{"paper_id":"276ba8bc-9f29-496c-8a2e-d557b27d0fbc","body_text":"S1\nThursday, March 7 ........ 5\nFriday, March 8 ........... 19\nSaturday, March 9 ....... 53\nSunday, March 10 ....... 83\nMonday, March 11 ..... 125\nA\nPostgraduate Educational \nProgramme\nCategorical Courses (CC)\nEFOMP Workshop (EF)\nESR meets Sessions (EM)\nEuropean Excellence in Education (E³)\nHonorary Lectures (HL)\nMini Courses (MC)\nMultidisciplinary Sessions (MS)\nNew Horizons Sessions (NH)\nOpening Lecture (OL)\nProfessional Challenges Sessions (PC)\nRefresher Courses (RC)\nRTF - Radiology Trainees Forum (TF)\nSpecial Focus Sessions (SF)\nState of the Art Symposia (SA)\nDOI 10.1007/s13244-01 -0 -3 227 y\nInsights Imaging (2013) 4 (Suppl 1):S1  –S S144  \n\nPostgraduate Educational Programme\nS\n C B D E F\n G\nA2\n\nPostgraduate Educational Programme\nS3\nB\n C D E F G\nA\nThursday, March 7\n\nPostgraduate Educational Programme\nS\n C B D E F\n G\nA\n14:00 - 15:30 Room B \nInteractive Teaching Session\nE³ 220 \nLung cancer \nA-003 14:00\nA. Detection \nS. Diederich; Düsseldorf/DE (stefan.diederich@vkkd‑kliniken.de) \nLung cancer most often presents as a pulmonary nodule or mass, less commonly \nas a hilar mass or endobronchial lesion. Most small tumours radiologically present \nas pulmonary nodules. Chest radiography (CXR) is limited in demonstration of small \nnodules and even lesions as large as 3 cm may be missed. Digital tomosynthesis \nhas been shown to markedly improve sensitivity for pulmonary nodules as com-\npared to CXR but is not yet widely available. Magnetic resonance imaging (MRI), \ntoo, is more sensitive than CXR, but is not routinely performed due to cost and \nlimited availability. The gold standard for detection of pulmonary nodules as small \nas 1-2 mm is multidetector computed tomography (MDCT). Technically, MDCT \ncan demonstrate pulmonary nodules with a sensitivity close to 100%, however, \nsensitivity of individual radiologists is much lower. Computer-assisted detection \n(CAD) software may improve sensitivity but may be limited by false positive find-\nings. Positron emission tomography (PET)-CT using 18 F-Deoxyglucose (18 FDG) \nhas a high sensitivity for lung cancer, however, false negative findings may be due \nto well-differentiated adenocarcinoma, carcinoid and nodules <  10 mm whereas \nfalse positive findings may be due to inflammatory lesions. This interactive ses-\nsion will include examples of manifestations of lung cancer as well as data on the \naccuracy of different imaging methods for lung cancer detection. Endobronchial \nand hilar tumours are more difficult to detect radiologically. Flat mucosal lesions \nmay go undetected altogether with bronchoscopy representing the gold standard \nfor these lesions.\nLearning Objectives:\n1.  To learn which imaging techniques are appropriate for detecting lung cancer.\n2.  To learn about the most relevant imaging findings in lung cancer.\n3.  To understand the behaviour of lung cancer related to imaging.\nA-004 14:45\nB. Follow-up \nF. Gleeson; Oxford/UK (fergus.gleeson@orh.nhs.uk) \nAlthough the initial staging of lung cancer is well worked up and agreed, the method \nof follow-up, and the frequency of follow-up investigations is less well investigated \nor agreed. There are now second line treatments available for patients with lung \ncancer initially treated with intention to cure. The second line treatments are in part \ndependent upon the volume of disease at relapse. It is important to understand \nwhich patients should be carefully followed up for potential second line treatment. \nSecond line treatments include surgery, radiotherapy, percutaneous ablation and \nchemotherapy. All have evidence to demonstrate an increase in survival follow-\ning relapse or disease progression. This presentation will summarise the current \nevidence and suggest algorithms that may be implemented to reduce cost and \nmaximise patient benefit.\nLearning Objectives:\n1.  To know the common features of lung cancer recurrence.\n2.  To learn how to establish follow-up protocols after treatment of lung cancer.\n12:30 - 13:30  Room N/O \nThe Beauty of Basic Knowledge: Head and Neck \nMC 24 A \nA taste of the oral cavity and salivary glands \nA-001 12:30\nA taste of the oral cavity and salivary glands \nA. Borges; Lisbon/PT (borgalexandra@gmail.com) \nThe oral cavity is a large mucosal space open anteriorly, bordered superiorly by \nthe nasal cavity and posteriorly by the oropharynx, containing a central muscular \npiece- the oral tongue. Inferiorly, the floor of the mouth, composed by the milohyoid \nmuscles, separates the mucosal space from the sublingual and submandibular \nspaces which contain the homonym salivary glands. The parotid gland, the larg-\nest of the salivary glands, lays in the parotid space with its major duct traveling \nthrough the buccal space and opening in the oral mucosa opposed to the second \nupper molars. It surrounds the ascending ramus of the mandible and is traversed \nby the main trunk of the facial nerve which divides the gland into superficial and \ndeep lobes; the later insinuating itself into the parapharyngeal space through the \nstylomandibular tunnel. Although the mucosal space is widely accessible to clinical \ninspection, imaging is crucial to depict pathology spreading to or originating from \nthe submucosa as well as to adequately depict areas of difficult clinical access \nsuch as the retromolar space- a small triangular area of mucosa posterior to the last \nmolars. Superficial structures in the submandibular and parotid-bucco-masseteric \nregion can be adequately depicted by ultrasound whereas deep seated structures \nare best evaluated using CT and/or MRI. Here, we will review the basic anatomy, \nimaging technique and main pathological processes affecting these head and \nneck structures.\nLearning Objecties:\n1.  To become familiar with the anatomy of the oral cavity and salivary glands.\n2.  To learn how to tailor imaging approaches to the patient’s clinical presentation.\n3.  To appreciate the main pathologic processes of the oral cavity and salivary \nglands.\n12:30 - 13:30 Room P \nThe Beauty of Basic Knowledge: Musculoskeletal Imaging \nMC 25 A \nTrauma \nA-002 12:30\nTrauma \nA. Kassarjian; Majadahonda/ES (akassarjian@gmail.com) \nA basic understanding of anatomy and biomechanics is crucial for the understanding \nof musculoskeletal injuries. Such thorough knowledge allows one to look beyond \nthe obvious/primary injury and search for commonly associated injuries that may \nbe quite subtle, are often overlooked, and may have significant clinical implications. \nThis session will cover upper and lower extremity injuries and explore the biome-\nchanics, pathophysiology and constellation of injury patterns as seen on imaging.\nLearning Objectives:\n1.  To learn about the basic mechanisms of musculoskeletal trauma.\n2.  To become familiar with typical musculoskeletal injuries and injury patterns.\n3.  To understand the impact of different radiological methods in the trauma set-\nting.\n4\n\nPostgraduate Educational Programme\nS\nB\n C D E F G\nA\nThursday\n16:00 - 17:30 Room C \nGI Tract \nRC 301 \nStaging and restaging of rectal and anal cancer \nA-007 16:00\nChairman’s introduction \nR.G.H. Beets-Tan; Maastricht/NL (r.beets.tan@mumc.nl) \nThe increasing role of radiologists in the multidisciplinary management team of \npatients with rectal and anal cancer is well recognised and MR imaging has become \nthe imaging method of choice for staging these tumours. Although organ saving \ntreatment has been adopted in patients with anal cancer, it is still debatable in pa-\ntients with rectal cancer. Partly, this is because in rectal cancer, in contrast to anal \ncancer - where clinical examination is accurate for selection of patients for organ \npreservation -, it is not reliable to solely base decision-making on the endoscopic \ninspection of the luminal aspect of the rectal wall. The shift in rectal cancer treatment \nhowever is eminent and the role of imaging pushing forward this shift is obvious. \nHence, the relevant questions that will be asked to radiologists in the coming years \nare: “how accurate can we assess response to treatment and how accurate can we \nmonitor sustained response during the long term surveillance?” The objective of this \nsession is to understand the value of modern planar imaging method for primary \nstaging of rectal and anal cancer patients (MRI, PET/CT). A second objective is to \nknow the performance of these imaging techniques for assessment of response, for \nselection of patients for organ preserving treatment and for monitoring of sustained \nresponse at long term follow-up. The session will elaborate on the similarities and \ndifferences of diagnostic questions for anal and rectal cancer.\nA-008 16:05\nA. Local staging of anal and rectal cancer and impact on initial \ntherapeutic strategy \nS. Gourtsoyianni; London/UK (sgty76@gmail.com) \nNew generation MRI scanners with optimal phased array body coils, resulting in \nimproved contrast and spatial resolution images due to better signal to noise ratio, \nhave contributed to production of high-resolution images in which visualisation of \nanatomical details such as the mesorectal fascia, mesorectal lymph nodes with a \ndiameter down to 2 mm and the bowel wall layers are feasible. Pre-operative MRI \nof the rectum using mainly high-resolution T2 weighted sequences has gained \nsignificant accreditation, especially after the introduction of total mesorectal excision \n(TME) surgery and neoadjuvant therapy in the treatment regimen of rectal cancer. \nMR Imaging is so far the only method that can preoperatively identify patients \nmost likely to benefit from neoadjuvant therapy as well as demonstrate high-risk \npatients for local recurrence. Anal cancers are more rare, account for < 1% of large \nbowel tumours, are predominantly squamous cell carcinomas and are treated with \ndefinitive chemoradiation. Imaging and especially MRI with multiple advanced \ncontrast mechanisms may play a significant role in radiotherapy planning as it may \naccurately delineate the extent of the primary tumour and allow for more precise \ngross tumour volume and potentially target volume definition.\nLearning Objectives:\n1.  To learn about optimised MR techniques for rectal and anal cancer staging.\n2.  To become familiar with the role of endorectal ultrasound in anorectal cancer \nstaging.\n3.  To understand basic TNM staging and assessment of the CRM on imaging.\n4.  To understand how imaging findings influence the initial therapeutic approach.\nA-009 16:35\nB. Assessment of rectal cancer response \nL. Curvo-Semedo; Coimbra/PT (curvosemedo@gmail.com) \nThe objective of neoadjuvant therapy is to downstage and downsize the tumour \nin order to improve resectability and achieve better local control. Preoperative \nchemoradiation therapy (CRT) has become standard of care for locally advanced \nrectal cancer and led to a decline in local recurrence rates. Post-CRT MRI for \nassessing invasion of mesorectal fascia (MRF) based on morphologic criteria \nalone shows both high sensitivity and NPV. Its main challenge is the assessment \nof hypointense “fibrotic” tissue in the initial tumour area that may contain small \nresidual tumour nests. DWI can help differentiate neoplastic from radiation-induced \nfibrosis and inflammation within the MRF, potentially improving the overall diag-\nnostic accuracy. The reported overall accuracy of MRI in assessing the T stage \n16:00 - 17:30 Room B \nInteractive Teaching Session \nE³ 320 \nMalignant pancreatic tumours \nA-005 16:00\nA. Solid tumours \nW. Schima; Vienna/AT (wolfgang.schima@khgh.at) \nThe most common pancreatic malignancy is ductal adenocarcinoma, with neu-\nroendocrine tumours (NET), lymphoma and metastases being important differential \ndiagnoses. Non-neoplastic pitfalls include focal pancreatitis and lipoma. Multi-phasic \nhydro-MDCT is very effective in detection of hypoattenuating adenocarcinoma (sen-\nsitivity up to 90%). In 5-11% of patients, isoattenuatting cancers will show only indi-\nrect tumour signs (duct dilatation, contour deformity, loss of lobulation, mass effect). \nMRI is a problem-solving tool in equivocal CT to depict small cancers. Best pulse \nsequences for detection are unenhanced T1w GRE fatsat, dynamic enhanced 3D-\nGRE fatsat and DWI. Important issues in cancer staging are presence of vascular \ninvolvement (celiac taxis, SMA, SMV, portal vein), lymph nodes, or liver metastases. \n3D reformations (MIP, VRT, CPR) of MDCT datasets are helpful to demonstrate \nvascular invasion, although minimal invasion may elapse CT or MR imaging. NET \ntend to be hypervascular, which is best seen in the arterial phase. RCC metastases \nto the pancreas are not uncommon. They are typically hypervascular, mimicking \nNET at imaging. Most important non-neoplastic solid mass is focal pancreatitis. \nThe duct penetrating sign at MRCP helps to differentiate focal inflammation from \ncancer, although multimodality imaging including biopsy is often required to make \na definitive diagnosis. Focal steatosis or lipoma is easily diagnosed by chemical \nshift MRI (T1w GRE in- and opposed-phase). In conclusion, multi-phasic hydro-\nMDCT is excellent for cancer detection, with 3D reformations for demonstration of \nvascular involvement. For differentiation between cancer and tumour-simulating \ndisease (focal pancreatitis, steatosis), MRI is complementary to MDCT. \nLearning Objectives:\n1.  To learn how to differentiate tumours from other non-tumoural pathology.\n2.  To understand how to choose the proper imaging technology.\n3.  To appreciate how to determine resectability and extension of the tumour.\nAuthor Disclosure:\nW. Schima: Advisory Board; GE Healthcare. Speaker; Siemens. \nA-006 16:45\nB. Cystic tumours \nG. Morana; Treviso/IT (gmorana@ulss.tv.it) \nCystic lesions of the pancreas can be recognised in up to 8%-10% of abdominal \nstudies, although most of them are benign. Real cystic tumours of the pancreas \nare more rare and less frequent than solid lesions; quite often they are occasionally \nrecognised, as many of these lesions are small and asymptomatic, but they may \nbe associated with pancreatitis. An accurate differentiation between different cystic \nlesions is important because they require a different treatment according to their \nhystological type and differentiation, but due to the frequent lack of specific clinical \nand laboratoristic signs, the overlap of imaging findings between different cystic \ntumours and between non-neoplastic and neoplastic cistic lesions of the pancreas, \nthe management of these patients is complex, and knowledge of symptoms of \nthe patients, natural history and predictors of malignancy are important. When \ndealing with pancreatic cysts, aim of the imaging is to differentiate cystic tumour \nfrom tumour-like lesions and to characterise cystic tumour, distinguishing benign \ntumour, which usually do not require surgical excission, from border-line or malig-\nnant ones, which must be resected whenever possible. On the basis of imaging \ncriteria alone, it can be very difficult to differentiate non-tumoural cystic lesions from \nneoplastic ones; in order to achieve a correct diagnosis, it is important to correlate \nthe imaging findings with the clinical history of the patient, the presence or absence \nof symptoms, and their type. US, CT and MRI are excellent tools which permit to \naccurately evaluate these lesions, making thus possible their correct management.\nLearning Objectives:\n1.  To learn how to choose the proper imaging modality.\n2.  To understand the criteria of malignancy and benignity.\n3.  To learn how to follow-up the lesions.\n5\n\nPostgraduate Educational Programme\nS\n C B D E F\n G\nA\nsubstantially benefit from the B0 increase. The work horse of cardiac MRI, cine \nSSFP is affected by off-resonance artifacts at higher B0, with proper adjustments \n(shimming, frequency scouting) though diagnostic image quality can be maintained. \nMost importantly, in daily routine also the safety aspect of the patient with potential \ndevices has to be taken into account.\nLearning Objectives:\n1.  To learn about the differences between 1.5 T and 3 T cardiac MRI.\n2.  To understand the clinical applications of high-field cardiac MRI.\n3.  To become familiar with the problems of using high-field cardiac MRI in daily \nroutine.\nAuthor Disclosure:\nB. J. Wintersperger: Speaker; Siemens Healthcare, Bayer Healthcare. \nA-012 16:30\nB. Cardiac CT: technique in 2020; where to next? \nK. Nikolaou; Munich/DE (konstantin.nikolaou@med.uni‑muenchen.de) \nIn recent years, technical advances and improvements in cardiac computed \ntomography (CT) have provoked increasing interest in the potential clinical role \nof this technique in the non-invasive work-up of patients with various cardiac \ndiseases - most importantly in patients with suspected coronary artery disease \n(CAD). Within the next years, several trends are foreseeable: from a research \nstandpoint, the strengthening of clinical evidence by larger, randomised, clinical \nmulticentre trials for cardiac-CT indications can be expected. From a technical \nstandpoint, there are two main fields of interest and technical developments to be \nexpected: further optimising radiation dose and image quality, by techniques such \nas high-pitch scanning, iterative reconstruction algorithms, wide detectors with \nsingle heart beat acquisitions and digital detector technology. On the other hand, \nintroduction of new applications and protocols, such as the combined assessment \nof cardiac morphology, function, and viability/perfusion, will broaden the clinical \napplicability of cardiac-CT.\nLearning Objectives:\n1.  To learn about the latest technical developments in state-of-the-art cardiac \nCT.\n2.  To explore what new developments will influence cardiac CT over the next \nfew years.\n3.  To understand if what you need is a lot of rows, tubes or both for optimal \ncardiac CT.\nA-013 17:00\nC. Cardiac hybrid imaging: “One-Stop-Shop” \nP.A. Kaufmann; Zurich/CH \n″Abstract Not Submitted″\nLearning Objectives:\n1.  To understand the principles of cardiac hybrid imaging.\n2.  To learn about the diagnostic value of hybrid imaging.\n3.  To know about possible indications for performing hybrid imaging.\n16:00 - 17:30 Room E1 \nMolecular Imaging \nRC 306 \nMolecular imaging in oncology \nModerator: \nO. Clément; Paris/FR \nA-014 16:00\nA. New PET-tracers for oncology \nP.L. Choyke; Bethesda, MD/US (pchoyke@nih.gov) \nPET tracers represent an exciting development in the imaging of cancers. Because \nof the sensitivity of PET (nano-pico molar sensitivity vs. micromolar for MRI), it is \npossible to image cell membrane-based receptors responsible for the abnormal \ngrowth associated with cancers and detect subtle changes in the integrity of cancer \ncells. FDG-PET /CT has been the trailblazer agent, demonstrating unique sensitiv-\nity for cancers, however, while FDG uptake does reflect glycolysis, it is relatively \nnon-specific and, to date, has not dictated the choice of therapies. The promise \nof new PET agents is that they will aid clinicians in adding or deleting therapies \ndepending on the pharmacodynamics of the imaging biomarker. For instance, \nclasses of agents have been developed to investigate angiogenesis, proliferation, \nof irradiated rectal cancer is 47%-54%. The major cause of overstaging is diffuse \nhypointense tissue infiltration into the mesorectal fat, related to marked fibrosis of \nthe bowel wall and desmoplastic reaction. Replacement by fibrotic scar tissue with \nan island of residual adenocarcinoma can make it difficult to identify viable tumour \non MR images, causing understaging. Imaging after CRT is not sufficiently accurate \nfor identifying complete responders, with PPVs ranging from 17 to 50%. In most \ncases, a hypointense scar replaces the site of disease, and the major component \nof error on MRI is overstaging due to its limited capability to differentiate between \nviable tumour, residual fibrotic tissue, and desmoplastic reaction. DWI in addition \nto standard MRI significantly improves the performance of radiologists to select \ncomplete responders.\nLearning Objectives:\n1.  To learn the rationale for following-up on patients after neoadjuvant chemo-\nradiation.\n2.  To understand conventional imaging criteria for assessing tumour response.\n3.  To learn about new techniques for assessing response, including diffusion \nMRI and PET/CT.\nA-010 16:55\nC. Assessment of anal cancer response \nV.J. Goh; London/UK (vicky.goh@kcl.ac.uk) \nAnal cancer is an uncommon cancer, accounting for 1.5% of all gastrointestinal \ncancers, but is increasing in incidence. Anal cancer is predominantly a loco-regional \ndisease; less than 5% of patients have disease outside the pelvis at presentation. \nDefinitive chemoradiation, combining radiotherapy with concomitant 5-fluorouracil \nand mitomycin C, is recognised to be the optimal treatment modality for squamous \ncell cancers of the anal canal and margin, offering good loco-regional control and \nsurvival rates similar to surgery. Traditionally clinical examination and proctoscopy \nhave been the main tools for locoregional tumour assessment, however, in recent \nyears, imaging has become the method of choice for assessing tumour regression \nfollowing chemoradiation. The advantage and limitations of the different imaging \ntechniques in assessing response will be described. The complications of treatment \nand imaging appearances will also be discussed.\nLearning Objectives:\n1.  To learn the rationale for restaging after therapy.\n2.  To know how to assess the tumour response with conventional imaging criteria.\n3.  To learn about new techniques for assessing response in anal cancer, including \ndiffusion MRI and PET/CT.\nPanel discussion:\nWhat clinicians expect from us in rectal and anal cancer staging and \nrestaging? How should we image patients? 17:15 \n16:00 - 17:30 Room D2 \nCardiac \nRC 303 \nCardiac imaging: the cutting edge \nModerator: \nE. Di Cesare; L ’Aquila/IT \nA-011 16:00\nA. Cardiac MRI: do we need more than 1.5 T? \nB.J. Wintersperger; T oronto, ON/CA (Bernd.Wintersperger@uhn.ca) \n1.5 T cardiac MR imaging is a main stay of cross-sectional imaging of various cardiac \ndiseases and has proven high accuracies and new insights into diseases. Based \non its success, diagnostic approaches have changed and also risk assessment \nfor some cardiac diseases has become possible. Based on continuous techni-\ncal developments though higher field strength have become available in recent \nyears with clinical use of 3 T and research use of 7 T. However, specific changes \nthat come along with the increase in B0 have to be incorporated in most aspects \nof a cardiovascular MR imaging procedures; from patient screening to imaging \ntechnique details. Basic changes at higher B0 are: B0 proportional increase of \nSNR, substantial increase in RF deposition, changes in magnetic tissue proper-\nties and B0/B1 inhomogeneities. While most of these changes affect all aspects \nof cardiac imaging at 3 T, some may only affect certain applications (e.g. assess-\nment of myocardial iron). CE MRA benefit from SNR increase at higher B0 (e.g. \n3 T) and improved background suppression based on short TR and prolonged T1 \nvalues. While some applications at higher B0 have not yet been proven to impact \ndiagnosis signal starving applications at 1.5 T (e.g. myocardial perfusion), also \n6\n\nPostgraduate Educational Programme\nS\nB\n C D E F G\nA\nThursday\nand to monitor cancer therapy. First molecular ultrasound microbubbles are currently \nunder clinical evaluation. Since microbubbles can also be used to permeate the \nvasculature locally and to transport drugs, its theranostic potential will be outlined. \nLearning Objectives:\n1.  To become familiar with optical imaging techniques and probes.\n2.  To learn about the potential of targeted US contrast agents.\n3.  To appreciate emerging hybrid imaging techniques.\nAuthor Disclosure:\nF. M. A. Kiessling: Board Member; ESR Research Board, Council ESMI. \nFounder; invivoContrast GmbH. Grant Recipient; DFG, BMBF, EU. Research/\nGrant Support; Financial support by Bracco, Bayer, Philips, Roche, Astra \nZeneca. \n16:00 - 17:30 Room E2 \nMultidisciplinary Session: Managing Patients with Cancer \nMS 3 \nColorectal liver metastases \nA-017 16:00\nChairman’s introduction \nV. Vilgrain; Clichy/FR (valerie.vilgrain@bjn.aphp.fr) \nPatients with colorectal liver metastases require a multidisciplinary approach includ-\ning hepatobiliary surgeons, oncologists, diagnostic and interventional radiologists. \nThis session will cover the most important issues in these patients. The role of \nimaging in assessing intra- and extrahepatic staging will be discussed. Cases will \nillustrate the most recent improvements in imaging such as diffusion-weighted and \nliver specific contrast-enhanced MR imaging. Curative hepatic surgery is standard \nof care for resectable patients, but most patients are not initially resectable. The re-\nsectability depends on the size, location, and extent of disease. Resectable and non-\nresectable cases will be shown as well as two-step procedures such as portal vein \nembolisation which allow surgical resection in patients who cannot initially meet the \nsurgical criteria. The role of systemic chemotherapy with or without targeted therapy \nis crucial in patients with resectable or non-resectable colorectal liver metastases. \nNotably, chemotherapy can render resectable patients who are unresectable. Yet, \nthese treatments can induce hepatotoxicities. Last, interventional radiology plays an \nimportant role in these patients allowing local ablation or endovascular treatments \nsuch as hepatic arterial chemoembolisation and selective internal radiation therapy. \nSession Objectives:\n1.  To learn about the prognostic factors of colorectal liver metastases.\n2.  To become familiar with the most common therapeutic strategies.\n3.  To understand the role of the multidisciplinary team in patients with colorectal \nliver metastases.\nA-018 16:05\nRole of imaging in the pretreatment assessment \nV. Vilgrain; Clichy/FR (valerie.vilgrain@bjn.aphp.fr) \nThere are various treatments for liver metastases from primary colorectal cancer \nincluding surgical resection, non-surgical ablative treatments, and chemotherapy. \nYet, surgical resection with perioperative chemotherapy has been shown to be the \nbest treatment option for cure in these patients. Therefore, the role of imaging in the \npretherapeutic assessment is key and can be splitted into four topics: 1) diagnosis of \nliver lesions as liver metastases, 2) extrahepatic staging including nodal metastases, \nperitoneal implants, regional or local recurrent or residual disease, and pulmonary \nmetastases, 3) intrahepatic staging which aims to define number and extent of liver \nmetastases in the segmental and lobar distribution in order to evaluate surgical \nresectability or feasibility of non-surgical ablative treatments, 4) and eventually \nresponse to chemotherapy with or without targeted therapy. Multimodal imaging is \nneeded to answer all these questions. The most important imaging modalities are \nCT, MR imaging and PET. Multidetector CT is particularly helpful for whole body \ninvestigation and anatomic information for surgical planning. MR imaging is better \nthan CT for lesion detection and lesion characterisation in the liver in particular with \ndiffusion-weighted images and sequences using liver-specific agents. PET imaging \nis highly sensitive in detecting extrahepatic metastatic lesions, particularly when \nCT and PET interpretation can be combined. Pretherapeutic and intraoperative \ncontrast-enhanced ultrasound may complete the work-up.\nLearning Objectives:\n1.  To become familiar with imaging findings indicating surgical resectability.\n2.  To understand the role of CT and MR imaging in staging liver metastases.\n3.  To learn about the role of new imaging techniques in staging liver metastases.\nhypoxia, apoptosis, hormone sensitivity and amino acid transport. Each of these \nprovides a unique window on the biology of each cancer and will hopefully guide \ntherapies in the near future. In the specific example of metastatic prostate cancers, \nSodium Fluoride PET is proving far more sensitive than conventional bone scans. \nAgents such as F-ACBC (amino acid transport), F-DCFBC (Prostate Membrane \nSpecific Antigen PSMA), F-DHT (androgen receptor) and F-Choline (cell membrane \nturnover) are proving efficacious in the detection of metastastic disease and reflect \nactual tumour burden in contrast to existing methods that only indirectly image \ntumour (bone uptake). Thus, there is a rich future in new PET tracers for oncology \nthat is only in its infancy.\nLearning Objectives:\n1.  To learn about the new specific tracers that can be used in oncologic patients.\n2.  To become familiar with their possible impact on patient management.\n3.  To understand their potential and limitations for practice.\nAuthor Disclosure:\nP. L. Choyke: Other; Research Agreements with GE, Siemens and Philips. \nA-015 16:30\nB. Potential of MRI for molecular imaging in oncology \nF.A. Gallagher; Cambridge/UK (fag1000@cam.ac.uk) \nImaging targets in cancer range from simple size measurements to more specific \nbiomarkers on functional, cellular, metabolic and molecular levels. As our under-\nstanding of basic tumour biology has advanced, techniques have been developed \nto exploit this information to produce increasingly specific molecular imaging tools. \nThe biodistribution of these molecular imaging probes should be more specific in \ndiagnosing and assessing cancer than the morphological information acquired \nusing anatomical imaging alone. This lecture will discuss current and emerging \nfunctional and molecular imaging techniques using MRI and their applications in \noncology. Functional measures of tumour blood flow and vascular permeability can \nbe made using dynamic contrast-enhanced MRI. Diffusion-weighted imaging is a \nsurrogate for the cellular content of the tumour and emerging methods can be used \nto probe features of the extracellular space such as tumour pH and stromal content. \nOn the molecular level, cell surface expression of specific proteins and enzyme \nactivity within the cell can be imaged; labelled probes have been developed which \nbind to these proteins and a new MR technique is being developed for assessing \ntumour glucose in a similar way to PET. Hyperpolarisation methods are emerging \nto overcome the major limitation of MR: its low sensitivity. One such approach is \ndynamic nuclear polarisation, which can probe carbon metabolism non-invasively \nin patients with cancer. Functional and molecular imaging techniques with MRI will \nincreasingly be used in radiology in conjunction with anatomical imaging methods \nto improve diagnosis and prognosis, target biopsies, as well as predict and detect \nresponse to treatment.\nLearning Objectives:\n1.  To become familiar with the different approaches to molecular imaging with \nMRI.\n2.  To understand the role of molecular imaging in oncology.\n3.  To learn about emerging MRI techniques for molecular imaging.\nAuthor Disclosure:\nF. A. Gallagher: Grant Recipient; GE Healthcare. \nA-016 17:00\nC. Emerging molecular imaging techniques \nF.M.A. Kiessling; Aachen/DE (fkiessling@ukaachen.de) \nOptical in vivo imaging derives from microscopy techniques and is establishing \nas a valuable and cheap tool in preclinical research. Some optical methods have \nrecently been translated to the patient and show promising results. However, the \nability to gain quantitative or spatially high resolved data differs between optical \nimaging methods. Therefore, principles, strengths and limitations of optical reflect-\nance imaging, mesoscopic epi-fluorescence tomography (MEFT), and fluorescence \nmolecular tomography (FMT) will be discussed. Optical imaging benefits from being \ncombined with CT or MRI and it will be show how µCT not only improves the locali-\nsation of fluorescent spots within animals but also improves the reconstruction of \nfluorescent raw data. Also in PET-CT, CT data is not only used as a morphological \ncorrelate but also to perform the attenuation correction. This is much more difficult, \nwhen using PET in combination with MRI. A possible solution is the use of UTE-\nDixon MR sequences that can reliably distinguish fat, soft tissue and bone, which \nare the tissue components with most different photon absorption. The last part of \nthe talk is dedicated to molecular ultrasound imaging. Here stabilised gas bubbles \nlinked to targeting moieties are used as intravascular contrast materials. Markers \nof vascular inflammation and of angiogenesis can be addressed. Many preclinical \nstudies successfully applied molecular ultrasound imaging to characterise cancer \n7\n\nPostgraduate Educational Programme\nS\n C B D E F\n G\nA\ntases approaches 35-50%. However, approximately half of the patients will have \na recurrence within 5 years. In spite of the significant progress made in systemic \ntreatment of metastatic disease, the development of image-guided percutaneous \ntechniques for local tumour ablation has been one of the major advances in the \ntreatment of non-resectable liver and pulmonary metastases. If tumour load is still \nlimited, local ablative therapy such as Radiofrequency ablation, Microwave or more \nrecently Irreversible Electroporation are relevant treatment options. Particularly in \npatients who previously underwent surgery, minimal invasive percutaneous ablative \nprocedures are preferred not only because of lower morbidity and mortality but \nalso because the procedure is easy to repeat in case of residual/recurrent tumour. \nTrans-arterial techniques are a feasible salvage treatment for chemorefractory meta-\nstatic colorectal cancer that remains a leading cause of cancer-related death with \npromising results of DC Beads loaded with doxorubicin and Irinotecan drug-eluting \nbeads. Although chemoembolisation represents the mainstay, 90Y microsphere \ntherapy has recently gained increasing awareness. Last, recent studies have shown \nthe safety and efficacy of intra-arterial hepatic chemotherapy and percutaneous \nisolated hepatic perfusion in the treatment of liver metastases of colorectal cancer.\nLearning Objectives:\n1.  To learn about the most common image-guided treatments.\n2.  To understand advantages and drawbacks of each treatment.\n3.  To become familiar with the role of image-guided treatments.\nCase presentation and discussion 17:05 \n16:00 - 17:30 Room F1 \nProfessional Challenges Session \nPC 3 \nBringing radiology to medical undergraduates \nA-022 16:00\nChairman’s introduction: why does it matter? \nS.J. Golding; Oxford/UK (stephen.golding@nds.ox.ac.uk) \nToday all radiologists face competing demands for their time and skills. Prioritisa-\ntion has become an essential tool of the efficient radiologist. In this scenario, it \nis inevitable that the greatest demand is clinical service, with the risk that other \nactivity will be displaced or excluded. This Professional Challenges session \narises from work of the ESR Working Group on Undergraduate Education. It \naddresses the need for radiologists to ensure that their involvement with medi-\ncal undergraduates is not lost due to pressure of clinical demand. The work is \nimportant because it ensures that: (1) medical undergraduates are equipped to \npractise appropriately, (2) their use of radiological resources is efficient and ef-\nfective, (3) Radiology achieves a greater profile in undergraduate career choice, \nand (4) the opportunities that Radiology offers to support learning elsewhere in \nthe curriculum are realised. To achieve effective involvement, radiologists require \nunderstanding of the needs of the undergraduate, the skills necessary to use \ntheir time efficiently, knowledge of which of the available educational options \nare appropriate to the speciality, and the skill and ability to maintain Radiology’s \nvoice in curricular planning and medical school direction. These presentations, \nfrom leaders in radiological education, are intended to assist the teaching ra-\ndiologist in their efforts to make such an impact on the medical undergraduate. \nSession Objectives:\n1.  To understand why radiologists need to make undergraduate teaching a priority.\n2.  To become familiar with the effect of teaching undergraduates on the student \nand the institution.\n3.  To appreciate the objectives with which the undergraduate should be taught.\nA-023 16:05\nEstablishing a radiological presence in the undergraduate curriculum \nR.N. Gibson; Melbourne/AU (r.gibson@unimelb.edu.au) \nEstablishing a radiological presence in the undergraduate medical curriculum em-\nbeds the perception of a specialty which is pivotal in medical education, health care \ndelivery and research. It also attracts students into radiology. Educational outcomes \nrelate to: (a) imaging as a learning tool for anatomy, pathology, and clinical medicine \n(b) the principles and practice of radiology (image generation and interpretation, \nprocedural radiology, interpretation skills for common or life-threatening conditions, \ndiagnostic accuracy, referral guidelines, and the consultative process, safety and \nrisk, cost and resource management, and the patient experience of diagnostic \nand procedural imaging). Gaining a curricular presence requires: (a) proactive \nengagement with university and clinical campus leaders in developing explicit \nA-019 16:20\nSurgical resection of liver metastases: when and how \nJ. Belghiti; Clichy/FR (jacques.belghiti@bjn.aphp.fr) \nLiver resection (LR) remains the only curative option for patients with colorectal \nliver metastases (CLM). Chemotherapy increases the possibility and the efficiency \nof LR. The indication of LR is increasing to patients with multiple and bilobar liver \nmetastases whatever their size and location if a sufficient remnant liver volume is \npreserved and even to selected cases with localised carcinomatosis and/or pulmo-\nnary metastasis. There is an ongoing debate regarding: (a) the optimal timing for \nLR in patients with synchronous liver metastases which can be performed before, \nduring or after resection of the primary lesion; (b) the exact benefits of neoadjuvant \nchemotherapy in patients with solitary metachronous metastases; (c) the trend in \nextending the indications for surgery for patients with initially unresectable CLM. \nIncreased efficiency of chemotherapy regimen using targeted therapies or intra-\narterial chemotherapy currently provides response rates up to 70%. Refinements \nin surgical technique such as liver volume modulation using portal vein occlusion \nand two-step strategies allow overcoming technical issues formerly considered as \nlimitations to surgery. Altogether, secondary resectability can be achieved in ap-\nproximately 25-30% of initially unresectable patients. However, both existence of \nchemotherapy liver injury following numerous cycles and complex resection in order \nto achieve adequate surgical margins can impair the post-operative course and \njeopardise post-operative chemotherapy. It therefore appears that these patients \nwould get benefit from both repeated morphological evaluation of the response to \nchemotherapy and more limited resection conservative strategies. \nLearning Objectives:\n1.  To become familiar with surgical indications of liver metastases.\n2.  To understand treatment planning strategies.\n3.  To learn about prognostic factors for surgical candidates.\nA-020 16:35\nChemotherapy and novel therapy in colorectal liver metastases: \nrationale, indications and results \nS. Faivre; Clichy/FR (sandrine.faivre@bjn.aphp.fr) \nDuring several decades, the only agent for the treatment of metastatic colorectal \ncancer was 5-fluoro-uracile (5  FU), yielding <  25% response rates and median \noverall survivals (OS) of 8-12 months. In the 1990s, oxaliplatin and irinotecan, \n2 major active compounds have been made available in combination with 5  FU \n(FOLFOX and FOLFIRI regimens), reaching #50% response rate and median \nOS >  16 months. From 2005 to 2006, the introduction of targeted therapies \n(cetuximab-ERBITUX; bevacizumab-AVASTIN) was shown useful to optimise \nthe effects of FOLFOX/FOLFIRI by blocking proliferation (EGFR for cetuximab in \nKRas non-mutated tumours) and angiogenesis (VEGF for bevacizumab), further \nimproving OS > 20 months. Doublet and triplet chemotherapies (CT) were usually \nwell tolerated. Importantly, systemic CT increases the proportion of patients who \nbecome candidate for liver surgery from #12% to #22%, several cases of patients \nwith liver metastasis being finally cured following multimodality treatments includ-\ning CT and surgery. This highlights the importance of multidisciplinary manage-\nment for liver metastasis to offer patients the best strategy. Baseline radiological \nassessment is crucial to address surgical resectability and urge deciding for the \nmost efficient CT regimen. Optimally, the first radiological evaluation, along with \nblood tumour markers, must be performed between 8 and 12 weeks. An objective \nresponse by RECIST criteria warrants continuing on the same CT if the patient \nremains not operable, or start planning liver resection if the patient is recognised \noperable by the multidisciplinary tumour board. In addition to tumour shrinkage, \na decrease in tumour density may indicate antitumour effects for patients treated \nwith antiangiogenic agents.\nLearning Objectives:\n1.  To appreciate the rationale behind chemotherapy and novel therapy.\n2.  To learn about the most common protocols of chemotherapy and novel therapy.\n3.  To consolidate knowledge in treatment efficacy.\nA-021 16:50\nRole of image-guided treatment in colorectal liver metastases \nM. Abdel Rehim, A. Sibert, V. Barrau, Z. Ben Lakhdar, V. Vilgrain; Clichy/FR \n(m_solouma@hotmail.com) \nThere are more than 200,000 cases of colorectal cancer (CRC) each year in \nEurope. More than half of patients with newly diagnosed (CRC) will develop \nmetastatic disease (25% synchronous, 30% metachronous). Hepatic resection is \nthe standard local treatment of hepatic metastases. Yet, only onethird of patients \nare eligible for curative resection. Survival following hepatic resection of all metas-\n8\n\nPostgraduate Educational Programme\nS\nB\n C D E F G\nA\nThursday\nA-026 16:50\nHow to ensure teachers are suitably trained \nE. Szabó, Z. Morvay, E. Nagy, I. Mátéka; Szeged/HU (endrebacsi@gmail.com) \nThe presentation will give a result-oriented overview of the history of research on \nlearning methods from Skinner to Wenger-Trayner, tries to highlight the most ap-\npropriate ones necessary for teaching the undergraduates and hopes to fertilise \nfurther discussions and future ECR involvement in this area. Some aspects of \ncourse composition and examinations will also be discussed. \nLearning Objectives:\n1.  To learn that teaching is a psychomotor skill with its own training requirements.\n2.  To understand the importance of course design and methods of assessment \nto learning.\n3.  To understand the ways in which radiological teachers may obtain training \nappropriate to their needs.\nPanel discussion:  \nWhat needs to be done to overcome the constraints on radiologists? 17:05 \n16:00 - 17:30 Room F2 \nBreast \nRC 302 \nFunctional imaging of the breast \nModerator: \nG. Esen; Istanbul/TR \nA-027 16:00\nA. Contrast-enhanced mammography \nC.S. Balleyguier1, E. Fallenberg2, S. Canale1, C. Dromain1; 1Villejuif/FR, \n2Berlin/DE (balleyguier@igr.fr) \nContrast-Enhanced Spectral Mammography (CESM) is a new imaging technique \ncombining Digital Mammography and injection of iodinated contrast agent. Mam-\nmography images are acquired at two (high and low) energy levels. Based on \ndifferent attenuation characteristics between iodine and soft tissue, parametric im-\nages showing enhancement are reconstructed. There is some mandatory hardware \nadaptation, for instance adding a copper filter and a dedicated software is required. \nHowever, interpretation of images is based on morphological criteria. Two sets of \nimages are acquired (CC and MLO). Obtained images compete with subtraction \nimages obtained after dynamic contrast-enhanced MRI. Radiation dose is 1.2 \nmore that of a normal Digital Mammogram. Indications for CESM are quite similar \nto that of MRI. CESM significantly improves characterisation of breast lesions as \ncompared with mammography. For breast cancer staging, as compared with MRI, \nCME carries a slightly lower sensitivity, but conversely a better specificity, cutting \ndown the number of false positives. Some false negatives were observed in case \nof Infiltrative Lobular carcinoma and DCIS. CESM might become a very practical, \ncost-saving, alternative to Breast MRI in specific clinical situations.\nLearning Objectives:\n1.  To understand the underlying physical principles of contrast-enhanced mam-\nmography (CEM).\n2.  To become familiar with different protocols.\n3.  To appreciate the potential impact of CEM on every day clinical practice.\nA-028 16:30\nB. Ultrasound elastography \nA. Athanasiou; Paris/FR (alex_athanasiou@hotmail.com) \nBreast ultrasound elastography provides information about tissue elasticity Young \nmodulus E = s / e, where s is the compression (stress) and e is the deformation \n(strain) of the tissue. It is a complementary tool to breast ultrasonography, easily \nperformed in clinical practice. Two elasticity modes are currently available: strain \nimaging, where manual compression is applied to the ultrasound probe and tis-\nsue displacement is registered; tissue deformation is then calculated by means \nof dedicated software providing real-time elasticity images (color- or grey-coded) \nsuperimposed on B-mode imaging. This is a qualitative or semi-quantitative mode. \nShear wave imaging, where US probe is used to induce mechanical vibrations using \nacoustic radiation force generating local tissue displacement. This mode provides \nquantitative information about either tissue displacement velocity or tissue stiffness \nitself in kPa. Functional information provided by elasticity imaging can be particularly \nuseful for BIRADS 3 or 4a lesions. Various studies indicate that elasticity combined \nto B-mode imaging can improve breast ultrasound specificity up to 75-88%. False \ncore curriculum and (b) identification of key radiologists as leaders. Preclinical \ninvolvement is most appropriate via anatomy learning and can introduce principles \nof image generation and interpretation. Engagement in clinical years should be \nstrong and integration with the clinical curriculum is desirable. Small versus larger \ngroup teaching depends on overall curriculum and human resources. Resources \ninclude print texts, CDs or on-line resources, and PACS teaching files and must be \npitched at medical student level. Development of local resources raises the local \nstatus of radiology and its place in the curriculum. Direct interface with the radiology \ndepartment can include structured departmental visits, clinicoradiological working \nmeetings, electives or clerkships. Opportunities should be provided for research if \npart of the overall curriculum. Involvement in assessment throughout the course \nis critical and linked to the curriculum.\nLearning Objectives:\n1.  To understand the importance of radiology’s undergraduate profile.\n2.  To understand the effect of a presence throughout the curriculum on education.\n3.  To become familiar with the ways in which radiology’s curricular presence may \nbe achieved at individual stages.\nA-024 16:20\nFinding the time and resources in the radiology department \nJ. del Cura; Bilbao/ES (joseluis.delcurarodriguez@osakidetza.net) \nOne of the problems of undergraduate teaching of Radiology is the lack of time \nfor teaching, due to competition for resources with other academic disciplines. \nAvailable classroom time and hours of practice are often insufficient to teach the \nincreasingly complex modern Radiology. Also, the availability of financial resources \nto hire staff or access to educational facilities is competitive and limited, especially \nin a context of economic crisis. A good solution is to shift the paradigm of education, \nchanging theoretical teaching into self-learning by students. This change allows to \nfree class time to effectively teach Radiology. Classes are converted in workshops, \ndoubt-solving sessions and problem-based learning, all of which matches better \nwith a visual discipline like Radiology. Both on-line classes and e-learning can be \nuseful for this purpose. This kind of teaching also makes Radiology a very attractive \ndiscipline for Medicine students. Also, Radiology practices can be carried out using \ncustom computer applications. The lack of professors (and time) for practices can \nbe solved with the help of residents, who are willing to participate as they are more \nprone to understand the learning needs of the students. Finally, the lack of economic \nresources makes it is necessary to seek alliances: with the industry, professional \nassociations or with professors from other universities, sharing resources. Internet \nalso provides free materials that can be used to teach.\nLearning Objectives:\n1.  To be aware of the competing demands on departmental resources.\n2.  To understand the available methods for creating time for teaching.\n3.  To understand the physical resources that aid effective and efficient teaching.\nA-025 16:35\nInvolving the undergraduate with the radiology department \nK.L.A. Verstraete; Gent/BE (koenraad.verstraete@ugent.be) \nThere are many opportunities to involve students in a radiology department. A \nbasic investment of the radiology staff is required, but the return from the students \nis certainly worthwhile for the whole department. In basic years: bring students \ninto contact with the radiological techniques (x-ray, US, CT, MRI), and use this \nopportunity to let them discover „normal anatomy“ (usually in guided visits to the \ndepartment or short clerckships). After basic years: 1. allow free clerckships to \nlet students discover „radiology“ as discipline (workload, workflow, techniques, \nresearch) and as potential future career, 2. involve students in the creation of \nteaching cases for students (practical methods will be explained in the lecture), 3. \ninvolve students in routine radiological practice (take history of patients, perform \nphysical exam, follow radiological investigation, preview imaging studies, make \ndifferential diagnosis, discuss their findings with radiologist); in some departments: \nstudents can perform the exams (ultrasound, take radiography), 4. involve students \nin ongoing research in the department (as volunteers; for gathering „data“, for \nprocessing „data“, for statistical analysis, as co-author or author of abstracts and \npublications); this student involvement can be integrated into the undergraduate \ncurriculum (e.g. via Master thesis), 5. allow longer clerckships for scientific work \n(e.g. 5 months during last year) for larger projects - studies and 6. other (literature \nstudies). In the lecture, practical examples of student involvement in the radiology \ndepartment will be provided.\nLearning Objectives:\n1.  To understand the effect of involvement in radiology on learning.\n2.  To become familiar with the potential methods of undergraduate involvement.\n3.  To understand the value and management of short-term and long-term attach-\nments to the radiology department.\n9\n\nPostgraduate Educational Programme\nS1\n C B D E F\n G\nA\nLearning Objectives:\n1.  To become familiar with the different imaging appearances of adrenal masses \nincluding pathological relation.\n2.  To learn the different imaging techniques to improve evaluation of benign \nversus malignant adrenal masses.\n3.  To understand the impact of imaging given the information that the patient \nhas/has not a known malignancy.\nA-031 16:30\nB. Staging renal cancer \nR. Pozzi-Mucelli; Verona/IT \nThe diagnosis of renal cell carcinoma (RCC) by means of imaging modalities \ninclude the identification of the lesion, its characterisation, the staging and the \nfollow-up. Staging is an important part of the diagnostic process since it has direct \neffect on the therapeutical decision. In the case of renal tumour, staging is based \non the TNM (AJCC Cancer Staging system) which has replaced other staging \nclassifications such as the Robson classification. Based on the TNM classifica-\ntion, two main types of renal tumours can be defined, the localised RCC (T1-T2) \nand the locally advanced RCC (T3-T4). In the case of T1 and T2 RCC, the most \nimportant parameter is tumour size: the cut point is 7 cm which separates T1 from \nT2 tumours. T1 tumours are further divided into T1a and T1b if less than 4 cm or \nbetween 4 and 7 cm, respectively. This further division has impact on type of surgery, \ni.e. partial versus radical nephrectomy. In the case of T3 and T4 RCC, different \nfeatures should be carefully evaluated: these include the perirenal fat invasion, the \ndirect infiltration of the ipsilateral adrenal gland, the infiltration of renal sinus fat, the \nvena cava and renal vein thrombosis, the urinary collecting system invasion and \nmetastatic disease to local lymphonodes and other organs. CT still represents the \nmethod of choice for the staging of renal tumours since, also by using MPR and \nVR images, it gives all the information for the local and distant evaluation. MRI can \nsupport CT in complex cases. \nLearning Objectives:\n1.  To recognise the CT/MRI/US findings for staging.\n2.  To learn about the optimal imaging protocol for the diagnosis and staging of \nrenal cancer.\n3.  To understand treatment options and implications.\nA-032 17:00\nC. How to deal with small indeterminate renal masses \nO. Hélénon; Paris/FR (olivier.helenon@nck.aphp.fr) \nRenal masses include three categories with respect to the size and the gross \narchitecture of the lesion: indeterminate very small masses, cystic and solid renal \nmasses. Very small lesions (<  10 mm) usually remain unclassified because of \npartial volume effect that prevents accurate CT attenuation measurement. With the \nexception of patients at risk of renal neoplasms such as familial-hereditary renal \ntumour disease and patients with history of removed carcinoma, such lesions are \nlikely to be microcysts and do not require further workup. If better characterisation \nis needed, MRI using T2 and Diffusion-Weighted imaging or contrast-enhanced \nUS may help differentiate very small cysts from solid neoplasms. Characterisation \nof small cystic masses relies on the Bosniak's classification which consists of 5 \ncategories: benign (I) and minimally complicated (II) cysts, indeterminate cystic \nlesions (IIF and III) and malignant cystic masses (IV). Certain cases of cystic \nmasses remain not categorisable at CT because of their proper atypical attenuation \ncharacteristics or enhancement properties. US and MRI play a major role by provid-\ning useful additional diagnostic information that help distinguish between atypical \nfluid fill masses and atypical solid neoplasms especially solid papillary RCC with \npoor vascularity. The goal of imaging in characterising small solid renal tumours is \nto differentiate typical angiomyolipoma containing macroscopic fat from non-fatty \nindeterminate renal neoploasms that should be removed. Percutaneous-guided \nbiopsy is performed when accurate characterisation is needed before surgery or \nwhen renal metastases or lymphoma are suspected.\nLearning Objectives:\n1.  To become familiar with the various appearances of small indeterminate renal \nmasses.\n2.  To learn about the respective roles of US, CT and MR imaging in investigating \nsmall renal masses.\n3.  To learn the main pitfalls in assessing small renal masses.\nnegative findings may be encountered in case of “soft” lesions (mucinous, medullary \nor cystic carcinomas) or inflammatory cancers. Differentiation between echogenic \ncysts and homogeneous solid lesions (such as fibroadenomas) can be improved \nas cystic features are usually specific in elasticity imaging. Iso-echoic lesions such \nas infiltrating lobular carcinomas may be better delimitated. Lymph-node charac-\nterisation and microcalcification assessment can be improved, although few data \nare available and need further validation. 3D elastography is actually in progress \nand would be useful in monitoring response to neoadjuvant treatment.\nLearning Objectives:\n1.  To understand the basic principles of US elastography.\n2.  To learn about the difference between strain and shear wave elastography \nand their respective results.\n3.  To appreciate the additional value of US elastography to B-mode US.\nA-029 17:00\nC. MRI diffusion, perfusion and spectroscopy \nP.A.T. Baltzer; Vienna/AT \nDynamic contrast-enhanced MR-mammography is the most sensitive method for \ndetection of breast cancer. Diagnostic results using this technique may vary due \nto reader experience as image interpretation is to some degree a subjective task. \nIn the last years, further, more or less quantitative MRI techniques have been in-\nvestigated. While pharmacokinetic modelling of high-temporal resolution dynamic \ncontrast-enhanced imaging (perfusion imaging) promises further, quantitative \ninsights into the pathological characteristics of neoplastic vasculature, diffusion-\nweighted imaging (DWI) and MR-spectroscopy (MRS) are based on entirely different \nconcepts. While MRS is a molecular imaging technique able to quantify biochemical \ntissue properties, DWI is influenced by microstructural tissue changes. This talk \naims to outline the concepts of perfusion, DWI and MRS, provide knowledge to \nimplement these techniques into clinical practice and critically discusses the pos-\nsible diagnostic benefit of doing so.\nLearning Objectives:\n1.  To understand the diagnostic value of diffusion weighted imaging (DWI) in its \npresent clinical applications.\n2.  To learn about the technical basics and potential use of MRI perfusion in the \nbreast.\n3.  To understand promises and challenges of MR spectroscopy in clinical practice.\n16:00 - 17:30 Room G/H \nGenitourinary \nRC 307 \nRenal and adrenal tumours \nModerator: \nB. Brkljacic;  Zagreb/HR \nA-030 16:00\nA. Adrenal masses, a practical approach \nG. Heinz-Peer; St. Pölten/AT (Gertraud.Heinz@stpoelten.lknoe.at) \nThe increased use of imaging modalities has demonstrated the presence of varying \nsized mass lesions in up to 5% of individuals subjected to CT studies for reasons \nunrelated to adrenal dysfunction. When confronting an adrenal incidentaloma for \nwhich the diagnosis is not certain, one must address the adverse outcomes by \nwhich the patient can potentially be harmed: morbidity or mortality from hormonal \nexcess or cancer and the anxiety that comes from knowing about a tumour which \nmight cause problems in the future. Most of these incidentally discovered lesions \nare non-functioning benign lesions of cortical origin. However, incidentalomas may \nalso represent functioning (clinical or subclinical) lesions arising from either the \ncortex or the medulla and malignant masses. Clinical diagnostic and biochemical \nevaluation is used to further subdivide functional and non-functional adrenal le-\nsions. CT and MR imaging are first choice in characterisation of adrenal lesions. \nRecently developed techniques of dual energy CT and histogram analysis may offer \nadditional information. The value of PET and PET/CT has already been proven. \nOther new functional imaging techniques, such as perfusion, diffusion-weighted \nimaging and MR-spectroscopy may play an important role in lesion characterisation. \nMost of adrenal masses can be characterised with accuracy of >  90% by using \nthese techniques. Differentiating benign from malignant adrenal masses using \nnon-invasive imaging methods can reduce the need both for percutaneous adrenal \nbiopsy in patients with underlying malignant disease and the follow-up imaging of \nincidentally detected adrenal adenomas. \n0\n\nPostgraduate Educational Programme\nS1\nB\n C D E F G\nA\nThursday\nA-035 17:00\nC. PET/CT \nC. Keyzer; Brussels/BE (caroline.keyzer@erasme.ulb.ac.be) \nFDG-PET/CT has proven diagnostic value for evaluating primary malignancy and \nmetastatic disease. Integrated PET/CT systems provide PET and CT images that \nare acquired nearly simultaneously and are capable of producing superimposed, \ncoregistered images, giving anatomic and molecular informations together suscep-\ntible to facilitate interpretation. Many interpretation pitfalls are however encountered \nparticularly in relation with biological factors, such as normal variants of FDG \nuptake. Knowledge of these pitfalls is thus important for preventing misinterpre-\ntation. Interpretation of PET/CT may be complicated by the presence of benign \nconditions that can display high metabolic activity simulating malignancy. These \nconditions include brown fat, granulomatous disease, post-therapeutic changes, \ninfection and inflammatory disease. Conversely, some malignant disease may \nexhibit only modest FDG uptake due to their histology, partial volume averaging \neffects, or respiratory motions. Hence, factors other than intensity of FDG uptake \nare often essential to discriminate benign and malignant diseases. Additional \nhelpful information includes patient history, lesion distribution and symmetry and \nCT characteristics of the lesions. The approach to interpretation and strategies for \ndiscriminating malignant from benign diseases will be highlighted with a special \nattention to the evaluation of thoracic neoplasia and their usual metastatic sites, \nas well as non-oncologic chest disorders.\nLearning Objectives:\n1.  To understand the basic principles of PET/CT using FDG.\n2.  To become familiar with physiologic FDG uptake and frequent pitfalls.\n3.  To learn about FDG PET/CT in non-oncologic and oncologic disorders and \nhow to report.\n16:00 - 17:30 Room L/M \nOrgans from A to Z: Heart \nMC 322 \nTechnical and anatomical fundamentals for imaging \nthe heart \nModerator: \nA. de Roos; Leiden/NL \nA-036 16:00\nA. Anatomy: too many details in cardiac imaging? \nA.J.B.S. Madureira; Porto/PT (ajbmadureira@gmail.com) \nThere has been a marked increase in the utilisation of cardiac CT and MR in the \nevaluation of cardiac and pericardial diseases. All those involved in these exami-\nnations must possess a solid knowledge of the anatomy of the heart and great \nvessels, in order to be able to identify normal structures and variants and not to \nmisdiagnose them as disease or pathological lesions. Each cardiac chamber has \nspecific and unique characteristics that allow its precise identification. The aortic \narch can be located on the left or on the right and can have different branching \npatterns. These must be recognised and diagnosed as such. Incidental findings are \nrelatively frequent when imaging the heart. When present they have to be divided \ninto non- or clinically significant.\nLearning Objectives:\n1.  To learn about the detailed anatomy of the heart.\n2.  To learn about the anatomy of the thoracic vasculature and great vessels.\n3.  To get an overview of important incidental findings in cardiac imaging.\nA-037 16:20\nB. Examination protocols for imaging the heart: CT \nH. Alkadhi; Zurich/CH \nThis presentation is aimed at a demonstration of the many steps that were under-\ntaken in the last decade for lowering the radiation exposure of patients undergoing \ncardiac CT examinations. Employing these various techniques, the effective radia-\ntion dose of a CT coronary angiography study can be reduced from around 15 to \nas low as 1 mSv in selected patients. In parallel to these options for lowering the \nradiation dose, it is important that radiologists adhere to the appropriate, defined \nindications for CT of the heart.\nLearning Objectives:\n1.  To get an overview of different examination protocols.\n2.  To learn about various strategies in radiation dose optimisation.\n3.  To identify suitable clinical indications for cardiac CT.\n16:00 - 17:30 Room I/K \nChest \nRC 304 \nHow I report \nModerator: \nJ. Cáceres; Barcelona/ES \nA-033 16:00\nA. Bedside chest radiography \nR. Eibel; Schwerin/DE (roger.eibel@helios‑kliniken.de) \nFilm-based imaging has been the workhorse of radiology ever since the x-rays had \nbeen discovered nearly 120 years ago. Despite well-known problems (projection \nof a volume onto a two-dimensional screen, over- or underexposure of the film, \npositioning of the patient, post-processing, and reproducible technical quality from \none day to another), e.g. the portable chest x-ray is still one of the most important \nparts of the work up and treatment of the patient in the ICU. The first part of this \nlecture is focussed on technical features, necessary to gain the best quality from \nthis medium. The second part deals with the interpretation principles and careful \nfilm analysis. Of course, a CT is in some instances much easier to interpret with \nregard to anatomy and pathology. It offers more tools for post-processing. On the \nother hand, the radiation exposure, the time and efforts and last not least the risk \nfor the patient to perform a CT in the radiology department is much higher than \ninvestigating the patient in the ICU with portable chest x-ray. From this point of \nview, it makes sense, to interpret plain film as comprehensive as possible including \nmost probable differentials. But it is also necessary to be familiar with its limitations. \nAnd of course, it is a condition sine qua non to have clinical information. In the last \npart and intrinsically tied to the second part a side-by-side comparison between \nstandard radiography and CT follows to better understand the imaging findings \nand discover the main pitfalls.\nLearning Objectives:\n1.  To learn a structured reporting approach.\n2.  To understand key imaging findings in different clinical settings.\n3.  To improve confidence by linking pattern recognition, interpretation and diag-\nnosis.\nA-034 16:30\nB. CTA and MRA of the pulmonary arteries \nJ.E. Wildberger; Maastricht/NL (j.wildberger@mumc.nl) \nThe clinical impact of CTA and MRA of the pulmonary arteries will be outlined. \nMultislice spiral CT allows for a robust examination of the entire chest with sub-\nmillimeter collimated protocols within a single breath-hold. This acquisition is the \nbasis for dedicated analysis of the thoracic vasculature, especially in an interactive \nsetting. CTA is mainly used for clinically suspicion of acute pulmonary embolism \n(PE) and may be regarded as the current clinical gold standard in this respect.\nCTA can also be included in the work-up of patients with acute chest pain. Iodine \nmapping, depicting the (sub)segmental defects in iodine distribution in locations \ncorresponding to embolic vessel occlusions, has become technically feasible, e.g. \nusing quantitative dual-energy acquisition protocols. This might further improve \ndetection of emboli and give insights into the effects on perfusion deficits in the \nadjacent lung parenchyma. MRA has made substantial improvements in the last \nyears which are not always reflected in the current literature (e.g. PIOPEDIII). At \nthis moment, there is no dedicated „official“ role for MRA in the assessment of acute \nPE. However, substantial efforts are made to provide MRA protocols on a 24/7 \nbasis, also under emergency conditions. Time-resolved angiography, steady-state \nfree precession sequences and utilisation of other new techniques, such as parallel \nimaging, will be discussed. MR is becoming increasingly popular in the follow -up \nsetting and for the evaluation of chronic disease. MRA and MR-derived pulmonary \nperfusion imaging are the current gold standard for non-invasive and quantitative \nassessment for chronic PE and pulmonary hypertension.\nLearning Objectives:\n1.  To learn more about recent improvements in CT and MR angiography.\n2.  To learn a structured approach to reporting CTA or MRA.\n3.  To become familiar with the role of CT angiography in comparison to MR \nangiography.\nAuthor Disclosure:\nJ. E. Wildberger: Research/Grant Support; Institutional: Siemens, Philips, GE, \nBracco, Bayer. Speaker; Siemens, GE, Bayer, Boston Scientific. \n1\n\nPostgraduate Educational Programme\nS1\n C B D E F\n G\nA\nbefore surgery. It is in the interest of the patient and of the imaging community \nthat these medical acts are being performed by trained interventional radiologists!\nAuthor Disclosure:\nA. D. Kelekis: Consultant; Benvenue Medical. \nA-041 16:05\nA. Sacroiliac joint syndrome \nD.J. Wilson; Oxford/UK (david.wilson@ndorms.ox.ac.uk) \nSacroiliac joint pain may arise from a number of conditions including inflammatory \narthritis, degeneration, fractures and tumours. Studies suggest a prevalence of 10% \nto 60% pain arising from the joint in patients with positive clinical signs. Temporary \neffect is provided by a mixture of local anesthetics with steroids with a response \nvarying between 50% and 80% in reported series. Dual blocks using agents of \ndiffering duration are considered more precise but as less often used in practice. \nImaging including MR and Scintigraphy are of limited predictive value. Injections \nmay be into the synovial joint, around the joint or adjacent to the nerve innervation \nof the joint. There is evidence that para-articular sources of pain are common and \ninjection outside the joint may be more effective. Sl-joint-injections are performed \nthrough a dorsal approach guided by ultrasound, fluoroscopy or by low-dose CT. \nShort acting agents may have lasting benefit but radio-frequency ablation has \nbeen employed in an attempt to obtain long term response. The evidence for last-\ning therapeutic response to intra-articular or periarticular injection of steroids and \nconventional radiofrequency neurotomy is weak. There is fair evidence of long \nterm response to cooled radiofrequency neurotomy. \nLearning Objectives:\n1.  To learn about relevant anatomy and clinical presentations of the syndrome.\n2.  To know more about the available treatments.\n3.  To learn about clinical results and possible further developments.\nAuthor Disclosure:\nD.J. Wilson: Advisory Board; Chair ESSR research committee. Author; Editor \nof a multiauthor text on MSK Imaging (Springer). Owner; St Luke’s Radiology \nOxford.\nA-042 16:28\nB. Facet syndrome \nM. Gallucci; L’Aquila/IT (massimo.gallucci@cc.univaq.it) \nThe most constant symptom of lumbar facet arthropathy is pain lateralized which \ncan radiate below the knee. Other symptoms are local paraspinal tenderness over a \nfacet joint, posterior pain aggravated by extension and rotation toward the involved \nside, hip and buttock pain in a non-radicular distribution, morning pain and stiffness. \nDifferential diagnoses include fibromialgia, lumbar compression fracture, lumbar \ndegenerative disk disease, lumbar spondylolysis and spondylolysthesis, sacroiliac \njoint syndrome, overuse injury, piriformis syndrome. Radiological images may dem-\nonstrate abnormalities like osteophytes, articular fluid or a synovial cyst. However, \nup to 45% of false positive had been registered on the base of clinical exam only, and \nthere is a poor correlation between pain and imaging. The diagnosis is, therefore, \nmade on both clinical and radiological grounds, and is confirmed by anthalgic facet \njoint block with elimination of pain. Anesthetic block include intra-articular or peri-\narticular injections and medial branch blocks. Some reports suggests that medial \nbranch block is more accurate than direct joint injection for prediction of outcome. \nIt offers both diagnostic information and therapeutic goals. However, since in 50% \nof cases, a recurrence of pain is registered after a period variable between 3 and \n6 months, cryoablation or radiofrequency are often proposed offering longer term \npain relief. Potential risks include allergic reaction, transient post-procedural pain, \nflare-up, bleeding, and infection. If steroids are administered, side effects and risks \nshould be discussed mostly in case of diabetic subjects.\nLearning Objectives:\n1.  To understand the difference between facet joint and disc disease.\n2.  To learn about different treatment options for facet disease.\n3.  To learn how to manage patients.\nA-043 16:51\nC. Intervertebral disc syndromes \nA. Gangi, J. Garnon, G. Tsoumakidou, I. Enescu; Strasbourg/FR \n(gangi@rad6.u‑strasbg.fr) \nPain management in disc herniation relies mainly on conservative care combin-\ning rest, physiotherapy and oral medication (analgesics and anti-inflammatory \ndrugs). If early conservative treatment fails, treatment options turn to percutaneous \ntechniques. Periradicular or epidural steroid injection (PSI) are the first minimally \nA-038 16:40\nC. Examination protocols for imaging the heart: MRI \nN.L. Kelekis; Athens/GR (kelnik@med.uoa.gr) \nCardiac MRI is among the most demanding MR applications, due to the complex \n3D  movement of the heart during contraction and relaxation. The goal of the wide \narsenal of fast/ultrafast/real time sequences, motion compensation techniques \ntriggering/gating/navigator gating), acceleration techniques (such as parallel \nimaging, k-t BLAST), flow sensitive and MR angiography sequences is to \nprovide information on:\nCardiac anatomy: all kinds of dark-blood SE or TSE single-phase sequences \n(diastolic or systolic), single-slice or multislice multi-phase GE sequences (bFFE, \nFIESTA, TrueFISP).\nAnatomy of thoracic vessels: non-gated white-blood GE sequences, single-slice \nor multi-slice multi-phase gradient echo sequences, MR angiographic sequences \n(static or time-resolved MRA with ultrafast techniques). Myocardial tissue: single-\nphase STIR sequences mainly for oedema, T1- and T2-weighted SE or TSE for \ntissue characterisation. Contrast-enhanced 2D or 3D IR sequences for ischaemic \nscar, myocardial necrosis, presence of fibrosis (of diverse etiology), presence of \nthrombi. Myocardial blood flow: ultrafast GE sequences (SR, bFFE) during first \npass of contrast medium. Myocardial contraction and relaxation: multislice multi-\nphase GE sequences covering the whole extent of ventricles, myocardial tagging \nsequences, phase-contrast flow sequences to assess myocardial velocity patterns. \nFlow quantification: phase-contrast sequences (through-plane in all 4 valves and \nthoracic vessels, in-plane for jet and stenosis quantification), combination with \nvolumetric measurements for complete quantification of normal/abnormal flows \nand volumes in both circulations. White-blood, dark-blood or contrast-enhanced \ncoronary angiography sequences. Regarding imaging planes, a multislice acqui-\nsition should cover both ventricles in the short-axis plane, as well as at least in \n4-chamber plane when addressing RV or congenital heart disease.\nLearning Objectives:\n1.  To get an overview of different examination protocols.\n2.  To learn about typical cardiac MR artefacts and pitfalls.\n3.  To identify suitable clinical indications for cardiac MRI.\nA-039 17:00\nInteractive case discussion \nA. de Roos; Leiden/NL (A.de_Roos@lumc.nl) \nCase material using CT and MRI will be presented for cardiovascular disease \nevaluation. A number of common and uncommon cases will presented, starting \nwith the clinical presentation, imaging findings and summary of teaching points. \nThe session is aimed to include incidental findings on routine chest imaging as \nwell as more specific cardiac applications.\n16:00 - 17:30 Room N/O \nInterventional Radiology \nRC 309 \nPercutaneous treatment of chronic back pain and \nsciatica \nA-040 16:00\nChairman’s introduction \nA.D. Kelekis; Athens/GR (akelekis@med.uoa.gr) \nIt is a fact that 80% of the human population will have at least one crisis of back \npain and/or sciatica. It is also a fact that amid a population of volunteers that had \nno incidence of back pain and/or sciatica, 60% will have at least one finding associ-\nated with disc/spine degeneration. Until now, most treatments associated with back \npain/sciatica were addressed by other medical communities either by medication \nor surgery. This has created a lot of inconsistencies. The interventional radiologist \nor neuroradiologist, who is trained in back pain interventional techniques has many \nadvantages. First, he is professionally trained to read and evaluate adequately the \nimaging information. Second, he has the skill to guide, through imaging, specific \ntools and medication in selective spine regions, being thus more efficient than other \nspecialties. The interventional spine and back pain treatments is the Eldorado of \nInterventional Radiology and can be compared to the 1970s of the percutaneous \nvascular Interventional world. As a new subspecialty, it is a fact that it lacks the \nnecessary structure of formal clinical training, but in modern back pain centers, \nimaging-guided interventions have a key role in treatment, after medication and \n2\n\nPostgraduate Educational Programme\nS1\nB\n C D E F G\nA\nThursday\nA-045 16:30\nB. Vertebrobasilar atherosclerotic disease \nL. Valvassori, M. Piano; Milan/IT (Luca.Valvassori@ospedaleniguarda.it) \nIntracranial atherosclerosis is a systemic and multifactorial disease, associated with \natherosclerosis of carotids, coronaries, aorta, renal and iliofemoral arteries. Over \none-third of ischaemic strokes occur in the posterior circulation, a leading cause \nof which is atherosclerotic vertebrobasilar (VB) disease. Symptomatic VB disease \ncarries a high annual risk of recurrent stroke, averaging 10-15% per year, despite \nmedical therapy. VB stroke is particularly prone to devastating consequences due \nto the eloquence of the regional brain tissue and is associated with high rates of \ndeath and disability. More common in older age and in Western countries, without \ndifferences of gender. CTA and/or MRA are excellent screening tool, but DSA is the \ngold standard to show focal stenosis, luminal irregularities, thrombosis, occlusion, \narteries ectasia and elongation, serpentine aneurysms. Transient ischaemic attack, \nalong with severe stenosis and progressive occlusion, are most common symptoms. \nAn important stroke mechanism in VB atherostenosis is regional hypoperfusion. \nFurthermore, both embolic and flow processes can synergize to increase stroke \nrisk, reducing the wash-out of emboli from the distal circulation in hypoperfused \nregions. Posterior circulation collateral channels may maintain adequate distal flow. \nThe existence and extent of these compensatory blood flow pathways, evaluated \nby DSA, may influence the risk of stroke. Percutaneous angioplasty and stenting \nfor symptomatic atherosclerotic VB stenosis is a feasible and effective therapeutic \nmethod, but good experience and full understanding of neurology and haemody-\nnamics are required, as well as for diagnostic purposes.\nLearning Objectives:\n1.  To learn about the appropriate imaging protocol and the imaging signs of \nextracranial and intracranial atherosclerosis.\n2.  To learn about the epidemiology, symptomatology and natural history.\n3.  To learn about the classification of lesions and indications for treatment.\nA-046 17:00\nC. Dissection and vasculitis of intracranial and extracranial arteries \nH.R. Jäger; London/UK (r.jager@ion.ucl.ac.uk) \nDissection of the cervical arteries is a major cause of stroke in young adults and \nmay also present with headache, neckpain, cranial nerve palsies. Intradural dis-\nsections can cause subarachnoid haemorhage. 80% of carotid artery dissections \nare extracranial and 20% are intracranial; vertebral artery dissections occur most \noften in the atlas loop or at the junction of the V2/V3 segments. Dissections are \ncasued by a tear in the intima leading to an intramural haematoma which results \nin an expansion of the external vessel diameter with a variable degree of luminal \nnarrowing. Compromise of the arterial lumen and complications, such apseudo-\naneurym formation, are visualised with angiographic techniques (CTA and MRA \nnow mostly replacing DSA). The intramuralhaematoma can be directly visualised \nwith cross-sectional CT and MR. The MR signal intensity of the heamatoma is time-\ndependent: it is T2- and T1- hypo- or isointense in the acute stage before becoming \nT2- and T1-hyperintense in the subacute stage. Cerebral vasculitis of the large \nand medium-sized intracranial vessel causes segmental narrowing or “beading” of \nthe intracranial vessels which is readily demontrated on CTA and high-resolution \nintracranial MRA. Reversible Cerebral Vasoconstriction Syndrome (RCVS) is an \nimportant differential diagnosis for these appearances. Cerebral vasculitis affecting \nthe small vessels (< 300 µm) is often difficult to diagnose, even on high-resolution \nDSA, and frequently requires confirmation with brain biopsy. Haemodynamic com-\npromise caused by arterial dissections or by cerebral vasculitis can be assessed \nwith CT perfusion and MR perfusion imaging.\nLearning Objectives:\n1.  To learn the imaging signs of dissection and different types of large/medium \nvessel vasculitis.\n2.  To learn about lesion morphology and haemodynamic consequences of dis-\nsection and vasculitis.\n3.  To learn about imaging protocols for detection of dissection and large/medium \nvessel vasculitis.\ninvasive technique which should be considered early in the treatment regime. It \naims to stop the biochemical inflammatory reaction around the nerve root. It is ide-\nally performed under image guidance to ensure proper deposition of steroid and \nto avoid complications. Although periradicular steroid injection has been used for \ndecades, its efficacy is still controversial. Non-controlled studies report success \nin 33% to 72% of patients. Short-term benefit of percutaneous nerve root block is \nquite high with good pain relief especially in irritative radiculopathy. Failure of 4 to 6 \nweeks of conservative therapy and a minimum of one selective image-guided steroid \ninjection, the treatment is directed to the disc. The minimally invasive percutane-\nous techniques in use today, aim at removing a small amount of central nucleus \npulposus, so as to reduce intradiscal pressure and thus obviate disco-radicular \ncompression. several alternative techniques of percutaneous nucleotomy have been \ndeveloped, relying either on pure mechanical (automated percutaneous lumbar \ndiscectomy), chemical (alcohol, oxygen-ozone) or thermal (Laser, radiofrequency) \ndecompression. Many non-controlled studies with large series report a high success \nrate of percutaneous thermal nucleotomy with 70 to 89% good results on radicular \npain. The three most critical elements for successful nucleotomy are: proper patient \nselection, correct needle placement and effective cavitation.\nLearning Objectives:\n1.  To understand possible treatment techniques for disc disease.\n2.  To know more about clinical and imaging findings in treatment.\n3.  To learn about published results on percutaneous disc treatment.\nPanel discussion:  \nHow can imaging methods separate candidates for percutaneous \ntherapy and surgery? 17:14 \n16:00 - 17:30 Room P \nVascular \nRC 315 \nVascular imaging in ischaemic stroke \nModerator: \nJ. Hendrikse; Utrecht/NL \nA-044 16:00\nA. Intracranial atherosclerotic disease of carotid arteries \nT. Jargiello; Lublin/PL (tojarg@interia.pl) \nIntracranial atherosclerotic lesions of carotid arteries are relatively seldom, espe-\ncially when compared with extracranial atherosclerosis. According to statistics, \nintracranial lesions do not exceed 2-3% of all carotid occlusive disease, and in \na whole group, less than 1% needs invasive treatment. This means that the role \nof intracranial stenotic disease is not big, but still important, especially when not \nproperly diagnosed. In practice, intracranial carotid lesions are the most frequently \nrevealed during the imaging process for evaluation of extracranial atherosclerotic \ndisease in patients qualified for carotid stenting or endarterectomy. In patients \nqualified for stenting, arteriography (DSA) is the main imaging modality, done right \nbefore intervention to look for possible tandem extracranial / intracranial stenosis. In \npatients qualified for open surgery, CT-angio and MR-angio are usually performed to \nassess intracranial circulation. CT-angio is more popular today (available and less \nexpensive) but contrast-enhanced MR-angio (CE-MRA) seems to be superior - be-\ning free of radiation, iodine contrast medium and has less possible artefacts (skull \nbas bones). Except stated above, there is a group of patients who are clinically \nsuspected with intracranial stenosis with negative extracranial findings. For them, \ntranscranial Doppler examination is a good solution as a screening test. When \npositive or even not evidently negative, CTA or CE-MRA are adviced. Indications \nfor invasive (endovascular) treatment depend strictly on the degree of stenosis, its \nlocation and coexistent other stenoses (tandem lesions). These factors are always \nevaluated together with visible and potential collateral circulation - individally for \neach patient.\nLearning Objectives:\n1.  To become familiar with appropriate imaging protocols for all imaging modali-\nties and the pros and cons of each modality.\n2.  To learn about imaging signs of atherosclerotic disease in the carotid artery \nterritory.\n3.  To learn about the classification of lesions and indications for treatment.\n3\n\nPostgraduate Educational Programme\nS1\n C B D E F\n G\nA\nA-049 16:28\nB. Intraoperative imaging for surgeons \nA. Pietrabissa1, L. Pugliese1, A. Peri1, F.P. Tinozzi1, V. Ferrari2; 1Pavia/IT, 2Pisa/IT \n(andrea.pietrabissa@gmail.com) \nModern radiological scanners allow the acquisition of volumetric datasets describing \nhuman anatomy, functionality and pathology, with high level of detail. On the other \nhand minimally invasive surgery offers excellent views of surface anatomy but is \nunable to provide details on deeper or hidden structures and bears the limit of a \nlow grade tactile feedback. The highly detailed information contained in radiological \nimages, which are partially lost when passing to the surgical room, can be expressly \nused to overcome these limitations. In this setting, computer-assisted technolo-\ngies allow to augment real views of the patient, taken by means of cameras and \noptical tracking systems, with virtual information obtained from pre-operative or \nintra-operative radiological images, coherently mixing them in order to obtain an \naccurate superimposition of both. This augmented-reality, or in general mixed-reality \ntechnique, introduces many advantages for some tasks where the surgeon has to \ninteract with the patient (localisation of target lesion, sharp definition of nodule’s \nmargins, identification of vascular or other relevant adjacent anatomic structures, \nintroduction of biopsy needle etc). improving the physician’s perception of deep \nor unexposed tissues and consequently the precision level of the procedure. The \nsurgical robotic platforms available, as computer-assisted systems provided with \n3D stereoscopic vision, may support the application of these techniques in many \nfields of surgery. Further technological development should be claimed since the \nrelevant implications involved with the clinical use of this promising new approach \nto enhance intra-operative visualisation during minimally invasive surgery. \nLearning Objectives:\n1.  To understand why surgeons need more intraoperative guidance.\n2.  To learn about the role of robotics and augmented reality in general surgery.\n3.  To become familiar with patient-specific simulation.\n4.  To appreciate the place of surgical training and accreditation.\nA-050 16:51\nC. Dismantling PACS: separating image viewing from the data \nstorage and sharing \nB. Gibaud; Rennes/FR (bernard.gibaud@univ‑rennes1.fr) \nThe evolution of a domain such as Picture Archiving and Communication Systems \nresults from four main factors: (1) the emergence of new functional needs; (2) the \nevolution of basic technology (i.e. communication, storage, computing); (3) the \nexistence and the maturity of standards; and (4) the evolution of general economic \nconditions. If we consider recent PACS evolution from these four viewpoints, we \ncan notice: (1) the growing importance of image processing and the emergence \nbesides radiology, cardiology and oncology of new sectors of medical imaging (e.g. \nsurgery, pathologic anatomy); (2) the supremacy of internet technologies and the \nemergence of cloud storage and cloud computing technologies; (3) the maturity \nof interoperability standards such as DICOM, HL7 and IHE, and finally (4) a very \nstringent economical context in public hospitals, leading to the absolute necessity \nof mutualising resources as much as possible. In this context, separating storage/\narchiving resources and image viewing/processing resources appears as an ap-\npealing approach. It is not a new idea, since PACS operation based on Application \nService Providers (ASP) appeared more than ten years ago, but they had limited \nimpact, yet. In this context, the course aims at: (1) clarifying the advantages - from \nboth functional and economical viewpoints - of PACS solutions based on a clear \nseparation of components implementing storage/archiving and image viewing/\nprocessing; (2) reviewing and discussing the difficulties of a such evolution, espe-\ncially with regards to security and confidentiality of information, on the one hand, \nand with compliance with existing interoperability standards, on the other hand.\nLearning Objectives:\n1.  To learn about strategic issues of generic image archiving and distribution.\n2.  To understand new concepts of independent ‘front ends’ of PACS.\n3.  To become familiar with new examples of PACS implementation based on \ncomponent architecture.\n4.  To appreciate new strategies of PACS architecture and migration.\nPanel discussion:  \nHow should we manage our images today? 17:14 \n1.  New challenges for large-scale image sharing and image distribution.\n2.  Use of imaging outside radiology.\n3.  Regulatory issues in image sharing.\n4.  Practical and workflow issues of image distribution and management. \n16:00 - 17:30 Room Q \nComputer Applications \nRC 305 \nNew PACS architecture: decoupling image \nmanagement from image navigation \nA-047 16:00\nChairman’s introduction \nH.U. Lemke; Berlin/DE (hulemke@cars‑int.org) \nImage-based diagnostic and therapeutic workflows, particularly in interventional \nsuites, are essential for the health care of patients but they are also a very cost-\nintensive component in clinical settings. The understanding of workflows and ICT \ntools for image management beyond radiology, and in particular, for image-based in-\nterventional suites has become not only of concern to radiologists and surgeons but \nalso to other healthcare providers, managers, and administrators. Communication, \nsimulation, visualisation and navigation with images and associated patient-specific \nmodels are becoming essential features in the planning and implementation of \ncomplex digital PACS like infrastructures in support of diagnostic and interventional \nprocedures (e.g. interventional radiology, minimally invasive surgery, computer \nassisted surgical procedures and image guided therapy). While the full potentiali-\nties of multidisciplinary image sharing within health care settings are being further \nexplored, it is now increasingly common to see intense cooperation between radiolo-\ngists and other clinicians for planning and guiding interventions. Surgical planning \nunits are a typical example of such a multidisciplinary setting. During the session \non “New PACS architecture: decoupling image management from image naviga-\ntion”, the lecturers - exceptional experts in their respective fields - will give insights \ninto image sharing: from hospital-based applications to remote consultation, with \nspecific reference to the support of surgeons (training and intraoperative guidance). \nSession Objectives:\n1.  To introduce models of image management and workflow.\n2.  To present the evolution of image management outside of radiology (surgery, \ninterventions etc).\n3.  To discuss the technical requirements for better image sharing and distribution.\nA-048 16:05\nA. Image navigation and new PACS architecture \nJ. Reponen; Raahe/FI (jarmo.reponen@oulu.fi) \nPicture archiving and communication systems (PACS) have become an instrumental \ntool for storing and distributing medical images, not only within radiology but also \nin other medical domains. Typically, a PACS consists of imaging modalities like \ncomputed tomography (CT) and magnetic resonance imaging (MRI), image stor-\nage device and reading workstations all connected with a secure data network. \nNew challenges are introduced when more and more images are distributed over \nwide area networks, even utilising mobile and web technologies. Thin clients are \nbecoming more widely used especially in clinical setting. When PACS is used \noutside radiology (e.g. in surgical operating theatre or in clinical wards) and for \nother modalities than radiology (e.g. for ECG or photographs) different types of \nuser interfaces are needed. A radiology information system (RIS) is mandatory \nin order to manage the information stored into the archive. As more and more \nhospitals utilise comprehensive electronic patient record, a seamless integration \nis necessary. Standardisation of the modules and pre-defined workflows through \nIntegrated Healthcare Enterprise (IHE) profiles will make interoperability easier. \nRegional image archives and shared access to images make it possible to distribute \nworkload remotely and also decrease repetitive examinations for moving patients. \nTeleradiology offers a means to share medical expertise and workload. Legal as-\npects have to be discussed if PACS storage is outsourced to a cloud-based PACS. \nStored information should be backed up, so that a full disaster recovery without \nunwanted breaks in service is possible. \nLearning Objectives:\n1.  To learn about recent changes in PACS design and infrastructure.\n2.  To understand the role of data management in PACS architecture.\n3.  To become acquainted with different PACS architectures.\n4.  To understand technical, workflow and legal aspects of innovative technologies.\n4\n\nPostgraduate Educational Programme\nS1\nB\n C D E F G\nA\nThursday\nwavelengths to resolve small concealed objects. The talk will describe properties \nof materials and contrast mechanisms, principles of operation of both active and \npassive imagers at millimetre-wave, submillimetre-wave and terahertz frequen-\ncies. Benefits, limitations, technology trends and a range of current and potential \napplications including aviation security, loss-prevention and stand-off detection \nwill be discussed. Non-ionising radiation standards, ethical and privacy issues will \nalso be discussed, together with the techniques and concepts-of-operation which \nare used to mitigate privacy concerns.