is more \neffective in the identification of imaging -revealed scars (71.1% for epicardial \nmap, 24.7% for endocardial map) to bipolar one (63.2% for epicardial map, 1% \nfor endocardial maps). \nConclusion: EAM may identify only upto 70% of post-myocarditis scar \nsubstrate underlying VT recurrence. Hence, an imaging based on \ncharacterisation of scar substrate should be always performed in these \npatients before ablation.  \nB-0722 10:39  \nDetection of myocardial oedema in acute myocarditis with diffusion-\nweighted imaging  \nA. Luna\n1, J. Broncano2, T. Martin1, J. Sanchez-Gonzalez3; 1Jaén/ES, \n2Córdoba/ES, 3Madrid/ES (j.broncano.c@htime.org)  \nPurpose: To evaluate DWI detection capability of myocardial oedema in \npatients with acute myocarditis in comparison to black-blood STIR (BB-STIR) \nand its accuracy in combination with delayed gadolinium enhancement (LGE) \nfor the diagnosis of acute myocarditis. \nMethods and Materials:  24 patients (19 men and 5 women; mean age \n37.4±15.54 years) with confirmed acute myocarditis were prospectively \nsubmitted to cardiac MRI with high field scanners (1.5 and 3 Tesla) using \nshort-axis BB-STIR, LGE and whole cardiac DWI. We performed a SS-EPI-\nDWI sequence with two b values (0 and 300 s/mm2) with cardiac and \nrespiratory triggering during the diastolic phase. Two readers with 14 and 2 \nyears of experience reading cardiac MRI, blindly analyse the studies in two \ndifferent sessions: BB-STIR+LGE and DWI+LGE. Quality assessment of DWI \nsequences was also performed (susceptibility and respiratory artefacts). \nResults: The combination of BB-STIR and LGE demonstrated a sensitivity and \nPPV of 100% for reader 1, 86% and 95.3% for reader 2, respectively. The \ncombination of DWI and LGE demonstrated a sensitivity and PPV of 95.6% \nand 100% for reader 1, 95.6% and 95.3% for reader 2. There were no \nsignificant differences in the evaluation of myocardial oedema and the \nextension of the disease between both techniques (p > 0.05). \nConclusion: DWI with high b value is able to detect myocardial oedema in \npatients with acute myocarditis in a similar manner to BB-STIR. The \ncombination of DWI and delayed enhancem ent shows similar sensitivity and \nPPV for the diagnosis of acute myocarditis compared to BB-STIR and late \nenhancement.  \nAuthor Disclosures: \nJ. Sanchez-Gonzalez: Employee; Philips Healthcare. Equipment Support \nRecipient; Philips Healthcare. \nB-0723 10:48  \nMRI findings in acute myocarditis and short-term clinical outcome  \nA. Vilaplana, J. Vivancos, M. Garcia, J. Marin, B. Perez; Sevilla/ES  \n(alejandra_vilaplana@hotmail.com)  \nPurpose: The aim of our study is to describe the most frequent and typical \nMRI findings in acute myocarditis and to evaluate if these MRI findings \ncorrelate with the severity of the disease and the short-term clinical outcome. \nMethods and Materials:  We evaluated MRI imaging findings in 32 patients \nwith a clinical diagnosis of myocard itis. We also evaluated their clinical \noutcome 6 months and one year after the acute onset of symptoms. \nResults: Delayed gadolinium enhancement was present in 69% of patients on \nthe acute phase. The lateral left ventricular wall was the most frequent \nsegment involved. Subepicardial focal enhancement was the most typical \nfinding, present in 55% of patients, whereas 25% presented with \nintramyocardial focal enhancement and 15% with lineal subepicardial \nenhancement. Only 5% of these patients showed pericardial enhancement. \n58% of patients with late enhancement showed T2 hyperintensity due to \noedema. 17% of patients presented with wall motion abnormalities. Left \nventricular telediastolic volume was slightly impaired in 2 patients, with \ncomplete recovery on cardiac ultrasound two weeks after the acute episode. \nLeft ventricular function was preserved in all patients. Five months after the \nonset of symptoms, all 6 patients who underwent a second MRI showed \npersistent enhancement. Only 1 patient had persistent T2 hyperintensity. \nConclusion: We did not find any significant relationship between the presence \nof delayed gadolinium enhancement and left ventricular function impairment \nand also we did not find any significant relationship between the presence of \ngadolinium enhancement in the acute phase and short-term clinical outcome.  \nB-0724 10:57  \nCardiac magnetic resonance evaluation of right ventricle (RV) volumetric \nand functional parameters in thalassaemia major patients: does the iron \naffect the RV?  \nF. Pitocco\n1, I. Di Giampietro1, C. Liguori2, A. Moscariello1, A. De Vivo1, \nM. Romano1, F. Sorrentino1, B. Beomonte Zobel1; 1Rome/IT, 2Naples/IT \n(F.Pitocco@unicampus.it)  \nPurpose: TM patients could present a right heart involvement characterised by \nRV failure related to chronic anaemia. It is still unknown if iron myocardial \ndeposition and iron overload can influence RV volume and function. Our aim \nwas to define the differences in volumetric and functional parameters between \npatients with and without myocardial iron overload \nMethods and Materials:  We enrolled 150 \nTM patients (mean age 37.8 ± 12.8 \nys; mean body surface area Kg/m2 1.64± 0.24) who underwent to CMR for \nfunctional LV-RV evaluation and LV iron assessment. All patients were under \niron-chelation therapy and none presented clinical or instrumental signs of \nS292  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\npulmonary hypertension or other cardiovascular comorbidity. RV volumes, \nejection fractions and masses were assessed. All parameters were indexed to \nBSA \nResults: We divided our population in patients with (T2* < 20 ms) and without \n(T2*> 20 ms) iron overload; 21% of TM patients showed myocardial iron \noverload. We observed significant differences between the two groups in: \nRVEF, stroke volume, end-systolic and end-diastolic volumes (p < 0.01), \ncharacterised by RV higher volumes and RV-EF impairment in subjects with \ncardiac siderosis. No significant differences in RV mass were observed \nConclusion: Cardiac siderosis can be associated with RV dysfunction and can \nbe considered as a contributor to heart failure in TM patients. These data must \nbe kept in mind in course of CMR for a correct clinical evaluation and \nmanagement in this setting of patients  \nB-0725 11:06  \nCardiac magnetic resonance comparison of cardiac left-right ventricular \nvolumetric and functional parameters in thalassemia major and \nthalassemia intermedia  \nA. De Vivo\n1, F. Pitocco1, C. Liguori2, I. Di Giampietro1, A. Moscariello1, \nF. Sorrentino1, B. Beomonte Zobel1; 1Rome/IT, 2Naples/IT \n(devivoeros@gmail.com)  \nPurpose: T2*CMR is considered the most useful imaging technique to non \ninvasively assess myocardial iron overolad in Thalassemia patients.Our aim \nwas to assess myocardial iron overload in TM and TI patients,the relationship \nbetween myocardial T2*values,LV-RV volumetric and functional parameters in \nthe two phenotypes of disease and to analyse differences in volumetric-\nfunctional parameters \nMethods and Materials:  207 Patients (157\nTM-50TI; mean age 37.8 ±12.8 ys; \nmean Body Surface Area Kg/m2 1.64 ±0.24)underwent CMR examination \n(Scanner 1.5 T,Avanto,Siemens-Germany). Myocardial iron load was \nevaluated by T2*measurements;Volumes and Ejection Fractions were \nanalysed using the Steady State Free Precession (SSFP) sequences. All \nparameters were indexed to body surface area.All \nTM patients were under iron-\nchelation therapy and blood transfusion support despite of TI subjects.None \npresented clinical or instrumental sign s of pulmonary hypertension or other \ncardiovascular comorbidity \nResults: TI patients showed no cardiac iron overload whereas in 21% of TM \ncardiac overload was found.In TI subjects not significant correlation was \ndetected between cardiac T2*and LV-RV volumetric-functional \nmodifications.Only in TM subjects statistically significant (p < 0.05)association \nbetween myocardial T2*and LV-RV End diastolic-systolic Volumes was found;a \nsignificant correlation between T2* values and EFLV-EFRV was noted. \nBetween TM and TI subjects a significant difference was noted in indexed \nvalues of Stroke Volumes,Systolic Volumes,Diastolic Volume of LV-RV.No \nrelationship between cardiac mass modifications and T2* was found. \nConclusion: Myocardial iron overload is linked to a deterioration of \nbiventricular function and to an enlargement of LV-RV volumes in TM patients \nwhile not significant relation with same parameters can be expected in TI \nsubjects mainly according to absence of cardiac iron load.  \nB-0726 11:15  \nInter-observer reproducibility improvement of myocardial iron T2* \ncalculation using CNR-optimised composite image  \nP. Triadyaksa, A. Handayani, T.P. Willems, M. Oudkerk, P.E. Sijens; \nGroningen/NL (p.triadyaksa@umcg.nl)  \nPurpose: Manual myocardial contouring contributes variability to the \ndetermination of cardiac iron by T2* MRI. We evaluate the calculation of \nMyocardial T2* by using CNR-optimised composite images on inter-observer \nvariability of myocardial contour determination. \nMethods and Materials: 36 short-axis slices from bright-blood T2* scans of 21 \npatients (9 hematological and 12 suspecte d of cardiomyopathy) were acquired \nat 8 TEs (2.59-18.20 ms, 2.23 ms increment). Four independent observers \ndrew free-hand contours of left ventricular epicard and endocard on one \nselected image and one CNR-optimised composite image per slice. The CNR-\noptimised composite image was made by blending three TE images with \noptimum CNR between the myocardium and its surrounding regions. The \ncalculated minimum mean myocard T2* values, determined for all segments \n(i.e. 4-6 values per slice), varied between 7.05-36.75 ms. Dice Similarity \nCoefficient (DSC) was used to assess similarity between observer's contours in \nthe two methods. \nResults: Inter-observer agreement in all images (n=216) was improved in the \ncontouring of the CNR-optimised composite image (DSC of 0.844 ±0.032 \nmedian absolute deviation) compared to the subjectively-chosen image \n(0.811±0.045), p < 0.001. In the presence of myocardial iron accumulation, \ndefined as T2* < 20 ms in at least one segment, the composite image also \nshowed significantly better contour agreement (0.842 ±0.032) compared to the \nsubjectively-chosen image (0.822 ±0.044), p < 0.001 (n=84). Furthermore, inter-\nobserver agreement of myocardial T2* improved when using the composite \nimage (r=0.956) rather than the subjectively-chosen image (r=0.915), \np < 0.001. \nConclusion: The CNR-optimised composite image improves inter-observer \nreproducibility of myocardial T2* calculation as a measure of iron deposition, \nby producing more consistent myocardial contours.  \nB-0727 11:24  \nPrevalence and clinical impact of left ventricular noncompaction (LVNC) \nin \u0002-thalassaemia patients: a cardiac magnetic resonance evaluation  \nF. Pitocco1, I. Di Giampietro1, C. Liguori2, A. Moscariello1, A. De Vivo1, \nG. Falchi1, F. Sorrentino1, B. Beomonte Zobel1; 1Rome/IT, 2Naples/IT \n(F.Pitocco@unicampus.it)  \nPurpose: LVNC is a congenital disorder, characterised by multiple and deep \ntrabeculations and a thickened ventricular myocardium with two distinct layers, \ncompacted and noncompacted. LVNC has been linked to several congenital \ndisorders while acquired cases have been described as \"isolated LVNC\". Its \nprevalence is < 0.14% in adults referred for echocardiography. Few cases of \nisolated LVNC in haematological disorders have been described. Our aim was \nto assess LVNC prevalence in 2-thalassaemia patients and to evaluate its \npotential association with cardiac siderosis \nMethods and Materials:  We evaluated 300 patients with 2-thalassaemia \npresenting for cardiac iron assessment by MRI. No patients had \nneuromuscular or congenital heart diseases. 25% patients had myocardial iron \noverload (T2* < 20 ms). Left-right ventricular volumes, masses and ejection \nfractions were indexed to the body surface area. A LVNC diagnosis was \nestablished according to the following criteria: (a) segmental LV wall thickening \nwith a thin compacted layer; (b) noncompacted vs compacted wall thickness \nratio > 2.5;(c) end-diastolic compacted layer <  4.5 mm \nResults: 34% patients fulfilled criteria for LVNC. There were no statistically \nsignificant differences between patients with and without LVNC in cardiac \nfunctional performance (ejection fraction; volumes). These data were \nconfirmed also comparing subjects with < 2 segments on LVNC vs > 2 \nsegments \nConclusion: 2-thalassaemia patients present a higher prevalence of LVNC \nthan normal population, in absence of conventional risk factors. A genetical \ncorrelation between thalassaemia mutation and ineffective myocardial \ndevelopment could be hypothesised. LVNC myocardium can be considered a \nnew feature to look for in course of cardiac MRI in thalassaemia studies  \nB-0728 11:33  \nDiagnostic value of late-enhanced multi-detector computed tomography \nacquisition in cardiac amyloidosis  \nC.I. Mihalache, J. Mayer, T. Damy, A. Luciani, H. Kobeiter, A. Rahmouni, \nJ.-F. Deux; Créteil/FR (cristian.i.mihalache@gmail.com)  \nPurpose: Evaluate diagnostic value of late-enhanced Multi-Detector \nComputed Tomography acquisition in cardiac amyloidosis. \nMethods and Materials:  Fifteen patients with amyloidosis (10 Transthyretin \nFamilial and 5 AL amyloidosis) and evidence of cardiac involvement on MRI, \nand 12 control subjects, were included in this prospective study. All subjects \nwere scanned with a 128-slice MDCT. The protocol included a prospective \ntriggering and a delayed acquisition performed 5 minutes after injection of \ncontrast medium. Myocardial volume and mean myocardial density of left \nventricle (LV) were calculated from manual contouring of LV boundaries. \nRegion-of-interests were placed in the LV cavity and in the air outside the \npatient in order to calculate blood density, myocardial signal-to-noise ratio \n(SNR\nmyoc), blood SNR (SNR blood) and contrast-to-noise ratio (CNR) between \nmyocardium and blood within LV cavity (CNRmyoc-blood). \nResults: Myocardial density and SNRmyoc were significantly (P < 0.05) higher in \npatients with cardiac amyloidosis than in control subjects (117 ± 38 vs. 81 ± 16, \nand 6.55 ± 2.8 vs. 4.88 ± 1.8). SNR blood didn't exhibit significant difference \nbetween amyloidosis versus control subjects (8.10 ± 3.1 and 7.69 ± 3.0; \nP=0.7). CNRmyoc-blood of amyloidosis patients was significantly lower comparing \nto control subjects (1.55 ± 0.9 and 2.82 ± 1.3; P < 0.05). LV volume was higher \nin amyloidosis patients (67 ± 46 mL) than in control patients (50 ± 28 mL) but \nthe difference was not statistically significant (P=0.28). \nConclusion: Late-enhanced MDCT can detect abnormal myocardial \nenhancement in patients with cardiac amyloidosis and could prove useful in \npatients requiring permanent pacing, contraindication for MRI.  \n \n \n \n \n \n \n \n \n \nS293  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0729 11:42  \nPredictors of arrhythmic events during the acute phase of \nhemodynamically stable myocarditis: a cardiac magnetic resonance \nstudy  \nL. Monti\n1, L. Occhi1, C. Moro2, G. Iacuitti2, G. Bassanelli3, B. Nardi1, M. Lettino1, \nL. Balzarini1; 1Rozzano/IT, 2Desio/IT, 3Castellanza/IT \n(lorenzo.monti@humanitas.it)  \nPurpose: We searched for imaging predictors of arrhythmic events in patients \nwith hemodynamically stable acute myocarditis. \nMethods and Materials:  There were 103 patients (pt) with hemodynamically \nstable acute myocarditis. All of them were hospitalised from the E.R. in one of \nthe 3 centres (ICH Rozzano, P.O. Desio, Mater Domini Castellanza). Acute \nmyocarditis was diagnosed with MR in the presence of oedema and LGE. \nClinical, bioclinical, ECG and imaging data were reviewed by a panel \nconsensus of 1 cardiologist and 1 radiologist to adjudicate events. \nResults: 80 males (77.67%) and 23 females (22.33%), 95% in NYHA class I. \nMean EF = 58.6% ±10. During hospitalisation in 14 pz (13.6%) were observed \narrhythmic events including 1 torsades de pointes, 4 NSVT, and 1 sustained \nVT. Only a reduced (i.e.: below normal reference range for MR studies) LVEF \nwas significantly associated with events, with OR = 8.4. Neither WBC count \n(OR 1.14), troponin peak (OR=1.18), end-diastolic volume (OR=1.0), Late \nGadolinium Enhancement mass (OR=1.06) or T2 STIR edema mass (OR=1.2) \nwere related to arrhythmic events during the acute phase of myocarditis. \nConclusion: In hemodynamically stable patients hospitalised for acute \nmyocarditis, clinical events are mainly  arrhythmic with a prevalence of 13.5%. \nA reduced LVEF, evaluated with MR, is the only parameter associated with \nclinical events during the acute phase of the disease.  \nB-0730 11:51  \nDiabetic cardiomyopathy: a cardiac magnetic study on progression of \nfunction impairment  \nN. Galea, E. Giannetta, A. Isidori, M. Francone, C. Catalano, I. Carbone; \nRome/IT (iacopo_carbone@hotmail.com)  \nPurpose: Diabetic cardiomyopathy (DCM) is a complication of diabetic mellitus \nand is characterised by high morbidity and mortality. It consists in a \nprogressive impairment of diastolic and systolic ventricular performance not \nrelated to ischemic disease. The aim of our study was to explore with Cardiac \nMagnetic Resonance (CMR) the alterations in myocardial contractility and \ngeometry in a cohort of selected patients over a four-year follow-up. \nMethods and Materials:  34 men with CMR findings suggestive of DCM \n(increased angle of ventricular torsion,reduced myocardial strain,increased LV \nmass, slightly increased end-diastolic volume[EDV] and concentricity index[LV \nmass/ EDV]) performed a 4-year follow-up CMR study. All images were \nanalysed to assess EDVi, end-systolic vol ume (ESV), ejection fraction (EF), \nmyocardial mass index (LVMi), myocardial strain and ventricular torsion. \nResults: Results revealed a decrease of myocardial strain ( ( from -12.6% to -\n10.9%, p=0.03), a non-significant increase of torsion angle (from 19.1°to 19.2, \np=0.76), an increase of LVMi (from 132 g/m2 to 118.52 g/m2; p=0.014) and a \nmild increase of EDVi (from 65.7 ml/m2 to 60.53 ml/m2, p=0.056) at \nfollow-up.͒The EF was unchanged (from 60.8% to 58.9%) and the \nconcentricity index showed no significant changes (from 2.1 g/ml to 2.0 g/ml, \np=0.51). Metabolic parameters showed no significant differences in glycemia \nand glycosylated hemoglobin. \nConclusion: Early features of DCM are contractile dysfunction, increased \nglobal angle of twist and LV concentric hypertrophy. A progressive dissociation \nbetween myocardial contraction and ventricular torsion characterise late \ndilative stages.  \nAuthor Disclosures: \nN. Galea: Research/Grant Support; Grant from FIRB project 2010 - \"Futuro in \nRicerca\" program (Protocol No RBFR10URHP_003) of Italian Ministry of \nEducation, University and Research. \n10:30 - 12:00 Conf. Room M3  \nInterventional Radiology  \nSS 1309  \nNew techniques and applications  \nModerators:  \nT. Andrasina; Brno/CZ  \nR. Uberoi; Oxford/UK  \nB-0731 10:30  \nMR-guided laser-induced interstitial thermotherapy of liver metastases \nfrom breast cancer and other non-colorectal liver metastases: prognostic \nfactors for overall survival and progression-free survival  \nT.J. Vogl, N.N.N. Naguib, K. Eichler, H. Ackermann, V. Freier; \nFrankfurt a. Main/DE (t.vogl@em.uni-frankfurt.de)  \nPurpose: To retrospectively evaluate prognostic factors for progression-free \nsurvival (PFS) and overall survival (OAS) after treatment of liver metastases \nfrom breast cancer and other non-colorectal cancers with MR-guided laser-\ninduced thermotherapy (LITT). \nMethods and Materials: 401 patients (58 males, 343 females; mean age 57.3 \nyears) with liver metastases from different primary tumours (breast cancer \nn=271, neuroendocrine cancer n=21, others n=109) were treated with MR-\nguided LITT between January 2000 and January 2011.  \nResults: Median OAS of all patients was 37.6 months starting calculation from \nthe date of first intervention with LITT. 1-year survival was 86.5%, 2-year \nsurvival 67.2%, 3-year survival 51.9%, 4-year survival 39.9%, and 5-year \nsurvival 33.4%. In patients with liver metastases from breast cancer, 1-year \nOAS was 86.7%, 2-year OAS 66.9%, 3-year OAS 51.5%, 4-year OAS 40.3%, \nand 5-year OAS 32.1% (median 37.6 months). 1-year PFS was 50.3%, 2-year \nPFS 36.3%, 3-year PFS 28.4%, 4-year PFS 24.5%, and 5-year PFS 19.9% \n(median 12.2 months). In patients with liver metastases from neuroendocrine \ncancer 1-, 2- and the 3-year OAS rates reached 94.1%, 72.1% and 51.5%, \nrespectively (median 36.6 months). 1-year PFS was 50.6%, 2-year PFS 33.8%, \n3-year PFS 26%, 4-year PFS 20.4% and 5-year PFS 17% (median 12.2 \nmonths). \nConclusion: MR-guided LITT of liver metastases from breast cancer and other \nnon-colorectal cancers results in a good OFS and PFS rates in comparison to \nhepatic resection and other therapies. For both groups, the initial number of \nmetastases and their volume can be seen as the most important prognostic \nfactors for clinical success.  \nB-0732 10:39  \nMRI T1 treatment-monitoring during laser-induced thermotherapy of \nhepatic metastases for necrotic size prediction  \nJ.L. Wichmann, M. Beeres, B.M. Borchard, N.N.N. Naguib, B. Bodelle, \nS. Zangos, T.J. Vogl, M.G. Mack, K. Eichler; \nFrankfurt a. Main/DE (docwichmann@gmail.com)  \nPurpose: To investigate the accuracy of real-time MRI T1-based treatment-\nmonitoring for predicting lesion volume during laser-induced thermotherapy \n(LITT) of hepatic metastases. \nMethods and Materials:  237 liver metastases in 151 patients were ablated \nduring 372 LITT procedures. 1.5 T MRI treatment-monitoring using longitudinal \nrelaxation time (T1) FLASH sequences was performed. Patients underwent \nadditional contrast-enhanced MRI directly after LITT, 24h after ablation and \nduring follow-up at 3, 6 and 12 months. The applied energy necessary for full \nablation within the various liver segments was investigated. \nResults: Total amount of applied energy during LITT varied from 6.12 to \n225.32 kJ (mean: 48.96 kJ) and peaked in the liver segments 5 (2.12 kJ/cm³) \nand 8 (2.16 kJ/cm³). The preablative metastasis volume ranged from 0.5 to \n51.94 cm³ (mean: 1.99 cm³; SD: 25.49 cm³) while the volume measured in the \nlast available T1 image varied from 1 to 120 cm³ (mean: 26.25 cm³; SD: \n25.66 cm³). Volumes measured via T1-based treatment-monitoring showed a \nstronger correlation with necrosis 24 h after LITT (r = 0.933; p < 0.001) than \ncontrast-enhanced MRI directly after the procedure (r = 0.888; p < 0.001). \nConclusion: Real-time MRI T1 treatment-monitoring during LITT of hepatic \nmetastases enables precise estimation of the resulting lesion volume and \nimproves control of the energy necessary during ablation.  \n \n \n \n \n \n \n \nS294  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0733 10:48  \nInitial clinical experience with a quadrupole butterfly coil for spinal \ninjection interventions in an open MRI system at 1.0 Tesla  \nM. Jonczyk1, B. Hamm1, A. Heinrich2, A. Thomas1, H. Rathke1, \nB. Schnackenburg3, F. Güttler2, U. Teichgräber2, M. de Bucourt1; 1Berlin/DE, \n2Jena/DE, 3Hamburg/DE (mdb@charite.de)  \nPurpose: To report our initial clinical experience with a new MRI quadrupole \ncoil which allows interventions in prone position. \nMethods and Materials:  Fifteen patients (7 women, 8 men; average patient \nage 42.8 years) were treated in a 1.0 Tesla Panorama High Field Open (HFO) \nMRI system (Panorama HFO) using a quadrupole butterfly coil (Bfly) and \ncompared with 15 patients matched for sex, age, and MR intervention using \nthe MultipurposeL coil (MPL) performed in conventional lateral decubitus \nposition (all, Philips Medical Systems, Best, The Netherlands). All interventions \nwere performed with a near-real-time proton density turbo spin echo (PD TSE) \nsequence (TR/TE/flip angle/ta: 600 ms/ 10 ms/ 90°/ 3 s/image). Qualitative and \nquantitative image analysis was performed including signal intensity, signal-to-\nnoise and contrast-to-noise ratio (SNR, CNR), contrast and full width at half \nmaximum (FWHM) measurements. \nResults: Contrast differed significantly between the needle and muscles (Bfly \n0.27/MPL 0.17) as well as the needle and periradicular fat (0.13/0.24) during \nthe intervention (both, p=0.029), as well as CNR between muscles and the \nneedle (10.61/5.23;p=0.010) although the FWHM values did not \n(2.4/2.2;p=0.754). Signal intensity of the needle in interventional imaging \n(1152.9/793.2;p=0.006), and postinterventional SNR values of subcutaneous \nfat (15.3/28.6;p=0.007), muscles (6.6/11.8;p=0.011), and the CNR between \nthese tissues (8.7/17.5;p=0.004) yielded significant differences. \nConclusion: The new coil is a valid alternative for MR-guided interventions in \nan open MRI system at 1.0 Tesla, especially if patients cannot (or prefer not to) \nbe in a lateral decubitus position, or if prone positioning yields better access to \nthe target zone.  \nB-0734 10:57  \nSingle centre experience of extending indications for percutaneous \nintraportal pancreatic islets auto-transplantation after pancreatic surgery \nto prevent type-1 diabetes: feasibility, technical aspects, complications, \nand clinical outcome  \nG. Agostini, M. Venturini, P. Maffi, G. Balzano, L. Piemonti, A. Del Maschio; \nMilan/IT (agostini.giulia@hsr.it)  \nPurpose: Percutaneous islet allo-transplantation, needing \nimmunosuppression, is a traditional less invasive alternative to surgical \npancreas transplantation for brittle-type-1 diabetes, while PIPIAT, not needing \nimmunosuppression, is usually performed after pancreatic surgery for chronic \npancreatitis to prevent diabetes. Our aim was to assess feasibility, technical \naspects, complications and clinical outcome of PIPIAT following pancreatic \nsurgery, not only for chronic pancreatitis but also for benign and malignant \nnodules. \nMethods and Materials:  From 2008 to 2012, 41 patients were enrolled for \nPIPIAT 24/48 hours after pancreatic surgery (total pancreatectomy, distal \npancreatectomy for benign/borderline neoplasms of pancreatic body-neck). \nPIPIAT was performed using a combined US and fluoroscopy-guided \ntechnique (4-F catheter): PIPIAT feasibility, complications, median-follow-up, \nmetabolic (insulin independence rate, graft function based on 2-score, marker \nof islet function) and oncologic (mali gnant and metastatic diseases) outcomes \nwere recorded. \nResults: PIPIAT wasn't performed in 7/41 patients (4 for inadequate islet \nmass, 2 for hemodynamic instability, 1 for islet culture contamination), while it \nwas successfully performed in 34/34 patients. PIPIAT-related complications \noccurred in 8 patients (23.5%): 4 bleedings (2 requiring transfusions), 3 portal \nthromboses (1 complete, 2 partial), 1 sepsis. Median follow-up duration was \n546 days. Insulin independence was achieved in 15/34 patients (44%), partial \ngraft function in 16/34 patients (47%), no function in 3/34 patients (6%). \nSeventeen patients had malignancy; none of them developed liver metastases \nduring follow-up. \nConclusion: PIPIAT, performed under a combined US and fluoroscopy \nguidance and not requiring immunosuppr ession, is feasible, with a relatively \nlow complication rate and a better metabolic outcome than allo-transplantation.  \nB-0735 11:06  \nSafety and mild-term permeability of ePTFE-covered portosystemic \nshunts (TIPS) in children  \nL. Zurera, J. Espejo, S. Lombardo, M. Canis, J. Gilbert, C. Villen; Cordoba/ES \n(mslombgalera@hotmail.com)  \nPurpose: To analyse retrospectively the safety and efficacy of ePTFE-covered \nTIPS in children. \nMethods and Materials:  We present 12 children (average-age 9 and weight \n30 kg)who received implants of 10-mm-diameter Viatorr ePTFE-covered \nendoprostheses for acute (n=7) or recurri ng upper-gastrointestinal bleeding \n(UGB) (n=4) caused by medically or endoscopically uncontrollable varices. All \nthe children had liver disease of differing causes, three with chronic portal \nthrombosis and cavernomatosis. The recurrence of UGB, associated \ncomplications and permeability were assessed with Doppler ultrasound \nsequentially or up to transplantation. \nResults: In all the children, a single endoprosthesis was implanted in a single \nsession, without mortality. The mean initial transhepatic gradient was 15 mmHg \n(3-21 mmHg), which dropped to 7 mmHg (1-12 mmHg) after TIPS implant. \nImmediate complications observed were mild encephalopathy (1) and acute \nocclusion TIPS (1) which was resolved with the implant of a coaxial \nendoprosthesis. Stenosis of the TIPS (1) was observed at 9 months and two \ncomplete thrombosis was observed: portal cavernomatosis of a liver \ntransplantation at 7 months and another one at 12 months; all were resolved \nwith angioplasty and coaxial endoprostheses. Four children received \ntransplants at 7- 9-10-17 months, with permeability of the TIPS observed. In \nthe other eight, permeability was demonstrated with Doppler ultrasound during \na mean follow-up period of 18 months (primary permeability=67% and \nsecondary permeability=100%). \nConclusion: Our results indicate the safety and permeability of Viatorr ePTFE-\ncovered endoprostheses for the treatment of UGB due to gastroesophageal \nvarices can be good, a fact that needs to be corroborated with larger series in \nthe future.  \nB-0736 11:15  \nPercutaneous transhepatic cholangioscopic lithotripsy for the treatment \nof intrahepatic stones  \nA. Cannavale, M. Corona, F. Fiocca, P. Lucatelli, F. Cereatti, C. Cirelli, \nG. Fanello, F. Fanelli, F.M. Salvatori; Rome/IT \n(alessandro.cannavale@hotmail.com)  \nPurpose: To assess the safety and effectiveness of percutaneous transhepatic \ncholangioscopic lithotripsy (PTCSL) for the treatment of hepatolithiasis in \nhostile abdomen. \nMethods and Materials:  From January 2011 to July 2013 we assessed 43 \npatients who underwent PTCSL. All patients performed pre-operative CT \nand/or MRCP to assess the location of intrahepatic stones and post-operative \nanatomy. PTCSL was performed using 2.8-mm cholangioscope (Olympus CHF \nCB30/S) with electrohydraulic shock-wave lithotripsy probes. This was \nperformed through a biliary percutaneous access previously obtained by \ninserting a biliary drainage (10 Fr). After the procedure, a biliary catheter was \nleft in place to make a cholangiographic follow-up. \nResults: All patients had prior complex hepatobiliary operations (i.e. \nduodenocefalopancreasectomy). The median duration of the condition prior to \nPTCSL was 6 (3-12) months. In all cases, stones were fragmented during the \nfirst procedure. There was minimal intraope rative blood loss. Median size of \nbile duct was 15 mm prior to the procedure. The number of stones ranged from \none to five with the largest size of stone comparable to the size of bile duct. \nThe median follow-up was 12 months. Forty-one patients were symptom free \nwith neither stone recurrence nor cholangitis immediately after the procedure \nor during follow-up. No bleeding or deaths were encountered. Only two \npatients had a transient episode of cholangitis with fever and chills immediately \nafter the procedure. \nConclusion: PTCSL is a feasible and an effective treatment method for \npatients with recurrent biliary stone, following complex abdominal surgery as \nthe success rate from endoscopic procedures is limited.  \nB-0737 11:24  \nOzone augmented percutaneous discectomy: a novel minimally invasive \nalternative to surgical discectomy in patients with refractory discogenic \nsciatica?  \nM.T. Crockett, M. Moynagh, N. Long, K. Synnott, S. Eustace; Dublin/IE \n(crockettmt@gmail.com)  \nPurpose: Discogenic sciatica is a prevalent and debilitating condition. Multiple \nminimally invasive treatment options are available with none demonstrating \ndefinitive equality or superiority to surgical discectomy. Automated \npercutaneous discectomy and intradiscal ozone therapy are established \nminimally invasive treatment options which have shown promise in cohorts of \npatients in whom first line therapies have failed. The purpose of this study was \nto assess the safety and efficacy of a novel combination treatment option; \nozone augmented percutaneous discectomy (OAPD). \nMethods and Materials:  100 patients were included in the study, all with a \ndiagnosis of discogenic sci atica confirmed following lumbar spine MRI and \nexamination by a consultant orthopaedic surgeon. All patients had failed first \nline therapies of 6 weeks physiotherapy and subsequent caudal epidural \ninjection (post treatment McNab score of 1). These patients then underwent \ncombination treatment of OAPD performed by an experienced musculoskeletal \nradiologist. Patient follow-up ranged from 6-18 months. Outcome measures \nwere McNab clinical outcome score and requirement to undergo subsequent \nsurgical discectomy. \nS295  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nResults: Over 70% of patients recorded significant symptomatic improvement \neliminating the requirement for operative intervention whilst the remainder \nproceeded to undergo surgical discectomy. Average McNab clinical outcome \nscore following OAPD was 3.6. No significant intra or post-procedural \ncomplications were recorded. \nConclusion: OAPD is a safe and effective novel minimally invasive treatment \noption in a cohort of patients with confirmed discogenic sciatica in whom first \nline treatment options have failed. Further research is required to assess \nlonger term outcomes and to directly compare OAPD with surgical discectomy.  \nB-0738 11:33  \nPercutaneous vertebroplasty in adult degenerative scoliosis for spine \nsupport: study for pain evaluation and mobility improvement  \nG. Velonakis, D. Filippiadis, A. Mazioti, M. Tsitskari, E. Brountzos, N. Kelekis, \nA.D. Kelekis; Athens/GR (giorvelonakis@gmail.com)  \nPurpose: To evaluate efficacy and safety of percutaneous vertebroplasty (PV) \nas primary treatment in adult degenerative scoliosis. \nMethods and Materials: During the last 4 years, PV was performed in 18 adult \npatients (68 vertebral bodies) with back pain due to degenerative scoliotic \nspine. Under anaesthesia and fluoroscopy, direct access to the most deformed \nvertebral bodies was obtained using 13G needles and PMMA for \nvertebroplasty was injected under continuous fluoroscopic control. The inner \narch of scoliosis was supported. Clinical  evaluation included immediate and \ndelayed follow-up studies of patient's general condition and neurological status. \nA NVS scale on a questionnaire helped assessing pain relief degree, life \nquality and mobility improvement. \nResults: Comparing the patients' scores prior to vertebroplasty (mean value \n8.06±1.3 NVS units), the morning after (mean value 3.11 ±1.2), at 12 (mean \nvalue 1.67±1.5) and 24 months post vertebroplasty (mean value 1.67 ±1.5 NVS \nunits), patients of our study presented a mean decrease of 6.39 ±1.6 NVS units \non terms of life quality improvement and pain relief (p < 0.001). Overall mobility \nimproved in 18/18 (100%) patients. No complications were observed. During \nthe follow-up period (mean value 17.66 months) patients underwent a mean of \n1.3 sessions for facet joint and nerve root infiltrations. \nConclusion: Percutaneous vertebroplasty in the inner arch seems to be an \neffective technique for supporting adult degenerative scoliotic spine. It can be \nproposed as an initial treatment in the scoliosis of the elderly prior to surgery. \nPreliminary results report significant pain reduction and mobility improvement, \nbut further studies are required.  \nAuthor Disclosures: \nA. Kelekis: Consultant; Benvenue Medical. \nB-0739 11:42  \nCT-guided screw fixation of vertical sacral fractures in local anaesthesia \nusing a standard CT  \nG.W. Reuther, U. Röhner, T. Will, I. Dehne, U. Petereit; \nSaalfeld/DE (gerd.reuther@thueringen-kliniken.de)  \nPurpose: To evaluate time efficiency, radiation dose, precision and \ncomplications of percutaneous iliosacral screw placement under CT-guidance \nand local anaesthesia. \nMethods and Materials:  Retrospective analysis of 143 interventions in 135 \npatients during a period of 42 months. Implant failures could be evaluated in \n85/182 screws and bony healing or refracturing in 46/182 screws. \nResults: A total of 182 iliosacral screw placements in 179 vertical sacral \nfractures (105 unilateral, 37 bilateral) took place in 135 patients. No screw \nmisplacements including the simultaneous bilateral procedures were noted. \nThe average time for a unilateral screw placement was 23 minutes (range: 14 - \n52 minutes) and 35 minutes (range: 21 - 60 minutes) for simultaneous bilateral \nscrewing. The dose length product was 365 mGy*cm (range: 162-\n1014 mGy*cm) for the unilateral and 470 mGy*cm (range: 270-1271 mGy*cm) \nfor the bilateral procedure. In relation to the previous diagnostic CT of the \npelvis the dose length product was 0.95 (SD: 0.33) for unilateral and 1.10 (SD: \n0.19) for bilateral screws. 1 gluteal bleeding occurred as the only significant \nacute minor complication (0.7%). Backing out of 12/85 screws occurred \nbetween 6 and 69 days after intervention. In 8 patients contralateral stress \nfractures were detected after unilateral screw placement. \nConclusion: CT-guided iliosacral screw placement in sacral fractures is a safe \ntool providing a high precision. The radiation dose is in the order of a \ndiagnostic CT of the pelvis for both unilateral and bilateral screws. \nContralateral stress fractures in unilateral screw placements must be \nconsidered during the first weeks after intervention.  \n \nB-0740 11:51  \nCombined implantation of central venous access ports and percutaneous \nradiological gastrostomy in patients with malignant disease is feasible \nand safe  \nA.R. Keulers, A. Stamm, A.H. Mahnken; Marburg/DE  \nPurpose: To evaluate the feasibility, safety and patient tolerance of combined \ncentral venous totally implantable access ports (TIAP) and percutaneous \nradiological gastrostomy (PRG) implantation in patients with advanced stage \nmalignant disease. \nMethods and Materials:  From 01/2010 to 07/2013 70 patients (61.7 ±10.25 \nyears; 54 men, 16 women) underwent fluoroscopy-guided TIAP via the internal \njugular vein and PRG during a single session. Indications for port and \ngastrostomy were advanced malignancy with the need of chemo or radiation \ntherapy. Minor and major-complications during the acute (0-24h), early (1-30d) \nand late phase (> 30d) were recorded according to the Society of Interventional \nRadiology classification and analysed retrospectively. As standard of care \npatients were questioned about their opinion regarding the combined \nprocedure. \nResults: For TIAP the following complications occurred: port infection with \nconsecutive explanation (major: n=1; 1.4%), thrombosis (minor: n=1; 1.4%). \nFor PRG one acute complication in terms of insufficient gastropexy followed by \nCT-guided PRG occurred (n=1; 1.4%). In 69 cases, PRG was successful with \nno early or late major-complications. Altogether 33 minor complications were \nnoted, 10 in early (14.3%) and 23 in late phase (32.8%). Most minor \ncomplications were due to incorrect handling (n=20; 60.6%) resulting in local \ninfection, dislocation or material defect. 94% of the patients preferred the \ncombined intervention over two separate procedures. \nConclusion: Combined TIAP and PRG-implantation is feasible and safe with \ncomplication rates comparable to those reported in literature while having an \nexcellent patient acceptance.  \n10:30 - 12:00 Board Room A  \nPaediatric  \nSS 1312  \nNew imaging applications  \nModerators:  \nK. Rosendahl; Bergen/NO  \nI. Sefic-Pasic; Sarajevo/BA  \nB-0741 10:30  \nUsing intravoxel incoherent motion MR imaging to predict vesicoureteral \nreflux in children with upper urinary tract infection: preliminary results  \nJ. Kim, C. Lee, Y. Park, J. Lee, J. Choi, K. Kim, C. Park; Seoul/KR \n(pridebio@naver.com)  \nPurpose: To compare diffusion parameters of intravoxel incoherent \nmotion (IVIM) diffusion-weighted imaging (DWI) between \"reflux\" and \"non-\nreflux\" kidneys, and to evaluate feasibility of IVIM DWI in predicting \nvesicoureteral reflux (VUR) in children with upper urinary tract infection (UTI). \nMethods and Materials:  This retrospective study was approved by our \ninstitutional review board and the requirement for informed consent was \nwaived. Sixty-three kidneys of 39 pediatric patients with upper UTI were \nincluded and classified into \"reflux\" a nd \"non-reflux\" groups according to the \npresence of VUR on VCUG. DWI using IVIM was performed with eight b \nfactors. ADC, true diffusion coefficient (D), pseudo-diffusion coefficient (D*), \nand perfusion fraction (F) were measured and compared in renal pelvis of both \ngroups. Four indeces (D*/ADC, F/ADC, D*/D, and F/D) were also calculated \nand ROC curve analyses were performed for each index to identify optimal cut-\noff value that can predict VUR. \nResults: VURs were detected in 17 kidneys on VCUG. In \"reflux\" group, ADC \nvalues were significantly lower (2.87 ±0.27vs.3.15±0.39×10\n-3 mm2/sec, \np=0.004), and D* and F values were significantly higher than \"non-reflux\" group \n(41.50±12.38vs.30.01±10.47×10-3 mm2/sec, p < 0.001, and \n0.31±0.12vs.0.22±0.14, p=0.018, respectively). Four indeces (D*/ADC, F/ADC, \nD*/D, and F/D) were all significantly higher in \"reflux\" group than \"non-reflux\" \ngroup (p=0.004,< 0.001,< 0.001 and 0.011,respectively). Among them, area \nunder ROC curve for D*/ADC was highest (0.803), and optimal cut-off value of \n10.87 corresponded to 82.35% sensitivity and 71.74% specificity for detecting \nVUR. \nConclusion: D* and F values are significantly higher and ADC values are \nsignificantly lower in renal pelvis of \"refl ux\" kidney than \"non-reflux\" kidney. Our \nnew index (D*/ADC) can be useful for predicting VUR.  \n \n \nS296  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0742 10:39  \nRole of noninvasive acoustic radiation force impulse imaging to predict \ncomplications in post-liver transplanted paediatric patients  \nM. Salsano, M. Candusso, G. Torre, G. Soglia, A. Pietrobattista, C. Grimaldi, \nP. Tomà, J. de Ville de Goyet, L. Monti; Rome/IT (marco.salsano@hotmail.it)  \nPurpose: Acoustic radiation force impulse (ARFI) imaging has been developed \nas a noninvasive ultrasound-based elastography modality to assess graft \nfibrosis after orthotopic liver transplantation (OLT), estimated as tissue \nstiffness. This method has attempted to replace periodical biopsy. The aim of \nthis study was to evaluate the clinical utility of ARFI imaging to detect \ncomplications after paediatric OLT, in comparison with histopathologic findings. \nMethods and Materials:  We periodically performed liver stiffness \nmeasurements by ARFI imaging in 54 paediatric OLT recipients (evaluated \nfrom 1 month to 2 years from the transplantation). In each recipient, the shear-\nwave velocity (SWV) was measured ten times to quantify hepatic stiffness. \nLiver biopsy and laboratory analysis (including functional liver markers) were \nperformed in a range of time from one day to one month from the ARFI \nimaging.Collected data were evaluated retrospectively. \nResults: Median SWV was higher in patients with clinical, biochemical and \nhistological signs of graft rejection than in patients without evidence of liver \ndisease [2.13m/s, 95% confidence interv al (CI) 1.84-2.42]. Median SWV values \nin patients with only hepatitis or fibrosis were respectively 1.41m/s (95% CI, \n1.25-1.56) and 1.67m/s (95% CI, 1.26-2.07). The median value of the ARFI \nmeasurements in normal patients was 1.27m/s (95% CI 1.17-1.36). \nConclusion: ARFI was a reliable, noninvasive and rapid method able to \npredict the diagnosis of graft disfunc tion in paediatric OLT. Liver stiffness \nmeasurements correlated with histopatholog ic findings. ARFI could be useful to \npostpone the time of liver biopsy and guide the immunosuppressive first line \ntherapy.  \nB-0743 10:48  \nHigh temporal versus high spatial resolution in MR quantitative \npulmonary perfusion imaging of 2-year-old children after congenital \ndiaphragmatic hernia repair  \nM. Weidner, F.G. Zöllner, C. Hagelstein, K. Zahn, T. Schaible, L. Schad, \nS.O. Schönberg, K.W. Neff; \nMannheim/DE (Meike.Weidner@medma.uni-heidelberg.de)  \nPurpose: Congenital diaphragmatic hernia (CDH) leads to lung hypoplasia. \nUsing dynamic contrast-enhanced (DCE) MR imaging, lung perfusion can be \nquantified. As according to Monte Carl o simulations, MR perfusion values \ndepend on temporal resolution; we compared two protocols to investigate if \nipsilateral lung perfusion is impaired after CDH, if simulation results can be \nconfirmed and which protocol should be preferred. \nMethods and Materials:  DCE-MRI was performed in 36 2-year-old children \nafter CDH on a 3 T MRI system. Protocol A (n=18) based on a high spatial (3.0 \ns; voxel: 1.25 mm3) and protocol B (n=18) on a high-temporal resolution (1.5 s; \nvoxel: 2 mm³). Pulmonary blood flow (PBF), pulmonary blood volume (PBV) \nand mean transit time (MTT) were calculated. Peak contrast to noise ratio \n(PCNR) was calculated. \nResults: Mean PBF was significantly reduced on the ipsilateral side, i.e. for \nprotocol A, PBFipsilateral was 45 ±26 ml/100 ml/min compared to \nPBFcontralateral (63 ±28 ml/100 ml/min; p=0.0016) and for protocol B side-\ndifferences were equivalent (PBFipsilateral=62 ±24 vs. \nPBFcontralateral=85±30 ml/100 ml/min; p=0.0034). PCNR was significantly \nhigher for protocol B (30 ±18) than for protocol A (20 ±9; p=0.0294). Protocol B \nshowed higher values of PBF in comparison to protocol A (p always <  0.05). \nConclusion: In 2-year-old children, after CDH repair ipsilateral lung perfusion \nis reduced. Higher temporal resolution and increased voxel size show a gain of \nPCNR and significantly decrease the by Monte-Carlo simulated \nunderestimation of PBF. Protocol B should therefore be preferred, as a 2 mm\n3 \nisotropic voxel resolution is still sufficient to detect side-differences of lung \nperfusion.  \nB-0744 10:57  \nElastosonography evaluation of testes with varicocele in paediatric \npatients, preliminary results  \nC. Bruno, A. Bucci, R. Pozzi-Mucelli; Verona/IT (costanza_bruno@libero.it)  \nPurpose: To determine whether elastosonography is able to detect differences \nin the testicular elasticity between normal testes and testes with varicocele. \nMethods and Materials:  13 boys (9-13 years old) with untreated varicocele \n(bilateral in 3 boys and left unilateral in 10) and 12 age-matched healthy \nsubjects underwent elastosonography. Varico cele was classified from a clinical \npoint (stage I: palpable only during the Valsalva maneuver - VM; II: palpable at \nrest; III: visible at rest) and considering the duration of reflux at Doppler ( short: \ndetectable only during the VM; medium: lasting some seconds after the VM; \nlong: independent of the VM). The testicular elasticity was expressed as an \narbitrary three-point scale (1: normal; 2: slightly-moderately stiffer than normal; \n3: severely stiffer than normal). \nStatistical analysis was performed by means of the Student's t-test. \nResults: The clinical stage of varicocele was I in 2 cases, II in 9 and III in 5; \nthe reflux was short in 3 cases, medium in 6 and long in 7. The elasticity was 1 \nin all 34 normal testes, 2 in 9 testes with varicocele and 3 in 7. The differences \nin the degree of elasticity between normal testes and testes with varicocele \nand between long-duration and medium/short-duration varicocele were both \nstatistically significant ( P \n< 0.001); the difference between stage III and stages \nI/II varicocele was just below significance (P = 0.053). \nConclusion: Testes with varicocele are significa ntly stiffer than normal ones, \nwith a positive correlation to both the clinical stage and the duration of reflux.  \nB-0745 11:06  \nCorrelation between post-mortem computed tomography and magnetic \nresonance imaging and autopsy findings in paediatric forensic imaging  \nN. Berkovitz, M. Vasserman, P. Gottlieb, S. Tal; Zerifin/IL \n(nadavber@gmail.com)  \nPurpose: To examine the cause of death using imaging in the paediatric \npopulation and the agreement between autopsy and imaging findings. To \nevaluate the feasibility of imaging to determine cause of death to reduce \npaediatric autopsies. \nMethods and Materials:  From Jan 2011 to Jan 2013, we performed CT and \nMRI imaging of 41 cases under 18 years of age. We examined the imaging \nfindings and compared the findings for those autopsied. \nResults: Imaging studies were performed for 41 children (average age \n4.5 ± 5.4, 34 younger than 10) with 24 (59%) autopsied. CT was performed on \n40, combining MRI in 15 and only MRI in one. There were 19 trauma and 22 \nnon-trauma cases. Imaging showed cause of death for the 9 cases autopsied. \nFor 10 cases, cause of death was based on imaging only. For the 22 non-\ntrauma cases, 15 were autopsied (68%). With imaging, pneumonia was cause \nof death for 18 cases (81% of non-trauma, 44% of total) with 13 (72%) \nconfirmed by autopsy. One autopsy confirmed cause of death was \nhyperthermia and one aortic rupture. There were complementary findings for \nimaging and autopsy in 4 cases, not significantly changing the cause of death. \nConclusion: Post-mortem imaging studies should be an inseparable part of \nthe post-mortem examination in all paediatric forensic investigation. \nPneumonia is common in non-trauma paediatric death. Once traumatic or \ncriminal involvement has been excluded by  imaging, invasive autopsy can be \nlimited.  \nB-0746 11:15  \nQuantitative cerebral perfusion imaging at 3.0 T after congenital \ndiaphragmatic hernia repair and ECMO therapy with or without common \ncarotid artery occlusion  \nC. Hagelstein, F.G. Zöllner, M. Weidner, C. Weiss, S.O. Schönberg, \nT. Schaible, K. Zahn, K.W. Neff; Mannheim/DE (Claudia.Hagelstein@umm.de)  \nPurpose: To quantify cerebral perfusion in children after congenital \ndiaphragmatic hernia (CDH) repair with right common carotid artery (rCCA) \nocclusion after extracorporeal membrane oxygenation (ECMO) therapy and to \nassess whether CCA occlusion leads to impaired cerebral perfusion. \nMethods and Materials:  Using pulsed arterial spin labelling (pASL; TR/TE \n2474.6/21 ms, FOV 210x210 mm\n2, section sickness 8 mm, voxel resolution \n2.2x2.2x8 mm3; measurements 60, TI 1 700 ms, TI 2 1800 ms, TI 1s 1600 ms; \nMagnetom Trio, Siemens Healthcare Sector, Germany) cerebral perfusion was \nevaluated and quantified in 29 2-year-old children (2.1 ±0.2 years) after CDH \nrepair. In 14 patients, the rCCA was occluded after ECMO therapy. 15 patients \nwithout ECMO and normal brain supplyin g circulation served as controls. 2 \ncortical (containing cortical gray matter) and subcortical (containing subcortical \ngray and white matter) ROIs were placed in both hemispheres of each child \nbased on ASL images superimposed with anatomic reference images. \nResults: Patients with rCCA occlusion showed significantly lower subcortical \nperfusion for the right hemisphere with regional cerebral blood flow (rCBF) of \n68.8±23.6 vs. 79.1± 30.5 ml/100 g/min left-sided, p=0.011. Cortical perfusion \nshowed a trend for reduced perfusion on the right side with rCBF 65.9 ±24.5 vs. \n72.2±29.0 ml/100 g/min, p=0.138. Patients with normal rCCA flow \ndemonstrated identical cerebral perfusion bilaterally (p=0.780 and 0.340). In \nnearly one third of the children with rCCA occlusion right rCBF was reduced \nmore than 20%. \nConclusion: After ECMO therapy and decannulation, ligation or reconstruction \nof the CCA can be performed. Based on the possible hypoperfusion of the \nhemisphere, with no complete collateralisation, reconstruction should be \npreferred, even if secondary occlusion can occur.  \n \n \n \n \nS297  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0747 11:24  \nOptimisation of time-resolved CE-MRA of the thoracic vasculature in \nFontan patients: a quantitative approach  \nK. Jaspers, M.C.L. Peek, D. Wolff, M.J.W. Greuter, T. Ebels, T.P. Willems; \nGroningen/NL (k.jaspers@umcg.nl)  \nPurpose: To optimise first-pass (FP) imaging of the cavo-pulmonary \nconnection in Fontan patients with time-resolved contrast-enhanced MR \nangiography (TR-MRA) by identifying protocol-related factors that contribute to \nvessel enhancement. \nMethods and Materials:  TR-MRA was performed in 38 patients (age:8-44 \nyears, median 16 years) with a total cavo-pulmonary Fontan connection on a \n1.5 T MR system using a T1-weighted 3D gradient-recalled echo sequence. K-\nspace was undersampled using a TWIST protocol. TR/TE were 2.8/1.1 ms, \nand flip angle was 25°. Reconstructed voxel size was 0.78×0.78×1 mm3. \nAcquisition time per phase ranged from 4.3 to 9.0s. After injection of \n0.1 mmol/kg gadobenate dimeglumine (MultiHance, Bracco) at injection rate \nIR=0.9 mmol/s, 11 phases were acquired. Signal enhancement curves \n(SE=SI (t)/SIpre) were measured in the pulmonary arteries (PA), superior and \ninferior venae cavae (SVC and IVC), and the aorta. For each patient, the \nmaximum concentration in the aorta and SVC were estimated using the \ncardiac output (CO) with Cmax (aorta)=IR/CO and \nCmax (svc)=3xCmax (aorta). \nResults: During first pass, the Fontan connection could generally not be \nvisualised. Signal enhancement was significantly lower (p < 0.01) in the SVC \n(SE=1.5±0.6) and PA (SE=2.0± 1.4) compared to the aorta (SE=4.7 ±1.1). \nEstimated Cmax (svc) was high: 18-72 mmol/L. However, no correlation \nbetween Cmax and SE was found. In the IVC, SE was 1.2± 0.5, resulting in \ninadequate visualisation. \nConclusion: First-pass TR-MRA of the cavo-pulmonary connection was \nsuboptimal due to a too high concentration in the SVC and resultant image \ndegrading T2* effects and low concentration in the IVC. Initial results \ndemonstrate improved visualisation when contrast injected was in the foot.  \nB-0748 11:33  \nPlacental diffusion MR imaging findings in intrauterine growth retardation  \nI. Çam1, Y. Anik1, E. Çaliskan1, S. Çaglayangil1, A. Yalniz1, T. Agirlar1, \nG. Anik Ilhan2, A. Demirci1; 1Kocaeli/TR, 2Istanbul/TR (isa.cam@mynet.com)  \nPurpose: To investigate diffusion-weighted MR imaging for the diagnosis of \nplacenta in patients with IUGR diagnosis. \nMethods and Materials:  The study included a total of 70 patients; 32 patients \nwith intrauterine growth restriction, diagnosed via US-Doppler, remaining were \nnon IUGR fetus. All patients were evaluated with diffusion MRI at 3 T MRI unit. \nROI values of b0, b1000 and ADC maps applied to the placenta were obtained. \nThe findings were compared with and without the diagnosis of IUGR. In \naddition, after birth, two groups' prenatal MRI measurements were correlated \nwith birth weights. \nResults: ADC values calculated from b0 and b1000 signal intensity values \nmeasured in the placenta in cases of IUGR were significantly decreased than \nthose without IUGR. IUGR infants' birth weights were significantly lower than \nthose without IUGR. There were significant correlations among prenatal and \nbirth weight with the diffusion MRI parameters. \nConclusion: Placental diffusion MRI examination can provide an important \ncontribution to the diagnosis of IUGR cases.  \nB-0749 11:42  \n3D ultrasound of the femoro-patellar articulation in newborns  \nE. Stranzinger, A. Bähler, J.T. Heverhagen, K. Ziebarth, H. Kohlhof; Berne/CH \n(enno.stranzinger@insel.ch)  \nPurpose: To establish a 3D ultrasound screening method of femoro-patellar \ndysplasia in newborns. \nMethods and Materials:  From 2012 to 2013, we prospectively imaged 160 \nconsecutive femoropatellar joints in 80 newborns from the 36 th to 6 1 st \ngestational week that underwent a hip sonography (Graf) and presented with a \ntype I hip. A paediatric radiologist performed the 3D ultrasound of the femoro-\npatellar joint in 30° flexion of the knee. Axial, coronal and sagittal reformats \nwere used to standardise a reconstructed axial plane through the femoral \ncondyle and the mid-patella. The sulcus angle, the lateral-to-medial facet ratio \nof the trochlea and the shape of the patella (Wiberg) were evaluated. \nResults: All 3D exams were diagnostic and feasible for reconstructions in a \nstandardised axial plane. The mean trochlea angle was 149.1° with ad STD of \n4.9°. There was no statistical difference between boys and girls. The lateral to \nmedial facet ratio of the trochlea ratio was 1.3 with a STD of 0.22. Wiberg type \nI patella was found in 95% of the babies and type II in 5%. \nConclusion: 3D ultrasound is a reliable technique to image the cartilaginous \nfemoro-patellar joint in newborns. The shape of the femoro-patellar articulation \nin newborns is already preformed in its adult form, which justifies this screening \nmethod for femoro-patellar dysplasia. Performing a 3D ultrasound with \nstandardised reconstructions of the axial plane allows sonographic \nmeasurements to be made. This may have the benefit of lower operator \ndependency.  \nB-0750 11:51  \nUltrasound and elastographic evaluation of the lower urinary tract in \npatients with hypospadia  \nC. Bruno, A. Bucci, R. Pozzi-Mucelli; Verona/IT (costanza_bruno@libero.it)  \nPurpose: To determine whether significant differences exist between patients \nwith hypospadia and normal subjects at conventional ultrasound (US) and \nelastography. \nMethods and Materials: 17 male children (age: 5-10 years) with mid-penile or \nanterior penile hypospadia and 11 age-matched normal subjects were enrolled. \nThe sagittal diameter of the corpus spongiosum, the sagittal and the \ntransversal diameters of the right corpus cavernosum and the angle between \nthe tangents to the medial surface of the two corpora cavernosa were \nmeasured on a transversal US scan on the ventral surface of the proximal \npenis. The length of the bladder neck and the thickness of the detrusor muscle \nwere also assessed. Real-time sonoelastography of the corpus spongiosum \nwas performed on a longitudinal scan at the ventral surface of the proximal \npenis; a semi-quantitative 3-point sc ale (1 = more, 3 = less elastic) was \nadopted. \nStatistical analysis was performed using the Mann-Whitney U test. \nResults: The patients with hypospadia with respect to the normal subjects had \nlower sagittal and transversal diam eters of the right corpus cavernosum, a \nwider inter-cavernous angle and a lower elasticity of the corpus spongiosum: \nall these differences were highly significant ( P < 0.001). The sagittal diameter \nof the corpus spongiosum was lower and the bladder neck longer in the \npatients' group ( P \n< 0.005), while no significant differences emerged as for the \nmean detrusorial thickness. \nConclusion: The patients with hypospadia are significantly different from \nnormal subjects at US evaluation of the corpora cavernosa, corpus \nspongiosum and bladder neck and at elastography of the corpus spongiosum.  \n10:30 - 12:00 Room P  \nContrast Media  \nSS 1306  \nSafety issues  \nModerators:  \nG. Heinz-Peer; St. Pölten/AT  \nY.W. Nielsen; Copenhagen/DK  \nB-0751 10:30  \nPrediction of chronic kidney disease as described in contrast-induced \nnephropathy prevention guidelines after contrast enhanced computed \ntomography: a cohort of 1000 patients  \nS.I. Moos, G. Nagan, R.S. de Weijert, D.N.H. van Vemde, J. Stoker, S. Bipat; \nAmsterdam/NL (s.i.moos@amc.uva.nl)  \nPurpose: Assessment of accuracy of predicting chronic kidney disease (CKD) \nin patients undergoing CECT. \nMethods and Materials:  Risk factors mentioned in CIN prevention guidelines \nwere assessed: diabetes mellitus (DM), history of urologic/nephrologic disease, \nnephrotoxic medication, cardiovascular disease, congestive heart failure, \nhypertension, anaemia, malignancy and kidney function (estimated glomerular \nfiltration rate (eGFR)). Association between combinations of risk factors and \nCKD (eGFR < 60 ml/min or < 45 ml/min) were studied by Chi\n2 test. False-\npositives (FP) and false-negatives (F N) were presented. We studied a \ncombination of: 1) all risk factors, 2) DM, history of urologic/nephrologic \ndisease, hypertension, age > 60 years; 3) DM, history of urologic/nephrologic \ndisease, nephrotoxic medication. \nResults: 998 patients, mean age 59.93 ±13.57 years.115 patients had eGFR \n< 60 ml/min and 31 < 45 ml/min. Combination 1 identified 816 patients: 108 \nwith eGFR <  60 ml/min (FN 7/FP 708/Odds-ratio 3.814) and all with eGFR \n< 45 ml/min (FP 785). Combination 2 identified 745 patients: 108 with eGFR \n< 60 ml/min (FN 7/FP 637/Odds-ratio 5.956) and all with eGFR < 45 ml/min (FP \n714)). Combination 3 identified 561 patients, 89 with eGFR < 60 ml/min (FN \n26/FP 472/Odds-ratio 2.981) and all with eGFR < 45 ml/min (FP 530). Of the \n26 FN patients with eGFR 45-60 ml/min, 6 had one risk factor (age > 75 \nyears/anaemia). All associations between eGFR and combinations were \nsignificant (p-values < 0.01). \nConclusion: Because of the proportion of FP, a combination of all risk factors \nis not accurate in predicting CKD. A less elaborate model seems more \naccurate and might also be more cost-effective.  \nS298  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0753 10:39  \nCIN or just fluctuations?  \nM. Azzouz1, J. Roemsing2, H. Thomsen1; 1Herlev/DK, 2Copenhagen/DK \n(henrik.thomsen@regionh.dk)  \nPurpose: To study fluctuations in estimated glomerular filtration rate (eGFR) in \nrelation to contrast medium (CM)-enhanced magnetic resonance imaging \n(MRI) and computed tomography (CT) compared to control groups in \noutpatients. \nMethods and Materials:  eGFR was determined right before the imaging \nprocedure and three days later at the department or at the patient's home. The \niodine-based and gadolinium-based contrast media were the same as used for \nall other examinations at the department. \nResults: A total of 716 patients completed the study. There was a statistically \nsignificant, but not clinically relevant rise in eGFR after three days in all four \ngroups. The average eGFR variation was 4.8 ml/min/1.73m\n2. There were large \nvariations in eGFR between the two measurements in 41% of the patients as \nthey had a change greater than ± 10 ml/min/1.73m2. Only three patients \nfulfilled the contrast-induced nephropathy (CIN) requirement when the \ndefinition s-creatinine \u0003 44 8mol/L was used. \nConclusion: eGFR in outpatients undergoing MRI or CT did vary \nindependently of whether the patient received contrast or not. The findings \nprobably reflect the natural variations in s-creatinine levels. This should be \ntaken into consideration when CIN is studied. The problem of CIN seems to be \noverestimated.  \nAuthor Disclosures: \nM. Azzouz: Equipment Support Recipient; Nova Biomedical sponsored the \nStatSensor Creatinine meter. J. Roemsing: Equipment Support Recipient; \nNova Biomedical sponsored the StatSensor Creatinine meter. H. Thomsen: \nEquipment Support Recipient; Nova Biomedical sponsored the StatSensor \nCreatinine meter. \nB-0754 10:48  \nEfficacy of questionnaire prior to contrast CT in predicting renal \nimpairment for patients older than sixty years of age  \nY. Li, K.K.-P. Lau; Melbourne/AU (jourenayyli@gmail.com)  \nPurpose: Contrast-induced-nephropathy (CIN) is a preventable condition. Pre-\nCT questionnaire was routinely used only on patients less than 60 years-of-age \nto reduce the incidence of CIN. Patients over 60 years-of-age commonly \nrequire pre-CT renal function tests. The aim of this prospective study was to \nassess the efficacy of pre-CT questionnaire in patients over 60 years-of-age in \npredicting renal impairment. \nMethods and Materials:  All consecutive outpatients older than 60-years-of-\nage, who underwent contrast enhanced CT over 9 months period, were \nrequired to complete questionnaires cont aining 14 risk factors for CIN. \nEstimated-glomerulofiltration-rate (eGFR) and serum creatinine level were \nobtained and results were compared. \nResults: A total of 922 patients were included (mean age: 71). 36.12% \npatients answered no risk factor. 37.2% patients had 1 risk factor and 26.68% \nhad \u00032 risk factors. All groups had similar patient demographics and disease \nprevalence. 103 (11.17%) patients had eGFR < 60, including 1.63% patients \nwith eGFR <  40. The questionnaire demonstrated an overall negative \npredictive value (NPV) of 96.7%. NPV was 97.6%, 97.5% and 91.7% for \npatients between 60-69, 70-79 and \u000380 years-of-age. NPV was 86.9% and \n80.9% respectively when there were 1 and \u00032 risk factors. Relationship \nbetween number of risk factors and severity of renal impairment was weak \n(correlation coefficient r=0.2393, p-value 0.0149). Kidney disease and \nmyeloma as risk factors had relatively higher correlation with renal impairment. \nConclusion: Negative pre-CT questionnaire is shown to be an effective \nscreening tool for renal impairment in patients over 60 years-of-age, hence, \nreduces the need and cost of performing renal function tests.  \nB-0755 10:57  \nCan a structured questionnaire identify patients with reduced renal \nfunction?  \nJ. Roemsing\n1, M. Azzouz2, H. Thomsen2; 1Copenhagen/DK, 2Herlev/DK \n(henrik.thomsen@regionh.dk)  \nPurpose: To evaluate the value of a structured questionnaire in identifying \noutpatients with renal dysfunction before MRI or CT examinations. \nMethods and Materials:  All patients completed a questionnaire with five risk \nfactors indicating renal dysfunction: renal disease, renal surgery, hypertension, \ngout and diabetes. S-creatinine determined by point of care (POC) technique \nand estimated glomerular filtration (eGFR) rate was calculated using CKD-EPI \nequation. \nResults: A total of 1467 patients were enrolled. Thirty-four (2%) patients had \nan eGFR < 30 ml/min/1.73m\n2 and 123 (8%) had an eGFR < 45 ml/min/1.73m2. \nAmong 55% patients reporting at least one risk factor, 30 (4%) had an \neGFR< 30 ml/min/1.73m2 and 105 (13%) had an \neGFR< 45 ml/min/1.73m2.Among 651 patients not reporting a risk factor, 4 \n(0.6%) had an eGFR < 30 ml/min/1.73m2 and 18 (3%) had an \neGFR< 45 ml/min/1.73m2. All 4 patients were >  70 years, and 12 of the 18 \npatients were > 70 years. Among 81 patients >  80 years, 33% had an \neGFR< 45 ml/min/1.73m2 and 16% of 368 patients were > 70 years. \nConclusion: The questionnaire used in patients < 70 years and determination \nof eGFR in patients > 70 years identified all patients with an eGFR between 30-\n45 ml/min/1.73m2 except 0.4%.  \nAuthor Disclosures: \nJ. Roemsing: Equipment Support Recipient; Nova Biomedical sponsored the \nStatSensor Creatinine meter. M. Azzouz: Equipment Support Recipient; Nova \nBiomedical sponsored the Statsensor Creatinine meter. H. Thomsen:  \nEquipment Support Recipient; Nova Biomedical sponsored the StatSensor \nCreatinine meter. \nB-0756 11:06  \nContrast induced nephropathy prevention guidelines: should we \ndetermine eGFR in all patients or in a selected group of patients based on \nrisk profile?  \nS.I. Moos, R.S. de Weijert, G. Nagan, J. Stoker, S. Bipat; Amsterdam/NL \n(s.i.moos@amc.uva.nl)  \nPurpose: To assess whether pre-selection by assessment of risk factors in \npatients before determining eGFR is more cost-effective compared to a \nstrategy where eGFR is determined in all patients undergoing CECT. \nMethods and Materials:  Patients were interviewed to assess risk factors and \ncosts. In our institute eGFR is evaluated in all patients, we considered a \ntenability of 12 months for eGFR, eGFR was available in all patients. For the \npre-selection strategy we extrapolated dat a by assuming equal distribution of \npatient characteristics between both strategies. \nResults: We included 1,001 patients, mean age 59.93 ± 13.57 years. Strategy \nwith eGFR in all patients: the number of patients in which eGFR was \ndetermined before CECT was 645/1,001. In this population 49 patients paid an \nextra visit to the hospital, 11 patients had to take a leaf of absence from work \nfor this visit. The total cost of this strategy was: 5766.05 euro. In the other 356 \npatients the eGFR was already known.Pre-selection strategy: 807/1,001 \npatients had risk factors, and eGFR determination was indicated. Based on the \nequal distribution, we assumed that 44 patients would have visited the hospital \nfor eGFR determination, 10 would have taken a leaf of absence. Total cost, \ninclusive eGFR determination in 807 patients would be: 6565.44 euro. No \npatients with an eGFR < 45 ml/min or eGFR < 60 ml/min and diabetes mellitus \nor > 1 other risk factor would have been missed by this strategy. \nConclusion: Determination of eGFR in all patients seems cost-effective when \ntenability for eGFR is applied.  \nB-0757 11:15  \nNSsaFe study: observational study on the incidence of nephrogenic \nsystemic fibrosis (NSF) in renal impaired patients following gadoteric \nacid administration  \nD. Verdries, C. Brussaard, L. Pipeleers, K. Francois, J. de Mey; Brussels/BE \n(douwe.verdries@uzbrussel.be)  \nPurpose: To prospectively estimate the incidence of NSF in patients with \nmoderate to severe renal impairment after administration of gadoteric acid. \nMethods and Materials: A worldwide post-marketing study being conducted to \ncollect safety data in 1,000 patients (adults and children) with moderate to \nsevere and end stage renal impairment, scheduled to undergo a routine \ncontrast-enhanced magnetic resonance imaging using gadoteric acid \n(DOTAREM®). Risk factors at inclusion, indications for MRI and occurrence of \nadverse events are recorded for each patient. Three follow-up visits are \nperformed between 3 and 27 months after MRI in order to detect any \noccurrence of NSF. \nResults: As of August 29, 2013, the cut-off date for the interim safety analysis, \nthe study included 309 patients (mean age: 69.6 years (range: 21-92); male, \n63.1%). Mean eGFR at inclusion was 35.8 ml/min/1.73m\n2 (range: 4.0-59.1) \nincluding 63.4% of moderate, 18.4% of severe, 14.9% of end stage renal \ninsufficiency or dialysis and 3.2% of kidney transplanted patients. The first \nfollow-up visit (between 3 and 12 months after MRI) was done for 128 patients, \nthe second follow-up visit (between 13 and 21 months after MRI) was done for \n42 patients. Only 2 patients (0.6%) had serious adverse events not related to \ngadoteric acid. No NSF occurred. \nConclusion: This interim safety analysis confirms the very good safety profile \nof gadoteric acid in renal impaired patients.  \n \nS299  \n\n \n \nBA C D E F G \nSunday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0758 11:24  \nTolerability and diagnostic effectiveness of gadoteric acid (Gd-DOTA): \nuse in daily routine and in patients with diminished kidney function  \nM. Maurer1, M. Wolf2, O. Heine3; 1Berlin/DE, 2Püttlingen/DE, \n3Sulzbach/DE (martin.maurer@charite.de)  \nPurpose: To investigate the tolerability and diagnostic effectiveness of Gd-\nDOTA (Dotarem®, Guerbet, Roissy, France) in routine clinical use and in \npatients with impaired kidney function. \nMethods and Materials:  Between January 2011 and July 2013, 32,286 \npatients (44.7% male, 55.3% female, mean age 52.0± 17.0 years) underwent \ncontrast-enhanced MRI (Gd-DOTA, mean volume 15.7 ml) in 43 German \ncenters, including neurological examinations (48.7%), musculoskeletal \nexaminations (30.7%) and examinations of the internal organs (13.2%). 26.8% \nof patients were at-risk patients including patients with allergies (16.7%) and a \nprevious reaction to contrast media (0.4%). In 854 patients (2.6%), eGFR was \n< 90 ml per minute. Imaging quality (assessed on a 5-point scale: \nexcellent/good/moderate/poor/very poor) and diagnostic effectiveness were \nassessed for each individual examination. Adverse reactions and serious \nadverse reactions were documented. \nResults: Adverse reactions occurred in 110 out of 32,286 patients (0.3%), \ngenerally involving gastrointestinal disorders (0.2%) or skin and subcutaneous \ntissue disorders (0.1%). In 5 patients (0.015%), the adverse reactions were \nserious. All patients with adverse reactions recovered after the examination. \nNo adverse reactions were observed in the 854 patients with an eGFR < 90 ml \nper minute. A diagnosis was possible in 99.9% of all examinations. Image \nquality was rated excellent or good in 98.5% of all examinations, moderate in \n1.4% and poor in 0.1%. \nConclusion: In routine clinical use, Gd-DOTA has proved to be a safe contrast \nmedium, including in patients with an eGFR < 90 ml per minute, which enables \nMRI examinations to be performed with high diagnostic effectiveness.  \nAuthor Disclosures: \nM. Maurer: Consultant; Guerbet GmbH. O. Heine: Employee; Guerbet GmbH. \nB-0759 11:33  \nSECURE study: observational post-marketing study on the safety of \ngadoteric acid  \nM. Hackenbroch, D. Maintz; \nCologne/DE (Matthias.Hackenbroch@uk-koeln.de)  \nPurpose: To prospectively assess the safety profile of gadoteric acid and the \noverall incidence of nephrogenic systemic fibrosis (NSF). \nMethods and Materials: An ongoing worldwide post-marketing study (PMS) is \nconducted to collect safety data in 40,000 patients (adults and children) with or \nwithout renal insufficiency, scheduled to undergo a routine contrast-enhanced \nmagnetic resonance (MR) imaging using gadoteric acid (Dotarem®). Risk \nfactors at inclusion, indications for MR imaging, conditions of the contrast \nmaterial administration and occurrence of adverse events are recorded. For \nany patient identified with renal impairment at the time of inclusion (i.e., \nestimated creatinine clearance or estimated glomerular filtration rate \n< 60 mL/min/1.73 m²), a follow-up is performed after at least 3 months in order \nto detect any suspicion or occurrence of NSF. \nResults: The latest interim safety analysis of this ongoing PMS included data \non 29,689 patients (mean age: 50 years; range: 0-98 years; female: 53.4%). \nMR examinations were mainly performed to image the central nervous system \n(55.1%). The main risk factors were renal insufficiency (12.7%) and \nhypertension (11.8%). Moderate to severe impaired renal function was \nreported in 552 patients (1.9%). Among them, 391 (70.8%) were reported \nwithout suspicion of NSF during the 3-month follow-up. For the remaining \npatients (29.2%), the follow-up evaluation was not yet reported at the time of \ndata analysis. Twenty-eight patients ( < 0.1%) had at least one adverse event \n(mainly nausea, urticaria, vomiting, fever and multiorgan failure syndrome). \nConclusion: This interim safety analysis already confirms the very good safety \nprofile of gadoteric acid.  \nAuthor Disclosures: \nM. Hackenbroch: Grant Recipient; Travel grant. \n \n \n \nB-0760 11:42  \nEffect of contrast agent temperature on aortic enhancement profile in CT \nangiography: a phantom study  \nM. Benz1, J. Froehlich2, U. Würtemberger1, G. Stadelmann1, J. Janetzki1, \nU. von Baer3, G.M. Bongartz1, S. Schindera1; 1Basle/CH, 2Zurich/CH, \n3Ulm/DE (matthias.r.benz@gmail.com)  \nPurpose: To analyse the effect of iodinated contrast agent temperature on \naortic enhancement characteristics in CT-angiography. \nMethods and Materials:  A custom made physiologic flow-phantom was \ndesigned to simulate the cardiovascular system in a medium-sized patient. \n70 ml of two contrast agents (agent A, iobitridol, Xenetix 300, Guerbet and \nagent B, iomeprol, Iomeron 400, Bracco) were administered at rates of 4 and \n6 ml/s (CT-Motion, Ulrich Medical) at three different temperatures (22 °C, \n30 °C, and 37 °C). At 37 °C, the viscosity of agent A and agent B are 6.0 \nmPa.s and 12.6 mPa.s. The phantom was scanned with 100 kVp and 200 mAs \n(Somatom Definition Flash, Siemens). Dynamic CT-images were acquired after \ncontrast agent injection with 1 image per second for 50 seconds. Peak aortic \nenhancement (PAE) and the duration of aortic enhancement \u0003 200 HU were \nrecorded. \nResults: For agent A the PAE at 22 °C, 30 °C and 37 °C measured 237, 231, \nand 235 HU, at a flow rate of 4 ml/s, and 297, 320, and 321 HU at a rate of \n6 ml/s, respectively. Corresponding PAE measurements for agent B were 308, \n312, and 310 HU, at a flow rate of 4 ml/s, and 422, 418, and 424 HU at a flow \nrate of 6 ml/s, respectively. The duration of aortic enhancement \u0003 200 HU was \ndependent on iodine concentration (9 to 10s for agent A, and 12 to 14s for \nagent B), but independent of contrast media temperature. \nConclusion: CT contrast agent temperature does not impact the aortic \nenhancement profile in CT-angiography.  \nAuthor Disclosures: \nJ. Froehlich: Employee; Guerbet AG. U. von Baer: Employee; Ulrich \nMedical. S. Schindera: Equipment Support Recipient; Ulrich Medical. \n \n \nS300  \n\n \n \nBA C D E F G \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n \n\u000f\u001a\u0019\u0014\u0012\u001f\u0002\u0001\u000f\u0012\u001b\u0013\u0017\u0001\u0005\u0004\u0001\nS301  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n10:30 - 12:00 Room B  \nAbdominal Viscera  \nSS 1701  \nFunctional MR of the liver  \nModerators:  \nB.I. Choi; Seoul/KR  \nH.J. Michaely; Mannheim/DE  \nB-0761 10:30  \nNon-invasive differentiation between simple steatosis and steatohepatitis \nusing gadoxetic acid-enhanced MRI in patients with non-alcoholic fatty \nliver disease: a feasibility study  \nN. Bastati-Huber; Vienna/AT (nina.bastati-huber@meduniwien.ac.at)  \nPurpose: To determine whether gadoxetic acid-enhanced MRI can be used to \ndistinguish between simple steatosis (S IS) and non-alcoholic steatohepatitis \n(NASH) in non-alcoholic fatty liver disease (NAFLD) patients defined according \nto the Steatosis Activity Scoring system (SAF). \nMethods and Materials:  This was a retrospective study of gadoxetic acid-\nenhanced 3-Tesla MRI performed on 81 consecutive patients with suspected \nNAFLD [45 (56%) males (mean age 56y, range: 25-78)]. Patients were \nclassified as SIS or NASH using the SAF score based on the semiquatitative \nscoring of steatosis, activity and liver fibrosis. The MR images were analysed \nusing the relative liver enhancement measured as the ratio of signal intensities \nof the liver parenchyma before and 20 minutes after intravenous administration \nof gadoxetic acid. Univariate and multivariate regression analyses were applied \nto identify variables associated with relative enhancement measurements, and \nthe performance of relative enhancement values was assessed for the \ndifferentiation between SIS and NASH using the area under the receiver \noperating characteristic curve (AUC) analysis. \nResults: Testing the relationship between enhancement measurements and \nhistology, relative enhancement values correlated strongly with lobular \ninflammation (r=-0.59, p= < 0.001), ballooning (r=-0.44, p= < 0.001), and fibrosis \n(r=-0.59, p= < 0.001), but not with steatosis (r=-0.15, p=0.15). In multivariate \nanalysis, all three histological parameters were independently associated with \nthe relative enhancement. The measurements performed well for the \ndifferentiation between SIS and NASH, with an AUC of 0.85, [cutoff=1.24, \n(Sesitivity=97.1%, Specificity =63%)]. \nConclusion: Gadoxetic acid-enhanced MRI may be used as a non-invasive \ndiagnostic tool to distinguish between SIS and NASH in NAFLD patients.  \nB-0762 10:39  \nMRI-proton spectroscopy in diognosis of NADFL  \nM. Sharia, G. Shirjaev; Moscow/RU (greshnic13@yandex.ru)  \nPurpose: Purpose of our study is to determine the possibilities of MRS for the \ndiagnosis of fatty liver and monitoring the effectiveness of treatment. \nMethods and Materials:  We investigated 85 patients (44 men, 41 women), \nmean age was 48 ± 11 years. The studied group consisted of two sub-groups: \nhealthy volunteers (15 men) and patients with non-alcoholic fatty liver disease, \ndiagnosed according to clinical examination (60 patients). In the group of \npatients MRS was performed twice: before treatment and six months after it \nbegan. The study was conducted on MRI scanner with magnetic field strength \nof 3 T, using a 32-channel coil. According these images the navigation of \nspectroscopic voxel (single voxel MRS, voxel size 20x20x20 mm) was done in \nthe fifth segment of the liver. We used the protocol: TE - 50 ms, TR - 2000 ms, \nthe spectral range - 2000, Samples - 1024. Calculation was done for each \npatient according to the formula of lipid concentration.s. (Lip) / S (H20) × 100. \nResults: In the group of patients lipid concentration in 45 cases was measured \nand draws up to more than 10%. the diagnosis of NAFLD was eliminated. At \nthe second examination (as a result of lipid-lowering therapy and diet) in 34 \npatients were detected reduction in the concentration of fat to normal values. \nConclusion: MRS could be used as an additi onal criterion for the diagnosis \nand assessment of treatment of NAFLD, especially in cases when carrying out \nliver biopsy is not possible.  \nB-0763 10:48  \nAssociation between central obesity and liver iron: a non-invasive \nassessment in general population by magnetic resonance imaging  \nA. Radmard, A. Abrishami, M. Gerami Seresht, M. Dadgostar, A. Yoonessi, \nA. Hashemi Taheri, H. Poustchi, S. Merat, R. Malekzadeh; Tehran/IR \n(amir.radmard@gmail.com)  \nPurpose: Existing evidence suggests an altered iron metabolism in obesity. \nPublished data evaluating association of he patic iron with obesity are lacking. \nWe aimed to investigate whether central obesity is independently associated \nwith liver iron content in general population using non-invasive assessment by \nMRI. \nMethods and Materials:  The study was carried out on 202 subjects randomly \nselected from general population, aged 50-77 years, who underwent \nabdominal MRI (1.5 T) including multiechoT2*-weighted sequence of liver. \nQuantitative T2* maps of entire cross-sectional area of liver was calculated on \na pixel-by-pixel basis using a semi-automated software to measure mean T2* \nof whole liver. Visceral and subcutaneous fat areas were measured by two \nexaminers in axial T1-weighted images at the level of umbilicus. \nResults: There was no significant difference in mean values of T2* between \nobese (BMI > 30 kg/m\n2) and non-obese (BMI \u000230 kg/m2) subjects. After \ncontrolling for other covariates including age, BMI, ferritin, hemoglobin, FBS, \nHBA1c and steatosis no statistically  significant association was detected \nbetween liver T2* values and visceral and subcutaneous fat areas in men and \nwomen. Likewise, the association between liver T2* values and ratio of visceral \nto subcutaneous fat was not demonstrated in multivariable analysis. \nConclusion: Central obesity indices are not correlated with estimated liver iron \ncontent in MRI. This study could not support the hypothesis of probable hepatic \niron release due to obesity-related biomarkers. The relationship, if it exists, \nshould be investigated in the future studies.  \nB-0764 10:57  \nThe feasibility of texture analysis using susceptibility-weighted magnetic \nresonance imaging in detecting patients with liver cirrhosis  \nD.S. Feier1, T. Knogler2, M.E. Mayerhoefer2, C. Balassy2, A. Ba-Ssalamah2; \n1Cluj-Napoca/RO, 2Vienna/AT (diana.feier@gmail.com)  \nPurpose: To establish the feasibility of textural features of liver parenchyma \nobtained on susceptibility weighted magnetic resonance imaging (SWI MRI) \nwhich will enable the detection of liver cirrhosis in patients with diffuse chronic \nliver diseases (CLD). \nMethods and Materials:  Sixty-five patients (mean age, 51.65 years; 60% \nmales) with CLD and histologically proven liver fibrosis (evaluated according to \nthe Metavir scoring) were included in a retrospective manner and grouped in \npatients with (F4 Metavir, n=27, 42%) and without (F0-F3 Metavir, n=38, 58%) \nliver cirrhosis. All patients underwent 2D multislice breath-hold SWI sequence \non a 3 T MRI unit and the imagines were used for texture analysis. Texture \nfeatures derived from the grey-level histogram, the co-occurrence matrix, the \nrun-length matrix, the absolute gradient, the autoregressive model, and the \nwavelet transform were calculated for the ROIs. Fisher coefficients were \ncalculated to determine which texture features were best suited for \ndistinguishing between no-cirrhosis and ci rrhotic liver tissue. Based on the ten \nbest-suited texture features, linear discriminant analysis was performed, and a \nk-nearest neighbor (k-NN) algorithm was used for disease classification. The \nclassification accuracy, sensitivity and specificity were used as primary and \nsecondary outcome measures. \nResults: Six out of ten texture features selected on the basis of Fisher \ncoefficients were derived from grey-l evel histogram. Of the 65 patients \nincluded, 62 (95.38%) were classified correctly by k-NN. Sensitivity was 96.3% \nand specificity was 94.7%. \nConclusion: Texture features extracted from the grey-level histogram are \nfeasible to correctly identify cirrhotic changes in liver parenchyma of patients \nwith CLD.  \nB-0765 11:06  \nUnenhanced MRI of the liver: morphology assessment on diffusion-\nweighted images has additional diagnostic value to quantitative apparent \ndiffusion coefficient (ADC) measurements  \nP.A.T. Baltzer\n1, M. Dietzel2, W.A. Kaiser3; 1Vienna/AT, 2Erlangen/DE, \n3Jena/DE  \nPurpose: Diffusion-weighted imaging (DWI) is regularly applied as an \nadditional contrast for detection and charac terisation of focal liver lesions (FLL) \nin MRI of the liver. Besides quantitative information by means of apparent \ndiffusion coefficient (ADC) measurements, DWI images do also provide \nmorphological information. We investigated whether diagnostic accuracy for \ndifferentiation of FLL could be improved by adding visual interpretation of DWI \nimages to quantitative ADC measurements. \nMethods and Materials: Consecutive patients with suspected liver metastases \nwithout prior treatment were examined using breathhold EPI-DWI (TR/TE: \n2100/62 ms, 2 b values). A blinded radiologist ( > 8years MRI experience) \nassessed morphological criteria such as lesion border (smooth vs irregular) \nand internal structure (homogeneous vs heterogeneous) on DWI images. \nAdditionally, ADC values were measured by means of regions of interest. The \nradiologist assigned a diagnostic rating on a 5-point confidence scale (1: \ndefinitive benign to 5: de finitive malignant). Diagnostic accuracy of ADC and \nqualitative assessment were compared by means of ROC analysis. \nResults: Eighty-nine FLL were detected using DWI (50 malignant and 39 \nbenign). Diagnostic accuracy of ADC-values was significantly lower (0.895, \n95% CI 0.812-0.950) as compared to additive assessment of morphological \ncriteria on DWI images (0.941, 95% CI 0.870-0.980; P <  0.05) \nS302  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nConclusion: In unenhanced MRI of the liver, diagnostic accuracy of DWI \ninterpretation could be improved compared to quantitative ADC measurements \nby integration of morphological criteria on DWI images as interpreted by an \nexperienced radiologist.  \nB-0766 11:15  \nSteatosis quantification: comparison MRI vs histology in rat model using \ntotal intrahepatic triglycerides as reference  \nL.