\nLearning Objectives:\n1.  To understand the current status of non-ionising radiation technology for the \ndetection of explosives and other threats.\n2.  To learn about trends for development of millimetre-wave and terahertz tech-\nnology.\n3.  To learn about the challenges and limitations of these technologies.\n18:30 - 18:50 Room A \nPlenary Session \nOL \nPresiding: \nJ.I. Bilbao; Pamplona/ES \nA-054 18:30\nPromises and facts of liver-directed gene therapy \nJ.M. Prieto; Pamplona/ES (jprieto@unav.es) \nGene therapy is based on the introduction of genetic material into the cells to \npromote local expression of a therapeutic protein. The transgene is incorporated \ninto vectors, frequently of viral origin, to facilitate cell transduction. Due to the \ndevelopment of neutralising antibodies, gene therapy is frequently one-time treat-\nment and therefore the duration and control of transgene expression is a key issue. \nHepatotropic long-term expression vectors such as adeno-associated virus (AAV) \nand third generation adenovirus (gutless Ad) are preferred vectors for many ap-\nplications. Recently, treatment of patients with haemophilia B with AAV encoding \nFactor IX resulted in cessation of spontaneous bleeding in most patients. Acute \nIntermitent Porphiria (AIP) is a hereditary metabolic disorder due to mutations of \nporphobilinogen deaminase (PBGD). Genetic supplementation of liver cells with \nAAV-PBGD normalises biochemistry in AIP mice and corrects the associated neu-\nrological alterations. A clinical trial involving 8 AIP patients is currently underway \nin our institution. In liver cirrhosis, hepatocellular insufficiency causes a sharp \ndecline in IGF1 synthesis. In experimental hepatic cirrhosis, liver transduction with \nAAV-IGF1 leads to fibrosis reversal and improved liver function holding promise for \nclinical application. Primary and metastatic liver cancer can be treated by forcing \nthe expression of molecules that stimulate antitumour immunity or block tumour \nprogression by reducing vessel formation or altering tumour microenvironment. In \nexperimental models of colorectal cancer metastatic to the liver, IL-12 immunogene \ntherapy was found to synergise with oxaliplatin chemotherapy to control tumour \ngrowth. Summarising, gene therapy constitutes today a realistic option to treat \npreviously intractable liver disorders. \nLearning Objectives:\n1.  To learn about novel therapeutic approaches in hepatology.\n2.  To understand principles and applications of liver-directed gene therapy.\n3.  To appreciate flexibility, potential and limitations of the procedure.\n4.  To become familiar with gene therapy vectors and their clinical use.\n5.  To consolidate knowledge of novel approaches to treat liver diseases.\nAuthor Disclosure:\nJ. M. Prieto: Advisory Board; Digna Biotech. Consultant; uniQure, Digna \nBiotech. \n16:00 - 17:30 Room Z \nESR Radiation Protection Session \nSecurity scanners at airports: are they safe? \nModerators: \nJ. Damilakis; Iraklion/GR \nP. Vock; Berne/CH \nA-051 16:00\nX-ray backscatter security scanners: principles, performance and \npotential health risks \nJ. Damilakis; Iraklion/GR (damilaki@med.uoc.gr) \nThe operation of x-ray backscatter security scanners is based on backscattering \nof photons. The equipment consists of two x-ray tubes, collimators and detectors \non both sides of the exposed passenger. Radiation detectors detect photons scat-\ntered back from the body and the scanner builds up front and back images of the \nindividual. Studies show that the effective dose to an adult passenger from scanners \nused in aviation security screening is lower than 0.25 μSv per screening, which is the \ndose limit defined by the American National Standards Institute. However, children \nreceive higher doses per screening than adults. This is a point of concern since \nchildren are more vulnerable to radiation than adults. Superficial organs receive \nhigher doses than deeper organs. Pregnant passengers may also be exposed to \nradiation from security scanners. A screening that delivers 0.25 μSv effective dose \nto the mother would deliver approximately 0.12 μGy to the uterus. Little information \nexists on the detection performance of x-ray backscatter systems. A study (Kaufman \nand Carlson, J Transp Secur, 4:73-94, 2011) shows that contraband can remain \nundetected by x-ray backscatter security scanners under certain conditions. In \nconclusion, doses and associated radiogenic risks from exposing individuals to \nradiation for backscatter x-ray screening are negligible. The possible effects on \npublic health, however, from very low-level exposure to ionising radiation remain \nunknown. For this reason, non-ionising technology should be considered before \nx-ray scanners become a primary screening tool in aviation security.\nLearning Objectives:\n1.  To become familiar with the technological principles of security scanners.\n2.  To learn about the detection performance of x-ray security scanners.\n3.  To understand the radiation doses and risks from x-ray backscatter security \nscanners.\nA-052 16:30\nCumulative low-level x-ray radiation exposure: is it harmful? \nP. Vock; Berne/CH (peter.vock@med.unibe.ch) \nWhile acute exposures of around 100 mGy and more of individuals and populations \nto ionising radiation have been studied quite well over the last 60 years, the evidence \nbase of the impact of lower level and cumulative exposure is much weaker. This \ntype of exposure tends to have similarities to the continuous natural exposure to \ncosmic radiation and - in certain geographical locations - to terrestrial radiation. \nThe limits of the linear-no threshold (LNT) model of stochastic radiation effects and \nreasons for a different biological impact at low levels will be discussed; potential \nconsequences to the individual person and to the population are important but can \nonly be estimated. The age at exposure and the sex are key factors determining \nthe impact, with a generally higher sensitivity of young and female individuals. \nCurrently, in medicine repeated low-level exposures tend to increase due to \nfollow-up imaging for disease and to new screening procedures; consequences \nof this development will be evaluated.\nLearning Objectives:\n1.  To learn about risks of x-ray exposure in relation to age.\n2.  To appreciate the difference between individual and collective radiogenic risks.\n3.  To understand issues related to cumulative radiation doses and possible risks \nfrom medical x-ray screening procedures.\nA-053 17:00\nSecurity scanners using non-ionising radiation: current status and \ntrends for development \nM. Kemp; Cambridge/UK (mike.kemp@iconal.com) \nSecurity scanners are used in aviation security and in other applications to detect \nmetallic and non-metal explosives, weapons and other contraband concealed \non the body. Whilst some types of scanner use low-dose x-rays, others avoid \nthe use of ionising radiation by employing radio waves at millimetre wavelengths \n(1 cm - 0.5 mm; 30 - 600 GHz), which penetrate clothing and have short enough \n5\n\nPostgraduate Educational Programme\nS1\n C B D E F\n G\nA6\n\nPostgraduate Educational Programme\nS1\nB\n C D E F G\nA\nFriday, March 8\n7\n\nPostgraduate Educational Programme\nS\n C B D E F\n G\nA\nof imaging for other reasons. Although small cysts are more likely to be benign, \nsize alone cannot be an independent decision making variable. Radiologists \nmust attempt to exclude the presence of morphologic abnormalities that raise the \nsuspicion of a complex cyst (mural nodules, dilatation of the common bile duct, \ndilatation of the main pancreatic duct larger than 6  mm, duct wall enhancement, \nlymphadenopathy, and peripheral calcifications). Microsyctic adenoma is the only \ntype of cystic neoplasm that can be diagnosed with almost complete certainty, while \ndiagnosis of mucinous cystic tumours is often hypothetical. Determination of CEA \nand amylase levels in cyst fluid aspirated by EUS-FNA is helpful in making the dif-\nferential diagnosis. Concerning correct management of unclassified cystic lesions at \nimaging one should keep in mind that even small morphologically benign-appearing \ncysts present moderate frequency of malignancy. Several professional societies \nhave developed guidelines for the management of pancreatic cysts. According to \nthe white paper of the ACR incidental findings committee any cyst > 3 cm should \nbe resected unless it is serous cystadenoma or proven to be pseudocyst through \naspiration. For cysts < 2 cm, a single follow-up in 1 year is needed, while for the \ncysts measuring 2-3 cm, a follow-up of every 6 months for 2 years and then yearly \nis proposed. Any decision should be based on a balance between the risk of ma-\nlignancy and the benefit of pancreatic resection.\nLearning Objectives:\n1.  To learn how to differentiate between benign and malignant cystic lesions.\n2.  To know the correct management of unclassified cystic lesions through imag-\ning.\n3.  To become familiar with the reference imaging criteria suggesting treatment.\n08:30 - 10:00 Room C \nOncologic Imaging \nRC 416 \nMR imaging for prostate cancer management: the \nessential guide for radiologists \nA-058 08:30\nChairman’s introduction \nH.-P. Schlemmer; Heidelberg/DE (h.schlemmer@dkfz.de) \nProstate cancer has become the most frequent cancer in men of the industrialised \ncountries over the last 30 years, and the incidence is still increasing. The disease \nis associated with high morbidity and accordingly high socio-economic impact. \nAlthough radical prostatectomy has been proven to prolong survival, avoidable \nmorbidity and costs are feared in a selective but unpredictable patient group due \nto overdiagnosis and overtreatment. The conventional way of establishing the \ndiagnosis and making individual treatment decisions relies on the individual PSA \nserum level and pathologic Gleason score from systematic TRUS biopsy samples, \nwhich has well-known limitations. Patient stratification for choosing the best indi-\nvidual treatment becomes increasingly challenging as various less invasive treat-\nment alternatives and active surveillance has been established. Multiparametric \nMR imaging has been proven to be remarkably advantageous in this context for \ndetecting cancer, characterising its heterogeneity and aggressiveness, targeting the \nmost aggressive part (the dominant intraprostatic lesion, DIL), guiding the biopsy \nneedle to that area and evaluation of local tumour spreading. The gained information \nsupports individualised decision making concerning treatment selection, planning, \nguidance, monitoring and follow-up. In case of active surveillance, functional MR \nparameters additionally yield objective and reproducible biomarkers for monitoring \ntemporal changes of individual tumour aggressiveness during follow-up. This course \nwill give an insight into the current diagnostic strategies and treatment options in \nprostate cancer and will discuss the role of MR imaging for patient management. \nA-059 08:35\nA. Clinical challenges: how to treat prostate cancer \nB.A. Hadaschik; Heidelberg/DE (Boris.Hadaschik@med.uni‑heidelberg.de) \nProstate cancer (PC) is the third leading cause of male cancer deaths in developed \ncountries. PSA-based screening results in a modest reduction of PC mortality, but \nis associated with considerable overdiagnosis of PC, which, in turn, results in a \nsignificant burden of overtreatment. PC diagnosis is currently made by systematic \nTRUS-guided random biopsies. Indication for biopsy is preferably an individual \nrisk assessment based on various parameters, predominantly PSA, age, prostate \nvolume, digital rectal examination, family history, and co-morbidity. However, the \nmajority of biopsies taken are negative. Moreover, random biopsies may miss \nimportant tumours and they also result in cancer detection in men who are unlikely \nto benefit from the diagnosis. Precise information of grade, stage and location of \n08:30 - 10:00 Room A \nAbdominal Viscera \nRC 401 \nPitfalls in interpretation of pancreatic imaging \nModerator: \nH.‑J. Brambs; Ulm/DE \nA-055 08:30\nA. Pancreatic cancer or pancreatitis? \nB.J. Op de Beeck, A. Snoeckx, M. Spinhoven, R. Salgado, P.M. Parizel; \nAntwerp/BE (bart.op.de.beeck@uza.be) \nA common diagnostic problem is how to differentiate malignant solid pancreatic \nlesions from benign entities like pancreatitis. Especially, if you are dealing with \nfocal forms like paraduodenal pancreatitis (cystic dystrophy of the duodenum \nor groove pancreatitis) or autoimmune pancreatitis (IgG4 related pancreatitis). \nParaduodenal pancreatitis is a distinct form of chronic pancreatitis characterised \nby inflammation and fibrous tissue formation, affecting the groove area near \nthe minor papilla between the head of the pancreas, the duodenal wall and the \ncommon bile duct. Paraduodenal pancreatitis has been divided into pure (the \nhead of the pancreas is spared), segmental (the pancreatic head and the ducts \nare affected) and non-segmental (secondary to established chronic pancreatitis) \nforms. Autoimmune pancreatitis is distinct from calcifying and obstructive forms \nof chronic pancreatitis. Destructive changes of the pancreatic ducts characterised \nby multiple or single strictures without marked upstream dilatation are important \nfeatures. Pancreatic calcifications and pseudocysts are usually absent. We radiolo-\ngists have the important role to differentiate these benign entities from pancreatic \nadenocarcinoma, neuroendocrine tumours, lymphoma and pancreatic metastases. \nThe typical CT-findings and limitations will be demonstrated as well as the additional \nand complementary role of MRI. We will focus on morphological signs (pancreatic, \nperipancreatic and ductal), dynamic contrast behaviour and value/limitations of \ndiffusion weighted imaging and ADC. Clues to a correct diagnosis will be given \nand pitfalls in imaging interpretation will be discussed.\nLearning Objectives:\n1.  To become familiar with the common benign mimickers of pancreatic malig-\nnancy.\n2.  To learn how to differentiate between benign and malignant lesions.\n3.  To know the limitations and complementary roles of CT and MR.\nA-056 09:00\nB. How can we differentiate cystic neoplasms from pseudocysts? \nT. Denecke; Berlin/DE (timm.denecke@charite.de) \nThe differential diagnosis of cystic lesions of the pancreas includes primary neo-\nplasms and pseudocysts. The clinical relevance of cystic pancreatic lesions is given \nbecause cystic neoplasms can be malignant or premalignant. The differentiation \nof pseudocysts and cystic lesions can be demanding. Ultrasound, endoscopic \nultrasound, computed tomography and magnetic resonance imaging are the imag-\ning tools employed for differentiation of cystic lesions, supplemented by image-\nguided biopsies. The initial findings determine the sequence of further diagnostic \nsteps and, if necessary, therapy. The initial non-invasive diagnostic work-up of \nincidential cystic lesions usually contents CT and/or MRI. Here, typical patterns of \nbenign cystic neoplasms, sings of malignancy, and imaging features in favour of \npseudocyst formations can be recognised. Prerequisites for differential diagnosis \nby radiologic imaging are a comprehensive examination protocol, exact knowledge \nof the entities possibly presenting as cystic lesion including their imaging features \nand clinical relevance, as well as important clinical and paraclinical cofactors which \naid in the discrimination of cystic neoplasms and pseudocysts. These issues will \nbe demonstrated and discussed in this presentation.\nLearning Objectives:\n1.  To learn the most common cystic lesions of the pancreas.\n2.  To know typical imaging findings of pseudocysts and cystic tumours.\n3.  To become familiar with imaging elements that help differentiate between \ncystic lesions.\nA-057 09:30\nC. How to manage incidental findings \nC. Triantopoulou; Athens/GR (ctriantopoulou@gmail.com) \nThe diagnosis and management of pancreatic cystic lesions is a common problem. \nHalf of these lesions are asymptomatic and incidentally discovered at the time \n18\n\nPostgraduate Educational Programme\nS\nB\n C D E F G\nA\nFriday\nLearning Objectives:\n1.  To learn how advanced MR techniques improve staging.\n2.  To learn how imaging impacts on clinical management (treatment selection \nand response monitoring).\n3.  To understand the need for the implementation of MRI in clinical practice and \nclinical trials.\n4.  To understand the need for specialised training of radiologists in prostate \ncancer imaging.\nPanel discussion:  \nIs MRI an integral part of the clinical routine? 09:44 \n08:30 - 10:00 Room D1 \nControversies in Breast Imaging \nMC 423 \nOverdiagnosis from screening mammography: \nshould we care about it? \nModerator: \nT.H. Helbich; Vienna/AT \nT easer: \nH.J. de Koning; Rotterdam/NL \nA-062 08:30\nA. The risk of overdiagnosis from screening mammography \nE. Paci, D. Puliti; Florence/IT (paci.eugenio@gmail.com) \nOverdiagnosis is the detection of a breast cancer through screening that would \nnever have been identified in the lifetime of the woman, and is thus an adverse \noutcome of screening. EUROSCREEN WG reviewed the observational studies \nevaluating overdiagnosis in Europe and published a balance sheet of the outcomes \nof service screening in Europe. From a literature search, studies were classified \naccording to the presence and the type of adjustment for breast cancer risk, and for \nlead time (statistical adjustment or compensatory drop). Estimates of overdiagnosis \nare percentage of the expected incidence in the absence of screening. There were \n13 primary studies in seven European countries (The NL, I, N, Sw, DK, UK and S). \nUnadjusted estimates ranged from 0 to 54%. Estimates adjusted for breast cancer \nrisk and lead time ranged from 2.8% in The Netherlands, to 4.6% and 1.0% in Italy, \n7.0% in Denmark and 10% and 3.3% in England and Wales. A summary measure \nof 6.5% was considered the most likely estimate of overdiagnosis. Higher estimates \nin the literature are due to the lack of adjustment for breast cancer risk and/or lead \ntime. A balance sheet of mortality reduction and overdiagnosis was estimated for a \nscreened womn starting at 50 years of age a 20 years screening regimen and fol-\nlowed up till 79 years of age. Out of 1000 women, 30 deaths for breast cancer were \nexpected and 7/9 lifes saved. 4 breast cancer were estimated as overdiagnosed.\nA-063 08:55\nB. How breast radiologists should control the risk of overdiagnosis \nU. Bick; Berlin/DE (Ulrich.Bick@charite.de) \nOverdiagnosis, defined as the detection of malignant disease, which without \nscreening would not have lead to significant morbidity for the patient, cannot be \navoided completely in mammography screening. Aggressive pursuit of subtle mam-\nmographic findings - both masses as well as microcalcifications - is a prerequisite \nfor the successful early detection of breast cancer, which in turn is the basis for \nthe desired reduction in breast cancer mortality. However, mammography, as a \nmodality primarily based on morphology, is inherently unable to reliably predict \nprognosis and outcome for lesions detected in screening. In addition, the so-called \nlength-time bias in screening will lead to preferential detection of slow-growing, \nless aggressive tumours. A possible strategy to lower the risk of overdiagnosis in \nmammography screening is the additional use of breast MRI as an assessment \ntool, since MRI may be better able to predict the biological behavior of breast le-\nsions, in combination with a short-term follow-up approach, e.g. for older patients, \nin whom based on imaging the likelihood of clinically relevant breast cancer is low. \nIdeally, the decision by the breast radiologist, whether to biopsy or not to biopsy \na suspicious lesion detected in screening, should not be based on imaging alone, \nbut should also incorporate clinical factors such as the individual breast cancer risk \nand the biological age of the patient as well as possible comorbidities.\nAuthor Disclosure:\nU. Bick: Equipment Support Recipient; Hologic, Inc, Toshiba Corporation. \nPatent Holder; Hologic, Inc. Speaker; General Electric Company, Carestream \nHealth, Inc. \ntumours is mandatory in order to counsel men with prostate cancer and to indi-\nvidualise therapy. To prevent overtreatment of low-risk disease and to decrease \ntreatment-related morbidity, active surveillance is the treatment modality of choice \nfor men with indolent tumours. Unfortunately, in most places, it is not used frequently \nand men who are unlikely to die of their cancer undergo unnecessary treatment, \nincluding radical prostatectomy and radiation therapy, which significantly impairs \nquality of life. At the same time, still up to 40% of men shift to active therapy dur-\ning their active surveillance due to tumour progression or reclassification towards \nhigher risk disease. To safely increase widespread use of active surveillance and \nto pave the way for focal therapy, PC diagnostics need to be refined to correctly \nidentify biologically significant disease.\nLearning Objectives:\n1.  To understand how diagnosis is established through PSA evaluation and \nbiopsy.\n2.  To learn about different treatment options.\nA-060 08:58\nB. The radiologist’s contribution: how to detect and characterise a tumour \nA.R. Padhani; Northwood/UK (anwar.padhani@stricklandscanner.org.uk) \nThe importance of detecting and accurately localizing significant intra-prostatic \nfocal disease lies in two clinical areas. First, in men with persistently raised serum \nPSA levels and in whom there have been multiple negative biopsies or positive \nbut low-grade/volume tumour with discordant PSA kinetics. These un- or under-\ndiagnosed cancers need to be located and histologic evaluated before appropri-\nate can be instituted. Second, the usage and future success of local ablative \ntreatments such as high-intensity focused ultrasound (HIFU) is dependent on the \naccurate identification of the dominant intra-prostatic lesion, also known as the \nindex lesion. Multiparametric MRI components including T2-weighted, diffusion, \ndynamic contrast enhancement and MR spectroscopy can all enable the accurate \ndetection, localisation and characterisation of prostate cancer to be undertaken \nwith high accuracy particularly when all components are combined into a single \ncomprehensive assessment. This is because each technique interrogates the \nunique biology of cancers which differs from normal tissues. In order for MRI data \nto inform on patient management, multiparametric data need to be communicated \nto oncologists/urologists in a simple but meaningful way. This is best done using \nstructured reporting systems, incorporating simple scoring systems via graphical \ninterface that matches prostate anatomy. These aspects will be discussed in detail.\nLearning Objectives:\n1.  To understand how multiparametric MRI detects prostate cancer.\n2.  To learn how to perform, interpret and communicate multi parametric MRIs.\n3.  To learn how to support image guided biopsy.\n4.  To understand the need for the standardisation of MRI protocols and reports.\nAuthor Disclosure:\nA. R. Padhani: Advisory Board; Siemens HeathCare. Speaker; Siemens \nHeathCare. \nA-061 09:21\nC. The radiologist’s influence on management. Staging prostate \ncancer: how it impacts on treatment selection \nH. Hricak; New York, NY/US \nTreatment recommendations for prostate cancer continue to evolve and are \naffected by technological advances (e.g., robotics, image-guided radiotherapy \n[IGRT)]), new discoveries regarding tumour biology, and the development of \npredictive and prognostic biomarkers. With the increased complexity of treatment \ndecision-making, the role of MRI is evolving as well. While the value of MRI in \nstaging prostate cancer, particularly for evaluating extracapsular extension and \nseminal vesicle invasion, has been documented, unresolved needs for uniform \ninterpretation and standardised reporting still pose obstacles to its widespread use. \nMRI findings affecting treatment decision-making extend beyond those of staging. \nTumour grade (aggressiveness), size/volume and location are all relevant to treat-\nment selection. When added to T2-weighted MRI, newer MR techniques, such as \ndiffusion-weighted MRI, dynamic-contrast-enhanced MRI, and MR spectroscopy \nimprove tumour detection while providing an indication of tumour aggressiveness. \nHowever, MRI performance on all sequences is dependent on lesion size/volume \nand grade, and this should be considered when applying MRI results to treatment \nselection and planning. Today, most patients are diagnosed with low-grade, clinically \nnon-palpable disease (stage T1c), and the role of MRI is expanding from staging \nadvanced disease to evaluating intraprostatic disease. The more individualized and \ntargeted the treatment approach, the greater the role of imaging in treatment plan-\nning. MRI is especially critical for planning technologically sophisticated treatment \napproaches such as robotic surgery, IGRT, or focal therapy and can help assess \npatients’ eligibility for active surveillance. \n19\n\nPostgraduate Educational Programme\nS2\n C B D E F\n G\nA\nThe principles of ATLS® and discrepancies between the radiological literature, \nATLS® and day-to-day practice will be addressed.\nLearning Objectives:\n1.  To understand the relationship between ATLS and emergency radiology.\n2.  To know more about the rational use of CR, US and CT according to patient \npriorities in the emergency setting.\n3.  To become familiar with priority-oriented reporting of findings.\nA-067 09:30\nC. Mechanism of injury and MDCT protocols: choosing the right \nprotocol for the right patient \nS. Voelckel1, M. Rieger2; 1Innsbruck/AT, 2Hall in Tirol/AT \n(sandra.voelckel@i‑med.ac.at) \nPolytrauma is the leading cause of death in younger people. Because of the broad \nconsensus on the time sensitivity of the very first emergency procedures, namely \n“time is life”, radiologists constantly attempt to devise new ways to reduce the \namount of time needed to adequately image trauma victims while simultaneously \nimproving image quality. Multidetector-row computed tomography (MDCT) is consid-\nered an accurate and reliable imaging modality for initial evaluation of patients with \nmultiple injuries and is widely used in modern emergency radiology. In patients with \nhaemodynamic and respiratory instability that is not appropriate for CT examination, \nthe delay in the first emergency room phase is used for conventional radiographs \nand a comprehensive sonogram. Knowledge of trauma mechanism is essential \nto adapt the ideal diagnostic protocol. Choosing a surgical treatment strategy for \npatients with traumatic extremity injuries requires rapid detection, localisation, and \ncharacterisation of a possibly accompanying vascular injury. In these patients, a \nMDCT-angiography is included in the standard whole body protocol. Blunt cervical \nvascular injuries (BCVI) represent serious conditions with an increased risk of being \ninitially underdiagnosed during the first patient management. If present, BCVI, e.g., \narterial dissections, potentially can cause severe or even fatal cerebral damage. \nTherefore, a MDCA-angiography of the cervical arteries should be included in the \nstandard work-up. \nLearning Objectives:\n1.  To understand mechanisms of traumatic injuries.\n2.  To become familiar with established whole body MDCT protocols and their \npossible relation to injuries.\n3.  To know the impact of MDCT findings on patient management.\n08:30 - 10:00 Room E1 \nState of the Art Symposium \nSA 4 \nDiffusion-weighted imaging (DWI) of the abdomen \nA-068 08:30\nChairman’s introduction \nY. Menu; Paris/FR (yves.menu@sat.aphp.fr) \nDiffusion-weighted imaging (DWI) is a very hot topic, because it comes with \nstructural and physiological information, added to morphology. As the technique \nbecomes mature, and as most of MRI machines are able to acquire DWI, it is in-\ncreasingly popular and the number of indications extends continuously. However, \nthere are still unanswered or partially answered questions: should we integrate \nDWI sequences in every single abdominal examination? How standard are the \nacquisition technique and ADC measurements? Does it improve the lesion detection \nand/or characterisation? Is there any benefit in predicting or evaluating disease \nresponse to treatment, whether inflammation or tumour? Can it compete with PET \nfor detection and/or characterisation? In this session, the basic principles and tools \nfor interpretation of DWI will be addressed, with a focus on abdominal organs. At \nthe end of the session, the speakers will comment on clinical cases provided by the \nModerator:, in order to provide the attendees with clear and practical messages. \nSession Objectives:\n1.  To understand DWI principles.\n2.  To learn about appropriate protocols for DWI of the abdomen.\n3.  To learn how to analyse and report DWI images.\n4.  To understand the clinical value of DWI for detection, characterisation and \nprognostic evaluation.\nA-064 09:20\nDiscussion \nT.H. Helbich1, H.J. de Koning2; 1Vienna/AT, 2Rotterdam/NL \nThe discussion will address the following issues:\n1.  Why do estimates of overdiagnosis differ?\n2.  Should we begin to think about stopping mammographic screening?\n3.  How to reduce overdiagnosis?\n4.  DCIS as major part of overdiagnosis.\n5.  How should we inform women about overdiagnosis?\n08:30 - 10:00 Room D2 \nEmergency Radiology \nRC 417 \nER: basic principles \nModerator: \nP. Valdés Solís; Marbella/ES \nA-065 08:30\nA. Logistics and organisation of an emergency radiology department \nM. Körner; Landshut/DE (markus@dr‑koerner.net) \nThe interest in emergency radiology has been growing over the last years. The \nEuropean Society for Emergency Radiology is still young, and their first summer \nmeeting in Munich in 2012 was a huge success, which is a strong indicator for the \ninterest in this subspeciality. Besides optimising technical equipment and proto-\ncols for imaging, different logistic concepts have to be considered in planning and \norganizing emergency radiology departments. First of all, logistic concepts have \nto be considered for having an optimal workflow: the radiology department has \nto be in close proximity to the emergency department and the admitting area, in \nparticular. The whole workflow must be optimised for speed and accuracy. This also \nmandates to have dedicated and standardised examination and viewing protocols \nfor CT. In contrast to the USA, where dedicated emergency radiology departments \nare well established, the reading of emergency radiology cases is still frequently \ndone by non-specialized radiologists in European countries. The radiologic staff \ninvolved has to be trained for interpretation of trauma and other emergent cases. \nThis does not only account for residents but also for consultants and attending \nradiologists as well. Since a large number of such cases will arrive during after \nhours and on weekends, staffing has to be adjusted to this fact, which includes \nattending radiologists to be available during these hours on call or, preferably, \non-site. This lecture will give an overview of logistic concepts, organization of an \nemergency department and will also discuss critical issues in polytrauma imaging.\nLearning Objectives:\n1.  To understand how an emergency radiology department should be organised.\n2.  To become familiar with the logistics, staffing and technical equipment of an \nER department operating 24/7.\nA-066 09:00\nB. Advanced trauma life support: basic knowledge for radiologists \nD.R. Kool; Nijmegen/NL (dignakool@gmail.com) \nAdvanced trauma life support® (ATLS®) is an established systematic approach \nassessing trauma patients prioritizing the most life-threatening injuries. The term \n‚golden hour‘ is used to emphasize a sense of urgency, not to define a set time \nframe. The assessment is divided in a primary and a secondary survey. In the \nprimary survey, the mnemonic ABCDE (Airway, Breathing, Circulation, Disability, \nExposure and Environment) is used to guide the order of assessment. For efficient \ncommunication, it is helpful to report imaging in a comparable order. Although imag-\ning should not postpone treatment, chest and pelvis radiographs and abdominal US \ncan influence treatment decisions and should be performed in the primary survey. \nIn the secondary survey, the patient is examined from head to toe and appropriate \nadditional radiographs are performed. According to ATLS® and contrary to literature \nevidence, CT plays a minor role in the evaluation of trauma victims and indicated \nCT scans should be done in the secondary survey. Although improved in the most \nrecent edition, the ATLS® is neither evidence-based nor up-to -date concerning \nimaging in trauma settings. However, surgeons use the ATLS® recommendations \nroutinely to support indications for diagnostic imaging. In addition, surgeons refer \nto ATLS® in error with indications for imaging that are not supported by the present \nATLS® guideline or radiological literature. In this refresher course, the rationale and \nindications of imaging will be assessed where it pertains to the ATLS® protocol. \n0\n\nPostgraduate Educational Programme\nS2\nB\n C D E F G\nA\nFriday\ncare. Abdominal lymph node evaluation alone is not an absolute indication for \nMRI. These are depicted on MR images acquired for local staging of primary \ntumours in the pelvis and abdomen and for whole body staging in case of extra \nabdominal primaries and systemic disease such as malignant melanoma, breast \nand lymphoma. Cross-sectional imaging relying on nodal size and morphology \nand PET on metabolic activity for lymph node characterisation have not yet pro-\nduced sufficiently effective staging results due to considerable overlap in imaging \nfeatures of benign and malignant lymph nodes. Diffusion weighted whole body \nimaging with background body signal suppression (DWIBS) with inversion of grey \nscale producing images similar to PET and axial single shot EPI DWI with fat sup-\npression depict normal lymph nodes with a relative impeded diffusion, while both \ntechniques increase conspicuity of small lymph nodes irrespective of histological \ncomposition. ADC map produced from the latter sequence using a wider range of b \nvalues is rendered necessary for quantification and thus characterisation of lymph \nnodes. ADC is relatively independent of lesion size and various criteria have been \nproposed to increase sensitivity of DWI in differentiation of metastatic from benign \nlymph nodes with a diagnostic accuracy comparable to PET/CT.\nLearning Objectives:\n1.  To understand the signal of lymph nodes on DWI sequences, and to identify \nthe correlation between histological changes and DWI signal in benign and \nmalignant lymph nodes involvement.\n2.  To learn whether or not ADC value is helpful for characterisation.\n3.  To compare DWI and PET and understand their respective roles.\n4.  To open the door to the future combination of PET and MRI.\nClinical cases 09:35 \n08:30 - 10:00 Room E2 \nFoundation Course: Neuroimaging \nE³ 420 \nThe orbit, the petrous bone and the sella \nModerator: \nB. De Foer; Antwerp/BE \nA-072 08:30\nA. Imaging of the orbit: the globe and conal lesions \nP.C. Maly Sundgren; Lund/SE (Pia.Sundgren@med.lu.se) \nThere is a broad spectrum of diagnoses to orbital lesions including congenital \nmalformation, traumatic, neoplastic, iatrogenic, inflammatory and infectious eti-\nologies. The purpose of this lecture is to briefly revise the pertinent anatomical \nand physiological properties of the globe and to familiarize the audience with the \nimaging findings of different lesions with the focus on the role of conventional and \nadvanced magnetic resonance imaging (MRI) sequences in the work-up of orbital \nlesions and the imaging findings in the most common orbital abnormalities and \ntheir differential diagnosis.\nLearning Objectives:\n1.  To understand the embryology and imaging findings of the most common \nmalformations of the orbit.\n2.  To learn about space occupying lesions and the differential diagnosis of tumours \nand inflammatory conditions.\n3.  To become familiar with the role of conventional and advanced MR sequences \nin the diagnostic approach of lesions in the orbit.\nAuthor Disclosure:\nP. C. Maly Sundgren: Board Member; ISMRM, ASNR. Consultant; ICON \nMedical Imaging. \nA-073 09:00\nB. The petrous bone \nF. Veillon; Strasbourg/FR (Francis.Veillon@chru‑strasbourg.fr) \nCT (CB CT) and MRI provide very precise information about the pathology of the \npetrous bone. Minor malformations of the inner ear are extremely frequent and \nconstitute a labyrinthine weakness which must be known by the otologist and pa-\ntient. Chronic otitis media is very well documented by CT considering the ossicles \nparticularly the stapes (with the footplate). MR is useful when the diagnostic is \ndoubtful with CT before the surgery and in the follow-up of the postoperative middle \near knowing than diffusion is not totally specific. The evaluation of T1 is essential to \navoid the false-positive diagnosis of cholesteatoma. CT allows a new classification \nof petrous traumatisms (we separate the fractures of the middle ear, the inner ear \nA-069 08:35\nDWI of the abdomen: a tutorial for beginners \nH.C. Thoeny; Berne/CH (harriet.thoeny@insel.ch) \nDWI is a non-invasive imaging technique providing information on the Brownian \nmotion of water molecules in the underlying tissue. The ADC is a quantitative DWI \nparameter and provides information on diffusion and perfusion depending on the \nchoice of the applied b-values. Extracranial applications of DWI mainly in the \nabdomen-gained increasing acceptance in recent years, thanks to newer techni-\ncal developments. It can easily be added to conventional MRI in daily routine and \nits interpretation is relatively easy - provided that accurate imaging protocols are \nused and correlation with morphological sequences is performed. In patients with \nrenal insufficiency, DWI can also be applied as an alternative for contrast medium \nadministration in various circumstances. DWI is helpful in lesion detection, lesion \ncharacterisation, functional evaluation of various organs, and treatment monitoring. \nImage interpretation can be performed qualitatively based on visual assessment \nof the high b-value images and the corresponding ADC map. In general, a cystic/\nnecrotic lesion is dark on the high b-value images and bright on the corresponding \nADC map, whereas a solid or hypercellular lesion as observed in most malignant \ntumours is usually bright on the high b-value images and dark on the ADC map. \nAbscess and haematoma can present with the same features, therefore, compari-\nson with morphological images is a prerequisite for correct image interpretation. \nQuantitative analysis is performed by ADC measurement, however, caution must \nbe used when comparing results to those published in the literature because the \nADC depends on the choice of underlying b-values.\nLearning Objectives:\n1.  To understand the principles of DWI.\n2.  To learn the different acquisition protocols (optimal b values, optimal se-\nquences) and their advantages and disadvantages.\n3.  To learn how DWI can be integrated into acquisition protocols, and whether it \nprecludes the need for other sequences.\n4.  To learn how to interpret ADC maps and values.\nA-070 08:55\nLiver and pancreas: answering burning questions \nF. Caseiro-Alves; Coimbra/PT (caseiroalves@gmail.com) \nDiffusion-weighted MR imaging is gaining wide acceptance for liver and pancreatic \nimaging, due to its superior contrast resolution, overtly cooperating in lesion detec-\ntion and/or characterisation. Focal liver lesion detection can be enhanced using DWI \nin a combined reading strategy of liver MR studies. The use of low b values are of \nutmost importance due to the black blood effect and higher b values assists further \non to depict the type of restriction within the lesions. The ADC measurement helps \non characterisation avoiding T2 shine-through effects. Pancreatic DWI may also \nassist on tumour detection increasing diagnostic confidence. The role of DWI for \nlesion characterisation is not clearly established since there is an overlap between \nbenignancy and malignancy. Other strategies such as intravoxel incoherent motion \n(IVIM) may be foreseen in order to calculate the perfusion component. DWI, both \nin liver and pancreas, may play a role in tumour response evaluation but clinical \nvalidation still lacks behind. Intra and inter-vendor variations in the calculated ADC \nvalues of tumours may be the most important drawback to be solved in the near \nfuture. Major shortcomings of DWI are currently technique-related due to the use \nof EPI causing low resolution imaging and strong artifacts of various kinds. This, \ntogheter with the lack of standardisation, are important problems that will be surely \nadressed and solved in order to increase the role of this technique for the daily \npractice in imaging the liver and pancreas.\nLearning Objectives:\n1.  To understand the images observed in the main focal liver and pancreatic \ndiseases.\n2.  To learn if DWI can provide useful information concerning tissue characterisa-\ntion.\n3.  To understand the clinical circumstances in which DWI is most helpful.\n4.  To learn if DWI helps in the evaluation of diffuse liver diseases and how iron \nand fat could be misleading issues.\nA-071 09:15\nDWI of abdominal lymph nodes: PET competitive or just pseudo? \nS. Gourtsoyianni; London/UK (sgty76@gmail.com) \nPrognosis and appropriate treatment planning of patients with malignant disease \ndepends on accurate tumour staging at presentation. Accurate identification \nof abdominal metastatic lymph nodes is of paramount importance as a single \nmetastatic lymph node may change treatment from curative surgery to palliative \n1\n\nPostgraduate Educational Programme\nS2\n C B D E F\n G\nA\nAuthor Disclosure:\nB. Sangro: Advisory Board; Bayer Healthcare and Sirtex Medical. Speaker; \nBayer Healthcare and Sirtex Medical. \nA-076 08:35\nAbdominal radiology \nA. Benito; Pamplona/ES (albenitob@unav.es) \nWorldwide accepted staging procedures for hepatocellular carcinoma include dy-\nnamic CT or MRI, both based on typical tumoural behaviour after contrast in arterial \n(hypervascular) and in portal-venous phases (“washout” appearance). However, \nsome tumours may show ambiguous features that precludes staging. Recent \nadvances such as perfusion for CT or diffusion and liver-specific contrast agents \nfor MRI have demonstrated a potential role to solve disagreements in diagnosis, \nstaging, or distinguishing the grade of malignancy. Imaging tumoural response \nafter non-surgical treatments (ablation, chemoembolisation, radioembolisation or \nsorafenib), based on tumoural viability as estimated by the degree of hypervascu-\nlarization in the arterial phase (modified-RECIST) seems to be more appropriate \nthan conventional systems (WHO/RECIST). However, uncommon radiological \npatterns can be seen after sorafenib (gradual decrease in tumour hypervascularity \nbefore shrinkage) or after radioembolisation (heterogenous patchy hypervascular \nareas and/or fibrosis) leading to misinterpretation or late recognised responses if \nonly morphologic changes are considered. Ethanol injection and RFA have been \nthe two most employed local ablative techniques for the local control of HCC. \nHowever, other procedures could offer potential benefits. The use of microwave \nablation is growing recently due to some presumed advantages such as larger \nablations, shorter duration, less susceptibility to heat sink effect, or no requirement \nof grounding pads. Irrevesible electroporation is also a new non-chemical, non-\nthermal technique (still under clinical investigation) that is based in the application \nof multiple direct pulses that result in an irreversible disruption of the cell membrane \nleading to cellular death. \nLearning Objectives:\n1.  To learn which imaging procedures should be considered standard of care for \nstaging HCC and which are potential improvements that await confirmation.\n2.  To understand the limitations of imaging in the diagnosis and evaluation of \nresponse to locoregional and antiangiogenic therapies.\n3.  To learn about the scientific evidence supporting the use of percutaneous \nablation procedures other than radiofrequency.\nA-077 08:50\nInterventional radiology \nJ.I. Bilbao; Pamplona/ES (jibilbao@unav.es) \nThe rationale to perform endovascular procedures for the treatment of patients \nwith Hepatocellular Carcinoma (HCC) is based on the anatomical fact that liver \nneovascular networks are nourished exclusively by arteries. Thus, HCC may be \nselectively treated by delivering therapeutic agents through the afferent arteries. \nIschaemia, provoked by the selective endovascular deployment of particles, may \ninduce tumoural necrosis with high local control. The drawback is that ischaemia \nwill also actively induce neoangiogenesis which may facilitate tumoural recurrence. \nTargeting of tumoural vessels is higher if smaller particles (or fluids like Lipiodol) \nare used and, for this reason, they could be loaded with anticancer agents. It \nhas been widely reported the high local control rates obtained with the mixed \neffect given by ischaemia (macroembolisation) and the delivery of drugs (chem-\noembolisation, drug-eluted-embolisation). Since macroembolisation will provoke \nischaemia in the embolized volume the procedure must be performed, as selective \nas possible trying to avoid any damage to the surrounding, usually cirrhotic, liver \nparenchyma. If not achievable the treatment should not be performed in patients \nwith liver insufficiency or in the presence of thrombosis of the main portal branches. \nEndovascular treatments may, even, pursue the superselective deployment of an \nanticancer agent (drug, radionucleide, antibodies) avoiding any ischaemic effect \n(microembolisation). Taking into account these considerations, their indications \nare increasing in patients with HCC. Several reports demonstrated its usefulness \nas a palliative method improving both local control and patients´ survival. But also \ntumours can be downstaged and then patients can receive curative treatments \n(surgery or ablation).\nLearning Objectives:\n1.  To learn about locoregional intraarterial therapies currently being used for \nHCC and the rationale behind their use.\n2.  To become familiar with patient selection for embolising procedures prior to \nand after angiographic evaluation.\n3.  To learn some tips that may help reduce side effects and prevent complications \nof transarterial therapies.\nand both middle and inner ear) and of otosclerosis (a particular emphasis is put \non the footplate which requires an excellent technic). MR opens a new way in the \ndiagnostic of Meniere disease (the dilation of the saccule is nicely demonstrated \nwith a 3 T MR unit) and in the analysis of the membranous labyrinth particularly in \nlabyrinthitis. A new way of reading the inner ear is also provided by the 3 T machines. \nThe foundation of the performance in imaging remains the knowledge of anatomy.\nLearning Objectives:\n1.  To understand the normal imaging anatomy.\n2.  To learn about the role of CT and MRI in the evaluation of congenital malfor-\nmations.\n3.  To become familiar with the most common acquired lesions of the middle and \ninner ear.\nA-074 09:30\nC. Sella and parasellar pathology \nR. Gasparotti; Brescia/IT (gasparo@med.unibs.it) \nThe sellar region can be subdivided into three anatomical compartments, intrasellar, \nsuprasellar and parasellar, each of which is characterised by different diseases. \nAlthough pituitary adenomas represent 90% of all sellar masses, a large spectrum \nof diseases can be encountered in such a small area, including congenital lesions, \ntumours, infectious and inflammatory conditions and vascular pathologies. The aim \nof neuroimaging is to characterise and to precisely define the anatomical relation-\nships of the lesions, since a thorough understanding of the radiological anatomy \nis essential for the differential diagnosis and treatment planning. MRI has almost \ncompletely replaced CT in the study of the central skull base, because of its superior \ncapability of tissue characterisation, although some tumours arising in this area \nmay still take advantage from CT, which better identifies the extensive calcified \ncomponents typical of craniopharingiomas or giant partially thrombosed aneurysms. \nA reliable diagnosis of sellar or parasellar mass lesion can usually be obtained \nwith conventional MRI based on T2W and pre/post-gadolinium T1W sequences, \nhowever, advanced MR techniques may be relevant for further characterising \nthe lesions. DWI sequences may represent a useful adjunct for the preoperative \nassessment of macroadenomas; 3D SPACE sequences may be used to identify \neither microcystic or tiny solid components respectively into large solid or cystic \nlesions, whereas 3D T1W fatsat post-gadolinium sequences can better display \ndural enhancement and cavernous sinus invasion by intrasellar mass lesions. We \npresent an overview of the relevant neuroimaging features of sellar and parasellar \npathology, including the differential diagnoses with less common lesions.\nLearning Objectives:\n1.  To consolidate knowledge about the normal anatomy and the age related \npatterns of the normal pituitary gland.\n2.  To learn how to evaluate congenital and acquired lesions of the sella and \nparasellar region.\n3.  To become familiar with imaging protocols.\n08:30 - 10:00 Room F1 \nMultidisciplinary Session: Managing Patients with Cancer \nMS 4 \nHepatocellular carcinoma \nA-075 08:30\nChairman’s introduction \nB. Sangro; Pamplona/ES (bsangro@unav.es) \nA variety of options are available for the treatment of hepatocellular carcinoma (HCC) \nfrom liver transplantation or resection to percutaneous ablation by chemical or physi-\ncal procedures, intraarterial injection of embolizing particles that may also serve \nas carriers of chemotherapeutic agents or radiation-emitting isotopes, or systemic \ndelivery of molecularly targeted agents. Although large scale studies have identified \ngroups of patients that may certainly benefit from some of these therapeutic tools, \nmany areas of uncertainty still exist. Only by the coordinated action of HPB Oncology \nmultidisciplinary teams may patients with HCC receive the best possible treatment.  \nSession Objectives:\n1.  To learn the current management of HCC as laid out in scientific guidelines.\n2.  To identify those areas of uncertainty, where multidisciplinary teams are needed \nmost.\n3.  To understand the basis of personalised care for HCC patients and the need \nfor multidisciplinary teams.\n2\n\nPostgraduate Educational Programme\nS2\nB\n C D E F G\nA\nFriday\nAuthor Disclosure:\nB. Sangro: Advisory Board; Bayer Healthcare and Sirtex Medical. Speaker; \nBayer Healthcare and Sitex Medical. \nCase presentation and discussion 09:35 \n08:30 - 10:00 Room F2 \nSpecial Focus Session \nSF 4a \n“MRI of the lung: to go?” \nA-080 08:30\nChairman’s introduction: “Apéritif \nH.-U. Kauczor; Heidelberg/DE (Hans‑Ulrich.Kauczor@med.uni‑heidelberg.de) \nMRI of the lung has experienced a series of groundbreaking technological de-\nvelopments in recent years. Most of them are related to imaging speed, gating \nand signal enhancement. It is now ready “to go” and to be used in clinical routine. \nPrerequisite is an easy-to-use standardised protocol off the shelf, which can be \ncustomized to clinical needs. Certainly, MRI rivals CT in many areas, however, \nthe unique combination of structural and functional aspects in a single examina-\ntion without using ionising radiation is an extraordinary asset. Patients suffering \nfrom vascular lung disease, e.g. pulmonary arterial hypertension and embolism, \nas well as neoplasms of the lung and mediastinum or inflammatory lung dis-\nease, especially, cystic fibrosis, pneumonia and pneumonitis will greatly benefit \nfrom the advantages of MRI. In patient population, such as children, younger \nsubjects and pregnant women, MRI should clearly be preferred to CT for these \nindications. Therefore, when you return to your clinical environment consider and \napply MRI of the lung more and more often: it is straightforward to do. Cheers!  \nSession Objectives:\n1.  To learn how to do MRI of the lung in clinical routine.\n2.  To understand the rationales and potential clinical applications of MRI of the \nlung.\n3.  To understand the prerequisites for acceptance of MRI of the lung by our \nclinical colleagues.\nAuthor Disclosure:\nH. -U. Kauczor: Advisory Board; Siemens. Investigator; Boehringer Ingelheim. \nSpeaker; Siemens, Boehringer Ingelheim, Bayer, Bracco. \nA-081 08:33\nThe sequence buffet \nJ.M. Wild; Sheffield/UK (j.m.wild@sheffield.ac.uk) \nMRI of the lungs has evolved radically in the last ten years to the point that it is now \nbecoming used routinely in clinical practice. This talk will focus on the technical chal-\nlenges and solutions for imaging lung structure and function with MRI methods using \nboth the endogeneous protons in the lungs and inhaled magnetic contrast agents. \nThe low proton density in the lungs (~ 0.1 g/cm3) and the magnetic inhomogoneity \nbetween tissue and air (susceptibility difference ~ 8 ppm) make structural proton MRI \nof the lung micro-structure challenging, particularly at higher B0 fields. Short echo \ntime pulse sequences, parallel imaging and respiratory gating can all help improve \nproton anatomical MRI. Signal from the major pulmonary vessels can be enhanced \nusing paramagnetic contrast agents and T1-weighted ultrafast pulse sequences for \nvolume coverage providing 3D pulmonary angiograms. Pulse sequence methods \nfor pulmonary angiography and time resolved pulmonary perfusion mapping will \nbe covered. The role of under sampled and view shared sequences with parallel \nimaging will be discussed within the constraints of tradeoffs between spatial and \ntemporal resolution. Again the focus will be on technical challenges with a “how to \ndo it” theme. Clinical images will be used as a means of highlighting the applica-\ntions of the respective methodologies.\nLearning Objectives:\n1.  To learn about the basic physics of MR imaging of protons in the lung.\n2.  To understand the role of different magnetic field strengths and parallel receiver \ncoils.\n3.  To appreciate the potential of fast imaging sequences for imaging the lung.\n4.  To understand how IRs can help patients with unresectable tumours being \nevaluated for resection.\nAuthor Disclosure:\nJ. Bilbao: Consultant; Sirtex, Terumo. \nA-078 09:05\nSurgery \nF. Pardo; Pamplona/ES (fpardo@unav.es) \nThe goals of hepatocarcinoma (HCC) surgery are to achieve an R0 resection, \nto protect the liver remnant parenchyma and to prevent morbidity and mortality. \nMultiple factors have been associated with morbidity and mortality as remnant liver \nvolume, age, comorbidities (cardiovascular disease, diabetes, renal function), liver \nfunctions tests, transfusion or the degree of portal hypertension. The requirements \nfor safe resection are a sufficient remnant liver parenchyma and an adequate liver \nfunction. Contraindications for resection would be given by tumour size, preoperative \nstaging and the degree of portal hypertension. Tumour size and location determines \nthe type of surgery needed to perform oncological resection. Recent studies have \nshown that it is feasible to perform a major hepatectomy even in cirrhotic livers \nwithout increasing the risk considerably. Preoperative portal vein embolisation is a \ngood strategy to increase the future liver remnant and reduce the morbi-mortality \neven in cirrhotic patients. Liver transplantation is the best option for patients with \nHCC and poor liver function. In 1996, Mazzaferro published excellent long term \nresults of HCC transplantation when patients had a single nodule less than 5  cm \nin diameter or up to three nodules, none larger than 3  cm. These “Milan criteria” \nwere adopted by most transplant teams in the world and confirmed by numerous \nseries. Other groups also published good results with broader criteria (UCSF, \nKyoto, Pamplona). Locoregional treatments such as TACE or SIRT are very useful \nfor assessing the biological behaviour of HCC and also for achieve down staging, \nallowing the rescue of initially inoperable patients. \nLearning Objectives:\n1.  To learn about the main factors behind the resectability of HCC.\n2.  To learn about the evolving criteria for liver transplantation.\n3.  To understand the potential role of radiologists in the intraoperative or post-\noperative management of HCC.\n4.  To learn about complications of locoregional therapies (percutaneous ablation \nor intraarterial therapies) that could complicate resection or transplantation.\nA-079 09:20\nHepatology/oncology \nB. Sangro; Pamplona/ES (bsangro@unav.es) \nThe scientific basis supporting the current treatment paradigm of hepatocellular \ncarcinoma (HCC) is relatively week due to the scarcity of large-scale randomised \nclinical trials. Several staging systems have been developed and most of them take \ninto account not-only tumour burden but also liver function, since the frequently \nunderlying cirrhosis may determine prognosis as much as tumour growth does. In \nEurope, the Barcelona Clinic Liver Cancer (BCLC) system has been endorsed by \nEASL and EORTC. Generally speaking, patients with small tumours are ablated \nsurgically (resection or liver transplantation depending on the presence of cirrhosis) \nor percutaneously (radiofrequency or ethanol injection). Intraarterial procedures \n(bland embolisation, chemoembolisation or radioembolisation) are used for larger \nor multiple tumourus not extended beyond the liver, while systemic therapy is used \nfor patients with extrahepatic disease or a contraindication to transarterial therapy \n(mainly because of portal vein thrombosis). However, guidelines issued by different \nscientific societies worldwide diverge in the definition of patients that benefit the most \nfrom each treatment. Sorafenib (an oral agent with antiangiogenic properties) has \nbeen shown to prolong the survival of patients with unresectable, advanced disease \nand preserved liver function. After this proof of concept, a great number of clinical \ntrials exploring agents with different molecular targets have been launched but so \nfar none of this trial has yielded positive results. Sorafenib has failed to show any \nadvantage in survival when given in combination with chemoembolisation and its \nrole as an adjuvant therapy after resection or ablation is is currently being studied. \nLearning Objectives:\n1.  To learn the basis of tumour staging in HCC and the general treatment para-\ndigm.\n2.  To learn about the discrepancies between different treatment guidelines and \nclinical practice.\n3.  To become familiar with systemic anticancer agents and their impact on \nlocoregional and surgical treatment of HCC.\n3\n\nPostgraduate Educational Programme\nS2\n C B D E F\n G\nA\nA-084 09:23\nBon appétit! Main course”: pulmonary and mediastinal neoplasms \nE.J.R. van Beek; Edinburgh/UK (edwin‑vanbeek@ed.ac.uk) \nCT remains one of the main tools for the diagnosis of pulmonary and mediastinal \nneoplasms. In addition, PET imaging (with or without CT) plays an integral role \nin planning therapy due to its ability to enhance the staging requirements prior to \ntreatment planning. However, MRI has made significant inroads into aiding treatment \ndecisions and planning. MRI is the mainstay in the management of superior sulcus \ntumours, tumours where chest wall invasion is suspected and for characterisation \nof mediastinal tumours. It is now increasingly able to detect, assess and give \nadditional (functional and often more detailed anatomical) information. The use \nof standard high-spatial resolution imaging in combination with the application of \nstandard and dynamic contrast-enhanced imaging and the utility of ultrafast imaging \ndemonstrating motion of organs and structures of the chest wall and diaphragm \nfurther enhance the capability of MRI. Thus, although still mainly reserved as a \ntool for “difficult cases”, it is very likely that MRI will play an increasingly important \nrole in the diagnosis and staging of chest tumours, ranging from lung cancer to \nmediastinal and pleural processes. This presentation will give examples of benign \nand malignant processes, linking this with the previously demonstrated menu of \nsequences now available.\nLearning Objectives:\n1.  To understand the application of MRI sequences to the staging of lung cancer.\n2.  To become familiar with the role of MRI in lung cancer work-ups.\n3.  To learn about the limitations of MRI in chest tumours.\nAuthor Disclosure:\nE. J. R. van Beek: Advisory Board; Siemens Lung MRI. CEO; Quantitative \nClinical Trials Imaging Services, Inc. Speaker; Toshiba Medical Systems, Vital \nImages. \nPanel discussion: \n“Bon appétit! Dessert”: what are the benefits of MRI of the lung in \nclinical workflow and decision-making? 09:43 \n08:30 - 10:00 Room G/H \nNeuro \nRC 411 \nThe paediatric brain: not just a small brain \nModerator: \nC. Venstermans; Edegem/BE \nA-085 08:30\nA. Neurocutaneous syndromes: more than neurofibromatosis \nB. Ertl-Wagner; Munich/DE (Birgit.Ertl‑Wagner@med.uni‑muenchen.de) \nNeurofibromatosis type 1 is the most common, but certainly not the only neurocuta-\nneous syndrome. In children, white matter signal alterations (“myelin vacuoles”) are \na common neuroimaging finding. The incidences of optic gliomas and other gliomas \nare increased. Neurofibromas can occur in almost any body region. Plexiform neu-\nrofibromas show a diffuse and often locally destructive growth. Neurofibrosarcomas \nare malignant nerve sheath tumours. Neurofibromatosis type 2 is characterised \nby acoustic neuromas (vestibular schwannomas), which can be uni- or bilateral. \nSchwannomas can also affect other cranial nerves and spinal nerves. The inci-\ndences of meningiomas and to a lesser extent of gliomas are also increased. The \nhallmark feature of tuberous sclerosis is the combination of cortical or subcortical \ntubers and subependymal nodules. Tubers are hyperintense on T2w and FLAIR \nsequences. Other than heterotopia, subependymal nodules are NOT isointense \nto gray matter. Giant cell astrocytomas are located at the foramina of Monroi, in-\ncrease in size over time and show a contrast enhancement. Sturge-Weber disease \n(encephalotrigeminal angiomatosis) is characterised by a leptomeningeal angioma \nand facial naevus flammeus. There is increased leptomeningeal enhancement \nand hypertrophy of the ipsilateral choroid plexus. Atrophy of the affected region \nand tramtrack calcifications typically ensue. Von Hippel-Lindau disease is not a \nneurocutaneous syndrome per se, but was classically considered a phakomatosis. \nTypical features include haemangioblastomas of the brain, spinal cord or retina, and \npapillary cystadenomas of the endolymphatic sac. Most neurocutaneous syndromes \nhave manifestations outside the central and peripheral nervous systems as well. \nMoreover, there are multiple rare neurocutanteous syndromes.\nLearning Objectives:\n1.  To become familiar with the typical clinical presentations of neurocutaneous \nsyndromes.\nA-082 08:48\nPreparing your menu \nJ. Biederer; Heidelberg/DE (Juergen.Biederer@med.uni‑heidelberg.de) \nCompared to other lung imaging modalities, magnetic resonance imaging might \nbe considered complex and difficult to use in clinical routine at first sight. However, \nin practice, the application is facilitated by dedicated, pre-set protocol trees cus-\ntomized for typical clinical questions. The procedures are simplified by avoiding \nECG triggering or other time-consuming preparations for the examination. A basic \nprotocol to be acquired within less than 15 min without administration of contrast \nmaterial covers most clinical problems including infiltrates and lung nodules almost \nequally to CT. Excellent soft tissue contrast facilitates tumour staging, e.g. the \ndifferentiation of tumour and atelectasis or the diagnosis of mediastinal and chest \nwall masses. Visualisation of respiratory motion contributes functional information. \nAdditional, contrast-enhanced series to be acquired within 5 more minutes increase \nthe sensitivity of the examination for the detection of tumour necrosis and pleural \nreaction/carcinosis. A dedicated protocol for the diagnosis of pulmonary embolism \ncan be acquired within 15 min. This comprises an initial, free breathing and non-\ncontrast-enhanced examination for quick detection of severe embolism combined \nwith dynamic contrast-enhanced perfusion imaging, a high-resolution angiogram \nand a final 3D breath-hold acquisition. These pre-set protocols offer solutions for \ntricky problems of daily routine, in the lungs and the chest wall as well as for imag-\ning the mediastinum, or for cases in which radiation exposure or administration \nof CT contrast material should be strictly avoided, e. g. in paediatrics, pregnant \nwomen or for scientific studies.\nLearning Objectives:\n1.  To learn how to combine MR sequences with a comprehensive imaging pro-\ntocol.\n2.  To become familiar with the different diagnostic scopes of the protocol com-\nponents.\n3.  To learn how to apply protocol variations for specific clinical questions.\n4.  To learn when to use IV contrast-enhanced series.\nAuthor Disclosure:\nJ. Biederer: Speaker; Siemens. \nA-083 09:03\nBon appétit! Starters”: cystic fibrosis, pneumonia and pulmonary \nembolism \nM.U. Puderbach; Heidelberg/DE (m.puderbach@dkfz.de) \nCF: MRI is comparable to CT with regard to the detection of relevant morphological \nchanges in the CF lung. Compared to CT, the strength of MRI is the additional as-\nsessment of „function“, i.e. perfusion, pulmonary haemodynamics and ventilation. \nIn CF, regional ventilatory defects cause changes in regional lung perfusion due \nto the hypoxic vasoconstriction response or tissue destruction. Using dynamic \ncontrast-enhanced MRI, these perfusion changes can be assessed. Pulmonary \nembolism: The current imaging reference technique in evaluation of acute pul-\nmonary embolism is helical computed tomography. To be competitive with CT, an \nabbreviated MR protocol focusing on lung vessel imaging and lung perfusion may \nbe accomplished within 15 min in-room time. As a first step, a steady-state GRE \nsequence acquired in two or three planes during free breathing enables a non-\ncontrast-enhanced detection of large central emboli. As a second step, the protocol \ncontinues with the contrast-enhanced steps including first pass perfusion imaging, \nhigh spatial resolution contrast-enhanced (CE) MRA and a final acquisition with \na volumetric interpolated 3D FLASH sequence in transverse orientation. Pneu-\nmonia: The potential of MRI to replace chest radiography, particularly in children, \nwas already investigated several years ago. The experience from this work may \nbe considered valid for the suggested protocols for 1.5-T scanners since image \nquality has significantly improved. Therefore, T2-weighted fat-suppressed as well \nas dynamic contrast-enhanced T1-GRE sequences are applied with a slice thick-\nness between 5 and 6 mm. Disease entities encompassing community-acquired \npneumonia, empyema, fungal infections and chronic bronchitis are detectable. \nLearning Objectives:\n1.  To understand the application of MRI to morphological and functional imaging \nof airway diseases.\n2.  To appreciate the potential of MRI for imaging pulmonary embolisms using \ndifferent morphological and functional MR-techniques.\n4\n\nPostgraduate Educational Programme\nS2\nB\n C D E F G\nA\nFriday\naware of the details of the staging system and pattern of spread for a given tumour; \nthe strengths and limitations of available imaging modalities in specific oncologic \napplications, especially in assessing tumour response to different conventional and \nnewer therapies and various pitfalls in the overall approach to interpretation and \nreporting of oncologic imaging examinations. Because a radiologic study is only a \n“snapshot” taken during a brief moment of a patient’s medical timeline, meaning-\nful interpretation (the radiologist’s “added value”) requires integration of current \nimaging findings with results from various prior radiologic studies and pertinent \nclinical information. The frequently numerous findings visible on an imaging study \nneed to be distilled into a focused, clinically relevant report; otherwise, the radiolo-\ngist functions simply as a “film reader” (rather than as a true consultant), and the \nresultant radiology report may be technically accurate but clinically unhelpful -- or \neven misleading. Better reports can be produced by using standardised report \ntemplates, integrated imaging summaries, and consistent lexicons.\nLearning Objectives:\n1.  To review general principles of oncologic imaging.\n2.  To understand the critical importance of clinical context during interpretation \nof oncologic exams.\n3.  To evaluate ways to ensure that our reports provide added value and reflect \nthe radiologist’s role as consultant.\nA-089 08:55\nB. Lung cancers (primary, metastases) \nC.J. Herold; Vienna/AT (Christian.Herold@meduniwien.ac.at) \nLung cancer is among the most common malignancies worldwide, and accounts for \nup to 30% of all lung cancer death annually. In the US, approximately 220.000 new \ncases are diagnosed every year. Accurate staging of non-small cell lung cancers \n(NSCLC) and small cell lung cancers (SCLC) is of utmost importance for selecting \nthose patients, who benefit from attempted curative surgery versus those who may \nundergo palliative treatment. Recently, a new TNM staging system (7 th edition) \nfor lung cancer was introduced by the International Union against cancer and the \nAmerican Joint Committee on Cancer and should now be uniformly used for lung \ncancer staging worldwide. This staging classification was based on the analysis \nof a large data base of approximately 70.000 cases of NSCLC and 13.000 cases \nof SCLC sampled in a multi-institutional effort containing detailed information from \n46 institutions in 19 countries. The most important parameter for the developing of \nthe subgroups was overall survival based on disease stage. The major changes \ninvolve the T and M categories, resulting in subgroups that would more accurately \nbe associated with prognosis of a patient with defined descriptors. In this course, \nthe new TNM-staging classification will be demonstrated, and case examples will \nbe used to interactively enhance the learning experience of attendees. In addition, \nthe role of imaging methods in evaluating standard and innovative therapy regimen \nwill be discussed, and typical findings and pitfalls will be presented. \nLearning Objectives:\n1.  To review the strengths and limitations of radiologic techniques suitable for \ndetecting and characterising primary and metastatic lesions in the lungs.\n2.  To understand the imaging findings relevant for lung cancer T, N and M staging, \nand appraise the implications of the new IASLC lung cancer staging system.\n3.  To evaluate the imaging findings used to assess response to conventional and \nnew therapies for lung cancers.\nA-090 09:25\nC. Colon cancer \nR.M. Gore, R. Silvers; Evanston, IL/US (rgore@uchicago.edu) \nThe treatment of colorectal cancer has significantly changed over the last decade. \nNeoadjuvant chemotherapy and radiation therapy have become the standard of \ncare for rectal cancer. New biologic agents are being used with increasing frequency \nleading to personalized colorectal cancer therapy. In this presentation, the staging \nof colorectal cancer is reviewed, the relative role of MDCT, PET-CT, MRI, TRUS in \nstaging these neoplasms, and the applications of molecular imaging in the monitor-\ning of tumour response to therapy is presented.\nLearning Objectives:\n1.  To get an overview of current recommendations for the diagnosis of colorectal \ncancer.\n2.  To understand the specific role of MDCT, MR imaging, endoscopic ultrasound, \nand PET/CT in the staging of colorectal cancer in optimising patient manage-\nment.\n3.  To learn the utility of imaging in assessing tumour response to therapy and in \nthe general follow-up of patients with colorectal cancer.\nQuestions 09:50 \n2.  To consolidate knowledge of the typical imaging patterns of the major neuro-\ncutaneous syndromes.\n3.  To become familiar with some less common features of neurocutaneous \nsyndromes.\nA-086 09:00\nB. Patterns of white matter disease in children \nA. Rossi; Genoa/IT (andrearossi@ospedale‑gaslini.ge.it) \nPaediatric inherited white matter disorders can be distinguished into well-defined \nleukoencephalopathies and undefined leukoencephalopathies. The first category \nmay be subdivided into: (a) hypomyelinating disorders; (b) dysmyelinating disorders; \n(c) leukodystrophies; (d) disorders related to cystic degeneration of myelin; and (e) \ndisorders secondary to axonal damage. The second category, representing up to \n50% of leukoencephalopathies in childhood, requires a multidisciplinary approach \nin order to define novel homogeneous subgroups of patients, possibly representing \n“new genetic disorders’’. An integrated description of the clinical, neuroimaging, \nand pathophysiological features is crucial for categorizing myelin disorders and \nbetter understanding their genetic basis. A review of the MR imaging findings in the \nmain genetic disorders affecting white matter in the paediatric age, including some \nnovel entities, will be provided with a highlight on the concept of pattern recognition. \nLearning Objectives:\n1.  To become familiar with the most common white matter diseases in children.\n2.  To learn how to differentiate between white matter diseases in children.\n3.  To consolidate knowledge of appropriate imaging protocols for MRI of children \nwith white matter disease.\nA-087 09:30\nC. Paediatric brain tumours \nC. Hoffmann; T el Hashomer/IL (chen.hoffmann@sheba.health.gov.il) \nIn this short lecture, we will discuss the indications for imaging in the paediatric age \ngroup, the technique for imaging and the imaging characteristics of brain tumours in \ngeneral, with examples of common and uncommon brain tumours. An emphasis will \nbe given to new MR sequences, such as MR spectroscopy, perfusion sequences \nand diffusion tensor imaging. Brain tumourus are the second most common type \nof paediatric cancer. The incidence of supretentorial and infra tentorial tumours \nis equal, in the first two years of life, supra tentorial tumours are more frequent, \nand infra tentorial tumours are more frequent at the 4-10 years age group. Over \nthe 10th year of life there is equal incidence. The location of brain tumours is help-\ning to predict the type of tumour. For example: tumourus in the 4 th ventricles are \nmainly medulloblastoma and ependymoma, in the cerebellar hemisphere pilocytic \nastrocytoma. Tumours of the 3rd ventricles can also be differentiated by the loca-\ntion in the ventricle. DWI sequences help in the diagnosis of the posterior fossa \ntumours. Tumours with high cellularity will present with low-ADC value (medullob-\nlastoma), whereas tumours with lower cellularity will present with high ADC value \n(astrocytoma). MRS can also help: lactate and lipids are markers of malignant \ntumours. The combination of the characteristic location with the DWI and MRS \nappearance can lead to the accurate diagnosis in most of the cases before the \npathology report is ready.\nLearning Objectives:\n1.  To learn about the difference between paediatric and adult brain tumours.\n2.  To understand the imaging strategy for the paediatric population.\n3.  To recognise the most common paediatric brain tumours.\n08:30 - 10:00 Room I/K \nJoint Course of ESR and RSNA (Radiological Society of North \nAmerica) \nMC 428 \nEssentials in oncologic imaging: what radiologists \nneed to know (part 1) \nModerator: \nD.M. Panicek; New York, NY/US \nA-088 08:30\nA. Principles of oncologic imaging and reporting \nD.M. Panicek; New York, NY/US (panicekd@mskcc.org) \nOncologic imaging examinations are often complex and specialized knowledge is \nrequired to interpret them in a clinically relevant manner. The radiologist needs to be \n5\n\nPostgraduate Educational Programme\nS2\n C B D E F\n G\nA\nA-093 09:10\nC. Cardiomyopathies \nP. Sipola; Kuopio/FI (petri.sipola@kuh.fi) \nCardiac magnetic resonance imaging (CMRI) is highly valuable in the differential \ndiagnosis of cardiomyopathies. MRI diagnosis is based on cine imaging of cardiac \nfunction, T2-weighted imaging of oedema and late gadolinium-enhanced (LGE) \npatterns of scar tissue. Hypertrophic cardiomyopathy (HCM). Left ventricular hyper-\ntrophy (LVH) is typically located in basal septum and anterior wall but has variable \nexpression (diffuse, localised). Associated abnormalities include left ventricular (LV) \nhigh-ejection fraction (EF), mitral valve abnormalities, apical aneurysm, and right \nventricular (RV) hypertrophy. Scattered intramyocardial LGE may occur in various \npatterns. The differential diagnoses in patient with hypertrophic phenotype include \npressure overload hypertrophy, amyloidosis, sarcoidosis, and Fabry’s disease. \nLGE patterns is useful in differentiation. Dilated cardiomyopathy (DCM): Dilated LV \nend-systolic volume and impaired EF% are characteristics. Non-ischaemic DCM \ntypically shows no LGE (in contrast to ischaemic cardiomyopthy). Sometimes faint \nmidwall enhancement can be observed, which has prognostic value. Presence of \nextensive non-compacted myocardium indicates non-compaction cardiomyopa-\nthy. Arrhythmogenic right ventricular cardiomyopathy (ARVC): The RV volume is \nenlargened and akinetic RV segments can be seen. Local bulging or dyskinesia \nin conjunction with fatty infiltration and LGE is typical. Restricted cardiomyopathy \n(RCM): Enlargened atrias and normal sized ventricles with preserved EF% and no \nLGE are characteristics. Myocarditis: LV systolic function is typically lowered but may \nbe normal. T2 images may show increased signal. LGE limited to the subepicardial \nmyocardium is highly suggestive of myocarditis. Iron overload cardiomyopathy: \nCine imaging is used to assess LV global function and T2*-weighted imaging to \nquantitate ventricular iron deposition. \nLearning Objectives:\n1.  To get an overview of different types of cardiomyopathies.\n2.  To differentiate typical imaging findings in various cardiomyopathies.\nA-094 09:30\nInteractive case discussion \nV.E. Sinitsyn; Moscow/RU (vsini@mail.ru) \nClinical cases of congenital heart disease, valvular disease and cardiomyopathy \nhave been presented. Combined use of cardiac MRI and CT give both morphologi-\ncal and functional information about heart structure, function, myocardial perfusion \nand myocardial viability. Cardiac CTA is superior in depiction general cardiac and \nextracardiac congenital abnormalities, such as anomalies of coronary vessels, \nsystemic and pulmonary veins, bronchi, pulmonary collaterals, etc. cardiac CT \ncan be used of diagnosis of valve abnormalities, especially in cases of aortic valve \ndiseases. Cardiac MRI provides quantitative and qualitative information about \nintracardiac blood flow (shunts), cardiac valve function, structure of myocardium. \nLate enhancement pattern in patients with cardiomypathies have both diagnostic \nand prognostic value. Rationales for selection of different protocols for cardiac CT \nand MRI in patients with non-ischaemic heart diseases are discussed. \n08:30 - 10:00 Room N/O \nEIBIR/EORTC Joint Workshop \nA radiologist with a ruler in his hand is a dangerous \nperson: seeking standardisation in multicenter \nimaging trials \nModerators: \nP. Brader; Vienna/AT \nY. Liu; Brussels/BE \nA-095 08:30\nIntroduction: imaging and the future of cancer therapy \nP. Brader1, Y. Liu2; 1Vienna/AT, 2Brussels/BE (peter@brader.md) \nThe use of imaging biomarkers will become more important in clinical trials in the \nfuture. Non-invasive imaging enables associations between therapy and effect, \nproviding morphlogic but also functional information. Assessment of tumour burden \nand time to the development of disease progression is of importance in clinical evalu-\nation of cancer therapy, however, with increasing use of cytostatic over cytotoxic \ntargeted agents, response evaluation using conventional morphologic assessment \nis limited and usually takes longer to detect response compared to functional and \nmolecular imaging techniques. Therefore, the question is raised whether it is time \nto move from anatomic assessment of tumour burden to functional and molecular \n08:30 - 10:00 Room L/M \nOrgans from A to Z: Heart \nMC 422 \nNon-ischaemic heart disease \nModerator: \nV.E. Sinitsyn; Moscow/RU \nA-091 08:30\nA. Congenital heart disease \nM. Gutberlet; Leipzig/DE (matthias.gutberlet@herzzentrum‑leipzig.de) \nThe numbers of newborns with congenital heart disease (CHD) is not rising but the \nnumber of infants with congenital heart disease who achieve adulthood is constantly \nincreasing due to improved medical treatment especially in cardiac surgery and \npaediatric cardiology. The imaging modality of choice during infancy in patients \nwith congenital heart disease is echocardiography. But in older patients, especially \nafter cardiac surgery, it becomes very often more and more difficult to achieve an \nadequate acoustic window to assess important anatomical structures. In particular \nthe visualisation of the right ventricle, which is involved in many CHD, becomes \ndifficult. Therefore, all cross-sectional imaging modalities, especially magnetic \nresonance imaging but also computed tomography, and also the radiologist comes \ninto play. The pros and cons of the different imaging modalities will be discussed \nas well as the possibilities in common diseases like coarctation, tetralogy of Fallot \nand Transposition of the Great Arteries. \nLearning Objectives:\n1.  To understand the value of available imaging modalities in congenital heart \ndisease.\n2.  To get an overview of common cases of congenital heart failure.\n3.  To learn how to read post-surgical cases in patients with congenital heart \ndisease.\nAuthor Disclosure:\nM. Gutberlet: Research/Grant Support; BmBF (German Federal Ministry of \nEducation and Research), Competence Network of Congenital Heart Defects. \nSpeaker; Bayer, Bracco, Siemens, Philips and GE. \nA-092 08:50\nB. Valvular disease \nJ. Bogaert; Leuven/BE (Jan.Bogaert@uz.kuleuven.ac.be) \nIn recent years there, has been an increased use of cardiac MRI and to a lesser \nextent also cardiac computed tomography (CT) to assess valvular heart disease. \nBoth techniques have shown to provide complementary often unique information \ncompared with conventional techniques such as echocardiography and cardiac \ncatheterization (x-ray angiography). When investigating cardiac valves, the infor-\nmation is required on 1. clarification of the affected valve after auscultation of the \nheart; 2. definition of the valvular anatomy; 3. assessment of valvular function and \n4. definition of the effect of the valvular dysfunction on other cardiac structures \nand function. These questions can be addressed by combining echocardiography \nwith x-ray angiography. However, MRI can provide the required information in \na single investigation that is safe, non-invasive and without exposure to x-rays. \nMoreover, both MRI and CT are increasingly used as pre-procedural imaging in \npatients scheduled for transcatheter, percutaneous treatment, ensuring optimal \npatient selection and safe implantation. Furthermore, with the increasing accept-\nance of cardiac MRI for the assessment of valvular heart disease, there has been \nan increase in the amount of follow-up and outcome data that enables MRI to be \nused to define when patients should undergo treatment of their valve disease. In \nthis presentation, an overview of the MRI and CT techniques that are currently \nused in the assessment of valvular heart disease, discussing the advantages \nand limitations of these techniques with reference to more conventional imaging \nmodalities for investigating valvular heart disease.\nLearning Objectives:\n1.  To learn about various imaging modalities available for imaging the cardiac \nvalves.\n2.  To get an overview of various types of valvular diseases.\n3.  To understand myocardial changes caused by valvular pathologies.\n6\n\nPostgraduate Educational Programme\nS2\nB\n C D E F G\nA\nFriday\nhas only modest diagnostic value for the assessment of such tumours. Numerous \nstudies on perfusion MR imaging (pMRI) have indicated potential added prognostic \nand diagnostic value of this advanced MR neuroimaging technique for the work-up \nand follow-up of brain tumour patients. These studies are, however, limited by the \nfact that they were monocentric and commonly retrospective, and did not include \na systematic histological or imaging review. To evaluate pMRI as its suggested \npotential as a neuro-oncological biomarker, the EORTC Brain Tumour Group initi-\nated a three-phase feasibility study on the implementation of pMRI in prospective, \nmulticentre, multinational trials of (anaplastic) gliomas. A standardised MR imag-\ning protocol, including pMRI, was developed and subsequently implemented in \n4 core sites. Available post-processing tools were assessed with respect to their \napplicability to multicentre data, and a protocol to standardise relative Cerebral \nBlood Volume (rCBV) measurement was established. Datasets from all core sites \nwere independently analysed by 4 experienced raters, assessing inter-rater vari-\nability for each of the post-processing tools. In this presentation, a brief overview \nof rCBV measurement and its potential value for brain tumour assessment is given. \nFurthermore, the EORTC Brain Tumour Group’s experience with and findings of \nthe feasibility study will be presented, highlighting the difficulties of consistently \nmeasuring rCBV in general, as well as those specifically arising in multicentre trials. \nA-099 09:40\nPresentation of LUNG study: from the beginning until today \nU. Nestle; Freiburg/DE (ursula.nestle@uniklinik‑freiburg.de)\nThe LungTech trial will be a European multicenter study adressing the challenge \nof stereotacic radiotherapy for small centrally located lung tumours. High precision \nradiotherapy poses special needs on pre-treatment assessment and target volume \ndefinition. Post treatment, radiation induced normal tissue alterations may lead to \ndiagnostic problems and misinterpretations. Therefore, imaging research will play a \nmajor role in the study concept. Beyond pre-treatment staging, 3D and 4D imaging \nwill be used for target volume delineation, positioning and follow -up concerning \ntumour control and toxicity. Several translational imaging research projects will or \nmay be attached to this study. These involve 4D FDG PET/CT for target volume \ndelineation, serial FDG PET/CT for evaluation of local control, DCE CT, and chest \nMRI. Besides insights in high precision radiotherapy for lung tumours, the concepts \nand methods of the related imaging studies will be discussed, obstacles and chal-\nlenges will be discussed. \n08:30 - 10:00 Room P \nProfessional Challenges Session \nPC 4 \nThe visibility of the radiologist \nA-100 08:30\nChairman’s introduction \nJ.A. Reekers; Amsterdam/NL (jimreekers@xs4all.nl) \nFor decades, radiology practise was located in the basement of the hospital, no day-\nlight and no natural relation to the rest of the hospital. This was more or less the natu-\nral habitat. The radiologist was “the person” taking the pictures, he was not perceived \nas a doctor whose opinion would value the patient directly. During the last decade, \nthe radiologist has come to the light, changing from light box to computer screen, \nand has started to become more involved in clinical decision taking. However, there \nis still a lot, which can be improved before the radiologist is a fulltime member of the \nclinical multidisciplinary treatment team. Reporting and at the same time, combining \nthis with knowledge about treatment will contribute to this role and increase the \nvisibility of the radiologist. The guidance of radiology in cancer treatment is a good \nexample of this. Clinical involvement in combination with delivering care and treat-\nment, like in interventional radiology, will also improve the visibility of the radiologist \nwithin the hospital. The radiologist should learn how to make alliances with other \nmedical specialists. To achieve these goals, it is also crucial to understand the \nimportance of having a prominent place for radiology in the medical curriculum. In \nmodern medicine, radiology needs to play a central role in diagnosis and treatment. \nThe visible radiologist should be a clinical doctor, a conductor and a Webmaster in \none. This special session will give suggestions and information how to achieve this.  \nSession Objectives:\n1.  To learn how the visibility of the radiologist can be increased.\n2.  To understand that radiology needs to play a central role in diagnosis and \ntreatment.\n3.  To learn from the experts and increase understanding through Q & A.\nassessment. Imaging biomarkers like apparent diffusion coefficient (ADC) reflect cell \ndensity/death/apoptosis, contrast enhanced magnetic resonance imaging (CE-MRI) \nor computer tomography (CE-CT) detect early changes of micro-vascularisation \nand perfusion in tumours, and magnetic resonance (MR) spectroscopy shows \nbiochemical changes in the tumour tissue. Undoubtedly, these advanced functional \ntechniques hold great promise, but qualifying these imaging biomarkers requires \nrobust methodology. One needs proper study design following standardised pro-\ncedures, correlation with pathology/outcome, reproducibility testing and optimal \ntiming of observation, and sufficient statistical power. In this session, a road map for \nfuture collaboration between EORTC and EIBIR will emerge with the aim of seeking \nstandardisation of advanced MR technology in multicenter cancer clinical trials. \nLearning Objectives:\n1.  To seek standardisation of imaging biomarkers in multicenter cancer clinical \ntrials.\n2.  To demonstrate examples of imaging implementation in optimised study design.\n3.  To explore future collaboration between EORTC and EIBIR.\nA-096 08:40\nSetting up clinical trials with functional imaging end-points: trials \nand tribulations \nN.M. deSouza; Sutton/UK (Nandita.Desouza@icr.ac.uk) \nThe standard imaging assessment of tumour response relies on size measure-\nments, which, with predominantly cytostatic targeted agents, may not reflect the \ndrug effect. Functional imaging biomarkers have the potential to quantify biological \ncharacteristics of tumours and measure on-target and off-target effects that indicate \nearly likelihood of response to a specific therapy, which can then be used to guide \nthe optimal biological dose and drug schedule. Serial, non-invasive assessments \nof whole tumour are possible. This is particularly important in the context of inter \nand intra-patient tumour heterogeneity as different parts of the tumour and primary \nvs metastatic lesions may be biologically different and these characteristics may \nchange with treatment. However, functional imaging end-points suffer from variabil-\nity, which can be very significant in a multicentre setting. Strict Quality Assuarance \nand Quality Control measures need to be implemented at the start of a trial and \nthe variability across centres documented. Data acquisition protocols need to take \naccount of equipment variations. Data analysis methodology needs standardisation \nof software, central review and preferably double reading of scans. Automation may \nnot always prove the most robust and reliable option. This presentation will focus \non the factors that are crucial in determining the compatibility of data in multicentre \ntrials with functional imaging end-points. \nLearning Objective:\n1.  To understand the processes involved in incorporating functional imaging end \npoints into clinical trials and appreciate the limitations.\nAuthor Disclosure:\nN. M. deSouza: Research/Grant Support; Cancer Research UK, Medical \nResearch Council UK, Engineering and Physical Sciences Research Council \nUK, National Institute for Health Research (NIHR) UK. \nA-097 09:00\nChallenges, problems on key imaging techniques \nB. Van Beers; Clichy/FR (bernard.van‑beers@bjn.aphp.fr) \nImaging methods used in clinical trials of new drugs should be able to objectively \nassess the early response to treatment. Therefore, the imaging biomarkers should \nbe validated and standardised and quality control should be performed. The amount \nof validation depends on the type of clinical trials. In phase 1 and 2 clinical trials, \npharmacokinetic/dynamic biomarkers may be sufficient for taking “go/no go” deci-\nsions. In phase 3 trials, surrogate imaging markers of hard endpoints, such as \nsurvival or time to progression, are required. The reproducibility of the imaging \nbiomarker is an important factor that should be taken into account. Standardisation \nshould concern both the image acquisition and analysis methods. Quality control \nmay require repeated phantom measurements and central reading. Finally, the \ncost benefit of the imaging biomarkers should be considered relative to that of \nnon-imaging biomarkers. \nA-098 09:20\nAdvanced MR neuroimaging in multicentre trials: experience from \nthe EORTC Brain Tumour Group \nM. Smits; Rotterdam/NL (marion.smits@erasmusmc.nl) \nAnaplastic gliomas constitute a group of brain tumours with heterogeneous clinical \nbehaviour, and the optimal treatment strategy is still a matter of debate. Conven-\ntional MR imaging, including T2w/T2-FLAIR and contrast enhanced T1w sequences, \n7\n\nPostgraduate Educational Programme\nS\n C B D E F\n G\nA\nphysicians in the appropriate use of diagnostic imaging studies. The radiologist’s \nparticipation in clinical meetings is also mandatory, but this takes time and neces-\nsitates speaking the same language as clinicians, reading the same journals. As \nan example, clinicians rely more than ever on imaging studies to assess tumour \nresponse to various treatments. This hidden and time-consuming work is often \nnot well recognised and rewarded. Lastly, answering clinicians’ questions needs \nadequate reporting, avoiding disorganized and imprecise document that can rarely \nbe taken seriously by colleagues. \nLearning Objectives:\n1.  To learn how to become more clinically involved.\n2.  To learn about the requirements of clinical radiology.\n3.  To learn how to manage the clinical problems of others.\nA-104 09:25\nRadiology in the 2 1st century: time to come out of the dark? \nA. Adam; London/UK (andy.adam@kcl.ac.uk) \nIn a few years, we are likely to see 3D images generated instantly, and with com-\nparable resolution to today’s 2D views. The detail on these images will make them \nincreasingly relevant as detailed diagnostic and presurgical planning tools. Inclusion \nof functional information, possibly at the molecular level, could also assist in clinical \ndecision-making. Specialist surgeons and physicians with intimate knowledge of \ntheir field of interest are likely to have a better understanding of the anatomy and \nphysiology of an organ system than a general radiologist. So given that the images \nwill be presented in a more familiar format, why should clinicians and surgeons wait \nfor a general radiologist to read them? If radiologists wish to retain their role as the \nexperts in image interpretation, they will not only need a thorough understanding of \nimaging, but also a detailed understanding of anatomy and pathophysiology and \nthey will need to subspecialize. In addition to subspecialization, radiologists will \nneed to play an important role in the determination of patient pathways. The way \nradiology is used at present is inefficient, as it is driven by requests for investigations \nby physicians who are not equipped to use imaging efficiently. Radiologists should \nbe proactive, and should communicate with referring physicians and with patients \nwhen significant abnormalities are detected, planning further investigations rather \nthan simply responding to requests. This will help to arrive at a diagnosis at an \nearlier stage, will save money and will improve clinical outcomes.\nLearning Objectives:\n1.  To learn about the role of the radiologist as quality controller.\n2.  To learn how to become proactive and drive patient pathways rather than \nsimply responding to requests.\n3.  To learn about improved visibility through improved service.\nPanel discussion: \nShould we improve the visibility of the radiologist? And if yes, how? 09:45 \n08:30 - 10:00 Room Q \nSpecial Focus Session \nSF 4b \nJustifying CT in paediatric radiology \nA-105 08:30\nChairman’s introduction \nC. Owens; London/UK (owensc@gosh.nhs.uk) \nThis session will provide a vitally important opportunity to listen to experts dis-\ncussing the core issues which we face in a world with increasing expectations \nand demands on the imaging world. That is to provide the best quality images in \nthe most challenging group of patients, i.e. children. The sensitivity of organs to \nradiation and the expectations of longer survival with state of the art treatment (for \ndiseases which were previously lethal) dictates that we must act with prudence \nwhen choosing the best and most apropriate imaging modality to answer the \nrelevant diagnostic question. The attendee will have an opportinity to indulge in \nthe opinions and expertise of the speakers from various relevant subspecialites. \nSession Objectives:\n1.  To become familiar with the importance of CT justification and optimisation.\n2.  To understand the evidence base for concern.\n3.  To become familiar with realistic alternatives to CT.\nA-101 08:33\nHow to optimise the visibility of the radiology department \nJ.A. Reekers; Amsterdam/NL (jimreekers@xs4all.nl) \nFor decades, the radiology department was located in the basement of a hospital. \nRadiation was the main reason for this stuffy and airless environment. A clinician \ndid not go to a radiology department, the pictures were sent to him, sometimes with \na note describing what could be seen on the pictures. Imaging was easy and most \nmedical specialists could read the film related to their own specialty. This has now \nchanged dramatically, reading diagnostic images has become very complicated with \nthe new imaging modalities and consultation on which imaging technique fits best \nwith a clinical question is now the domain of the radiologist. With this new position \nalso a new department has to be structured as a service-centre. First of all, out of \nthe basement and centrally located in the hospital. All medical conferences where \nimaging plays an important role should take place at the radiology department. This \nmeans that smaller and larger conference rooms with state-of-the-art projection and \naccess to a PACS should be build. As all reading is done from a computer screen, \nworkspaces should be able to facilitate interactive medical specialist discussions. \nRadiology departments should be organised around medical subspecialties with \nfixed stations to make it easy for specialist to find there diagnostic partner. Natural \nlight is important but if this is not possible daylight systems will improve the well \nbeing and ambiance at a department. In this session some important details will \nbe discussed about how to increase the radiologist’s visibility by building an open \ndepartment.\nLearning Objectives:\n1.  To learn how to organise a radiology department within a hospital.\n2.  To learn how to optimise contact with clinical partners.\n3.  To learn how to create an open radiology department.\nA-102 08:45\nStart early with radiological visibility \nM. Maas; Amsterdam/NL (m.maas@amc.nl) \nThe future of radiology depends on what current medical students think of radiology \nand how they are attracted into the field. There is a high responsibility for academic \nradiologists to increase awareness amongst medical students considering the \npivotal role of radiology as clinical speciality and of the opportunities in the field of \nradiological research. Radiology has got very powerful selling points: Radiology \nhas got images (one image is more than 1000 words), Radiologists are used to \nperform (in clinical meetings), Radiology is the most Computer Integrated Spe-\ncialty, Students nowadays are computer centered learners (digital natives, Homo \nZappiens). Possible strategies to reach the goals are: 1. Teaching (Radiological \nAnatomy, in combination with department of Anatomy, Computer-based learning \nprograms, Moderating small group learning); 2. Faculty development (Clinical \nrotations, Mentoring medical students); 3. Curriculum development (Board Medical \nschool, National Advisory Boards). Some steps need to be taken, to be successful \nin this track. Head of the Department strategically needs to reserve time and money \nfor some staff to pursue this goal. The individual Radiologist needs training in the \nfield of education, attends courses on curriculum building and faculty development, \nas well as on preparation of exams and on class room performing. CME credits in \nthe field of Medical Education need to be obtained. Furthermore, the person needs \nto be willing, creative and flexible, while skills in mentoring and providing feedback \non students also are important to develop. IT IS GREAT FUN!\nLearning Objectives:\n1.  To learn how to set up an undergraduate teaching programme for radiology.\n2.  To learn how to overcome the barriers of a traditional curriculum.\n3.  To learn about the results of an undergraduate teaching programme for radiol-\nogy.\nA-103 09:05\nClinical radiology puts you in the spotlight: taking over the clinical \nresponsibility \nE. de Kerviler; Paris/FR (eric.de‑kerviler@sls.aphp.fr) \nClinical radiology is the use of imaging to diagnose, treat and monitor various \ndisease processes. Radiology is somewhat different from most other clinical \npractices because there is in theory a relatively weak connection to the individual \npatient. However, there are subspecialties of Radiology, which include a lot of \npatient interaction. Unfortunately, the volume and complexity of imaging work has \ndriven many radiologists underground. There are many other factors that influence \na radiologist’s clinical implication such as administrative, managerial, teaching \nor research duties. The radiologist must however recover his place in patients’ \nmanagement, from imaging workup to therapeutic decision. This begins in guiding \n28\n\nPostgraduate Educational Programme\nS\nB\n C D E F G\nA\nFriday\nand chest imaging, in comparison with CT. Moreover, functional applications of \nMRI represent a promising field, challenging for example scintigraphy, an ionising \nmodality, in measurement of renal function.\nLearning Objectives:\n1.  To become familiar with alternative imaging methods to replace CT.\n2.  To appreciate the advantages and disadvantages of these alternative methods \nof imaging.\n3.  To become familiar with a practical model for CEUS and MRI in body imaging.\nPanel discussion:  \nDo we have guidelines for paediatric CT? Do we have alternatives? 09:40 \n10:30 - 12:00 Room A \nInteractive Teaching Session \nE³ 520a \nPitfalls in abdominal imaging \nA-109 10:30\nA. Liver \nV. Vilgrain, M. Ronot, A. Kerbaol, O. Bruno; Clichy/FR \n(valerie.vilgrain@bjn.aphp.fr) \nThe purpose of this lecture is to emphasize some pitfalls in liver imaging. Morpho-\nlogic changes in the liver are usually attributed to chronic liver disease where liver \ncirrhosis represents the most important cause. However, non-cirrhotic diseases \nmay also induce atropho-hypertrophic changes of the liver. The most common \nmechanisms are related to venous obstruction (either portal or hepatic venous) and \nbiliary obstruction. Multidetector CT and MR imaging are essential to highlight these \nabnormalities. When dealing with liver tumours, the most important question that \nhas to be solved is tumour characterisation. Yet, it is often difficult to assess whether \na large tumour is intra- or extrahepatic. Imaging findings that might be helpful will \nbe shown. Last, some liver lesions can mimic liver tumours. Vascular disorders \nand focal fatty changes or focal fatty sparing are the most common causes. Some \nother conditions can be also mimickers and such cases will be shown.\nLearning Objectives:\n1.  To learn about morphologic changes in the liver observed in non-cirrhotic \ndiseases.\n2.  To understand imaging features enabling distinction between intra and extra-\nhepatic tumours.\n3.  To become familiar with liver lesions mimicking liver tumours.\nA-110 11:15\nB. Pancreas and bile ducts \nR. Manfredi; Verona/IT (riccardo.manfredi@univr.it) \nThe technique and the anatomy of the bile duct and pancreatic duct will be de-\nscribed. Anatomical variants of the biliary duct and the pancreatic duct system will \nbe analyzed and their possible role in generating diagnostic imaging pitfalls, will \nbe described. Strategies to avoid pitfalls in diagnostic imaging of the bile duct and \nthe pancreatic duct system will be illustrated, considering the possible source of \npitfalls. Diagnostic imaging findings of different diseases involving the biliary ducts \nand pancreatic duct system will be illustrated, as well as the diagnostic imaging \ncriteria useful for the differential diagnosis.\nLearning Objectives:\n1.  To understand the MRI technique for evaluating the pancreatic parenchyma, \nthe pancreatic duct system and the biliary tree, the functional assessment \nfollowing secretin stimulation.\n2.  To appreciate the signs in MR imaging of the pancreas and bile ducts.\n3.  To understand the diagnostic imaging criteria useful for differential diagnosis.\nA-106 08:34\nHow should CT be optimised? \nW.A. Kalender; Erlangen/DE (willi.kalender@imp.uni‑erlangen.de) \nIn general, optimisation aims at maximising the benefit of a procedure while at the \nsame time minimising potential risks or side effects. In paediatric radiology, this \nmeans that dose should be kept to the minimum necessary for adequate image \nquality. The aim of this lecture is to focus on dose issues and at options for reducing \npatient‘s dose without impairing image quality. Dose levels today are typically quoted \nat 1 to 15 mSv as effective dose per CT scan and will depend on the examination \nand on the anatomic range examined. The underlying dosimetry issues will be \ndiscussed briefly. Modern CT scanners offer a variety of means for reducing dose \nwithout a detriment in image quality. The availability of voltage values below the \nstandard 120 kV setting is one of the most important steps. Model-based iterative \nimage reconstruction, dedicated filtration, tube current modulation and automated \nexposure control are further examples which will be discussed. These measures \nhave to be complemented by proper assessment of dose and by providing the re-\nspective information to the user on the console. Respective tools will be presented. \nThe current trend is to bring doses in paediatric CT down to the sub-mSv range \nand thereby to increase the benefit-to-risk ratio further. „As high as reasonably \nachievable“ or AHARA is the goal regarding this ratio.\nLearning Objectives:\n1.  To become familiar with the dose levels currently encountered in paediatric \nCT.\n2.  To become familiar with new developments towards dose reduction in CT.\n3.  To learn about tools for assessing organ dose and effective dose values.\nAuthor Disclosure:\nW. A. Kalender: CEO; CT Imaging GmbH, Erlangen, DE. Consultant; Siemens \nHealthcare, Erlangen, DE. Founder; CT Imaging GmbH, Erlangen, DE. \nOwner; CT Imaging GmbH, Erlangen, DE. Research/Grant Support; Siemens \nHealthcare, Erlangen, DE; CT Imaging GmbH, Erlangen, DE. \nA-107 08:56\nWhen, how, and why I perform CT \nC. Owens; London/UK (owensc@gosh.nhs.uk) \nThis presentation will help the atendee to understand how CT must be used with \ncaution in children, and appropriate justification will be discussed in detail. We will \ngive recommendations for appropriate use of in children, with examples of weight-\nbased protocols, used in house, for paediatric body imaging. Various tips and tricks \nfor enhancing images with different acquistion tecniques and post-processing will \nbe shown using cardiothoracic models, Relative strengths and weaknesses of the \nvarious modes of CT acquisition which can be prescribed by the attending radiolo-\ngist will be discussed, and analysed.\nLearning Objectives:\n1.  To become familiar with the concept of CT ‘fit for purpose’.\n2.  To appreciate the role of CT in paediatric body imaging.\n3.  To become familiar with suggested parameters for use of CT in cardiothoracic \nimaging, describing risks and benefits.\nA-108 09:18\nWhy and when CT does not need to be performed \nM. Claudon; Vandoeuvre‑les‑Nancy/FR (m.claudon@chu‑nancy.fr) \nWhile CT examination provides major clinical information in many cases, two other \nmodalities which do not entail ionising radiation exposure have to be considered \nas appropriate methods and/or substitutes to CT in children and adolescents, in \nrespect to an ALARA approach. Ultrasound (US) is a well assessed, low-cost and \nnon-invasive modality, widely used for a large spectrum of diseases. It has to be \nconsidered as the first imaging modality in the emergency room and intensive care \nunit (ICU). New applications also include chest US, musculoskeletal US and flow \nimaging. Recent advances allow encompassing previous technical limitations, \nincluding high-frequency probes, fast imaging, elastography and volume imag-\ning. Contrast-enhanced sonography is still waiting for approval in the paediatric \npopulation. Paediatric US requires appropriate experience and sufficient alloca-\ntion of technical and human resources to ensure high-quality performance. MRI \noffers another interesting alternative to CT. High-resolution images with various \nspontaneous contrast patterns are useful for morphological evaluation, and in \nsome cases for characterisation of lesions. However, long exam times, sedation, \nmotion artefacts, and cost are barriers to expand the use of MRI. This may be \npartly reduced by technical improvements, such as high-field systems, accelera-\ntion and navigation processes. The place of US and MRI in diagnostic strategies \nwill be discussed in abdominal imaging, including in emergency and ICU, renal \n29\n\nPostgraduate Educational Programme\nS3\n C B D E F\n G\nA\nAuthor Disclosure:\nJ. Macho: Consultant; STRYKER, eV3. \nA-113 10:55\nInterlude: Spanish radiologists: open to the world \nE. Fraile Moreno; Madrid/ES (eduardo.fraile@salud.madrid.org) \nFounded on February 11, 1917, SERAM, “Sociedad Española de Radiología \nMédica” is the Scientific Society that groups more than 4,700 members among \nSpanish radiologist. It is a professional scientific organization dedicated to promot-\ning education, research and development of all diagnostic and therapeutic aspects \nin relation to diagnostic images. As a society, the main challenges for us are to \npromote the education of radiologists and courses sponsored and run by SERAM \nare available for radiologists throughout all of their training. We also hold courses \nfor senior radiologists in specific areas of interest such as oncology, molecular \nimaging or vascular diseases. SERAM also provides grants to attend different \nmeetings like the ECR in Vienna or RSNA in Chicago and grants in research in \ncollaboration with different companies involved in radiology. Another of SERAM’s \ncontributions include promoting the sharing of knowledge creating and releasing \ndifferent types of publication. Our official journal is called “Radiologia.” it is the only \nSpanish radiological publication in PubMed, and is also included in the GORAD \nportal of radiology magazines. The english version is also available online on our \nwebsite www.seram.es. Other contribution that SERAM makes are available on \nour website is the virtual library. In 2009, with the support of SERAM, the book \n“Radiologia Esencial” was published. Establishing standards and references is \nanother of SERAM’s contributions, since the year 2000, we have published the \nreference book of current procedural terminology.\nA-114 11:00\nAortic aneurisms \nJ.J. Martínez Rodrigo; Valencia/ES (martinez.jjo@gmail.com) \nAortic aneurisms are a potentially devasting condition if misdiagnosed or not \nearly detected and corrected. Aortic aneurism rupture prevention with a proper \nimaging follow-up and treatment indication are essential to provide a standard of \ncare to these patients. Screening programs among elderly and risk patients have \nbeen addressed to detect patients with aortic aneurysms amenable to follow -up \nor treatment. Multidisciplinary teams focused on early detection and treatments of \nthese pathologies have improved the outcomes of this disease. We will describe \nstrategies to develop a multidisciplinary approach to early detection and diagnosis \nof aortic aneurisms and will describe our experience. Stent graft devices allowed \ninterventional radiologists and other specialists a less-invasive approach to treat \naortic patients but new challenges derived from this new treatment related to en-\ndovascular treatment complications. The simple bifurcated technique has evolved \nto treat complex abdominal and thoracic aneurisms by means of fenestrated grafts \nand branched devices. The totally percutaneous approach with the new low-profile \ndevices and percutaneous suture techniques is a fact. Imaging again is the leading \ntool allowing us to improve outcomes. We will discuss imaging role in increasing \nsecurity in performing and guiding these interventions especially in 3D guiding \nimaging. Radiologists play also a major role in the follow-up of stent grafts to de-\ntect endoleaks and other complications. Finding the right approach to solve these \nproblems is mainly dependant on imaging techniques that provide interventional \nradiologists the tools to plan the adequate treatment strategies.\nLearning Objectives:\n1.  To understand the role of imaging modalities in diagnosis and endovascular \ntreatment of aortic aneurisms.\n2.  To learn about the role of 3D  imaging techniques to assist the endovascular \ntreatment of aortic aneurisms.\n3.  To appreciate the role of imaging modalities in evaluating the complications \nof endovascular aortic repair.\nA-115 11:20\nInterlude: Radiologists and Spanish wines \nL. Martí-Bonmatí; Valencia/ES (marti_lui@gva.es) \nWhy are wines different? Which is the influence of the country, the climate and \nthe situation. Why is the soil (and by extension terroir) so important? A wine from \na particular patch of ground expresses characteristics related to the physical en-\nvironment in which the grapes are grown. A combination of certain vineyard sites \nand grape varieties creates unique wines that faithfully express their geographical \norigins. But, how do soils affect wine quality? Is it a direct or indirect relationship? \nWhat are the scientific explanations for terroir effects? How many soils are present \nin wine-producing regions? The miracle of the plant kingdom is that these complex \n10:30 - 12:00 Room B \nESR meets Spain \nEM 1 \nImaging: essential tool from diagnosis to treatment \nWelcome by the ESR President: \nG.P. Krestin; Rotterdam/NL \nPresiding: \nC. Ayuso; Barcelona/ES \nJ.I. Bilbao; Pamplona/ES \nA-111 10:30\nIntroduction \nC. Ayuso; Barcelona/ES (cayuso@clinic.ub.es) \nRadiology had been continuously improving since x-rays were discovered by C. \nRoentgen in 1895, until nowadays. The technological developments had been \ndramatically followed and new tools and complex procedures guided by means \nof imaging techniques had been developed. These facts had been crucial for \nthe clinical approach of Radiology in the recent decades. The organ-system \norganization of Radiology conducted us to focus in more specific scenarios, al-\nlowing us to acquire deep knowledge on specific fields. Knowledge on Radiology \nis based on evidence nowadays. This has been the basis of the tremendous \nimpact of including Radiology in the task of multidisciplinary teams where radi-\nologists have an interesting role in the decision making process. The session \nwill include three particular scenarios where radiologists have a crucial role from \nthe diagnosis of the disease, to the treatment and the follow -up of the patients. \nSession Objectives:\n1.  To discuss the role of imaging techniques in different clinical scenarios where \nradiologists are key, from diagnosis to treatment.\n2.  To present technical imaging innovations that assist the diagnosis, treatment \nand follow -up in three different clinical scenarios: ischaemic stroke, aortic \naneurism and hepatocellular carcinoma.\n3.  To present specific clinical advantages and results of the multimodality ap-\nproach.\nA-112 10:35\nIschaemic stroke \nJ. Macho; Barcelona/ES (jmmacho@clinic.ub.es) \nInterventional neuroradiology (INR) has become an essential tool during the last \ndecades in the management of hemorrhagic stroke as well as in the diagnosis and \ntreatment of the different vascular lesions that may lead to them (aneurysms, AVM’s, \nDural Fistulas, etc). However, the role of INR in the treatment and prevention of \nischemic stroke has been controversial, with carotid stenting, intracranial stenting \nand intraarterial techniques in acute stroke, being frequently under debate. Lately, \nnew devices and technology specifically designed for intracranial thrombectomy in \nacute stroke have shown their effectiveness in revascularization with better reper-\nfusion rates than those achieved with intravenous lytics or previous thrombectomy \ndevices. However, these good revascularization rates were not always correlated \nwith good clinical outcomes. Advanced multimodal imaging techniques have been \nadvocated as essential in the decision-making algorithm in order to achieve better \nlong-term clinical outcomes. Morphological (angioMR - angioCT) and especially \nperfusion imaging techniques (perfusion computed tomography and diffusion and \nperfusion weighted magnetic resonance) have proved to be effective in the identi-\nfication of cerebral penumbra in acute stroke and thus in the selection of patients \nfor thrombolytic therapy, being both techniques equivalent in this task. Multidis-\nciplinar stroke teams in which diagnostic and therapeutic neuroradiology plays a \nsignificant role are achieving excellent rates of clinical recovery in this otherwise \ndevastating disease. We will show algorithm protocols and stroke unit designs \nspecifically addressed to improve clinical outcomes in those patients selected for \nIntraarterial treatment and with the aim to increase the number of patients eligible \nfor revascularization. \nLearning Objectives:\n1.  To discuss the clinical and neuroradiologic implications of an early diagnosis. \nEvaluation of CT and MR diffusion/perfusion in patient selection for endoarterial \ntreatment.\n2.  To understand the rationale behind mechanical endoarterial reperfusion of \nacute vascular occlusion.\n3.  To analyse the short and medium term results of a regional programme for \nacute stroke treatment after three years.\n0\n\nPostgraduate Educational Programme\nS3\nB\n C D E F G\nA\nFriday\nor Dynamic Contrast Enhanced Magnetic Resonance Imaging (DCE-MRI) can be \nhelpful in this setting. The presentation aims to familiarize general radiologists, who \nhave an interest in head and neck imaging, with common pitfalls encountered on \nCT and MR studies focussing on the neck. Both the pre-therapeutic, as well as \nthe post-treatment setting, will be discussed using examples from daily practice.\nLearning Objectives:\n1.  To understand the variations of normal anatomy in the neck that should not \nbe interpreted as abnormal.\n2.  To become familiar with the incidental findings that are frequently encountered \nwhen searching for neck disease.\n3.  To recognise suboptimal neck studies, or technique related problems and \nunderstand how these may influence interpretation.\nA-118 11:15\nB. Pitfalls in maxillofacial and skull base imaging \nR. Hermans; Leuven/BE (Robert.Hermans@uzleuven.be) \nImaging of the skull base and maxillofacial skeleton requires a meticulous imag-\ning technique and a good knowledge of normal anatomy and possible anatomical \nvariants. Asymmetry in the pneumatisation of the paranasal sinuses, skull base or \ntemporal bone is a common reason for misinterpretation. For example, hypoplasia \nof the maxillary sinus may be misinterpreted on conventional radiography as maxil-\nlary sinusitis or an orbital blow out fracture, depending on the context; asymmetric \npneumatisation of the petrous apex or mastoid bone may mimick, respectively, \na cholesterol granuloma and fluid effusion in the non-pneumatised side on MRI. \nVascular variants may also cause interpretation problems. For example, turbulent \nflow in a large jugular bulb may mimick a jugular foramen tumour on MRI. Variants in \nthe vascular plexus surrounding the facial nerve or branches of the trigeminal nerve \nmay occur, and cause asymmetric findings on MRI, possibly mimicking neuritis or \nperineural tumour spread. Incomplete maturation or arrested development of skull \nbase structures may also cause confusion. Examples are the cochlear cleft, not be \nconfused with otosclerosis, or arrested pneumatisation of the sphenoid sinus, pos-\nsibly mimicking a tumoural lesion in the central skull base. To avoid problems, one \nshould keep in mind the existence of such variants, while correlating the imaging \nfindings with the clinical problem; in some cases, an additional imaging study may \nbe needed to exclude a pathological process more confidently. \nLearning Objectives:\n1.  To understand the basic requirements for an optimal imaging study of the skull \nbase and maxillofacial region.\n2.  To become familiar with anatomical variants, potentially mimicking disease.\n3.  To learn to appreciate incidental findings, avoiding unnecessary concern while \nrecognising relevant pathology.\n10:30 - 12:00 Room E2 \nFoundation Course: Neuroimaging \nE³ 520c \nPaediatric \nModerator: \nD. Prayer; Vienna/AT \nA-119 10:30\nA. Neonatal hypoxic-ischaemic brain injury \nM.I. Argyropoulou; Ioannina/GR (margyrop@cc.uoi.gr) \nThe pattern of neonatal brain lesions associated with hypoxia-ischaemia depends on \nthe severity of the event and gestational age at birth. The immature brain of preterm \nbabies reacts to hypoxia-ischaemia differently than the brain of full-term babies. \nImaging plays an important role in the diagnostic work up of these patients, with \nbrain ultrasound being the first line examination performed at bedside, followed by \nbrain Magnetic Resonance Imaging. Germinal Matrix Haemorrhage appearing as \nan ovoid lesion anterior to the caudothalamic groove, Intraventricular Haemorrhage, \nParenchymal Venous Haemorrhagic Infarction appearing as a paraventricular fron-\ntoparietal triangular lesion pointing towards the lateral ventricle, Post-haemorrhagic \nHydrocephalus, Periventricular Leukomalacia with a focal necrotic form (fPVL) \nappearing with multiple coalescent periventricular cysts, irregular outlines of the \nlateral ventricles and white matter loss and a diffuse form (dPVL) appearing with \nregular outlines of the lateral ventricles and white matter loss represent the spec-\ntrum of lesions responsible for the encephalopathy of prematurity. Parasagittal \nWatershed Infarcts affecting the cortex and the subcortical white matter, Diffuse \nlesions of Macrocystic Encephalomalacia, due to partial prolonged asphyxia (1-3 \norganisms build themselves from virtually nothing: all a plant needs to grow is some \nwater, sunlight, air and a mix of trace elements and nutrients. Many viticultural \ninterventions aim at encouraging the vine to partition nutrients to the grapes so that \nthey ripen properly, rather than concentrating on growing more leaves and stems. \nSpain is a peninsula with so many different rivers, mountains, seas and climates. \nEven more, the soil composition of vineyards, one of the most important viticultural \nconsiderations when planting grape vines, is so different that a clear explanation \nhas to be done. This will be the focus of this interlude.\nLearning Objectives:\n1.  To understand the influence of the country, the climate and the situation in the \nquality of wines.\n2.  To learn about Spain’s characteristics that influence the wine quality.\n3.  To appreciate why the soil (and by extension the terroir) is so important.\nA-116 11:25\nHepatocellular carcinoma: the BCLC approach \nM. Burrel; Barcelona/ES (marta_burrel@yahoo.com) \nHepatocellular carcinoma is recognised as one of the major cancer causes of death, \nits incidence has increased in several Western countries, and it is the leading cause \nof death in patients with cirrhosis. Screening allows detection at an early stage \nand there is a large range of therapeutic options to be considered while taking into \nconsideration tumour burden and liver function. Imaging techniques are a key tool \nfor clinical decision making in the evaluation of patients with liver tumours. The de-\nvelopment of ultrasound, computed tomography and magnetic resonance imaging \nhas allowed the detection and diagnosis of liver tumours at an asymptomatic stage, \nwhich has modified their diagnostic approach and treatment. Moreover, assessment \nof treatment efficacy and follow-up is done through imaging. Imaging techniques \nand radiologists executing them have also a major impact in a variety of image-\nguided therapeutic interventions. The capacity to identify the tumour site in real \ntime allows percutaneous tumour ablation; several cohort studies and randomised \ntrials have shown the value of ablation in patients with HCC at an early stage; cur-\nrently, radiofrequency ablation and ethanol injection are established therapies in \nconventional clinical practice. Transarterial chemoembolisation has also shown to \nbe effective in terms of burden reduction and has proved to positively affect patient \nsurvival in patients with multinodular HCC confined to the liver.\nLearning Objectives:\n1.  To understand the clinical implications of an early diagnosis, when the lesion \nis small and asymptomatic.\n2.  To learn about the rationale behind the current guidelines for model treatment \noptions.\n3.  To appreciate the spectrum of locoregional therapies for HCC from percutane-\nous to intravascular approaches.\nPanel discussion: \nIs the multidisciplinary environment the natural way to develop \nexcellence and leadership in clinical imaging? 11:45 \n10:30 - 12:00 Room C \nInteractive Teaching Sessions \nE³ 520b \nPitfalls in head and neck imaging \nA-117 10:30\nA. Pitfalls in neck imaging \nF.A. Pameijer; Utrecht/NL (f.a.pameijer@umcutrecht.nl) \nPitfall: „a hidden or unexpected danger or difficulty“. Imaging methods can provide \nan extraordinary amount of useful data to specialists treating head and neck (can-\ncer) patients. It is crucial that these data are used to full advantage of individual \npatients. The most important factor in this process is mutual cooperation between \nthe physicians in charge of patient care and the diagnostic imaging specialist. Pitfalls \nin the head and neck may present in various ways: normal variants may look like \ndisease, incidental findings are frequently encountered, suboptimal technique may \nobscure important findings. Moreover, many pitfalls are directly related to techni-\ncal errors. In this potential ‚minefield‘, the post-treatment patient presents a major \nchallenge to the imaging specialist. Ablative surgery usually results in distortion of \nthe anatomy, especially when combined with flap reconstruction. When adequate \npreoperative and/or baseline postoperative imaging is lacking, determination of \nrecurrence on a single postoperative examination may well be impossible. PET \nCT (MR) and advanced MR-techniques; e.g. Diffusion Weighted Imaging (DWI) \n1\n\nPostgraduate Educational Programme\nS3\n C B D E F\n G\nA\n10:30 - 12:00 Room I/K \nJoint Course of ESR and RSNA (Radiological Society of North \nAmerica) \nMC 528 \nEssentials in oncologic imaging: what radiologists \nneed to know (part 2) \nModerator: \nH. Hricak; New York, NY/US \nA-122 10:30\nA. Pancreatic cancer \nF. Caseiro-Alves; Coimbra/PT (caseiroalves@gmail.com) \nDespite advances in cross-sectional techniques, imaging has still difficulties on as-\nsessing pancreatic tumours and in particular adenocarcinoma. The main problems \nremain the early detection of small tumours and the clearcut definition of patients \nthat are amenable to curative surgery. After reviewing current concepts in the \nclassification of pancreatic tumours including the role of molecular biomarkers, the \nlecture will address the strategies that may be used to maximize tumour conspicuity \nin a multi-modality perspective that also encompasses uprising techniques, such \nas dual energy CT, perfusion CT/MR and diffusion-weighted MRI. The concept of \nborderline resectable pancreatic cancer will be explained as well as the key points \nfor image interpretation in the setting of clinical decisions for patient management. \nIn addition, the current role of adjuvant or neoadjuvant therapy will be shortly ad-\ndressed especially concerning its imaging implications, as well as the new concepts \non pancreatic adenocarcinoma oncogenesis and possible imaging strategies that \nmay be used for earlier detection.\nLearning Objectives:\n1.  To understand current pathologic concepts for the classification of pancreatic \ntumours.\n2.  To learn about imaging findings used for tumour detection, staging, and restag-\ning after adjuvant therapy.\n3.  To understand the role of functional and molecular information provided by \nPET/CT, DWI and perfusion imaging when assessing pancreatic tumours.\nA-123 10:55\nB. Kidney cancer \nE.K. Fishman; Baltimore, MD/US (efishman@jhmi.edu) \nCarcinoma of the kidney is responsible for over 100,000 deaths worldwide each \nyear. With advances in radiologic imaging up to two-thirds of renal cancers are \npicked up as serendipitous findings. Despite multiple advances in imaging chal-\nlenges in lesion classification remain and may result in up to one fourth of lesions \nunder 3 cm being resected being benign lesions. In this presentation we will focus \non the role of CT in the detection, staging and management of the patient with \nrenal cell carcinoma discussing both renal cell carcinoma (clear cell and papillary) \nand transitional cell carcinoma. The importance of proper protocol design, the use \nof multiphase acquisition and the value of 3D mapping will be discussed. The role \nof CT in staging tumours and its role in surgical planning will also be addressed. \nNew understanding of how CT findings on arterial phase imaging closely correlate \nwith the genetic findings is also addressed. The pitfalls in lesion detection and \nclassification are also addressed and case examples of some of the pitfalls are \nprovided. Protocols for the use of imaging as well as the use of dose reduction \ntechniques including iterative reconstruction are addressed. \nLearning Objectives:\n1.  To understand the diagnostic implications of minimally invasive treatments of \nrenal cancer.\n2.  To review the genetic causes of renal cancer and the radiologic appearances \nof specific histologic subtypes.\n3.  To review the potential role of molecular imaging in the management of ad-\nvanced renal cancer.\nAuthor Disclosure:\nE. K. Fishman: Advisory Board; GE, Siemens. Board Member; HipGraphics Inc. \nFounder; HipGraphics Inc. Research/Grant Support; GE, Siemens. \nh) and Lesions of the basal ganglia, the perirolandic cortex and the brain stem \ndue to acute total asphyxia (10-15 min) comprise the spectrum of lesions following \nhypoxia ischaemia in the full-term baby. Stroke is an important cause of mortality \nand morbidity in the neonatal period. Neonatal stroke is less common than adult \nstroke but more common than that in childhood and the carotid artery territory is \nmost commonly affected.\nLearning Objectives:\n1.  To understand gestational age-related patterns of brain injury.\n2.  To understand the role of ultrasound and MRI for the initial diagnosis and \nfollow-up of these patients.\n3.  To understand when and how to use advanced MRI techniques for delineation \nof lesions and for prognosis.\nA-120 11:00\nB. Spine and spinal cord malformations \nA. Rossi; Genoa/IT (andrearossi@ospedale‑gaslini.ge.it) \nSpinal and spinal cord malformations are collectively named spinal dysraphisms. \nThey arise from defects occurring in the early embryological stages of gastrulation \n(weeks 2-3), primary neurulation (weeks 3-4), and secondary neurulation (weeks \n5-6). They are categorized into open spinal dysraphisms, in which there is exposure \nof abnormal nervous tissues through a skin defect, and closed spinal dysraphisms, \nin which there is a continuous skin coverage to the underlying malformation. Open \nspinal dysraphisms basically include myelomeningocele and other rare abnormali-\nties such as myelocele and hemimyelo (meningo)cele. Closed spinal dysraphisms \nare further categorized based on the association with low-back subcutaneous \nmasses. Closed spinal dysraphisms with mass are represented by lipomyelocele, \nlipomyelomeningocele, meningocele, and myelocystocele. Closed spinal dys-\nraphisms without mass comprise simple dysraphic states (tight filum terminale, \nfilar and intradural lipomas, persistent terminal ventricle, and dermal sinuses) and \ncomplex dysraphic states. The latter category further comprises defects of midline \nnotochordal integration (basically represented by diastematomyelia) and defects \nof segmental notochordal formation (represented by caudal agenesis and spinal \nsegmental dysgenesis). Magnetic resonance imaging is the preferred modality for \nimaging these complex abnormalities. The use of the aforementioned classification \nscheme is greatly helpful to make the diagnosis. \nLearning Objectives:\n1.  To understand the embryology underlying the different categories of malforma-\ntions.\n2.  To learn the key morphological features.\n3.  To learn how to use a simplified diagnostic imaging approach.\nA-121 11:30\nC. Imaging of the foetal brain \nC. Garel; Paris/FR (catherine.garel@trs.aphp.fr) \nThe foetal brain undergoes changes throughout pregnancy according to a specific \ntiming. Hence, the changing appearance of the cerebral parenchyma over time, \nthe development of the different sulci and the structures of the posterior fossa \nmust be well known in order to provide an accurate analysis of the fetal brain. \nUltrasonography (US) is the imaging modality of choice for routine evaluation of \nthe fetal brain. In favourable conditions, it enables detection of most cerebral abnor-\nmalities. The acquisition of images in the three planes of the space is mandatory. \nWhen available, the use of high-frequency probes enhances spatial resolution and \nmay provide important details regarding brain anatomy. The different structures of \nthe brain must be systematically analysed. Magnetic Resonance Imaging (MRI) \nprovides excellent images whatever the foetal position and the thickness of the \nmaternal wall but may be hampered by foetal motion. It is important to be aware of \nthe contribution of the different sequences. The contrast resolution is better with MRI \nthan with US. Imaging findings of the most common cerebral abnormalities will be \ndisplayed with emphasis on respective contribution, limitations and indications for \nboth imaging modalities. For instance, certain lesions, such as focal parenchymal \ncalicifications, may be overlooked by MRI. Conversely, other lesions such as focal \nhaemorrhage or subependymal tubers may be missed by US. Awareness of these \nlimitations is of utmost importance.\nLearning Objectives:\n1.  To become familiar with the normal appearance of the developing brain.\n2.  To learn about the protocols and the limitations of foetal imaging.\n3.  To gain knowledge about the imaging findings of the most common brain \nabnormalities.\n2\n\nPostgraduate Educational Programme\nS3\nB\n C D E F G\nA\nFriday\nLearning Objectives:\n1.  To understand the basic pathophysiology of degenerative processes in pe-\nripheral joints and in the spine.\n2.  To become familiar with typical imaging findings of osteoarthritis and degenera-\ntive changes in the spine.\n3.  To learn about the differential diagnosis of degenerative disorders.\n12:30 - 13:30 Room Q \nThe Beauty of Basic Knowledge: Head and Neck \nMC 24B \nThe infrahyoid neck and lymph nodes \nA-126 12:30\nThe infrahyoid neck and lymph nodes \nM.G. Mack; Munich/DE (m.mack@radiologie‑muenchen.de) \nThe CT and MRI analysis of the anatomic compartments of the infrahyoid neck, and \nthe signal intensity or the density of the different lesions correlated to the clinical \nhistory enable a precise assessment of the neck masses with a high degree of \naccuracy. The infrahyoid neck can be divided into a posterior or nuchal region and \nan anterior or cervical region. The nuchal region is composed primarily of muscular \nstructures, but also of fat tissue and bone. The anterior region is almost entirely \noccupied by glands, nerves, muscles and vessels (arterial, venous and lymphatic) \nand can be further divided in one median and two lateral areas. The infrahyoid \ncompartment is containing trachea, larynx, oesophagus, thyroid and parathyroid \nglands. Nodal classification is essential to accurately discuss the location of cervical \nnodes. About 300 of the 800 lymph nodes in the body are located in the head and \nneck. A simplified level nomenclature is used since 1984 cervical lymph nodes in \nseven levels. Lymphnode size is one of the most frequently used criteria for dis-\ncrimination of metastatic lymph nodes from benign reactive nodes. Furthermore, \nthe shape of the node, abnormality of internal architecture, including necrosis, and \nextracapsular tumour spread have been demonstrated as additional morphologi-\ncal criteria which lead to a diagnostic In the childhood, tumours and tumour-like \nlesions of the neck are rare and they tend to be benign. However, most of the soft \ntissue neck masses in the adult over the age of 40 are metastatic nodal lesions.\nLearning Objectives:\n1.  To become familiar with the different anatomic compartments of the infrahyoid \nneck.\n2.  To understand lymph node classification and level system.\n3.  To learn about the best imaging approach to an IHN mass.\n4.  To be able to localise and provide a useful differential diagnosis.\n12:45 - 13:15 Room A \nPlenary Session \nHL 1 \nJosef Lissner Honorary Lecture\nPresiding: \nJ.I. Bilbao; Pamplona/ES \nA-127 12:45\nMR guided focused ultrasound: a new string to the radiologist’s bow \nC. Catalano; Rome/IT (Carlo.Catalano@uniroma1.it) \nIn the recent past, minimally invasive therapies have greatly benefited of the continu-\nous developments of imaging modalities. In fact, it has become feasible to perform \nminimally invasive therapies with high precision in the routine clinical practice under \nimaging guidance. MR-guided Focused Ultrasound is a new non-invasive method \nof treatment that allows, under continuous MR guidance, precise thermal ablation. \nMRI is used for target definition, planning of treatment and continuous control of \nthermal effect at the target and in the surrounding tissues. High-intensity focused \nultrasound is an efficacious means of extracorporeal thermal ablation. For guid-\nance and monitoring, MRI provides several advantages over any other imaging \nmodality; in fact, it allows to identify the target, it defines excellent three-dimensional \nplanning, and with MR thermometry, it provides continuous thermal mapping at \nthe target and the surrounding tissues. MR-guided Focused Ultrasound has been \napproved for uterine fibroids treatment and bone metastasis palliation; several are \nthe ongoing clinical trials in breast, liver, pancreas, prostate, brain tumours and in \nA-124 11:20\nC. Ovarian cancer \nH. Hricak; New York, NY/US \nIn the developed world, ovarian cancer continues to have the highest mortality \nrate among gynaecologic cancers. At diagnosis, more than 62% of patients have \nadvanced disease. The mainstay of treatment is comprehensive staging laparotomy \n(including transabdominal hysterectomy, bilateral salpingo-oophorectomy, omentec-\ntomy, retroperitoneal lymph node sampling, peritoneal and diaphragmatic biopsies \nand cytology of peritoneal washings), usually followed by adjuvant chemotherapy. \nPatients with advanced non-resectable disease benefit from neoadjuvant (preop-\nerative) chemotherapy. This lecture will review the key imaging findings in the \nmanagement of ovarian cancer and will briefly consider how advances in molecular \nimaging may improve outcomes in the future. In ovarian cancer management, \ncross-sectional imaging is essential in (1) tumour characterisation; (2) treatment \nselection and planning (identifying difficult-to-reach tumour deposits or inoperable \ndisease for which neoadjuvant chemotherapy is indicated); (3) monitoring treat-\nment response; (4) detecting recurrent disease. Ultrasound is the primary modality \nfor detecting and characterising adnexal masses. MRI is used for characterising \nsonographically indeterminate lesions. CT is the modality of choice for preopera-\ntive staging. FDG-PET-CT is valuable for detecting recurrent disease, particularly \nin the mesentery, bowel serosa and normal-sized lymph nodes. In recurrent dis-\nease, tumour size and standardised uptake values are also powerful prognostic \nbiomarkers. The development of sensitive molecular imaging (MI) biomarkers could \nimprove ovarian cancer management by allowing detection of the disease before \nsymptoms arise and, in high risk patients, enabling repeat MI to substitute for \npreventative oophorectomy. In treatment selection and response assessment, MI \nmay provide more powerful predictive biomarkers. Intraoperative MI may facilitate \nmore complete tumour resection. \nLearning Objectives:\n1.  To get an overview of the essential imaging findings in characterisation and \nstaging of ovarian cancer.\n2.  To learn the key imaging findings that affect management of ovarian cancer.\n3.  To understand the changes in imaging armamentarium in ovarian cancer, and \nlearn the best practice in proper image utilisation.\nQuestions 11:50 \n12:30 - 13:30 Room P \nThe Beauty of Basic Knowledge: Musculoskeletal Imaging \nMC 25B \nDegenerative disorders \nA-125 12:30\nDegenerative disorders \nT.M. Link; San Francisco, CA/US (tmlink@radiology.ucsf.edu) \nDegenerative disease is related to abnormal loading and/or tissue-related deficien-\ncies. Chronic and acute trauma, excessive physical activity and obesity are among \nthe conditions that promote degenerative disease. In addition, dysplastic morphol-\nogy, inflammatory and metabolic disorders may eventually lead to degeneration. \nWhile cartilage and intervertebral disc are the target tissues, it should be noted \nthat multiple structures are involved in the degenerative process. This includes the \nadjacent bone and bone marrow, ligaments, menisci and labrum. While standard \nradiographs have been the standard technique to diagnose and score osteoarthritis \nfor many years, MR imaging has an increasing role in identifying early degenerative \nchanges and determining the disease burden. Using molecular imaging techniques \nsuch as T1rho and T2 relaxation time measurements, the biochemical abnormalities \nof the cartilage and disc can be detected before macro-morphological damage. \nSubsequently, focal and diffuse defects of cartilage are shown with adjacent bone \nmarrow abnormalities, such as subchondral cysts and bone marrow edema pattern. \nMucoid degeneration with swelling and tears of ligaments are typical findings, so \nare degenerative meniscal and labral tissue transformation with signal abnormali-\nties and tears. The typical radiographic findings include joint space narrowing and \nosteophytes. Frequently, secondary degenerative disease is observed related to \nconditions such as previous infection, inflammatory arthropathies, trauma and \nmetabolic disorders, which lead to deformity of the joint with altered biomechani-\ncal loading. Underlying conditions and differential diagnoses of degenerative joint \ndisease were need to be correctly identified. Sometimes differentiation between \ndegenerative and inflammatory joint disorders can be challenging. \n3\n\nPostgraduate Educational Programme\nS3\n C B D E F\n G\nA\nA-130 14:50\nDiscussion \nF. Sardanelli1, N. Houssami2; 1Milan/IT, 2Sydney/AU \nThe discussion will address the following issues:\n1.  How come there are divergent views on the evidence from randomised con-\ntrolled trials?\n2.  Is the device for MR-guided procedures absolutely necessary?\n3.  How to manage additional findings?\n4.  How to reduce false positives?\n5.  How to reduce overtreatment?\n6.  How to translate MRI information from radiology to the operating theatre? \n14:00 - 15:30 Room E2 \nFoundation Course: Neuroimaging \nE³ 620 \nTrauma and vascularity \nModerator: \nA. Molyneux; Oxford/UK \nA-131 14:00\nA. CNS trauma \nP.M. Parizel, C. Venstermans, F. De Belder, T. Van der Zijden, \nL. van den Hauwe, M. Voormolen, J. Van Goethem; Antwerp/BE \n(paul.parizel@ua.ac.be) \nNeuroimaging techniques constitute an essential part of the diagnostic work-up \nof patients with traumatic brain injury (TBI). In the acute setting, imaging findings \ndetermine patient management and influence clinical course. CT remains the first \nchoice technique to determine the presence and extent of injury, and to guide \nsurgical planning. Multi-detector CT allows simultaneous assessment of head and \ncervical spine, obviating the need for plain radiographs. From a clinical point of \nview, it is important to understand the difference between primary and secondary \nTBI. Primary injuries occur as a direct result of the impact with damage to brain \ntissue. Examples include fractures, different types of traumatic haemorrhage (epi-\ndural, subdural, intracerebral, subarachnoid), cerebral contusion, diffuse axonal \ninjury (DAI). CT-angiography is useful to document traumatic blood vessel injury. \nWhenever there is a discrepancy between the patient‘s clinical status and imag-\ning findings, MRI is indicated. Secondary injuries are caused by systemic factors \nsuch as increased intracranial pressure, oedema, brain herniation, decreased \ncerebral blood flow, excitotoxic damage. These lesions can be documented with \nmultiparametric MRI including diffusion, perfusion, and susceptibility weighted \nimaging. Diffusion tensor imaging with fractional anisotropy mapping may show \nmicrostructural abnormalities in patients with mild TBI, even when traditional MRI \nsequences appear normal. Neuroimaging also plays a role in the chronic stage \nof TBI, identifying sequelae, determining prognosis, and guiding rehabilitation. In \nconclusion, advances in neuroimaging improve our understanding of the patho-\nphysiology of craniocerebral trauma and allow us to detect abnormalities, even in \npatients with mild TBI, when routine imaging studies appear normal.\nLearning Objectives:\n1.  To become familiar with the different types of intracranial injury and the ap-\npropriate imaging patterns.\n2.  To learn about the imaging characteristics of intracranial haemorrhage by CT \nand MR.\n3.  To be able to recognise imaging findings that are critical for the patient’s \nprognosis.\nA-132 14:30\nB. Cerebral ischaemia and infarction \nL. Pierot; Reims/FR (lpierot@gmail.com) \nIschaemic stroke is a diagnostic and therapeutic emergency. The diagnostic has \nto be established as rapidly as possible in order to be able to offer to the patient \nthe best therapeutic approach. At the acute phase of stroke, the diagnostic is \nusually based on CT or MRI. CT will eliminate any haemorrhagic stroke, but will \nbe normal in approximately 50% of cases. Precocious signs of ischaemia are \nsometimes visible including decreased density of lentiform nuclei, loss of gray-white \nmatter interfaces, sulcal effacement, and hyperattenuating artery (indicating acute \nthrombus). CTA will show the occluded artery. MRI has an increased sensitivity \ncompared with CT. At the hyperacute stage, diffusion will show hyperintensity in the \nother benign tumours and neurologic functional disorders. Furthermore, it appears \nto be an exceptional research tool, as it may temporarily modify cell membrane \npermeability and release or activate compounds for targeted drug delivery or gene \ntherapy. There is no doubt that MR-guided Focused Ultrasound represents a new \nextremely powerful tool with already well defined clinical fields of applications and \nenormous potentials of research.\nLearning Objectives:\n1.  To learn about the technical and physical principles of MR guided focused \nultrasound.\n2.  To understand the advantages of MR guidance.\n3.  To become familiar with the approved clinical applications and the ongoing \nclinical trials.\n4.  To learn the research activities and the possible future applications in the fields \nof drug delivery and gene therapy.\n14:00 - 15:30 Room D1 \nControversies in Breast Imaging\nMC 623 \nPreoperative MRI in newly diagnosed breast cancer: \nto do or not to do? \nModerator: \nF. Sardanelli; Milan/IT \nT easer: \nN. Houssami; Sydney/AU \nA-128 14:00\nA. Why we should do preoperative MRI \nW.A. Kaiser; Jena/DE (Werner.Kaiser@med.uni‑jena.de) \nMR-Mammography (MRM) has been used in clinical research and in routine \nsince 30 years now. It is now accepted that the sensitivity is extremely high for \ninvasive cancers in a size of more than 3 mm (between 95 and 100%) and - using \nimportant morphological and kinetic signs in combination - the specificity is also \nmuch higher than previously published (above 90%). The positive arguments to \nuse MR-Mammography preoperatively are the following: it is always important to \nknow the truth (multifocality, multicentricity, bilaterality of breast cancers); both \nlumpectomy+radiation as well as mastectomy are equally effective, but not able to \nstop the continuous drop in long-term survival curves. The aim should be perma-\nnent healing; knowing the precise staging is helpful for an exact surgical planning; \nknowing the precise staging is helpful for the inclusion or avoidance of radiation; \nknowing the precise staging is helpful for the avoidance of legal problems; the \nprevious publications about the use of preoperative MRI are controversial and \npartially misleading. \nA-129 14:25\nB. Reasons not to do preoperative MRI \nM.G. Wallis; Cambridge/UK (matthew.wallis@addenbrookes.nhs.uk) \nPre-operative MRI staging undoubtedly finds additional disease with retrospec-\ntive and prospective studies showing that this changes surgical practice. To date, \nthere is no good prospective evidence that this change in surgery affects patient \noutcome in terms of reduction in re operation rates or improved disease free or \noverall survival. In fact, the 2 prospective studies show no or detrimental effects on \ncare and there is evidence of increasing mastectomy rates. Conservation surgery \nplus radiotherapy was shown to be equivalent to mastectomy many years ago and \nsurgery plus modern adjuvant treatment is associated with increasing survival and \nvery low local surgical failure. Therefore, there are good reasons to suggest that \nthe majority of the additional disease picked up by MRI is biologically and clinically \nirrelevant and only serves to increase the surgical burden on our patients. I will con-\ntend that by merely demonstrating that our bigger/better (more expensive) kit finds \nmore disease in not enough. We the radiological research community and those \nthat fund our research have failed the profession, our patients and the community \nas a whole. We should be obliged to take the next step and demonstrate we can \nimprove our patient’s outcomes, both survival and well being, before introducing \nnew technology. Pre-operative MR staging is a classical example, after all if we had \ndone a proper trial 10 years ago we would be standing here demonstrating 5-year \ndisease free survival rather than entertaining you with an unanswerable debate.\n4\n\nPostgraduate Educational Programme\nS3\nB\n C D E F G\nA\nFriday\nexperience. The differential between cancer progression and complications of the \ntreatment might be very difficult and requires an adequate communication with the \nreferring clinician. Overall, most of the decisions taken by the clinician will be related \nto imaging results, stressing the importance of adequate protocols and reports.\nLearning Objectives:\n1.  To get an overview and precise explanation of current cancer-related terminol-\nogy, definitions and “buzz” words used in everyday practice.\n2.  To understand why and how this terminology should ensure and simplify \ncommunication with all specialists involved in cancer management, including \nclinicians, researchers as well as other radiologists.\n3.  To learn common tricks and traps in providing a radiology report, illustrated \nwith clinical cases.\nA-135 14:20\nB. Liver cancers (primary, metastases) \nR.L. Baron; Chicago, IL/US (rbaron@uchicago.edu) \nHepatocellular carcinoma (HCC) is the most common primary tumour with cholan-\ngiocarcinoma comprising 5-10% and only rare other primary tumours. HCC is \ncommonly associated with chronic liver with hepatitis or cirrhosis. Nodular and \nfibrotic changes inherent in cirrhosis both simulate and obscure tumours and \nparticular emphasis will be placed on characterising small nodular changes in cir-\nrhosis that are often diagnostic dilemmas. Contrast enhancement characteristics \nand MR signal intensity changes play a critical role in these evaluations resulting \nin nonbiopsy imaging criteria for HCC diagnosis as the standard of care for man-\nagement. Staging and treatment for HCC are based on lesion size and number \n(TNM staging system). False positive diagnoses in cirrhosis will be discussed. \nCholangiocarcinoma has a varied imaging appearance based on the underlying \nhistologic stroma (from glandular mucin producing to dense fibrous). The contrast \nenhancement characteristics that vary with the stroma is a key to detect and to \ncharacterise these lesions. There is no effective chemotherapy or interventional \ncure, and treatment options are limited to aggressive surgical approaches and the \nimaging assessment of extent of disease is critical in planning. Metastatic liver \ndisease most often has very nonspecific imaging features that preclude diagnosis \non imaging characteristics alone. Certain contrast enhancement characteristics, \nhowever, allow for characterisation and more importantly, assessment of response \nto treatment, particularly in vascular metastatic lesions such as GIST tumours. \nDetection of small lesions that can be critical for detection, characterisation and \nstaging can be optimised with MR liver-specific imaging agents and with diffusion-\nweighted imaging.\nLearning Objectives:\n1.  To get an overview of the AASLD/EASL imaging criteria for noninvasive diag-\nnosis of hepatocellular carcinoma.\n2.  To learn about best practice CT/MR/US imaging techniques that optimise \ncharacterisation, detection and staging of primary and metastatic liver tumours.\n3.  To understand the key role specific findings reported by radiologists have in \ndetermining patient treatment options for hepatocellular carcinoma.\nA-136 14:55\nC. Prostate cancer \nJ.O. Barentsz; Nijmegen/NL (J.Barentsz@rad.umcn.nl) \nThis presentation provides guidelines for how to be successful in prostate MRI and \nconvince urologists to use MRI. It is important that radiologists performing prostate \nMRI speak the same language as their referring physicians. They should know as \nto what is important for the patient. Therefore, this presentation provides guidelines \nfor prostate MRI, assessed by prostate MRI experts from the European Society of \nUrogenital Radiology (ESUR). The proposed MRI protocols for “detection”, “stag-\ning” and “node and bone” will be shown. The use of endorectal coil versus pelvic \nphased array coil and 1.5 versus 3  T will be discussed. And most importantly, \nclinical indications are provided. Finally, the ESUR PiRADS classification and a \nreporting system will be presented.\nLearning Objectives:\n1.  To learn the key clinical indications for MR imaging in prostate cancer.\n2.  To get an overview of essential MR imaging techniques in detection, charac-\nterisation, localisation and staging of prostate cancer.\n3.  To understand how MR imaging influences therapeutic decisions and how \nbest to provide a value added MR report.\nQuestions 15:20\nischaemic area with reduced apparent diffusion coefficient. At this stage, T2 and \nFLAIR images are usually normal and hyperintensity will appear after few hours. \nOccluded vessels are easily detected by MRA. Perfusion imaging will permit an \nevaluation of the mismatch (penumbra). At the acute phase of stroke, treatment is \nbased on IV administration of thrombolytics (rtPA), or mechanical thrombectomy. \nOnly IV administration of rtPA has been validated in large randomised studies. It \ncan be performed in the first 4.5 h of ischaemia. Mechanical thrombectomy can be \nperformed after failure of the IV treatment or as a first line treatment.\nPrecocious follow-up imaging (CT or MRI) is performed to detect any haemorrhagic \ntransformation of the ischaemic zone.\nLearning Objectives:\n1.  To consolidate knowledge of CT findings and conventional MRI findings.\n2.  To become familiar with the imaging findings and diagnostic role of diffusion \nand perfusion MRI.\n3.  To be informed of the indications and techniques for endovascular stroke \ntreatment.\nAuthor Disclosure:\nL. Pierot: Consultant; EV3, Codman. \nA-133 15:00\nC. Vascular malformations of the spinal cord \nD.A. Rüfenacht, I. Wanke; Zurich/CH (danielrufenacht@gmail.com) \nVascular malformations of the spinal cord are rare, present with variable clinical \nsymptoms and exhibit a variety of distinct oedema pattern in the spinal cord and \ndistinct vascular pattern in- and outside the spinal cord. Accordingly, vascular le-\nsions of the spinal cord are best evaluated by a combination of MRI and catheter-\nbased angiography. In addition, current treatment options relay for the majority \nof conditions on endovascular, image-guided methods. The lecture will include \nexplanation and illustration of the criteria used to assess and classify lesions \nbased on imaging. Imaging elements interesting to consider for lesion assessment, \ndisease evolution, and success and risk prediction will be provided in form of a \nquery. Spinal cord oedema being the most frequent form of changes that become \nvisible along evolution of vascular malformations of the spinal cord is the reason \nto provide pathophysiological explanations and imaging examples to the variable \noedema pattern. Examples of each type of vascular malformation will be given. \nKnowledge of such information may be useful to radiologist performing spinal MRI \nin the interest of avoiding to ignore subclinical lesions that may be readily detected \nwith current MR imaging methods, and should not be missed. Early and correct \nidentification of vascular spinal lesions may avoid progression into clinical potentially \nnon-reversible damage of the spinal cord. Knowledge about current methods of \ndiagnostic imaging and about endovascular treatment options allows for providing \nexpert advice to referring physicians, something that should be in part possible \nafter this medical education. \nLearning Objectives:\n1.  To understand the pathophysiology of vascular anomalies.\n2.  To become familiar with imaging protocols.\n3.  To be informed of the indications of interventional therapeutic procedures.\n14:00 - 15:30 Room I/K \nJoint Course of ESR and RSNA (Radiological Society of North \nAmerica) \nMC 628 \nEssentials in oncologic imaging: what radiologists \nneed to know (part 3) \nModerator: \nY. Menu; Paris/FR \nA-134 14:00\nA. Oncologic imaging: terminology, definitions and buzzwords \nY. Menu; Paris/FR (yves.menu@sat.aphp.fr) \nThe routine practice of oncologic imaging requires standardisation, which means \nthat we need to harmonise technical protocols and agree on the meaning of selected \nwords for the radiological report. The words “Response, “Progression” and “Stable \ndisease” are precisely defined according to internationally accepted thresholds and \ncriteria. Although the rules are quite simple and rather easy to apply, they are very \nefficient in the classification of the response to treatment, and therefore for the medi-\ncal decisions. However, the role of the radiologist is not limited to measurements \nand calculation. The detection of new lesions may be challenging and requires \n5\n\nPostgraduate Educational Programme\nS3\n C B D E F\n G\nA\n16:00 - 17:30 Room B \nESR meets E-AHPBA \nEM 2 \nPancreatic cystic neoplasms 2013 \nWelcome by the ESR President: \nG.P. Krestin; Rotterdam/NL \nPresiding: \nJ.I. Bilbao; Pamplona/ES \nP.‑A. Clavien; Zurich/CH \nA-144 16:00\nIntroduction \nP.-A. Clavien1, K. Conlon2; 1Zurich/CH, 2Dublin/IE (clavien@access.uzh.ch) \nPrimary pancreatic cysts are being seen more commonly in clinical \npractice in part to increased awareness and improved diagnostic mo-\ndalities. This timely symposium that the European-Africian Hepato-Pancreatico-\nBiliary Association is pleased to co-sponsor with the European Society of \nRadiology will explore our understanding of the current pathological classifica-\ntion, illustrate and define the “state-of-the-art” imaging modalities available, \ndescribe the role of Endoscopic Ultrasonography in contemporary diagnostic \nalgorithms and establish the role for surgical resection for these conditions.  \nSession Objectives:\n1.  To understand the importance of the recent WHO classification and its rel-\nevance to therapy.\n2.  To become familiar with the radiological work-up for patients with pancreatic \ncystic tumours.\n3.  To appreciate the current role of endoscopic ultrasonography in diagnosis and \nmanagement.\n4.  To become familiar with the indications for surgical intervention and the role \nof organ-sparing therapies.\nA-145 16:03\nClassification/pathology \nC. Verbeke; Stockholm/SE (caroline.verbeke@ki.se) \nThe increasing use of imaging has led to a more frequent detection of cystic le-\nsions in the pancreas. Such lesions can be of a various nature, i.e. they may be \nneoplastic or non-neoplastic, benign, potentially or overtly malignant, epithelial or \nmesenchymal, congenital or degenerative. As these cystic entities obviously differ \nin terms of treatment, prognosis and need for follow -up, it is important that they \nare correctly diagnosed. The current morphological classification of pancreatic \ncystic lesions is based on the distinction between neoplastic/non-neoplastic and \nepithelial/non-epithelial cysts. In view of this significant histogenetic diversity, it is \nnot surprising that pancreatic cystic lesions also differ in their gross appearance. \nBecause the latter is the pathology correlate of findings on imaging, it is important \nto become familiar with the key distinctive macroscopic features of the various \ncyst entities and to understand the basic microscopic diagnostic features. It should \nbe appreciated, however, that significant variation in macroscopic appearances \ncan occur within single entities, whilst there can also be a considerable overlap in \nfeatures between various entities. Therefore, in the individual case, the morphologi-\ncal diagnosis of pancreatic cystic lesions can be problematic. The identification \nof malignant transformation within primarily benign cystic lesions represents a \nfurther diagnostic challenge. While this important diagnosis is ultimately based \non unequivocal microscopic findings, there are certain macroscopic features that \nmay suggest invasive malignancy and find their correlate in radiological imaging. \nLearning Objectives:\n1.  To understand the morphological classification of pancreatic cystic lesions \nbased on the distinction between neoplastic/non-neoplastic and epithelial/\nnon-epithelial cysts.\n2.  To become familiar with the key distinctive macroscopic features of the various \ncyst entities and to understand the basic microscopic diagnostic features.\n3.  To appreciate the considerable variation in macroscopic appearances and the \npotential overlap between certain entities.\n4.  To become familiar with the macroscopic features of malignant transformation \nwithin primarily benign cystic lesions.\n16:00 - 17:30 Room A \nInteractive Teaching Session \nE³ 720a \nNeurological emergencies \nA-142 16:00\nA. Non-traumatic \nC. Ozdoba; Berne/CH (christoph.ozdoba@insel.ch) \nNeurological emergencies, i.e. the sudden loss of motor, sensory, or cognitive \nfunctions up to coma, have numerous causes. The probably most important \nneurological emergency in absolute number of patients and in socio-economic \nimpact is stroke. With recent advances in devices and techniques for interventional \nneuroradiology, neuroendovascular surgery is playing an increasing role in the \ntreatment of acute stroke. Early diagnosis with a complete imaging work-up by CT \nor MRI is mandatory before these therapies can be applied, and although the time \nspan for a successful therapy has increased to 4.5 h for i.v.-thrombolysis and up to \n8 h for intraarterial therapy, an efficient time-saving algorithm in the management \nof stroke patients remains crucial. Other causes besides stroke, however, must \nnot be forgotten. This talk focuses on CNS pathology; conditions like coma due \nto metabolic causes or intoxication will not be covered. A wide range of possible \naetiologies remains, ranging from vascular pathology (e.g. cervical artery dissection \nor venous sinus thrombosis) to epilepsy, metastatic disease, and inflammation. As \nin stroke, imaging studies today are an essential component of early diagnosis. MRI \nis the method of choice for nearly all of the above-mentioned conditions; at least \nin tertiary care centers, indications for MR in a neurological emergency should be \nseen generously - around the clock (24/7). In an emergency situation, structural \nimaging should routinely be complemented by special techniques like diffusion- and \nsusceptibility-weighted imaging and perfusion studies. Examples will be shown and \nrecommendations for optimised emergency study protocols are given.\nLearning Objectives:\n1.  To learn which imaging modality to use.\n2.  To understand how to identify early ischaemia.\n3.  To be able to select patients for treatment.\nAuthor Disclosure:\nC. Ozdoba: Consultant; Siemens Healthcare. Investigator; Bayer. Speaker; \nBayer. \nA-143 16:45\nB. Traumatic \nM. Stajgis; Poznan/PL (stajgis@gmail.com) \nTraumatic brain injury (TBI) is a significant cause of mortality and morbidity in Eu-\nrope. TBI encompasses a wide, heterogeneous group of intracranial injuries that \ninclude acute primary insults occurred at the time of impact and secondary ones \nsuch as cerebral swelling or herniation. Non-contrast CT is still the “gold standard” \nimaging modality in acute setting. Epidural, subdural and subarachnoid haemor-\nrhage (extra-axial) as well as cortical contusion, intraparenchymal hematoma, \ndiffuse axonal injury (intra-axial haemorrhage) will be discussed. Conventional \nMRI sequences are less-sensitive than CT in detection of hyperacute intracranial \nbleeding. However, FLAIR technique are capable to detect even small amount \nof extravasated blood. Susceptibility-weighted imaging (SWI) is mandatory in \nevaluation of microhemorrhages, together with DWI they play an important role in \ndiagnosis of axonal injury. Traumatic injury of spinal cord (SCI) in majority of cases \nresults with devastatingconsequences. MR examination is the imaging modality \nof choice in such patients. It enables the clear assessment of lesion morphology, \nextent and severity of trauma. For optimal characterisation of SCI, one has to start \nwith estimation of canal compromise and the degree of spinal cord compression. \nThen qualitative intramedullary changes like cord swelling, oedema, contusive \nhaemorrhage, haematomyelia, partial or complete laceration should be evaluated. \nProtocols for routine MRI of the patients SCI are proposed and discussed. \nLearning Objectives:\n1.  To understand the proper imaging protocols for trauma patients.\n2.  To become familiar with imaging findings in acute head trauma.\n3.  To learn about the imaging findings in spinal cord trauma.\n6\n\nPostgraduate Educational Programme\nS3\nB\n C D E F G\nA\nFriday\napproach. In general, symptomatic patients with low surgical risk should undergo \nresection unless the lesion is considered to be a serous cystadenoma on imaging. \nPatients with moderate surgical risk are more challenging and risk of resection \nversus risk of malignancy should be carefully taken into account. These patients \nrequire careful investigation tailored at grading the true malignant potential of their \nlesion. Of patients with a high operative risk, resection should be confined only to \npatients with confirmed malignant disease. Specific conditions require a tailored ap-\nproach. Decisions regarding resection should be based on assessment of malignant \npotential of a lesion, size of lesion (³3 cm) and the patient's surgical risk factors. \nLearning Objectives:\n1.  To understand the clinical indications for surgical intervention.\n2.  To appreciate the rationale for deciding on a particular procedure.\n3.  To discuss the outcomes of observation versus surgery.\nPanel discussion: \nThe multidisciplinary assessment and management of pancreatic \ncystic neoplasia 17:15 \n16:00 - 17:30 Room C \nNew Horizons Session \nNH 7 \nCartilage imaging \nA-149 16:00\nChairman’s introduction \nV.N. Cassar-Pullicino; Oswestry/UK (Victor.Pullicino@rjah.nhs.uk) \nIn this New Horizon session dedicated to cartilage imaging, the audience will \nlearn of new advances in imaging the normal and abnormal cartilage matrix and \nunderstand the basic techniques used in this assessment. It is hoped that these \nnew techniques which are currently in the research field would very soon be \ntranslated into clinical application. Early detection of cartilage disease may lead \nto novel therapies which can help reverse and repair the degenerative process. \nSession Objectives:\n1.  To review the basics of articular cartilage physiology.\n2.  To introduce the quantitative MR tools used to assess collagen and proteo-\nglycan depletion.\n3.  To learn about the problems arising from the avascular nature of articular \ncartilage.\nA-150 16:03\nSodium imaging \nS. Trattnig; Vienna/AT (siegfried.trattnig@meduniwien.ac.at) \nThe major advantage of sodium MRI in musculo-skeletal applications is that it \nis highly specific to glycosaminoglycan content. The recent proliferation of 7 T \nwhole-body MRI offers a significant impact on sodium MRI and its potential for \nclinical use. Since SNR scales linearly with increasing field strength and the lack \nof B1 penetration and B0 susceptibility problems sodium MRI can be particularly \nadvantageous at higher fields. The low-gyromagnetic ratio of sodium also means \nlower power deposition, thus reducing SAR problems at 7 T. Although sodium \nMRI has high specificity and does not require any exogenous contrast agent, it \ndoes require special hardware capabilities (multinuclear) and specialized RF coils. \nWith the application of a 7T whole body system and a modified 3D GRE optimised \nfor sodium imaging and dedicated multi-element sodium coils, we performed a \nseries of clinical studies: in a small group of 12 patients after matrix-associated \nautologous chondrocyte transplantation (MACT) sodium imaging allowed to dif-\nferentiate between sodium content and hence GAG in the transplants compared \nto native, healthy cartilage. In all patients, the sodium SNR was lower in the repair \ntissue compared to healthy cartilage. In another study, 18 patients after different \ncartilage repair surgery sodium SNR was significantly lower in BMS and MACT \nrepair tissue, compared to reference cartilage, but sodium SNR was significantly \nhigher in MACT repair tissue. In addition to cartilage sodium imaging, preliminary \nclinical studies have shown the potential of sodium imaging in the quantification of \nglycosaminoglycans in the intervertebral disc and Achilles tendon.\nLearning Objectives:\n1.  To get familiar with the basic principles of sodium imaging.\n2.  To understand technical challenges of sodium imaging and how to handle \nthem.\n3.  To learn about clinical applications of sodium imaging in cartilage, cartilage \nrepair and other MSK structures.\nA-146 16:21\nRadiological diagnosis \nS. Skehan; Dublin/IE (s.skehan@st‑vincents.ie) \nPancreatic cysts are recognised increasingly commonly in symptomatic and asymp-\ntomatic individuals. The challenge of imaging is to differentiate cysts that need to be \nresected from those that can be safely left alone or kept under observation. While \nCT and ultrasound are often the initial modality that identifies a pancreatic cyst, \nMRI and endoscopic US typically provide the most useful diagnostic information. \nMR can accurately demonstrate the size of any cystic components of a lesion in \naddition to showing septations, mural nodules and areas of enhancement. MRI is \nalso the optimal technique for imaging surveillance of pancreatic cysts. Pancreatic \ncystic lesions include pseudocyst, serous cystadenoma, mucinous cystadenoma \nand cystadenocarcinoma, intraductal papillary mucinous neoplasm, solid and \npapillary epithelial neoplasm and cystic neuroendocrine tumour. In classical cases, \nimaging features combined with knowledge of patient demographics can allow a \nconfident non-invasive diagnosis. However, imaging features often overlap and in \nthese cases the results of fine needle aspiration at the time of endoscopic ultrasound \nare critical in arriving at a diagnosis. \nLearning Objectives:\n1.  To become familiar with the optimal imaging modalities for cystic pancreatic \nlesions.\n2.  To learn about the characteristic imaging features of cystic pancreatic lesions \nand to describe how imaging can contribute to preoperative diagnosis.\n3.  To discuss the appropriate imaging surveillance of selected cystic pancreatic \nlesions.\nA-147 16:39\nCurrent role of endoscopic ultrasonography \nP. Bauerfeind; Zurich/CH (peter.bauerfeind@usz.ch) \nWith the increasing use of abdominal imaging (CT-scan and MRI) more and more \npancreatic cystic lesions are incidentally detected. Pancreatic cystic neoplasms \n(PCN) represent 2/3 of all pancreatic cystic lesions. After initial detection it is cru-\ncial to distinguish between benign, malignant or potentially malignant pancreatic \ncystic lesions. EUS allows morphologic analysis, guides fine-needle aspiration, \nand provides fluid for cytology, CEA, Amylase and DNA analysis. In future, \nEUS may play a role in the treatment of some PCN, e.g. intracystic injection of \nethanol or ethanol/paclitaxel for intraductal papillary mucinous neoplasm (IPNM). \nCross-sectional imaging and medical history allow in a large portion of patients to \ndifferentiate PCN from pseudocyst and to determine the type of PCN. In unclear \ncases, endoscopic ultrasonography (EUS) with CEA measurement in aspirated \nfluid can be used to discriminate between mucinous and benign serous cysts. A \ncut-off CEA level of 192 ng/mL has the sensitivity of 73%, specificity of 84%, and \naccuracy of 79% for differentiating mucinous from non-mucinous pancreatic cystic \nlesions (Brugge Gastroenterology 2004;126:1330). In case of mucinous lesions \nlarger than 2 cm the primary question is whether the cyst is malignant or benign. \nFluid cytology allows with 80% sensitivity and specificity to identify malignant IPMN. \nAmylase in aspirated fluid may allow to distinguish between IPMN and mucinous \ncystic neoplasms, the latter is usually without communication with the pancreatic \nduct. In summary, EUS with cyst fluid analysis increase the diagnostic certainty in \npatients with pancreatic cystic lesions. \nLearning Objectives:\n1.  To appreciate the technical aspects, performance characteristics and limitations \nof EUS and EUS-FNA in PCNs.\n2.  To understand how EUS and EUS-guided FNA help to establish a diagnosis \nin PCNs.\n3.  To appreciate the added information that EUS brings in staging pre-malignant \nand malignant PCNs and in orientating surgical decision-making.\nA-148 16:57\nHow aggressive should the surgeon be? \nK. Conlon; Dublin/IE (Kevin.Conlon1@amnch.ie) \nPrimary pancreatic cysts are more prevalent in surgical practice due to improve-\nments and availability of sophisticated cross-sectional imaging techniques. They are \nidentified in approximately 1% of patients undergoing abdominal CT scanning. His-\ntorically, surgical resection was recommended for all pancreatic cystic neoplasms. \nThis philosophy resulted partly from limited understanding of the natural history, \npoor sensitivity and specificity of investigations and improved safety of pancreatic \nsurgical resections. An aggressive surgical algorithm results in resection of numer-\nous benign lesions; frequently in asymptomatic patients with incidentally detected \nlesions. A consensus has now emerged towards a more conservative and tailored \n7\n\nPostgraduate Educational Programme\nS\n C B D E F\n G\nA\nclinical equipment and protocols can easily be implemented in a routine clinical \nworkflow, the signal analysis in gagCEST imaging and the reading of gagCEST \nimages are technically complex. For example, effects, which alter the T2 relaxation \ntime of tissue such as high relative water concentration, can affect the magnitude \nof gagCEST effects although the absolute concentration of GAG is unchanged. \nUnless confounding effects are automatically corrected, careful analysis of images \nis necessary for proper interpretation of results. \nLearning Objectives:\n1.  To understand basic principles of CEST imaging.\n2.  To learn about the current status of gagCEST imaging.\n3.  To become aware of technical pitfalls and future approaches.\nAuthor Disclosure:\nB. Schmitt: Research/Grant Support; Siemens Healthcare. \nPanel discussion: \nWhat are the envisaged future advances in these cartilage imaging \ntechniques and can we expect to introduce them into clinical \npractice? 17:15 \n16:00 - 17:30 Room D1 \nControversies in Breast Imaging \nMC 723 \nShould we add ultrasound to mammographic \nscreening of dense breasts? \nModerator: \nF.J. Gilbert; Cambridge/UK \nT easer: \nA. Tardivon; Paris/FR \nA-154 16:00\nA. We can reduce the interval cancer rate \nW.A. Berg; Pittsburgh, PA/US (wendieberg@gmail.com) \nGreater rates of interval cancers (detected clinically in the interval between screen-\nings), and even greater mortality, have been observed in women with dense breast \ntissue (heterogeneously dense or extremely dense mammographically) compared \nto those in women whose breasts are fatty or show minimal scattered fibroglandular \ndensity. Importantly, breast density itself is a strong risk factor for the development \nof non-hereditary breast cancer, with relative risk from extremely dense breast \ntissue 4- to 5-fold higher than for women with fatty breast tissue. Ultrasound (US) \nhas been considered for supplemental screening of women with dense breasts. \nAcross 8 single-center studies, and three prospective multicenter trials, encom-\npassing over 64,000 examinations, supplemental cancer detection rate of US has \nconsistently been 3 to 4 per 1000. Over 90% of cancers seen only on ultrasound \nare invasive, with median size of 10 mm. Over 85% of invasive cancers seen only \non ultrasound are node negative. Interval cancer rate (ICR) after three years of \nprogrammatic screening with mammography plus ultrasound was only 8% after \nthree years of screening mammography and ultrasound in the ACRIN 6666 study \n(which evaluated women with dense breasts and at least one other risk factor). \nIn the Italian multicenter trial, after adding US to mammography in women with \ndense breasts, the ICR was not different than for women with nondense breasts. \nUS carries a substantial risk of false positives, with from 2 to 7% of women biopsied \nbecause of screening US, and only 10% of additional biopsies prompted only by \nUS showing cancer.\nAuthor Disclosure:\nW. A. Berg: Advisory Board; Philips Healthcare. Consultant; Naviscan, Inc. \nEquipment Support Recipient; Gamma Medica, Inc. Grant Recipient; Hologic, \nInc. Research/Grant Support; Gamma Medica, Inc. Speaker; SuperSonic, \nImagine. \nA-155 16:25\nB. Do we have enough radiologists to do it? Alternatives to \nultrasound to reduce interval cancers \nA. Frigerio; Turin/IT (alfonso.frigerio@gmail.com) \nMammography screening (MS), i.e. screening with mammography only, is an \neffective and efficient means of significantly reducing breast cancer mortality. \nHowever, many European countries fail short of complete population coverage. \nThis is largely due to the costs involved and mainly to a shortage in dedicated \nradiologists. Moreover, some countries already started, and others are considering, \nA-151 16:21\ndGEMRIC (delayed gadolinium-enhanced MR imaging of cartilage) \nG. Welsch1, S. Trattnig2; 1Erlangen/DE, 2Vienna/AT (welsch@bwh.harvard.edu) \nAcute and chronic articular cartilage lesions are a common pathology and many \npatients could benefit from cartilage treatment which needs high sophisticated \nfollow-up. Whereas standard morphological approaches can demonstrate the \nconstitution of cartilage, quantitative/biochemical MR approaches are able to \nprovide a specific measure of the composition of cartilage. One of the biochemical \nMRI techniques most often reported to visualise cartilage ultra-structure is delayed \nGadolinium-Enhanced MRI of Cartilage (dGEMRIC). Using dGEMRIC, biochemical \nMRI has the ability to quantify functionally relevant macromolecules within articular \ncartilage such as glycosamnioglycans (GAG). GAG are the main source of fixed \ncharge density in cartilage, which are often decreased in the early stages of cartilage \ndegeneration and are considered as a key factor in the progression of cartilage \ndamage. The role of GAG is comparably important in the follow-up after cartilage \nrepair procedures where hyaline-like repair tissue with a normal or nearly normal \namount of proteoglycans has been described to have a positive predictive value. \nThe technical requirements and possible applications of dGEMRIC are presented \nin this „New Horizon session (NH 7) Cartilage imaging“. \nLearning Objectives:\n1.  To learn the basic principles of dGEMRIC and the current used techniques for \nclinical imaging.\n2.  To learn about the current clinical applications of dGEMRIC.\n3.  To get an overview of future uses of dGEMRIC in therapeutic studies.\nA-152 16:39\nDiffusion tensor imaging \nC. Glaser; Munich/DE (glaser@rzm.de) \nDTI aims to monitor water proton diffusion as modified by a tissue’s macromolecular \nstructure. This implies to apply (and register) at least 6 diffusion sensitizing gradi-\nent directions in order to obtain an adequate diffusion tensor data matrix. From \nthe data metrics, commonly the apparent diffusion coefficient (ADC), fractional \nanisotropy (FA) and the principal eigenvector (EV1), are derived to characterise \narchitectural tissue properties. This approach has been demonstrated to be feasible \nand applicable to articular cartilage in an experimental setting, and promising first \nin vivo data of human cartilage have been published. ADC appears to correlate \nto proteoglycan (PG) and water content and an increase of ADC (both bulk and \ndepth dependent) has been shown to correlate to (local / bulk) PG depletion. FA \nreflects depth dependent anisotropy in the collagenous fibre architecture and is \nindependent of PG content. EV1 has the potential to define cartilage zonal height \nbut is the most SNR-demanding parameter of the three. A first in vivo study has \nshown very good accuracy for bulk ADC and FA to differentiate healthy volunteers \nfrom early OA patients and reproducibility data are comparable to dGEMRIC and \nT2. Most recently, an ex vivo study has obtained an excellent predictive value of DTI \nfor the diagnosis of early cartilage degeneration and a good ability to grade early \nstages of cartilage degeneration - confirming the potential of DTI as a non-invasive \nnon-CM-dependent biomarker for (early) OA. Current challenges are to implement \nand standardize robust acquisition protocols for in vivo human and animal imaging.\nLearning Objectives:\n1.  To discuss basic principles of diffusion imaging in MSK.\n2.  To review technical challenges and current achievements.\n3.  To look into potential future directions.\nA-153 16:57\nCEST (chemical exchange saturation transfer) \nB. Schmitt; Vienna/AT (benjamin.schmitt@meduniwien.ac.at) \nCEST imaging in principle relies on the chemical exchange of protons bound to \nsolute molecules and surrounding bulk water molecules. The effect can be used \nfor MRI because the magnetization of each solute proton, is also transferred to \nbulk water, and can thus be visualized via the MR signal. CEST effects can be \nevaluated for specific molecular groups due to their characteristic proton resonance \nfrequencies, which provides the technique with a high intrinsic sensitivity to these \ngroups. In healthy cartilage tissue, strong CEST effects from exchangeable protons \nof glycosaminoglycan (GAG) molecules can be observed. The magnitude of these \neffects decreases when concentration ratio between bulk water protons and GAG \nprotons decreases, e.g. in the early stages of osteoarthritis (OA). Initial studies \non patients after cartilage repair surgery with GAG-dependent CEST (gagCEST) \nimaging have demonstrated that it is feasible to visualize GAG loss in vivo at 7.0 \nTesla. Initial reports also claim that the technique might be transitioned to the clini-\ncal field strength of 3 T. Although CEST imaging can be performed with standard \n38\n\nPostgraduate Educational Programme\nS\nB\n C D E F G\nA\nFriday\nA-158 16:30\nB. PERCIST: evolving considerations for PET response criteria in \nsolid tumours \nT.F. Hany; Zurich/CH (thomas.hany@gmail.com) \nIn solid as well as non-solid tumours, PET/CT imaging using 18-Fluoro-Deox-\nyglucose (FDG) has demonstrated the ability to a) correctly stage disease, b) \ndemonstrate therapy response and c) predict therapy outcome. FDG-uptake can \nbe measured objectively, however several factors in the standardization proc-\nesses of tracer application, image acquisition and post-processing are needed for \nreproducibility. The term standard uptake value (SUV) measurement is used for \ncompensating the influence of injected dose, decay time, body mass and repre-\nsents FDG-uptake in any selected pixel of the image. For therapy assessment, \ndrop in FDG-uptake represents tumour cell kill, notably a negative PET scan does \nnot exclude viable tumour cells but overall has a better outcome. PET response \ncriteria in solid tumours (PERCIST 1.0) have been introduced to refine previously \nestablished PET response criteria by EORTC. Major changes concern the use of \nlean-body-mass based SUV (SUL), SULpeak measurement in a fixed ROI, use of \nonly a single target lesion and normalisation to liver uptake. Metric measurements \nin CT component of the PET/CT as an intrinsic asset like in RECIST 1.1 have not \nyet been introduced but might be crucial in the future. The proposed PERCIST 1.0 \ncriteria are not yet standard since several limitations hamper its general use but \nmay improve metabolic tumour response assessment.\nLearning Objectives:\n1.  To learn about the evaluation of solid tumours through metabolic imaging.\n2.  To understand the benefits of metabolic imaging.\nA-159 17:00\nC. Evaluation of brain tumours \nC. Majós; L‘Hospitalet de Llobregat/ES (cmajos@bellvitgehospital.cat) \nMalignant gliomas (WHO grade III and IV) are the most common primary tumours \nin the brain. Consensus guidelines consider that the standard of care for malignant \ngliomas include maximal surgical resection followed by combined treatment with \nchemoradiotherapy including temozolomide. Radiological assessment is critical in \nthe follow-up and should be done by MRI at three different times: (1) in the early \npostsurgical period, (2) 2 to 6 weeks after completing treatment with radiotherapy, \nand then (3) every 2 to 4 months. (1) Early postsurgical MR must be done within \n72 h after surgery to evaluate residual tumour and to be used as baseline for \nfollow-up. (2) A new MR exam is recommended 2 to 6 weeks after completing \nRT to evaluate response to treatment. According to the Macdonald criteria, the \nresponse can be classified as Complete Response, Partial Response, Stability or \nProgressive Disease. The evaluation of this first exam after RT is challenging, and \nthe pseudoprogression phenomenon can appear. Advanced MR imaging techniques \ncan be of help. Recently, the Macdonald criteria of response have been updated \nby the Response Assessment in Neuro-Oncology Working Group, being the RANO \ncriteria those to be preferentially used. (3) Additional follow -up with MR should \nbe done every 2 to 4 months. When Progressive Disease is detected, several \noptions can be offered, including antiangiogenic drugs. Evaluation of response to \nantiangiogenic drugs is challenging too, and the pseudoresponse phenomenon \ncan appear. Management of these tumours in the context of multidisciplinary teams \nincluding neuroradiologists is recommended due to its complexity.