-M. Leiber, J. Boursier, S. Michalak, V. Roullier, L. Fizanne, J. Roux, \nY. Gallois, C. Aube; Angers/FR (lm.leiber@gmail.com)  \nPurpose: To evaluate the steatosis quantification by MRI in a murine model \nand compare it to histological quantifi cations using semi quantitative visual \nanalysis or automated surface analysis. \nMethods and Materials:  Eleven groups of two rats undergo a choline \nmethionine deficient diet. An 1.5 T MRI was carried out at day 0, 2, 4, 5, 6, 7, 8 \nand week 2, 3, 4, 5. Using a phased-array surface coil, an EG T1 in and out \nphase multi echo sequence, without cardiac or respiratory synchronisation, \nwas performed. Steatosis was calculated with the 3 echo method. Histological \nquantifications were performed both by visual evaluation of the percentage of \nfatty hepatocytes and by an automated measurement of the steatosis area \n(AOS). The reference was the total intrahepatic triglycerides (TIT) \nconcentration. \nResults: A steatosis without inflammation was obtained with an amount \nproportional to the duration of the diet. Correlations with TIT were better for \nMRI than for AOS and for histological quantification (RSpearman respectively \nr=0.897 r=0.889, r=0.753 p < 0.0001). Analysis of intra-class correlation \ncoefficient was better for MRI than for AOS which tends to overestimate the \nsteatosis (ICCC=0.889 versus ICCC=0.629). For visual histological \nquantification ICCC was low (0.280). In multivariate analysis, only MRI was \nidentified as independent predictor of liver TIT. \nConclusion: MRI is reliable, easy, fast and superior to histological techniques \nfor the assessment of hepatic steatosis in a murine model.  \nB-0767 11:24  \nThe effect of echo times on the accuracy of susceptibility weighted \nmagnetic resonance imaging in staging liver fibrosis  \nC. Balassy1, D. Feier2, F. Wrba1, S. Witoszynskyj1, A. Ba-Ssalamah1; \n1Vienna/AT, 2Cluj-Napoca/RO (csilla.balassy@meduniwien.ac.at)  \nPurpose: To assess the effect of echo-sampling on the accuracy of magnetic \nresonance (MR) susceptibility-weighted imaging (SWI) to detect and stage liver \nfibrosis in patients with chronic liver  diseases (CLD), using histology as \nreference. \nMethods and Materials:  Sixty-eight patients were included. SWI was \nperformed with two different echo times (TE), 2.5 ms and 10 ms. Signal \nintensity (SI) of the liver and spinal muscle was measured and liver-to-muscle \nsignal intensity ratios were calculated . Diagnostic performance of both LMR in \nstaging liver fibrosis was assessed using sensitivity (Se%), specificity (Sp%) \nand area under receiver operating characteristics (AUROC) analysis. \nResults: Histology resulted F0 (n=13), F1 (n=6), F2 (n=8), F3 (n=12), F4 \n(n=28). Both 2.5TE LMR and 10TE LMR correlated strongly with liver fibrosis \n(r=-0.74, p < 0.0001 and r=-0.84, p < 0.0001, respectively). Diagnostic \nperformance of LMR at 2.5 TE was very good, with an AUROC of 0.85 \n(Se=90.7%, Sp=76.9%) for stages \u0003F1, 0.88 (Se=95.8%, Sp=73.7%) for \nstages \u0003F2, 0.90 (Se=92.5%, Sp=74.1%) for stages \u0003F3 and 0.89 (Se=85.7%, \nSp=82.1%) for liver cirrhosis diagnosis (F4). Diagnostic accuracy improved \nwhen the TE was increased to 10 ms, reaching an AUROC of 0.96 (Se=96.3%, \nSp=100%) for stages \u0003F1, 0.95 (Se=100%, Sp=78.9%) for stages \u0003F2, 0.94 \n(Se=85%, Sp=92.6%) for stages \u0003F3 and 0.92 (Se=92.9%, Sp=76.9%) for F4 \ndiagnosis. MecNemar tests revealed a sta tistically significant difference \nbetween the two parameters regarding the diagnosis of early fibrosis (stages \n\u0003F1, p < 0.0001). \nConclusion: SWI is a promising non-invasive tool to detect and stage liver \nfibrosis in CLD patients, having increased accuracy with higher TE values.  \nB-0768 11:33  \nDWI of liver lesions: IVIM model with different combination of 11 b values  \nG. Morana1, G. Scattolin2, R. Zanato2, F. De Leo1; 1Treviso/IT, 2Padova/IT \n(gmorana61@gmail.com)  \nPurpose: Purpose of this study was to investigate diffusion coefficients \nevaluated with intravoxel incoherent motion (IVIM) model in liver lesions, in \ntheir different parameters: apparent di ffusion coefficient (ADC), perfusion \nfraction (f), diffusion and pseudodiffusion coefficient (D and D*). Moreover, we \ntried to calculate the optimal b values to be utilised in their analysis. \nMethods and Materials:  Retrospective study of 96 patients undergoing MR \nwith DWI between June 2011 and September 2012 with diagnosis of HCC \n(n=28), colorectal carcinoma metastasis (CCM) (n=24) or FNH (n=44). MR \nexaminations were performed on a 1.5-T scanner (Siemens_Avanto) and DWI \nsequence was EPI (TR/TE=4361/54 ms) with 11 b-values. Using MatLab, the \nestimations of D, D* e f were carried out for different combination of b-\nvalues:C1,C2,C3. Statistics Analysis: scatter plot; 2 sample t test; Kruskal-\nWallis test. \nResults: ADC and D values were not significantly different between lesions. D* \nand f were not significantly different between HCC (160x10-3 mm2/sec; 22% \nrespectively) and FNH (114x10-3 mm2/sec; 18%), whereas were significantly \nhigher than in CCM (81x10-3 mm2/sec;8%) (p < 0.05).͒With lesser b values \n(C2,C3) D* shows a significant (p < 0.05) decrease in HCC (88x10-3 mm2/sec) \nwhile does not show significantly decrease in FNH and in CCM, thus loosing \nthe difference between the above groups. f does not show a significantly \ndecrease in the above groups,thus maintaining the statistical difference. D \ndoes not change. f in background liver parenchyma were not significantly \ndifferent between HCC (21%), FNH (22%) and CCM (20%). \nConclusion: IVIM data are dependent of b values being utilised. The D* and f \nvalues are useful for the characterisation of hyper (HCC; FNH) and \nhypovascular lesions (CCM). A standardisation of techniques is necessary in \norder to compare results between different studies.  \nB-0769 11:42  \nAccuracy of ultrasound in the assessment of liver fat: an MRI correlation \nstudy  \nP.-O. Behrndt, M. Habes, H. Völzke, J. Mayerle, K. Hegenscheid, J.-P. Kühn; \nGreifswald/DE (kuehn@uni-greifswald.de)  \nPurpose: To investigate the accuracy of ultrasound in the assessment of liver \nfat using chemical shift encoded confounder corrected magnetic resonance \nimaging (MRI) as standard of reference. \nMethods and Materials:  In the context of a population-based screening, 1122 \nvolunteers, 558 women, 564 men with a mean age of 53.0 ±13.7 years, \nunderwent liver MRI (1.5 T, Avanto; Siemens Healthcare) and ultrasound (Vivid \nI; GE-Healthcare; 3.6Mhz transducer). Liver ultrasound was performed by \ncertified observers evaluating the presence of liver steatosis subjectively. In \naddition, percentage of liver fat content was assessed using a R2*-,T1-,multi-\npeak fat-corrected chemical shift MRI. Sensitivity, specificity and area under \nthe curve (AUC) were calculated for ultrasound compared to MRI as reference \nfor all subjects and for subjects with ranges of the liver fat content separately. \nResults: With MRI frequency of liver steatosis was 39.5%(443 subjects) in the \ngeneral population: 304 (69%) subjects with mild, 121 (27%) and 18 (4%) \nsubjects with moderate and high liver fat content, respectively. In contrast, with \nultrasound frequency of liver steatosis was lower 32% (359 subjects). All over \nsensitivity, specificity and AUC for the assessment of liver steatosis by \nultrasound were 0.65, 0.90, and 0.77, respectively. While the specificity of \nultrasound was not affected by liver fat content (mild, moderate, high fat \ncontent: 0.89, 0.89, 0.90) the sensitivity (0.54, 0.88, 0.94) and AUC (0.71, 0.89, \n0.92) increased with the amount of liver fat. \nConclusion: Ultrasound is a moderate approach to assess liver fat. The \nweakness of ultrasound in the assessment of liver fat, especially in subjects \nwith mild steatosis should be considered.  \nB-0770 11:51  \nAssessing liver function by liver enhancement during the hepatobiliary \nphase with Gd-EOB-DTPA-enhanced MRI at 3 Tesla  \nN. Verloh, M. Haimerl, F. Zeman, M. Schlabeck, C. Stroszczynski, C. Fellner, \nP. Wiggermann; Regensburg/DE (niklas.verloh@stud.uni-regensburg.de)  \nPurpose: The purpose of this study was to evaluate the usefulness of Gd-\nEOB-DTPA-enhanced 3 T MRI to determine the hepatic functional reserve \nexpressed by the MELD score. \nMethods and Materials:  150 consecutive patients underwent contrast-\nenhanced MRI with liver specific contrast media at 3 T. Patients were \nsubdivided into two groups: 121 patients with a MELD score lower than or \nequal to 10 (normal liver function, NLF) and 29 patients with a MELD Score \nhigher than 10 (impaired liver function, ILF). T1-weighted volume interpolated \nbreathhold examination (VIBE) sequences with fat suppression were acquired \nbefore and 20 minutes after contrast injection. Relative enhancement (RE) \nbetween plain signal intensity and contrast-enhanced signal intensity was \ncalculated and was used to determine and compare Gd-EOB-DTPA uptake \ninto the liver parenchyma for patients with different MELD scores. \nResults: RE differed significantly (p \u0002 0.001) between patients with normal \nliver function (NLF, MELD score \u0002 10) (87.20% ± 29.50%) and patients with \nimpaired liver function (ILF, MELD score > 10) (45.44% ± 26.52%). Cut-off \nvalues regarding the RE to differentiate NLF from ILF was 47.7% (AUC: 0.87). \nThis cut-off value showed a sensitivity of 82.8% and a specificity of 92.7% \nregarding the differentiation of the analysed groups. \nConclusion: Gd-EOB-DTPA uptake into hepatocytes is strongly affected by \nliver function. In conclusion, Gd-EOB-DTPA-enhanced MRI and assessment of \nrelative enhancement during the HBP may serve as a useful image-based test \nin liver imaging for determining regional and global liver function.  \nS303  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n10:30 - 12:00 Room C  \nCardiac  \nSS 1703  \nCoronary artery imaging with CT  \nModerators:  \nL. Natale; Rome/IT  \nF. Wolf; Vienna/AT  \nB-0771 10:30  \nEffect of reduced x-ray tube voltage, low iodine concentration contrast \nmedium and iterative reconstruction on image quality and radiation dose \nat coronary CT angiography: results of the prospective multicentre \nREALISE trial  \nA.D. McQuiston\n1, W.-H. Yin2, U.J. Schoepf1, J.-B. Gao3, P.-L. Li4, K. Sun5, \nZ.-F. Wu6, F.G. Meinel1, B. Lu2; 1Charleston, SC/US, 2Beijing/CN, \n3Zhengzhou/CN, 4Shenyang/CN, 5Baotou/CN, 6Taiyuan/CN \n(mcquisa@musc.edu)  \nPurpose: To assess the effect of reduced x-ray tube voltage, low iodine \nconcentration contrast medium and iterative reconstruction on image quality \nand radiation dose at coronary CT angiography (CCTA). \nMethods and Materials:  231 consecutive patients with suspected coronary \nartery disease were prospectively randomised to one of two dual-source CCTA \nprotocols: 120-kVp, 370 mgI/mL iopromide or iopamidol, and filtered back \nprojection (n=116; 44 women; 55.3 ±9.8 years); or 100-kVp, 270-mgI/mL \niodixanol, and iterative reconstruction (n=115; 48 women; 54.2 ±10.4 years). \nAttenuation in the ascending aorta and coronary arteries along with image \nnoise was measured. Signal-to-noise ratio (SNR) and contrast-to-noise ratio \n(CNR) were calculated. Image quality was scored on a five-point scale for each \ncoronary segment. Size-specific dose estimates and effective doses were \ncalculated. Data were compared using Student's t test and <\n2 test. \nResults: There were no statistically signifi cant differences in mean arterial \nattenuation (406.6± 76.7 vs. 410.6 ±67.0 HU, p=0.673), image noise (18.7 ±3.8 \nvs. 17.9± 3.4 HU; p=0.141), SNR (22.5± 5.4 vs. 23.7 ±6.1; p=0.108), CNR \n(37.1±14.7 vs. 38.1 ±15.2; p=0.609) or image quality scores (4.1 ±0.9 vs. \n4.0±0.9; p=0.179) between the 120 and 100-kVp protocols. Mean iodine dose \nwas 26.5% lower (18.3 ±0.5 vs. 24.9 ±0.9 g; p < 0.0001) and mean effective \ndose was 34.9% lower (2.3 ±1.0 vs. 3.5 ±1.1 mSv; p < 0.0001) with the 100 kVp \ncompared with the 120-kVp protocol. \nConclusion: Using low x-ray tube voltage and iterative reconstruction allows \nfor decreasing the iodine load and effective radiation dose at CCTA while \nmaintaining image quality.  \nAuthor Disclosures: \nU.J. Schoepf: Consultant; UJS is a consultant for and / or receives research \nsupport from Bayer, Bracco, GE, Medrad and Siemens. Grant Recipient; GE \nHealthcare provided grant support and supplied contrast material for this \nstudy.  \nB-0772 10:39  \nInfluence of iodinated contrast agents on heart rate variability during CT \nangiography of the coronary arteries: a prospectively randomised study  \nC. Loewe, L. Reider, V. Schöpf, S. Unterhumer, D. Beitzke, F. Wolf, \nJ. Lammer; Vienna/AT (christian.loewe@meduniwien.ac.at)  \nPurpose: To assess the influence of different contrast agents on heart rate \nvariability during CTA of the heart. \nMethods and Materials:  207 patients (95 women) referred for cardiac CTA to \nrule out CAD and at a baseline heart rate below 70 were consecutively \nenrolled. CTA was performed after randomisation either during administration \nof Iodixanol (n=101) or Iomeprol. Patients were divided into three groups \naccording to their body weight. In all patients within same body weight group \nsame iodine delivery rate was used. Heart rates were recorded with a mobile \nheart rate monitor before, while and after contrast media administration. \nContrast enhancement was evaluated at four predefined anatomical regions. \nResults: While both contrast agents raise mean heart rates within 60 seconds \nafter injection, iomeprol elevates heart rates earlier and to higher levels with a \npeak heart rate change of 13 bpm (iodixanol 7 bpm). 33 seconds after start of \ncontrast administration iomeprol was found to induce significantly higher heart \nrate increases when compared to iodixanol. In the group of patients with body \nweight between 50 and 100 kg (n=177), differences in heart rates became \nsignificant within 18 seconds after start of contrast injection. There was no \ndifference in arterial contrast enhancement between the two agents. \nConclusion: Iodixanol showed less influence on heart rate during cardiac CTA \nwhen compared to Iomeprol. The difference of heart rate increase between the \ntwo agents becomes significant after 18 seconds in most of the patients (and \nafter 33 seconds in all patients).  \n \nB-0773 10:48  \nHemodynamic significance of coronary stenosis by vessel attenuation \nmeasurement on CT compared with adenosine perfusion MRI  \nM.A.M. den Dekker, G. Pelgrim, K.G.O. Ike, G. Pundziute, \nE.R. van den Heuvel, M. Oudkerk, R. Vliegenthart; Groningen/NL \n(m.a.m.Dekker@umcg.nl)  \nPurpose: Corrected contrast opacification (CCO) calculation is a new \ntechnique based on coronary computed tomography angiography (cCTA) data, \nestimating the effect of stenosis on coronary flow. We assessed the \nassociation between CCO and inducible ischemia by adenosine perfusion \nmagnetic resonance imaging (APMRI). \nMethods and Materials:  Sixty cardiac asymptomatic patients with extra-\ncardiac arterial disease (mean age 64.4 ±7.7 years;78% male) underwent cCTA \nand APMRI. Luminal CT attenuation values (Hounsfield Units) were measured \nin coronary arteries from proximal to  distal. Additional measurements were \nperformed in arteries with significant, > 50% lumen stenosis. CCO was \ncalculated by dividing coronary CT attenuation by descending aorta CT \nattenuation at equal level. Decreases in CCO across the coronary artery and \nacross stenosis were calculated, and compared with presence of inducible \nischemia on APMRI using regression analysis. \nResults: In total, 169 coronary stenoses were found. Seven patients had 8 \nperfusion defects on APMRI, with 11 stenoses in the corresponding coronary \narteries. Baseline characteristics did not differ between patients with and \nwithout perfusion defect. Median CCO for normal coronary arteries was 1.075 \n[25\nth,75th percentile:0.978.1.169] at the origin, and 1.021 [0.876.1.142] at the \ndistal segment. Difference in CCO across stenosis was significantly larger in \npatients with perfusion defect than in those without (0.144 ±0.112 \nvs.0.047±0.104,respectively;P=0.003). No difference was found between \npatients with anatomically significant stenosis and those without (0.054 ±0.116 \nvs.0.052±0.101;P=0.89). \nConclusion: Decrease in CCO across coronary stenosis is associated with \nmyocardial ischemia on APMRI. CCO is a novel method to assess the \nhemodynamic significance of a stenosis, based on common cCTA data.  \nB-0774 10:57  \nCT coronary angiography: effect of iodine concentration on vascular \nattenuation: the CT-CON multicentric study preliminary results  \nM. Rengo1, A. Dharampal1, M. Das2, M. Kock3, A. Niezen4, F. van Tilborg5, \nD. Caruso1, K. Nieman4, G.P. Krestin4; 1Rome/IT, 2Maastricht/NL, \n3Dordrecht/NL, 4Rotterdam/NL, 5Tilburg/NL (marco.rengo@gmail.com)  \nPurpose: To explore the relative impacts of iodine concentration versus iodine \ndelivery rate on intracoronary attenuation. To describe the effect of iodine \nconcentration on contrast bolus characteristics. \nMethods and Materials:  675 patients were prospectively randomised in 4 \ngroups and underwent CT coronary angiography (CTCA). Four CM with \ndifferent iodine concentrations (300, 350, 370 and 400 mgI/ml) were delivered \nat a fixed iodine delivery rate (2.0 mgI/s). Intracoronary attenuation values \nwere measured and grouped on a per-vessel and per-segment bases. Time-to-\npeak and pressure curves during CM injection were evaluated and compared. \nResults: Injection fluxes were 6.7 ml/sec, 5.7 ml/sec, 5.4 ml/sec and 5 ml/sec \nfor group A, B, C and D, respectively. No significant differences were observed \namong four groups in terms of intravascular density on a per-segment and per-\nvessels analysis. Time-to-peak was significantly earlier in group A (15.3 sec) \nthan in the other three groups. The injection peak pressure was significantly \nlower in group A (185.16 psi) and C (189.05 psi) than in group B (215.89 psi) \nand D (243.33 psi). No extravasations were noted in all groups. \nConclusion: Contrast media with different iodine concentrations, if injected at \nthe same IDR, provide similar intravascular attenuation values. The lower \nconcentration contrast medium provided significantly lower injection pressure \nvalues and a significantly shorter time to peak enhancement.  \nB-0775 11:06  \nCollateral classification by computed tomography in patients with \ncoronary total occlusion and its relation with downstream myocardial \ninfarction  \nJ. Zhang; Shanghai/CN (andrewssmu@msn.com)  \nPurpose: To study the hypothesis that the filling pattern of distal collaterals \nobserved at coronary computed tomography angiography (CCTA) in patients \nwith chronic total occlusion (CTO) may correlate to the extent of myocardial \ninfarction (MI), with reference to cardiac magnetic resonance (CMR) imaging. \nMethods and Materials:  All patients gave written informed consent and the \ninstitutional review board committee approved the study protocol. 97 patients \n(mean age: 68.5± 11.5, range 38 to 87 years, 77 males and 20 females) with \n106 coronary total occlusions were prospectively enrolled in this study. Distal \ncollaterals were classified into three types according to their filling patterns \nusing Rentrop classification. Rentr op grade 3 was considered as well-\ndeveloped collaterals and Rentrop grade 0-2 were considered as poorly \nS304  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\ndeveloped collaterals. Downstream myocardial infarction and wall motion \nabnormality was verified by CMR semi-quantitatively. Mann-Whitney U test \nwas used for comparison. \nResults: The overall diagnostic accuracy of CCTA classification of distal \ncollaterals was 86.8% (92/106), with correlation to invasive coronary \nangiography (ICA). Highest collateral grading was associated with non-MI \nsubgroup whereas lowest grading was associated with transmural-MI subgroup \n(2.7±0.6 versus 1.8 ±1, p=0.005). Compared to poorly developed collaterals \ngroup, well-developed collaterals group (Rentrop grade 3) correlated to lower \nsummed transmurality score (1.4± 2.5 versus 3± 2.6, p < 0.001) and lower \nsummed regional wall motion abnormality score (0.5 ±1.7 versus 1.1 ±2, \np=0.029). \nConclusion: The presence of well-developed distal collaterals as revealed by \nCCTA in patients with CTO lesions correlates to the lower frequency and \nextent of downstream MI.  \nB-0776 11:15  \nThe impact of combining low-tube voltage scanning with iterative \nreconstruction on total iodine dose in coronary CT angiography  \nT. Van Cauteren, N. Buls, K. Tanaka, D. Verdries, G. Van Gompel, K. Nieboer, \nI. Willekens, G. Verfaillie, J. De Mey; Brussels/BE \n(toon.van.cauteren@vub.ac.be)  \nPurpose: To assess the impact of combining low-tube voltages and iterative \nreconstruction (IR) on contrast dose in coronary CTA. \nMethods and Materials:  A standard of care (SoC) 120 kVp scan with \n320 mgI/ml iodine-based contrast (Visipaque, GE Healthcare) and FBP \nreconstruction was compared with two study protocols: 80 kVp with 160 mgI/ml \n(protocol A) and 100 kVp with 200 mgI/ml (protocol B), both reconstructed with \nIR (ASiR). Each protocol was scanned (Discovery) three times on two minipigs \n(Ellegaard) with constant injection protocol (speed 3 ml/s, volume 1.5 ml/kg) \nand radiation dose. Quantitative image quality was evaluated by CT-value and \nsignal-to-noise ratio (SNR) of the right coronary artery (RCA), left anterior \ndescending coronary (LAD) and left circumflex artery (LCx). Expert readers \nperformed qualitative assessment for overall quality, vessel sharpness, noise \nand streak artefacts. \nResults: Despite reduced iodine load, both study protocols did not yield \ninferior CT-value and SNR for all arteries. For RCA, the mean SoC signal \n(307 HU) was preserved with protocol A (273 HU, p=0.15) and B (258 HU, \np=0.08). Also the SNR was non-inferior from SoC (SNR=7.0) with A (8.1, \np=0.75) and B (8.7, p=0.57). All scans were perceived to be of at least \nacceptable quality on all evaluated parameters allowing diagnostic \ninterpretation. No statistical differences were observed (all p-values > 0.12), \nexcept for streak artefacts (p=0.01) who were considered to be more severe, \nalthough acceptable, with protocol A. \nConclusion: The use of a reduced tube voltage combined with iterative \nreconstruction allows a marked reduction in iodine dose up to a factor of two \nwithout impairing image quality.  \nAuthor Disclosures: \nN. Buls: Advisory Board; GE Healthcare. K. Nieboer: Advisory Board; GE \nHealthcare. J. De Mey: Advisory Board; GE Healthcare. Research/Grant \nSupport; GE Healthcare. \nB-0777 11:24  \nModified Morise score in predicting obstructive coronary artery disease \nprevalence at 64-row coronary CT angiography  \nN. Tomizawa, Y. Hayakawa, T. Nojo, S. Nakamura; Matsudo/JP \n(tomizawa-tky@umin.ac.jp)  \nPurpose: To evaluate modified-Morise score (MMS) including contrast \nmedium arrival time (AT) in conventional Morise score to predict obstructive \ncoronary artery disease (CAD) prevalence in coronary CT angiography. \nMethods and Materials:  Consecutive 665 patients who underwent coronary \nCT angiography were restrospectively included. AT was determined as the \ntime from the start of the injection to the threshold of 100 HU at the descending \naorta during the bolus-tracking scan. Morise pre-test score was calculated for \neach patient. AT-heart-rate product (AHP) and MMS was defined as AT*heart \nrate/100 and AHP*Morise score/10, respectively. Obstructive CAD was \ndetermined as stenosis \u000350% at coronary CT angiography. \nResults: A total of 441 patients (66%) showed no obstructive CAD. AT, AHP \nand MMS were larger in patients with obstructive CAD compared with patients \nwithout (19.1 vs 18.7; p = 0.06, 11.8 vs 11.3; p = 0.0014, 15.7 vs 13.7; \np < 0.0001). Receiver operating characteristics analysis showed that MMS \nsignificantly improved the area under the curve compared with Morise score \nalone in predicting obstructive CAD (0.63 vs 0.59; p = 0.01). The prevalence of \nobstructive CAD was significantly higher in the second to fourth quartiles \ncompared with the first quartile of MMS (odds ratio (OR): 2.21, 95% confidence \ninterval (CI): 1.34-3.71; OR: 2.66, 95%CI: 1.63-4.41 and OR: 3.72, 95%CI: \n2.28-6.18, respectively). \n \nConclusion: Larger MMS was associated with higher prevalence of \nobstructive CAD. MMS had an additive value over the Morise model alone to \npredict obstructive CAD in coronary CT angiography.  \nB-0778 11:33  \nThe cost-effectiveness of cardiac CTA for the detection of significant \ncoronary artery disease in patients undergoing pre-operative liver \ntransplantation evaluation  \nT. Rosamond, L. Wetzel, D. Stanojevic, R. Genton, P. Tadros, R. Gilroy; \nKansas City, KS/US (tlrosamond@kumc.edu)  \nPurpose: Screening for significant coronary artery disease (CAD) in pre-liver \ntransplantation candidates with end-stage liver  disease is controversial due to \nconcerns about screening test (ST) accuracy and cost-effectiveness (CE). This \neconomic evaluation modeling study was performed to determine the CE of \ncoronary CT angiography (CTA), dobutamine stress echo, SPECT imaging, \nand invasive cardiac CATH compared to a no screening test strategy (NST).  \nMethods and Materials:  A retrospective review of 242 consecutive transplant \ncandidates was conducted to define model inputs for decision analysis. \nPerspective: large tertiary academic university hospital in the Midwest USA. \nOther sources: extant literature, systematic reviews, meta-analysis, hospital \naccounting and clinical testing laboratory certification data, and expert panel \ninput utilising a modified Delphi exercise. Outcome measure: net monetary \nbenefit (NMB), willingness-to-pay (WTP) criteria and incremental health care \ncost and quality adjusted life years (QALYs) gained, one-way and probabilistic \nsensitivity analysis. \nResults: CTA is the optimal ST strategy with an incremental effect of 1.16 \nQALYs gained at an incremental cost of $31,632 equivalent to $27,222 per \nQALY gained (ICER) when compared to the undominated NST. CTA resulted \nin a NMB of $36,186 assuming a WTP of $50,000, at a cost per QALY of \n$42,248 and demonstrated extended dominance over the alternative screening \ntest strategies. According to sensitivity analysis the results are dependent only \nupon the prevalence of CAD and were insensitive to screening test and \ninterventional costs. \nConclusion: When compared to a NST, CTA may be more cost-effective than \nother imaging modalities in the evaluation of liver transplant candidates.  \nB-0779 11:42  \nDose optimisation in coronary CT angiography: is it restricted to the \nprospective ECG gating mode? Results from a multicentre study  \nF. Mafalanka\n1, J.-L. Rehel1, D. Pesenti-Rossi2, L.-P. Christiaens3, \nR. Convers-Domart4, P. Ou5, E. Schouman-Claeys5, M. Sirol5, C. Etard1; \n1Fontenay-aux-Roses/FR, 2Neuilly-sur-Seine/FR, 3Poitiers/FR, \n4Le Chesnay/FR, 5Paris/FR (cecile.etard@irsn.fr)  \nPurpose: To compare patient dose in coronary Computed Tomography \nAngiography (cCTA) using different dose reduction techniques and different CT \nscanners. \nMethods and Materials:  Volume Computed Tomography Dose Index \n(CTDIvol) was retrospectively collected from 387 cCTA performed in 7 centres, \nwithin both academic and non-academic hospitals specialised in cardiac \nimaging, using 64-, 128- or 320-detector CT scanners. About 50 examinations \nwere collected in each centre over a 3 months period, using the routine local \nprotocols, taking differently into account the Body Mass Index (BMI). \nProspective ECG-gating was used in 4 centres and iterative reconstruction (IR) \nin 5 centres. Image quality was considered satisfactory in each centre and has \nnot been evaluated in this study. Data were analysed by the French National \nInstitute for Radiation Protection (IRSN). \nResults: Mean CTDIvol per centre varied by a factor of 4.5 (range of \nmeans±SD: 14±6 to 63±9 mGy). Minimum and maximum values were collected \non CT scanners using IR. The dispersion of the mean CTDIvol was more \nimportant using retrospective compared to prospective gating (21 ±10 to \n63±9 mGy and 14±6 to 31±15 mGy respectively). \nConclusion: Prospective ECG gating and IR are efficient dose reduction \ntechniques in cCTA but they do not exempt the centres from a more global \noptimisation approach. Whatever the brand and the generation of CT scanner, \na significant dose optimisation is possible, using simple methods such as tube \ncurrent and voltage adaptation to the BMI.  \nB-0780 11:51  \nComparison of three iodine concentrations in the visualisation of \ncoronary arteries by CT: a randomised European multicenter trial  \nM.H.K. Hoffmann and X-ACT Investigators; Lucerne/CH \n(martin.hoffmann@luks.ch)  \nPurpose: To assess the diagnostic efficacy of iobitridol (Xenetix® 350) \ncompared to iopromide (Ultravist® 370) and iomeprol (Iomeron® 400) in the \nvisualisation of coronary arteries. \nMethods and Materials:  Randomised, double blind, non-inferiority phase IV \ntrial including 468 patients with suspected coronary artery disease (CAD) who \nS305  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nwere scheduled to undergo CT angiography. The primary endpoint was the CT \nscan evaluability for CAD diagnosis in terms of quality and interpretability of \nimages. It was based on the full evaluation of 18 coronary segments for each \npatient and assessed by 2 off-site independent readers. Secondary endpoints \nwere related to the safety and efficacy of the 3 contrast media (mainly image \nquality, stenosis assessment, and signal quantification). \nResults: Out of the 452 patients completed for the primary analysis, 92.1% \nhad their 18 segments fully evaluable in the iobitridol group, vs. 94.6 and \n95.4% in the iomeprol and iopromide groups, respectively. Non-inferiority was \nstatistically demonstrated between the 3 products, and no relevant differences \nbetween the 3 groups were observed for secondary endpoints. Eventually, the \ngood general safety profile of products was confirmed. \nConclusion: This large trial shows that an optimal benefit/risk ratio is achieved \nas soon as an iodine concentration of 350 mgI/ml is administered for the \nvisualisation of coronary arteries.  \nAuthor Disclosures: \nM.H.K. Hoffmann and X-ACT Investigators:  Advisory Board; NVT \nTechnologies Hechingen Germany. Research/Grant Support; Guerbet. \nSpeaker; Abbott Vascular  Philips Medical Systems. \n10:30 - 12:00 Room D  \nChest  \nSS 1704  \nChallenges in oncologic imaging  \nModerators:  \nF. Gleeson; Oxford/UK  \nM.O. Wielpütz; Heidelberg/DE  \nB-0781 10:30  \nComparisons of capability for TNM and clinical stage assessment in non-\nsmall cell lung cancer patients among whole-body MRI, whole-body FDG-\nPET/CT and co-registered whole-body PET/MRI  \nY. Ohno\n1, S. Seki1, M. Nishio1, H. Koyama1, T. Yoshikawa1, S. Matsumoto1, \nK. Aoyagi2, H. Yamagata2, K. Sugimura1; 1Kobe/JP, 2Otawara/JP \n(yosirad@kobe-u.ac.jp)  \nPurpose: To directly compare the capability for clinical stage assessment \namong whole-body MR imaging (MRI), integrated FDG-PET/CT and co-\nregistered FDG-PET/MRI in non-small cell lung cancer (NSCLC) patients. \nMethods and Materials:  70 consecutive pathologically diagnosed NSCLC \npatients prospectively underwent whole-body MRI at 3 T system, integrated \nFDG-PET/CT, conventional radiological examination, surgical treatment, \npathological examination and more than 2-year follow-up examinations. Final \ndiagnosis of TNM factors and clinical stage in each patient was determined \naccording to all examination results. All co-registered FDG-PET/MRIs were \ngenerated by means of our proprietary software. Then, TNM factor and clinical \nstage on all methods were visually assessed by radiologists and nuclear \nmedicine physicians. Then, final dia gnosis in each patient was made by \nconsensus of two readers on each method. To determine the agreements of \nTNM factor and clinical stage between each method and final diagnosis, kappa \nstatistics were performed. To compare the diagnostic capability for operability \nassessment among all methods, sensitivities, specificities and accuracies were \nstatistically compared each other by using McNemar's test. \nResults: Each agreement with final diagnosis was as follows: T factor, \n0.90\u00025\u00020.93; N factor, 0.60\u00025\u00020.88; M factor, 0.78 \u00025\u00020.93; clinical stage, \n0.55\u00025\u00020.87, respectively. When compared each operability assessment \ncapability, sensitivity (100 < 51/51>) %) and accuracy (95.7 < 67/70>) %) of \nclinical stage assessment on MRI were significantly higher than those \n(sensitivity: 88.2 < 45/51>) %, p < 0.05; accuracy: 87.1 < 61/70>) %, p < 0.05) \nof PET/MRI and PET/CT. \nConclusion: Whole-body MRI is more accurate than co-registered FDG-\nPET/MRI and integrated FDG-PET/CT for clinical stage assessment in NSCLC \npatients.  \nAuthor Disclosures: \nY. Ohno: Research/Grant Support; Toshiba Medical Systems Corporation, \nEizai Co. Ltd., Daiichi-Sankyo, Co. Ltd, Guerbet Japan. M. Nishio: \nResearch/Grant Support; Toshiba Medical Systems Corporation. T. \nYoshikawa: Research/Grant Support; Toshiba Medical Systems \nCorporation.s. Matsumoto: Research/Grant Support; Toshiba Medical \nSystems Corporation. K. Aoyagi: Employee; Toshiba Medical Systems \nCorporation. H. Yamagata: Employee; Toshiba Medical Systems Corporation.  \nB-0782 10:39  \nEvaluation of dual-input perfusion in lung cancer: using a 640-slice \nvolume CT scan  \nE.-J. Kang1, K.-N. Lee1, J.-Y. Han1, J. Lee2; 1Busan/KR, 2Daegu/KR \n(medcarrot@naver.com)  \nPurpose: The purpose of our study was to assess the dual blood input supply \nof lung cancer using a CT perfusion technique, and to analyse the correlations \nbetween dual perfusion and various characteristics of lung cancer. \nMethods and Materials:  Thirty-six consecutive patients with lung tumour that \nhighly suggestive of malignancy were included in this study. All subjects \nunderwent a dual-input dynamic perfusion volume scan using 320-raw-detector \nCT before CT-guided biopsy. Pulmonary trunk and descending thoracic aorta \nwere selected for arterial input functions. From the computed CT data, \npulmonary arterial perfusion (PP), aortic perfusion (AP) and perfusion index \n[PI, = PP/(PP+AP)] were calculated using the dual-input maximum-slope \nmethod. We statistically analysed the rela tionship of perfusion data with tumour \nlocations (central, peripheral, and abutting the pleural locations), tumour \nvolumes, pathologic type, and the presence of lymph node or distant \nmetastasis. \nResults: All subjects were pathologically diagnosed as primary malignant lung \ncancers by the CT-guided aspiration biopsy. The overall mean PI was \n53.3 ± 7.5%. The PI's showed significant difference by the tumour locations \n(central, 49.2 ± 3.3; peripheral, 55.5 ± 7.2; abutting the pleural, 48.9 ± 7.6, P \n=0.043). In contrast, no significant difference was presented by tumour sizes (r \n= -0.252, P = 0.139) and by the presence of metastasis (P > 0.05). \nConclusion: We found the proportion of the dual perfusion in lung cancer is \nsignificantly dependent on tumour locati on, and this result may benefit of the \nmanagement of lung cancer or prediction of prognosis.  \nB-0783 10:48  \nDiscriminating between pneumonia and atelectasis on contrast-enhanced \ncomputed tomography: a quantitative approach  \nR.M. Edwards, G. Kicska; Seattle, WA/US (edwards5@uw.edu)  \nPurpose: It is well known that atelectasis demonstrates greater enhancement \nthan pneumonia on contrast-enhanced CT. However, radiologists underutilise \nthis information because a quantitative threshold has never been determined \ndiscriminating between pneumonia and at electasis. Our study establishes this \nthreshold, which may allow for earlier diagnosis and treatment of pneumonia. \nMethods and Materials:  CT pulmonary angiogram (CTPA) exams containing \nconsolidations were identified between 1/1/2012 and 7/31/2013. Consolidation \nwas diagnosed as atelectasis (12 patients) or pneumonia (18 patients) based \non multiple clinically accepted criteria. Hounsfield attenuation was measured in \nconsolidated lung parenchyma (CL), ascending aorta (Ao), main pulmonary \nartery (MPA), and non-consolidated lung (NL). Mean enhancement values \nwere compared of CL, Ao, MPA, NL in subjects with pneumonia and \natelectasis. ROC analysis was performed to determine sensitivity and \nspecificity of enhancement diagnosing pneumonia. \nResults: The mean enhancement of atelectatic and pneumonia consolidations \nwas 110.1 HU and 58.8 HU, respectively (p-value = 4.58E-07). There was no \nstatistically significant difference in Ao, MPA and NL enhancement between \npneumonia and atelectasis patients. The optimal threshold for discriminating \nregions of pneumonia from atelectasis in this sample was 70 HU (CI: 69, \n97 HU). Using this threshold, where \u000270 would indicate pneumonia, the \nsensitivity and specificity for pneumonia was 93% (CI: 63, 99%) and 100% (CI: \n88, 100%), respectively. \nConclusion: A threshold enhancement of 70 HU on a CTPA exam excludes \npneumonia with a high degree of certainty. In combination with clinical history, \na threshold of 70 HU enhancement allows for earlier and diagnosis treatment \nof pneumonia.  \nAuthor Disclosures: \nG. Kicska: Grant Recipient; General Electric. \nB-0784 10:57  \nSolitary fibrous tumours of the pleura: are there any scanographic \nfeatures suggestive of malignancy? A 56-patient case series with \nanatomopathological correlation  \nS. Hélage, M.-P. Revel, A. Mansuet-Lupo, É. Audureau, M. Alifano, D. Vadrot; \nParis/FR (siegfriedhelage@yahoo.fr)  \nPurpose: To identify scanographic features predictive of anatomopathological \nmalignancy, from a retrospective study of preoperative CT scans of resected \nsolitary fibrous tumors (SFT) of the pleura. \nMethods and Materials:  CT scans of operated patients between December \n2004 and November 2012 were analysed retrospectively. Scanographic \nfeatures were studied without knowing anatomopathological diagnosis. \nResults: The study population consisted of 56 patients (33 females and 23 \nmales, mean age: 60 years old). SFT was asymptomatic, diagnosed \nincidentally in 22 cases (45.83%). Anatomopathological examination of \nS306  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nresection specimens (R0 resection in all cases) revealed that 23 tumors \n(41.07%) were histologically malignant. The significantly different criteria \nbetween malignant and benign types were: size (p=0.002) with a discriminatory \nthreshold of 10 centimeters, tumor heterogeneity spontaneously (p=0.019) or \nafter contrast medium injection (p=0.029), existence of intratumoral fluid \ndensity areas (p=0.011), a pleural effusion (p=0.010), measurable intratumoral \nvessels (p=0.019), a hypervascular character (intratumoral vessels and/or \nintense enhancement) (p=0.001). Intratumoral calcifications (p=0.200) and \nmaximum post contrast density (p=0.58) were not significantly different. \nConclusion: CT features suggestive of anatomopathological malignancy of a \nSFT are: size greater than or equal to 10 centimeters, tumor heterogeneity, a \nhypervascular character of the tumor, presence of pleural effusion.  \nB-0785 11:06  \nThe role of multi-sequence MR in the detection of pulmonary nodules  \nA. Lisowska, A. Cieszanowski, R. Krenke, P. Korczynski, M. Dabrowska, \nM. Zukowska, O. Rowinski; Warszawa/PL (antoninalisowska@wp.pl)  \nPurpose: The purpose of this study was to assess the role of multi-sequence, \nmultiplanar MRI in the detection of pulmonary nodules as compared to \ncomputed tomography (CT). \nMethods and Materials: Thirty patients underwent both MRI and MSCT of the \nlungs (age range: 54-83 years, mean: 67.3). MRI (1.5 T) studies were \nperformed in the following sequences: axial and coronal T2 TSE and T1 3D \nGRE and axial FatSat T2 TSE, T2 STIR, T2 HASTE and chemical shift \nimaging. Data was independently analysed by two blinded radiologists. MRI \ndata was then compared to MSCT and verified to include a one-to-one \ncorrelation of nodule size and location. The general sensitivity, diameter-based \nsensitivity and MR sequence sensitivity was assessed in correlation to the \ndetection rate of lung nodules. \nResults: The overall sensitivity of MRI was 79.2%. MRI sensitivity according to \nnodules size was: 0% for nodules \u00023 mm, 77.8% for nodules between 3.1 mm \nand 7.9 mm, 100% for nodules between 8 mm and 19.9 mm and 100% for \nnodules between 20 mm and 30 mm. The positive predictive value (PPV) for \nthe detection of pulmonary nodules was: 47% for nodules 3.1 - 7.9 mm, 81% \nfor nodules 8 - 19.9 mm and 100% for nodules 20 - 30 mm. \nConclusion: MRI of the lungs does not allow for the detection of nodules \u0002 \n3 mm and shows moderate sensitivity for the detection of nodules between 3.1 \nand 7.9 mm. MRI yielded a 100% sensitivity for the detection of pulmonary \nnodules \u00038 mm.  \nB-0786 11:15  \nSteady-state free-precession sequence in differentiating lung cancer from \nadjacent atelectasis  \nT. Saida, S. Shiotani, T. Kobayashi, K. Mori, K. Nasu, H. Ishikawa, H. Ichimura, \nM. Minami; Tsukuba/JP  \nPurpose: Inoperable, advanced lung cancer is often accompanied with \nadjacent atelectasis. Differentiation  between cancer and atelectasis is \nnecessary to determine the field of radiation therapy or to evaluate the effect of \ntherapy. Computed tomography (CT) is the gold standard, however, it is often \ndifficult to distinguish cancer from atel ectasis. Recently, diffusion-weighted \nimaging (DWI) has been reported as useful for this purpose, however, the \nimage quality and anatomical information of DWI is insufficient. The aim of this \nstudy is to evaluate the steady-state free precession sequence (SSFP) for \ndifferentiating lung cancer from atelectasis. \nMethods and Materials:  Ten patients suspected of lung cancer with adjacent \natelectasis on CT underwent magnetic resonance (MR) imaging. Using a 1.5-T \nscanner, DWI (b=0.1000 s/mm\n2), T2-weighted images (T2WI) and SSFP were \nperformed and apparent diffusion coeffici ent (ADC) and relative contrast of \nT2WI and SSFP were calculated for cancer and atelectasis. In addition, two \nindependent observers evaluated the differentiating ability and the image \nquality using the 3-point scales. Statis tical analyses were performed with \npaired t-test, Friedman test, Wilcoxon test, and analysis of variance. \nResults: There was a significant difference between lung cancer and \natelectasis on all evaluated imaging sequences. However, SSFP showed \nsignificantly high differentiating ability than T2WI and showed significantly \nbetter image quality than DWI and T2WI. \nConclusion: Advantages of the SSFP were a short acquisition time to avoid \nartefact and an inherent high contrast between lung cancer and atelectasis \nwith detailed anatomical information, and SSFP could be considered as a \nuseful modality.  \n \n \n \nB-0787 \n11:24  \n3D non-contrast-enhanced pulmonary perfusion MRI in non-small cell \nlung cancer patients: comparison of capability for postoperative lung \nfunction prediction with dynamic first-pass perfusion MRI, thin-section \nCT and Q scan  \nY. Ohno\n1, S. Seki1, M. Nishio1, H. Koyama1, T. Yoshikawa1, S. Matsumoto1, \nY. Kasai2, M. Yui2, K. Sugimura1; 1Kobe/JP, 2Otawara/JP \n(yosirad@kobe-u.ac.jp)  \nPurpose: To directly the compare capability for postoperative lung function \nprediction among non-CE- and CE-perfusion MRIs, thin-section CT and Q scan \nin non-small cell lung cancer (NSCLC) patients. \nMethods and Materials:  Thirty-five NSCLC patients underwent thin-section \nMDCT, non-CE- and CE-perfusion MRIs, Q scan, surgical treatment and pre- \nand postoperative FEV 1% measurements. All non-CE-perfusion MRIs were \nacquired with an ECG-gated 3D half-Fourier fast SE sequence using a 3 T \nscanner. On non-CE- and CE-perfusion MRIs and Q scan, each regional \nperfusion rate in the resected lobe was determined as signal intensity or \nradioisotope uptake ratio between resected lobe and total lung. Then,each \npostoperative FEV\n1% (poFEV1%) was predicted from preoperative FEV 1% and \nregional perfusion rate in the resected lobe. poFEV 1%s of qualitative and \nquantitative CTs were predicted preoperative FEV 1% and total and resected \nlung segments and functional lung volumes determined by density-masked CT. \nTo determine the capability of non-CE-perfusion MRI for regional perfusion \nassessment, regional perfusion rate of non-CE-perfusion MRI was statistically \ncorrelated with that of CE-perfusion MRI and Q scan. To determine the \ncapability for prediction of postoperative lung function among all methods, each \npredicted poFEV1% was correlated with actual poFEV1%. \nResults: Regional perfusion rate of non-CE-perfusion MRI had significant and \nexcellent correlations with that of CE-perfusion MRI and Q scan (r=0.70, \np < 0.0001). There were significant and excellent correlations between actual \npoFEV1% and each predicted poFEV1% (r > 0.88, p < 0.0001). \nConclusion: Non-CE-perfusion MRI has a potential for postoperative lung \nfunction prediction, and is considered as valuable as other methods in NSCLC \npatients.  \nAuthor Disclosures: \nY. Ohno: Research/Grant Support; Toshiba Medical Systems Corporation, \nDaiichi-Sankyo, Co. Ltd., Bayer Pharma.m. Nishio: Research/Grant Support; \nToshiba Medical Systems Corporation. T. Yoshikawa: Research/Grant \nSupport; Toshiba Medical Systems Corporation.s. Matsumoto: \nResearch/Grant Support; Toshiba Medical Systems Corporation. Y. Kasai: \nEmployee; Toshiba Medical Systems Corporation. M. Yui: Employee; Toshiba \nMedical Systems Corporation.  \nB-0788 11:33  \nDynamic contrast-enhanced magnetic resonance imaging of lung lesions \nusing a straightforward technique for morphological and quantitative \nkinetic analysis  \nM. Koenigkam Santos\n1, E. Optazaite2, G. Sommer3, H.-P. Schlemmer2, \nC. Heussel2, H.-U. Kauczor2, M. Puderbach2; 1Ribeirao Preto/BR, \n2Heidelberg/DE, 3Basle/CH (marcelk46@yahoo.com.br)  \nPurpose: To propose a straightforward technique for both morphological and \nquantitative kinetic perfusion analysis of lung lesions using dynamic contrast \nenhanced MRI. \nMethods and Materials:  36 patients with 39 lung lesions (size range, 10-\n220 mm; 33 malignant) were prospectively scanned prior to therapeutic \nintervention. Fat-suppressed volumetric-interpolated T1W gradient-echo (VIBE) \nimages were obtained during sequential short breath-holds after bolus \ntriggered contrast injection. To obtain higher temporal resolution during the first \npassage of contrast, volume coverage of first 3 measurements was limited to \ninclude the lesion. Subsequent acquisiti ons were obtained with 1, 3 and 4 min. \nTwo radiologists evaluated presence and morphology of enhancement \nseparately and blinded. ROI-based signal intensity (SI)-time curves were \ncreated to evaluate the quantitative kinetic parameters. \nResults: Readers agreed moderately in regard to enhancement morphology \nand substantially in regard to presence of significant enhancement inside the \nlesion. Different SI-time curve patterns and derived parameters (early peak of \nenhancement, slope of enhancement, maximum enhancement, washout ratio \nand relative enhancement at the 4\nth minute) were obtained for all lesions. An \nearly peak > 15% showed 100% sensitivity to detect malignancy. \nConclusion: The proposed technique allows the analysis of nodules, masses \nand consolidations, permits the evaluation of enhancement morphology / \nprogression together with the creation of SI-time curves, and acquirement of \nderived quantitative perfusion parameters. This strategy is simple and robust, \nbased on visual and ROI-based analysis, and is therefore a step forward to \nbring lung MRI into the clinical scenario.  \n \nS307  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0789 11:42  \nGround glass nodules evolution according with an history of tumour  \nM. Silva, F. Centra, D. Colombi, L. Ampollini, P. Carbognani, C. Rossi, \nN. Sverzellati; Parma/IT (mariosilvamed@gmail.com)  \nPurpose: To test the relation between oncologic anmnesis and CT pattern of \ngrowth in ground glass nodules (GGN). \nMethods and Materials:  209 GGNs were diagnosed by CT in 147 subjects at \nour hospital. Demographic data and anamnesis were recorded. Subjects were \ncategorized according to history of tumor as follows: \"oncologic\" and \"non-\noncologic\". CT features of each GGN were assessed from an initial and a \nfollow-up CT. GGNs of each category were then divided into \"persisting\" or \n\"resolved\". Pattern of growth in persisting GGNs was defined by an increase of \ntotal diameter or an appearance/increase of solid component diameter. \nAssociation of oncologic anamnesis with GGN growth was tested by Fisher's \nexact test and Kruskall-Wallis test. \nResults: The 209 GGNs were found in 98/147 (66.7%) oncologic and 49/147 \n(33.3%) non-oncologic subjects. Pure GGNs (pGGN) were evenly represented \nin oncologic (91.9%) and non-oncologic (83.6%) subjects (p = 0.09). \nDisappearance rate was similar between non-oncologic (13.1%) and oncologic \n(20.27%) category (p = 0.24). Persisting GGNs showed similar growth rate \nbetween non-oncologic (30%) and oncologic (22.9%) subjects (p = 0.34). \nGrowth pattern was associated with CT features of GGN, namely, diameter > \n10 mm in pGGNs (HR = 15.43) and presence of solid component (HR = \n23.08). \nConclusion: GGNs showed the same rate of growth pattern in either oncologic \nor non-oncologic subjects. Growth was related to CT features of GGN in all \nsubjects, despite history of tumor. Therefore, CT management of GGN in \noncologic patients should follow the same parameters used for non-oncologic \nsubjects.  \nB-0790 11:51  \nDetermining the lowest radiation dose parameters for virtual CT \nbronchoscopy: how low can we go?  \nA.R. Seyal, K. Parekh, R. Agrawal, T.H. Grant, A. Goodwin, V. Yaghmai; \nChicago, IL/US (rishi.agrawal@northwestern.edu)  \nPurpose: To study the impact of radiation dose reduction strategies and \nreconstruction algorithms on conspicuity and size of endobronchial lesion by \nvirtual CT bronchoscopy. \nMethods and Materials:  An anthropomorphic chest phantom containing a \n1.2 cm bronchial polyp was scanned using 80, 100 and 120 kV and 10, 20, 40, \n75 and 110 mA. Images were reconstructed with filtered back projection (FBP) \nand sinogram-affirmed iterative reconstruction (SAFIRE) algorithms. \nRandomised images were shown to two chest radiologists. Largest lesion \ndiameter was measured in axial section. Volume-rendered images were \nevaluated for image quality and bronchial polyp conspicuity on a five-point \nscale. A score of 4 (corresponding to good image quality and lesion \nconspicuity) was considered acceptable for both. Paired t-test, Wilcoxon \nsigned rank test and kappa statistics were used for analysis. \nResults: The lowest radiation parameter at which both image quality and \nbronchial polyp conspicuity were given acceptable scores was 120 kV/10 mA \n(0.378mSv) for both FBP and SAFIRE. Image noise, CNR and SNR improved \nsignificantly for image sets reconstructed with SAFIRE when compared with \nFBP (p < 0.0001). Mean lesion diameter was comparable between the two \nreconstruction algorithms for effective doses above and below 1mSv (p > 0.05). \nThe diameter measurements were similar for both radiologists below 1 mSv for \neach reconstruction algorithm (p > 0.05). Inter-observer agreement was good \nfor lesion conspicuity (k=0.73). \nConclusion: Virtual CT bronchoscopy maintains good image quality and lesion \nconspicuity at significantly reduced effective dose, regardless of the \nreconstruction algorithm used. However, objective measures of image quality \nsignificantly improved with iterative reconstruction.  \nAuthor Disclosures: \nA.R. Seyal: Research/Grant Support; Educational Grant support from Siemens \nHealthcare. K. Parekh: Research/Grant Support; Educational Grant support \nfrom Siemens Healthcare.  \n10:30 - 12:00 Board Room B  \nPaediatric  \nSS 1712  \nThe child before and after surgery  \nModerators:  \nF.E. Avni; Lille/FR  \nR. Llorens; Valencia/ES  \nB-0791 10:30  \nDoppler ultrasound for preoperative assessment of hepatic \nhaemodynamics and prediction of early portal vein thrombosis after liver \ntransplantation in paediatric patients with biliary atresia  \nL. Gu, H. Fang, F. Li, S. Zhang; Shanghai/CN (renjiglh@126.com)  \nPurpose: To assess the preoperative hepatic hemodynamics in pediatric \npatients with BA (biliary atresia) at Doppler US and determine whether the \nultrasonographic warning signs may predict early portal vein thrombosis (PVT) \nafter liver transplantation (LT). \nMethods and Materials:  This retrospective study was approved by an \ninstitutional review board; informed consent was waived. 128 pediatric patients \n(66 male, 62 female, mean age, 11.73 months ±6.25 [standard deviation]) with \nBA younger than 3 years of age underwent Doppler US within 7 days before \nLT between October 2006 and June 2013. 7.03% experienced early PVT \n(within 1 month after LT). Receiver operating characteristic (ROC) analysis was \nperformed to determine the optimal cutoff value for predicting early PVT. \nResults: Of the 128 recipients, 32.03% (41 of 128 LT recipients) had a \nhypoplasia PV, 40.63% (52 of 128 LT recipients) had a hepatofugal portal flow \nand 31.25% (40 of 128 LT recipients ) had a high hepatic artery resistance \nindex (HARI) of \u0003 1. Optimal cutoffs for PV di ameter, PVVmax, and HARI were \n4 mm, 20 cm/sec, and 1, respectively. S ensitivity and specificity were 88.89% \nand 72.27% for PV diameter , 55.56% and 58.82% fo r PVVmax, 77 .78% and \n62.18% for hepatofugal PV flow, and 77.78% and 72.27% for HARI, \nrespectively. \nConclusion: Liver hemodynamic disturbances including PV hypoplasia \n(32.0%), hepatofugal PV flow (40.63%) and high HARI (31.25%) were mainly \nobserved in BA. Small PV size ( \u0002 4 mm) are strong warning signs for the \nprediction of early PVT, and hepatofugal PV flow and high HARI (\u0003 1) had \nrelatively high risk factor.  \nB-0792 10:39  \nMR foetal lung volume in congenital diaphragmatic hernia: association of \nprenatal MR imaging findings with postnatal need for prosthetic patch \nrepair of the hernia  \nC. Hagelstein, K. Zahn, M. Weidner, C. Weiss, T. Schaible, S.O. Schönberg, \nK.A. Büsing, K.W. Neff; Mannheim/DE (Claudia.Hagelstein@umm.de)  \nPurpose: To assess whether the type of surgical closure of the diaphragmatic \ndefect (primary vs. prosthetic patch repair) in neonates with congenital \ndiaphragmatic hernia (CDH) is associated with the antenatal measured \nobserved-to-expected MR-FLV (o/e MR-FLV). \nMethods and Materials:  Using T2-weighted HASTE imaging, the o/e MR-FLV \nwas calculated in 247 foetuses with isolated CDH between 24 and 40 weeks \ngestation. Logistic regression analysis and receiver operating characteristics \n(ROC) analysis were performed to assess the prognostic value of the individual \no/e MR-FLV for association with postnatal need for prosthetic patch repair of \nthe hernia. \nResults: 77% (190/247) of the patients with CDH required patch repair and in \n23% (57/247) the diaphragmatic defect was closed primarily. Patients with \npatch requirement showed a significantly lower o/e MR-FLV (27.7 ±10.2%) than \npatients with primary repair (40.8 ±13.8%, p < 0.001, AUC=0.786). With a \nprenatally assessed o/e MR-FLV of 20%, 92% of the patients with CDH \nrequired patch repair, compared to only 24% of the foetuses with an o/e MR-\nFLV of 60%. Postnatal patch requirement was further influenced by the liver \nposition (liver herniation vs. no liver herniation) determined during foetal MR \nexamination (p < 0.001). Foetal liver position additionally to the o/e MR-FLV \nimproves the prognostic accuracy (AUC=0.827). \nConclusion: Logistic regression analysis based on the prenatally measured \no/e MR-FLV is useful for prenatal estimation of prosthetic patch requirement in \npatients with CDH. In addition to the o/e MR-FLV, the position of the liver \ndetermined by foetal MR imaging helps to improve the prognostic accuracy of \nthe estimated probability of patch requirement.  \n \n \nS308  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0793 10:48  \nUtility of real-time US-guided percutaneous liver biopsy in paediatric liver \ntransplant recipients  \nS. Mandal1, R. Miraglia2, L. Maruzzelli2, R. Liotta2, K. Cortis2, A. Luca2; \n1Pittsburgh, PA/US, 2Palermo/IT (kelvincortis@gmail.com)  \nPurpose: The purpose of this study was to assess the safety of ultrasound \n(US)-guided percutaneous liver biopsy (PLB) within paediatric liver allograft \nrecipients, to describe the pathological outcomes according to the early ( \u000212 \nmonths) and late (>  12 months) post-transplantation period, and to analyse the \nvalue of liver function tests (LFT) and Doppler US variables in determining \nthese outcomes. \nMethods and Materials: Two hundred and nineteen consecutive real-time US-\nguided PLB in 85 paediatric liver transplant patients (mean age 7 years, range \n6 months-18 years) performed between March 2005 and May 2012 were \nretrospectively evaluated. All patients underwent liver function testing and \nDoppler US evaluation within one day of early (n=92, 42%) and late term \n(n=127, 58%) post-transplantation biopsy. \nResults: All samples were deemed adequate for histological analysis, 2 \nbiopsies (0.91%) had complications consisting of mild bleeding requiring blood \ntransfusion. The early- and late-term biopsy results included cholestasis at \n36% vs. 18% (p=.003), no pathology or minimal changes 16% vs. 24% (non-\nsignificant, NS), acute rejection 13% vs. 5% (p=.027), inflammatory diseases \n15% vs. 15% (NS), indeterminate acute rejection 11% vs. 7% (NS), chronic \nrejection 4% vs. 14% (p=.017), fibrotic diseases 4% vs. 12% (NS), and other \ndiseases 0% vs. 5% (NS), respectively. Multinomial logistic regression \nrevealed that neither LFT nor US variable s are significantly correlated to \npathological outcomes. \nConclusion: The rate of complications after US-guided liver biopsy is very low. \nA range of pathological outcomes exists between early and late post-\ntransplantation liver biopsy. LFT and Doppler US findings are not predictors of \npathological outcomes.  \nB-0794 10:57  \nDifferential effect of right ventricular volume to left ventricular volume in \nchildren with repaired tetralogy of fallot  \nQ. Yao, X.-H. Hu; Shanghai/CN (eecchhooo1@gmail.com)  \nPurpose: To compare the diagnostic value between indexed right ventricular \nend-diastolic volume (RVEDVi) and the ratio of right ventricular volume to left \nventricular volume (RV/LV ratio) in prediction of the severity of pulmonary \nregurgitation (PR) after surgery of tetralogy of Fallot (TOF). \nMethods and Materials:  Tirty-nine consecutive patients with repaired TOF \n(mean age of operation, 22.33 ±29.59 months; mean age of MRI, 81.62 ±50.85 \nmonths) were included in the study. RVEDVi, RV/LV ratio, and PR were \nmeasured with the use of magnetic resonance imaging (MRI). PR fraction of \nmore than 20% was considered significant. The predictive capability of the two \nmarkers (RVEDVi and RV/LV ratio) for significant PR was compared by using \nmultivariate linear regression analysis and receiver operating characteristic \nanalysis (ROC). \nResults: A significant correlation between RVEDVi and the RV/LV ratio was \ndemonstrated (r = 0.776, P=0.0001). Both RV/LV and RVEDVi had correlation \nwith PR in correlation analysis (r=0.435/0.353, P=0.006/0.027), but in \nmultivariate analysis, the only independent predictor of PR fraction was the \nRV/LV ratio (F=8.835, P=0.005). ROC analysis revealed better discrimination \nof significant (20%) from insignificant ( < 20%) PR with the use of the RV/LV \nratio than RVEDVi (area under the receiver operating characteristic curve, \n0.751 vs 0.711, P =0.01). \nConclusion: The RV/LV ratio is more accurate and useful than the RVEDVi in \nstratification of PR.  \nB-0795 11:06  \nPrenatal diagnosis of fetal abdominal cystic masses: can MR change the \noutcome?  \nS. Bernardo, V. Vinci, M. Saldari, P. Sollazzo, F. Capozza, A. Giancotti, \nL. Manganaro; Rome/IT \nPurpose: The purpose is to evaluate the role of fetal MRI in predicting \noutcomes for fetuses with abdominal cystic masses. \nMethods and Materials:  Forty-nine fetuses with doubtful US for fetal \nmalformation underwent MRI. All MRI findings were compared with \nultrasonographic findings regarding detection, anatomical localisation and \ntissue characterisation. MRI findings were considered to have affected \nmanagement if subsequent treatment was influenced by the MR findings and \ndiagnosis. \nResults: Out of the 49 fetuses, 44 had intra-abdominal cystic masses and \nformed our study group. The mean GA was 27 weeks. Final individual \ndiagnoses were: meconium pseudocyst (n= 8), mesenteric cyst (n= 4), \nhydrometrocolpos (n =1), small intestine duplication (n=7), ovarian cyst (n=4), \nmesenteric lymphangioma (n=4), hydroneph rosis with pelvic-ureteric junction \nobstruction (n= 3), choledochal cyst (n=6), urinoma (n= 2), megaureter caused \nby posterior urethral valves (n= 1), m egabladder (n=3), persistent cloaca (n= \n1). MRI was superior to sonography and had supplemental value because of \nbetter anatomical localisation in 30 cases. Addition of MRI changed the \ndiagnosis and management in 21 cases. Eleven fetuses had neonatal surgical \ntreatment. In 33 cases, MRI provided additional information than US. \nConclusion: Prenatal MRI enhances fetal anatomic evaluation and facilitates \nperinatal management and family counseling. Ultrafast imaging sequence MRI \nis helpful to refine US diagnoses in delineation and characterisation of \nabdominal cystic masses. Fetal MRI is a valuable adjunct to US for prenatal \ndiagnosis before fetal surgical intervention for selected life-threatening birth \ndefects.  \nB-0796 11:15  \nQuantification of aortic pressure gradients by 4D flow MRI in patients \nwith repaired aortic coarctation: comparison to echocardiography  \nF. Rengier\n1, M. Delles2, J. Eichhorn1, Y.-J. Azad2, H. von Tengg-Kobligk1, \nH.-U. Kauczor1, R. Unterhinninghofen2, S. Ley1; 1Heidelberg/DE, \n2Karlsruhe/DE (hendrik.vontengg@insel.ch)  \nPurpose: In patients with aortic coarctation, routine follow-up after repair \nincludes measurement of pressure gradients by 2D echocardiography. \nPurpose of this study was to compare pressure gradient measurements based \non 4D flow MRI with 2D echocardiography. \nMethods and Materials: 8 patients after repair of aortic coarctation (mean age \n15.5 years) underwent 2D echocardiography and 4D flow MRI at 1.5 T with a \nspatial/temporal resolution of 1.6x1.6x2.1 mm3/28 ms. Pressure gradient \nmeasurements by echocardiography based on the simplified Bernoulli equation \nwere used for comparison. Pressure gradients by 4D flow MRI were \ndetermined after automatic vessel segmentation applying two different \nmethods: 1, measurement of maximum blood flow velocities in the operated \naortic isthmus and calculation of pressure gradients using the simplified \nBernoulli equation; 2, computation of 4D pressure difference maps based on \nthe Navier-Stokes equation and measurement of the peak systolic difference \nbetween mean pressures directly proximal and distal to the operated aortic \nisthmus. \nResults: Mean pressure gradient by echocardiography was 26.5 ±10.2 mmHg \ncompared to 18.0 ±6.9/13.0±6.2 mmHg by MRI Bernoulli method/MRI 4D \nmapping method. Spearman correlation coefficients were 0.93 (p=0.001) for \nMRI Bernoulli method and 0.76 (p=0.028) for MRI 4D mapping method. Bland-\nAltman plots showed consistently lower pressure gradients for both MRI \nmethods compared to echocardiography. \nConclusion: Pressure gradient measurements based on 4D flow MRI showed \ngood correlation with consistently lower pressure gradients compared to \nroutinely performed measurements by 2D echocardiography. Since such \ndifferences could be due to the pub lished possible overestimation of \nechocardiography, further studies need to compare measurements by 4D flow \nMRI to invasive measurements.  \nAuthor Disclosures: \nH. von Tengg-Kobligk: Research/Grant Support; W. L. Gore & Associates, \nInc. H.-U. Kauczor: Research/Grant Support; Boehringer Ingelheim GmbH, \nSiemens AG. Speaker; Boehringer Ingelheim GmbH, Bayer AG, Siemens AG.  \nB-0797 11:24  \nAcute appendicitis in children: multidetector CT and US findings in \nnegative appendectomy cases  \nS. Kim, Y. Choi, J. Cheon, W. Kim, I. Kim; Seoul/KR \n(evazzang23@gmail.com)  \nPurpose: To evaluate the negative appendectomy rate (NAR) among different \nimaging modalities, age groups and sexes and to describe the findings with US \nand MDCT that cause radiologists to misdiagnose acute appendicitis in \npaediatric patients. \nMethods and Materials: 382 patients were enrolled by reviewing their medical \ncharts. Among them, 348 patients were confirmed with acute appendicitis, \nwhile 26 patients were confirmed as negative for appendicitis. The NAR was \ncompared and the radiological reports and imaging findings from US and \nMDCT in the negative appendectomy cases were retrospectively reviewed. \nResults: Overall, the NAR was 7.0%. The NAR was lowest in the group \nreceiving MDCT only (5.6%), was highest in age group of 0-4 years old \n(14.7%), and was higher in the male paediatric population (9.2%), but there \nwere no statistically significant di fferences. The most common misleading \nfinding in US was equivocal dilatation of the appendix with associated \nsonographic tenderness and/or noncompressibility (13/16, 81%). The two most \ncommon misleading findings in CT were the borderline diameter of the \nappendix with appendicolith or hyperdense fecalith (5/12, 42%) and secondary \ninflammatory changes in the appendix (4/12, 33%). In almost all the negative \nappendectomy cases, periappendiceal fat inflammation was not present on the \nimaging studies. \nConclusion: The radiologists may misdiagnose acute appendicitis, especially \nwhen sonographic tenderness or noncompressibility is present on US \nS309  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nexamination, and an appendicolith or hyperdense fecalith is noted on the \nMDCT scan. The absence of periappendiceal  fat inflammation either on US or \nMDCT, provides some clues for the exclusion of acute appendicitis.  \nB-0798 11:33  \nImaging features of childhood desmoplastic small round cell tumour  \nA. Youssef, Y. Mahfouz, A. Refaat, T. Rafaat, E. Mahmoud, M. EL Wakil, \nI. Zaky; Cairo/EG (aydayoussefegypt@gmail.com)  \nPurpose: Desmoplastic small round cell tumour (DSRCT) is a rare aggressive \nmalignant small cell neoplasm tends to occur in children and adolescents, who \npresent with vague abdominal discomfort or distention and are often evaluated \nwith cross-sectional imaging. Our purpose is to review the imaging features, \nhistopathology and outcome of 10 patients with DSRCT treated at a single \ninstitution. \nMethods and Materials: This is a retrospective observational study of patients \nwith DSRCT who presented to our hospital between 2010 and 2013. Ten \npaediatric patients with pathologically proven DSRCT seen during this period. \nResults of imaging studies (CT in the ten patients, ultrasonography [US] in \nthree) and histopathologic specimens were analysed. \nResults: The cohort of 10 patients included 1 male (1%) and 9 females (90%) \nwith a mean age of 12.7 years (range 9 to 17 years). The peritoneum affected \nin the majority of cases (n=9) and pleura is affected only in one case. There \nwere 3 patients (33%) had metastatic disease at presentation. The hallmark \nimaging feature was diffuse peritoneal thickening with multiple focal lobulated \nperitoneal masses (n=6). Less common multiple focal peritoneal masses (n=3). \nAscites was present in five patients. Calcification was encountered in one \npatient. \nConclusion: Desmoplastic small round cell tumour is uncommon, aggressive \nsmall-cell tumour typically presenting with multiple large serosal soft-tissue \nmasses. The imaging of this tumour is somewhat nonspecific, yet this \nuncommon diagnosis should be considered in assessment of young female \nteenager presenting with widespread peritoneal malignant disease without \ncertain solid organ involvement.  \nB-0799 11:42  \nNoninvasive quantitative 4D pressure difference mapping derived from \n4D flow MRI shows alterations in patients with repaired aortic coarctation  \nF. Rengier\n1, M. Delles2, J. Eichhorn1, Y.-J. Azad2, H. von Tengg-Kobligk1, \nH.-U. Kauczor1, R. Unterhinninghofen2, S. Ley1; 1Heidelberg/DE, \n2Karlsruhe/DE (hendrik.vontengg@insel.ch)  \nPurpose: To assess spatial and temporal pressure characteristics in patients \nwith repaired aortic coarctation compared to young healthy volunteers using \n4D pressure difference maps derived from 4D flow MRI. \nMethods and Materials:  13 patients after aortic coarctation repair without \nrecoarctation (mean age 18.8 years) and 13 healthy volunteers (mean age \n22.9 years) underwent 4D flow MRI of the thoracic aorta at 1.5 T. \nSpatial/temporal resolution was 1.6x1.6x2.1 mm3/28 ms. 4D pressure \ndifference maps relative to the proximal ascending aorta were computed based \non the Navier-Stokes equation. The thoracic aorta was divided into four \nsegments: ascending aorta, aortic arch, proximal descending aorta and distal \ndescending aorta. For each segment, spatial pressure range at mid systole \nand maximum slope of local pressure amplitudes were determined. \nResults: Mean spatial pressure range at mid systole for patients/volunteers \nwas (in mmHg): ascending aorta 1.8/1.6 (p=ns), arch 4.8/1.7 (p=0.02), \nproximal descending 8.9/1.6 (p < 0.001) and distal descending 2.8/1.6 \n(p=0.002). Mean maximum slope of local pressure amplitudes for \npatients/volunteers was (in mmHg/cm): ascending aorta 7.4/2.5 (p=ns), arch \n6.6/2.1 (p < 0.001), proximal descending 12.1/1.9 (p=0.002) and distal \ndescending 3.9/2.1 (p=0.002). \nConclusion: Noninvasive quantitative 4D pressure difference mapping derived \nfrom 4D flow MRI showed significant alterations of spatial and temporal \npressure characteristics in patients with repaired aortic coarctation compared \nto young healthy volunteers, particularly affecting aortic arch and proximal \ndescending aorta, but also distal descending aorta. The technique may evolve \ninto a noninvasive alternative to catheterisation in coarctation follow-up.  \nAuthor Disclosures: \nH. von Tengg-Kobligk: Research/Grant Support; W. L. Gore & Associates, \nInc. H.-U. Kauczor: Research/Grant Support; Boehringer Ingelheim GmbH, \nSiemens AG. Speaker; Boehringer Ingelheim GmbH, Bayer AG, Siemens AG.  \n10:30 - 12:00 Room E1  \nMusculoskeletal  \nSS 1710  \nHip and artefacts reduction  \nModerators:  \nP. Omoumi; Brussels/BE  \nA.P. Toms; Norwich/UK  \nB-0800 10:30  \nMeasurement of acetabular cup orientation after total hip arthroplasty in \nstanding and sitting positions with a novel low dose biplanar slot \nscanner  \nR. Ferré, C. Bourdet, A. Feydy, M. Hamadouche, J.-L. Drape, B. Guenoun; \nParis/FR (benjamin.guenoun@gmail.com)  \nPurpose: Improper positioning of the acetabular cup after total hip arthroplasty \n(THA) is a cause of dislocation. Cup orientation (CO) is assessed with a \ncomputed-tomography (CT) scan in the supine position. Slot scanner (SS) \nallows a three-dimensional (3D) assessment of CO in standing and sitting \npositions. The aim was to evaluate the interest of SS to assess CO. \nMethods and Materials:  Fifteen THA patients were included after dislocation. \nAfter reduction, a scan and SS acquisitions were performed to measure cup \nanteversion both in the standing and sitting positions. 3D modelling of the \npelvises was performed by two independent observers with a dedicated \nsoftware, cup inclination and anteversion were calculated. Variations of cup \nanteversion and inclination between the different positions were detected with \nthe student t-test. The interobserver agreements of the SS evaluation of CO \nwere assessed with the intraclass correlation coefficient (ICC). \nResults: CT measurement of cup anteversion was 23.3°. SS measurement of \ncup anteversion was 24.4° in the standing position and 37.2° in the sitting \nposition (p < 0.01). CT measurement of cup anteversion did not differ \nsignificantly from SS measurement in the standing position (p=0.9), but the \ndifference between CT and SS was statist ically significant when considering \nthe sitting SS acquisition (p < 0.01). SS measurement of cup inclination was \n43.6° in the standing position and 50.6° in the sitting position (p < 0.01). \nConclusion: Cup orientation shows significant variations between stand-up \nand sat positions. SS might be a relevant and reliable tool to understand cases \nof hip dislocations occurring during postural changes. \nB-0801 10:39  \nImproving sensitivity of conventional MR arthrography in detection of \narthroscopically confirmed lig. teres lesions subsequent to FAI by adding \naxial leg traction  \nF. Schmaranzer\n1, M. Kogler2, M. Reichkendler2, E. Schmaranzer2; \n1Innsbruck/AT, 2St. Johann in Tirol/AT \n(florian.schmaranzer@student.i-med.ac.at)  \nPurpose: Recent research focuses on the increasing relevance of lig. teres \nlesions as contributors to hip pain and instability. Detection of these lesions is \nchallenging, thus it was aimed to improve diagnostic performance of MR \narthrography by adding leg traction. \nMethods and Materials:  Out of 135 patients with FAI, 48 imaging studies \n(mean age 34.6a, 34 mixed-, 12 cam-, and 2 pincer-type) with confirmed lig. \nteres lesions were selected. MR arthrograms were obtained according to the \ninstitutional routine protocol using a 1.5 T scanner and an intraarticular injected \nvolume of up to 30 ml. Weight load ranging from 15 to 23 kg was adapted to \nconstitution and applicated with a dedicated traction device. Lesions were \ngraded as partial tear (type 2; subtotal fluid interposition and/or ligamentous \nflap) and degeneration (type 3; hypertrophy ± mucoid degeneration) on coronal \nimages ± traction. Overall sensitivity and se nsitivity for each imaging modality \nas such was calculated. \nResults: Overall sensitivity was 85.3% (35/41), 100% (7/7) for type 2, 3 \nlesions, respectively. Sensitivity of imag ing analysis without traction was 60.9% \n(25/41) for type 2 and 57.1% (4/7) for type 3 lesions. 10 type 2 (P = 24.3%) and \n3 type 3 lesions (P = 42.8%) were only seen with traction. \nConclusion: Traction improved detection of lig. teres lesions. It is \nhypothesised that traction during MR arthrography enables visualisation of the \nligament more similar to the arthroscopic point of view that reflects a more lax \ncondition of stress thereby facilitating the evaluation of flaps, intrasubstantial \nfluid accumulation and hypertrophy.  \n \n \nS310  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0802 10:48  \nFemoroacetabular impingement pattern of hip involvement in ankylosing \nspondylitis  \nJ. Lee, J.-A. Choi, E. Lee, H. Kang; Seongnam/KR  (jachoi88@gmail.com)  \nPurpose: To evaluate FAI patterns of hip involvement in AS and correlate with \nsacroiliitis grades. \nMethods and Materials:  153 patients with AS were analysed regarding \nradiologic signs of FAI, sacroiliitis grades. FAI was classified according to alpha \nangle, lateral center-edge (CE) angle, crossover sign, pistol grip deformity. \nPrevalence of FAI types was determined and evaluated for association with \nsacroiliitis grades. Alpha angles were m easured on translateral radiographs or \noblique axial CT/MR images. Lateral CE angle, crossover sign, pistol grip \ndeformity were measured on AP radiographs. Sacroiliitis was graded according \nto New York criteria. Cam type FAI was considered if flattening of head-neck \njunction (pistol grip deformity) and/or alpha angle > 50°; pincer FAI if lateral CE \nangle > 39°, and/or positive crossover sign; combined type with findings of both \ntypes. Statistical analysis was done using Chi-square test for gender, T-test for \nage, sacroiliitis score, Kruskal-Wallis test for sacroiliitis score, Mann-Whitney \nU-test, corrected by Bonferroni methods. \nResults: 53 (34.6%) had FAI pattern of hip. Male predominance was found \n(84.9%) (p=0.031). Hip involvement group showed greater sacroiliitis score \n(p=0.001). Regarding type of FAI (n=53), pincer was most common (n=25). \nSacroiliitis grade was different among FAI types (p=0.002). Combined-type FAI \npattern (n=20, 3.20±0.77) had greater sacroiliitis score (p=0.018). \nConclusion: FAI pattern of hip involvement was frequent in AS (34.6%), more \nfrequent in males, associated with greater sacroiliitis grade. FAI type of hip \ninvolvement should be considered in AS patients with hip symptoms and \nmanaged accordingly.  \nB-0803 10:57  \nHow common are hip labral tears? Comparison of individuals with and \nwithout hip symptoms  \nS. Lee\n1, L. Nardo1, U.R. Heilmeier1, D. Kumar1, M. Kretzschmar1, A. Yu1, \nS. Majumdar1, N.E. Lane2, T.M. Link1; 1San Francisco, CA/US, 2Sacramento, \nCA/US (Sonia.Lee@ucsf.edu)  \nPurpose: To compare frequencies of hip la bral tear in individuals with and \nwithout hip symptoms \nMethods and Materials: Ninety volunteers (49 male and 41 female, age range \n23-72) were prospectively recruited for this cross-sectional study. All \nunderwent non-contrast 3 T MRI and clinical assessment for hip symptoms. \nThree-plane non-contrast intermediate-weighted fast spin echo imaging \nsequences were performed of the hip. Images were analysed for labral \npathology and other significant hip joint findings. Labral abnormalities were \nclassified into 4 groups, any tear, intra-substance tear, complex tear and \nmaceration. Hip pain, stiffness, noise such as clicking or grinding and stiffness \nwere assessed on a 5-point scale using the Hip Osteoarthritis Outcome score \n(HOOS) questionnaire. Chi-square test was performed to assess the difference \nof labral abnormality frequency in each symptom subgroup. \nResults: Hip pain, noise and stiffness were reported in 49, 25 and 38 of the 90 \nsubjects. The frequency of labral abnormalities were, any tear 91.1 %, intra-\nsubstance tear 58.8 %, complex tear 43.3 % and maceration 14.4 %. No \nsignificant differences in overall frequency of hip tears were found between \nsubjects with and without symptoms; i ndividuals with hip stiffness, however, \nshowed a statistically significant higher number of complex tears (P=0.01) and \na statistical trend toward increase in intra-substance tears (P=0.06). \nConclusion: A high percentage of labral tears were found in individuals with \nand without hip pain, noise and stiffness. The only clinical symptom with \nstatistical frequency increase of hip l abral abnormality was hip stiffness, which \nwas associated with complex tears.  \nB-0804 11:06  \nValue of lower-limb MRI examination for the prediction of joint collapse in \nhaematological paediatric patients with osteonecrosis of femoral heads \nand condyles: role of lesion volume assessment  \nA. Masetto, D. Ippolito, P.A. Bonaffini, A. Casiraghi, V. Besostri, S. Sironi; \nMonza/IT (dr.masetto@gmail.com)  \nPurpose: To assess the reliability of the measurement of the osteonecrosis \nvolume as predictive factor of joint collapse in femoral heads and condyles of \npaediatric patients treated for haematologic malignancies. \nMethods and Materials:  A total of 120 patients with lymphoproliferative \ndiseases, treated with chemotherapy and corticosteroids and/or bone marrow \ntransplant, with suspicion of osteonecrosis, underwent a lower-limb MRI \nexamination between June 2005 and January 2013. Studies were performed at \nbaseline and during follow-up on a 1.5 T magnet, acquiring coronal STIR and \nT1-weighted sequences from the hips to the ankles. On baseline MRI, the \nvolumes of femoral heads (FHs), medial condyles (MCs), lateral condyles \n(LCs) and the osteonecrosis volume (ONV) were measured. The volumetric \ninvolvement (relative volume, RV) of the bone by necrosis was calculated \n(ONV/epiphyseal bone volume). Statistical  analysis was performed with ROC \ncurve test. \nResults: Twenty-six patients (9 males, mean age 15 years) presented ON \naffecting femoral heads and/or condyles, for a total of 23 FHs, 23 MCs and 28 \nLCs. During the follow-up (11 ±2 months), joint deformity was observed in \n12 FHs, 2 MCs and 5 LCs. Considering a threshold of 24% of volume \ninvolvement, RV predicted joint deformity in 12/12 FHs, with sensitivity=100%, \nspecificity=90%, accuracy=95%, PPV=93%, NPV=100%. Using a threshold of \n27% and 11% of volume involvement, RV predicted joint deformity in 2/23 (8%) \nMCs (sensitivity=100%, specificity=57%, accuracy=61%, PPV=9%, \nNPV=100%) and in 5/28 (18%) LCs (SN=100%, specificity=35%, \naccuracy=46%, PPV=25%, NPV=100%), respectively. \nConclusion: In haematological paediatric patients with post-treatment \nosteonecrosis, RV showed high prognostic value for the prediction of deformity \nin femoral heads, but not in femoral condyles.  \nB-0805 11:15  \nModel-based iterative reconstruction: reduction of metal artefact on CT \nimages  \nS. Boudabbous, D. Arditi, E. Paulin, A. Syrogiannopoulou, C.D. Becker, \nX. Montet; Geneva/CH (sanaboudabous@yahoo.fr)  \nPurpose: To reduce artefacts resulting from implanted metal prosthesis on CT \nimages using model-based iterative reconstruction (MBIR). \nMethods and Materials:  A total hip prosthesis, screws and metal plates were \nscanned in vitro (CT Discovery, GEMS). Images were reconstructed with \nfiltered-back projection (FBP) and MBIR algorithms, and the size of the \nresulting artefacts on each image series was measured. CT scans obtained \nwith the same scanner in 63 patients with similar implants were reconstructed \nwith FBP and MBIR. The visibility of the interface between metal and bone and \nof the neighbouring soft tissue structures was recorded on each set of images \nand graded on a 3-point scale. \nResults: In vitro, the mean size of the artefacts was 1.4 cm\n2 with FBP and \n0.25 cm2 with MBIR corresponding to a reduction of 80%. In vivo, the size of \nthe artefacts decreased from 6.46 to 3.53 cm 2 (p < 0.0001) when using MBIR. \nThe interface between metal and bone was equal or better visible on images \nreconstructed with MBIR than on those with FBP in 85% of cases (p < 0.05), \nand the results for soft tissue evaluation were better in 75% of cases (p < 0.05) \nparticularly in pelvis. \nConclusion: Both qualitative and quantitative results showed that the MBIR \nimprove image quality by reduction of artefacts and better assessment of the \nadjacent structures.  \nB-0806 11:24  \nWARP imaging of metal-on-metal hip resurfacing arthroplasty at 1.5 T \nand 3 T MRI compared to standard imaging techniques: what more do we \nsee?  \nA. Lazik, O. Kraff, P. Schulte, S. Landgraeber, T.C. Lauenstein, \nJ.M. Theysohn; Essen/DE (andrea.lazik@uk-essen.de)  \nPurpose: To evaluate the metal artefact reduction technique WARP (Siemens \nHealthcare) for the assessment of metal-on-metal hip resurfacing at 1.5 T and \n3 T according to advantages and disadvantages over standard MR-sequences, \nfocused on the detection of pseudotumours. \nMethods and Materials:  23 arthroplasties (Conserve plus, Wright Medical \nTechnology) were evaluated 3 - 9 years after surgery, randomised for 1.5 T \nand 3 T MRI. Additionally eight patients were examined at both field strengths \nusing the same protocol: TIRM, T1w and T2w TSE in coronal and axial \norientation, each with and without WARP (Bandwidth: 558 Hz/px (HBW), view-\nangle-tilting 100% (VAT)). Sequences were evaluated regarding artifacts (size; \n5-point-scale: 1= no artifacts, 5= no ndiagnostic), delineation of soft-tissue \nstructures (3-point-scale: 1= fully visible, 3= not visibl e) and the existence of \npseudotumours. The results were compared between the correlating \nsequences. \nResults: WARP showed less quality degradation through artefacts (i.e. 1.5 T \nTIRM: 3.9 ±0.3 vs. 4.9 ±0.2) and smaller artefacts (i.e. 3 T T1w: 87.4 ±9.0 mm \nvs. 100.6 ±3.8 mm). The delineation of soft tissue structures was better with \nWARP (i.e. internal obturator tendon at 1.5 T T1w: 1.8 ±0.4 vs. 2.6 ±0.5). \nWARP showed only slightly better results then HBW alone for the size of \nartefacts. Pseudotumours appeared in 5 cases (19 - 30 mm), which could be \nseen with and without WARP. \nConclusion: WARP is feasible at 1.5 T and 3 T for imaging hips after metal-\non-metal resurfacing and provides better image quality then standard \nsequences. WARP shows a slight advantage over HBW alone. Detected \npseudotumours did not profit from WARP.  \n \nS311  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0807 11:33  \nUsefullness of slice encoding metal artefact correction for reducing metal \nartefact after spinal instrumentation  \nM. Reichert, M. Sertdemir, M. Moursy, H.P. Scharf, U.I. Attenberger, \nS.O. Schönberg, F. Bludau; Mannheim/DE (Miriam.Reichert@umm.de)  \nPurpose: To compare metal artifact reduction after spinal instrumentation in \nMRI at 1.5 T using novel MRI sequence strategies. \nMethods and Materials:  Two sequences were compared for the imaging of \nmetal implants after spinal instrumentation: a slice encoding sequence for \nmetal artifact correction (SEMAC) and a standard sequence. Images were \nacquired on a 1.5 T system. 13 patients with titanium implants and 2 patients \nwith stainless steel implants were evaluated. Degree of artifact reduction was \nassessed quantitatively and qualitatively by both, artifact measurements and a \nblinded read. The images were ranked on the basis of the following \nparameters: artifact size, distortion of normal structures, and the ability to \nvisualise the bone marrow, bone cortex and soft tissues. The SEMAC \ntechnique was compared directly to the standard sequence. \nResults: In comparison to conventional sequences artifact size was 45% less \nutilising SEMAC. In terms of bone marrow, bone cortex and soft tissue \nvisualisation SEMAC was ranked superior to the corresponding standard \nsequence. Distortion was less with SEMAC. For the evaluation of blur, the \nstandard images were ranked superior to the corresponding SEMAC \nsequence. In terms of overall image quality, SEMAC was ranked superior to \nthe standard sequence. \nConclusion: SEMAC effectively reduces artifacts caused by metallic implants \nafter spinal instrumentation relative to standard imaging. This allows for an \nimproved detectability of postoperative complications such as epidural \ninflammation or hematoma.  \nB-0808 11:42  \nDual-energy CT of hip prosthesis: metal artefact reduction system image \nand 140keV monochromatic image contrast and noise on non-prosthesis \nside  \nM. Guzinski, L. Waszczuk, M. S \u0017siadek; Wroclaw/PL (guziol@wp.pl)  \nPurpose: To compare image quality (SNR, CNR) on non-hip prosthesis side in \ndual-energy CT examinations obtained with different protocols: with metal \nartefact reduction system (MARS) and high energy (140 keV) monochromatic \nreconstruction without MARS. \nMethods and Materials:  Hip prosthesis studies of 31 consecutive patients \n(mean age 68 yrs) after hip prosthesis revision surgery were examined, using \nDECT (GE Discovery CT750HD; 64x0.625 mm; pitch 1:1.375, 600 mAs). From \neach patient, two series of monochromatic energy scan were obtained. First \nwith MARS and 75keV and second without MARS, 140keV. Two blind \nradiologists reviewed two series of monochromtic image of DECT examinations \nassessing image noise (SNR), contrast (CNR) on the side of hip prosthesis and \nin mirror contralateral region. SNR and CNR in fat muscle for prosthesis' side \nand opposite side were measured on the level of femoral head. \nResults: There were no statistically significant differences between SNR of fat \non hip prosthesis and opposite site (4.8 vs. 5.2, p=0.07) in MARS image. \nHowever, significant difference between SNR was found in 140keV images \n(3.9 vs. 5.3, p=0.0001). Differences between CNR (fat/muscle) of both sides on \nMARS and 140keV images were: 5.5 vs. 6.8, p=0.05; 5.9 vs. 7.3, p=0.05, \nrespectively. \nConclusion: In the monochromatic 140 keV image on non-prosthesis side, the \nsignificant lower level of noise was detected. We propose to perform MARS \nreconstruction in high voltage level.  \nB-0809 11:51  \nReduction of metal artefact from cobalt-chromium-molybdenum alloy hip \nprostheses in gemstone spectral imaging dual-energy CT with and \nwithout metal artefact reduction software  \nF. Wang, H. Xue, W. Han, Y. Fan, W. Qian, Z. Wu, Y. Zhang, Z. Jin; Beijing/CN \n(fengdanw@gmail.com)  \nPurpose: To assess the usefulness of gemstone spectral imaging (GSI) dual-\nenergy CT (DECT) with/without metal artefact reduction software (MARs) in \ncobalt-chromium-molybdenum alloy hip prostheses, and to detect the optimal \nphoton energy setting. \nMethods and Materials:  This study had institutional review board and local \nethics committee approval. The DECTs were performed using fast kV-\nswitching GSI between 80 and 140 kV. The CT data were reconstructed \nwith/without MARs, and with synthesized monochromatic energy in the range \nof 70-140 keV with 10 keV interval. Seventeen in vivo cobalt-chromium-\nmolybdenum alloy total hip prostheses of 11 unilateral implanted patients and 3 \nbilateral implanted patients were included. Two independent readers evaluated \nthe visualisation of periprosthetic regions and the severity of artifacts according \nto a 4-score scale. CT attenuation of gluteus maximus muscle ipsilateral to the \nside of the replaced hip from non-metal level, acetabular cup and femoral head \nlevel, femoral neck level, and femoral shaft level were measured. Statistical \nanalysis included the Chi-square test, and Friedman test. \nResults: The GSI-MARs reconstruction markedly reduced the cobalt-\nchromium-molybdenum alloy hip prostheses related artifacts (P < 0.05). CT \nattenuation of gluteus maximus muscle in GSI-MARs images from the \nacetabular cup and femoral head level (<2=4.765, P=0.029), femoral neck level \n(<2=13.235, P=0.000), and femoral shaft level ( <2=7.118, P=0.008) was much \ncloser to the reference non-metal level. Optimal metal artefact reduction and \nimage noise could be achieved above 100 keV. \nConclusion: GSI-MARs reduced metal artefacts from cobalt-chromium-\nmolybdenum alloy hip prostheses. Optimal energy range was found between \n110 and 140 keV.  \n10:30 - 12:00 Room E2  \nHead and Neck  \nSS 1708  \nThyroid and parathyroid glands  \nModerators:  \nH. Ahmadzadehfar; Bonn/DE  \nS.S. Özbek; Izmir/TR  \nB-0810 10:30  \nRole of TIRADS in nodular thyroid disease  \nB. Raghavan, S. Paul; Chennai/IN (drbagyam@gmail.com)  \nPurpose: 1. To classify nodular thyroid disease according to TIRADS \nclassification. 2. To correlate TIRADS categories with the rates of malignancy \nin each category, in select study population. 3. To assess reliability of TIRADS \nclassification. \nMethods and Materials:  219 nodules were evaluated by B-mode imaging and \ncolour Doppler. These nodules were cl assified into TIRADS grades according \nto the guidelines proposed by Horvath et al. The TIRADS subgroups (based on \nB-mode imaging and colour Doppler) were compared with the cytopathological \ndiagnosis and analysed statistically using Chi-square test, and logistic \nregression analysis to find out the correlation between the sonographic \nvariables and final cytological end resul t. The odds ratio for malignancy for \neach TIRADS group was calculated thereby. \"SSPS for Windows, Version 17\" \nwas used for the statistical analysis. \nResults: TIRADS is a system of classification for categorisation of thyroid \nnodules. As such it can be used to predict tissue morphology, whether benign \nor malignant. According to our study, univariate logistic regression of TIRADS \n2 to TIRADS 4B with malignancy has an odds ratio (OR) of less than 1 with a \nsignificant confidence interval. TIRADS has a statistically significant OR of \nmore than 1 when compared with malignancy. \nConclusion: TIRADS is a novel method of categorising nodular thyroid \ndisease. It helps in classifying these into benign and malignant according to \nsonographic features. Thus, the need of biopsy can be reduced.  \nB-0811 10:39  \nNon-diagnostic results of fine needle aspiration cytology of thyroid \nnodules  \nS. Jacobs\n1, F. van Nederveen2, P. Burger2, R. Peeters2, M. Vernooij2, \nA. van der Lugt2, J. Peluso3; 1Dordrecht/NL, 2Rotterdam/NL, 3 Tilburg/NL \n(jacobs.sanne@gmail.com)  \nPurpose: Fine needle aspiration (FNA) cytology has a central place in the \ndiagnosis of thyroid gland nodules. We evaluated the proportion of non-\ndiagnostic cytology results after first a nd after repeat FNA. Also the effect of \noperator experience was evaluated. \nMethods and Materials:  483 cytology results of FNA performed in our \ninstitution in 2010, 2011 and 2012 were available for retrospective analysis. 77 \nwere excluded from further analysis (70 previous FNA before 2010, 3 second \nrepeat FNA, 4 interval > 6 months). 406 remaining cytology results in 336 \npatients were dichotomised using the Bethesda system with 1 as non-\ndiagnostic and 2 to 6 as diagnostic. Operator experience was categorised as \nexperienced (staff radiologist) or inexperienced (radiology resident). \nDifferences were analysed using the Chi-square test. \nResults: The cohort consisted of predominantly females (N=250, 74%). Mean \npatient age was 52.6 (median 53, 14-93). Non-diagnostic cytology occurred in \n98 of 353 initial FNA (28%). Non-diagnostic cytology occurred in 20 of 53 \nrepeat FNA (38%). Total non-diagnostic cytology after second FNA was 21%. \nApproximately, 40% of the FNA was performed by a staff radiologist. There \nwas no significant difference between experienced and inexperienced \noperators (25% and 32%; p=0.13). \n \n \nS312  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nConclusion: Although FNA cytology is a valuable tool in the evaluation of \nthyroid gland nodules there is a high proportion of non-diagnostic test results \n(28%). It is important to repeat FNA cytology because diagnostic results are \nobtained in 62% of the previously non-diagnostic FNA. In this study, non-\ndiagnostic FNA cytology is not influenced by operator experience.  \n  \nB-0813 10:48  \nDifficulties in the performance of ultrasound elastography of thyroid \nmalignancies  \nA.N. Sencha, Y. Patrunov, Y. Sergeeva; Yaroslavl/RU \n(senchavyatka@mail.ru)  \nPurpose: To analyse disadvantages, difficulties, and artifacts during \nultrasound elastography of thyroid cancer. \nMethods and Materials:  Ultrasound examinations with elastography of 141 \npatients with verified thyroid cancer were analysed. The reference group with \nverified benign nodules included 432 persons. The scanners S2000 (Siemens-\nAcuson), SonixSP (Ultrasonix), DC-8 (Mindr ?y) with linear 7.5-15 MHz probes \nwere utilised. \nResults: The efficacy of the combination of compression and share-wave \nelastography in diagnosis of thyroid canc er was characterised with sensitivity \nof 96.4% and specificity of 90.1%.  Compression elastography was \naccompanied with difficulties in interpretation in 13 cases (9.2%). In 4 cases \n(2.8%) the artifact of excessive color pattern within the malignant lesion was \nobserved, while 9 cases (6.4%) had the artifact of poor (deficiency or absence) \ncolor pattern or absence of difference between the color of the lesion and the \nsurrounding thyroid parenchyma. However, all lesions were well visualised in \nother ultrasound regimens. Artifacts duri ng compression elastography resulted \nfrom inadequate adjustments of equipment, \"noise\" due to thyroid lesion \nlocation, different approaches in image processing in scanners of different \nmanufacturers, significant operator-dependency of the technology. Difficulties \nin the performance of share-wave elastography were experienced in 12 \n(14.9%) cases. They were the consequence of substernal thyroid location, \nsubcentimetric or large ( > 3 cm) lesions, prominent heterogeneity of lesions, \nand severe background changes in thyroid parenchyma. In 9 cases (6.4%) \ncompression elastography and share-wa ve elastography exhibited discordant \nresults. \nConclusion: Effective acquisition and interpretation of elastographic images \ndemands certain knowledge, skills, and experience with complex analysis of \nquantitative and qualitative data.  \nB-0814 10:57  \nQ-elastography in the presurgical evaluation of thyroid nodules with \nindeterminate cytology: bicenter experience on large population  \nV. Cantisani, M. Di Segni, N. Di Leo, C. Fioravanti, A. Rubini, P. Lodise, \nC. Catalano, F. D'Ambrosio, P. Ricci; Rome/IT (vito.cantisani@uniroma1.it)  \nPurpose: To assess the role of Q-Elastography (Q-USE) in the \ncharacterisation of thyroid nodules with indeterminate cytology (Thy3). \nMethods and Materials:  260 nodules in 220 patients (185 females; 75 male \npatients) with Thy3 (mean age 50 years, range 18-78) were prospectively and \nconsecutively enrolled in two specialised University Centers. All patients \nunderwent multiparametric CDUS and Q-USE evaluation measuring the Strain \nRatio (SR) and then underwent surgery or FNAC. To evaluate the relationship \nbetween categorical data and final histological outcome, univariate analysis \nwith the chi-square test and multiple logistic regression analysis was \nperformed. Sensitivity, specificity, positive predictive value, negative predictive \nvalue and diagnostic accuracy were calcul ated. Cut-off value for strain ratio \nwas calculated by Receiver Operating Characteristic (ROC) analysis, with \nAreas Under the Curve comparison with Bonferroni test. Histopathology was \nthe gold standard. \nResults: Malignant nodules were 95; while the benign were 165 (18 adenomas \nand 147 hyperplastic nodules). A higher Strain Ratio in malignant nodules than \nbenign ones was demonstrated, with an optimum SR cut-off equal to 2 \nobtained with ROC analysis. Hypoechogenicity, irregular margins and SR \u0003 2 \nshowed accuracy of 69%, 80% and 91%, respectively. A multivariate analysis \nshowed a significant association between the SR and margins irregularity, thus \nconfirming the univariate analysis findings. The diagnostic accuracy of \nhypoechogenicity (ROC area = 0.6725) was significantly lower than that of the \nstrain ratio (p,0.0001) and irregular margins (p = 0.0092). \nConclusion: Q-USE is a useful additional tool to Color-Doppler US in the \ndifferential diagnosis of thyroid nodules with indeterminate cytology.  \n \n \n \nB-0816 \n11:06  \nA novel application: the role of ARFI sonoelastography for the diagnosis \nof chronic autoimmune Hashimoto's thyroiditis  \nK. Hekimoglu, F. Yildirim, S. Arslan, A. Ozdemir, C.C. Demir, C. Yazici; \nAnkara/TR \nPurpose: The aim of this study was to prospectively assess the applicability of \nreal-time acoustic radiation force impulse (ARFI) sonoelastography in \ndiagnosis of chronic autoimmun thyroidi tis (CAT). This study revealed and \ncompared the thyroid tissue stiffness in patients with CAT with healty control \nsubjects (CS). \nMethods and Materials:  The study group consist of 50 patients with first-\ndiagnosed CAT and 40 CS matched for age and gender. ARFI \nsonoelastography was performed at 2-3 days before the exact diagnosis and \ntreatment initiation. In all patients with CAT and CS, 10 sonoelastographic \nmeasurements were made in the everyone of thyroid lobe. Median values were \ncalculated for thyroid stiffness (TS) and expressed in meters/second (m/s). The \ndiagnostic performance of ARFI sonoelastography was evaluated using ROC \ncurves. Optimal cut-off values were chosen to maximise the sum of sensitivity \nand specificity. Positive predictive va lue (PPV), negative predictive value \n(NPV), and accuracy values were also calculated. \nResults: TS assessed by means of ARFI in CAT patients (2.55 ± 0.32 m/s) \nwas significantly higher than in CS (1.63 ± 0.13 m/s) (P \n< 0.0001). The optimal \ncut-off value for the prediction of CAT was 2.03 m/s. For this cut-off value TS \nhad 85% sensitivity, 90% specificity , 92% PPV, 81% NPV,  and 87% accuracy \nfor the presence of CAT. \nConclusion: ARFI sonoelastography seems to be useful method for the pre-\ndiagnosis assessment of CAT patients.  \nB-0817 11:15  \nDoes new FDG-PET/CT64 show different uptake values than in previous \nPET scans in thyroid incidentalomas (TI)?  \nR. Zalazar, M. Paramo, L. Sancho Rodriguez, M. Hernandez, J. Larrache, \nJ. Arbizu, M. Garcia Velloso, A. Villanueva; Pamplona/ES (lzalazar@unav.es)  \nPurpose: Ultrasound fine needle aspiration cytology (USFNAC) has been \nproved to be a useful tool in the characterisation of TI detected with FDG-PET \nas well as new PET/CT64 devices show higher uptake than previous ones in \nsmall lesions. The aim of the study is to determine whether TI characterised by \nUSFNAC and histology, detected with FDG-PET/CT64, FDG-PET/CT2 and \nFDG-PET showed different standard uptake values (SUVmax) \nMethods and Materials:  Sixty-five TI were studied with USFNAC,11 of them \nwith histology after thyroidectomy,54 were benign and 11 malignant.Fourteen \nwere studied with FDG-PET-(group1),37 with FDG-PET/CT2-(group2) and 14 \nwith FDG-PET/CT64-(group 3).SUVmax was calculated and the values \nobtained comparing the 3 devices. Data were expressed as mean ± S.D. T-\nTest, ANOVA and non parametric tests were applied. \nResults: SUVmax was 3.5 ±1.1 for group 1, 5.6 ±3 for group 2 and 6.9 ± 6.9 for \ngroup 3 (p= 0.08).SUVmax for 54 benign lesions was 4.9 ±2.6 (range1.4-13.7) \nand for 11 malignant lesions was 8.1 ±7.8 (range 2.2-26.4) (p=0.02). In group 1, \nSUVmax for benign lesions was lower than for malignant ones (3.4 ±1.2 vs \n3.9±0.5 p=NS), as well as in group 2 (5.4 ±2.4 vs 6.9± 5.9 p=NS) and in group \n3 (4.9±3.5 vs 14.4±12.1 p=0.003). \nConclusion: SUVmax values of TI detected with FDG-PET/CT64 were higher \nthan those obtained with FDG-PET/CT2 and FDG-PET, with no significant \ndifferences.Even though malignant TI presented significantly higher SUVmax \nvalues than benign ones, some overlap was found, and these differences were \nonly detected by FDG-PET/CT64. FNAGUS is required to characterise TI \nbecause there is overlap between benign and malignant lesions.  \nB-0818 11:24  \nPreoperative detection of parathyroid adenomas with 3 T MRI in patients \nwith hyperparathyroidism  \nB. Sacconi, R. Argirò, A. Iannarelli, E. d'Adamo, M. Rosignuolo, E. Romagnoli, \nd. Cipriani, M. Bezzi, C. Catalano, D. Diacinti; Rome/IT  \n(beatrice.sacconi@fastwebnet.it)  \nPurpose: To identify MRI features of parathyroid adenomas in patients with \nprimary hyperparathyroidism, using a fast protocol with a 3 T MR scanner. \nMethods and Materials: 22 patients with primary hyperparathyroidism with US \nand Tc-99 sestamibi positive scans were enrolled and submitted to \npreoperative MR scan. MRI imaging was performed on a 3 T unit using a \ndedicated protocol: T2 IDEAL sequences on three-plane and axial T1 IDEAL \nsequences before and after administration of 10 ml of gadolinium. The average \nscan time was 16 minutes. Once the adenoma was identified, two radiologists \nin consensus evaluated the presence of five features: hyperintensity, \nhomogeneous or marbled appereance and oblong shape on T2 IDEAL \nsequence; cleavage plane from thyroid gland shown by \"Indian Ink artefact\" on \nT2 outphase IDEAL; rapid enhancement in post-contrast T1-weighted images. \nS313  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nResults: Radiologists identified adenomas as hyperintense on T2 IDEAL \nsequence in 29/29 (100%), marbled in 23/29 (79.3%) and oblong in 26/29 \n(89.7%). \"Indian ink artefact\" on T2 outphase IDEAL was noticed in 23/29 \n(79.3%) and a rapid enhancement on T1-weighted sequence in 9/29 (31%). \nConclusion: This study demonstrates that some MR features recurs in high \npercentage. In particular, we detected the hyperintensity in all cases; marbled \nand oblong appereance on T2 IDEAL sequence and the presence of \"Indian \nink artefact\" on T2 outphase IDEAL were also frequently observed.  \nB-0819 11:33  \nThe success of MRI in preoperative detection of primary \nhyperparathyroidism focus and contribution to other imaging methods  \nV. Kaplanoglu, D. Ciliz, H. Kaplanoglu, U. Toprak, S. Parlak, B. Sakman, \nE. Yuksel; Ankara/TR (selcuk_parlak@yahoo.com.tr)  \nPurpose: Single parathyroid adenoma is the most common cause of primary \nhyperparathyroidism (HPT). HPT focus should be detected before minimally \ninvasive surgery. Our aim is to investigate the success of magnetic resonance \nimaging (MRI) and contribution of it to other imaging methods in detecting \nprimary HPT focus. \nMethods and Materials:  One hundred fifty-nine parathyroid lesions of 150 \npatients, detected and pre-diagnosed by using MRI (159), ultrasound \n(US)(159), 99mTc-MIBI scintigraphy (159), SPECT (73) and SPECT/CT (85), \nproven pathologically after surgery, were evaluated retrospectively. \nResults: Parathyroid lesions were classified as normal/ectopic location, \nsingle/double, hyperplasia and reoperated lesions. Success ratios of imaging \ntechniques were calculated when they were used single and together with \nothers.When single or more imaging techniques were used for investigation of \nparathyroid lesions, general sensitivity, sensitivity in ectopic lesions and double \nadenomas, accurate detection rates of re-operated lesions are: MRI: 68.2%; \n72.7%; 38.9%; 71.4%, US:80.3%; 54.5%; 50.0%; 42.8%, MIBI planar: 69.7%; \n81.8%; 55.6%; 85.7%, SPECT: 68.4%; 80%; 62.5%; 50%, SPECT/CT: 86.5%; \n87.5%; 81.1%; 100%, MRI+US: 90.2%; 81.8%; 72.2%; 100%, \nMRI+MIBI:82.6%; 90.9%; 72.2%; 85.7%, MRI+SPECT: 80.7%; 80.0%; 75.0%; \n71.4%, MRI+SPECT/CT: 87.8%; 87.5%; 81.8%; 85.7%, US+MIBI: 94.7%; \n90.9%; 88.8%; 85.7%, MRI+US+MIBI: 96.2%; 100%; 94.4%; 100%, \nMRI+US+MIBI+SPECT: 98.2 %; 100%; 100%; 100%, \nMRI+US+MIBI+SPECT/CT: 97.3%; 100%; 100%; 100%, respectively. \nConclusion: Although MRI is not the first imaging technique in primary HPT \nroutinely, it increases the accuracy rates in the cases of insufficiency of US and \nMIBI scintigraphy and particularly in detection of ectopic lesions, double \nadenomas and re-operated parathyroid lesions, when used as additonal \nimaging method. \n10:30 - 12:00 Room F1  \nOncologic Imaging  \nSS 1716  \nPET/CT as diagnostic and prognostic \nbiomarker  \nModerators:  \nA. Pomoni; Lausanne/CH  \nN.N. \nB-0820 10:30  \nThe impact of PET-CT in detecting non-nodal extrathoracic metastases in \nlung cancer compared to the staging CT  \nJ.S.Z. Lee, K.M. Bradley, F. Gleeson; Oxford/UK (jean.lee@cantab.net)  \nPurpose: NICE Lung Cancer Guidelines 2011 recommend performing a PET-\nCT after a staging CT prior to radical treatment. As CT detects mediastinal \nlymphadenopathy and intervention determines its aetiology, the true value of \nPET-CT is in detecting non-nodal extrathoracic metastases. The yield of PET-\nCT in detecting non-nodal extrathoracic metastases has not been reported in \ncomparison to that of reviewing the prior staging CT. \nMethods and Materials:  235 consecutive lung cancer patients with no known \nextrathoracic metastases referred for a PET-CT prior to radical therapy \nunderwent a contrast-enhanced neck, chest and liver CT and whole body PET-\nCT. \nResults: The median age was 72 years, 141 men (60%). Patients had stage Ia \n(16%), Ib (19%), IIa (6%), IIb (7%), IIIa (25%), IIIb (6%) and IV (20%) disease. \nThe median interval between CT and PET-CT was 25 days (IQR, 18-29). 21 \n(9%) patients had 25 extrathoracic and extra-cerebral metastases. 9 \nmetastases were identified on PET-CT and review of the prior staging CT. 16 \nmetastases were invisible on the staging CT; 4 bone metastases were outside \nthe field of view, 6 had developed since referral (median interval 28 days; IQR, \n19-39), and 6 were only identified on PET-CT. \nConclusion: PET-CT detects extrathoracic metastases which were missed or \ninvisible on the staging CT. Lung cancer patients should be offered a contrast-\nenhanced pelvic CT in addition to the neck, chest, abdomen CT at staging to \nincrease the detection of extrathoracic metastases. An interval CT should be \nperformed if the PET-CT is delayed by greater than 30 days.  \nB-0821 10:39  \nFluorodeoxyglucose positron emission tomography and chemotherapy-\nrelated tumour marker expression in non-small cell lung cancer  \nX. Duan; Xi`an/CN (duanxy@mail.xjtu.edu.cn)  \nPurpose: The chemotherapy resistance of non-small cell lung cancer (NSCLC) \nremains a clinic challenge and is closely associated with several biomarkers \nincluding epidermal growth factor receptor (EGFR), p53 and excision repair \ncross complementing gene 1 (ERCC1). FDG-PET is the best non-invasive \nsurrogate for tumour biology with the maximal standardised uptake values \n(SUVmax) being the most important paradigm. The purpose of this study was \nto determine the correlation of chemotherapy related tumour markers with \nFDG-PET SUVmax in NSCLC. \nMethods and Materials:  FDG-PET SUVmax were calculated in patients with \nNSCLC (n = 62) and immunohistochemical analysis was performed for EGFR, \np53 or ERCC1 on the intraoperative NSCLC tissues. The SUVmax difference \nbased on the histologic characteristics, gender, differentiation, grading and age \nas well as correlation analysis among these parameters were performed. \nMultiple stepwise regression analysis was further performed to determine the \nprimary predictor for SUVmax. \nResults: The significant age, tumour size, p53 positivity or ERCC1 positivity-\ndependent differences of SUVmax values were observed. The tumour \ndifferentiation is significantly correl ated with SUVmax, tumour size, grading, \ngender as well as the expression levels for p53 and ERCC1. Furthermore, the \nexpression level of p53 is significantly correlated with SUVmax and grading. \nThe FDG-PET SUVmax is also significantly correlated with cancer \ndifferentiation. Furthermore, multiple stepwise regression analysis revealed \nthat p53 expression was the primary predictor for SUVmax. \nConclusion: The current study suggests that SUVmax of primary tumour on \nFDG-PET might be a simple and good non-invasive method for predicting p53-\nrelated chemotherapy resistance in NSCLC.  \nB-0822 10:48  \nIntegrated PET-CT in patients with non-small cell lung carcinoma: \nevaluation of equivocal mediastinal lymph nodes  \nF. Moloney, D. Ryan, L. McCarthy, M. Henry, M. Kennedy, J. McCarthy, \nS. McSweeney, M.M. Maher, K. O'Regan; Cork/IE \n(fiachramoloney@hotmail.com)  \nPurpose: The aim of this study was to identi fy radiological factors that may \nreduce false-positive results and increase diagnostic accuracy when staging \nthe mediastinum of patients with non-small cell lung carcinoma (NSCLC). \nMethods and Materials:  This was a retrospective, interdisciplinary, per-node \nanalysis study. We included patients with NSCLC and mediastinal nodes with \nan SUV max in the range of 2.5 to 4.0 kBq/ml on PET-CT. We hypothesised \nthat the greatest number of false positive cases would occur in this cohort of \npatients. \nResults: A total of 92 mediastinal lymph nodes were analysed in 44 patients. \nMediastinal disease (N2/N3) was histologically confirmed in 15 of 44 patients \nand in 34 of 92 lymph nodes; positive predictive value of 37% and false \npositive rate of 63%. Node SUV max, tumour size, ratio of node SUV max to \ntumour SUV max (SUV node/tumour), and ratio of node SUV max to node size \n(SUV node/size) were significantly higher in true positive cases. Using a \nthreshold of 0.3 for SUV node/tumour and 3 for SUV node/size yielded \nsensitivities of 91% and 71% and specificities of 71% and 69%, respectively, \nfor the detection of mediastinal disease.  Using both ratios in combination \nresulted in a sensitivity of 65% and a specificity of 88%. Concurrent benign \nlung disease was observed significantl y more frequently in false-positive \ncases. \nConclusion: SUV node/tumor and SUV node/size may be complimentary to \nconventional visual interpretation and SUV max measurement in the \nassessment of mediastinal disease in patients with NSCLC.  \nB-0823 10:57  \nFDG PET-CT staging of breast cancer in young women  \nC.C. Riedl, E. Slobot, M.S. Jochelson, W.A. Weber, G.A. Ulaner; New York, \nNY/US (riedlc@mskcc.org)  \nPurpose: To assess the impact of FDG PET-CT staging in female breast \ncancer patients under the age of 40. \nMethods and Materials:  In this IRB waived retrospective study, we screened \nour Hospital Information System (HIS) for breast cancer patients < 40 years of \nage who underwent staging PET-CT prior to any treatment at our instititution \nbetween 2003 and 2012. To minimise sel ection bias, patients with symptoms \nor conventional imaging findings suspici ous for extra-axillary nodal or distant \nS314  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nmetastases, and patients with prior malignancy were excluded. Metastases \nfound on PET-CT were confirmed by pathology in the majority of cases or by \nfollow-up imaging. Initial clinical stage was based on physical exam, \nmammography, ultrasound and breast MRI. Relevant upstaging was defined \nas PET-CT stage greater than initial clinical stage and higher than stage II. In \naddition, incidental synchronous malignancies were recorded. \nResults: Of 399 women identified in our HIS search, 134 met the inclusion \ncriteria. PET-CT findings lead to relev ant upstaging in 27 patients (20%), \nincluding 1 of 20 (5%) with initial clinical stage I, 18 of 92 (20%) patients with \ninitial stage II, and 8 of 22 (36%) patients with initial stage III. Additionally, 4 \nthyroid and 1 rectal synchronous malignancies were found. \nConclusion: FDG PET-CT upstaged 20% of women <  40 years of age. \nAlthough, current NCCN breast cancer guidelines include FDG PET-CT only \nfor stage III patients, these data suggest that women < 40 may benefit from \nPET-CT staging even at stage II. A prospective study should verify these \nfindings.  \nB-0824 11:06  \nImaging of prostate cancer biological relapse: our experience of MRI and \nPET-CT comparison in the evaluation of bone and lymphnode metastases \nand in detection of local recurrency  \nL. Cristiano, A. Bartoloni, R. D'Amico, G. Fioroni, R. Persechino, M. Tuccimei, \nT. Lanzolla, F. Scopinaro, G. Argento; Rome/IT (laralu84@hotmail.it)  \nPurpose: Our aim was to compare the accuracy of 18 F-Choline PET-CT \nversus MRI in the diagnosis of local recurrency, bone and lymphnode \nmetastases in prostate cancer. Appropriate imaging improves therapy and \nfollow-up in malignant recurrency and can lead radiation therapy (RT). \nMethods and Materials:  We selected 32 patients reporting post-surgery and \npost-radiotherapy increased PSA serum levels who had undergone both 18 F-\nCholine PET-CT and T2W HR, DWI and DCE perfusional MRI. \nResults: 18 F-Choline PET-CT and MRI showed up prostate cancer local \nrecurrency in the same 22 patients. PET-CT showed up 8 suspicious \nlymphnodes in 4 patients whereas MRI revealed 30 lymph nodes -mostly false \npositive- in 16 patients (including those reported by the PET-CT). True positive \nPET-CT lymph nodes were confirmed by PSA serum value < 0.1 ng/ml one \nyear after RT. Regarding bone metastases, PET-CT showed up 18 F-Choline \nbone uptake in 80 areas suspicious for malignancy (mostly in the vertebrae) in \n16 patients with a SUV borderline value. Among all the 80 areas showed up by \nthe PET-CT only 12 (in 8 patients) were confirmed by MRI. \nConclusion: PET-CT and MRI appeared to be equally accurate in revealing \nprostate cancer local recurrency. PET is much more specific in the evaluation \nof lymphnode metastases. In recognising bone metastases, PET-CT revealed \nhigh sensitivity but low specificity (owing to the borderline SUV levels) whereas \nMRI is more sensitive and specific. Therefore PET-CT an MRI image \nintegration seems to be the best choice in making more accurate diagnosis \nand re-staging.  \nB-0825 11:15  \nThe nature of incidental colonic FDG uptake at PET/CT  \nC. Keyzer, B. Dhaene, D. Blocklet, V. De Maertelaer, P. Gevenois; \nBrussels/BE (caroline.keyzer@erasme.ulb.ac.be)  \nPurpose: To investigate the nature of incidental colonic focal FDG uptakes \nand that of simultaneous lesions detected at colonoscopy but missed at \nPET/CT. \nMethods and Materials:  Among 9,073 patients scanned at PET/CT between \nSeptember 2008 and July 2012, 82 without history of colonic disease had focal \ncolonic uptakes and subsequent colonoscopy. Reading in consensus these \nPET/CT examinations, a radiologist and a nuclear physician recorded the \nlocation of uptakes and CT abnormalities, measured standardised uptake \nvalue (SUV) and metabolic volume (MV), firstly not informed and secondly \ninformed about lesion location at colonoscopy. Records and measurements \nwere compared between histological types (benign, premalignant, or \nmalignant) of lesions detected at colonoscopy. ANOVA, logistic regression, t-\ntest, and Pearson's test were used. \nResults: 107 uptakes at PET/CT and 150 lesions at colonoscopy were \ndetected. Among 107 uptakes, 65 (61%) corresponded to a lesion at \ncolonoscopy (true positive) while 42 (39%) did not (false positive). Among 150 \nlesions at colonoscopy, 85 (57%) were non FDG-avid (false negative). MV of \ntrue positive uptakes was lower than that of false positive ones (4.0 ±0.4 cm\n3 \nvs. 6.16 ±0.7 cm3; p=0.006), but their SUVmax were not significantly different \n(7.4±0.5 vs. 7.7±0.5; p=0.649). MV was the only variable predictive of a lesion \nat colonoscopy (p=0.018). There was no difference in SUVmax or MV between \nbenign, premalignant, and malignant lesions (p ranging from 0.184 to 0.601). \nConclusion: Focal uptake can correspond to any histological type of colonic \nlesions. Their detection should be followed by colonoscopy not restricted to the \nzone housing the uptake.  \n \nB-0826 11:24  \nAssessment of recurrent peritoneal carcinomatosis with 18 F-FDG-\nPET/CT in patients after cytoreductive surgery and hyperthermic \nintraperitoneal chemotherapy  \nB.D. Klumpp, N. Schwenzer, S. Gatidis, I. Koenigsrainer, A. Koenigsrainer, \nS. Beckert, M. Mueller, C.D. Claussen, C. Pfannenberg; \nTübingen/DE (bernhard.klumpp@med.uni-tuebingen.de)  \nPurpose: In patients with peritoneal carci nomatosis (PC), cytoreductive \nsurgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is an \napproach with curative intention. Differentiation between posttherapeutic \nfindings and relapse of PC is challenging. We evaluated 18 F-FDG-PET/CT in \nthe follow-up to detect relapse of PC after HIPEC. \nMethods and Materials:  36 patients with recurring PC after HIPEC were \nincluded (44 examinations). The examination included 3D 18 F-FDG-PET and \ncontrast enhanced CT. Images were assessed by two experienced readers \nregarding the presence and the extent of PC using the peritoneal \ncarcinomatosis index (PCI). Imaging results were correlated with surgical \nfindings or follow-up. \nResults: Relapse was suspected in 40 of 44 18 F-FDG-PET/CT examinations \n341±269 days after HIPEC. PC was suspected in 237 of 572 peritoneal \nsegments. Relapse was missed by 18 F-FDG PET/CT in 4 patients and \nsignificantly underestimated in 8 patient s. Diagnostic accuracy for the detection \nof PC on patient base was 91%, sensitivity  91% and positive predictive value \n100%. The correlation of imaging and surgical findings on segmental base \nregarding the extent of PC was moderate (r=0.624). The mean PCI found by \nPET/CT was 11.4 ±11.9 and by surgical exploration 16.6± 15.0. The extent of \nPC was systematically underestimated by PET/CT (p < 0.05). \nConclusion: The diagnostic value of 18 F-FDG PET/CT after cytoreductive \nsurgery and HIPEC in the detection of recurring PC is good. However the \nquantification of the extent of PC is limited due to post therapeutic tissue \nalterations.  \nB-0827 11:33  \nThe influence of 18 F-FDG PET/CT on therapy management of patients \nwith malignant melanoma stage III/IV: survival analysis after 5 years of \nfollow-up  \nS.-C. Schuele, C. Garbe, T. Eigentler, C. Pfannenberg; \nTübingen/DE (susann-cathrin.schuele@med.uni-tuebingen.de)  \nPurpose: To evaluate the influence of 18 F-FDG-PET/CT on therapy \nmanagement and outcome of patients with stage III/IV melanoma. \nMethods and Materials:  Patient-based re-evaluation of CT and 18 F-FDG-\nPET/CT scans of 64 patients with advanced, primarily examined by a lesion-\nbased analysis (Pfannenberg et al. 2007). The cohort included 52 primary and \n12 restaging examinations. For each patient, it was analysed if PET/CT caused \na change in therapy in comparison to the decisions based on CT alone. \nTherapy modifications were classified in  \"major\" (surgical vs. systemic therapy) \nand \"minor\" (1\nst line to 2 nd line chemotherapy). Patient's follow-up was \ndocumented and 5-year survival rates were calculated. \nResults: PET/CT resulted in a change of therapy in 54% of patients of the \nentire group including \"major\" changes in 45%. PET/CT excluded distant \nmetastases in 8/64 patients primarily planned for metastasectomy based on \nCT-scan. The highest number of shifts (59%) occurred in patients for primary \nstaging consisting of 52% major changes. The corresponding data for the \nrestaging group were 33% therapy changes (4/12 patients), thereof two \npatients with a major shift. In 11/27 patients already scheduled for surgery \nPET/CT revealed further metastases, making an operation futile. The 5-year \nsurvival rate of the entire cohort was 30.1% with an increase to 33.6% in \nprimary staging and a reduction to 16.7% in restaging group. \nConclusion: FDG-PET/CT significantly infl uences therapy decisions in \npatients with stage III/IV melanoma, especially for the proper selection for \ncomplete metastasectomy, thereby increasing the long-time survival of this \npatient group.  \nB-0828 11:42  \n18 F-FDG PET/CT for characterisation of peripheral nerve sheath tumours \nin patients with neurofibromatosis type 1: intratumoral heterogenity of \ntracer uptake as new parameter  \nJ. Salamon, P. Bannas, J.D. Busch, J. Herrmann, G. Adam, V.F. Mautner, \nT. Derlin; Hamburg/DE (j.salamon@uke.de)  \nPurpose: The aim of this study was to evaluate the usefulness of intratumoural \ntracer uptake heterogeneity on 18 F-fluorodeoxyglucose (FDG) PET/CT as \ncompared to a cut-off SUV max for characterisation of peripheral nerve sheath \ntumours (PNSTs) in patients with neurofibromatosis type 1 (NF1). PNSTs may \nundergo focal malignant transformation. Heterogeneity of tumour composition \nis known a histopathological hallmark of malignant change. Malignant \nperipheral nerve sheath tumours (MPNSTs) usually demonstrate increased \nand inhomogenous tracer uptake. \nS315  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nMethods and Materials:  50 patients with NF1 underwent 18F-FDG PET/CT. \nIntralesional 18F-FDG uptake was analysed by measuring the mean and \nmaximum standardised uptake value (SUV). Heterogeneity of tracer uptake \nwas evaluated using a SUV-based heterogeneity index (HI SUV) and qualitatively \ngraded using a three-point scale. Histopathologic evaluation as well as clinical \nand radiological follow-up served as reference standard. \nResults: Both, HI\nSUV and SUV max could identify malignant tumours with a \nsensitivity of 100%. Qualitative intratumoural uptake heterogeneity and \nmalignant transformation in peripheral nerve sheath tumours showed a \nsignificant association (p < 0.0001). MPNST showed a significantly larger HI SUV \ncompared to benign tumours (p=0.0002). Cohen`s 5 was 0.86 for interrater \nagreement and 0.88 for intrarater agreement on heterogeneity. \nConclusion: MPNSTs in patients with NF1 reveal strong intratumoural \nheterogeneity of tracer uptake in 18 F-FDG PET/CT. Either a SUVmax cut-off \nvalue or a heterogeneity index can identify malignant PNSTs with a sensitivity \nof 100%. The SUV\nmax approach using a cut-off value leads to a higher \nspecificity. There is no significant improvement in diagnostic performance \nusing both methods in combination.  \nB-0829 11:51  \nThe value of F18-FDG PET/CT in the diagnosis of CUP syndrome: a \nretrospective study  \nI. Sacarea, F. Weber, S. Maune, J. Wustrow, A. Zöllich, J. Müller-Hübenthal; \nCologne/DE (ilinca.sacarea@gmail.com)  \nPurpose: Metastatic cancer without a primary site is known as cancer of \nunknown primary (CUP Syndrome). We distinguish between head/neck \ntumours (mostly squamous) and tumours of the whole body (usually \nadenocarcinomas). The life expectancy of these patients may increase by \nproper identification of the original tumour and consequent adapted therapy. \nThe aim of this analysis is to show the value of F18-FDG PET/CT in the \ndiagnosis of primary tumours in comparis on to conventional diagnostics based \non the database of Praxis in KölnTriangle, Germany. \nMethods and Materials: Between 2008 and 2013 out of a total of 2800 cases, \nwe performed 134 F18-FDG PET/CTs for 116 patients (56 male/60 female, \nmedian age 61y). with CUP Syndrome. So far, 59 cases (44%) were tracked \n(medical letters, histology, therapeuti c approach). Conventional diagnostics \n(CT, MRI, scintigraphy, panendoscopy) was primarily performed in almost all \npatients. \nResults: We could identify a possible primary in 80 cases (59.7%), 70 cases \nadditional to conventional diagnostics. In head/neck tumours, the primary was \nmost commonly found in the nasopharynx and tonsils (34.6%, resp. 23.07%). \nWhole-body tumours were found mostly in the lungs (38.8%) and the \ngastrointestinal tract (20.37%). Unknown metastases have been identified in \n50 cases (37.3%). For head/neck tumours, the examination-related sensitivity \nfor the detection of primary tumours was 90% and the specificity was 85%. For \nwhole-body tumours, these values were 93%, respectively 88%. \nConclusion: The F18-FDG PET/CT can identify additional primary tumours \nand metastases in 52% of cases when compared to conventional diagnostics \nand facilitate possible life-prolonging therapy.  \n10:30 - 12:00 Room F2  \nBreast  \nSS 1702  \nBreast density and general breast MRI  \nModerators:  \nR.M. Pijnappel; Utrecht/NL  \nK. Pinker-Domenig; Vienna/AT  \nB-0830 10:30  \nFully automated breast density measures and breast cancer risk: a case-\ncontrol validation study  \nM. Abdolell, K.M. Tsuruda, S.E. Iles, C.B. Lightfoot, J.I. Payne, J. Caines; \nHalifax, NS/CA (m.abdolell@gmail.com)  \nPurpose: Legislation requiring reporting of breast density to women has been \nenacted and endorsed across the US. The current standard of care for breast \ndensity assessment is visual assessment by radiologists applying the \nAmerican College of Radiology (ACR) BI-RADS density lexicon. However, the \nACR has indicated that BI-RADS assessments are not reproducible and no \nlonger endorses its use. Automated breast density measurement software \nprovides such reproducible measures of density, but must be clinically \nvalidated. \nMethods and Materials:  A case-control study (n=1287), frequency matched \n(1:2) on 5-year age-group at screen, was conducted using data from the Nova \nScotia Breast Screening Program and Capital District Health Authority (Nova \nScotia, Canada). Logistic regression was used to model the association \nbetween mammographic density and breast cancer risk, controlling for age, \nfirst-degree family history of breast cancer, menopausal status, number of \nbirths and HRT use at time of screen. Percent density was measured from \nsingle digital MLO views using Densit as (Densitas Inc)., an automated \nmammographic density assessment software. \nResults: Cases and controls were similar number of births, HRT use, \nmenopausal status and family history. Controlling for these risk factors, women \nwith \u000375% density had a significantly increased risk of breast cancer compared \nto women with \u000225% mammographic density [odds ratio 3.58 (1.7, 7.4)]. \nConclusion: The results from this study show that breast density measured \nusing Densitas' automated breast density software is similarly associated with \nbreast cancer risk as visually assessed breast density measured by \nradiologists.  \nAuthor Disclosures: \nM. Abdolell: Founder; Densitas Inc. Patent Holder; Densitas Inc. K.M. \nTsuruda: Employee; Densitas Inc.  \nB-0831 10:39  \nVery low mammographic breast density predicts poorer outcome in \npatients with invasive breast cancer  \nA. Masarwah, P. Auvinen, M. Sudah, S. Rautiainen, A. Sutela, O. Pelkonen, \nR. Vanninen; Kuopio/FI (amro.masarwah@kuh.fi)  \nPurpose: To examine the prognostic value of mammographic breast density \n(MBD) and tumor features and their relationship with established prognostic \nfactors in selected patients with invasive breast cancer. \nMethods and Materials:  This study is based on a database of 278 breast \ncancer patients treated in Kuopio University Hospital during 2002-2008. \nAltogether 139 consecutive HER2-positive breast cancer patients were first \nselected and subsequently complemented with HER2-negative patients \n(n=139) matched for age and time of operation. Mammograms were analysed \nin consensus by 5 radiologists to evaluate tumor features and MBD according \nto the Breast Imaging Reporting and Data System (BI-RADS). Breast density \nwas dichotomized into Very Low Density (VLD; BI-RADS 1) or Mixed Density \n(MID; BI-RADS 2+3+4). Mammographic features were then compared with \nestablished prognostic factors and outcome of the patients. \nResults: 50 deaths occurred during the follow-up time, of which 40 (14.4%) \nwere from breast cancer. Patients with VLD breasts had a significantly worse \nprognosis compared to patients with MID breasts (disease free survival 75.6% \nvs. 90.7%, p < 0.01; and overall survival 75.5% vs. 90.2%, p=0.01). The \nassociation remained significant even after correcting for age ( \u000250 and >  50 \nyears). No other mammographic feature was prognostically significant. In Cox \nregression analysis VLD proved to be an independent poor prognostic feature \nsecond only to HER2 positivity. \nConclusion: Previously, high breast density has been shown to be a \nsignificant risk factor for breast cancer . However Very Low Breast Density is \nassociated with poorer outcome.  \nB-0832 10:48  \nGeographical variation in mammographic density distribution in the \nNetherlands  \nD. van der Waal1, C.H. van Gils2, M.J.M. Broeders1, G.J. den Heeten1; \n1Nijmegen/NL, 2Utrecht/NL (D.vanderWaal@ebh.umcn.nl)  \nPurpose: Mammographic density is related to screening sensitivity. \nDifferences in breast density distribution between populations may thus explain \npart of the variation in regional screening performance. The aim of this study \nwas to determine whether regional differenc es in breast density distribution are \npresent in the Netherlands. \nMethods and Materials:  As part of the DENSE trial, density profiles of \nunprocessed mammograms were collected from screening units. The regions \nin our study were based on the geographical coverage of 13 radiology groups. \nIn total, 149,167 screening examinations between 2012 and 2013 were \nincluded. Volumetric breast density was determined using the fully-automated \nsoftware Volpara (M +takina Technology, New Zealand). Three breast density \nmeasures were studied, namely: dense tissue volume (in cm3), percent density \n(in %), and the Volpara Density Grade (VDG; categories 1-4). \nResults: The distribution did appear to vary between the regions. The highest \ndensity was observed in the middle of the country, with a geometric mean \npercent density of 7.86 (95%CI: 7.81-7.90) and 9.6% of the examinations \nclassified as VDG4. In the lowest breast density region, the geometric mean \npercent density was 6.56 (95%CI: 6.44-6.69) and 6.3% of the exams were \nclassified as VDG4. Preliminary analyses showed that the effect of age-\nadjustment was limited. Analyses on potentially explanatory variables like \nsocio-economic status (SES) and breast cancer incidence will be presented at \nthe conference. \nConclusion: The preliminary results suggest that geographical variation in \nmammographic density distribution is present in the Netherlands, which would \nsupport structural assessment of breast density within the screening \nprogramme.  \n \nS316  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nAuthor Disclosures: \nC.H. van Gils: Other; Principal investigator of the DENSE trial. Matakina has \nprovided the Volpara software licenses for this trial. Bayer Health Care \nprovides a financial contribution for the DENSE trial. G.J. den Heeten: \nAdvisory Board; Former member of the medical advisory board of Matakina. \nB-0833 10:57  \nVolumetric breast density: can computer assessment really reduce \nhuman variability?  \nG. Gennaro, E. Baldan, E. Bezzon, C. Dal Bosco, I. Polico, A. Proietti, \nL. Pescarini; Padua/IT (gisella.gennaro@ioveneto.it)  \nPurpose: To verify if breast density assessment computer-based can reduce \ninter-reader variability for women with dense breasts. \nMethods and Materials:  2103 consecutive patients from a diagnostic \npopulation who underwent bilateral digital mammography in two views between \nJan and Mar 2013 were included in the study. Volumetric breast density (VBD) \ncalculated by Volpara 1.4.3 was compared with the BIRADS scores assessed \nby six breast radiologists independently. Inter-reader variability was evaluated \nusing kappa statistics, and the subset of dense breasts (classified by each \nreader as BIRADS 3 and 4) was further analyse, comparing individual \nagreement/disagreement versus the majority of readers. \nResults: The overall kappa across the readers was 0.56, associated to a \nmoderate agreement. However, the mean absolute agreement between \nindividual readers and the majority was 81.0%. In particular, cases for which \nthe individual readers assigned a BIRADS 3 while the majority was 4 and vice \nversa, ranged from 3.1% to 8.7%, leading to a mean by 6.4%. Mean VBD for \nthose cases was between 18.12% to 21.34% depending on the reader. The \nVBD distributions were overlapped with the distributions of VBD for cases of \ntotal agreement (either BIRADS 3 or 4) for 3 out of 6 readers, indicating that \nthe threshold between BIRADS 3 and 4 is not the same across the readers. \nConclusion: Volumetric breast density computer-based can remove inter-\nreader variability in categorisation of dense breasts and following decisions \nabout patient workup.  \nB-0834 11:06  \nBreast density percentage assessment using a 3 T MRI system: \ncomparison amongst sequences using IDEAL (iterative decomposition of \nwater and fat with echo asymmetry and least squares estimation) \nsequences as reference standard  \nA. Tagliafico, B. Bignotti, D. Astengo, L. Martino, A. Signori, G. Taglaifico, \nM. Calabrese; Genoa/IT (albertotagliafico@gmail.com)  \nPurpose: There is no standardised method to evaluate breast density. IDEAL \n(iterative decomposition of water and fat with echo asymmetry and least \nsquares estimation) sequences permit a differentiation of breast tissue \ncomposition on MRI. We used this sequence as a reference standard to \ncompare breast density percentage evaluated on standard MRI sequences. \nMethods and Materials:  The study was approved by the Local Ethics \nCommittee (National Institute for Cancer Research) and written informed \nconsent was obtained from participati ng women. MRI examination was \nperformed in 48 consecutive patients (mean age 41, years; range, 35-67 \nyears) on a 3.0 T scanner with a dedicated eight-channel bilateral breast coil. \nMRI protocol included: T1-turbo spin-echo (T1-tSE), T2-turbo spin-echo (T2-\ntSE), IDEAL and VIBRANT (volume imaging for breast assessment) before and \nafter injection of contrast media. Breast density was calculated with a semi-\nautomated software. Statistical analysis was performed with non-parametric \ntests as appropriate. \nResults: Mean percentage of breast density calculated in each sequence was: \nT1-tSE = 56%; T2-tSE = 52%; IDEAL Fat Only = 55%; IDEAL Water Only = \n53.46%, VIBRANT = 54.85%. Significant differences were observed between \nT2-tSE and both T1-tSE (p < 0.001), VIBRANT sequences (p = 0.009), T1-tSE \nand both IDEAL Water Only (p = 0.007) and IDEAL Fat Only (p = 0.047). \nBreast density percentage showed a positive linear correlation amongst \ndifferent sequences: r\u00030.93. \nConclusion: Differences amongst MRI sequences used to assess breast \ndensity percentage exist. T1-weighted sequences showed the more similar \nbreast density percentage values to IDEAL Water Only sequences used as \nreference standard.  \nB-0835 11:15  \nVisual and automated volumetric assessment of mammographic density \n(MD): do measurements depend on the digital mammography unit?  \nS.J. Vinnicombe, A.J. Evans, K. Hart, P. Whelehan; Dundee/UK \n(s.vinnicombe@dundee.ac.uk)  \nPurpose: Full field digital mammography (FFDM) fac ilitates automated \nvolumetric measurement of mammographic density (MD), a potent risk factor \nfor breast cancer. It is unknown if there are systematic differences between MD \nmeasurements derived from mammograms acquired on different vendor units. \nThis work aimed to assess this using a commercially available volumetric tool. \nMethods and Materials:  IRB approval was waived for this retrospective study \nof anonymised images. Mammograms from 100 subjects obtained on GE \nSenographe™ and Hologic Selenia™ units 1 year apart were studied. Percent \nvolumetric density was measured with Volpara™. For comparison, two \nexperienced observers with proven excellent intra- and inter-observer reliability \nvisually assessed MD, blinded to manufacturer, using ACR BI-RADS scoring \nand a percentage scale. Agreement between paired scores was tested using \nintraclass correlation coefficients and Cohen's kappa. \nResults: Agreement between paired scores was excellent for all methods \n(ICC/kappa all > 0.9, p < 0.001). For Volpara, mean absolute difference \nbetween paired scores was 0.67% (95% CI -0.17% - 1.16%), ~8% of the \nmedian Volpara score (8.4%). No syst ematic bias was identified. 10% of \nBIRADS paired scores disagreed and higher scores were assigned to \nSenographe mammograms in 85%. Visual percentage scores were statistically \nsignificantly higher for Senographe mammograms in 79% of cases (Chi2, \np < 0.001). \nConclusion: Variances between volumetric MD measurements using \nVolpara™, obtained from GE Senographe and Hologic Selenia mammograms \nin the same women one year apart, were small and equally distributed in both \ndirections, whereas human visual densit y scores were statistically significantly \nmore likely to be higher in Senographe mammograms.  \nB-0836 11:24  \nBreast MRI and false negative invasive ductal carcinoma at our \ndepartment  \nG. Trecate, R. Agresti, B. Valeri, M. Sandri, M. Capalbo, C. Ferranti, \nD. Vergnaghi, G. Scaperrotta, P. Panizza; Milan/IT \n(giovanna.trecate@istitutotumori.mi.it)  \nPurpose: High sensitivity of MRI in breast cancer (BC) diagnosis is known to \nbe supported by angiogenesis, which is responsible of the early uptake of \ngadolinium. The aim of this study was to analyse the inner architecture of some \ninvasive carcinoma (IC) that didn't correspond to this semeiotic basis. \nMethods and Materials:  Between 2009 and 2012 we staged 194 BC, 4 of \nwhich not combined with contrast-uptake. Histology revealed IC, triple-negative \nstatus, grading3, proliferative index > 60%. We compared these 4 cases with \n12 consecutive BC with the same biology but normally enhancing at MRI. \nResults: Pathology revealed in all non-enhancing BC a common pattern of \ndensely stuffed cells, with and an epithelial-stroma ratio prevalent for cells. For \nthe non-enhancinc BC the cell number average was 120x10hpf (high-power-\nfield), while in the normally-enhancing BC this average was 47xhpf (p=0.0036 \nWilcoxon test). \nConclusion: False negative results due to the non-uptake of gadolinium are \nmainly described for in situ carcinoma. Non enhancement for IC is conversely \nvery rare. Since the biodistribution of gadolinium foresees a transition from \nperipheral vessels into extracellular space, a possible explication of the low \nuptake can be related to a mechanic phenomenon given by the numerosity of \nthe cells compared with the lack of the stroma. The clinical relevance of this \nphenomenon is that if gadolinium can't reach these neoplasm, even for \nchemotherapy it could be difficult to target them. For this subgroup of BC, MRI \nimaging can thus become a predictive indicator of the sensibility to some \nspecific therapies.  \nB-0837 11:33  \nDifferentation of ductal carcinoma in situ (DCIS) vs fibrocystic breast \ndisease using breast MRI: new insights on imaging patterns and \ndiagnostic accuracy  \nM. Dietzel\n1, W.A. Kaiser2, P.A.T. Baltzer3; 1Erlangen/DE, Jena/DE, 2Jena/DE, \n3Vienna/AT, Jena/AT (dietzelmatthias2@hotmail.com)  \nPurpose: In breast-MRI one very frequent cause for false-positive DCIS \ndiagnoses remains fibrocystic breast disease (FBD). Surprisingly, there is little \nsystematic data on the characteristic imaging-patterns of FBD and its \ndifferentiation from DCIS. This breast-MRI study aims to identify typical \nappearances of both entities and to in vestigate accuracy for the differentiation \nof DCIS from FBD. \nMethods and Materials:  Consecutive patients receiving breast-MRI \n(standardised-protocols: dynamic-T1w-GRE before/after Gd-DTPA \n[0.1 mmol/kgBW]; T2w-TSE) with subsequent pathological-sampling were \ninvestigated. 16 previously published breast-MRI descriptors were \nprospectively assessed by two experienced radiologists in consensus ( > 500 \nMRM-examinations; blinded to pathology). All patients showing DCIS (n=76) or \nFBD (n=219) were evaluated statistically: Univariate- and multivariate statistics \nwere performed to identify accuracy of single descriptors, accuracy of \ndescriptor-combinations, as well as overall-accuracy of breast-MRI for the \ndifferential-diagnosis of FBD vs. DCIS ( <\n2-statistics; CHAID-tree: area-under-\nthe-ROC-curve[AUC]; Bonferroni-correction). \nS317  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nResults: 5 (31%) breast-MRI descriptors significantly differentiated DCIS form \nFBD ( Pcorrected< 0.05). Highest accuracy was identified for \"Wash-in\" (Odds-\nratio/OR=5.7), \"Blooming-sign\" (OR=3.4), \"Wash-out\" (OR=3.2) and \"Adjacent-\nvessel-sign\" (OR=3.0). Performance of single features could be improved, if \nmultiple descriptors were applied in combination, e.g.: presence of \"wash-in \n(weak)\" & \"oedema (absent or diffuse)\" was highly typical of FBD (OR=22.8), \nwhereas presence of \"wash-in (intermediate or strong)\", \"shape (irregular)\" and \n\"blooming-sign\" was characteristic of DCIS (OR=6.4). Overall accuracy of \nbreast-MRI for the differential-diagnosis of DCIS vs. FBD revealed AUC=0.75 \n(cross-crossvalidated sample). \nConclusion: We identified typical breast-MRI features of DCIS and FBD. Such \nshowed significant potential to differentiate both pathologic entities, particularly \nif they were used in combinations.  \nB-0838 11:42  \nInflammatory breast disorders - benign vs malignant: does T2-weighted \nmagnetic resonance sequence (MRI) meet this diagnostic challenge?  \nI.F. Kamal, R.M.K.E. Fouad, S.M. Mansour, L.A. Salaheldin, S.T. Hamed, \nO.S. Omar; Cairo/EG (paradiseway81@hotmail.com)  \nPurpose: The purpose of the study is to assess the role of T2-weighted MRI \nsequence in discriminating benign from malignant inflammatory breast \ndisorders. \nMethods and Materials:  The study included 90 patients presenting with signs \nof mastitis. They were subjected to MRI examinations. Lesions were classified \nas of bright, intermediate or of low signal intensity. The presence of collections \nand skin thickening were reported. Biopsy was performed. Pathology results \nwere correlated with the postulated MRI diagnosis. Measures of diagnostic \naccuracy were then calculated. \nResults: According to pathology reports, 60 (66.7%) cases were benign and \n30 (33.3%) cases were malignant. Bright T2 signal correlated with benign \npathologies (53/60, 88.3%) and dark T2 signal (26/30, 86.66%) correlated with \nmalignant ones (P value=0.018). Presence of ill-defined collections (56/60, \n93.3%) was significantly higher in benign cases (P value=0.001). A cut off \nvalue of skin thickness \u00035 mm was considered indicative of malignancy (area \nunder ROC 0.668). The overall calculated sensitivity, specificity, PPV, NPV and \nefficacy of MRI based on the T2 WIs findings were 86.7%, 96.67%, 92.86%, \n93.55% and 93.33%, respectively. \nConclusion: In this study, we verified the role of T2 WIs in differentiating \nbetween benign and malignant forms of mastitis. T2W MRI images should be \nincorporated in the diagnostic work up of mastitis patients especially in cases \nthat are resistant to medical treatment. Bright T2 signal, ill-defined collections \nand mild skin thickening were considered indicative of benign lesions. Dark T2 \nsignal, absence of collections and extensive skin thickening were considered \nas indicative of malignant lesions.  \nB-0839 11:51  \nA rim-enhanced mass with central cystic changes on MR imaging: how to \ndistinguish breast cancer from inflammatory breast diseases?  \nL. Wang, D. Wang; Shanghai/CN (wangjun.124@163.com)  \nPurpose: To evaluate the capacity of magnetic resonance imaging (MRI) to \ndistinguish breast cancer from infla mmatory breast diseases manifesting a rim-\nenhanced mass with central cystic changes. \nMethods and Materials:  Forty cases of breast cancer and 52 of inflammatory \nbreast diseases showing a rim-enhanced mass with central cystic changes \nwere retrospectively reviewed. All cases underwent dynamic contrast-\nenhanced MRI and 31 of them underwent diffusion-weighted imaging (DWI). \nMorphological features, dynamic parame ters and apparent diffusion coefficient \n(ADC) values were comparatively analysed using univariate analysis and \nbinary logistic regression analysis. \nResults: The mean age of breast cancer was older than that of the \ninflammatory disease group (55.4 years vs. 44.5 years, P < 0.001). Breast \ncancer had a significantly thicker wall than the inflammatory diseases \n(P < 0.001), while internal enhancing septa were more common in \ninflammatory diseases (P=0.003). On DWI, 86.7% of breast cancers showed a \nperipheral hyperintensity, whereas 93.8% of inflammatory breast diseases had \na central hyperintensity (P < 0.001). Compared to the inflammatory diseases, \nbreast cancers had a lower ADC value for the wall (1.02×10\n-3 mm2/s vs. \n1.45×10-3 mm2/s, P=0.001) and a higher ADC value for the cavity (1.93×10 -\n3 mm2/s vs. 1.01×10-3 mm2/s, P < 0.001). \nConclusion: Both breast cancer and inflammatory breast disease could \npresent as a rim-enhanced mass with central cystic changes on MRI. \nIntegrated analysis of the MR findings can allow for an accurate differential \ndiagnosis.  \n \n \n \n \n10:30 - 12:00 Room G/H  \nGenitourinary  \nSS 1707  \nImaging of the kidney: an update  \nModerators:  \nM.-F. Bellin; Le Kremin-Bicêtre/FR  \nJ.J. Fütterer; Nijmegen/NL  \nB-0840 10:30  \nAssessment of renal function with unilateral ureteral obstruction using \n320-detector MDCT  \nX.-R. Cai, J. Yu, Z.-H. Xian, W.-C. Yang; Guangzhou/CN (caixran@126.com)  \nPurpose: To investigate the renal cortical and medullary perfusion changes \nassociated with unilateral ureteral obstruction (UUO) using 320-detector \nMDCT. \nMethods and Materials:  This study included 64 patients with UUO. According \nto the hydronephrosis severity, they were divided into three groups: mild, \nmoderate and severe group. The 320-detector row CT scanner enabled renal \nperfusion CT without table movement. Perfusion was calculated using the \nmaximum slope and Patlak model. The mean cortex and medulla perfusion of \nhealthy and diseased kidneys were compared. \nResults: Mean cortical and medullary blood flow (BF), blood volume (BV) and \nclearance statistically decreased from the mild group to the moderate group to \nthe severe group (p < 0.05). An inverse correlation was observed between \ncortical BV, BF, clearance, medullary clearance and hydronephosis severity \n(r=-0.270, p=0.004; r=-0.474, p=0.000; r=-0.515, p=0.004; r=-0.329,p=0.001, \nrespectively). Compared to the healthy kidneys, the mean cortical BF, BV and \nclearance in the severe group were found to have a statistically significance \n(p < 0.05). The mean cortical and medullary BF, BV and clearance in the other \ntwo groups were lower than those in the normal group, but did not achieve \nstatistical significance (p> 0.05). \nConclusion: 320-Detector MDCT makes it possible to conduct perfusion \nmeasurements of the whole kidney. Our preliminary results suggested that \nestimated perfusion values have the po tential to be used for evaluation of UUO \nrenal injury.  \nB-0841 10:39  \nRenal sinus fat invasion in renal cell carcinoma: evaluation of \nmultidetector computer tomography (MDCT) predicting factors  \nA. Lebovici\n1, M. Buruian2, D.S. Feier1, A. Tamas-Szora1, M.D. Suciu1, \nS.A. Sfrangeu1; 1Cluj-Napoca/RO, 2Targu-Mures/RO \n(andrei1079@yahoo.com)  \nPurpose: To determine imaging factors of MDCT that are able to predict renal \nsinus fat invasion in patients with renal cell carcinoma (RCC). \nMethods and Materials:  A total of 113 patients (84 males, mean age 57.4± 12 \nyears) with RCC (91 clear cell, 15 chromophobe, 4 papillary, 2 collector duct, 1 \ntranslocation) who underwent multiphase contrast-enhanced 64-MDCT and \npartial or radical nephrectomy were included in this retrospective study. \nDetection of enhanced nodules in the renal sinus fat, maximum tumor \ndimensions, the ratio between intra- and extrarenal tumor diameter, the \nabsence of a pseudo-capsule and vascular invasion were considered \npredictors of histologically confirmed renal sinus fat invasion. \nResults: In multivariate logistic regression analysis, enhanced nodules, the \nratio between intra- and extrarenal tumor diameter < 0.4 and vascular invasion \nwere the only independent predictors of renal sinus fat invasion (p < 0.0001). \nThe detection of an enhanced tumor nodule in renal sinus fat alone, is able to \npredict the invasion with an AUROC of 0.75 (Se=60%, Sp=91%). Adding the \nvascular invasion quantification and a rati o between intra- and extrarenal tumor \ndiameter < 0.4, increases the diagnosis value to an AUROC=0.85 (Se=83%, \nSp=81%), with 79.56% correctly classi fied patients according to histology \nreports. \nConclusion: Our data suggest that the detection of an enhanced nodule, \ntogether with vascular invasion and a ratio between intra- and extrarenal tumor \ndiameter < 0.4 are better predictors of histologically confirmed renal sinus fat \ninvasion than the presence of an enhanced tumor nodule alone.  \n \n \n \n \nS318  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0842 10:48  \nEstimation of postoperative renal function through virtually calculated \nrenal cortical volume on CT in patients undergoing total nephrectomy  \nS.-H. You, D. Sung, N. Han, B. Park, M. Kim, S. Cho; Seoul/KR \n(nipponica@korea.ac.kr)  \nPurpose: The purpose of our study was to estimate the postoperative renal \nfunction through the virtually calculated renal cortical volume measured by \npreoperative CT in patients undergoing total nephrectomy. \nMethods and Materials:  A total of 105 patients undergoing MDCT and total \nnephrectomy for kidney donation (n=65) or renal mass (n=40) were included in \nthis study. The preoperative CT was assessed to measure the volume (cm 3) of \nboth kidneys using the software that automatically contours the renal cortex. \nEstimated glomerular filtration rate (eGFR, ml/min/1.73m\n2) was measured after \noperation. Statistical analysis was done using the linear mixed-effects models \n(MIXED) procedure in SPSS. \nResults: Renal volume measurements yielded a mean virtual pre- and \npostoperative renal cortical volume of 254.2 and 125.6, respectively. \nPreoperative mean eGFR was 72.3, and postoperative eGFR was respectively \n61.7, 71.4 and 69.3 at 6, 12 and 18 months after operation. The MIXED \nprocedure revealed that the reason of operation (donation or tumor), gender, \nHTN, proteinuria, weight, age, virtual preoperative, postoperative, removed \nrenal cortical volume and the time after operation correlate significantly with the \neGFR. Especially, the reason of operatio n, virtual preoperat ive renal cortical \nvolume and the time after operation are more important factors for predicting \npostoperative eGFR (p < 0.001). \nConclusion: Renal cortex volume measured on CT can allow the prediction of \nrenal function. Postoperative eGFR ma y be estimated by the virtual renal \ncortical volume calculation.  \nB-0843 10:57  \nRenal transplantation: 3D quantification of perfusion defects using \ncontrast enhanced ultrasound, and its clinical significance  \nB. Stenberg, M.A.F. McNeill, S.T. Elliott; Newcastle Upon Tyne/UK \n(mafm@doctors.org.uk)  \nPurpose: Nearly 3000 renal transplants are performed annually in the UK, \nfollowing which it is common practice to obtain a Tc-DTPA renogram to assess \nperfusion of the graft. Although this provides functional information, \ndisadvantages include its use of ionisi ng radiation coupled with low spatial \nresolution, whilst being both time consuming and costly. We suggest that \ncontrast enhanced ultrasound (CEUS) would provide a quick, cost efficient, \nhigh resolution, accurate alternative. \nMethods and Materials:  97 renal transplants underwent both CEUS and Tc-\nDTPA after surgery. Tc-DTPA was performed in the nuclear medicine \ndepartment with a standard dose of 150mBq over at least 10 minutes of \nscreening. CEUS consisted of 2.4 ml Sonovue IV contrast, with 60 seconds \ncontinuous capture and 3D acquisition. 3D CEUS was analysed using QLab \nsoftware. Patient renal function was monitored for 3 months post-operatively. \nResults: Tc-DTPA detected 9 perfusion defects of varying sizes. CEUS \ndetected all of these plus an additional 14 defects not identified on Tc-DTPA. \nFurther analysis comparing perfusion defect against serum creatinine and \neGFR demonstrates a positive correlation between the presence and size of \nthe defect and degree of subsequent renal dysfunction. \nConclusion: CEUS is an accurate examination for detecting renal transplant \nperfusion defects. Due to high spatial and temporal resolution, CEUS will \nidentify a significant number of ad ditional defects not seen on standard \nrenogram imaging. With the quantification of these perfusion defects, valuable \nprognostic information can be obtained to predict the degree of subsequent \nrenal dysfunction influencing future clin ical decision making and informing \nfunctional expectation.  \nB-0844 11:06  \nDifferentiation of small (<< 4 cm) angiomyolipoma with minimal fat from \nnon-clear cell renal cell carcinoma on biphasic MDCT  \nS. Woo, J. Cho, S. Kim, S. Kim; Seoul/KR (j_crew7@hotmail.com)  \nPurpose: To evaluate quantitative biphasi c MDCT features that differentiate \nbetween small AMLmf and NCCRCC, and to integrate them to develop a \nsimple and easy diagnostic algorithm. \nMethods and Materials:  This study was IRB-approved; informed consent was \nwaived. Biphasic MDCT images of pathologically proven AMLmfs (n= 24) and \nNCCRCCs (n = 55) of 79 patients were evaluated. Age, sex, size, long-to-short \naxis ratio (LSR), attenuation and enhancement degree in all phases, \nprecontrast tumour-kidney attenuation difference (PTKAD) in Hounsfield units \n(HU) were compared with Chi-square analysis, independent-samples t-test, \nROC curves. A criterion was formulated with classification and regression tree \nanalysis (CART). Thereafter, CART-based algorithm was tested with additional \ninterpretations from two radiologists. Intra- and inter-observer variability was \nanalysed with Bland-Altman analysis. \nResults: LSR was greater in AMLmf than NCCRCC (p < 0.001). AMLmf \nshowed higher attenuation (all phases), CMP enhancement and washout than \nNCCRCC (p \u0002 0.001). PTKAD was greater in AMLmf than NCCRCC \n(p < 0.001). ROC curve analysis yielded area under the curves of 0.936, 0.888, \nand 0.853 using PTKAD, precontrast attenuation, and LSR. CART-based \nalgorithm (PTKAD > 7.5 HU, LSR > 1.23) predicted AMLmf with sensitivity, \nspecificity, PPV, and NPV of 87.5%, 96.4%, 91.3%, and 94.6%. Mean intra-\n/inter-observer difference was -0.1 HU/0.03 and -1.0 HU/0.09 for PTKAD/LSR, \nrespectively. These interpretations changed the final diagnosis in 1.3% (1/79) \nand 5.1% (4/79) patients for radiologists 1 and 2. \nConclusion: Biphasic MDCT was useful for differentiating AMLmf and \nNCCRCC. CART-based algorithm using PTKAD > 7.5 and LSR > 1.23 was \nsimple and accurate in predicting AMLmf.  \nB-0845 11:15  \nAssessment of diffusion parameters of the kidney over the entire cardiac \ncycle using ECG-triggered, time-resolved diffusion-weighted imaging \n(DWI)  \nR.S. Lanzman, P. Heusch, J. Weller, A. Müller-Lutz, F. Miese, P. Kröpil, \nG. Antoch, H.-J. Wittsack; \nDüsseldorf/DE (Rotem.Lanzman@med.uni-duesseldorf.de)  \nPurpose: To assess changes in renal diffusion properties over the entire \ncardiac cycle using ECG-gated, time-r esolved diffusion-weighted imaging \n(DWI). \nMethods and Materials:  20 healthy volunteers (10 males, 10 females, \n26.2 ± 7.2 years) were investigated on a 1.5 T MR scanner. Blood flow within \nthe renal arteries was determined by ECG-gated phase contrast (PC) flow \nmeasurements. For time-resolved renal diffusion weighted imaging (DWI), an \nECG-gated and respiratory-triggered coronal single-slice EPI-sequence was \nacquired at 14 defined time points over the cardiac cycle \n(20.70,120,.,620,720 ms after R-wave) using the following parameters: 4 b-\nvalues (0, 50, 100, 300 s/mm2), 3 directions, TR/TE =3000 ms/66 ms, \nFOV=400 mm2, MxP =192x192, slice thickness 6 mm. ROI measurements \nwere performed and an ADC pulsatility index (PIADC) was defined as \nnormalised maximal change in ADC values within the cardiac cycle \n(ADXmax/ADCmin). \nResults: Minimal renal blood flow velocity was 16.9 ± 5.6 cm/s at the time-\npoint of the R-wave raising to a maximum of 40.4 ± 10.6 cm/s about 142 ms \nafter the R-wave (p < 0.05). Minimal mean ADC value was 2145 ± 107 x 10-\n6 mm²/s at the time-point of the R-wave and maximum mean ADC was \n2766 ± 213 x 10-6 mm²/s 138 ms after the R-wave (p < 0.05). Mean ADC \npulsatility index in the renal cortex was PIADC = 1.30 ± 0.06. \nConclusion: Renal ADC values exhibit pulsatile characteristics over the \ncardiac cycle, enabling calculation of an ADC pulsatility index. Further studies \nare required to determine the diagnostic value of the ADC pulsatility index in \npatients with renal pathologies.  \nAuthor Disclosures: \nG. Antoch: Speaker; Siemens Medical Solutions, Bayer Healthcare, BTG.  \nB-0846 11:24  \nDiffusion-weighted magnetic resonance imaging of kidneys in healthy \nvolunteers and living kidney donors  \nK. Sulkowska, P. Palczewski, M. Golebiowski; Warsaw/PL (zlakasia@tlen.pl)  \nPurpose: Despite promising reports on diffusion-weighted MRI in diagnostics \nof renal disease, the lack of normalised data on water diffusion parameters in \nkidneys impedes a comparison of results obtained in different centers. Our \nstudy was aimed into establishing the normal ADC values in healthy kidneys, \ncomparing them with literature, and assessing the correlation between ADC \nvalues, creatinine blood level, and GFR. \nMethods and Materials:  24 healthy volunteers and 26 living kidney donors \nwere examined on a 1.5 unit (Ingenia, Philips, The Netherlands). Two DWI \nsequences were included in the study protocol (sequence I-16 b values, \nsequence II- 10 b values). Before examinati on blood and urine samples were \ncollected. GFR was calculated with Cockcroft&Gault and MDRD (Modification \nof Diet In Renal Disease) formulas and the ADC values were measured \nseparately for the cortex and medulla of each kidney by two independent \nobservers. All statistical analyses were performed using the STATISTICA \n(version 10.0) software package. Data were analysed using an unpaired t test; \np-value< 0.05 indicated a statistically significant difference. \nResults: The average ADC value for sequence I for the cortex was 2.26x10-\n3 mm2/sec, for the medulla 2.21x10-3 mm2/sec. In protocol II, the respective \nvalues were 2.13x10-3 mm2/sec and 2.06x10-3 mm2/sec. Neither statistically \nsignificant interobserver differences nor correlation between ADC values, GFR, \nand creatinine serum level were observed. \nConclusion: The average ADC values were established. The measurements \nshow high interobserver consistency. The differences in reported ADC values \nsuggest dependence on the equipment and methodology and point to the \nnecessity of obtaining ADC norms for each MR unit.  \nS319  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0847 11:33  \nThe role of MR perfusion in evaluating polycystic kidney disease: \ncorrelation with laboratory data (creatinine clearance)  \nM.G. Bernieri, V. Panebianco, V. Forte, F. Barchetti, C. Zini, C. Catalano; \nRome/IT (mariagiulia.bernieri@gmail.com)  \nPurpose: To compare MRI perfusion technique with laboratory data (creatinine \nclearance) in patients affected by polycystic kidney, in order to develop useful \nMRI patterns to monitor the progression of the disease. \nMethods and Materials: 47 patients with polycystic kidney in various stages of \nthe disease underwent MRI examination with a 3 T magnet (GE Discovery MR \n750) with multi-channel surface coil. For each patient first we evaluated the \nmorphological pattern by using T2 and T1 imaging, then we assessed the \nvascularisation degree of the residual healthy renal parenchyma. \nVascularisation data were collected using a T1-weighted GRE perfusion \nsequences acquired during intravenous administration of contrast medium \nperfusion volume (PV). MRI patterns were correlated with laboratory data. \nResults: A statistically significant correlation (P < 0.05) between PV of both \nkidneys and creatinine clearance (CC) was found in all patients. A PV between \n750 and 500 cm3 was correlated to a CC between 90 and 60 mL/min; a PV \nbetween 500 and 200 cm3 corresponded to a CC between 60 and 30 mL/min \nand a PV < of 200 cm3 corresponded to a CC < 30 mL7 min. \nConclusion: Functional MRI perfusion technique may be considered a \nvaluable tool for assessing the progression of polycystic kidney disease.  \nB-0848 11:42  \nRenal artery anomalies associated with horseshoe kidneys: value of CT \nangiography  \nT. Ichikawa, J. Koizumi, S. Kawada, Y. Imai; Isehara/JP \n(tamaki-i@mars.sannet.ne.jp)  \nPurpose: Arterial blood supply in patients with horseshoe kidney (HSK) is \nabnormal in about 75% and troublesome on surgery such as aortic aneurysm. \nWe evaluated incidence of surplus renal arteries in HSK patients focused on \nnumbers and diameters using CT angiography (CTA). \nMethods and Materials:  Thirty-two patients with HSK and 83 patients with \nnormal kidney (NK) underwent CT angiography (CTA) using 64 MDCT. Based \non 2D CT including MPR, MIP and volume-rendered images with 0.5 mm \nreconstruction interval on CTA, we assessed incidence of surplus renal arteries \nand those of greater than 3 mm in diameter and compared incidences of those \nbetween HSK and NK patients using Chi-square test. \nResults: Total 320 arteries were identified (HSK: 117, NK: 203). Mean \nnumbers of renal arteries were 3.66 ±1.1 in HSK patients and 2.45 ±0.7 in NK \npatients. The incidence of patients with surplus renal arteries was 90.6% in \nHSK patients and 33.7 % in NK patients. The incidence of patients with surplus \narteries greater than 3 mm in diameter was 68.7% in HSK patients and 8.4% in \nNK patients. There was a significantly higher incidence of surplus renal arteries \nand surplus arteries of greater than 3 mm in diameter in patients with HSK than \nin NK patients on CTA (p=0.0029, 1.8E-6). \nConclusion: The incidences of large and surplus renal arteries were frequently \nfound in HSK patients. Evaluation of renal artery anomalies of HSK using CTA \nmay provide useful information for surgical managements and interventional \ntreatments.  \nB-0849 11:51  \nDose-optimisation of dual-source, dual-energy CT for urinary calculi: \nassessment of the image quality and radiation dose  \nM. Pansini\n1, T. Schubert1, J. Hohmann1, B.K. Kovács1, Z. Szücs-Farkas2, \nG.M. Bongartz1, S. Schindera1; 1Basle/CH, 2Biel/CH (pansinim@uhbs.ch)  \nPurpose: To assess the image quality and radiation dose in dose-optimised, \ndual-energy CT (DECT) for suspected renal stones. \nMethods and Materials:  75 patients who underwent unenhanced CT \n(SOMATOM Definition Flash, Siemens) for urinary calculi were divided into \nthree groups of 25 patients each. In group A, DECT acquisition was performed \nwith the standard protocol (tube-A, 100 kVp, 210 reference mAs; tube-B, \n140 kVp, 162 reference mAs); in group B a low-dose single-energy CT \n(100 kVp, 100 reference mAs) was performed, followed, in case of stone-\ndepiction, by standard DECT acquisition targeted to the stones; group C \nreceived a dose-optimised DECT protocol (tube-A, 100 kVp, 90 reference mAs; \ntube-B, 140 kVp, 70 reference mAs), previously assessed in a phantom study. \nThe radiation dose was assessed with the dose-length product (DLP). The \nimage noise and the CNR were calculated. Subjective image quality was \nanalysed by three independent radiologists. \nResults: Mean DLP in groups B and C (186.7 mGycm ±59.6 and \n219.4 mGycm±57.3, respectively; P=0.39) were significantly lower compared \nwith group A (443.5 mGycm ±107.6) (P < 0.001). Image noise was similar in \ngroups B and C (8.9 HU ±2.6 and 9.5 HU ±3.2, respectively; P=0.65), but \nsignificantly higher than in group A (5.9 HU ±1.7) (P < 0.001). The CNR was \nsignificantly higher in group A (27.6 ±6.6) compared to groups B and C \n(18.7±5.6 and 17.4± 5.3, respectively; P=0.7) (P < 0.001). In the subjective \nanalysis, the mean diagnostic image quality was rated as good or better for all \ngroups. \nConclusion: Compared to a low-dose, single-energy protocol, the radiation \ndose of the standard DECT protocol, can be substantially lowered without \ncompromising objective and subjective image quality.  \n10:30 - 12:00 Room I/K  \nNeuro  \nSS 1711  \nResting-state and task-based fMRI  \nModerators:  \nM. Sasiadek; Wroclaw/PL  \nM. Vernooij; Rotterdam/NL  \nB-0850 10:30  \nResting-state and stimulus induced fMRI data fusion  \nK.-H. Nenning, R. Donner, D. Prayer, G. Langs; Vienna/AT \n(kh.nenning@gmx.at)  \nPurpose: Contrary to stimulus induced fMRI, resting-state fMRI captures \nspontaneous modulations in the blood oxygen level dependent signal during a \nresting condition. Resting-state fMRI offers insight in the brains' intrinsic \nconnectivity architecture, and has clinical relevance. However, the relationship \nto task dependent networks is not yet fully understood. In this work the joint \nanalysis of resting-state and stimulus induced fMRI data is evaluated. \nMethods and Materials:  The dataset consisted of 22 subjects from the NKI-\nRS - Multiband Imaging Test-Retest Pilot Dataset, published as part of the \n1000 Functional Connectomes Project, with data acquisitions from a resting-\nstate condition and a visual checkerboard stimulus available for each subject. \nMultiple Relational Embedding was used to establish a single joint embedding \nspace encoding the functional connectivity structures of the resting-state and \nthe visual checkerboard data. Functional registration followed by clustering \nwas used to delineate similar network structures across the group. Cluster \nstabilities were quantified and compared to resting-state analysis without using \ninformation about the visual stimulus and to concatenated time-series. \nResults: The results show that the additi onal visual stimulus data causes a \nstable split of the visual networks into two sub networks. Interestingly, the \nadditional visual stimulus causes also a more stable delineation of basic \nresting-state networks, e.g. the default mode network. Additionally, it offers \nhigher cluster resolution, i.e. we can differentiate smaller clusters while the \ncluster stability remains high. \nConclusion: The presented work shows that additional stimulus data can \nfacilitate resting-state analysis, it can increase the network resolution in \nspecific functional regions.  \nB-0851 10:39  \nEvaluation of multiparametric quantitative bold approach and \ncerebrovascular reserve in patients with severe intracranial arterial \nstenosis: a comparison study  \nJ. Bouvier\n1, O. Detante1, F. Tahon1, A. Attye1, T. Perret1, I. Tropres2, S. Grand1, \nE. Barbier1, A. Krainik1; 1Grenoble/FR, 2Suresnes/FR \n(akrainik@chu-grenoble.fr)  \nPurpose: To better characterise perfusion and oxygen metabolism disorders in \npatients with severe intracranial arterial stenosis (SIAS), we studied basal and \nfunctional changes of perfusion using functional MRI of cerebral vasoreactivity \n(CVR fMRI) with oxygenation measurement using a multiparametric qBOLD \napproach. \nMethods and Materials:  Eleven patients (2 females; 65.6 ±15.2yo) with SIAS \nof the internal carotid artery (n=5), middle cerebral artery (MCA) (n=6) were \nstudied. Basal perfusion was measured using dynamic susceptibility contrast \nwith deconvolution of the arterial input function to calculate conventional \nparameters (CBF, CBV, MTT, Tmax). BOLD CVR fMRI was acquired with a \nblock-design hypercapnic challenge (8% CO\n2). Average end-tidal CO2 pressure \n(EtCO2) was used as a physiological regressor for statistical analyses (SPM8). \nStO2 maps were obtained from a combination of CBV and T2' (1/T2'=1/T2*-\n1/T2). Cerebral metabolic rate of oxygen (CMRO2) map was computed using \nCMRO2=CBF.(1-StO2/100). Regions of interest (ROI) were drawn onto the \nsegmented gray matter of vascular territories of the MCA to record basal \nperfusion CVR ( \u0005BOLD/mmHg EtCO\n2) and CMRO2. For each parameter, we \ncalculated laterality indices with LIMCA=(LeftMCA-RightMCA)/(LeftMCA + \nRightMCA). \nResults: No adverse reaction to the protocol was reported. In the MCA territory \nipsilateral to SIAS, basal perfusion (CBF, Tmax), CVR, and CMRO2 were \nimpaired. Interhemispheric CMRO2 impairments expressed using LIMCA were S320  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\ncorrelated with CBF (R=0.96, p < 0.001), MTT (R=-0.85, p < 0.001), and CVR \n(R=0.92 p < 0.001). \nConclusion: In patients with SIAS, basal and functional hemodynamic \ndisorders are associated with a decreased oxygen metabolism, suggesting a \nlow-grade chronic ischemia.  \nB-0852 10:48  \nEffects of refractive errors on functional magnetic resonance imaging of \nvisual cortex  \nA. Akça, Y. Anık, Z. Sakçı, M. Gençtürk, B. Özkul, A. Kaya, Ö. Altınta\u000e; \nKocaeli/TR (one_442@yahoo.com)  \nPurpose: The purpose of our study is to evaluate the effects of refractive \nerrors on functional magnetic resonance imaging of visual cortex \nMethods and Materials:  We performed a prospective study that included 13 \npatients with refractive error (group 1) and 30 emetropic volunteers (group 2). \nGroup 2 was also subgrouped as 20-32 years old (young) and over 45 years \nold (old) to analyse presbyopia and accomodation effect. fMRI data were \nacquired with a block design pradigm with 3 Tesla MRI. In both groups, BOLD \ndata initially was acquired in normal refractive state. fMRI was performed again \nin group 1 without their glasses/lenses and in group 2 with induced-myopia via \n+2D and +4D lenses. BOLD activation areas on visual cortex were calculated \nas square centimetre area in another workstation. Total activated area on \nvisual cortex was compared between normal refractive state and \ninduced/uncorrected refractive error. \nResults: In group 1, fMRI data during uncorrected refractive error revealed \nsignificantly decreased activation areas compared with corrected refractive \nerror (p=0.001). In group 2, induced-myopia resulted significant decrease \ncompared with normal refractive state. Decrease in activation areas was \nsignificant both in 2D (p=0.003) and 4D (p < 0.001) myopia compared with \nnormal refractive state. Both in young and old group, activation areas were \nsignificantly decreased during induced-myopia. We revealed no difference \nbetween young and old groups. \nConclusion: fMRI is a useful method to facilitate function preserving surgery in \npatients with brain tumour and epilepsy. Because the refractive errors affect \nthe visual fMRI activations, they should be corrected in all refractive states.  \nB-0853 10:57  \nFunctional connectivity of the subthalamic nucleus changes with age  \nC. Mathys\n1, F. Hoffstaedter1, J. Caspers1, S. Caspers2, S.B. Eickhoff1, \nR. Langner1, C. Rubbert1; 1Düsseldorf/DE, \n2Jülich/DE (christian.rubbert@med.uni-duesseldorf.de)  \nPurpose: The subthalamic nucleus (STN) plays a major role in motor control \n(which is known to decline with age), but also in emotionally and cognitive \nprocessing. The aim of this study was to detect age-related functional \nconnectivity (FC) changes of the STN with resting state imaging (RSI). \nMethods and Materials:  361 healthy adults (mean age 41.8 years) had RSI \nscans (> 8.5 min) at three different sites. Th e bilateral STN seeds were derived \nfrom 7-Tesla high-resolution susceptibility mapping. Confound removal \n(motion; mean tissue class-related si gnals) and band-pass filtering (0.01-\n0.08 Hz) was applied. Activity in the STN seed regions was represented by the \nfirst eigenvariate of the respective voxels' time-series and then correlated with \nthe time-series of all other voxels in the brain. Age was used as a covariate in \nthe analysis to identify regions with age-related changes of FC (p < 0.05, \ncorrected for multiple comparisons at cluster level). \nResults: An age-related decline of FC with STN was found for caudate \nnucleus, thalamus (all right), for bilateral posterior insula and vermis, while a \ndecrease with age was found for bilateral sensorimotor cortex and bilateral \nputamen. \nAge-related decrease in functional anticorrelations with STN was detected for \nleft precuneus and left posterior cingulate cortex. \nConclusion: Changes in positive FC might provide a neural substrate for \ndegradation of motor performance. On the other side, the reduced uncoupling \nof anticorrelated brain areas (like the precuneus, which is known to be involved \nin introspection) might indicate an increased interference from irrelevant \ncognitive processing in advanced age.  \nB-0854 11:06  \nRegional cerebral changes and functional connectivity during the \nobservation of negative emotional stimuli in earthquake survivors with \npost-traumatic stress disorder in l'Aquila  \nM. Anselmi, A. Catalucci, V. Felli, L. Patriarca, M. Pino, M. Mazza, M. Gallucci; \nL'Aquila/IT (monicanselmi@libero.it)  \nPurpose: Patients with PTSD exhibit exaggerated brain responses to \nemotionally negative stimuli, which normally activate the limbic system. \nIdentifying the neural correlates of emotion regulation in these subjects is \nimportant for elucidate the neural circuitr y involved in emotional dysfunction. To \ninvestigate the functional connectivity between the areas activated during \nemotional processing of negative stimuli in a sample of PTSD compared to \nhealthy subjects. \nMethods and Materials:  Ten PTSD subjects (survived the 6.3magnitude \nearthquake on April 6.2009 in L'Aquila) (DSM-IV-R, APA 2000)  and ten healthy \ncontrols underwent fMRI (GE 1.5 T), during observation of 80 images (40 \nnegative emotional stimuli and 40 scrambled neutral stimuli). Clinical and \nneuropsychological assessment was administered to all subjects with PTSD. \nStatistical data analysis were performed using Brain Voyager QX4.6. \nResults: A higher activation was found in the left posterior (LP) insula for \nPTSD group, and in the ventromedial prefrontal cortex (vmPFC) for the healthy \ngroup. Two sets of Granger causality modeling (GCM) analyses were \nperformed, to examine the directed influences to other brain regions from LP-\ninsula and vmPFC, identified individ ually for each PTSD and healthy subject \nrespectively. Activity in the vmPFC in the healthy group while observing \nnegative emotional stimuli predicted activi ty in several subcortical regions and \ninsula. \nConclusion: The activation of the fronto-limbic network in healthy but not in \nPTSD suggests a lack of mediation and cortical control of emotional processes \nin these patients. This pattern of directed influence can be interpreted as the \nneural correlate of emotional control.  \nB-0855 11:15  \nAltered functional connectivity of the marginal division in medication \noveruse headache using resting state fMRI  \nZ. Chen, X. Chen, L. Ma, S. Yu; Beijing/CN (yyqf@hotmail.com)  \nPurpose: To investigate the functional connectivity changes of the marginal \ndivision (MrD) in the patients with medication overuse headache (MOH). \nMethods and Materials:  Conventional MRI, 3D structure images and resting-\nstate functional MRI (rs-fMRI) were performed in 21 patients with MOH and 21 \nmatched normal control subjects. MrD was defined using manual drawing on \nstructure images, and was applied to the computation of functional connectivity \n(FC) maps. Two-samples t-tests were performed on the individual FC maps the \ncomparison of FC of MrD between two groups. \nResults: Compared with normal controls, the increased functional connectivity \nof left MrD was demonstrated in left inferior temporal gyrus, right anterior and \nmiddle cingulate gyri for the patients with MOH. The increased right MrD \nconnectivity was gathered in the left inferior temporal gyrus and frontal orbital \ngyrus, and right anterior cingulate gyrus. No decreased functional connectivity \nwas detected. \nConclusion: The results of increased functional connectivity of bilateral MrD \nmay support that MrD play a key role in the pathogenesis of MOH, and our \nfindings also suggest that the char acteristics of MrD connectivity could \nplausibly provide an early imaging biomarker for the diagnositc and evaluation \nof MOH.  \nB-0856 11:24  \nEffect of mindfulness meditation on BCI performance: a fMRI study  \nS.-S. Kuok, N. Ramli, Y.-Q. Tan, L.-K. Tan, L.-F. Tan, S.-Y. Goh, K.-J. Goh; \nKuala Lumpur/MY (susim.kuok@gmail.com)  \nPurpose: To observe the functional changes in brain activity while performing \nreal and imagery movement using functional MRI (fMRI). To compare the fMRI \nchanges of motor imagery before and after mindfulness meditation (MM) \ntraining and correlate this with actual brain computer interface (BCI) \nperformance. \nMethods and Materials:  Eight right handed healthy volunteers were recruited \nto participate the EEG brain mapping, BCI performance test and fMRI of real \nand imagery movement of right hand (RH), left hand (LH) and both feet (BF). \nThey were then randomly assigned into control and intervention groups. The \nintervention group received 12 hours of MM training. EEG brain mapping, BCI \nperformance test and fMRI scanning were repeated after intervention. \nStatistical parametric mapping software was used for post processing and \nanalysis of fMRI data. \nResults: fMRI groups results showed activation of motor imagery of RH, LH \nand BF at premotor, prefrontal and vi sual cortices before MM training (p < 0.05, \nFWE). After MM training, fMRI results revealed more focus of activation in 3 \nout of 4 of the trained subjects on RH motor imagery, 2 out of 4 of the trained \nsubjects on LH and BF motor imagery, comparing with the control group. This \nis also correlated with the improvement of BCI accuracy of the intervention \ngroup after MM training. \nConclusion: Mindfulness meditation improves BCI performance and is \nassociated with more focus of functional changes in cerebral cortex on motor \nimagery.  \n \n \nS321  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0857 11:33  \nCharting the emergence of the foetal functional brain connectome in the \nthalamus and subplate: an in utero fMRI study  \nA. Jakab, G. Langs, E. Schwartz, G. Kasprian, D. Prayer, V. Schöpf; \nVienna/AT (andras.jakab@meduniwien.ac.at)  \nPurpose: Endeavours to optimise prenatal MRI have opened the way for the \nutilisation of functional MRI in neurodevelopmental studies. We introduce an \nimage processing and evaluation approach for the exploration of recurrent, \ndeveloping patterns of fMRI signal fluctuations of the foetal brain. \nMethods and Materials:  MRI was indicated to exclude or confirm \nsonographically suspected abnormalities; after removing cases with motion-\nrelated artefacts, images of 32 foetuses were analysed (gestational weeks: 21-\n37). In utero functional brain MRI was performed using a gradient-recalled \necho-planar sequence on a 1.5 T scanner. Slices were acquired perpendicular \nto the brainstem, each comprising 50 time points (TE/TR: 50/1000 ms). \nAnalysis included motion and nuisance signal correction approaches; \ncorrelations of regional time courses were evaluated after transforming brains \nto gestational week specific templates. ROIs of the thalamus and subplate \ngross subdivisions were propagated through a temporal model of \nmorphological development and connectivity matrices were provided. \nResults: Spectral coherence tests revealed sy nchronicity of fMRI time courses \nwithin the subplate and thalamus in the 0.01-0.2 Hz frequency range. The \nstrength of thalamus-subplate interconnections remained strong in the \nobserved developmental phase (R > 0.5), whilst the regional subplate \nconnectivity showed increased inter-hemispheric correlations with a marked \nshift from the 28\nth week. We were unable to reveal long-range intra-\nhemispheric connections in the mid- and late-foetal period. \nConclusion: In the mid-foetal period, brain activity can be characterised by \nspontaneous, low-frequency signal fluctuations predominantly located within \nthe subplate. We suggest this in vivo technique for the refinement and \nelucidation of models on the emerging human brain functioning.  \nB-0858 11:42  \nAlterations of the regional cerebral metabolism and dysfunction of the \nresting state default mode network (RS DMN) in patients with Parkinson's \ndisease (PD) and different level of cognitive impairment (CI): \n1H MRS and \nfMRI study  \nZ.Z. Rozhkova, O.M. Omelchenko; Kiev/UA (invivo@ukr.net)  \nPurpose: To investigate local metabolic state and integrity of RS DMN \nconnectivity in patients with PD and different level of CI. \nMethods and Materials:  Three groups of PD-patients (57-73y) with various \ncognitive statuses are studied by fMRI, 1H MRS with 1.5 TSIGNAEXCITE (GE). \nThe 1st group (DPDG) consists of 13 PD-patients with dementia (MMSE < 25), \n2nd (CIPDG)-15 PD-patients with mild CI (30 >MMSE\u000325), 3 rd (NPDG)-12 PD-\npatients with normal cognitive function (MMSE > 30). Spectra are recorded in \nthe white matter of the anterior (APCG), and in the posterior portion of \ncingulate gyrus (PPCG): SVSSTEAM (TR/TE= 1500/144 ms). EPIBOLD scans \nwere acquired with: TR/TE=3000/71 ms. ICA analysis was used to identify 20 \nnetworks of RS-activity, MELODIC (FSL). \nResults: In APCG, the values of NAA/Cr in DPDG, CIPDG, NPDG are:(1.68+-\n0.02),(2.04+-0.03),(2.32+-0.05), Cho/Cr:(0.84+-0.02),(0.81+-0.05),(0.53+-0.03). \nIn PPCG values NAA/Cr in DPDG, CIPDG, NPDG are: (1.14+-0.12), (1.81+-\n0.02), (1.98+-0.04), Cho/Cr: (0.96+-0.02), (0.77+-0.03), (0.68+-0.03). We have \nfound the progressive decreasing NAA/Cr in the PPCG and increasing of \nCho/Cr for the patient of NPDG, CIPDG, DPDG, associated with CI. The \nanalysis of the DMN revealed a gradual reduction in functional connectivity for \nthe patients of DPDG in the cuneus, precuneus and PPCG, which correlate \nwith severity of CI. Our findings suggest that RSNs involving areas of the \ncerebellum and frontal lobe, that could be interpreted as a potential \ncompensatory mechanism to functional disorders caused by the CI. In NPDG \nconnections between APCG and PPCG, and infe rior parietal gyrus bilaterally \nwere found. In NPDG activation of APCG decreased, but connectivity patterns \npersisted. \nConclusion: fMRI in RS, and MRS data gives as markers of neuronal \ndysfunction in patients with PD and different level of CI.  \nB-0859 11:51  \nEloquent brain areas localisation by functional MRI in tumour resection \nsurgery  \nA. Arellano Reynoso, E. Aguilar Castañeda; Mexico/MX \n(alfonso_arellano@yahoo.com)  \nPurpose: To correlate the Neuronavigated Functional Magnetic Resonance \nImaging (fRMI) obtained with motor and language tasks with cortical \nstimulation during tumour resection surgery. \nMethods and Materials:  48 patients with tumours in or around motor and \nlanguage areas were studied preoperatively with Functional 1.5 T Magnetic \nResonance Images (hand motor and language BOLD images). The images \nwere processed and integrated into a Brain Lab Vector Vision2 \nNeuronavigation System and compared during surgery with cortical and \nsubcortical stimulation. Motor and language tasks were the same at MR setting \nand at the operating room. The differences were calculated and sensitivity and \nspecificity determined. \nResults: A very good correlation was found in the hand motor area assessed \nby fMRI when motor task was made actively by patient (sensitivity and \nspecificity of 96.8%). Language BOLD images has a low sensitivity and \nspecificity (37 and 66% respectively) and is not a reliable method to locate and \npreserve language function during surgery. Patients who cannot execute motor \ntask actively were assisted and an activation area 9-13 mm caudal to motor \narea confirmed by CS were found in all of them. \nConclusion: Although Cortical and Subcortical stimulation are the gold \nstandard in function location and preservation, progresses have been made in \ndevelopment and performance in Image guided neurosurgery. A multimodal \nimaging approach and its correlation with cortical and subcortical stimulation is \nencouraged in order to progress in understanding in mechanisms of activation \nand connectivity of eloquent brain areas.  \n10:30 - 12:00 Room L/M  \nPhysics in Radiology  \nSS 1713  \nNovel MRI techniques  \nModerators:  \nT.G. Maris; Iraklion/GR  \nW.J.M. van der Putten; Galway/IE  \nB-0860 10:30  \nOptimisation of k-space sampling and view-sharing parameters in time-\nresolved MR angiography  \nK. Jaspers\n1, W.H. Backes2, M.J.W. Greuter1, T.P. Willems1; 1Groningen/NL, \n2Maastricht/NL (k.jaspers@umcg.nl)  \nPurpose: To optimise k-space sampling parameters in contrast-enhanced \ntime-resolved MR angiography with interleaved stochastic trajectories (TWIST-\nMRA) for vessels with varying calibres. \nMethods and Materials:  With TWIST-MRA, the centre of k-space (surface \narea fraction fA) is acquired for every dynamic phase. An evenly distributed \nfraction fB of the periphery is updated, supplementing the remainder with \npreviously or subsequently acquired data (forward and backward sharing, \nrespectively). TWIST acquisition was simulated in a 2D cross-sectional vessel \nmodel (diameter=[3.5,10 pixels]). Dynamic signal profiles were constructed \nfrom aortic enhancement curves measured with MRA. For scan time reduction \nfactors (RF=fA+fB*(1-fA)) of 20% and 35% of full k-space acquisition time, the \noptimal combination of fA and fB in terms of maximal signal enhancement \n(SEmax) and vessel blurring (VB, defined as average difference between \noriginal and simulated image) was determined. \nResults: Backward sharing produced higher SEmax and lower VB than \nforward sharing. For RF=20%, SEmax was optimal for fA/fB=20/0%, resulting \nin 84%, 93% and 96% of maximum input enhancement for diameter=3.5 and \n10 pixels, respectively. For RF=35%, relative SEmax was 90%, 91%, and 95% \nfor diameter=3.5 and 10 pixels, respectively. VB was slightly higher for \nRF=20% compared to RF=35%. \nConclusion: Optimal parameter selection depends on the area of interest. For \nmaximum enhancement of small vessels (diameter=3 pixels), backward view \nsharing should be used and fA should be chosen as large as possible given a \ncertain RF. Reducing dynamic scan time by decreasing RF from 35% to 20% \nonly slightly decreased enhancement of small vessels, while low VB was \nmaintained.  \nB-0861 10:39  \nMRI-drawn pulsatile flow, can we accept it? In-vitro validation using \naortic flow model  \nJ.J. Lee\n1, J.-E. Park1, N. Lee1, J.-H. Kim1, S. Youn1, E.-J. Kang2; 1Daegu/KR, \n2Busan/KR (jonglee@knu.ac.kr)  \nPurpose: MR phase-contrast imaging demonstrates pulsatile blood flow \nvelocity. The pulsatile flow pattern may show blood flow abnormality. The MR-\nbased pulsatile flow pattern was validated in vitro. \nMethods and Materials:  An electromechanical pulsatile flow model was self-\nestablished to simulate aortic blood flow. The model consisted of cylinder \npump, check valves, electromagnetic flowmeter, 19-mm silicone tube, 3 \nmanometers, computerised controller, and ECG generator. As input variables, \nheart rate (40-90 bpm) and systolic time interval ratio (30-60%) were \ncontrolled. Stroke volume was fixed to 90 ml. The velocity data simultaneously \nacquired by embedded electromagnetic flowmeter was used as the reference \nstandard. Under strictly controlled condition, MR phase-contrast imaging (3 T, \nS322  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n40 phases, 100Cm/sec Venc) and particle-induced velocimetry (PIV, 15 Hz \nrepetition rate, 2Kx2K camera, Rhodamine-B fluorescent seeding particles) \nwere performed. By two-time data acquisition at each setting, 36 data sets \nwere acquired and compared. \nResults: At whole 18 flow settings, the embedded flowmeter measured \nmaximal, minimal, and mean velocities as 84.02, 2.30, and 37.02 Cm/sec, \nrespectively. Whereas, MRI and PIV showed 76.15, 2.77, 35.83 Cm/sec and \n48.02, 1.66, 21.73 Cm/sec, respectively. Maximal, minimal, and mean \nvelocities and time to half flow volume showed significant difference among 3 \nmodalities (p < 0.001). However, the correlation with reference standard was \nsignificant by MRI and PIV (p < 0.005). MRI showed significantly higher \ncorrelation coefficient than PIV for maxi mal and mean velocities, and time to \nhalf flow volume, except minimal velocity (p < 0.001). \nConclusion: Although MR-drawn pulsatile flow pattern showed blunted, \nexpanded, and delayed pulsatility, the correlation with standard reference was \nacceptable.  \nB-0862 10:48  \nAutomated selection of optimum acceleration parameters for highly \naccelerated 3D contrast-enhanced MR angiography  \nS. Riederer, P.T. Weavers; Rochester, MN/US (riederer@mayo.edu)  \nPurpose: To present the methodology and in vivo results which demonstrate \nhow optimum k-space sampling parameters can be selected for highly \naccelerated (R\u00038) 3D contrast-enhanced MRA. \nMethods and Materials:  When acceleration is performed along the two phase \nencode directions (Y, Z) of 3DFT acquisition, there is considerable flexibility in \nselecting the individual accelerations R Y and R Z so that their product R Y x R Z \nequals the target acceleration R. We show that the performance of a trial (R Y, \nRZ) pair can be predicted by determining a metric which can be calculated from \nthe 3D coil sensitivity images. These images are themselves generally \nacquired prior to the contrast-enhanced run of a CE-MRA exam. High-speed \ncomputation enables the multitude (several hundred) of trial R-pairs to be \nevaluated within seconds, allowing the optimum to be used in the actual \ncontrast-enhanced run. The method is tested in CE-MRA exams of the \nabdomen, calves, and feet. \nResults: For a given acceleration factor, e.g. R=8, the optimum R-pair \ndepends strongly on the anatomic region under study, the interplay of the coil \narray with the body habitus of the individual patient, and the amount of air in \nthe FOV. It is shown that acceleration optimisation can provide marked \nimprovement in image quality compared to reference accelerations. Time-\nresolved contrast-enhanced angiograms of the feet can be routinely generated \nwith sub-millimetre isotropic resolution and 6.5 sec frame times. \nConclusion: Automated selection of optimum parameters for 2D acceleration \nin CE-MRA can be done on a patient-specific basis and permits high image \nquality.  \nB-0863 10:57  \nPerformance of fat-suppression in large field-of-view 3D T1w gradient \necho imaging of the body using a 3 T system with improved magnetic \nfield homogeneity  \nG. Sommer\n1, T. Schubert1, T. Heye1, M.D. Nickel2, W. Horger2, B. Kiefer2, \nE.M. Merkle1; 1Basle/CH, 2Erlangen/DE  \nPurpose: To compare the technical performance of spectral pre-saturation \n(FatSat) and two-point Dixon fat-water separation (Dixon) for T1-weighted 3D \nlarge FOV volume interpolated breath-hold examinations (VIBE) at 3 T. \nMethods and Materials:  Ten healthy volunteers (7m, 3f, mean age 41 y, \nrange 26-71 y) were prospectively examined using a novel 3 T whole-body \nMRI scanner (MAGNETOM Prisma, Siemens Healthcare) with excellent \nmagnetic field homogeneity (1.1 ppm at 50 cm diameter spherical volume). 3D \nVIBE with FatSat and Dixon was applied with identical spatial parameters \n(coronal FOV 450x363x192 mm\n3, resolution (1.6 mm) 3). TR and TE were \nminimised for each sequence (FatSat: TR=2.9 ms, TE=1.1 ms; Dixon: \nTR=4.1 ms, TE=1.3/2.6 ms). Flip-angle was 10°. Acquisition time was 20s for \nboth methods with parallel imaging acceleration factors 3 using GRAPPA (with \nFatSat) and 6 in two directions using CAIPIRINHA (with Dixon). Two \nradiologists rated image quality on a 4-point scale (excellent-good-fair-poor) \nand analysed the images for fat-suppression artefacts. Fat-suppression was \nassessed quantitatively by contrast measurements of solid tissue (liver, psoas \nmuscle) compared to adjacent fatty tissue. \nResults: Fat-suppression artifacts were significantly less with Dixon than with \nFatSat (0.5 ±1.1 vs 6.1 ±2.1/dataset; P < 0.001). Dixon provided significantly \nhigher contrast than FatSat for liver (0.85 ±0.03 vs 0.78 ±0.06; P=0.003) and \nmuscle (0.85± 0.04 vs 0.77 ±0.08; P=0.02). Dixon was more often affected by \nnoise from parallel imaging than FatSat (6 vs 1 dataset). Overall image quality \nof Dixon was rated (4 excellent, 4 good, 2 fair) vs. FatSat (8 good, 2 fair; \nP=0.2). \nConclusion: Dixon provides significantly better quality of fat-suppression than \nFatSat for large FOV body imaging at 3 T.  \nAuthor Disclosures: \nM.D. Nickel: Employee; Siemens Healthcare. W. Horger: Employee; Siemens \nHealthcare. B. Kiefer: Employee; Siemens Healthcare.  \nB-0864 11:06  \nMR thermometry feasibility during LITT in ex vivo porcine pancreas  \nF. Giurazza, G. Frauenfelder, R. Del Vescovo, E. Schena, P. Saccomandi, \nG. Allegretti, F. Siano, B. Beomonte Zobel; Rome/IT \n(francescogiurazza@hotmail.it)  \nPurpose: Laser-induced thermotherapy (LITT) is a minimally invasive \ntreatment technique modality to treat neoplastic tissue. LITT effects are \ninfluenced by parenchymal heat distribution and temperature monitoring is \ncritical for the procedural outcome. We evaluated effects of LITT on intensity \nvariation during porcine pancreases MR examination, in order to assess the \nfeasibility of MR thermometry during ablation procedure on pancreas. \nMethods and Materials:  Two ex vivo porcine healthy pancreases undergoing \nLITT (Nd:YAG laser, Power 2 W, Energy 480J) were monitored by a 1.5-T MR \nscanner, utilising two fast Inversion-Recovery sequences (IRTF and SRTF). \nEach pancreas was scanned during the whole treatment (session time 240s) \nand images were analysed with MATLAB\n®; signal intensity was recorded in two \nRegions of Interest (ROIs): ROI-a and ROI-b, positioned at 7 and 20 mm from \nthe tip of laser applicator, respectively. \nResults: In ROI-a, temperature increase caused a significant signal intensity \ndecrease in both sequences, while in ROI-b signal showed a negligible \nvariation due to the larger distance from the applicator. Evaluating ROI-a, IRTF \npresented a higher thermal sensitivity than SRTF (i.e., -0.076s\n-1 for IRTF and -\n0.067s-1 for SRTF) in both pancreases. The result is confirmed by the \nmaximum decrease of the signal intensity during the procedure (-35 for IRTF \nand -23 for SRTF). Signal decrease with SRTF sequence showed a significant \nlinear correlation with time (P < 0.01). \nConclusion: MR thermometry seems to be a valuable non-invasive and time-\neffective approach to monitor thermal ablation effects on pancreas; in our \nexperience IRTF is more sensitive than SRTF.  \nB-0865 11:15  \nEvaluation of abdominal organs by using breath hold and non-breath \nhold diffusion-weighted imaging  \nD. Herek, N. Karabulut, A. Kocyigit; Denizli/TR (dtherek@yahoo.com)  \nPurpose: Our aim was to evaluate the appa rent diffusion coefficient (ADC) \nvalues of normal abdominal parenchymal organs and signal to noise ratio \n(SNR) measurements in the same patients with breath hold (BH) and non- \nbreath hold (NBH) diffusion weighted imaging (DWI).  \nMethods and Materials:  Thirty-five healthy patients underwent both BH and \nNBH DWI. Free hand region of interest (ROI) was placed on right hepatic lobe, \nspleen, cortices of kidneys and pancreas. ADC values were calculated for \nevery organ on both BH and NBH sequences. Image noise was measured in a \nROI placed outside the abdomen. SNR was calculated using the formula: SNR \n= signal intensity (SI)\n(organ)/standard deviation (SD)(noise). \nResults: There were no statistically significant differences in ADC values of the \nparenchymal abdominal organs between BH and NBH DWI sequences (p \n> 0.05). There were statistically significant differences between SNR values of \norgans on BH and NBH DWIs. SNR of NBH DWI sequences were better than \nBH sequences (p < 0.01). Patients were divided into two groups as group1 \npatients > 65 years old (n= 9) and group 2 patients \u0002  65 years old (n= 26). \nStatistically significant differences in SNR measurements of the kidneys \nbetween group 1 and 2 were found on both BH and NBH DWI (p < 0.05). SNR \nof kidneys decreases with age. \nConclusion: Non- breath hold (free breathing) DWI technique significantly \nreduces image noise and increases SNR for abdominal examinations. We \nrecommend NBH technique for the evaluation of abdominal organs by DWI.  \nB-0866 11:24  \nCorrelation between presurgical DTI-tractography motor tract definition \nand intraoperative evoked potentials assessment  \nY.P. Velasco Díaz\n1, J. Sanchez Fernandez1, J. Quispe Bravo1, \nG. Rivera Sierra1, P. Puyalto2, C. Aguilera1, M. Virumbrales Cancio3, \nA. Olazabal2; 1Hospitalet de Llobregat/ES, 2Badalona/ES, \n3Sant Cugat del Valles/ES (patricia.velasco@bellvitgehospital.cat)  \nPurpose: The objective of the study was to correlate the reliability of MR \ntractography sequences to define the pyramidal tract and its translation into the \ngross anatomy (obtained by evoked potentials)in order to conclude that MR \ntractography assesses, before surgery, accurately the distance between the \npyramidal tract and tumour. \nMethods and Materials:  43 patients with gliomas near the pyramidal tract \nwere prospectively. Histological analysis confirmed: 13 diffuse anaplastic \ngliomas, 4 oligoastrocytomas and 26 GBM. In the 43 patients the motor tract \nwas identified by presurgical MRI studies (DTI sequences and tractography) \nS323  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nand MRI studies within 72 hours after surgery. The way of defining the \npyramidal tract was through the intersection of the fibbers passing through \nthree zones labelled in the precentral gyrus on the internal capsule and \nipsilateral cerebral peduncle. After craniotomy, the central sulcus was visually \nidentified and confirmed by evoked pote ntials. Direct cortical monopolar high \nfrequency phase (250 Hz) stimulation was performed. For cortical stimulation \nan 8 contacts electrode was used whereas a current waveform with eight \nelectromyograms was used for evoked potentials continuous monitoring. When \nresection approaches the pyramidal tract, subcortical stimulators were used \nand the electromyographic response was observed after subcortical \nstimulation. \nResults: The distance between the resection cavity and the motor tract in \ntractographic sequences postoperatively were 2.5 to 23.7 mm. The results \nwere correlated with data obtained from cortical evoked potentials monitored \nduring surgery. There was a significant linear correlation of 1.08 by applying a \nregression test between distance and stimulus intensity (R2 = 0.8202, \nP < 0.001). \nConclusion: Correlation was demonstrated between the electrophysiological \nand DTI in the analysis of the pyramidal tract by imaging based on the use of \ndirect subcortical stimulation.The DTI sho uld be systematically included in the \nstandard imaging protocol for the study of brain tumours both for etiologic \ndiagnosis to treatment planning.  \nB-0867 11:33  \nThe principles of diffusion-weighted magnetic resonance imaging (DWI-\nMR): experimental models and clinical applications  \nF. Fornasa, L. Bernardin, F. Pantalone, M. Bellotti; S. Bonifacio/IT \n(francescafornasa@libero.it)  \nPurpose: To clarify the origin of the findings obtained with Diffusion-Weighted \nMagnetic Resonance Imaging (DWI) in its clinical (current and future) \napplications. \nMethods and Materials:  DWI measures the speed of the random movement \n(\"diffusion\") of extra-cellular water molecules, which varies among different \ntissues according to several parameters such as the viscosity of the milieu, the \nconcentration of inorganic solutes and of macromolecules, the membrane \npermeability, the number of cells and the temperature. In the diagnostic \nworkout of several diseases DWI is currently included (early recognition of \nbrain ischemia, differentiation between benign and malignant neoplasms, \nmonitoring of cancer outcome after therapy), while in some fields its possible \nrole is under investigation (characterisation of diffuse liver disease, evaluation \nof pancreatic and intestinal inflamma tion, assessment of foetal organ \ndevelopment, identification of physiologi c changes of the endometrium during \nthe menstrual cycle). \nResults: The speed of diffusion decreases with increasing viscosity, increasing \nconcentration of inorganic solutes, increasing concentration of \nmacromolecules; it increases with cell membrane rupture and with the growing \nnumber of cells, and directly parallels the changes in the temperature. These \nrelationships are confirmed by the measurement of diffusion in a series of \nexperimental models (raw versus boiled eggs and potatoes; distilled water \nversus 5% sodium chloride water solution and emulsion of butter in water; \nripen versus rotten peaches; 25 °C versus 50 °C 5% sodium chloride water \nsolution and air-temperature versus frozen beefsteak). \nConclusion: Non-human experimental models help our comprehension of the \nfactors influencing the speed of water diffusion in human healthy and diseased \ntissues.  \nB-0868 11:42  \nSide effects in ultra-high-field-MRI at 7 Tesla in comparison to a \"Mock-\nup\"-scanner  \nB. Friebe\n1, A. Wollrab1, M. Thormann1, M. Grüschow2, K. Fischbach1, J. Ricke1, \nS. Kropf1, F. Fischbach1, O. Speck1; 1Magdeburg/DE, 2Zurich/CH \n(bjoern.friebe@med.ovgu.de)  \nPurpose: To determine the subjective experience of subjects undergoing 7-\nTesla-MRI compared to a \"Mock-up\"-Scanner with no magnetic field. \nMethods and Materials:  44 healthy subjects were exposed both to the B0-\nField of a 7-Tesla-whole-body MRI and a realistic \"mock-up\" scanner with no \nmagnetic field. Subjects were blinded to the actual field strength and no \nscanning was performed, i.e. no RF or gradient exposure. After exposure to \nthe B0-Field, subjects rated their experi ence regarding potential sensations of \ndiscomfort, such as phosphenes, nausea, dizziness or vertigo. \nResults: The most frequently observed side effect was vertigo while entering \nthe gantry, which was reported by 36.3 % (n= 16). Other frequent side effects \nwere the appearance of phosphenes (18.2%), unsteady gait after exposure \n(13.6%), thermal heat sensation (13.6%) and dizziness (11.4%). Nausea \noccurred in no case. All side effects were reported significantly more often after \n7-Tesla exposure. However, regarding these five main side effects 19 subjects \n(43.2 %) neither reported them in the 7-Tesla-Scanner nor in the mock-up \nscanner. \nConclusion: Light vertigo while entering the gantry is the main side effect of \nUltrahigh-Field MRI consistent with previous reports. Other light subjective \nsensations as the appearance of phosphenes, unsteady gait after exposure, \nthermal heat sensation or dizziness can occur in a small percentage, of which \nin part might not be correlated to the magnetic field exposure but to the subject \nconsent procedure, sensitizing them to possible effects. The appearance of \nnausea in this study was well below that previously reported in the literature.  \nB-0869 11:51  \nMR safety: the potential of ferromagnetic detection systems and the \nchallenge of a ferrous-free policy  \nN. Oberhofer1, N. Surname2; 1Bolzano/IT, 2Merano/IT \n(nadia.oberhofer@asbz.it)  \nPurpose: To evaluate advantages and limitations of ferromagnetic detection \nsystems in a ferrous-free MR environment. \nMethods and Materials:  The commercial ferromagnetic detection systems \n(Ferroguard®, Metrasens) consisted of a wall-mou nted, high sensitivity patient \nscreener (optical alarm) and a lower sensitivity doorway detector (optical and \nacoustic alarm), mounted in front of the magnet room entry (in-swinging door, \n1.5 T). For the latter, the detected signal (magnetic flux density variations) was \nprocessed to activate the audible alarm only if appropriate. Besides a foldable \nwheelchair and a patient bed (fixed height) were supplied, both MR conditional \n3 T and not triggering any detector alarm. Additionally, site staff wore ferrous \nfree clothing. Patient screening was carried out on all walking patients after \nchanging clothes and the outcome registered. \nResults: The \"patient screener\" was well accepted by staff and patients. 3 \npatients out of 399 were refused the scheduled exam because of \nferromagnetic items brought out by it. The door entry detector required \nrepeated fine tuning to adjust to site conditions and staff behaviour. In order to \navoid false alarms, staff needs to comply with minimal \"behaviour rules\". \nConclusion: Patient screener and doorway detectors are complementary. The \npatient screener demonstrated simple in use, reliable in detecting hidden \nferrous items and helpful in avoiding potentially critical patient scanning. \nPositioning the doorway detector a few meters ahead of the exam room entry \nfacilitates calibration and correct staff behaviour. To gain the most, the MR site \nshould embrace a \"ferrous free\" policy.  \nAuthor Disclosures: \nN. Oberhofer: Equipment Support Recipient; Merano Hospital. N. Surname: \nEquipment Support Recipient; Merano Hospital. \n10:30 - 12:00 Room N/O  \nEmergency Radiology  \nSS 1717  \nNew strategies in imaging  \nModerators:  \nJ.M. Artigas; Zaragoza/ES  \nC. Colantoni; Milan/IT  \nB-0870 10:30  \nDoes inclusion of imaging in the work up of patients with clinically \nsuspected appendicitis reduce the rate of unnecessary surgical \nprocedures?  \nM.J. Lahaye, D.M. Lambregts, E. Mutsaers, B. Essers, S. Breukink, \nR.G.H. Beets-Tan; Maastricht/NL (MJ.Lahaye@gmail.com)  \nPurpose: Since February 2010 new Dutch guidelines have been implemented \nrecommending the use of US or CT to confirm or refute clinically suspected \nappendicitis before (laparoscopic) surgery. For equivocal cases with US \nadditional imaging (CT/MRI) is recommended. This study aimed to see whether \nthese new guidelines lowered the percentage appendix sana. \nMethods and Materials:  This retrospective study included all consecutive \npatients operated for clinically suspec ted appendicitis at our hospital from \n2008-2009 (before guidelines) and 2011-2012 (after guidelines). The use of \nimaging (none versus US, CT and/or MRI) and its findings were recorded. \nSurgical and histopathological findings -where available- were notified. The \nprimary study endpoint was the number of appendix sana before and after the \nguideline implementation. \nResults: 1556 patients were included, of which 756 were collected before the \nimplementation of the guidelines and 800 after. During the pre-implementation \nperiod, 36.3% of the patients received imaging focussed on the appendix. \nPost-implementation, 97.4% of the patients received imaging before surgery. \nThe average percentage of an 'appendix sana' before the guidelines was \n23.2%. After implementation, this average percentage dropped significantly to \n6.2% (p < 0.001). \nConclusion: Use of preoperative imaging in all patients with suspected \nclinically appendicitis result in a si gnificant reduction in the percentage of \nS324  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n'appendix sana'. This suggests that the implementation of imaging in the work \nup of these patients could be an effective strategy to reduce the number of \nunnecessary surgeries.  \nB-0871 10:39  \nDiagnostic imaging pathways and clinical outcomes of acute \nappendicitis: a multi-institutional cross-sectional study  \nP. Ji Hoon1, LOCAT Group2; 1Seongnam-si/KR, 2Metropolitan Seoul/KR \n(pjihoon79@gmail.com)  \nPurpose: To investigate imaging utilisation patterns and the negative \nappendectomy rate (NAR) in metropolitan Seoul. \nMethods and Materials:  A cross-sectional study involving 2321 adolescents \nand adults undergoing appendectomy in 2011 at eleven hospitals. \nResults: Ten sites acquired multi-phase computed tomography (CT). The \ntypical effective radiation dose exceeded 10 mSv at 10 sites and 20 mSv at 2 \nsites. Overall imaging utilisation rate was 99.7% (95% confidence interval, \n99.4%-99.9%). CT and ultrasonography utilisation rates as an initial imaging \nmodality were 93.1% (92.0%-94.1%), and 6.5% (5.6%-7.6%), respectively. \nRelatively higher ultrasonography utilisation was associated with younger age, \nfemale, and presentation during working hours. The overall NAR was 4.1% \n(3.3%-4.9%). The NAR in patients undergoing CT only, complementary \nultrasonography following CT, ultrasonography only, and complementary CT \nfollowing ultrasonography were 3.3% (2.6%-4.1%), 27% (14%-44%), 9% (4%-\n16%), and 8% (2%-20%), respectively. The use of ultrasonography instead of \nCT as the initial imaging modality was significantly associated with the higher \nNAR (adjusted odds ratio [AOR], 2.28 [1.22-4.27]; risk difference, 4.4 [0-8.8] \npercentage points), however, the population attributable risk was 0.3 [0-0.6] \npercentage points. The choice between CT and ultrasonography did not \nsignificantly affect appendiceal perforation (AOR, 1.11 [0.74-1.66]). \nConclusion: We observed a very high CT utilisation rate and a low NAR in \nmetropolitan Seoul, similar to those recently reported from the United States. \nThe use of CT instead of ultrasonography as the initial imaging modality \nsignificantly decreased NAR. However, only marginal further reduction of the \nNAR would be achieved by additional utilisation of CT in the population.  \nB-0872 10:48  \nSigns of acute appendicitis on CT in comparison with both \nhistopathological findings and C-reactive protein  \nM. Karul, M. Avanesov, C. Behzadi, S. Keller, P. Stahl, G. Adam, \nJ. Yamamura; Hamburg/DE (m.karul@uke.de)  \nPurpose: To assess signs of acute appendicitis (AA) on multidetector \ncomputed tomography (MDCT) and to compare findings with both \nhistopathological evaluation and C-reactive protein (CRP) levels. \nMethods and Materials:  Preoperative MDCT images of 76 patients with \nhistopathologically confirmed AA were retrospectively interpreted by two \nradiologists in consensus. Criteria for AA were appendiceal wall thickness \n> 2 mm with ring-like contrast enhancement, increased cross-sectional \ndiameter > 6 mm, and periappendiceal fat attenuation. Abscess formation was \nconsidered as a specific sign of appendiceal perforation. Patients were \ncategorised into one of three groups (GR) based on histopathological \nclassification: ulcero-phl egmonous (GR1), gangrenous (GR2), and perforation \nwith abscess formation (GR3). CRP levels were correlated using receiver \noperating characteristic (ROC) curve analysis. \nResults: 49 patients were assigned to GR1, 5 to GR2, and 22 to GR3. AA was \ndiagnosed on MDCT in 42/49 cases (85.7%) in GR1, and 2/5 cases (40%) in \nGR2. In the remaining patients MDCT was unremarkable, respectively. \nAbscess formation with a diameter > 3 mm was diagnosed in 19/22 cases \n(86.4%) in GR3. CRP levels were in normal range in 4/49 patients (8.2%) in \nGR1, mildly elevated in all patients in GR2, and never < 59 mg/l in GR3. Mean \nCRP levels significantly correlated  with histopathological severity of \ninflammation (p < 0.03), showing an optimal cut-off point for perforation \n> 72 mg/l. \nConclusion: MDCT is a powerful diagnostic tool to depict signs of AA and is \nrequired immediately in patients with CRP levels > 72 mg/l to avoid \ncomplications. CRP levels and signs of AA on MDCT taken together may \ninfluence treatment strategy.  \nB-0873 10:57  \nAcoustic radiation force impulse elastography in diagnosis and staging \nthe severity of acute appendicitis  \nC. Göya, C. Hamidi, M. \u000bçer, A. O\buz, M.H. Okur, S. Hattapo\blu, \nM.G. Çetinçakmak, M. Teke; Diyarbakir/TR (cegoya1@yahoo.com)  \nPurpose: The aim of this study is to investigate the qualitative and quantitative \nrole of acoustic radiation force impulse (ARFI) elastography in the diagnosis of \nacute appendicitis and also to compare it with histopathologic results along \nwith Alvarado score. \nMethods and Materials:  Forty-eight follow-up patients with no apparent \ncomplaint and 53 patients with right lower quadrant pain were evaluated using \nARFI elastography and ultrasonography (US). Following the recording process \nfor Alvarado scores, the severity of appendicular inflammation was assessed in \nthe 48 patients who were diagnosed with acute appendicitis on ARFI \nelastography and later underwent surgery. Once the findings on imaging were \nconfirmed, the results were compared and al so the sensitivity and specificity \nfor Alvarado scores, ARFI elastography and US were then calculated. \nResults: Alvarado score had a sensitivity  of 79.59% and specificity of 93.51%,  \nARFI elastography had sensitivity and specificity of 100% and 96.7% each, \nwhereas sonography had sensitivity of 91.03% and specificity of 96.70%. \nAccording to the inflammation severity rates, 14 patients had mild, 12 had \nmoderate, and 22 had severe appendicitis. \nConclusion: The combined use of US and ARFI elastography raises both \nqualitative and quantitative sensitivities in the diagnosis of acute appendicitis \nand can also be used in severe and pervasive inflammation.  \nB-0874 11:06  \nUsefulness of contrast-enhanced ultrasound in the diagnosis of acute \ngangrenous cholecystitis: a comparative study with surgical and \npathological findings  \nI. Carbonell, R.R. Revert, M. Martínez, Y. Fernández, J. Vizuete, T. Ripolles; \nValencia/ES (medisa740@gmail.com)  \nPurpose: Determine usefulness of contrast-enhanced ultrasound (CEUS) for \nthe diagnostic of acute gangrenous cholecystitis (AGC), compared with \npathologic specimens as gold standard. \nMethods and Materials:  From December 2011 to March 2013, patients with \nclinical and sonographic diagnosis of  acute cholecystitis underwent a CEUS \nexamination. CEUS diagnosis of AGC was made when discontinuity of \ngallbladder wall enhancement was seen after contrast injection. Sonographic \nfindings prospectively evaluated were: wall thickness, biliary sludge, lithiasis, \nMurphy sign, wall striations, intraluminal membranes, wall interruption, \npericholecystic fluid, or hyperemia. We included only patients who underwent \ncholecystectomies 24 hours after CEUS. Sonographic was compared with \npathologic analysis of the gallbladder speci men. Sensitivity, specificity, positive \nand negative predictive values, and CEUS accuracy were calculated. \nRetrospectively, two experienced radi ologists reviewed sequences to calculate \ninterobserver agreement, using kappa statistics. \nResults: 64 patients were included (32 women, mean age of 71 years). Final \npathological diagnoses were 6 chronic cholec ystitis, 10 acute cholecystitis and \n48 AGC. Absence of gallbladder wall enhancement on preoperative CEUS \nimage was accurately associated with pathologically confirmed AGC \n(sensitivity, specificity  and accuracy of 79.2%, 81.3% and 79.7%). \nInterobserver agreement was good (k value: 0.719). Radiologic criteria with \nhighest sensitivity and specificity to  gangrenous form were defects of \nenhancement, wall striations and biliary sludge. Intraluminal membranes had \nhigh specificity (92.8%) but low sensitivity (22.9%). \nConclusion: Local or widespread absence of gallbladder wall enhancement \non CEUS is associated with the presence of AGC.  \nB-0875 11:15  \nDiagnostic accuracy of full-body linear X-ray scanning in trauma patients \nin comparison to CT  \nA. Jöres, J.T. Heverhagen, A. Exadaktylos, T. Klink; Berne/CH \n(andreas.joeres@insel.ch)  \nPurpose: To evaluate the diagnostic accuracy of full-body linear X-ray \nscanning (LS) in polytrauma patients in comparison to computed tomography. \nMethods and Materials:  Following institutional review board approval, 106 \npolytrauma patients (female, 33; male 73; mean age, 46.7 years; age range, \n16 - 93) were retrospectively included in this study. All patients underwent \nlinear slot X-ray scanning (LS; Lodox Statscan, South Africa) of the whole-body \nincluding extremities (scan time,13s/1.80m; entrance dose, 0.12 mGy), and \n128-multi-slice computed tomography (MSCT; Definition Edge, Siemens, \nForchheim, Germany) covering neck, thorax, abdomen, and pelvis during \n2012. Diagnostic accuracy of LS for the detection of fractures of the truncal \nskeleton and pneumothoraces was evaluated in comparison to MSCT by two \nobservers in consensus. Extremity fractures detected by LS were documented. \nResults: Overall sensitivity of LS was 50 .0%, specificity 93.3%, positive \npredictive value 91.2%, and negative predictive value 57.5% in comparison to \nCT. Sensitivity for vertebral fracture s was 16.7%, and specificity 100%. \nSensitivity was 50.0% and specifici ty 98.2% for all other fractures. \nPneumothoraces were detected in 13 patients by CT, but not by LS. 30 \nfractures of the extremities were detected by LS, but not covered by MSCT. \nConclusion: Diagnostic accuracy of LS is limited in the evaluation of acute \ntrauma of the truncal skeleton. LS allows for fast and ultra-low dose whole-\nbody X-ray imaging, and may be valuable for detecting extremity fractures in \ntrauma patients additional to CT imaging.  \nS325  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0876 11:24  \nBowel and mesenteric injuries in blunt abdominal trauma: the role of \nmultidetector-CT for addressing a surgical approach  \nM. Tonerini; Pisa/IT (m.tonerini@tiscali.it)  \nPurpose: To describe the MDCT findings of blunt bowel and mesenteric \ninjuries (BBMI) and to determine which types of lesions warrant a surgical \napproach. \nMethods and Materials:  Retrospective study of 30 patients (18 male; 12 \nfemale; mean age 35 y.o). who sustained a major trauma and who were \nevaluated with a 64- MDCT in a I level Emergency Department. The MDCT \nfindings were evaluated by an experienced staff dedicated for Emergency \nRadiology (24 h) and they were then confirmed by laparotomy/laparoscopy or \nby MDCT follow-up. \nResults: 70% patients had surgically important BBMI and 30% of patients had \nsurgically unimportant BBMI. Bowel wall defect, bowel wall ischemia, \nextraluminal air, mesenteric vessel beading or extravasation and abrupt \ntermination of mesenteric vessels showed the best positive likelihood for \nsurgically important BBMI. Mesenteric infiltration, intraperitoneal fluid, bowel \nwall thickening or bowel wall abnormal enhancement were not specific findings \nof BBMI and they did not warrant an emergent surgical approach. The absence \nof peritoneal fluid showed the best negative predictive value. \nConclusion: MDCT accurately revealed surgically important BBMI. When \nnonspecific features of BBMI are the only CT findings, the need for surgical \nintervention is highly dependent on clinical judgment. Reevaluation with MDCT \nwithin 6-8 hours may help to elucidate the significance of such findings.  \nB-0877 11:33  \nFollow-up and characterisation of indeterminate spleen lesions in \nprimary CT after blunt abdominal trauma: potential of MR imaging  \nS. Gordic, H.-P. Simmen, G. Wanner, D. Cadosch, H. Alkadhi; Zurich/CH \n(sonja.gordic@usz.ch)  \nPurpose: To determine the value of MR imaging for follow-up and \ncharacterisation of indeterminate spleen lesions in primary CT of patients with \nblunt abdominal trauma. \nMethods and Materials:  Twenty-five patients (8 female, mean age 51.6 ±22.4 \nyears) with an indeterminate spleen lesion diagnosed at CT after blunt \nabdominal trauma underwent MR imaging with T2- and T1-weighted images \npre- and post-contrast material administration. MR images were reviewed by \ntwo radiologists. Age, gender, injury mechanism, injury severity score (ISS), \nmanagement of patients, time interval between CT and MR imaging, and \nlength of hospital stay were included into the analysis. Patient history, clinical \nhistory, imaging and two-month clinical outcome including review of medical \nrecords and telephone interviews served as reference standard. \nResults: From the 25 indeterminate spleen lesions in CT, 11 (44%) were \ntraumatic and 14 (56%) non-traumatic. The ISS (P \n<.001) and length of \nhospital-stay (P=.03) were significantly higher in patients with traumatic spleen \nlesions as compared to those without. All other parameters were similar among \ngroups (all,P>.05). The MR imaging features ill-defined lesion borders, variable \nsignal on T1-and T2-weighted images, focal contrast enhancement indicating \ntraumatic pseudoaneurysm, perilesional contrast enhancement and edema \nwere indicative for traumatic spleen lesi ons. As compared to CT (2/25), MR \nimages (5/25) better depicted thin subcapsular hematomas as indicator of \ntraumatic spleen injury. \nConclusion: MR imaging shows value for follow-up and characterisation of \nindeterminate spleen lesions in primary CT after blunt abdominal trauma and is \nhelpful for discriminating traumatic from non-traumatic spleen lesions.  \nB-0878 11:42  \nX-ray findings and morphologic changes in lungs after thermal injury  \nE.A. Beresneva, S.V. Smirnov, S.V. Sheviakova, T.G. Spiridonova, \nM.V. Barinova; Moscow/RU (erasklif@mail.ru)  \nPurpose: To characterise changes in lungs after thermal injury. \nMethods and Materials:  We have studied chest X-ray findings and lung \nmorphology changes following thermal injury in 240 patients distributed in 3 \ngroups: isolated inhalation injury (Group 1), skin burn only (Group 2), the \ncombination of inhalation injury with a skin burn (Group 3). \nResults: Following inhalation injury, lung edema and pneumonia were most \ncommonly revealed by X-ray at early stage (day 1-2, and day 3-4, \nrespectively). We identified a radiographic  sign indicating a terminal bronchiole \nobstruction, and appearing in X-ray as peripherally located (in the lung) small \nclear bubbles closely arranged in a \"mulberry\" pattern. Terminal bronchiole \nobstruction was confirmed morphologically. In 45.1% of Group 2 patients no \nabnormalities in lungs were seen. Pneumonia was the most common \ncomplication occurring at week 2-3. In combination of inhalation injury and skin \nburn, chest X-ray showed no abnormal signs in lungs in 35% of patients in \ninitial 5-6 days. Only some patients showed the radiologic sign of \"mulberries\" \nor signs of venous congestion. Advanced pulmonary edema and pneumonia \nwere reveled later: at day 7 or 8. Morphology demonstrated increased blood \nvolume in all vessels, sludge, and blood clots. \nConclusion: We found radiologic and morphologic differences between the \nthree groups. The radiologic sign of \"mulberries\" is consistent with the terminal \nbronchiole damage and lumen obstruction. Absence of abnormal X-ray signs in \nlungs of patients with combination of inhalation injury and skin burn in initial \nseveral days suggests the presence of severe microcirculation impairments.  \nB-0879 11:51  \nThe lung CT patterns in fat embolism syndrome  \nM. Piolanti, M. Fiscaletti, C. Coniglio, G. Dalpiaz, M. Miceli, S. Violini, \nL. Barozzi; Bologna/IT (marpiolanti72@gmail.com)  \nPurpose: The aim of this study is to define the lung CT pattern of the \npulmonary involvement in fat embolism syndrome (FES). \nMethods and Materials:  In this study, 3 radiologists retrospectively reviewed \n18 CT studies of patients with clinical diagnosis of pulmonary fat embolism \nsyndrome. The protocol was approved by the Ethics Committee of the AUSL of \nBologna, Italy. Imaging evaluation was particularly focused on the lobular \nabnormalities, and the terminology use d followed the Fleischner Society \nglossary of 2008. Presence and extension of all CT signs of interstitial and \nalveolar involvement were carefully assessed by consensus by the observers. \nStatistical analysis was performed to analyse distribution of the findings and \ncorrelate them with the clinical parameters. \nResults: All patients in our series showed presence of nodules and micro-\nnodules with random distribution. Consolidations and ground-glass opacities \nwere present in all patients as well. Consolidations had predominantly a \ndependent distribution, while ground glass opacities had always a random \ndistribution. Ground glass opacities and nodules resulted to be prevalent in the \nupper lobes while consolidation prevailed in the lower lobes. \nConclusion: In conclusion, from the CT findings of our series FES seems to \nhave a peculiar CT pattern; although it is not a specific CT pattern in itself, in \nthe proper clinical context CT findings might well suggest, or confirm, the \ndiagnosis of pulmonary FES.  \n10:30 - 12:00 Conf. Room M3  \nInterventional Radiology  \nSS 1709  \nPercutaneous ablation  \nModerators:  \nC.W. Kim; Busan/KR  \nG. Widmann; Innsbruck/AT  \nB-0880 10:30  \nSystemic hyperthermia after local tumour ablation: comparison of \nmonopolar and multipolar radiofrequency ablation  \nA.H. Mahnken\n1, V. Fischer1, J. Tacke2, P. Bruners3; 1Marburg/DE, 2Passau/DE, \n3Aachen/DE (mahnken@med.uni-marburg.de)  \nPurpose: To assess changes in body temperature during mono- and \nmultipolar radiofrequency (RF) ablation. \nMethods and Materials:  112 consecutive patients (62 male; 63.8 ±12 years) \nundergoing RF ablation for primary or secondary hepatic malignancies were \nincluded in this retrospective analysis. All monopolar ablation procedures \n(n=164) were performed with the RF3000 system (Boston Scientific, Natick, \nMA) with LeVeen probes (2-4 cm), while multipolar ablation procedures (n=69) \nwere performed using the Celon Power generator (Celon, Teltow, G) with 1 to \n6 RF-probes. Body temperature was continuously monitored throughout all \nprocedures via an oral temperature probe (Datex-Ohmeda, GE-Healthcare, \nChalfont St. Giles, UK). Data were statist ically analysed using Wilcoxon test \nand uni- and multivariate analysis of variance. \nResults: Both ablation techniques resulted in a significant increase in body \ntemperature (p < 0.0001) with an average increase of body temperature of \n1.4±1.6 (0-5.9)°C in monopolar and 0.7 ±0.7 (-0.1-2.2)°C in multipolar ablation. \nThe increase in body temperature was significantly lower with multipolar \nablation (p < 0.0001), when compared with monopolar ablation. Multivariate \nanalysis proved probe size (p < 0.0001), ablation duration (p=0.0002) and \nsummarised tumour diameter (p=0.049) to have a significant influence on \nchanges in body temperature. Proximity to large vessels did not show \nsignificant effects on body temperature (p > 0.05). \nConclusion: The use of multipolar ablation is an effective option to minimise \nsystematic body heating in RF-ablation of liver tumours. In high-risk patients, \nthis offers a strategy to avoid negative side effects of systemic body \nhyperthermia, as it may occur in monopolar RF-ablation of large lesions.  \n \nS326  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0881 10:39  \nEfficay and cost-analysis of radiofrequency ablation compared to surgery \nfor the treatment of benign thyroid nodules  \nG. Bazzocchi, S. Bernardi, C. Dobrinja, B. Fabris, N. Sabato, V. Ulcigrai, \nE. Barro, N. De Manzini, F. Stacul; Trieste/IT (gabrielebazzo@yahoo.it)  \nPurpose: The aim of this study was to evaluate radiofrequency thermal \nablation (RFA) efficacy, tolerability and costs, and comparing it to \nemithyroidectomy, including short stay thyroid surgery, for the treatment of \nbenign thyroid nodules. \nMethods and Materials: 29 patients underwent RFA of benign thyroid nodules \nand were compared with 72 patients surgically treated, either in a standard \ninpatient or in a short stay surgical regimen. Efficacy, complications, cosmetic \nscore and costs were evaluated. \nResults: RFA reduced nodular volume by 68% after 6 months and it was \neffective in treating all nodule-related clinical problems, including \nhyperthyroidism, neck symptoms and cosmetic score. RFA and surgery, \nregardless of the length of the hospital stay, were both safe, although RFA had \nless complications. RFA, however, did not allow for any pathological analysis \nof the nodules, which, in 5 patients who underwent surgery (7%), revealed that \nthe nodules harboured malignant cells. RFA costs 1629 €, surgery costs 4668 \n€ and short stay surgery costs 4218 € per patient. \nConclusion: These data suggest that RFA cost-effectiveness is likely to \ntransform our approach to benign thyroid nodules.  \nB-0882 10:48  \nCT-guided RF ablation improves survival in patients with liver metastases \nfrom breast cancer  \nA.H. Mahnken1, K. Kühl1, P. Bruners2; 1Marburg/DE, \n2Aachen/DE (mahnken@med.uni-marburg.de)  \nPurpose: To evaluate the results of radiofrequency (RF) ablation in the \ntreatment of liver metastases from breast cancer. \nMethods and Materials:  29 female patients (age 49 ±12 years) with 76 liver \nmetastases from breast cancer were included in this retrospective analysis. All \npatients had previously received chemotherapy. Mean lesion size was \n2.4±1.3 cm. Extrahepatic metastases were present in 18/29 patients with bone \n(15/29) and lung (9/29) metastases being the most common locations of \nextrahepatic disease. CT-guided RF-ablation of liver metastases was \nperformed using 2-4 cm LeVeen probes. Follow-up included contrast enhanced \nCT every 3-6 months. Mean follow-up period was 18 (1-75) months. Overall \nsurvival and factors affecting outcome were analysed using Kaplan-Meier \nstatistics and univariate analysis of variance. \nResults: A total of 47 treatment sessions were successfully completed without \nmajor complications. Minor complications were observed in 4/29 patients, with \none patient requiring embolisation for bleeding. Complete necrosis was \nachieved in all lesions. Local recurrence rate was 6.5%. Median survival from \nablation was 27 months. Corresponding 1- and 3-year overall survival rates \nwere 81% and 33%, respectively. Univariate anaylsis did not show a significant \neffect of extrahepatic disease, number of metastases or diameters of lesions \non survival. There was a trend towards a better survival if RF-ablation was \nperformed within 3 months after the diagnosis of liver metastases (p=0.0669). \nConclusion: Percutaneous RF-ablation has a role in the management of \nmetastatic breast cancer. Extrahepatic disease should not preclude treatment if \nthe liver is the dominant site of metastatic disease.  \nB-0883 10:57  \nPatient outcome after pulmonary radiofrequency ablation: a prospective \nanalysis of results from a single centre  \nC.J. Zagorski, S.A. Forbes, P.E. Jennings, R. Soomal, S.L. Smith; Ipswich/UK \n(cjzagorski@gmail.com)  \nPurpose: To assess the safety of pulmonary RFA and analyse factors \naffecting overall survival and disease fr ee survival in patients with pulmonary \nmalignancy treated with ablation. \nMethods and Materials: 90 tumours in 45 patients treated between April 2009 \nand August 2013 during 83 separate procedures were analysed using a \nprospective database. For each patien t we recorded the histologically \nconfirmed nature of the primary tumour, site and number of metastases and if \nthe patient received prior chemotherapy or other treatments. On a lesion-by-\nlesion basis we recorded the lesions' site and size, ablation details, lesional \nprogression free survival, complications and overall survival. Factors were \ncompared using log rank testing and Kaplan-Meier survival analysis performed. \nResults: Median overall survival was 105 weeks from initial RFA, with 1, 2 and \n3-year survival of 95.5%, 89.9% and 77.7% respectively. 15 lesions (17%) \ndeveloped recurrence; with mean time to recurrence 32 weeks. 40% of those \nwith recurrence occurred when the lesion abutted a major vessel. Repeat RFA \nin 8 of these 15 lesions demonstrated no further recurrence in 7. The rate of \nsignificant complications (those requiring treatment) was 12%. Patients with \u0003 3 \nlesions ablated had a mean survival of 150 weeks, compared to 195 weeks in \nthose with a total number of lesions \u0002 2. This came close to statistical \nsignificance (p=0.091). \nConclusion: Three-year survival of 77.7% compares favourably with surgery. \nPatients with \u0003 3 lesions treated are likely to have lower survival than those \nwith \u0002 2 lesions treated.  \nB-0884 11:06  \nDiaphragmatic hernias after lung percutaneous radiofrequency ablation: \nincidence and risk factors  \nN. Alberti1, G.R. Ferretti2, X. Buy1, J. Palussiere1; 1Bordeaux/FR, 2Grenoble/FR \n(nicolasalberti@aol.com)  \nPurpose: To evaluate diaphragmatic hernias (DH) after PRFA for basal lung \nnodules and detect risk factors. \nMethods and Materials:  Between January 2009 and December 2012, \npresence of DH was retrospectively recorded in all the patients who underwent \npercutaneous radiofrequency ablation (PRFA) with multitine expandable \nelectrodes for ablation of lower-lobe nodule. All the nodules were classified into \nthree groups according to the location of the tines after deployment relative to \nthe diaphragm. In group 1, the tines were at a distance of more than 1 cm to \nthe diaphragm. In group 2, at least one tine was in contact with the diaphragm \nwithout perforation. Finally, in group 3, at least one tine was perforating the \ndiaphragm. \nResults: Four cases of DH (3 on the left side, 1 on the right) were recorded in \nour series of 156 patients (2.3% of our procedures). The delay of onset was \n7.8 months. Only the three DH that occurred on the left side were symptomatic \n(2 intussusceptions and one gastroesophageal reflux) and were surgically \nrepaired. DH occurred in groups 2 (n=1) and 3 (n=3). The electrode was \npositioned in the centre of the diaphragm in all cases. \nConclusion: The central position of the electrode and the contact of at least \none tine with the diaphragm after deployment seem to be a risk factor to \ndevelop a DH.  \nB-0885 11:15  \nAblation therapy of hepatocellular carcinoma (HCC): a comparative study \nbetween radiofrequency ablation (RFA) and microwave ablation (MWA)  \nT.J. Vogl, S. Zangos, J. Trojan, N.N.N. Naguib, N.-E. Nour Eldin; \nFrankfurt a. Main/DE (t.vogl@em.uni-frankfurt.de)  \nPurpose: To prospectively evaluate and compare the therapeutic response of \nradiofrequency ablation (RFA) and microwave ablation (MWA) of \nhepatocellular carcinoma (HCC). \nMethods and Materials:  This prospective study was approved by the \nInstitutional review board and written informed consent was obtained from all \npatients. From September 2008 to December 2011, 53 consecutive patients \n(42 males/11 females; mean 59 years; range 40-68) underwent CT-guided \npercutaneous RFA and MWA of 68 HCC-lesions. Inclusion and exclusion \ncriteria were in accordance with the Barcelona Clinic Liver Cancer (BCLC) \ncriteria. Morphologic tumour response (number/location/size) was evaluated by \nMRI. Follow-up protocol was 24 h post ablation, 3-month intervals post ablation \nin the first year and 6-month intervals thereafter. \nResults: Complete response was documented in 84.4% (27/32) of lesions \ntreated with RFA and in 88.9% (32/36) of lesions with MWA (p=0.6). Complete \nresponse was achieved in all lesions \u00022.0 cm in diameter in both groups. There \nwas no significant difference in rates of residual foci of HCC-lesions between \nRFA and MWA (p=0.15, Log-rank test). Recurrence rates for 3, 6, and 9 \nmonths were 6.3%, 3.1%, 3.1% in RFA vs. 0%, 5.6%, 2.8% in MWA. Time-to-\nprogression in patients treated with RFA was 6.6 months vs. MWA 8.3 months. \nProgression-free-survival was 96.9%, 93.8% and 90.6% (RFA group) at 1, 2, \nand 3 years and 97.2%, 94.5%, and 91.7% (MWA group), respectively \n(p=0.98). \nConclusion: In conclusion, RFA and MWA showed no significant difference in \nthe treatment of HCC regarding complete response, rates of residual foci of \nuntreated disease and recurrence rate.  \nB-0886 11:24  \nMicrowave ablation (MWA) therapy of liver metastases from colorectal \ncarcinoma post-systemic chemotherapy  \nN.-E.A.N. Mohammed, N.N.N. Naguib, T. Lehnert, T.J. Vogl; \nFrankfurt a. Main/DE (nour410@hotmail.com)  \nPurpose: To evaluate the safety, efficiency, effectiveness, and overall \noutcome in patients treated with microwave thermal ablation of colorectal \nmetastases post-systemic chemotherapy. \nMethods and Materials:  An institutional review board-approval was obtained \nwith informed consent of all patients. Retrospective analysis of prospective \nintention to treat study was performed from January 2008 to January 2013, and \nincluded 92 patients (mean age 56 years SD: 2.6) with 132 liver metastases \nmeasuring 0.7-5.0 cm, who were treated with microwave ablation (MWA). \nLocal tumour control, complications, and long-term survival were analysed. \nS327  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nResults: The mean follow-up period was 32.5 months. Complete ablation was \nachieved in 117 of 132 (88.6%) nodules. Seventeen of the 117 (14.5%) \nsuccessfully treated nodules developed local recurrence. Univariate analysis \nshowed that tumour size of < 3 cm is a significant risk factor (P = 0.04). \nMultivariate analysis showed that number of cycles of chemotherapy \n(FOLFOX) was a significant prognostic factor for overall recurrence (P=0.03), \nwhereas disease-free interval was the si gnificant prognostic factor for distant \nrecurrence (P=0.03). Major complications occurred in 1.1% of patients. No \nprocedure-related mortalities were observed. The 1-, 2-, 3-, and 5-year overall \nsurvival rates after the initial ablation were 82, 61.2, 51.2, and 38.3%, \nrespectively. The main cause of death was systemic tumour progression in \n65.3% of the patients. \nConclusion: MWA is a safe and effective treatment therapeutic option for \npatients with liver metastases from colorectal carcinoma post-systemic \nchemotherapy.  \nB-0887 11:33  \nMRI chest parameters used in the assessment of tumour response post-\nmicrowave ablation of pulmonary metastases  \nN.-E.A.N. Mohammed, N.N.N. Naguib, A. Emam, S. Zngos, T. Lehnert, \nT.J. Vogl; Frankfurt a. Main/DE (nour410@hotmail.com)  \nPurpose: To determine the value of contrast enhanced MRI (CE-MRI) \nfollow-up in the assessment of tumour response of microwave (MW) ablated \npulmonary metastases by correlating the results with CE-CT. \nMethods and Materials:  This prospective study included 130 ablation \nsessions for pulmonary metastases in 80 patients. CE-MRI chest scanning was \nperformed 1 week before the ablation and at 24 hours, 3, 6, 9 and 12 months \npost-ablation. Thin-section CT volumetric measurement of the lesions was \nperformed at the same time periods as a second parameter for comparison. \nThe lesion MRI enhancement intensity in each study was estimated, and the \nratio to the paraspinal muscle enhancement intensity at the same level was \nmeasured (Lesion muscle signal (LMS ratio). The correlations between post-\nablation follow-up CT volume of tumours and CE-MRI LMS ratio at the \nfollow-up periods were assessed. \nResults: The preablation tumour volumes were in the range of 0.30-6.1 cm \n(mean: 1.5 cm³, SD: 1.3). LMS ratio 1 was noted in: preablation due to high \ncontrast enhancement of the tumour,in 24 h post-ablation due to the \ninflammatory response associated with the thermal ablation and due to tumour \nresidue or progress. Weak correlation was detected between the LMS ratios \nand CT volumetric changes in 24 h post-ablation. Strong correlation between \nthe LMS ratios was estimated between the follow-up periods of 3 months \n(Spearman R: 0.62, p=0.0021), 6 months (Spearman R: 0.66,p=0.001), \n9months (Spearman R: 0.61, p < 0.001) and 12 months (Spearman R:0.7, \np < 0.00001). \nConclusion: CE-MRI follow-up of the MW ablated lung tumours can be used \neffectively to assess the tumour response to ablation using LMS ratio as a \nparameter of assessment.  \nB-0888 11:42  \nMid-term outcome of percutaneous image-guided cryoablation on \ninoperable extra-abdominal desmoid tumors  \nM. Havez, F. Cornelis, N. Lippa, S. Al Ammari, M. Kind; Bordeaux/FR \n(marion.havez@gmail.com)  \nPurpose: To report the effectiveness and mid-term outcome of percutaneous \nimage-guided cryoablation on extra-abdominal desmoid tumors. \nMethods and Materials:  The institutional review board approved this study \nand informed consent was waived. Between 2011 and 2012, 13 patients (17 \ntumors), with a mean age of 39.3 years (15-74), consecutively treated with \ncryoablation under ultrasound (n=8), computed tomography (n=1) or both (n=8) \nguidance for extra-abdominal desmoid tumors were retrospectively selected \nand followed until 2013. The study included 2 patients with Gardner syndrome \nand 9 recurrences on ablative site after initial surgical treatment. Tumor \nvolumes were between 0.8 to 127.2 mm3 (median: 28 mm3). Disease free \nsurvival (DFS) and local control were calculated on clinical (pain evaluation) \nand imaging (according to RECIST criteria) follow-up, respectively. Kaplan-\nMeier method was used for calculation of DFS. \nResults: Cryoablation was performed under general (n=15) or local (n=2) \nanesthesia. Two probes were used in mean (range: 1-4) per procedure. Mean \nfollow-up was 10.3 months (4-27 months). The disease-free survival rates \nbased on clinical evaluation were 82.3% at 6, 12 and 24 months. The rates of \nlocal tumour progression based on RECIST criteria were 0% at 6, 12 or 24 \nmonths. Eight patients (47%) presented asymptomatic residual tumors \nsurrounding the ablative site on imagi ng follow-up. Two patients (12%) \npresented an in situ recurrence. The major complications rate was 5.8% per \nsession (1/17). \nConclusion: Despite high rate of partial ablation, percutaneous image-guided \ncryoablation appears to be safe and effective for mid-term local control in case \nof inoperable extra-abdominal desmoid tumors.  \nB-0889 11:51  \nPercutaneous cryoablation of lung tumours: one year follow-up  \nC. Pusceddu; Cagliari/IT (clapusceddu@gmail.com)  \nPurpose: To report the data of one year follow-up with CT-guided \npercutaneous cryoablation (PCA) in patients with primary and secondary \npulmonary tumours. \nMethods and Materials:  CT-guided PCA was performed on 46 lung masses \n(18 NSCLC = 39%; 28 metastases = 61%) in 40 consecutive patients not \nsuitable for surgical resection. Lung ma sses were treated using three types of \ncryoprobes: IceRod, IceSfere and IceSeed capable of obtaining different size \nof iceball. After insertion of the cryoprobes into the lesion, the PCA were \nperformed. \nResults: All cryoablation sessions were successfully completed. All tumours \nwere ablated. No procedure-related deaths occurred. Morbidity consisted of \n20% (8 of 40) pneumothorax, 7% (3 of 40) pleural effusion and 3% (1 of 40) \ncases asymptomatic small pulmonary haemorrhage, respectively, all of CTCAE \ngrade 1 (Common Terminology Criteria for Adverse Events). Low density of \nentire lesion, central necrosis and solid ma ss appearance were identified in 32 \n(70%), 8 (17%) and 6 (13%) of cryoablated tumours, respectively. Technical \nsuccess was achieved in 80%, 95%, 91% and 85% of treated lesions at 1-, 3-, \n6-, and 12-months CT follow-up scan, respectively. Comparing the tumour \nlongest diameter between the baseline and at 6 and 12 months CT images, \ntechnical success was revealed in 91% and 83% cases, respectively. \nConclusion: Cryoablation of the lung tumours is a safe and effective \nprocedure capable of obtaining complete ablation of the tumour in a high \nnumber of patients after one year follow-up.  \n10:30 - 12:00 Board Room A  \nRadiographers  \nSS 1714  \nExploring current issues in medical \nimaging practice  \nModerators:  \nV. Donoghue; Dublin/IE  \nN.N.  \nB-0890 10:30  \nBest single-slice CT location to measure visceral adipose tissue in \nchildren  \nM. O'Connor, J. Ryan, S. Foley; Dublin/IE (michelle.oconnor@ucd.ie)  \nPurpose: To investigate the optimal single CT slice location for predicting total \nabdominal visceral adipose tissue (VAT) volume in children and the relations \nbetween anthropometric measurements, gender, age and VAT volume. \nMethods and Materials:  With ethical permission, 112 abdomen CT scans \nwere retrieved from the PACS systems of paediatric hospitals in Ireland (N= 3), \nvia a random stratified sampling, according to age and gender. VAT area was \nmeasured at each intervertebral level between T12 and S1 using Image J \nanalysis software by setting threshold values of -190 to -30 HU and manually \nsegmenting VAT. Abdominal VAT volume was then derived. Waist \ncircumference (WC) and sagittal diameter (SD) were measured at L3-L4 and \nL4-L5 slices, respectively. Single-slice VAT measurements were correlated \nwith total VAT volume for each slice to identify the optimal slice location for \nVAT measurements. Regression analysis was used to evaluate WC, SD, age \nand gender as VAT volume predictors. \nResults: Preliminary results have shown that VAT area measured at L4-L5 \n(r=0.919) was best correlated to abdominal VAT volume in males and at L2-L3 \nin females (r=0.951). Mean abdominal VAT volume was lower in males \n(2,443.7 cm^3) than in females (3,490.5 cm^3) although this was not significant \n(p=0.237). Regression between WC, SD, age, gender and VAT volume \nshowed that waist circumference was most predictive of VAT volume \n(Beta=1.076, p=0.001). \nConclusion: The optimal slice location for VAT measurements was at L4-L5 in \nmale children and L2-L3 in female children.  \n \n \n \n \n \n \n \n \n \n \nS328  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0891 10:39  \nRisk factors leading to coronary heart disease within the Maltese \npopulation: further factors for consideration  \nK. Borg Grima1, L.A. Rainford2, P. Bezzina1, D. O' Leary2; 1Msida/MT, \n2Dublin/IE (karen.borg-grima@um.edu.mt)  \nPurpose: Several cardiovascular risk factors are identified within the literature: \nage, smoking history, blood pressure and c holesterol levels are the major risk \nfactors leading to coronary heart disease (CHD) (Desai et al, 2004). Many \nresearchers have indicated that these traditional risk factors alone fail to \nexplain the high mortality and morbidity rates associated with CHD, suggesting \nthat underlying risk factors may also be present. This work investigates the risk \nfactors leading to CHD within the Maltese population, as part of an ongoing \nPhD study. \nMethods and Materials:  Ethical approval was obtained to review 250 patient \nmedical histories for cardiovascular risk factors within the Maltese population. \nPrimary risk factors were established from a CHD literature search, however \nrisk criteria that are not always taken into consideration such as chronic kidney \ndisease, diabetes and the presence of in flammatory arthritic conditions were \nalso included. The electrocardiogram and myocardial perfusion scintigraphy \nresults in comparison to the results of the Duke risk score were also \nconsidered. \nResults: The results obtained were compared through regression analysis and \nthe use of IBM SPSS (version 20). Risk factors unique to the Maltese \npopulation such as employment type and body mass index were also included. \nThe results were discussed in semi-structured interviews with the Nuclear \nMedicine physicians and Cardiologists working in Malta to establish a triage \nsystem uniquely fitted to these patients. \nConclusion: The triage of patients into appropriate cardiac scintigraphy \nprotocols cannot be exclusively based upon the traditional CHD risk factors \nestablished within the literature.  \nB-0892 10:48  \nSex estimation from scapular length measurements by CT scan images in \na Caucasian population  \nF. Giurazza\n1, R. Del Vescovo1, E. Schena1, F. Paternostro2, B.B. Zobel1, \nG. Frauenfelder1; 1Rome/IT, 2Florence/IT (giulia.frauenfelder@gmail.com)  \nPurpose: Together with race, stature and age, sex is a main component of the \nbiological identity. Thanks to its proportional correlation with parts of the human \nbody, sex can be evaluated form the skeleton. The most accurate approach to \ndetermine sex by bone size is based on os coxae or skull. After natural \ndisaster or in archaeological findings, t heir presence can never be guaranteed. \nHerein, sexual dimorphism in the human scapula is used to develop a two-\nvariable discriminant function for sex estimation. \nMethods and Materials:  We have enrolled 100 males and 100 females with a \nmean age of 64.2 years (SD 12.8 years) who underwent low-dose thoracic CT \nscan evaluation and we have estimated two scapular diameters: longitudinal \nscapular length (LSL) and transverse scapular length (TSL). The estimation \nhas been carried out by analyzing images of the scapulae of each patient after \nthree-dimensional post-processing reconstructions. \nResults: The two-variable function allows to obtain an overall accuracy of 88% \non the calibration sample; using a single scapular parameter accuracy was \n84% for LSL and 87% for TSL. Furthermore, we have employed the mentioned \nfunction on a collection of 10 Caucasian adult skeletons and sex has been \ncorrectly predicted in 9 cases. \nConclusion: In our study, scapula seemed to be a valuable skeletal segment \nfor sex estimation: the two-variable discriminant function provide accuracy of \n88% and 90% for the calibration sample and the skeletons, respectively.  \nB-0893 10:57  \nClinical audit in a service of paediatric radiology: preliminary approach  \nR.M. Grunho, F.S. Pires, J. Santos, G. Paulo; Coimbra/PT \n(rmegru@gmail.com)  \nPurpose: Radiation protection and dose optimisation play key roles in pediatric \nradiology mainly due to children's high sensitivity to radiation. Clinical audit is a \nprocess that aims to improve the quality of healthcare, being essential in a \nPaediatric Radiology department. The main objective was perform the first step \nof Clinical Audit in a Radiology Department, evaluating the radiological practice \nin pediatrics and establishing local Diagnostic Reference Levels (DRL's), \nallowing analyse a potential optimisation. \nMethods and Materials:  After selecting the two most common radiological \nprocedures by radiological modality, we performed a retrospective data \ncollection in PACS with 10 patients by procedure and specific age (0, 5, 10 and \n15) in order to establish local DRL's based on the 75\nth percentile of the dose \ndescriptors. \nResults: The local DRL's were: 6 mGy.cm2, 38 mGy.cm2, 7 mGy.cm2 and \n11 mGy.cm2 for chest radiography (0, 5, 10 and 15 years respectively); \n38 mGy.cm2 and 314 mGy.cm2 for pelvis radiography (5 and 10 years); \n48 mGy, 50 mGy, 55 mGy and 63 mGy for head Computed Tomography (CT), \n(0, 5, 10 and 15 years, respectively); 2 mGy 4 mGy for and chest CT (5 and 15 \nyears respectively), and 104 mGy.cm2 for micturating cystourethrography in \nnewborns. \nConclusion: The local DRL's obtained for the chest and pelvis radiography \nand micturating cystourethrography are in accordance with the ones \nestablished in the European level. The majority of the local DRL's in CT are \nabove the levels specified in comparat ive studies, which indicates a large \nmargin of optimisation of these procedures.  \nB-0894 11:06  \nAcoustic noise in MRI  \nÓ. Tavares1, H. Simões1, J. Castro Costa2, E. Cantante1, M. Santos1; \n1Coimbra/PT, 2Castelo Branco/PT (joaocastrocosta@gmail.com)  \nPurpose: Hearing loss, caused by noise, is one of the 10 most common \ndiseases in the European Union. The acoustic noise in magnetic resonance \n(MR) is associated with activation and deactivation of the electrical current that \ninduces vibrations in the gradient co ils. The noise levels of the safety \nguidelines of the Food and Drug Administration (FDA) according to \nmeasurements should be between 65 and 95 dB. Determine radiographer \nnoise daily personal exposure at work per day (LEX, 8h) and the sound \npressure level peak (LCpico). With this values, potential harm from exposure to \nnoise in MR cloud be analysed and prevent and control noise \nrecommendations will be created. \nMethods and Materials: The study was divided into three phases: a screening \ntest of acoustic noise with a sonometer, measurements with a dosimeter \nDC112 in radiographer shoulder during several sequences and measurements \nduring one day daily practice of radiographer. \nResults: The daily personal noise exposure at work per day was 75.8 dB (A) \nand the sound pressure level was 88.4 dB (C). The obtained frequency values \nare according to FDA Guidelines. \nConclusion: We conclude that the sequences noisiest are the diffusion and \nthe quieter the SPGR. In none of the evaluations to check noise levels higher \nthan those imposed by the Directive No 2003/10/EC of the European \nParliament and of the Council of 6 February and Portuguese law 182/2006.  \nB-0895 11:15  \nA study of the psychological distress of fMRI volunteers  \nC. Vandulek1, G. Biro1, L. Refi2, L. Toth1, M. Emri3, I. Repa1, A. Kovacs1; \n1Kaposvár/HU, 2Budapest/HU, 3Debrecen/HU (cvandulek@gmail.com)  \nPurpose: The majority of MRI patients have experienced some form of \ndistress; distress may compromise the outcome of the examination. Due to the \nlimited data available of the measure of distress amongst fMRI subjects, this \nstudy aimed to study the anxiety level of fMRI volunteers. \nMethods and Materials:  Eighteen volunteers participated in the study. The \nState-Trait Anxiety Inventory (STAI) was used for data collection. The test was \ntaken pre and post in every fMRI examination to map the volunteers' level of \nanxiety. The STAI test was supplemented with the measurement of the \nvolunteers' blood pressure and pulse rate pre and post fMRI examinations. \nResults: The results of the STAI test revealed the volunteers' tendency for \nanxiety in general, as well as a measurable state of current anxiety pre and \npost the fMRI examination. The results of the STAI test pre and post fMRI \nexamination revealed that the subjects' state anxiety level decreased following \nthe fMRI examination in comparison with their level prior to the examination \n(p=0.032. The results of the volunteers' blood pressure showed no significance \nbetween the values pre and post examination (p=0.65). Decrease of the \nvolunteers' pulse rate following the examination was significant (p=0.005). \nConclusion: This study aimed to measure the level of anxiety pre and post \nfMRI data acquisition since it may influence the outcome of an fMRI \nexamination. The results of the STAI test did not confirm distress amongst the \nvolunteers. This may be attributed to the careful patient preparation prior to the \nexamination.  \nB-0896 11:24  \nA European collaborative research study investigating paediatric cardiac \ninterventional radiation dose levels  \nD. Catania\n1, M. Pasquato1, L. Masterson2, S. Foley2, L.A. Rainford2; 1Milan/IT, \n2Dublin/IE (cataniadiego@hotmail.com)  \nPurpose: To investigate examination protocols and radiation dose levels \nduring paediatric cardiac interventional procedures in two European centres. \nMethods and Materials:  Institutional permission was granted to access \nimaging records. Retrospective data (n=12 months) was collated in the Irish \nnational centre for paediatric cardiac imaging, performed on a Siemens Bicor \nunit. Examination data was age categorised: 0 > 1 years, 1 > 5 years, 5>  10 \nyears, 10> 15 years, 15> 18 years, and 18+ years. Italian prospective data was \ncollated for five matching cardiac in terventional examinations performed using \nPhilips Integris Allura equipment: aortic coarctations; aortic and pulmonary \nS329  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nvalvuloplasty procedures, ICD and pulmonary PTA studies. Equipment and \nprotocol details were recorded to include: detector specifications, X-ray beam \nfiltration levels and type, magnification factors applied and routine frame rates \nduring fluoroscopy and image capture. \nResults: Irish data for 405 procedures resulted and Italian data for specified \nprocedures is on-going. Comparable additional copper filtration levels of \n0.2 mmCu were identified and similar screening rates of 25 fps and \nmagnification factors routinely applie d. Preliminary findings indicate Italian \nexamination times are within ranges recorded in the Irish centre, across the \nfive age groupings. DAP levels are comparable, however the 10-15 age \ngrouping recorded higher DAP readings for the bi-plane imaging equipment \n(Irish centre) compared to the flat panel detector model (Italian centre). Across \nboth centres procedural imaging times generally decreased with increasing \npatient age. \nConclusion: Initial findings indicate com parable practice and dose outcomes \nacross European paediatric cardiac centres. Further review of imaging \nprotocols and the completed dose data analysis will be presented.  \nB-0897 11:33  \nThe influence of observer training for the detection of simulated \npulmonary lesions on single CT images of an anthropomorphic chest \nphantom: a jackknife alternative free-response ROC analysis  \nC. Buissink\n1, J. Thompson2, M. Voet1, A. Sanderund3, L.V. Kamping1, \nL. Savary4, M. Mughal3, C.S.P. Rocha5, G.E. Hart2, R. Parreiral5, G. Martin6, \nP. Hogg6; 1Groningen/NL, 2Manchester/UK, 3Oslo/NO, 4Lausanne/CH, \n5Lisbon/PT, 6Salford/UK (m.voet@pl.hanze.nl)  \nPurpose: To determine the influence of both observer training in free-response \nmethodology and simulated lesion appearances on an observer's ability to \nsuccessfully localise simulated lesions within an anthropomorphic chest \nphantom on single computed tomography (CT) images. \nMethods and Materials: 34 undergraduate radiography students, attending an \nERASMUS intensive programme, analysed 46 (31 abnormal containing 1-3 \nlesions, 15 normal) low-resolution CT images produced primarily for \nattenuation correction (AC) by two single photon emission computed \ntomography/computed tomography (SPECT/CT) systems. The evaluation was \ncompleted under two conditions, pre- and post-training, with a six-week wash-\nout period between evaluations. Lesions were localised under the free-\nresponse receiver operating characteristic (FROC) paradigm and each \nevaluation was analysed separately using jackknife alternative FROC \n(JAFROC) analysis. \nResults: JAFROC analysis revealed a stati stically significant difference in \nlesion detection performance between the two sets of low-resolution CT \nimages in both evaluations (pre-training, F (1,506) = 25.2, p < 0.001; post-\ntraining, F (1.1435) = 32.6, p < 0.001). In addition to offering a slight increase in \nstatistical power, the figure-of-merit ( 4) for all treatments was increased from \nthe pre-training evaluation (0.684 (0.573.0.796) and 0.437 (0.334.0.540)) to the \npost training evaluation (0.784 (0.694.0.875) and 0.560 (0.464.0.655)). The \nincorrect localisation fraction was also reduced post-training (0.128) compared \nto pre-training (0.282). \nConclusion: Focussed training of lesion appearances and FROC \nmethodology has a significant impact on a naïve observer's ability to localise \nsimulated lesions on CT images produced with an anthropomorphic chest \nphantom.  \nB-0898 11:42  \nTask shifting towards radiologists in medical imaging: what are the views \nof the radiographers?  \nH.H. Hjemly, E. Stranden, A.M. Myklebust; Drammen/NO \n(hakon@radiograf.no)  \nPurpose: To explore and provide insight about radiographer's opinions in \ngeneral, and identify influential fa ctors, regarding task shifting towards \nradiologists and to provide knowledge for further research and work with \nradiographer's role development in to advanced practice. \nMethods and Materials:  Qualitative methods based on focus group \ndiscussions with 11 radiographers from a medium to large-sized hospital in the \nhealth region southeast of Norway. An inductive data analysis was done with a \nhermeneutic approach in five stages. Results are seen in relation to previous \nresearch and the researcher's own experience related to task shifting for \nradiographers in Norway. \nResults: The radiographers in the study express that the most limiting factor \nfor task shift into advanced practice is resistance amongst the radiologists. The \nradiographers believe that by relieving some advanced diagnostic \nresponsibilities from the radiologists, they can lead to service improvements. \nHowever, in spite the negative a ttitude amongst radiologists towards \nradiographers taking on diagnostic responsibilities, and the lack of formal \nsupport from the department, the radiographers do take decisions regarding \njustification and clinical follow-up when they feel they have to so in the best \ninterest for their patients. \nConclusion: The radiographers in the study are motivated for task shift \ntowards radiologists, but experience strong resistance in terms of negative \nattitudes. The study provides knowledge that may be of value in future \nresearch and planning of role development processes for radiographers and \nteamwork in clinical imaging. The study also indicates need for investigation of \nscope and effect of informal advanced radiographer practice.  \nB-0899 11:51  \nMolecular MRI  \nN.F. Kezi; Margate/UK (nikolasqezi@gmail.com)  \nPurpose: To introduce the new, innovative and cutting-edge MR technique \nnamed molecular-MRI. \nMethods and Materials:  The molecular-MRI as a high-sensitivity MR \ntechnique provides vital information at the cel lular or nanomolar level. mMRI is \nused both for medical diagnostics and for research purposes. Ideal for therapy \nplanning and monitoring/follow-up. Can give precise information about the \ngene expression and facilitates the examination of cell migration. Very efficient \nat characterising angiogenesis and brain tumours/its expression levels \n(VEGFR-2). A recent study evaluates the mMRI differentiation of VEGFR-2 \nlevels in untreated gliomas in a GL261 mouse model. The expression of \nVEGFR-2 levels was evaluated by using anti-VEGFR2-albumin-Gd-DTPA \nprobe with mMRI. Two separate treatment groups show us different uptake of \nthese levels in tumour region. \nResults: Focusing on the study, it confirmed that in vivo VEGFR-2 levels can \nbe monitored as function of therapeutic evaluation. Optimisation is always the \nkey priority. \nConclusion: mMRI offering all these advantages, can help the scientific \ncommunity to evaluate better the architecture of the 'nano-world' and definitely \nwill be a powerful tool in molecular imaging.  \n10:30 - 12:00 Room P  \nContrast Media  \nSS 1706  \nNew applications and developments  \nModerators:  \nN. Lassau; Villeiuif/FR  \nA. Wibmer; Vienna/AT  \nB-0900 10:30  \nBile duct evaluation of potential living liver donors with Gd-EOB-DTPA \nenhanced MRI: should we use single-dose, double dose or half-dose?  \nS. Kinner, V. Steinweg, A. Radtke, M. Forsting, T. Schröder; \nEssen/DE (Sonja.Kinner@uni-due.de)  \nPurpose: Detailed knowledge of the biliary anatomy is essential to avoid \ncomplications in living donor liver transplantation. The aim of this study was to \ndetermine the optimal dosage of Gd-EOB-DTPA for contrast-enhanced \nmagnetic resonance cholangiography (ce-MRC) with reference to contrast-\nenhanced CT cholangiography (ce-CTC). \nMethods and Materials:  30 potential living liver donors underwent both ce-\nCTC and ce-MRC. Ce-CTC was performed after drip infusion of meglumine \niotroxate. For ce-MRC, ten candidates each received single, double or half-\ndose Gd-EOB-DTPA. Ce-MRC images with and without inversion recovery \npulses (T1w ±IR) were acquired 20-30 minutes after intravenous contrast \ninjection. Image data were quantitatively and qualitatively reviewed by two \nradiologists based on a on a 5-point scale. Data sets were compared using \nMann-Whitney-U-test or Wilcoxon-rank-sum-test. Kappa values were also \ncalculated. \nResults: All image series provided sufficien t diagnostic information both \nshowing normal biliary anatomy and variant bile ducts. Ce-CTC showed \nstatistically significant better results compared to all ce-MRC data sets \n(p < 0.001). T1w ce-MRC with single dose Gd-EOB-DTPA proved to be \nsuperior to half and double dose in subj ective and objective evaluation without \na statistically significant difference (p=033-0.62). Interobserver agreement was \ngood to excellent (k=0.69-0.9). \nConclusion: T1w MRCP after Gd-EOB-DTPA is at any dosage still inferior to \nmeglumine iotroxate-enhanced CTC. Si nce preoperative planning of bile duct \nsurgery most often is focused on the central biliary anatomy, T1w ce-MRC \nmeets these specific diagnostic demands and allows for replacing harmful ce-\nCTC strategies. Best results were seen with single dose GD-EOB-DTPA \ncombined with an inversion recovery sequence 20-30 minutes after injection.  \n \n \n \n \nS330  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0901 10:39  \nEnhancement properties of a high relaxivity macromolecular Gd-based \ncontrast agent (P846) with a standard extracellular Gd-chelat (Gd-DTPA) \nin rats with experimental liver tumours at 9.4 Tesla  \nP. Fries\n1, D. Morr1, A. Müller1, P. Robert2, R. Dabew1, A. Massmann1, \nR. Seidel1, A. Buecker1, G.K. Schneider1; 1Homburg/DE, 2Roissy/FR \n(drpeterfries@googlemail.com)  \nPurpose: To evaluate the enhancement properties of an experimental Gd-\nbased, high relaxivity, macromolecular contrast agent (P846, Guerbet \nResearch, Aulnay-Sous-Bois, France) in comparison with a standard \nextracellular Gd-chelate (Gd-DTPA) at 9.4T in a rat model of hepatic colorectal \ncancer metastases. \nMethods and Materials: Nine rats with hepatic metastases were evaluated on \na 9.4T MRI unit (Bruker, Germany) acquiring T1w self-gated FLASH \nsequences (TR/TE=45/2.5 ms, FA=45°, TA=1:23 min, FOV=5.12x5.12 cm2, \nmatrix=256x256) before and at 10 consecutive time points after contrast \ninjection. Each animal received intraind ividually both agents at equal doses of \n0.1 mmol/kg body weight separated by 48 h. Based on ROI measurements we \ncalculated SNR of normal liver tissue (SNRliver) and tumors (SNRtumor), CNR \nand lesion enhancement (LE). Statistical analyses included paired t-tests and \nWilcoxon tests (p < 0.05). \nResults: Mean SNRliver, SNRtumor, CNR and LE were significantly higher \nusing P846 as compared with Gd-DTPA (mean ( ±SD), p < 0.001 each): \nSNRliver: Gd-DTPA 17.3 ( ±1.2)/P846 24.6 ( ±1.5), SNRtumor: Gd-DTPA \n23.8 (±1.8)/P846 37.2 ( ±2.0), CNR: Gd-DTPA 6.5 ( ±0.9)/P846 12.6 ( ±0.9) and \nLE: Gd-DTPA 7.9 ( ±1.8)/P846 13.9 ( ±2.0) were significantly higher for P846 as \ncompared to Gd-DTPA. Both compounds demonstrated comparable \nenhancement kinetics with an early peak followed by a gradual washout. \nConclusion: P846 provides significantly better enhancement at 9.4T as \ncompared to Gd-DTPA for equal doses of injected Gd. The large molecular \nsize and subsequent reduced rotational rate of P846 improves the interaction \nwith protons leading to a higher relaxivity. Yet, P846 demonstrates contrast \nkinetics comparable to those of the extracellular agent during the first 20 min \nafter application in this liver metastases model.  \nAuthor Disclosures: \nP. Robert: Employee; Guerbet. A. Buecker: Research/Grant Support; BMBF \n(German Ministry of Education and Research, Grant Number: 0314101). \nB-0902 10:48  \nIntraindividual comparison of an experimental high relaxivity extracellular \nGd-based contrast agent (P03277) with Gadubutrol in a rat model of \nhepatic metastases at 9.4 Tesla  \nP. Fries\n1, A. Müller1, P. Robert2, J. Stroeder1, M. Menger1, A. Massmann1, \nR. Seidel1, G.K. Schneider1, A. Buecker1; 1Homburg/DE, 2Roissy/FR \n(drpeterfries@googlemail.com)  \nPurpose: To evaluate the enhancement properties of the experimental \nextracellular Gd-based contrast agent P03277 (Guerbet Research, Aulnay-\nsous-Bois, France) compared with the commercially available extracellular \ncontrast agent Gadobutrol (Bayer HealthCare, Berlin, Germany) in a model of \nhepatic colon cancer metastases in rats at 9.4T. \nMethods and Materials:  10 rats with hepatic metastases were examined by \nMRI using a 9.4T animal scanner (Bruker, Germany). Each animal received an \nintravenous injection of 0.1 mmol/kg body weight (BW) Gadobutrol. Two days \nlater, P03277 was applied at 0.1 mmol/kg BW. T1w self-gated FLASH \nsequences (TR/TE=45/2.5 ms, alpha= 45°, TA=1:23 min, FOV=5.12x5.12 cm2, \nmatrix:256x256) were acquired before and at 10 time points after contrast \ninjection. SNR of tumor (SNRtumor) and liver tissue (SNRliver), contrast-to-\nnoise ratio (CNR) and lesion enhancement (LE) were calculated based on ROI \nmeasurements. Statistical analyses included paired t-test and Wilcoxon tests \n(p < 0.05). \nResults: Mean SNRliver, SNRtumor, CNR and LE were significantly higher \nusing P03277 as compared with Gadobutrol at equal doses (mean ±SD): \nSNRliver: Gadobutrol:16.3 ±4.5 / P03277:21.6± 6.1 (p= 0.027). SNRtumor: \nGadobutrol:21.8±4.8 / P03277:31.8± 6.2 (p=0.003). CNR: Gadobutrol:5.0 ±2.5 / \nP03277:9.3±3.3 (p=0.002). LE: Gadobutrol:8.4± 5.5 / P03277:16.4 ±5.3 \n(p=0.02). Both agents demonstrated an early peak enhancement followed by a \ncontinuous washout during the experimental period (20 min). \nConclusion: P03277 demonstrates better contrast enhancement properties as \ncompared to Gadobutrol applied at equal doses (0.1 mmol/kg BW) in this \nmodel of hepatic metastases. Based on its high relaxivity P03277 is a highly \neffective compound for contrast enhanced studies in animal tumor models at \n9.4T.  \nAuthor Disclosures: \nP. Robert: Employee; Guerbet.  \nB-0903 10:57  \nDiagnostic imaging after Yttrium 90 therapy in patients with \nhepatocellular carcinoma (HCC): preliminary comparison of magnetic \nresonance imaging with Gd-EOB-DTPA and gadobutrol  \nS. Kinner, J. Ertle, J.M. Theysohn, G. Gerken, N. Sippel, M. Forsting, \nT.C. Lauenstein; Essen/DE (Sonja.Kinner@uni-due.de)  \nPurpose: A precise evaluation of tumour response after Yttrium-90 (Y90) \ntherapy is essential for adequate clinical management. However, evaluation of \nimaging may be hampered as Y90 itself can lead to reactive liver changes with \nsimilar appearance to progress. We compared liver MRI using a liver specific \ncontrast agent (Gd-EOB-DTPA) gadobutrol-enhanced liver MRI concerning \ntherapy response evaluation. \nMethods and Materials:  20 patients with HCC underwent contrast-enhanced \ncomputed tomography (CT) and gadobutrol MRI on the day before and Gd-\nEOB-DTPA MRI directly before Y90 therapy. Follow-up images were \nperformed 30, 90 and 180 days after therapy. Two radiologists reviewed the \ngadobutrol and Gd-EOB-DTPA enhanced liver MR images in consensus. They \nrated therapy response using a 4-point-scale: 1=definitely response, \n2=probably response, 3=probably no response, 4=definitely no response. CT in \ncombination with laboratory parameters served as reference standard. \nResults: CT and laboratory parameters revealed progress in 5 patients after \n30, 3 patients after 90 and 7 patients after 180 days. With Gd-EOB-DTPA MRI \nradiologists were more determinate compared to gadobutrol-MRI (mean values \nday 30 for responders with Gd-EOB-DTPA=1.4; gadobutrol=1.9). In one patient \neach on day 90 and 180 radiologists rated gadobutrol-MRI as probable \nresponse while Gd-EOB-DTPA MRI revealed definite progress which was \nconfirmed by Alpha- fetoprotein levels. \nConclusion: Gd-EOB-DTPA MRI allows for a more precise assessment of \ntumour response after Y90 therapy. The liver specific contrast agent enabled \nearlier diagnosis of tumour progress compared to gadobutrol MR and also to \nCT and can differentiate between therapy-induced changes and real tumour \nprogress.  \nB-0904 11:06  \nUse of high-relaxivity paramagnetic complex Mn-DCTA as contrast agent \nfor simultaneous MR-coronarography and contrast-enhanced MRI of the \nheart  \nW.Y. Ussov, A.A. Bogunetsky, V.E. Babokin, M.L. Belyanin, S.G. Goltsov, \nV.D. Filimonov; Tomsk/RU (wolfussov@yandex.ru)  \nPurpose: The complex of manganese with trans-1, 2-diaminocyclohexane- N, \nN, N', N'-tetraacetate (Mn-DCTA, ™Cyclomang) was tested as possible \ncontrast agent for simultaneous MR-coronarography and ECG-gated contrast-\nenhanced MRI of myocardium. \nMethods and Materials:  21 patients with three-vessel coronary heart disease \ncomprised the study group and seven persons with normal coronary arteries \nand minor left ventricle hypertrophy due to arterial hypertension were recruited \nto control one. ECG- and breath-synchronised ssfp-coronarography has been \ncarried out in everybody for thr right coronary (RCA), left anterior descendent \n(LAD) and left circumflex (LCx) coronary arteries. Also the CE-MRI of the heart \nwas performed in everybody. In all patients, the diagnosis was verified with \ncoronaroventriculography. \nResults: The R1 relaxivity of Mn (II)-DCTA measured in saline as high as \nR1=3.68 mM-1*s-1 did not differ significantly from the values obtained with \ngadopentetate. The senisitivity of Mn-DCTA enhanced MR-coronarography \nwas, respectively, as high as: RCA 87%, LAD 92% and LCx89%. The \nspecificity was for the particular coronary arteries as follows: RCA 81%, LAD \n86% and Lcx82%. The subsequent CE-MRI of the heart detected the areas of \nnon-transmural ischaemic myocardial damage for all walls of LV with \nequivalent 98% sensitivity and 96% specificity . Both sensitivity and specificity \nin transmural infarctions were 98.8%. \nConclusion: The non-gadolinium paramagnetic agent Mn-DCTA could be \nsuggested as acceptable contrast for complex \"one-stop-shop\" MRI evaluation \nof both coronary vessels and myocardial ischaemic damage, without risk of \ngadolinium toxicity.  \n \nS331  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0905 11:15  \nCan Ferumoxytol be used as a contrast agent to differentiate between \nacute and chronic inflammatory kidney disease? Feasibility study in a rat \nmodel  \nJ. Budjan, S. Neudecker, D. Schock-Kusch, N. Gretz, S.O. Schönberg, \nH.J. Michaely, S. Haneder; Mannheim/DE (johannes.budjan@umm.de)  \nPurpose: Ferumoxytol, an intravenous iron supplement, can be used as a \ncontrast agent in magnetic resonance imaging (MRI). Aim of this study was to \nassess Ferumoxytol in animal models of acute and chronic inflammatory \nkidney diseases. \nMethods and Materials:  A total of 18 rats were examined: 6 healthy Sprague \nDawley rats as a control group; 6 rats with polycystic kidney disease (PKD) as \na model for chronic inflammatory disease; Thy-1, a antibody that triggers \nglomerulonephritis was injected in 6 rats as a model for acute inflammation. \nEach rat was examined using a clinical 3 T scanner (Magnetom Trio, Siemens) \nand a dedicated rat coil (Rapid Biomedical) directly before and 24 hours after \nintravenous administration of Ferumoxytol. Changes in relative T2 signal \nintensity and T2*-times were measured. The rats' kidneys were histologically \nexamined. \nResults: In the evaluation of the MRI scans, stati stically significant differences \nbetween the three groups were found: Thy-1 rats showed the highest T2 signal \nloss in the renal cortex (T2 signal intensity ratio after/before: Thy1 0.49, PKD \n0.87, control 0.81; p=0.038). Thy1 and PKD rats showed statistically significant \nchanges of T2*-times compared to the control group (T2*-time ratio \nafter/before: Thy1 0.21, PKD 0.19, Control 0.28; p=0.002). MRI findings were \nconfirmed by histological analyses: stati stically significant differences in \nFerumoxytol particle count between the three groups were found. \nConclusion: Ferumoxytol-enhanced MRI allows detecting acute and chronic \ninflammatory kidney disease with typi cal patterns of Ferumoxytol distribution. \nFerumoxytol thus might help to differentiate between different types of \ninflammation in various kidney diseases.  \nB-0906 11:24  \nSolid phase peptide synthesis (SPPS) combined with the inverse Diels-\nAlder reaction: a versatile tool for novel theranostic applications  \nD. Komljenovic, M. Wiessler, R. Pipkorn, W. Waldeck, R. Bangert, \nW. Semmler, K. Braun; Heidelberg/DE (d.komljenovic@dkfz-heidelberg.de)  \nPurpose: Development of novel diagnostic approaches in imaging of \nmolecular processes at the transcription level and synthesis of \npharmacologically active patient-specific metabolic components requires high \nstandards of safety, quality, and specifi city but also, rapid, efficient and \nirreversible ligation routes. Here, we assessed the applicability of the inverse \nDiels-Alder ligation reaction with inverse electron demand (DARinv) for \nimproved synthesis of novel diagnostic and therapeutic agents. \nMethods and Materials:  We synthesized using SPPS a fluorescent dye \nconjugate composed of a cell-penetrating peptide (CPP) facilitating the \npassage across the cell membrane by \"Click chemistry\" ligation of the CPP \ncarrier and the fluorescent cargo component similar to Cy5. DU-145 and PC-3 \ncells were incubated for 15 minutes with the conjugate (12.5 \u0001M final \nconcentration), co-stained with DAPI and wheat germ agglutinin (WGA) and \ninvestigated using CLSM for the detection of fluorescence signals. \nResults: After incubation with the Cy5-labelled conjugate, both PC-3 and DU-\n145 human prostate cancer cells revealed strong fluorescence signal in the \ncytoplasm and in the perinuclear areas. Specific signals were observed as dot-\nlike areas scattered in particular in the proximity of the cell membrane as \nvisualised by WGA-staining (labeling membrane glycoproteins and glycolipids). \nConclusion: DARinv is an eligible ligation technology not only for prospective \nmedical applications e.g. patient-specifi c approaches, but also for selective \nmodification by functionalization of peptide-based polymers, organic and \ninorganic surfaces and micro arrays. We conclude that ligation technology \nbased on DARinv has a high potential of becoming an important approach for \neasier and faster molecular diagnostics and patient-specific therapy.  \nB-0907 11:33  \nMagnetic particle imaging (MPI): kinetics of the intravascular signal in \nvivo  \nR.L. Duschka, J. Haegele, M. Graeser, K. Luedtke-Buzug, C. Schaecke, \nN. Panagiotopoulos, T.M. Buzug, J. Barkhausen, F.M. Vogt; \nLübeck/DE (robert.duschka@uksh.de)  \nPurpose: In magnetic particle imaging (MPI) image quality is determined by \nthe properties of the used superparamagnetic iron oxide nanoparticles \n(SPIOs); thus, a long blood half-life of the SPIOs is desirable. The aim of this \nstudy is to evaluate the blood half-life of the Resovist-induced MPI-signal. \nMethods and Materials:  A dilution of Resovist (50 \u0001mol/kg) was administered \ninto the ear artery of ten fully anaesthetised New Zealand white rabbits. Blood \nsamples were drawn before and directly, 5, 10, 15 min and then every 15 min \nafter Resovist administration. Every blood sample was evaluated using \nmagnetic particle spectroscopy. The decay of the MPI signal was calculated for \neach time point. \nResults: The highest spectral MPI signal was measured directly after \nResovist® administration (1.79*10^-8 Am^2 Hz^-1). After application of \nResovist the signal decreased to 30.0 % within 5 min and to 14.8 % and 7 % \nwithin 10 and 15 min, respectively. Within 30 min, the measured signal was \nbelow the background noise level. \nConclusion: The decrease of the intravenous signal is faster than the blood \nhalf-life of Resovist determined by MRI. This might be explained by the faster \nblood-clearance of the fraction of larger particles and particle aggregates \ncontributing to the better part of the MPI-signal in comparison to the smaller \nparticles which only contribute a small part of the MPI-signal. Additionally, \nbecause of the higher sensitivity of the MPS-system compared to the current \nMPI-scanners, the visualisation of blood vessels will be possible for an even \nshorter time period.  \nB-0908 11:42  \nComparative in vitro dissociation of gadolinium chelates in human serum \nmeasured by relaxometry  \nN. Fretellier, J.-M. Idee, G. Jestin-Mayer, M. Rasschaert, C. Factor, C. Corot; \nRoissey-Charles-de-Gaule/FR (ideej@guerbet-group.com)  \nPurpose: Assessment of the stability of all marketed categories of gadolinium \nchelates (GC), in human serum at 37 °C. \nMethods and Materials:  GCs gadoterate (Dotarem®), gadopentetate \n(Magnevist®), gadobenate (MultiHance®) and gadodiamide (Omniscan®) (1 \nmM) were incubated in human serum for 15 days, with or without addition of 10 \nmM phosphate, at 37 °C. Relaxation times T\n1 were measured (Minispec mq60 \nBruker relaxometer) at 60 MHz. Relaxation rates R 1 (s -1) were calculated \n(R1=1/T1). The influence of serum proteins on gadodiamide dissociation was \ninvestigated by ultrafiltrating the samples. \nResults: A marked increase in the R 1 relaxation rate value over the time was \nobserved only after incubation of gadodiamide in serum (+49 %/+78% at day \n15 without/with phosphate, versus T0), suggesting a gradual dissociation for \nthis GC. After incubation of gadopentate or gadobenate, a slight increase in R 1 \nvalue was also observed. This increase in R 1 value was greater and faster after \nadjustment of phosphate concentration to 10 mM (+5%/+9% and +9%/+14%, \nwithout/with phosphate, respectively, at day 15). For the macrocyclic GC \ngadoterate, R 1 values remained stable throughout the study, indicating the \nabsence of dissociation. Serum ultrafiltration completely inhibited gadodiamide-\ninduced increase in R\n1 value. \nConclusion: Our data indicate a gradual in vitro dissociation with gadodiamide \nand binding of dissociated and soluble Gd 3+ to serum proteins (an effect \nfacilitated by phosphate anion). The macrocyclic GC gadoterate remained \nstable over 15 days.  \nAuthor Disclosures: \nN. Fretellier: Employee; Guerbet. J. Idee: Employee; Guerbet. G. Jestin-\nMayer: Employee; Guerbet. M. Rasschaert: Employee; Guerbet. C. Factor: \nEmployee; Guerbet. C. Corot: Employee; Guerbet. \nB-0909 11:51  \nTOF MRA versus ultra-low-dose contrast-enhanced MRA at 7T  \nL. Umutlu, A. Fischer, M. Forsting, M. Ladd, S. Maderwald, O. Kraff, \nT.C. Lauenstein; Essen/DE (Lale.Umutlu@uk-essen.de)  \nPurpose: The aim of this trial was to compare the diagnostic ability of non-\nenhanced (TOF) versus ultra-low-dose contrast-enhanced renal MRA at 7 \nTesla. \nMethods and Materials:  10 healthy subjects were examined on a 7T MR \nsystem (Magnetom 7T), utilising a custom-built 8-channel RF body coil. For \nnon-enhanced renal MRA Time-of-flight (TOF) datasets with a voxel size of 1.0 \nx 2.0 x 2.5 mm3 were obtained. For ultra-low-dose contrast-enhanced (ce) \nrenal MRA, dynamic 3D FLASH data sets (voxel size 1.0 x 1.5 x 1.0 mm3) \nwere obtained unenhanced and in arterial phase after the application of \n0.025 mmol/kg BW Gadobutrol (Bayer Healthcare). Image subtraction was \nperformed subsequently. Contrast ratios (CR) were measured in the aorta and \nboth renal arteries in correlation to adjacent psoas major muscle. Qualitative \nanalysis with regard to delineation of the renal arterial vasculature was \nperformed by two radiologists using a five-point-scale (5=excellent to 1= non \ndiagnostic). \nResults: vasculature. Qualitative analysis revealed comparable results of \nvessel conspicuity in subjective ratings for non-enhanced (mean left renal \nartery = 4.4) and subtracted contrast-enhanced datasets (mean left renal artery \n= 4.7). Background suppression in subtracted datasets was superior to \nbackground suppression of TOF-images, reflected in superior contrast ratio \nvalues for subtracted datasets (mean aorta =0.74) compared to TOF-MRA \n(mean aorta = 0.45). \n \n \n \nS332  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nConclusion: Preservation of high-image quality while facilitation of significant \nreduction, or respectively complete omission of contrast agent, may be of high \ndiagnostic value for MR angiographic examinations in patients with renal \nimpairment.  \n14:00 - 15:30 Room A  \nCardiac  \nSS 1803  \nMyocardial perfusion and late \nenhancement: CT  \nModerators:  \nG. Balázs; Budapest/HU  \nE. Mershina; Moscow/RU  \nB-0910 14:00  \nIncremental value of pharmacological stress dual-energy cardiac CT over \ncoronary CT angiography alone for the assessment of coronary artery \ndisease in a high-risk population  \nC. De Cecco, U.J. Schoepf, A.W. Krazinski, A. Bucher, A.D. McQuiston, \nF.G. Meinel; Charleston, SC/US (carlodececco@gmail.com)  \nPurpose: To prospectively determine the value of stress dual-energy CT \n(DECT) myocardial perfusion imaging to coronary CT angiography (cCTA) for \nthe assessment of coronary artery disease (CAD) in a high-risk population. \nMethods and Materials:  We prospectively enrolled 29 consecutive patients \nwho were referred for cardiac SPECT examinations for known or suspected \nCAD to additionally undergo pharmacological stress cardiac DECT. In 25 \npatients cardiac catheterization was available as the reference standard for \nmorphologically signific ant stenosis. The performance of CCTA alone, DECT \nmyocardial perfusion alone and the combination of both was assessed by \ncalculating sensitivity, specificity and area under the curve (AUC) values. \nResults: For morphologically significant ste nosis, cCTA alone and myocardial \nDECT assessment alone had 95% sensiti vity and 50% specificity. The \ncombined approach yielded 100% sensitivi ty at 33% specificity if either was \npositive and 90% sensitivity at 67% specifi city if both were positive. The AUC \nvalue was highest (0.78) if both were positive. For hemodynamically significant \nlesions, cCTA alone had 91% sensitivity at 38% specificity and DECT alone \nhad 95% sensitivity and 75% specificity. The combined approach yielded 100% \nsensitivity at 38% specificity if either was positive and 86% sensitivity at 75% \nspecificity if both were positive. AUC values were highest for DECT alone \n(0.85) and the \"both positive\" evaluation (0.80). \nConclusion: The combined analysis of cCTA and DECT myocardial perfusion \nreduces the number of false positives in a high-risk population for CAD and \noutperforms the purely anatomical test of cCTA alone for the detection of \nmorphologically and hemodynamically significant CAD.  \nB-0911 14:09  \nQuantitative analysis of dynamic CT myocardial perfusion imaging in a \nlarge, multi-center patient population  \nF.G. Meinel\n1, C.N. De Cecco1, F. Bamberg2, U. Ebersberger1, U.J. Schoepf1, \nG.G. Lo3, Y. Wang4, J.A. Maivelett1; 1Charleston, SC/US, 2Munich/DE, \n3Hong Kong/CN, 4Beijing/CN (felix.meinel@med.uni-muenchen.de)  \nPurpose: To determine the accuracy of quantitative measurements of \nmyocardial blood flow (MBF), myocardial blood volume (MBV) and volume \ntransfer constant (K trans) derived from stress dynamic CT myocardial perfusion \n(CTMP) imaging to differentiate between myocardium with and without \nperfusion defects. \nMethods and Materials:  We retrospectively analysed CTMP datasets from \n146 patients from 5 centres who underwent coronary CT angiography (CCTA) \nand CTMP imaging. CCTA datasets were evaluated for the presence of \ncoronary stenosis on a per-vessel basis. In correlation with the CCTA, CTMP \ndatasets were visually evaluated for perfusion defects in each vessel territory. \nFor the quantitative analysis, regions of interest were placed in the \nmyocardium of each vessel territory to obtain MBF, MBV and K\ntrans. \nResults: The areas under the receiver operating characteristic curves (AUCs) \nto discriminate between vessel territori es with and without perfusion were \n0.964 for MBF, 0.967 for MBV and 0.849 for K trans. The optimal cutoffs were \n\u000288 mL/100 mL/min for MBF, \u000215 mL/100 mL for MBV and \u000269 for K trans. \nSensitivity and specificity for myoc ardial perfusion defects were 93% and 98% \nfor MBF and 95% and 91% for MBV, respectively. \nConclusion: MBF and MBV measurements on dynamic CT myocardial \nperfusion imaging can differentiate between myocardial territories with and \nwithout perfusion defects with high discriminatory power.  \nAuthor Disclosures: \nU.J. Schoepf: Consultant; Bayer, Bracco, GE, Medrad, Siemens.  \nB-0912 14:18  \nEvaluation of accuracy for detection and extent of occult myocardial \nscars using delayed-enhancement CT in patients with asymptomatic \ndiabetes: results from the ACCREDIT study  \nJ.-W. Kang\n1, S. Choi2, S. Ko1, T.-H. Lim1; 1Seoul/KR, 2Seongnam-Si/KR \n(joonwon.kang153@gmail.com)  \nPurpose: To evaluate the accuracy of delayed-enhancement CT (DE-CT) for \ndetecting occult myocardial scars (OMS) and to evaluate the transmurality of \nOMS using DE-CT compared with delayed enhancement MRI (DE-MRI) in \nasymptomatic patients with type 2 diabetes. \nMethods and Materials:  DE-MRI and DE-CT were respectively performed \nwith gadoterate meglumine and Iobitridol on 167 patients. Image quality of DE-\nCT was evaluated. The prevalence and the transmurality of OMS on both DE-\nMRI and DE-CT at patient level and segment level were evaluated. The \naccuracy of DE-CT for detecting OMS was evaluated in comparison with DE-\nMRI both at patient and segment level. The transmurality of OMS in DE-CT \nand DE-MRI for each scar was assessed in terms of over- or underestimation \nof DE-CT. \nResults: The image quality of DE-CT was good and adequate in 165 (98.8%) \npatients. The OMS was detected in 12 (7.3%) by DE-MRI and 7 (4.3%) by DE-\nCT. Of the 2788 segments, OMS was detected in 24 segments on DE-MRI and \nin 12 segments on DE-CT. The sensitivity , specificity, positive and negative \npredictive value of DE-CT for detecting OMS was 58.3%, 100%, 100%, and \n96.8% at patient level, and 50%, 100%, 100%, and 99.6% at segment level. \nThe grade for transmurality of OMS between DE-CT and DE-MRI was matched \nat segment level in 41.7%, under-evaluation of transmurality on DE-CT was in \n54.2%. \n \nConclusion: The sensitivity of DE-CT for detecting OMS is moderate, but the \nspecificity is high. Under-evaluation of the transmurality of OMS is common \nusing DE-CT.  \nAuthor Disclosures: \nJ. Kang: Research/Grant Support; Guerbet Group, France. S. Choi: \nResearch/Grant Support; Guerbet Group, France. S. Ko: Research/Grant \nSupport; Guerbet Group, France. T.-H. Lim: Research/Grant Support; Guerbet \nGroup, France. \nB-0913 14:27  \nQuantitative evaluation of novel beam-hardening artefact correction \ntechnique in dual-energy CT perfusion imaging of the myocardium  \nA.M. Bucher1, L.L. Geyer2, U.J. Schoepf1, T.J. Vogl3, J.M. Kerl3, \nA.W. Kazinski1, A.J. Lewis1, F.G. Meinel1, C.D. Wolla1; 1Charleston, SC/US, \n2Munich/DE, 3Frankfurt am Main/DE (ajlewismusc@gmail.com)  \nPurpose: In cardiac dual energy CT (cDECT) perfusion imaging, contrast \nmedium filling of the left ventricle and descending aorta and the spine are \nrelevant sources of beam-hardening artefacts (BHA) impeding diagnostic \nevaluation of myocardial regions for perfusion defects. The purpose of this \nstudy was to quantitatively assess the impact of a novel Kernel (D33f) with \nimplemented beam hardening correction on BHA of the myocardium. \nMethods and Materials:  Rest series of cDECT perfusion examination from 14 \npatients were retrospectively analysed. Six reconstructions were performed for \neach patient with 3.0 mm section thickness: a) 100 kV b) 140 kV c) mixed \nimage, each with (D33f) and without (D30f) BHA correction kernel. 792 \nmyocardial regions of rest studies were compared. Regions of interest (ROI), \ntraced by a reader, equally subdivided the myocardium in the axial slice where \nBHA was most visually prevalent. This individual ROI mask was copied onto all \ncorresponding series. Three subdivisions were made within areas of BHA. \nPaired student t-test was used for statistical evaluation. \nResults: Myocardial attenuation signi ficantly differed on corrected \nreconstructions (D30f 85.1 HU ± 82.9-87.3; D33f 89.2 HU ± 87.0-91.4, \np < 0.001). Relative difference from average myocardial attenuation \nsignificantly differed within visu ally chosen ROIs (D30f 21.9% ± 18.6-25.2%; \nD33f 11.1% ± 9.3-12.8% p <  0.001). RD\nTM difference was greatest for BHA \noccurring in the infero-lateral basal myocardium (D30f 30.7% ± 26.5-34.9%; \nD33f 11.5% ± 8.7-14.3% p < 0.001). \nConclusion: D33f kernel application in post-processing of cDECT perfusion \nstudies can significantly reduce BHAs, improving myocardial perfusion defect \nassessment.  \nAuthor Disclosures: \nU.J. Schoepf: Research/Grant Support; Bayer, GE, Bracco, Medrad, \nSiemens.  \nS333  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0914 14:36  \nCT evaluation of myocardial extracellular volume in patients with chronic \nmyocardial infarction: a novel approach for objective assessment of \nmyocardial viability  \nY. Kurita, K. Kitagawa, T. Ito, N. Nagasawa, H. Nakajima, S. Nakamori, \nM. Ishida, H. Sakuma; Tsu/JP (y-kurita@clin.medic.mie-u.ac.jp)  \nPurpose: Myocardial viability is commonly evaluated by assessing extent of \ndelayed enhancement (DE) which depends on choice of threshold value. CT \nassessment of extracellular volume (ECV) is a new approach towards \nquantitative evaluation of myocardial scar. The purpose of this study was to \ninvestigate if ECV quantified in each myocardial segment could be used for \nobjective assessment of myocardial viability. \nMethods and Materials: Pre-contrast and delayed-phase CT were obtained in \n20 patients with chronic myocardial infarction by using a dual-source CT. \nDelayed-phase CT was reconstructed with a targeted spatial frequency \nfiltration (TSFF) algorithm to obtain stable attenuation of the myocardium. ECV \nwas calculated with the following equation: ECV=( ,HUm / ,HUb)\u0001(1\u0003Hct), \nwhere ,HUm and ,HUb is the change in attenuation of the myocardium and \nthe LV blood, respectively, before and after contrast administration. Extent of \nDE by visual assessment and ECV were determined in each of 16 myocardial \nsegments. \nResults: There was a significant segment-based linear relationship between \nextent of DE and ECV (y=0.20x+27.0, r 2=0.58), with ECV of 27%, 32%, 37% \nand 42% corresponding to DE extent of 0%, 25%, 50% and 75%, respectively. \nROC curve analysis demonstrated AUC of 0.962 for detecting segments with \nDE of > = 50%, with sensitivity of 91% and sp ecificity of 92% with threshold \nECV of 34.5%. High inter-observer reproducibility was found in measuring \nECV, with intraclass correlation coefficient of 0.898. \nConclusion: Accurate and objective assessment of myocardial viability can be \nperformed by using ECV determined by dual-source CT with TSFF algorithm in \npatients with chronic myocardial infarction.  \nAuthor Disclosures: \nH. Sakuma: Research/Grant Support; Siemens Japan, Bayer. \nB-0915 14:45  \nDiagnostic accuracy of late iodine enhancement on cardiac DSCT with \ndenoise filter in the evaluation of myocardial infarction  \nT. Matsuda1, T. Kido1, T. Itoh2, S. Shigemi3, H. Saeki3, K. Watanabe3, \nT. Matsuda3, M. Yamamoto3, T. Mochizuki1; 1Toon/JP, 2Tokyo/JP, \n3Matsuyama/JP  \nPurpose: We evaluated diagnostic accuracy of the late myocardial \nenhancement (LME) on a dual-source CT (DSCT) with both a denoise filter \nand an improved injection protocol (LIE-CT), by comparing with the late \ngadolinium enhancement on MRI (LGE-MR). \nMethods and Materials: In 18 patients with acute myocardial infarction, DSCT \nand 1.5 T MRI were performed within 3 weeks. After the coronary CTA, an \nadditional contrast medium with a slow injection rate (50 ml, 12 ml/min) was \nadded, and then the LIE-CT was performed. To reduce image noise, we \napplied an iterative 3D denoise filter to LIE-CT images. Detectability of LME \nwith LIE-CT and LGE-MR was compared. Infarct area was assessed as \npercentage of the myocardium. The CT value ratios were calculated as \ncontrast enhancement of myocardium divided by that of left ventricular cavity. \nResults: LME was detected in 17/18 patients in LGE-MR and 15/17 patients in \nLIE-CT. LIE-CT areas (mean=9.4%) correlated well with those of LGE-MR \n(mean=10.3%). Mean CT values of normal and infarction areas were \n75.4 ± 12.5 HU and 108.12 ± 19.1 HU, respectively. Mean CT value ratios of \nthe normal and the infarction areas were 0.45 ± 0.16 and 1.09 ± 0.56, \nrespectively. Mean CT value and mean CT value ratio of the infarction areas \nwere significantly higher than those of the normal areas, respectively \n(p < 0.001). \nConclusion: Late myocardial enhancement areas on both DSCT and MRI are \ncorrelated well. DSCT with the denoise filter and the additional slow contrast \nmedium injection protocol can improve the diagnostic accuracy.  \nAuthor Disclosures: \nT. Itoh: Employee; Siemens Japan.  \nB-0916 14:54  \nMyocardial dynamic perfusion imaging with DSCT: a comparative study \nwith magnetic resonance imaging  \nA. Grande, C. Delgado, C. Trinidad, R. Oca, A. Fernandez del Valle, A. Bustos; \nVigo/ES (aletxu86@hotmail.com)  \nPurpose: To evaluate the feasibility of adenosine-stress dynamic myocardial \nvolume perfusion imaging with second generation dual source computed \ntomography (DSCT) for the qualitative and quantitative assessment of \nmyocardial blood flow (MBF) compared with stress perfusion and viability \nmagnetic resonance imaging (MRI). \n \nMethods and Materials:  Prospective study including 13 patients (10 male, 3 \nfemale, mean age 61.2 ± 8.69 years) who underwent stress/rest perfusion and \ndelayed-enhancement MRI, and a cardiac DSCT protocol: 1. Dynamic \nadenosine-stress myocardial perfusion imaging using a \"shuttle\" mode \n2. Coronary CT angiography. 3. Delayed enhancement acquisitions. Two \nindependent observers visually assess ed myocardial perfusion defects and \nquantified perfusion values of segments with and without defects. \nResults: A total of 221 segments were analysed. Sensitivity, specificity, \npositive and negative predi ctive values for detection of myocardial perfusion \ndefects at CT compared with MRI were 63%, 99%, 85%, and 96%, \nrespectively. Quantitative assessment show ed myocardial blood flow values of \n82.4 ± 26.2 ml/100 ml/min and 125.3 ± 43.6 ml/100 ml/min for ischemic and \nnonischemic segments respectively, existi ng significant differences. Mean total \ndose length product for the entire cardiac CT protocol was 9.85 ± 2.5 mSv. \nConclusion: DSCT is able to obtain qualitative and quantitative images of \ndinamic myocardial perfusion. Diagnostic accuracy is acceptable, although with \nlower sensibility values compared with other publications, specially in the study \nof myocardial viability. More studies are needed to set the real diagnostic \naccuracy of this technique.  \nB-0917 15:03  \nEarly myocardial gadolinium enhancement in patients with myocarditis: \nvalidation of \"Lake Louise consensus\" criteria using a single bolus of \n0.1 mmol/Kg of a high relaxivity gadolinium-based contrast agent  \nN. Galea, I. Carbone, G. Cannavale, V. Noce, C. Catalano, M. Francone; \nRome/IT (nicogale2000@yahoo.it)  \nPurpose: Early gadolinium enhancement (EGE) has been indicated as major \nCMR criterion for the diagnosis of myocarditis according to the Lake Louise \nconsensus (LLC). However, the suggested threshold of 4.0 for early \nenhancement ratio (EER) specifically refers to use of conventional Gd-chelates \n(gadopentetate dimeglumine). Our purpose was to evaluate performance of a \nhigh relaxivity contrast agent (gadobenate dimeglumine) for the detection of \nEGE applying the suggested cut-off. \nMethods and Materials:  Fifty-seven consecutive patients with a histologically \nproven diagnosis of acute myocarditis and 18 controls performed a CMR study \non a 1.5 T unit. CMR protocol included: T2w-STIR sequences, early \ngadolinium enhancement (EGE) and late gadolinium enhancement (LGE) \ntechnique after a single bolus of 0.1 mmol/Kg Gd-BOPTA. For each study early \nmyocardial enhancement ratio was calculated as follows: early gadolinium \nenhancement ratio = enhancement myocardium/enhancement skeletal muscle. \nIn patients with evidence for skeletal  muscle involvement, an absolute \nmyocardial enhancement of more than 45% was considered as diagnostic \ncriterion. Receiver operating characteri stic (ROC) curve analysis was applied \non the overall population. \nResults: EGE was present in 35 patients with myocarditis. Applying the EGE \nthreshold proposed by LLC (EER value > 4.0) to the ROC curve, sensitivity and \nspecificity of, respectively, 60.7% and 88.9% (area under curve: 0.722) were \nobserved. These results are comparable to those obtained using \ngadopentetate dimeglumine reported in literature. \nConclusion: Use of Gd-BOPTA provides comparable results to conventional \nGd-chelates regarding the application of EGE suggested thresholds for the \ndiagnosis of acute myocarditis and it is therefore applicable in daily clinical \nroutine.  \nB-0918 15:12  \nComparison between unenhanced and contrast-enhanced post-mortem \nCT for diagnosis of death by cardiovascular events at virtual autopsy  \nJ.C. Apitzsch\n1, S. Westphal2, T. Penzkofer2, R. Knüchel-Clarke2, \nA.H. Mahnken1; 1Marburg/DE, 2Aachen/DE (japitzsch@ukaachen.de)  \nPurpose: To evaluate the value of contrast-enhanced post-mortem CT in \ncomparison to non-enhanced post-mortem CT in the detection of \ncardiovascular causes of death and the clinical value of the method. \nMethods and Materials:  In a prospective study, 21 corpses were examined \nusing multislice computed tomography before and after intraarterial perfusion \ncontrast agent with a CT-value of 300 HU and ventilation of the lungs. CT-\nvalues were measured in the following locations: left ventricle, descending \naorta, common carotid arteries, common iliac arteries and popliteal arteries. \nThe cause of death was determined in enhanced and unenhanced scans and a \nlevel of confidence was given. Results were compared to autopsy results as \ngold standard. \nResults: Intraarterial perfusion resulted in a very homogeneous arterial \ncontrast enhancement with equally 300 HU in every of the mentioned \nlocations. No extravasation due to methodical failures or shunting into the \nvenous system occurred. The method allowed visualisation of different types of \ncause of death. Unenhanced and enhanced scans were compared and the \nresults compared to those of conventional autopsy. There was a significant \nimprovement in LOC in enhanced scans compared to unenhanced scans as \nwell as an improvement in the detection of COD.The ventilation of the lungs \nS334  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\ninflated and distended the thorax, making diagnoses easier. The COD could be \ndetermined in 20 out of 21 patients. \nConclusion: Post-mortem contrast-enhanced CT is feasible and appears to be \nrobust for diagnosing cardiovascular causes of death. When compared with \nunenhanced post-mortem CT intraarterial perfusion and pulmonary ventilation \nsignificantly improve visualisation and diagnostic accuracy.  \nB-0919 15:21  \nDiagnostic accuracy of myocardial perfusion assessment using \ncomputed tomography in comparison to SPECT and ICA: a meta-analysis  \nG. Pelgrim, X. Xie, M.D. Dorrius, A. Handayani, M. Den Dekker, M. Oudkerk, \nR. Vliegenthart; Groningen/NL (gjpelgrim@gmail.com)  \nPurpose: To determine the diagnostic accuracy of perfusion computed \ntomography (CT) in rest and stress for the detection of significant coronary \nartery disease (CAD), using single photon emission computed tomography \n(SPECT) and invasive coronary angiography (ICA) as a reference standard. \nMethods and Materials:  Pubmed, Embase and Web of Knowledge were \nsearched until March, 2013. Two reviewers independently screened 5,110 \nrecords regarding diagnostic accuracy of CT perfusion in rest and stress, \nbased on title and abstract. Two reviewers then assessed the full-text of the \nresulting 390 studies for inclusion and extracted information. True-positive, \ntrue-negative, false-positive and false-negative numbers were extracted for \ndiagnostic performance. The studies were grouped according to CT perfusion \ntechnique and reference method. Patient-based results were pooled using a \nrandom effects model. Statistical analysis required at least 4 studies using \nequal methodology to be included. \nResults: In total, 11 studies (744 participants) of the total 5,110 were included. \nFor rest CT perfusion, 6 out of these 11 studies were pooled (457 participants). \nPooled sensitivity and specificity for ischaemia was 0.87 (0.77, 0.93) and 0.88 \n(0.79, 0.94) compared to rest SPECT. Regarding stress CT perfusion, 5 out of \nthe 11 studies were pooled (287 participants) with ICA as reference standard. \nPooled sensitivity and specificity for stress CT perfusion was 0.86 (0.64, 0.95) \nand 0.90 (0.57, 0.98) compared to ICA. \nConclusion: CT perfusion techniques and reference standards vary in current \nliterature. Based on limited studies, CT perfusion techniques seem sensitive \nand specific for diagnosis of significant CAD compared to ICA and SPECT.  \nB-0920 15:30  \nComparison study of the rest and adenosine stress of myocardial \nbetween CT perfusion and SPECT in CHD  \nS. Ou, S. Li, s. Ou, F. Long, H. Lin; Guangzhou/CN (oushanxing@sina.com)  \nPurpose: The aim of this study was to determine the agreement of adenosine \nstress CTP and SPECT-MPI under rest and stress including every segment \nand vessel in CHD. \nMethods and Materials:  47 patients underwent a nuclear stress test in 3 \nmonths in the study. DECT was performed as follows: 1. stress CT of contrast-\nenhanced scan during adenosine infusion. 2. rest CT of contrast-enhanced \nscan by prospective triggering. Perfusion defect was graded as transmural \n(炪50%) versus nontransmural ( 炩50%). CTPI and SPECT were completed by \n2 independent and 5 years experienced radiologists. \nResults: 47 subjects (average age 61.4+ 10.7 years; An average radiation \ndose of 12.7 mSv of per CTP. CTP had a sensitivity of 78% and a specificity of \n81% for the vessel stenosis of \u000350%, whereas SPECT myocardial perfusion \nimaging had a sensitivity of 66% and a specificity of 83% (P=0.442 in \nsensitivity, P=0.864 in specificity). When stenosis of \u000370% by CTA was used \nas the reference standard,the sensitivity  and specificity were 84% and 68% by \nCTP, but 71% and 73% by SPECT (P=0.564 in sensitivity, P=0.688), \nrespectively. \nConclusion: Adenosine stress CTP can identify the accuracy of stress-\ninduced myocardial perfusion defects compared to SPECT and provide more \ninformation on coronary stenosis in CHD.  \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n14:00 - 15:30 Room B  \nAbdominal Viscera  \nSS 1801a  \nAdvances in CT  \nModerators:  \nS.T. Schindera; Basle/CH  \nJ. Votrubova; Prague/CZ  \nB-0921 14:00  \nSequential contrast-enhanced CT analysis of reduction effect on \nmulticentric type recurrence of HCC with Peretinoin  \nS. Kobayashi, T. Gabata, O. Matsui, W. Koda, T. Minami, K. Kozaka, A. Kitao, \nN. Yoneda, K. Yoshida; Kanazawa/JP  \nPurpose: To evaluate the reduction of multicentric type recurrence (MC \nrecurrence) with Peretinoin, an acyclic retinoid, in patients previously treated \nfor HCC with sequential contrast-enhanced CT (CECT) images. \nMethods and Materials:  After curative resection or ablation for HCC, patients \nreceived either Peretinoin 600 mg/day (the high-dose group, H), 300 mg/day \n(the low-dose group, L) or placebo (P). Total 210 cases showed recurrence of \nHCC (H, 53; L, 80; P, 77) during follow-up period. Among the recurrent \nhypervascular HCCs, nodules which appeared in the point where hypovascular \nhepatic nodules were previously observed and regarded to be multistep \nhepatocarcinogenesis on follow-up sequential CECT images are defined to be \nMC recurrence of HCC. The cumulative MC recurrence free survival (MCRFS) \nrates were calculated. Hazard ratio (HR) was calculated using Cox regression \nanalysis. \nResults: MC recurrence occurred in 43 cases (H n=6; L, n=18; P, n=18). \nMCRFS rates in H were higher than those in P or L (during the first year, H, \n95.8%; L, 93.6%; P, 94.2%: during the 2 years, H, 90.1%; L, 86.0%; P, 81.4%: \nduring the 3 years, H, 90.1%; L, 78.2%; P, 69.5%). No events occurred in H \nafter 2 years of enrollment. The HR (H vs. P) for 3 years \u0002 was 0.41 (95% CI, \n0.16 to 0.93). The HR (L vs. P) for 3 years \u0002 was 0.99 (95% CI, 0.51 to 1.92). \nConclusion: Analysis of sequential CECT could show that Peretinoin \n600 mg/day reduced the MC recurrence of HCC.  \nAuthor Disclosures: \nO. Matsui: Advisory Board; KOWA Company, LTD.  \nB-0922 14:09  \nEffect of reconstruction algorithm on semi-automated quantification of \nliver lesion size and density at MDCT  \nV. Yaghmai, F.D. Gonzalez-Guindalini, A.R. Seyal, K. Parekh; Chicago, IL/US \n(v-yaghmai@northwestern.edu)  \nPurpose: To evaluate the effects of Filtered Back Projection (FBP) and \nSinogram Affirmed Iterative Reconstruction (SAFIRE) on liver lesion size and \ndensity using semi-automated quantification. \nMethods and Materials:  This HIPAA compliant retrospective study was IRB \napproved. Fifteen oncology patients with 30 hypodense liver metastases who \nhad undergone a CT scan of the abdomen and pelvis were evaluated. The \nscans were simultaneously reconstructed using two different algorithms: \nFiltered Back Projection (FBP - Protocol 1) and Sinogram Affirmed Iterative \nReconstruction (SAFIRE - Protocol 2). Lesion largest diameter (RECIST), bi-\ndimensional diameters (WHO) and volume, as well as the whole lesion density \nwere obtained using semi-automated software and were compared. Wilcoxon \nsigned-rank test was used for analysis. P < 0.05 was considered significant. \nResults: Lesion size measurements did not change between different \nreconstruction algorithms. The median largest diameters for protocols 1 and 2 \nwere 2.3 cm (IQR: 1.4) and 2.3 cm (IQR: 1.4) (P=0.55). The bi-dimensional \nmeasurements were 3.9 cm\n2 (IQR: 4.9) and 3.8 cm 2 (IQR: 5) for protocols 1 \nand 2, respectively (P=0.7). Volumetry was also comparable between protocol \n1 and protocol 2 with P=0.9 (3.6 cm\n3 - IQR: 6.7 vs. 3.5 cm 3 - IQR: 6.0, \nrespectively). Lesion density values were similar in both protocols, P=0.47 \n(71.5 HU - IQR: 60 HU vs. 76 HU - IQR: 63 HU). \nConclusion: CT reconstruction algorithm did not affect the semi-automated \nquantification of size and density of liver metastasis.  \nAuthor Disclosures: \nA.R. Seyal: Research/Grant Support; Educational Grant Support from \nSiemens Healthcare. K. Parekh: Research/Grant Support; Educational Grant \nSupport from Siemens Healthcare. \nS335  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0923 14:18  \nAutomatic tube voltage selection and combined SAFIRE reconstruction: \nthe application research in the enhanced abdominal scan  \nR. Zhang, B.J. Gao; Zhengzhou/CN (zhangrui6886@126.com)  \nPurpose: To investigate the value of automatic tube voltage selection (CARE \nkV) and combined with sinogram-affirmed iterative reconstruction (SAFIRE) \ntechnology in improving image quality and reducing radiation dose in the \nabdominal imaging. \nMethods and Materials:  Retrospective analysis,70 patients underwent \ncontrast-enhanced abdominal CT and randomly divided into 2 groups. 35 \npatients were assigned to study group, using the tube voltage of CARE kV, \nreconstructed with FBP (protocol A) and SAFIRE (protocol B), respectively; 35 \npatients were assigned to control group, using the tube voltage of 120 kVp, \nreconstructed with FBP (protocol C). Assess the radiation dose (CTDIvol, DLP, \nED), the mean image noise, contrast-to-noise ratio (CNR) and signal-to-noise \nratio (SNR) relative to muscle for liver, pancreas, kidney, aorta and portal vein \nwith each protocol. A five-point scale was used to evaluate the subjective of \nimage quality. The statistical analysis method includes: paired-sample t test, \nindependent-samples t test and Wilcoxon test. \nResults: ED in the study group and control group is (3.90 ±0.37, 4.93± 0.41) \nmSv, reduced by 20.89%. The subjective rating scores in protocol A/B/C in \narterial and venous phase were (3.65 ±0.08, 3.57±0.08), (4.41±0.10, 4.41±0.10) \nand (3.79 ±0.10, 3.95± 0.11) point (P < 0.001). The image noise of protocol \nA/B/C in dual-phase were (11.96± 0.33, 12.79 ±0.39), (8.45 ±0.26, 9.14± 0.36) \nand (10.38 ±0.26, 11.13 ±0.18) HU (P < 0.001). SNRs and CNRs in protocol B \nwere the highest of three protocols (P < 0.001). No statistically significant \ndifferences between protocol A and C in SNRs and CNRs. \nConclusion: Use of CARE KV technology alone can reduce the radiation dose \nbut increase image noise; the combination use of SAFIRE reconstruction \ntechnique can reduce dose and improve image quality.  \nB-0924 14:27  \nGenerating normal reference values for examinations of the liver using \nacoustic radiation force impulse virtual touch tissue quantification (ARFI-\nVTTQ) elastography and comparison with acoustic radiation force \nimpulse virtual touch imaging and quantification (ARFI-VTIQ) \nelastography: first results of a pilot study  \nT. Graeter, S. Galgenmueller, W. Kratzer, M. Beer, S. Oeztuerk, M. Haenle, \nA. Akinli; Ulm/DE (tilmann.graeter@uniklinik-ulm.de)  \nPurpose: Virtual touch tissue quantificati on (VTTQ) and virtual touch imaging \nand quantification of acoustic radiation force impulse (ARFI) permits \nquantitative measurement of tissue el asticity. Reliable use of these methods \nfor assessing pathological changes in hepatic tissue requires establishment of \nnormal reference ranges for findings returned by ARFI-VTTQ and ARFI-VTIQ \nin the healthy liver. \nMethods and Materials:  After excluding patients with known history of liver \ndisorders, a total of 188 volunteers (57.4%, women; 42.6%, men; mean age, \n31.1±13.0 years) were examined. All patients were examined in the right MCL \ncranially and caudally, and in the right and left liver lobes using the 6C1 (ARFI-\nVTTQ) and 9L4 (ARFI-VTIQ) transducers. ARFI-VTIQ measurements were \nexamined in 15 and 25 mm and ARFI-VTTQ measurements in 5 cm depth. \nResults: ARFI-VTTQ showed a mean value of 1.3 ±0.2 m/s (range=0.9-2.1). \nThe difference in ARFI-VTTQ values between men and women was statistically \nsignificant (p <.0001). Significant correlation of ARFI-VTTQ values with age \nwas observed (p=0.0.0281). ARFI-VTTQ values were not higher in female \nsubjects using oral contraceptive steroids (p=0.8823).There was, however, a \nstatistical significant correlation between ARFI-VTIQ and ARFI-VTTQ values. \nAdditionally, ARFI-VTIQ values for measurements near with liver capsule were \nsignificantly higher than those for measurements of deeper measurement \nregions. \nConclusion: ARFI-VTTQ and ARFI-VTIQ values in healthy hepatic \nparenchyma can be influenced by many factors. Differences between the two \ntransducers used in the present study are related to physical factors. The study \ncould serve as the basis for further studies of measurements in pathologically \naltered hepatic parenchyma.  \nB-0925 14:36  \nHypodense liver lesions in patients with steatosis hepatis: do we profit \nfrom the additional image information of dual-energy computed \ntomography?  \nJ. Nattenmüller, W. Hosch, T.T. Nguyen, L. Grenacher, H.-U. Kauczor, \nC.M. Sommer, W. Stiller; Heidelberg/DE (johannawelzel@gmx.de)  \nPurpose: To assess potential benefits of dual-energy CT (DECT) for imaging \nof hypodense liver lesions in patients with steatosis hepatis with regard to \nobjective image quality (IQ). \nMethods and Materials:  105 patients with steatosis hepatis underwent DECT \n(portal-venous phase) with reconstruction of 4 different datasets: pure iodine \n(PI), optimum contrast (OC), 80 kVp, and 120 kVp-equivalent (linear blended \ndataset: 30% 80 kVp, 70% 140 kVp; M0.3). Objective image quality was \nevaluated by determining image noise (IN) in liver parenchyma, hypodense \nliver lesion, muscle, lesion-to-liver signal-to-noise (SNR) and lesion-to-liver \ncontrast-to-noise (CNR) ratios, and comparing these by one-way-ANOVA / \nDunn's-Multiple comparison test. Intra- and inter-observer agreement (2 \nobservers, each performing 2 independent ROI-measurements) was \ndetermined by Bland-Altman-Analysis. Average effective radiation dose (ERD) \nwas determined. \nResults: 21 patients with hypodense liver lesions were identified. IN for liver \nparenchyma, hypodense lesion, and muscle was lowest in PI (6.7/6.9/7.6 HU) \nfollowed by M0.3 (11.9/12.9/13.6 HU), and OC (16.7/13.5/16.3 HU), highest in \n80 kVp (20.5/22.1/21.9 HU). SNR was highest in PI (1.3), followed by M0.3 \n(0.72), and 80 kVp (0.63), lowest in OC (0.55). CNR was highest in M0.3 \n(4.95), followed by OC (4.55), and 80 kVp (4.1), lowest in PI (3.63). Intra- and \ninter-observer agreement was high for all IQ parameters. ERD was 5.45mSv \n(3.48 - 10.16mSv). \nConclusion: Highest overall objective IQ for depicting hypodense liver lesions \nin patients with steatosis hepatis was found for 120 kVp-equivalent images. \nTherefore, DECT does not seem necessary for these patients despite \nadditional image information offered by  DECT, especially given the potentially \nincreased radiation exposure compared with 'single-energy' CT at 120 kVp.  \nB-0926 14:45  \nDiagnostic performance of liver imaging in patients with suspected \ncolorectal liver metastases: the superiority of MRI  \nA. Schulz, E. Viktil, J.C. Godt, C.K. Johansen, J.B. Dormagen, J.E. Holtedahl, \nK.J. Labori, T. Bach-Gansmo, N.E. Kløw; Oslo/NO \n(anselm.schulz@gmail.com)  \nPurpose: To evaluate the diagnostic performance of preoperative state-of-the-\nart imaging of colorectal liver metastases (CRLM). \nMethods and Materials:  Forty-six consecutive patients scheduled for \nresection of suspected CRLM were evaluated prospectively over a 1.3-years \nperiod (2011 to 2013). None of the patients had undergone previous treatment \nfor their CRLM. Dynamic 40-slice CT (unenhanced, arterial, portal-venous and \ndelayed-phase), low-dose FDG-PET/CT and liver-MRI with T2-weighted single-\nshot, T1-weighted in- and opposed-phase, T2 weighted TSE-SPIR, diffusion-\nweighted and dynamic Gd-EOB-DTPA (Primovist®) enhanced sequences were \nused. Examinations were evaluated by two independent and blinded readers. \nThe reference standard (RS) was histopathological confirmation (77/135 \nCRLM) or a clinical assessment based on follow-up examinations (58/135 \nCRLM). \nResults: RS confirmed 412 lesions including 135 CRLM. On a per lesion \nbasis, sensitivity was 70%, 90% and 63% for CT, MRI and FDG PET/CT, \nrespectively. The corresponding specificity was 94%, 87% and 99%. RS \nconfirmed CRLM in 42 patients and sensiti vity on a per patient basis was 93%, \n100% and 98% for CT, MRI and PET/CT. For CRLM of less than 10 mm in size \nsensitivity was 17%, 68% and 10% for CT, MRI and PET/CT, respectively. \nSpecificity was 96%, 89% and 98%, respectively. \nConclusion: MRI had higher sensitivity especially for CRLM of less than \n10 mm in size but specificity was comparable to CT and FDG-PET. \nDifferentiation of hemangiomas and concurrent mucinous CRLM was \nchallenging on MRI. In cases of remaining uncertainty CT and FDG-PET/CT \ncan improve characterisation of liver lesion particular if above 10 mm in size.  \nB-0927 14:54  \nNormal values of liver and spleen stiffness measurements using shear \nwave elastography (SWE)  \nP.S. Zoumpoulis; Kifissia/GR (p.zoumpoulis@echomed.gr)  \nPurpose: /o determine the normal range of Liver Stiffness (LS) and Spleen \nStiffness (SS) measured by Shear Wave Elastography (SWE) and the cutoff \nlevel between normal liver and CLD. \nMethods and Materials:  89 patients underwent US and Color Doppler of the \nliver, the portal vein, the spleen and SWE of the liver and spleen. Normal group \n(n=48) was defined as men and women 21 to 50 years old with body mass \nindex < 25 and without any clinical evidence of liver disease and normal \nlaboratory and ultrasonographic findings. Comparative groups were non-\ncirrhotic chronic liver disease (NCCLD; n=16) and liver cirrhosis (LC; n=25) \ngroups with various CLD, including viral hepatitis and alcoholic LD. \nResults: In the normal group, mean value of LS was 4.9 ± 1.7 kPa (95% CI, \n4.6-6.6 kPa) and mean SD was 1.7 ± 0.5 kPa (95% CI, 1.5-1.7 kPa). In the \nnormal group the mean spleen stiffness (SS) was 10.4 ± 3.4 kPa (95% CI, 9.1-\n10.4 kPa). In the NCCLD group mean LS were 9.4 ± 4.4 kPa (95% CI, 7.8-9.9 \nkPa) and 18.7 ± 8.9 kPa (95% CI, 15.9-21.7 kPa) in the LC group. SD were \n2.35 ± 1.49 kPa (95% CI, 1.96-2.74 kPa) in NCCLD and 7.37 ± 7.06 kPa (95% \nCI, 4.74-10.01 kPa) in LC. \nS336  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nConclusion: The range of Liver Stiffness in the normal group was 4.6 to 6.6 \nkPa and for Spleen Stiffness was 9.1 to 10.4 kPa. The LS considered as a cut-\noff level differentiated from Chronic Liver Disease was 7.4 kPa.  \nB-0928 15:03  \nPotential dual energy volume scan implemented by 320-section area \ndetector CT (320-deADCT) through lower-dose acquisition imaging \nprotocol applied in liver tri-phase CT application: initial experience in \nTaiwan  \nC.-H.C.K. Liang; Taipei/TW (leehomliang@gmail.com)  \nPurpose: The aim of the study was to decrease radiation dose utilised by 320-\ndeADCT scanner with DE imaging protocol for HCC follow-up cases without \ncompromising image quality and volume accuracy. \nMethods and Materials: 51 hepatocellular carcinoma (HCC) follow-up patients \nimplemented by liver tri-phase examination were collected in this study. The \nfirst phase of 16 cm coverage liver exam was performed using conventional \nhelical scan with 120 kVp, tube current modulation and denoising iterative \nreconstruction (IR) technology for non-contrast enhancement; whilst 16 cm \nlower-dose DE volume scans with 135 kVp/80 kVp switch, mA adjustment and \nIR technology were executed to catch arterial and venous phases. Both \nqualitative and quantitative analyses were done and liver volume accuracy was \nevaluated with liver phantom as well. \nResults: With the 320-deADCT scanner, we can intensify contrast resolution in \nthe hypervascular HCC lesions. 110 kVp enhanced images were chosed for \nquality optimisation in comparison with that of 120 kVp images. The qualitative \nrating of 110 kVp images for arterial (venous) phases is 4.94; SNRs of 110 kVp \nand 120 kVp images for quantitative analysis are 8.2 ±0.6 (7.8± 0.1), 15.0 ±2.5 \n(12.0±2.2), 30.7 ±4.0 (27.1 ±5.2), 12.2 ±1.1 (9.3± 1.3), 7.6 ±2.7 (6.9± 0.9), and -\n19.3±4.7 (-18.0± 3.8) on liver parenchyma, liver lesion, aorta, spleen, muscle \nand subcutaneous fat, respectively. Patients received 1.6mSv mean dose with \nexcellent volume accuracy (p < 0.05) acquired 34.7% radiation dose reduction \ncompared to that in general helical scan (2.5mSv mean dose). \nConclusion: 320- deADCT scanner with lower-dose DE acquisition protocol \ncould generate excellent image quality without compromising diagnostic \npurposes.  \nB-0929 15:12  \nPerformance of integrated adaptive iterative dose reduction 3D into \nautomatic tube current modulation in radiation dose and image noise \nreduction compared with filtered-back projection for 80-kVp liver CT: \nanthropomorphic phantom and patient study  \nC.-M. Chen\n1, M.-Y. Hsu1, Y.-L. Liao2, H.-Y. Tsai3; 1Taipei/TW, 2Hsinchu/TW, \n3 Taoyuan/TW (dr.cmchen@gmail.com)  \nPurpose: Evaluate the radiation dose and image quality of adaptive iterative \ndose reduction 3D (AIDR 3D) integrated into automatic tube current modulation \n(ATCM) compared with filtered-back projection (FBP). \nMethods and Materials:  Two part study consisting of anthropomorphic \nphantom validation and prospective patient evaluation using the same \nacquisition parameters. Sixty-three patients underwent 80-kVp non-contrast \nliver CT with FBP and AIDR 3D acquisitions using the same standard deviation \nof noise level. AIDR 3D images were reconstructed with 'strong' and 'standard' \nsettings. The mean attenuation, image noise , signal-to-noise (SNR) of the left \nand right liver, aorta and psoas muscle were measured and compared. The \neffective diameter (ED) at level of T12 was measured. The size-specific dose \nestimate (SSDE) was calculated from console CTDIvol. \nResults: Initial phantom study validated the radiation and image noise \nreduction potential of AIDR 3D reconstruction. In patients, there was no \nsignificant difference in mean attenuations between FBP and AIDR 3D \nreconstructions. The mean SSDE for AIDR 3D and FBP acquisitions was 13.3 \nand 25.2 mGy, respectively. In patients with ED < 29 cm, there was a 55.3% \nradiation dose reduction compared with FBP, whilst AIDR 3D 'strong' and \n'standard' reconstructions showed a mean noise reduction of 28.5 and 16.2%, \nrespectively. The SNR was significantly higher in AIDR 3D and independent of \nthe patient's ED (p < 0.01). \nConclusion: Integration of AIDR 3D into ATCM allows for significant automatic \nreductions in radiation dose and image noise compared with FBP. AIDR 3D \nacquisitions allows for imaging of larger patient sizes with low-kilovoltage \nacquisitions.  \n \n \n \n \n \n \n \n \n \nB-0930 15:21  \nComparison between CT perfusion and indocyanine green retention test: \ntime to peak values can provide a non-invasive esteem of liver function  \nR. De Robertis, M. D'Onofrio, A. Ruzzenente, G. Puntel, S. Conci, S. Crosara, \nS. Canestrini, A. Guglielmi, R. Pozzi-Mucelli; Verona/IT \n(riccardo.derobertis@hotmail.it)  \nPurpose: To evaluate the use of perfusion CT in the estimation of liver \nfunction, comparing the perfusional data with the indocyanine green retention \ntest results and assessing their correlation with post-hepatectomy liver failure. \nMethods and Materials:  31 patients with hepato-biliary malignancies, \nscheduled for liver resection, have been enrolled. A pre-operative perfusion CT \nand the indocyanine green retention test were performed in the same day and \nthe results were compared using Pearson's correlation test. Perfusion \nparameters were also compared with CT-measured future remnant liver \nvolume \nResults: High correlation was found between the single arterial input time to \npeak values and the ICGR15 and ICG-PDR values (R= 0.789 and -0.790, \nrespectively; p < 0.0001). The comparison between the time to peak values \nobtained by pCT with single portal input analysis and the ICGR15 and ICG-\nPDR values reported even higher correlation (R= 0.832 and - 0.823, \nrespectively; p < 0.0001). In cirrhotic patients arterial TTP, ICGR15 and \nprothrombin Time are significantly higher compared with non-cirrhotic patients \n(p=0.048). Higher levels of arterial TTP, ICGR15 and PT are significantly \nrelated with signs of PHLF (p=0.004, 0.004 and 0.001, respectively). At \nmultivariate analysis arterial TTP, ICGR15 and FRLV are significantly related \nwith incidence of PHLF (HR 2.886, p value 0.024 and HR 0.034, p value 0.023, \nrespectively). \nConclusion: pCT may be an effective method to estimate liver function. Time \nto peak values have shown high correlation with ICGR15 and ICG-PDR values. \nFurther studies are needed to validate these results.  \n14:00 - 15:30 Room C  \nNeuro  \nSS 1811a  \nNovel CT techniques  \nModerators:  \nC. Hoffmann; Tel Hashomer/IL  \nE. Pravatà; Lugano/CH  \nB-0931 14:00  \nUltra-low-dose Sinogram affirmed iterative reconstruction in head CT: \nsatisfactory for repeated surveillance exams in neurosurgical ICU  \nI. Corcuera Solano, L. Tanenbaum, A. Doshi; New York, NY/US \n(icorcuerasolano@gmail.com)  \nPurpose: To assess the image quality of ultra-low-dose (ULDCT) head CT \nreconstructed with sinogram affirmed iterative reconstruction (SAFIRE) versus \nlow-dose (LDCT) SAFIRE and standard-dose (SDCT) examinations \nreconstructed with filtered back projection (FBP), by evaluating examinations of \nthe same patient, and to compare its effect on radiation dose in a neurosurgical \nintensive care unit (NSICU) population. \nMethods and Materials:  A retrospective analysis of 60 head CT acquired \nduring 2012-2013 was performed. We compared ULDCT (n=28, avg CTDIvol \n=15.55 mGy), LDCT (n=12, 36.46 mGy) and SDCT (n=20, 48.38 mGy). SDCT \nexams were performed on a variety of clinical Siemens scanners using FBP \nreconstruction technique. All LDCT and ULDCT exams utilised a commercially \navailable iterative reconstruction (IR) technique - SAFIRE at a setting of 3 on a \nSiemens AS+ 128 scanner. These studies were evaluated for image quality, \nnoise and radiation dose. \nResults: With ULDCT-SAFIRE, a 68% reduction of the CTDIvol of head CT \nexams was seen compared to routine SDCT-FBP (79% below ACR \nguidelines), while maintaining comparable quality and similar noise levels. \nLDCT-SAFIRE offers a higher image quality compared to SDCT-FBP with no \ndifferences in noise. When compared to LDCT, ULDCT had significantly higher \nimage noise and lower, yet still satisfactory, qualitative measures of image \nquality. \nConclusion: ULDCT-SAFIRE allows a substantially lower dose, while \nmaintaining quality sufficient for repeated surveillance head studies of NSICU \npatients. ULDCT-SAFIRE studies were satisfactory, comparing favourably to \nSDCT-FBP. Implementation of SAFIRE for CT scans performed on NSICU \npatients leads to a 68% reduction of radiation while maintaining image quality.  \n \n \n \nS337  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0932 14:09  \nKnowledge-based iterative reconstruction technique allows for extreme \nlow dose for cerebral and carotid CT angiography studies  \nF. Zhang, L. Yang; Beijing/CN (fanzradiology@126.com)  \nPurpose: To evaluate the potential of substantially reduced dose for cerebral \nand carotid CT angiography studies by using a new knowledge-based iterative \nreconstruction technique (IMR, Philips Healthcare) without any adverse impact \non accuracy. \nMethods and Materials:  Cerebral and carotid CT angiography scans were \nacquired using a 256-slice MSCT (Brilliance iCT, Philips Healthcare) on 60 \npatients with normal body mass index (BMI, 20-25 kg/m 2) who were randomly \nassigned into 2 groups (group A and group B). The scan protocols for different \ngroups were drawn up as follows (table in uploaded image).The mean image \nnoise and CNR of different groups were measured on CT images and \ncompared using the paired-t test. In addition, image quality evaluation was \nperformed by two radiologists who were blinded to scan protocol, using a five-\npoint confidence scale (1 [poor] to 5 [excellent]).The results of the two groups \nwere compared with the Mann-Whitney U-test. \nResults: There was no difference in mean image noise, CNR and image \nquality between group A and B (p > 0.05). By using knowledge-based IMR \nreconstruction technique, the low dose protocol for group B was feasible with \nno significant loss in image quality or any negative effect on diagnosis \nconfidence. Compared to group A, group B reduced radiation dose by 71% and \nthe iodine volume by 27%. \nConclusion: Knowledge-based iterative reconstruction technique allows for \nboth low radiation and contrast medium doses for cerebral and carotid CT \nangiography.  \nB-0933 14:18  \nBrain CT perfusion: effective dose reduction by using hybrid iterative \nreconstruction and different low-dose protocols  \nA. Vishnevskaia, E. Kondratyev, N. Tarbaeva, G.G. Karmazanovsky; \nMoscow/RU (Vishnevskaia.radiolog@yandex.ru)  \nPurpose: To evaluate the effect of hybrid iterative reconstruction on qualitative \nand quantitative parameters of low-dose 256-MDCT perfusion imaging. \nMethods and Materials:  30 consecutive patients were enrolled in the study. \nCT perfusion in first group (n=10) was examined under 80 kv 150 mAs, second \ngroup (n=10) - 80 kv 100 mAs, and 80 kv 50 mAs in third group. CT images in \nfirst group were reconstructed only with the filtered back projection (FBP). CT \ndata in second and third groups were reconstructed both with FBP and three \nlevels of hybrid iterative reconstruction algorithms (iDose1, 3, 5). We compared \nquantitative and qualitative parameters of images among the three groups. \nQuantitative blood flow perfusion parameters were compared between four \nreconstructions in second and in third groups. \nResults: Effective dose was 4.7 ±0.07mSv in first group, 3.08 ±0.07mSv in \nsecond group and 1.5 ±0.07mSv in third group; differences were significant \n(p < 0.05). Image noise using FBP was 3.1 ±0.49 in first group, 4.64 ±0.6 in \nsecond group and 7.1± 0.88 (p < 0.05) in third group. Overall CT perfusion \nmaps quality decreased using second and third low-dose protocols in \ncombination with FBP. The quality of images increased significantly (p < 0.05) \nwhen applying hybrid iterative reconstruction. In all studies there was no \nsignificant difference in selected quantitative parameters between acquired \ndata after FBP and iDose1, 3, 5 reconstructions (p > 0.05). \nConclusion: Low-dose CT perfusion using hybrid iterative reconstruction may \nprovide sufficient image quality and allows for significant reduction of radiation \ndose to the patient.  \nB-0934 14:27  \nIterative reconstruction: Improvement of image quality for dynamic CT \nbrain perfusion imaging  \nH. Einhellig, H. Poppert, E.J. Rummeny, A. Huber; \nMunich/DE (heike.einhellig@gmx.de)  \nPurpose: Impact quantification of iterative reconstruction (iDose) on image \nnoise, SNR and CNR of brain matter and investigation of radiation dose \nsavings by evaluation of stability of rCBV in iMTT. \nMethods and Materials:  CTP was obtained in 27 patients using a 256- slice \nCT. Images were reconstructed with filtered backprojection (FBP) and five \ndifferent levels of IR (LD 1- LD 5). Noise, CNR (cortex vs. white matter), SNR \nand rCBV in iMTT were determined. \nResults: Noise was reduced from 5.7 ± 0.1 (FBP) to 3.8 ± 0.2 (LD 5) for grey \ncortex and from 6.4 ± 0.0 (FBP) to 4.0 ± 0.1 (LD 5) for white matter. SNR \nimproved from 6.7 ± 3.3 (FBP) to 10.3 ± 0.6 (LD 5) for grey cortex as well as \nfor white matter from 4.0 ± 12.3 (FBP) to 6.5 ± 3.3 (LD 5). CNR increased from \n2.2 ± 0.1 (FBP) to 3.5 ± 0.1 (LD 5) for grey matter vs. white matter. The \nparameter rCBV in iMTT were varying only slightly with a mean rCBV 4.1 ± 0.1 \nand a mean relation rCBV/nCBV 0.27 ± 0.02 for all IR- levels. \nConclusion: Iterative recontruction can improve SNR and CNR by noise \nreduction of about 33%. Iterative reconstruction may save radiation dose in \nbrain perfusion imaging. Moreover, the use of different IR-levels of iDose (LD \n1-5) does not effect the CT brain perfusion parameters rCBV and MTT as two \ndistinct PCT parameters which differ the penumbra and the infarct core in the \nsummary maps.  \nB-0935 14:36  \nHead CT: adaptive statistical iterative reconstruction protocol- the same \nimage quality and lower radiation dose comparing to filtered back \nprojection (FBP) protocol  \nM. Guzi\u001bski, L. Waszczuk, A. Czarnecka, T. Kra !nicki, M. S\u0017siadek; \nWroclaw/PL (guziol@wp.pl)  \nPurpose: To compare dose radiation and image quality (SNR, CNR) of head \nCT examinations of the same patients obtained with different protocols: \nAdaptive Statistical Iterative Reconstruction (ASIR) and Filtered Back \nProjection (FBP) using two 64 MDCT scanners. \nMethods and Materials:  Head CT studies of 55 consecutive patients (29 \nfemales/26 males, mean age 60 yrs) were examined twice for medical \nindications (trauma), using two different  64 MDCT scanners. Initial examination \nwas performed using FBP reconstruction. In the follow-up examination of the \nsame patient ASIR protocol was used. Scan parameters were held constant \nregarding tube voltage (120 kV), sequential scanning (2.5 mm/5 mm). ASIR \nwas performed at 40% level. CT dose index volume (CTDvol) were recorded \nand compared. Two blind radiologists reviewed all CT examinations assessing \nimage noise (SNR), contrast (CNR) and diagnostic acceptability. \nResults: Comparison of head CT using FBP and ASIR scanners showed very \nsignificant differences (p < 0.001) in average effective dose (1.72 ±0.07 and \n1.38±0.12 [mSv], respectively). There was no significant difference in image \nquality between two types of reconstructions. SNR for white matter was 7.3 for \nFBP and 8.7 for ASIR (P=0.1) and for grey matter 9.7 vs. 11.6 (p=0.6) \nrespectively. Contrast between white and grey matter was 0.8 and 1.2 (p=0.1), \nrespectively. The overall diagnostic score was 2.6 vs. 2.7 (in 3-point scale). \nConclusion: Head CT using ASIR protocol effectively reduces exposure \ndosage by about 25% without sacrifying image quality. Contrast between white \nand grey matter is on the equal level in FBP and ASIR group.  \nB-0936 14:45  \nA reduced contrast volume acquisition regimen based on cardiovascular \ndynamics reduces radiation dose during carotid MDCT angiography  \nC. Saade, M. Hourani; Beirut/LB (charbel.saade@aub.edu.lb)  \nPurpose: To investigate the dose length product (DLP) during carotid \ncomputed tomography angiography (CCTA) using a patient-specific contrast \nformula. \nMethods and Materials:  CCTA was performed in 202 patients with stroke like \nsymptoms using a 64-channel computed tomography scanner and a dual-\nbarrel contrast injector. Patients were subjected in equal numbers to one of two \nacquisition/contrast regimens. Patient age an d gender were equally distributed \nacross both groups. Regimen A, the department's standard protocol, consisted \nof a caudocranial scan direction with 100 mL of contrast, intravenously injected \nat a flow rate of 4.5 mL/s; Regimen B, involved a craniocaudal scan direction \nand a novel contrast formula based on patient cardiovascular dynamics. Each \nscan acquisition comprised of 120 kVp, 300 mA with modulation, temporal \nresolution 0.4 sec and pitch 0.981:1. The DLP was measured between each \nregimen and data generated were compared using Mann-Whitney U non-\nparametric statistics. \nResults: The mean contrast volume was significantly lower in regimen B \n(53 ± 10 mL) compared to A (100 ± 1 mL) (p < 0.001). There was no significant \ndifference in mean scan time in regimen B (4.22 ± 1.2 sec) compared to A \n(4.01 ± 1.3 sec) with equal distribution in scan range between each regimen (A: \n29.2 + 3.01 cm and B: 28.9 + 4.03 cm). Mean DLP demonstrated significant \nreduction in regimen B (3.09+0.22 mSv) compared to A (4.74+0.22 mSv)(p = \n0.02). \nConclusion: Significant reduction in radiation dose during CCTA can be \nachieved using low contrast volume based on patient specific contrast formula.  \nB-0937 14:54  \nPatient-specific contrast protocol based on cardiovascular dynamics \nreduces radiation dose during intra-cranial MDCT angiography  \nC. Saade, M. Hourani; Beirut/LB (charbel.saade@aub.edu.lb)  \nPurpose: To investigate the dose length product (DLP) during intra-cranial \ncomputed tomography angiography (ICTA) using a patient-specific contrast \nformula. \nMethods and Materials:  ICTA was performed in 80 patients with stroke-like \nsymptoms using a 64-channel computed tomography scanner. Patients were \nsubjected in equal numbers to one of two contrast regimens. Regimen A, the \ndepartment's standard protocol, consisted of a craniocaudal scan direction with \nS338  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n80 mL of contrast, intravenously injected at a flow rate of 4.5 mL/s; Regimen B, \ninvolved a novel contrast formula based on patient cardiovascular dynamics. \nEach scan acquisition comprised of 120 kVp, 300 mA with modulation, \ntemporal resolution 0.4 seconds and pitch 0.981:1. The DLP was measured \nbetween each regimen and data generated were compared using Mann-\nWhitney U non-parametric statistics. \nResults: Mean vessel attenuation in the segments of the circle of Willis was up \nto 39% (p < 0.02) greater in regimen B compared to A. In the venous system, \nattenuation was significantly lower in regimen B compared to A with a \nmaximum reduction of up to 86% (p < 0.001). The mean contrast volume was \nsignificantly lower in regimen B (53 ±10 mL) compared to A \n(80±1 mL)(p < 0.001). There was no significant difference in mean scan time in \nregimen B (4.22 ±1.2 sec) compared to A (4.01 ±1.3 sec) with equal distribution \nin scan range between each regimen (A: 29.2 ±3.01 cm and B: 28.9 ±4.03 cm). \nMean DLP demonstrated significant reduction in regimen B (3.99 ±0.22 mSv) \ncompared to A (4.74±0.22 mSv) (p = 0.02). \nConclusion: Significant reduction in radiation dose during ICTA can be \nachieved using low-contrast volume based on patient-specific contrast formula.  \nB-0938 15:03  \nBoth contrast medium dose and injection rate reduction in carotid-\ncerebral angiography with 256-slice MSCT: feasibility study of a new \ninjection protocol for improving patient safety  \nF. Zhang, L. Yang; Beijing/CN (fanzradiology@126.com)  \nPurpose: To evaluate the potential of substantially reduce dose for cerebral \nand carotid CT angiography studies by using a new low-dose protocol without \nany adverse impact on accuracy. \nMethods and Materials:  CT carotid-cerebral angiography scans were \nacquired using a 256-slice MSCT (Brilliance iCT, Philips Healthcare) for 60 \natherosclerosis suspected patients with normal BMI (20-25 kg/m2) who were \nrandomly assigned into 2 groups (30 patients each). Patients in group A \nreceived 60 ml iodine contrast medium (370 mgI/ml) with an injection rate of \n4.5 ml/s by using bolus tracking, while patients of group B received 30 ml \ncontrast medium (370 mgI/ml) with an injection rate of 3.0 ml/s also by using \nbolus tracking. The scan protocol for both groups was 120 kV, 250 mAs and all \nimages were reconstructed using an IR technique (iDose4, Philips Healthcare). \nMean carotid-cerebral arterial CT numbers and CNRs of two groups were \nmeasured. In addition, each group was blindly evaluated by two radiologists for \nimage quality (rated on a 5-points confidence scale (1 [poor] to 5 \n[excellent]).Statistical analysis was performed using paired-t test. \nResults: Compared to group A, group B reduced the iodine delivery rate by \n33.5% from 1.67 gI/s to 1.11 gI/s and the total iodine volume by 50% from \n22.2 gI to 11.1 gI. There was no significant difference in mean carotid-cerebral \narterial CT numbers, CNRs and image quality between two groups (p > 0.05)). \nConclusion: By using 256-slice MSCT and an iterative reconstruction \ntechnique, a low-iodine contrast protocol for carotid-cerebral CTA can reduce \nboth contrast medium dose and injection rate without any negative impact on \naccuracy.  \nB-0939 15:12  \nCo-registration of transcranial ultrasound and CT-angiography: a \nmethodological study in cerebrovascular disease  \nA. Nygård, S. Rosenbaum, J. Nielsen, C. Ovesen, A. Christensen, \nH. Christensen; Copenhagen/DK (achr0019@regionh.dk)  \nPurpose: Multimodal imaging is used increasingly in acute cerebrovascular \ndisease. A previously obtained CT dataset can guide a real time transcranial \nduplex (TCD) dataset if a mutual focus point determines interpretation of \nmovement directions represented by scrolling on CT and corresponding \nangulation of the transducer, i.e. identifying the same middle cerebral artery \nbranch. Aim was to evaluate a fast bedside method using a CT dataset as \nguide for serial monitoring of acute stroke patients with transcranial duplex. \nMethods and Materials:  The temporal window centre was chosen as focus \npoint on TDC and subsequently transcribed to the CT modality. Local bone \ndensity and thickness vary and the possibility of repeated identification the \nidentical focus point equals the degree of measurement variation. Bilateral \nmeasurements were obtained in 10 patients 3 times each on 3 different non-\ncontrast cerebral CTs (one observer). A phantom applicable to both computed \ntomography and ultrasound was used to test for software and intermodality \ninduced size distortion. The phantom underwent CT-scan equipped with a \ncasement fixating an ultrasound transducer in one location, which was used \nduring the subsequent ultrasound performed during real-time fusion on a Logic \nE9 GE ultrasound apparatus. Using distance measurements from the surface \nto 5 predefined fix points; variation was considered insignificant below 3 mm. \nResults: Measurement between modalities did not reach or exceed the \ndefined level of significance. Repeated measurements of focus point showed \nno significant variation. \nConclusion: We present a novel technique for monitoring patients in the \nunstable phase of acute stroke.  \nB-0940 15:21  \nOne-step stroke imaging: does an interleaved acquisition of cerebral CT \nperfusion and CTA of the carotids affect CTP values?  \nM.T.H. Oei, R. Manniesing, F.J.A. Meijer, M. Prokop; Nijmegen/NL \n(m.oei@rad.umcn.nl)  \nPurpose: One-step stroke imaging is a CT perfusion (CTP) scan in which one \nvolumetric acquisition is replaced to acquire a carotid CTA using toggling table \ntechnique and a single dose of contrast agent. The purpose of this study is to \ndetermine if missing one acquisition of the CTP influences the CTP values. \nMethods and Materials:  Ten patients with suspicion of ischemic stroke were \nscanned with a clinical CTP head protocol (14 scans every 2s, 5 scans every \n5s) with a total duration of 55s using a 320-row CT scanner. The one-step \nstroke protocol is simulated from the original clinical protocol by deleting one \nacquisition. For every patient, the timepoint of the bolus arrival time (BAT) and \nthe arterial peak (AP) in the middle cerebral artery was determined. One \nacquisition was deleted starting from the BAT up to the fifth time point after AP. \nCorresponding perfusion maps were calculated with bSVD using PMA-ASIST. \nRegions of interests (ROIs) were annotated in normal-appearing grey and \nwhite matter. The percentage errors were calculated per timepoint and patient. \nResults: The absolute mean of the percentage errors across all patients for \neach timepoint in grey matter compared to the original CBF, CBV and MTT is \n3.40%(range 0.10-9.53%), 3.22%(0.00-9.98%) and 3.08%(0.00-13.79%), \nrespectively. Percentage errors > 8.50% occurred for some patients if an \nacquisition was deleted at BAT, 2s-4s after BAT, AP or after the AP. Similar \nresults were found in WM. \nConclusion: A one-step stroke protocol is feasible with only minor effects on \nthe CTP maps if CTA is acquired 2-4s after BAT and before the AP.  \nAuthor Disclosures: \nR. Manniesing: Grant Recipient; Toshiba Medical Systems Corporation, \nJapan. M. Prokop: Grant Recipient; Toshiba Medical Systems Corporation, \nJapan, Philips Medical Systems. Speaker; Bracco, Toshiba Medical Systems \nCorporation, Bayer-Schering, CME Science, Philips Medical Systems. \n14:00 - 15:30 Room D  \nChest  \nSS 1804  \nLung structure and function  \nModerators:  \nP.A. Grenier; Paris/FR  \nN. Sverzellati; Parma/IT  \nB-0941 14:00  \nSize and collapsibility of emphysema holes on CT of COPD: evaluation \nwith a new method  \nS.Y. Oh, J.B. Seo, S. Lee, N. Kim, M. Lee; Seoul/KR (ojangsa@gmail.com)  \nPurpose: Although the extent of LAA at CT of COPD is known to correlate with \nloss of lung function, the size and collapsibility of emphysema holes were \nrarely investigated. The purpose of this study is to assess the size and \ncollapsibility of emphysema clusters with a new method and to correlate it with \npulmonary functional test (PFT). \nMethods and Materials: Volumetric, inspiration and expiratory CT scans in 60 \nCOPD patients were selected. After extracting the area of LAA using the \nthreshold of -950 HU, a new method of size classification of LAA, which is \nrepeated application of multiple low-pass filter with various size of Gaussian \nkernel, was used. Emphysema clusters were divided into four groups; \nE1< 1.5 mm, 1.5 mm \u0002E2< 7 mm, 7 mm \u0002E3< 15 mm, 15 mm \u0002E4. The \ndifference in distribution of each group between inspiration and expiration CT \nwas assessed. The results were compared with PFT with Pearson correlation. \nResults: The mean extents of LAA, E1, E2, E3, and E4 were 27.2%, 3.9%, \n6.8%, 12.9%, 3.5% on inspiration CT, 16.5%, 1.66%, 7.8%, 4.2%, 2.9% on \nexpiratory CT, respectively. Among the four clusters, E3 showed larger decline \non expiratory CT than other clusters. Both E2 and E3 were significantly \ncorrelated with FEV1 (r=-0.449 and -0.423, respectively). \nConclusion: Emphysema clusters of sublobular size were most collapsible. \nEmphysema of acinar and sublobular size contribute most to the FEV1 decline. \nThis study shows that in addition to the extent of LAA, the size of emphysema \nclusters at CT of COPD should be also considered in relation to the loss of \nlung function.  \n \nS339  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0942 14:09  \nCT-quantified airway wall thickness and emphysema: association with \nlung function decline and development of airflow limitation  \nF.A.A. Mohamed Hoesein1, M. Schmidt2, B. van Ginneken3, J.-W.J. Lammers1, \nH.J. de Koning4, M. Oudkerk5, D.S. Postma5, P.A. de Jong1; 1Utrecht/NL, \n2Bremen/DE, 3Nijmegen/NL, 4Rotterdam/NL, 5Groningen/NL \n(fmohamedhoesein@gmail.com)  \nPurpose: Structural pulmonary changes like airway wall thickness and \nemphysema contribute to airflow limitation. It is unknown whether emphysema \nand airway wall thickness quantified on computed tomography (CT) \nindependently associate with lung function decline and development of airflow \nlimitation. \nMethods and Materials:  Male former and current smokers without and with \nairflow limitation participating in a lung cancer screening study were included \nand underwent baseline and follow-up spirometry and chest CT scanning. \nAirway wall thickness and emphysema were quantified automatically and \nexpressed as the square root of wall area for a theoretical airway with 10 mm \nlumen perimeter (Pi10) and the 15\nth percentile method (Perc15), respectively. \nResults: 2,021 subjects were included. Median (interquartile range) of \nfollow-up was 3.0 (2.9-3.1) years. At univariate analyses Pi10 and Perc15 \ncorrelated with baseline FEV1, r=-0.49 and 0.11, respectively (p < 0.001). \nMultiple linear regression analysis showed that Pi10 and Perc15 were \nindependently associated with a lower FEV1 after follow-up (p < 0.05). For \neach standard deviation increase in Pi10 and standard deviation decrease in \nPerc15, FEV1 decreased with additional 20 mL and 30.2 mL, respectively. The \nadjusted odds ratio's for developing airflow limitation were 1.26 and 2.44, \nrespectively. \nConclusion: A greater degree of airway wall thickness and emphysema on CT \nindependently associate with a lower FEV1 and with development of airflow \nlimitation after three-year of follow-up.  \nB-0943 14:18  \nComparative assessment of T1 imaging, oxygen-enhanced MRI and first-\npass perfusion MRI in chronic obstructive pulmonary disease at 1.5 Tesla  \nB.J. Jobst, S. Triphan, O. Sedlaczek, A. Anjorin, H.-U. Kauczor, J. Biederer, \nS. Ley, J. Ley-Zaporozhan, M.O. Wielpütz; Heidelberg/DE  \nPurpose: COPD phenotype and severity are insufficiently assessed by lung \nfunction testing alone. Therefore, alternative endpoints for interventional trials \nare pivotal. Lung T1 is known to depend on lung tissue and blood volume. It \nwas the aim of this study to validate MRI-based T1 mapping and oxygen-\nenhanced MRI (OE-MRI) against first-pass perfusion MRI in COPD patients \napplying a user-friendly standardised assessment method. \nMethods and Materials:  20 COPD patients (GOLD I-IV) underwent MRI, \ncomprising of a coronal 2-dimensio nal inversion recovery snapshot flash \nsequence (8 slices/lung) at room-air and after supplementing pure oxygen, as \nwell as first-pass contrast-enhanced perfusion imaging with high-temporal \nresolution (1.5s/lung) at roomair. The spatial extent of T1 shortening at roomair \n(,T1RA), reduction of oxygen-induced T1 shortening ( ,T1O2) and perfusion \ndeficits of the upper, middle and lower zone of both lungs was reported by 2 \nchest radiologists in consensus, using a semi-quantitative 3-point scale for \neach item. \nResults: In a zone-based approach ,T1RA correlated positively with the \nextent of perfusion deficits (r=0.81; p < 0.001). ,T1O2 also correlated \npositively with perfusi on deficits (r=0.80; p < 0.001) and ,T1RA (r=0.80; \np < 0.001). Interestingly, in mild COPD ,T1O2 was normal in 16/39 lung zones \nwith perfusion deficits. In a per-patient approach perfusion deficits (r=0.52; \np < 0.05), ,T1RA (r=0.45; p < 0.05), and ,T1O2 (r=0.52; p < 0.05) positively \ncorrelated with GOLD stage. \nConclusion: T1 mapping and OE-MRI demonstrated a good agreement with \nperfusion MRI and GOLD stage and provide complementary information about \npathologic changes in COPD. In particular, OE-MRI contributes to the \ndifferentiation of hypoxic vasoconstriction and genuine perfusion impairment.  \nB-0944 14:27  \nAnatomical detail of single breath-hold, high resolution ultra-fast 3D \nbalanced SSFP MRI of the chest in comparison to low-dose CT  \nT. Heye, G. Sommer, J. Bremerich, O. Bieri; Basle/CH (tobias.heye@web.de)  \nPurpose: To evaluate anatomical detail and image quality of a novel three-\ndimensional balanced steady state free precession (bSSFP) MRI sequence in \ncomparison to low-dose CT. \nMethods and Materials:  In this IRB approved study 16 male patients (mean \nage 64 yrs). underwent same day chest imaging on a 1.5 T MRI (Avanto, \nSiemens Healthcare) and a 64-slice MDCT scanner (Definition Flash, Siemens \nHealthcare). MR acquisition was performed in a single breathhold ( < 25sec) \nwith 1.8 mm isotropic spatial resolution. Depiction of detail by ultra-fast bSSFP \nwas evaluated by two experienced readers independently who assessed the \nnumber of branching points for 6 pre-defined pulmonary arteries. The distance \nbetween the most peripheral visible segments to the pleural surface was \nmeasured for each vessel and at 6 locations on 50 mm coronal maximum \nintensity projections (MIP). Image quality and sharpness was rated on a 5-point \nscale (5=best score). Similar measurements on CT data served as reference \nstandard. \nResults: Ultra-fast bSSFP identified 72.0% of branching points detected by CT \n(1077/1496). The mean distance, distal segments to pleura, on thin slices was \n13.3 ± 4.3 mm versus 9.0 ± 3.3 mm (ultra-fast bSSFP versus CT; p < 0.001 t-\ntest) and 8.9 ± 4.1 mm versus 4.8 ± 2.7 mm respectively on MIP \nreconstructions (p < 0.001 t-test). Mean image quality and sharpness were \neach rated as 4 (range 3-5). \nConclusion: Ultra-fast SSFP of the chest offers high resolution imaging in a \nsingle breath-hold with adequate image quality and sharpness allowing for \nvisualisation of anatomical details comprising peripheral pulmonary vessels \nless than 15 mm to the pleural surface.  \nB-0945 14:36  \nRegional obstruction in cystic fibrosis: correlation of electric impedance \ntomography (EIT) and high-resolution-CT (HRCT) findings  \nU.G. Mueller-Lisse1, Z. Zhao1, I. Frerichs2, R. Fischer1, M.F. Reiser1, \nK. Moeller3; 1Munich/DE, 2Kiel/DE, \n3Villingen-Schwenningen/DE (ullrich.mueller-lisse@med.uni-muenchen.de)  \nPurpose: Electric impedance tomography (EIT) provides both global and \nregional information on airway obstruction in patients with cystic fibrosis (CF). \nWe correlated obstruction in CF patients as measured by EIT with high-\nresolution-computed-tomography (HRCT) findings based on the Brody-scoring \nsystem. \nMethods and Materials:  HRCT images (120 KVp, 35 mA, 64x0.5 mm, \nreformatting slice thickness, 1.0-1.5 mm and 3 mm, Brilliance CT64, Philips-\nMedical-Systems, Hamburg, Germany) of 5 selected CF patients (2 male, 3 \nfemale; age 38± 11 years; height 165 ±8 cm; weight 56 ±8 kg; mean ±SD) \ncovering EIT-electrode positions ±5 cm were evaluated by means of a weighted \nBrody-score, which considers bronchiectasis, mucous plugging, peribronchial \nthickening, parenchymal opacity and hy perinflation. Two-dimensional EIT \nmeasurements were performed at the level of the fifth intercostal space (EIT \nEvaluation KIT 2, Dräger Medical, Lübeck, Germany) on the same patients \nwithin 2 months of HRCT, during standard pulmonary function tests as \nrecommended by the American-Thoracic-Society and European-Respiratory-\nSociety guidelines. Ratios of maximum-expiratory-flow at 25% and 75% of vital \ncapacity ( MEF\n25/MEF75) were calculated for different lung regions in EIT \nimages. After normality testing (Lilliefors test), linear regression (significance \nlevel, p < 0.05) was performed to assess the correlation between MEF25/MEF75 \nvalues and weighted Brody-scores. \nResults: Regional airway obstruction identified in MEF25/MEF75 maps matched \nHRCT findings. Median values of MEF25/MEF75 and weighted Brody-Score \nwere highly correlated (r2=0.83, P < 0.05). \nConclusion: In CF patients, severity of regional airway obstruction, as \nmeasured by means of EIT, correlates with severity of morphologic lung \nlesions, as measured in HRCT images by means of weighted Brody scores.  \nB-0946 14:45  \nKrypton ventilation imaging with dual-energy CT: correlation with \npulmonary function tests in patients with chronic obstructive pulmonary \ndisease (COPD)  \nF. Molinari, S. Badr, N. Tacelli, J.-B. Faivre, B. Wallaert, M. Remy-Jardin; \nLille/FR (martine.remy@chru-lille.fr)  \nPurpose: To correlate krypton ventilation CT with pulmonary function tests \n(PFT) in COPD patients. \nMethods and Materials:  31 patients underwent dual-source, dual-energy \nchest CT after inhalation of a mixture of 80% krypton and 20% oxygen, with \nreconstruction of morphologic and krypto n-ventilation images with calculation \nof: (a) the total lung volume enhanced by krypton; and (b) the mean density of \nvoxels with krypton. All patients were assessed with routine PFTs, including \nmeasurements of bronchial obstruction (FEV1; FVC; FEV1/FVC ratio), lung \ndistension (RV; FRC; TLC), and destruction (DLco). \nResults: Correlations were found between: (a) pulmonary volume enhanced \nby krypton (6161 ±1385 mL) and indexes of lung distension (TLC: r=0.78, \np < 0.0001; FRC: r=0.57, p < 0.01); and (b) mean density of krypton \n(7.5±2.3 HU) and indexes of bronchial obstruction (FEV1: r=0.71, p < 0.0001; \nFVC: r=0.66, p < 0.0001; FEV1/FVC: r=0.54, p < 0.01) and lung destruction \n(DLco: r=0.62, p < 0.01). The difference in TLC, measured by body \nplethysmography versus the helium dilution method, inversely correlated with \nthe mean density of krypton on ventilation maps (r=-0.55, p=0.0029). The \nmean density of krypton within voxels on the krypton-ventilation maps \ndecreased from GOLD stage 1 to GOLD stage 4 (GOLD 1: 9.4 ±1.8 HU, GOLD \n2: 8.1±0.5, GOLD 3: 7.6 ±2.4, GOLD 4: 5.8± 1.6) and was significantly different \nbetween GOLD stages 1 and 2 (n=11) vs. GOLD stages 3 and 4 (n=17) \n(8.2±2.3 HU vs. 6.3±1.7 HU; p=0.016). \nS340  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nConclusion: Krypton ventilation imaging on dual-energy CT correlates with \nfunctional parameters of bronchial obstruction, lung distention, and destruction, \nand provides significantly different results according to the GOLD stages.  \nB-0947 14:54  \nValue of density mapping in computed tomography for detection of \nbronchiolitis obliterans syndrome (BOS)  \nS. Dettmer, O. Solyanik, T. Kaireit, C. de Wall, F. Wacker, H.-o. Shin; \nHannover/DE (sabine-dettmer@t-online.de)  \nPurpose: To prospectively evaluate the diagnostic value of density mapping \nfor detection of bronchiolitis obliterans syndrome (BOS) following lung \ntransplantation. \nMethods and Materials:  386 CT examinations were performed in lung \ntransplant patients in inspiration/expiration (64 row MDCT, 120 kVp, rotation \ntime 0.8s, pitch 0.984, collimation 1.25 mm, reconstruction increment 1 mm). \n44/342 examinations were performed in patients with/without BOS. Following \nautomatic lung segmentation and non-rigid registration of inspiration to \nexpiration, a point-to-point mapping of the HU values in inspiration and \nexpiration was performed. A scatter plot was used to depict the frequency \ndistribution of the point-to-point mapping (density mapping). This was \ncharacterised by the following location scales: the x value and y value of the \nmedian, the distances of the median to the origin/bisecting line and the first \nprincipal component (PCA). \nResults: Scatter plots of HU values of the re gistered inspiration and expiration \nshowed significant differences in patients with/without BOS. A shift to lower \ndensity values and a convergence to the bisecting line could be observed in \npatients with developing BOS. Evaluated measures of the frequency \ndistribution in the density mappings we re significantly different in patients \nwith/without BOS for the y value of the median (p < 0.001, mean: -768 HU/-\n712 HU), the distance of the median to the origin (p < 0.001), the distance of \nthe median to the bisecting line (p < 0.001) and PCA (p=0.030). The x value of \nthe median (p=0.859) was not significant. \nConclusion: Density mappings were significantly different in patients \nwith/without BOS and might be used as an imaging biomarker for the detection \nof BOS.  \nB-0948 15:03  \nVoxel-to-voxel analysis of inspiration-expiration CT datasets for detection \nof pathologic air trapping in lung transplant patients: comparison to the \nthreshold-based method in expiration  \nO. Solyanik\n1, S. Dettmer2, T. Kaireit2, C. de Wall2, F. Wacker2, H.-o. Shin2; \n1Moscow/RU, 2Hanover/DE  \nPurpose: To determine whether voxel-to-voxel analysis of inspiration-\nexpiration CT datasets is more precise in detection of pathologic air trapping \n(pAT) in lung transplantat patients than the threshold-based method in \nexpiration. \nMethods and Materials:  144 lung transplant recipients underwent paired \ninspiratory-expiratory CT and PFTs six months after lung transplantation. Two \nmethods based on voxel-to-voxel mapping of inspiration-expiration CT \ndatasets (density mapping (DM) and parametric response map (PRM)) were \ncompared to the threshold-based method in expiration (EXP). Attenuation \nranges for EXP and DM were optimised by systematic variation and correlation \nwith the ratio of residual volume to total lung capacity (RV/TLC) by Spearman \nrank correlation tests. For PRM published data was used. Correlations of CT \nmethods with RV/TLC were evaluated by Spearman rank correlation test. AT \nwas considered pathologic if RV/TLC was beyond the 95\nth percentile of the \npredicted values. The detection of pAT was assessed by comparing the areas \nunder the receiver operating characteristic curves (AUC) of quantitative CT \nmeasures. \nResults: According to RV/TLC pAT was present in 34 patients. DM and PRM \ncorrelated significantly better with RV/TLC than Exp \n-790 to -950 HU  (DM r =0.66, \nPRM r=0.65 EXP r=0.52; p < 0.01). AUC of PRM and DM were significantly \nlarger than by EXP (PRM: AUC 0.79, 95 % CI 0.704-0.876; DM: 0.78, 95% CI \n0.691-0.865; Exp -790 to -950 HU: 0.708, 95% CI 0.608-0.808). \nConclusion: DM and PRM showed better correlation with RV/TLC than the \nthreshold-based method and were more precise in detection of pAT in lung \ntransplantat patients.  \nB-0949 15:12  \nEarly cystic fibrosis lung disease: monitoring changes in structure and \nperfusion and response to therapy with MRI  \nM.O. Wielpütz, M. Puderbach, A. Kopp-Schneider, M. Stahl, E. Fritzsching, \nJ. Biederer, H.-U. Kauczor, M. Eichinger, M.A. Mall; \nHeidelberg/DE (mark.wielpuetz@me.com)  \nPurpose: Recent studies demonstrating early structural lung damage in infants \nand preschool children with cystic fibrosis (CF) suggest that non-invasive \nmonitoring will be important to identify patients who may benefit from early \ntherapeutic intervention. For older CF patients, previous studies demonstrated \nthat magnetic resonance imaging (MRI) detects structural and functional \nabnormalities in the lungs without radiation exposure. Therefore, our aim was \nto evaluate the potential of MRI to detect abnormal lung structure and \nperfusion in infants and young children with CF, and to monitor response to \ntherapy for pulmonary exacerbation. \nMethods and Materials:  MRI studies were performed in 50 children with CF \n(age 3.1± 2.1years, range 0-6years) in stable clinical condition (n=40) or \npulmonary exacerbation before and after antibiotic treatment (n=10), and in 14 \nnon-CF controls (age 2.1 ±1.8years). T1-weighted sequences before and after \nintravenous contrast, T2-weighted sequences and first-pass perfusion imaging \nwere acquired, and assessed using a dedicated morpho-functional score. \nResults: MRI demonstrated bronchial wall-thickening/bronchiectasis, mucus \nplugging and perfusion deficits from the first year of life in most stable CF \npatients (global score 10.0± 4.0), but not in non-CF controls (score 0.0 ±0.0; \nP < 0.001). In patients with exacerbations, the global score was significantly \nincreased to 18.0 ±2.0 (P < 0.001), and was restored to 12.0 ±3.0 (P < 0.05) \nafter antibiotic therapy. \nConclusion: MRI detected abnormalities in lung structure and perfusion, and \nresponse to therapy for exacerbations in infants and preschool children with \nCF. These results support the development of MRI for non-invasive monitoring \nand as an endpoint in interventional trials for early CF lung disease.  \nB-0950 15:21  \nIs bronchial imaging affected by temporal resolution? Comparative \nevaluation at 140 and 75 ms in 90 patients  \nN. Tacelli, A. Hutt, T. Santangelo, C.-F. Murphy, M. Remy-Jardin, J. Remy; \nLille/FR (martine.remy@chru-lille.fr)  \nPurpose: To evaluate the influence of temporal resolution (TR) on cardiac \nmotion artifacts at the level of bronchial walls. \nMethods and Materials:  90 patients (mean age: 50.2 yr, mean heart rate: \n81.2 bpm) underwent a noncontrast CT examination with dual-source, single-\nenergy (collimation: 32x2x0.6 mm; rotation time: 0.28 s). Two series of images \nwere reconstructed using data from both tubes on a prototype workstation with \na TR of 75 ms (i.e., optimised TR) (Group 1) and 140 ms (i.e., standard TR) \n(Group 2). Two radiologists independently analysed the presence and severity \nof cardiogenic artifacts at the level of 8 target bronchi (total number of bronchi \nexamined: n=720). \nResults: Cardiogenic artifacts were significantly less frequent and less severe \nin Group 1 than in Group 2 (p < 0.0001) with the highest scores of discordant \nratings for bronchi in close contact wi th cardiac cavities: RB5 (61/90; 68%); \nLB5 (66/90; 73%); LB7 (63/90; 70%) (p < 0.0001). In Group 1, 78% (560/720) \nof bronchi showed no cardiac motion artifacts whereas 22% of bronchi \n(160/720) showed artifacts, rated as mild (152/160; 95%), moderate (7/160; \n4%) and marked (1/160; 1%). In Group 2, 30% of bronchi (217/720) showed no \ncardiac motion artifacts whereas 70% of bronchi (503/720) showed artifacts, \nrated as mild (410/503; 82%), moderate (82/503; 16%) and severe (11/503; \n2%). Intraobserver agreement for cardiac motion assessment was excellent \n(reader 1: kappa=0.85 [95CI: 0.73-0.96]; reader 2: kappa=0.88 [95CI: 0.76-\n0.99]); the interobserver agreement was good (kappa=0.61 [95IC: 0.43-0.80]). \nConclusion: At 75 ms, most bronchi can be depicted without cardiogenic \nartifacts.  \n14:00 - 15:30 Board Room B  \nPaediatric  \nSS 1812  \nRadiation reduction in paediatric imaging  \nModerators:  \nR.A.J. Nievelstein; Utrecht/NL  \nS. Stafrace; Aberdeen/UK  \nB-0951 14:00  \n\u0003-H2 AX foci as effect biomarker for CT radiation exposure in paediatric \npatients: an individualised approach to estimate radiation risks  \nC. Vandevoorde1, C. Franck1, K. Bacher1, C. Ernst2, L. Breysem3, P. Smeets1, \nK. Van De Moortele4, A. De Backer1, H. Thierens1; 1Ghent/BE, 2Brussels/BE, \n3Leuven/BE, 4Bruges/BE (charlot.vandevoorde@ugent.be)  \nPurpose: To evaluate biological effects and estimate cancer risks from \npaediatric CT, the 3-H2 AX foci assay was used as biomarker for radiation-\ninduced double strand breaks in combination with patient-specific Monte Carlo \ndose simulation. \nMethods and Materials:  51 paediatric patients (mean age, 4.5 years) were \nincluded. Patients underwent CT abdomen (10) or CT chest (41) in five Belgian \nradiology departments using state-of-the-art CT instrumentation and protocols. \nBlood samples were taken before and after the CT procedure and 3-H2 AX foci \nS341  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nwere determined in peripheral blood T-lymphocytes. Patient-specific organ and \ntissue doses were calculated using ImpactMC 1.3.1 Monte Carlo software. \nBlood doses were calculated as a weighted sum of doses to lungs, heart, liver \nand remainder. Patient individualised esti mations of lifetime attributable risks \n(LAR) for cancer mortality were determined according to the BEIR VII risk \nmodels. \nResults: An average increase of 0.173 foci/cell was observed, despite the low \nCT doses (mean DLP chest 35.2 mGycm). Differences in observed 3 -H2 AX \nfoci scores reflected the differences in dose levels between radiology centers. \nPlotting the induced 3-H2 AX foci data versus the calculated blood doses, \nindicated a low-dose hypersensitivity. LA R of cancer mortality according to the \nLNT-model for paediatric chest CT or CT abdomen was 0.1 and 0.2 ‰. \nIncluding the 3-H2 AX foci data, the LAR is 8-10 times higher. \nConclusion: Even when low dose equipment and specific protocols are used \nCT X-rays induce DNA-damage in children. The present study emphasises the \nneed for justification and dose optimisation in paediatric radiology.  \nB-0952 14:09  \nOptimising the balance between radiation dose and image quality in \npaediatric head CT: findings before and after intensive radiological staff \ntraining  \nL. Faggioni, F. Paolicchi, L. Bastiani, S. Molinaro, M. Puglioli, D. Caramella, \nC. Bartolozzi; Pisa/IT (lfaggioni@sirm.org)  \nPurpose: To assess radiation dose and image quality of paediatric head CT \nexaminations before and after radiological staff training. \nMethods and Materials:  215 contrast-unenhanced head CT examinations \nwere performed in outpatients aged between 1 month and 14 years old before \nand after intensive training of staff radiologists and technologists to \noptimisation of CT technique. Patients were divided in three age groups (0-4, \n5-9, and 10-14 years old), and pre- and post-training CT dose index (CTDI), \ndose-length product (DLP), tube voltage (kV), and tube current per rotation \n(mAs) values were retrieved from our hospital PACS. Pre- and post-training \ngrey matter conspicuity and contrast-to-noise ratio were calculated, and \nsubjective image quality in terms of artefacts, grey/white matter differentiation, \nnoise, visualisation of posterior fossa structures, and need for repeat CT \nexamination was visually evaluated by three neuroradiologists. \nResults: Median post-training CTDI and DLP values were significantly lower \nafter than before training in all age groups (27 mGy and 338 mGy \u0002cm vs \n107 mGy and 1444 mGy \u0002cm in the 0-4 years old group, 41 mGy and \n483 mGy\u0002cm vs 68 mGy and 976 mGy \u0002cm in the 5-9 years old group, and \n51 mGy and 679 mGy \u0002cm vs 107 mGy and 1480 mGy \u0002cm in the 10-14 years \nold group, respectively; p < 0.001). Post-training kV and mAs settings were \nsignificantly lower compared to pre-training levels (p < 0.001). Subjective post-\ntraining image quality was not inferior to pre-training levels for all items except \nfor noise (p < 0.05), which however was never diagnostically unacceptable. \nConclusion: Radiological staff training can be effective in reducing radiation \ndose while preserving diagnostic quality of paediatric head CT examinations.  \nB-0953 14:18  \nEuropean guidelines on paediatric chest x-rays: is our dedicated \npaediatric division able to fulfil the standards quantitatively and \nqualitatively?  \nS. Tschauner, M. Gübitz, R. Marterer, S. Weissensteiner, E. Sorantin; Graz/AT \n(sebastian.tschauner@medunigraz.at)  \nPurpose: As paediatric patients are more susceptible to radiation, correct \ncollimation in chest X-rays helps to reduce unnecessary exposure. European \nguidelines from 1996 define a minimal field size from \"just above the lung \napices\" to \"T12/L1\" plus tolerances of 2 cm. This study's aim was to check our \ndivision's performance in the qualitative standards and measure overexposures \nquantitatively. \nMethods and Materials:  A total number of 307 unprocessed digital chest \nimages, acquired in June and July 2013, were selected for analysis. 14 studies \nwere excluded because of patient age greater than 18 years. The remaining \n293 included patients had mean age of 6.28 years (SD 4.88, 0 to 17.87 years). \n58% were boys, 42% girls. Overexposed areas plus amount of tissue on all \nfour sides were measured: Image analyses were done with a self-developed \nImageJ (open source image processing program) macro script. \nResults: Examined patients' chest films showed a mean areal overexposure of \n51.58% (SD 14.04%, range 15.99% to 107.88%) and the overexposed areas \nincluded 70.33% (SD 10.31%) tissue on average. Areal overexposure was \nfound to decrease significantly with age. \nOnly 1% (3 out of 293) of our images fulfilled all quantitative and qualitative \nparameters of the European guidelines. \nConclusion: In our samples we found a mean unnecessary overexposure by \nmore than half. As only a small minority of our division's chest films met all \nEuropean Commission criteria, constant and recurrent quality assurance is \nnecessary. On the other hand the mentioned guidelines may potentially be too \nstrict in some situations.  \nB-0954 14:27  \nDiagnostic reference ranges: a new quality improvement tool in \npaediatric CT of the abdomen  \nM.J. Goske\n1, K.J. Strauss1, L. Coombs2, A. Towbin1, D. Larson1, M. Callahan3, \nK. Darge4, D. Frush5; 1Cincinnati, OH/US, 2Reston, VA/US, 3Boston, MA/US, \n4Philadelphia, PA/US, 5Durham, NC/US (keith.strauss@cchmc.org)  \nPurpose: To develop diagnostic reference ranges (DRR) to be used as a \nquality improvement tool for individual  practices to compare their size-specific \ndose estimates (SSDE) for 5 body widths (BW) with SSDE ranges from six \nchildren's hospitals. \nMethods and Materials:  A multicenter retrospective study was performed. CT \ndoses from September 1 to December 1, 2009 in 939 paediatric patients and \n954 scans were reviewed through the American College of Radiology Dose \nIndex Registry. SSDE were measured at the level of the splenic vein in \ntransverse diameter. An appropriate dose range for each of 5 BW was \ndeveloped by reviewing image quality on a subset of CT scans and compared \nto a 5 point reference scale created with the addition of simulated quantum \nmottle. \nResults: For 954 scans, DRR (SSDE mGy) were 5.8-12.0, 7.3-12.2, 7.6-13.4, \n9.8-16.4, 13.1-19.0 mGy for BW less than 15, 15-19, 20-24, 25-29, and 30 cm \nor greater. \nConclusion: DRR developed by a consortium of 6 children's hospitals \n(QUIRCC) address the balance between a patient's risk (radiation dose) and \nbenefit (diagnostic image quality) and may be used by a local facility to \ncompare their practice to the QUIRCC ranges for the purpose of quality \nimprovement. Goske MJ et al. Radiology 2013; 268:208-218.  \nAuthor Disclosures: \nD. Larson: Patent Holder; Guidance. D. Frush: Consultant; GE. \nB-0955 14:36  \nOptimisation of image reconstruction method with sinogram affirmed \niterative reconstruction in pediatric CT: chest, abdomen and head  \nK. Lee, J. Park; Seoul/KR (beall34@naver.com)  \nPurpose: To evaluate the image quality and clinical efficacy of pediatric CT \nusing a recently available sinogram affirmed iterative reconstruction (SAFIRE) \ncompared with filtered back-projection (FBP). \nMethods and Materials:  From january to march 2013, 82 of pediatric CT \nexaminations were retrospectively divided into three groups which are based \non each anatomic region of abdomen, chest and head. each image was \nreconstructed in soft tissue kernel by using standard FBP and 3 strength of \nSAFIRE among 5 different SAFIRE strengths. a phantom study with same \nprotocol was also performed to analyse the relationship of noise reduction \namong 5 different SAFIRE strengths on average. \nResults: Three-strength of SAFIRE can reduce image noise by 23.73% in \nchest (mean, 8.04), and 28.13% in abdomen (mean, 7.58) compared with each \nFBP (each mean, 11.09 and 10.81). on the other hand, noise reduction \nshowed 15.53% in head (mean, 4.98) compared with FBP (mean, 6.30). in \nphantom study, noise reduction patterns were similar to clinical patient's data. \nthe average noise reduction was as follows: 32.99% in chest CT, 27.78% in \nabdomen CT and 18.54% for head CT, respectively. the figure of noise \nreduction with five-strength of SAFIRE in head CT was similar to noise level \nwith three-strength of SAFIRE in chest and abdomen CT. \nConclusion: A choice of the appropriate iterative method is necessary to \nachieve an optimal balance for image quality. when five-strength of SAFIRE is \nutilised in pediatric head CT, the level of noise reduction is similar to three-\nstrength of SAFIRE in pediatric body CT.  \nB-0956 14:45  \nEvaluation of organ-specific dose reduction in paediatric chest computed \ntomography  \nJ. Boos, P. Kröpil, D. Klee, P. Heusch, G. Antoch, R. Lanzman; \nDüsseldorf/DE (Johannes.Boos@med.uni-duesseldorf.de)  \nPurpose: To assess the impact of a novel Organ-Specific Dose Reduction \n(OSDR) algorithm on image quality of pediatric chest computed tomography \n(CT). \nMethods and Materials:  Twenty pediatric patients (8 male, 12 female; mean \nage 12.4 ± 5.6 years (range 3-17 years)) undergoing contrast-enhanced chest \nCT examinations on a 128-row-CT scanner were included. CT scans were \nperformed at 100 kV using automated tube current modulation and a novel \nOSDR algorithm (XCare, Siemens AG, Forchheim, Germany). Nine patients \nhad a previous chest examination performed on a 64-row-CT scanner at \n100 kV without the OSDR algorithm. Subjective image quality was assessed \nusing a five-point-scale (1- not diagnostic; 5- excellent) in all patients. In 9 \nchildren who underwent CT scans with and without OSDR, contrast-to-noise \nratio (CNR) and signal-to-noise ratio (SNR) were determined in the aorta. \nResults: In 20 patients, mean subjective image quality was 4.3 ± 0.7. In 9 \npatients that were also examined without OSDR, subjective image quality was \nS342  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\ncomparable with OSDR (4.4 ± 0.5) and without OSDR (4.4 ± 0.7)(p> 0.05). \nFurthermore, there was no significant difference in mean SNR and CNR of the \naorta with OSDR (31.6 ± 17.1 and 22.3 ± 15.0, respectively) and without OSDR \n(27.4 ± 13.3 and 18.8 ± 12.4, respectively) (p > 0.05). CTDIvol was comparable \nfor acquisitions with OSDR (2.3 ± 0.9 mGy) and without OSDR \n(2.6 ± 1.9 mGy)(p> 0.05). \nConclusion: Organ-specific dose reduction can be recommended for pediatric \nchest CT in order to reduce the radiation exposure to radiosensitive tissues as \nthe breast or thyroid gland  \nAuthor Disclosures: \nG. Antoch: Speaker; Siemens Medical Solutions, Bayer Healthcare, BTG.  \nB-0957 14:54  \nImage quality and reconstruction time of CT angiography with model-\nbased iterative reconstruction in newborns and infants with congenital \nheart disease  \nK. Choo, J. Roh, J. Hwang; Busan/KR (nje4559@naver.com)  \nPurpose: To evaluate image quality and reconstruction time of CT \nangiography (CTA) with model-based iterative reconstruction (MBIR) in \nnewborns and infants with congenital heart disease (CHD) and to compare \nwith filtered back projection (FBP), adaptive statistical iterative reconstruction \n(ASIR) \nMethods and Materials:  Thirty-six consecutive children (age 4.79 ± 3.7 \nmonths, weight 4.79 ± 0.47 kg) with suspected or confirmed CHD underwent \n64 detector MDCT (Discovery 750HD, GE health care) without ECG gating \n(80 kVp, 30-40 mA using tube current modulation).The CT images were \nreconstructed with FBP, ASIR and MBIR. Both objective and subjective image \nquality (4 point scale) were compared according to reconstruction method. In \naddition, each reconstruction time was also reported \nResults: Images from all patients were diagnostic acceptable and total DLP \nwas 0.06 mSv. HU of MBIR was significantly higher than other two \nreconstruction methods in ascending aorta and descending aorta (p < 0.05) \nand image noise of MBIR was significantly lower than other two methods in all \nchamber and great vessels (p < 0.05). On the other hand, each subjective \nimage quality were 3.72 in FBP, 3.89 in ASIR, 3.84 in MBIR, respectively and \nstatistically insignificant (p > 0.05). Each mean reconstruction time was 5.1 \nseconds in FBP, 5.1 seconds in seconds, 15.1 minutes in MBIR, respectively. \nConclusion: CTA with MBIR did not make a difference subjective image \nquality and needed relatively long reconstruction time in the evaluation of CHD, \nalthough image noise of MBIR was significant lower than one of FBP and ASIR  \nB-0958 15:03  \nEffect of tube voltage reduction on radiation dose and image quality in \npaediatric thoracic 256 multidetector computed tomography  \nM. Cellina, B. Tagliaferri, A. Torresin, M. Maddalo, L. Trombetta, G. Oliva; \nMilan/IT (m.cellina@yahoo.it)  \nPurpose: To determine the effect of lowering tube-voltage on radiation dose \nand image quality in chest MDCT in children. \nMethods and Materials:  30 children aged 2-10 years (6.8± 2.2 years), \nweighting 12-30 kg (21.5 ±5.1 kg) underwent 256 chest MDCT. Acquisition \nparameters were: tube-voltage 100 kV; reference current 130 mAs with \nattenuation-based-tube-current-modulation; pitch 3; rotation-time 0.28 s; \ncollimation 3x 0.6 mm; image reconstruction-thickness 3 mm; position-\nincrement 3 mm. A second group of 30 patients with similar characteristics \n(age range: 2-10 years; mean: 6.2 ±2.1 yy; weight range: 12-30 kg; mean: \n20.9±5 kg)underwent chest MDCT with the same parameters, except tube \nvoltage: 80 kV. Image quality, artefacts, diagnostic confidence were evaluated \nfor the 2 groups by 2 radiologists in consensus, blind to kV, using a 5-point-\ngrading-scale (1=unacceptable; 5= perfect). Image noise was calculated by \nplacing a region of interest at ambient  air at the same 3 levels (aortic arch, \ncarina, the first slice in which right diap hgram is visible) measuring the average \nof the standard deviations in HU. Effective doses were calculated using DPL \nmethod with accepted age-dependent-convertion-factors. \nResults: Mean image quality, artefacts and diagnostic confidence were for \ngroup 1 vs group 2: 4.6 ±0.5 vs 4.5±0.6, 4.6±0.4 vs 4.4±0.5; 4.7±0.4 vs 4.5±0.5, \nwithout statistically significant difference (p=0.19, 0.11, 0.14, respectively). \nMean image noise was 12.9± 5 HU for group 1 and 13.4 ±6 for group 2 \n(p=0.22). Mean effective radiation doses in the 2 groups were statistically \ndifferent: 1.4±0.7 mSv vs 0.8±0.2 mSv (p=0.01). \nConclusion: Our findings support the practice of lowering tube-voltage to \n80 kV for paediatric chest MDCT.  \n \nB-0959 15:12  \nDefinition of a scoring system for assessment of skeletal age using MRI \nof hand and wrist in healthy male children  \nS. Battisti\n1, M. Martino1, K. Rodacki2, E. Tomei1, R. Semelka3; 1Rome/IT, \n2Blumenau/BR, 3Chapel Hill, NC/US (aivlim@hotmail.it)  \nPurpose: To evaluate skeletal age determination, using Magnetic Resonance \nImaging (MRI) of hand and wrist by creating a scoring system method. \nMethods and Materials:  96 healthy young male (mean age 14.2 ±3.7; range \n1y 6m to 19y 1m). Two operators (A, B) prior in consensus established a \nprototype of scoring system to establishi ng MRI skeletal age using as basis the \nanner and Whitehouse x-ray method. The scoring system was based on \ndifferent grade of maturity carpal bones (range from 1 to 12 grades). To test \nthe method two operators in double blind assigned a MRI skeletal age. \nCorrelation between chronological age and MRI skeletal age was determined \nby linear regression analysis (R 2). k-Cohen was used to measure inter-\nobservator variability and inter-rater reproducibility. Spearman' correlation \ncoefficient (r) was used to analyse each carpal bone stage development. \nResults: A strong positive linear correlation was obtained between MRI \nskeletal age and chronological age (R 2=0.976, 0.978; A, B respectively)). k-\nCohen test demonstrated a pretty good values (reproducibility=0.6 and \nrepeatability =0.7). The Radius and Ulna showed the strongest correlation with \nthe MRI skeletal age (r=0.96 and 0.963 p= < 0.0001). A good linear correlation \nbetween sum of the scoring system and chronological age was observed \n(R2=0.96). \nConclusion: MRI skeletal age estimation can be potentially used as a clinical \ntool to identify with more details cartilage and bone ossification during skeletal \ndevelopment. A non-invasive method to determinate bone age is clinically \nimportant in children to avoid radiation exposure.  \nB-0960 15:21  \nECG-gated CT angiography in 324 consecutive pediatric patients: \npredictors of radiation dose  \nF.G. Meinel\n1, T. Henzler2, P.A. Park1, U.J. Schoepf1, C.N. De Cecco1, \nA.J. Lewis1, J.V. Spearman1, A.M. Hlavacek1; 1Charleston, SC/US, \n2Mannheim/DE (felix.meinel@med.uni-muenchen.de)  \nPurpose: We aimed to identify the main determinants of radiation exposure \nfrom pediatric ECG-gated CTA. \nMethods and Materials:  Between June 2005 and June 2013, 324 ECG-gated \nCTAs were performed to evaluate pediatric patients with known or suspected \ncardiovascular abnormalities (median age 8.1 years). The effective dose (ED) \nwas calculated from the dose-length product (DLP) using age-specific \ncorrection factors. The patients' age and average heart ratie during the scan, \nthe method of ECG-synchronisation, tube potential (kV) and effective tube \ncurrent (mAs) were analysed in univariate and multivariate regression analysis \nto identify predictors of radiation dose. \nResults: Overall, the median ED was 1.85 mSv (range: 0.07 - 30.7 mSv). \nMedian radiation exposure decreased from 13.38 mSv for patients examined in \nthe years 2005-2007 to 1.25 mSv for patients examined in the years 2011-\n2013 (p < 0.001). Patients scanned using a tube potential of 80 kV (n=259) had \na significantly lower median radiation dose (1.41 mSv, range 0.07-8.64 mSv) \ncompared to patients who were scanned at 100 kV (n=46, median 6.3 mSv, \nrange 1.26-14.83 mSv) or 120 kV (n=19, median 18.63 mSv, range 4.28-30.67 \nmSv, p < 0.001). On multivariate analysis, tube voltage, followed by tube \ncurrent and the method of ECG-synchronisation were the strongest \nindependent predictors of radiation dose. \nConclusion: The radiation exposure from pediatric ECG-gated CTA has \ndecreased dramatically in recent year s. With dedicated pediatric protocols, \nECG-gated CTA can now be routinely performed with very low radiation \nexposure.  \nAuthor Disclosures: \nU.J. Schoepf: Consultant; Bayer, Bracco, GE, Medrad, Siemens. \nResearch/Grant Support; Bayer, Bracco, GE, Medrad, Siemens.  \nS343  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n14:00 - 15:30 Room E1  \nMusculoskeletal  \nSS 1810  \nKnee osteoarthrosis  \nModerators:  \nF.M. Buck; Zurich/CH  \nJ. Labuscagne; Bunbury, WA/AU  \nB-0961 14:00  \nSubchondral bone oedema after matrix-assisted autologous chondrocyte \ntransplantation: MRI evaluation at different follow-up times  \nM. Busacca, D. Capannelli, A. Moio, E. Kon, G. Filardo, U. Albisinni; \nBologna/IT (diana.capannelli@yahoo.it)  \nPurpose: Subchondral bone oedema is a common finding after cartilage \ntreatment but its interpretation is still debated. The aim of this study is to \nanalyse the presence of oedema after matrix-assisted autologous chondrocyte \ntransplantation (MACT) for knee cartil age lesions at different follow-up times \nand its correlation with clinical outcome. \nMethods and Materials:  116 patients (mean age 28.6 ±10.3 yrs) treated with \nMACT underwent 1.5-T MRI. 57 patients were affected by degenerative \ncartilage lesions, 27 traumatic and 32 OCDs (osteochondritis dissecans). MRI \nfollow-up was performed from 1 to 5 years after treatment. A standard \nsequence protocol was optimisated for the study of articular cartilage and \nsubchondral bone. Other than its presence or absence, the subchondral \noedema was evaluated using a 3-level grading considering extension and \nhyper-intensity, and with the WORMS score oedema classification. IKDC \nsubjective score was collected at the time of every MRI. \nResults: Subchondral oedema presents a particular and well-defined trend \nduring the follow-up: it was present in the first period and markedly reduced or \ndisappeared at 2-3 years. Afterwards level of oedema increased again and \nremained steadily present at medium/long-term follow-up. Patellar lesions \npresented significantly lower oedema, whereas OCDs presented an increasing \nlevel of oedema over time. No correlation found between oedema and clinical \noutcome. \nConclusion: Edema after MACT is present during the first phases to 2 years \nof follow-up, and then tends to disappear. Less oedema was found in patella, \nwhereas more oedema was found in OCDs. Interestingly, presence of oedema \nwas not correlated with poorer clinical outcome.  \nB-0962 14:09  \nMeniscal lesions and effusion synovitis assessed by semiquantitative \nMRI strongly predict quantitatively measured cartilage thickness loss \nover 30 months: multicenter osteoarthritis study  \nA. Guermazi\n1, F. Eckstein2, D. Hayashi1, F.W. Roemer1, W. Wirth2, T. Yang1, \nJ. Niu1, L. Sharma3, D. Felson1; 1Boston, MA/US, 2Salzburg/AT, 3Chicago, \nIL/US (ali.guermazi@bmc.org)  \nPurpose: Aims were to examine which pathological MRI and radiographic \nfeatures of knee osteoarthritis (OA) are most predictive of quantitative cartilage \nthickness loss measured by MRI. \nMethods and Materials:  A subcohort of 196 subjects from the MOST \nparticipants had baseline and 30-mo nth knee MRIs, quantitative cartilage \nthickness measurement, and semiquantitative scoring (Whole Organ MRI \nScore) of cartilage, bone marrow, meniscus, effusion-synovitis, and Hoffa-\nsynovitis at both time points. Radiographic joint space narrowing (JSN) was \nassessed at baseline. Knees were classified into progressors (those who lost \ncartilage thickness above thresholds) and non-progressors. MRI predictors \nwere dichotomized into present or absent. Differences in baseline scores of \nipsicompartmental predictor variables were compared between progressors \nand non-progressors by logistic regression. Odds ratios (OR) were calculated \nfor medial (MFTC) and lateral femorotibial compartment (LFTC) cartilage loss. \nWe combined MFTC and LFTC to calculate ORs of ipsicompartmental cartilage \nloss across compartments. \nResults: Of 196 knees (mean age 59.8 ±6.3, BMI 29.5± 4.6), 46 had \nradiographic OA at baseline. Compared to non-progressors (n=149), \nprogressors (n=47) had higher adjusted OR (aOR) for having baseline medial \nmeniscal damage (MD) (aOR 2.4 [95%CI 1.2-5.1]), medial meniscal \nextrusion (ME) (aOR 2.5 [1.2-5.3]) and effusion-synovitis (aOR 3.2 [1.2-8.2]) in \nMFTC. In LFTC, baseline JSN (aOR 7.0 [1.8-27.1]), lateral MD (aOR 8.1 [2.5-\n26.6]) and lateral ME (aOR 4.1 [1.4-12.5]) predicted cartilage loss. In analysis \ncombining MFTC and LFTC, results were similar to LFTC, with baseline \ncompartment specific JSN, MD/ME predicting cartilage loss. \nConclusion: Meniscal damage/extrusion and effusion-synovitis assessed by \nsemiquantitative MRI strongly predict quantitatively measured cartilage \nthickness loss over 30 months.  \nAuthor Disclosures: \nA. Guermazi: Consultant; TissueGene, Merck Serono, Sanofi Aventis. \nShareholder; Boston Imaging Core Lab. F. Eckstein: CEO; Chondrometrics \nGmbH. Consultant; MerckSerono, Abbvie. Owner; Chondrometrics \nGmbH. F.W. Roemer: Consultant; MerckSerono, NIH. Shareholder; Boston \nImaging Core Lab. L. Sharma: Grant Recipient; NIH. D. Felson: Grant \nRecipient; NIH. \nB-0963 14:18  \nKnee pain and inflammation in the infrapatellar fat pad estimated by \nconventional and dynamic contrast-enhanced magnetic resonance \nimaging in obese patients with osteoarthritis: a cross-sectional study  \nC. Ballegaard1, R. Riis1, R. Christensen1, M. Henriksen1, E. Bartels1, \nS. Lohmander2, D. Hunter3, R. Bouert1, M. Boesen1; 1Frederiksberg/DK, \n2Lund/SE, 3Sydney/AU (mikael.boesen@gmail.com)  \nPurpose: To investigate the association between knee pain and signs of \ninflammation in the infrapatellar fat pad (IPFP) in obese patients with knee \nosteoarthritis (KOA). \nMethods and Materials:  In a cross-sectional setting, 3-T conventional \ncontrast-enhanced (CE) magnetic resonance imaging (MRI) and dynamic \ncontrast-enhanced (DCE) MRI of KOA were analysed to quantify the extent of \ninflammation in the IPFP, and correlated to self-reported outcomes on pain, \nsymptoms and quality of life assessed via the Knee injury and Osteoarthritis \nOutcome Score (KOOS). The extent of inflammation in the IPFP was assessed \naccording to MOAKS (MRI Osteoarthritis  Knee Score) using CE-MRI and by \nperfusion variables using DCE-MRI. The perfusion variable, \"Inflammation\", - \nIRE x (N-plateau+N-washout), was chosen as primary perfusion variable in the \nanalysis. \nResults: MRI and clinical data were obtained in 95 patients. The typical patient \nparticipating in this study was a 65-year-old woman with a body mass index of \n32 kg/m\n2. The bivariate association between KOOS pain and the DCE-MRI \nperfusion variable \"Inflammation\" showed a statistically significant correlation \n(r=-0.42, p < 0.0001). Furthermore, a statistical ly significant correlation was \nfound between KOOS pain and MOAKS Hoffa-synovitis (r=-0.21, p=0.046). \nIntraclass correlation coefficients for the perfusion variables ranged from 0.81 \nto 0.99. \nConclusion: Perfusion variables on DCE-MRI reflecting inflammation in the \nIPFP and MOAKS Hoffa-synovitis were related to pain in obese patients with \nKOA. These results suggest that increasing inflammation in the IPFP is \nassociated with increasing pain in KOA and that DCE-MRI is a robust and \nreproducible method to study the impact of inflammation in KOA.  \nAuthor Disclosures: \nD. Hunter: Other; DH has received royalties from DJO. R. Bouert: Other; RB \nhas acted as independent non-paid clinical advisor for Image Analysis Ltd, \nLondon. M. Boesen: Other; MB has acted as independent non-paid clinical \nadvisor for Image Analysis Ltd, London. \nB-0964 14:27  \nDynamic contrast-enhanced MRI in patellofemoral pain syndrome: \nperfusion quantification of patellofemoral joint tissues  \nR.A. van der Heijden, D.H.J. Poot, E.E. Bron, S. Klein, J.A.N. Verhaar, \nS.M.A. Bierma-Zeinstra, M. van Middelkoop, G. Kotek, E.H.G. Oei; \nRotterdam/NL (r.a.vanderheijden@erasmusmc.nl)  \nPurpose: Patellofemoral pain syndrome (PFPS) is a common knee pathology \nwith unknown aetiology. A hypothesis on the aetiology is a disturbed blood flow \nin the patellofemoral joint. Dynamic contrast-enhanced MRI (DCE-MRI) \nenables us to study perfusion, but there is no tailored method for the \npatellofemoral joint yet. In this study, we developed and evaluated a DCE-MRI \nprotocol with dedicated post-processing tool, enabling perfusion quantification \nof patellofemoral joint tissues in order to disentangle the aetiology of PFPS. \nMethods and Materials:  We evaluated our method in 5 control subjects from \nan ongoing DCE-MRI study in PFPS and control subjects. Sagittal DCE image \nslices with SI phase encoding were acquired at 3 T using a 8-channel knee \ncoil. Our volume of interest (VOI) consisted of the patellar bone. Motion \nbetween scans was corrected for by automated image registration. Voxel-wise \nquantitative perfusion parameters (kep) were calculated with Tofts model. \nSince precision of kep varies spatially, weighted mean and standard deviation \nwere computed over the VOI, with weights given by the reciprocal Cramér-\nRao-Lower-Bound (indicating fit uncertainty). \nResults: Weighted mean kep values of the patellar bone ranged between \n0.045 and 0.071 s\n-1, which is in correspondence with the literature. The mean \nweighted standard deviation in the VOI was 0.031 s -1, suggesting \nheterogeneous perfusion within the patella. \nConclusion: The results suggest that our DCE-MRI protocol and post-\nprocessing tool are adequate, and can be used to study patellar blood \nperfusion. Quantitative kep maps even allow study of regional perfusion. This \nmay yield important information on the aetiology of PFPS.  \n \nS344  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0965 14:36  \nDiffusion-weighted imaging for the assessment of knee synovitis: a \ncomparative study against contrast-enhanced MRI  \nE.H.G. Oei, E.J. McWalter, B. Sveinsson, M.T. Alley, B.A. Hargreaves, \nG.E. Gold; Stanford, CA/US (e.oei@erasmusmc.nl)  \nPurpose: MRI of synovitis currently requires contrast-enhanced imaging which \nincreases cost, risks, and imaging time. The novel 3D double echo steady \nstate (DESS) sequence can be modified by increasing diffusion weighting, \nthereby improving contrast between synovium and joint fluid. Our purpose was \nto compare DESS with contrast-enhanced (CE) MRI for knee synovitis \nassessment. \nMethods and Materials:  Nine individuals with symptomatic inflammatory knee \narthritis underwent MRI at 3.0 T. Routine clinical sequences were performed \nfollowed by the modified 3D DESS sequence (matrix 256x256; slice thickness \n3 mm; duration 5:00 minutes) with high diffusion (10 cycles/voxel) gradient and \nCE T1-weighted imaging (matrix 384x256;slice thickness 3 mm; duration \n4:30 minutes). DESS and CE  MRI images were scored independently by a \nblinded musculoskeletal radiologist. Synovi tis was graded semiquantitatively at \n11 sites and a whole-joint sum score was calculated according to Guermazi \netal. Agreement statistics were calculated on site and patient levels and whole-\njoint synovitis scores of DESS were correlated with those of CE MRI \n(reference). \nResults: DESS showed good agreement (86% and 77% based on analysis on \npatient and site level respectively) with CE MRI for detection of synovitis, but \nsystematically underestimated synovitis severity (61% absolute agreement \nanalysed by site). Excellent correlation was found between summed whole-\njoint synovitis scores of DESS and CE MRI (Pearson's correlation coefficient \n0.85 (p=0.016), intra-class correlation coefficient 0.82 (95%CI 0.28-0.97)). \nConclusion: Diffusion weighted imaging with a modified 3D double echo \nsteady state (DESS) sequence with high diffusion gradient is promising for the \n(semiquantitative) assessment of knee synovitis without need for contrast \nagents.  \nAuthor Disclosures: \nB.A. Hargreaves: Research/Grant Support; General Electric Healthcare. G.E. \nGold: Consultant; Zimmer, Boston Scientific, Isto Inc. Research/Grant Support; \nGeneral Electric Healthcare. \nB-0966 14:45  \nRelationship of total hip arthroplasty to ipsilateral and contralateral knee \nosteoarthritis: a 4-year longitudinal 3 T MRI study from the osteoarthritis \ninitiative  \nP.M. Jungmann\n1, M.C. Nevitt2, H. Liebl1, L. Nardo2, T. Baum1, F. Liu2, \nN.E. Lane3, C.E. McCulloch2, T.M. Link2; 1Munich/DE, 2San Francisco, CA/US, \n3Sacramento, CA/US (pia.jungmann@tum.de)  \nPurpose: To evaluate the association of unilateral total hip arthroplasty (THA) \nwith the prevalence and worsening of OA degenerative changes and strength \nin the ipsilateral and contralateral knee. \nMethods and Materials:  We studied both knees of 30 individuals in the \nosteoarthritis Initiative (OAI) with pr evalent unilateral THA at baseline. We \ncompared knees ipsilateral and contralateral to THA within each subject on \nbaseline values, and change over 4 years, in Western Ontario and McMasters \nUniversities Arthritis Index (WOMAC) scores, upper leg isometric strength, \nwhole-organ MR imaging scores (WORMS) and (in right knees) cartilage T2 \nrelaxation time measurements. Ipsilateral  and contralateral knees were \ncompared using multivariate regression models and paired t-tests. \nResults: WOMAC scores did not differ between knees at baseline, but there \nwas a trend for greater contralateral knee worsening of WOMAC pain (paired t-\ntest, P=0.087), stiffness (P=0.039), physical function (P=0.057) and total \nscores (P=0.059) in subjects with unilateral THA. Strength did not differ \nbetween knees at baseline, but contralateral extension strength declined more \nover 4 years (P=0.037) than ipsilateral. Contralateral knees had higher \ncartilage scores (P=0.007) and total WORMS scores (P=0.008) at baseline. \nTotal WORMS score also showed greater worsening over 4 years (P=0.008). \nBaseline T2 was not significantly different between knees, but T2 values \nincreased more in knees contralateral to THA (mean ±SEM, 2.9±1.4 ms versus \n0.2±1.1 ms; P=0.007). \nConclusion: THA is associated with an increased progression of degenerative \nfindings in the contralateral knee compared to the ipsilateral knee.  \n \nB-0967 14:54  \nAssociation of T2 relaxation time measurements with different grades of \nradiographic knee osteoarthritis over 48 months - data from the \nOsteoarthritis Initiative  \nU.R. Heilmeier\n1, H. Liebl2, L. Nardo1, M. Kretzschmar1, S. Lee1, G.B. Joseph1, \nC.E. McCulloch1, M.C. Nevitt1, T.M. Link1; 1San Francisco, CA/US, \n2Munich/DE  \nPurpose: To analyse the cross-sectional and longitudinal association between \ncartilage biochemical composition (a s measured by MRI T2) and various \nstages of radiographic OA as defined by Kellgren-Lawrence (KL-)-score. \nMethods and Materials:  Right knee 3 Tesla MRI studies of 190 subjects (105 \nfemale, 85 male, aged 45-70, BMI 24.7 ±2.4) from the Osteoarthritis Initiative \nwere selected based on their baseline radi ographic KL-readings and stratified \ninto 4 KL-groups (KL 0-3). Knee cartilage was segmented at baseline, 2-year \nand 4-year follow-up. Mean cartilage T2 quantification as well as laminar- and \nGLCM-texture analysis were performed at each timepoint. Global mean T2 \nvalues and T2 changes over time were calculated for each KL-group. \nRegression models adjusted for age, gender, and BMI were used to determine \nthe difference in cartilage T2 parameters between KL-groups. \nResults: Subjects with KL-grades of 1, 2 or 3 showed significantly higher \nglobal mean T2 values than subjects with KL0, at baseline (p < 0.005; \np < 0.001, p < 0.001), at 24 months (p=0.001; p < 0.001, p=0.044) and 48 \nmonths (p < 0.001; p=0.002, p < 0.001). Texture and laminar cartilage analyses \nrevealed additional signi ficant T2-differences between KL1 and KL3 (p=0.004) \nand KL2 and KL3 (p=0.031) at most timepoints. The annual increase in mean \nT2 was similar for each KL-group and ranged from 0.36 ms/yr in KL1 subjects \nto 0.25 ms/yr in KL3 subjects (p=0.61). \nConclusion: Our findings suggest that T2 relaxation time measurements, and \nparticularly laminar and texture cartilage analyses, can depict different degrees \nof osteoarthritis related cartilage damage cross-sectionally and longitudinally, \nand might therefore be promising tools to monitor osteoarthritis progression.  \nB-0968 15:03  \nDelayed gadolinium-enhanced MRI of the Meniscus (dGEMRIM) in \npatients with knee osteoarthritis: relation with meniscal degeneration on \nconventional MRI, reproducibility, and correlation with dGEMRIC  \nJ. van Tiel, G. Kotek, M. Reijman, P.K. Bos, S. Klein, J.A.N. Verhaar, \nG.P. Krestin, H. Weinans, E.H.G. Oei; Rotterdam/NL (e.oei@erasmusmc.nl)  \nPurpose: (I) To assess if menisci identified as normal or degenerated on \nconventional MRI differ in T1 relaxation times of delayed gadolinium-enhanced \nMRI (T1GD), (II) to assess the reproducibility of T1GD of the meniscus and (III) \nto assess the correlation between T1GD of the meniscus and the articular \ncartilage in knee osteoarthritis (OA) patients. \nMethods and Materials:  In 17 OA patients who underwent delayed \ngadolinium-enhanced MRI twice within 7 days, we calculated T1GD in the \nmedial and lateral anterior and posterior meniscus and femoral and tibial \ncartilage. Meniscus pathology was evaluated on conventional MRI. T1GD in \nnormal and degenerated menisci were compared using an unpaired t-test. \nReproducibility of T1GD was assessed using intraclass correlation coefficients \n(ICC). Pearson's correlation coefficient was calculated between meniscus and \ncartilage T1GD. \nResults: A trend towards lower T1GD in degenerated menisci (mean: 448 ms, \n95%CI: 423-473 ms) compared to normal menisci (mean: 402 ms, 95%CI: 359-\n444 ms) was observed (p=0.05). ICCs of meniscus T1GD ranged from 0.85 to \n0.90. The correlation between meniscus and cartilage T1GD was moderate in \nthe lateral compartment (r=0.52-0.75) and strong in the medial compartment \n(r=0.78-0.94). \nConclusion: Degenerated menisci have a clear trend towards lower T1GD \ncompared to normal menisci. Since thes e results are highly reproducible, \nmeniscus degeneration might be assessed within one delayed gadolinium-\nenhanced MR examination simultaneously with articular cartilage. The strong \ncorrelation between meniscus and cartilage T1GD indicates concomitant \ndegeneration in both structures in OA, but also suggests that dGEMRIC may \nnot be regarded entirely sulphated glycosaminoglycan specific.  \nAuthor Disclosures: \nG.P. Krestin: Consultant; General Electric Healthcare. Grant Recipient; \nGeneral Electric Healthcare.  \nS345  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0969 15:12  \nKnee joint space measurements on computer automatically aligned \nimages vs conventional reconstructions  \nA. Chabra,1, Z. Peng2, X. Zhou2, C. Florin2; 1Dallas, TX/US, 2Malvern, PA/US \n(zhigang.peng@siemens.com)  \nPurpose: To evaluate the time and measurement differences for the \ninterpretation of knee joint space measurements on computer auto-aligned CT \nimages versus conventional reconstructions. \nMethods and Materials:  30 randomly selected CT scans of the knee (mean \nage 51 yrs, range 12-76 yrs), all performed on 64-slice scanner, reconstructed \nat 0.75-3 mm slice thickness. These scans were reviewed by experienced \nmusculoskeletal radiologist who measured joint space in the medial, lateral and \npatella-femoral compartments of the knee on conventional coronal and axial \nimages (CCT). The same measurements were then performed on computer \nauto-aligned CT images (ACT) obtained by an algorithm prototype using \nanatomical landmarks to reorient the images for optimal display of the knee \njoint space. Differences in joint space measurements and time for evaluation \nwere assessed. \nResults: The mean medial-tibio-femoral space on CCT was 3.2 mm (range \n1.1-8.2 mm, SD-1.4 mm), and on ACT was 3.2 mm (range 1.1-7.9 mm, SD-\n1.5 mm) (p-value 0.06). The mean lateral-tibio-femoral space on CCT was \n4.5 mm (range 1.5-7.9 mm, SD-1.6 mm), and on ACT was 4.7 mm (range 1.5-\n11.1 mm, SD-2.3 mm) (p-value 0.30). The mean lateral-patella-femoral space \non CCT was 3.2 mm (range 1.4-5.8 mm, SD-0.9 mm), and on ACT was \n3.3 mm (range 1.5-6.8 mm, SD-1.3 mm) (p-value 0.20). The mean time for \nevaluation of the three measurements on CCT was 47.6 sec (range 27-110 \nsec, SD-15 sec), and on ACT was 33.8 sec (range 25-77 sec, SD-10 sec). The \ndifference was statistically significant (pvalue < 0.001). \nConclusion: Computer auto-alignment of CT image reconstructions (ACT) \nallows significantly faster evaluation time without statistically significant impact \non the results of joint space measurements. It can save radiologists' time and \npotentially lead to cost savings.  \nAuthor Disclosures: \nA. Chhabra,: Consultant; Siemens Medical Solutions USA, Inc. Z. Peng: \nEmployee; Siemens Medical Solutions USA, Inc. X. Zhou: Employee; Siemens \nMedical Solutions USA, Inc. C. Florin: Employee; Siemens Medical Solutions \nUSA, Inc. \nB-0970 15:21  \nWeight-bearing CT of the knee: does the joint alignment change from \nsupine to upright position?  \nA. Hirschmann, F.M. Buck, S. Fucentese, C.W.A. Pfirrmann; Zurich/CH \n(anna_kerner@web.de)  \nPurpose: To compare patellofemoral and femorotibial joint alignment in supine \nnon-weight-bearing (NWBCT) and upright weight-bearing computed \ntomography (WBCT). \nMethods and Materials:  Institutional review board approval and informed \nconsent of all patients were obtained. NWBCT and WBCT scans of the knee \nwere obtained of 26 patients (mean age, 57.0 ± 15.9) using a 64-row CT for \nNWBCT and a novel cone-beam extremity CT for WBCT. Two musculoskeletal \nradiologists quantified joint alignment by measuring femorotibial  rotation, tibial \ntuberosity-trochlear groove distance (TTTG), lateral patellar tilt angle (LPTA), \nlateral patellar shift (LPS), and medial and lateral femorotibial joint space width. \nSignificant differences between NWBCT and WBCT were sought using \nWilcoxon signed-rank test. P values < 0.05 were considered statistically \nsignificant. \nResults: Significant differences were found for femorotibial rotation \n(P=0.051/P=0.009;reader 1/reader 2), TTTG (P=0.008/P=0.002), LPTA \n(P=0.011/P=0.188) and medial joint space width (P=0.003/P=0.004). \nFemorotibial rotation changed from NWBCT (mean 0.0° ± 6.1 internal rotation) \nto WBCT (3.6° ± 6.8 external rotation). TTTG decreased from NWBCT \n(13.8 mm ± 5.1/13.8 mm ± 3.9) to WBCT (10.5 mm ± 5.0/10.9 mm ± 5.2). \nLPTA decreased from NWBCT (15.6° ± 6.7/16.9° ± 7.4) to WBCT \n(12.5° ± 7.7/15.0° ± 6.2). The medial femorotibial joint space decreased from \nNWBCT (3.9 mm ± 1.4/4.5 mm ± 1.3) to WBCT (2.9 mm ± 2.2/3.5 mm ± 2.2). \nInterreader agreement was in average good to excellent (0.42-0.88). \nConclusion: Knee joint alignment significantly changes in the upright weight-\nbearing position using CT.  \n \nB-0971 15:30  \nQuantitative assessment of biological expression and physiological \nimaging in the experimental osteoarthritis  \nW. Yao; Shanghai/CN (yaoweiwu@yahoo.com)  \nPurpose: To evaluate the relations among the level of cytokines in rabbits' \nserum, quantitative parameters of MR physiological imagings (T2, T2* \nrelaxation time) and pathology of experimental osteoarthritis. \nMethods and Materials:  18 New-Zealand White rabbits were manufactured to \nbe animal models of experimental osteoarthritis, and divided into 6 groups by \nweeks (2, 4, 8, 12, 16, 20), another 6 rabbits as the control group by means of \npseudosurgery. The concentration of BMP-2,CTX-II and COMP in rabbits' \nserum were recorded. Every left knee of each group was scanned by MR Pd-\nWI, T2 mapping and T2* mapping imaging accordingly and T2 and T2* values \nof the articular cartilage in 10 subregions based on the Whole-Organ MRI-\nScore were calculated. Differences were analysed and compared with the \nconcentration of cytokines by biochemical analysis and HE staining. \nResults: The T2 relaxation time were 21.33, 20.21, 17.85, 25.61 ms at the \ntime of 8.12,16, 20 weeks after the surgery (P < 0.05, compared to their control \ngroups, respectively). The mean T2* relaxation time was 9.07 ms before \noperation and elevated by 1.39.1.83, 3.33.14.6, 5.02, 3.31 ms, respectively, at \ndifferent time points. They are closely related to the difference of BMP-2, CTX-\nII and COMP (r1=0.6, r2=0.72, r3=0.68). The difference of BMP-2 and CTX-II \nwithin every group was statistically significant. HE staining demonstrated that \nthe proportion and extent of injured cartilage increased along with the \nprolonged moulding time. \nConclusion: The T2,T2* relaxation time can depict injury extent of articular \ncartilage of osteoarthritis and they are closely related to the concentration of \nBMP-2,CTX-II,COMP in the serum reflecting different periods of cartilage \ndamage as well.  \nAuthor Disclosures: \nW. Yao: Research/Grant Support; NSFC (No. 81171312).  \n14:00 - 15:30 Room E2  \nGI Tract  \nSS 1801b  \nBowel imaging: advancing the use of US, \nCT and MRI  \nModerators:  \nA. Graser; Munich/DE  \nC. Stoupis; Männedorf/CH  \nB-0972 14:00  \nReducing image noise in CT colonography: effect of an integrated circuit \nCT detector  \nC.H. McCollough, Y. Liu, S. Leng, G. Michalak, T.J. Vrieze, X. Duan, M. Qu, \nM.M. Shiung, J.G. Fletcher, K. Grant; Rochester, MN/US  \nPurpose: To investigate whether an integrated circuit (IC) CT detector results \nin reduced noise in CT colonography (CTC). \nMethods and Materials:  366 consecutive patients underwent clinically-\nindicated CTC using the same CT scanner system, except for a difference in \nCT detectors (IC or conventional). Image noise, patient size, and scanner \nradiation output (CTDI\nvol) were quantitatively compared between the patient \ncohorts for each detector system, with separate comparisons for the abdomen \nand for the pelvis.  \nResults: For the abdomen and the pelvis, despite significantly larger patient \nsizes in the IC detector cohort (both p < 0.001), image noise was significantly \nlower (both p < 0.001), whereas CTDI\nvol was unchanged (both p>  0.05). Based \non the observed image noise reduction, radiation dose could alternatively be \nreduced by approximately 20% to result in similar levels of image noise. \nConclusion: CTC images acquired using the IC detector had significantly \nlower noise than using the conventional detector. This noise reduction can \npermit further radiation dose reduction in CTC.  \nAuthor Disclosures: \nC.H. McCollough: Grant Recipient; Siemens Heatlthcare. G. Michalak: \nEmployee; Siemens Medical Solutions. J.G. Fletcher: Grant Recipient; \nSiemens Heatlthcare. \nS346  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0973 14:09  \nCT colonography with rectal iodine tagging: evaluation of diagnostic \naccuracy, patient acceptance and overall examination time  \nL. Faggioni1, A. Mantarro1, E. Neri1, P. Bemi1, R. Scandiffio1, G. D'Ippolito2, \nC. Bartolozzi1; 1Pisa/IT, 2São Paulo/BR (annalisamantarro@gmail.com)  \nPurpose: To assess diagnostic accuracy and image quality of CT \ncolonography (CTC) with rectal iodine tagging. \nMethods and Materials:  Thirty-five asymptomatic patients with 57 colonic \nlesions sized 6-30 mm underwent CTC for colorectal cancer screening. Patient \npreparation consisted of a three-day low-residue diet plus Macrogol 4000 and \nBisacodyl after lunch, followed by a 50 mL enema of diatrizoate dimeglumine \n(Gastrografin™) diluted in 300 mL warm tap water and automatic insufflation \nwith 3L carbon dioxide immediately before CTC. CTC findings were compared \nwith optical colonoscopy, and per-segment image quality was assessed using \na semiquantitative score (1=poor, 2=adequate, 3=excellent). Tagging quality, \npatient acceptance, and total examination time of 80 unremarkable CTC \nstudies (40 performed with rectal tagging and 40 with oral tagging) were \nevaluated. \nResults: Overall tagging quality and patient acceptance were comparable with \nrectal and oral tagging, while total exami nation time was significantly lower with \nrectal tagging (18.3 ±3.5 vs 215.6± 10.3 minutes, p < 0.0001). Per-segment \nimage quality of CTC with rectal tagging was adequate to excellent in all \ncolonic segments, with a sensitivity and sp ecificity in lesion detection of 100% \nand 100% in the sigmoid-rectum, 100% and 96.7% in the descending colon, \n100% and 89.3% in the transverse colon, and 100% and 95.2% in the caecum-\nascending colon, respectively. Per-lesion sensi tivity and specificity were 94.6% \nand 98.8% for lesions sized 6-9 mm, and 100% and 99.4% for lesions sized \n10-30 mm, respectively. \nConclusion: Rectal iodine tagging can be an effective and well-tolerated \nalternative to oral tagging for CTC with the advantage of a substantially shorter \noverall examination time.  \nB-0974 14:18  \nStructured reporting of CT colonography examinations to support \nnational data registries and outcomes analyses  \nD.J. Vining1, T. Yang1, U. Salem1, C. Popovici2, A. Pitici2, A. Prisacariu2, \nM. Jurca2; 1Houston, TX/US, 2Chapel Hill, NC/US (dvining@mdanderson.org)  \nPurpose: Standardised reporting of CT colonography (CTC) is essential for the \neffective communication of diagnostic results, tracking of patient outcomes, \noutcomes analyses, and support of national data registries including the \nAmerican College of Radiology's (ACR) CTC Data Registry. Various imaging \nsystems exist for the creation and interpretation of 2D and 3D CTC images, but \nno standardised reporting methods have been proposed. We present a \nmultimedia structured reporting solution, called ViSion, which can be used to \nstandardise the reporting of CTC exams, code results with C-RADS criteria, \nand automate data entry into international registries. \nMethods and Materials:  We developed a multimedia structured reporting \nsystem, called ViSion, which can function with any CTC image display and \ninterpretation workstation. ViSion tags key images captured from a CTC image \nprocessing system with metadata describing the anatomical location of a \nfinding, radiological observation/diagnosi s, and disease metrics. Furthermore, \nthe radiological findings can be linked to pathology outcomes in graphical \ndisease timelines to support outcomes analyses. The data contained within a \nViSion structured report can be transported automatically into national data \nregistries. \nResults: We applied the ViSion structured reporting system to 100 CTC cases \nperformed at our institution to create standardised CTC reports which were \nsubsequently uploaded into the ACR's CTC Data Registry. \nConclusion: The practice of radiology is undergoing a transition from narrative \nreporting to structured reporting. We have developed a structured reporting \nsystem that can be used to standardise the reporting of CTC examinations, \nsupport international disease registries , and conduct data mining for outcomes \nanalyses.  \nAuthor Disclosures: \nD.J. Vining: CEO; VisionSR, Inc. Founder; VisionSR, Inc. Shareholder; \nVisionSR, Inc. C. Popovici: Employee; Eloquentix, Inc. A. Pitici: Employee; \nEloquentix, Inc. A. Prisacariu: Employee; Eloquentix, Inc. M. Jurca: \nEmployee; Eloquentix, Inc. \n \nB-0975 14:27  \nMR colonography including diffusion-weighted imaging (DWI) in children \nand adolescents with inflammatory bowel disease (IBD): do we really \nneed intravenous contrast?  \nS. Sirin, S. Kathemann, B. Schweiger, M. Hahnemann, M. Forsting, \nT.C. Lauenstein, S. Kinner; Essen/DE (selma.sirin@uk-essen.de)  \nPurpose: MR colonography (MRC) is a well-accepted, non-invasive imaging \nmodality for the depiction of inflammatory bowel disease. Diffusion-weighted \nimaging (DWI) has been shown to show lesions in abdominal MRI as good as \ncontrast-enhanced imaging and can also be used for bowel imaging. Aim of \nthis study, therefore, was to assess if contrast enhancement is really needed to \ndepict inflammatory lesions in bowel MRI if DWI is available. \nMethods and Materials:  37 patients (23 girls, 14 boys, mean age 14.6years) \nunderwent MRC on a 1.5 T (Magnetom Avanto, Siemens). In addition to T2-\nweighted and contrast-enhanced T1-weighted (ce-T1-w) data, DWI sequences \nin axial and coronal plane (b = 50,500.1000) were acquired. Two reviewers \nseparately evaluated i) DWI, ii) ce-T1-w MRC as well as iii) DWI and ce-T1-w \nMRC concerning lesions (1=none,2=one/continuous lesion (s), 3=multiple, \ndiscontinuous lesions). Furthermore, bow el distension (1=good, 2=moderate, \n3=poor) and preferred b-value were assessed. Colonoscopy (up to 48 hours \nafterwards) including biopsies served as reference standard. \nResults: Depiction of inflammatory lesions significantly increased with DWI \ncompared to T1-w MRC alone (sensiti vity/specificity 78.4%/100% vs. \n95.2%/100%, respectively, compared to colonoscopy/histopathology, \np < 0.001). In six patients, lesions were only detected by DWI, in another six \npatients DWI detected additional lesions. Kappa values for the two readers \nwere excellent (k=0.92-0.96). A combination of b=500 and 1000 was preferred \nfor DWI. \nConclusion: DWI of the bowel shows inflammatory lesions with high accuracy \nand proved to show lesions that were not seen with ce-T1-w imaging. \nTherefore, DWI seems to be able to replace, in any case complement ce-T1-w \nMRC.  \nB-0976 14:36  \nMR enterocolonography: feasibility study  \nL. Tkal\u0013i\u0011; Rijeka/HR (lovro.tkalcic@gmail.com)  \nPurpose: To evaluate feasibility of magnetic resonance enterocolonography \n(MREC) in patients with Crohn's disease. \nMethods and Materials:  We prospectively enrolled 108 consecutive patients, \n65 men and 43 women diagnosed with Crohn's disease, mean age 41 ±14 \nyears (age range, 17 - 68 years). After bowel cleansing patients ingested \n1000 ml of the solution containing 0.5% of mannitol and 0.5% of milled carob \nprior to examination. Patients were examined in prone position and warm tap \nwater enema was administered. HASTE, trueFISP, and VIBE sequences were \nacquired. Six bowel segments were independently analysed by two \nexperienced radiologists. Bowel distension was assessed as poor, suboptimal \nbut diagnostic, and excellent by consent. \nResults: Excellent large bowel distension was acquired in 93%, 94%, and 97% \nof patients for ascending/transverse colon, descending/sigmoid colon, and \nanorectal segment, respectively. Ileocecal and ileal distension was excellent in \n82%, and 88% of examinees. Jejunal distension was excellent in 46%, \nsuboptimal but diagnostic in 43%, and poor in 11% of examinees. There was \nno significant correlation between gender, age or body mass index (BMI), and \nbowel distension. Four patients vomited (4%), and 24 examinees (22%) had \nmore than three stools during the oral ingestion of contrast. Significant \ncomplications were not detected. \nConclusion: MREC is feasible. Optimal colonic, ileocecal, and ileal distension, \nfair overview of the jejunal loops, good patient's acceptance, and lack of \nradiation burden makes it promising diagnostic tool in diagnosis and follow-up \nof patients with Crohn's disease.  \nB-0977 14:45  \nCT enterography: comparison of dose-reduced CT with hybrid iterative \nreconstruction and routine-dose CT with filtered back projection for the \nevaluation of sigmoid diverticulitis  \nA. Laqmani\n1, S. Veldhoen2, S. Dulz1, F.O. Henes1, T. Derlin1, F. Wassenberg1, \nH.D. Nagel3, G. Adam1, M. Regier1; 1Hamburg/DE, 2 Würzburg/DE, \n3Buchholz/DE (a.laqmani@uke.de)  \nPurpose: To assess image quality of dose-reduced CT enterography (CTE) \nreconstructed with hybrid iterative reconstruction (HIR) and filtered back-\nprojection (FBP) to routine-dose examinations reconstructed with FBP in \npatients with suspected sigmoid diverticulitis (SD). \nMethods and Materials:  30 patients with suspected SD underwent contrast-\nenhanced dose-reduced CTE (Brilliance iCT, tube voltage;120 kVp; mean \nCTDIvol: 9.9 mGy; mean DLP: 523.4 mGy*cm; mean BMI: 29). 30 patients, \nwho had undergone routine-dose CTE (tube voltage;120 kVp; mean CTDIvol: \n15.6 mGy; mean DLP: 852.7 mGy*cm; mean BMI: 30.5) served as reference. \nS347  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nRoutine-dose CTE images were reconstructed with FBP, dose-reduced CTE \nimages were reconstructed with FBP and the HIR iDose (Philips Healthcare) \nusing two strengths (iDose4 and 6). Four independent radiologists evaluated \nimage quality (1 [worst] to 5 [best]) including findings of SD. Objective image \nnoise (OIN) was recorded, CNR was calculated. Statistical analysis was \nperformed using t-test, random intercept model and ICC. \nResults: In dose-reduced CTE, CTDIvol could be reduced up to 37% in \ncomparison to routine-dose CTE (p < 0.05). HIR reduced the OIN in dose-\nreduced CTE of up to 58% compared to FBP. The lowest scores of subjective \nimage quality were reached in dose-reduced CTE with FBP (2.7). Dose-\nreduced CTE with iDose4 was determined to be of equivalent image quality as \nroutine-dose CTE with FBP (Scores: 4 vs. 4.3, respectively). Interobserver \nagreement was excellent (ICC: 0.91; p < 0.05). \nConclusion: HIR reduces image noise and improves image quality in dose-\nreduced CTE, thus allowing for a dose reduction of 37% in CTE with \ncomparable image quality as routine-dose CTE.  \nB-0978 14:54  \nSubmilisievert ultralow-dose CT colonography: comparison of filtered \nback projection and model-based iterative reconstruction technique  \nL. Lambert, J. Daneš, J. Jahoda, J. Ho ejš; Prague/CZ \n(lambert.lukas@gmail.com)  \nPurpose: To evaluate diagnostic acceptability of ultralow-dose CT \ncolonography. \nMethods and Materials:  Sixteen patients underwent CT colonography with \nstandard protocol in supine position and ultralow-dose protocol in prone \nposition. Supine datasets were reconstructed both with filtered back projection \nand advanced model-based iterative reconstruction technique. Two \nradiologists with experience in reading CT colonography independently \nevaluated 96 colonic segments in endoluminal view and axial thin sections. \nDiagnostic acceptability, colonic distension, smoothness of colonic wall, \nsharpness of colonic wall delineation, perceived image noise were rated on a \nfive-point scale. \nResults: All distended segments were rated evaluable in standard dose and \nultralow-dose series reconstructed with iterative reconstruction technique, \nwhereas 61% segments were rated inevaluable in ultralow-dose series where \nfiltered back projection was used with worst ratings in the rectum and the \nsigmoid colon. The mean radiation dose was 0.42 mSv resp. 5.48 mSv in \nprone resp. supine scans. \nConclusion: Submilisievert CT colonography renders acceptable images \nwhen advanced model-based iterative reconstrution technique is used. Further \ninvestigations of larger scale need to be done to clarify, whether such a low-\nradiation dose would influence the detection of polyps.  \nB-0979 15:03  \nLow-dose CT scans of subjects smuggling illicit concealed packages at \nthe UK border: a liquid situation  \nS. Gwyther1, A. Thompson2, L. McLennan3, D. Hillier3; 1Redhill/UK, \n2Crawley/UK, 3Horley/UK (GwytherSJ@aol.com)  \nPurpose: To identify subjects who have concealed illicit drugs at the UK \nborder. Such drugs have typically been swallowed in the solid powder form \nconcealed in packages such as condoms which can usually be detected by \nplain abdominal radiographs (AXR). Re cently packages containing concealed \nillicit drugs in the liquid form have b een encountered which are extremely \ndifficult to detect using AXR. Very low-dose CT scans (VLDCT) were \nperformed on subjects suspected of smuggling drugs in this form. \nMethods and Materials:  The UK Border Agency (UKBA) provided solid and \nliquid packages containing cocaine which had been recovered from subjects \nattempting to smuggle them into the UK. An improvised phantom was \nconstructed to act as a virtual colon containing the solid and liquid packages \nwhich were imaged using AXR MRI and VLDCT. \nResults: AXR identified solid packages as regular well-defined opacities \nthough liquid packages were very difficult to identify using the phantom. MRI \nwas of no benefit. VLDCT detected solid and liquid packages with ease despite \nliquid packages having irregular borders and contained air. 10 subjects \nconsidered suspicious for smuggling illicit concealed drugs by UKBA \nunderwent VLDCT. 2 demonstrated solid packages 1 liquid packages 1 was a \nfalse positive the remainder negative . All positive cases showed similar \nappearances to those in the phantom. \nConclusion: This is the first report using VLDCT to detect concealed \npackages in the liquid form. VLDCT reliably detects illicit concealed packages \nin both the solid and liquid form with ease whilst imparting a low radiation dose.  \n \n \n \n \n \nB-0980 15:12  \nRight colonic diverticulitis: clinical and CT characteristics in a large \nseries of Caucasian patients  \nL. Valbousquet Schneider\n1, F.-X. Arnaud2, E. Peroux1, J. Potet2, M. Zins3; \n1Saint Mandé/FR, 2Clamart/FR, 3Paris/FR (laura.valbousquet@gmail.com)  \nPurpose: To assess the clinical and CT-scan characteristics of right colonic \ndiverticulitis (RCD) in a large, monoc entric series of Caucasian patients in \ncomparison with left colonic diverticulitis (LCD). \nMethods and Materials:  Two radiologists blinded to clinical information \nreviewed CT-scans of 30 consecutive patients with a final diagnosis of RCD \nand 70 consecutives patients with a final diagnosis of LCD, performed in our \ninstitution between July 2005 and February 2013 and between May 2010 and \nFebruary 2013, respectively. Clinical features, CT-scan characteristics, type of \ntreatment and follow-up were collected in all cases (n=100). Final diagnosis \nwas established by an expert panel formed by 2 gastrointestinal surgeons and \na gastrointestinal radiologist, with full access to clinical, laboratory, radiologic, \npathologic and surgical findings, including a follow-up of at least 6 months. \nResults: The median age was lower in RCD than in LCD patients (48 versus \n64 years old, p 180°) and was more common in LCD compared to RCD (80% \nversus 33.3%, p < 0.001). CT signs of severity were less frequent in RCD \ncompared to LCD; pericolonic abscess (3.3% versus 17.1%, p=0.06), detection \nof peritoneal free air (3.3% versus 18.6%, p=0.06). RCD were associated with \nless clinical complication (6.7% versus 25.7%, p=0.03), necessitating less \nemergency surgery (0% versus 2.9%, p=0.10) and had a lower recurrence rate \ncompared to LCD (16.7% versus 34.3%, p=0.07). \nConclusion: Compared to LCD, RCD occurs in younger patients with a lower \nrisk of complication or recurrence. An inflamed diverticulum is a more frequent \nfinding in RCD.  \nB-0981 15:21  \nTechnical feasibility and interobserver variability of elastosonography in \nthe assessment of pathological bowel tracts  \nA. Colleoni\n1, L. Romanini1, V. Cantisani2, P. Ricci2, F. Calliada3, M. Dal Corso1, \nL. Grazioli1, R. Maroldi1; 1Brescia/IT, 2Rome/IT, 3Pavia/IT \n(ale.colleoni@hotmail.it)  \nPurpose: To investigate the feasibility of elastosonography (USE) and the \ninter-observer variability in the assessment of pathological bowel loops as \ncompared with B-mode US (US). \nMethods and Materials:  We examined prospectively 41 consecutive patients \nwith at least one thicked bowel loop. US and USE were performed by one \nexpert Abdominal Radiologist with a GE E9. Images acquired by the operator \nwere then evaluated by two other blinded radiologists, separately. Statistical \nanalysis were performed with Cohen's K and Yates chi square tests. We \nconsidered: layering and echogenicity of bowel wall on B-Mode images; wall \nlayering, definition of wall and peripheral tissues boundaries, and the rectus \nabdomins muscle pattern (as reference) on USE images. \nResults: 46 pathological loops were examined: 38 at 5 MHz, 36 at 7.5 MHz \nand 31 with both frequencies. Overall 74 evaluations were performed; in all out \nof 10/74 (13.5%) an adequate elastogram was obtained. For the first reader, \nthe agreement about bowel wall stratification between US and USE was fair, \nwithout statistically significant diffe rences between the two frequencies \n(p=0.56). Among the three readers, a moderate agreement was found on B-\nMode images about bowel wall layering and echogenicity. On USE images \nCohen's test provided a moderate agreement for layering; a slight agreement, \ninstead, was found for bowel wall and peripheral tissues boundaries, and in the \nevaluation of rectus abdominis muscle. \nConclusion: USE evaluation of pathological bowel walls is feasible. A \nmoderate agreement among the three Radiologists was found. Further studies \nwill define the clinical role of this tool.  \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nS348  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n14:00 - 15:30 Room F1  \nOncologic Imaging  \nSS 1816  \nTumour characterisation: methodological \naspects and clinical prospects  \nModerators:  \nL.S. Fournier; Paris/FR  \nN.N. \nB-0982 14:00  \nMultiparametric quantitative MRI in neurooncology: impact of single \nparameters on overall accuracy  \nM. Dietzel1, B. Volbers1, P.A.T. Baltzer2, S. Kloska1, T. Struffert1, \nT. Engelhorn1, S. Lettmaier1, R. Fietkau1, A. Dörfler1; 1Erlangen/DE, \n2Vienna/AT  \nPurpose: Multiparametric quantitative MRI provides a large range of measures \nfor tissue characterisation. Interestingly, knowledge on the additional \ndiagnostic-value of each single parameter and knowledge on the overall \ndiagnostic accuracy of all parameters in combination is still limited. \nMethods and Materials:  Patients were investigated using a clinical MR-\nscanner (Siemens Magentom Aera, B 0=1.5T) applying DTI (diffusion tensor \nimaging), DWI (diffusion weighted imaging) as well as DCE sequences \n(dynamic contrast enhanced; after i.v. injection of 6 ml Gadovist @2 ml/s). For \nmultiparametric quantitative assessment of the tumors ktrans, k ep, V e (DCE: \nTofts-Modell), ADC (DWI) und FA (DTI) were calculated using appropriate \npost-processing software. Clinical follow-up as well as histopathology served \nas reference-standard (fifteen malignant and non-malignant brain tumors). All \nquantitative MR-parameters were analysed by means of uni- and multivarate \nstatistics and were correlated with the reference-standard (malignant vs. non-\nmalignant: AUC- and ROC-analysis, logistic regression with feature selection). \nThis approach allowed exploring significant and independent but also \nredundant MR-parameters; furthermore, overall-accuracy of the protocol could \nbe addressed to stratify the reference-standard. \nResults: In univariate analysis FA reached highest accuracy (AUC=0.92). K\nep \nand ADC did not provide additional diagn ostic value in multivariate analysis \n(P < 0.05). Yet Ktrans, Ve and FA were identified as significant and independent \npredictors of malignant brain tumours (r2=1; AUC=1). \nConclusion: Multiparametric magnetic resonance imaging enabled accurate \nquantitative assessment of brain tumours. Ho wever, our analysis identified also \nredundant information without additional diagnostic-value. This approach might \nhelp to translate multiparametric imaging parameters into diagnostic \ninformation and thus could facilitate its application in clinical practice.  \nB-0983 14:09  \n7 Tesla MRI goes clinical: imaging Glioblastoma multiforme at 7T versus \n3 T  \nL. Umutlu, A. Fischer, J. Hense, T.C. Lauenstein, M. Forsting, M. Ladd, \nO. Kraff, M. Schlamann; Essen/DE (Lale.Umutlu@uk-essen.de)  \nPurpose: Aim of this trial was to compare the delineation of glioblastoma \nmultiforme on susceptibility-weighted (SWI) and contrast-enhanced MPRAGE \nMRI utilising 3 T and 7T MRI. \nMethods and Materials:  5 subjects were examined on a 3 T (Magnetom \nSkyra) and a 7T whole-body MR system (Magnetom 7T) utilising 32-channel \nhead-coils (Siemens Healthcare). Minimum intensity projections (MinIP) of a 3 \nT SWI sequence (voxel size 0.7x0.8x2.6 mm3) were compared to 7 T SWI \nMinIPs (voxel size = 0.25x0.25x1.0 mm3). A T 1-w 3D MPRAGE at 3 T (voxel \nsize = 0.5x1.0x1.0 mm3) after the application of Gadobutrol (Bayer Healthcare) \nwas compared to 7 T MPRAGE MRI (voxel size = 0.7 x 0.7 x 0.7 mm3). Two \nradiologists assessed the delineation of the (1) tumor in T1w MRI, (2) \nmicrovasculature in SWI imaging and (3) impairment due to artifacts utilising a \n5-point scale (5= excellent to 1= non-diagnostic). \nResults: Visual analysis revealed an equivalently excellent delineation of \ntumor extent and morphology for MPRAGE imaging at both field strengths \n(MPRAGE 3 T 4.78 vs MPRAGE 7T 4.80). 7T SWI demonstrated its superiority \nin vessel assessment, yielding a significant improvement in the delineation of \ntumor-associated microvasculature (SWI 3 T 3.79 vs SWI 7T 4.85). Evaluation \nof artifacts showed slightly stronger image impairment for 7T imaging (mean3 T \n4.79 vs mean7T 4.34). \nConclusion: Both field strengths provide high-quality assessment of tumor \nextent and morphology, with 7T SWI demonstrating its superiority in the \nassessment of microvasculature. Hence, an increase of the field strength to 7T \nmay help to better understand tumor-associated neoangionesis.  \n \nB-0984 14:18  \nHistogram analysis of apparent diffusion coefficient map of diffusion-\nweighted MR imaging in endometrial cancer: a preliminary correlation \nstudy with histological grade  \nS. Woo, J. Cho, S. Kim, S. Kim; Seoul/KR (j_crew7@hotmail.com)  \nPurpose: To explore the role of histogram analysis of ADC maps based on \nentire tumour volume in determining the grade of endometrial cancer. \nMethods and Materials: This study was IRB-approved with waiver of informed \nconsent. 33 patients with endometrial cancer underwent diffusion-weighted MR \nimaging (b=0, 600, 1000 s/mm2), and corresponding ADC maps were acquired. \nROIs were drawn on all slices of the ADC map in which the tumour was \nvisualised including areas of necrosis to derive volume-based histographic \nADC data. Histogram parameters (5-95 th percentiles, mean, standard \ndeviation, skewness, kurtosis) were corr elated with histological grade using \none-way ANOVA with Tukey-Kramer test for post hoc comparisons, and were \ncompared between high (grade 3) and low (grades 1/2) grade using Student t-\ntest. ROC curve analysis was performed to determine the optimum threshold \nvalue for each parameter, and their corresponding sensitivity and specificity. \nResults: The standard deviation, quartile, 75\nth, 90 th and 95 th percentiles of \nADC showed significant differences between grades (P \u00020.03 for all) and \nbetween high- and low-grades (P \u00020.024 for all). There was no significant \ncorrelation between tumour grade and other parameter. ROC curve analysis \nyielded sensitivities/sp ecificities of 75%/96%, 62.5%/92%, 100%/52%, \n100%/72%, and 100%/88%, using standard deviation, quartile, 75 th, 90 th and \n95th percentiles for determining high grade with corresponding AUCs of 0.787, \n0.792, 0.765, 0.880, and 0.925, respectively. \nConclusion: Histogram analysis of ADC maps based on entire tumour volume \ncan be useful for predicting the histological grade of endometrial cancer. The \n90th and 95 th percentiles of ADC were the most promising parameters for \ndifferentiating high- from low-grade.  \nB-0985 14:27  \nTumour-to-liver ratio is superior to a SUVmax cut-off for detection of \nmalignant peripheral nerve sheath tumours in neurofibromatosis type 1  \nJ. Salamon, P. Bannas, J.D. Busch, J. Herrmann, G. Adam, V.F. Mautner, \nT. Derlin; Hamburg/DE (j.salamon@uke.de)  \nPurpose: For evaluation of malignant transformation of peripheral nerve \nsheath tumours (MPNSTs) in patients with neurofibromatosis Type 1 (NF1), a \nstandard SUV cut-off value is used without accounting for the interindividual \nvariability, leading to a substantial number of false-positive results. The aim of \nthis study was to evaluate the potential usefulness of normalisation of \nintratumoural tracer uptake in FDG PET/CT to a reference tissue as compared \nto a cut-off SUV\nmax to reduce false negative results. \nMethods and Materials:  49 NF1 patients underwent 18F-FDG PET/CT. \nIntralesional 18F-FDG uptake was analysed by assessment of the maximum \nstandardised uptake value (SUV). Tracer uptake was normalised to different \nreference tissues. To assess the diagnostic performance of normalised tracer \nuptake for detection of malignancy in PNSTs as compared to a standard \nSUV\nmax cut-off of 3.5, ROC analyses were performed. Histopathology, clinical \nand radiological follow-up served as reference standards. \nResults: Using a SUV\nmax cut-off value of 35 demonstrated a sensitivity of \n100% and a specificity of 79.8%. Norma lisation of tracer uptake to liver tissue \nresulted in a significant improvement (p=0.013, McNemar test), demonstrating \na specificity of 90.3%, maintaining a s ensitivity of 100%. A cut-off value of 2.6 \nusing the tumour-to-liver ratio was the optimum threshold for tumour \ndifferentiation (AUC=0.9735). \nConclusion: Quantitative 18 F-FDG PET/CT may identify malignant change in \nplexiform neurofibromas with high accuracy. Increased accuracy could be \nobtained by calculating a tumour-to-liver ratio, offering significantly higher \nspecificity than the standard SUV\nmax cut-off. We recommend using a tumour-to-\nliver ratio cut-off value of 2.6 for detection of malignancy.  \nB-0986 14:36  \nDynamic features of MR-guided histologically proven lesions: \ncomparison 1.5 T vs 3 T MRI  \nA. Malich\n1, J. Dvorak1, U. Teichgräber2, A. Kott1, J. Feger1; 1Nordhausen/DE, \n2Jena/DE (ansgar.malich@shk-ndh.de)  \nPurpose: Current study compared dynamic features of only MR-visible lesions \nat 1.5 T vs 3 T according to histopathology outcome (MR-guided biopsy). \nMethods and Materials:  425 MR-guided biopsies were recommended due to \ndiagnostic breast-MRI from 2007 to 2013 at our departement. Dynamic \ncharacteristics (initial signal incr ease; wash out, enhancement-shape, type, \nblooming, adjacent vessel) were matched to histopathology. 354 and 71 \ninterventions were performed at 1.5 T and 3 T (Philips Achiva and Ingenia). \nMean lesion size was 6 and 7 mm, respectively. Diagnostic study protocol was \nsimilar. \nS349  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nResults: In 285/354 and in 62/71 cases, biopsy was finished successfully at \n1.5 T and 3 T, respectively (19.5% vs. 9.8%). 50.8%/42.2% of recommended \nbiopsies were proven as B2 at 1.5 T/3 T, respectively. Rapid initial peak signal \nincrease occurred in 81.7%/80.0% vs. 88.9%/88.2% at benign/malignant \nlesions at 1.5 T/3 T. Wash out curve was observed at 61.7%/56.7% of benign \nlesions and 72.2%/76.5% of malignant lesions at 1.5 T/3 T. Blooming is \nsignificantly more common at malignant and premalignant lesions, but also at \n3 T vs. 1.5 T: benign: 1.5 T/3 T: 28.9%/66.7%; in situ: 49%/64.7%; invasive \nmalignant: 44.4%/82.3%. Ring enhancement is more common in malignant \nlesions and slightly more common at 3 T: Benign 1.5 T/3 T: 17.2%/20.0%; in \nsitu: 11.8%/23.5%; malignant: 27.8/29.4%. Adjacent vessel sign is significantly \nmore often visible at 3 T/1.5 T: benign lesions: 76.5%/36.1%; malignant lesions \n88.2%/50.0%. \nConclusion: Dynamic features differ dignity dependent suggesting a \nmalignant lesion to be associated with ring enhancement, blooming, adjacent \nvessel. Sign-occurance dependends on magnetic field-strength. MR-guided \nbiopsies at 3 T are safe, abortion rate is significantly lower and verification of \nB3b/B5a/B5b is significantly more common at 3 T vs. 1.5 T.  \nB-0987 14:45  \nModification in abdominal fat distribution after aromatase inhibitor in \nbreast cancer patients using CT volumetry  \nS. Battisti1, D.M.A. Vaccaro1, R.C. Semelka2, B. Beomonte Zobel1; 1Rome/IT, \n2Chapel Hill, NC/US (sofia.battisti@hotmail.it)  \nPurpose: To describe modification of subcutaneous adipose tissue (SAT) and \nvisceral adipose tissue (VAT) distributions in breast cancer patients following \ntherapy with aromatase inhibitors (AI) using CT volumetric measurement of \nabdominal body fat distribution. \nMethods and Materials:  64 consecutive patients (mean age 55.8 ±11.7 years; \nage range 36-77) with a history of radical mastectomy, who were receiving \nadjuvant AI therapy (anastrozolo n=33; letrozolo n=31) were included. Patients \nwere evaluated with CT before and after AI therapy, with imaging follow-up of \n4.3±2.2 years. Abdominal fat distribution analysis was automatically calculated \nusing a workstation that obtained total abdominal adipose tissue (TAAT) area \n(mm\n3). SAT was manually segmented and VAT was determined as TAAT-SAT. \nPercentages were calculated for change of TAAT, VAT and SAT. VAT/SAT \nratio was calculated. Student-T-test was used to compare the variables. \nResults: Percentage of TAAT after AI therapy: mean increase of 9.1% from \nase-line 16280.3 ±6953.3 mm3 (average and standard deviation SD) to \n17763.6±6850.8 mm3. Two groups of patients were observed: those with an \nincrease in TAAT (group A, 43 patients), those with a decrease (group B, 21 \npatients). Modification of VAT/SAT ratio was observed (1.38-1.69) in all \nsubjects, reflecting a relatively increased volume of VAT (mean 18%) and \nslight mean reduction of SAT (mean 1.9%). \nConclusion: Therapy with AI in breast cancer patients was accompanied with \na change in fat distribution to relatively greater VAT/SAT ratio in all the \npatients, regardless of whether they gained or lost weight after therapy. Since \nthis pattern of fat distribution is associated with the metabolic syndrome, \nattention must be paid to these clinical manifestations in patients during their \nfollow-up management.  \nB-0988 14:54  \nAssessing pathologic response in colorectal liver metastases undergoing \npreoperative chemotherapy: a comparison of CT texture analysis with \nRECIST and tumour volumetry  \nS.-X. Rao\n1, D.M. Lambregts2, F. Albarello3, M.H. Martens2, L.A. Heijnen2, \nR. Schnerr2, M.-S. Zeng4, G.L. Beets2, R.G.H. Beets-Tan2; 1Shanghai/CN, \nMaastricht//NL, 2Maastricht/NL, 3Ferrara/IT, Maastricht/NL, 4Shanghai/CN \n(d.lambregts@mumc.nl)  \nPurpose: Aim was to compare the potential of CT texture analysis, CT tumour \nvolumetry and unidimensional (RECIST) measurements for response \nassessment of colorectal liver metastases undergoing preoperative \nchemotherapy. \nMethods and Materials:  Twenty-two patients with known colorectal liver \nmetastases who underwent CT both before and after chemotherapy were \nincluded. Texture analysis of the total volume of all metastatic lesions was \nperformed on portal phase CT-images. Mean intensity (M), entropy (E) and \nuniformity (U) were derived without filtration (0.0) and with different filters \ncorresponding to fine (0.5), medium (1.5), and coarse (2.5) textures. \nAdditionally, total tumour volume ( mm3) and largest lesion diameter (according \nto RECIST 1.1) were determined. Pre-, post-chemotherapy and relative \nchange rates ( \u0005) of the different texture parameters, volume and RECIST-\ndiameters were compared between good responders (n=8, defined as \nhistological tumour regression grade (TRG) of 1-2) and poor responders (n=14; \nTRG 3-5). \nResults: For CT texture analyses, the post-treatment E0.0, U0.0 as well as the \n\u0005E0.0, E0.5, E1.5, U0.5 and U1.5 were significantly different between good \nand poor responders (p=0.01-0.04). Pre-chemotherapy texture parameters \nwere not significantly different (p > 0.05). The \u0005volume of good responders was \nsignificantly different from poor responders (p=0.048).There were no \ndifferences between good and poor responders for mean diameters according \nto RECIST. \nConclusion: Unidimensional tumour measurements according to RECIST are \nnot helpful to assess pathologic response after treatment. Tumour volumetry \nand in particular CT texture analyses withhold promise to discriminate between \npoor and good responders after chemotherapy.  \nB-0989 15:03  \nTexture analysis on pre-treatment contrast-enhanced CT of colorectal \ncancer liver metastases: prediction of response to bevacizumab-\ncontaining chemotherapy according to Choi's criteria  \nU. Navarro, M. Ravanelli, C. Barbieri, A. Colleoni, A. Berruti, R. Maroldi; \nBrescia/IT (navarrougo@gmail.com)  \nPurpose: To test the correlation between tumour heterogeneity measured on \npre-treatment contrast-enhanced CT (CECT) and response to bevacizumab-\ncontaining therapy assessed by Choi's criteria in colorectal cancer liver \nmetastases (CRC-LM). Recent studies suggest that response to anti-\nangiogenetic drugs defined by Choi's criteria better correlates with prognosis \nthan RECIST-based evaluation. \nMethods and Materials:  Fifty-seven CRC-LM in 25 patients treated with \nbevacizumab-containing therapy were included. Uniformity (U) of fine texture \nwas quantified for each lesion on pre-treatment CECT (portal phase). \nTreatment response was assessed by Choi's criteria at lesion-level. \nMultivariate logistic regression was used to test the predictive value of U and \nother lesion- and patient-related variables. \nResults: 34 CRC-LM responded to therapy (partially or completely), 23 \nremained stable or progressed. U was signi ficantly lower in responders than in \nnon-responders (p < 0.0001). Multivariate analysis (including: U, lesion size, \nlesion CT density, scheme of bevacizumab-associated chemotherapy, \nchemotherapy line number) demonstrated that U was the unique predictor of \ntreatment response. Dividing U into tertiles, lesions belonging to 1 st tertile had \n12-folds (p0.03) and 71-folds (p0.0003) higher probability of response \ncompared to lesions belonging to 2\nnd and 3 rd tertile, respectively. Ninety-five \npercent, 39% and 21% of lesions belonging respectively to 1 st, 2 nd and 3 rd \ntertile responded to therapy (p < 0.0001, p trend < 0.0001). \nConclusion: Heterogeneity of CRC-LM quantified on CECT correlates with \nprobability of response to bevacizumab-containing therapy, as assessed by \nChoi's criteria, and could help to stratify patients undergoing chemotherapy.  \nB-0990 15:12  \nTexture analysis on pre-treatment contrast-enhanced CT of colorectal \ncancer liver metastases: prediction of response to bevacizumab-\ncontaining chemotherapy according to RECIST 1.1  \nM. Ravanelli, A. Colleoni, D. Farina, R. Maroldi; Brescia/IT  \n(marcoravanelli@hotmail.it)  \nPurpose: To test whether texture analysis (TA) on pre-treatment contrast-\nenhanced CT (CECT) has the potential to predict the response of colorectal \ncancer liver metastases (CRC-LM) to bevacizumab-containing therapy. \nMethods and Materials:  Fifty-seven CRC-LM in 25 patients treated with \nbevacizumab-containing therapy were included. Fine texture of each lesion \nwas extracted and quantified on pre-treatment CECT images (portal phase), \nresulting in a parameter (uniformity, U) describing tumour heterogeneity. \nTreatment response was assessed by RECIST1.1 at lesion-level. Interobserver \nvariability of U was measured using Bland-Altman method. The predictive \nvalue of U and other lesion- and patient-related variables was tested by \nmultivariate logistic regression. \nResults: Twenty-two lesions showed a response (partial/complete); absence \nof response was observed in 35 lesions. Interobserver variability of U was low. \nU was significantly lower in responders than in non-responders (p > 0.0001). \nMultivariate analysis (U, lesion size, lesion CT density, bevacizumab-\nassociated chemotherapy scheme, chemotherapy line number) demonstrated \nthat U was the unique predictor of treatment response. Dividing U into tertiles, \nlesions belonging to 1\nst tertile had a 13-folds (p0.02) and 39-folds (p0.001) \nhigher probability of response compared to lesions belonging to 2 nd and 3 rd \ntertile, respectively. Lesion CT density wa s close to a marginally significant \nlevel (p0.06), suggesting that lesions with higher CECT enhancement tend to \nbetter respond to therapy. \nConclusion: Tumour heterogeneity quantified by TA on CECT allowed to \npredict response to bevacizumab-containing therapy in CRC-LM, according to \nRECIST1.1.  \n \n \n \n \n \nS350  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-0991 15:21  \nTexture analysis as a predictive and prognostic biomarker of tumoural \nresponse to neoadjuvant chemoradiotherapy in rectal cancer patients \nstudied with 3 T MR  \nC. De Cecco\n1, B. Ganeshan2, M. Ciolina1, M. Rengo1, D. Bellini1, A. Laghi1; \n1Latina/IT, 2Brighton/UK (carlodececco@gmail.com)  \nPurpose: To determine if T2-weighted MR image texture features of rectal \ncancer can predict tumoral response in patients treated with neoadjuvant \nchemoradiotherapy. \nMethods and Materials:  Fifteen consecutive patients underwent pre- and \npost-treatment (6-8 weeks) MRI performed at 3 T. Treatment protocol \nconsisted of neoadjuvant chemoradiotherapy with oxaliplatin and 5-\nFluorouracile. Texture was assessed within unenhanced axial T2-weigthed \nimages by manually delineating a ROI around the tumor outline for the largest \ncross-sectional area. Heterogeneity within this ROI was quantified using \nTexRAD, a commercially available researc h software algorithm that selectively \nfilters and extracts texture at different anatomic scales (features of 2-6 mm \nradius representing fine to coarse scales) with quantification of kurtosis \n(pointedness of distribution or histogra m) and mean value of positive pixels \n(MPP). Surgical specimens were the gold standard. \nResults: Six patients showed complete pathological response (cPR) and 4 \npatients partial response (PR). Five patients were classified as non-responders \n(NR). A significant difference in basel ine kurtosis was observed between cPR \nin comparison with PR+NR (p=.01). After treatment, a significant difference in \nkurtosis and MPP was observed between cPR and PR+NR (p=.045) and \nbetween cPR+PR and NR (p=.041) respectively. Relative change in kurtosis \nand MPP acted as prognostic biomarkers between cPR and PR+NR (p=0.034 \nand p=0.045 respectively) in addition to between cPR+PR and NR (MPP, \np=0.041). \nConclusion: Texture parameters derived from T2w images of rectal cancer \nhave the potential to act as a predictive and prognostic biomarker of tumoral \nresponse to neoadjuvant chemoradiotherapy.  \n14:00 - 15:30 Room F2  \nBreast  \nSS 1802  \nPEM, PET and novel MRI techniques  \nModerators:  \nA. Selim; Cairo/EG  \nP. Zamecnik; Nijmegen/NL  \nB-0992 14:00  \nHigh specificity and even high sensitivity of positron emission \nmammography (PEM) in diagnosis of breast cancer  \nF.H.H. Müller\n1, A.G. Müller1, M. Hentschel2, J. Farahati3; 1Ludwigshafen/DE, \n2Berne/CH, 3Dorsten/DE (dr.frank.h.h.mueller@t-online.de)  \nPurpose: What will cause the diagnostic performance of PEM, a HR-PET with \nintrinsic resolution of 1.6 mm in detection of breast cancer (B-Ca)? \nMethods and Materials:  PEM was performed in 122 lesions with suspicious \nbreast lesions 90 min after i.v. application of 3.5 MBq F-18-FDG per KG body \nweight. A ROI marked the target lesion, measured by the maximum PEM \nuptake value (PUVmax) and was correlated with a corresponding non-target \nROI in the contra lateral healthy breast determining the target/non-target ratio. \nTwo independent readers analysed images of all 122 lesions and compared \nthe results to histopathology (11 PEM-Biopsies/8 Breast-Cancers) later. The \ngroup analyses for all malignant, benign, corresponding non-target lesions and \nthe mean target/non-target ratio were calculated by paired Student t-Test. \nResults: 22 out of 122 lesions were malignant. Mean of PUVmax was \nmeasured 4.3 ±2.7 in malignant lesions and 1.2 ±0.4 for the contra-lateral \nhealthy breast (p=0.001). The mean target/non-target ratio in patients with B-\nCa of 3.7 ±1.5 was significantly higher compared to benign lesions 1.2 ±0.35 \n(p=0.001). Considering a PUVmax > 1.9, PEM was true-positive in all 22 \ncancers resulting in a sensitivity of 100%, specificity of 97%, PPV of 88% and \nNPV of 100%. Detecting of B-Ca by PEM was at it´s best observed with a \nPUVmax cut-off level of > 1.9 combined with a target/non-target ratio of > 1.4. \nConclusion: PEM detects Breast Cancer with high sensitivity and high \nspecificity. The higher specificity causes a lower rate of biopsies, surgery, \nchemotherapy and costs, therefore a evidence based study will start in \nGermany.  \n \n \n \n \nB-0993 14:09  \nCorrelation of MIB1 proliferation index with quantitative PET and 3 Tesla \nMRI-derived imaging biomarkers  \nK. Pinker-Domenig, P.A.T. Baltzer, H.F. Magometschnigg, G. Wengert, \nM. Bernathova, W. Bogner, G. Karanikas, Z. Bago-Horvath, T.H. Helbich; \nVienna/AT (katja.pinker-domenig@meduniwien.ac.at)  \nPurpose: In recent years, proliferative markers have been broadly evaluated \nas prognostic and predictive factors for early stage breast cancer (BC) patients \nand studies have shown a statistically significant correlation with clinical \noutcome. In clinical practice, proliferation in BC is often assessed through \nimmunohistochemistry (IHC) measurement of MIB1 expression. This study \naimed to determine possible correlations between quantitative biomarkers \nobtained from PET-CT and 3 T MRI and the MIB1 proliferation index. \nMethods and Materials:  In this IRB-approved prospective study, 249 patients \nwith primary BC were included. Before undergoing surgery, all patients \nunderwent 3 T-MRI including ADC measurements of BC lesions. Further, Cho-\nSNR was measured by 1H-MRSI in 62 patients. 134 patients underwent \n18 FDG breast PET-CT and maximum standardised uptake value (SUVmax) of \ntumours was calculated. Cell proliferation of tumours was assessed through \nstandard immunohistochemistry with MIB1. Proliferative activity derived from \nMIB1 was categorised into: 30 high. Approp riate statistical tests were used to \ntest for any association among SUVmax, ADC, SNR and MIB1. \nResults: A significant association between MIB1 of BC and SUVmax was \nidentified (p < 0.001). There was a significant difference of SUVmax for \ntumours with high proliferation compared to medium (p < 0.001) and low \n(p < 0.001) proliferation. There was no significant correlation of MIB1 with both \nADC (p=0.424) and Cho-SNR (p=0.082). \nConclusion: In primary BC, a correlation of MIB proliferation index was found \nfor the imaging biomarker SUVmax with 18 FDG breast PET-CT, but not for \nquantitative imaging biomarkers obtained from 3 Tesla MRI.  \nB-0994 14:18  \nThe role of FUSION between MRI and PET-CT as preoperative staging  \nM. Páramo, R. Zalazar, A. Elizalde, L.J. Pina Insausti, C. Vigil, M. Hernández, \nM. Rodríguez-Fraile; Pamplona/ES (mparamo@unav.es)  \nPurpose: The objective of our study was to compare the sensitivity (SE) and \nspecificity (SP) of preoperative MRI, PET-CT and FUSION between both \ntechniques. \nMethods and Materials:  31 consecutive patients with histologically proven \ninvasive breast cancer and both preoperative MRI and PET-CT were selected. \nAll the PET-CT studies were performed using the breast MRI coil with the \npatient in prone position. We retrospectively evaluated the MRI and PET-CT \nimages blinded to the final diagnosis. The FUSION between MRI and PET-CT \nwas performed using the software TRUE-D. The FUSION images were \ninterpreted in agreement between 2 breast radiologists and 2 nuclear medicine \ndoctors. All the lesions were classified as positive (malignant) or negative for \neach technique and compared with the gold standard (surgery or follow-up). \nThe results were collected using an excel table to calculate the sensitivity and \nspecificity, and the statistical significance was studied using the PEPI software. \nResults: 31 patients with 67 lesions were studied. Out of them, 40 lesions \nwere histologically malignant. The SE and SP for each technique were: MRI \n97.5% and 11.1%; PET-CT 92.5% and 85.2%; FUSION 95% and 96.3%. The \ncomparison between MRI and FUSION showed statistically significance for SP \n(11.1% vs 96.3%; p < 0.05) but not for SE (97.5% vs 95%; p > 0.05). However, \nthe comparison between PET-CT and FUSION showed no statistically \ndifferences (SE: 92.5% vs 95%; SP: 85.2% vs 96.3%; p > 0.05). \nConclusion: The FUSION between MRI and PET-CT significantly increases \nthe specificity of preoperative MRI without decreasing the sensitivity.  \nB-0995 14:27  \nThe value of DWI based on biexponential model in differential diagnosis \nbetween benign and malignant lesions of breast  \nJ. He, Y. Zhang, J. Cheng, Y. Hu; Henan/CN (hejie1988000@163.com)  \nPurpose: To investigate the application value of DWI based on biexponential \nsignal decay modelling with extender b-fact or range in differential diagnosis of \nbenign and malignant lesions of breast. \nMethods and Materials:  A total of 73 patients with breast tumour underwent \nDWI based on the biexponential signal decay model with extended b-factor \nrange (eight b-factors, were 0, 20, 50, 100, 200, 400, 800, 1200 s/mm 2). \nAmong them, benign lesions were found in 35 cases (41 breast tumour, benign \ngroup), while malignant lesions were found in 38 cases (39 breast tumour, \nmalignant group). The value of slow apparent diffusion coefficient, fast \napparent diffusion coefficient and fraction of fast ADC of lesions were \nmeasured on Advantage Windows 4.5 workstation and these parameters were \ncompared if they had statistically significant differences between the benign \nand malignant groups. \nS351  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nResults: ADCslow, ADCfast and f fast were (1.24±0.40) ×10-3 mm2/s, (10.70±8.26) \n×10-3 mm2/s and (15.69 ±3.88)% in benign group. While they were \n(0.80±0.14)×10-3 mm2/s, (13.79 ±7.62)×10-3 mm2/s and (20.02 ±5.79)% in \nmalignant groups. The statistically significant differences of ADC slow and f fast \nwere found among the two groups with comparison, while the statistically \nsignificant differences of ADC fast were not found among the two groups with \ncomparison. \nConclusion: Biexponential signal decay model of DWI with extended b-factor \nrange can provide significant tissue ch aracterisation parameters for differential \ndiagnosis between benign and malignant lesions of breast.  \nB-0996 14:36  \nPeritumoral anisotrophy of the breast cancer on diffusion tensor imaging  \nT.-H. Chang, H.-H. Hsu, G.-S. Huang; Taipei/TW \n(m10708@mail.ndmctsgh.edu.tw)  \nPurpose: Our goal is to demonstrate the anisotropic water diffusion at the \nperiphery of the breast cancer, and to survey the clinical implications. \nMethods and Materials:  To collect breast cancer cases due to preoperative \nassessment from March 2010 to July 2013, we have 22 cases who received \ndiffusion tensor imaging (DTI), and 13 cases were proved to be malignant. We \nanalyse their DTI images and correlate wi th their histopathology, including \nimmunohistochemical (IHC) stains. \nResults: Of these 13 malignant cases, there are 1 case with lymphoma, 4 \ncases with in situ carcinoma, and 8 cases with invasive ductal carcinoma. \nPeritumoral anisotrophy is only identi fied in invasive ductal carcinoma (7/8). \nParametric DTI ( 61, 62, 63, 61-63, FA, MD, ADC) reveals no significant \nrelationship with IHC stains (ER/PR/Her2/Ki67). However, there is relatively \nsignificant finding on a Her2 type case, but it does not demonstrate peritumoral \nanisotropy. \nConclusion: Normal breast tissues (ductal/glandular region) reveal low-to-\nmoderate anisotropy. When a breast tumor develops, it will cause \nfibroglandular tissue less anisotrophy together with peritumoral anisotropy \n(mass effect). DTI seems not to predict the prognosis of breast cancer due to \nno significant relationship with IHC stain. \nB-0997 14:45  \nClinical utilisation of breast diffusion tensor MRI  \nN. Nissan1, M. Feinberg-Shapiro2, N. Weisenberg2, Z. Tanya2, D. Grobgeld1, \nH. Degani1, E. Furman-Haran1; 1Rehovot/IL, 2Kfar Saba/IL \n(noamniss@gmail.com)  \nPurpose: To investigate breast diffusion tensor parameters under various \nhormonal manipulations and to evaluate the ability of these parameters to \ndetect and diagnose breast cancer. \nMethods and Materials: All volunteers were scanned at 3 T using DTI and T2-\nweighted protocols. Patients with breast lesions (n=106) were also scanned \nusing a DCE protocol. Hormonal changes were investigated (n=45) in \npremenopausal women scanned four-times during menstrual-cycle, in lactating \nwomen and in postmenopausal (HRT ±) women. \nResults: DTI parameters of premenopausal healthy volunteers were highly \nsteady along the menstrual cycle, exhibiting low (1-2 %) within-subject \ncoefficient of variance, and high (0.93-0.98) intra-class correlation. Significantly \nlower diffusion coefficients were found in the HRT (-) as compared with \nHRT (+) or premenopausal volunteers, and in lactating volunteers as compared \nwith premenopausal volunteers. All breast lesions were enhanced by DCE but \nvaried in the dynamic features. The DTI parameters: 6 1, 61-63 and ADC were \nsignificantly lower in the cancers than in normal tissue and benign lesions, \nenabling high detection sensitivity. In heterogeneously dense and highly dense \nbreasts DTI detection rate was the same as DCE. However, in highly fatty \nbreasts technical challenges due to inhomogeneous fat-suppression, low S/N \nand EPI distortions impaired DTI utility. \nConclusion: DTI has the potential to serve as a standalone method for \ndetecting breast cancer in patients with moderate to high-dense breasts and \nwhen DCE is prohibited. The timing for performing breast DTI is not restricted \nto a certain phase during menstruation. The modulations in diffusion \nparameters due to HRT and lactation should be taken into account upon DTI \nevaluation.  \nB-0998 14:54  \nBreast MR spectroscopy at 3 T in biopsy proved breast cancers: does \ncholine peak correlate with prognostic factors?  \nM. Luciani, F. Pediconi, M. Telesca, F. Vasselli, V. Casali, A. Castrignanò, \nI. Carpignano, C. Catalano; Rome/IT (marialauraluciani@gmail.com)  \nPurpose: To evaluate the correlation between the presence of choline peak on \nMR spectroscopy at 3 T and prognostic factors in patients with biopsy proved \nbreast cancer. \nMethods and Materials:  Breast MR spectroscopy was performed at 3 T in \npatients with biopsy proved malignant lesions measuring 8 mm or larger at MR \nimaging. Single-voxel MR spectroscopy data were collected from a single \nrectangular volume of interest that encompassed the lesion. MR spectroscopy \nfindings were then compared with histol ogic findings. Lesion size, histotype, \nnuclear grade, receptor status (ER, PgR), and Ki67 and HER2 expression \nwere evaluated. \nResults: 102 patients with BI-RADS 6 lesions (94/102 IDC; 8/102 ILC) were \nevaluated. Choline peak was detectable in 48/102 cases, it was not detectable \nin 54/102. There was a statistically significant association between the choline \npeak and the lesions size (p=0.005). The choline peak was significantly \nassociated with Ki-67 (median value 24.63 ± 21.37, p=0.003). We observed a \nstatististically significant association between choline peak and grade 3 \n(24/102 patients, 23.5%, p=0.001) and between choline peak and HER2 \n(p=0.04). No statistically significant association of choline peak with receptor \nstatus (ER, PgR) and Luminal A, B1 and B2 was detected, as well as, between \ncholine peak and triple negative; although 66.66% of triple negative patients \nwith no detectable choline peak, had lesions with a large central area of \nnecrosis. \nConclusion: 3 T breast MR spectroscopy, can be a tool to predict tumour \naggressiveness and the correlation between choline peak and prognostic \nfactors such as Ki67, HER2 and grading 3, may have a clinical relevance.  \nB-0999 15:03  \nValue of MR-breast elastography as an adjunct tool to MRI to diagnose \nand characterise breast lesions  \nC.S. Balleyguier\n1, A. Ben Lakhdar1, A. Dunant1, M.-C. Mathieu1, S. Delaloge1, \nR. Sinkus2; 1Villejuif/FR, 2Clichy/FR (balleyguier@igr.fr)  \nPurpose: To evaluate the value of MR-Breast elastography (MRE) in \nassociation with standard breast MRI to improve lesion analysis. \nMethods and Materials:  An optimised MRE sequence covering entire breast \nin 10 minutes was developed and applied on 10 healthy volunteers. 50 patients \npresenting an undetermined or suspicious breast lesion (37 cancers, 13 benign \nlesions) were also included in this study. All patients were examined with \nstandard breast MRI (T1w and T2w with fat suppression sequences, dynamic \n3DFSPGR sequence with and without IV gadolinium chelates injection) and \nMRE with a dedicated prototype; Morphologi cal, kinetic and visco-elastic MR \nparameters (Gd, (dynamic modulus: elastici ty), Gl (loss modulus, viscosity) and \ny=Gl/Gd) were correlated to pathology. Specific histological parameters \n(vascular grading, fibrosis, necrosis) were analysed and correlated to visco-\nelastic MR parameters. \nResults: MR visco-elastic properties were strongly correlated with Bi-RADS \nmalignancy score and with malignant and benign status (p=0.02). Gd value \n(stiffness) decreased as BI-Rads score increased. Gl parameter (Loss \nmodulus) was higher in malignant lesions in comparison with benign lesions, \nwith viscosity level statistically higher in  malignant lesions (p=0.02). Ratio y \n(Gl/Gd) was significantly higher in malignant lesions (p=0.002). Addition of \nMRE sequence to standard breast MRI improved significantly breast MRI \nsensitivity (78 to 91 %) without reduction in specificity. MR viscoelastic \nparameters were not significantly linked to specific histological parameters. \nConclusion: MRE may be an adjunct new functional tool to better discriminate \nundetermined or suspicious enhancing lesions on standard breast MRI. \nViscoelastic MR properties may be linked to BI-Rads categories.  \nB-1000 15:12  \nMagnetic resonance electrical impedance mammography: a new \napproach to breast cancer imaging  \nM. Kallergi\n1, J.J. Heine2, E. Wollin3; 1Egaleo/GR, 2Tampa, FL/US, 3Sarasota, \nFL/US (kallergi@teiath.gr)  \nPurpose: The purpose of this study was to investigate the use of magnetic \nresonance electrical impedance mammography (MREIM) for breast cancer \nscreening. We have previously shown that breast MRI specificity could improve \nby combining standard breast MR with a time varying electric field and \nexploiting conductivity differences between normal and malignant breast \ntissue. \nMethods and Materials:  Dedicated phantoms and hardware were developed \nto fit within the stabilisation paddles of a standard MR breast coil. Electrical \nconductivity differences between tissue and tumour-like materials were \nstudied. A theoretical model was developed for the conductive properties of the \ntumour-normal tissue environment within the induced magnetic field. Computer \nsimulations of the perturbed MR acquisition process were then generated and \ncompared to the experimental data. \nResults: A detectable differential signal was produced in phantom areas of \nhigher electrical conductivity by the confluence of a frequency encode effect \nthat manifests as a differential signal across the \"malignancy\" area and a \nphase encode effect that appears as a differential signal about the \n\"malignancy\" border. The signal was generated without gadolinium contrast \ninjection and did not require special image reconstruction. Imaging seems \npossible with an add-on apparatus \"i nvisible\" to the patient without \ncumbersome electrode configurations. Theory and simulation agreed with the \nexperiment. \nS352  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nConclusion: Preliminary results suggest that tissue conductivity combined with \nmagnetic imaging properties could be the new biomarker for breast cancer. \nCurrent work includes the development of durable and compliant phantoms \nwith stable electrical and mechanical prope rties to allow optimisation of the MR \nsequence parameters for this technique.  \nAuthor Disclosures: \nE. Wollin: Patent Holder; MREIM. Other; President, Wollin Ventures Inc. \nB-1001 15:21  \nQuantitative imaging of breast cancer: association between receptor \nstatus, 18 FDG-PET and 3 Tesla MRI using DWI and 3D-MR-spectroscopy  \nK. Pinker-Domenig, H.F. Magometschnigg, P.A.T. Baltzer, M. Bernathova, \nW. Bogner, S. Gruber, Z. Bago-Horvath, G. Karanikas, T.H. Helbich; \nVienna/AT (katja.pinker-domenig@meduniwien.ac.at)  \nPurpose: To determine whether correlations exist between imaging \nbiomarkers such as SUVmax with 18 FDG breast PET-CT or ADC with \ndiffusion-weighted imaging and choline (Cho) SNR with 1H-MRSI of primary \nbreast cancer (BC) lesions and IHC-derived receptor status. \nMethods and Materials:  In this IRB-approved prospective study, 249 patients \nwith primary BC were included. Before surgery, all patients underwent 3 T MRI \nincluding DWI with ADC measurements in all patients. Cho-SNR obtained by \n3D-1H-MRSI was available in 62 cancers. 134 patients underwent 18 FDG \nbreast PET-CT and SUVmax of tumours was calculated. IHC was performed \non a surgical specimen. Appropriate statistical tests were used to test for \npossible associations among ER, PR, HER2 and imaging biomarkers. \nResults: A significant association was found between a triple negative status \nand the SUVmax (p < 0.001) of breast cancer. ER-negative BC (mean \nSUVmax 9.9) demonstrated a significantly higher SUVmax than did ER-\npositive BC (median SUV, 5.1) (p= 0.02). A statistical significant difference was \nfound for SUVmax of PR-negative vs. PR-positive lesions with a mean \nSUVmax of 7.7 and 4.9 (p=0.026), respectively. No such associations were \nfound for ADC and Cho measurements (P \u00030.556). HER2 receptor status did \nnot correlate with any imaging biomarker (P \u00030.252). \nConclusion: Receptor status of BC correlates with SUVmax. ER-negative BC \ndisplays higher 18 FDG uptake than ER-positive BC. Triple-negative BC is \nassociated with increased 18 FDG-uptake commensurate with its aggressive \nbiology. No such associations were found for ADC and Cho measurements \n(P\u00030.556). HER2 receptor status did not correlate with any imaging biomarker \n(P\u00030.252).  \n14:00 - 15:30 Room G/H  \nGenitourinary  \nSS 1807  \nNew frontiers in GU imaging  \nModerators:  \nB. Brkljacic; Zagreb/HR  \nM. Notohamiprodjo; Munich/DE  \nB-1002 14:00  \nAdded value of functional MRI with diffusion-weighted imaging (DWI) and \nADC map in characterisation of undetermined adrenal lesions: \ncomparison with chemical shift imaging  \nC.R.G.L. Talei Franzesi, D. Ippolito, P.A. Bonaffini, O. Minutolo, M. Colombo, \nS. Sironi; Monza/IT (ctfdoc@hotmail.com)  \nPurpose: To assess the diagnostic performanc e of diffusion-weighted imaging \n(DWI) with apparent diffusion coefficient (ADC) value, in the evaluation and \ncharacterisation of indeterminate adrenal lesions. \nMethods and Materials:  From October 2011 to may 2013, a total of 87 \npatients (36 women, 51 men; mean age 56 years; range 31-85 years) with \ndifferent benign and malignant adrenal lesions (adenomas, myelolipomas, \nmetastases and primitive carcinomas) were prospectively evaluated on a 1.5 T \nMRI scan (Achieva, Philips), with a phased array multi-coil, using a \nconventional study protocol that included also the acquisition of DWI \nsequences with b-values of 0, 300, 500 and 1000 mm\n2/sec. DWI were \ncompared with T1 FFE in- and out of phase. Mean ADC values of adrenal \nlesions were calculated, manually drawing a region of interest (ROI) along the \ncontours of adrenal lesion on corresponding maps. Then, obtained data were \ncompared and correlated with chemical shift images and statistical analysis \nwas performed. \nResults: The diagnosis of adrenal lesions was proved either by follow-up \nexaminations (stability or size increase over a period of time) or through \nbiopsy. All adrenal lesions showed restricti on of diffusion and motion of water \nprotons on DWI images. There was no significant difference in ADC values \ncalculated between adenomas (mean value: 1182 ±87.3 mm\n2/sec), \nmyelolipomas (mean value:1245 ±180.6 mm2/sec) and primitive tumours (mean \nvalue:1164±79.2 mm2/sec). The adrenal metastases (mean \nvalue:910±87.5 mm2/sec) presented lower ADC value as compared to the \nother adrenal lesions but not statistical ly significant difference were achieved \n(p> 0.05). \nConclusion: The DWI and ADC map are not useful to differentiate between \nbenign and malignant adrenal lesions, but may be helpful in detection of small \nadrenal lesions. The chemical shift imag ing technique remains the most useful \nsequences for characterisation of indeterminate adrenal lesions.  \nB-1003 14:09  \nElastosonography with transvaginal approach in assessing response to \nMRgFUS treatment of uterine fibroids: preliminary experience  \nC. Marigliano, F. Ciolina, L. Molisso, G. Panzironi, A. Napoli, P. Ricci; Rome/IT \n(chiaram83@virgilio.it)  \nPurpose: To investigate the effects of Magnetic Resonance guided Focused \nUltrasound (MRgFUS) treatment on fibroids as found at multiparametric \nultrasound (US) and real-time elastography (RTE) with transvaginal (TV) \napproach in symptomatic patients. \nMethods and Materials:  Ten women (mean age 34) with 10 uterine fibroids \nwere treated with MRgFUS using ExAblate 2100 device (FDA treatment \nguidelines). All patients performed TV-US before (time0) and after (time1) \nMRgFUS within the same day. Follow-up TV-US was performed after 3 months \n(time2). All patients performed CE-MRI following the same schedule. The \nfollowing features at time0, 1 and 2 were analysed: maximum diameter, color \ndoppler, elastosonography and strain ratio (SR) between fibroids and normal \nmyometrium. \nResults: Four/10 patients had a good response (>  80%), 6/10 partial response \n(< 50%) in terms of NPV (non-perfused volume) as assessed at post treatment \nCE-MRI. Comparing US-parameters as assessed at time0 vs time1, and 2 we \nfound: decrease in color doppler signals in most of the patients (8/10); no \nsignificant difference in maximum diameter comparing time0 to time1 and 2. \nRTE TV-US showed a significant decrease in SR in 2/10 patients at time1 \nfollow-up, while 3/10 had an increase in SR and in 5/10 there were no \ndifference. At time2 follow-up, as compared to time0, 8/10 patients had a \ndecrease of mean SR after treatment. \nConclusion: Elastosonography is a new diagnostic tool usefull for characterise \nfibroids for MRgFUS and can be usefull to assess the efficiency of treatment. \nFurther data are needed to confirm our preliminary findings.  \nB-1004 14:18  \nAssessment of delayed renal allograft function by arterial spin-labelled \nmagnetic resonance imaging: comparison with kidney biopsy  \nK. Hueper, M. Gutberlet, F. Lehner, J.U. Becker, M.J. Peperhove, \nA. Großhennig, F. Wacker, W. Gwinner, D. Hartung; \nHannover/DE (hueper.katja@mh-hannover.de)  \nPurpose: Delayed renal allograft function (DGF) is defined as failure of serum \ncreatinine to decrease or need for dialysis during the first week after \ntransplantation. DGF is associated with an increased risk of graft loss and \nacute rejection. We investigate whether arterial spin labelling (ASL) allows \ndetection of DGF. \nMethods and Materials:  Fourty patients were examined 4-10 days after \nkidney transplantation using a 1.5-T magnet. Flow alternating inversion \nrecovery (FAIR) trueFISP ASL-sequences were acquired and parameter maps \nof renal perfusion were calculated. DGF was diagnosed by a nephrologist. \nRenal biopsy was available in 16/40 patients. Statistical analysis comprised \nunpaired t-tests, ANOVA and correlation analysis. Perfusion values were \nadjusted for recipient age, gender and the day of MRI. \nResults: DGF was diagnosed in 19/40 patients, 42% of them had an acute \nrejection at histology. Patients with DGF were significantly older, donor serum \ncreatinine was higher and cold ischaemi a time was longer. Renal perfusion in \nDGF-patients was significantly reduced to 218 ±18 ml/(min*100 g) compared to \npatients with normal initial graft function (324 ±18 ml/(min*100 g); p < 0.001). In \nthe subgroup of DGF-patients with acute rejection, renal perfusion was even \nlower (180 ±24 ml/(min*100 g)) compared to the subgroup of DGF-patients \nwithout rejection (p < 0.05) and to patients with normal graft function \n(p < 0.001). Renal perfusion correlated with eGFR at the day of MRI and after \n3-months (r=0.69 and r=0.55, respectively). \nConclusion: Non-invasive renal perfusion measurement by ASL allows \ndetection of DGF and renal perfusion signi ficantly correlates with allograft \nfunction. Thus, ASL-MRI may improve diagnosis of patients early after kidney \ntransplantation.  \n \n \n \nS353  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-1005 14:27  \nFunctional evaluation of the kidneys in renal artery stenosis using \ndiffusion tensor imaging  \nC. Gaudiano1, F. Busato1, B. Corcioni1, V. Clementi2, R. Golfieri1; 1Bologna/IT, \n2Milan/IT (caterina.gaudiano@aosp.bo.it)  \nPurpose: To evaluate the capability of the diffusion tensor imaging (DTI) to \ndetect parenchymal involvement in renal artery stenosis (RAS) by measuring \napparent diffusion coefficient (ADC) and fractional anisotropy (FA). \nMethods and Materials:  Seventeen patients with RAS (10 men; mean age \n52.3 years) and 15 patients (9 men; mean age 37.7 years) who did not have \nkidney diseases, were studied with a 1.5 T MRI scanner. RAS was detected \nusing contrast-enhanced magnetic resonance angiography (CE-MRA). In all \ncases, DTI sequence was added to the routine MRI protocol. Cortical and \nmedullary regions of interest (ROI) were placed to obtain the corresponding \nADC/FA values. Normal kidneys constituted the control group and kidneys with \nhaemodynamic RAS ( > 50%) constituted the study group. Student's t test was \nused to compare the mean values of ADC and FA, for each ROI site, between \nthe two groups. \nResults: Mean values of ADC and FA in the control group were: \n2.53±0.16×10\n\u00033 mm2/s for cortical ADC, 2.21 ±0.18×10\u00033 mm2/s for medullary \nADC, 0.31 ±0.062 for cortical FA and 0.39 ±0.055 for medullary FA. There was \nno significant difference between the two kidneys. By using CE-MRA, \nhaemodynamic RAS was detected in 14 patients, bilateral in 2: overall, 16 \nkidneys constituted the study group. The comparison between the two groups \nshowed that medullary ADC and FA in the study group were significantly lower \nthan in the control group ( P=0.034 and 0.022, respectively); there was no \nsignificant difference for the other parameters. \nConclusion: The DTI could be a useful tool in evaluating renal alteration in \nhaemodynamic RAS.  \nAuthor Disclosures: \nV. Clementi: Employee; General Electric Medical Systems.  \nB-1006 14:36  \nMapping of T1 relaxation time for assessment of renal pathology \nfollowing ischaemia-induced acute kidney injury in mice  \nM.J. Peperhove, M. Gutberlet, D. Hartung, M. Meier, S. Rong, S. Tewes, \nF. Wacker, F. Gueler, K. Hueper; \nHannover/DE (Peperhove.Matti@mh-hannover.de)  \nPurpose: Acute kidney injury (AKI) leads to inflammation, tubular necrosis and \nrenal insufficiency. The purpose was to investigate whether T1-mapping allows \nevaluation of renal pathology in a mouse model of ischaemia-induced AKI. \nMethods and Materials:  AKI was induced in C57Bl/6-mice by transient \nclamping of the right renal pedicle for 35 min (n=10, moderate AKI) or 45 min \n(n=7, severe AKI). MRI was performed before surgery and at five time points \nthereafter (d1-d28) using a 7-Tesla magnet. T1-maps were calculated from a \nfat-saturated echoplanar inversion recovery sequence, and mean T1-values of \nrenal cortex, outer and inner medulla were determined. Kidney volume and the \ndegree of tubular injury at histology were assessed in all animals after the last \nMRI. Statistical analysis comprised unpaired t-tests, ANOVA, correlation and \nROC-curve analysis. \nResults: Following AKI, a significant T1-increase, indicating tissue oedema, \noccurred in all anatomical layers at d7 with highest values in the outer medulla. \nCompared to pre-surgery values, T1-values after severe AKI were significantly \nhigher (138 ±2%) than after moderate (121 ±3%, p=0.001), and T1-increase \npersisted until d28 (123 ±4%, p < 0.05). Already at d7, T1-values in the outer \nmedulla negatively correlated with relative kidney volume and positively with \nthe degree of tubular injury four weeks after AKI (r=-0.93 and r=0.87, \nrespectively). ROC-curve analysis revealed that T1-increase > 1525 ms at d7 \npredicts significant tubular injury > 5% after four weeks with sensitivity and \nspecificity of 100% (AUC=1). \nConclusion: T1-mapping allows non-invasive detection of renal damage after \nAKI in mice and predicts further outcome by assessment of tissue oedema and \nstructural abnormalities.  \nB-1007 14:45  \n3 T Diffusion tensor imaging (DTI) in the evaluation of periprostatic nerve \nbundle before and after radiation therapy  \nC. Zini, V. Panebianco, F. Barchetti, D. Musio, V. Forte, C. Catalano; Rome/IT \n(zini.chiara@gmail.com)  \nPurpose: To assess the use of diffusion tensor imaging (DTI) at 3 T for \nevaluating the periprostatic nerve bundle in terms of neuroanatomical \ndistribution, density and relationship with the capsule before and after radiation \ntherapy (RT). \nMethods and Materials:  63 patients with unresectable prostate cancer were \nenrolled. All underwent a prostate Multiparametric-MRI examination at 3 T \nmagnet (Discovery M750, GE) equipped with an endorectal and a surface coil, \nbefore and after 2 months of radiation treatment (35 cycles). Scan protocol \nincluded: a morphological study obtain ed with TSE high-resolution T2-weighted \nsequences on multiple plans, a dynamic study with contrast medium for lesion \nlocalisation, a diffusion study (DWI) with different b values (500.1000,3000) \nand DTI technique (fibre tracking) using a b value of 1000 with 16 directions. \nResults: In all cases before RT it has been possible to display the periprostatic \nnerve bundle in terms of anatomical di stribution, density and distance of the \nnerve fibres from the capsule; after RT we observed a findings' superposition in \n27 patients, partial fibres integrity in 31 patients (fibre loss ranging from 19% to \n35%) and massive rarefaction in 5 patients (fibre loss ranging from 42% to \n59%). These results compared with IIEF-5 test showed a statistically \nsignificative correlation (p < 0.05). \nConclusion: DTI technique allows a complete visualisation of periprostatic \nnerve bundle and plays an important role in evaluating damaged fibres in \npatients who underwent RT.  \nB-1008 14:54  \nDiffusion tensor imaging of the kidney with optimisation of the b value: \nthe initial clinical experience  \nQ. Feng\n1, Z. Ma1, J. Wu2; 1Tianjin/CN, 2Dalian/CN (fengqiang1975@163.com)  \nPurpose: To evaluate the fractional anisotropy (FA), apparent diffusion \ncoefficient (ADC), signal-to-noise ratio, contrast-to-noise ratio, ADC maps of \nMR protocols with different b values and obtain the optimal b value of renal \ndiffusion tensor imaging (DTI) at 1.5 T. \nMethods and Materials:  Twenty healthy volunteers with a mean age of 30 ±6 \nyears were examined with a respiratory-triggered echo-planar DTI sequence of \nthe kidneys at 1.5 T (TR1400 ms; TE, 74-82 ms; 10 slices; slice thickness, \n6 mm with no intersection gap; number of signals acquired, 4; diffusion \nweightings b=0 and 200, 400, 600, 800, 1000 s/mm 2; 6 diffusion directions). \nThe regions of interests were placed in the cortex and medulla on the ADC \nmap using DTI task card software. The FA value, ADC value and signal \nintensity were determined and SNR was calculated with the difference-image \nmethod. Statistical analysis was performed using one-way ANOVA. \nResults: The ADC values of renal parenchyma, cortex and medulla decreased \nat higher b values, similar to the SNR of renal parenchyma, while the FA \nvalues and CNR remained constant at different b values. The ADC values of \nthe cortex were significantly higher than those of the medulla, whereas the FA \nvalues of the cortex were lower than those of the medulla. Image quality of the \nADC map decreased at higher b values, and b values (0 and 400, 600, 800 \ns/mm\n2, respectively) can be applied to evaluate renal DTI. \nConclusion: Renal DTI (with a b value of 0, 600s /mm 2) was appropriate with \ngood cortex-medulla discrimination.  \nB-1009 15:03  \nMultiparametric MRI and state-of-the-art US techniques for the \ncharacterisation of prostate cancer in the setting of MR-US fusion biopsy  \nT. Fischer, C. Stephan, T. Slowinski, A. Thomas, B. Hamm, T. Durmus; \nBerlin/DE (thom.fischer@charite.de)  \nPurpose: To investigate whether multiparametric magnetic resonance imaging \n(MRI) allows lesion localisation in prostate cancer in patients scheduled for \nMR/US fusion biopsy and whether the findings correlate with state-of-the-art \nultrasound in terms of lesion characterisation and guidance of needle \nplacement. \nMethods and Materials:  Fifty consecutive patients with elevated PSA levels \nand a history of at least one negative TRUS-guided biopsy underwent \nmultiparametric 3 T MRI without an endorectal coil. MR Datasets (T2w, DWI) \nwere uploaded into a state-of-the-art ultrasound system (Aplio 500, Toshiba), \nand images were fused in real-time mode during biopsy. Prostate lesions were \nclassified on the basis of MRI (T2w+DWI) and US (B-mode scan, power \nDoppler, elastography/TDI, CEUS) using a 4-point semiquantitative analogue \nscale (not suspicious, 0 - highly suspicious, 3). The maximum sum score was \n15. Targeted biopsies were performed in the MR/US fusion mode followed by a \nstandard TRUS-guided biopsy. \nResults: The detection rate was 40% in the fusion biopsy group versus 22% in \nthe standard TRUS group (p < 0.01). PSA levels were significantly higher in \npatients with prostate cancer. The sum score was higher in the targeted biopsy \ngroup with prostate cancer compared to those whose biopsy was negative \n(11.6±2.7 versus 6.3 ±2.4; p < 0.05). The result correlates with the Gleason \nscore, which increased with the sum score. \nConclusion: Real-time MR/US image fusion may enhance cancer detection \nrates of TRUS-guided biopsies and contributes to lesion characterisation by \nstate-of-the-art US techniques.  \n \n \n \nS354  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-1010 15:12  \nQuantitative Shear Wave ultrasound elastography and multi parametric \nMR imaging performance for prostate cancer detection as a function of \nsize and Gleason score  \nJ.-M. Correas, A. Khairoune, A.-M. Tissier, G. Khoury, O. Hélénon; Paris/FR \n(jean-michel.correas@nck.aphp.fr)  \nPurpose: To prospectively evaluate Shear Wave Elastography (SWE) and \nmulti-parametric MRI (mpMRI) diagnostic performance for prostate cancer \n(PCa) detection and characterisation. \nMethods and Materials:  66 men underwent mpMRI (1.5 T, MR-Discovery, \nGE, USA) and a transrectal SWE examination (AixPlorer, SuperSonic Imagine, \nFrance).Two experienced radiologists independently analysed prostate sextant \nstiffness and mpMRI. Biopsy core pathology (Gleason Score (GS) and PCa \nsize) of corresponding prostate sextants constituted the reference method. The \ndiagnostic performance (sensitivity (Se), spe cificity (Spe), positive predictive \nvalue (PPV), negative predictive value (NPV)) at the sextant level was \ncalculated for SWE and mpMRI considering two PCa populations; PCa1: \nsize\u00033 mm and GS \u00036; PCa2: size \u00039 mm and GS \u00037. For mpMRI, two scenari \nwere considered; for mpMRI1 the test was considered positive in the sextant if \nat least one of T2, Diffusion, and DCE imaging was positive. For mpMRI2, at \nleast two sequences of the three were positive. \nResults: A total of 748 sextants was analysed. 99 PCa foci were detected in \n32 patients for PCa1 patient population, while for PCa2 36 foci were detected \nin 16 patients. The different imaging technique performance are summarised \nbelow (cutoff value of 35 kPa for SWE): PCa1: Se Spe PPV NPV, mpMRI1 \n44% 89% 50% 91%, mpMRI2 37% 93% 45% 91%, SWE 87% 86% 50% 98%, \nPCa2: mpMRI1 72% 87% 33% 98%, mpMRI2 58% 91% 26% 98%, SWE 86% \n98% 18% 99%. \nConclusion: mpMRI exhibited good performance for larger and aggressive \nPCa while SWE provided good diagnostic performance for all PCas.  \nAuthor Disclosures: \nJ.-M. Correas: Speaker; Philips Healthcare, Toshiba Medical System, \nSuperSonic Imagine, Bracco. \n14:00 - 15:30 Room I/K  \nNeuro  \nSS 1811b  \nNeuroinflammation and infectious \ndiseases  \nModerators:  \nE.L. Gasparetto; Rio de Janeiro/BR  \nK.-O. Løvblad; Geneva/CH  \nB-1012 14:00  \nImproved differentiation between MS and vascular brain lesions using \nFLAIR* at 7 Tesla  \nI.D. Kilsdonk\n1, M.P. Wattjes1, J.P.A. Kuijer1, M.C. de Jong1, M.M.A. Conijn1, \nP.R. Luijten2, J.J.G. Geurts1, M.I. Geerlings2, F. Barkhof1; 1Amsterdam/NL, \n2Utrecht/NL (i.kilsdonk@vumc.nl)  \nPurpose: Common question in daily radiology practice is the challenging \ndifferentiation between multiple sclerosis (MS) lesions and white matter (WM) \nlesions of vascular origin. We aimed to investigate the performance of a new \nmagnetic resonance (MR) image contrast called FLAIR*, at differentiating \nbetween MS and vascular brain lesions, at 7 Tesla (T). \nMethods and Materials:  We examined 16 MS patients (10 female, mean age \n50.4 years) and 16 age-matched patients with (risk factors for) vascular \ndisease (6 female, mean age 50.9 years). 3D-FLAIR and 3D T2*-weighted \nimages were combined to generate FLAIR* images. Lesiontype and intensity, \nperivascular orientation and presence of a hypointense rim were analysed. \nDifferences between patientgroups regarding lesion distribution and \nperivascular orientation were tested with Fisher's exact test. In addition, \nsensitivity and specificity of 7T FLAIR* were calculated. \nResults: In total, 433 lesions were detected in MS patients versus 86 lesions \nin vascular patients. Lesions in MS patients were significantly more often \noriented in a perivascular manner: 74% vs. 47% (P < 0.001). 8 MS lesions \n(2.3%) were encircled by a hypointense rim, and 28 MS lesions (5.5%) were \nhypointense on T2*. No vascular lesions showed any rim or hypointensity. \nSpecificity of differentiating MS from vascular lesions on 7T FLAIR* increased \nwhen presence of a central vessel is taken into account (from 63% to 81%), \nmost obviously for deep white matter lesions (from 69% to 94%). \nConclusion: 7T FLAIR* improves differentiation between MS lesions and \nvascular brain lesions based on lesion type, perivascular orientation and \ndistinct morphological characteristics.  \n \nAuthor Disclosures: \nI.D. Kilsdonk: Grant Recipient; Dutch MS Research Foundation (grant. no 11-\n769), Noaber Foundation. M.P. Wattjes: Consultant; Biogen Idec. Speaker; \nBiogen Idec, Bayer Healthcare, Roche, Janssen Cilag. J.J.G. Geurts: \nAdvisory Board; Dutch MS Research Foundation, MS Academics, \nMerckSerono. Board Member; MS International, BMC Neurology. Consultant; \nMerckSerono, Biogen Idec, TEVA. F. Barkhof: Board Member; Brain, \nEuropean Radiology, Radiology, Multiple Sclerosis, Neuroradiology. \nConsultant; Bayer-Schering Pharma, Sanofi-Aventis, Biogen-Idec, TEVA, \nMerckSerono, Novartis, Roche, Synthon BV, Janssen Research. Grant \nRecipient; Dutch MS Society (EU-FP7). Speaker; Serono Symposia \nFoundation. \nB-1013 14:09  \nThe clinical subtype of multiple sclerosis determines the timeline of \ntemporal lobe atrophy - a voxel based morphometry study  \nL.R. Kozák, A. Iljicsov, M. Simó, B. Dániel, G. Rudas, P. Barsi; Budapest/HU \n(lkozak@mrkk.sote.hu)  \nPurpose: Temporal lobe atrophy is associated with the development of \ndisability and cognitive decline in multiple sclerosis (MS). We investigated \nwhether and how temporal gray matter (GM) volume loss depends on the \nclinical course of MS. \nMethods and Materials:  We retrospectively analysed 3 T-acquired contrast-\nenhanced T1-weighted images of 46 patients (32 females, mean age: \n36.2±8.7 yrs, mean disease duration: 57.6 ±50.3 months, mean expanded \ndisability status scale (EDSS): 1.5± 1.8); 7 patients had clinically isolated \nsyndrome (CIS), 19 relapsing-remitting (RR), 9 clinically benign RR (RR-B), 7 \nprimary progressive (PP), and 5 secondary progressive (SP) disease course. \nVoxel based morphometry was performed using the VBM8 toolbox of SPM8 \npackage. Between-group differences were assessed using one-way ANOVAs \nmodeling interactions with EDSS and disease duration, respectively. Age and \ngender served as nuisance variables in all models. Statistical parametric maps \nwere thresholded at p < 0.001 uncorrected, with a cluster-size threshold of 72 \nvoxels. \nResults: EDSS-score and disease duration had very similar strong and \nsignificant positive correl ation across groups (r=0.52, p < 0.0001), thus for \nbrevity we only report the latter, below. The GM volume and disease duration \nrelationship was significantly different in  the temporal lobes, insular cortices, \nand superior temporal gyri bilaterally, and in the left temporal pole and right \nanterior cingulate cortex. The middle temporal and insular cortices of the PP \nand the superior temporal gyri of the RR, RR-B and SP groups showed the \nmost prominent deterioration. \nConclusion: There is differential involvement of the temporal lobes, insulae \nand other areas depending on the clinical course of MS.  \nB-1014 14:18  \nAssociation of MR findings and serum bilirubin and uric acid levels \nchanges during neuroinflammation in patients with initial and relapsed \ndemyelisation attacks  \nD. Stojanov, S. Ljubisavljevi\u0011, S. Vojinovi\u0011, I. Stojanovi\u0011; Nis/RS \n(drstojanov@gmail.com)  \nPurpose: To examine the endogenous antioxidants values in the earliest \nphase of demyelisation, we have determined bilirubin and uric acid (UA) serum \nvalues in the patients with clinically  isolated syndrome (CIS) and relapsing \nremitting multiple sclerosis (RRMS), regarding their clinical disability, measured \nby Extended Disability Status Scale (EDSS) and magnetic resonance imaging \n(MRI) disease activity. \nMethods and Materials:  The cross-sectional study included 50 CIS patients, \naged 17-57 years, 57 RRMS patients, aged 23-58 years, and 20 control \npatients, aged 23-45 years with non-specific neurological symptoms. All CIS \nand RRMS patient's clinical presentations were assessed using EDSS. The \nnumber of T2W hyperintense lesions and the lesion load of Gd-enhancing \nlesions on T1W images were calculated. The lesion loads were calculated to \nvolumes. Serum total bilirubin, direct bilirubin and indirect bilirubin \nconcentration as well as UA serum values were measured. \nResults: Obtained values of bilirubin and UA were higher in patients with lower \nMRI lesion number, lower EDSS, and shorter disease duration (p < 0.05). The \nresults suggest negative linear correlation between bilirubin and UA levels and \nMRI findings, disease duration, and EDSS in CIS (p < 0.01), with the same \ncorrelation between bilirubin and UA levels and disease duration in RRMS \npatients (p < 0.01). There was also significant correlation between bilirubin \nlevel and MRI findings and UA levels and EDSS in RRMS patients (p < 0.01). \nConclusion: There is a negative linear correlation between bilirubin and UA \nlevels and MRI findings in CIS as well as significant correlation between \nbilirubin level and MRI findings in RRMS patients.  \n \nS355  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-1015 14:27  \nLongitudinal DTI changes in multiple sclerosis patients with different \ncortical reorganisation patterns  \nS. Kulikova, A. Peresedova, V. Bryukhov, O. Trifonova, M. Krotenkova, \nI. Zavalishin; Moscow/RU (kulikovasn@gmail.com)  \nPurpose: To investigate longitudinal changes of diffusion-tensor imaging (DTI) \ndata in relapsing-remitting multiple sclerosis (RRMS) patients with different \ncortical reorganisation patterns. \nMethods and Materials:  25 patients with RRMS (7 men), all right-handed, \naged 19-50, underwent MRI (Avanto1.5 T, Siemens) during relapse with \nunilateral light hand palsy, in three and twelve (20 of 25 patients) months after \nit. Scanning protocol included functional MRI (fMRI) and DTI sequences. FMRI \nwas performed using simple movement paradigm for both hands. DTI data \nwere assessed in regions of interest:corticospinal tract (CST) - pons, \npeduncles and internal capsules (IC) level; splenium (SCC) and motor area of \ncorpus callosum (MACC). \nResults: Differently directed changes of primary sensorimotor cortex (SMC) \nfunctional activity during relapse allowed us to divide all patients into two \ngroups: the first one with decrease of SMC activation on palsy-corresponding \nside in comparison with opposite one (volume ratio (VR) range 0.22-0.79) and \nthe second one with the increase (VR range 1.17-6.19). During relapse these \ngroups differed by DTI indices in CST on the pons level, the first one also had \nasymmetrical decrease of deep sensitivity on palsy hand (Mann-Whitney U \ntest, p < 0.05). In the follow-up, the first group was characterised by DTI \nchanges in palsy-corresponding medial lemniscus, CST on IC level and SCC, \nthe second group - in palsy-corresponding CST on pons and peduncles level \nand in MACC (repeated measures ANOVA; Newman-Keuls post-hoc test, \np < 0.05). \nConclusion: RRMS relapse with similar palsy but different sensitivity \nimpairment is characterised by contrary cortical reorganisation patterns, which \nare associated with different specific longitudinal structural changes, probably \ndue to initially different pathologic mechanisms.  \nB-1016 14:36  \nUpdate on CNS complications after allogeneic bone marrow transplant  \nM. Díez Blanco, E. López Uzquiza, M. Drake Pérez, J. Navasa Melado, \nE. Marco de Lucas; Santander/ES (maria.diez.blanco@gmail.com)  \nPurpose: 1. To stand out the importance to know the different states of \nimmunosuppresion after a bone marrow transplant (BMT), in order to establish \na proper clinical-radiological correlation. 2. To review the main neuroimaging \nfindings of CNS complications observed after BMT. \nMethods and Materials:  We review the neurological complications in 935 \npatients who had received an allogeneic bone marrow transplantion at our \nhospital in the past 12 years. We analysed the neuroimaging findings (CT and \nMRI) of forty-three patients with neurologic complications and their clinical and \nautopsy correlation. \nResults: The main neurologic CNS complications observed were: a) infections: \nincluding viral (12 patients: EBV, CMV, HHV6), bacterial caused by \nPneumococcus in 3 cases, Toxoplasmosis in 2 cases, fungal (2 patients with \nAspergillus, Scedosporium); b) neoplasm recurrence (9 patients); c) toxic (3 \npatients); d) vascular complications in 6 patients including subarachnoid \nhaemorrhage, ischaemic strokes and TTP. \nConclusion: Over the last few years, there has been a significant decrease in \nmortality and complications of BMT. It is essential to carry out a successful \nclinical-radiological correlation to make a proper diagnostic orientation. Viral \ninfections are one of the biggest diagnostic challenges because MRI findings \nare often subtle alterations and quite different from the usual lesions described \nin immunocompentent patients.  \nB-1017 14:45  \nEvaluation of brain vascularity and perfusion in TB meningitis using \nMRA/MR perfusion imaging  \nK. Rahmat, F. Abu-Bakar, N. Ramli, S. Tai, C. Tan; Kuala Lumpur/MY  \n(katt_xr2000@yahoo.com)  \nPurpose: Cerebral vasculitis is one of the complications of tuberculous \nmeningitis (TBM). Cerebral infarctions in TBM commonly affect the basal \nganglia, thalamus and the internal capsule.The aim of this study is to evaluate \nthe imaging features, vasculitic changes and perfusion of the infarcted brain \nregions in TBM comparing with the contralateral normal region/healthy \nsubjects. \nMethods and Materials:  A prospective study of newly diagnosed TBM \npatients was undertaken between March 2012-September 2013. Standard 3 T \nbrain MRI sequences (T1W, T2W, Flair, DWI, GRE), TOF MRA) and MR \nPerfusion (Dynamic susceptibility contrast enhanced MR perfusion) were \nperformed at the time of diagnosis. \nResults: A total of 8 patients were enrolled. Leptomeningeal and basal \ncisterns enhancement and tuberculomas were demonstrated in all patients. \ncerebral infarctions were demonstrated in 6 patients, with similar occurrence of \ninfarction in what has been described as 'TB zone', referring to the heads of the \ncaudate nuclei, anteromedial thalami and internal capsules.All patients \ndemonstrated vasculitis in the anterior or posterior circulations.All patients \ndemonstrated vasculitis in the anterior circulations mainly involving the M1, M2 \nand A1 segments. Vasculitis in the anterior and posterior circulations was \nobserved in 3 patients. Acute obstructive hydrocephalus was present in 6 \npatients. MR perfusion study in 4 patients with acute infarctions showed \nsignificantly low rCBV and rCBF and increased MTT. \nConclusion: Vascular abnormality mainly affected the middle cerebral, \nanterior cerebral and supraclinoid internal carotid arteries. Area of acute \ninfarctions shows significant reduction in rCBV and rCBF with prolonged MTT \ncompared to the contralateral normal regions.  \nAuthor Disclosures: \nK. Rahmat: Grant Recipient; RG390/09H\nTM. F. Abu-Bakar: Grant Recipient; \nRG390/09HTM. N. Ramli: Grant Recipient; RG390/09HTM. \nB-1018 14:54  \nDiffusion-weighted tractography to reconstruct the optic radiation in \nsupport of temporal lobe epilepsy surgery  \nS.P.L. Meesters1, P.P.W. Ossenblok2, B.M. ter Haar Romeny1, O. Schijns3, \nL. Wagner2, P. Hofman2, A. Vilanova1; 1Eindhoven/NL, 2Heeze/NL, \n3Maastricht/NL  \nPurpose: Surgical resection of drug-resistant temporal lobe epilepsy (TLE) \nleads most pf the candidates to seizure relief. However, disruption of the optic \nradiation (OR) leads to a visual field deficit (VFD). Diffusion-weighted \ntractography was applied to reconstruct the OR and pre-operatively predict the \nVFD. Methodological improvements were made to provide the most reliable \nreconstruction and its plausibility was evaluated. \nMethods and Materials: Diffusion tensor imaging (DTI) is of limited use due to \nits inability to resolve crossing fibers. Constrained spherical deconvolution \n(CSD) can describe multiple orientations from the fiber orientation density \nfunction. To correct for echo-planar imaging (EPI) distortions, an unwarping \nmethod using two-phase encoding directions was evaluated against the \nfieldmap method for healthy volunteers (n =4). The post-operative damage to \nthe OR in relation to the resection area was compared to pre-operative \nreconstructions for TLE surgery candidates ( n=3). \nResults: Reconstructions of the OR with CSD were better described by the \nunderlying diffusion data. The estimat ed EPI distortions using the two-phase \nencoding direction method showed a shift of distance of the temporal pole to \nthe anterior extent of the OR in the order of 1 cm. Pre- to post-operative \ncomparisons indicated a good correlation between expected and observed \ndamage to fibers. The presented results are visualised using a 3D smart \nimage. \nConclusion: Significant shifts due to distortions were observed, demonstrating \nthe importance of correction. In the absence of a ground truth, pre- to post-\noperative comparison allows validation of the reconstruction of the OR, useful \nfor preoperative prediction of VFD.  \nB-1019 15:03  \nComparative evaluation of fungal and pyogenic brain abscesses with \nsusceptibility-weighted imaging  \nR. Antulov\n1, K. Dolic2, J. Fruehwald-Pallamar3, D. Miletic1, M.M. Thurnher3; \n1Rijeka/HR, 2Split/HR, 3Vienna/AT (ronald.antulov@ri.htnet.hr)  \nPurpose: Conventional MRI techniques are inadequate to determine the \ncausative agent of brain abscesses. We investigated the value of susceptibility-\nweighted imaging (SWI) in the differentiation of fungal and pyogenic brain \nabscesses and the effect of field strength (1.5 T versus 3 T) in SWI for the \ndetection of specific imaging characteristics of brain abscesses. \nMethods and Materials:  MRI studies of 10 patients with pyogenic and 6 \npatients with fungal brain abscesses were reviewed. Ten patients underwent \nexaminations on a 3 T scanner and six patients on a 1.5 T scanner. Imaging \ncharacteristics on conventional MRI, diffusion-weighted imaging (DWI) and \nSWI were recorded in all abscesses. All lesions were assessed for the \npresence of a \"dual-rim sign\" on SWI. \nResults: Homogeneous hyperintensity on DWI was present in 88% of \npyogenic abscesses, but in only 7.1% of fungal abscesses. On SWI, 94% of \npyogenic abscesses had a complete low signal intensity rim, while 17.9% \nfungal abscesses showed a complete low signal rim. On a 3 T scanner, the \n\"dual-rim sign\" was apparent in all pyogenic abscesses. None of the pyogenic \nabscesses or any of the fungal abscesses were positive for a \"dual-rim sign\" on \na 1.5 T scanner. \nConclusion: In fungal abscesses, the \"dual-rim sign\" is not present, but rather, \na prominent peripheral rim or marked central susceptibility effects will be seen. \nThe appearance of pyogenic abscesses on SWI depends on the field strength, \nwith the \"dual-rim sign\" a specific feature of pyogenic brain abscesses on a 3 T \nscanner.  \n \nS356  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-1020 15:12  \nBrain involvement in patients with inflammatory bowel disease: a voxel-\nbased morphometry and diffusion tensor imaging study  \nA. Zikou, M. Kosmidou, L. Astrakas, L. Tzarouchi, E. Tsianos, \nM.I. Argyropoulou; Ioannina/GR (anzikou@cc.uoi.gr)  \nPurpose: Investigation of structural brain changes associated with \ninflammatory bowel disease (IBD) by assessing the presence of white-matter \nhyperintensities (WMHIs) and applying voxel-based morphometry (VBM) and \ntract-based spatial statistics (TBSS) methods. \nMethods and Materials:  Brain magnetic resonance imaging (MRI) was \nperformed on 18 patients with IBD aged 45.16 ± 14.71 years and 20 aged-\nmatched control subjects. The imaging protocol consisted of a sagittal fluid-\nattenuation-inversion-recovery (FLAIR), a T1-weighted high-resolution 3-\ndimensional spoiled gradient-echo sequence, and a multisection spin-echo \nplanar diffusion-weighted sequence. Differences between patients and control \nsubjects in brain volume and diffusion indices were evaluated using the VBM \nand TBSS methods, respectively. The presence of WMHIs was evaluated on a \nsagittal FLAIR sequence. \nResults: VBM revealed decreased grey matter (GM) volume in patients with \nIBD in the fusiform and the inferior temporal gyrus bilaterally, the right \nprecentral gyrus, the right supplementary motor area, the right middle frontal \ngyrus and the left superior parietal gyrus (p < 0.05), but no significant \ndifference was observed in white matter (WM) volume. TBSS showed \ndecreased axial diffusivity (AD) in the right corticospinal tract and the right \nsuperior longitudinal fasciculus in the patients with IBD compared to the control \nsubjects, and a larger number of WMHIs was observed in the patients \n(p < 0.05). \nConclusion: Patients with IBD show an increase in WMHIs and GM atrophy, \nprobably related to cerebral vasculitis and ischemia. Decreased AD in their \nmajor WM tracts could be a secondary phenomenon, representing Wallerian \ndegeneration.  \nB-1021 15:21  \nPreserved white matter integrity is a marker of familial longevity  \nI. Altmann-Schneider, A. de Craen, I. Veer, A. van den Berg-Huysmans, \nP. Slagboom, R. Westendorp, M. van Buchem, J. van der Grond; Leiden/NL \n(I.Altmann-Schneider@lumc.nl)  \nPurpose: Brain tissue integrity is highly heritable. Its decline is a common \nageing phenomenon. This study aimed to determine whether the phenotype of \nfamilial longevity is marked by a relative preservation of brain tissue \nmicrostructure. \nMethods and Materials:  Participants came from the Leiden Longevity Study. \nIn total, 185 elderly offspring of nonagenarian siblings, who are enriched for \nfamilial factors of longevity, were contrasted with 171 environmentally and age-\nmatched controls. All subjects underwent 3 T whole brain MR diffusion tensor \nimaging. \nResults: Voxel-wise analysis revealed widespread age-related decrease of \nwhite matter fractional anisotropy and increase of axial, radial and mean \ndiffusivity (all p < 0.003). Offspring showed higher mean white matter fractional \nanisotropy (Mean (SE): offspring: 0.3232 (0.0009); controls: 0.3212 (0.0009), p \n= 0.04) compared to control subjects independent of cardiovascular risk \nfactors. When differences in white matter diffusion parameters between \noffspring and control subjects were assessed voxel-wise, offspring showed \nhigher white matter fractional anisotropy and lower white matter radial \ndiffusivity predominantly in the callosal genu and body (both p < 0.003). Taking \nthe effect of chronological age on white matter microstructure into account, \noffspring can be considered 4.5 years \"biologically younger\" compared to \ncontrol subjects concerning white matter integrity. \nConclusion: Both elderly offspring of nonagenarian siblings and control \nsubjects show common age-related decline of white matter integrity, which is \nless marked in the callosal genu and body among the offspring, corresponding \nto a biological age benefit of 4.5 years.  \nAuthor Disclosures: \nA. de Craen: Grant Recipient; Grant. P. Slagboom: Grant Recipient; Grant.  \n14:00 - 15:30 Room L/M  \nPhysics in Radiology  \nSS 1813  \nAdvances in digital x-ray imaging  \nModerators:  \nH. Bosmans; Leuven/BE  \nS.J. Foley; Dublin/IE  \nB-1022 14:00  \nDigital subtraction angiography: can we reduce the dose maintaining \nenough image quality?  \nH. de las Heras\n1, J. Fernández Soto1, R. Torres2, I. Hernando2, \nE. Vañó Carruana1; 1Madrid/ES, 2Valladolid/ES (hugo.heras@daad-alumni.de)  \nPurpose: Suggest a practical method for dose optimisation in digital \nsubtraction angiography using three different kinds of phantoms. \nMethods and Materials:  Series of images using digital subtraction \nangiography were obtained in two different angiography systems for two \ndifferent patient thicknesses simulated by PMMA plates. Three commercially \navailable phantoms (following IEC/German, British and NEMA standards) were \nused to assess the features of digital subtraction: mask creation and \nlogarithmic subtraction, dynamic range and contrast sensitivity. In addition, \nimage quality was quantified using measur ements of signal-difference-to-noise \nratio (SDNR). Phantom entrance dose was measured with both an ionisation \nchamber and a solid-state detector. \nResults: Available phantoms can be used for quality control of the digital \nsubtraction and simultaneously for the quantification of image quality and \nconsequent dose optimisation. For the IEC-DIN phantom, visibility of 5 mg \nIodine per ml of contrast at a vascular diameter of 1 mm within homogeneous \nbackground was identified with SDNR > 0.20 for a phantom entrance air kerma \nof 0.43 mGy/image. Equivalent thresholds were found for the British standard \nphantom and for the NEMA phantom. Similar thresholds for other contrast \nconcentrations can be used to pre-define exposure modes, which may be \nchosen by the radiologist during the procedure depending on the imaging task. \nConclusion: Dose optimisation of devices featuring digital subtraction can be \ncarried out with a single dedicated phantom. The exposure modes can be \nadjusted to tasks of different complexity by simultaneous measurement of dose \nand quantification of image quality.  \nAuthor Disclosures: \nH. de las Heras: Consultant; QUART GmbH.  \nB-1023 14:09  \nComparison of image quality and radiation dose measurements between \nan image-intensifier system and a solid-state detector system  \nM. Weidner, C. Hagelstein, T. Diehm, S.O. Schönberg, K.W. Neff; \nMannheim/DE (Meike.Weidner@medma.uni-heidelberg.de)  \nPurpose: To compare image contrast, image resolution and radiation dose \nbetween an image-intensifier based system and a solid-state detector based \nsystem both used in a paediatric radiology unit. \nMethods and Materials:  Using a technical phantom (Primus DL, IBA, \nGermany) two imaging systems---a conventional image-intensifier system \n(Philips Easy Diagnost, Philips Healthcare, The Netherlands) and a new solid-\nstate detector system (Luminos Agile, Siemens Healthcare Sector, Germany)--\n-were compared. Dosimetry was performed by an ion chamber and by the \ndose area product. Image contrast and image resolution were evaluated \nvisually by comparing the number of detectable contrast objects and the \nnumber of line pairs per millimetre (lp/mm), respectively. Two different modes--\n-a fluoroscopic (20 sec exposure time, 3 pulses per sec, 5 measurements) and \na radiographic mode---were compared in all possible magnifying steps. \nResults: Image contrast was equal in both systems. Image resolution was \nincreased by the solid-state detector system in comparison to the image-\nintensifier system both in the fluoroscopic mode (1.5 lp/mm vs. 1.3 lp/mm) and \nthe radiographic mode (1.9 lp/mm vs. 1.3 lp/mm). Radiation dose was reduced \nby the solid-state detector system in fluoroscopic mode (0.9 vs. 2.7 mGy, \np < 0.0001) and in radiographic mode (0.4 vs. 2.2 mGy). Radiation dose \nreduction measured by the radiation dose area product was equivalent. \nConclusion: With the new solid-state detector system an equal image \ncontrast, higher image resolution and a lower radiation dose can be achieved \nin comparison to the conventional image-intensifier system. The solid-state \ndetector system is therefore preferred for use in paediatric radiology.  \nAuthor Disclosures: \nM. Weidner: Equipment Support Recipient; Cooperation with Siemens \nHealthcare Sector. T. Diehm: Equipment Support Recipient; Cooperation with \nSiemens Healthcare Sector. S.O. Schönberg: Equipment Support Recipient; \nCooperation with Siemens Healthcare Sector. K.W. Neff: Equipment Support \nRecipient; Cooperation with Siemens Healthcare Sector. \nS357  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-1024 14:18  \nComparative study of the corrosion behaviour of peripheral stents in a \naccelerated corrosion model: experimental in vitro study of 28 metallic \nvascular endoprostheses  \nK.J. Kutter, P.M. Paprottka, M.F. Reiser, T. Waggershauser; \nMunich/DE (karolin.kutter@med.uni-muenchen.de)  \nPurpose: Clinical cases of stent-fractures caused by corrosion show that the \nselection of stents due to their corrosion behaviour might play a role. Implanted \nin vivo, especially in combination with other implanted foreign-materials, stents \nare exposed to special conditions, which can cause a process of corrosion. \nMethods and Materials:  28 peripheral stents of different materials (nitinol, \ncobalt-chromium-nickel, tantalum, V4 A) and surface treatments (electro-\npolishing, mechanical-polishing, without polish) were tested in vitro. Corrosion \nwas accelerated by applying a constant voltage of 3.5 volts and amperage of \n1.16 mA in 0.9% NaCl. At defined points-of-time, the stents were investigated \nfor macroscopic and microscopic damage. \nResults: Nitinol stents showed the lowest susceptibility to corrosion and the \nlongest period without damage. The Memotherm II was the only stent that \nshowed neither macroscopic nor microscopic damages. The worst material \nwas cobalt-chromium-nickel. Here corrosion damages already occurred about \n1/10 earlier compared to nitinol. Considering the reasons for determination of \nthe test nitinol stents primarily showed length deficits, V4 A and tantalum stents \nmainly fractures. Cobalt-chromium-nickel stents had half a fraction in multiple \nparts or a complete lysis. Placed in direct contact nitinol stents came out on \ntop, regardless of what material they were combined with. Testing the influence \nof polishing treatments, electro-polished stents performed best, mechanical-\npolished and stents without polishing treatment followed. \nConclusion: All available stents are actual a compromise on advantages and \ndisadvantages. The analysis of the corrosion behaviour is thus a necessary \nbasis to provide a large number of different stents to fulfill the individual needs \nof patients.  \nB-1025 14:27  \nRadiation doses to patients in interventional cardiology procedures  \nL. Sukupova; Prague/CZ (lucie.sukupova@ikem.cz)  \nPurpose: A number of procedures in cardiology are performed under \nfluoroscopy control with cine series, e.g. coronary angiography (CA), \npercutaneous transluminal coronary angioplasty (PTCA), closure of patent \nforamen ovale (PFO), implantation of pacemakers (PM) and implantable \ncardioverter-defibrillators (ICD), but also electrophysiological procedures \n(RFA). It is not long ago when transcatheter implantations of aortic valve \n(TAVI) began. This study provides information about radiation burden of \npatients undergoing mini-invasive cardiological procedures. \nMethods and Materials:  All procedures except implantation of PM and ICD \nwere performed on angiography x-ray systems (2005-2012) which provides the \nradiation dose structured report useful for assessment of patient doses. \nImplantations of PM and ICD are performed on a different x-ray system, \nproviding only total PKA and fluoroscopy time. For patient's dose assessment, \nonly PKA values were used. In this study, a following number of patients were \nincluded: CA-517, CA+PTCA-157, PFO-13, PM-94, ICD-94, RFA-250, TAVI-\n22. The CA group includes not only patients with coronary angiography, but \nsometimes left ventriculography was a part of exam. The RFA group includes \npatients treated for atrial fibrillation, atrial flutter, and other. \nResults: Average values of PKA (Gy.cm2) are as follows: CA-39 Gy.cm2, \nCA+PTCA-94 Gy.cm2, PFO-21 Gy.cm2, ICD-26 Gy.cm2, PM-17 Gy.cm2, \nRFA-10 Gy.cm2, TAVI-249 Gy.cm2. \nConclusion: Highest doses are associated with TAVI and lowest with RFA. \nAccording to the number of procedures performed annually, doses from \nCA+PTCA most significantly contribute to the collective effective dose.  \nB-1026 14:36  \nEuropean skin-dose trigger levels for interventional radiology and \ncardiology procedures  \nA. Trianni\n1, J. Farah2, E. Carinou3, J. Dabin4, J. Domienik5, H. Järvinen6, \nA. Negri7, L. Novak8, Z. Knezevic9; 1Udine/IT, 2Fontenay-aux-Roses/FR, \n3Athens/GR, 4Mol/BE, 5Lodz/PL, 6Helsinki/FI, 7Padova/IT, 8Prague/CZ, \n9Zagreb/HR (trianni.annalisa@aoud.sanita.fvg.it)  \nPurpose: The large use of fluoroscopy in interventional radiology procedures \nmay induce unintended patient skin injuries. To help physicians and staff \nrecognise and avoid situations at risk, trigg er levels based on online dosimetric \nindicators, available on most of the new angiography equipment, have been \nintroduced. However, such trigger levels are usually centre and procedure \ndependant. This work aims to evaluate the feasibility of establishing a \nEuropean set of trigger levels for high-risk interventional procedures. \nMethods and Materials:  Within EURADOS WG12 9, European countries \nperformed measurements in clinical settings to evaluate the correlation \nbetween maximum skin dose (MSD) and cumulative air kerma (CK) at the \nreference interventional point. This easy-to-use method provides the staff with \nreal-time MSD estimates. The study focused on the PTCA (coronary \nangioplasty), NE (neuroembolisations) and CE (chemoembolisations) \nprocedures which extensively use x-rays. \nResults: The MSD showed good correlation with CK for the evaluated \nprocedures despite the multiple factors affecting MSD including skin dosimetry \nuncertainties, operator's experience and methodology. Two provisional \nEuropean trigger levels have been established: 5.5 Gy for CE and 2.5 Gy for \nNE which indicate a 3 Gy skin dose. Trigger level for PTCA is still under \nevaluation. \nConclusion: Trigger levels are still a necessary tool, until real-time dose \nmapping systems become available on angiographic equipment to identify \nsituations associated with high probability of exceeding the dose threshold for \ndeterministic effects. Future steps will include extending the work to other \nradiology procedures pooled depending on their tube projections, field of view \nand equipment protocols.  \nB-1027 14:45  \nMonte Carlo reference data sets for imaging research: results of the \nAmerican Association of Physicists in Medicine (AAPM) task group no. \n195  \nI. Sechopoulos\n1, E. Ali2, A. Badal3, A. Badano3, J. Boone4, E. Mainegra-Hing2, \nK.L. McMillan5, D.W.O. Rogers2, A. Turner5; 1Atlanta, GA/US, 2Ottawa, ON/CA, \n3Silver Spring, MD/US, 4Sacramento, CA/US, 5Los Angeles, CA/US \n(isechop@emory.edu)  \nPurpose: To develop a set of reference Monte Carlo simulations relevant to \ndiagnostic imaging research for use by researchers needing to validate their \nown simulations. \nMethods and Materials:  Complete details of six different Monte Carlo \nsimulations relevant to x-ray diagnostic imaging have been developed and \nimplemented using four well-established software packages (EGSnrc, Geant4, \nPenelope and MCNP). The simulations implemented are: x-ray half value layer \ncharacterisation; dosimetry and x-ray scatter in radiography, mammography, \nbody and breast tomosynthesis; dosimetry in body CT; and x-ray production. \nResults obtained with the four software packages were compared. The Task \nGroup report includes complete details of the simulation conditions and all \nresults. \nResults: Excellent agreement was found among the four implementations of \nall six simulation conditions. The simulation of x-ray production showed the \nlargest differences among the different codes due to the complexity of the \nphysics involved and the many physics parameter options available in each \ncode. During implementation of the simulations, many lessons were learned on \ndifferences in interpretation of simulation conditions and behaviour of the \nsoftware packages. These are included in the Task Group report. The relative \nefficiency of the codes varied considerably. \nConclusion: When simulation conditions were equivalent, results obtained \nwith the four Monte Carlo packages tested were consistent. However, ensuring \nthat all simulation conditions match is not straightforward. The publication of \nthe details of all simulation conditions and results will be useful to other \nresearchers who need to validate their own Monte Carlo simulation software.  \nB-1028 14:54  \nQuantitative assessment of the spatial dependence of non-stationary \nhigh-contrast spatial resolution, low-contrast detectability, and noise \nbehaviour in 3D imaging of the breast  \nC. Steiding, D. Kolditz, A.