\nLearning Objectives:\n1.  To learn about evaluation criteria for brain tumours.\n2.  To become familiar with the evaluation of brain tumours after treatment with \nvarious therapies.\n16:00 - 17:30 Room E1 \nMusculoskeletal \nRC 710 \nPeripheral nerve imaging: MRI and US \nA-160 16:00\nChairman’s introduction \nJ. Renoux; Paris/FR (jeromerenoux@hotmail.com) \nThanks to their excellent tissue contrast, ultrasonography and MRI can perfectly \nvisualize peripheral nerves. Nevertheless, knowledge of their anatomic relationship \nremains necessary. The pathologic state can affect the nerve surrounding area or \nthe nerve itself; therefore, good comprehension of these conditions is necessary to \nto extend the age target of MS to 45-75. This expanded target would obviously \nenhance the relevance of any staffing problems. It has been estimated that add-\ning traditional, hand-held ultrasound to MS - aiming to decrease interval cancers \n(IC) - might increase the need for radiologists by 40-100% depending on different \nestimates and especially on the criteria for the selection of women to be studied \nby ultrasound (age, breast density, different thresholds). This is simply not feasible, \neven not considering other relevant drawbacks of such a policy, as the increase in \npercutaneous biopsies and surgical procedures with a benign outcome. Alternative \nto ultrasound to reduce IC might include: 1. to employ only well trained, dedicated \nradiologists: this alone has been shown to reduce false negative IC rates from \n40% to below 10%. 2. consider new technologies, the most promising being at this \nmoment (2a) digital breast tomosynthesis, while a complementary option could be \n(2b) automated whole breast ultrasound. These two options require proper valida-\ntion in a screening setting. Indeed, both would also imply an increased demand in \nradiological personnel, mostly related to reading times. These could be tackled by \nthe development of dedicated CAD systems.\nA-156 16:50\nDiscussion \nF.J. Gilbert1, A. Tardivon2; 1Cambridge/UK, 2Paris/FR \nThe discussion will address the following issues:\n1.  How to define breast density?\n2.  Additional cancer detection rate using ultrasound.\n3.  The level of evidence for routine use of ultrasound as an adjunct to mam-\nmography.\n4.  How many more breast radiologists do we need to carry out ultrasound screen-\ning in Europe?\n16:00 - 17:30 Room D2 \nOncologic Imaging: Follow-up of Systemic and Local Therapies \nCC 719 \nImaging after systemic therapies: the standards \nModerator: \nE.L. van Persijn van Meerten;  Leiden/NL \nA-157 16:00\nA. RECIST criteria \nY. Menu; Paris/FR (yves.menu@sat.aphp.fr) \nRECIST is a universal standard in tumour response evaluation. Therefore, it is of \nutmost importance that imaging technique and radiological reports are compliant \nwith the recommendation. Advantages of standardization comprise the comparabil-\nity of different examinations in the same patient, and responses in a cohort. Precise \ndefinition of response or progression makes possible to evaluate the accuracy of \na specific treatment. Another advantage is that structured reporting is easier to \nperform, improving efficiency and communication. Technical requirements are \nimportant though easily achievable: slice thickness of 5 mm or less reconstructed \nin the axial plane, contiguous slices (on CT, minimal gap on MRI), robust and re-\nproducible contrast injection with similar delay and injection rate, similar coverage \nensure proper comparison of images and clear basis for decision making. Thinner \nslices, alternative planes, specific contrast media and/or customized MRI sequences \nare optional, and should not replace basic techniques. Interpretation of baseline \nimages requires a perfect knowledge of the method for measurement of the larg-\nest diameter, identification of targets and non targets. Interpretation of evaluation \nexaminations needs iterative comparison with Baseline and Nadir examinations, \nand identification of unequivocal new lesions. Obviously, a universal standard does \nnot fit all oncology cases. It appears that some tumours like GIST or HCC may \nneed adapted criteria in addition to RECIST. PET is only mildly included among \nthe criteria, although it proves to be an important method for evaluation. Finally, \nmorphology does not summarize tumour biology. Besides RECIST, the addition of \nstructural, metabolic and/or functional information would be desirable.\nLearning Objectives:\n1.  To consolidate knowledge of evaluation of solid tumour response.\n2.  To learn about tips and tricks to help bring RECIST to everyday practice.\n3.  To understand advantages and limitations of RECIST.\n39\n\nPostgraduate Educational Programme\nS4\n C B D E F\n G\nA\nMR imaging have followed parallel paths for nerve imaging with little comparison of \nthe two modalities, US seems to have some advantages over MR imaging, including \nhigher spatial resolution, time effectiveness, the ability to explore long nerve seg-\nments in a single study and to examine tissues in both static and dynamic states.\nLearning Objectives:\n1.  To become familiar with the strengths and weaknesses of US and MRI for \nassessing lower limb nerves.\n2.  To appreciate the imaging findings of lower limb nerve entrapment.\nPanel discussion: \nWhich on-going technological advances in MRI and US could \ninfluence the way we image peripheral nerves in the future? 17:14 \n16:00 - 17:30 Room E2 \nFoundation Course: Neuroimaging \nE³ 720b \nInfection and inflammation \nModerator: \nA. Gouliamos;  Athens/GR \nA-164 16:00\nA. Infection \nE.T. Tali; Ankara/TR (turgut.tali@gmail.com) \nCerebral infections can be caused by bacteria, fungi, parasites, viruses and pri-\nons. Radiological evaluation plays an important role in the diagnosis, subsequent \ntreatment and treatment monitoring. Cerebritis is characterised by poorly local-\nised perivascular inflammatory infiltrations with scattered necrosis, oedema, and \npetechial haemorrhage. Radiological findings vary according to the stage of the \ninfection from oedema, mass effect, mild/patchy/heterogeneous enhancement of \ncerebritis to ring-like lesions, with the capsule hypointense on T2WI, hyperintense \non T1WI, heterogeneous enhancement, central necrotic area, surrounding oedema \nof abscesses. DWI shows high-signal intensity while ADC map shows low-signal \nintensity of the central necrotic area of the abscesses. MRS shows elevated lactate \nand amino acid peaks. Cystic lesions isointense to CSF are also seen with the \nparasitic infestations. Treatment can also be monitored mainly by MRI; decrease \nin oedema, in mass effect, and in the degree of enhancement, decreasing signal \non DWI, increasing signal on ADC maps, gliosis, occasionally focal calcifications, \nturning of lactate and amino acid peaks to normal at MRS are the indicators of \nsuccessful treatment. Imaging findings vary according to the causative fungus; \nfrom granuloma with hypointense signal on T2, abscess with rim enhancement, \ndiffuse cerebritis with signal change and haemorrhages, haemorrhage, infarcts, \nenlarged perivascular space to gelatinous pseudocyst. Acute encephalitides are \ndiffuse brain parenchymal inflammatory diseases mainly caused by viruses. They \ncan also involve meninges. Pathologically the primary features of viral encepha-\nlitis include neuronal degeneration and inflammation with or without mass effect. \nLearning Objectives:\n1.  To understand the concept of ‘leaky vessels’ in the infectious meningeal, \nparenchymal and ventricular involvement.\n2.  To learn how to proceed with imaging when ‘time is of the essence’.\n3.  To become familiar with the specific imaging patterns of bacterial, viral, fungal, \nparasitic and prion infections.\nA-165 16:30\nB. Multiple sclerosis \nF. Barkhof; Amsterdam/NL (f.barkhof@vumc.nl) \nMRI is often being used to demonstrate dissemination of lesions in the CNS in \npatients with multiple sclerosis (MS). In the McDonald diagnostic criteria for MS \nthat rely more heavily on MRI than previously, a high specificity is warranted in \ndemonstrating dissemination in space (DIS) and dissemination in time (DIT). In \nthe 2010 updated criteria, DIS can be demonstrated by the presence of one or \nmore asymptomatic T2 lesions in minimally 2 of 4 crucial anatomical locations: \njuxtacortical, periventricular, infratentorial or in the spinal cord. Simultaneous pres-\nence of asymptomatic gadolinium-enhancing and non-enhancing lesions at any \ntime is sufficient for demonstration of DIT, or any new lesion at follow -up. MRI is \nalso used to initiate and monitor treatment efficacy and its side-effects (like PML). \nIn addition, neurodegenerative features such as atrophy and black holes can be \ndetermined. The most common differential diagnosis of WM lesions in patients \nsuspected of MS are hypoxic-ischaemic white matter changes due to small vessel \ndisease (SVD). They are usually asymptomatic but can also present with migraine, \nperform diagnostic imaging. Most of the time, clinical examination or electrophysi-\nological study come before imaging and help to orientate the exploration. The first \npart of this course will address brachial plexus anatomy and pathology. The two \nfollowing parts will give an understanding on nerve anatomy and pathology of the \nupper and the lower limbs. Strengths and weaknesses of the two techniques will \nbe discussed. \nA-161 16:05\nA. Applied radiological anatomy and pathology of the brachial plexus \nS. Gerevini; Milan/IT (gerevini.simonetta@hsr.it) \nThe Brachial Plexus (BP) originates from the ventral branches of the cervical nerve \nroots from C5 to T1.It comprises roots, trunks, divisions, cords, and branches, \ntopographically divided into supraclavicular (roots and trunks), retroclavicular (divi-\nsions), and infraclavicular sections (cords and branches).The various divisions of the \nbrachial plexus appear as linear structures with low signal intensity on MR images \nobtained with all sequences and in all planes (especially sagittal and coronal). The \nT1-weighted images optimally delineate normal nerve tracts from the musculature \nand blood vessels, and show the size of the nerve. The nerves appear as elongated \nfibers that are isointense to the scalene muscle in T1 weighted images, posteriorly \nand superiorly to the curvilinear flow void of the subclavian artery. The general \nabnormal findings include: loss of fat planes around BP components, diffuse or \nfocal enlargement of the nerves, hyperintensity of nerve signal on T2-weighted \nimages, focal or extensive Gadolinium uptake of the nerves on T1 fat-saturated \nimages. Pathology of brachial plexus can be divided into non-traumatic and trau-\nmatic brachial plexopathies. Post-actinic fibrosis is the most commonly reported \nnon-traumatic cause of brachial plexopaties, accounting for about 30% of cases, \nfollowed by metastatic breast cancer (20%) and primary or metastatic lung cancer \n(20%). Together, these three processes represent almost 70% of the explainable \ncauses of brachial plexopathies. The remaining cases are caused by a variety of \nsituations ranging from benign and malignant tumours to inflammatory disease \nand Thoracic Outlet Disease.\nLearning Objectives:\n1.  To understand the anatomy of the brachial plexus as demonstrated with MRI.\n2.  To appreciate the range of pathology seen at the brachial plexus.\n3.  To become familiar with the MRI findings of brachial plexus pathology.\nA-162 16:28\nB. Upper limb nerve entrapment \nD. Weishaupt; Zurich/CH (dominik.weishaupt@triemli.zuerich.ch) \nThe peripheral nerves of the upper limb are affected by a number of entrapment \nand compression neuropathies. These syndromes involve the brachial plexus as \nwell as the musculocutaneous, axillary, suprascapular, ulnar, radial and median \nnerves. Clinical examination and electrophysiological studies are traditionally the \nmainstay of diagnostic work-up. However, ultrasonography and magentic resonon-\nance imaging (MRI) may provide key information about the exact anatomic location \nof the lesion or may help to narrow the differential diagnosis. In certain patients with \nthe diagnosis of a peripheral neuropathy, imaging using either ultrasononography \nof MRI may help establish the cause of the condition and provide information \ncrucial for conservative management or surgical planning. In addition, imaging is \nparticularly valuable in compex cases with discrepant nerve functions test results.\nLearning Objectives:\n1.  To become familiar with the strengths and weaknesses of US and MRI for \nassessing upper limb nerves.\n2.  To appreciate the imaging findings of upper limb nerve entrapment.\nA-163 16:51\nC. Lower limb nerve entrapment \nC. Martinoli, A. Tagliafico; Genoa/IT (carlo.martinoli@libero.it) \nA variety of peripheral neuropathies can be encountered in the lower limb. Most are \nentrapment syndromes affecting many nerves, such as the sciatic, gluteal, femoral, \nlateral femoral cutaneous, obturator and pudendal around the hip, the peroneal \nand its branches and the saphenous at the knee, the superficial peroneal at the \nlateral leg, the tibial with its plantar and calcanear branches at the ankle, the deep \nperoneal and the interdigital nerves in the foot. Although clinical examination and \nnerve conduction studies are the mainstays of the diagnostic work-up of peripheral \nneuropathies, ultrasound (US) and magnetic resonance (MR) imaging may provide \nkey information about the exact anatomic location of a lesion and the nature of the \nconstricting finding or may help narrow the differential diagnosis. In patients with \nperipheral neuropathies of the lower extremity, US and MR imaging may provide \ncritical information for planning an adequate treatment strategy. Although US and \n0\n\nPostgraduate Educational Programme\nS4\nB\n C D E F G\nA\nFriday\nA-168 16:05\nLevels of training and competencies across Europe \nM.T. Stanton; Dublin/IE (marie.stanton@ucd.ie) \nThe aim of this presentation is to add to the knowledge we have of education and \nclinical practice of ultrasound by radiographers in Europe. Data collected via a \nsurvey of professional bodies and centres offering ultrasound education in Europe \nform the basis of the discussion. The aims of European ultrasound programmes \nare compared, and regulations guiding training and clinical practice are reviewed. \nTeaching and learning activities employed in the development of competent ultra-\nsonographers are deliberated. Formative and summative assessment strategies \nare debated. The session finishes with some proposals for the development of \nultrasound education for European Radiographers. \nLearning Objectives:\n1.  To appreciate the similarities between radiographer competencies across \nEurope.\n2.  To become familiar with the regulations for radiographers to train and practice \nin Europe.\n3.  To understand an expert-derived consensus of educational standards for \nradiographer in Europe.\nA-169 16:28\nThe role and impact of the radiographer conducted US in Portugal \nR.T. Ribeiro; Lisbon/PT (ricardo.ribeiro@estesl.ipl.pt) \nRadiographers have a role in ultrasound (US) within their professional boundaries. \nWith the proper strategy, US have an unconditional value towards professional \ndevelopment. Abstract knowledge controlled by a group is the characteristic that \nbest defines a profession, since abstraction gives survivability in a competitive \nsystem of professions. Radiographers exist integrated in the portuguese health \nsystem, so their professional development should consider the interdependence \nsystem that characterises the relationship between the professional groups. The \nfocus of this professional framework should not only be on the cognitive knowledge, \nbut also in the translation of it to the clinical practice. Radiographers can play an \nimportant role in the response time for diagnosis and therapeutic monitoring. The \nrole of radiographers in US should be organized in an organ-oriented workflow \ndivision, profoundly related with the clinical problems that emerge from each \nmedical specialty. The basic principle is that the incorporation of US as a routine \nextension of the clinical examination will lead to a considerable contribution to \nthe understanding of the natural history of disease and to improve/optimise the \nfollow-up. In this framework, the radiographer assumes the complex coordination \nprobe-eye and special navigation while the clinician is focused on the clinical \nanalysis of the normal/abnormal findings of the exam. In conclusion, the inclusion \nof a radiographer in clinical routines leads to a less patient waiting time, a more \ndynamic workflow and improved clinical services. \nLearning Objectives:\n1.  To become familiar with the radiographers’ role in the context of a professional \nprogression framework.\n2.  To understand the synergies at play in interprofessional relationships and \nteam-work.\n3.  To learn the benefits of having radiographers in the management and optimisa-\ntion of health systems.\nA-170 16:51\nEvolution of radiography education for US in the Netherlands since \n1990, and its influence on their role \nG. Plug; Haarlem/NL (Geert.plug@inholland.nl) \nThis presentation will provide an overview of the past, present and future role of \nradiographers working in the field of ultrasound in the Netherlands. At the imple-\nmentation of ultrasound in radiography practice in the 1970s, examinations were \nsolely done by radiologists. The workload for the radiologists expanded quickly and \nalready in 1980, a vocational one year course in ultrasound started in Haarlem \nto meet with the growing need for trained radiographers to work in ultrasound. \nBecause the number of radiographers working in ultrasound was rising, ultrasound \neducation became part of a four-year bachelor programme including radiography, \nradiotherapy and nuclear medicine (MIRT) from 1989. The initial one year course \nbecame a post-graduate course for diploma holders and later part of the Master \ncourse medical imaging and radiation oncology. The ultrasound education in the \nbachelor programme focuses on basis ultrasound physics and examination skills \nin abdominal ultrasound, as were the post-graduate course focuses on advanced \npractice. In present day, ultrasound is performed by radiographers in almost 75% \nof the hospitals in the Netherlands. Because of a growing availability of MIRT \ntransient ischaemic attacks, stroke or subcortical arteriosclerotic encephalopathy. \nSeveral MRI features help distinguish between MS and SVD such as the presence \nof micro-bleeds in the basal ganglia and deep white matter regions, borderzone \nor watershed lesions and lacunes. The vascular distribution of lesions may differ \nbetween MS and SVD; perivenular versus arterial respectively. Spinal cord imaging \nmay aid in the differentiation between MS and SVD, since cord lesion are never \nfound in the latter. \nLearning Objectives:\n1.  To learn about the role of MRI in detecting focal and diffuse multiple sclerosis \npathology.\n2.  To consolidate knowledge of lesion distribution, signal intensity characteristics \nand patterns of contrast enhancement.\n3.  To be able to apply the 2010  McDonald criteria to the diagnosis of MS.\nA-166 17:00\nC. Mimics of multiple sclerosis \nV. Dousset; Bordeaux/FR (vincent.dousset@chu‑bordeaux.fr) \nAlthough the misdiagnosis of MS is very low due to the constant improvement \nof MS diagnostic criteria, there is no single biomarker to establish a definite MS \ndiagnosis, and MRI lacks of specificity despite the use of new sequences or tedious \npost-processing methods! In addition, MS diagnostic criteria have a high-positive \npredictive value but they lack of sensitivity making numerous patient in suspense \nfor the definite diagnosis. Since there are many diseases, very frequent or very \nrare which manifest symptoms similar to MS, an attentive inspection of clinical \npresentation, biological (both blood serum and CSF) and imaging markers may \nhelp in tracking mimics of MS and other differential diagnoses: immune-related \ndisorders (ADEM, SLE, Sjögren’s Sd, Clippers Sd, thyroiditis, sarcoidosis, im-\nmune reconstitution inflammatory Sd, etc)., microvessels diseases (diffuse small \nvessel occlusions, primary CNS angitis, etc)., infections (Lyme disease, HTLV1, \netc)., primary CNS tumours, metabolic disorders (Biermer’s disease) and inherited \nmyelinopathies. During the presentation we will review MRI and MRS signs that \nhelp in targeting diseases that may mix-up with MS : white matter lesions number, \nlocation, shape, signal intensity, enhancement and duration of enhancement, \nassociated signs such as grey matter abnormalities, meninges involvement, T2* \nsensitive findings, changes in MRS biomarkers, etc.\nLearning Objectives:\n1.  To be aware of the top ten mimics of multiple sclerosis.\n2.  To become familiar with the imaging findings suggestive of other disorders.\n3.  To be informed of the importance of imaging the spinal cord for the differential \ndiagnosis of MS/MS mimics.\n16:00 - 17:30 Room F1 \nSpecial Focus Session \nSF 7a \nRadiographers and ultrasonography in Europe \nA-167 16:00\nChairmen’s introduction \nD. Pekarovic1, V. Vilgrain2; 1Ljubljana/SI, 2Clichy/FR (dean.pekarovic@kclj.si) \nIn the recent years, US became a new field for radiographers in some countries \nacross Europe. Radiographers are now performing and reporting US examinations. \nAccordingly, a new role for radiographers in US performance and reporting has to be \nestablished. New emphasis on clinical knowledge and pathological correlation has to \nbe implemented during radiographers educational curricula. In addition, regulations \nin some countries has to be adjusted accordingly. This session will also include \nPortuguese model with additional facts about the role of radiographers in the context \nof a professional framework and about the benefits and duties of radiographers in US \nmanagement team. Dutch model of education will focus on US module curriculum \nin the first level of education. Guidelines and models will be available framework \nfor those embracing the idea of US radiographer. The question: What are the chal-\nlenges and barriers for role extension for radiographers role in US will be discussed \nduring the debate including an overview of educational models across the Europe. \nSession Objectives:\n1.  To understand why ultrasound continues to be a growth area in diagnostic \nimaging.\n2.  To identify the challenges posed by the growth of this field.\n3.  To understand the challenges faced by radiographers carrying out US across \nEurope.\n1\n\nPostgraduate Educational Programme\nS4\n C B D E F\n G\nA\nA-173 16:23\nPET/CT for radiotherapy planning: how does it assist IMRT? \nA. Loft; Copenhagen/DK (annika.loft@rh.regionh.dk) \nIn Radiotherapy, the use of PET/CT scans for dose planning is increasing. On the \nPET images, the viable tumour can be delineated as a support for the delineation \nperformed on the corresponding CT. Small malignant foci are detected and can \nincrease the Gross Tumour Volume- oppositely, non-malignant but on CT patho-\nlogical structures can be left out- of course at the discretion of the oncologist! \nEspecially for IMRT, the tumour delineation must be very precise. This demands \nthat the patient is prepared for therapy planning with use of fixation equipment \nfor correct positioning and that the staff is well trained and collaborate with the \nstaff from Radiotherapy when PET/CT scanning these patients. The collaboration \nacross specialities, the technical issues, the tumour delineation process and the \nclinical impact are discussed.\nLearning Objectives:\n1.  To learn about anatomical imaging risk compartments that define gross tumour \nvolume (GTV).\n2.  To understand how PET/CT assists in delineating the GTV.\n3.  To understand the role of PET/CT guided IMRT and how it can lead to treat-\nment adaptation.\nA-174 16:41\nResponse evaluation and treatment adaptation \nK. Haustermans; Leuven/BE (karin.haustermans@uzleuven.be) \nMultimodal imaging is becoming more important in radiotherapy planning and \ndelivery especially in the curative setting. Typically, before the start of a radiation \ntreatment, a CT scan in the treatment position is taken. On this CT scan, the clini-\ncal target volume, the gross target volume and the organs at risk are delineated. \nHowever, soft tissue contrast on CT scan is low, that is why MRI is often used as \nwell. MR images are then registered to the CT scan as the HU are needed to cal-\nculate the dose distribution. Also PET with different tracers and DW MR are under \nevaluation in the radiation treatment preparation process. These functional imaging \nmodalities allow to depict more radioresistant areas within the tumour. Theoreti-\ncally, a dose escalation to radioresistant subregions within the tumour becomes \npossible also thanks to the evolution in the technology to deliver the radiation. \nSeveral Phase II studies are ongoing to evaluate the benefits of an inhomogene-\nous dose distribution. Reimaging during a course of treatment allows to adapt the \ndose distribution, and this is called adaptive radiotherapy. Moreover, the changes \nmeasured on functional imaging performed during treatment, for example, changes \nin ADC values and/or SUV max are often predictive for treatment outcome. Overall, \nthere is a rapid evolution in the integration of multimodal imaging in the radiation \ntreatment process which will lead to a more personalized radiation treatment and \nto better patient outcome with higher chances of local control and less side effects. \nLearning Objectives:\n1.  To understand the molecular tumour microenvironment (tumour hypoxia, \n-apoptosis and -proliferation) that may impact response to radiation treatment.\n2.  To learn how tumour heterogeneity, reflecting tumour microenvironment, influ-\nences dose distribution in IMRT.\n3.  To learn how response assessment during IMRT leads to adaptation and \ntailoring of radiation treatment.\nA-175 16:59\nMR imaging biomarkers for response evaluation \nR.G.H. Beets-Tan; Maastricht/NL (r.beets.tan@mumc.nl) \nImaging plays a pivotal role in cancer diagnostics and therapy monitoring. Magnetic \nresonance imaging (MRI) stands out from other imaging modalities as a high-spatial \nresolution technique with superior soft-tissue contrast, which enables anatomic, \nfunctional as well as metabolic characterisation of the lesions. Anatomical informa-\ntion on itself is invaluable but not sufficient to understand the biological profile of \nthe tumour. With nowadays cancer specific treatment, non-invasive assessment of \ntumour biomarkers is highly desired to predict outcome of anti-cancer treatment. \nThe most widespread method of non-invasive assessment of imaging biomarkers \nis functional imaging: perfusion dynamic contrast-enhanced MRI and diffusion \nweighted MRI. This lecture will elaborate on the value of perfusion and diffusion MR \nimaging for assessment of response after radiation treatment and for predicting of \nresponse during radiation treatment. The audience will learn whether the imaging \nbiomarkers derived from such MR techniques enable a reliable stratification of \ntreatment and patient specific adjustment of radiation treatment.\nbachelors, it is to be expected that related work fields, such as echocardiography, \ngynaecology and obstetrics, vascular ultrasound, musculoskeletal ultrasound and \nultrasound in private practice will be performed by radiographers in the near future. \nA continuous adjustment of ultrasound education is therefore essential. \nLearning Objectives:\n1.  To learn about US education over an entire four year bachelor programme.\n2.  To understand the role of the radiographers as a result of this bachelor pro-\ngramme.\n3.  To appreciate changes in the education programme following changes in the \nrole of the radiographers.\nPanel discussion: \nWhat are the challenges and barriers facing role extension? 17:14 \n16:00 - 17:30 Room F2 \nSpecial Focus Session \nSF 7b \nImaging and radiotherapy: all you need to know \nA-171 16:00\nChairman’s introduction \nV.J. Goh; London/UK (vicky.goh@kcl.ac.uk) \nIn this session, “Imaging and radiotherapy: all you need to know” the audi-\nence will have a comprehensive overview of the rationale for radiotherapy \nin cancer, current state-of-the-art planning and delivery of radiotherapy in \ncancer patients, and evaluation of the treatment response and radiotherapy \neffects. Following this session, the audience have insight into how develop-\nments in imaging may have contributed to improved outcomes in radiotherapy. \nSession Objectives:\n1.  To understand the principles of modern radiotherapy.\n2.  To learn how functional and metabolic imaging have been integrated into \nradiotherapy planning, adaptation and response evaluation.\n3.  To become familiar with imaging findings after radiotherapy.\n4.  To understand how imaging affects radiotherapy outcomes.\nAuthor Disclosure:\nV. J. Goh: Research/Grant Support; Siemens. \nA-172 16:05\nModern radiotherapy: what are the new technologies? \nV. Valentini; Rome/IT (vvalentini@rm.unicatt.it) \nModern radiation oncology offers to cancer patients a safe, organ sparing, cost-\neffective, well-validated treatment. Nowadays, radiation can be modulated in the \nfour dimensions of space and time, and the dose can be precisely defined to \nproduce a specified local effect of a given magnitude. The administration of non-\nuniform intensity-modulated radiotherapy (IMRT) to patients as a way to create a \nspecified, non-uniform absorbed dose distribution that provides better conformality \naround the tumours and increasing the amount of spared surrounding organs. \nThe optimal implementation of IMRT requires effective control of the tumour’s \nlocation as well as of the changes in tumour volume during the daily treatment. \nImage-guided radiation therapy (IGRT) aims at in-room imaging guiding the radia-\ntion delivery based on instant knowledge of the target location. The combination \nof diagnostic tools and radiation intensity modulated technology is providing new \ngeneration of hybrid machine, suitable to offer this new service. The effectiveness \nand convenience for the patient to practice high dose delivery in few fractions \nthrough stereotactic body radiotherapy (SBRT) implies optimal reduction of treat-\nment margins, practical implementation of sharp dose gradients and interactive \nadaptation of the treatment based on IGRT modalities. Its efficacy and feasibility \nenlarged the offer of SBRT to different clinical conditions, where small volumes \nhave to be treated in primary or also in oligometastatic setting. The conformality \nand reliability of dose delivery provided by new technology and imaging integration \npromoted new onset of clinical benefit and more affordability of cure to address \nthe aging of cancer patient population.\nLearning Objectives:\n1.  To become familiar with 3D  conformal radiotherapy and intensity modulated \nradiation therapy (IMRT) and intensity modulated radiosurgery (IMRS).\n2.  To learn about brachytherapy and intraoperative radiotherapy (IORT) and its \nindications.\n3.  To understand how IMRT contributes to better treatment outcomes as com-\npared with conventional radiotherapy.\n2\n\nPostgraduate Educational Programme\nS43\nB\n C D E F G\nA\nFriday\nremain useful both in the initial evaluation and in the follow -up of trauma to the \nurinary bladder and urethra.\nLearning Objectives:\n1.  To be able to identify patients requiring urgent cysto-urethrography.\n2.  To learn to identify bladder and urethral injury.\n3.  To learn the imaging techniques necessary for accurate initial evaluation of \nthe urethra in cases of complicated pelvic trauma.\nA-178 17:00\nC. Interventional radiology for GU trauma \nB. Peynircioglu; Ankara/TR (borapeynir@gmail.com) \nGU trauma can easily being missed when associated with other abdominal/pelvic \ninjuries.The type/mechanism of the trauma is the key for both imaging and treat-\nment. Iatrogenic injuries of the GU tract are getting more and more common as a \nresult of increasing numbers of percutaneous procedures (e.g. nephrolithotomies, \nbiopsies). In general, renals are the most common injured part of the tract, however, \nby increasing numbers of renal transplantation, ureteral injuries are now common as \nwell. Timing of the intervention is as important as taking the decision of percutaneous \napproach for optimal management of injury. Multiphasic CT imaging with contrast \ninjection via both IV line and trans-urethral catheter (if possible) can demonstrate \nmost of the injured sites with high sensitivity. CT is also useful in predicting which \nhemodynamically stable patients may benefit from percutaneous (non-operative) \nmanagement. Vascular injury of the GU tract almost always involves renals, and \nbleeding and/or ischaemia is the problem. Unless the patient is at unresponsive \nhaemodynamic shock, or has complete vascular avulsion, endovascular treatment \nmay always be the choice.The American Association for the Surgery of Trauma‘s \nsystem for grading injury to the kidney is also helpful in making a decision whether \nsurgical or endovascular intervention. Embolisation of a bleeding artery/pseudoan-\neurysm or stenting of an intimal dissection are the most common cases. Although the \nvascular injuries of the GU results with retroperitoneal hemorrhages, non-vascular \ninjuries leading urine leaks may present with intra or extra-peritoneal urinomas. \nNon-vascular percutaneous intervention may be applied to urinoma, urine leak, \nureteral laceration and transection injuries. These interventions include percutane-\nous nephrostomy for urine diversion, ureteral stent placement for ureteral injuries, \nand drainage tube placement for urinoma formation.\nLearning Objectives:\n1.  To be able to determine which cases deserve management by interventional \nradiology.\n2.  To understand the techniques to manage fistulas and ruptures of the ureter \nand urethra.\n3.  To appreciate the vascular and non-vascular interventional techniques in kidney \ntrauma.\n16:00 - 17:30 Room I/K \nJoint Course of ESR and RSNA (Radiological Society of North \nAmerica) \nMC 728 \nEssentials in oncologic imaging: what radiologists \nneed to know (part 4) \nModerator: \nM.F. Reiser; Munich/DE \nA-179 16:00\nA. Lymphoma \nH. Schoder; New York, NY/US \nThis presentation will emphasize the important contributions of FDG PET imaging \nin staging and management of lymphoma, with particular emphasis on response \nassessment and response adapted therapy. The role of surveillance imaging, imag-\ning in the setting of stem cell transplant, as well as the potential utility of alternate \nradiotracers and DWI will also be discussed briefly. \nLearning Objectives:\n1.  To get a practical, clinically relevant summary of key imaging issues in Hodgkin \nand non-Hodgkin lymphoma.\n2.  To learn how imaging, especially PET and PET-CT can optimally assess and \nmeasure tumour treatment response, providing a value-added radiology report.\nLearning Objectives:\n1.  To learn about the range of MR imaging biomarkers that can be used for \nmarkers of tumour microenvironment and heterogeneity.\n2.  To understand the role and accuracy of diffusion and perfusion (MR) imaging \nfor evaluation of response during and after radiotherapy.\n3.  To become familiar with the MR imaging findings after radiotherapy and un-\nderstand the pitfalls and interpretation difficulties.\nPanel discussion: \nHow can imaging improve outcomes in radiotherapy? 17:17 \n16:00 - 17:30 Room G/H \nGenitourinary \nRC 707 \nDiagnosis and management of GU tract trauma \nModerator: \nA. Magnusson;  Uppsala/SE \nA-176 16:00\nA. Imaging the kidney and ureter \nM.-F. Bellin; Le Kremlin‑Bicêtre/FR (marie‑france.bellin@bct.aphp.fr) \nUrinary tract injuries occur in approximately 10% of all abdominal trauma patients, \nthe kidney being the most commonly injured organ. The spectrum of renal injuries \nranges from minor trauma requiring no treatment to major life-threatening renal inju-\nries that require surgical intervention. There is a growing trend toward conservative \nmanagement of renal trauma. To help predict the outcome and to guide manage-\nment of renal trauma, the American Association for Surgery of Trauma has created \na renal injury grading system, which is based on the appearance of the kidney at \nsurgery. Indications for renal imaging include: penetrating trauma and haematuria; \nblunt trauma, shock, and haematuria; and gross haematuria. Contrast-enhanced \nMDCT is currently the test of choice for assessing renal injury, since it provides, \nwith short examination times, both anatomic and functional data. It is helpful to \nassess the type and extent of parenchymal injuries. It can help in detecting active \nextravasation of contrast and is of great help in guiding transcatheter embolisation. \nIt may demonstrate vascular injuries including dissection, thrombosis, laceration, \npseudoaneurysm, or arteriovenous fistula. It may also show urine leakage, pre-\nexisting abnormalities with increased risk of injury from blunt trauma, and associ-\nated abdominal and retroperitoneal injuries. The volumetric data acquired can be \nused to obtain high-resolution MPR, MIP, and 3D images that help display complex \ninjuries. The wide availability of MDCT in major trauma patients has reduced the \nuse of other imaging modalities: IVU in unstable patients already in the operative \nroom, and ultrasonography. \nLearning Objectives:\n1.  To learn the indications, advantages and disadvantages of imaging modalities \nafter trauma.\n2.  To learn the appropriate diagnostic imaging studies and imaging findings of \ndifferent types of trauma.\n3.  To be able to identify a kidney that is in danger after trauma.\nA-177 16:30\nB. Imaging the bladder and urethra \nU.G. Mueller-Lisse; Munich/DE \nTrauma to the bladder and urethra may be caused by blunt force or by penetrat-\ning objects in the course of accidents, or by invasive surgical measures, such as \ncatheterization, prostatectomy, sling operations for urinary obstruction or urinary \ncontinence or by foreign bodies introduced into the urethra. Diagnostic clarification \nof the exact location and nature of urethral injury requires high-quality imaging \nstudies. In patients who have suffered either blunt or penetrating abdominal or \npelvic trauma, or polytrauma, multiorgan injury is common and frequently involves \nthe genitourinary tract. Contrast-enhanced CT is currently considered to be the \nprimary imaging technique to evaluate trauma patients. In trauma affecting the \npelvis, urethral injury is a common complication which may lead to significant long-\nterm morbidity if remaining undiagnosed. The posterior urethra, which is close to \nthe pubic rami and the puboprostatic ligaments, is particularly vulnerable in pelvic \ntrauma. Certain types of pelvic fractures are associated with an increased risk of \nurethral injury, such that timely radiologic recognition facilitates the early diagnosis \nof urethral injury and ensures that serious long-term sequelae are minimized. Ure-\nthral injury may be better assessed and classified by means of urethrography than \nby CT. Thus, the traditional imaging modalities of RUG, VCUG, and cystography \n\nPostgraduate Educational Programme\nS4\n C B D E F\n G\nA\n16:00 - 17:30 Room L/M \nOrgans from A to Z: Heart \nMC 722 \nIschaemic heart disease \nModerator: \nC. Catalano; Rome/IT \nA-182 16:00\nA. Imaging of the coronary arteries: the Holy Grail \nG. Roditi; Glasgow/UK (Giles.Roditi@ggc.scot.nhs.uk) \nSmall critical structures in the human body require high spatial resolution imag-\ning. Coronary artery disease carries a high disease burden regarding morbidity \nand mortality. The coronary arteries are not only small but also move rapidly and \nin a complex manner predicated on movements of the beating heart with super-\nimposed asynchronous respiratory motion. Conventional angiography has high \ntemporal fidelity and spatial resolution, however, this lumenogram does not fully \nevaluate coronary disease, a process affecting the vessel wall. The non-invasive \nacquisition of three-dimensional data combining high spatial and temporal resolu-\ntion for coronary visualisation has proven challenging, hence the description as \nthe ‘Holy Grail’. The Holy Grail was sought not as an object but for what it could \ndo. In similar fashion not only are the heart and related great vessels now reliably \nimaged in unprecedented detail but the heart can be reincorporated into a holistic \nevaluation of the whole patient and the advances in technology allowing coronary \nCT to enter clinical routine have benefited many other CT techniques. Advances \nin temporal resolution, broad detector arrays and dual energy imaging spurred by \ncardiac CT have expanded the opportunities in other areas such as whole organ \nCT perfusion. Perhaps more importantly the high radiation doses delivered by the \ninitial schema for cardiac CT have led to development of dose reduction techniques \nwith profound benefits in all CT applications as the risk:benefit changes compared \nto plain film radiography become compelling to allow CT as a first line modality \nin many situations.\nLearning Objectives:\n1.  To learn about the meaning of CT coronary calcium screening for risk assess-\nment.\n2.  To identify suitable modalities and challenges for non-invasive coronary an-\ngiography.\n3.  To understand the potential of coronary plaque imaging beyond calcium.\nAuthor Disclosure:\nG. Roditi: Advisory Board; Bayer Advisory Board member 2012. Consultant; \npast consulting for Toshiba Medical Visualisation Systems Europe. Speaker; \nIn the past 5 years I have undertaken speaking engagements for the following: \nBayer, Bracco, Guerbet, GE Healthcare & Toshiba Medical Systems. \nA-183 16:20\nB. The ischaemic myocardium: what to do? \nC. Loewe; Vienna/AT (christian.loewe@meduniwien.ac.at) \nIn case of ischaemic heart disease, the assessment of myocardial viability is crucial \nfor treatment decision making. Simply, patients with viable tissue left will improve \nby revascularization therapy, whereas treatment of non-viable tissue by revascu-\nlarization could be fatal. Assessment of myocardial viability by imaging is dedicated \nto and follows different distinct pathophysiological mechanisms. It includes the \nassessment of regional wall motion abnormalities, regional perfusion deficits, \nabnormal metabolism or the direct demonstration of myocardial scars. Different \nmethods have been established so far for demonstration of the different abnormali-\nties including SPECT (perfusion), PET (metabolism), PET/CT (metabolism) and \ncardiac MR (perfusion, function, scar). Recently, even cardiac CT was introduced \nas comparative method for the assessment of myocardial viability and function of \nischaemic myocardium combined with the possibility of direct demonstration of the \ncoronary pathologies. Given the number of different modalities and their different \napproaches, knowledge about the specific strengths of each method is crucial for \nadequate management of patients with ischaemic heart disease. In this presen-\ntation, the importance of careful assessment of myocardium in ischaemic heart \ndisease for adequate treatment decision making and planning will be underlined. \nThe different methods with their different approaches to myocardial assessment \nshould be presented together with possible advantages and disadvantages. Based \non this, potential imaging algorithm will be proposed. In addition, possibilities of \ncareful assessment of contractile reserve will be presented. Finally, therapeutic \nconsequences of different imaging results will be demonstrated based on clinical \ncases, and the most important differentials should be shown.\nA-180 16:30\nB. Musculoskeletal neoplasms \nM.F. Reiser; Munich/DE \nDiagnosis, staging and follow-up of musculoskeletal tumours are most important \nfor selection of adequate therapeutic measures and prognosis of patients. Modern \nimaging technologies have greatly contributed to improvement. With modern MRI \nsystems high contrast of neoplastic tissue versus normal uninvolved structures is \nachieved. This allows for adequate delineation of intraosseous and soft tissue ex-\ntension and thereby facilitating high precision in staging. Compartmental infiltration \nis readily detected. Dynamic, contrast-enhanced studies allow for assessment of \nvascularity and perfusion, which provides valuable information concerning malig-\nnancy and benign character of a particular tumour. With diffusion-weighted imaging \nand diffusion-tensor imaging, microstructural information can be obtained, which \ncorrelates with response to chemotherapy and viability of the tissue. Malignant \nbone tumours may spread within the bone or to distant organs. Therefore, whole \nbody imaging modalities hold great potential for comprehensive assessment. In \ncomputer tomography, major advances have been achieved recently. The combina-\ntion of CT and PET in hybrid systems allows to assess function and morphology \nwithin one session. With FDG-PET, the metabolic activity of a particular lesion can \nbe analyzed. The standard uptake value (SUV) can be utilised for differentiation \nof benign malignant lesions. However, there are various benign lesions, such as \nNOF, fibrous dysplasia, eosinophilic granuloma and aneuysmal bone cysts as well \nas inflammation and infection. False-negative results in FDG-PET may be found in \nlow-grade chondrosarcoma, multiple myeloma, low-grade osteosarcoma, Ewing’s \nsarcoma and low-grade soft tissue sarcomas. \nLearning Objectives:\n1.  To become familiar with the imaging modalities which enable to detect and \ndifferentiate benign and malignant bone neoplasms.\n2.  To consolidate knowledge of radiographic, CT and MRI findings which enable \nto classify and stage bone tumours.\n3.  To understand the potential role of PET-CT and whole body MRI.\n4.  To learn the signs indicative of favourable and poor response to preoperative \nchemotherapy and for recurrence of malignant bone tumours.\nA-181 16:55\nC. Chemo- and radiation therapy-induced toxicity \nH.-U. Kauczor; Heidelberg/DE (Hans‑Ulrich.Kauczor@med.uni‑heidelberg.de) \nMultimodal cancer therapy, including chemotherapy, biologicals and radiotherapy, is \nfrequently associated with adverse toxic effects. Depending on the specific agent, \ndifferent organs, such as brain, lung, liver, bowel, bone, heart might be affected. \n„Inflammatory“ reactions will occur. These will be detected on imaging as white \nmatter lesions in the brain, reticular changes and consolidations in the lung (fibrosis, \ncryptogenic organizing pneumonia), diffuse liver disease, colitis, bone necrosis, or \ncardiomyopathy. These direct toxic effects have to be differentiated from infectious \ncomplications due to chemotherapy-induced neutropenia. These infections mainly \naffect the lung and are caused by fungi or viruses. Angioinvasive aspergillosis of \nthe lung is the most frequent, but sinusitis, abscesses in brain and liver as well as \nsepsis with haematogeneous foci are also encountered. Toxic effects of radiotherapy \nwill mainly occur within the planned target volume and result from application of \nhigh doses to radiosensitive normal tissue leading to inflammation, fibrosis and \nnecrosis. As imaging is routinely performed for therapy response monitoring or \nsurveillance in patients suffering from cancer, toxic effects have to be differentiated \nfrom infectious complications, postsurgical or postradiation scar tissue or tumour \nrecurrence. Specific patterns of toxic effects of cancer therapy in brain, lung, liver, \npelvis and their differential diagnoses will be reviewed.\nLearning Objectives:\n1.  To get an overview of organ-specific toxicity and other adverse effects of \nchemo- and radiotherapy.\n2.  To review the key imaging findings of therapy-induced organ toxicity and \nadverse effects.\n3.  To understand how to differentiate inflammatory, infectious, fibrotic, and necrotic \nchanges from tumour recurrence.\nAuthor Disclosure:\nH. -U. Kauczor: Advisory Board; Siemens. Investigator; Boehringer Ingelheim. \nSpeaker; Siemens, Boehringer, Bayer, Bracco. \nQuestions 17:20 \n4\n\nPostgraduate Educational Programme\nS\nB\n C D E F G\nA\nFriday\nB, solitary HCC or up to 3 nodules < 3 cm in size) HCC. The best outcomes have \nbeen reported in Child-Pugh a patients with small single tumour, commonly less \nthan 2 cm in diameter. When the patient is considered inoperable, RFA can be \nindicated also in huge tumours, even in combination with other procedures. After \ncorrectly indicated and performed RFA, we can expect a 5-year survival in 40 - \n70% and curative treatments in 30% patients. RFA also plays an important role in \nthe multidisciplinary treatment of HCC. Substantial number of HCC patients has \nundergone TACE as the first-line treatment for tumour control and survival prolon-\ngation. TACE (transcatheter arterial chemoembolisation) is recommended as first \nline non-curative therapy for non-surgical patients with large-multifocal HCC who \ndo not have vascular invasion or extrahepatic spread. The choice of the treatment \nmodality depends on the size and the number of tumours, the stage and the cause \nof cirrhosis and finally on the availability of various modalities in each centre.\nA-187 16:05\nA. RF ablation \nJ. del Cura; Bilbao/ES (joseluis.delcurarodriguez@osakidetza.net) \nRF ablation is currently indicated in HCC as curative treatment in Child-Pugh A-B \npatients with: single < 2 cm nodule and not candidates for transplation, 1-3 nod-\nules < 3 cm and not candidates for resection or transplantation. RF can be also \nperformed in patients waiting for liver transplantation. Some studies suggest that \nsurvival does not differ between RF ablation and resection in 5 cm because of the \nhigh possibility of recurrence. Different types of electrodes can be used: internally \ncooled, cluster, expandable, with saline instillation. Although results can be good \nwith any of them, every type of device requires a different technique of ablation. \nObtaining a margin of at least 0.5  cm of ablated tissue around the tumour is key \nto avoid recurrences. Combined treatments like combining chemoembolisation \nor PEI with RFA can be useful to increase the ablation volume. Published data \nshow a pooled 5-year survival of 48-55%, with better outcomes in Child-Pugh A \npatients. In candidates for surgery, 5-year survival is similar to resection: 76%. \nRFA is safe: major complications appear in 10% and reported mortality is 0.15%. \nTumours located subcapsular or near major vessels, biliary tree or bowel are more \nprone to complications. Laparoscopic ablation can be an alternative in these cases. \nImaging follow-up with CT, MRI or CEUS is performed to assess the outcome and \ndetect recurrences, new lesions or complications. Although not well established, \nmost protocols include an immediate post-procedure imaging, 1-month follow-up \nand explorations every 3 or 6 months for 2-3 years.\nLearning Objectives:\n1.  To understand the indications for RF ablation.\n2.  To learn about the technique and devices for RF ablation.\n3.  To learn about results, complications and follow-up strategies.\nA-188 16:28\nB. Intra-arterial procedures \nF. Orsi; Milan/IT (franco.orsi@ieo.it) \nLiver resection and ablation are the standard of care for early stage HCC, but \nmajority of patients are not candidate because of a more advanced stage. Several \nintra-arterial procedures are now available for treating advanced HCC.There is no \nconsensus on the best intra-arterial local therapy; however, it represents a great \nrationale of care, based upon the premise that HCC is almost exclusively supplied \nby arteries. Embolisation, chemoembolisation and radioembolisation are some of \nthe local treatments for advanced HCC and several embolics were developed for \nthat purpose. Both TACE and TAE may shut-down the arterial blood flow, leading \nfor tumour ischaemia and tumour cell death. Association of local chemotherapy \nto the embolic effect represents the rationale for TACE. For this purpose, new \nembolic particles, which may precisely elute drugs, were introduced (Drug Eluting \nBeads). For radioembolisation, micro-particles are injected into the feeding arteries \nas vehicles for delivering interstitial sources of radiation. When disease is widely \nspread into the liver, a whole hepatic liver distribution of antiblastic drug may be \nindicated. It may be obtained with intrarterial chemotherapy or with the newer \ntechnique, called percutaneous liver chemoperfusion. Because hepatic tumours \nare supplied by several feeders, complete tumour death may be obtained only if the \nentire vascular network is treated. If small feeding arteries are be missed, tumour \nwill be not completely treated and it will relapse. For this reason, the knowledge of \nvascular abnormalities is mandatory for a better outcome.\nLearning Objectives:\n1.  To become familiar with the indications for intra-arterial treatment of HCC.\n2.  To learn the techniques of intra-arterial treatment.\n3.  To learn about results, complications and follow-up strategies.\nAuthor Disclosure:\nF. Orsi: Research/Grant Support; CELONOVA. Other; PROCTOR FOR \nDELCATH SYSTEM. \nLearning Objectives:\n1.  To learn how to evaluate the function of the ischaemic myocardium.\n2.  To identify methods of assessing the viability of the ischaemic myocardium.\n3.  To get an overview of the therapeutic consequences depending on imaging \nfindings.\nAuthor Disclosure:\nC. Loewe: Board Member; member of the steering committee B;S (Apixaban \nstudies). Investigator; investigator for different multicenter trials sponsored by \nBayer, Guerbet, BMS, GE HEalthcare. Speaker; speaker for Siemens, Bracco, \nGE Healthcare, Bayer, Guerbet, Covidien. \nA-184 16:40\nC. The ischaemic heart after treatment: still alive? \nG. Bastarrika; T oronto, ON/CA (bastarrika@unav.es) \nNon-invasive cardiac imaging modalities have shown to possess diagnostic and \nprognostic value in patients with coronary artery disease. Moreover, non-invasive \nimaging-guided therapy has gained significant importance in the last decades. In \nparticular, computed tomography (CT) and cardiac magnetic resonance (CMR) \nimaging have emerged as primary imaging modalities useful to evaluate the status \nof coronary vasculature and myocardium before and after coronary artery revascu-\nlarization. CT is particularly helpful to assess patency/stenosis of coronary artery \nbypass grafts or stents, to detect atherosclerosis progression in non-revascularized \nvessels and to plan new interventions. CMR is exceptionally effective in risk \nstratification after coronary revascularization, differentiating angina and non-cardiac \nchest pain, assessing periintervention myocardial damage and determining long \nterm prognosis. Therefore, the assessment of the ischaemic heart after treatment \nmay benefit from both, anatomical and functional imaging modalities. Appropri-\nate knowledge of the added clinical value of each imaging modality will enable \nto choose the more adequate diagnostic test for a given patient. This lecture will \nintroduce and enhance knowledge about how to analyse cardiac images following \nstent implantation and bypass grafting, will determine the appropriateness of CT \nafter coronary intervention and will introduce the value of MRI in the follow -up of \npatients undergoing coronary revascularization therapy. Importance of conventional \nas well as stress-based CMR protocols will be emphasized, within the context of \navailable state of the art non-invasive cardiac imaging modalities.\nLearning Objectives:\n1.  To learn how to analyse cardiac images following bypass grafting.\n2.  To understand the value of cardiac imaging after coronary interventions (PTA \nand stenting).\n3.  To assess potential therapeutic consequences.\nAuthor Disclosure:\nG. Bastarrika: Speaker; Bayer, General Electric, Medrad, Siemens. \nA-185 17:00\nInteractive case discussion \nC. Catalano; Rome/IT (Carlo.Catalano@uniroma1.it) \nDuring the presentation, cases on ischaemic heart disease will be shown in an \ninteractive fashion. Cases will be selected in order to strenghten the concept that \nthe speakers during the session have gone through. In particular, CT angiography \ncases of coronary arteries will be shown as well as examples on the ischaemic \nmyocardium providing morphological and functional information. Eventually, \ncases of the ischaemic heart after treatment will also be shown, demonstrating \nthe importance of cardiac imaging, especially in the clinical suspect of recurrency.\n16:00 - 17:30 Room N/O \nInterventional Radiology \nRC 709 \nExpanding the role of interventional radiology in \nhepatocellular carcinoma \nA-186 16:00\nChairman’s introduction \nV. Válek; Brno/CZ (vlvalek@med.muni.cz) \nPoor prognosis of HCC has shown some improvement during the last years. \nTargeted therapy with radiofrequency ablation (RFA) and transcatheter arterial \nchemoembolisation (TACE) seems to have an influence on this development. \nRFA is recommended as a technique for the treatment of early stage (Child A or \n54\n\nPostgraduate Educational Programme\nS4\n C B D E F\n G\nA\nLearning Objectives:\n1.  To understand the background to the publication of RP 159  along with \nits purpose and scope.\n2.  To become familiar with the principles and prerequisites of clinical audit as \noutlined by RP 159.\n3.  To become familiar with the relationship between clinical audit and regulatory \ncontrols.\n4.  To gain an insight into potential national, regional and international issues \nassociated with clinical audit.\nAuthor Disclosure:\nP. Wood: Advisory Board; European Commission project 2007-2008 Contract \nN TREN/07/NUCL/S07. 71512, Panel of Experts Member. CEO; Society of \nRadiographers in Finland. Consultant; Qulitor Ltd, clinical audits. \nA-191 16:30\nB. Implementation in practice: a comparison of different models \nS. Geers-van Gemeren; Utrecht/NL (s.geers@nvmbr.nl) \nThe Dutch Society of Medical Imaging and Radiotherapy (NVMBR) has implement-\ned clinical audit in 1999 for the fields radiology, nuclear medicine and radiotherapy. \nIn the Netherlands, clinical audit is since 2010 obligatory for healthcare professions, \nregulated by law, to be able to practice. With clinical audit the quality of the provi-\nsion of care by professionals is assessed by peers. In 1999, the NVMBR started \nwith clinical audit. The NVMBR audit radiographers working in the Radiology and \nNuclear Medicine departments every five years on request. For the radiotherapy, \na multidisciplinary audit is developed since 2003. Pilots of multidisciplinary audits \nhave been performed for radiology in 2004 and for nuclear medicine in 2010 and \n2012. The evaluation of the pilots shows a benefit for the department and for the \nprofessional groups. Implementation: in 2008, the NVMBR started with a web-\nbased tool ADAS (General Digital Audit System) to support the audit. The use of \nADAS is evaluated amogst the members of the audit team and the departments. \nThe development of professional standards is a prerequisite to start clinical audit. \nThe use of ADAS in multidisciplinary audits is a requirement to be able to audit \ndifferent professions and focus on the content and the quality of their contribution \nto patient care. Clinical audit is a good tool to improve the quality of patient care. \nImportant are the professional standards, the culture of learning and willing to \nimprove by the professionals. „Every defect is a treasure“. \nLearning Objectives:\n1.  To understand the key components required to allow clinical audit to be imple-\nmented in practice.\n2.  To gain an insight into different implementation models.\n3.  To be informed about the key considerations that must be made prior to \nimplementing an audit model: organisation, auditors, process, financing, the \nroles of professional bodies, and outcomes.\nA-192 17:00\nC. A perspective on the impact and benefits of clinical audit \nS. O’Connor; Dublin/IE (s.oconnor@globaldiagnostics.ie) \nThe purpose of this lecture is to demonstrate how systematic clinical audit can be \nembedded in a radiology department and to provide practical insight and advice \non audit selection and implementation and how to achieve critical buy in from a \nmulti-disciplinary team to ensure that clinical audit remains an integral and self-\nsustaining component of a modern radiology service. The importance of appropriate \nresources and training will be discussed in tandem with review of current literature \nand guidelines available in this field. The findings, actions and outcomes will be \nevaluated to demonstrate the tangible and beneficial impact audits can have on \npatients, the team and the service delivery. Clinical Audit remains one of most \nimportant ways we have to ensure the quality of the service we provide. When \nimplemented properly, it will result in an effective and efficient quality-assured and \nsafe radiology service. The service must be delivered by a committed team of \ninformed clinicians and will underpin an optimised patient journey.\nLearning Objectives:\n1.  To gain an insight into the use of clinical audit from the perspective of a clinical \naudit lead in an international diagnostic imaging service provider.\n2.  To become familiar with the challenges that may be encountered when un-\ndertaking clinical audit.\n3.  To understand the significant impact that clinical audit can have from the \nperspective of the patient, the healthcare team and on service delivery.\nA-189 16:51\nC. Portal vein embolisation before surgery \nA. Denys, P. Bize; Lausanne/CH (Alban.Denys@chuv.ch) \nPortal vein embolisation (PVE) is performed before hepatectomy. Portal branches \nof segments that will ultimately be resected are embolized. This embolisation \nproduces local per-portal inflammation and reroutes the portal flow towards seg-\nments that will be left in place by the surgeon inducing liver regeneration of these \nsegments. Indications are mainly hepatectomies removing more than 70-80% of \nthe functional liver in healthy liver of more than 50-60% when the liver has been \nharmed either by a chronic liver disease or cirrhosis or by chemotherapy or steatosis. \nThe procedure is done percutaneously and different embolic agents can be used \nfor PVE, such as embolic particles, coils and plugs. Results from experimental \nworks suggest that PVE is more efficient when embolic agent occludes small \nportal branches and produces significant periportal inflammation. PVE indications \nas well as results are evaluated by CT volumetry of the liver either manually or \nautomatized by dedicated algorithms.\nLearning Objectives:\n1.  To become familiar with imaging strategies and indications for embolisation.\n2.  To understand embolisation methods.\n3.  To learn about results, complications and follow-up strategies.\nAuthor Disclosure:\nA. Denys: Advisory Board; Bayer. Grant Recipient; Biocompatibles, Cook, \nTerumo. P. Bize: Advisory Board; Bayer. Grant Recipient; Biocompatibles, Cook, \nTerumo. \nPanel discussion:  \nHow to allow for more patients with HCC to be treated?  17:14\n16:00 - 17:30 Room P \nRadiographers \nRC 714 \nClinical audit: from EURATOM to the clinical \nenvironment \nModerators: \nE.J. Adam; London/UK \nD. Pronk‑Larive; Middelburg/NL \nA-190 16:00\nA. Clinical audit: from the EURATOM treaty to EU guidelines: clinical \naudit RP 159 \nP. Wood; Helsinki/FI (paivi.wood@suomenrontgenhoitajaliitto.fi) \nThe EC directive 97/43/EURATOM introduced the concept of Clinical Audit for \nthe assessment of radiological practices. The Member States were required to \nimplement clinical audits in accordance with national procedures. This concept \nis of high importance for the improvement of the quality of imaging practices. \nIn the past years, the implementation of clinical audits has been commenced in \na number of varying “national procedures”. Need for guidance was obvious to \nachieve meaningful results. In 2007-2008, the EC conducted a project to prepare \nguidance on clinical audit. The purpose of the project was to provide clear and \ncomprehensive information on existing procedures and criteria for clinical audits \nin radiological practices. The final European Guidelines were published in June \n2009. The EC guideline is to provide guidance on clinical auditing in order to \nimprove implementation of Article 6.4 of Council Directive 97/43/ EURATOM. The \nguideline provides comprehensive information on existing procedures and criteria \nfor clinical audit in radiological practices: diagnostic radiology, nuclear medicine \nand radiotherapy. Clinical audit is not research, quality system audits nor regulatory \ninspections and it is systematic and planned activity. Clinical audit is a systematic \nreview of medical radiological procedures which seeks to improve the quality and \nthe outcome of patient care through structured review. Clinical audit should be a \nmulti-disciplinary, multi-professional activity. Follow general accepted rules and \nstandards which are based on international, national or local legal regulations, \nor on guidelines developed by international, national or local medical and clinical \nprofessional societies.\n6\n\nPostgraduate Educational Programme\nS4\nB\n C D E F G\nA\nFriday\nsecond focus will be to outline key features helpful for differential diagnosis because \nCT of the lung - similarly as radiography - frequently suffers from the fact that the \npattern of lung reaction to inflammatory/infectious noxa is quite nonspecific. Taking \nthese two goals into consideration, the following four pathologic situations will be \ndiscussed: pneumonia and complications, ARDS staging and signs of barotrauma, \noedema and its differentialdiagnosis, and post-surgical conditions: normal versus \npathologic findings.\nLearning Objectives:\n1.  To understand the spectrum of pathological lung conditions, which complicate \nintensive care treatment.\n2.  To learn about the role of diagnostic imaging and its technical difficulties and \nrequirements in the intensive care environment.\n3.  To become familiar with the most important imaging signs and symptoms of \ntracheobronchial and lung conditions, influencing the treatment and survival \nof the intensive care patient.\nA-196 16:41\nPoint-of-care versus diagnostic ultrasound in the intensive care unit \nE. Danse, P.-F. Laterre, L. Jacquet, A. Dragean, I. Nica, P. Trefois, L. Annet; \nBrussels/BE (etienne.danse@uclouvain.be) \nThis topic will be focused on the role of sonography in the critical care. Point care \nsonography is mainly dedicated to procedural guidance (vessels access or fluid \npunction) or assessement of fluid in the pleural space or the abdominal cavity (for \ninstance, FAST sonography in trauma patients). This “ultrasonic” stethoscope is \nmore and more popular due to its miniaturisation at low cost. Diagnostic sonography \nhas another medical scope based on the imaging knowledge of radiologists and on \nthe capabilities of mid-range or high-level machines. The B mode and Color Doppler \nmodalities are routinely used with additional contribution of contrast ultrasound when \nneeded or available. In the intensive care unit, point care or diagnostic sonography \nare contributive for the diagnosis work-up of critical care patients, allowing an \noptimal use of CT and angiography or an urgent access to the operating room.\nLearning Objectives:\n1.  To understand the concept and role of point-of-care ultrasound and its technical \nand training requirements.\n2.  To become familiar with the role and tasks of diagnostic ultrasound versus \npoint-of-care ultrasound in the most common pathologic conditions in intensive \ncare.\n3.  To learn more about typical ultrasound findings and their significance in the \ndiagnosis, differential diagnosis and therapy of intensive care patients.\nA-197 16:59\nImaging in polytrauma \nU. Linsenmaier; Munich/DE (Ulrich.Linsenmaier@kliniken‑pasing‑perlach.de) \nManagement of patients after polytrauma on IC units can be complex and de-\nmanding. Clinical diagnoses relay today on a thorough diagnostic workup which \nis mostly based on a standardised whole body CT (WBCT). ICU patients undergo \nfollow-up MDCT to control findings (e.g.in non-operative treatment), new clinical \nCT indications arise, CT is often combined with bedside US and CR. Radiological \nManagement of patients with polytrauma: imaging protocol for the initial workup: \nWBCT comprises nCCT, CMCT of thorax, neck and c-spine (arterial) and (pv) ab-\ndomen. CRs were mostly replaced, US is only used as FAST (focused abdominal \nsolography in trauma). WBCT can be modified by CTA (@35-45s; for e.g. extremity \ninjuries), late CT scans (@120s; e.g. for bleeding dynamics, pseudoaneurysms) \nand delayed CT urography (CTU @ 400-500s, for pelvic and GU injuries) and also \nretrograde CT cystography. CT scout views and clinical findings determine the \nextent. Follow-up imaging of ICU patients after polytrauma: comprise dedicated \nMDCT, US and CR, secondary imaging procedures are MR, MRA (indicated only \nin stable patients) and DSA (e.g. for interventional procedures). Findings from initial \nWBCT determine how to proceed in a “first things first” priority-oriented clinical \nalgorithm. Special considerations apply in imaging MOF, shock, brain oedema and \nin paediatric and pregnant polytrauma. Radiological findings must be discussed in \nthe clinical context. Treatment is priority oriented and carefully planned in the context \nof possible concomitant injuries, and the possible risk of multi-organ failure (MOF).\nLearning Objectives:\n1.  To appreciate the clinical significance of conditions characterised by multiple \nsevere injuries and their systemic and multi-organ complications.\n2.  To explain the special role of imaging, the diagnostic algorithm and the techni-\ncal, organisational and training requirements for the diagnosis and follow-up \nof polytrauma patients.\n3.  To consolidate knowledge of imaging signs and symptoms and their diagnostic \nvalue in patients with polytrauma.\n16:00 - 17:30 Room Q \nSpecial Focus Session \nSF 7c \nImaging in intensive care patients \nA-193 16:00\nChairman’s introduction \nA. Palkó; Szeged/HU (palkoand@gmail.com) \nIntensive care units are special places where everything happens very fast and \nmost decisions taken are influencing not only the healing but also the survival \nof the patient; while the amount of available information supporting these deci-\nsions is frequently rather limited. Results of imaging examinations are therefore \nof very high importance, however, the extraordinary circumstances both in terms \nof technical conditions and in state of the patients challenge the expertise of \nthe radiology department. Radiologists cooperating with intensive care special-\nists must understand the unique constraints in this environment and be aware \nof the clinical significance of their reports. Imaging diagnostic algorithms and \nexamination techniques are to be flexibly adapted to the clinical situation and a \nfast and close communication of and consultation about the imaging findings is \na basic requirement. Speakers of this session will address these general topics \nthrough the most challenging specific areas of imaging the intensive care patients. \nSession Objectives:\n1.  To understand the importance of imaging diagnostics in the unique and chal-\nlenging clinical setting of the intensive care units.\n2.  To learn about the technical and methodological considerations to be taken \ninto account with this patient group.\n3.  To learn more about the most important conditions and the imaging findings \nas well as the diagnostic imaging algorithms to be used in the intensive care \nenvironment.\nAuthor Disclosure:\nA. Palkó: Advisory Board; Euromedic Intl. Consultant; Covidien. \nA-194 16:05\nValue of MRI for intensive care coma patients with unclear brain pathology \nP.C. Maly Sundgren; Lund/SE (Pia.Sundgren@med.lu.se) \nEvaluation of the degree of severity of injury, coma duration, and prediction of \noutcome are integral parts of the management of patients in coma at the intensive \ncare unit. Advanced magnetic resonance imaging techniques with special focus \non MR spectroscopy (MRS) and diffusion (DWI) but also of the cerebral vascular-\nity in form of different perfusion measurements have shown to be a valuable tool \nin the work-up or both patients with known as well as unknown cause for coma. \nThe causes for coma are many including infections, metabolic, traumatic and can \nalso be seen secondary to space occupying brain lesions. The present lecture will \nfocus the value of different MR imaging techniques and sequences in the work-up \nof possible cause, monitor treatment and predict outcome in coma patients at the \nintensive care unit.\nLearning Objectives:\n1.  To understand the importance of magnetic resonance imaging in cases of \nunclear brain pathology causing severe dysfunction of the central nervous \nsystem.\n2.  To understand the significance of imaging in the evaluation of brain function \nand potential outcome following anesthesia, injuries and hypoxia.\n3.  To become familiar with the imaging signs and their predictive value and ac-\ncuracy regarding brain death, and future role of imaging in decisions concerning \nthe termination of intensive treatment.\nAuthor Disclosure:\nP. C. Maly Sundgren: Board Member; ISMRM, ASNR. Consultant; ICON Medial \nImaging. \nA-195 16:23\nComputed tomography of pathologic lung conditions complicating \nintensive care treatment \nC.M. Schaefer-Prokop; Amersfoort/NL (cornelia.schaeferprokop@gmail.com) \nMethod of choice for imaging the lung of an intensive care patient is the bedside \nchest radiograph. CT is only done if complications are anticipated or radiographic \nfindings are equivocal. One focus of the presentation is, therefore, to outline which \ndiagnostic information is added by CT compared to the bedside radiograph. The \n7\n\nPostgraduate Educational Programme\nS\n C B D E F\n G\nA\nA-200 17:00\nC. Evaluation of malfunction \nR. Uberoi; Oxford/UK (raman.uberoi@orh.nhs.uk) \nThe incidence of end-stage renal disease is increasing, with limited availability of \ntransplants, hemodialysis accesses have become the most commonly performed \ntype of vascular surgical procedure.However, only 50% of all haemodialysis ac-\ncesses remain patent at 3 years and interventional radiology plays a major role in \nmaintaining function. Indications for intervention include failing haemodialysis graft \nor fistula, arm oedema, imaging findings indicative of a significant stentosis > 50% or \npresence of accessory veins. Clinical assessment alone will detect a large number \nof failing fistula's. If the venous pressures during haemodialysis exceed 120 mmHg, \nfistula flow falls to < 500 ml/min, graft flow decreases to < 650 ml/min, or access \nblood flow falls by more than 25%. There remains debate if prophylactive treatement \nof failing fisutlas results in better outocmes. Venous stenoses are characterised \nby extensive fibrosis and require ultra-high pressure balloon inflations or cutting \nballoon angioplasty for optimal treatment. Stenting provides no clear benefit over \nPTA alone and eliminates the option of using the stented vein for future surgical \nrevision. Stenting is genenerally reserved for sub-otpimal results with no convincing \nevidence currently to support using covered stentgrafts over bare nitinol stents. \nWhen critical flow reduction and clotting ensue, the bulk of the thrombus is red \nthrombus, which is rich in fibrin and red cells and easily extracted with aspiration, \nrheolytic methods or pulse-spray thrombolysis, but a platelet-rich white clot at the \narterial anastomosis may require mechanical removal with an angioplasty balloon \nor devices such as the Fogarty thrombectomy in 35% to 60%.\nLearning Objectives:\n1.  To understand the main indications and results of angioplasty.\n2.  To learn about thrombectomy and aspiration.\n3.  To become familiar with the indications for stenting.\nPanel discussion: \nWhat training and special skills are radiologists expected to have \nin order to work with intensive care units? How should we manage \nthe clinical and technical challenges posed by this very specific \nenvironment? 17:17 \n16:00 - 17:30 Room Z \nVascular \nRC 715 \nDialysis fistula \nModerator: \nH.A. Deutschmann;  Graz/AT \nA-198 16:00\nA. Preoperative mapping \nL. Turmel-Rodrigues; T ours/FR (luc.turmel@wanadoo.fr) \nNephrologists and surgeons are increasingly aware of the limitations of physical \nexamination as a tool to assess arterial and venous anatomy prior to creating a \nvascular access. Greater emphasis is now being placed upon more objective \nmethods. Arterial mapping is feasible almost exclusively by color duplex ultrasonog-\nraphy. Imaging of the veins is indicated if there are inadequate findings on physical \nexamination or whenever central vein stenosis is suspected. Iodinated contrast \nvenography and later carbon dioxide venography were the modalities of choice \nbefore the advent of ultrasonographic mapping in the 1990s. CT angiography and \nmagnetic resonance angiography play an equally shrinking role. Anatomic variability \nis a common feature of upper limb vasculature. The most common arterial variant \nis a high origin of the radial or ulnar artery at any level from the axillary artery to \nthe elbow. Despite having more anatomical variation than arteries, the cephalic \nand basilic veins are the predominantly seen veins in the forearm and upper arm \nof normal subjects. At the elbow, the accessory cephalic, main cephalic, median \ncubital, and forearm basilic veins converge to form a venous network in the shape of \ncapital “M”. Vessel size is usually underestimated since it is not always easy to tell \nfrom an image if a vein or artery is partially or completely spastic despite warming \nor use of vasodilators. There is a wide variation in practice as to what a surgeon \ndoes with a venous mapping report and the vascular access that is finally created.\nLearning Objectives:\n1.  To become familiar with the indications and techniques for pre-operative arterial \nvenous mapping.\n2.  To learn about the venous anatomy.\n3.  To become familiar with the potential pitfalls of preoperative mapping.\nA-199 16:30\nB. Screening for problems \nD. Vorwerk; Ingolstadt/DE (dierk.vorwerk@klinikum‑ingolstadt.de) \nDysfunction of dialysis fistulas and grafts is frequent and usually a stenotic process \nrepresents the underlying cause. While in grafts - in the absence of side branches - \nthis will result in complete thrombosis after reaching a critical stenosis in conjunction \nwith thrombophilic circumstances, in fistulas partial thrombosis is not rare leaving \nsome parts of the fistula patent. There is few scientific work about the value of \nregular screening programs in dialysis fistulas and grafts and most did not find in \nan improved patency after starting surveillance programs by ultrasound. However, \nreintervention is not a good marker for the success of a surveillance program as it \ncould be for the purpose of treatment of a stenotic leasion as well as for thrombosis. \nDefinitively reintervention for a restenosis is usually simple, quick, effective and \ninexpensive while treating a thrombosed fistula or graft is time-consuming, expen-\nsive and technically more challenging. Alternatively to ultrasound, measurement \nof recirculation is a less time-consuming method to detect dysfunction in addition \nto clinical exam and palpation.\nLearning Objectives:\n1.  To understand the spectrum of problems with dialysis fistula.\n2.  To learn about screening protocols and the results of screening.\n3.  To learn about the most common problems and how to detect them.\nAuthor Disclosure:\nD. Vorwerk: Consultant; Covidien, Cook, Bard,. Speaker; Cordis, Gore. \n48\n\nPostgraduate Educational Programme\nS\nB\n C D E F G\nA\nFriday\n49\n\nPostgraduate Educational Programme\nS5\n C B D E F\n G\nA0\n\nPostgraduate Educational Programme\nS5\nB\n C D E F G\nA\nSaturday, March 9\n1\n\nPostgraduate Educational Programme\nS5\n C B D E F\n G\nA\n08:30 - 10:00 Room B \nSpecial Focus Session \nSF 8a \nIs diagnostic catheter angiography still useful in \nneuroimaging? \nA-203 08:30\nChairman’s introduction \nM. Essig; Erlangen/DE (mediag@me.com) \nWith the rapid development of CT and MRI - angiography most diagnostic catheter \nangiographic studies have been replaced and conventional angiography has gained \nin the field of interventions. However, there are contraindications and limitations of \nthese non-invasive techniques for diagnostic work-up. In this Special Focus Session \n“Is diagnostic catheter angiography still useful in neuroimaging?”, the audience \nwill learn about the current indications of diagnostic catheter angio, its alternatives \nand the pro- and cons - both in three lectures and a panel discussion to follow. \nSession Objectives:\n1.  To become familiar with the current debate on the need for diagnostic catheter \nangio.\n2.  To learn about the pros and cons of diagnostic catheter angio.\n3.  To learn about the pros and cons of alternative non-invasive angiography \ntechniques.\nA-204 08:35\nWhat can we expect from vascular diagnostic procedures? \nR. Siemund; Lund/SE (roger.siemund@skane.se) \nDiagnostic vascular procedures are an important part in the primary work-up, \ntherapy planning and follow -up of many disease of the central nervous system. \nAssessment of the supraaortic vessels is obviously mandatory in case of intrac-\nranial bleeding and acute or sub-acute stroke. Even in many cases with unclear \nneurological disease or symptoms vascular assessment is unavoidable at certain \npoints during the diagnostic work-up in order to proof or to rule out, e.g. vasculitis \nor sinus thrombosis. For the referring clinicians and for the radiologist performing \nthese vascular procedures, it is crucial to choose the most appropriate modality in \neach case. This presentation will focus on the different diagnostic needs in certain \nclinical situations. Strategies to chose the optimal modality based on a trade off \nbetween diagnostic yield, patient risk and economic costs will be discussed. \nLearning Objectives:\n1.  To learn about the expectations from vascular diagnostic procedures in the \ndiagnostic work-up.\n2.  To become familiar with the expectations from vascular diagnostic procedures \nin therapy planning and therapeutic procedures.\n3.  To learn about the expectations from vascular diagnostic procedures in the \nfollow-up assessments.\nA-205 08:58\nCan non-invasive techniques as CTA and MRA replace catheter \nangio for diagnostic work-up? \nL. van den Hauwe, M. Voormolen, T. van der Zijden, R. Salgado, \nJ.W. Van Goethem, P.M. Parizel; Antwerp/BE (lucvdhauwe@mac.com) \nAlthough catheter angiography remains the gold standard for cerebrovascular \nimaging, in recent years, it has been replaced to some extent by less-invasive \ntechniques, such as CTA, MRA, and ultrasound. Some of these techniques allow \nfor cerebrovascular imaging without exposure to ionising radiation, and/or without \nrequiring an exogenous contrast agent that could cause nephrotoxicity, allergic \nreaction, or other adverse effects. Moreover, all of these techniques avoid the extra \ntime, expense, and possibility of complications that are associated with arterial cath-\neterization. Ongoing developments in CT- and MR-based angiography continue to \nimprove the effectiveness of these techniques, and to expand the clinical roles that \nthey can fulfill. Nowadays, these noninvasive techniques not only provide images \nwith high spatial resolution, but also offer time-resolved images, in which arterial \nand venous phases can be distinguished, and can provide selective visualisation \nof vessels supplied by a single supplying artery. This presentation will review the \nlatest developments in CT- and MR-based cerebral angiography, and illustrate the \nuse of these CT- and MR-techniques in the diagnosis of cerebral aneurysms and \nvascular malformations.\n08:30 - 10:00 Room A \nInteractive Teaching Session \nE³ 820a \nPitfalls in heart imaging \nA-201 08:30\nA. CT \nG. Bastarrika; T oronto, ON/CA (bastarrika@unav.es) \nCardiac CT is becoming the imaging modality of choice for an increasing number \nof clinical indications, not only to rule out coronary artery disease but also to \nevaluate cardiac morphology and function, and to determine patient outcome \nafter coronary artery revascularization. However, as with any other imaging tools, \nappropriate interpretation of cardiac CT examinations is required in order to asset \nthe clinical value of this newly established diagnostic imaging modality. This proc-\ness requires performance of thorough cardiac CT acquisition protocols, detailed \nknowledge of standard cardiac anatomic and physiologic terminology, as well as \nappropriate post-processing, reading, and reporting. In particular, radiologists \nneed to recognize and be aware of the imaging findings that may confound and \nmislead to interpretation errors. This lecture will summarize practical aspects of \npost-processing, reading and reporting non-invasive cardiac CT examinations. The \nvalue and limitations of every available CT post-processing technique including \ntwo-dimensional multiplanar reformations, curved multiplanar reformats, maximum \nintensity projection (MIP), and volume-rendered images will be explained. Hints \nto improve reading results by recognizing technical causes for various artifacts in \ncardiac CT will be elucidated and reading approaches to diminish false positives, \nfalse negatives and inaccuracies when assessing coronary artery stenosis will \nbe suggested. Finally, the essentials to achieve a comprehensive and structured \ncardiac CT report will be provided.\nLearning Objectives:\n1.  To learn about practical aspects of postprocessing, reading and reporting \nnon-invasive cardiac CT examinations.\n2.  To learn how to improve reading of results by recognising technical causes \nfor various artifacts in cardiac CT.\n3.  To become familiar with approaches to reducing false inaccuracies and mis-\ninterpretations when assessing coronary artery stenosis.\nAuthor Disclosure:\nG. Bastarrika: Speaker; Bayer, General Electric, Medrad, Siemens. \nA-202 09:15\nB. MRI \nM. Francone; Rome/IT (marco.francone@uniroma1.it) \nCardiac Magnetic Resonance (CMR) is a complex imaging technique due to the \nintrinsic anatomical and technical peculiarities of the exam. The first include the \nnon-orthogonal cardiac orientation within the chest cavity requiring dedicated \nacquisition planes, but also the complex respiratory and cardiac motion to which \nheart is subject and the ubiquitous presence of fat tissue surrounding the cavi-\nties which can be overcome respectively using a combination of ECG-gated and \nbreath hold sequences with additional utilisation of fat-suppression techniques. \nPotential additional anatomical pitfalls also include normal structures and variants \nlike the Moderator: band, papillary muscles and the presence of prominent crista \nterminalis or myocardial trabeculations which recognition is mandatory and may \nmimic in some cases a pathological condition. Technical issues of CMR concerns \nthe continuous intracavitary inflow of protons and the associated “slow-flow” artifacts \n(limiting visualisation of endomyocardial border in some cases), pitfalls related to \nECG gating like inadequate synchronization or the T-Wave Swell phenomenon and \nfinally a series of specific artifacts intrinsically related to the use of different pulse \nsequences that may interfere with image quality. An additional more complex issue \nto consider is also the widespread diffusion of high-field magnets which have further \nenhanced those aspects. Knowledge of the spectrum of those CMR peculiarities is \nmandatory in order to approach and provide a correct diagnosis according to the \nmain clinical request. Present lecture with review most important anatomical and \ntechnical pitfalls of CMR examination offering, when possibile, practical solutions \nto overcome those limitations. \nLearning Objectives:\n1.  To learn about common pitfalls in MRI evaluation of the heart.\n2.  To become familiar with cardiac anatomical variants, potentially mimicking \ndisease.\nAuthor Disclosure:\nM. Francone: Speaker; Bracco Medical Imaging. \n2\n\nPostgraduate Educational Programme\nS5\nB\n C D E F G\nA\nSaturday\nchanges in cholinergic neurotransmission/brain. Networks in cognitive impairment \nstates of different dementia forms and Parkinson‘s disease, or changes of CBF early \nafter ischemic stroke. To achieve this goal, a number of methodological challenges \nrelated to the unique technique design of combined PET-MR systems needs to be \novercome, like realizing attenuation correction of the PET data, desirably without \nmeasured attenuation data. Taken together, combined brain PET-MR imaging is \nan important tool to support patient handling and research in neuropsychiatry and \nwill help us to develop further towards individualized medicine. \nLearning Objectives:\n1.  To learn about what we are able to do now.\n2.  To understand the nuclear aspect of neuroimaging.\n3.  To learn about the possibilities and limitations of neuroimaging.\nAuthor Disclosure:\nO. Sabri: Consultant; Bayer Healthcare. Grant Recipient; Bayer Healthcare. \nInvestigator; Bayer Healthcare. Speaker; Bayer Healthcare. \nA-209 08:51\nMR/PET in neuroimaging: radiology \nB.R. Rosen; Charlestown, MA/US (bruce@nmr.mgh.harvard.edu) \nPET and MRI are imaging modalities routinely used for clinical and research applica-\ntions. PET is a quantitative technique that provides exceptionally sensitive assays \nof a wide range of biological processes. MRI provides high-resolution anatomical \ninformation with excellent soft tissue contrast, and the ability to measure a variety \nof physiological, metabolic and biochemical parameters. Given the complementary \nnature of each modality’s strengths and weaknesses, integrating PET and MRI \nshould allow both investigators and clinicians the opportunity to gain in a single \nexamination many of the positive attributes of both, and mitigate some of their \nlimitations. More important, the wealth of information beyond morphology that \nMRI provide enables PET/MRI to go far beyond simple anatomical registration of \nPET molecular imaging, while the simultaneous acquisition of PET and MRI data \nopens up opportunities impossible to realize using sequentially acquired data. This \nmanuscript paraphrases the Wagner Lecture delivered by B.R. at the 2011 Society \nof Nuclear Medicine Annual Meeting and summarizes the technical aspects of the \nnovel technology PET/MRI in addition to emphasizing the areas where PET/MRI \nmay make a significant impact. Although these areas include oncologic, neurologic, \ncardiac and psychiatric applications, PET/MRI has the potential to impact dramati-\ncally the burgeoning field of molecular imaging. \nLearning Objectives:\n1.  To demonstrate the value of this hybrid technique.\n2.  To understand the radiological aspect of neuroimaging.\n3.  To learn about the possibilities and limitations of neuroimaging.\nAuthor Disclosure:\nB. R. Rosen: Advisory Board; Janssen Scientific. Consultant; Siemens Medical \nSolutions. Other; Expert Witness for Wolf Greenfield Patent Lawyers. \nA-210 09:09\nMR/PET in oncologic imaging: nuclear medicine \nO. Ratib; Geneva/CH (osman.ratib@hcuge.ch) \nWe evaluated a new generation of whole-body hybrid PET-MR scanner to as-\nsess its performance and added value in clinical application in oncology. A new \nwhole-body hybrid PET/MR system (Philips Ingenuity TF) consisting of a GEMINI \nTime-of-Flight PET system and an Achieva 3 T X-series MRI system was tested \nin a clinical setting. The two scanners are separated by approximately 3 m, with a \nsliding bed allowing 180° rotation of the patient from one scanner to another with \naccurate registration between the two modalities. An initial evaluation included 62 \npatients having two successive studies on PET-CT and PET-MR device. This initial \nphase was then followed by routine utilisation of the device in clinical applications, \nin particular, in head and neck cancers, in breast and prostate cancers as well as in \npaediatric cases. In the initial cohort of patients, PET images acquired in the PET/\nMR with a delay of 85 ± 22 min (range 49-120 min) showed perfect correlation and \nidentical diagnostic quality compared to the first PET acquired on PET/CT. In 42 \npatients (68%), additional high-resolution MR sequences were acquired for clinical \ndiagnosis showing excellent quality without any visually detectable artifacts. SUV \nmeasurements of tumour lesions obtained after correction with MR attenuation \nmaps showed an excellent correlation with PET-CT (R2 = 0.89 and R2 = 0.95). Our \npreliminary data show that total body PET/MR is clinically applicable in oncologic \npatients yielding a comparable diagnostic performance as PET/CT with respect to \nlesion detection and localisation. \nLearning Objectives:\n1.  To learn about what we are able to do now.\n2.  To understand the nuclear aspect of oncologic imaging.\n3.  To learn about the possibilities and limitations of oncologic imaging.\nLearning Objectives:\n1.  To become familiar with the diagnostic potential of CTA and MRA.\n2.  To understand the current proved clinical indications where CTA and MRA can \nreplace catheter angio.\n3.  To learn about safety issues in non-invasive procedures.\nA-206 09:21\nDiagnostic catheter angiography is not dead: current indications and \nadvantages over the non-invasive techniques \nT. Engelhorn; Erlangen/DE (tobias.engelhorn@uk‑erlangen.de) \nDespite computed tomography (CT) and magnetic resonance imaging (MRI), \nangiography including dynamic contrast-enhanced sequences, diagnostic catheter \nangiography is still considered the gold standard for imaging cerebral vasculature. \nHereby, diagnostic catheter angiography is typically done in intracranial hemor-\nrhages to exclude arteriovenous malformations (AVMs), dural extra-intracranial \narteriovenous fistulas and aneurysms as cause of haemorrhage. AVMs as well as \ndural fistulas can be obscured by the surrounding blood in CT and MRI; aside, small \n(blister-like) aneurysms (< 2 mm) can be overlooked with CT and MRI angiography. \nIn already diagnosed AVMs, fistulas and aneurysms, diagnostic catheter angiogra-\nphy has to be performed to assess the exact architecture of the vascular malforma-\ntion to decide absolutely certain if endovascular treatment is possible and what \n(special) material will be needed for neurointerventional treatment. Furthermore, \ndiagnostic catheter angiography is still needed for follow-up imaging after endovas-\ncular and surgical treatment of vascular malformations and intracranial stenosis. \nNevertheless, despite the problem of metal artefacts intravenous high-resolution \nflat panel detector CT (DynaCT) seems to be almost comparable to diagnostic \ncatheter angiography in follow-up imaging after neurointerventional procedures.\nLearning Objectives:\n1.  To learn about the current indications for diagnostic catheter angiography.\n2.  To become familiar with complication rates of selective catheter angiography \nin high volume centers.\n3.  To appreciate some technical innovations for diagnostic catheter angiography.\nPanel discussion: \nThe pros and cons of diagnostic catheter angiography in \nneuroimaging 09:44 \n08:30 - 10:00 Room C \nNew Horizons Session \nNH 8 \nMR/PET: a marriage made in heaven or hell? \nA-207 08:30\nChairman’s introduction \nB. Hamm; Berlin/DE (bernd.hamm@charite.de) \nThis New Horizons session aims to provide the latest insights into the hybrid \nimaging technique of MR/PET. Reflecting current research interests, this session \nfocuses on MR/PET in neuroimaging and in oncologic imaging. These topics will \nbe presented from two perspectives: that of nuclear medicine and that of radiol-\nogy. MR/PET uniquely combines functional and morphological diagnostic imaging \nin a single examination. With this new technology, imaging eliminates the known \nlimitations of anatomical and molecular resolution. What we will also discuss in \nthis session are the challenges we are faced with in showing that this new hybrid \ntechnology improves not only diagnostic accuracy but also treatment outcome.  \nSession Objectives:\n1.  To introduce the potential of this new imaging modality.\n2.  To appreciate a new opportunity for cooperation between radiology and nuclear \nmedicine.\nA-208 08:33\nMR/PET in neuroimaging: nuclear medicine \nO. Sabri; Leipzig/DE (osama.sabri@medizin.uni‑leipzig.de) \nWith the recent introduction of simultaneous PET-MR imaging systems, it is possible \nfor the first time to investigate functional and morphological brain changes or differ-\nent functional brain processes at the same time in the living human subject. This new \nopportunity has great potential to improve both clinical routine and research brain \nimaging. Examples of improved clinical routine imaging relate to dementia and brain \ntumour imaging. Research applications focus on the exciting opportunity to acquire \nPET and MR data simultaneously, focusing our interest to fast kinetic processes, like \n3\n\nPostgraduate Educational Programme\nS5\n C B D E F\n G\nA\nLearning Objectives:\n1.  To learn about the imaging modalities used for the assessment of cardiovas-\ncular risk.\n2.  To learn how to select the right test for the right patient.\n3.  To become familiar with the newest innovations and newest guidelines in \nnon-invasive cardiovascular risk assessment.\nA-214 09:30\nC. Interactive case discussion: how to deal with the results? \nA. van der Lugt; Rotterdam/NL (a.vanderlugt@erasmusmc.nl) \nIn this session, several cases from patient care and preventive screening programs \nwill be discussed. First, the application of the appropriate risk stratification strat-\negy based on clinical risk scores and imaging risk scores will be discussed. It will \nbecome that the strategy is tailored to specific patient populations. Second, the \naudience is asked to participate in the choice of the appropriate imaging technique, \nthe interpretation of the results and the recommendation for advanced image \nworkup or treatment. Finally, misuse of stratification tests in patients is discussed \nand explained. The audience will be encouraged to participate in the discussions \nvia the electronic voting system.\nLearning Objectives:\n1.  To understand the strength of non-invasive risk stratification in properly selected \npatient populations.\n2.  To consolidate knowledge of the selection of the appropriate imaging technique, \nimage interpretation and image-based treatment recommendation.\n3.  To learn about the risks of the inappropriate use of such risk stratification tests \n(Ca-scoring) in symptomatic patients.\n08:30 - 10:00 Room D2 \nOncologic Imaging: Follow-up of Systemic and Local Therapies \nCC 819 \nImaging after systemic therapies: advanced \ntechniques \nModerator: \nD.‑M. Koh; Sutton/UK \nA-215 08:30\nA. What can we expect from biomarkers \nB. Van Beers; Clichy/FR (bernard.van‑beers@bjn.aphp.fr) \nThe purpose of this lecture is to become familiar with biomarkers and to consolidate \nknowledge of various biomarkers and their utility. Evidence-based assessment of \nanatomical and functional imaging biomarkers for tumour response. Biomarkers \nare quantitative parameters measured with imaging methods that can objectively \nassess disease status. Compared with biochemical and histological markers, im-\naging biomarkers have the advantage of being spatially and temporally resolved \nand are thus especially useful for assessing response to treatment. Anatomical \nimaging biomarkers based on tumour size (RECIST) are increasingly used but have \nlimitations for assessing response to targeted treatments that induce biological \nchanges much earlier than size changes in tumour burden. Therefore, reliance \non tumour viability has increased. Viability criteria such as the mRECIST, EASL \nand Choi criteria are based on size measurements of viable, contrast-enhancing \ntumour regions or on tumour attenuation. The diagnostic efficacy and the repro-\nducibility of the different viability criteria should be further compared. In addition, \nthere is a growing interest for validating functional imaging biomarkers such as \nperfusion and diffusion parameters obtained with ultrasound, CT and MR imaging. \nAlthough promising for early assessment of response to treatment, these newer \nfunctional biomarkers need extensive validation and standardization for their wide \nclinical use. The added value of the more complex functional biomarkers relative \nto the viability parameters should also be shown. Viability and functional imaging \nbiomarkers are evolving and emerging parameters for the early assessment of \nresponse to treatment.\nLearning Objectives:\n1.  To become familiar with biomarkers.\n2.  To consolidate knowledge of various biomarkers and their utility.\nA-211 09:27\nMR/PET in oncologic imaging: radiology \nH.-P. Schlemmer; Heidelberg/DE (h.schlemmer@dkfz.de) \nSequential CT, MR and PET/CT is routine in daily oncology practice. In particular, \nPET/CT has emerged as an important method to detect, characterise, monitor and \nfollow-up different tumour entities. Compared to CT, however, MRI provides superior \nsoft tissue contrast and enables additionally to assess functional information, why \nMRI plus PET/CT would be desirable in many cases. But sequential imaging has \nseveral limitations: it is uncomfortabel for critically ill patients, costly and inefficient \nfrom a work-flow perspective. It results in spatial mismatch and misalignment cor-\nrection is time consuming and still limited. Scientific and clinical considerations \nconsequently argue for temporal and spatial coregistration of MR and PET data. \nVarious MR techniques for imaging of perfusion, diffusion and metabolism could \nbe precisely be related to PET-based measurements of perfusion, metabolism \nand cell receptor densities. Simultaneous PET/MR imaging can be advantages \nin different tumour, e.g. lung cancer, breast cancer, prostate cancer, lymphoma, \nseminal carcinoma concerning detection, staging as well as for therapy monitoring \nand follow-up. Coregistration of MR and PET data will also be useful for MRI-gated \nPET measurements of moving organs (in e.g. bronchial carcinoma) and can sup-\nport biologically adapted Radiotherapy. It furthermore reduces the x-ray exposures, \nwhich is important particularly for young patients and patients who need multiple \nfollow-up examinations. But crossfire of criticism is still justified, because the novel \nimaging technology may not enter routine before improvements of diagnostic ac-\ncuracy, influence on therapeutic management and economic reasonability have \nbeen carefully considered and evidenced by clinical studies. \nLearning Objectives:\n1.  To demonstrate the value of this hybrid technique.\n2.  To become familiar with the radiologic aspect of oncologic imaging.\n3.  To learn about possibilities and limitations of oncologic imaging.\nAuthor Disclosure:\nH. -P. Schlemmer: Research/Grant Support; Siemens. \nPanel discussion: \nWhat benefits and risks should we expect in terms of basic research, \nclinical service, and economics? 09:45 \n08:30 - 10:00 Room D1 \nCLICK (Clinical Lessons for Imaging Core Knowledge): Never \nwithout Arteries \nCC 818 \nHow old are you in reality? Vascular age and clinical \nevents \nModerator: \nL. Lonn; Copenhagen/DK \nA-212 08:30\nA. Clinical considerations \nE. Minar; Vienna/AT (erich.minar@meduniwien.ac.at) \n″Abstract Not Submitted″ \nLearning Objectives:\n1.  To learn about the frequency and importance of vascular diseases.\n2.  To become familiar with clinical risk stratification strategies.\n3.  To learn about the possibility of reducing cardiovascular risk.\nA-213 09:00\nB. Imaging techniques and typical findings \nH.J. Lamb; Leiden/NL (H.J.Lamb@lumc.nl) \nIn this lecture, an overview will be given on available imaging techniques for car-\ndiovascular imaging. Focus will be on imaging modalities used for the assessment \nof cardiovascular risk, with special attention to obesity related imaging procedures. \nImaging strategies are needed for selecting obese patients at risk for developing \nobesity related cardiovascular complications and progression to type 2 diabetes. \nIn these selected patients, tailored, more agressive therapy should be initiated \nguided by imaging findings. \n4\n\nPostgraduate Educational Programme\nS5\nB\n C D E F G\nA\nSaturday\n08:30 - 10:00 Room E1 \nEmergency Radiology \nRC 817 \nPolytrauma: redefining imaging issues for \nmanagement priorities \nA-218 08:30\nChairman’s introduction: advanced imaging, logistics and \nmanagement priorities in patients after polytrauma \nH. Alkadhi; Zurich/CH \nThe management and logistics of the polytrauma patient remains challenging. \nThis holds true for emergency physicians, orthopaedic surgeons, and for radiolo-\ngists. In addition, workflow issues continues to evolve, with the current focus on \nthe introduction of whole-body CT into the early resuscitation phase of severely \ninjured patients as a standard and basic diagnostic imaging method. This sess-\nsion is aimed at a thorough discussion on the requirements for advanced imaging \nin the early clinical situation, logistics and management priorities, and on quality \ncontrol in emergency radiology. \nA-219 08:40\nA. Vascular trauma \nG. Schueller; Bülach/CH (gerd.schueller@spitalbuelach.ch) \nIn vascular trauma, it is essential to immediately recognize life-threatening condi-\ntions and to initiate early treatment. New logistic concepts enable an accelerated \ndiagnostic work-up, which is mainly driven by the early use of multidetector CT. The \nmajority of patients succomb at the site of the injury according to severe injuries of \nthe CNS, heart and great vessels. There is another peak of early deaths within the \nfirst 4 h after the injury, which, in the majority of cases, is due to visceral hemor-\nrahge. On the other hand, this means that the vast majority of internal injuries can \npotentially be survived. From a radiologic point of view, this capability becomes \nfeasible if standard of care is carried out by dedicated facilities in which trauma \nteams provide service in an 24 by 7 mode. The goal of this lecture is to describe \nthe most relevant traumatic lesions to the aorta, the thorax, the abdomen as well \nas the pelvis. Both, classifications of major injuries will be emphasized, and several \ncases will be discussed, pointing out the crucal role of an interdisciplinary approach \nof surgeons, anesthesistsm and radiologists in the emergency setting. \nLearning Objectives:\n1.  To become familiar with the use of dedicated MDCT protocols, classification \nof vascular injuries and treatment options.\n2.  To become familiar with alternative imaging modalities such as US, DSA and \nMR.\n3.  To learn about typical and atypical imaging findings.\nA-220 09:00\nB. Chest and abdomen \nM. Scaglione; Castel Volturno/IT (mscaglione@tiscali.it) \nThoraco-abdominal injuries are a significant cause of death in the polytraumatized \npatients. Early recognition and communication of life-threatening thoraco-abdominal \ninjuries is the major task the radiologists involved the emergency room. Although, \nmost of these patients reach the hospital prior to die, lethality continues to remain \nhigh. Heart, thoracic great vessels, trachea, bronchus, pleura, lung, diaphragm, \nabdominal/retroperitoneal vascular and solid organ injuries are potential cause \nof death. Any appropriate surgical/interventional management approach must be \ncarried out “around the clock”, before thoraco-abdominal injuries reach the level \nof clinical evidence. On the other way, non-operative management has actually \nbecome the standard of care for the most serious thoraco-abdominal injuries. \nThese goals become feasible if a correct contrast-enhanced MDCT diagnosis, in \na dedicated facility in which the trauma team works effectively 24 h a day, 7 days \na week, is performed. Thus, in this lecture, the most serious thoraco-abdominal \ninjuries will be illustrated, with special emphasis on vascular/ injuries as well as the \nvalue of post-processing techniques, protocols, pitfalls, tips and tricks. Furthermore, \nA-216 09:00\nB. MRI biomarkers: from acquisition to post-processing \nO. Lucidarme, M. Wagner, C. Pellot Barakat, F. Frouin; Paris/FR \n(olivier.lucidarme@psl.ap‑hop‑paris.fr) \nMRI biomarkers must be able to show how tumours will respond to specific treat-\nment. They need to allow an assessment of the effectiveness of new treatment \nmore rapidly than classical clinical end points. These biomarkers must be easy \nto obtain in order to facilitate a large spread of the technique. They have to be \nreproducible. The longest diameter of the tumour remains the easiest biomarker \nthat can be obtained from any kind of morphologic acquisition with no need of post-\nprocessing. Additional information about the tissular organization and cellularity \ncan be now easily obtained using modern scanners through diffusion-weighted \nsequences. The ease with which those sequences are obtained masked for a while \nthe necessity to perform a more complex post-processing than the one initially \ndone to get reliable biomarkers. The MRI biomarkers of the microcirculation are \nnumerous reflecting the O2 consumption, the blood volume, the blood flow, the \nvessel permeability, the extravascular volume. To get them, we need to do more \nsophisticated acquisitions and image processing that take into account the T1 of \nthe tissue, the arterial input function, the respiratory motion, etc. Most of these \nnew MRI biomarkers are now used in research and in phase I studies but remains \nnot validated in more advanced clinical trial or in clinical practice. If we want to \nbe able to use them widely and reliably we need to perfectly understand what are \nthe consequences of the choices we make during the acquisition and the post-\nprocessing of these biomarkers.\nLearning Objectives:\n1.  To become familiar with MRI biomarkers.\n2.  To learn about tips and tricks for MRI biomarker evaluation.\nA-217 09:30\nC. Assessing the precision and accuracy of biomarker imaging: is it \nreproducible? \nC.B. Sirlin; San Diego, CA/US (csirlin@ucsd.edu) \nValidation of imaging biomarkers is the process of demonstrating that the bi-\nomarkers are acceptable for their intended purpose. Two important metrics used \nin validation are accuracy and precision. Accuracy refers to the correctness of \nan imaging biomarker (e.g., hepatic proton density fat fraction estimated by MR \nimaging) in predicting an endpoint of interest. The endpoint of interest may be \nanother imaging biomarker (e.g., hepatic proton density fat fraction measured by \nMR spectroscopy), a histology-based biomarker (e.g., steatosis grade estimated \nby histology), a disease process-based biomarker (e.g., gene expression assessed \nby an immuno-histochemical analysis), or a clinical outcome (e.g., future develop-\nment of cirrhosis assessed by a longitudinal outcome e study). Depending on the \nendpoint, biomarker accuracy often is evaluated by diagnostic performance/ROC \nanalysis or regression analysis. Precision refers to the closeness of agreement \n(degree of scatter) between a series of biomarker estimates made on the same \nsubject under prescribed conditions. The closer the agreement between repeated \nestimates, the more likely the estimates will be similar in the future, assuming no \ntrue change in the underlying property. For this reason, knowing the precision of \na quantitative biomarker is critical for interpreting changes over time when the \nbiomarker is estimated longitudinally in clinical care or clinical trials. Precision has \ntechnical and biological components. Technical precision may be considered at \nfour levels: within-examination repeatability, between-examination repeatability, \nbetween-”laboratory” (e.g., manufacturer, platform, field strength, center) reproduc-\nibility, and robustness (invariance to typical changes in acquisition parameters). \nBiological precision may be affected by temporal variability and spatial variability. \nLearning Objectives:\n1.  To understand imaging biomarker precision (repeatability and reproducibility) \nand accuracy and how it is evaluated.\n2.  To understand how to interpret biomarker precision and accuracy in the context \nof the biomarker’s intended use.\nAuthor Disclosure:\nC. B. Sirlin: Advisory Board; GE, Bayer, Genzyme. Consultant; Bayer, \nGenzyme, Takeda, Profil, Isis, Vical, Merck, Synageva, Gilead, Siemens. \nEquipment Support Recipient; Siemens, GE. Research/Grant Support; NIH, \nBayer, Bracco, GE, Siemens. Speaker; Bayer. \n5\n\nPostgraduate Educational Programme\nS5\n C B D E F\n G\nA\nLearning Objectives:\n1.  To understand when and why you should image dementia.\n2.  To become familiar with the imaging findings of the most common primary \ndegenerative and secondary vascular dementias.\n3.  To understand how to recognise normal pressure hydrocephalus as an underly-\ning cause of subcortical dementia.\nA-223 09:00\nB. Movement disorders \nT.A. Yousry; London/UK (t.yousry@ucl.ac.uk) \nDisease or degeneration of the basal ganglia, cerebral cortex and sometimes the \nthalamus give rise to disorders of movements (MD) known as dyskinesias (Greek: \ndifficult movement), which can be differentiated into hypokinetic and hyperkinetic \nsyndromes. We will be concentrating on the hypokinetic syndromes, which include \nIdiopathic Parkinson’s disease (IPD), atypical PD (APD): multiple system atrophy \n(MSA), progressive supranuclear palsy (PSP) and cortico basal degeneration \n(CBD). These movement disorders (MD) are often difficult to diagnose and to treat. \nUp to now, the diagnosis is based on clinical criteria. However, despite the fact \nthat imaging plays an increasing role in establishing and confirming the diagnosis \nof MD, many radiologists are not familiar with the role of the various imaging tech-\nniques, in establishing the diagnosis, monitoring disease progression and furthering \nour understanding of the pathophysiology of MD. We will first review the role of \n“conventional” MRI in the workup of MD by presenting imaging signs that assist in \nthe daily routine and that should be known by radiologists and neuroradiologists \nexposed to this disease entity. We will then review the contribution of specific \nimaging techniques such DTI, SWI and high field imaging as well as quantitative \nMR post-processing techniques in improving the diagnosis, providing biomarkers \nfor the monitoring of the natural history and furthering our understanding of the \npathophysiology of MD.\nLearning Objectives:\n1.  To learn the typical imaging findings, their anatomic substrate and the limita-\ntions of conventional MRI.\n2.  To understand the contribution of advanced imaging techniques such as \nDTI, SWI and high field imaging as well as quantitative MR post-processing \ntechniques.\n3.  To understand the role of MR in the diagnosis and differential diagnosis of \nmovement disorders.\nAuthor Disclosure:\nT. A. Yousry: Advisory Board; Biogen Idec. Author; T Yousry. Board Member; \nEuropean Radiology. Research/Grant Support; MS Society of Great Britain and \nNorthern Ireland, PSP Association, MRC, Wellcome Trust, Stroke Association, \nBritish Heart Foundation, UCL/UCLH Biomedical Research Centre, Biogen Idec, \nGlaxoSmithKline, Novartis. Speaker; ESOR, King Abdullah Medical City. \nA-224 09:30\nC. Metabolic disorders \nJ.F. Schneider; Basle/CH (jacques.schneider@ukbb.ch) \nMetabolic disorders may present at any age. Their clinical symptoms are often \nscarce or non-specific. Brain MRI is often used in the setting of an acute illness \nbut may be delayed in slowly progressive disease. Imaging appearance can be \nconfusing as acute and chronic signal intensity alterations may overlap in many \ndisorders. Furthermore, imaging appearance will vary during the course of the \ndisease. Recognition of signal changes in specific structures is most helpful in the \nacute setting before chronic changes set in, which will blur characteristic patterns. \nA systematic approach based on the pattern of brain involvement is useful in the \nanalysis of neurometabolic disorders, and has even been computerized. First, a \ndecision whether grey or white matter involvement or both must be made based \nupon volume and signal alterations on T1-wi, T2-wi, FLAIR imaging and contrast \nenhancement. Second, alterations within either focal grey matter structures or \nspecific white matter tracts must be recorded and estimation upon their timing, \nwhether acute or chronic, must be made. Finally, this pattern recognition must be \nsupplemented by microstructural data from diffusion-weighted images (DWI) and \nmetabolic data from proton MR spectroscopy (MRS). Additional information from \nDWI is often restricted to the acute setting, because chronic diffusivity changes are \nmainly driven by unspecific myelin breakdown. On the other hand, MRS may not \nonly identify abnormal levels of normal metabolites or demonstrate the presence \nof abnormal metabolites, but can also be used to monitor therapy. \nLearning Objectives:\n1.  To become familiar with the imaging findings of the most important innate \nmetabolic defects affecting CNS.\n2.  To learn how to recognise patterns of gray and white matter involvement.\n3.  To learn about specific discriminating imaging findings.\nthe importance of a rational and integrated imaging approach will be pointed out \nand, finally, the role of the radiologist in emergency room will be emphasized. \nLearning Objectives:\n1.  To become familiar with the most important imaging findings and their impact \non patient management.\n2.  To understand common classification systems, trauma scoring systems and \ntheir impact on patient management.\n3.  To learn about typical and atypical imaging findings.\nA-221 09:20\nC. Extremities \nU. Linsenmaier, L.L. Geyer; \nMunich/DE (Ulrich.Linsenmaier@kliniken‑pasing‑perlach.de)\nExtremity injuries in patients after polytrauma can be complex and are initially often \ndifficult to be fully diagnosed. Emergency radiology diagnosis is mostly based on \na standardised whole body CT (WBCT), which can be extended and adapted to \ncover extremity injuries. Extremityinjuries comprise: fractures off (1) long bones, \n(2) articular joints, (3) complex fractures of hands and feet, (4) vascular, (5) soft \ntissue, (6) nerve and plexus injuries and (7) amputations. Imaging protocol: extrem-\nity MDCT is indicated in all major and complex bony fractures, carried out early or \nintegrated with WBCT, CTA MIPs and MPRs enable a thorough workup.The role \nof US and CR is limited. Secondary imaging procedures comprise MR, MRA (in \nstable patients only) to evaluate instable articular injuries, injuries of tendons or \nmajor ligaments and nerve and plexus injuries) and DSA (for intervention). Clinical \nfindings and findings from WBCT determine how to proceed, “first things first” in a \npriority oriented clinical algorithm. Treatment of extremity injuries must be priority \noriented and carefully planned in the context of possible concurrent injuries, and \na possible risk of multi-organ failure (MOF).\nLearning Objectives:\n1.  To become familiar with imaging strategies, the role of CR, CT and MR.\n2.  To understand common classification systems and their impact on patient \nmanagement.\n3.  To learn about typical and atypical imaging findings.\nPanel discussion: \nHow to speed up your diagnoses? 09:40 \n08:30 - 10:00 Room E2 \nFoundation Course: Neuroimaging \nE³ 820b \nMetabolic and neurodegenerative disorders \nModerator: \nS. Lehéricy; Paris/FR \nA-222 08:30\nA. Dementia \nB. Gómez-Ansón; Barcelona/ES (bgomeza@santpau.cat) \nCognitive decline and dementia consitute an increasingly important public health \nissue in Europe and worldwide. Our insight in several of these conditions has in-\ncreased. Thanks to knowledge gained in brain imaging. Also, imaging plays a crucial \nrole in early, and differential diagnosis of dementia conditions. Recently, surrogate \nmarkers with imaging have been described in research literature, that can aid in \ntreatment response and prognosis. Different techniques, such as CT, MRI, SPECT \nand PET with different tracers provide various types of information, and thus may \nhave an added value to patient management. As progress is made, controversies \narise about the most efficient use of imaging tools in clinical practice at different \nlevels of health care, and especially in European countries with universal coverage. \nThis lecture will deal with these various aspects. Recommendations and guidelines \nto investigate patients with dementia with imaging, and the added value of knowl-\nedgeable radiologists will be discussed. Some of the imaging findings in the most \ncommon neurodegenerative dementias such as AD, and FTLD will be covered. In \naddition, due to recent advances in the field, the following contributions of imaging \nin knowledge about, and in clinical practice in dementia will be presented in more \ndetail: 1) Reportable causes, such as prion disease and other rapidly progressive \ndementias; 2) Vascular involvement in dementias: vascular/mixed type dementia, \nand amyloid angiopathy; and 3) Ventricular dilatation and NPH.\n6\n\nPostgraduate Educational Programme\nS5\nB\n C D E F G\nA\nSaturday\nA-227 08:58\nB. Non-mass like enhancement (NMLE): when to biopsy? \nC.K. Kuhl; Aachen/DE (ckuhl@ukaachen.de) \nNon-mass-like enhancement is a frequent finding in breast MRI. It relates to the \nfact that enhancement occurs in the normal-appearing fibroglandular tissue that \nsurpasses that of the other parts of the parenchyma. There is no associated space \noccupying lesion. In pre-contrast non-fat-suppressed or fat-suppressed T1- and \nT2-weighted images, there is usually no observable correlation. The differential \ndiagnosis of non-mass-like enhancement is between benign non-specific fibrocystic \ndisease/adenosis, hormonal stimulation, and subclinical mastitis on one hand versus \nDCIS or (less likely) diffusely infiltrating (usually lobular) cancer on the other. Key \ncomponents of differential diagnosis is configuration of the enhancement (does it \nfollow the orientation of the milk duct or not?) and symmetry (symmetric or asym-\nmetric). Less important criteria are internal enhancement (internal architecture) \nand enhancement kinetics. It is important to realize that enhancement kinetics \ncan only be used to corroborate the suspicion of DCIS - but they cannot be used \nto alleviate the indication to biopsy a finding which, based on configuration and \nasymmetry, is suspicious. Management depends on the different constellation of \nclinical, mammographic, and MRI findings. It usually includes short-term follow-up \n(6 months) and, if stable/persistent, MR guided vacuum biopsy.\nLearning Objectives:\n1.  To learn about the clinical significance of NMLE.\n2.  To understand differential diagnosis for NMLE.\n3.  To become familiar with a work-up algorithm of NMLE cases.\nA-228 09:21\nC. Monitoring response to neo-adjuvant chemotherapy \nT.H. Helbich; Vienna/AT (Thomas.Helbich@meduniwien.ac.at) \nAssessment of the change in tumour burden is an important feature of the clinical \nevaluation of cancer therapeutics. Tumour shrinkage and time to the development \nof disease progression are important end-points in cancer clinical trials. However, \nthese end-points are useful only if they are based on widely accepted and read-\nily applied standard criteria. Criteria, known as RECIST, were published and are \nupdated on a regular base. The revised RECIST includes a new imaging appendix \nand underlines the importance to move from anatomic unidimensional assessment \nto either volumetric anatomical assessment or to functional assessment with PET \nor MRI. The goal of the lecture is to discuss the value of the different MR imaging \ntechniques (e.g. MR spectroscopy, diffusion-weighted imaging, angiogenesis map-\nping, PET-MRI) that evaluate response to treatment in breast cancer. Participants \nwill learn about particular imaging challenges of assessing response to neo-adjuvant \nchemotherapy. In addition, they will learn to understand clinical aspects of neo-\nadjuvant chemotherapy based on RECIST. \nLearning Objectives:\n1.  To understand the clinical aspects of neo-adjuvant chemotherapy.\n2.  To appreciate evidence-based protocols for imaging in this clinical setting.\n3.  To learn about particular imaging challenges of assessing response to neo-\nadjuvant chemotherapy.\nAuthor Disclosure:\nT. H. Helbich: Advisory Board; Phillips, Hologic. Grant Recipient; SIEMENS. \nPanel discussion:  \nHow can the specificity and sensitivity of breast MRI in these \nindeterminate clinical and imaging scenarios be maximised? 09:44 \n08:30 - 10:00 Room F2 \nSpecial Focus Session \nSF 8b \nGI imaging: technological advances and clinical \napplications \nA-229 08:30\nChairman’s introduction \nS.A. Jackson; Plymouth/UK (simon.jackson1@nhs.net) \nDuring the past two decades, gastrointestinal imaging has undergone a number \nof exciting and rapid technological advances resulting in new areas of clinical \napplication in the management of patients with GI and abdominal pathology. This \nevolution has included both improvements in speed and diagnostic accuracy of \n08:30 - 10:00 Room F1 \nBreast \nRC 802 \nClinical challenges in breast MRI \nA-225 08:30\nChairman’s introduction \nF.J. Gilbert; Cambridge/UK (fjg28@cam.ac.uk) \nBreast MRI is now recognised as one of the most useful breast imaging techniques. \nIn this session we adress the use of MRI as a screening tool in the high risk popula-\ntion. The high sensitivity of dynamic contrast enhanced MRI together with the high \nnegative predictive value make this a worthwhile test that should be implemented in \nclinical practice. Diffusion weighted imaging is now used diagnostically and could be \nconsidered in the screening situation. The advantage is no requirement for contrast \nand the rapidity and lower cost of the test. However further trials are needed to \nconfirm this as a screening tool. Non mass like enhancement is an interpretation \nchallenge in breast MRI. Often there is confusion between normal parenchymal \nenhancement and that of a more sinister pathology such as lobular cancer or DCIS. \nThis presents difficulties for the radiologist. This talk gives guidance as to the cor-\nrect interpretation of this feature and advises on further management. The use of \nMRI in the management of patients having neo-adjuvant vchemotherpy is widely \naccepted. Baseline examinations to assess the disease extent and subsequent \nexaminations to establish size or volume changes together with a pre-operative \nexamination to facilitate surgical planning are well accepted. The use of functional \ninformation that is available is less well established. Analysis of the DCE data \ncan predict repsonse after one or two courses of treatment and the ADC values \nat baseline can be prognostic. Baseline choline measurements can also be of \nprognostic value with a low measure predicting a good response. \nAuthor Disclosure:\nF. J. Gilbert: Equipment Support Recipient; GE. Grant Recipient; Philips. \nSpeaker; Bracco. \nA-226 08:35\nA. High risk patients: establishing clinical protocols \nJ. Veltman; Almelo/NL (j.veltman@zgt.nl) \nContrast-enhanced MRI has, especially in younger women with dense breasts, \na superior sensitivity for detecting breast cancer. Young women usually do not \nneed screening unless they have an increased risk for developing breast cancer. \nAn increased risk can be based on a positive familial history or based on a proven \ngene-mutation. The BRCA1 and BRCA2 gene mutations are the most well known \ngene mutations related to an increased breast cancer risk. In this group, false \nnegative rates up to 62% have been reported for mammography. Several papers \nhave demonstrated the value of contrast-enhanced MRI in high risk screening for \nearly detection and even demonstrated a more favourable lymph node status for \nthese women. An upcoming MRI technique for detecting and classifying breast \nlesions is diffusion-weighted imaging (DWI). The main advantages of DWI are \nthe short examination time and that no contrast is needed. In literature, DWI has \ndemonstrated great diagnostic potential. Especially, high sensitivities have been \nreported (80%-97.8%). The specificity and spatial resolution are however still \nmoderate. The high sensitivity values reported do give DWI potential to become \na fast, non-contrast, and therefore relatively cheap, highly sensitive screening \ntechnique. At this point, contrast-enhanced MRI is the best available modality for \nthe detection of breast cancer in women with an increased risk. The detection of \nsmaller lesions, the patient anxiety, the often benign morphologic characteristics \nseen in cancers and the often aggressive nature of breast cancer in young women \nshould lower the threshold for MRI-guided-biopsies significantly.\nLearning Objectives:\n1.  To become familiar with the literature on the role of breast MRI in screening \nof high risk patients.\n2.  To understand current protocols in clinical practice.\n3.  To appreciate the challenges of breast MRI imaging in this patient group.\n7\n\nPostgraduate Educational Programme\nS\n C B D E F\n G\nA\nA-232 09:21\nMR imaging of GI tract motility \nS.A. Taylor; London/UK (csytaylor@yahoo.co.uk) \nRapid sequence MRI now allows capture of intestinal motility. In particular with \nsub-second image acquisition, it is possible to image bowel peristalsis and func-\ntion. The technique can be applied anywhere from the mouth to the colon, but \nmost work has focussed on gastric imaging and increasingly for the assessment of \nsmall bowel motility. MRI evaluation of gastric emptying has been validated against \nbarostat measurements and scintigraphy, and is has entered clinical practice in the \nevaluation of gastric function both in disease and in response to pharmacokinetic \nstimulation. Repeat measurement of gastric volume is used to calculate emptying \ntimes while rapid sequences such as TRUEFISP facilities evaluation of peristaltic \nactivity. Validating MRI assessment of small bowel motility is more complex-there \nis no simple standard if reference. Nevertheless, increasing data confirms the \nability of MRI to detect abnormal small bowel motility, particularly in the context of \nCrohn’s disease, and following drug stimulation or inhibition. Software solutions \nare being developed which can quantify intestinal motility captured using MRI. This \npresentation will describe basic MRI protocols for assessing motility, introduce how \nsoftware can be used to quantify activity, outline current areas of research and \nexplore how the technique can be used in clinical practice.\nLearning Objectives:\n1.  To learn about the MRI protocols that can best assess bowel motility.\n2.  To understand the various software approaches to quantifying bowel motility.\n3.  To become familiar with how motility MRI can be used in clinical practice.\nPanel discussion:  \nWhen should we integrate these technological advances into our \nroutine practice? 09:44 \n08:30 - 10:00 Room G/H \nEFOMP Workshop \nNew technology in diagnostic radiology: new frontiers in imaging \nof the lung\nEF 1 \nLung and chest imaging: new approaches \nModerators: \nP. Sharp; Aberdeen/UK \nW.J.M. van der Putten; Galway/IE \nA-233 08:30\nWelcome address \nJ.I. Bilbao1, P. Sharp2; 1Pamplona/ES, 2Aberdeen/UK (jibilbao@unav.es) \nA-234 08:40\nRadiologist’s point of view: clinical and technical requirements for \nimaging of the lung \nH.-U. Kauczor; Heidelberg/DE (Hans‑Ulrich.Kauczor@med.uni‑heidelberg.de) \nLung imaging has recently shown a series of groundbreaking technological de-\nvelopments. They especially involve CT, MRI, and PET, and are mainly related to \nhigh imaging speed; gating techniques; signal enhancement technologies including \nnew contrast agents and mechanisms, as well as new probes and targets. Some \nyears ago, MRI paved the way for comprehensive imaging of structure and func-\ntion in lung disease. Such protocols targeted perfusion, ventilation, V/Q ratio; gas \nexchange, vascular permeability, blood flow, shunt; haemodynamics, heart function, \nlung volumes, respiratory motion and mechanics. Recent developments, such as \n„Interpolated volume imaging“ with high spatial resolution; contrast enhancement; \nsingle and multiphasic MR angiography; diffusion-weighted and diffusion tensor MRI \nsequences; multidirectional blood flow measurements; angiogenesis imaging and \nhigh-resolution ventilation imaging with hyperpolarized 129Xenon gas are the main \ndrivers for broader translational and clinical implementation. In the meantime, CT \nhas demonstrated a surprising development towards a complex quantitative imaging \ntechnology with fast progress in iterative image reconstruction, post-processing, \nregistration algorithms as well as multi-energy CT, such as imaging of ventilation \nby inhaled Xenon gas. Beyond the modality-driven radiological view onto the future \ndirection of pulmonary functional and molecular imaging, the objectives are shifting \nfrom morphology, e.g. size, volume, shape onto function, metabolism and molecular \ninteractions as well as on multilevel analysis of tissue composition. Thus, future \nthe cross-sectional imaging modalities but also the emergence of new functional \nand quantitative techniques. In particular, the role of both the non-ionising radiation \nmodalities of ultrasound and MRI as well as developments in MDCT have led to \nsignificant improvements in the assessment of anatomy, organ function and disease \nactivity as well as the emerging concept of personalised imaging. This session \nwill review the place of these technological advances with cutting edge, in-depth \nlectures presented by international GI radiology experts assessing the current \nand future imaging applications in the management of patients with GI disease. \nSession Objectives:\n1.  To review the significant recent advances in GI imaging.\n2.  To understand the place of these advances in the clinical imaging of patients.\n3.  To summarise the future directions of GI radiology in the 2 1st century.\nA-230 08:35\nCEUS of the bowel wall: when and how \nF. Maccioni; Rome/IT (francesca.maccioni@uniroma1.it) \nContrast-enhanced ultrasound (CEUS) may play a relevant role in the evaluation of \nbowel wall microvascularity particularly in Crohn’s disease (CD), although strictly in-\ndicated for characterisation of liver lesions only. CEUS of the bowel requires the use \nof harmonic technology and specific softwares. Post-processing includes analysis \nof TTP (time to peak), time-intensity curve and patterns of contrast-enhancement \ndistribution within the bowel wall (inward, outward). Ultrasound contrast agents \nfor intravenous use are made of a suspension of micro-bubbles (mean diameter \n3.0 -3.5 μm) passing through the pulmonary microcirculation. They are safe and \ndo not require laboratory tests before their administration, not being nephrotoxic. \nAdvantages in the evaluation of CD include the possibility to evaluate degree, \ncharacteristics and dynamics of contrast-enhancement of diseased intestinal \nsegments without radiation exposure. Dynamics and patterns of enhancement \nhave been correlated to CD activity with good sensitivity and specificty. CEUS as-\nsessment of microvascular changes before and after pharmacological treatment \nmay be valuble to monitor therapeutic effects. On the other hand, CEUS cannot \nprovide information on the entire small and large bowel, because of its limited field \nof view. Only a few centimeters of diseased bowel, usually the terminal ileum, may \nbe investigated, while CD frequently involves longer intestinal segments of small \nand large bowel. Therefore, the choice of the segment to analyze with CEUS is \ncrucial. A limited evaluation may impair the final evaluation. CEUS of the bowel \nshould be considered an advanced but focused diagnostic tool, to use after a \ncomprehensive intestinal evaluation.\nLearning Objectives:\n1.  To review the relevant clinical indications for CEUS of the bowel.\n2.  To learn how to optimally perform a CEUS examination of the bowel wall.\n3.  To appreciate important findings in patients with IBD and learn how to evaluate \ninflammatory activity of the bowel wall.\nA-231 08:58\nDual-energy (spectral) CT: GI applications \nP. Rogalla; T oronto, ON/CA (Patrik.Rogalla@uhn.on.ca) \nDual-energy CT refers to the use of CT data representing two different energy \nspectra to display anatomy and pathology in addition to differentiating and clas-\nsifying tissue composition. First applications are dating back to several decades \nago, however, only recent technological advances in rapid data acquisition allowed \nfor virtually simultaneous recording of two spectra: dual-source, rapid kV switch-\ning, dual energy helical or volume scanning, and dual-layer detector technology. \nBowel peristalsis obviates the need for quasi simultaneous data recording to avoid \nmisregistration. Nevertheless, clinical applications of dual-energy of the GI tract are \nsparse but exciting: mesenteric ischaemic disease, bleeding, Crohn’s disease, and \nCT colonography including digital cleansing and polyp detection using CAD. Beyond \nthe fascinating technology, the challenging question however remains: is there an \nincremental value over single energy CT that translates into better patient care? \nLearning Objectives:\n1.  To review the concept and technique of dual-energy CT.\n2.  To understand the clinical application of dual-energy CT in GI imaging.\n3.  To appreciate the additional benefits of the technique in routine clinico-\nradiological practice.\nAuthor Disclosure:\nP. Rogalla: Research/Grant Support; Toshiba Medical Systems. \n58\n\nPostgraduate Educational Programme\nS\nB\n C D E F G\nA\nSaturday\n08:30 - 10:00 Room I/K \nChest \nRC 804 \nPatterns in chest radiology: are there subtype \npatterns of ground glass opacity (GGO)? \nA-237 08:30\nChairman’s introduction \nA. Oikonomou; Alexandroupolis/GR (aoikonom@med.duth.gr) \nGround-glass opacity (GGO) is characterised on HRCT by the presence of a hazy \nincrease in lung opacity that does not cause obscuration of underlying bronchial \nand vascular margins. Although a very common finding, it also constitutes a very \nnon-specific term since it can be seen in a variety of different intraalveolar and \ninterstitial processes with different histology including inflammatory, infectious and \nneoplastic diseases that have a common physiologic mechanism: partial displace-\nment of air. GGO may even be seen in normal processes such as poor ventilation \nin dependant lung areas and in expiration. Moreover, GGO can represent either \nan ongoing, active and potentially treatable disease or an irreversible process. In \norder to interprete correctly this highly non-specific but very significant finding, it \nis crucial to attempt to further classify the different large main entities in which this \nradiologic finding appears. Are there specific radiologic and HRCT findings that can \nhelp us differentiate GGO in autoimmune-inflammatory conditions from infectious \nand neoplastic processes? Are there associated findings other than GGO - such as \nnodules, reticulation or focal disease and distribution of findings that can narrow the \ndifferential diagnosis? Systematic evaluation of GGO and associated findings as \nwell as integration with clinical information (acute, subacute or chronic symptoms) \nis essential in defining GGO subtypes in order to improve radiologic diagnosis. \nSession Objectives:\n1.  To learn about the prevalence and low specificity of GGO.\n2.  To appreciate the need for definition of GGO subtypes to improve radiological \ndiagnoses.\nA-238 08:35\nA. Ground glass opacification: why do we see it and what does it mean? \nS.R. Desai; London/UK (sujal.desai@nhs.net) \nRadiologists who regularly review high-resolution CT (HRCT) should be aware of \nthe range of patterns and, more importantly, their potential pathological meaning. \nA pattern of ground-glass opacification is one of the more common HRCT findings \nbut, to the unwary, its interpretation can be problematic. An important underlying \nprinciple is that a ground-glass pattern may be caused by any process - physiologi-\ncal or pathological - which partially displaces air. Physiological (i.e. non-disease \nrelated) ground-glass opacification is perhaps most commonly seen in subjects \nwho, for whatever reason (e.g. breathlessness, obesity), are unable to maintain \nor achieve a satisfactory inspiratory effort during scanning. A generally increased \nlung density (in contrast to adults) is also a feature in infants and young children \nsimply because there are fewer alveoli in the developing lung. Finally, it is worth \nnoting that intravenous contrast administration (presumably because of a relative \nbut temporary increase in capillary blood volume causing partial displacement of air) \ncan unpredictably increase lung density. Disease processes which lead to partial \nfilling of the air spaces, thickening of the interstitium, partial collapse of alveoli and/or \nan increased capillary blood volume will also manifest as a pattern of ground-glass \nopacification. In clinical practice, the recognised causes of ground-glass opacities \non HRCT include pulmonary oedema (cardiogenic or otherwise), infections (e.g. \npneumocystis jiroveci pneumonia) and some of the idiopathic interstitial pneumonias \n(e.g. non-specific interstitial pneumonia and respiratory bronchiolitis-associated \ninterstitial lung disease). The presentation will review and revise the causes of \nphysiological and disease-related ground-glass opacification on HRCT.\nLearning Objectives:\n1.  To appreciate the different physiological conditions which cause GGO pattern.\n2.  To learn about the associations and reversibility of physiology-related GGO.\nendpoints of pulmonary imaging might be: inflammation, homeostasis and energy \nbalance, real-time visualisation of lung function: „Watch the lungs work“; imaging \ntumour biology and phenotype/genotype correlation. \nLearning Objectives:\n1.  To comprehend the new approaches towards functional and molecular lung \nimaging.\n2.  To understand their potential in comprehensive and quantitative lung imaging.\n3.  To become familiar with new applications of structural functional and molecular \nimaging in lung disease.\nAuthor Disclosure:\nH. -U. Kauczor: Advisory Board; Siemens. Investigator; Boehringer Ingelheim. \nSpeaker; Siemens, Boehringer, Bayer, Bracco. \nA-235 09:10\nRespiratory motion correction in lung imaging \nJ.A. Schnabel; Oxford/UK (julia.schnabel@eng.ox.ac.uk) \nLung imaging poses challenging problems for diagnostic image interpretation and \ntreatment planning due to motion corruption caused by respiratory motion and \ninconsistent breath holds. This is particularly true for multi-modality lung imaging, \nwhere complementary information provided by different scanning systems cannot \nbe adequately fused without prior motion compensation. We present recent meth-\nodological advances for respiratory motion correction in single- and multi-modality \nlung imaging. We have developed a range of non-linear registration methods, \nwhich are suitable for CT-CT lung registration, taking the complex sliding motion \nof the lungs into account. In addition, we have designed a modality-independent \nshape descriptor (MIND) suitable for MR-CT lung registration and reconstruction. \nFinally, we have made advances in registering diagnostic CT volumes to PET/\nCT acquisitions, combining sliding motion with rigid/non-rigid motion modelling. \nWe have applied our lung registration framework including 10 patients with em-\npyema, imaged using CT and MR; 10 patients with lung cancer scanned with CT \nover time; and 10 patients with lung cancer scanned with diagnostic CT and PET/\nCT. Using clinically annotated landmark locations, we find a sub-voxel accuracy \nalignment and improved overlaps of the lungs after registration, compared to more \nconventional lung registration methods. Recent advances in non-linear registration \nof single- and multi-modality lung imaging have shown that respiratory motion can \nbe compensated for, paving the way for more accurate clinical diagnosis and more \neffective treatment planning. \nLearning Objectives:\n1.  To comprehend the problem of motion corruption and difference in breath \nholds in lung imaging.\n2.  To become familiar with state-of-the-art motion correction methods in single- \nand multi-modality lung imaging.\n3.  To understand the concept of modelling complex sliding motion of the lungs.\nA-236 09:35\nRole of tomosynthesis in lung imaging \nM. Båth; Gothenburg/SE (magnus.bath@vgregion.se) \nTomosynthesis is an imaging technique that in recent years has become avail-\nable for lung imaging. Using low-dose projections of the chest, acquired over a \nlimited angular range, an arbitrary number of section images can be reconstructed, \nenabling the chest to be visualised in millimetre-thick slices at a very low effective \ndose. Compared to conventional chest radiography, the disturbance of overlapping \nanatomy (the main limiting factor for detection of pathology, e.g. pulmonary nodules \nin chest radiography) is considerably reduced in chest tomosynthesis. Early evalu-\nations have also shown that the detectability of pulmonary nodules is significantly \nhigher in chest tomosynthesis than in conventional radiography. However, compared \nto computed tomography (CT) the limited angular range used in tomosynthesis \nresults in a reduction in depth resolution, not allowing tomosynthesis to reach \nthe same detection rate as can be obtained with CT. Especially, pathology in the \nsubpleural region may be more difficult to interpret. Nevertheless, most lesions \nare visible in retrospect on chest tomosynthesis, suggesting that the technique \nmay be suitable for follow-up. This presentation will summarise early evaluations \nand reported clinical experiences of the technique, as well as describe some of \nits strengths and limitations. \nLearning Objectives:\n1.  To understand the technical principles of chest tomosynthesis.\n2.  To become familiar with the results of the latest clinical evaluations of chest \ntomosynthesis.\n59\n\nPostgraduate Educational Programme\nS6\n C B D E F\n G\nA\n08:30 - 10:00 Room L/M \nVascular \nRC 815 \nHow I report \nModerator: \nD. Bilecen; Basle/CH \nA-241 08:30\nA. CTA and MRA of supra-aortic arteries \nJ.H. Gillard; Cambridge/UK (jhg21@cam.ac.uk) \nThere have been considerable advances in the imaging tools available for imaging \nthe supra aortic vessels, specifically the carotid arteries. Developments ranging \nfrom rotational DSA (allowing for accurate delineation of vascular disease) to \nimprovements in CTA and MRA (particularly Gadolinium-enhanced studies) have \ngreatly improved our diagnostic armamentarium. In addition, there is increased \nunderstanding that atheromatous disease localised to the carotid bifurcation is \nonly part of the problem with cerebrovascular disease. Increased coverage of \nthe arch and intracranial circulation are becoming increasingly important requir-\ning greater spatial coverage. In the future, imaging of the wall components may \nbecome important. For the moment, however, management remains dependent \non the accurate assessment of luminal stenosis. The greatest evidence suggests \nthat contrast-enhanced MRA is the investigation of choice. However, CTA is ex-\ntremely popular especially with clinicians, particularly as it allows algorithms for \nincluding or excluding calcification. There is a lesser evidence base, although the \nrelentless progress of technology such as dual beam techniques makes it difficult \nto provide timely evidence. There are pros and cons for all methodologies, which \nwill be addressed.\nLearning Objectives:\n1.  To learn about a structured reporting approach to angiographic studies of \nsupra-aortic arteries.\n2.  To understand the role of post-processing techniques and quantitative analysis \nof arterial stenosis.\n3.  To be able to answer specific clinical questions about supra-aortic arterial \nocclusive diseases.\nA-242 09:00\nB. CTA and MRA of thoracic and abdominal aorta \nH.J. Michaely; Mannheim/DE (henrik.michaely@umm.de) \nThis refresher course will review pertinent and state-of-the-art techniques for angi-\nographic imaging of the aorta with Magnetic Resonance Imaging and Computed \nTomography Imaging. Clinical protocols and applications will be presented based \non specific pathologies and key findings which should be included in every report \nwill be highlighted. Where necessary radiologic-pathologic correlations and clas-\nsifications are presented.\nLearning Objectives:\n1.  To learn about a structured reporting approach to aneurysmal and obstructive \ndiseases.\n2.  To learn the classifications of aneurysmatic aortic diseases.\n3.  To understand the role of post-processing techniques in aortic diseases.\n4.  To be able to answer specific clinical questions about aortic diseases.\nAuthor Disclosure:\nH. J. Michaely: Speaker; Siemens Healthcare Sector. \nA-243 09:30\nC. CTA and MRA of peripheral arteries \nT. Leiner; Utrecht/NL (t.leiner@umcutrecht.nl) \nCTA and MRA are highly valuable imaging techniques in the diagnostic and inter-\nventional workup of patients with (suspected) peripheral arterial occlusive disease. \nIn this part of the refresher course, the role of CTA and MRA in the diagnostic and \ninterventional pathway of patients with suspected peripheral arterial occlusive \ndisease will be discussed, also relative to the role of more widely available tech-\nniques such as duplex ultrasonography. An important focus of the presentation \nwill be how to report relevant findings in a structured and coherent fashion to the \nreferring clinician. The role of source image review and advanced postprocessing \ntechniques to detect and to visualize clinically relevant features to optimally facilitate \ninterventional radiological and surgical treatment will be discussed in detail. In this \nA-239 08:58\nB. Inflammatory and infectious GGO \nK. Marten-Engelke; Göttingen/DE (kmarten@med.uni‑goettingen.de) \nGround-glass opacity (GGO) is defined as increased attenuation of the lung paren-\nchyma without obscuration of the pulmonary vascular markings on CT images. GGO \nmay be the result of a variety of interstitial and alveolar infectious and non-infectious \ninflammatory diseases. As an imaging finding alone, GGO does usually not allow \na specific diagnosis. GGO in inflammatory disorders often will be present in the \ncompany of other interstitial or alveolar findings. However, the number of diseases \nthat cause diffuse-isolated GGO or GGO as the predominant finding is relatively \nsmall and can be prioritised with clinical information. The most common cause of \ndiffuse-isolated GGO in immunocompromised hosts are a variety of diffuse, oppor-\ntunistic pneumonias, e.g. pneumocystis jiroveci pneumonia (PCP), cytomegalovirus \npneumonia (CMV) or herpes simplex pneumonia (HSV), that constitute the first \ndifferential. Chronic onset disorders in immunocompetent patients include cellular \nnon-specific interstitial pneumonia (NSIP), subacute hypersensitivity pneumonitis \n(HP), organising pneumonia, air-space sarcoid and drug-induced lung disease. \nIn these disorders, ancillary findings such as an associated reticular pattern with \ntraction bronchiectasis/bronchiolectasis (NSIP), mediastinal lymphadenopathy \n(sarcoidosis), superimposed nodularity or cysts may help to refine the diagnosis. \nIn patients with collagen vascular disorders, e.g. scleroderma, GGO secondary to \npulmonary involvement needs to be differentiated from drug-induced lung disease. \nThis refresher course will put GGO in the context of outpatients versus inpatients, \nthe acuity of clinical symptoms, e.g. fever, cough and dyspnoea, signs of massive \nsystemic inflammation, and the clinical situation such as inhalational history, pneu-\nmotoxic drug administration, immunocompromisation, or bone marrow-suppression.\nLearning Objectives:\n1.  To learn more about the inflammatory conditions which cause GGO.\n2.  To appreciate the histopathological correlates of inflammatory and infectious \nGGO.\n3.  To become familiar with GGO in autoimmune and infectious lung disease.\nA-240 09:21\nC. GGO in dysplasia and neoplasia \nG.R. Ferretti, S. Lantuejoul; Grenoble/FR (GFerretti@chu‑grenoble.fr) \nIn this course, we will review the dysplastic and neoplastic conditions that are \nassociated with persistent GGO in the lung parenchyma. We will separate these \nconditions into those that are responsible for localised diseases such as single \nnodular GGO and those responsible for more extended diseases. Nodular GGO \ncan be separated into pure or mixed or part-solid nodules. Pathology-radiology \ncorrelations showed that Nodular GGO are related to atypical adenomatous hyper-\nplasia (AAH), adenocarcinoma (ADC) in situ (AIS), minimally invasive ADC (MIA), \nand invasive ADC according with the new IASLC/ATS/ERS lung adenocarcinoma \nclassification. Differential diagnosis include exceptional metastases of angiosar-\ncoma and melanoma as well as infection, inflammation and localised fibrosis. Dif-\nfuse GGO related to neoplastic conditions is rare and may be due to lepidic ADC \n(former advanced ADC with BAC component), diffuse large B-cell non-Hodgkin’s \nLymphoma, Intravascular lymphomatosis (IVL), mucosa-associated lymphoid tissue \n(MALT) lymphoma. These neoplastic diseases should be differentiated from infec-\ntious and inflammatory causes of diffuse GGO. We will review the value of different \nmorphological CT criteria in order to differentiate benign from malignant localised \nGGO such as the size, the morphology (round, oval, flat), presence of mixed versus \npure GGO, and the multiplicity of nodular shadows. Discussion will also include the \nchanges that may occur within the nodule as well as the mean doubling time. The \nrole of PET CT and trans-thoracic biopsy will be discuss. Finally, we will present \nthe current recommendations regarding the management of nodular GGO.\nLearning Objectives:\n1.  To learn more about the dysplastic and neoplastic conditions causing GGO.\n2.  To appreciate the histopathological correlates of dysplastic and neoplastic \nGGO.\n3.  To understand how to estimate malignancy on the basis of GGO pattern.\nPanel discussion: \nHow should we report and manage ground glass opacity? 09:44 \n0\n\nPostgraduate Educational Programme\nS6\nB\n C D E F G\nA\nSaturday\nA-246 08:58\nB. EVAR techniques and results \nF. Fanelli; Rome/IT (fabrizio.fanelli@uniroma1.it) \nAbdominal aortic aneurysm (AAA) is a relatively common disease among the \nelderly population. AAA, more than 5 cm in diameter, is generally prone to rupture \nwith a mortality rate up to 63%. Stent-grafts’ expected characteristics are related \nto low profile, adequate flexibility, kink resistance, longitudinal strength, easy and \nprecise deployment, reliable fixation system, low permeability and modularity for \ncustomization of limb length. Endoleak is the most frequent complication of EVAR. \nType I and III require immediate treatment for the continuous pressure present \nwithin the sac. Type II is necessary when the sac increases. Aortic stent-grafts can \nbe successfully positioned in more than 90 % to 95 % of cases. A cause of failure \nmay be the inability to insert the device through a severely diseased or tortuous \niliac artery. Device misplacement or migration are rare but dangerous and require \nsurgical conversion. EUROSTAR reports operative complications can be grouped \ninto three categories: failure to complete the procedure (2.5 %); device or procedure \nrelated complications (10  %); arterial complications (3%). The incidence rate of \nsystemic complications within the first 30 days is 18  %. Mortality within 30 days \nafter operation is 2.6 %. The recent introduction of fenestrated and branched aortic \nendografts has greatly broadened the management options of patients with aortic \naneurysms. Consequently, the use of such devices is becoming widespread and \nthanks to technology clinical outcomes are proving quite satisfactory.\nLearning Objectives:\n1.  To understand indications and contraindications for EVAR.\n2.  To know more about advantages of different types of stent-graft.\n3.  To become familiar with percutaneous vascular access.\n4.  To learn about the latest trials.\nAuthor Disclosure:\nF. Fanelli: Consultant; Medtronic, Ev3 - Covidien, WL Gore. Research/Grant \nSupport; Cook. Speaker; Cook, Medtronic, WL Gore. \nA-247 09:21\nC. Imaging follow-up and treatment of complications \nR. Morgan; London/UK (robert.morgan@stgeorges.nhs.uk) \nThe first part of the lecture will discuss the optimal imaging protocol for follow -up \nafter endovascular aneurysm repair. The merits of CT versus ultrasound versus \nMRI will be discussed. In the second part, the material will focus on the different \ntypes of complications after EVAR and their management. This will include the \nmanagement of type 1a and 1b endoleaks, the embolisation of type 2 endoleaks \nby both the transarterial and the direct sac puncture routes, iliac limb problems, \nendograft migration and component separation.\nLearning Objectives:\n1.  To learn about available imaging methods for follow-up.\n2.  To become familiar with complications and failure of EVAR.\n3.  To understand how to treat endoleaks.\nAuthor Disclosure:\nR. Morgan: Advisory Board; Angiodynamics. Consultant; William Cook, Europe, \nCovidien. \nPanel discussion:  \nWhat are the best imaging methods for follow-up? 09:44 \n08:30 - 10:00 Room P \nCardiac \nRC 803 \nPractical approach to cardiovascular risk \nstratification with CT and MRI \nModerator: \nC. Peebles; Southampton/UK \nA-248 08:30\nA. Modern views on value of coronary calcium scoring for risk assessment \nA. Stadler; Vienna/AT (alfred.stadler@meduniwien.ac.at) \nThe assessment of the amount of arterial calcification with computed tomography \nis a standard method in the risk stratification of coronary heart disease. Coronary \ncalcium detection by CT has been shown to identify atherosclerotic plaque and to \nquantitatively assess coronary calcium. Many studies have demonstrated the as-\npresentation, the relative merits and shortcomings of both techniques in specific \npatient populations will also be discussed.\nLearning Objectives:\n1.  To learn about a structured reporting approach to peripheral arterial obstructive \ndiseases.\n2.  To understand the importance of quantitative analysis of peripheral arterial \nobstructions and how to report these analyses.\n3.  To be able to answer specific clinical questions about peripheral arterial dis-\neases.\nAuthor Disclosure:\nT. Leiner: Grant Recipient; The Netherlands Organisation for Health Research \nand Development. Research/Grant Support; My department receives research \nsupport from Philips Healthcare, Bracco, Bayer Healthcare. Speaker; Philips \nHealthcare, Bracco, Bayer Healthcare, GE Healthcare, Lantheus Medical. \n08:30 - 10:00 Room N/O \nInterventional Radiology \nRC 809 \nWhat should every radiologist know about the \nendovascular treatment of abdominal aortic \naneurysms? \nA-244 08:30\nChairman’s introduction \nH. Rousseau, J. Auriol, C. Lions, F. Mokrane; T oulouse/FR \n(rousseau.h@chu‑toulouse.fr) \nEndovascular aneurysm repair (EVAR) is a well-established technique for the \ntreatment of abdominal aortic aneurysms (AAA). Meta-analysis have demonstrated \nthat it can reduce perioperative mortality, complications and hospitalization but \npatient selection, technical expertise, surveillance and complication detection and \nmanagement are crucial to determine long-term performance of EVAR devices. \nActually, profound knowledge of state-of-the-art imaging techniques and strong \ndiagnostic and interventional imaging skills play a fundamental role. Whether it \nis patient assessment, the choice of the appropriate technique and follow-up, the \noutcome of interventional procedures will always be closely related to the efficiency \nof pre, peri and post-procedural imaging. There will be a discussion on imaging after \nEVAR, focusing on imaging techniques like CT, MRA and CEUS, just to name a few. \nAuthor Disclosure:\nH. Rousseau: Consultant; GORE, MEDTRONIC, BOLTON.\nA-245 08:35\nA. Pre-therapeutic radiological evaluation \nJ. Raupach, O. Renc, P. Hoffmann, J. Zizka; Hradec Kralove/CZ \n(janraupach@seznam.cz) \nEndovascular abdominal aortic aneurysm repair (EVAR) was introduced over 20 \nyears ago to primarily treat old and sick patients. Due to technical improvements \nand satisfactory clinical results of this technology, the number of patients treated with \nstent-grafts is steadily increasing. There is also tendency to use this therapy for rup-\ntured abdominal aortic aneurysms. Pre-operative assessment of aortic morphology \nregarding suitability for stent-graft implantation is, therefore, an important challenge \nfor every radiologist now. Main limitation of EVAR is unfavourable anatomy of landing \nzones and access vessels. Gold standard for EVAR planning is contrast-enhanced \nCTA. Alternative modality for patients with contraindications for CT, such as renal \nimpairment, is unenhanced MR with steady-state free precession sequence. A \nnumber of 2D or 3D reconstructions are generated to provide information about \nthe aneurysm morphology. Dedicated vessel analysis and planning software can \nbe applied. Usually, axial images and thin MPR reconstructions are sufficient in \nemergent cases. Proper stent selection is a domain of operator and is still matter \nof his/her experience. The planning procedure can be subdivided into 4 different \nsections: infrarenal neck, aneurysmal sac, aortic bifurcation and access vessels. \nThere are several critical and rules which must be obeyed during the evaluation \nprocess and general radiologists should be aware of. The presentation will review \nmain inclusion and exclusion criteria for EVAR. \nLearning Objectives:\n1.  To learn about the best pretreatment imaging modality.\n2.  To understand planning and sizing of appropriate stent-graft.\n3.  To become familiar with critical criteria and vessel morphology.\n1\n\nPostgraduate Educational Programme\nS6\n C B D E F\n G\nA\n2.  To understand the accuracy of myocardial perfusion in identifying ischaemia \nand its role in risk assessment.\n3.  To learn the prognostic value of viability imaging in ichaemic heart disease.\n08:30 - 10:00 Room Q \nPaediatric \nRC 812 \nImaging the paediatric spine \nModerator: \nC.J. Kellenberger;  Zurich/CH \nA-251 08:30\nA. Craniocervical junction abnormalities \nB. Ozgen Mocan; Ankara/TR (burce@hacettepe.edu.tr) \nCraniocervical junction (CCJ) is defined as the region extending from the basioc-\nciput to the second cervical interspace. This region anatomically consists of the \nocciput, the first and second cervical vertebrae, surrounds the cervicomedullary \njunction and the lower cranial nerves. Evaluation of this region requires a basic \nknowledge of the anatomical landmarks and the normal osseous relationships. \nThe radiologists must also be familiar with the CCJ craniometry that uses several \nlines, angles and measurements, such as Chaberlain’s line, McGregor’s line and \nWelcher’s basal angle. The CCJ pathology may result in clinical symptoms when \nthere is compression of adjacent neurovascular structures or abnormal cerebrospi-\nnal fluid dynamics and the symptoms may range from pain, vertigo to cranial nerve \npalsies. The discussion of CCJ pathologies often involves the terms platybasia, \nbasilar invagination and basilar impression; terms that are often subject to confusion \nand misnaming. The disorders of this region include congenital malformations (as \na component of a syndrome such as achondroplasia, Down syndrome or as an \nisolated developmental anomaly) as well as acquired conditions including inflam-\nmatory, infectious and neoplastic processes.\nLearning Objectives:\n1.  To learn about normal cervical junction development and anatomy.\n2.  To understand congenital cervical junction anomalies.\n3.  To appreciate acquired cervical junction pathology.\nA-252 09:00\nB. Inflammation, infection and tumours: the role of imaging \nM.I. Argyropoulou; Ioannina/GR (margyrop@cc.uoi.gr) \nIntramedullary and intradural-extramedullary tumours are less common than in-\ntracranial tumours. Spinal cord enlargement and heterogeneous appearance with \nsolid and cystic components represent the main characteristics of intramedullary \ntumours. Low-grade astrocytomas (pilocytic) are the most common followed by \ngangliogliomas. Extensive involvement of the spinal cord is common. Holocord in-\nvolvement and calcifications are most frequently seen in gangliogliomas. Paediatric \nintramedullary ependymomas are almost never seen outside the context of NF2. \nMetastatic disease due to CSF seeding of intracranial tumours (Medulloblastomas) \nrepresent the most common intradural-extramedullary tumours. Multiple intradural \nneurinomas and meningiomas are found in NF2. Inflammatory demyelinating dis-\norders may affect the cord and the spinal nerve roots in childhood. Guillain--Barre \nsyndrome is an autoimmune acute demyelinating poly-radiculoneuropathy charac-\nterised by either diffuse or ventral nerve root enhancement. Spinal cord lesions in \nmultiple sclerosis (MS) are mainly located dorsolaterally, extend over less than two \nvertebral segments in length and affect less than half of the cross-sectional area \nof the cord. Spinal cord lesions in Acute disseminated encephalomyelitis (ADEM) \nextend over more than three vertebral segments in length and occupy more than \ntwo-thirds of the cross-sectional area of the cord. Differences in brain and spinal \ncord imaging findings are useful in the differential diagnosis between MS and ADEM. \nSpinal cord involvement similar to that found in ADEM may be found in idiopathic \nacute transverse myelitis (A TM) and in neuromyelits optica (NMO). Lack of brain \ninvolvement in ATM and the presence of the NMO specific IgG autoantibody are \nuseful in the differential diagnosis with ADEM.\nLearning Objectives:\n1.  To learn about the etiologies and the imaging findings of infectious, para-\ninfectious and autoimmune disorders.\n2.  To appreciate the role of spinal MRI in the differential diagnosis of multiple \nsclerosis vs its mimics.\n3.  To become familiar with the imaging findings of primary and metastatic tumours.\n4.  To learn about the indications of whole spine MRI with presence of brain \ntumours.\nsociation between the degree of coronary calcium, the burden of atherosclerosis, \nand the risk for cardiovascular events associated with coronary calcium. The CAC \nscorning can provide individual risk assessment and can reclassify the low and \nparticularly intermediate Framingham risk cohort into lower- and higher-risk strata. \nAbsence of CAC is associated with a very low risk of future cardiovascular events, \nwith modest incremental value of other diagnostic tests in this very low-risk group. \nThe role of CAC in the work up of symptomatic patients is under discussion and \nthere is evidence that the absence of CAC has a high negative predictive value \nfor ruling out acute coronary syndrome. Although the CAC measurement is highly \nstandardised, some technical aspects have to be considered, all possibilities of \ndose reductions have to be utilised. This presentation will show the technical and \nepidemiological fundamentals of CAC scoring and discuss the clinical applications \nof the method. \nLearning Objectives:\n1.  To understand what kind of information calcium scoring can deliver and the \nappropriate indications.\n2.  To become familiar with its role in an asymptomatic and in a symptomatic \npopulation.\n3.  To learn about the current data and guidelines supporting its use for assess-\nment of cardiac risk.\nA-249 09:00\nB. Coronary CTA: from detection of stenosis to prognosis \nN.R. Mollet1, F. Cademartiri2; 1Turnhout/BE, 2Rotterdam/NL \n(nramollet@gmail.com) \nCT coronary angiography permits comprehensive assessment of coronary artery \ndisease including detection of both significant stenosis and non-significant plaques, \nand their location and extent within the coronary tree. Plaques can be further divided \ninto calcified, non-calcified or mixed plaques. Such comprehensive assessment \nof coronary artery disease may further improve risk stratification compared to \nassessment of the calcified plaque burden only. The vast majority of current pub-\nlications investigating the prognostic value of CT coronary angiography included \nsymptomatic patients. These studies have shown that CT coronary angiography \nhas an independent prognostic value compared to traditional risk factors. Moreover, \nCT coronary angiography significantly improved currently used risk stratification \nmodels, e.g. the Framingham risk score alone or combined with calcium scoring. \nTo date, data on the prognostic value of CT coronary angiography in asymptomatic \nindividuals is scarce, mainly because of the relatively high radiation exposure \nusing older 16- or 64-slice CT equipment. However, radiation exposure can be \nsignificantly reduced to values approaching these of traditional calcium scoring \nusing more up-to-date CT scanner technology. The results of currently ongoing \nfollow-up studies investigating the prognostic value of CT coronary angiography \nin high-risk, asymptomatic patients are needed to further establish its precise role \nin clinical decision making.\nLearning Objectives:\n1.  To understand the accuracy of CTA in the diagnosis of coronary disease.\n2.  To become familiar with the strengths and limitations of the various quantifica-\ntion techniques.\n3.  To appreciate the prognostic value of CTA in coronary disease.\nA-250 09:30\nC. Myocardial perfusion and viability for risk scoring \nA. de Roos; Leiden/NL (A.de_Roos@lumc.nl) \nThe combined evaluation of coronary anatomy, myocardial perfusion at rest/\nstress as well as viability imaging using late gadolinium enhancement provides a \ncomprehensive evaluation of ischaemic and non-ischaemic heart disease. Recent \nadvances in myocardial perfusion imaging include demonstration of superior per-\nformance over SPECT imaging, whole heart perfusion imaging and developments \nfrom visual to true quantitative perfusion analysis. Integrated coronary/perfusion/vi-\nability evaluation has great diagnostic as well as prognostic performance. Perfusion \nanalysis provides highly relevant information on the haemodynamic significance \nof a coronary artery stenosis in correspondance to the invasive assessment frac-\ntional flow reserve measurement. Myocardial perfusion may help to select optimal \ntherapy in coronary artery disease. Dysfunctional, hibernating myocardium can be \ncharacterised by the combined assessment of perfusion (perfusion-contractility \n(mis)match), late gadolinium enhancement of scar transmurality and recovery of \nwall motion under low dose dobutamine stimulation. MRI evaluation of perfusion, \nscar, area at risk, wall motion at rest and under stress provides optimal data for \nimproved risk stratification in various clinical scenarios.\nLearning Objectives:\n1.  To become familiar with the current status of CT and MRI for evaluation of \nmyocardial perfusion and viability.\n2\n\nPostgraduate Educational Programme\nS6\nB\n C D E F G\nA\nSaturday\n10:25 - 12:00 Room B \nESR meets South Africa \nEM 3 \nImaging HIV and TB \nWelcome by the ESR President: \nG.P. Krestin; Rotterdam/NL \nPresiding: \nJ.I. Bilbao; Pamplona/ES \nC. Sperryn; Cape Town/ZA \nA-256 10:30\nIntroduction \nC. Sperryn; Cape T own/ZA (csperryn@iafrica.com) \nIn South Africa, HIV infection is a high risk factor for stroke in young patients. \nProf Victor Mngomezulu will present HIV-related Cerebrovascular Disease: The \nSouth African experience. A systematic review of published literature from three \nmajor South African academic centres in the last 12 years. The concept of the \nRich focus as the cause of tuberculous meningitis is controversial. Using original \nimages from Arnold Rich’s work, as well as that of the South African physician JN \nCoetzee’s thesis on tuberculous meningitis, Dr Pieter Janse van Rensburg will \nillustrate why there is doubt as to the role of the Rich focus as the cause of basal \ncisternal tuberculous meningitis and propose a more likely pathogenetic mechanism \nbased on radiological-pathological correlations using MR imaging. The incidence \nof tuberculosis (TB) is increasing in both developing and developed world, and \nis complicated by the emergence of multi-drug resistant disease and co-infection \nwith HIV. Dr Tracy Kilborn will cover the varied presentations of TB in the spine \nand discuss the MRI features. South Africa has the highest global HIV prevalence, \nestimated at 5.6 million people, including 377,000 children. Prof Richard Pitcher de-\nscribes the 5-year findings of a Cape Town-based US-UCT collaborative paediatric \npulmonology HIV-research group focussing on severe CXR abnormalities in HIV \ninfected children. The two interludes will be presented by Prof Zarina Lockhat. The \nfirst will cover radiology training in South Africa. The final interlude will be a celebra-\ntion of SOUTH AFRICA: the country, its people, its diversity, and its attractions.  \nSession Objectives:\n1.  To learn about cerebrovascular disease in HIV infected patients in South Africa.\n2.  To understand the pathogenesis of TB meningitis and its implications for treat-\nment.\n3.  To become familiar with the MR imaging of spinal TB in children and possible \ndifferential diagnoses.\n4.  To consolidate knowledge of chest radiograph reporting in HIV-infected chil-\ndren.\n5.  To appreciate South Africa, the country, its diversity and how its radiologists \nare trained.\nA-257 10:35\nHIV-related cerebrovascular disease: the South African experience \nV. Mngomezulu; Johannesburg/ZA (victor.mngomezulu@wits.ac.za) \nThe purpose of this lecture is to describe the South African experience in HIV-\nrelated cerebrovascular disease. A systematic review of published literature from \nthe three major South African academic centres in the last 12 years was conducted \nin order to catalogue their combined experience and to highlight unique features \nof these conditions in the setting of a developing country with a relatively high \nseroprevalence. A comparison was made with experiences in developed countries. \nIn South Africa, HIV infection is a high risk factor for stroke in young patients less \nthan 46 years. These patients do not exhibit the usual risk factors for stroke found \nin non-infected patients. Most (> 90%) present with ischaemic stroke and (< 5%) \nwith intracranial haemorrhage. In the majority of cases (> 80%), a primary aetiol-\nogy is usually found and in 20% HIV vasculopathy, presenting with characteristic \nclinical and imaging features is thought to be the cause. 2/3 of infarcts are large \nvessel cortical and 1/3 small vessel sub-cortical infarcts. Intracranial haemorrhage \nis often a consequence of HIV-related dilated aneurysmal arteriopathy. Dissection \nis a possible complication of this arteriopathy and is thought to be a more likely \ncause of SAH than saccular aneurysm formation and rupture. In 40-50% patients, \nstroke is the first manifestation of HIV infection. Intravenous drug abuse and \natherosclerotic strokes are not prominent features. HIV-related cerebrovascular \ndisease in South Africa mirrors that found in most parts of the world. There are \nhowever some features that appear to be unique in this setting.\nA-253 09:30\nC. Imaging spinal trauma in childhood \nM. Maas; Amsterdam/NL (m.maas@amc.nl) \nThe presentation will focus on acute trauma in the cervical spine and more chronic, \nsports-related overuse kind of trauma in the lumbar spine of pediatric patients. The \nclearance of the paediatric cervical spine on admission on the Emergency Room re-\nmains a challenge for both clinicians as well as attending radiologists. The literature \non the use of The National Emergency X-Radiography Utilisation Study (NEXUS) \ncriteria in children is discussed. Also, the use of MDCT in the paediatric population \nis critically debated. Focus is set on age-related trauma mechanism. In clearing \nC-spine, conventional Radiography remains mainstay. Guidelines for interpretation \nof these views will be given and examples of its use are presented. In addition, the \nimaging findings when using MDCT will be enhanced. A brief discussion on use of \nMRI in the (sub) acute setting, in the light of evidence-based criteria will be sup-\nplied. In high-performing athletes, overuse trauma of the spine, mainly the lumbar \nspine is well known. The urge for competing at the highest level leads to intensive \ntraining programs in young children and adolescents. The growing lumbar spine is \nan area of well-known overuse-related injuries. Within the range of stress-induced \nbone marrow edema like patterns of abnormality, the devastating end stage is a \nstress fracture, of the pars intervertebralis. The potential role of imaging, both in \ndetecting as well as in potential prognosis will be discussed. Imaging strategy both \nin the acute as well as in the overuse type of injury will finalize the presentation.\nLearning Objectives:\n1.  To understand how best to investigate suspected spinal trauma in a child.\n2.  To appreciate the imaging findings.\n3.  To consolidate knowledge about the differences between paediatric and adult \nspinal trauma.\n10:30 - 12:00 Room A \nInteractive Teaching Session \nE³ 920a \nTips and tricks in chest imaging \nA-254 10:30\nA. Plain radiography \nJ. Cáceres; Barcelona/ES (josecac@gmail.com) \nThere are certain signs in the chest radiograph, which help in the identification and \ndifferential diagnosis of selected processes. Their appearance is characteristic \nenough to be identified. Some of them correspond to normal variants, which should \nnot be confused with pathologic processes. In this presentation, we will describe \nseveral signs in chest imaging that, in our experience, have proven helpful to us \nin the diagnosis of chest pathology.\nLearning Objectives:\n1.  To become familiar with useful signs in the diagnosis of chest disorders in the \nchest radiograph.\n2.  To learn about common pitfalls in plain radiography of the chest.\n3.  To understand the mechanisms that cause errors in image interpretation of \nchest radiographs.\nA-255 11:15\nB. CT \nJ. Vilar; Valencia/ES (vilarsamper@gmail.com) \nInterpretation of chest images is fraught with errors. Confusing images may occur in \nchest CT and conventional radiography. Understanding the cause of the error and \nusing some “ tricks” the radiologist may overcome these situations. Three aspects \nthat may be of useful are: Gravity, Space and Time. Gravity may help the radiologist \nby using simple manoeuvres such as prone or lateral decubitus. Space relates to \nthe location of the lesion. Upper or lower lobe locations are associated with certain \npathologies. Time lapse is a major factor that may influence our diagnosis. Previous \nstudies are essential. Fast growth or reduction of a lesion usually is associated with \nnon-neoplastic disorders. Follow-up in acutely ill patients may be of great value and \nwell as in lesions in oncologic patients. The lecture will present cases of variable \ndifficulty where using these simple “tricks” the diagnostic problem can be solved.\nLearning Objectives:\n1.  To become familiar with useful signs in the diagnosis of chest disorders in CT.\n2.  To learn about common pitfalls in CT of the chest.\n3.  To understand the mechanisms that cause errors in image interpretation of \nchest CT.\n3\n\nPostgraduate Educational Programme\nS6\n C B D E F\n G\nA\nA-260 11:10\nInterlude: South Africa: the country, its people, its diversity and its \nattractions \nZ. Lockhat; Pretoria/ZA (Zarina.Lockhat@up.ac.za) \nSouth Africa (SA) is an extraordinary country, with so many mixed cultures, extreme \ndiversity and a deep rooted history, that is constantly undergoing change not as \nan event but rather as a process. Herewith, I have tried to present a lighthearted \ncelebration of South Africa, the country, its people, its diversity and its attractions. \nThe Great Outdoors- SA has an abundance of everything nature can bestow, \nmountains, forests, endless beaches and world heritage sites. With a population \nof 55 million people, diverse, yet integrated, it is a nation that is growing and heal-\ning, and the pride of our nation include people who have had a profound effect on \nthe national and international psyche. South Africa, like many other countries, has \nits fair share of troubles and tribulations; however, its people have a tenacity and \nresilience whose stories shine brightly despite all the dark headlines we are sadly \nfamous for. Leave ordinary behind, visit South Africa, and explore and experience \nthe land of the Big Five, the longest wine route in the world, diamonds, gold, whale \nwatching, shark diving, languorous hikes and climbs, the Comrades or the Two \nOceans Marathon, the Cape Argus cycling tour.\nA-261 11:15\nSpinal tuberculosis in children \nT. Kilborn; Cape T own/ZA (tracykilborn@gmail.com) \nChildren represent a high-risk group for acquiring tuberculosis (TB). Although TB \ninvolving the spine occurs in less than 1% of paediatric patients with TB, it remains \na significant cause of morbidity usually as a result of its insidious onset and indolent \ncourse that results in delayed presentation. Radiography has disadvantages, the \natlanto-occipital and cervicothoracic junctions and posterior elements are difficult \nto visualise. CT carries a high-radiation burden but is useful prior to surgical \nreconstruction. MRI is the optimal imaging modality. Spondylodiscitis is the most \nfrequent manifestation of spinal TB. Hallmarks are the involvement of multiple ver-\ntebral bodies (usually > 3) most commonly thoracic. The resultant kyphotic gibbus \nis more often responsible for cord compromise than the inflammatory mass. Lack \nof proteolytic enzymes results in partial or complete disc preservation, commonly \nwith anterior subligamentous, paravertebral or extradural spread, all specific for \nTB. The addition of a coronal T2 of the mediastinum to show lymphadenopathy \nand parenchymal disease is useful in supporting the diagnosis, as skin testing is \nfrequently negative. Radiculomyelitis is seen on post-contrast MRI in up to 80% \nof cases of meningitis as a result of inferior extension but can also be seen in \nspondylodiscitis. Intramedullary tuberculomas and tuberculous abscesses are \nrare, more commonly associated with meningitis than as an isolated finding, their \nT2 signal correlates with the degree of caseous necrosis; the pattern of contrast \nenhancement and MRS assist in diagnosis. Accurate, timely radiological diagnosis \nis crucial in spinal TB to guide management and achieve good clinical outcomes.\nLearning Objectives:\n1.  To learn about the spectrum of tuberculous infection of the spine in children \nnamely; intramedullary spinal tuberculomas, tuberculous spondylitis and rarely \ntuberculous epidural abscess.\n2.  To appreciate the incidence of tuberculous arachnoiditis and tuberculomas \nin patients presenting with tuberculous meningitis and its implications for \nmanagement.\n3.  To become familiar with MR imaging of spinal TB and possible differential \ndiagnoses.\n4.  To discuss the role of ultrasound and CT in the imaging algorithm.\n5.  To understand the importance of accurate and timely radiological diagnosis \nfor guiding management.\nA-262 11:30\nChronic chest radiographic changes in a cohort of HIV-infected \nSouth African children \nR. Pitcher, C. Lombard, M. Cotton, S. Beningfield, H. Zar; Cape T own/ZA \n(pitcher@sun.ac.za) \nSub-Saharan Africa (SSA) remains the region most affected by HIV. South Africa \nhas the highest global prevalence, estimated at 5.6 million people, including \n377,000 children. However, there has been progress in addressing the SSA HIV \npandemic. Twenty-two countries, including SA, documented a declining HIV inci-\ndence from 2001 to 2009; approximately 105,000 South African children are now \non ART, compared to 12,000 in 2005. Respiratory illness is the leading cause of \nmorbidity and mortality in HIV-infected children and includes both acute and chronic \nconditions. The high burden of respiratory illness is reflected in a high prevalence \nLearning Objectives:\n1.  To learn about the clinical and imaging spectrum of cerebrovascular disease \nin HIV infected patients in South Africa.\n2.  To appreciate the role of other co-factors in the pathogenesis of HIV related \ncerebrovascular disease.\n3.  To become familiar with the challenges and technical strategies in the medical \nand interventional management of these conditions.\nA-258 10:50\nInterlude: Radiology training in South Africa \nZ. Lockhat; Pretoria/ZA (Zarina.Lockhat@up.ac.za) \nAcademic Radiology in South Africa is dynamic, evolving and exciting. Various \nfacets and institutions are involved in academic training, teaching and continuing \nmedical education. These include the Radiological Society of South Africa (RSSA), \nThe College of Medicine of South Africa (CMSA), the nine academic universities, \nand the international liaisons that the RSSA has nurtured and developed over many \nyears. The College of Medicine hosts biannual national examinations in Diagnostic \nRadiology and Imaging, and this is supported by the academic institutional cur-\nriculum, which may extend over a period of four or five years. Training and exami-\nnations in Radiology is constantly being reviewed and refined with consultations \nbetween the RSSA and CMSA, and attention being given to local and international \nstandards. Training and teaching is conducted in many forms, with supervision by \nConsultant Radiologists and includes didactic lectures, presentations at multidis-\nciplinary interdepartmental meetings, journal review, group and individual tutorials \nand workshops. Practical training is hands-on with supervision by Consultants in \nall aspects of Radiology including general radiology and special investigations, \nmammography and biopsy, ultrasound, CT and PET/CT, MRI and angiography and \nintervention. Registrars rotate through these subspecialty areas during their train-\ning. Candidates have access to academic libraries, a multitude of e-resources, and \ndigital imaging. The Radiological Society of South Africa plays a fundamental role \nin continuing medical education and specialty training in South Africa. The RSSA \nhas hosted numerous international speakers at congresses, workshops, webinars, \nvisiting lecture programs. There is ongoing support for private and public sector \nradiologists and specialists in training in terms of radiological literature, awards \nand financial support towards fellowships and postgraduate training. Amongst the \nchallenges facing South African Radiology, are the vast spectrum of pathology that \nis seen in imaging not only due to Tuberculosis and AIDS, but diseases peculiar to \nthe African continent; and perhaps more importantly, the retention of highly skilled \nand talented Radiologists.\nA-259 10:55\nNew concepts in the pathogenesis of cerebral TB \nP. Janse van Rensburg, R. Hewlett; Stellenbosch/ZA \n(neurotb2013‑ecr@yahoo.com) \nFrom its inception, the concept of the Rich focus as the ordinary cause for tu-\nberculous meningitis has been controversial. Unfortunately, the concept persists \nunequivocally in certain in parts of academic literature. Using some of the original \nimages from Arnold Rich‘s work, as well as that of the South African physician JN \nCoetzee‘s thesis on tuberculous meningitis, we illustrate why there is significant \ndoubt as to the role of the Rich focus as the cause of basal cisternal tuberculous \nmeningitis. A more likely pathogenetic mechanism based on the original work done \nby them, as well as on radiological-pathological correlation using MRI, is direct \ninfection of the choroid plexi. The MRI correlate of the Rich focus is proposed to be \nthe combination of granulomata and meningeal enhancement following the course \nof a convexity sulcus amongst others. Although the Rich focus may co-exist with \nbasal cisternal tuberculous meningitis, these eruptive granulomata have no role \nin the pathogenesis of the inflammatory reaction localised to the basal cisterns.\nLearning Objectives:\n1.  To learn more about the morphological spectrum of tuberculous meningoen-\ncephalitis as shown on contrast MRI.\n2.  To understand the pathogenesis of TBM and its implications for disease \nprogression and treatment.\n3.  To appreciate the importance of imaging-pathologic correlation.\n4.  To become familiar with imaging of TBM.\n5.  To consolidate knowledge of neurotuberculosis.