-C. Roessler, W.A. Kalender; \nErlangen/DE (christian.steiding@imp.uni-erlangen.de)  \nPurpose: To investigate the dependence of objective image quality (IQ) \nmetrics on direction and position in th e 3D volume for breast tomosynthesis \n(BT) and breast computed tomography (bCT). \nMethods and Materials: In addition to standard IQ procedures, we focused on \nassessing physical imaging performance in the central and the peripheral field \nof measurement (FOM) in radial, azimuthal, and axial direction. Two \nhomogeneous tissue-equivalent phantoms mimicking compressed and \npendant female breasts were designed and equipped with identical test inserts. \nFor the evaluation of in-plane and axial resolution, 3D low-contrast \ndetectability, and spatially-dependent noise behaviour, the modulation transfer \nfunction's 10% value (MTF10%), slice sensitivity profile's full width at tenth \nmaximum, object size-dependent contrast-to-noise ratio (CNReff), and local \nnoise power spectra (NPS) were determined. Measurements were carried out \non a clinical BT and a prototype high-resolution bCT system at comparable \ndose levels. \nResults: Both modalities showed MTF10% > 5 lp/mm in the center and \nspatially asymmetric noise behaviour of local volumes through 3D NPS \nestimation. Massive discrepancies between in-plane and axial system \nresponse was determined in BT, while bCT featured isotropic resolution. In BT, \nthe smallest low-contrast insert (2 mm) was not revealed in the center, as \nindicated by CNReff <  5. For bCT, CNReff was significantly higher and all low-\ncontrast structures were visible regardless of their position. \nS358  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nConclusion: Assessing only transverse system response in the central FOM \nappears to be insufficient since resolution, image contrast, and noise depend \ncritically on direction and position.  \nAuthor Disclosures: \nC. Steiding: Employee; CT Imaging GmbH. D. Kolditz:  Employee; CT \nImaging GmbH. W.A. Kalender: CEO; CT Imaging GmbH. Founder; CT \nImaging GmbH. \nB-1029 15:03  \nEvaluation of DNA damage induced by total body CT scans  \nN. Della Vecchia, F. Giurazza, R. Del Vescovo, B.B. Zobel; Rome/IT \n(nico.dvecchia@libero.it)  \nPurpose: The cellular damage induced by ionizing radiation has been \npreviously quantified analyzing the DNA double strand breaks (DSBs) in \nlymphocytes through the rate of 3-H2 AX phosphorylated histone protein. We \naimed to demonstrate and quantify molecular damage induced from ionizing \nradiation by evaluating t he expression of histon 3-H2 AX in lymphocites of \npatients who underwent CT scan evaluation. \nMethods and Materials:  30 patients (15 males, 15 females) underwent full-\nbody CT scan for oncological diseases. The mean radiation dose delivered \nwas 101.63 mGy. Three blood samples have been taken for analysis: \nimmediately before the emission of radi ation (T0), 15 minutes and 30 minutes \nafter the beginning of the exam (T1 = T0 +15 min, T2 = T0+ 30 min). Cell \npreparations were afterwards examined with FACS (fluorescence-activated cell \nsorting). \nResults: At T1, in 90% of cases, we identified the presence of cell damage in \nterms of increased expression of 3-H2 AX of about 27%. At T2, in 36% of the \nsamples we appreciated a reduction in the expression of 3-H2 AX compared to \nT1, probably linked with activation of cellular repair mechanisms; in the \nremaining 64% of cases, we found increasing expression of 3-H2 AX, \nsuggesting damage progression. \nConclusion: Already 15 minutes after in vivo ionizing radiation exposure, like \nCT exams, a significant nuclear damage in terms of DNA DSBs is appreciable; \nin some cases, it seems that the human organism activates in short-time \nmechanisms of biological repair able to reduce this damage.  \nB-1030 15:12  \nSmall animal imaging with a preclinical x-ray phase-contrast and dark-\nfield scanner  \nA. Yaroshenko\n1, A. Velroyen1, M. Bech1, A. Tapfer1, M. Müller1, B. Pauwels2, \nP. Bruyndonckx2, A. Sasov2, F. Pfeiffer1; 1Garching/DE, 2Kontich/BE \n(andre.yaroshenko@mytum.de)  \nPurpose: The purpose of this study was to demonstrate that a compact small-\nanimal x-ray phase-contrast and dark-field scanner yields superior soft-tissue \ncontrast and complementary information, when compared to the conventional \nabsorption-based imaging. \nMethods and Materials:  We developed a compact preclinical scanner that \nacquires conventional x-ray absorption simultaneously with phase-contrast and \ndark-field images. This is achieved by placing a three-grating interferometer in \nthe beam. This is the first scanner that has a grating interferometer \nimplemented on a rotating gantry. The scanner was used to acquire a CT scan \nof an ex vivo 10-week-old C57BL/6N mouse, fixated in formalin. Subsequently, \na C57BL/6N in vivo mouse was imaged using the scanner in a radiography \nmode. During image acquisition the mouse was breathing freely. \nResults: The phase-contrast CT of the ex vivo mouse showed significantly \nhigher soft-tissue contrast than the conventional absorption CT, e.g. in the \nabdomen region. On the acquired projection image of an in vivo mouse, the \nlung is clearly visible in  the dark-field modality. Furthermore, the trachea is \nclearly visualised in phase-contrast, whereas bones are best visible in the \nabsorption modality. \nConclusion: It has been observed that dark-field radiography has a very high \npotential for lung imaging, as the signal-to-noise ratio is much higher than in \nother imaging modalities. Furthermore, it has been shown that the developed \nrotating gantry is stable for CT acquisition. In fact, all ex vivo CT results \nshowed superiority of the x-ray phase-contrast imaging for biomedical \napplications.  \nAuthor Disclosures: \nB. Pauwels: Employee; Bruker microCT. P. Bruyndonckx: Employee; Bruker \nmicroCT. A. Sasov: CEO; Bruker microCT. \n \n \n \nB-1031 15:21  \nAutomatic assessment of upper urinary tract clearance during the initial \nphase of digital pyelography  \nI.S. Leichter, V. Neeman, E.Y. Panfil, O. Gleisner, R. Morag, M. Duvdevani; \nJerusalem/IL (Izhak@hadassah.org.il)  \nPurpose: Upper urinary-tract clearance, affected by kidney pathologies, is \ncurrently estimated by visual monitoring of contrast-media clearance from the \nrenal pelvis in retrograde or antegrade pyelography. Since such estimation \ninvolves high radiation dose and is very subjective, this study explores a new \ncomputerised method for assessing quantitatively upper urinary-tract \nclearance, using only images from the initial phase of pyelography. \nMethods and Materials:  The computerised method is based on analyzing the \nradio-density of the contrast-media in sequential pyelography images. 55 \npatients following PCNL and retrograde or antegrade pyelography were \nstudied. 18 of the patients experienced known kidney pathologies. Following \nimage normalisation by a novel phantom attached to the patient, the integrated \noptical-density of the contrast-medi a in the renal pelvis was analysed \nquantitatively in sequential images, to  yield clearance curves. Significance of \ndifferences was calculated by Pearson t-test. \nResults: For all patients, the obtained clearance curves highly fitted \nexponential regression and the relative clearance-rate per minute was \ncalculated. The mean clearance rate per minute for the pathologic cases \n(7.78%) was significantly (p < 0.001) lower than for normal cases (50.45%). \nMeasurements showed that after the first 3 minutes of pyelography the relative \nclearance of contrast-media was already significantly lower (p < 0.001) for \npathologic cases (19.5%) compared to normal cases (70.8%). \nConclusion: The mean clearance rate measured by the new method for \nnormal patients was about 6.5 times higher than of pathologic cases. The \ndifferences in clearance-rate were already significant after the first 3 minutes of \npyelography, providing an accurate quantitative assessment with reduced \nradiation dose.  \n14:00 - 15:30 Room N/O  \nVascular  \nSS 1815  \nCarotid pathology evaluation  \nModerators:  \nP. Almeida; Coimbra/PT  \nP. Minko; Homburg a.d. Saar/DE  \nB-1032 14:00  \nAtherosclerotic plaque texture from 3D carotid ultrasound improves \nprediction of vascular events  \nA. van Engelen\n1, T. Wannarong2, G. Parraga2, W.J. Niessen1, A. Fenster2, \nJ.D. Spence2, M. de Bruijne1; 1Rotterdam/NL, 2London, ON/CA \n(a.vanengelen@erasmusmc.nl)  \nPurpose: To compare the predictive value of change in carotid ultrasound \nderived plaque texture ( ,Texture), change in total plaque volume ( ,TPV), and \na combination of those two measures, for the occurrence of vascular events. \nMethods and Materials:  298 patients with carotid atherosclerosis were \nscanned with 3D-US at baseline and after one year. Plaque volume and 376 \nmeasures of texture were measured in all plaque areas at both time points. \nPatients were followed up to 5 years for occurrence of myocardial infarction, \nTIA, stroke and death due to vascular causes. Sparse Cox Regression was \nused to select the most predictive texture measures and to combine them into \none risk measure. Selection and combination of texture measures, and \ncombination with ,TPV, was performed in independent training sets using a \ntenfold cross-validation to ensure unbiased results. \nResults: Kaplan-Meier analysis showed improved predictive value for \n,Texture and ,TPV combined (difference between tertiles: p < 0.001) \ncompared to ,Texture (p < 0.01) and ,TPV (p=0.039) individually. In Cox \nregression, adjusted for 13 clinical parameters including age, sex, smoking \nstatus, cholesterol, diabetes and previous events, ,Texture (HR=1.66, \np=0.012) and ,TPV (HR=1.47 per 100 mm3, p=0.001) were both significant \npredictors of vascular events, with no oth er traditional risk factors being \nsignificant. \nConclusion: Changes in plaque texture and in plaque volume are both \npredictive of vascular events, and have high er power than more traditional risk \nfactors. Their combination improves predictive value, and therefore may be \nrelevant to include in the monitoring of patients and for risk stratification in \nvascular disease.  \nS359  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nAuthor Disclosures: \nA. van Engelen: Research/Grant Support; CTMM, the Center for Translational \nMolecular Medicine, project Parisk grant 01C-202; the Dutch Heart Foundation; \nthe Erasmus Trustfund. J.D. Spence: Research/Grant Support; Heart & Stroke \nFoundation of Canada (Ontario), grant number NA5912.  \nB-1033 14:09  \nMicrovesicle protein CD14 levels reflect carotid intima-media thickness in \n8-year-old children  \nA.L.M. Eikendal, H. den Ruijter, A.M.V. Evelein, G. Pasterkamp, I.E. Hoefer, \nD.P.V. de Kleijn, T. Leiner, M.L. Bots, C.S.P.M. Uiterwaal; Utrecht/NL \n(a.l.m.eikendal@umcutrecht.nl)  \nPurpose: Atherosclerosis, a process that begins in childhood, develops over \ndecades and underlies the majority of cardiovascular events. In adults, \nmicrovesicle (MV) proteins relate to atherosclerotic disease. However, little is \nknown about the relation of MV proteins with atherosclerosis in children. This \nstudy evaluates the relation between levels of MV proteins CD14, Serpin F2, \nSerpin G1 and cystatin C and vascular characteristics in children. \nMethods and Materials:  In 8-year-old children of the ongoing Wheezing-\nIllnesses-Studie-LEidsche-Rijn (WHISTLER) birth cohort, anthropometrics and \nblood pressure were measured. Common carotid intima-media thickness \n(CIMT), carotid distensibility and carotid elastic modulus were obtained non-\ninvasively. In 130 children, a fasting lipid spectrum was acquired and MVs \nwere isolated from plasma. MV protein levels of CD14, Serpin F2, Serpin G1 \nand cystatin C were measured using a multiplex assay. In a multivariable \nmodel, we assessed the relationship between these MV proteins and vascular \ncharacteristics. \nResults: Of the MV proteins under study, CD14 levels were positively \nassociated with CIMT ( 2=4.09x10\n-4, p=0.019). This association proved to be \ndependent on total cholesterol levels (p=0 .049 for interaction). Only in children \nwho had low total cholesterol levels ( \u00024.4 mmol/L, mean of total), MV protein \nCD14 levels were positively related with CIMT ( 2=4.98x10-4, p=0.024). There \nwere no significant associations between levels of MV proteins and \ndistensibility or elastic modulus. \nConclusion: In children with low total cholesterol levels, MV protein CD14 \nlevels are positively related to the degree of CIMT. Therefore, MV protein \nCD14 levels may be useful markers for atherosclerosis burden from childhood \nonwards.  \nB-1034 14:18  \nCarotid plaque vulnerability: could contrast enhanced ultrasound play a \nrole in patient management?  \nM. la Torre, R. Iezzi, E. Antonuccio, M. Nestola, A. Guerra, L. Bonomo; \nRome/IT (m.latorre84@alice.it)  \nPurpose: To assess a relationship between CEUS and immuno-histological \nevaluation of carotid artery \"inflammatory-vulnerable plaque\". \nMethods and Materials:  50 consecutive patients (18 symptomatic; 32 \nasymptomatic) referring to our Department in order to perform carotid \nendarterectomy, were enrolled. Ultrasound examination was performed using \nhigh-frequency (8-14MHZ) linear probe and a non-linear pulse inversion \ntechnique during a double contrast media injection (Sonovue,2-4 ml; Bracco, \nItaly). Two videotapes were recorded for every injection: early \"dynamic\" phase \nand late \"flash\" phase, performed with 6 high mechanical index impulses. \nMovies were evaluated in terms of intraplaque enhancement and proliferation \nof adventitial vasa vasorum both qualitatively, on the basis of a 4-point scale, \nand quantitavely, using Esaote Qontrast 4.0 software. After surgical resection, \nplaque specimens were evaluated imm unohistologically in order to assess \nneovascularisation. Qualitative and quanti tative evaluation were statistically \ncompared to immunohistological results, considered as gold standard. \nResults: Qualitative CEUS evaluation obtained high statistical results when \ncompared to immunohistological results, wi th values of sensitivity, specificity, \npositive predictive value (PPV), negative predictive value (NPV), and \ndiagnostic accuracy of 94%, 68%, 87%, 85% and 86%, respectively, which \nbecame higher if considering only asymptomatic patient, with a NPV of 91%. \nNevertheless, quantitative software evaluation proved less effective and \ncouldn't reach similar results. \nConclusion: Carotid plaque enhancement assessed with CEUS well \ncorrelates with histological density of neovessels, which is associated with \nplaque vulnerability. CEUS may provide valuable information for plaque risk \nstratification and may play a role in the indi cation to treatment of patients with \ncarotid stenoses, particularly in asymptomatic population.  \n \nB-1035 14:27  \nThe relationship between the volume of carotid bodies assessed by \ncomputed tomography angiography and cardiac autonomic function in \npatients with essential hypertension  \nP. Jazwiec, R. Poreba, P. Gac, M. Poreba, T. Miszalski-Jamka, G. Mazur, \nM. Sobieszczanska; Wroclaw/PL (sogood@poczta.onet.pl)  \nPurpose: Determine the relationship between the estimated volume of the \ncarotid bodies (V rCB+lCB) assessed by computed tomography angiography \n(CTA) and the autonomic cardiac function in patients with essential \nhypertension (EH).  \nMethods and Materials:  The study included 22 consecutive individuals with \ndiagnosed and treated pharmacologically EH. Estimated volume of each \ncarotid body (CB) was evaluated on the basis of scans obtained in the CTA of \ncarotid and vertebral arteries, using the formula: 4/3 F x transverse dimension \nof CB in axial projection x CB longitudinal dimension in the axial projection x \nCB craniocaudal dimension in the sagitt al/frontal projection. Autonomic cardiac \nfunction was assessed using analysis of heart rate variability (HRV). Time \ndomain HRV parameters: mRR, SDNN, SDANN, SDNNi, rMSSD, pNN50 were \nobtained.  \nResults: Mean values of rMSSD and pNN50 were significantly lower in \npatients with hypertension with the values of V\nrCB+lCB\u0003median, compared to the \ngroup of hypertensive patients with the values of V rCB+lCB<median (rMSSD: \n50.18±10.15 ms vs. 64.63 ±6.18 ms, p < 0.05; pNN50: 10.73 ±2.49 % vs. \n13.27±4.01 %, p <  0.05). Statistically signific ant negative linear correlations \nwas demonstrated between V rCB+lCB and rMSSD and between V rCB+lCB and \npNN50 (r: -0.33, -0.48). Based on the regression analysis it has been shown \nthat the higher values of V rCB+lCB are an independent risk factor in HRV \nreduction in patients with EH.  \nConclusion: In patients with EH a relationship between the volume of CB \nassessed by CTA of carotid and vertebral arteries and autonomic cardiac \nfunction seems likely, especially in terms of parasympathetic component.  \nB-1036 14:36  \nT1- and T2-weighted SE carotid plaque imaging and contrast-enhanced \nMR angiography in comparison with intravascular ultrasonography: \nqualitative and quantitative assessment  \nP.T. Klimeczek, B. Kozierowski-Do \u0002\u0019ga, K. Dy!, U. Zaleska-Dorobisz, W. W; \nWroclaw/PL (pklimeczek@gmail.com)  \nPurpose: The study aimed to assess in vivo quantitative and qualitative plaque \nfeatures on 1.5 T carotid MR imaging and CE-MRA in comparison with \nstandard-IVUS. \nMethods and Materials:  20 pts (age73 ±9yr,9females) with symptomatic \ncarotid stenosis 50%-90% initially detected in USG were enrolled. Patients \nunderwent carotid MRI and MRI carotid angiography one to two weeks before \nconventional angiography with IVUS study and PCI. Patients were studied with \na whole-body MR imaging scanner (Aera, Siemens) using 4-channel phased-\narray surface head and neck coil. MR pre-contrast images were obtained with \n3-DTOF, inversion recovery pre-contrast T1, double inversion T2 and proton \ndensity fat saturation (in plane resolution 0.7x0.7x2 mm). Carotid angiography \nwas obtained with bolus tracking method and study inversion recovery CE-T1 \n5 minutes after intravenous infusion of 0.2-mmol gadoteridolum/kg. MRI \nimages were transferred and analysed on commercially available software. \nIVUS imaging was performed using Volcano Therapeutics\n® EagleEye Gold \ncatheter and Volcano Therapeutics ®IVG3 OracleImaging System. Spearman \nrank correlation and p value for 95% CI were calculated for measured \nparameters. \nResults: There was no statistical difference (p0.07) between pre-contrast MRI \n(T1,T2 imaging) and IVUS calculations of maximal plaque area, minimal lumen \ndiameter, area, reference area, area and plaque volumen, stenosis \nassessment. Low correlation rho 0.55 and p value > 0.11 were found in \nmeasurements of CE angiography stenosis as compared with IVUS. The \noverall high-signal intensity (PD imaging) and high-contrast enhancement \ncorrelated with large complicated fibroatheroma (p < 0.01). \nConclusion: 1. T1WI and T2WI are useful to quantitative assessment of \ncarotid plaque 2. CE angiography weakly correlated with IVUS stenosis \nmeasurements 3. T1 contrast study and PD imaging could be useful for \ndetection of complicated and advanced plaques.  \nB-1037 14:45  \nPrevalence, distribution and outcome of patients with calcified nodules in \ncarotid arteries  \nK.J. Kutter, D.C. Saam, F. Schwarz, T. Saam, M.F. Reiser, A. Helck; \nMunich/DE (andreas.helck@med.uni-muenchen.de)  \nPurpose: Calcified nodules are responsible for up to 5% of coronary infarcts \nand are therefore classified as a minor criteria of the \"vulnerable\" \natherosclerotic plaque. We sought to evaluate the prevalence, distribution and \noutcome of patients with calcified nodules in the carotid arteries. \nS360  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nMethods and Materials:  108 consecutive patients (90 with unilateral \nischaemic stroke, 37 female) with carotid plaques \u00032 mm by duplex ultrasound \nunderwent a carotid black-blood 3 T-MRI with fat-saturated T1w-, PDw-, T2w- \nand TOF images using dedicated surface coils. Based on previous histological \nvalidation, calcified nodules were defined as distinct calcification with an \nirregular, protruding, and convex luminal surface. Prevalence of calcified \nnodules was determined in both common and internal carotid arteries in \nconsensus by two reviewers who were blinded to clinical information. \nResults: In total, 18 calcified nodules in  13 distinct arteries of 12 distinct \npatients were identified. Calcified nodules were more commonly found in the \ncommon compared to the internal carotid artery (11 vs. 7), in asymptomatic \ncompared to symptomatic arteries (8.2 vs. 3.4%) and in arteries with \u000350% \ncompared to arteries with < 50% stenosis (10% vs. 5.3%); although all these \ndifferences were not statistically si gnificant (P=0.34, 0.15 and 0.26, \nrespectively). \nConclusion: Calcified nodules were found in approx. 10% of patients with \ncarotid plaques \u00032 mm by duplex ultrasound. We were not able to establish an \nassociation of calcified nodules and ischaemic symptoms, suggesting that \ncalcified nodules play a minor role in the pathogenesis of ischaemic stroke in \nthe carotid arteries.  \nB-1038 14:54  \nQuantitative x-ray phase-contrast Hounsfield units for the differentiation \nof carotid atherosclerotic plaque components  \nT. Saam1, M. Willner2, F. Bamberg1, C. Habbel1, J. Herzen2, U. Schueller1, \nA. Hipp2, F. Pfeiffer2, H. Hetterich1; 1Munich/DE, \n2Garching/DE (tobias.saam@med.uni-muenchen.de)  \nPurpose: Conventional CT can distinguish between soft, mixed and calcified \nplaques but has difficulties to further differentiate soft plaques due to an \noverlap in Hounsfield units of fibrous and lipid tissue. Phase-contrast imaging \nis a novel x-ray-based imaging technique that relies on the x-ray phase-shift \nrather than its absorption, yielding a high er contrast in biological soft tissue. \nWe sought to evaluate whether plaque components can be differentiated \nbased on their phase-contrast HU (HU-P), which can be calculated in analogy \nto absorption-contrast HU. \nMethods and Materials: Four ex vivo human carotid arteries were imaged at a \nlaboratory-based set-up using a conventional x-ray tube (35 kV) and grating-\ninterferometer. Tomographic images were reconstructed with an effective pixel \nsize of 100 \u0001m and correlated with histopathology sections. Regions \ncorresponding to fibrous, lipid or calcifi ed tissue based on histopathology were \nmanually traced. Mean HU-P were calculated for all analysed regions. \nResults: A total number of 80 cross-sections with 72 fibrous, 19 lipid and 24 \ncalcified tissue containing regions we re assessed. Fibrous, lipid and calcified \ntissues were associated with significant different mean HU-P (52.6 ±7.0, \n21.0±9.8 and 371.5± 158.0, p < 0.001). Furthermore, there was no overlap of \nHU-P between fibrous (range 44.9 - 63.3) and lipid tissue (3.1-30.1). Similarly, \nno overlap of HU-P was observed between calcified tissue (range 174.4 - \n593.7) and the other tissue components. \nConclusion: In an ex vivo experimental set-up grating-based phase contrast \nCT can reliably differentiate between calci fied, fibrous and fatty tissue based \non quantitative HU-P, indicating its hi gh potential for improved assessment of \ncarotid atherosclerotic disease.  \nAuthor Disclosures: \nT. Saam: Research/Grant Support; Diamed Medizintechnik. Speaker; \nGlaxoSmithKline, MSD SHARP & DOHME Gmbh.  \nB-1039 15:03  \nIntra-individual comparison of carotid and femoral atherosclerotic plaque \nfeatures with in vivo MR plaque imaging  \nA. Helck1, N. Bianda2, G. Canton3, C. Yuan3, M.F. Reiser1, A. Gallino2, \nR. Wyttenbach2, T. Saam1; 1Munich/DE, 2Bellinzona/CH, 3Seattle, WA/US \n(andreas.helck@med.uni-muenchen.de)  \nPurpose: To evaluate differences of plaque composition and morphology \nwithin the same patient in different vascular beds using non-invasive MR-\nplaque imaging. \nMethods and Materials:  28 patients (67.8± 7.4 years, 8 females) with high \nFramingham general cardiovascular disease 10-year risk-score and mild-to-\nmoderate atherosclerosis were consecutively included in the study. All subjects \nunderwent dedicated MRI-plaque-imaging-protocol using TOF- and T1w- and \nT2w-black-blood-sequences with fat suppression (1.5 T). The scan was \ncentered on the carotid bulb of the carotid and on the most stenotic lesion of \nthe femoral arteries, respectively. Plaques were classified according to the \nAmerican-Heart-Association lesion ty pe classification and area measurements \nof lumen, wall and the major plaque components, such as calcification, necrotic \ncore and haemorrhage were determined in consensus by two blinded \nreviewers using dedicated software. Plaque components were recorded as \nmaximum percentages of the wall area. \n \nResults: Carotid arteries had larger maximum wall and smaller minimum \nlumen areas (P < 0.001). Prevalence of lipid-rich AHA-lesion-type-V and \ncomplicated AHA-lesion-type-VI with haemorrhage/thrombus/fibrous-cap \nrupture was significantly higher in the carotid arteries compared to the femoral \narteries. Plaque composition as percentage of the vessel wall differed \nsignificantly between carotid and femo ral arteries: Max. %necrotic core and \nmax. %haemorrhage were significantly higher in carotid arteries compared to \nfemoral arteries (P=0.001 and P=0.02, respectively). Max.%Calcification did \nnot differ significantly. \nConclusion: In vivo MRI is able to visualise differences in plaque composition \nof distinct vascular beds within the same patient. More specifically, the plaque \nphenotype and thus the extent of atherosclerosis differs within the same \npatient across different vascular beds.  \nB-1040 15:12  \nGenetic and environmental effects on carotid flow velocities: an \ninternational twin study  \nP. Lucatelli\n1, A.D. Tarnoki2, D.L. Tarnoki2, F. Fanelli1, V. Berczi2, E. Medda1; \n1Rome/IT, 2Budapest/HU (pierleone.lucatelli@gmail.com)  \nPurpose: Altered carotid blood flow velocities (CFV) have a complex \nbackground but the underlying genetic contribution is still unclear.We sought to \nevaluate the influence of genetics, shared and unshared environmental \ncomponents on individual differences of CFV. \nMethods and Materials:  193 healthy twin pairs,126 monozygotic (MZ) and 67 \ndizygotic (DZ)(mean age 53 ±14 years)recruited in Italy, in the United States \nand in Hungary underwent bilateral color-coded Doppler flow assessment of \nthe common carotid artery (CCA)and of the internal carotid artery (ICA)in order \nto assess the peak systolic (PSV) an d end diastolic (EDV)velocities.Means of \nbilateral CFV values were used in the analysis. \nResults: Age- and country-adjusted intra-class correlations were higher in \nmonozygotic than in dizygotic pairs for mean PSV of the ICA indicating a \nheritability of 63%. Unique environmental factors contributed to 37% of ICA \nPSV.With regards to the mean PSV and EDV of the CCA, and EDV of the ICA, \nheritability analysis indicated no discernible role for genetic components, while \nthe contributions of shared and unshared environmental factors ranged \nbetween 56% and 63%, and between 37% and 44% adjusted for age and \ncountry, respectively.ICA/CCA ratio was driven by unique environmental \nfactors (81-88%)with negligible heritability (0-12%). \nConclusion: Our study showed that the heritability of ICA PSV is moderate, \nwhile the findings do not support heritability of other investigated CFV \nvalues.Environmental effects account for a moderate to major portion of the \nvariance.These findings support the value of early ultrasound screening as well \nas the prevention of modifiable environmental factors in case of altered carotid \nflow-velocities.  \nB-1041 15:21  \nCarotid artery dissection in CT: does the colour improve the diagnostic \nconfidence of the readers?  \nL. Saba1, E. Raz2, P.P. Bassareo1, G.M. Argiolas1, J.S. Suri3, M. Piga1; \n1Cagliari/IT, 2New York, NY/US, 3Roseville, CA/US (lucasaba@tiscali.it)  \nPurpose: To evaluate if the use of chromatic analysis, instead of the use of \ngray-scale, in the MDCTA study of carotid artery dissection (CAD) modify the \nobserver's diagnostic accuracy. \nMethods and Materials:  One hundred patients (61 men; mean age, 51 years) \n40 with and 60 without CAD, that underwent MDCTA formed the study cohort. \nPatients from three different groups were included (patients with MR \nconfirmation of CAD, n = 40; patients with MR confirmation of CAD absence, n \n= 20; patients that underwent MDCTA for suspected atherosclerosis, n = 40). \nFour blinded observers with different level of expertise analysed the \nrandomised basal scan of the MDCTA dataset. ROC curve analysis, the Cohen \nweighted test and sensitivity, specificity, PPV, NPV, accuracy, LR+ and LR- \nwere performed. \nResults: The ROC curve analysis showed that for all observers the use of \nchromatic-scale produced an improvement of the diagnostic confidence with \nAUC values from 0.896 to 0.936; from 0.823 to 0.849; from 0.84 to 0.909 and \n0.749 to 0.861 for expert, intermediate A, intermediate B and trainee \nobservers. In particular, the variation of diagnostic confidence (between the \nAUC areas) for the trainee was statistically significant (p = 0.036). Also \naccuracy, as well as sensitivity, specificity, PPV, NPV, LR+ and LR- were \nbetter using the chromatic scale \nConclusion: Results of our study suggest that the use of chromatic scale \ninstead the classic gray-scale improves the diagnostic confidence of the \nreaders, in particular of the junior ones, by improving also the accuracy, \nsensitivity and specificity.  \n \n \n \nS361  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n14:00 - 15:30 Conf. Room M3  \nInterventional Radiology  \nSS 1809  \nEmbolisation including radioembolisation  \nModerators:  \nJ.I. Bilbao; Pamplona/ES  \nN. Ptohis; Athens/GR  \nB-1042 14:00  \nYttrium-90 radioembolisation vs sorafenib for hepatocellular carcinoma: \na cohort study with a propensity score analysis  \nA. Cappelli, C. Mosconi, E. Giampalma, M. Renzulli, M. Galaverni, \nA. Gramenzi, A. Granito, F. Trevisani, R. Golfieri; Bologna/IT \n(alberta.cappelli@aosp.bo.it)  \nPurpose: Sorafenib and transarterial 90Y-radioembolisation (TARE) are \npossible treatments for Barcelona Clinic Liver Cancer (BCLC) intermediate-\nadvanced stage hepatocellular carcinoma (HCC). No study directly comparing \nsorafenib and TARE is currently available. This study compares patient \noutcomes achieved with these therapies. \nMethods and Materials:  This retrospective study evaluated 112 patients \ntreated with sorafenib and 73 with TARE. Selection criteria: Child-Pugh class \nA/B, performance status \u00021, HCC unfit for effective therapies, no metastases \nand previous systemic chemotherapy. Propensity analysis provided one-to-one  \nmatch between sorafenib and TARE patients for independent prognostic \nfactors. \nResults: Seventy-four sorafenib (71 ±10 years, male 87%, BCLC B/C \n53%/47%) and 63 TARE patients (66± 9 years, male 79%, BCLC B/C \n41%/59%) were included in the analysis. Median overall survival was 14.4 \nmonths (95% CI: 4.3-24.5) in sorafenib and 13.2 months (6.1-20.2) in TARE \npatients, with 1-, 2- and 3-year survival rates of 52.1%, 29.3% and 14.7% \nversus 51.8%, 27.8% and 21.6%, respectively (P=0.959). Two TARE patients \nunderwent liver transplantation after successful downstaging. After the \npropensity model had matched 32 patients of each group for median age, \ntumour gross pathology and the independent prognostic factors (portal vein \nthrombosis, performance status, Model for End Liver Disease), the median \nsurvival was 13.1 months (1.2-25.9) in sorafenib and 11.2 months (6.7-15.7) in \nTARE patients, with 1-, 2- and 3-year survival rates of 53.1%, 23.0% and \n15.3% versus 44.7%, 19.0% and 9.5%, respectively (P=0.392). \nConclusion: In cirrhotic patients with intermediate-advanced or not-otherwise-\ntreatable HCC, sorafenib and TARE provide similar survivals. Down-staging \nallowing liver transplantation only occurred after TARE.  \nB-1043 14:09  \nSafety of radioembolisation with 90Yttrium-microspheres depending on \ncoiling or no-coiling of aberrant vessels  \nP.M. Paprottka\n1, A. Walter1, A. Haug1, C.G. Trumm1, P. Bartenstein1, \nM.F. Reiser1, C. Zech2; 1Munich/DE, \n2Basle/DE (philipp.paprottka@med.uni-muenchen.de)  \nPurpose: To evaluate the safety of radioembolisation with 90Yttrium-\nmicrospheres depending on coiling or no-coiling of aberrant vessels. \nMethods and Materials:  The early and late toxicities of 400 radioembolisation \nprocedures were retrospectively analysed according to the National Cancer \nInstitute's Common Terminology Criteria for Adverse Events (CTCAE v3.0). In \n200 procedures the aberrant vessels were coiled prior to radioembolisation and \nin 200 procedures we chose a more peripheral position to treat the right or left \nliver lobe. \nResults: Except for one instance of treatment-associated cholecystitis (grade \n4 toxicity) there were no acute or delayed toxicities according to the CTCAE \ncriteria higher than grade 2. No radiation-induced liver disease was noted. \nThere was no significant difference (p > 0.05) in acute or delayed toxicities \ndepending on actually recommended coiling of aberrant vessels prior to \ntreatment in comparison to choosing a peripheral treatment position. \nConclusion: Radioembolisation with 90Yttrium-microspheres is a safe and \neffective treatment option. Performing of radioembolisation without coiling \naberrant vessels prior to treatment could be an alternative option for \nexperienced centers.  \n \n \n \n \n \n \n \nB-1044 14:18  \nYttrium-90 radioembolisation for the treatment of unresectable liver \ncancer or liver metastases from gastrointestinal system cancers: results \nof a one-center study  \nÖ. Özgür, S. Gunduz, E. Alimoglu, M. Erkılıc, H.S. Bozcuk, H.T. Sindel; \nAntalya/TR (ealimoglu@akdeniz.edu.tr)  \nPurpose: To determine the effects of yttrium-90 (Y-90) resin microsphere \nradioembolisation therapy on patients with unresectable liver cancer who do \nnot benefit from chemotherapy. \nMethods and Materials:  Fifty-five patients underwent radioembolisation \ntherapy between 2010 and 2012 were included in the study. All of these \npatients had unresectable primary or metastatic liver cancer originating from \nthe gastrointestinal tract. Three were excluded from the study after pre-\nevaluation angiography. Thirteen (23.6%) of the remaining 52 patients had \nhepatocellular carcinoma and 39 (76.4%) had metastatic liver cancer. Fifty-two \npatients underwent Y-90 radioembolisation treatment. After the procedure, \nclinical follow-up of each patient was retrospectively conducted using our \nhospital's data processing programs. Each patient's response to the \nadministered treatment was evaluated using the Response Evaluation Criteria \nin Solid Tumors (RECIST) and the overall probability of survival was displayed \ngraphically by the Kaplan-Meier method. \nResults: Fifty-five patients underwent pre-evaluation angiography had their \nextrahepatic branch embolised (46 gastroduodenal artery, 3 accessory right \ngastric artery, 2 supraduodenal artery) for hepatic arterial isolation. Fifty-two of \nthem that were evaluated using gamma camera imaging with \nmacroaggregated albumin were determined to be suitable for treatment. After \nY-90 therapy, 47 patients were follow-up. While 57% of the patients responded \nto treatment as clinical benefit, the disease progressed in 43%. The median \nhepatic progression-free survival time of the patients was 3.4 months (95% \nconfidence interval (CI):1.4-5.3) and the overall survival time was 11.3 months \n(95% ci:8.7-14.03). \nConclusion: This study emphasises that Y-90 resin microsphere \nradioembolisation treatment is effective in patients with unresectable liver \ncancer.  \nB-1045 14:27  \nSelective internal radiation therapy of hepatic tumours: is coiling of the \ngastroduodenal artery always beneficial?  \nJ. Schelhorn, J.M. Theysohn, J. Ertle, J.F. Schlaak, S. Müller, A. Bockisch, \nT.C. Lauenstein; Essen/DE (juliane.schelhorn@uk-essen.de)  \nPurpose: To minimise the risk of extrahepati c 90-yttrium (90Y) deposition. the \ngastroduodenal artery (GDA) is often coil embolised before SIRT.The aim of \nthis study was to assess the effect of GDA occlusion with regards to arterial \nhepato intestinal collateralization (HIC). \nMethods and Materials:  606 patients were scheduled for SIRT between 2006 \nand 2012 at our hospital. Digital subtraction angiography (DSA) followed by \n99m-technetium labelled human serum albumin microspheres (99mTc-HSAM) \nadministration and SPECT/CT was initially performed. Depending on vascular \nanatomy and hepatic tumor load, GDA coil embolisation was considered. In \nsubsequent 99mTc-HSAM, rescans or the therapeutic DSA HIC and its \nconsequences for SIRT were analysed. \nResults: In 86 of 606 patients (14%), the GDA was occluded. 22 of these 86 \npatients did not undergo SIRT due to the patients' clinical status or SIRT \ncontraindications. In 28 of the remaining 64 patients, newly apparent or \nreopened HIC were seen either at the site of the proximal GDA ( n=21) or in the \nperiphery of the hepatic arteries ( n=7). In 25 of these 28 patients, the HIC \ncould be occluded or the catheter position could be changed achieving a safe \n90Y application. However, due to the HIC in 3 of 28 patients SIRT was \nregarded unsafe and was abandoned. \nConclusion: GDA occlusion may induce arterial hepato intestinal collaterals. \nAlthough most of these collaterals do not impede 90Y administration, SIRT \nmay become unfeasible in specific occasions. Hence, we recommend \nsegmental or lobar SIRT instead of a whole liver approach with GDA coiling.  \nB-1046 14:36  \nRandomised comparison of SIRT and TACE for treatment of intermediate \nstage HCC  \nM.B. Pitton, R. Kloeckner, G.M. Wirth, C. Ruckes, W. Eichhorn, M.A. Woerns, \nA. Weinmann, G. Otto, C. Dueber; \nMainz/DE (Michael.Pitton@unimedizin-mainz.de)  \nPurpose: To compare SIRT and DEB-TACE for treating intermediate stage \nHepatocellular Carcinoma (HCC). \nMethods and Materials:  24 patients with intermediate stage HCC were \nrandomised 1:1 for SIRT or DEB-TACE. In case of recurrence, SIRT was \nallowed to be repeated once. TACE was repeated every 6 weeks until no \nviable tumor was detected by MRI. Follow-up included contrast enhanced MRI \nevery 3 months. \nS362  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nResults: There were no differences in terms of demographics and tumor load \nbetween both groups. Progression-free survival (PFS) was 180 days for SIRT \nand 216 days for TACE (Median, n.s). Time to progression (TTP) was of 371 \ndays versus 336 days (n.s). and Overall survival (OS) was 592 days versus \n788 days, respectively (n.s). Causes of death were liver failure (predominant in \nSIRT group), tumor progression (predominant in TACE group), cardiovascular \nevents, and inconclusive. \nConclusion: There was no significant difference in PFS, TTP, and OS after \nSIRT or TACE. SIRT presented a lower rate of tumor progression but a greater \nrate of liver failure. This randomised pilot study might be used for sample size \ncalculations of future studies.  \nB-1047 14:45  \nPreoperative estimation of remnant liver function using contrast-\nenhanced ratio following percutaneous transhepatic portal embolisation \non Gd-EOB-DTPA-enhanced MRI  \nY. Sato1, S. Matsushima1, Y. Inaba1, H. Yamaura1, M. Kato1, T. Ishiguchi2; \n1Nagoya/JP, 2Nagakute/JP (ysato@aichi-cc.jp)  \nPurpose: The indocyanine green plasma disappearance rate (ICG-K) of the \nfuture remnant liver (ICG-Krem) might not provide accurate assessment for \nestimating heterogeneous liver function  owing to percutaneous transhepatic \nportal embolisation (PTPE). The purpose of this study was to evaluate the \ncontrast-enhanced ratio in the hepato-biliary phase (Enhanced Ratio) on \ngadoxetic acid disodium (GD-EOB-DTPA)-enhanced MR imaging as a \npreoperative estimation of future remnant liver (FRL) function in patients \nundergoing PTPE. \nMethods and Materials: In 53 patients, the correlation between ICG clearance \nand Enhanced Ratio imaging was analysed as preoperative estimation for \nhepatectomy (first analysis). Twenty-three of 53 patients underwent PTPE for \nextended hepatectomy and Enhanced Ratio imaging as preoperative \nestimation after PTPE was analysed (second analysis). Whole liver function \nand FRL function were calculated on MR imaging as follows: Enhanced Ratio × \ntotal liver volume (Enhanced Ratio Index) and FRL Enhanced Ratio × FRL \nvolume (Rem Enhanced Ratio Index), respectively. \nResults: ICG-K correlated with the Enhanced Ratio Index (coefficient 0.375, P \n= 0.006), and ICG-Krem strongly correlated with the Rem Enhanced Ratio \nIndex (0.821, P < 0.001) at the first analysis. ICG-Krem and the Rem \nEnhanced Ratio Index were significantly correlated after PTPE (0.597, \nP < 0.003) at the second analysis. The rate of improvement from before PTPE \nto after PTPE of the Rem Enhanced Ratio Index (48.6%) was significantly \nhigher than that of ICG-Krem (26.4%) (P < 0.05). \nConclusion: Enhanced ratio imaging can be used to estimate FRL function \nafter PTPE.  \nB-1048 14:54  \nOutcome of emergency trans-arterial embolisation of spontaneous \nruptured hepatocellular carcinoma with emphasis of angiography and CT \ncorrelation  \nJ.H.Y. Leung, R. Lee, S. Yu, J. Hui, J. Wong, H. Hung, D. Siu, T. Cheung, \nC. Chu; Shatin/HK (jleunghy@gmail.com)  \nPurpose: To analyse the outcome of emergency trans-arterial embolisation \n(TAE) of spontaneous ruptured hepatocellular carcinoma (HCC) and to \ncorrelate the outcome with the angiographic and CT findings. \nMethods and Materials:  A total 63 patients diagnosed with spontaneous \nruptured HCC and unstable hemodynamic status were treated with TAE \nbetween Aug 2001 and Jan 2013. 50 males and 13 females with a mean age \nof 56.8 (range 30-88) followed up for a mean time of 87 months (range 3-138) \nwere retrospectively analysed. The primary end-point was the technical \nsuccess of embolisation to the target vessel territory. The secondary end-\npoints were clinical successful rate of bleeding control within 30 days, early \ndeath within 30 days and embolisation related complications. The angiographic \nand CT findings were assessed and correlated with the early mortality. \nResults: Embolisation was technically successful in 100% cases. The clinical \nsuccessful rate of bleeding control within 30 days was 97% (61/63). There \nwere 10 cases (16%) of self-limited post-embolisation syndrome. No \nembolisation related complication, liver failure or treatment-related death \noccurred. The early 30-day mortality rate was 38% while the overall median \nsurvival was 8.75 months. Imaging (angiographic and CT) findings that were \nassociated with early 30-day mortality included large tumour size and partial \nportal vein thrombosis. Surgical resecti on were possible in 11 patients with \ncumulative survival significantly longer than that of patient managed with non-\noperative treatment (p=0.04). \nConclusion: Emergency TAE is effective and well tolerated treatment for \nhemostasis of ruptured HCC in patients with hemodynamically unstable \ncondition.  \n \n \nB-1049 15:03  \nProstate artery embolisation: preliminary outcomes for symptomatic \nbenign prostate hyperplasia  \nK.J. Kowalik, J. Golzarian; Minneapolis, MN/US (kowal008@umn.edu)  \nPurpose: This pilot project provides guidance for the clinical and logistical \nfeasibility of a larger study evaluating the safety and effectiveness of prostate \nartery embolisation (PAE) as a treatment for benign prostate hyperplasia \n(BPH). A multidisciplinary clinical team collaborated to develop a pilot study \nprotocol. BPH will affect the majority of men over age 60. Global quality of life \ndeclines as BPH increases. Medical and surgical treatments may be ineffective \nor unappealing to some. \nMethods and Materials:  After urologic and imaging evaluation, 10 male BPH \npatients age 60.6 -93.6 with prostate size 30-170 g (average 84.6) and avg. \nmax urinary flow rate 6.3 ml/sec had PAE. Clinical outcomes include IPSS \nsymptom scores, QOL, prostate size and max flow rate before and after PAE. \nResults: There were no technical or device-related procedure complications. 2 \npatients had delayed episodes of acute urinary retention. Average IPSS scores \nwere 23.3 pre-PAE (range 11-29) and 15.3 (5-25) at 1-month post-PAE. \nAverage prostate size was 84.6 g pre-PAE (30-170) and 57.8 (37-71) at 1-\nmonth post-PAE. 8 of 10 reported improved QOL at 1-month post-PAE. One \nsubject was lost to follow-up. \nConclusion: PAE is a clinically viable treatment for BPH. Although the 1-year \nfollow-up period is not quite completed, this series provides guidance for \ndevelopment of larger PAE studies. The primary impediment to this study is \nlogistical. Patients who no longer have si gnificant prostate symptoms may lose \ninterest in follow-up encounters, and may need encouragement to continue \nwith imaging and urologic evaluations to provide data.  \nB-1050 15:12  \nUsage of uterine artery embolisation in obstetrical practice  \nD. Tazhibaev, B. Abishev; Astana/KZ (abishevb1@mail.ru)  \nPurpose: Use of uterine artery embolisation in obstetric bleeding and \nevaluation of its efficiency. \nMethods and Materials:  UAE as the prevention of obstetric bleeding in \nadnation and previa of placenta was made on 54 patients. In 51 cases, UAE \nwere made on pregnant women in terms of 35-40 weeks in combination with \ncaesarean operation. In three cases, UAE were made after caesarean \noperation to stop post operation uterine bleeding. UAE were done after \nremoval of foetus under the control of the fluoroscopy for preventing embolus \nreflux into other vessels. Microspheres of 355-1000 micron were used for \nocclusion of uterine artery. \nResults: According to our data in 42 (82.3%) of the 51 observations after \nbilateral UAE was noticed stable stop of uterine bleeding. In 8 (15.7%) of 51 \nobservations was made amputation of uterus due to the low efficiency of UAE. \nIn one case, uterine amputation was done after bilateral UAE in 10-12 hours \nbecause of uterine rebleeding. UAE on the early stage allowed to make certain \nhaemostasis in three cases with bleeding after caesarian operation and to save \nreproductive organ. The blood-loss during surgery was 500-1200 ml. \nConclusion: As a result, UAE is quite effective method in preventing \nmeasures of massive postoperative bleeding in obstetric practice in placenta \npathology. In addition, UAE is effective in stopping of uterine bleeding in \npostoperative period.  \nB-1051 15:21  \nUterine artery embolisation: long-term follow-up of leiomyoma  \nB. Abishev, D. Tazhibaev; Astana/KZ (abishevbnncmd1@rambler.ru)  \nPurpose: To evaluate fibroid size using ultrasonography (US) and magnetic \nresonance imaging (MRI) after uterine arteries embolisation (UAE) of \nleiomyoma. \nMethods and Materials:  From 2008 to 2013 September, 524 women with \nsymptomatic leiomyoma were treated by bilateral transcatheter UAE. The size \nof particles depended on uterine arteries diameter and anastomosis between \nuterine and ovary arteries. Mean age was 35.5 years (range - 20-52). \nResults: The moderate reduction of leiomyoma's size was observed in one \nmonth after UAE. Decrease of fibroid size determined by US - 18.4%, by MRI - \n17.3%, in 1 month. Following reduction of fibroid's size was in 3 months by US \n- 41%, by MRI - 42.7%, in 6 months by US - 58.4%, by MRI - 59.3%, in 12 \nmonths by US - 70.8%, by MRI - 72.7%. Doppler US-control showed blood flow \ndecrease during first month after UAE, in 3 months blood flow data were \nrestored in uterine arteries. \nConclusion: UAE is an effective, minimal-invasive kind of leiomyoma's \ntreatment. MRI and US are the modalities that can accurately estimate fibroid's \nchanges and blood flow in uterine arteries. The tendency of fibroid's shrinkage \nafter UAE is well-defined in period from 1M to 12M. After UAE the blood supply \nof myometrium is restored according to US Doppler data in the period from 1M \nto 3M.  \nS363  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n14:00 - 15:30 Board Room A  \nRadiographers  \nSS 1814  \nIssues in management and delivery of \nmodern imaging services  \nModerators:  \nK. Kupcs; Riga/LV  \nL.A. Rainford; Dublin/IE  \nB-1052 14:00  \nBiocide aerosolisation: a new method for disinfection of radiology \ndepartment  \nR. Pintaric1, J. Matela1, Š. Pintari \u00132; 1Maribor/SI, 2Ljubljana/SI \n(robert.pintaric@gmail.com)  \nPurpose: Hospitals are faced with increasingly resistant strains of \nmicroorganisms. When it comes to disinfec tion, individual parts of electronic \nequipment of angiology diagnostics such as patient couches of computer \ntomography (CT) and magnetic resonance imaging (MRI) scanners prove to be \nvery hard to disinfect. Disinfectants of choice are therefore expected to \npossess properties such as rapid, residue-free action without any damaging \neffect on the sensitive electronic eq uipment. This paper discusses the use of \nthe neutral electrolysed oxidising water (EOW) as a biocide for the disinfection \nof diagnostic rooms and equipment. \nMethods and Materials:  The CT and MRI rooms were aerosolised with EOW \nusing aerosolisation device. The presence of microorganisms before and after \nthe aerosolisation was recorded with the help of sedimentation and cyclone air \nsampling. Total body count (TBC) was evaluated in absolute and log values. \nResults: The number of microorganisms in hospital rooms was low as \nexpected. Nevertheless, a possible TBC reduction between 78.99-92.50% or \n50.50-70.60% in log values was recorded. The research has shown that the \nuse of EOW for the air and hard-surface disinfection can considerably reduce \nthe presence of microorganisms and consequently the possibility of hospital \ninfections. It has also demonstrated that the sedimentation procedure is \ninsufficient for the TBC determination. \nConclusion: The use of biocide aerosolisation proved to be efficient and safe \nin all applied ways. Also, no eventual damage to exposed devices or staff was \nrecorded.  \nB-1053 14:09  \nService development by radiographer managers: a case study in MRI \nservice portfolio development through a formal research-based process  \nJ. Castillo\n1, C.J. Caruana2, P.S. Morgan3, C. Westbrook4; 1San Gwann/MT, \n2Msida/MT, 3Nottingham/UK, 4Cambridge/UK (josecast@melita.com)  \nPurpose: Ongoing service development is a key activity of the radiographer \nmanager. The purpose of the study was to develop a 2020 MRI service \nportfolio using a formal research-based approach. \nMethods and Materials:  A two-round Delphi process was conducted amongst \na panel of 11 MRI stakeholder experts which included policy makers, various \nhealthcare professions and patient advocates. Participants' views about the \ncurrent MRI service catalogue, service pipeline and desired 2020 MRI services \nwere initially elicited through semi-structured interviews which were transcribed \nand subjected to thematic analysis. An online questionnaire consisting of 43 \nstatements was developed for the second round of the Delphi. Level of \nagreement was assessed via a Likert scale; with the agreement threshold set \nat 80%. \nResults: Key points of agreement were that the current MRI service catalogue \nshould be maintained, whilst new services such as guided breast biopsies, \nimaging for oncological purposes (particularly staging of prostate cancer) and \nenterography should be introduced. There was a lower level of consensus \nregarding the introduction of breast screening, prostate MRI, 3 T MRI, and \nMRI-PET fusion with reasons ranging from present low-funding levels to \ninadequate physics expertise by radiol ogists, radiographers and medical \nphysicists. \nConclusion: The multi-stakeholder approach adopted ensured that the \nproposed portfolio was successful in bridging customer needs, professional \naspirations and the organisation's strategic intent. It is suggested that \nradiographer managers adopt such a formal research approach to service \ndevelopment on a routine basis.  \n \n \n \n \n \nB-1054 14:18  \nDiagnostic value of ultrasound in the detection of rheumatoid arthritis  \nJ. Castro Costa1, L.A. Torres1, J.L.M.O. Belo1, Ó. Tavares2, A. Saraiva2, \nT. Patrão1; 1Castelo Branco/PT, 2Coimbra/PT (joaocastrocosta@gmail.com)  \nPurpose: To compare the articular bone destruction evidenced in the \ntechniques of nephelometry, conventional radiology and ultrasonography. \nMethods and Materials:  The collected sample universe consisted of 60 \npatients, in whom the rheumatoid arthritis was diagnosed after the realisation \nof supplementary diagnosis exams, incl uding nephelometry, conventional \nradiology and ultrasonography. The rheumatoid factor was quantified by the \nnephelometry, whilst the number of bone erosions was quantified by \nradiographies and echographies. The gathered data were analysed by a \nstatistic programme (SPSS version 19). \nResults: Rheumatoid arthritis affects both sexes at any group of age, being \nmore common in women between 33 and 41 years old and men between 36 \nand 41 years old, in a ratio of 7:5. We obtained differences between the \nnumber of bone erosions visualised in  conventional radiology and the number \nof bone erosions visualised in ultrasonography (P < 0.001). According to the \nsame test, more bone erosions were visualised by ultrasonography in 44 \ncases, and only in 3 of them more bone erosions were visualised by \nconventional radiology technique, whilst in the remaining 13 the same number \nof bone erosions was visualised in both techniques. \nConclusion: Ultrasound is a diagnostic technique that can be used as first line \nexamination in the detection of rheumatoid arthritis, since it uses no ionising \nradiation and detects a greater number of bone erosions, when compared with \nconventional radiology.  \nB-1055 14:27  \nThe impact of real time active dosimetry monitoring during endoscopic \nretrograde cholangiopancreatography  \nP.M.N. Mendes, T.A.R. Laranjeiro, G. Paulo, J. Santos; Coimbra/PT \n(p.nobre91@gmail.com)  \nPurpose: Evaluation of the occupational exposure and analysis of the impact \nof the use of real time active dosimetry monitoring during endoscopic \nretrograde cholangiopancreatography (ERCP). \nMethods and Materials: Data of staff exposure was collected during 55 ERCP \nprocedures in three separate phases using Raysafe i2 equipment. In phase 1 \nan active dosimeter was used under the apron; in the phase 2 the dosimeter \nwas above the apron and in phase 3 Raysafe i2 monitor was visible for staff \nand the dosimeter was used above the apron. Fluoroscopy time was also \nrecorded. \nResults: The gastroenterologist and the nurse were the professionals with \nhighest exposure, 6.78 \u0001Sv and 7.63 \u0001Sv per procedure. The use of lead apron \nprotection allows the average dose decrease 77%. When showing monitor with \nreal time exposure values the average reduction was 44% to 71% due to \nbehaviour alterations. \nConclusion: The values of occupational exposure for ERCP are similar to the \nones found in the literature. All the professionals were informed about the \nimportance of their positioning in the room during the procedure, with the help \nof real time exposure monitoring. Personal protection and real time dose \nmonitoring are important tools for decreasing occupational exposure.  \nB-1056 14:36  \nIs it economically justifiable to let sonographers perform diagnostic \nultrasound examination in the upper abdomen? A cost/benefit analyse \nfrom a hospital cluster in Norway  \nK.G. Vikestad; Oslo/NO (ka-gervi@online.no)  \nPurpose: A scientific study from Norway concluded in 2011 that sonographers \nare qualified to perform ultrasound examinations of upper abdomen equal to \nradiologists. This is a cost/benefit analyse to explore whether it's justifiable to \nuse sonographers to perform diagnostic ultrasound in the upper abdomen. \nMethods and Materials:  A cost/benefit analyse where a developed form \nwhere used and contained variables as salary, time spent performing reports \nby the radiologists, time spent and frequency of the sonographers need for \nassistance by the radiologists, time spent and frequency of examinations \nwhere radiologists had to take over the examinations because of the lack of \nsonographers competence. The form also included a comparison of all the \nexaminations each sonographer made independently, the new tasks that the \nradiologists find time to do in their sav ed time, the change of waiting time for \nultrasound examinations and change of waiting time of other radiology \nexaminations. \nResults: The radiologists' have 36 or 17 hours saved time per week for other \ntasks as a consequence of using the sonographers to perform all ultrasound \nexaminations in upper abdomen independently. The waiting list for ultrasound \nexaminations of upper abdomen is reduced. \nConclusion: The findings in this study shows that the waiting time is reduced \nand the radiologists have saved time to perform more examinations with \nS364  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nadvanced diagnostic and CT, MRI and conventional x-ray examinations. This \nstudy concludes that from a society perspective the benefits are documented, \ndepending on that the society will invest in the sonographer's education.  \nB-1057 14:45  \nAssessment of psychosocial risks faced by radiographers in Portugal \nusing the Copenhagen psychosocial questionnaire  \nJ.M. Saude; Vila Nova de Gaia/PT (mcs@estsp.ipp.pt)  \nPurpose: The economic recession and the development of new forms of \norganisation in health institutions asso ciated with changes in the employment \nrelationship between health workers and employers brings inevitable \nconsequences in psychosocial risks exposures. The aim of the study was to \ntest an instrument for assessing psychosocial risk in radiographers and \nexamine psychosocial risk factors. \nMethods and Materials:  We conducted a cross-sectional study design based \non Copenhagen Psychosocial Questionnai re (short version), completed by 329 \nradiographers.Sociodemographic and employment characteristics of the \nparticipants were also collected. The original structure of the questionnaire was \naccepted and the internal consistency of each scale was inspected. To assess \nthe internal consistency was used Cronbach's ' for the different scales. It was \nconsidered that the value '> 0.70 as a criterion for a satisfactory internal \nconsistency. A descriptive correlation design is also being made to identify \ninterrelationships between psychosocial risk and workplace environment. \nResults: Of the 8 work psychosocial workplace scales of the COPSOQ's short \nversion, 6 showed a satisfactory internal consistency ( '> 0.70). The scale \n\"Demands at work\" ( '= 0.648) is below that value and the scale \"Health in \ngeneral\" has only one item. Further results are expected from the descriptive \ncorrelation analysis. \nConclusion: The version of the \"Copenhagen Psychosocial Questionnaire\" \n(COPSOQ) \"presented appears to be a valid instrument measure the \npsychosocial work environment of radiographers. Further conclusions are \nexpected from the descriptive correlation analysis.  \nB-1058 14:54  \nSetting standards for an MRI unit in Malta: a study in establishing image \nquality criteria for MRI of the knee joint  \nS. Attard Mifsud, J. Castillo, F. Zarb; Msida/MT (suzanne.attard@gov.mt)  \nPurpose: The concept of quality criteria was introduced by the Commission of \nthe European Communities (CEC) for most imaging modalities. Despite the \ncomplexity of MRI procedures, to date, there are no established image quality \ncriteria for MRI. The purpose of the study was to develop MRI quality criteria \nfor examinations of the knee using a formal research approach. \nMethods and Materials:  A list of image quality criteria was developed \nfollowing a review of related literature. Potential anatomical structures were \nidentified, after which content validity was performed by a musculoskeletal \nradiologist and an orthopedic specialist.  Ten pathology free previously reported \nMR knee examinations, performed on a GE 1.5 Tesla unit at the local general \nhospital (Malta), each consisting of 3-pl anar fat-suppressed proton density fast \nspin echo sequences were evaluated by radiographers. Visual grading analysis \nwas utilised to rate the extent of visibility of each anatomical structure. \nResults: Key findings indicate that the current protocol fulfills the developed \nimage quality criteria. The importance of 3-planar imaging and the benefits of \ntailored protocols which highlight the anatomical structures under investigation \ntherefore contributing to diagnostic accuracy were among the results emerging \nafter implementation of these criteria in the clinical setting. \nConclusion: Image quality criteria for MRI knee was established which will \nguide the development of other MRI protocols. It is suggested that CEC \nintroduce image quality criteria for MRI to harmonize this complex mode of \nimaging thus also providing a standard of patient care across departments.  \nB-1059 15:03  \nKinematic X-ray imaging of the hip joint for patients after hip resurfacing \narthroplasty and total hip arthroplasty  \nH. Kawashima, Y. Kajino, T. Kabata, Y. Matsuura, H. Tsuchiya, S. Sanada; \nKanazawa/JP (kawashima1160@gmail.com)  \nPurpose: This study aimed to evaluate the usefulness of dynamic radiographs \nusing a dynamic flat-panel detector (FPD) system for patients after hip \nresurfacing arthroplasty (HRA) and total hip arthroplasty (THA). \nMethods and Materials: A total of 27 patients who underwent HRA for 34 hips \nand 6 patients who underwent THA for 6 hips were included in this study. \nSequential images of active and passive fl exion in a 45-degree semi-lateral \nposition and active abduction in a supine  position were obtained using the FPD \nsystem. We examined the imaging findings of impingement between the \nacetabular component and femoral neck along with cooperative motion at \nmaximal exercise; moreover the central component coordinate of the \nacetabulum side and femoral head side was measured. \nResults: Among the HRA patients, impingement was detected in 20 hips \n(60%) during flexion and in 2 hips (6%) during abduction. There were no \nfindings of subluxation between the acetabular and femoral components after \nimpingement, but cooperative motion of lumbar and pelvic flexion did occur. In \ncontrast, subluxation was detected during passive flexion in a patient with THA \nwho experienced pain during deep flexion. \nConclusion: We investigated detailed postoperative kinematics of the hip in \npatients after HRA and THA using a dynamic FPD system. This imaging \nmethod facilitated assessments of impingement and cooperative motion, and it \ncan be possibly used for patient lifestyle guidance.  \nB-1060 15:12  \nIntegrating ultrasound guided MR arthrography in an outpatient institute - \nthe radiographers' role  \nG. Biró, D. Kovács, Z. Gyevnár, C. Vandulek, I. Repa; Kaposvár/HU \n(biro.gergely@sic.ke.hu)  \nPurpose: MR arthrography is widely accepted as a diagnostic procedure \nperformed on various joints. Its role is vital in examinations of the shoulder, \nevaluating rotator cuff tears, capsulolabral complex, rotator interval, \nglenohumeral ligaments and in certain cases after surgery. As MR \narthrography is an invasive examination, including it as a routine examination \nin an outpatient may be a challenge in many ways - it requires considerate \npatient, equipment and last but not least, time management - a perfect \n'challenge' for a radiographer. \nMethods and Materials: Prior to the injection of contrast medium (gadolinium) \nwe perform a native MR scan of the selected joint. Afterwards, with the help of \nultrasound guidance (US) we inject 0.1 ml Gd and 10 ml iodine contrast \nmedium mixed with 10 ml saline into the joint. Through the preliminary \nexaminations we aimed to optimise the scanning protocols and examination \ntimes. Patient preparation, coil changes etc. were standardised in order to work \nout a smooth time management profile for MR arthrography. \nResults: US guided MR arthrography was introduced in our diagnostic \nportfolio without noticeable delays for patients and referring clinicians. \nRadiographers have a key role not only in performing the examinations, but in \nthe patient management phase starting with the arrival of the referral and \nending with the finalised medical report. \nConclusion: Through careful planning and mindful time and equipment \nmanagement, the radiographers contribute to the succesful integration of US \nguided MR arthrography even in an outpatient institute running with a tight \nschedule.  \nB-1061 15:21  \nSelf-assessment of clinical image quality in plain radiography: an \nevidence-based practice for radiographers  \nN. Kärnä\n1, U.-M. Aakula1, E. Metsälä2; 1Hämeenlinna/FI, 2Helsinki/FI \n(niina.karna@gmail.com)  \nPurpose: To carry out the self-assessment of clinical image quality in plain \nradiography of adult patient's lungs and knee according to best practice. \nMethods and Materials: This master's thesis comprised an applied systematic \nliterature review and a study, performed in 2012-2013, which combined a \nqualitative and quantitative approach. The first stage was to develop an \nevidence-based best practice for self-assessment of clinical image quality in \nKanta-Häme Central Hospital. The content of 19 articles and 151 pages of self-\nassessment documents and 28 pages of transcribed interviews from three co-\noperative organisations were analysed for this purpose. The frame for the \nanalysis was constructed from the literature and comprised three main \ncategories: planning and preparation, execution and evaluation. The pilot study \nof the developed best practice was quantitative. Radiographers and one \nradiologist from Kanta-Häme Central Hospital used an electronic survey to \nperform a retrospective self-assessment of radiographs. The assessors' \nexperiences of this self-assessment were examined at the end of the survey. \nResults: Very little evidence-based data was found and there seems to be a \nlack of strong evidence. Practices in self-assessment of clinical image quality in \nplain radiography were diverse. The de scription of self-assessed image quality \nand assessors' experiences of the pilot study are discussed. \nConclusion: There is a need for local, national and global standards for the \npractice of self-assessment of clinical image quality in plain radiography. These \nstandards could enhance the implementation of systematic and regular self-\nassessment of clinical image quality. The role of radiographers in self-\nassessment could be strengthened.  \n \n \n \n \n \n \n \n \nS365  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\n14:00 - 15:30 Room P  \nMolecular Imaging  \nSS 1806  \nClinical and experimental studies  \nModerators:  \nI. Carrió; Barcelona/ES  \nT. Lammers; Aachen/DE  \nB-1062 14:00  \nCorrelation of biological characteristics with metabolic information on \n11C-methionine PET in primary brain tumours  \nE. Lopci, L. Bello, F. Raneri, M. Riva, M. Rodari, A. Chiti; Rozzano/IT  \n(egesta.lopci@gmail.com)  \nPurpose: In this study we aimed assessing the relation between biological \ndata and metabolic information as determined by 11C-methionine PET (MET-\nPET) in patients affected by primary brain tumour and eligible for surgical \nresection. \nMethods and Materials:  Overall, we enrolled 54 consecutive patients \n(M:F=34:20; mean age 45years) affected by pathologically proven gliomas and \nreferred to our Institution for primary surgery. All patients underwent MET-PET \nand in all cases semi-quantitative analyses were obtained by taking into \nconsideration SUVmax, SUVratio, and Metabolic Tumour Burden \n(MTB=metabolic tumour volume x SUVmean). MET-PET data were then \ncorrelated with biological information including WHO grade/MIB1, isocitrate \ndehydrogenase 1 gene (IDH1) mutation, 1p/19q co-deletion and O6-\nmethylguanine-DNA methyltransferase (MGMT) promoter methylation. \nResults: We analysed 23 low-grade gliomas (LGG: grade II), and 31 high-\ngrade gliomas (HGG: 16 grade III and 15 grade IV). Based on semi-\nquantitative analyses, we determined a statistically significant correlation \nbetween SUVmax, SUVratio and MTB with tumour grading (p < 0.001) and \ncould define optimal cut-off points for differentiating LGG and HGG: \nrespectively, SUVmax > 2.8, SUVratio > 2.08 and MTB > 6.63. A statistically \nsignificant correlation was found also between tumour uptake and IDH1 \nmutation, expressed in patients with lower SUVmax (p=0.003) and SUVratio \n(p=0.002). The correlation was not confirmed for MTB, tumour grade/MIB1 and \nIDH1 mutation, 1p/19q co-deletion or MGMT methylation. \nConclusion: Metabolic information obtained by MET-PET significantly \ncorrelates with histological grading in primary brain tumours. Among other \nbiological characteristic s, also IDH1 mutation resulted correlated to tumour \nuptake, with a prevailing expression in gliomas with lower SUVmax and \nSUVratio, suggesting a better prognosis in these cases.  \nB-1063 14:09  \nComparison of PET/CT using 11C-choline and 11C-methionine for \ndifferential diagnosis of gliomas  \nY. Ilyushchenko, A. Panfilenko, L. Tyutin, N. Kostenikov, A. Stanzhevskiy; \nSt. Petersburg/RU (dr-jurassik@mail.ru)  \nPurpose: To compare possibilities of PET with 11C-Choline (CHOL) and \n(MET) in the differential diagnosis of gliomas. \nMethods and Materials:  24 patients with brain tumors (9 cases of \nglioblastoma, 4 - anaplastic astrocyto ma, 6 patients with low grade gliomas \nand 5 cases of anaplastic oligodendroglioma) were examined by MET and \nCHOL PET-CT. The standardised uptake values of brain tumors and the T/NT \nratios were determined. Histological veri fication of PET findings was carried out \nin all cases. \nResults: The mean CHOL and MET T/NT ratios in glioblastomas were found \nto be higher than those in anaplastic astrocytomas (mean ±SD: 11.0 ± 3.5 and \n2.9 ± 1.07 versus 4.9 ±  2.29 and 1.92 ± 0.33 correspondently, p <  0.05). Low \ngrade gliomas showed significantly lowe r tracer accumulation than the malign \nastrocytomas in both CHOL and MET studies (2.14 ± 1.08 and 1.5 ± 0.85 \ncorrespondently, p < 0.05). The CHOL T/N ratio in anaplastic \noligodendrogliomas was significantly higher than that in astrocytomas of the \nsame grade (7.82 ± 1.47 versus 4.9 ± 1.07, p < 0.05). \nConclusion: CHOL PET can distinguish between malignant and benign \ngliomas and may be useful in differential diagnosis of anaplastic astrocytomas \nand ologodendrogliomas.  \n \n \n \n \n \n \n \nB-1064 14:18  \nSimultaneous [18 F] FDG PET/MRI in patients with tumours of the head \nand neck region: initial results  \nA. Wetter, F. Nensa, K. Nassenstein, T. Schlosser, T.C. Lauenstein, \nM. Forsting, M. Schlamann, M. Ruhlmann; \nEssen/DE (axel.wetter@uk-essen.de)  \nPurpose: To evaluate simultaneous [18 F] FDG PET/MRI in patients with \ntumours of the head and neck region regarding image quality and standardised \nuptake values (SUVs). \nMethods and Materials:  Twenty-two patients with tumours of the head and \nneck region (squamous cell carcinoma: n=17, Adeno-CUP: n=3, adenoidcystic \ncarcinoma: n=2) were examined with simultaneous [18 F] FDG PET-MRI. MR \nimage quality and PET image quality of the PET/MRI scanner were assessed. \nSUVs were quantitatively analysed by measuring and comparing SUVmax \nbetween PET/MRI and PET/CT. \nResults: Simultaneous acquisition of MRI and PET data were possible in all \npatients without artefacts. Quality of MR images and PET images was judged \nto be good or very good, there was no difference of PET image quality \nbetween PET/MRI and PET/CT. The number of detected lesions was equal in \nPET/MRI and PET/CT. The SUVmax of squamous cell carcinomas was 11.92 \n(± 6.89) for primary tumours in PET/MRI and 9.54 ( ± 4.05) in PET/CT (p= \n0.048). SUVmax of lymph node metastases of squamous cell carcinomas was \n7.83 (± 6.76) in PET/MRI and 6.38 ( ± 4.71) in PET/CT (p= 0.0064). \nConclusion: Simultaneous [18 F] PET/MRI in patients with tumours of the \nhead and neck region is feasible for routine clinical use. PET image quality of \nPET/MRI and PET/CT is comparable. Differences of SUVmax between \nPET/CT and PET/MRI might be explained by biokinetics of [18 F] FDG and \ndifferences in attenuation correction of PET/MRI and PET/CT.  \nB-1065 14:27  \nAssessment of bone metastases in whole-body [18 F]FDG PET/MRI: \ncomparison to PET/CT  \nK. Beiderwellen\n1, M. Huebner1, P. Heusch2, J. Grueneisen1, V. Hartung1, \nF. Nensa1, H. Kuehl1, L. Umutlu1, T.C. Lauenstein1; 1Essen/DE, \n2Düsseldorf/DE (karsten.beiderwellen@uk-essen.de)  \nPurpose: To compare the diagnostic value of simultaneous [18 F]FDG \nPET/MRI with [18 F]FDG PET/CT for the assessment of bone lesions in \noncologic patients. \nMethods and Materials:  67 patients (28 women, 39 men, age 56 ±13 years) \nwith solid tumors scheduled for a PET/CT with [18 F]FDG were enrolled for a \nsubsequent whole body contrast enhanced PET/MRI with an integrated \nscanner. The datasets (PET/CT, PET/MRI) were rated by two readers with \nregard to bone lesion conspicuity (4-poi nt ordinal scale, 0: not visible - 3: high \ncontrast) and diagnostic confidence (5-point ordinal scale; 1: certainly benign; \n2: rather benign; 3: indeterminate; 4: rather malignant; 5: certainly malignant). \nMedian scores were compared using Wilcoxon's rank sum test. A consensus \nreading based on prior examinations, PET/CT, PET/MR as well as a clinical \nfollow-up of 213±84 days served as standard of reference. \nResults: Bone metastases were present in 10 patients (12%), benign bone \nlesions in 15 patients (22%) and no osseous lesions in 42 (63%) patients. 45 \nout of 48 bone metastases (94%) were correctly identified by PET/CT, whereas \na correct identification of all bone metastases was possible based on PET/MRI. \nLesion conspicuity for metastases was high for both modalities with \nsignificantly higher results using PET/MRI (p < 0.05). Diagnostic confidence in \nmetastases was high for both modalities as well, yet without any significant \ndifference. In contrast, for benign lesions conspicuity was significantly higher \non PET/CT (p < 0.05). \nConclusion: Integrated PET/MRI with [18 F]FDG shows a high potential in the \nassessment of bone metastases and might serve as valuable alternative to \nPET/CT.  \nAuthor Disclosures: \nH. Kuehl: Speaker; Siemens Healthcare. \nB-1066 14:36  \nQuantitative evaluation of bone metastases from prostate cancer with \nsimultaneous (18 F) choline PET/MRI: combined SUV and ADC analysis  \nA. Wetter, C. Lipponer, F. Nensa, T. Schlosser, T. Pöppel, T.C. Lauenstein, \nJ. Nagarajah; Essen/DE (axel.wetter@uk-essen.de)  \nPurpose: Quantitative analysis of bone metastasis from prostate cancer with \ncorrelation of apparent diffusion coefficients (ADC) and standardised uptake \nvalues (SUVs). \nMethods and Materials:  67 patients with biopsy proven prostate cancer or \nsuspected recurrent prostate cancer were examined with simultaneous 18 F \nPET/MRI. In 11 patients, altogether 32 PET  positive bone metastases could be \nidentified that were located in the fi eld-of-view of the DWI-sequence. Region-\nof-interest (ROI) analyses were performed to measure the average and \nminimal ADCs and to assess maximum and mean SUVs of every bone lesion. \nS366  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nCorrelations between maximum and mean SUVs and average and minimal \nADCs were calculated. \nResults: The SUVmax of all lesions was 5.5 ± 3.13 (mean ± SD). The \nSUVmean was 1.75 ± 0.91. The average ADC (ADCaver) of all lesions was \n666.45 ± 133.18 x 10-3 mm2/s. The minimal ADC (ADCmin) of all lesions was \n564.24 ± 135.19 x 10-3 mm2/s. There was a moderate but significant inverse \ncorrelation of SUVmax vs. ADCaver with a correlation coefficient of -0.4 (p = \n0.02). There was also a significant inverse correlation of SUVmax vs. ADCmin \nwith r = -0.41 (p = 0.02). \nConclusion: Our results demonstrate a moderate but significant inverse \ncorrelation between increased choline metabolism and ADC values of bone \nmetastases from prostate cancer. There is a possible complementary value of \nDWI and choline PET for further characterisation of bone lesions in prostate \ncancer patients. Further research on a multimodality approach using \nsimultaneous PET/MRI in bone metastases of prostate cancer seems to be \njustified.  \nB-1067 14:45  \nRole of (18)F-sodium fluoride PET/CT in characterising osteoblastic \nprostate cancer skeletal metastases  \nL. Nardo, M. Kretzschmar, S. Lee, C. Schreck, J. Slater, R. Hawkins, \nM.J. Hernandez Pampaloni; San Francisco, CA/US (lorenzo.nardo@ucsf.edu)  \nPurpose: To evaluate the diagnostic values of 18 F-sodium fluoride (NaF) \npositron emission tomography/computed tomography (PET/CT) imaging to \ncharacterise osteoblastic prostate cancer skeletal metastases and to \ndistinguish them from benign processes. \nMethods and Materials:  One hundred and ten patients (56-82 y.o., mean age \n69 yrs) with biopsy proven adenocarcinoma of the prostate underwent \nstandard PET/CT imaging from vertex to toes approximately 45-60 minutes \nafter the intravenous administration of 370 ±37 MBq of 18NaF. Gleason \ngrading, serum prostate specific antigen levels (PSA), radiotherapy (RT), \nhormone, surgical or chemotherapy treatments were recorded. One spine \nlesion and one pelvic lesion were selected as index lesion per subject, and the \nmaximum standardised uptake values (SUV (max)) were calculated as a \nsemiquantitative surrogate measure for osteoblastic activity. \nResults: The SUV (max) of metastasis was significantly higher than chronic \ndegenerative disease (p < 0.001). In those who did not undergo any treatment, \nthe SUVmax was not significantly different between pelvis and spine \nmetastasis (p=0.19).No statistical difference was found in SUV max between \nsubgroups separated by Gleason grading, serum PSA levels or TNM staging. \nThe SUV (max) of pelvic metastasis was significantly lower in patient status \npost radiation therapy (p=0.049). The SUV (max) of both pelvic and spine \nmetastasis were not significantly lower in patients treated with antiandrogen. \nHowever, a trend characterised by lower SUV max values was \ndemonstrated (p=0.08). \nConclusion: Our preliminary data suggests that semiquantitative \nmeasurements of 18NaF activity with PET  imaging can be useful in detection \nof active skeletal metastasis in patients with prostate adenocarcinoma. \nImportantly,18NaF PET imaging can accurately distinguish between benign \nchronic degenerative changes and metastatic involvement.  \nB-1068 14:54  \nThe impact of F18 choline PET/CT in the biochemical relapse of prostate \ncarcinoma: a retrospective analysis in a large collective  \nM. Pixberg, M.K. Pixberg, A. Zöllich, J. Müller-Hübenthal; \nCologne/DE (martin.pixberg@web.de)  \nPurpose: Relapse in prostate cancer after 10 years occurs in 20-50% of \nsurgically treated and in 30-40% of radiated patients with increased PSA. An \nearly differentiation between local relapse and systemic progression is \nimportant, as in local relapse further curative therapy is possible. In case of \nlocal disease, focused therapy such as radiation can delay hormone therapy. \nAim of this retrospective study is to analyse the impact of F18 Choline PET/CT \nin relapse diagnosis of primarily successfully treated prostate carcinoma. \nMethods and Materials:  Between 2007 and 2013, we analysed 196 \ninvestigations in 165 patients. Some patients had more than one relapse. \nPatients with unsuccessful primary therapy and patients under hormone \ntherapy were excluded. \nResults: Recurrence in the prostate fossa was found in 15% of cases, PSA \nrange 0.88 - 13, mean 4.54. Local lymph nodes were involved in 15% of cases, \nPSA range 0.21 - 27, mean 3.7. Distant metastases were detected in 54% of \ncases, PSA range 0.1 - 75.5, mean 5.18. No correlation was found in 16% of \ncases, PSA range 0.02 - 13.14, mean 2.6. In 18 cases therapy was confirmed \nby the PET/CT result. In 42 cases therapy strategy changed and in 5 cases \nintention (curative/palliative) changed. \n \n \n \nConclusion: Choline PET/CT is valuable for identification of biochemical \nrelapse in cancer of the prostate and can find potentially curable cases. A \ncorrelation can be identified even for low PSA concentrations of < 0.2 ng/ml. In \nspite of high PSA concentrations of > 13neg/ml some cases showed no \nmetabolical or morphological correlation.  \nB-1069 15:03  \nHybrid 18 F-fluoride PET and MR imaging of the spine - a pilot study and \ncomparison of signals in patients with axial spondyloarthritis  \nC. Buchbender1, X. Baraliakos2, B. Ostendorf1, P. Heusch1, V. Hartung3, \nK. Beiderwellen3, J. Braun2, G. Antoch1; 1Düsseldorf/DE, 2Herne/DE, \n3Essen/DE (philipp.heusch@med.uni-duesseldorf.de)  \nPurpose: This study was performed as a pilot study on simultaneous 18 F-F- \nPET/MRI of the spine in patients with axial spondyloarthritis (axSpA). PET/MRI \ndata were compared to MRI alone in order to evaluate whether 18 F-F-PET \nprovides additional information to MRI alone. \nMethods and Materials:  In 11 axSpA patients, median age 39 years, disease \nduration range 0.5-10 years, mean Bath ank ylosing spondylitis disease activity \nindex 5.3, 18 F-F- PET/MRI was performed 40 minutes after injection of a \nmean dose of 157 MBq Fluoride using a hybrid whole-body PET/MRI scanner. \nMRI data alone and fused 18 F-F- PET/MRI data sets were scored by two \nblinded readers using the Berlin MRI score and by recording inflammatory PET \nand MRI lesions on a vertebral edge (VE) level. \nResults: Acquisition of whole-spine 18 F-F PET/MRI scans was successful in \nall patients. The mean Berlin MRI score was 6.8 (range 0 - 31). Inflammatory \nfindings were consistent on both, MRI and 18 F-F-PET/MRI, in 90% of the \ninvolved sites. In the remaining 10 %, focal 18 F-F-uptake without correlating \nMRI pathology was detected. Current evaluations are aimed at characterising \nthese discrepant findings. At presentation we are going to present data on the \nclinical relevance of the above named discrepancies between 18 F-F- \nPET/MRI and MRI alone. \nConclusion: 18 F-F- PET/MRI of the spine provides additional metabolic \ninformation on inflammatory bone lesions in axSPA patients compared to MRI \nalone. The clinical relevance of these additional findings is currently under \ninvestigation.  \nB-1070 15:12  \nAssessment of 68Ga DOTATOC uptake in neuroendocrine cancer patients \nundergoing PRRT to improve therapeutic stratification - a retrospective \nresponse analysis  \nM. Stefanova\n1, C. Kratochwil1, A. Afshar-Oromieh1, E. Mavriopoulou1, W. Mier1, \nL.H. Schwartz2, U. Haberkorn1, F.L. Giesel1; 1Heidelberg/DE, 2New York, \nPR/US (f.giesel@dkfz.de)  \nPurpose: The goal of our investigation was to assess the somatostatin \nreceptor (SSR2) expression by determining SUVmax in the liver metastases \nthat will be most beneficial for patients with neuroendocrine tumours (NETs) \nundergoing peptide-related radionuclide therapy (PRRT). \nMethods and Materials: 30 patients with 60 hepatic metastases of NETs were \nevaluated in the retrospective study. Patients were divided into responders and \nnon-responders according to structural lesion changes. The response was \ndetermined on a lesion-by-lesion basis evaluating morphological changes in \ntumour size between baseline and follow-up CE-CT after three cycles of PRRT. \nSSR2-expression of liver metastases in both groups was assessed at baseline \n[SUV maximum (SUVmax), metastases-to-spleen SUV ratio (SUVm/s) and \nmetastases-to-liver SUV ratio (SUVm/l)]. \nResults: There was a statistically signifi cant difference between the mean \nSUVmax of morphologically non-responders vs. responders prior PRRT in the \ninitial \n68Ga DOTATOC PET/CT. The mean SUVm/s (1.20 ±0.37 vs.1.90 ±0.45, \np < 0.05) and mean SUVm/l (3.15 ±0.53 vs.4.97 ±0.62, p=0.0003) also showed \nstatistically significant difference betwe en the non-responders and responders. \nWe observed also statistically significant difference in the SUVm/s ratio prior \nand after treatment in the responders patients. The longest diameter on CE-CT \nof the lesions was determined and in the non-responders there was no \nstatistically significant difference pre and post three cycles of the PRRT. In the \ngroup of the responders there was statistically significant difference between \nthe LD on CE-CT pre and post therapy (2.96 ±0.40 vs.1.58±0.43, p =0.00001). \nConclusion: In this retrospective study, our data suggest that mean SUVmax \nis a useful prognostic biomarker to improve patient selection undergoing \nPRRT.  \n \n \n \n \n \n \n \n \n \nS367  \n\n \n \nBA C D E F G \nMonday \n\u0010\u0013\u0018\u0015\u0019\u001d\u0018\u0016\u0018\u0013\u0001\u0010\u0015\u001c\u001c\u0018\u001a\u0019\u001c\u0001\nB-1071 15:21  \nPerfusion-MRI and 18-FDG-PET for monitoring the effects of regorafenib \non experimental colorectal carcinomas in rats with immunohistochemical \nvalidation  \nR. Eschbach, W. Fendler, M. Hacker, L. Havla, M.J. Schneider, L. Späth, \nK. Nikolaou, M.F. Reiser, C.C. Cyran; \nMunich/DE (Ralf.Eschbach@med.uni-muenchen.de)  \nPurpose: To investigate a multimodal, multiparametric perfusion MRI / 18 F-\nFDG-PET imaging protocol for monitoring regorafenib therapy effects on \nexperimental colorectal adenocarcinomas in rats with immunohistochemical \nvalidation. \nMethods and Materials:  Human colorectal adenocarcinoma xenografts (HT-\n29) were implanted subcutaneously in n=17 (n=10 therapy group; n=7 control \ngroup) female athymic nude rats (Hsd:RH-Foxn1rnu). The animals were \nimaged at baseline and after a one-week daily treatment with regorafenib \n(10 mg/kg bodyweight) using a multimodal, multiparametric perfusion MRI / \n18 F-FDG-PET imaging protocol. In perfusion MRI, quantitative parameters of \nplasma flow (PF, mL/100 mL/min), plasma volume (PV, %) and extraction flow \n(EF, mL/100 mL/min) were calculated. In 18 F-fluoro-deoxyglucose-(18 F-\nFDG)-PET, tumor-to-background-ratio (TTB) was calculated. Perfusion MRI \nparameters were correlated with TTB and immunohistochemical assessments \nof tumor angiogenesis (CD-31) and cell proliferation (Ki-67). \nResults: Regorafenib significantly (p < 0.01) suppressed PF (80.9 ±7.9 to \n51.1±16.9 mL/100 mL/min), PV (12.1 ±3.8 to 7.7± 1.6 %) and EF (13.9± 3.2 to \n8.2±2.2 mL/100 mL/min) as well as TTB (3.4 ±0.6 to 1.9 ±1.1) between baseline \nand day 7. Immunohistochemistry revealed significantly (p < 0.03) lower CD-31 \n(8.5±3.2 vs. 14.9 ±5.3) and Ki-67 (500.6± 102.3 vs. 596.3± 55.5) in therapy \ngroup than in control group. Perfusion MRI parameters \u0005PF, \u0005PV and \u0005EF \nshowed strong and significant (r=0.64-0.77;p < 0.01) correlations to the PET \nparameter \u0005TTB and moderate, but significant correlations (r=0.49-\n0.57;p < 0.05) to immunohistochemical Ki-67. \u0005PF and \u0005PV also correlated \nmoderately to the CD-31-stainings (r=0.49-0.53;p < 0.05). \nConclusion: A multimodal, multiparametric perfusion MRI / PET imaging \nprotocol allowed for monitoring regorafenib therapy effects on experimental \ncolorectal adenocarcinomas with significant correlations between perfusion \nMRI parameters and 18 F-FDG-PET, as validated by immunohistochemistry.  \n \nS368","source_license":"CC-BY-4.0","license_restricted":false}