\n4\n\nPostgraduate Educational Programme\nS6\nB\n C D E F G\nA\nSaturday\nA-264 11:00\nB. Tumours of the spinal cord \nJ. Van Goethem, C. Venstermans, F. De Belder, L. van den Hauwe, P. Parizel; \nAntwerp/BE (johan.vangoethem@ua.ac.be) \nTumours of the spinal cord are rare but may cause significant and longstanding \nmorbidity. Detecting spinal cord tumours on imaging and differentiating them \nfrom other pathology is the most important task for the neuroradiologist. Second, \ndetermining the relationship of the tumour with the spinal cord and the extent of \nthe tumour along with non-tumoural spinal cord changes such as oedema or sy-\nringomyelia is essential in therapy planning and monitoring. Finally, attempting to \ndiagnose the type of tumour according to imaging criteria may be difficult in some \ncases but is less critical in patient management.\nLearning Objectives:\n1.  To become familiar with the imaging findings of primary and metastatic tumours \nof the spinal cord.\n2.  To be able to recognise metastatic disease in the extradural, epidural, subdural \nand paraspinal compartments.\n3.  To learn how best to use imaging and create the appropriate protocol.\nA-265 11:30\nC. Phacomatosis \nM.A. Papathanasiou; Athens/GR (matpapath@hotmail.com) \nThe phakomatoses, also referred to as neurocutaneus syndromes, are congenital \nmalformations affecting mainly structures of ectodermal origin, i.e., the nervous \nsystem, the skin, the retina, the globe and its contents. Visceral organs are also \ninvolved, but to a lesser extent. The classical diseases included in this group are \nneurofibromatosis, type I (NF1-Von Recklinghausen disease) and type II (NF2-\nbilateral vestibular schwannomas), tuberous sclerosis (Bourveville’s disease), \nretinocerebellar angiomatosis (Von Hippel-Lindau disease) and encephalotrigeminal \nangiomatosis (Sturge-Weber syndrome). Although these conditions are separate, \neach the result of a change in a distinct gene, they share a tendency towards \ndevelopment of hamartomatous lesions and tumours of the nervous system, \nassociated with other multisystem features. In addition, even though the genes \ninvolved are different, they all act through a tumour suppressor mechanism. The \nimaging findings of these disorders will be reviewed and appropriate imaging \nprotocols will be presented for each of the conditions. The role of neuroradiology \nwill be discussed in confirming the diagnosis, follow-up of patients and screening \nof asymptomatic relatives.\nLearning Objectives:\n1.  To learn how and when you should image.\n2.  To consolidate knowledge about conventional neuroimaging findings of the \nmore common phacomatoses.\n3.  To be informed of the possible applications of advanced neuroimaging tech-\nniques.\n10:30 - 12:00 Room G/H \nEFOMP Workshop \nNew technology in diagnostic radiology: new frontiers in imaging \nof the lung\nEF 2 \nLung imaging: multidisciplinary scenario \nModerators: \nA. Torresin; Milan/IT \nJ.N. Vassileva; Sofia/BG \nA-266 10:30\nPulmonary nodule detection using CAD \nA. Retico; Pisa/IT (alessandra.retico@pi.infn.it) \nComputer-aided detection (CAD) systems can be usefully implemented to assist \nthe radiologists in the detection of pulmonary nodules in screening for lung cancer \nwith low-dose computed tomography (CT). The main necessary steps to build a \nCAD system are presented: the lung segmentation algorithm, the selection of the \nnodule candidates, the feature extraction and the classification procedure to reduce \nthe number of false positive findings. The use of CAD systems for the detection of \npulmonary nodules at low-dose CT screening for lung cancer may have a strong \nimpact on the positivity of screening results and follow-up recommendations; thus, \na high sensitivity and a limited false-positive rate are the fundamental goals to be \nof chest x-ray (CXR) abnormality. The CXR remains the most common imaging \nmodality in the evaluation of respiratory illness in HIV-infected children in low and \nmiddle income countries. A better understanding of the clinical and immunological \ncorrelates of severe CXR abnormalities is, therefore, important for those practicing \nin Sub-Saharan Africa. This presentation describes the 5-year findings of a Cape \nTown based collaborative paediatric HIV-research group and focuses on severe \nCXR abnormalities in 330 HIV-infected children with limited access to antiretroviral \ntherapy (ARV). CXR reporting methodology will be described. The prevalence of \nsevere radiographic abnormality and the main chest radiographic patterns will be \ndocumented. The clinical and immunological correlates of severe CXR abnormality \nas well as the factors implicated in persistence, will be defined. The impact of ARV’s \non the natural history of severe CXR abnormality will be reported. Recommenda-\ntions will be made with respect to appropriate interventions to prevent severe CXR \nabnormalities in this context. \nLearning Objectives:\n1.  To learn about the level of chronic chest radiographic changes encountered \nin HIV-infected children who do not have access to HAART.\n2.  To better understand the clinical and immunological correlates of chest radio-\ngraphic changes in HAART-naïve HIV-infected children.\n3.  To appreciate\na. the burden of paediatric pulmonary disease on resource-limited healthcare \nenvironment with a high prevalence of paediatric HIV-infection.\nb. the impact of HAART on chest radiographic changes in HIV-infected children.\nc. the importance of the early initiation of HAART in HIV-infected children.\nd. the challenges to healthcare delivery in a resource-limited healthcare \nenvironment.\n4.  To become familiar with standardised chest radiographic reporting techniques \nutilised for research in paediatric pulmonary radiology.\n5.  To consolidate knowledge of paediatric chest radiograph reporting, with par-\nticular emphasis on:\ni. The impact of technical factors\nii. The importance of standardised terminology\niii. Paediatric-specific normal variants\niv. Useful chest radiographic signs\nPanel discussion:  \nHIV and TB: What impact do they have on health care workers? 11:45 \n10:30 - 12:00 Room E2 \nFoundation Course: Neuroimaging \nE³ 920b \nTumours and phacomatosis \nModerator: \nN. Girard; Marseille/FR \nA-263 10:30\nA. Brain tumours \nM.M. Thurnher; Vienna/AT (majda.thurnher@meduniwien.ac.at) \nBrain tumour imaging objectives include: a) the diagnosis of brain tumour and the \nability to distinguish it from non-tumoural lesions, b) assessment of histological \ngrade of the tumour, c) delineation of the tumour borders and exact extention, d) \ndifferentiation between tumour and peritumoural oedema, and e) the evaluation of \npossible recurrence and therapy-induced phenomena. In the past years, several \nadvanced MR techniques have been developed that provide new insights into \npathophysiology of brain tumours. In general, the more aggressive a neoplasm, the \nmore abnormal the vasculature with greater vascular density, tortuosity, permeability \nand higher tumour blood volume. Perfusion MRI methods have been developed \nto provide non-invasive and robust surrogate markers of tumour angiogenesis \nand capillary permeability. Furthermore, MRI provides information on microstruc-\ntural (diffusion-weighted imaging), physiologic, and metabolic (MR spectroscopy) \nchanges of tumour tissues. In this lecture, the most common diagnostic problems \nin evaluation of brain tumours and a standardised MRI protocol for brain tumour \ncharacterisation will be discussed.\nLearning Objectives:\n1.  To learn about the imaging findings and the limitations of conventional MRI in \nthe evaluation of brain tumours.\n2.  To become familiar with new MRI techniques available for advanced brain \ntumour imaging.\n3.  To learn about the potential of ‘functional imaging’ (fMRI, PET, SPECT) in \ntumour characterisation, treatment decisions, and follow-up.\n5\n\nPostgraduate Educational Programme\nS6\n C B D E F\n G\nA\nA-269 11:35\nLung imaging: developments in role of MR \nJ.M. Wild; Sheffield/UK (j.m.wild@sheffield.ac.uk) \nMRI of the lungs has evolved radically in the last ten years to the point that it is now \nbecoming used routinely in clinical practice. This talk will focus on the technical chal-\nlenges and solutions for imaging lung structure and function with MRI methods using \nboth the endogeneous protons in the lungs and inhaled magnetic contrast agents. \nThe low proton density in the lungs (~ 0.1 g/cm3) and the magnetic inhomogoneity \nbetween tissue and air (susceptibility difference ~ 8 ppm) make structural proton \nMRI of the lung micro-structure challenging, particularly at higher B0 fields. Short \necho time pulse sequences, parallel imaging and respiratory gating can all help \nimprove proton anatomical MRI. Signal from the major pulmonary vessels can be \nenhanced using paramagnetic contrast agents and T1 weighted ultrafast pulse \nsequences for volume coverage providing 3D pulmonary angiograms. Pulse se-\nquence methods for pulmonary angiography and time resolved pulmonary perfusion \nmapping will be covered. The role of under sampled and view shared sequences \nwith parallel imaging will be discussed within the constraints of tradeoffs between \nspatial and temporal resolution. Functional lung imaging methods will be covered \nwith particular focus on the role of inhaled gaseous contrast agents ranging from \npulmonary blood pool enhancement by oxygen inhalation to state of the art methods \nfor imaging lung function with hyperpolarised 3He and 129Xe MRI. Again the focus \nwill be on technical challenges with a “how to do it” theme. Clinical images will be \nused as a means of highlighting the applications of the respective methodologies. \nLearning Objectives:\n1.  To comprehend the basic MR physics of imaging protons and hyperpolarised \ngases in the lungs.\n2.  To understand the techniques that are in use in clinical lung and pulmonary \nvascular MRI.\n3.  To become familiar with established and future clinical applications of MRI in \nlung and pulmonary vascular disease.\nAuthor Disclosure:\nJ. M. Wild: Advisory Board; Novartis. Author; NA. Board Member; NA. CEO; \nNA. Consultant; NA. Employee; University of Sheffield. Equipment Support \nRecipient; GE Healthcare. Grant Recipient; Novartis, GSK, Bayer, Pfizer. \nResearch/Grant Support; EU FP7, EPSRC. \n10:30 - 12:00 Room L/M \nStandards and Audit Session  \nAssessment of radiologists’ professional \nperformance \nModerator: \nE.J. Adam; London/UK \nA-270 10:30\nRadiologists’ performance: assessment using peer review \nG. Boland; Wellesley, MA/US (gboland@partners.org) \nPeer review is a necessary and essential quality standard, but is adherence to a \nroutine robust program is variable across imaging practices. Peer review should \nfocus not just on perception error but on reporting content, language and mode of \ncommunication, as well as adherence to best practices, national guidelines and \nvariability of radiologist recommendations, ideally within a clinically time-sensitive \nframework. There is lack of consensus on how to achieve these goals including the \npercentage, frequency and types of cases peer reviewed, whether by individuals \nor consensus, by subspecialty or generalist radiologist, by rank or educational \nlevel (trainee versus practicing specialist), real time versus remote peer review \n(weeks or months after the original imaging procedure), use of electronic tools \nand/or integration, communication of variation or error to radiologists, referring \nphysicians and/or patients, medico-legal issues, remuneration policies and disci-\nplinary procedures. This lecture will address the current and future status of peer \nreview, evaluating the issues highlighted above and will propose workable peer \nreview tools and procedures that are intended to maximize quality and minimize \nunnecessary overhead. \nLearning Objectives:\n1.  To comprehend the importance of peer review to education, clinical care, \nresearch, best practices and cost.\n2.  To understand how to implement an effective peer review program.\n3.  To become familiar with the differing peer review tools including electronic \ndecision support.\nAuthor Disclosure:\nG. Boland: Board Member; Radiology Consulting Group. \nachieved by the CAD developers. As different CAD systems may be characterised \nby different strengths and weaknesses, a procedure to combine them can enhance \nthe detection performance. The method to combine CAD systems, the CAD usage \nmodalities, and the way to estimate the impact of CAD systems on the observer \nperformance are discussed. \nLearning Objectives:\n1.  To comprehend the basic steps to design a CAD system for lung nodule \ndetection in CT scans.\n2.  To be aware of the possible usage of CAD as second reader in the clinical \npractice.\n3.  To understand how the impact of CAD on the reader sensitivity is evaluated.\nA-267 10:50\nOptimisation in lung imaging of children \nC. Owens; London/UK (owensc@gosh.nhs.uk) \nThis presentation will try to address the issues surrounding the use of CT in children \nand to outline the concept of how CT can be designed and customised for children, \nso as to be ‘fit for purpose.’ That is to answer specific clinical questions accurately \nand precisely, yet be delivered at the lowest possible radiation dose to the patient. \nThe session will attempt to outline the role which CT plays and the relative strengths \nand weaknesses within cardiothoracic (body) CT using specific examples. \nLearning Objectives:\n1.  To understand the importance of a dynamic team approach to optimisation of \nlocal CT techniques in all hospitals.\n2.  To appreciate the iterative nature and concept of sharing protocols across \nsites.\n3.  To become familiar with the techniques, tips and tricks to perform ‘as low as \nreasonably achievable’ CT imaging that is ‘fit for purpose’.\n4.  To consolidate knowledge of low dose acquisition of CT images and post \nprocessing techniques to optimise images using images to illustrate.\nA-268 11:10\nLung imaging: developments in role of PET \nM.-E. Meyer, P. Bailly, J. Daouk; Amiens/FR \n(Meyer.Marc‑Etienne@chu‑amiens.fr) \nRespiratory motion management: Lung PET acquisitions typically last several \nminutes, leading to a spread in the activity projection. In reconstructed images, this \nspreading results in poor evaluation of the lesion intensity and overestimation of the \nlesion size. Respiratory-gated PET/CT acquisition is one solution to this problem. \nSeveral processing methods are based on amplitude- or frequency-based analyses \nof the respiratory signal and reconstruction of a few gates, each of which contains \nnegligible residual motion. However, none of these methods are fully satisfactory, \ndue to inappropriate attenuation correction (although the latter can be improved \nby breath-hold or 4D CT acquisitions). Moreover, positional blurring related to the \nunderlying, inter-cycle variability in respiratory amplitude may still exist, especially \nwith frequency-based methods. To overcome this issue, advanced techniques \nrelying on proper event selection (respiratory motion compensation or full motion \ncorrection) have been suggested. Adaptive treatment and advanced follow-up: Even \nthough clinical PET imaging of the lung is mainly performed for diagnostic purpose, \nit also has other uses. Various methods for gross tumour volume definition have \nbeen developed for radiotherapy planning. Furthermore, gated PET/CT acquisi-\ntions may help to optimise the definition of processing margins and minimize the \ndose delivered to non-malignant tissues. Moreover, the lesion’s functional volume \nmeasured with 18F-FDG PET during radiochemotherapy is likely to have significant \nprognostic value. Lastly, other radiopharmaceutical agents are being developed \nfor the optimization of radiotherapy planning, notably by assessing hypoxic cell \ntargeting (e.g. 18F-FMISO). \nLearning Objectives:\n1.  To learn about respiratory motion management in PET acquisitions.\n2.  To understand techniques of respiratory motion compensation or full motion \ncorrection to prevent inappropriate attenuation correction and errors in quan-\ntification.\n3.  To consolidate knowledge of adaptive treatment and advanced follow -up: \noptimisation of radiotherapy planning.\n6\n\nPostgraduate Educational Programme\nS6\nB\n C D E F G\nA\nSaturday\n12:15 - 12:45 Room A \nPlenary Session \nHL 2 \nWilhelm Conrad Röntgen Honorary Lecture \nPresiding: \nJ.I. Bilbao; Pamplona/ES \nA-273 12:15\nInterventional oncology: the era of molecular targeted therapy \nJ.-F. Geschwind; Baltimore, MD/US (jfg@jhmi.edu) \nCancer is a disease characterised by healthy cells undergoing genetic mutations \nthat result in the uncontrolled growth of a tumour, which in turn causes a grave \ndisruption of homeostasis and eventually leads to death. Current treatments in-\ncluding surgery, chemotherapy, radiotherapy and immunotherapy have not proved \neffective enough to cause a significant reduction of cancer-related mortality in the \nlast decade. The WHO projected the number of global cancer deaths to increase \n45% from 2007 to 2030 (7.9 to 11.5 million deaths). Cancer is also characterised by \nseveral hallmarks or phenotypes, which can be difficult to target. One of the most \nimportant phenotypes is the up-regulation of the major energy-producing pathway, \nglycolysis, which plays a crucial role in the uninterrupted growth of tumours and is \nan indispensible “metabolic event” critical for the sustained growth and invasion \nof tumours. This phenotype has been used clinically for diagnostic purposes but \nnever exploited as a possible therapeutic approach. A new class of drugs has been \ndesigned to selectively target such a pathway causing tumour cell death. Although \ncancer is considered a “systemic” disease, it can be treated loco-regionally. The \nprogress in imaging technology has led to a revolution in image-guided therapies \nfor cancer. It has become possible to zoom in on the tumour and deliver toxic \ndoses of chemicals or radiation, which would not be feasible systemically. With \nbetter drugs, more effective drug delivery systems and sophisticated imaging, \nwe now have more potent tools to design weapons with increased precision and \nlethality against cancer.\nLearning Objectives:\n1.  To learn about basic principles of cancer biology.\n2.  To understand the importance of tumour metabolism and recognise its role in \ncancer growth.\n3.  To appreciate the growing impact of image-guided therapies for cancer.\nAuthor Disclosure:\nJ. -F. Geschwind: CEO; PreScience Labs, LLC. Consultant; Biocompatibles/\nBTG, Bayer HealthCare, Guerbet, Nordion, Merit, Abbott and Jennerex. Grant \nRecipient; Biocompatibles/BTG, Bayer HealthCare, Philips Medical, Nordion. \nOther; Founder, PreScience Labs, LLC. \n12:30 - 13:30 Room N/O \nThe Beauty of Basic Knowledge: Head and Neck \nMC 24C \nMain pipelines of the neck: pharynx and larynx \nA-274 12:30\nMain pipelines of the neck: pharynx and larynx \nM. Becker; Geneva/CH (minerva.becker@hcuge.ch) \nThe purpose of this lecture is to familiarize the radiologist with current imaging \nprotocols for the evaluation of common pathologic conditions of the larynx and \npharynx, to describe the key anatomic structures relevant to tumour spread and \nto discuss the clinical implications of CT and MRI in the pre-therapeutic work-up \nof squamous cell carcinoma of this region. A systematic review will include key \nradiologic features and characteristic patterns of submucosal spread in squamous \ncell carcinoma of the larynx and pharynx, as well as implications of cross-sectional \nimaging for staging and treatment. The lecture will also review the characteristic \naspect of rare tumours of the region and of common and less-common inflammatory \nor traumatic conditions. Typical radiologic findings in neoplastic and non-neoplastic \nconditions will be discussed with an emphasis on potential pitfalls and on how to \nA-271 11:00\nRadiologists’ individual performance: use of standardised test images \nA.G. Gale; Loughborough/UK (a.g.gale@lboro.ac.uk) \nHow well an individual radiologist performs is complex. Such performance can \nbe understood in two ways: how well does someone identify an abnormality cor-\nrectly and how well do they agree with colleagues on the radiological outcome. \nVarious measures of performance can be utilised such as; sensitivity, specificity, \nROC scores, abnormality detection and radiological feature classifications. Test \nsets of carefully selected exemplar images are useful in assessing these skills. \nSuch sets are particularly important in screening scenarios where in real life the \nabnormality incidence is very low and so it can be difficult to gauge an individual’s \nskill level. However, care must be taken in interpreting the results of test sets as \nthe individual knows it is a test, the sets are usually weighted with abnormal and \npossibly rare cases - all factors which affect any performance measures. Illustra-\ntions will be presented from the use of the PERFORMS national self-assessment \nscheme in the UK which is used in breast screening. Individuals examine sets of \nrecent challenging screening cases and receive immediate detailed feedback as \nwell as subsequent feedback where their performance is anonymously compared \nto colleagues. The scheme identifies individuals who are under-performing, the \nunderlying reasons for their performance can be determined and improvement \nstrategies proposed for them to follow. The PERFORMS scheme is available in-\nternationally as well as being rolled out across other radiological domains. Overall \nit is argued that screening performance test sets, are a very useful educational \nexercise as well as an external quality assurance tool. \nLearning Objectives:\n1.  To understand the use of standardised test sets.\n2.  To comprehend the advantages and limitations of using test sets to measure \nthe radiological performance.\nAuthor Disclosure:\nA. G. Gale: Research/Grant Support; NHS Breast Screening Programme. \nA-272 11:30\nRadiologists’ performance: referrers’ view \nJ.M.L. Bosmans; Gent/BE (janbosmans@telenet.be) \nSince 1988, several authors have surveyed the views and expectations of refer-\nring clinicians regarding the radiology report. Their findings are strikingly similar, \ntaking into account that these have been obtained over a quarter of a century, and \nin several countries in North America and Europe. In general, referring clinicians \nare rather pleased with the radiology report. Their greatest concern is that the \nradiologist may not properly address the clinical question. However, they are quite \naware that the radiologist, to think and act as a clinician, needs adequate clinical \ninformation and a clearly formulated clinical question. They value clarity, brevity, \nclinical correlation and timely delivery of the report. Depending on their specialism, \nreferrers appreciate the report to a different degree. General practitioners rely more \non the report than on hospital specialists and they especially value the radiologist’s \nadvice on planning of future investigations. A clear majority of the referrers would \nfavor a shift from free text reporting to structured reporting, as well as the use of \na comprehensive radiological lexicon. Although radiologists share many of the \nviews and expectations of referrers, concretizing these preferences will necessitate \nfundamental organisational and educational changes. Together with the conviction \nthat things are at their best the way they are, the main obstacle is fear of productiv-\nity loss. As we already know very well what referring clinicians want, there is little \nneed for further descriptive research. Instead, we should concentrate on guidelines, \neducation, and technical solutions for the productivity problem. \nLearning Objectives:\n1.  To become familiar with the views and expectatations of referring clinicians \nconcerning communication with the radiologist and more specifically regarding \nthe radiology report.\n2.  To understand the different needs of particular subgroups of referrers.\n3.  To become familiar with the views and expectations of referrers regarding \nstructured reporting and its potential effect on productivity and training.\n7\n\nPostgraduate Educational Programme\nS\n C B D E F\n G\nA\nfrom Spain, represented by their National Society AETR (Asociación Española de \nTécnicos en Radiología), that represents near 10,000 Radiographers in the fields \nof Diagnostic imaging, nuclear medicine and radiotherapy, working in a very high-\nstandard Health System, with almost 800 hospitals, providing care to 46 millions \ninhabitants. At this first historical EFRS meets session, the invited speakers will give \nus a perspective of Spanish Radiographers’ role in advanced areas of practice. In \nthe last decade, AETR has essentially being focused in promoting Radiographer \nEducation in Spain and therefore an overview about this topic will also be addressed. \nThis “EFRS meets Spain” session intends to be a space of a proactive debate \nand exchange of knowledge as a trigger for the development of the profession. \nSession Objectives:\n1.  To understand Spanish radiographers’ education and professional status and \nits comparison with other European countries.\n2.  To learn about the role of radiographer within the framework of the Spanish \nhealth system.\n3.  To learn about areas of professional development for radiographers in Spain.\nA-285 14:05\nThe Spanish radiographer’s role in advanced MRI research \nE. Alfayate Sáez; Madrid/ES (ealfayate@fundacioncien.es) \nA Radiographer, as part of a MRI research team, is more than just a professional \nobtaining patient´s images for either the investigational studies or clinical trials. \nBeing part of the team means participating and understanding the project as a \nwhole. It means one must know the study‘s objectives, collaborate in the protocol \ndesign and optimization, and inform the patient about the exam and steps to follow \nin order to maximize his cooperation. Personal data protection and individual privacy \nmust be guaranteed through all the process; a written informed consent should \nbe signed by the patient as well. Taking care of all these particular aspects is very \nimportant for a successful completion of each study/trial. Due to rapid technologi-\ncal advances, and the necessity to deal permanently with state-of-the-art scientific \nareas, Continuous Professional Development (CPD) for a Radiographer working \nin a research team is critical. The radiographer is part of a multidisciplinary team, \nwhere each professional performs a very specialized task, combining efforts is \ncrucial in order to produce a work of excellence that can be shared with the scientific \ncommunity. Thanks to the continuous investment in new technology, we have the \nopportunity, in our site, to conduct research in diverse areas, such as cardiology, \ntraumatology, gynaecology, obstetrics and neurology. Through this presentation \nwe will share some of the research we are working on, as well as the importance \nof the Radiographer role in a research centre. \nLearning Objectives:\n1.  To understand the role of radiographer in a MRI research centre.\n2.  To understand the daily activity in a MRI research center and the continuous \nprofessional development related to it.\n3.  To learn about the potential areas of research development in MRI.\nA-286 14:23\nThe radiographer’s specialisation in ultrasound: two decades of \nexperience in a public hospital \nM.P. Peña Fernández; Getafe/ES (mpalomapena@yahoo.es) \nAbout 20 years ago, a Radiology Department from a hospital belonging to the \ncommunity of Madrid, from the Spanish National Health System, started to train \nRadiographers to perform ultrasound procedures. Currently, there are 10 radiogra-\nphers perfoming ultrasound in our Hospital. To perform ultrasound exams with high-\nquality standards, a good training and a professional commitment with Continuous \nProfessional Development (CPD). According to our experience, a training period of \n7 months (35 h per week) was considered adequate as a minimal requirement for \na Radiographer to perform high-standard ultrasound exams. Radiologists‘ support \nand participation in the learning process was extremely important for the success \nof the integration of Radiographers in Ultrasound. Study protocols and image \nquality parameters were established in order to facilitate the delegation process \nfrom Radiologists. Radiographers give oral and/or written comments about imaging \nfindings, to facilitate the clinical report made by the Radiologist. The integration of \nRadiographers in performing ultrasound exams resulted in a considerable improve-\nment on the Department productivity and patient workflow.\nLearning Objectives:\n1.  To understand the role of the radiographer in ultrasound.\n2.  To learn about inter-professional relations in ultrasound.\n3.  To appreciate the advantages of a radiographer in ultrasound for radiology \ndepartment outcomes and for the quality of patient care.\navoid them. Emphasis will be put on what the clinician needs to know and how to \nreport the findings in a systematic way.\nLearning Objectives:\n1.  To become familiar with the anatomy of the pharynx and larynx.\n2.  To learn how to choose and tailor imaging techniques according to clinical \npresentation.\n3.  To appreciate the most common pathologies affecting these structures.\n4.  To be able to provide a useful differential diagnosis of pharyngeal and laryngeal \nlesions.\n12:30 - 13:30 Room P \nThe Beauty of Basic Knowledge: Musculoskeletal Imaging \nMC 25C \nInflammatory/infectious disorders \nA-275 12:30\nInflammatory/infectious disorders \nV.N. Cassar-Pullicino; Oswestry/UK (Victor.Pullicino@rjah.nhs.uk) \nThere are a host of inflammatory and infections insults that can manifest focally \nor diffusely within the musculoskeletal system. The appearances of the underly-\ning pathological processes in both the soft tissues and skeleton cover a very wide \nimaging spectrum. The appearances vary depending on the timing and degree of \ninflammatory insult and the host response in the involved tissues. The approach \nof this lecture will cover the imaging manifestations using all modalities covering \nradiography, ultrasound, CT, scintigraphy and magnetic resonance imaging. The \nbasic knowledge that is required will be displayed in 4 major musculoskeletal cat-\negories covering disorders involving the Soft Tissues, Joints, Bones and Entheses. \nThe imaging manifestations will also be linked with the evolution of the pathologi-\ncal processes covering acute, sub-acute and chronic stages of the inflammatory/\ninfections disorders. By the end of the session, the audience will have a clear \nunderstanding of how to make best use of the imaging modalities in the correct \ndiagnosis of a wide variety of inflammatory and infections conditions that can affect \nthe musculoskeletal system.\nLearning Objectives:\n1.  To understand the pathophysiology of inflammatory conditions of the muscu-\nloskeletal system.\n2.  To learn about the basic imaging criteria for the diagnosis of arthritis, osteo-\nmyelitis, and spondylitis.\n3.  To become familiar with the differential diagnosis of the most common inflam-\nmatory diseases.\n14:00 - 15:30 Room B \nEFRS meets Spain \nEM 5 \nKnowledge development as a tool for radiographers’ \nprofessional improvement \nPresiding: \nG. Paulo; Coimbra/PT \nC. Ruiz Blanco; Madrid/ES \nA-284 14:00\nIntroduction \nG. Paulo1, C. Ruiz Blanco2; 1Coimbra/PT, 2Madrid/ES \n(graciano@estescoimbra.pt) \nRadiographers’ involvement in ECR has already a tradition and a history of success, \nrevealed not only by the increase of participants but also for the quality development \nof the scientific content of Radiographers’ sessions. The consolidation of the rela-\ntionship between ESR/ECR and the young EFRS (European Federation of Radiog-\nrapher Societies, founded in 2008 and representing Radiographers’ Societies from \n33 European Countries and 35 Higher Education Institutions - HENRE) gave us the \nopportunity to have, for this first time in ECR history an “EFRS MEETS” session. For \nthis session, the country of ECR 2013 President, Prof. José Ignacio Bilbao, was cho-\nsen and therefore we have the privilege and the honour to receive Radiographers’ \n68\n\nPostgraduate Educational Programme\nS\nB\n C D E F G\nA\nSaturday\nSpain, in relation with the rest of Europe, through the different comparative studies \nof Radiographers that have been done by the Ministry of Health and Consumer \nAffairs, as well as the different Associations and Syndicates of the states, European \nand International that represent our community. So, which is our present educative \nframework in respect to our European workmates? \nLearning Objectives:\n1.  To understand the Spanish radiography education model.\n2.  To learn about the limitations of Spanish education on free movement on \nprofessionals in Europe.\n3.  To learn about solutions for education-model development regarding profes-\nsional harmonisation.\nPanel discussion:  \nCould a transnational and multi-professional combined statement \ncontribute to professional development? 15:22 \n16:00 - 17:30 Room A \nInteractive Teaching Session \nE³ 1120 \nBreast cancer \nA-296 16:00\nA. Detection \nC.S. Balleyguier; Villejuif/FR (balleyguier@igr.fr) \nBreast Cancer detection relies almost exclusively on the radiologist. Mammography \nis the basic tool for screening. Sonography and MRI are complementary techniques. \nSensitivity of mammography is very high (close to 90%) in case of fatty breast. \nHowever, accuracy declines in case of dense breast. The most challenging cancers \nare infiltrative lobular carcinoma and cancers presenting only with architectural \ndistortion. Mammography is by far the best examination for the detection and \ncharacterisation of microcalcifications. Sonography is not a screening tool, but \nis a useful complement to questionable mammograms. MRI is very powerful and \nmight become the primary screening tool in selected populations like high-risk \nwomen, but should not replace mammography in all cases due to the risk of false \npositive findings. A combined report of both MRI and mammogram is desirable. The \nradiologist should be familiar with the most common traps: lesions seen on only \none view, cancer seen only as a mild asymmetry of breast density, identification \nof neoplastic calcification in the middle of uneven microcalcifications and mildly \nenhancing images in MRI or lesions masked by a severe background enhancement. \nThe radiologist should be fully aware of BIRADS terminology and should be able \nto propose the correct indications for biopsy, as well as the preferred guidance.\nLearning Objectives:\n1.  To understand the respective role of each imaging technique in the diagnosis \nof breast cancer.\n2.  To learn about common pitfalls in the diagnosis of breast cancer.\nA-297 16:45\nB. Follow-up \nG. Forrai; Budapest/HU (forrai.gabor@t‑online.hu) \nThe role of radiologist is to provide detailed pre-operative assessment and post-\ntherapy follow-up included detection and differential diagnosis of recurrence and \npost-therapy sequelae. Diagnostic tools are combination of clinical examination, \nmammography, sonography, MRI, PET/CT and guided biopsy. Additional diagnostic \nhelp is obtained by comparison with prior films. The quality of the post-operative \nimaging depends also on preoperative assessment. All the congenital and benign \nconditions must be known before surgery in order to avoid post-operative interpre-\ntation problems. Pathology results and preoperative films as well as prior surgical \nand/or needle biopsy results must be present. Post-therapy conditions are some-\ntimes challenging because post-therapy changes may mimic recurrent disease. \nBreast cancer is a heterogeneous disease, therefore, the spectrum of morphology \nand progression dynamics may be very different. Follow -up is chosen when the \npost-therapy changes are stable or show typical benign morphology features. \nProgressing or indeterminate lesions have to be biopsied if all imaging modalities \nfail to provide an equivocal diagnosis. Monitoring neoadjuvant chemotherapy by \nprediction of response is a new step toward individualized therapy of breast cancer.\nLearning Objectives:\n1.  To understand the common features of recurrent breast cancer.\n2.  To learn how to establish imaging follow-up protocols or breast cancer.\nA-287 14:41\nInterlude: Radiology and Spanish art \nC. Ruiz Blanco; Madrid/ES (presidencia@aetr.net) \nThis interlude in digital video format, wants to show another application of x-rays \nused in Art. This relation of the x-rays and art goes back to France, during the \nFirst World War, where the first x-ray art image was made, using an x-ray table. \nIn 1931, the Siemens-Reiniger-Feifa build the first x-ray unit especially designed \nfor the study of paintings. This technique has evolved using the technological \ndevelopments advances of the radiological field, such as film digitalization, digital \nx-ray systems, CT, and even more sophisticated techniques. The use of Radiol-\nogy in art created the possibility to analyse, study, observe and identify, through a \n“non-invasive” technique, several kinds of damages from different sources, giving \nimportant orientations for restoring strategies. The use of x-rays is also used in \nthe conservation and restoration of archaeological artifacts, giving orientation for \ncleaning and conservation and also information about the method of the origin and \ncreation of archaeological objects. The given information also contributes to obtain \ninformation about the evolution of civilizations as well as artistic changes through \ncenturies. There are several other applications for Radiology in art. Through this \nvideo, a visit to several Spanish museums will give us an overview about this \ninteresting topic.\nA-288 14:46\nThe radiographer as the interface between patient and technology in \npromoting safety in radiation protection \nJ.A. Soria Jerez; Madrid/ES (juansoria.madrid@gmail.com) \nSince Roentgen discovered x-rays, two facts are scientifically irrefutable: they \nare a irreplaceable tool for clinical diagnosis and therapy and despite this major \nadvantage they are not harmless. During the exposure to ionising radiation, several \ninteractions with matter happen that can cause deleterious effects to patients and \nstaff, if high-standard radiation protection measures are not used. Radiographers, \nacting in the interface between patient and technology in medical imaging, are the \nultimate gatekeepers of patient and staff radiological protection, keeping always \nin mind the necessity to deliver acceptable diagnostic images according to ALARA \nprincipal. Being the last contact point with the patient before the exam is performed \nits mandatory that the Radiographer verifies several important check points related \nto patient information, patient physical condition and the clinical information given \nby the referrer in order to guarantee the best approach for the exam performance, \nnamely if it is justified. A specific explanation about the exam to be performed \nmust be given, with a language adequate for patient understanding, not only to \nobtain the necessary informed consent but also to get the maximum cooperation \npossible. Taking into account the diversity of parameters used when performing \nthe radiological procedure, they should be carefully adapted to each individual \npatient and to the outcome expected according to the clinical information. In this \npresentation, an overview through the key elements for the radiological procedure \nwill be made concluding that an optimal knowledge about them will allow to obtain \nthe best diagnostic image with the lowest exposure possible.\nLearning Objectives:\n1.  To learn how to enhance patient safety in radiation protection.\n2.  To learn about radiographers’ role in optimising procedures.\n3.  To understand the continuous professional development requirements needed \nto maintain high standards in patient safety.\nA-289 15:04\nEducational status of radiographers in Spain: comparison with the EU \nM.R. Soto García; Barcelona/ES (martasotogarcia@gmail.com) \nAs Radiographers, in Spain we develop our professional activity in a techno-\nscientific area that is in constant evolution and specialization. The characteristics \nand the importance of these activities are linked to the continuous advances of the \ntechniques taken in the Diagnose for the Image centres. This reality requires a deep \nchange in the formative curricular content in our profession. Our profession must \nevolve towards university training. It is very important to the process of the medi-\ncal image, that the developments in technology are accompanied by well-trained \nprofessionals, trained in the different modalities and possibilities of acquisition of \nimages, and with adequate knowledge of use, protection concepts and attention \nto patients, that only a grade career can give. Without this base, the quality of \nmedicine in this country is seriously limited. Because of that, we should not let \nRadiographers be condemned to undertake their duties in Spain, in comparison \nwith the EU spirit in the right of free circulation of citizens, because the bureaucratic \nand real difficulties that take to have a lower qualification to the rest of countries \naround us are insurmountable. For this reason, I will present the actual situation in \n69\n\nPostgraduate Educational Programme\nS7\n C B D E F\n G\nA\nearlier. Furthermore, several studies revealed that a complete remission of my-\neloma confirmed by MRI or PET-CT goes along with a better prognosis compared \nto a complete response based only on serological parameters. Therefore, current \nstudies address the capabilities of the novel imaging techniques to assess minimal \nresidual disease to identify possible sources of relapse. \nLearning Objectives:\n1.  To understand the pathophysiologic mechanisms of multiple myeloma.\n2.  To be able to compare the significance of imaging and serological markers for \nresponse evaluation in myeloma.\n3.  To assess the significance of the depth of response to systemic treatment.\nA-301 16:51\nEvaluation of response in lymphoma with PET/CT \nS.F. Barrington; London/UK (sally.barrington@kcl.ac.uk) \nChanges in glucose metabolism with 18  F Fluorodeoxyglucose (FDG) Positron \nEmission Tomography and CT (PET-CT) give an early indication of response to \nlymphoma treatment, prior to changes in tumour size. ‘Interim’ PET-CT (iPET) after \n1-3 cycles of chemotherapy is more accurate than CT alone and outperforms the \ninternational prognostic score (IPS) in advanced Hodgkin Lymphoma (HL) and the \nIP index (IPI) in aggressive non-Hodgkin Lymphoma (NHL). The importance of iPET \nlies in its potential application for response-adapted therapy, with current phase \nIII trials in progress to establish: 1. if abbreviated chemotherapy ± radiotherapy is \nsufficient to cure patients with good 'metabolic' response in HL. 2. If escalation of \nchemotherapy and/or early transplantation can improve survival in patients with \npoor 'metabolic' response in advanced HL and aggressive NHL. iPET assesses \nthe degree of chemosensitivity rather than the completeness of overall response. \nA method of interpretation which reflects the continuous nature of data obtained \nusing iPET with the ability to alter the threshold used to define a 'positive' versus \nnegative result, according to the clinical or research question led the development \nof a five-point scoring system (5PS). The 5PS was adopted at the first international \nconference in iPET held in Deauville. The 'Deauville Criteria' (DC) grade response \nby comparing any residual uptake with uptake in normal mediastinum and liver. The \nDC have been validated in an international study in HL and have good interobserver \nagreement in a multicentre trial setting. DC are gaining widespread acceptance \nfor clinical and trial use.\nLearning Objectives:\n1.  To understand the role of interim PET/CT in the evaluation of metabolic re-\nsponse to lymphoma.\n2.  To become aware of proposed reporting criteria developed for assessment of \ninterim PET/CT.\n3.  To get an overview of current clinical trials exploring the role of response \nadapted therapy according to PET/CT.\nPanel discussion:  \nIs it time for biomarker response criteria in haematological \nmalignancies? 17:14 \n16:00 - 17:30 Room C \nUrogenital Imaging \nCC 1121 \nStones: diagnosis and intervention \nModerator: \nN.C. Cowan; Oxford/UK \nA-302 16:00\nA. Imaging patients with renal colic \nG. Heinz-Peer; St. Pölten/AT (gertraud.heinz@stpoelten.lknoe.at) \nHelical CT is now accepted as the imaging technique of choice for evaluating \npatients with acute flank pain in whom renal or ureteral calculi are suspected. It is \nsuperior to excretory urography and there is no need for intravenous contrast media \ninjection for this study. Diagnostic confidence is often improved and the likelihood of \nstone passage can be predicted. Non-urologic causes of abdominal pain can often \nbe diagnosed. Recently, dual-energy CT scanners have been utilised to detect and \nto characterise urinary tract calculi. It has been shown that uric acid stones can be \ndifferentiated from non-uric acid stones with high specificity. Disadvantages of CT \ninclude that it is generally more expensive compared to conventional techniques \nand that it may be less accurate in guiding treatment, since the degree of obstruction \n16:00 - 17:30 Room B \nState of the Art Symposium \nSA 11 \nEvaluation of response in haematological \nmalignancy \nA-298 16:00\nChairman’s introduction \nE. de Kerviler; Paris/FR (eric.de‑kerviler@sls.aphp.fr) \nResponse to treatment in haematological malignancies has long been assessed \nby the evolution of serological markers in multiple myeloma or bidimensional \nmeasurements of target lesions in lymphoma. However, these response criteria \nfailed to identify patients with minimal residual disease or with inactive residual \nmasses. Functional imaging such as PET, diffusion or perfusion studies have already \nproven to be effective or are very promising ones. This aim of this multidisciplinary \nsession with a Nuclear Medicine physician, a Haematologist and a Radiologist, is \nto present the State of the Art in the management of patients with haematological \nmalignancies and to show the techniques that may become tomorrow’s standards. \nSession Objectives:\n1.  To become reacquainted with the standard criteria for therapeutic response \nin myeloma and lymphoma.\n2.  To demonstrate the role of CT, MRI and PET in the assessment of therapeutic \nresponse.\n3.  To show that functional imaging is now essential for patient evaluation at \nbaseline and follow-up.\n4.  To consider future imaging biomarkers in the assessment of response.\nA-299 16:05\nOpportunities and limitations of PET, CT and MRI answering the \nhaematologist’s questions \nT.C. Kwee; Utrecht/NL (thomaskwee@gmail.com) \nImaging plays an important role in the evaluation of lymphoma; relevant targets for \nimaging include 1. tumour characterisation and detection of Richter‘s transformation, \n2. staging, 3. response assessment and 4. restaging. Although several of these \ntargets can be reached to some extent, considerable challenges remain. In this \nlecture, the imaging characteristics of lymphoma at ultrasound, CT, MRI, and PET \nwith 18F-FDG will be briefly reviewed. Subsequently, the utility and limitations of \nstructural imaging with CT and MRI, and the additional value of 18F-FDG PET will \nbe demonstrated. Finally, the following emerging imaging concepts and techniques \nwill be discussed: tumour biology assessment with 18F-FDG PET, immuno-PET with \n89Zr-rituximab and diffusion-weighted MRI. \nLearning Objectives:\n1.  To learn the various imaging features of lymphoma.\n2.  To learn the advantages and limitations of CT, PET, and MRI in the evaluation \nof lymphoma.\n3.  To understand the importance of and opportunities provided by (new) functional \nimaging methods for staging and follow-up of lymphoma.\nA-300 16:28\nEvaluation of response in multiple myeloma \nJ. Hillengass; Heidelberg/DE (jens.hillengass@med.uni‑heidelberg.de) \nMultiple myeloma is a haematologic malignancy characterised by the infiltration \nand proliferation of monoclonal plasma cells mainly in the bone marrow. Previously, \ntreatment-response was assessed mainly by measurement of the concentration \nof monoclonal protein in serum and light chains in urine. The introduction of \ncross-sectional imaging such as MRI, CT and PET-CT to extend or even replace \nconventional radiological survey in the imaging work up of patients with monoclonal \nplasma cell diseases led to new insights in the pathophysiology of the disease but \nalso showed that imaging findings improve response assessment. Especially, MRI \nhas extended the knowledge concerning growth patterns of myeloma cells in bone \nmarrow. It was found that patients with this disease can present with either a diffuse \ninfiltration, a focal pattern or a combination of both. Furthermore, some patients \neven do not show any signs of infiltration at all. Although conventional response \ncriteria correlate with imaging-based assessment of the remission of the disease, \nit has been demonstrated that, e.g., PET-CT is able to detect response to therapy \n0\n\nPostgraduate Educational Programme\nS7\nB\n C D E F G\nA\nSaturday\nA-305 17:00\nD. Interactive case discussion \nN.C. Cowan; Birmingham/UK (nccowan.uro@gmail.com) \n16:00 - 17:30 Room D1 \nCLICK (Clinical Lessons for Imaging Core Knowledge): Never \nwithout Arteries \nCC 1118 \nStroke \nModerator: \nM.M. Thurnher; Vienna/AT \nA-306 16:00\nA. Clinical considerations \nP.M. Parizel, P. Cras, T. Menovsky, T. Van der Zijden, M. Voormolen; Antwerp/BE \n(paul.parizel@ua.ac.be) \nStroke is the most common non-traumatic neurological emergency, and the lead-\ning cause of serious, long-term disability. Worldwide, each year, an estimated 15 \nmillion people suffer a stroke. Accurate data on stroke incidence across Europe \nare lacking, but according to WHO estimates, the number of stroke events is likely \nto increase to more than 1.5 million per year in 2025. On average, higher rates of \nstroke occur in eastern, and lower rates in Southern European countries. Stroke \nrisk factors and predisposing diseases can be broadly categorized as “controllable” \nor “uncontrollable”. Controllable risk factors are subdivided into medical (hyperten-\nsion, atrial fibrillation, hypercholesterolemia, diabetes, atherosclerosis) and lifestyle \n(smoking and tobacco use, alcohol use, obesity, physical inactivity). Uncontrollable \nrisk factors include age, gender, race, famility history, previous stroke or TIA, fibro-\nmuscular dysplasia, patent foramen ovale. In acute stroke patients, non-invasive \nmultiparametric neuroimaging plays a pivotal role in patient selection, treatment \ndecision-making, and and guiding therapeutic interventions. Identification of the \nischaemic penumbra, using MRI and/or CT, has entered routine clinical practice. \nIn acute stroke patients, the challenge for radiologists is to provide a fast and ac-\ncurate diagnosis, and using the tools that are available, to assess the infarct core/\nischaemic penumbra, to guide the decision-making, and to perform interventional \ntreatment of stroke patients, in order to reduce the size of the infarction and to \nprotect the surrounding brain at risk. Ultimately, thanks to advanced neuroimaging \ntechniques, we have the potential to elucidate mechanisms of recovery and develop \nimaging biomarkers for predicting recovery and monitoring treatment responses.\nLearning Objectives:\n1.  To become familiar with the frequency and causes of stroke.\n2.  To learn about the most important risk factors and predisposing diseases.\n3.  To learn about the importance of imaging for treatment decision-making and \nplanning.\nA-307 16:30\nB. Imaging techniques and typical findings \nJ. Vymazal; Prague/CZ (Josef.Vymazal@homolka.cz) \nCerebrovascular disease represents a major source of global mortality and morbid-\nity. Imaging examinations play a critical role in the management of stroke patients, \nfrom establishing the initial diagnosis to determining and guiding further treatment. \nHaemorrhagic stroke, or intracerebral haemorrhage, represents 10-15 % of stroke \ncases and approximately 85 % of strokes are ischaemic. The specificity of clinical \ntests is unacceptably low, therefore imaging is the initial step in the management \nof a stroke patient. Non-contrast CT confirms the presence of haemorrhage, it \ndoes not exclude ischaemia and/or stroke mimics such as encephalitis, multiple \nsclerosis, hypertensive encephalopathy, etc. Perfusion CT confirms the presence \nof ischaemia immediately. Its radiation burden is not negligible. MRI with SWI \nconfirms the presence of haemorrhage and DWI reveals ischaemia minutes after \nstroke. Perfusion MRI with DWI is able to detect the ischaemic penumbra. PWI and \nDWI with MRI always cover the whole brain. Modern state-of-the-art CT scanners \ncover almost the whole brain with PWI; older scanners a limited slab only. The \npresence of penumbra is important for further management decisions but it is not \nunambiguous. MRI is also better in imaging the posterior fossa and better detects \nsmall infarcts. There is no radiation burden with MRI. However, MRI is slower, it \nis less clear. The overall radiation dose to patients is greater than that of observed \nwhen excretory urography was the imaging study of choice. Ultrasonography (ei-\nther by itself or in conjunction with conventional radiography) is utilised to image \nrenal colic patients as an alternative to CT at some institutions. The color Doppler \ntwinkling artifact increases sensitivity in detecting small urinary tract stones that \nlack posterior acoustic shadowing. Magnetic resonance urography has been used \nby some as another alternative to CT. The management of urinary stone disease \ndepends on the clinical presentation, stone location, stone size, and possibly on \nstone “hardness”. \nLearning Objectives:\n1.  To learn about imaging approaches to patients with renal colic.\n2.  To become familiar with the strengths and limitations of various imaging \ntechniques.\n3.  To learn about the management of patients with renal colic.\nA-303 16:20\nB. Percutaneous treatment of renal stones \nS. Moussa; Edinburgh/UK (smoussa@sky.com) \nUrinary tract calculi: common condition, 15% of men and 6% of women in devel-\noped countries will have one stone, 50% will recur, majority are idiopathic 80%. \nTreatment modalities include Extracorporeal Shock Wave Lithotripsy (ESWL), \nFlexible Ureteroscopy and Lasertripsy, Percutaneous Nephrolithotomy (PCNL), \nLitholapaxy, Open surgery! Stone size (burden), stone position, radiolucency, \nobstruction, anatomy, body (spinabifida, spinal deformity/fusion), renal (horseshoe, \nectopic), calyceal (duplex, diverticular). are the factors affecting the management \nof urinary tract calculi. The management of stone disease has evolved in recent \nyears since the advent of ESWL as well as with advances in interventional radio-\nlogical techniques allowing for safer percutaneous access to the upper urinary \ntract. There has been an increase in the use of CT in the evaluation of patients \nwith stone disease, particularly complex stones where 3D reconstraction has been \nshown to be of great value as well as CT-guided renal access. The technique of \npercutaneous nephrolithotomy will be described together with factor affecting the \nchoice of approach, number of puncture and patient position. Examples of some \ncomplex cases will be discussed. For best practice in stone management, the fol-\nlowing points must be considered: accurate imaging and preoperative evaluation \nof the patient, if possible use of 3D-CT for planning, close discussion between \nradiologist and endourologists, team effort including anaesthesia and all theatre \nstaff, and recognition and early management of complications.\nLearning Objectives:\n1.  To appreciate the importance of imaging, stone selection and planning for \npercutaneous nephron-lithotomy (PCNL).\n2.  To become familiar with the technical aspects and different approaches to \nPCNL.\n3.  To appreciate the importance of recognising and avoiding complications.\nA-304 16:40\nC. Intervention in ureteral obstruction and ureteral trauma \nA. Magnusson; Uppsala/SE (anders.magnusson@radiol.uu.se) \nThere are a variety of causes of obstruction of the upper urinary tract out of which \nureteral stones, gynaecologic malignancies and prostatic cancer are the most \ncommon. Treatment depends upon the level of obstruction, and whether it is an \nacute or chronic obstruction. Acute as well as chronic obstruction is usually initially \ntreated by the insertion of a nephrostomy tube. However, chronic upper urinary \ntract obstruction is often later treated by the insertion of a ureteric stent using ei-\nther an ante- or retrograde approach. Most nephrostomy tubes are inserted using \nultrasound guidance combined with fluoroscopy but in some cases, it is neces-\nsary to use CT guidance. The majority of nephrostomy insertions can wait until \ndaytime with one important exception, patients with obstruction and suspicion of \ninfection of the upper urinary tract. These patients require immediate relief as it is \na life-threatening condition! Nephrostomy relief was one of the first interventional \nprocedures, but the technology has evolved so that today it is simple and safe. \nTrauma to the ureter is rare, and are most likely to occur iatrogenically. Patients \nwith ureteral trauma and urine leakage requires relief with a nephrostomy tube. \nOften these tube insertions are more complicated because it generally is no hy-\ndronephrosis due to urine leakage.\nLearning Objectives:\n1.  To learn how to manage a patient with ureteral obstruction.\n2.  To understand when and how to treat a patient with ureteral trauma.\n3.  To learn more about how to perform a nephrostomy.\n1\n\nPostgraduate Educational Programme\nS7\n C B D E F\n G\nA\nfunctions will be underlined. Clues to clinical/radiological differential diagnoses of \nmost common conditions and radiological features at the anterior cranial fossa \nwill be highlighted.\nLearning Objectives:\n1.  To learn the imaging techniques of the anterior skull base with an emphasis \non the olfactory apparatus.\n2.  To become familiar with the imaging findings.\n3.  To understand how to differentiate between lesions in the anterior skull base.\nA-310 16:30\nB. Middle cranial fossa pathologies \nA. Borges; Lisbon/PT (borgalexandra@gmail.com) \nThe central skull base (CSB) is a complex anatomic area pierced by a variety of \nforamina and canals which provide crossroads for disease spread between the \nextracranial head and neck and the middle cranial fossa. Of utmost importance are \nthe cavernous sinuses located intracranially on each side of the sphenoid body and \nthe pterygopalatine fossa in the extracranial compartment,squeezed between the \nposterior wall of the maxillary sinus and the base of the pterygoid plates.Besides \nintrinsic pathology originating from the bone structures composing the central skull \nbase and systemic disease, the CSB can also be involved by intracranial lesions \nand those originating from different compartments of the suprahyoid neck. Imaging \nbares a tremendous impact on the diagnosis and patient’s management as this \narea is essentially occult to clinical examination. CT and MRI have a complimentary \nrole in the evaluation of CSB lesions providing a roadmap of bone and soft tissue \ninvolvement, respectively. Often, tailored imaging technique is mandatory to answer \nspecific clinical questions. Here, we present a radiology friendly approach to central \nskull base pathology based on the site of origin, pattern of growth and imaging \ncharacteristics of different lesions, highlighting the most important features in the \ndifferential diagnosis and in treatment planning.\nLearning Objectives:\n1.  To become familiar with imaging strategies for the middle cranial fossa.\n2.  To know more about imaging findings of common lesions.\n3.  To learn how to differentiate between the lesions in middle cranial fossa.\nA-311 17:00\nC. Posterior cranial fossa pathologies \nH. Tanghe; Rotterdam/NL (tanghe@planet.nl) \nThe jugular foramen is an opening in the skull base. The radiologic evaluation \nrequires high quality imaging with CT and MR. Angiography is reserved for preop-\nerative embolisation. It is important to recognize the “pseudo lesions”. The most \ncommon tumour of the jugular foramen is the paraganglioma. The second is the \nschwannoma of the lower cranial nerve causes, the jugular foramen meningioma \nis the third most common. The differential diagnosis shall be discussed. The cer-\nebellopontine angle (CPA) and the internal auditory canal (IAC): The IAC is a bony \nconduit for several nerve’s and a vessel: the neuro-vascular bundle. The CPA is \na cistern of the peripheral cerebral spinal fluid, and several anatomical structures \ngoes through this cistern, it is also the place of some frequent disease processes. \nMost of the lesions in the CPA are benign tumours with in order of frequency: \nvestibular schwannoma and meningioma. The third most common lesion is a \nbenign cystic lesion: the epidermoid cyst. In the IAC you can encounter the same \nbenign tumoural lesion as in the CPA, but also inflammatory lesions, viral lesions \nand malign lesions. Why is it important in your imaging protocol of the IAC and \nCPA region to use gadolinium? The differential diagnosis of the different lesions \nshall be discussed.\nLearning Objectives:\n1.  To learn the imaging techniques in the posterior cranial fossa.\n2.  To become familiar with the imaging findings of common posterior cranial fossa \npathologies.\n3.  To understand how to differentiate between the lesions in the posterior cranial \nfossa.\nhas limited availability and it is often not suitable for restless patients and those \nwith some metallic implants.\nLearning Objectives:\n1.  To learn about state-of-the art imaging in cases of suspected stroke.\n2.  To discuss potential pros and cons of using MR and CT.\n3.  To become familiar with most recent innovations in stroke imaging.\nA-308 17:00\nC. Interactive case discussion: what is next after diffusion and perfusion? \nA. Dörfler; Erlangen/DE (arnd.doerfler@uk‑erlangen.de) \nThe management of acute ischemic stroke is rapidly developing. Clinical data sug-\ngest that interventional stroke treatment may provide superior clinical outcomes \nwhen compared with intravenous thrombolytic therapy only. However, organized \nand comprehensive stroke care is currently delivered in only a few cerebrovascular \ncenters providing an efficient system for rapid diagnosis and especially dedicated \ninterventional stroke treatment. Delivery of expert and timely neuroendovascular \ninterventions to a large number of acute stroke patients is challenging. Especially \nadvanced neuroimaging capabilities have shown to be crucial for patient selection \nfor subsequent aggressive therapies. Hereby the combination of various imaging \ntechniques may help to differentiate patients who may profit from intravenous or \ninterventional therapy in an even extended time window from those who do not. \nRegarding our own experience, „multimodal MR imaging“ and a mismatch between \nfindings on diffusion and perfusion MR images may be pragmatically used to predict \nthe presence of a penumbra and provide substantially greater information about \nbrain ischemic pathophysiology and overall a more sensitive diagnosis for acute \nstroke, especially in patients with an uncertain time window of symptom onset and \nvertebrobasilar ischemia. The current presentation focuses on our imaging work-\nflow and algorithm of patient selection. A focus is put on interactive clinical cases, \nsubsequent interventional stroke treatment and on some organisational aspects \nnecessary for providing a comprehensive neurointerventional stroke service. \nLearning Objectives:\n1.  To become familiar with typical cases demonstrating the crucial role of imaging \nmodalities in the diagnosis and treatment decision-making in ischaemic stroke.\n2.  To consolidate knowledge of the selection of the appropriate imaging technique, \nimage interpretation and image based treatment recommendation.\n3.  To learn about the importance of imaging for treatment decisions and planning.\n16:00 - 17:30 Room D2 \nHead and Neck \nRC 1108 \nSkull base lesions: imaging studies and differential \ndiagnosis \nModerator: \nL. Grzycka‑Kowalczyk;  Lublin/PL \nA-309 16:00\nA. Anterior cranial fossa with special emphasis on olfactory \napparatus lesions \nT.P.J. Duprez; Brussels/BE (thierry.duprez@uclouvain.be) \nMedical imaging has nowadays integrated the diagnostic armamentarium of anos-\nmic patients regarding not only qualitative assessment of the olfactory tract but \nalso quantitative evaluation of olfactory bulb volumes which are known to closely \ncorrelate to the olfactory function. Many clinical studies in various pathological \nconditions have evidenced the value of such measurements in the work-up of \nolfactory dysfunction for both aetiologic and prognostic purposes. Imaging work-up \nalso plays a role in the medico-legal evaluation of post-traumatic anosmia together \nwith electrophysiological and clinical olfactory testings. Technical improvements in \nfibre tracking (FT) using diffusion-tensor imaging (DTI) and appropriate designs of \nolfactory stimulation at BOLD-based functional MRI (fMRI) are expected to allow \ninsights into the neurophysiological processes and circuitry of olfaction in a very \nnear future. Imaging work-up of the anosmic patients will be the corner stone of \nthis lecture. The relevance of the different imaging techniques will be detailed. \nBeyond the work-up of anosmia, a comprehensive overview of the most common \nlesions of the olfactory tract seen in clinical practice will be given. Additional review \nof lesions observed at the anterior cranial fossa near the olfactory tract will be done \nwhich comprehensively includes all commonly observed developmental, traumatic, \ninflammatory and neoplastic conditions that are not arising from the olfactory tract. \nTheir potential impact on the olfactory function or on other sensory/neurological \n2\n\nPostgraduate Educational Programme\nS7\nB\n C D E F G\nA\nSaturday\nto be aware of the imaging appearance to avoid misdiagnosis and inappropriate \ntreatment, and to be familiar on new functional MRI sequences (DWI-DCE) to \nimprove the diagnostic work-up. Soft-tissue tumours/tumour-like lesions about the \nknee include a wide variety of  entities, ranging from cysts or anatomical variants \nto aggressive high-grade sarcomas. Special vigilance in evaluation is warranted  \nwhen a soft-tissue mass is not in the typical position or does  not have other \ncharacteristic features of a cyst, when the size of the mass or the accompanying \nsymptoms seem out of proportion to the injury or underlying degenerative process, \nand when symptoms persist beyond what is expected. It is essential to be familiar \nwith the imaging characteristic appearance of these lesions to allow a confident \ndiagnosis as most of these lesions are benign. A complete review of the spectrum \nof soft tissue lesions will be performed: sarcomas, lipoma, haematoma, haeman-\ngioma, chondroma, synovitis, bursae-cysts like lesions intra and para-articular, \nhaematoma, ossifications, aneurysms, adventitial disease or anatomical variants \nsuch as accessory gastrocnemius muscle. Not only the most common lesions will \nbe discussed but also less common but important lesions with characteristic US \nand/or MRI appearance. \nLearning Objectives:\n1.  To know more about the spectrum of intra and para-articular soft tissue tumours, \nand soft tissue tumour-like lesions.\n2.  To become familiar with US and MRI findings of specific soft tissue lesions.\nPanel discussion:  \nWhat are the remaining clinical questions that imaging currently \ncannot answer and how can we answer them in the future? 17:14 \n16:00 - 17:30 Room E2 \nMultidisciplinary Session: Managing Patients with Cancer \nMS 11 \nCholangiocarcinoma \nA-316 16:00\nChairman’s introduction \nB. Hamm; Berlin/DE (bernd.hamm@charite.de) \nCholangiocarcinoma comprises carcinomas arising from the biliary duct system and \ncan be divided into intra- and extrahepatic cholangiocarcinomas. Depending on the \ntumour localisation and extent, local and systemic therapy differs. Especially surgical \ntherapy, which is the cornerstone of treatment in many patients, is demanding and \ncomplex. Radiology plays a key role in the primary diagnosis of this disease, therapy \ndecision making, preparation for surgery, and image-guided locoregional therapy. \nAn interdisciplinary experienced team is needed for the selection and performance \nof the appropriate diagnostic and therapeutic sequence in an individual patient. The \ndiagnostic and interventional radiologist in this team has to know about surgical \nand clinical relevance of imaging findings and needs profound understanding of the \npotential of the different therapy options. This session gives an insight into experi-\nences from the past and future concepts in the cholangiocarcinoma management \nprovided by an expert team of clinicians from surgery, oncology, and radiology. \nSession Objectives:\n1.  To learn about state-of-the-art diagnosis of cholangiocarcinoma.\n2.  To understand the value of surgical and systemic strategies in therapy.\n3.  To appreciate image-guided interventional treatment.\nA-317 16:05\nSurgery of hilar and extrahepatic cholangiocarcinoma \nP. Neuhaus; Berlin/DE (peter.neuhaus@charite.de) \nThe characteristic growth pattern of hilar cholangiocarcinoma with periductal \ninfiltration makes curative tumour resection with appropriate safety margins dif-\nficult. Therefore, a radical surgical strategy is required and extrahepatic bile duct \nresection alone is considered as palliative procedure, and recurrence is inevitabley. \nExtended hepatectomies have evolved as curative treatment standard - adequate \nliver function provided. If permitted by tumour extension and liver volumes, a right-\nsided hepatectomy is preferable, because of its higher radicality compared to left \nhemihepatectomies. Due to the biliary anatomy, a R0 resection is more likely in right \nhemihepatectomies, since the left hepatic duct has a longer extrahepatic course, \nwhich facilitates an adaequate safety margin. In addition, a second critical step, the \ndissection of the right hepatic artery running dorsally close to the tumour region, \ncan be avoided. Major drawback of right trisectionectomies is a low-remnant liver \nvolume, leading to an elevated perioperative risk. Therefore, optimal conditioning \n16:00 - 17:30 Room E1 \nMusculoskeletal \nRC 1110 \nThe knee \nA-312 16:00\nChairman’s introduction \nF.M.H.M. Vanhoenacker; Antwerp/BE (filip.vanhoenacker@telenet.be) \nMRI of the knee joint is one of the most requested examinations in most MR depart-\nments. Most MRI exams are performed for evaluation of internal derangement of \nthe joint due to trauma or (degenerative) cartilage lesions. Inflammatory disorders \nand infectious processes about the knee may cause significant morbidity and \ntherefore early detection is of utmost importance. Soft tissue tumours (STT) and \npseudotumours around the knee joint comprise a heterogeneous group of benign \nand malignant lesions. This integrated RC on the knee will provide an up-to-date \noverview of the role of imaging in the diagnosis and planning of treatment strategy \nof knee trauma, inflammation and soft tissue lesions. Current controversies and \nremaining clinical questions include the role of high-field MR imaging, imaging \nevaluation of clinical instability patterns, evaluation of disease activity of inflamma-\ntory disorders and response to Disease Modifying Anti-Rheumatic Drugs treatment \nand the role of functional imaging in the evaluation of STT.\nA-313 16:05\nA. Patterns of injury \nP. Van Dyck; Antwerp/BE (pieter.van.dyck@uza.be) \nTraditional classification systems for knee joint instability include straight, rotational \nand combined types of knee instability. The basic consideration in this classifica-\ntion is the status of the posterior cruciate ligament after injury. Correct diagnosis \nof knee instability is not a simple matter. Much controversy remains as to which \nligaments are being tested during the standard clinical knee laxity tests. This \nsometimes leaves the clinician, even the most experienced ones, confused as to \nwhat the laxity tests really show. In addition, the arthroscope cannot fully assess \nthe unstable knee. Thus, the addition of the information provided by magnetic \nresonance (MR) imaging can be extremely helpful in order to establish prognosis \nand plan for definitive treatment. Therefore, a thorough knowledge and recognition \nof the different knee ligament instability patterns by radiologists is essential to ac-\ncurately report the findings on MR and to heighten awareness for specific injuries \nto improve their detection.\nLearning Objectives:\n1.  To know more about the imaging appearances of soft tissue and osteoarticular \ninjury.\n2.  To become familiar with the patterns of bone and soft tissue injury in the knee.\nA-314 16:28\nB. Inflammatory disease \nA. Cotten; Lille/FR (anne.cotten@chru‑lille.fr) \nInflammatory disorders of the knee are mainly related to infectious or rheumatic \ndiseases, but other disorders can be associated with a similar clinical, biological or \nradiological presentation, including degenerative and crystal-induced diseases, and \ntumours. The bone, the joint and/or the soft tissue can be affected. The aims of this \nlecture are to present the main radiological features of the different inflammatory \ndisorders encountered at the knee, the usefulness of each imaging modality and \nthe more frequent misdiagnoses when such a condition is suspected.\nLearning Objectives:\n1.  To know more about the imaging appearances of soft tissue and osteoarticular \ninflammation.\n2.  To become familiar with imaging findings of specific inflammatory conditions.\nA-315 16:51\nC. Soft tissue tumours/tumour-like lesions \nJ.C. Vilanova; Girona/ES (kvilanova@comg.cat) \nBecause MRI of the knee is the most frequent examination, so does the frequency \nof encountering incidental soft tissue tumour/tumour-like lesions in and about the \nknee. Although, sometimes imaging techniques are requested due to symptoms \nrelated to a soft tissue lesion around the knee. It is important for the radiologist \n3\n\nPostgraduate Educational Programme\nS7\n C B D E F\n G\nA\nA-320 16:50\nRadiology - diagnostics and image guided therapies in intrahepatic \ncholangiocarcinomas \nB. Gebauer; Berlin/DE (bernhard.gebauer@charite.de) \nApproximately 5-10 % of all cholangiocarcinomas (CC) are intrahepatic cholangi-\nocarcinomas (ICC). Because of the lack of symptoms ICCs are usually later diag-\nnosed, compared to extrahepatic CCs. ICCs are subclassified in a mass-forming, \na periductal infiltrating and an intraductal ICC. Mass forming ICC is characterised \nby usually large hypovascular, intrahepatic mass in CT or MRI. Periductal infiltrat-\ning and intraductal ICCs usually present with a cholestasis distal to the tumour. \nTumourthrombosis of intrahepatic portal vein branches is often associated with \nICCs. Therapy of first choice is surgical resection, however only 10-30% are surgical \ncandidates. Local tumour ablation using thermal (e.g. RFA, MWA) or radiogenic \n(e.g. CT-brachytherapy) are alternatives in non-surgical patients with localised \ndisease. For RFA a maximum of 5 cm with a maximum of 5 lesions is commonly \naccepted as the upper limit. ICCs are often centrally in the liver with limitations to \nthermal ablation (e.g. heat sink effect). Radiogenic ablation (e.g. CT-guided brachy-\ntherapy) is suitable to overcome size and location limitations of thermal ablation. \nIn unresectable, disseminated ICC whole liver treatment strategies (e.g. hepatic \narterial infusion (HAI) or radioembolisation) could be an alternative to systemic \nchemotherapy. Liverarterial ports could be implanted by interventional radiologist \n(IR) using either the femoral or the subclavian artery as access site. Transarterial \nchemoembolisation (TACE) with doxorubicin and cisplatin as therapeutic agents is \noften performed in ICCs with median survival rates of 9-28 months. Radioemboli-\nsation with admission of Y-90 loaded particles via the liver artery into the tumour \ndemonstrated a median survival of 9.3-22 months.\nLearning Objectives:\n1.  To learn about image guided therapy decisions.\n2.  To learn about local ablation in non-surgical candidates (RFA, CT-brachyther-\napy).\n3.  To learn about intra-arterial port implantation.\n4.  To learn about transarterial radioembolisation.\nAuthor Disclosure:\nB. Gebauer: Other; Sponsorship for studies or traveling expenses or proctoring: \nPerceptive Inf. /Parexel, C. R. BARD, SIR-Tex Medical, AGA Amplatzer/St. Jude \nMedical, Cook, Angiodynamics/RITA, Bayer-Schering. \nCase presentation (part 1): hilar cholangiocarcinoma 17:05 \nCase presentation (part 2): CCC multimodal treatment 17:17 \n16:00 - 17:30 Room F1 \nSpecial Focus Session \nSF 11 \nAdults with congenital heart disease (GUCH) \nA-321 16:00\nChairman’s introduction: Why should a radiologist gather \ninformation on GUCH patients? \nM. Gutberlet; Leipzig/DE (matthias.gutberlet@herzzentrum‑leipzig.de) \nThe numbers of newborns with congenital heart disease (CHD) is not rising but the \nnumber of infants with congenital heart disease who achieve adulthood is constantly \nincreasing due to improved medical treatment especially in cardiac surgery and \npediatric cardiology. The imaging modality of choice during infancy in patients with \ncongenital heart disease is echocardiography. But in older patients, especially after \ncardiac surgery, it becomes very often more and more difficult to achieve an ad-\nequate acoustic window to assess important anatomical structures. In particular the \nvisualisation of the right ventricle, which is involved in many CHD, becomes difficult. \nTherefore, all cross-sectional imaging modalities, especially magnetic resonance \nimaging but also computed tomography, and also the radiologist comes into play.  \nSession Objectives:\n1.  To learn about the increasing number of GUCH patients.\n2.  To appreciate the importance of lifelong imaging follow-ups.\n3.  To become familiar with the need for specialised GUCH centres.\nAuthor Disclosure:\nM. Gutberlet: Research/Grant Support; BmBF (German Federal Ministry of \nEducation and Research), Competence Network of Congenital Heart Defects. \nSpeaker; Bayer, Bracco, Siemens, Philips, GE. \nof the liver is mandatory. This includes decompression of cholestasis via ERc or \nPTC, portal embolisation of the right lobe and treatment of cholangitis. However, \nin about 30%, severe atrophy of the left lobe due to long-standing cholestasis or \nocclusion of the left portal branch interdicts an extended right hemihepatectomy. \nFor tumours below the cystic duct junction, surgery consist of partial pancreato-\nduodenectomy. In case of additional hilar involvement, combined hepatectomy and \npancreatic resection might be considered in selected cases. Depending on tumour \ncharacteristics and surgical methods 5-year survival rates of 20-50 % have been \nreported after curative major liver resection.\nLearning Objectives:\n1.  To become familiar with prognosis depending on the evolution of surgical \napproach.\n2.  To become familiar with surgical decision making: left/right liver resection, hilar \nresection, pancreatic head resection.\n3.  To become familiar with technique of extended right hemihepatectomy.\n4.  To become familiar with liver function, volume.\n5.  To become familiar with biliary decompression left/right, internal/external.\nA-318 16:20\nRadiology - diagnostics and portal vein embolisation in hilar and \nextrahepatic cholangiocarcinoma \nT. Denecke; Berlin/DE (timm.denecke@charite.de) \nIn hilar and extrahepatic cholangiocarcinoma, en-bloc resection of the tumour \nis prognostically advantageous. This requires accurate diagnosis of the tumour \nbefore the resection. Some pitfalls may occur due to benign lesions mimicking \ncholangiocarcinoma with stricture of the biliary duct; the sequence of diagnostic \nimaging (including MRI with MRCP, CT, and ERC/PTC), examination protocol, and \nbrush cytology help to avoid these. Furthermore, the prediction of the actual tumour \nextent has to be accurate. This necessitates not only accurate imaging but also \na standardised terminology and classification system to enable non-ambiguous \ncommunication between the surgeon, gastroenterologist, and radiologist. This \nregards the tumour extent concerning bile ducts, portal vein, and hepatic arteries. \nBesides the local tumour extent, also the liver configuration and volume of the future \nliver remnant determine the possibility of surgery and the surgical technique. If too \nsmall, hyperplasia of the left-sided liver remnant in preparation of extended right \nliver resection can be achieved by right portal vein embolisation. Distinct volumetric \nand functional analysis of the embolized liver is performed also after embolisation \nto avoid hepatic insufficiency after the resection.\nLearning Objectives:\n1.  To learn about diagnosis/differential diagnosis.\n2.  To learn about surgical planning through imaging: bile ducts, vascular system, \nhyperplasia induction, liver function testing.\nA-319 16:35\nMedical treatment of cholangiocarcinomas \nH. Riess; Berlin/DE (hanno.riess@charite.de) \nThe purpose of medical treatment in patients with biliary tract cancers is to improve \nsurvival and quality of life. In the postoperative setting, adjuvant chemotherapy has \nbeen investigated alone or in combination with radiotherapy, however its role is \nstill undefined, but it should be considered. Most patients present with unresect-\nable or relapsed cancer. To ensure biliary drainage and to prevent cholangitis \nand biliary abscess formation is an essential prerequisite prior to the application \nof cytotoxic drugs. A few prospective randomised controlled trials demonstrated \na survival benefit of chemotherapy as compared with best supportive care alone \nand improvement of quality of life has been confirmed. The combination regimen \nof gemcitabine combined with cisplatin (or oxaliplatin) has been recognised as \nstandard therapy. Beyond these, other cytotoxic drugs have to be considered \nexperimental. The same is true for molecular-targeted therapies due to the fact \nthat to date only a few agents have been tested in this disease. Due to the fact \nthat biliary tract cancers may remain limited to the liver for a long period of time \nhepatic arterial infusions therapy has been used with success but its role is still \nundefined. This and various issues remain to investigated in the setting of large \ncooperative clinical trials. \nLearning Objectives:\n1.  To become familiar with chemotherapy of extrahepatic cholangiocarcinoma.\n2.  To become familiar with treatment concepts for intrahepatic cholangiocarci-\nnomas.\n3.  To become familiar with systemic vs. intra-arterial chemotherapy.\n4\n\nPostgraduate Educational Programme\nS7\nB\n C D E F G\nA\nSaturday\nor flow quantification e.g. through baffles or in dysfunctional valves after surgical \nrepair, 3. excellent soft tissue contrast enabling tissue characterisation. Both, MR \nand CT are powerful tools for imaging grown-up congenital heart disease. Thus, \nimaging should be tailored to the specific needs of the patient, desired information \nand available expertise and equipment.\nLearning Objectives:\n1.  To learn about the pros and cons of different imaging modalities for GUCH \npatients.\n2.  To become familiar with imaging of the most common entities in GUCH.\n3.  To consolidate knowledge of imaging protocols after surgical correction of \nCHD.\nPanel discussion:  \nCan we now get all the information we need to treat GUCH patients, \nnon-invasively? 17:20 \n16:00 - 17:30 Room F2 \nProfessional Challenges Session \nPC 11 \nPersonalised radiology \nA-325 16:00\nChairman’s introduction \nG.P. Krestin; Rotterdam/NL \nMedical imaging has always been personalized as it provides individual assess-\nment of the location and extent of an abnormality, and in the future, it will prove \nfundamental to almost all aspects of personalized medicine. Stratification based \non imaging biomarkers can help identify individuals for preventive intervention and \ncan improve disease staging. In vivo visualisation of loco-regional physiological, \nbiochemical, and biological processes using molecular imaging can detect diseases \nin pre-symptomatic phases or facilitate individualized drug delivery. Furthermore, \nimaging is essential to patient-tailored therapy planning, therapy monitoring, and \nfollow-up of disease progression, as well as targeting non-/minimally-invasive \ntreatments, especially with the rise of theranostics. For personalized medicine to \nreach its highest potential, medical imaging must be an integral part. Radiologists \nneed to be prepared for this new paradigm as it will mean changes in training, in \nresearch, and in clinical practice. Following an in-depth explanation of the role of \npredictive, prognostic and personalized medicine for modern health-care, given by \nthe Secretary General of EPMA, renowned experts in the different fields of personal-\nized medical imaging will give an insight into the recent developments in this new \narea of our profession. The presentation will be followed by a panel discussion. \nSession Objectives:\n1.  To understand the concept of personalised radiology.\n2.  To get an overview of the role of imaging in personalised medicine.\n3.  To learn about the concept of personalised medicine and personalised health-\ncare.\nA-326 16:06\nPersonalised medicine: hope or hype? \nO. Golubnitschaja; Bonn/DE (Olga.Golubnitschaja@ukb.uni‑bonn.de) \n1. Current healthcare: what is behind the issue? For many acute and chronic disor-\nders, the current healthcare outcomes are considered as being inadequate. In fact, \nsevere chronic pathologies such as cardiovascular disorders, diabetes and cancer \nare treated after onset of the disease. Pessimistic prognosis considers pandemic \nscenario for type 2 diabetes mellitus, neurodegenerative disorders and some types \nof cancer over the next 10-20 years followed by economic disaster of healthcare \nsystems in a global scale. 2. Advanced healthcare tailored to the person: What \nis beyond the issue? Advanced healthcare promotes the paradigm change from \ndelayed interventional to predictive medicine tailored to the person, from reactive \nto preventive medicine and from disease to wellness. The innovative Predictive, \nPreventive and Personalised Medicine (PPPM) is emerging as the focal point of \nefforts in healthcare aimed at curbing the prevalence of both communicable and \nnon-communicable diseases such as diabetes, cardiovascular diseases, chronic \nrespiratory diseases, cancer and dental pathologies. Cost-effective management of \ndiseases and critical role of PPPM in modernisation of healthcare is acknowledged \nas priorities by global and regional organizations and health-related institutions (UN, \nEU, NIH, etc). 3. Why integrative medical approach by PPPM as the medicine of \nthe future? PPPM is the new integrative concept in healthcare. Expected outcomes \nare conducive to more effective population screening, prevention early in childhood, \nA-322 16:05\nA list of typical surgical procedures: the top ten in GUCH \nM. Hübler, D. Hitendu, M. Schweiger, M. Greutmann; Zurich/CH \n(michael.huebler@kispi.uzh.ch) \nAdvances in the treatment of congenital heart disease (CHD) in pediatric cardiac \ncare have resulted in an increasing number of grown up congenital heart (GUCH) \npatients. More than 90% of those diagnosed with CHD will now survive into adult-\nhood thus increasing the prevalence of CHD in adults to about 0.4% of the general \npopulation. In the near future the number of GUCH patients will be exceeding \nthose pediatric patients with CHD. Unfortunately quite a considerable number of \nGUCH patients will have anatomic and physiologic abnormalities. At least 10% \nof them suffer even from severe lesions with an urgent need for medical and/or \ninterventional and/or surgical therapies. Echocardiography plays a key role as a \ndiagnostic tool but specially in complex post-operative anatomies cross-sectional \nimaging techniques were indispensible. Almost two third of surgeries in GUCH \npatients were first surgical procedures. One third of them being single or multiple \nreoperations. Percentage of frequent surgeries in GUCH patients: Aortic valve /\nLVOT procedures: 25%; Tetralogy of Fallot repair/pulmonary valve replacement: \n16%; Atrial septal defect surgery: 15%; Aortic arch/coarctation operations: 13%; \nVentricular septal defect surgery: 10%; AV-valve repair: 8%; Univentricular heart/\nFontan procedures: 6%; Transposition complex: 3%; Ebstein-repair: 2%; Heart \ntransplantation/Mechanical circuclatory support: 2%. Median age of the patients \nwas 36.5 years (range limits 18.0 - 72.2 years). Perioperative mortality was higher \nafter palliative surgery than after corrective surgery and was highest among pa-\ntients withuniventricular heart (20%) and transposition of the great arteries 12 (%). \nLearning Objectives:\n1.  To become familiar with the most common surgical procedures in congenital \nheart disease (CHD).\n2.  To know more about the typical postoperative problems in GUCH patients.\n3.  To learn about how imaging can help the cardiac surgeon.\nA-323 16:30\n‘Adults are not just big children’: differences between children and adults \nA.M. Taylor; London/UK (a.taylor76@ucl.ac.uk) \nThough the assessment of congenital heart disease shares many similarities \nacross all ages, there remain specific issues for those with adult, or gown-up, \ncongenital heart disease. These include: the importance of cross-sectional imaging \n(MRI & CT) due to the difficulty of echocardiography in many patients (poor echo \nwindows, complex vascular anatomy) in this patient group, the presence of histori-\ncal operative procedures and anatomies (e.g. patients with Senning and Mustard \nprocedures) that are now vary rarely seen in the paediatric population, and, as the \nadult population with congenital heart disease ages, the ever increasing burden of \natherosclerosis and other common disease of ageing. This presentation will outline \nthe role of cross-sectional (MRI & CT) for assessing patients with adult congenital \nheart disease, with focus on pre-procedural planning and post-procedural following. \nLearning Objectives:\n1.  To understand the age dependency in the selection of imaging modalities.\n2.  To learn about radiation exposure issues in GUCH patients.\n3.  To understand what the difference between imaging of children and adults.\nAuthor Disclosure:\nA. M. Taylor: Advisory Board; Medtronic. Employee; UCL Institute of \nCardiovascular Science. Grant Recipient; Siemens, Medtronic, UK NIHR, \nUK DH. Research/Grant Support; Siemens – Research agreement. Speaker; \nSiemens – ESC Munich. \nA-324 16:55\nWhich modality, for which patient? MRI or CT, that’s the question \nJ. Bremerich; Basle/CH (jbremerich@uhbs.ch) \nBoth, MR and CT provide relevant information on cardiac morphology and func-\ntion for management of CHD. Arguments in favour of CT are 1. short acquisition \ntime which is particularly relevant in patients with limited capability to cooperate; \n2. high sensitivity and specificity for calcification in pericardial/valvular disease or \nafter surgical repair; 3. submillimeter spatial resolution enabling precise measure-\nments for procedure planning or assessment of small structures such as atrial \nbaffle stenosis after atrial switch procedure; 4. short bore with the patients head \nlocated outside the scanner, which is particularly helpful in claustrophobia; 5. 3D \ndatasets enabling postprocessing in any desired plane and slice thickness; 6. no \nrestrictions related to electric implants. Arguments for MR on the other hand are \n1. no radiation required which is particularly relevant for repeated imaging in this \nyoung patient group, 2. capability of imaging cardiac function with the goldstandard \n5\n\nPostgraduate Educational Programme\nS7\n C B D E F\n G\nA\nA-329 16:54\nRole of imaging in personalised therapy monitoring \nA.R. Padhani; Northwood/UK (anwar.padhani@stricklandscanner.org.uk) \nMany imaging biomarkers have emerged which individually or collectively provide \nunique information on tumour behaviour including response to treatment. There \nare several requirements that must be met before imaging biomarker  (s) can be \nconsidered as being able to direct a person’s management. First, the biomarker \nshould have a known biologic basis with a recognised method for quantification \nand to be adequately validated. With regard to the latter, it is important that the \nbiomarker reports on/measures biologically meaningful cellular/tissue process such \nas reporting on cell death, on angiogenesis, proliferation and metabolic shutdown \nNOT simply conveying information on receptor occupancy or down regulation of \npathways that may or may not be important. Data acquisition procedures should \nhave been optimised and the test’s performance should have been established. \nThe level of change in the imaging biomarker that can be considered as real should \nbe known (that is, the measurement error). Reproducibility needs to have been \ndetermined by appropriately powered test-retest studies. Imaging biomarkers can \nonly be useful if they can detect biologically meaningful effects directly related to \ntreatments (that is, magnitude of biological effects detected must be greater than \nthe reproducibility/measurement error) at appropriate time points to be able to \neffect patient management. Finally, it must be know how much therapy-induced \nchange is meaningful in terms of patient benefit in terms of hard clinical endpoints \nsuch as surgical resectability, organ preservation, progression free and overall \nsurvival, etc. These aspects will be considered in detail using practical examples.\nLearning Objectives:\n1.  To become familiar with the general role of imaging in treatment monitoring \nand drug development.\n2.  To understand the requirements of imaging biomarker development for treat-\nment monitoring in personalised medicine.\n3.  To understand how to develop the evidence base so that imaging biomarkers \ncan be used for personalised therapeutic approaches.\nAuthor Disclosure:\nA. R. Padhani: Advisory Board; Siemens HeathCare. Speaker; Siemens \nHeathCare. \nPanel discussion:  \nIs imaging providing an added value to the ‘omics’ of personalised \nmedicine? 17:10 \n16:00 - 17:30 Room G/H \nNeuro \nRC 1111 \nBrain tumours: advanced imaging techniques in \ndaily practice - do we really need them? \nModerator: \nZ. Merhemic; Sarajevo/BA \nA-330 16:00\nA. Diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) \nM. Law; Los Angeles, CA/US (meng.law@usc.edu) \nWe have made significant progress in the application of advanced MRI techniques, \nsuch as DWI and DTI. DWI has certainly been useful in differentiating acute \nischaemic stroke from other pathologies that could mimic stroke, such as demy-\nelinating lesions, tumours and inflammatory disease. DTI has gained popularity \nin visualisation of the white matter tracts for pre-surgical planning. We will review \nhow DTI can be used in this setting. We will also review what the challenges and \npitfalls are for using DTI, fiber tractography (FT) and fractional anisotropy (FA) \nmaps for pre-surgical planning. These include the need for standardization of \nacquisition techniques (direction, stopping criteria), processing, visualisation and \nquantitation of DTI metrics. We will also review what errors have been reported \nwith using FT and FA maps when compared with intra-operative electrophysiologic \nmapping. DWI, functional diffusion maps and DTI have also been used in the pre \nand post-therapeutic brain. We will review potential applications in characterisa-\ntion of pseudoprogression, pseudoresponse and radiation necrosis. In addition, \nhow diffusion can potentially help in predicting a favourable therapeutic response \nto chemo-radiation. Finally, as there are some challenges and limitations, we will \nreview some of the controversies about DTI, FT and whether in fact these tools \nare ready, reliable or really needed in clinical practice. Perhaps review what needs \nto be done to make these tools essential and easy to use in everyday practice.\nidentification of persons at-risk, stratification of patients for optimal therapy planning, \nprediction and reduction of adverse drug-drug or drug-disease interactions relying \non emerging technologies: medical imaging, pharmacogenetics, pathology-specific \nmolecular patters, disease modelling, individual patient profiles, etc.\nLearning Objectives:\n1.  To understand the definition of personalised medicine.\n2.  To learn about some of the successful examples of personalised healthcare.\n3.  To understand the present limitations in adapting personalised medicine.\nA-327 16:22\nImaging for disease prediction \nM. Vernooij; Rotterdam/NL (m.vernooij@erasmusmc.nl) \nEpidemiology being a group-level discipline, it seems a long way off from per-\nsonalized or individual-level medicine. But nothing could be less true. Regarding \npersonalized medicine as stratified medicine, it is exactly this stratification that \nis enabled by results from epidemiological group-level studies. Increasingly, it is \nbeing realized that population studies will play a key role in achieving the medical \nparadigm shift from “cure” to “prevention”. The large-scale application and analysis \nof medical images in controlled population cohorts is known as Population Imaging. \nIt centers on the non- or minimally invasive assessment of structural and functional \nchanges that may reflect specific pathology. The new imaging techniques that are \ncurrently applied in population studies are likely to be the beginning of an ava-\nlanche in epidemiologic studies of many diseases. Population Imaging enables \nepidemiologists to study disease at an earlier stage than when a clinical diagnosis \ncan be made, allows for objective assessment of the disease or trait, and makes \nrepeated assessment possible. Of essential importance is that recent developments \nin image data acquisition and analysis make it feasible to use these techniques \nat a large scale. Yet, this poses increasingly high demands on data management \nand storage infrastructures that are both costly and technically demanding. Other \npotential drawbacks include that population imaging is subject to important ethical \nconsiderations - for example, regarding incidental abnormalities - and is critically \nlooked at regarding valorization of results. This presentation will discuss Population \nImaging and its role in improving models for disease prediction and prevention.\nLearning Objectives:\n1.  To learn about population imaging.\n2.  To become familiar with the role of imaging in disease prediction.\n3.  To understand the need for validated imaging biomarkers.\nA-328 16:38\nMolecular imaging: a solution for personalised diagnosis and treatment? \nF.M.A. Kiessling; Aachen/DE (fkiessling@ukaachen.de) \nWith increasing knowledge in molecular mechanisms of diseases, the number of \ntherapeutics that specifically block disease-related pathways rise. However, due \nto the heterogeneity of tumours, not all patients will benefit from these specific \ntherapies. Therefore, advanced in vitro and in vivo diagnosis is required to pre-\nselect patients to therapy, to monitor therapy response and to optimise doses \nand combinations of therapeutics. Molecular imaging can be used to characterise \npathologies by their particular molecular profile. By this, pre-selection of patients, \ntherapy optimisation and monitoring and sensitive therapy response assessment \nbecome feasible. Another important aspect of personalised diagnosis is the en-\nhanced permeability and retention (EPR) effect. Many drugs will only be effective \nif they sufficiently extravasate in the target tissue to reach the tumour cells. In this \nrespect, theranostic agents (drugs with imaging markers) can help to investigate \nwhether EPR is high enough to justify its use. Even more, there are agents that \nslowly release drugs from carriers (e.g. liposomes, hydrogels or polymers). In this \ncase, not only EPR is interesting to be monitored but also the release kinetics and \nthe effectiveness of the drugs at the target tissue. In this context, release of drugs \ncan be triggered and controlled by imaging, as it was shown for microbubbles \ncarrying drugs or genes.\nLearning Objectives:\n1.  To become familiar with the role of molecular imaging for disease localisation \nand characterisation, patient selection to therapy and therapy monitoring.\n2.  To learn about individualised image-guided drug delivery systems.\n3.  To understand the concept of theranostics: the combination of targeted imaging \nand targeted therapy.\nAuthor Disclosure:\nF. M. A. Kiessling: Board Member; ESR Research Board, Concil ESMI. \nFounder; invivoContrast GmbH. Grant Recipient; DFG, BMBF, EU, GIF. \nResearch/Grant Support; Financial Support by Bracco, Bayer, Philips, Astra-\nZeneca, Roche. \n6\n\nPostgraduate Educational Programme\nS 7\nB\n C D E F G\nA\nSaturday\n16:00 - 17:30 Room I/K \nChest \nRC 1104 \nPulmonary infections: the old and the new \nModerator: \nF. Gleeson; Oxford/UK \nA-333 16:00\nA. Mycobacterial infections \nC. Beigelman; Lausanne/CH \nPrimary TB typically presents with consolidation in the middle and lower lobes, \nand necrotic lymphadenopathy. Fibrosis, tuberculomas and calcified nodes may \nresult as sequelae. Cavitation and tree-in-bud appearance involving the apical \nand posterior segments of the upper lobes and the superior segments of the lower \nlobes are the hallmarks of reactivation TB, typically seen in immunocompetent \npatients. In immunocompromised patients, primary TB findings are more commonly \nobserved, as miliary or disseminated disease or atypical manifestations in case \nof severe immunosuppression. Pleural effusion and tracheobronchial involvement \nmay be observed. The “classical” appearance of Non-TB mycobacteria (NTM), less \ncommon and more indolent than TB, typically affects males more than 50 years old \nwith pre-existing pulmonary disease or underlying immunologic disorder. Despite \na great overlap in the radiologic appearances of both infections, the presence \nof cavities on sites other than than the upper lobes should suggest a N TM infec-\ntion. The “nonclassical” form related to MAC infection that predominantly affects \nelderly women with no pre-existing pulmonary disease mainly consists in mild \nbronchiectasis and centrilobular nodules predominantly located in the lingula and \nmiddle lobe. A high rate of lymphadenopathy and disseminated disease are seen \nin immunocompromised patients. The radiologist has to ensure the diagnosis of \nactive TB and mention scarring before starting specific treatments to suggest NTM \ninfections, immune reconstitution inflammatory syndrome with paradoxal worsening \nin HAART treated HIV-infected patients as multi-drug resistant TB, to appreciate \nextent of disease and follow-up, to diagnose the complications and to propose MRI \nor PET scans in some situations. \nLearning Objectives:\n1.  To appreciate the imaging features of primary and post-primary infections in \nTB.\n2.  To learn about the similarities and differences between TB and non-TB my-\ncobacterial infections.\n3.  To understand the radiologist’s role in diagnosis.\nA-334 16:30\nB. Infectious disease in immuno-compromised patients \nC.-P. Heussel; Heidelberg/DE \nThe appropriate investigation technique, frequently targeted differential diagnosis \nand the special needs of immunocompromized patients are the needs to be un-\nderstood by the referring physician as well as by the radiologist. Thus, an intensive \ninterdisciplinary co-operation on a patient basis, as well as on a department basis \nis essential. Early detection of a focus is the major goal in febrile neutropenic \npatients. As pneumonia is the most common focus, chest imaging is a special \nradiological task. The sensitivity of chest x-ray, especially in supine position, is \nknown to be less. Therefore, the very sensitive thin-section multislice-CT became \ngold standard in neutropenic hosts and might be cost-effective in comparison to \nantibiotic treatment. The infiltrate needs to be localised, so that this information can \nbe used as guidance for invasive procedures for further microbiological work-up. \nFurthermore, the radiological characterisation of infiltrates gives a first and rapid \nhint to differentiate between different sorts of infectious (e.g. typical bacterial, \natypical bacterial, fungal) and non-infectious aetiologies. Follow-up investigations \nneed careful interpretation according to disease, recovery, and concomitant treat-\nment. Due to a high incidence of fungal infiltrates, interpretation of the follow -up \nof an infiltrate must use further parameters besides to the lesion size. Besides the \nLearning Objectives:\n1.  To appreciate DWI in the characterisation of focal brain lesions.\n2.  To understand how to differentiate between tumoural and non-tumoural disease \nusing DWI.\n3.  To consolidate knowledge on how to combine DWI with other advanced MRI \ntools.\n4.  To find out if DTI is really useful in the clinical setting or merely a mathematical \nalgorithm of the tensor.\nAuthor Disclosure:\nM. Law: Advisory Board; Bayer Healthcare. Consultant; Fuji Inc, iCAD inc. Grant \nRecipient; Bayer Healthcare. Shareholder; Prism Clinical Imaging. Speaker; \nToshiba America Medical. \nA-331 16:30\nB. Perfusion imaging \nY. Özsunar; Aydin/TR (yeldaozsunar@gmail.com) \nConventional contrast-enhanced CT and/or MR imaging are the current standard \ntechniques for the diagnosis and treatment evaluation of brain neoplasms. However, \nthis method is quite limited in its ability to depict the angiogenesis which is a hall-\nmark of tumour growth and metastases. To characterise the angiogenesis of brain \ntumours, Perfusion Weighted Imaging (PWI) and Nuclear Medicine Tecniques, such \nas PET and SPECT are used. PWI is an evolving technique proven to be especially \nvaluable and practical for the evaluation of central nervous system neoplasia. Both \nexogenous and endogenous tracer methods can be used as in ASL and Dynamic \nSusceptibility Weighted Perfusion Imaging, respectively. Perfusion imaging refers \nto several recently developed techniques that are used to non-invasively measure \ncerebral perfusion via assessment of various haemodynamic measurements, \nsuch as cerebral blood volume, cerebral blood flow, and mean transit time. These \ntechniques have great potential in becoming important clinical tools in the evalu-\nation of pre and post-treated brain tumours. PWI is used to differentiate tumoural \nversus non-tumoural brain masses and primary versus secondary brain tumours. \nThe technique helps to grade primary tumours, guide biopsy and surgery, and \ndifferentiate recurrent tumour from radiation necrosis.\nLearning Objectives:\n1.  To appreciate the value of perfusion imaging.\n2.  To understand why perfusion imaging is needed.\n3.  To become familiar with principles, applications, and pitfalls of various perfu-\nsion imaging techniques.\n4.  To consolidate knowledge of perfusion imaging of various brain masses that \ncan be encountered in daily practice.\nA-332 17:00\nC. Follow-up after treatment \nP.C. Maly Sundgren; Lund/SE (Pia.Sundgren@med.lu.se) \nGlioblastoma is the most common primary brain tumour. Due to the ineffective \ntherapy, the prognosis of gliomblastoma is poor and has driven the research to find \nnew therapeutic agencies. However, despite advanced neuroimaging techniques, it \nremains difficult to predict and to monitor tumour response in individual patients. For \nexample, anti-angiogenic therapy may present with decreased contrast enhance-\nment of the tumour and reduced surrounding edema, so called “pseudoresponse” \nsince the decreased enhancement can be secondary to an antipermeability effect \nrather than the result of reduction in tumour size. The opposite is seen in the treat-\nment with termozolomide and radiation where an increase in area of enhancement \nis seen that resolves over time - so called pseudoprogression. Both these conditions \nare well demonstrated on conventional MR imaging as well as on advanced MRI \nlike diffusion and perfusion imaging. However, they still may cause confusion and \nwrongly results in change of therapy as well as in the interpretation of results of \nPhase I and Phase II clinical trials. To partially address this issue, the MacDonald \ncriteria have recently been revised. The present lecture will focus on present \nknowledge and research on the use of advanced imaging to support response or \nprogression during ongoing therapy.\nLearning Objectives:\n1.  To understand the present traditional model for the follow-up and monitoring \nof brain tumour treatment.\n2.  To become familiar with different imaging biomarkers for early assessment of \nbrain tumour treatment response.\n3.  To consolidate presently available knowledge and ideas on brain tumour imag-\ning follow-up for future brain tumour treatment and monitoring of response.\nAuthor Disclosure:\nP. C. Maly Sundgren: Board Member; ISMRM, ASNR. Consultant; ICON \nMedical Imaging. \n7\n\nPostgraduate Educational Programme\nS\n C B D E F\n G\nA\nThis distinction between MSCT and CBCT is useful, as there are decisive differ-\nences in application, performance, and in image reconstruction. These differences \nwill be reviewed in the presentation, with a particular focus on why image quality \nin MSCT is so much better than in CBCT.\nLearning Objectives:\n1.  To understand the principles of volumetric image formation with flat detectors.\n2.  To understand the difference between CBCT and MSCT.\n3.  To learn about reconstruction techniques and image processing.\n4.  To become acquainted with the important image quality parameters.\nA-337 16:30\nB. Medical applications of CB imaging \nM. Grass; Hamburg/DE (Michael.Grass@Philips.com) \nTomographic x-ray imaging using flat detectors is used today on a variety of dif-\nferent imaging systems. The most important area is cone beam imaging using \ninterventional C-arm systems. For these systems, the increasing complexity of \nminimal invasive procedures requires the availability of high-resolution 3D image \ninformation for intervention planning, guidance and outcome control. Interventional \nvolume imaging was first applied in neuroradiology using rotational angiography \nacquisitions. Today, it is used in a wide variety of procedures in interventional radiol-\nogy, cardiology and oncology based on angiographic and soft tissue protocols. One \nof the inherent advantages of this approach is the direct registration of the volume \nimages into the interventional procedure for image guidance. Other application \nareas using different scanning systems are on-board imaging in radiation therapy \nor integration of flat detector tomography and SPECT. The course teaches the \ngeneration of 3D volume information from flat detector systems and its utilisation \nin clinical applications. Image acquisition protocols are introduced and scan modes \nand system design parameters are explained. Application specific calibration and \nprocessing steps are introduced to show how cone beam imaging is tailored for \nspecific clinical applications. Image quality characteristics and their relevance \nfor the different clinical applications are discussed. Examples are presented for \nangiographic and soft tissue volumetric imaging. Medical applications utilising \nthe reconstructed volume images for diagnosis, intervention planning, guidance \nor outcome control are discussed. Image-guided interventions are presented for \nneedle and catheter procedures. Examples for medical applications in radiation \ntherapy and nuclear medicine are introduced.\nLearning Objectives:\n1.  To become acquainted with the applications of CB imaging.\n2.  To learn about systems design and parameters.\n3.  To understand image quality characteristics.\n4.  To learn how to use cone beam images in image guided interventions.\nAuthor Disclosure:\nM. Grass: Employee; Philips Research. \nA-338 17:00\nC. 3D dentomaxillofacial imaging \nK. Horner; Manchester/UK (keith.horner@manchester.ac.uk) \nIn the last decade, three-dimensional dentomaxillofacial imaging through cone-\nbeam CT (CBCT) technology has become widely available. While uptake amongst \ndentists in Europe is quite low, it is increasing. Dental CBCT (Digital Volumetric \nTomography; DVT) equipment is compact and often affordable. The driver for \ndental CBCT was implant dentistry, but its use has spread into other areas, includ-\ning paediatric applications. Radiation doses are variable. Some systems offer a \nfixed, large, field of view and others fixed exposure factors, obstructing attempts \nat optimization. Typically, doses are at least an order of magnitude greater than for \n“conventional” imaging. Image quality is also variable, which means that certain \ntypes of equipment may be unsuitable for some clinical applications. A key aspect of \nusing CBCT relates to justification. Imaging in three dimensions may be perceived \nby dentists as inevitably superior, a view which is often implicitly encouraged by \nthose selling equipment. The research on diagnostic efficacy is limited and often \nfails to consider differences between laboratory research and the clinical situation. \nIn 2012, The European Commission published “Radiation Protection 172: Evidence-\nbased Guidelines on Cone Beam CT for Dental and Maxillofacial Radiology”. This \nprovides a comprehensive set of recommendations, including referral criteria, a \nquality assurance programme and optimization strategies. Priorities for future \nresearch are relating exposures to the necessary image quality requirements for \nspecific clinical applications, along with research on the impact on clinical outcomes \nof CBCT-based treatments. It is clear that much work remains before the place of \nCBCT in dentistry can be established. \nlungs, also other organs systems suc as brain, liver and para nasal sinuses need \nattention and are to be imaged with the appropriate technique. \nLearning Objectives:\n1.  To appreciate the various types of immuno-deficiencies and their related \ninfections.\n2.  To become familiar with the role of the radiologist in immuno-compromised \npatients.\n3.  To learn how to follow pulmonary infections in immuno-compromised patients.\nAuthor Disclosure:\nC. Heussel: Grant Recipient; Novartis, Pfizer. Shareholder; GSK, Stada. \nSpeaker; Schering-Plough, Pfizer, Basilea, Boehringer Ingelheim, Novartis, \nRoche, Astellas, Gilead, MSD, Lilly, Bracco, MEDA Pharma, Intermune, Chiesi, \nSiemens, Covidien, Pierre Fabre. \nA-335 17:00\nC. Emerging infections \nT. Franquet; Barcelona/ES (tfranquet@santpau.cat) \nDespite advances in diagnosis and treatment, new pulmonary infections have been \ndiagnosed. Streptococcus pneumoniae remains the main etiological agent in out-\npatients with community-acquired pneumonia (CAP). Elderly patients or those with \ntoxic habits, and various comorbidities favour the development of severe CAP. In \naddition, the development of nucleic acid amplification techniques has emphasized \nthe role of concomitant bacterial and viral pneumonia in the outcome of CAP in \nelderly patients. Healthcare-associated pneumonia has been recently defined as a \ndifferent infectious condition by the American Thoracic Society/Infectious Diseases \nSociety of America (ATS/IDSA). The main concern of this new disease is the risk of \nhaving an infection due to multidrug-resistant pathogens. With the advent of HAART \nand increased long-term survival of HIV-positive patients, the range of pulmonary \nmanifestations has also evolved. In patients with haematological malignancies or \nafter HSC transplant, Aspergillus is a common infection. Actually, Aspergillus spp. \nisolation from LRT samples in COPD may indicate an increased diagnosis pos-\nsibility of IPA. New emerging viruses such as Human metapneumovirus (hMPV), \nSARS-associated coronavirus, and Avian influenza caused by the H5N1 virus \nhave been diagnosed. In 2009, an outbreak of a novel swine-origin influenza A \n(H1N1) virus was reported. The clinical diagnosis of new pulmonary infections \nas well as the presence of concomitant bacterial and viral infections has been \nsignificantly enhanced by improved laboratory methods. A systematic approach \nto the radiological evaluation of lung infections is essential and includes not only \nchest imaging pattern recognition, but also integration of available demographic, \nclinical and laboratory information. \nLearning Objectives:\n1.  To learn more about emerging infections.\n2.  To become familiar with radiological patterns and conditions which suggest \nviral infections.\n3.  To learn how to improve diagnostic accuracy.\n16:00 - 17:30 Room L/M \nPhysics in Radiology \nRC 1113 \nCone-beam imaging \nModerators: \nO. Ciraj‑Bjelac;  Belgrade/RS \nA. Trianni; Udine/IT \nA-336 16:00\nA. Fundamentals of cone-beam imaging \nM. Kachelrieß; Heidelberg/DE (marc.kachelriess@dkfz.de) \nTraditionally, x-ray CT scanners were equipped with a single or a few detector \nrows only, image reconstruction was assuming parallel slices, which was a good \napproximation for these fan-beam systems. About a decade ago, the number of \nslices increased to 16 or more and the parallel slice approximation was no longer \nvalid. The cone-beam nature of these multi-slice CT (MSCT) scanners had to be \ntaken into account by specific cone-beam reconstruction algorithms. While these \nMSCT systems -- today they are simultaneously acquiring up to 320 slices - are \ncone-beam CT systems in a general sense, the notion of cone-beam CT (CBCT) \nis also associated with a specific kind of cone-beam CT, namely those equipped \nwith flat detectors, i.e. the non-diagnostic or non-clinical CT systems. MSCT, in \ncontrast, is a cone-beam CT system for diagnostic use, i.e. a clinical CT system. \n78\n\nPostgraduate Educational Programme\nS\nB\n C D E F G\nA\nSaturday\nA-341 16:28\nB. Interventions after liver transplantation \nP.P. Goffette; Brussels/BE (pierre.goffette@uclouvain.be) \nBile tract complications occur in 10-35% of liver transplants. The incidence is high-\nest in the first few months after LT. Type of surgical anastomosis, cold and warm \nischaemic liver injury and pre-existing biliary diseases are all the factors influenc-\ning the frequency, type and severity of complications which includes strictures, \nleakage, stones formation and bilomas. Systematic PTC at 6 months after LT is \nrecommended to disclose biliary complications at early stage. Main indications \nfor percutaneous approach include: 1. early anastomotic strictures unaccessible \nto endoscopy, 2. late non-anastomotic strictures due to arterial occlusion, recur-\nrent sclerosing cholangitis, CMV infection, 3. access for subsequent procedures \nsuch as lithotripsy, intrahepatic stones, sludge or biliary cast removal and 4. \nbiliary leaks. The conventional approach to biliary strictures included: 1. repeated \nprolonged high-pressure balloon bilioplasty (3X) at 3 weeks interval. 2. long-term \ndrainage with large bore drains, 3. chronic catheters left in place in patients with \nrecurrent or diffuse strictures. Long-term patency of bilioplasty is reported from 50 \nto 60% at 5 years (80% 6 months patency). Cutting balloons and metallic stents \nmay be useful to treat refractory strictures in non surgical candidates. Retrievable \ncovered stents for resistant stenosis is associated with an 50% restenosis rate at \n12 months. The management of biliary leaks (5-15%) includes drainages of both \ninjured biliary duct and biloma. Temporary insertion of covered stent may be neces-\nsary to manage hilar or anastomotic leaks. Selective embolisation of intrahepatic \nleaks or segmental portal vein embolisation is an alternative to surgery to manage \nrefractory non-anastomotic leaks.\nLearning Objectives:\n1.  To know about the appropriate imaging algorithm for the detection of biliary \ncomplications after liver transplantation.\n2.  To become familiar with the techniques of interventional treatment of biliary \ncomplications after liver transplantion.\n3.  To understand the results and complications in comparison with surgical \nmanagement.\nA-342 16:51\nC. In tandem with endoscopy \nD.F. Martin; Manchester/UK (derrick.martin@uhsm.nhs.uk) \nMost biliary intervention are performed endoscopically but endoscopy may fail and \nthe trans-hepatic placement of a catheter into the duodenum assists endoscopic \naccess. Previously, the primary management of malignant bile duct obstruction \nwas with the endoscopic placement of 10  F plastic stents. When ERCP failed, \nPTC using a 7 F catheter allowed the placement of an endoscopic 10 F stent but \nkept complications low because of the avoidance of a 10  F trans-hepatic track. \nNow, with the advent of 6  Fr trans-hepatic delivery systems for 10  mm diameter \nmetal stents, this combined procedure has fallen into disuse. However, endoscopic \naccess for the management of stones can fail, most commonly because of a peri-\nampullary diverticulum. In this situation, a trans-hepatic approach allows wire-guided \nsphincterotomy leading to successful endoscopic management and the avoidance \nof open bile duct surgery. This presentation will describe the technical aspects of \nthis approach together with illustrative case examples. The technique has a very \nhigh success rate with complications of haemorrhage, bile leak and cholangitis \nin approximately 10% of patients. Polya-gastrectomy is declining in its incidence \nand experienced Endoscopists who can deal with these patients are becoming \nuncommon. A trans-hepatic approach may allow a guide wire to be passed along \nthe afferent loop for endoscopic access. There is a small but growing experience of \nEUS-guided biliary drainage for the management of biliary obstruction. Gastroenter-\nologists favour this approach because it appears to generate fewer complications \nthan a trans-hepatic approach and is certainly less uncomfortable for the patient. \nThese newer techniques will be illustrated and discussed.\nLearning Objectives:\n1.  To be aware of the indications for tandem use of percutaneous and endoscopic \napproach.\n2.  To learn the tips and tricks of tandem technique.\n3.  To learn about the results and complications of tandem treatment.\nPanel discussion:  \nAre there new possibilities in the area of biliary interventions? 17:14 \nLearning Objectives:\n1.  To become acquainted with CBCT systems for dentomaxillofacial imaging.\n2.  To learn about image quality characteristics and patient dose compared to \nother techniques.\n3.  To learn how to access CB images and influence the clinical outcome.\n16:00 - 17:30 Room N/O \nInterventional Radiology \nRC 1109 \nUpdate on biliary interventions \nA-339 16:00\nChairman’s introduction \nM. Krokidis1, A.A. Hatzidakis2; 1Cambridge/UK, 2Iraklion/GR \n(mkrokidis@hotmail.com) \nThere are some basic IR techniques everybody needs to know before starting to \ntreat biliary diseases. Τhese are Percutaneous Transhepatic Cholangiography \n(PTC) and Percutaneous Transhepatic Biliary Drainage (PTBD). These basic proce-\ndures are essential first for opacification and then for getting access into the biliary \ntree. After accessing the biliary system, decisions must be made about the need \nfor further interventional procedures. Presence of benign or malignant strictures, \nstones or other kind of disease are leading us to the necessary actions, such as \ndilatation, stenting or lithotripsy. Dilatation of stenosed parts of the biliary system is \nperformed after negotiation of the stricture or occlusion with help of high-pressure \nangioplasty balloons of variant sizes. Balloons of 8-14 mm width can be used alone \nor two parallel to each other. Stenting is rarely needed in benign biliary disease \nand usually in cases where multiple dilatations are not responding. Percutaneous \nlithotripsy with or without cholangioscopic assistance is a wide-used technique for \nclearance of biliary stones or fragments. Extraction balloons or baskets and special \nlithotripsy devices are commonly used for impacted or large calculi.\nSession Objective:\n1.  To review the various interventional techniques for the treatment of complex \nbiliary diseases.\nA-340 16:05\nA. Fistula and benign stenosis \nM. Bezzi; Rome/IT (mario.bezzi@uniroma1.it) \nBenign biliary strictures (BBS) can be seen with a wide array of non-neoplastic \ncauses. In westerncountries, iatrogenic stricture accounts for up to 80% of all \nBBS, with cholecystectomy and orthotopic liver transplantation being the most \ncommon causes. Post-surgical BBS often present with biliary fistulas. Various \nimaging modalities are used in diagnosing fistulas and BBS, the most commonly \nused being ERCP and MRCP. MRCP has the advantage of non-invasive imaging, \nallows evaluation of the biliary system beyond a tight stricture with assessment of \nhepatic parenchyma and other intra-abdominal organs. The cause, number, and \ndistribution of BBS decide the type of management. Other factors to be considered \nare the degree of inflammation/fibrosis, the presence of ongoing infection or sep-\nsis, and the experience of the surgeon and interventional radiologist/endoscopist \nat the institution. Balloon dilatation or balloon dilatation with long-term external/\ninternal drainage are generally accepted as the treatment of choice for benign \nbiliary strictures. The percutaneous treatment of these strictures by dilatation has \na success rate from 60 to 90 %. The primary insertion of a bare metallic stent is not \ncurrently indicated, while, covered metal stents can be placed in selected patients \nif they can be safely retrieved. Successful outcomes regarding the management of \nBBS requires careful planning by a multidisciplinary team with regard to thorough \ndiagnostic studies, and appropriate operative approach. Whatever appropriate \ntreatment is selected, the need for careful long-term follow -up must be strongly \nemphasized, as no therapy is totally free of recurrence.\nLearning Objectives:\n1.  To know about the etiology of fistulas and benign stenoses.\n2.  To become familiar with the various imaging modalities and findings in benign \nfistulas and stenoses.\n3.  To understand the techniques, results, and complications of interventional \ntreatments.\n79\n\nPostgraduate Educational Programme\nS80\n C B D E F\n G\nA\n3.  To appreciate how image quality is defined in MRS, to highlight the parameters \nwhich affect image quality in MRS and how these can be modified by the \nradiographer.\n4.  To become familiar with examples of common MRS artefacts and how these \ncan be corrected by the radiographer.\nA-345 17:00\nC. Challenges and opportunities in paediatric MR \nV. Syrgiamiotis; Athens/GR (syrgiamiotisvasilis@gmail.com) \nMagnetic Resonance Imaging paediatric examination requires a particular set of \nskills and expertise in order to successfully obtain diagnostic images with minimal \ndistress to the patients and their family. Many developments have already been \nprocessed, but there is too much space uninvestigated. The four main challenges in \nimaging children are: anatomical, physiological, behavioural, developmental issues \nwhich will be overviewed. Techniques and opportunities, which may overcome daily \ndifficulties, will also be presented. Paediatric MR Imaging can be considered as a \nseries of subspecialties. Each field requires its own specialized skills, knowledge \nand equipment to be performed. 3 T imaging develops rapidly, but even in 1 and \nin 1, 5 T, there are common challenges and opportunities - techniques that apply \nto imaging paediatric patients and number of them will be presented. The lack \nof ionising radiation, simultaneously with the high level of imaging details, has \nmade MRI the examination of choice. There is no “one size fits all” regarding to \nthe children imaging. Awareness of the challenges and pediatric techniques are \nthe key for the success.\nLearning Objectives:\n1.  To learn about the basic anatomical/physiological differences within the pae-\ndiatric population, contrasting it with the general adult population.\n2.  To understand the MRI scan parameter modifications required to accommodate \nthese differences and their trade-offs.\n3.  To become familiar with examples of improved, optimised imaging protocols \nagainst standard, preset, commercially available adult imaging protocols.\n4.  To consolidate knowledge on the optimal use of equipment to achieve a suc-\ncessful and clinically useful paediatric MRI exam.\n16:00 - 17:30 Room P \nRadiographers \nRC 1114 \nHot topics in magnetic resonance imaging \nModerators: \nK. Haller; Wiener Neustadt/AT \nL. Martí‑Bonmatí;  Valencia/ES \nA-343 16:00\nA. New trends in MR safety \nP. Bauer; Vienna/AT (petra.bauer@akhwien.at) \nWith the introduction of high-field and ultra-high-field MR scanners operating at 3 \nT and recently at 7 T and with the development of stronger gradient systems MR \nsafety issues become more and more critical. The specific absorption rate (SAR) \nproduced by the radiofrequency (RF) field of the transmitting coils increases with \nthe square of the field strength that means that the SAR at 3 T is four times higher \ncompared to 1.5 T. This may lead to thermal injuries. The stronger gradient mag-\nnetic fields may result in peripheral nerve stimulation which produces paresthesias \nand pain. With the stronger static magnetic field the attraction forces significantly \nincrease therefore a strict access control to the magnet room is mandatory. Pos-\nsible access control will be discussed. Another topic in MR safety is the increasing \nnumber of patients with different kinds of implants which may pose a problem when \nan MR examination is planned. Therefore, careful screening of such patients in \nnecessary to detect implant an possible harmful metallic material in the body an \nwhen detected or known the compatibility of these implants have to be checked \nto provide a safe MR examination of these patients. Possible ways to define MR \nsafety of implants will be discussed. The White paper on MRI safety, last updated in \nJune 2007, is the most important scientific paper concerning MRI safety. It can be \nused as basic concept for building up an own safety concept in your own institute.\nLearning Objectives:\n1.  To become familiar with the standard MRI safety measures (metal check and \nSAR limits).\n2.  To understand the new challenges for MRI safety given the technological \nadvances in high-field magnets, faster gradients coils, hybrid MR imaging and \nnew contrast agents.\n3.  To learn about updated MRI safety guidelines with reference to recent literature, \nwhite papers and accredited MRI safety websites.\n4.  To appreciate the MRI safety implications for pregnant women, neonates and \nthe general paediatric population.\nA-344 16:30\nB. MR spectroscopy: the role of radiographers in data optimisation \nJ. McNulty; Dublin/IE (jonathan.mcnulty@ucd.ie) \nMagnetic resonance spectroscopy (MRS) is an advanced quantitative imaging \ntechnique discovered by Bloch and Purcell in 1946 which preceded clinical magnetic \nresonance imaging (MRI). MRS uses the gradient system to selectively excite small \nvolumes of tissue but rather than producing an image, it uses the free induction \ndecay (FID) of specific nuclei to produce a spectrum which contains key informa-\ntion about the chemical/metabolic composition of the volume of interest. MRS \nhas been used clinically for a wide range of disease processes to aid diagnosis, \nto monitor response to treatment or disease progression and is widely used in \nresearch. Clinical applications include lesion characterisation in oncology imag-\ning along with the imaging of neurological and psychiatric disorders. High-quality \nMRS data have been shown in some cases to reduce the need for further invasive \ndiagnostic procedures such as biopsy. Radiographers have a key role to play in \nthe acquisition of high-quality spectra in order to ensure the acquired data can be \nused for quantitative purposes and is free of any significant artefacts. Appropriate \nquality assurance, detailed consideration of sequence parameters, appropriate \nvoxel position in single voxel MRS, the correct application of spatial saturation \nbands and chemical suppression techniques, shimming, eddy current, motion \nand susceptibility minimisation will all directly impact on the quality of the spectra \nand thus radiographers undertaking MRS for clinical or research purposes should \nbe aware of such challenges and the steps that may be taken to ensure quality.\nLearning Objectives:\n1.  To learn about the basic principles of MR spectroscopy contrasting them to \nthe basic principles of MR imaging.\n2.  To understand the benefits of using MRS in clinical practice.\n\nPostgraduate Educational Programme\nS81\nB\n C D E F G\nA\nSunday, March 10\n\nPostgraduate Educational Programme\nS82\n C B D E F\n G\nA\n60 min for proximal small bowel (1000 ml) and 2 h for distal small bowel or colonic \nanastomosis (1000 ml). Rectal contrast should be instilled via a bag using gravity - \n200-300 ml is usually sufficient for distal colonic or rectal anastomoses and no delay \nnecessary. In patients with catastrophic post-operative complication is suspected \n(such as haemorrhage or perforation) IV contrast alone may be used. In a minority \nof patients with severe renal impairment risk of renal toxicity from IV contrast must \nbe balanced against detection of signs that indicate bowel ischaemia or improve \ndelineation of anatomy in oedematous patients. Specific complications or patterns \nof complication are recognised in individual operations. However, additional factors \ncomplicate interpretation including use of haemostatic compounds (misinterpreted \nas abscess) or mesh placement (limiting access for interventional procedures). \nRetained swabs left in error must be notified to the surgeons.\nLearning Objectives:\n1.  To become familiar with an optimised MDCT protocol for the detection of post-\noperative complications.\n2.  To learn the normal post-operative appearance of common surgical material \nincluding mesh, packing and sutures.\n3.  To understand the expected findings of peritoneal air, fluid and bowel dilatation \nin the immediate post operative course.\n4.  To learn the most common causes of clinical deterioration in the post-operative \nstate and their imaging findings.\nA-349 09:00\nB. MDCT in a patient with small bowel ischaemia \nS. Romano; Naples/IT (stefromano@libero.it) \nIntestinal ischaemia and infarction are important causes of acute abdominal dis-\nease which appropriate diagnosis has to be as more as accurate being of crucial \nimportance for the surgical or medical managament of the affected patients. At \nthe basis of an efficient report lays the deep knowledge of the patho-physiologic \nmechanism leading to arterial, venous or low-flow state vascular injury of the intes-\ntines. When the mechanism is clearly understood, from a radiological point of view, \nit is essential to know how to optimise the MDCT technique in case of suspected \nintestinal ischaemia and what are main findings and intestinal features of the injured \nintestine. A further step is represented from the differentiation of various stages of \ndisease from early potential transient ischemia to late infarction. However, it is also \nstrongly important to become familiar with the reperfusion damage of the intestine, \nfrequently observed but as still as a challenge for an effective diagnosis. The ac-\ncuracy of the various radiological signs of bowel ischaemia should be considered \nand discussed, whereas presentation of several clinical cases with the description \nof their respective reports and final diagnosis still represents the “key” to improve \nan effective diagnosis of intestinal ischemia in daily radiological practise. \nLearning Objectives:\n1.  To understand the patho-physiologic mechanism leading to arterial, venous \nor low-flow state vascular injury.\n2.  To learn how to differentiate different stages of disease from early potentially \ntransient ischaemia to late infarction.\n3.  To become familiar with reperfusion damage of the intestine.\n4.  To understand the accuracy of the various radiological signs of bowel isch-\naemia.\nA-350 09:30\nC. MDCT in a patient with small bowel obstruction \nP. Taourel; Montpellier/FR (p‑taourel@chu‑montpellier.fr) \nThe questions regarding the CT diagnosis of bowel obstructions are as follows: \nis there an obstruction? What is the level and the cause? Are there findings of \nclosed loop obstruction and of strangulation? What is the treatment recommended: \nsurgery or follow-up, laparoscopy or laporotomy? To answer these questions, the \nCT semiology is based on findings validated in the literature that will be described \nin this lecture, by underlining the potential pitfalls in interpretating a CT exam in \nbowel obstruction. The technical modalities of the CT will be detailed: thickness of \nthe slices, role of acquisition without contrast and reformatting.\nLearning Objectives:\n1.  To understand a simple classification for the causes of bowel obstruction.\n2.  To become familiar with CT protocols.\n3.  To learn a structured approach to the reporting of CT.\n4.  To understand the accuracy of the various radiological signs of bowel obstruc-\ntion.\n08:30 - 10:00 Room A \nInteractive Teaching Session \nE³ 1220 \nPitfalls in brain imaging \nA-346 08:30\nA. CT \nL. van den Hauwe1, S. Pugliese2, J.W. Van Goethem1, C. Venstermans1, \nF. De Belder1, T. van der Zijden1, M. Voormolen1, P.M. Parizel1; 1Antwerp/BE, \n2Rome/IT (lucvdhauwe@mac.com) \nThe majority of emergency CT studies reported by junior radiologists or general ra-\ndiologists out-of-hours comprise brain scans. Brain CT studies are often performed \nto detect acute life-threatening abnormalities, such as stroke, intraparenchymal or \nsubarachnoid haemorrhage, cerebral edema, etc. Misrecognition of these - often \nsubtle - but life-threatening abnormalities can lead to inappropriate patient man-\nagement and worsen patient outcome. Errors in interpretation can generally be \ncategorized as either perceptual or cognitive in nature. Perceptual errors are those \nin which the radiologist does not see the abnormality, resulting in a false-negative \ninterpretation (e.g. basilar artery thrombosis, deep cerebral venous thrombosis, \nPRES,…). Cognitive errors, on the other hand, are those in which an abnormality \nis identified but the meaning or significance of the abnormality is not recognised. \nCognitive errors can result in false-positive interpretation if, for example, a normal \nanatomic variant is mistaken for a pathologic condition. While the more common \nnormal variants and artifacts often do not present a problem for experienced clini-\ncians and neuroradiologists, less-experienced individuals should beware of these \ndiagnostic hazards. In order to reduce false-negative and false-positive reporting, \na check list of the review areas (blind spots) to be verified on any brain CT scan \nwill be offered and most frequent normal variants will be discussed.\nLearning Objectives:\n1.  To learn about common pitfalls in CT evaluation of the brain.\n2.  To become familiar with anatomical variants, potentially mimicking disease.\nA-347 09:15\nB. MRI \nM. Essig; Erlangen/DE (mediag@me.com) \nIn this interactive teaching session, the audience will learn about normal anatomic \nvariations as well as common diagnostic pitfalls in neuro-MR imaging commonly \nencountered in clinical practice. The lecture will cover variants commonly seen on \nbrain and head and neck MRI as well as common vascular variations seen on MR \nangiography. Further, the use and limitations of the newer diagnostic techniques, \nsuch as diffusion-weighted MRI, perfusion-weighted MRI, magnetic resonance \nspectroscopy will be discussed.\nLearning Objectives:\n1.  To learn about common pitfalls in MRI evaluation of the brain.\n2.  To become familiar with anatomical variants, potentially mimicking disease.\n08:30 - 10:00 Room B \nGI Tract \nRC 1201 \nHow I report \nModerator: \nG.A. Rollandi;  Genoa/IT \nA-348 08:30\nA. MDCT in the post-operative abdomen \nD.J.M. Tolan; Leeds/UK (djmtolan@doctors.org.uk) \nMDCT offers rapid assessment of the post-operative abdomen in a very complex \npatient group - an open dialogue with the surgical team allows precise knowledge \nof procedure performed, any resection performed and anastomoses created \n(including if bowel has been defunctioned with stoma) and the current clinical \nstatus (especially, if there is concern for sepsis or haemorrhage) or any concern \nfor obstruction or ileus. Positive oral contrast can assess anastomotic integrity, \neither orally/via nasoenteral tube or rectally via foley catheter. The authors uses \n8% non*ionic iodinated contrast with 30-min delay for oesophagogastric (500 ml), \n\nPostgraduate Educational Programme\nS8\nB\n C D E F G\nA\nSunday\nA-353 09:10\nC. Malignant tumours \nR.H. Oyen, F. Claus, D. Hompes, L. De Wever; Leuven/BE \n(Raymond.Oyen@uzleuven.be) \nThe retroperitoneum can host a variety of malignancies, primary or metastatic. They \ncan cause a diagnostic and therapeutic challenges because of rarity, substantial \nsize, and close relationship with vital structures. Sarcomas comprise a third of \nretroperitoneal tumours, liposaroma and leiomyosarcoma predominating. Other \ninclude lymphomas and metastases (germ cell tumours, carcinomas, melano-\nmas). CT is the modality of choice to determine the origin, size, relationship to \nadjacent structures and to evaluate metastases. Low-grade liposarcomas harbour \na predominantly fatty component; high-grade lesions show solid attenuation with \ncontrast enhancement. Biopsy is not required with clear radiological diagnosis. \nWhen the appearance is not typical of a liposarcoma, other diagnosis must be \nconsidered. Lymphoma is not uncommon, displacing or encasing main vessels. \nSome reluctance remains on FNAC or needle biopsy of retroperitoneal lesions. \nIn selected patients with non-diagnostic imaging, biopsy is safe, rapid, reliable, \naccurate and inexpensive (1) to identify lesions that may not require resection, (2) \nwhen the appearance suggests a mass where neoadjuvant treatment may be ap-\npropriate (gastrointestinal stromal tumour, Ewing’s sarcoma) and (3) to determine \nfurther therapeutic strategies if a tumour is deemed unresectable or with distant \nmetastases. Although parts of the gastrointestinal and/or urinary tracts are often \nlargely displaced, invasion and related symptoms are unusual. However, complete \nsurgical resection is the only potential curative treatment option and clearance of \nmacroscopic disease often requires en bloc resection of the contiguous organs (i.e. \ncolon, kidney, pancreas and spleen). Local recurrence occurs in a large proportion \nand remains the major cause of death.\nLearning Objectives:\n1.  To learn about the spectrum of malignant retroperitoneal neoplasms.\n2.  To understand the role of preoperative cytology/histology by needle aspiration/\nbiopsy.\n3.  To learn about the predictors for survival after resection of retroperitoneal \nsarcoma.\nA-354 09:30\nD. Interactive case discussion \nU.G. Mueller-Lisse; Munich/DE \nThe retroperitoneum includes the adrenal glands, the different organs of the urinary \ntract and the male and female reproductive system, the large blood vessels of \nthe body, and different structures of the lymphatic system, the peripheral nervous \nsystem, and the lower gastro-intestinal tract. During embryologic development, the \nretroperitoneum separates from both the peritoneal cavity and the lung cavities, \nwhile it remains connected with the mediastinum. Different fascial planes subdivide \nthe retroperitoneum and separate it from other spaces in the body. Congenital \nanomaly or acquired disease may alter those separations and, subsequently, bring \nabout secondary diesease or disorder. The interactive case discussion will highlight \nclinically relevant aspects of retroperitoneal anatomy, normal variants, and disease \nin selected examples that illustrate each of the sub-topics of the categorical course.\n08:30 - 10:00 Room D1 \nCLICK (Clinical Lessons for Imaging Core Knowledge): Never \nwithout Arteries \nCC 1218 \nChest pain: vascular non-cardiac causes \nModerator: \nE. Brountzos; Athens/GR \nA-355 08:30\nA. Clinical considerations \nR. Iezzi; Rome/IT (roberto.iezzi@rm.unicatt.it) \nAcute Aortic Syndrome (AAS) describes the acute presentation of patients with \ncharacteristic “aortic pain” caused by one of several life-threatening thoracic aortic \npathologies. These include aortic dissection, intramural haematoma, penetrating \natherosclerotic ulcer, aneurismal leak and traumatic transaction. All disorders giving \nrise to AAS can be distinguished in terms of their aetiology and radiological appear-\nance. There is, however, considerable overlap with the possibility of progression \nfrom one pathological process to another. The need to consider and highlight acute \n08:30 - 10:00 Room C \nUrogenital Imaging \nCC 1221 \nRetroperitoneal anatomy, variants and diseases \nModerator: \nU.G. Mueller‑Lisse;  Munich/DE \nA-351 08:30\nA. Retroperitoneal anatomy: an embryology based approach \nF.M. Danza; Rome/IT (fmdanza@gmail.com) \nThe classical radiological anatomy of the retroperitoneum (RP) divided into 3 com-\npartments (perirenal, anterior and posterior pararenal spaces). in some instances, \nit does not fit with the diffusion and appearence of fluid collections or masses, sug-\ngesting the need of some anatomical corrections.The embryologic development of \nthe abdomen, with rotations and adesions of primitive gut and mesia, is the key to \nunderstand the real radiological anatomy of retroperitoneum and entire abdomen in \nadults. This new vision, based on embryo, recognizes acquired and true retroperi-\ntoneal compartments and distinguishes the sopramesocolic from undermesocolic \nones. In such a way becomes evident that RP compartments are more than 3, \nhave asymmetric and different topographic distribution in abdomen and pelvis and \ndevelop different intercommunication with the peritoneal portion of the abdomen. \nThe diagnostic importance of fascial planes, better defined as “peritoneal fascial \nadesions”, is crucial in determining and recognizing the patterns of diffusion of \ndiseases and their radiological counterpart. The real comunications between RP \nlodges and peritoneal reflections is better understood, leading to identification of \nfive doors of intercomunication, that are crossroads for the spread of diseases. In \nsuch a way RP and peritoneum are to be considered as a unique anatomic complex \nand the so called “subperitoneal space” is the “common denominator” leading to \na modern view of the radiological anatomy for a correct reading of patological \npictures. The consciousness of these anatomical landmarks and the application \nof these new concepts during diagnostic radiological work are a formidable aid in \ninterpreting pathological patterns.\nLearning Objectives:\n1.  To understand the development of the retroperitoneum during the embryo \ndevelopment, introducing the concept of a unique subperitoneal space.\n2.  To understand the importance of fascial planes in determining the pattern of \ndiffusion of diseases.\n3.  To apply these new concepts signs during routine diagnostic work.\nA-352 08:50\nB. Anatomical variants and benign diseases \nS. Merran; Paris/FR \nThis lecture will deal with the imaging findings observed in patients with benign \nretroperitoneal lesions, including variants of vascular anatomy and of renal position \nand morphology. Such anomalies are often encountered during imaging studies, \nand must be recognised before surgery and/or interventional manoeuvers to \navoid iatrogenic damage. The role of radiology in the diagnosis of patients with \nretroperitoneal fibrosis will be discussed, with special attention to findings during \nfollow-up and about criteria which can help to differentiate such condition from \nretroperitoneal lymphoma. There will be presentation of findings in patients with \nretroperitoneal abscess, together with discussion of techniques to guide efficiently \nand safely percutaneous drainage. A large variety of space occupying lesions can \nbe encountered within the retroperitoneum, both benign and malignant. Diagnostic \nclues to recognise the benign ones will be presented, with discussion on how to \nreach a differential diagnosis among them. \nLearning Objectives:\n1.  To learn about the most important variants of retroperitoneal vessels and about \nrenal anomalies.\n2.  To understand the role of radiology in patients with retroperitoneal fibrosis and \ninfections.\n3.  To become familiar with benign retroperitoneal tumours and learn about the \nclues for differential diagnosis.\n3\n\nPostgraduate Educational Programme\nS8\n C B D E F\n G\nA\ninvolvement of arterial branches should be evaluated. In coronary artery disease, \naffected arteries, obstruction and degree of stenosis, areas of infarction and signs \nof pulmonary congestion are important.\nLearning Objectives:\n1.  To become familiar with typical cases illustrating the role of imaging modalities \nin the diagnosis and differential diagnosis of acute chest pain.\n2.  To consolidate knowledge of the selection of the appropriate imaging technique, \nimage interpretation and image based treatment recommendation.\n3.  To understand the most important information urgently needed for treatment \ndecisions and planning.\nAuthor Disclosure:\nT. R. C. Johnson: Research/Grant Support; Bayer, Siemens. Speaker; \nSiemens. \n08:30 - 10:00 Room D2 \nOncologic Imaging: Follow-up of Systemic and Local Therapies \nCC 1219 \nAssessing HCC response \nModerator: \nR. Lencioni; Pisa/IT \nA-358 08:30\nA. Systemic therapies \nV. Vilgrain, M. Ronot, M. Zappa, S. Faivre, E. Raymond; Clichy/FR \n(valerie.vilgrain@bjn.aphp.fr) \nSorafenib, a tyrosine kinase inhibitor, has shown clinical efficacy in patients with \nhepatocellular carcinoma (HCC) and is the standard of care for patients with \nadvanced-stage HCC. Nowadays, many targeted therapies are evaluated in HCC \neither as sole treatment or in combination with other treatments such as tumour \nablation, chemo-embolisation, and surgical resection. Therefore, there is a need \nto assess efficacy of targeted therapy in HCC. RECIST is the reference method \nto evaluate treatment efficacy in solid tumours but does not seem appropriate in \nevaluating targeted therapy as objective responses were seen in very few cases \nin patients treated with sorafenib or sunitinib. New criteria have been proposed \nto evaluate treatment efficacy of non-surgical treatments in patients with HCC. \nThe most common ones are the Choi criteria, the EASL criteria, and the modi-\nfied RECIST criteria. All these criteria mainly focus on internal tumour changes \nsuch as appearance of necrosis or disappearance of tumour hypervascularity. \nMany examples will be shown during the lecture. Another approach is based on \nfunctional imaging and especially perfusion-related imaging. Contrast-enhanced \nultrasound, CT perfusion and dynamic contrast-enhanced MR imaging have the \ncapability to assess perfusion changes in patients under treatment. Advantages \nand disadvantages of these modalities will be discussed. Last, other functional \ntools that are not routinely used will be presented.\nLearning Objectives:\n1.  To learn about difficulties in HCC assessment with local therapy.\n2.  To become familiar with various evaluation criteria of HCC.\nA-359 09:00\nB. Endovascular therapies \nR. Salem; Chicago, IL/US (r‑salem@northwestern.edu) \nThe mainstay treatment for HCC include ablation and embolisation. Chemoemboli-\nsation, the gold standard treatment for intermediate disease, results in response \nrates ranging from 35-45%. New treatment modalities including drug-eluting beads \nand radioembolisation appear to improve on this, with responses up to 50% by \nsize and 75% by necrosis criteria. This presentation will focus on the methodolo-\ngies for response assessment and the specific challenges faced by radiologists \nwhen interpreting response following embolotherapy. Response criteria including \nWHO, RECIST, EASL and mRECIST, as they relate to endovascular therapies, \nwill be discussed in detail. \nLearning Objectives:\n1.  To appreciate the value of different imaging techniques for assessment of \nintra-arterial therapies of HCC.\n2.  To become familiar with post-treatment imaging after intra-arterial therapies \naccording to type of therapy.\nAuthor Disclosure:\nR. Salem: Advisory Board; Sirtex, Nordion. Consultant; Nordion, Sirtex. \nthoracic pathology as an AAS is clear. In an ageing morbid population and with \nmodern imaging techniques, it is becoming a more commonly encountered clinical \nphenomenon. Furthermore, thoracic aortic pathology can be a difficult diagnosis to \nmake. Clinical findings are often absent, the chest radiograph may be normal, and \nsymptoms may be confused with acute myocardial infarction. An AAS, therefore, \nencourages prompt recognition of symptoms heralding an unstable phase in these \ndisease processes indicating imminent aortic rupture. This will hopefully expedite \nrecognition and avoid diagnostic delays. Current diagnostic techniques center \naround the use of computed tomography (CT), transesophageal echocardiography \n(TEE), magnetic resonance imaging (MRI), and aortography. These four techniques \nprovide variable informations, in order to obtain a correct diagnosis, an assessment \nof the localisation and extension of disease, and an accurate planning of treatment. \nIt is mandatory to underline that aortic pathology is often unsuitable for conservative \nmedical treatment and many patients are also poor surgical candidates. As a result \nminimally invasive endovascular aortic repair is now increasingly being undertaken.\nLearning Objectives:\n1.  To become familiar with clinical diagnostic algorithms in cases of non-cardiac \nacute chest pain.\n2.  To learn about the constituents of acute aortic syndrome.\n3.  To become familiar with prognosis, treatment and outcome and learn about \nthe influence of imaging on treatment decisions in acute chest pain.\nA-356 09:00\nB. Imaging techniques and typical findings \nF. Wolf; Vienna/AT (florian.wolf@meduniwien.ac.at) \nAcute chest pain is a very common admission diagnosis of patients entering an \nemergency department. The sufficient triage of these patients is crucial in order to \nstart the right treatment and to minimize unnecessary hospital stays. Computed \ntomography is a very important tool in the differential diagnosis of acute chest pain. \nAortic pathologies are one of the clinical most relevant differential diagnoses of \nacute non-cardiac chest pain. There are 5 variants of aortic dissections: classical \ndissection, atherosclerotic penetrating ulcer (PAU) ± intramural haematoma, intimal \ntear without intramural haematoma, intramural haematoma (without intimal tear) \nand traumatic/iatrogenic dissection. CT plays a major role in the detection and dif-\nferential diagnosis of these 5 variants as well as in the decision how to treat these \npatients. Choosing the right imaging protocol is crucial in order to find the right \ndiagnosis. ECG-triggering is a key factor that has positive influence on the image \nquality especially in the region of the aortic root. Using a so-called \"triple-rule-out\" \nprotocol is critical due to different reasons and might offer sufficient image quality \nonly with scanners of the newest generation. This presentation will show stable \nimaging protocols for aortic pathologies in patients with acute chest pain. Moreo-\nver, it will discuss the usefulness of the \"triple-rule-out protocol\". The 5 variants of \nthoracic aortic dissection will be presented combined with clinical cases.\nLearning Objectives:\n1.  To learn about state-of-the-art CT angiographic imaging in acute chest pain \n(after ruling out MI).\n2.  To become familiar with the techniques and advantages of ECG gating in CT \nangiographies of acute chest pain.\n3.  To discuss the potential role of additional MR angiography.\nA-357 09:30\nC. Interactive case discussion: what is really important? \nT.R.C. Johnson; Munich/DE (thorsten.johnson@med.uni‑muenchen.de) \nIn chest pain evaluation, a close collaboration with clinicians is essential. An initial \nworkup should include a brief history, clinical exam, ECG and laboratory markers \nincluding tropin and d-dimer. TSH and creatinine are not mandatory in acute cases. \nChest x-ray is the modality of choice in subacute pain if the clinical presentation \nis suggestive of, for example, pulmonary edema, pneumothorax, pneumonia, \nrib fractures or metastases. If clinical history and presentation are suspicious of \nmyocardial infarction or there are ECG findings or a positive troponin, the patient \nshould be referred to cardiology to allow immediate catheterization. In cases of \nacute, unclear chest pain, CT is the modality of choice. Long bolus techniques can \nbe used to cover pulmonary and aortic system, and high-pitch modes with ECG-\ntriggering are preferable to assess coronary arteries, depending on the available \nCT technology. In case of acute pulmonary edema with typical presentation, the \nadministration of contrast media can worsen the situation and should be avoided. \nDepending on the diagnosis, there are different important diagnostic criteria. In \npulmonary embolism, number and level of affected arteries, degree of obstruction, \nand right heart strain should be assessed. In case of aortic dissection, involvement \nof coronary ostia, entry and re-entry, and organ supply or ischaemia are important \ncriteria. In case of aortic ulcer or aneurysm, signs of rupture or haematoma and \n4\n\nPostgraduate Educational Programme\nS8\nB\n C D E F G\nA\nSunday\nnot surprising that especially amongst elite gymnasts low-back pain is a very com-\nmon phenomenon. It is not always easy to recognize this. They usually accept a \ncertain amount of pain as being normal and consider it more or less normal. There \nare, however, some potentially devastating diseases and conditions that can be \nthe underlying cause and it is very important to recognize these, so that proper \ntreatment can be applied.\nLearning Objectives:\n1.  To become familiar with the types of chronic injuries seen in the gymnast’s \nspine.\n2.  To understand the strengths and weaknesses of different imaging modalities \nfor imaging these injuries.\nA-363 09:30\nC. Upper limb overuse injuries in golfers \nP.J. O’Connor; Leeds/UK (philip.o’connor@leedsth.nhs.uk) \nGolf is particularly well suited to the development of upper limb overuse injury. \nRepetitive actions combined with relatively high forces damage soft tissues, joints \nand bone. This is particularly the case in professional golfers where the swing \nforces are more clearly reproduced with higher repetition rates compared to ama-\nteurs. This lecture details the common upper limb overuse injuries focussing on \nthe elbow, wrist and shoulder.\nLearning Objectives:\n1.  To understand the types and mechanisms of overuse injuries seen in the upper \nlimb in golfers.\n2.  To understand the advantages and disadvantages of different imaging modali-\nties.\n3.  To become familiar with the imaging findings seen in overuse injuries of the \nupper limb.\n08:30 - 10:00 Room E2 \nNeuro \nRC 1211 \nStroke: is the prognosis getting any better? \nA-364 08:30\nChairman’s introduction \nJ.-P. Pruvo; Lille/FR (jean‑pierre.pruvo@chru‑lille.fr) \nStroke remains a major health burden, the first cause of disability in young adults, \nthe second cause of dementia and the third cause of death in Europe and the \nUS. Brain imaging must be performed very early after symptom onset in order to \nconfirm the diagnosis, to evaluate the infarct size, to assess the salvageable brain \ntissue and to detect the site of occlusion. The role of each imaging technique, CT or \nMR, remains widely debated by the scientific community. This specific topic will be \ndeveloped by PM Parizel during the first lecture. In case of ischaemic stroke which \nrepresent more than 80% of cases, several therapeutic options may be chosen ac-\ncording to the delay between symptom onset and patient admission. This includes \nIV thrombolysis, mechanical thrombectomy or, after the initial phase, craniectomy in \ncase of malignant stroke. In the near future, the use of brain hypothermia during the \nfirst 6 h after stroke onset and before brain imaging could potentially reduce brain \ndamage related to ischaemia in large population of patients. This will be discussed \nin the second lecture by VM Pereira. For the secondary prevention of ischaemic \nstroke, P Vivela will talk about the exact role of extracranial or intracranial stenting \nwhich is another topic widely debated since the recent multicenter studies which \ndid not prove the real benefit of these techniques to prevent a recurrent stroke. \nA-365 08:35\nA. Initial imaging work-up: CT or MR? \nP.M. Parizel, T. Van der Zijden, F. De Belder, C. Venstermans, \nL. van den Hauwe, R. Salgado, J. Van Goethem, M. Voormolen; Antwerp/BE \n(paul.parizel@ua.ac.be) \nNeuroimaging plays a crucial role in the diagnosis, management, and outcome \nprediction of patients with acute stroke. Patient history and clinical neurologic \nexamination neither reliably identify the involved vascular territory, nor the etiol-\nogy, extent or type of stroke. With the arrival of promising new therapies aimed \nat re-establishing blood flow, reducing the size of the infarction and protecting \nthe surrounding brain at risk (penumbra), the traditional role of neuroimaging has \nchanged. Thanks to multiparametric CT and MRI techniques, our understanding of \nA-360 09:30\nC. Ablative therapies \nC. Ayuso; Barcelona/ES (cayuso@clinic.ub.es) \nThe evaluation of treatment efficacy is a key issue with prognostic and patient \nsurvival implications. It is crucial to have objective and reproducible criteria for \nspecific groups of patients. The goal of ablative therapies of HCC is to induce \ntumoural tissue destruction. Complete response (CR) after initial chemical and \nthermal percutaneous ablation, defined as the absence of contrast enhancement \nof the treated tumour at CEUS, dynamic CT or MR, has been reported to correlate \nto long-term survival. Nevertheless, the clinical effectiveness of imaging techniques \nto assess initial treatment success differs according to tumour size. The success \nrate of RF has been demonstrated superior to PEI in HCCs > 2 cm, and it depends \non the ability to ablate all viable tumour tissue including an adequate tumour-free \nmargin all around the lesion of 0.5 to 1 cm. Thus, the effectiveness of RF directly \ndepends on the tumour location and size. RF is considered an effective treatment \nin lesions ² 3 cm and its effectiveness is progressively reduced along tumour size \nand it is not effective in lesions > 5 cm. CEUS beyond one month may confirm CR \nor detect residual tumour, deserving a final ablation procedure. CT and MR are \nmore effective in the follow -up to confirm the CR and to detect local recurrence, \nor additional HCC lesions in the liver parenchima. The presence of transient hy-\nperaemic inflammatory changes in the periphery of the treated area is a common \nfinding that should be considered to avoid overestimation of the recurrence rate.\nLearning Objectives:\n1.  To learn about the value of different imaging techniques for the assessment \nof ablative therapies of HCC.\n2.  To become familiar with post-treatment imaging after ablative therapies ac-\ncording to type of therapy.\n08:30 - 10:00 Room E1 \nMusculoskeletal \nRC 1210 \nOveruse injuries in sport: a multimodality approach \nModerator: \nE. Llopis; Valencia/ES \nA-361 08:30\nA. Overuse injuries in the footballer’s ankle \nS.J. Eustace; Dublin/IE (eustacesj@gmail.com) \nThis talk will briefly review normal ankle MRI anatomy and biomechanics. It will \nthen make brief reference to common MR imaging protocols and finally review \nimaging appearances of common injuries encountered in footballers, including \nboth technical and diagnostic pitfalls.The relative advantages and disadvantages \nof MRI versus other imaging techniques including ultrasound in both diagnosis and \nprediction of return to sport will be reviewed.\nLearning Objectives:\n1.  To learn the spectrum of overuse injuries sustained by footballers at the ankle \njoint.\n2.  To understand the mechanisms by which these injuries occur.\n3.  To become familiar with the imaging findings seen in overuse injuries at the \nankle.\nA-362 09:00\nB. Overuse injuries in the gymnast’s spine \nM.C. De Jonge; Amsterdam/NL (MdJonge@zuwehofpoort.nl) \nGymnastics participation has increased in the last years. It is predominantly a \nsport in which very young children and adolescents participate. It is also an activity \nthat is characterised by one of the highest injury rates. Whereas in the adult, the \nskeleton is usually much stronger than the supporting soft tissues (e.g. muscles \nand ligaments) and this is not the case in children and adolescents. They are, \ntherefore, at special risk to sustain injuries to the skeletal structures. It is also the \nlarge number of training hours and intensity of the training that is very demanding. \nApart from the acute injuries they are particularly vulnerable to injuries caused by \nthis overuse. Not only the appendicular skeleton is at risk due to the use of the \nupper extremity as a weightbearing structure but also the axial skeleton is under \nconstant strain. The repetitive high-force flexion and (hyper)extension movements \ntogether with rotation and compressive loading of the spine puts the thoracic and \nmore commonly the lumbar spine under a lot of stress and force. It is, therefore, \n5\n\nPostgraduate Educational Programme\nS8\n C B D E F\n G\nA\natherosclerotic and non-atherosclerotic diseases, make a critical appraisal of the \nliterature, discuss the current indications for endovascular treatment and give a \nglimpse into the future challenges for stenting.\nLearning Objectives:\n1.  To understand the natural history of extracranial and intracranial carotid and \nvertebral artery atherosclerotic and non-atherosclerotic diseases.\n2.  To become familiar with the endovascular treatment indications of extracranial \nand intracranial arterial disorders.\n3.  To understand the endovascular treatment strategies aimed at stroke preven-\ntion.\n4.  To recognise the present and future challenges for PTA and stenting of extra-\ncranial and intracranial arteries.\nPanel discussion:  \nWhat is the future of stroke prevention and treatment? 09:44 \n08:30 - 10:00 Room F1 \nSpecial Focus Session \nSF 12 \nQuantitative imaging biomarkers in cardiac \nradiology \nA-368 08:30\nChairman’s introduction \nA. van der Lugt; Rotterdam/NL (a.vanderlugt@erasmusmc.nl) \nBiomarkers are increasingly important in clinical practise and research as \nthey reflect normal and pathological biological processes. Imaging biomarkers \nhave the advantage of being non-invasive, spatially located, and temporally \nresolved. Quantification is of utmost relevance for imaging biomarkers to fully \nexploit the morphological and/or functional information in the images. Accurate \nquantification in medical imaging relies on standardised data acquisition and \ndata analysis. Although tremendous progress has to be made in the coming \nyears, some imaging biomarkers have already reached the clinical and research \ndomain. The ESR has released a white paper on imaging biomarkers (Insights \ninto Imaging 2010; 1:42-45), prepared by the ESR Working Group on Imag-\ning Biomarkers. That document aims to contribute to further exploitation of the \nenormous wealth of biomarker information available in imaging. In this session, \nthe concept of imaging biomarkers is explained and applied to the field of car-\ndiac radiology. It will make clear what the prerequisites are for qualification as \nimaging biomarker and which imaging biomarkers are currently being developed. \nSession Objectives:\n1.  To appreciate the increasing role of imaging biomarkers in radiological research \nand clinical practice.\n2.  To understand the importance of quantification and standardisation of imaging \nbiomarkers.\n3.  To become familiar with the spectrum of quantitative imaging biomarkers in \ncardiac radiology\nA-369 08:33\nImaging biomarkers \nJ.-P. Vallée; Geneva/CH (jean‑paul.vallee@hcuge.ch) \nA biomarker is “a characteristic that is objectively measured and evaluated as an \nindicator of normal biological processes, pathogenic processes, or pharmacological \nresponses to a therapeutic intervention”. There is a tremendous interest of both in-\ndustry and the scientific community to develop and validate new biomarkers as they \ncan be used for risk and disease assessment as well as being efficient surrogates \nof clinical endpoints to decrease study sizes. Biomarkers are derived from either \nbiospecimens or imaging. Imaging biomarkers are mainly represented on parametric \nmaps, where the intensity of each pixel corresponds to an anatomical, functional \nor molecular parameter measured from the images. As a unique feature, imaging \nbiomarkers are able to analyze the whole organ rather than just a sample. However, \nthe measurement process of imaging biomarkers that rely on some kind of signal \nemitted from the human body is usually more complex and less standardised than \nthe measurement of biomarkers obtained from biospecimens. The qualification of \nimaging biomarkers is therefore of utmost importance. This includes the acceptance \nof standardised and reproducible procedures for both the image acquisition and \nprocessing, a correlation with pathology, as well as with other validated biomarkers, \nthe pathophysiology of stroke, in terms of cerebral blood flow and cell metabolism, \nhas greatly improved. Identification of the ischaemic penumbra with MRI and/or \nCT has entered routine clinical practice. A patient suspected of having suffered an \nacute stroke should be cleared for thrombolytic therapy, by excluding intracranial \nhemorrhage and non-stroke causes of the patient‘s symptoms. The critical 3 to 6 \nh time window for thrombolytic therapy necessitates rapid and accurate diagnosis. \nThe fundamental goals of neuroimaging in the patient with acute stroke are therefore \nto rule out intracranial hemorrhage, e.g. by CT or MRI, to show ischaemic brain \ntissue, e.g. by DW-MRI, to show tissue blood flow and identify the penumbra, \ne.g. by perfusion CT or MRI, and to assess vessel patency, e.g. by performing \nCTA or MRA. The purpose of this presentation is to present a comprehensive \nimaging protocol for patients with suspected stroke, to discuss advantages and \ndisadvantages of CT and MR in the initial work-up of acute stroke patients, and to \nillustrate imaging patterns.\nLearning Objectives:\n1.  To become familiar with a comprehensive imaging protocol in patients with \nsuspected stroke.\n2.  To know the advantages and disadvantages of CT and MR in the initial work-up \nof stroke patients.\n3.  To recognise the different imaging patterns in stroke.\nA-366 08:58\nB. Stroke: is there really any therapy? \nV. Mendes Pereira, K.-O. Lovblad; Geneva/CH (vitormpbr@hotmail.com) \nStroke is a life-threatening condition that affects significant amount of active patients \naccounting for a large number of disabilities or deaths. The treatment of acute stroke \ntreatment started in 1990s with the use of rtPA intravenously. The NINDS study \ndemonstrated the efficacy this approach in a cohort of patients up to 3 h. The results \ndemonstrated a clinical improvement (mRS 0-1) of 36% on the treated group. The \nIV therapy demonstrated better results for patient arriving early at the hospital and \nfor distal located occlusions. Proximal occlusions and posterior fosse lesions had \nstill a very bad clinical prognosis. Intra-arterial (IA) therapy was then proposed to \nbe an alternative for those proximal occlusions by promoting lyses of clot in situ. \nThe PROACT II was the study that demonstrated a significant improvement (mRS \n0-2: 40%) of the IA treatment compared to placebo up to 6 h after the beginning of \nthe symptoms for M1 located lesions. Mechanical thrombectomy was proposed to \nenlarge the therapeutic window and to be used in cases with contra-indications to \nthe use of thrombolytics. The first studies reported recanalization rates higher than \nprevious studies with a variable effect on patient’s outcome: 25% for an aspiration \nsystem (penumbra device) to 36% for the Merci device. More recently, retrievable \nintracranial stents started to be used in stroke and have demonstrating a remark-\nable efficiency on recanalization and on clinical improvement.\nLearning Objectives:\n1.  To learn the natural evolution of untreated stroke.\n2.  To understand the advantages and disadvantages of the different therapeutic \noptions in stroke patients.\n3.  To recognise imaging patterns that may determine therapy in stroke patients.\nA-367 09:21\nC. Stenting: does it prevent stroke? \nP. Vilela; Almada/PT (ferrovilela@sapo.pt) \nAngioplasty and stenting has been increasingly used to treat extra/intracranial \nstenosis aiming to prevent future strokes. Extracranial atherosclerotic stenosis trials \nwere focused in comparing the results of stenting and surgey, especially for carotid \nartery. Most of these trials have shown higher rate of periprocedural complications, \nespecially stroke, with carotid artery stenting (CAS). However, the CREST trial \nresults have showed a similar 30-day overall complication rate and equivalents \nrates of future strokes and restenosis. For the intracranial atherosclerotic stenosis, \nthe SAMMPRIS trial has demonstrated that aggressive medical treatment was \nsafer and had better long-term results compared with endovascular treatment. \nThe benefits and risks of each treatment may differ between patients. It has been \ndemonstrated that older patients have worse outcomes with CAS than with CAE. \nMoreover, arterial stenosis may cause a stroke by different mechanisms, such as \nhaemodynamic failure, direct occlusion of perforating arteries or thrombosis at the \nsite of the atheromatous plaque, and distal thromboembolism. It is reasonable to \naccept that angioplasty and stenting may not have the same protective effect in \nthese different situations. Patient selection based on the subgroup analysis taken \nfrom the published and future trials, in the plaque vulnerability or in the cerebrov-\nascular reserve status may depict which patients will benefit most from each type \nof treatment modality. The author will review natural history of extra and intracranial \n6\n\nPostgraduate Educational Programme\nS8\nB\n C D E F G\nA\nSunday\nA-372 09:25\nImaging biomarkers of myocardial ischaemia \nL. Natale; Rome/IT (lnatale@rm.unicatt.it) \nQuantification of myocardial perfusion is tipically obtained by nuclear medicine; \nboth MRI and CT are relatively new techniques in this field, and the major limitation \nfor their application as imaging biomarkers is represented by lack of standardiza-\ntion and a not so high reproducibility for MRI, while for CT the experience is still \nlimited. Furthermore, there is a lack of clinical trials and data on patiets outcome. \nNevertheless, new dual bolus techniques for perfusion MRI seems to be promis-\ning as well as new applications of CT, as fractional flow reserve measurements \ndemonstrated by the Discover Flow study. However, semiquantitative approaches, \nsuch as upslope of time/intensity or time/density curves, have been vaidated and \ncan represent a valid surrogate of myocardial blood flow quantification. From their \nnormalisation, the perfusion reserve index can be obtained, and this has been \nstandardised in some studies. Atherosclerosis biomarkers with CT have been \nrepresented for a long time only by Coronary Calcium Score. Standardization of \nAgatston Score has been achieved with EBCT and now also with MDCT, while \nless data are available for volume and mass indexes. New possible biomarkers of \nplaque composition, such as density measurements of plaques, need further studies \nfor standardization and reproducibility, both for acquisition and post-processing. \nConcerning quantitative assessment of dobutamine stress MRI, there are still no \nsignificant published data. In clinical practice only qualitative assessment is used, \nwith a very poor reproducibility reported in many papers.\nLearning Objectives:\nTo become familiar with the quantitative imaging biomarkers of:\n1)  myocardial perfusion (MRI/CT),\n2)  cardiac contraction after high dose dobutamine challenge (MRI)\n3)  coronary atherosclerosis (CT)\nPanel discussion:  \nHow should we implement quantitative biomarkers in clinical \npractice? 09:45 \n08:30 - 10:00 Room F2 \nBreast \nRC 1202 \nMulti-modality breast imaging \nA-373 08:30\nChairman’s introduction \nM. Lesaru; Bucharest/RO (mlesaru@hotmail.com) \nMulti-modality breast imaging appears as a natural result of the radiologist‘s im-\nplication in the multidisciplinary clinical team. The classical role in the diagnosis \nof breast malignancies is improved by multimodality lymph node imaging by this \nhelping to better determine targets for biopsy in preoperative staging.The onco-\nplastic reconstructive techniques became another challenge for breast-imaging \nspecialists, especially when local recurrence is suspected. For a correct follow-up \nof these patients, the need of „imported“ information from other specialties is obvi-\nous and this should be coupled with a correct imaging protocol. In our days, the \nrole of the radiologist expands from diagnosis to therapy using innovative image \nguided procedures, aspect which is also true for the breast. In this integrated RC, \nexperts will present a clinical update of these new techniques and there will be an \nopportunity to discuss about how the evolution of such techniques is changing the \nnature of the modern multi-disciplinary team meeting.\nA-374 08:35\nA. Conventional, functional and interventional lymph node assessment \nP.D. Britton; Cambridge/UK (peter.britton@addenbrookes.nhs.uk) \nPatients with newly diagnosed breast cancer require their axillary lymph node status \nto be histologically established. Standard practice is to perform this surgically with \nsentinel lymph node biopsy (SLNB). Those patients whose nodes are free of disease \nrequire no further treatment. However patients with metastatic deposits usually \nundergo a second operation to remove all their remaining nodes [axillary lymph \nnode dissection (ALND)]. If such patients can have their lymph node metastases \ndiagnosed pre-operatively, they will be spared an (unnecessary) preliminary SLNB \noperation. Consequently all patients eligible for SLNB now undergo pre-operative \nand a demonstration of an impact on patient outcome or estimation of the size of \nthe effect in clinical trials or experimental studies. In an standardization effort, the \nstructured reporting of imaging biomarkers is likely to expand and affect the clini-\ncal practice of radiologists. Imaging biomarkers, therefore, provide a tremendous \nopportunity for Radiology to move toward an integrative discipline.\nLearning Objectives:\n1.  To understand the concept of imaging biomarkers.\n2.  To learn about the different types of biomarkers (anatomical/functional/mo-\nlecular).\n3.  To understand the different applications of imaging biomarkers (detection, \nprediction, response).\n4.  To learn about the standardisation and validation of imaging biomarkers.\nA-370 08:45\nImaging biomarkers for myocardial function \nJ. Bogaert; Leuven/BE (Jan.Bogaert@uz.kuleuven.ac.be) \nAs the heart generates the driving force to propagate the blood through the vascular \nsystem, assessment of its performance (“cardiac function”) is crucial since many \ndiseases have an impact on the performance of the heart. Though the patient’s \ncomplaints and clinical examination provide valuable information regarding the \nfunctional status of the heart, quantitative measures of cardiac function (‘imaging \nbiomarkers’) have been established in the last decades, and are nowadays rou-\ntinely used in daily clinical practice. The ease of these measures is that age- and \ngender-adjusted normalised values can be used as reference to determine whether \na patient’s cardiac function is still within normal limits, and thus allow to assess \nseverity of dysfunction and to categorize patients. Moreover, functional parameters \nsuch as ejection fraction (EF) have shown to yield prognostic value and are therefore \noften used as surrogate for hard end points such as cardiac death in many stud-\nies. Though ejection fraction, expressing the relative amount of blood ejected by \na ventricle during each cardiac contraction. is definitely the functional parameter \nwith whom we are most familiar with, it is important to emphasize that cardiac \nfunction assessment cannot be reduced or simplified to one single parameter, and \nthat several other parameters need to be considered. It has become clear over \nthe last decades that unraveling and assessment of cardiac function is extremely \ncomplicated. This presentation will deal how MRI and CT can be used to quantify \nthe most important imaging biomarkers on cardiac function.\nLearning Objectives:\nTo become familiar with the quantitative imaging biomarkers of:\n1)  cardiac mass (MRI/CT)\n2)  ventricular volume (MRI/CT)\n3)  ventricular function (MRI/CT)\nA-371 09:05\nImaging biomarkers of myocardial viability \nP. Croisille; Saint‑Etienne/FR (pierrecroisille@me.com) \nDirect imaging of myocardial necrosis and/or fibrosis is now possible with the use \nof delayed-enhancement MRI (DE-MRI) that show abnormalities in the distribution \nof gadolinium chelates and demonstrates nonviable tissue as “hyper enhanced” of \nbright regions. It is related to various mechanisms including delayed wash-in and \nwash-out kinetics of non-viable tissue that contains replacement fibrosis and differ-\nent volumes of distribution of gadolinium in viable and nonviable regions. Accurate \nquantification of areas of scar and viable tissue is now of outmost importance in \npredicting mortality, as the benefits of revascularization rise steeply when this area \nreaches a critical size. When combined with low-dose dobutamine challenge that \ncan be assess either using cine-MRI or quantitative strain imaging with motion \nencoding techniques such as MR-tagging, CMR provides a unique tool that can not \nonly assess the amount of irreversibly damaged myocardium but also its mechanical \nimpact and further help to predict the potential benefits of revascularization. After \nacute myocardial infarction, oedema is believe to be an important biomarker that \ncan be uniquely assess using CMR. More than an estimate of the area at risk, T2 \nimaging provides an overall marker of both ischaemic and reperfusion injuries that \nmay be used to monitor reperfusion strategies.\nLearning Objectives:\nTo become familiar with the quantitative imaging biomarkers of:\n1)  infarct size using delayed enhancement (MRI/CT)\n2)  areas at risk in myocardial infarction using T2w MRI\n3)  cardiac contractility using cine or tag MRI after low dose dobutamine challenge\n7\n\nPostgraduate Educational Programme\nS\n C B D E F\n G\nA\nLearning Objectives:\n1.  To understand indications for therapeutic interventions in malignant and benign \nlesions.\n2.  To learn about current image guided therapeutic techniques in malignant and \nbenign lesions.\n3.  To appreciate possible future developments of therapeutic interventions.\nPanel discussion: \nHow is the evolution of multi-modality breast imaging changing the \nnature of the multi-disciplinary meeting (MDM)? 09:44 \n08:30 - 10:00 Room G/H \nGenitourinary \nRC 1207 \nHow I report \nModerator: \nG.M. Villeirs; Gent/BE \nA-377 08:30\nA. Female pelvis MRI \nA.G. Rockall; London/UK (a.rockall@imperial.ac.uk) \nIn this refresher course lecture, a systematic approach for reporting MRI in the \nfemale pelvis will be presented. Reports will be tailored to the clinical details and \nthe information required by the clinician for further patient management. Critical \nfindings that need to be included in the report will be reviewed. Items to be included \non a ‘check-list’ will be also presented. Examples will include cases of cervical and \nendometrial cancer and complex adnexal masses. Proforma reporting styles for \ncervical and endometrial cancer will be presented and discussed. \nLearning Objectives:\n1.  To learn a structured reporting approach to MR imaging.\n2.  To learn a structured reporting approach to uterine and cervical cancer staging.\n3.  To learn a structured reporting approach to adnexal masses.\nA-378 09:00\nB. Prostate MRI \nJ.J. Fütterer; Nijmegen/NL (j.futterer@rad.umcn.nl) \nIn this presentation, a standardised reporting system for multiparametric prostate \nMRI examinations will be presented (PI-RADS). Furthermore, the imaging assess-\nment of prostate cancer, with emphasis on information useful for surgical and focal \ntreatment planning, will be discussed. Emphasis will be placed on functional MR \nimaging techniques in conjunction with clinical staging nomograms and tumour \nlocalisation. The major teaching points of this exhibit are knowledge of the role of \nmulti-parametric MR imaging in the detection, localisation, and characterisation \nof prostate cancer. Knowledge of standardised reports will enable us to overcome \ncurrent limitations in communication with the referring physicians.\nLearning Objectives:\n1.  To learn a structured reporting approach to MR imaging.\n2.  To learn the most essential points and details to be reported in prostate cancer \npatients.\n3.  To understand the major weaknesses of a prostate MR report.\nAuthor Disclosure:\nJ. J. Fütterer: Consultant; Galil Medical, Inivivo. \nA-379 09:30\nC. CT urography \nN.C. Cowan; Birmingham/UK (nccowan.uro@gmail.com) \nThe principal reason for the existence of CT urography is for diagnosing upper \nurinary tract urothelial cancer (UUC), which most often presents with haematuria. \nStudies providing a breakdown of the prevalence of disease in patients presenting \nwith haematuria show UUC to be a rare but important cause of disease. Examples \nof the typical and atypical UUC and bladder cancers will be demonstrated so the \nradiologist will become familiar with the spectrum of radiological signs in order to \nmake the diagnosis. A structured method for reporting CT urography will be demon-\nstrated using a template and examples worked through. Aspects of CT urography \ntechnique especially those influencing image acquisition and processing will be \nexplored and technical tips relating to protocol design given to optimise reporting. \nultrasound of the axilla and needle biopsy of any morphologically abnormal node. \nThis enables 40% of patients with lymph node metastases to be diagnosed pre-\noperatively and these patients are saved an unnecessary SLNB operation. The \nauthor will describe examination technique and the appearances of normal and \nabnormal lymph nodes. Biopsy criteria and the auditing of results will also be \ndiscussed. Current ultrasound and biopsy techniques are imperfect and 60% of \npatients with lymph node metastases are still diagnosed surgically. Reduction of \nthis false negative rate will require both improved targeting and improved sampling \nof the sentinel node. The author will discuss how this might best be achieved by \nbreast radiologists in the future.\nLearning Objectives:\n1.  To learn about normal lymph node morphology.\n2.  To understand criteria suggestive of morphological abnormality.\n3.  To become familiar with factors affecting overall sensitivity of pre-operative \nlymph node assessment.\nA-375 08:58\nB. Multi-modality assessment of the breast following oncoplastic surgery \nM. Torres-Tabanera, S. Perez-Rodrigo; Madrid/ES \n(mtorrestabanera@gmail.com) \nOncoplastic breast procedures were introduced to fill the gap between compre-\nhensive oncologic surgical treatment of breast cancer, and the achievement of \ncosmetic results that fulfill patient expectations in both, body imaging and psycho-\nlogical wellbeing. Due to its complexity and relevance for the patient, the decision \nof performing these procedures must be made as part of the multidisciplinary \napproach of breast cancer treatment. As a consequence, the role of breast radi-\nologists has expanded beyond the anatomic region of the breast and the usual \nimaging techniques. A basic knowledge of oncoplastic techniques is mandatory \nin order to understand the spectrum of findings from a multi-modality approach. \nImplants and/or autologous reconstruction techniques (based on pedicle, free or \nperforator flaps, as well as lipofilling techniques) are widely applied. The role of the \nradiologist in the multidisciplinary team is twofold: assessment during the planning \nstage, and imaging evaluation at follow -up. The assessment during the planning \nstage includes the determination of the local extent of the disease, that make it \npossible the choice of the appropriate surgical technique, and the imaging study of \nthe donor site in those cases where autologous reconstruction is elected. Imaging \nevaluation at follow-up comprises the recognition of changes and potential pitfalls \nafter reconstruction, the identification of short/mid/long-term reconstruction compli-\ncations, and the detection of recurrent/second carcinomas. Controversial aspects \nwill be reviewed, as the probability of recurrence after oncoplastic surgery, the need \nto establish multimodality follow -up protocols and the interrelations between the \nautologous tissues and the mastectomy bed or remaining breast.\nLearning Objectives:\n1.  To learn about the range of oncoplastic breast procedures in current clinical \npractice.\n2.  To become familiar with imaging features resulting from oncoplastic surgery.\n3.  To appreciate the potential pitfalls encountered while imaging such cases.\nA-376 09:21\nC. Image guided therapy in breast lesions: indications and techniques \nG. Manenti, G. Simonetti; Rome/IT (guggi@tiscali.it) \nBreast conservation therapy has become the treatment standard for early-stage \nbreast cancer. There is increasing demand for minimally invasive and non-surgical \ntreatment methods for patients with small breast cancer. With the improvements \nin imaging techniques that have allowed the earlier detection of smaller breast \ncancers and the desire for improvements in cosmetic outcome, a number of \nminimally invasive techniques for the treatment of early-stage breast cancers are \nbeing investigated. The challenge is that these therapies can be used as a routine \nadjunct in the treatment of selected breast cancers. Percutaneous tumour excision, \nradiofrequency ablation (RFA), interstitial laser ablation, focused ultrasound abla-\ntion (FUS) and cryotherapy provide interesting alternatives to open breast surgery. \nThese techniques may offer complete tumour ablation with less psychological mor-\nbidity, better cosmetic results and reduced inpatient care compared with traditional \nsurgery. The challenge will lie in the ability to identify multifocal disease and in situ \ncarcinoma as well as to ensure complete and effective eradication of the breast \ncancer. Additional research is needed to determine the efficacy of these techniques \nwhen they are used as the sole therapy and to determine the long-term local recur-\nrence rates and survival. In this course, we give an overview of minimally invasive\napproaches for the therapeutic management of benign breast lumps and early-stage \nbreast cancer, related to indications and techniques.\n88\n\nPostgraduate Educational Programme\nS\nB\n C D E F G\nA\nSunday\nLearning Objectives:\n1.  To learn about the T staging of lung cancer.\n2.  To become familiar with the current state of the different imaging technique to \nassess the T stage.\n3.  To appreciate limitations and pitfalls.\nA-382 08:58\nB. Lymph node staging \nW.F.M. De Wever; Leuven/BE (walter.dewever@uzleuven.be) \nAccurate lung cancer staging is essential. Mediastinal lymph node metastases \ndetermine patient outcome. Non-invasive radiological mediastinal staging investiga-\ntions (CT, PET, PET/CT) have their limitations and yield false negative and positive \nresults, so tissue sampling is needed. This must be done in a more invasive way \n(mediastinoscopy, mediastinotomy, endobronchial ultrasound-guided transbronchial \nneedle aspiration (EBUS-TBNA), endo-oesophageal ultrasound-guided fine needle \naspiration (EUS-FNA). EBUS-TBNA is a minimally invasive mediastinal staging \ntool. It allows the bronchoscopist to visualize airway structures and surrounding \nprocesses. The main indications for EBUS-TBNA are 1. staging the mediastinum \nin suspected non-small cell lung cancer, 2. diagnosis of lung cancer when there is \nno endoluminal tumour but mediastinal or hilar adenopathy, 3. diagnosis of unex-\nplained mediastinal lymphadenopathy and 4. tissue banking samples for research \nstudies. EBUS-TBNA samples the same lymph node stations as mediastinoscopy \nbut also stations 10-11. Based on data from systematic reviews and meta-analysis, \nresults for sensitivity, specificity and negative predictive value with EBUS-TBNA \nfor mediastinal staging are 88-93%, 98-100% and 60-86%, respectively. At this \nmoment, mediastinoscopy should still be done to confirm negative EBUS-TBNA \nresults and when the pre-test clinical probability of lung cancer is high. EBUS-TBNA \nis well tolerated. Pneumomediastinum, pneumothorax, haemomediastinum and \ninfectious complications can occur very rarely. A post-procedure chest radiograph \nis not usually needed.\nLearning Objectives:\n1.  To learn about N staging in lung cancer.\n2.  To learn the current state of endobronchial ultrasound for intrathoracic inter-\nvention.\n3.  To become familiar with limitations and pitfalls.\nA-383 09:21\nC. Distant metastasis and whole body imaging \nG. Antoch; Düsseldorf/DE (antoch@med.uni‑duesseldorf.de) \nStaging lung cancer patients includes whole-body assessment to exclude distant \nmetastases. Detection of distant metastatic spread has an impact on patient \nmanagement. Currently, a variety of different guidelines and staging algorithms \nare available from different countries and different societies. The most important of \nthese guidelines will be summarized to give the audience an overview concerning \ncurrent recommendations. In addition, state-of-the-art imaging with whole-body \nPET/CT and MRI have been available for some time. These imaging modalities \noffer tumour staging including T-stage, N-stage, and M-stage in a single session. \nTaking into account both, time and budget, „one-stop shopping“ may be considered \ndesirable when staging lung cancer patients. But do whole-body MRI and PET/CT \nreally offer staging in a single session at comparable accuracy? This talk addresses \ncurrent recommendations for staging of distant metastases in lung cancer patients \nand discusses the accuracies of whole-body imaging modalities in this indication.\nLearning Objectives:\n1.  To appreciate the role of PET/CT and whole-body MRI.\n2.  To learn about the sensitivity and specificity.\n3.  To become familiar with the role of imaging in early response evaluation and \nin follow-up.\nAuthor Disclosure:\nG. Antoch: Speaker; Bayer Healthcare, Nordion, Siemens. \nPanel discussion: \nFacts and controversies in lung cancer staging 09:44 \nIn adults, CT urography is now the preferred initial examination for patients with \nhaematuria at high risk for UUC. A practical method for risk stratification will be dis-\ncussed. For patients with haematuria, early and accurate diagnosis helps optimise \nprognosis but conventional investigative pathways are complicated and lengthy, \nutilising multiple imaging tests and many diagnostic algorithms exist without rigorous \nevaluation. CT urography offers a single imaging test of high-diagnostic accuracy \nwith the potential to replace multiple alternative imaging tests in the diagnostic \npathway, improve patient experience, improve diagnostic performance and accel-\nerate diagnosis. A system for imaging haematuria involving use of CT urography, \nunenhanced CT of the kidneys, ureters and bladder, urinary tract ultrasound and \ncystoscopy will be proposed.\nLearning Objectives:\n1.  To learn how to read and report CT urography.\n2.  To understand how to optimise CT urography for haematuria and urothelial \ncancer.\n3.  To report specimen cases and self-assess your own performance.\n08:30 - 10:00 Room I/K \nChest \nRC 1204 \nLung cancer staging in 2013 \nA-380 08:30\nChairman’s introduction: the latest TNM classification \nJ. Biederer; Heidelberg/DE (Juergen.Biederer@med.uni‑heidelberg.de) \nBased on comprehensive evaluation of clinical outcomes, the latest 7th TNM clas-\nsification of lung cancer has brought significant changes compared to the former \neditions. For the first time, non-small cell and small cell lung cancer are covered \nby one system. Local tumour size (M-staging) is now categorized in 5 steps with \ndiameters of 2, 3, 5 and 7  cm. The classification of lymph node involvement (N-\nstaging) has been refined, now integrating findings from PET, if available. Staging \nof distant metastases differentiates between metastases inside the contralateral \nlung (M1a) and lesions inside other organs (M1b). Lung metastases on the same \nside of the chest are now called T3 (within the same lobe) or T4 (within other \nlobes). The recommended imaging technology for lung cancer staging comprises \nCT (T, N, M), PET (N-staging) and MRI (M-staging). The diagnostic scope of all \nmodalities individually, in combination or as hybrid technology for T/N/M-staging \nwill be presented and discussed against the background of the current guidelines. \nThe role of other important methods (endobronchial ultrasound) and thoracic \ninterventions will be addressed.\nAuthor Disclosure:\nJ. Biederer: Speaker; Siemens. \nA-381 08:35\nA. Local tumour staging \nL. Bonomo; Rome/IT (lbonomo@rm.unicatt.it) \nMain changes in the 7 th edition TNM classification are reflected in the T-staging. \nThese changes are largely related to the re-classification of the size and location \nof the primary tumour and satellite nodules. In particular, the new staging system \ndistinguishes five size-based categories (with cut-off points at 2, 3, 5 and 7  cm), \ndespite the two size groups of the former classification (divided by a 3  cm cut-off \npoint). Therefore, inside the old T1 and T2 groups, the new classification distin-\nguishes T1a, T1b, T2a and T2b, according to a significantly different survival rate \namong the subgroups. For the same reason, additional ipsilateral nodules are \nnow classified as T3 if located in the same lobe as that of the primary tumour and \nT4 if located in a different lobe. Multidetector computed tomography (MDCT) is \nthe standard imaging technique for assessing the T-staging of patients with lung \ncancer. Due to the increased image quality compared to the conventional CT, \nMDCT scanners can depict with greater confidence an invasion in surrounding \ntissues (pleura, mediastinum and chest wall or a transfissural tumour growth) and \ncan detect more and smaller lesions. To investigate T-staging other non-invasive \nimaging techniques, including FDG-PET scanning and MRI, are now available. \nHowever, they offer only a little extra benefit in the T-staging of lung cancer, owing \nto the limited ability of PET for precise anatomic location and size measurement \nand to the significant challenges of MRI in the study of the lungs, mainly due to \ninhomogeneity of magnetic field and cardio-respiratory motion artifacts.\n89\n\nPostgraduate Educational Programme\nS9\n C B D E F\n G\nA\nA-386 08:58\nB. Risk in MRI \nR.R. Peeters; Leuven/BE (ronald.peeters@uzleuven.be) \nWith the advent of higher field MRI scanners in clinical practice and the construc-\ntion of ‘MRI compatible’ implanted devices, the list of the do’s and don’ts while \nperforming an MRI examination on patients changes constantly. In this presentation, \nbasic safety guidelines and rules will be explained regarding static magnetic field \neffects, time varying magnetic field effects, radiofrequency effects and acoustic \nnoise effects, both with regard to the patient as well as the personnel using the \nequipment. Due to the advances in medical technology, the list of possible ‘safe’ \nand ‘unsafe’ items changes almost daily. Therefore, it is very important to have all \nthe information about the patient’s condition and implants prior to the MRI procedure \nin order to asses possible contraindications in advance. While until a couple of \nyears ago cardiac pacemakers and neurostimulators were contraindicated in the \nMRI environment, the advent of ‘MRI compatible’ pacemakers and other implanted \ndevices introduces challenges in patient safety management. In fact, these devices \nare only safe in certain configurations and also in a lot of cases specific MRI scan \nsequences and RF antennas are only allowed. Following the postponed European \nEMF directive, the protection of staff working with EM fields also became a topic of \ndebate. What are the possible risks for staff working with MRI magnets and how \ncan one implement practical rules for the safe use of the MRI equipment.\nLearning Objectives:\n1.  To learn about the risks for patients from MRI procedures.\n2.  To be informed about the contraindications for MRI scan.\n3.  To learn about risks for staff in an MRI department.\nA-387 09:21\nC. Communication of risk to patients and public \nG. Gamhewage; Geneva/CH (gamhewageg@who.int) \nCommunicating risk to key stakeholders is core work in both public health and \nclinical medicine. While most professionals understand instinctively and culturally, \nhow risk should be communicated. But few use a systematic tool to determine \nthe best strategy for risk communications. The first critical step in communicating \nrisk is to clarify the change we want to see in our target audiences as a result \nof our communications. Step two looks in depth at the different audiences and \nlooks at their position on the issue being communicated against the energy they \nwill invest in either agreeing or disagreeing with the change you want to see. The \nthird step deals with choosing a risk communications strategy for the target group. \nOne practical model builds on Peter Sandman’s framework for communicating \nrisk. The model, which has been tested extensively and adapted by the World \nHealth Organization, places emphasis on the perception, beliefs and emotional \nreaction of the target audience. Perception is influenced by many factors includ-\ning controllability of the hazard, impact on children, novelty and magnitude, and \ncultural beliefs. The emotional response of the target audience is then analyzed \nagainst the extent of the hazard as determined by technical experts. Based on this \nanalysis, one of four risk communications strategies can be used to communicate \nrisk: education and surveillance; precautionary advocacy; crisis communication; \nor outrage management. As changes occur in the perception or the magnitude of \nthe risk over time, and changing circumstances, the analysis is repeated and the \nbest current strategy applied.\nLearning Objectives:\n1.  To become familiar with communicating risk according to the imaging modality.\n2.  To become familiar with important rules in communication.\n3.  To understand the relationship between threat/hazard and perception of parents \nregarding imaging for their child.\n4.  To learn how to select an appropriate risk communications strategy suited to \nparents and children.\nAuthor Disclosure:\nG. Gamhewage: Advisory Board; Sarvodaya Shramadana Samithiya, Sri \nLanka. Author; authorship of any material I have produced in the last 12 years \nis the property of my employer. Board Member; Formerly Vice-Chair of the \nCo-existence Initiate based in the USA. Employee; World Health organization. \nFounder; Amazing Teens Project, Switzerland. Grant Recipient; through \nemployer only. Speaker; too many to list, all within public health or community \ndevelopment. \nPanel discussion:  \nHow to communicate risk to patients and the public? 09:44 \n08:30 - 10:00 Room L/M \nPhysics in Radiology \nRC 1213 \nRisk assessment and risk communication \nA-384 08:30\nChairmen’s introduction \nM.M. Rehani1, P. Vock2; 1Vienna/AT, 2Berne/CH (madan.rehani@gmail.com) \nRisk free society is utopian. Every action in life entails some risk. What mat-\nters is the balance between risk and benefit. Wherever benefit to the person \noverweighs risks, it is easy to accept. Situations become critical when the risk \nis unknown, is unsubstantiated but still probable sometime in future, is well \nknown at higher level but cannot be demonstrated at the levels at which action \nis taken or is disputed in the scientific community. Some of these features match \nwith radiation risk. Besides scientific aspects of extent of risk, there are issues \nof perception of risk. Medical radiation risk reminds many professionals of the \nrisks observed after the Hiroshima and Nagasaki incident. Moreover, many get \ndeterred by an extremely small amount of radiation emitted by radioisotopes \nwhereas thousands of times higher x-radiation in radiology practice does not \ncause any flutter. Rational understanding of risk, its estimation, perception and \ncommunication is needed. Current knowledge of radiation risks provides clear \nground for safe practice of radiology and effective communication of risks to \npatients, public and referring doctors. It is the duty of the radiology, medical phys-\nics and radiological technology professional to communicate risks appropriately \nso as to avoid misinformation. In this session, the first two speakers will analyse \nthe risks of imaging using ionising radiation and MRI, and the third speaker will \nintroduce the delicate task of communication that we will then discuss in the panel.  \nSession Objectives:\n1.  To learn about risk, risk estimation, risk perception and communication.\n2.  To become familiar with radiation risk: past and present.\n3.  To appreciate why we need to inform patients and the public about the risks \nand how.\n4.  To understand what referring doctors should know about risk.\nA-385 08:35\nA. Radiation risks for patients and staff \nE. Vaño; Madrid/ES (elivano@terra.es) \nThe International Commission on Radiological Protection (ICRP) made a revision of \nthe risk factors for stochastic effects in 2007. No substantial changes in the global \nfactors of cancer risk occurred in comparison with the previous ones from 1990. But \nrelevant changes were proposed for some organs as breast and lung. ICRP insisted \non the important differences on the higher risk factors for children compared to \nadults and on the caution to apply the quantity effective dose in medical exposures. \nFor deterministic effects (tissue reactions), the most relevant changes (proposed in \n2001) are the new threshold doses for radiation opacities (cataracts) in the lens of \nthe eyes and for circulatory disease to the heart or brain. These changes, especially \nthe one on the lens opacities, should have a relevant impact on the radiation safety \naspects of professionals involved in fluoroscopy-guided interventional procedures. \nThe ICRP released a statement in April 2011, alerting the medical community on \nthese changes and recommending a change in the dose limit for the lens of the eye \nfor occupationally exposed persons. The immediate consequence was a change \nin the International and European Basic Safety Standards to adopt this new limit. \nConcerning radiation induced cataracts, it appears that the rate of dose delivery \ndoes not modify the incidence. Radiation cataracts develop in a characteristic \nsequential and progressive fashion. The rate at which these changes develop, is \nstrongly dose-dependent with an age-modulating component. The latent period for \nradiation cataracts seems to be inversely related to dose.\nLearning Objectives:\n1.  To get the latest information on stochastic risks in radiology.\n2.  To understand the risks for children compared to adults.\n3.  To get the latest information on tissue reaction to medical procedures.\n4.  To learn about radiation cataract and its dose dependence.\n0\n\nPostgraduate Educational Programme\nS9\nB\n C D E F G\nA\nSunday\nA-390 08:58\nB. Can we prevent post-partum haemorrhage in high-risk patients? \nJ.-P. Pelage; Caen/FR (pelage‑jp@chu‑caen.fr) \nPost-partum hemorrhage remains a major cause of maternal mortality and mor-\nbidity worldwide. Prevention of post-partum haemorrhage should be promoted to \nreduce the incidence and the severity of this complication. Identification of high-risk \npatient such as women with abnormal placentation is necessary. Placenta accreta \nis mainly related to the increased use of cesarean section. This condition is often \ndiagnosed after failed attempts to manually remove the placenta. However, placenta \naccreta can be suspected before delivery with the use of ultrasound and Doppler. \nConfirmation of the diagnosis should be obtained with pelvic MRI. Placenta percreta \nis defined as the trophoblastic invasion of the whole myometrium and serosa of \nthe uterus. This invasion may also involve adjacent structures such as the blad-\nder or the digestive tract. Placenta percreta carries a high risk of complications \nand its management may ultimately require hysterectomy and partial resection of \nadjacent organs. Placental abnormalities present a formidable clinical challenge \nand interventional radiologists play a major role. Among the various options, two \ntypes of procedures have been popularized in tertiary care centers. Placenta ac-\ncrete should be left in place and prophylactic embolisation of the uterine arteries \ncan be performed. In patients with placenta percreta, prophylactic placement of \nangiography balloons or compliant occlusion balloons in the common or internal \niliac arteries can be discussed. These balloons should be inflated at the time of \ndelivery only in case of haemorrhage. Additional embolisation of the uterine arteries \nmay be needed. Some authors recommend non-resorbable microspheres instead \nof gelatin sponge to obtain better devascularization.\nLearning Objectives:\n1.  To learn how to identify a high-risk patient.\n2.  To become familiar with preventive measures and medication.\n3.  To know more about techniques for invasive prevention.\n4.  To learn about the results obtained through preventive techniques.\nAuthor Disclosure:\nJ. -P. Pelage: Advisory Board; Keocyt. Consultant; Cook, Terumo, Merit Medical. \nResearch/Grant Support; Cook, Terumo, Merit Medical. \nA-391 09:21\nC. Treatment of post-partum haemorrhage \nM. Szczerbo-Trojanowska; Lublin/PL (ewamak@MRI.am.lublin.pl) \nPost-partum haemorrhage (PPH) is a life-threatening complication of approximately \n1%  of deliveries. Is defined as blood loss of more than 500  ml during a vaginal \ndelivery, more than 1000 ml with a caesarean delivery or a reduction of haematocrit \nlevel by at least 10%  between admission and the post-partum period. Bleeding \nwhich appears during the first 24  h following delivery is recognised as a primary \nPPH. Delayed or secondary bleeding may occur after the first 24  h up until the \nsixth week following delivery. Active bleeding can be detected most frequently from \nvaginal, pudendal or uterine arteries with an approximate flow rate of 0.5-1 ml/min. \nUterine atony or diminished myometrial contractility account for 80%  of PPHs. \nEmbolisation of the pelvic arteries represents an attractive alternative procedure \nfor management\nof post-partum bleeding. In unstable patients with massive bleeding embolisation \ncan be performed from the anterior division of the internal iliac artery. Selectivity \nof catheterisation and subsequent embolisation depends on the haemodynamical \nand clinical status of the patient. Several embolic materials can be used: pledgets \nof absorbable gelatin sponge, microspheres, fibred steel coils or fibred platinum \nmicrocoils. Success rates for embolisation have been reported to exceed 90%. \nSecondary embolisation is required in 9-14%  of cases and is usually satisfactory. \nComplications of are rare and do not exceed 6-7%  of cases. The most common \nare pelvic infections and non-target embolisations. The postembolisation syndrome, \nincluding pain and fever, typically resolves in 2-3 days. Return of normal menses \nis observed 3-4 months after embolisation. \nLearning Objectives:\n1.  To learn about clinical evaluation of post-partum haemorrhage.\n2.  To become familiar with relevant anatomy.\n3.  To understand catheterisation and embolisation techniques.\n4.  To become familiar with results of embolisation\n \nPanel discussion:  \nHow to reduce the radiation doses of these methods? 09:44 \n08:30 - 10:00 Room N/O \nInterventional Radiology \nRC 1209 \nGynaecological and obstetrical haemorrhagic \nemergencies \nA-388 08:30\nChairman’s introduction \nA.-M. Belli; London/UK (Anna.Belli@stgeorges.nhs.uk) \nInterventional Radiology (IR) is increasingly being applied in the management of \nobstetric and gynaecological haemorrhage. National reviews of maternal deaths \nfrom post-partum haemorrhage have recognised that maternal deaths may be \nprevented by IR and that all obstetric units should have protocols and arrangements \nin place to ensure appropriate and timely referral to IR. The important role that IR’s \nplay in the management of fibroids has also highlighted how these techniques can \nbe applied to other gynaecological conditions which may result in haemorrhage. \nThis session will start by describing which gynaecological disorders may result in \nhaemorrhage, and the technical aspects of treatment followed by the published \nevidence for embolisation. The session will then focus on obstetric haemorrhage, \nwith an emphasis on prophylaxis and how women deemed at high risk from \nhaemorrhage might be managed safely. The techniques used for prophylaxis of \nhaemorrhage will be described in detail and the published data presented. The \nfinal presentation will concentrate on the technical aspects of embolisation when \nhaemorrhage has occurred to ensure the best results by knowing the relevant \nanatomy and appropriate technique of embolisation. The publshed evidence of \nthe results of embolisation in PPH will be presented. These presentations will be \nfollowed by a panel discussion on how IR’s can reduce the radiation dose whilst \nsimultaneously ensuring successful outcomes for their therapies, an important \nissue in a young and fertile group of women. \nA-389 08:35\nA. Etiology and treatment of gynaecological benign and malignant \ncauses of massive bleeding \nA. Keeling; Dublin/IE (aoifekeeling@hotmail.com) \nFollowing this presentation, one should be familiar with causes of massive bleeding \ndue to gynaecological disorders, diagnostic imaging of gynaecological bleeding, \nclinical indications for embolisation, technique employed for embolisation, po-\ntential procedure-related complications and management and existing literature \nand embolisation results. Uterine fibroids and post-partum haemorrhage are the \nmost common causes of vaginal bleeding treated with uterine artery embolisation \n(UAE). However, a myriad of other benign and malignant aetiologies for massive \nvaginal bleeding are less commonly discussed. As vaginal bleeding can be life-\nthreatening, it is paramount that Interventional Radiologists are familiar with its \ndiagnosis, aetiology and the pivotal role of UAE. Traditionally, surgery, usually \nhysterectomy, was performed. The minimally invasive technique of transcatheter \nembolisation has become a viable alternative due to speed of haemostasis and its \nuterus preserving, thus fertility preserving nature. Technology advancement with \nadvent of microcatheters and choice of embolic material, along with refinement of \nprocedure skill have enabled the widespread practice of embolisation. Pelvic arterial \nanatomy, including possible arterial communications will be revised. Aetiology of \nnon-obstetric massive vaginal haemorrhage, along with typical clinical presenting \nfeatures are outlined. Imaging appearances of the aetiologies are presented. \nSelection of patients, procedure technique, pitfalls and procedure complications \nare discussed. Importance of clinical involvement of Interventional Radiologists \nin patient follow-up is emphasized. Massive gynaecological haemorrhage is life-\nthreatening and Interventional Radiologists are well positioned to successfully treat \nthis with transcatheter arterial embolisation. Overview of aetiology, radiological \nappearances, embolisation technique and literature is provided.\nLearning Objectives:\n1.  To know more about causes of massive bleeding due to gynaecological dis-\norders.\n2.  To learn about diagnostic imaging and therapeutic embolisation.\n3.  To review published results obtained through embolisation.\n1\n\nPostgraduate Educational Programme\nS9\n C B D E F\n G\nA\n2.  To understand the categories of patients for which specifically tailored protocols \nmust always be employed.\n3.  To appreciate the potential impact of patient specific protocols on image quality \nand patient dose through the use of sample cases.\n4.  To discover a simple framework which could assist radiographers in introducing \npatient specific examination protocols to their departments.\n08:30 - 10:00 Room Q \nPaediatric \nRC 1212 \nOncologic imaging: how to image, follow-up and \nreport \nA-394 08:30\nChairman’s introduction \nD. Roebuck; London/UK (derek.roebuck@gosh.nhs.uk) \nCancer is a major cause of death and disability in children. Radiologists have an \nimportant part to play in the paediatric oncology multidisciplinary team. Our potential \nroles include screening (in children at high risk of developing a tumour), initial diag-\nnosis and staging, biopsy, treatment, supportive care (for example central venous \nand/or enteric access procedures), detection and characterisation of complications \nof treatment, surveillance for recurrence and palliative care. Despite the relative \nrarity of each type of paediatric cancer, radiologists have tried hard to develop imag-\ning protocols, working in collaboration with colleagues in oncology. The approach \nis more standardised in some tumour types than others. This session will help the \npracticing paediatric radiologist develop methods for reporting imaging studies in \nchildren with tumours of the liver, adrenals, kidneys, and central nervous system. \nA-395 08:35\nA. Renal and adrenal tumours in children \nA.M.J.B. Smets; Amsterdam/NL (a.m.smets@amc.uva.nl) \nPrimitive malignant renal tumours comprise 6% of all childhood cancers. Wilms’ \ntumour (WT) is the most frequent type accounting for more than 90%. Imaging \nalone cannot differentiate between these tumours with certainty but it plays an \nimportant role in screening, diagnostic workup, assessment of therapy response, \npreoperative evaluation and follow-up. The outcome of WT after therapy is excel-\nlent with an overall survival around 90%. This allows for a risk-based stratification \nmaintaining excellent outcome in children with low-risk tumours while improving \nquality of life and decreasing toxicity and costs. The imaging issues for WT from \nthe European perspective will be discussed as well as the characteristics of other \npaediatric malignant renal tumours. Primary adrenal malignant tumours can be \ncategorized according to their origin. Adrenocortical neoplasms are rare in chil-\ndren. A size greater than 5-10 cm suggests malignancy as well as signs of local \ninvasion or distant metastasis. The most frequent malignant medullary tumour is \nneuroblastoma. It accounts for 7-10% of all childhood cancers and has a survival \nrate between 5 and 80% depending on age at diagnosis, tumour spread, genetic \nmarkers, etc. It is related to borderline malignant ganglioneuroblastoma and be-\nnign ganglioneuroma. Imaging cannot distinguish between these tumours but it is \nessential in the diagnostic workup and during follow-up. Currently, 2 systems are \nused to stage neuroblastoma: The International Staging System (INSS) is based on \nsurgery; the International Neuroblastoma Risk Group (INRG) has developed image-\ndefined risk factors (IDRF) used for staging. Both staging systems will be discussed. \nLearning Objectives:\n1.  To appreciate the role of US, CT, MRI and scintigraphy.\n2.  To become familiar with the imaging findings and the main differential diagno-\nses.\n3.  To learn about the imaging strategies for diagnosis and staging.\nA-396 08:58\nB. Paediatric liver malignancies \nD. Roebuck; London/UK (derek.roebuck@gosh.nhs.uk) \nThe main aims of imaging are confirmation of the hepatic origin of the tumour, \ndiagnosis and staging. Differential diagnosis is facilitated by combining imaging \nfindings with clinical parameters, such as serum alpha-fetoprotein (AFP). Children \nwith malignant liver tumours often require three modalities (US, chest CT and \nMRI) for optimal imaging. Vascular tumours of infancy (congenital and infantile \nhaemangiomas) and mesenchymal hamartoma should be diagnosed on imaging \n08:30 - 10:00 Room P \nRadiographers \nRC 1214 \nDose optimisation in computed tomography \nModerators: \nG. Frija; Paris/FR \nD. Pekarovic; Ljubljana/SI \nA-392 08:30\nA. Innovations in dose optimisation \nS. Foley; Dublin/IE (shane.foley@ucd.ie) \nComputed Tomography (CT) use has grown dramatically in recent years especially \nwith the advent of multidetector technologies. Although providing non-invasive \nhigh-quality cross-sectional images of the body, concerns exist given the relatively \nlarge radiation doses involved and the rising number of referrals. In keeping with \nthe ALARA principle, efforts continue apace to optimise radiation doses throughout \nradiology but within CT in particular, to minimise risks to both patients and popula-\ntions, while maximising the diagnostic yield. This refresher course considers CT \ndose optimisation techniques and especially recent innovations within the modality. \nFirst, it looks at the knowledge base pertaining to radiation dose within CT, the \ninfluencing factors, and how these are routinely combined within clinical practice. \nRecent developments in scanner design and software have greatly assisted CT \nusers in optimising radiation doses and allowed the consistent individualisation of \ndoses. The principles of these technologies, such as automatic exposure control, \ncardiac gating and innovative reconstruction algorithms will be introduced and \ndiscussed. A variety of non-scanner based approaches to optimisation will also be \nexamined, such as the use of superficial shielding, heart rate control medication \nand patient positioning as well as some useful tips from the literature that can help \nusers optimise doses within their own CT departments. Finally, as numerous CT \nmanufacturers aim to provide routine sub-millisievert scanning, possibilities for \nfuture optimisation methods will be presented\nLearning Objectives:\n1.  To consolidate knowledge in the area.\n2.  To become familiar with recent developments based on scanner design features \nand to be aware of the evidence base that supports these developments.\n3.  To become familiar with recent developments based on non-scanner based \napproaches such as shielding and to be aware of the evidence base that \nsupports these approaches.\n4.  To learn more about the potential for future developments in the area.\nA-393 09:15\nB. Developing patient specific examination protocols \nH. Precht; Odense/DK (hepr@ucl.dk) \nThe CT technology has developed rapidly during the last years and facilitates \nmultiple technical settings, such as dose, collimation, pitch and more advanced \npossibilities as Iterative Reconstructions, Dual Energy and contrast protocol. All \nthese technical opportunities can be used to optimise the CT examination focusing \non image quality and/or dose. Optimization strategies addressing patient groups \nand/or anatomic protocols to start optimising image quality involves consideration \nof patient‘s age, radiation sensitive area, suspected pathology or volume of a given \nanatomy according to ICRP. On this basis, the level of information about the patient \nand purpose of the examination is essential. Hereby requested image quality will \ndiffer regarding the specific patient and case. Image quality involves both objective \nand subjective parameters and will always be based on individual preferences. \nTo optimise image quality, close cooperation between radiologists, radiographers \nwith technical capabilities and physicists is required. This interaction can serve as \nleverage for the possibility to make the CT examination present the expected pathol-\nogy more precise at the lowest possible radiation dose and use the full potential \nof the CT scanner. Sample clinical cases representing optimization focusing on \nthe individual patient will be presented to support reflection on radiation dose and \nimage quality. An ongoing research project implementing technical optimization in \nCardiac CT aiming on the newly developed technical factors including a subproject \nof post-mortem cardiac CT compared to histopathology will be presented as an \nexample to how these techniques could have a future applicability in the Medical \nImaging departments. \nLearning Objectives:\n1.  To understand the importance of employing patient specific examination pro-\ntocols in computed tomography by exploring the benefits of such protocols.\n2\n\nPostgraduate Educational Programme\nS9\nB\n C D E F G\nA\nSunday\n08:30 - 10:00 Room Z \nProfessional Challenges Session \nPC 12 \nLegal matters related to multimodality techniques \nA-398 08:30\nChairman’s introduction \nK. Åhlström Riklund; Umea/SE \nMutimodality imaging is rapid increasing and with this combined imaging \nradiology and nuclear medicine meet in a new way. The hybrid techniques \ngive new combined information of both structural and molecular or biochemical \ntype of the patient. The two principally different types of information should \nnot compete but complement each other. It is however a challenge to use \nthe combined information in the best way and not least the legal issues of for \ninstance training and allowance are sensitive issues needing to be discussed. \nThere are several ways to take care of hybrid imaging. PET/CT and SPECT/\nCT are so far the most common used hybrid imaging techniques but also PET/\nMR is recently introduced. In the beginning the CT was used only for attenuation \ncorrection and some anatomical guidance. Todays PET/CT-scanners are \nequipped with high performance CT and the challenge to use them in a proper \ndiagnostic way has to be solved. There are educational issues both for radiology \nand nuclear medicine. The development of hybrid imaging influences guidelines \nand a restricted update will be presented. The radiation safety is also an issue \nand the different modalities engaged in hybrid imaging have different demands \nfor buildings, personnel and patients. All these demands have to be taken into \nconsideration and educational activities have to be done. A wide range of legal \nissues are involved in imaging and some of them are different for CT and PET. \nThis symposium will give an introduction to the situation but the discussion must \ncontinue. \nSession Objectives:\n1.  To learn about legal matters in multimodality imaging in different parts of \nEurope, in radiology and nuclear medicine.\n2.  To understand the challenges in hybrid imaging, with respect to both radiology \nand nuclear medicine.\n3.  To consolidate knowledge of the situation in different parts of Europe.\nAuthor Disclosure:\nK. Åhlström Riklund: Research/Grant Support; Research contract at my \ndepartment, for 3T from General Electric and Philips and for PET/CT from \nGeneral Electric. Speaker; invited speaker at single educational occasions for \nGeneral Electric (no fees).\nA-399 08:35\nRadiological legal matters in eastern Europe \nM. Studniarek; Gdansk/PL \nComparison of organisation in departments equipped with hybrid imaging units \nwere performed on the basis of questionnaires sent to National Societies of 15 \ncountries. Installation of PET/CT, PET/MRI and SPECT/CT in the departments of \nnuclear medicine provides the possibility to produce, prepare and inject adequate \nactivities of any radiopharmaceuticals. We did not find any such installation out-\nside the Nuclear Medicine Unit. 4-5-year specialisations of radiology and nuclear \nmedicine are separated and independent in majority of national education systems. \nNM specialisation provides more clinical settings and frequently only few months \n(3-6) in radiology unit. Organisation of reporting system is different, but the main \nrule is acceptation of National Health Organisation and Funds. There are some \nconditions of insurance companies for payment: at PET/CT scanner there have \nto be employed both NM specialist and radiologist. Responsibility for the report is \nalso shared. But if CT part is only for attenuation correction the report is frequently \nprepared by NM specialist alone. Specialist fully reporting (with diagnostic CT and \nMRI) in most of countries needs supplementary education, but usually a nuclear \nmedicine specialist needs longer training in radiology. Anywhere symmetric condi-\ntions exist, basing on personal experience (more than 600 PET/CT procedures \nelaborated under supervision). In PET/MRI diagnostic potential of MRI needs better \nexperience. In this new modality neither experience based solutions nor separated \nprocedures are elaborated yet. Guidelines for hybrid procedures are prepared by \ngrounds if possible, and biopsy is rarely required. The major malignant primary \ntumours are hepatoblastoma, hepatocellular carcinoma, rhabdoid tumour, undif-\nferentiated (embryonal) carcinoma, and hepatocellular carcinoma variants (tran-\nsitional liver cell tumour and fibrolamellar carcinoma). Malignant vascular tumours \n(epithelioid haemangioendothelioma and angiosarcoma) are rare. The distinction \nbetween multifocal primary liver tumours and metastases from an extrahepatic \nprimary tumour (or multifocal infantile haemangioma) can almost always be made \non a combination of imaging and clinical features. There are two major staging \nsystems in current use. The Children’s Oncology Group (COG) use a surgical \nstaging system, in which the main role of radiology is the detection of extrahepatic \nspread and preoperative surgical planning. The other major trials group, SIOPEL, \nuses the PRETEXT system, in which the role of imaging is much more important \nbecause surgery is delayed and chemotherapy is stratified according to clinical \nand radiological risk factors. Because COG now also collect PRETEXT data, there \nis an intercontinental consensus that the ideal radiology report should include a \ndescription of each of its parameters. \nLearning Objectives:\n1.  To understand the role of US, CT and MRI.\n2.  To become familiar with the imaging findings and the main differential diagno-\nses.\n3.  To learn the imaging strategies for diagnosis and in staging.\nA-397 09:21\nC. Oncologic imaging in the paediatric brain \nG. Hahn; Dresden/DE (gabriele.hahn@uniklinikum‑dresden.de) \nBrain tumours of children account for 15% to 20% of all primary brain tumours. \nPosterior fossa tumours and supratentorial tumours occur in nearly equal frequency. \nHowever, supratentorial tumours are more common in the first two to three years of \nlife, whereas infratentorial tumours predominate from ages 4 to 10. The symptoms \nof children with brain tumours depend upon the age at the time of presentation and \nthe location. MR is today the study of choice for diagnosis of intracranial neoplasms \nbecause the multiplanar imaging capability is extremely useful in determining the \nexact extent of the tumour and its relationship to surrounding normal structures. \nFor MR evaluation, the standard sequences are T2-, T1-, FLAIR-sequences in \naxial, saggital and coronal planes. Neuronavigation sequences are important for \nplanning tumour surgery. The most common posterior fossa tumours of childhood \nare medulloblastomas, astrocytomas and ependymomas. Brainstem tumours \nshould be separated into four separate major categories with different diagnostic \npathway, prognosis and therapy. Supratentorial tumours involve the parenchyma \nof the brain or grow intra- or suprasellar, intraventricular and in the pineal region. \nTumours arising from the calvarium are rare in childhood.\nLearning Objectives:\n1.  To understand the role of CT, MRI and MRS.\n2.  To become familiar with the imaging findings and the main differential diagno-\nses.\n3.  To learn about the imaging findings of post-chemo/radiation therapy conditions \nand complications.\nPanel discussion:  \nHow far should the radiologist go in suggesting tumour recurrence \nor post-treatment complications? 09:44 \n3\n\nPostgraduate Educational Programme\nS9\n C B D E F\n G\nA\nAuthor Disclosure:\nK. Åhlström Riklund: Research/Grant Support; Research contract at my \ndepartment, for 3T from General Electric and Philips and for PET/CT from \nGeneral Electric. Speaker; invited speaker at single educational occasions for \nGeneral Electric (no fees). \nA-402 09:29\nInternational, regional, national and local framework requirements\nA. Perkins; Nottingham/UK \nThe installation of clinical PET-CT, SPECT-CT and PET-MR scanners has placed \nadditional demands on organisations and staff with respect to safety and training. \nAdequate training of the clinical and radiographer/technologist (practitioner) work-\nforce in dual modalities is still not in place in many countries. Throughout the world \nmedical exposures continue to constitute the major source of radiation exposure \nto the population, hence it is essential to minimize such activity whilst ensuring \nappropriate medical benefit. Radiological protection frameworks originate from the \nICRP, however the final requirements at national and local level vary depending on \nthe different regulatory systems in place. Even with regulatory structures in place, \nthere is much scope for improvement at local level. In the US the “Image Gently” \ncampaign was an example of medical communities striving to reduce radiation \ndoses, especially in paediatric patients. In order to ensure requirements it is es-\nsential to have appropriate scientific support. In the EU the European Directive \n97/43/Euratom (1997) on the health protection of individuals against the dangers of \nmedical exposures, introduced the term “Medical Physics Expert”. Directive 97/43 \ndefines the Medical Physics Expert as an expert in radiation physics or radiation \ntechnology applied to exposure, whose training and competence is recognised by \nthe competent authorities. These individuals are required to have expertise in all \nmodalites relating to the safety of patients, staff and the general public. The object \nof this presentation is: to provide information about the origin of the radiation protec-\ntion framework; to describe the framework for radiation protection at international, \nregional and national levels; to explain the responsibilities of different parties and \nstaff groups within the working environment. Examples of suitable educational and \nprofessional resources will be provided. \nLearning Objectives:\n1.  To learn about the origin of the radiation protection framework.\n2.  To appreciate the framework for radiation protection at international, regional \nand national levels.\n3.  To understand the responsibilities of different parties within the working envi-\nronment.\nAuthor Disclosure:\nA. Perkins: Author; Multiple. Board Member; Gamma Technologies Ltd. UK. \nCEO; Gamma Technologies Ltd. UK. Consultant; Quotient Bioresrech, UK. \nEmployee; University of Nottingham. Founder; Gamma Technologies, UK. Grant \nRecipient; Multiple. Investigator; Multiple. Research/Grant Support; Multiple. \nSpeaker; Multiple.\nPanel discussion:  \nA discussion with questions from the audience about the differences \nacross Europe 09:47 \n10:30 - 12:00 Room B \nESR meets Chile \nEM 4 \nTopics of ongoing radiological research from the \nAndes \nWelcome by the ESR President: \nG.P. Krestin; Rotterdam/NL \nPresiding: \nJ.I. Bilbao; Pamplona/ES \nM.A. Pinochet;  Santiago/CL \nA-403 10:30\nIntroduction: Radiology in Chile: reality and challenges \nP. Soffia, M.A. Pinochet; Santiago/CL (psoffia@alemana.cl) \nChile is a long and narrow strip of land between the Andes and the Pacific Ocean. \nDue to its length, it has a wide variety of climates, from the dryest desert in the world, \nlocated in the northern part of the country, to the ice-covered Patagonia in the south. \nnational societies including indications of European societies, except of SPECT/\nCT procedure. In Poland only SPECT is paid. \nLearning Objectives:\n1.  To learn about legal matters in multimodality imaging in eastern Europe.\n2.  To understand the specific role and diagnostic applications of PET/CT imag-\ning as a result of national guidelines in eastern Europe, with the example of \nPoland.\n3.  To consolidate knowledge of the limits of the application of diagnostic CT in \nPET/CT units in radiology and nuclear medicine procedures listed (officially \nidentified) in Poland.\nA-400 08:53\nLegal matters in nuclear medicine \nG.K. von Schulthess; Zurich/CH (gustav.vonschulthess@usz.ch)\nMultimodality imaging using PET faces two main obstacles in Switzerland. First, a \ncombined tariff had to be devised after the government no longer accepted billing \nas PET and CT separately. After long negotiations a new flat tariff has been ac-\ncepted which is subdivided into technical, NM and radiological reading fees and \ncost for PET-tracers. It is assumed that eventually a similar tariff can be used for \nPET/MR and for SPECT/CT. One additional optional tariff applies for either CM-\nCT, dual isotope or dual time point imaging with PET, and is billable only once. \nSecond, the major legal issues arises from the introduction of new tracers. FDG \nis largely reimbursed for oncological procedures, but not for other indications, nor \nare other tracers reimbursed. Swissmedic approval (Swiss FDA approval) exists \nfor FDG, Fluoride and F-Choline, but the latter two are not reimbursed as the \ngovernment thinks that there is not enough evidence for the cost-effectiveness of \ntheir use. Currently the largest nuisance concerns tracers such as F-ethyltyrosine, \nGa-Dotatate and F-DOPA, as similar very costly procedures with inferior PET- or \nSPECT tracers (e. g. FDG in brain tumors) are fully reimbursed. This results in the \ndilemma for the physician to either apply an inferior method and get reimbursed or \nan excellent method without reimbursement.\nLearning Objectives:\n1.  To understand issues facing tracer development and clinical use of tracers.\n2.  To understand the process of getting new tracers approved for clinical use.\n3.  To understand the process of getting reimbursement for integrated imaging \nprocedures.\nAuthor Disclosure:\nG. K. von Schulthess: Consultant; Icon Medical Imaging plc. Equipment \nSupport Recipient; GE. Grant Recipient; GE, Bayer. Research/Grant Support; \nGE. Speaker; GE. \nA-401\t 09:11\nLegal matters in Scandinavia \nK. Åhlström Riklund; Umea/SE \nRecently, the medical specialties in Sweden have undergone comprehensive \nchanges. Radiology was the base for all radiology specialties, with a possibility to \nobtain additional specialty license in pediatric radiology, or neuroradiology. In 2006, \na new specialty was introduced. All three radiology specialties together with basic \ntraining in nuclear medicine and clinical physiology were merged into a common \nspecialty. After achieving this specialty in imaging it was possible to proceed with \nmodular training in clinical physiology, neuroradiology or nuclear medicine to qualify \nfor additional licenses. Recently, a new national review of the specialties decided to \nrevert to the old system where the training in radiology and clinical physiology are \nseparated and with a possibility to ad on training to achieve additional licenses in \nneuroradiology or nuclear medicine. It is not possible to get a license only in nuclear \nmedicine. The updating of national guidelines is an ongoing work and increasing \nrecommendation of PET/CT in several diagnoses can be seen. A few examples will \nbe presented. To operate a cyclotron and PET/CT facility requires several permits \nfrom national authorities. For the cyclotron a permit from the Radiation and Nuclear \nSafety authority is demanded. To produce PET tracers permits from the National \nMedical Products Agency is needed. All tracers have to be produced in accordance \nwith good manufacturing practice and a marketing approval is required for each \ntracer. For FDG, which is marketed in Sweden a manufacturing authorization is \nalso required. The process to receive these permits is time consuming.\nLearning Objectives:\n1.  To learn about the educational situation in multimodality imaging in northern \nEurope.\n2.  To learn about national guidelines for multimodality imaging in northern Europe.\n3.  To learn what you need to run a PET/CT and cyclotron facility in northern \nEurope.\n4\n\nPostgraduate Educational Programme\nS9\nB\n C D E F G\nA\nSunday\ncultural traditions. Chile is a magic land with contrasting cultural manifestations and \ngeographical landmarks, a unique country to live, visit and enjoy. \nA-406 11:00\nNeuroimaging in epilepsy: in search of invisible lesions \nM. Galvez; Santiago/CL (mgalvezm@gmail.com) \nEvaluation of patients with refractory epilepsy includes review of clinical manifes-\ntations, electroencephalography and brain MRI findings. Brain images attempt to \nlocalize and characterise the epileptogenic lesion that can correspond to cortical \ndysplasia, mesial temporal sclerosis, brain tumour or vascular lesion. Nevertheless, \nit is possible to identify a structural lesion in patients with focal epilepsy in only \napproximately 85% of the cases, even when utilising imaging protocols optimised \nfor epilepsy. The group of patients with refractory parcial seizures and a normal \nconventional MRI has a worse post-operative prognosis. This is the reason why \nit is necessary to have alternative imaging techniques to better visualize these \nbrain lesions. Brain segmentation and cortical dysplasia: Cerebral cortex and white \nmatter brain segmentation obtained from post-processing analysis of the images \ncan determine subtle areas of alteration of the cortical - subcortical differentiation, \nwhich is a characteristic finding for cortical dysplasias. MRI brain volumetry and \nmesial temporal sclerosis: volumetric quantification of different brain structures has \nsignificantly improved the sensibility and specificity of the diagnosis of hippocampal \natrophy. This is a useful tool specifically to identify subtle unilateral alterations \nand atrophy or for identifying mild bilateral hippocampal atrophy which are dif-\nficult to identify by expert visual evaluation. Functional MRI (fMRI) resting state \nand brain connectivity: epilepsy corresponds to electrical alterations of neuronal \nbrain circuits that can be visible today with fMRI using resting state technique, \nwhich in initial reports shows alterations of brain connectivity in these patients. \nLearning Objective:\n1.  To learn about solutions to improve visualisation of epileptogenic lesions not \nvisible on conventional MRI.\nA-407 11:20\nInterlude: Chile, land of wine and poets \nG. Soto Giordani; Santiago/CL (gloria.soto@gmail.com) \nChile is a land of poets and wine, a land where wines are a matter not just of \ntaste but also of economic performance - it’s the world’s fifth largest exporter of \nwine - a land and where poets, like Neruda and Gabriela Mistral, are not just in-\nspirational, but Nobel laureates. Nicanor Parra, the Chilean self-named anti-poet, \nintroduces Chilean wine to the world by saying: “Wine is everything, it’s the sea, \nthe twenty-league boots, the magic carpet, the sun, the seven-tongued parrot”. At \nthe same time he asks, “Is there anything more noble than a bottle of wine and a \ngood conversation between two twin souls?” Neruda’s devotion to Chilean wine, \nconsidered a national treasure, is magnificently related in his poem Ode to Wine: \n“I like on the table, when we’re speaking, the light of a bottle of intelligent wine. \nDrink it, and remember in every drop of gold, in every topaz glass, in every purple \nladle, that autumn labored to fill the vessel with wine; and in the ritual of his office, \nlet the simple man remember to think of the soil and of his duty, to propagate the \ncanticle of the wine”. Poetry and wine are part of Chilean identity, they form part \nof the profound soul of the country. \nA-408 11:25\nMDCT patterns in mesenteric ischaemia: usefulness in predicting \nclinical outcome \nA. Huete; Santiago/CL (hueteahg@hotmail.com) \nMesenteric ischaemia has high morbidity and mortality. Intestinal necrosis is a major \ndeterminant of poor outcome. Patterns of bowel abnormality on MDCT predicting \nnecrosis and patient death are evaluated in patients with superior mesenteric artery \nembolism (SME). Bi-phasic MDCT angiography was obtained in 31 patients with \nSME. Consensus evaluation by 2 readers depicted 5 patterns of abnormal bowel \nwall: absent enhancement on both phases (wAV), absent enhancement only on \narterial phase (wA), “target” appearance (wT), homogeneous thickening (wH) \nand hyper-enhancement (wE). Correlation was made with surgical findings and \nmedical charts. Intestinal resection was used as marker of bowel necrosis and \nmortality was based on in-hospital death. 13/31 patients had intestinal necrosis \n(42%). Mortality was 29% (9/31). 22 patients had an abnormal bowel wall, 13/22 \nwith necrosis. aAV was seen in 11 patients, 10 with necrosis (p < 0.01). No other \npattern correlated significantly with intestinal necrosis. wAV demonstrated 77% \nsensitivity (0.46-0.94 95%CI), 94% specificity (0.71-1.00), 91% PPV (0.57-1.00), \n85% NPV (0.61-0.96), +LR 13.85 (2.01-95.19) and -LR 0.24 (0.09-0.66) as imaging \nmarker predicting bowel necrosis. Normal bowel was seen in 9 cases, none with \nApproximately 17 million people live in Chile, mainly distributed in the central region \nwhere a Mediterranean climate predominates. From a total of 25,000 physicians, \nonly 600 are radiologists. Radiology was one of the first medical specialities in the \nhistory of Chilean medicine. In 1896, only 3 months after Roentgen’s discovery of \nx-rays, Professors Zegers and Salazar took the first radiograph in Latin America, at \nthe University of Chile. The Chilean Society of Radiology was founded in 1941 and \nhas approximately 400 members. Eight radiology residency programs are offered to \nmedical graduates, 6 of them in Santiago, the main city. Chile has a mixed health \nsystem, 75% of the population belong to the public system and 25 % to the private \nsystem. Most public hospitals have Radiology Departments with CR, state of the art \nUS and multi-slice CT. Only 6 public hospitals have 1.5 T MR systems, in contrast, \nmore than 70 MR scanners are available in private centers. About half of the main \npublic hospitals have RIS-PACS systems, and several teleradiology services have \nbeeing stablished. The main challenges faced by Chilean radiology are related to the \nshortage of radiologists, implementation of teleradiology systems and turf battles.  \nSession Objectives:\n1.  To learn about some interesting recent and ongoing Chilean radiological \nresearch projects in the field of diagnostic imaging.\n2.  To get a glimpse of unique radiological and non-radiological topics in Chile.\nA-404 10:35\nTI-RADS: a US classification of thyroid nodules related to cancer risk \nE. Horvath; Santiago/CL (eleonora.horvath@gmail.com) \nThere is a high prevalence of thyroid nodules on ultrasonographic (US) examina-\ntions. However, most of them are benign and may be subjected to excess FNAB. We \npropose a new, useful classification called TIRADS that is based on the concepts \nof the Breast Imaging Reporting and Data System of the American College of \nRadiology. Our TIRADS classification is based upon ten characteristic US patterns \nthat allow us to approach the likelihood of malignancy regardless of nodule size. \nThis classification was developed based on a prospective series of 1097 nodules \nstudied by FNAB, allowing us to classify these patterns into one of five categories: \nTIRADS 1 = normal thyroid; TIRADS 2 = benign findings (0% malignancy); TIRADS \n3 = probably benign findings (< 5% malignancy probability); TIRADS 4 = suspicious \nfindings (5 to 80% malignancy probability) and TIRADS 5 = highly suspicious find-\nings (> 80% probability of malignancy). In a similar fashion to the BIRADS system, \nTIRADS 4 or 5 nodules require a diagnostic procedure such as FNAB, while those \nclassified as TIRADS 2 or 3 are subject to follow -up.TIRADS classification is a \npowerful tool to classify thyroid nodules regarding their likelihood of malignancy, \nallowing to correctly select those that require punction given their suspicious \nUS pattern, and sort out those low-risk nodules to be followed-up. This reduces \npatient-related stress, and provides a better administration of resources involved. \nIt also provides a standarized report, allowing a fluid communication with clinicians. \nLearning Objectives:\n1.  To learn about an ultrasonographic-based pattern classification that enables a \ncancer risk approach to an accurate selection of thyroid nodules that require \nfine needle aspiration biopsy (FNAB).\n2.  To understand the description of the 10 US pattern for thyroid nodule clas-\nsification.\n3.  To correctly classify the pattern into the TIRADS categories.\n4.  To learn how to determine those patterns most closely related with malignancy.\nA-405 10:55\nInterlude: Chile, land of geographical and cultural contrasts \nG. Soto Giordani; Santiago/CL (gloria.soto@gmail.com) \nChile is one of the slimmest countries in the world, 4,265 km long and just 356 km \nwide at its widest point. It has the driest desert in the world along with enormous \nglaciers, fjords, beaches, lakes, forests, volcanoes, as well as spouting geysers. \nImposing natural barriers mark the nation’s boundaries, isolating the country from \nthe rest of South America. The Atacama Desert separates the country from Peru, \nthe Andes Mountains create a frontier with Bolivia and Argentina, and the chilly \nwaters of the Drake Sea point to Chile’s proximity with Antarctica in the south. The \nimmensity of the Pacific Ocean to the west completes the country’s geographic \nisolation. The diversity of climate along its length and the differences in ethnic \nbackground result in a variety of cultural expressions, each with its own traditions \nof music, dance, and mythological tales. In the north, Aymara Indians have been \nable to preserve many aspects of their Andean culture. Central Chile, a fertile land \nwell known for its fine vineyards, has strong European influence. In the south, the \nMapuche Indians are a cultural group who strongly contributed to the formation of \nChilean culture. On the other hand, 3680 km off the coast of Chile, the remote Easter \nIsland is inhabited by native islanders who keep alive many of their Polynesian \n5\n\nPostgraduate Educational Programme\nS9\n C B D E F\n G\nA\nLearning Objectives:\n1.  To become familiar with common and rare benign adnexal lesions.\n2.  To appreciate the added value of CT and MRI in the differential diagnosis of \nbenign adnexal masses.\n3.  To learn about an algorithm for evaluating incidental adnexal masses with \nimaging.\nA-411 11:10\nC. Imaging the infertile couple \nJ. McHugo; Birmingham/UK \nInvestigating the subfertile couple: Infertility is a common problem said to effect \nbetween 9 and 20% of couples; defined as an inability to conceive following 2 years \nof unprotected intercourse. Modern technologies now allow the majority of couples \nto achieve a successful pregnancy. Imaging plays a major part in the investiga-\ntion particularly of the female allowing an individualised cost effect approach to \ntherapy in this situation. This lecture will allow the participant to understand the \ncommon causes of infertility, understand the role of imaging in the investigation \nof the infertile couple, be able to update their knowledge of imaging techniques \nin the assessment of tubal patency and integrate an imaging strategy to provide \na cost effective service. \nLearning Objectives:\n1.  To understand the incidence and causes of infertility in female and male \npatients.\n2.  To learn about cost-effective strategies for imaging in cases of female and \nmale infertility.\n3.  To understand the rationale for best outcomes.\nA-412 11:30\nD. Interactive case discussion \nE. Sala; New York, NY/US (salae@mskcc.org) \n10:30 - 12:00 Room Q \nRTF - Radiology Trainees Forum  \nTF 1 \nHighlighted Lectures \nModerators: \nD. Bulja; Sarajevo/BA \nV.H. Koen; Harleem/NL \nA-413 10:30\nEmergency radiology management in patients with polytrauma \nU. Linsenmaier, L.L. Geyer, S. Wirth; \nMunich/DE (Ulrich.Linsenmaier@kliniken‑pasing‑perlach.de) \nPolytrauma results in patients suffering from multiple injuries and is the leading \ncause of death below the age of 45. Adequate handling of these complex patients \nand their injuries is a major challenge for any trauma hospital and deserves an \ninterdisciplinary approach in which emergency radiology plays a key role. Even \nfor advanced trauma centers running designated emergency radiology units, it is \na challenge to integrate advanced radiology services in an interdisciplinary team \ntreating patients with multiple injuries. Besides diagnostic imaging, the manage-\nment of the patient in an interdisciplinary environment is crucial. This lecture will \nfocus on 1st management and logistics, 2nd what must be diagnosed and what can \nbe diagnosed with advanced state of the art radiological imaging. The lecture will \ncomprehensively cover: the use of conventional radiography, ultrasound, MDCT; \nlogistics and management of the patient; MDCT in the primary patient survey, the \nATLS concept; advanced scanning protocols for MDCT; volume image reading \nVIR and handling large datasets; metastable and unstable patients undergoing CT; \nMDCT during or after CRP Imaging protocol for the initial workup. WBCT comprises \nnCCT, CMCT of thorax, neck and c-spine (arterial) and (pv) abdomen. CRs were \nmostly replaced, US is only used as FAST (focused abdominal solography in \ntrauma). WBCT can be modified by CTA (@35-45s; for e.g. extremity injuries), late \nCT scans (@120s; e.g. for bleeding dynamic, pseudoaneurysms) and delayed CT \nurography (CTU @400-500s, for pelvic and GU injuries) and also retrograde CT \ncystography. CT scout views and clinical findings determine the extent.\nintestinal necrosis (p:0.004). wAV also showed a strong correlation with mortality \nas 8/9 patients with wAV died (89%) and 3/14 (14%) survived the embolic event \n(p < 0.001). Absent mural enhancement of bowel wall in arterial and venous phase \ndepicted on MDCT angiography correlates strongly with the presence of bowel \nnecrosis and mortality in SME.\nLearning Objectives:\n1.  To learn to identify the most frequent patterns of ischaemic bowel wall damage \nin patients with arterial mesenteric ischaemia using MDCT angiography.\n2.  To correlate patterns of bowel wall ischaemia on MDCT with clinical outcome.\n3.  To identify secondary, non-specific findings of bowel ischaemia on MDCT that \nsignal a potential adverse clinical course.\nPanel discussion:  \nCreating networks between Latin American and European radiology: \na unique opportunity for collaborative research projects 11:45 \n10:30 - 12:00 Room C \nUrogenital Imaging \nCC 1321 \nThe female pelvis \nModerator: \nE. Sala; New York, NY/US \nA-409 10:30\nA. Imaging congenital anomalies of the female genital system \nK. Kinkel; Chêne‑Bougeries/CH (karen.kinkel‑trugli@wanadoo.fr) \nDiagnostic circumstances of congenital anomalies of the female reproductive sys-\ntem correspond to repeated pregnancy loss or dysmenorrhoea due to obstruction \nat the onset of menstruation during childhood. A septated or unicornuate uterus \nmay benefit from subsequent surgery, whereas no surgical solution exist so far for \nbicornuate or didelphus uterus. The 3D capabilities of ultrasound allow differentiation \nof septated versus bicornuate uterus but remains challenging for associated uterine \npathologies. To confirm uterine aplasia, the thickness and length of a uterine septa \nand any functionality of a remnant uterine horn unenhanced MRI is indicated. The \nprotocol includes native sagital T2, oblique axial and coronal T2 and T1-weighted \nsequences with and without fat suppression to identify associated endometriosis \nor ovarian poly cystic disease. Hysterosalpingography helps to verify tubal patency \nand communication between cavities. Associated renal tract anomalies are seen \nin 30% and can be classified with either ultrasound or MRI.\nLearning Objectives:\n1.  To understand Mullerian duct anomalies through embryology and its classifica-\ntion.\n2.  To learn about the indications of MRI or 3D US according to clinical and \nsonographic findings.\n3.  To understand imaging technique and report requirements and the impact of \nimaging results on treatment options.\nA-410 10:50\nB. Benign ovarian masses \nR. Forstner; Salzburg/AT (r.forstner@salk.at) \nThe goal of imaging adnexal masses is to identify patients with definitely benign le-\nsions from those that require further evaluation for ovarian cancer. Sonography has \nbeen established as first-line imaging modality allowing characterisation in 80-90% \nof adnexal lesions. Complementary MRI is a powerful diagnostic tool and renders \nspecific diagnosis of a spectrum of benign lesions, e.g. of dermoids, haemorrhagic \ncysts, endometriomas, hydrosalpinx, and of inflammatory masses. Compared to \nCT, it is particularly superior in assessment of haemorrhagic and solid adnexal \nlesions. In the latter, diffusion-weighted MRI aids in the differentiation of benign \nfrom malignant masses, e.g. of solid metastases. Challenges in imaging adnexal \nmasses include rare benign mimicks of ovarian cancer, e.g. cystadenofibroma, \nrare types of dermoids and sometimes ovarian torsion. Important discrimina-\ntors for management of a patient presenting with an adnexal mass include age, \nmenopausal status, imaging findings (size, complexity of lesion, vascularization), \nchange in follow- up, clinical information including symptoms, laboratory data and \nCA-125. An algorithm how to evaluate adnexal masses including incidental adnexal \nlesions will be provided.\n6\n\nPostgraduate Educational Programme\nS9\nB\n C D E F G\nA\nSunday\nin observing isolated neurons and discussing their connections. Research at this \ntime was an individual activity. Soon, however, knowledge widened and became \nmultidisciplinary, demanding working in groups. Research groups constituted the \nnew minimal structure. Only groups were able to develop multidisciplinary projects \nwith enough quality to survive. However, as in biology, the functional explanation \nof excellence shows that only international networks can explain a successful \ndevelopment. As the brain is structured in a network of connections, research is \nalso organized today as a network of groups with a common interest, varying in \ntime. The connectome, considered as the complete set of nerve cells and their \nconnections, will change over time as new connections form and old ones die. \nThis plastic networking allows groups and individuals to participate in worldwide \nhigh quality research. Similar to neural centres and connections, only research \nnetworks with a well-defined structure, formed by successful groups of qualified \nscholar researchers advance science. This lecture will focus on the concept of \nscience and research, and how communication, grouping and socialisation do influ-\nence both. As young researchers are the basis of science, they should know and \nfollow the path and rules of scholars such as Ramón y Cajal and Humboldt. Some \ninteresting facts and controversies about science, research, advices, personalities \nand countries will be presented.\nLearning Objectives:\n1.  To learn about Santiago Ramón y Cajal, a Spanish histologist, neuroscientist, \nand Nobel laureate.\n2.  To appreciate the change from individual research to multidisciplinary working \ngroups.\n3.  To understand the concept of science and research, and how communication, \ngrouping and socialisation do influence both.\n12:30 - 13:30 Room P \nThe Beauty of Basic Knowledge: Musculoskeletal Imaging \nMC 25D \nNeoplastic/non-neoplastic lesions \nA-417 12:30\nNeoplastic/non-neoplastic lesions \nF.M.H.M. Vanhoenacker; Antwerp/BE (filip.vanhoenacker@telenet.be) \nAnalysis of clinical features (age, location, concomitant diseases) is a prerequisite \nfor characterisation of bone tumours. For imaging characterisation, plain films are \nthe mainstay, as they accurately depict matrix, cortical permeation or disruption, \nand periosteal reaction. MRI has an additional role as most tumours have low SI on \nT1-WI and high SI on T2-WI. In certain cases, however, a combination of distinctive \nfindings (SI, enhancement patterns) allows for an accurate diagnosis or narrows \nthe differential diagnosis. Intratumoural fluid-fluid levels are often seen in ABC, but \nalso in fibrous dysplasia, chondroblastoma, (telangiectatic) osteosarcoma, and GCT. \nRing-and-arc enhancement is seen in chondroid tumours. Intraosseous lipomas, \nhaemangioma and nontumoural lesions (Paget’s disease, irradiation) are of high \nSI on T1-WI. GCT and dense bone islands are of low SI on T1-WI and T2-WI. \nFlow voids may be seen in metastasis of renal cell carcinoma. Characterisation \nand grading of Soft Tissue Tumours (STT) based on imaging remains even more \nlimited and histology is usually required for a definitive diagnosis. Ultrasound is \nmostly nonspecific but may be used for superficially located cystic STT. On MRI, \nanalysis of multiple parameters (shape, presence of signal voids, fluid-fluid levels, \nSI, intratumoural necrosis, multiplicity, pattern/degree of enhancement) yields the \nbest results. The highest confidence is reached in benign lesions, such as lipomas, \nvascular lesions, benign neural tumours, periarticular cysts, hematomas, PVNS, \nGCTTS, and abscesses. The major role of MRI consists -however- of local tumour \nstaging and monitoring of treatment. Whole body MRI and PET-(CT) may evaluate \ndistant tumour spread. \nLearning Objectives:\n1.  To understand the basic principles of diagnosing bone and soft tissue tumours.\n2.  To become familiar with the most important entities and their typical imaging \npresentations.\n3.  To learn about the specific advantages and weaknesses of the different imaging \nmodalities.\nLearning Objectives:\n1.  To understand the complex up to date radiological management of patients \nwith polytrauma/multiple trauma.\n2.  To become familiar with basic concepts, MDCT protocols and major findings \nin patients with polytrauma/multiple trauma.\nA-414 11:00\nImaging of non-traumatic intracranial haemorrhage \nZ. Merhemic; Sarajevo/BA (merhemic.zulejha@gmail.com) \nNon-traumatic intracranial haemorrhage can be classified according to its lo-\ncalisation as subarachnoid haemorrhage (SAH), intracerebral haematoma (ICH), \nintraventricular haemorrhage (IVH), and subdural haematoma (SDH). In 80-90% \nof cases, the cause of non-traumatic haemorrhage is an aneurysm rupture. In \nyoung individuals, the most common cause is bleeding in vascular malformation, \nand in eldery patients high blood pressure or haemorrhagic transformation of a \ncerebral infarct will be more commonly seen. Less frequentlly, coagulopathy, or \nintratumoural bleeding will be the underlying pathology. The accurate identification \nand characterisation of an intracranial haemorrhage has important and immediate \nimplications for further diagnostic workup, clinical management, and patient out-\ncome. In emergency situation, the diagnosis of intracranial hemorrhage is usually \nobtained by NECT scan. CT angiography (CTA) will usually follow demonstrating \naneurysm or vascular malformation. MRI has proved to be more accurate in identify-\ning the underlying aetiology of non-traumatic haemorrhage. Selective intra-arterial \nsubtraction angiography (DSA) will be necessary in some cases.\nLearning Objectives:\n1.  To review different underlying pathologies of non-traumatic intracranial haemor-\nrhage.\n2.  To learn how to use CT/CTA, MRI/MRA, and DSA in patients with non-traumatic \nintracranial haemorrhage.\n3.  To discuss the value of T2* (GRE/SWI) in evaluation of causes of intracranial \nhaemorrhage.\nA-415 11:30\nCase-based learning in radiology \nP. Pokieser; Vienna/AT (peter.pokieser@meduniwien.ac.at) \nTo learn directly from routine cases by observation of professional work is by far the \nmost established and time-tested learning method. “Case-based learning (CBL)” \nis a widely used term of modern medical education for learning techniques includ-\ning “real world settings” to facilitate collaborative, interactive and student-centred \nexploration of different clinical situations. Case-based learning strategies can give \nthe opportunity to see theory in practice. In diagnostic radiology, the case materi-\nals are easy to use for case-based eLearning. This advantage has led to many \ninstitutional, national and international teaching activities, supporting case-based \nlearning in many ways. Materials like case collections can be helpful to design \nCBL courses. CBL courses often include blended learning scenarios, where the \ndirect contact of participants is enriched by collaborative online learning between \nmeetings. This lecture will provide an overview about CBL followed by dedicated \nexamples of successful CBL. \nLearning Objectives:\n1.  To learn about the basics of case based learning.\n2.  To understand the pedagogic potentials of “real world settings”.\n3.  To become familiar with case based ESR learning facilities.\n12:15 - 12:45 Room A \nPlenary Session \nHL 3 \nSantiago Ramón y Cajal Honorary Lecture \nPresiding: \nJ.I. Bilbao; Pamplona/ES \nA-416 12:15\nResearch and science: from individuals to societies - the Ramón y \nCajal background \nL. Martí-Bonmatí; Valencia/ES (marti_lui@gva.es) \nSantiago Ramón y Cajal (1852-1934) was a Spanish histologist, neuroscientist, \nand Nobel laureate. His pioneering investigations on brain microscopic structure \nmade him the father of modern neuroscience. He was a solitary researcher involved \n7\n\nPostgraduate Educational Programme\nS\n C B D E F\n G\nA\n3.  To improve the skills required for accurate interpretation of plain film and CT \nimaging of the chest.\n14:00 - 15:30 Room B \nNew Horizons Session \nNH 14 \nImaging of the mind \nA-420 14:00\nChairman’s introduction: New insights into the state of \nconsciousness through neuroimaging \nS. Sunaert; Leuven/BE (Stefan.Sunaert@uz.kuleuven.ac.be) \nThe past 15 years have seen a major change in the scientific understanding \nof comas, with the main advances being made using EEG, positron emission \ntomography and MRI. Experts are now able to prove that some patients who \nseem comatose are in fact conscious, but their ability to communicate with the \noutside world has been damaged, for instance following a traumatic or anoxic \nevent. This session addresses how locked-in syndrome patients are able to com-\nmunicate through MRI, showing that they still feel, hear and understand what is \ngoing on around them, a development which could dramatically improve their fate.  \nSession Objectives:\n1.  To become familiar with recent advances in functional brain imaging, and how \nthese lead to ‘the imaging of consciousness’ and ‘reading the mind’.\n2.  To understand how imaging contributes to the study of the functional con-\nnectivity and network topology of the human brain.\n3.  To understand how these new techniques and insight lead to (pre-) clinical \napplications.\nA-421 14:05\nBrain wiring: resting state fMRI \nF. Barkhof; Amsterdam/NL (f.barkhof@vumc.nl) \nFunctional MRI employs the contrast between oxygenated and deoxygenated blood \nto create the so-called “BOLD” contrast using T2*-sensitive sequences like EPI. \nClassically, functional MRI is used to determine the effect of task using a variety of \nmotor and cognitive paradigms, for example, to map hand and language function \nin preoperative work-up. However, in the absence of an overt task, continuous \nlow-frequency oscillations in the BOLD signal occur, very much like in EEG. These \nresting-state fMRI changes show temporo-spatial coherence and can be analysed \nusing a variety of methods, including seed-based correlation analysis and inde-\npendent component analysis (ICA) or graph analysis. Resting-state fMRI studies \nin normal subjects consistently show around 10 networks, including the so-called \ndefault-mode network (DMN), but also primary visual and auditory networks, and \nmore complex salience, working memory and executive networks. These major \nnetworks are extremely consistent across subjects and can be determined from fMRI \nruns as short as 5-10 min while lying still in the scanner. In a variety of diseases, \nalterations in resting-state networks have been reported, often leading to lower \nDMN activity (e.g. in Alzheimer’s disease, coma and advanced multiple sclerosis), \nbut increased activity can also be found early in the disease course. Graph analysis \ntechniques are developing quickly and reveal complex alterations in hierarchical \nconnectivity across the brain, with for example rewiring from posterior to a more \nanterior dominance in Alzheimer’s disease.\nLearning Objectives:\n1.  To understand the basics of resting-state fMRI.\n2.  To become familiar with the organisation of intrinsic connections as detected \nwith resting state fMRI in the human brain.\n3.  To consolidate the current knowledge of brain networks in aging and dementia, \nand pharmacology research.\nA-422 14:28\nfMRI in disorders of consciousness: diagnostic and legal challenges \nC. Di Perri, S. Laureys; Liège/BE (caroldiperri@hotmail.com) \nWhen patients in “vegetative state” (recently coined unresponsive wakefulness \nsyndrome) show minimal signs of consciousness but are unable to reliably com-\nmunicate the term minimally conscious state (MCS) is used. MCS was recently \nsubcategorized in MCS+ (i.e., presence of command following) and MCS- (i.e., \npresence of non-reflex movements). Patients who show non-behavioral evidence \nof consciousness or communication only measurable via ancillary testing (e.g., \nfunctional MRI,) can be considered to be in a functional locked-in syndrome. Taken \n12:30 - 13:30 Room Q \nThe Beauty of Basic Knowledge: Head and Neck \nMC 24D \nThe suprahyoid neck: anatomy and diagnostic \nalgorithm of the neck mass \nA-418 12:30\nThe suprahyoid neck: anatomy and diagnostic algorithm of the neck mass \nA. Trojanowska; Lublin/PL (agnieszka30@yahoo.com) \nThree layers of the deep cervical fascia define the suprahyoid neck compartments, \nwhich include prevertebral, retropharyngeal, carotid, masticator, parapharyngeal \nand pharyngeal mucosal space. Knowledge of the structures inherent to these \nspaces will provide the radiologist with an accurate basis for differential diagnosis, \nsince allocation of a tumour to a certain compartment limits the number of diagnos-\ntic possibilities. Expanding lesions usually distort or displace adjacent structures \nand fascia in predictable fashion, which is crucial in defining the site of origin. \nBoth MRI and CT are frequently used in the imaging of suprahyoid neck lesions. \nThe introduction of functional imaging has also given some benefits. Primary and \nsecondary, benign and malignant processes occupying major suprahyoid neck \nspaces will be discussed, with regard to crucial findings necessary for appropriate \ntreatment selection and treatment planning. Since correct diagnosis requires close \ncollaboration with ENT surgeons, clinical findings will also be discussed, together \nwith practical information needed for surgery.\nLearning Objectives:\n1.  To become familiar with the compartmental anatomy of the suprahyoid neck.\n2.  To understand the central role of the parapharyngeal space in the localisation \nof suprahyoid neck masses.\n3.  To be able to localise and provide a useful differential diagnosis of a SHN \nmass.\n4.  To learn the best imaging approach to the suprahyoid neck.\n14:00 - 15:30 Room A \nInteractive Teaching Session \nE³ 1420 \nCommon and uncommon errors in plain film and \nCT imaging of the chest: how to improve your \nperformance \nA-419 14:00\nCommon and uncommon errors in plain film and CT imaging of the \nchest: how to improve your performance \nD. Tack1, N. Howarth2; 1Baudour/BE, 2Chêne‑Bougeries/CH \n(denis.tack@skynet.be) \nMissed lung lesions are one of the most frequent causes of malpractice issues. \nChest radiography plays an important role in the detection and management of \npatients with lung cancer, chronic airways disease, pneumonia and interstitial lung \ndisease. Among all diagnostic tests, chest radiography is essential for confirming \nor excluding the diagnosis of most chest diseases. However, numerous lesions \nof a wide variety of disease processes affecting the thorax may be missed on a \nchest radiograph. The chest radiograph will also help narrow a differential diag-\nnosis, help to direct additional diagnostic measures, and serve during follow -up. \nThe diagnostic usefulness of the radiograph will be maximized by the integration \nof the radiological findings with the clinical features of the individual patient. CT \nhas a tremendous spatial resolution that helps detecting lesions in the chest, and \nhas proven to be more sensitive and specific than chest radiographs. However, \nmissing lesions or misinterpreting lesions in CT of the chest is not uncommon. In \nthis session, we will provide interactive cases of chest examinations (radiographs \nand CT) in which lesions have been missed and or misinterpreted, with a special \nfocus on how correlation with MDCT of missed lung lesions can help improve \ninterpretation of the plain chest radiographs. \nLearning Objectives:\n1.  To learn about the common reasons for errors in interpretation of plain film \nand CT imaging.\n2.  To understand how a side-by-side comparison of chest x-rays and MDCT of \nmissed lesions can help reduce the busy radiologist’s error rate.\n98\n\nPostgraduate Educational Programme\nS\nB\n C D E F G\nA\nSunday\nimpact on quality of life. This is of special importance because more than 25%  \nof patients eligible for radical treatment are in the age range of 40  to 65  years.\nConventional anatomical T2-weighted MRI is the mainstay in prostate cancer \nimaging. On T2-weighted images, normal prostate tissue displays an intermediate \nto high-signal intensity while the transition-zone has lower signal intensity than the \nperipheral zone. Currently, several MR imaging techniques are being explored. \nThese include 1H-MR spectroscopic imaging, dynamic contrast-enhanced MR \nimaging, and diffusion-weighted imaging. Multiple studies have explored optimal \nparameter settings for the diagnostic MR-protocol, which allows accurate tumour \nlocalisation. Although reported accuracies of the different separate and combined \nMP-MRI techniques vary for diverse clinical prostate cancer indications, MP-MRI \nhas shown promising results and may be of additional value in prostate cancer \nlocalisation and local staging. To increase MR imaging accuracy for the different \nclinical prostate cancer indications, one or more functional MR imaging techniques \nshould be combined with T2-weighted MR imaging in a MP-MRI of the prostate. \nThe optimal strength of MP-MRI is yielded by combining the information of the \nvarious techniques.\nLearning Objectives:\n1.  To understand multiparametric MR imaging techniques.\n2.  To learn how to interpret prostate MRIs.\n3.  To understand the potential of new MRI developments.\nAuthor Disclosure:\nJ. J. Fütterer: Consultant; Galil Medical, Invivo. \nA-425 14:20\nB. Scrotal tumours \nP.S. Sidhu; London/UK (paulsidhu@btinternet.com) \nUltrasound remains the imaging modality of choice for the assessment of any form \nof scrotal pathology. The resolution capabilities of the technique and the superficial \nnature of the scrotal contents allow ultrasound examination to deliver optimal imag-\ning. Testicular tumours maybe imaged and characterised with ease, without need \nfor further imaging techniques. The addition of colour Doppler ultrasound allows \nfor the interrogation of the vascularity of any lesion seen, and the addition of newer \ntechniques such as contrast-enhanced ultrasound and tissue elastography has \nbeneficial effects to aid interpretation and diagnosis. Nearly all focal abnormalities \nof the testis in the adult patient are malignant lesions, with primary germ cell tu-\nmours a frequent abnormality in the younger patient, and lymphoma or a secondary \nmalignancy common in the older patient. However, benign abnormalities such as \na focal infarction, haematoma or an epidermoid cyst may mimic malignancy. It is \nimportant to be able differentiate benign from malignant causes, with testis sparing \nthe ultimate goal. Non-germ cell tumours present a specific conundrum, with the \nnewer imaging techniques likely to be of benefit in distinguishing these tumours \nfrom germ cell tumours. Extra-testicular tumours are nearly always benign and \ninclude lipoma and adenomatoid lesions. Inflammatory disease may also simulate a \ntumour and presents an unexpected pitfall. A carful scrotal ultrasound examination, \nusing all the available ultrasound techniques should allow the examiner to make a \nconfident assessment of any scrotal tumour, and allow for the correct management \nwithout need for further imaging. \nLearning Objectives:\n1.  To understand the pathological types of primary and secondary tumours of \nthe testis.\n2.  To appreciate the US features of the various histological types of testicular \ntumours.\n3.  To appreciate the role of newer US imaging techniques, and the role of further \nimaging.\nAuthor Disclosure:\nP. S. Sidhu: Author; Multiple peer reviewed papers on testicular abnormalities. \nSpeaker; Bracco, Hitachi and Siemens. \nA-426 14:40\nC. The penis \nM. Bertolotto; Trieste/IT (bertolot@univ.trieste.it) \nUltrasonography (US) is the first-line imaging modality in patients with penile \ndisease. Using high-end equipment, after pharmacologically induced erection \npenile anatomy is well defined and virtually all clinically significant penile vessels \ncan be evaluated in normal and in impotent men. The superior soft-tissue contrast \nresolution afforded by MR imaging provides an opportunity to advanced imaging \nevaluation of the penis in selected cases. In the clinical practice, erectile dysfunc-\ntion is the most frequent penile abnormality which is investigated with Doppler \nUS. The clinical role of this evaluation, however, reduced after the introduction of \ntogether, our studies show that awareness is an emergent property of the collective \nbehavior of frontoparietal top-down connectivity. Within this network, external (sen-\nsory) awareness depends on lateral prefrontal/parietal cortices while internal (self) \nawareness correlates with precuneal/mesiofrontal midline activity. Of clinical impor-\ntance, this permits to improve the diagnosis, which remains very challenging at the \nbedside. Current technology now also permits to show command-specific changes \nin fMRI signals providing motor-independent evidence of conscious thoughts and \nin some cases even of communication. We will conclude by discussing related \nethical and legal issues and the challenge of measuring and improving quality of \nlife in these challenging patients with disorders of consciousness. \nLearning Objectives:\n1.  To understand the role of structural MRI, DTI and spectroscopy in severe brain \ninjury.\n2.  To become familiar with the role of resting state and activation fMRI in diagnosis \nand prognosis after coma.\n3.  To understand which fMRI paradigms are “consciousness tests” in coma and \nrelated condition.\nA-423 14:51\nfMRI of cognitive functions: discriminating normal aging, minimal \ncognitive impairment and Alzheimer’s disease \nA. Falini; Milan/IT (falini.andrea@hsr.it) \nThe earliest pathologic abnormalities associated with Alzheimer’s disease (AD) \ndevelop in the brain decades before the onset of the first memory symptoms. \nSuch alterations include misfolded proteins aggregating into extracellular amyloid \nplaques and intracellular neurofibrillary tangles, followed by inflammatory dam-\nage, oxidation, excitotoxicity, and cell death in the central nervous system. The \nprospect of experimental treatment to slow or prevent disease progression has \nprompted an increased interest in the identification of individuals with AD early in the \ncourse of the disease. The primary end points in current trials for AD are dictated \nby cognitive outcomes; owing to their reduced variability compared with clinical \nmeasures surrogate biological and imaging outcomes are of great interest. Recent \nyears have witnessed impressive advances in the use of MR imaging with varying \nsuccess either to contribute to establish a diagnosis of AD and to monitor disease \nprogression, as well as to test the efficacy of disease-modifying agents. New MR \ntechniques such as Diffusion Tensor Imaging (DTI) and functional imaging (fMRI) \nare likely able to fill voids and improve our ability to discover early the pathologic \nprocess associated with dementia. Detecting such preclinical changes could imply \na major role for neuroimaging in risk stratification and early disease prevention. \nSome of the brain changes occurring in dementia can also be seen in middle-aged \nand elderly individuals who are cognitively intact, and are considered part of the \nnormal aging process. The possibility to distinguish normal from abnormal aging \nis another fundamental issue in which neuroimaging may play a role.\nLearning Objectives:\n1.  To consolidate knowledge of dementia and Alzheimer’s disease clinically.\n2.  To become familiar with common imaging features of dementia and Alzheimer’s \ndisease.\n3.  To appreciate the results from fMRI and DTI and other advanced neuroimaging \ntechniques used in research of dementia and Alzheimer’s disease.\nPanel discussion:  \nNew insights into the state of consciousness through neuroimaging. \nWhere are we and where should we go? 15:14 \n14:00 - 15:30 Room C \nUrogenital Imaging \nCC 1421 \nThe male genital system \nModerator: \nJ.O. Barentsz; Nijmegen/NL \nA-424 14:00\nA. Imaging of prostate cancer: an update \nJ.J. Fütterer; Nijmegen/NL (j.futterer@rad.umcn.nl) \nProstate cancer is a major health issue in ageing men. No treatment is required \nin less-aggressive prostate cancer but there is consensus that radical treatment \nis needed in aggressive prostate cancer. Radical treatment has to start while the \ntumour is still confined to the gland and has not spread beyond. Potential side ef-\nfects of radical treatment, such as impotence and incontinence, have a substantial \n99\n\nPostgraduate Educational Programme\nS1\n C B D E F\n G\nA\nhas a high chance of missing ischaemia, active bleeding or focal abnormalities \nwhile MR is logistically more challenging, more time consuming and artefact-prone. \nInvasive angiography is a technique that is best suited for evaluating the smaller \nvessels and for combination with endovascular treatment. CT is best performed \nusing biphasic techniques that include a late arterial phase that also serves as \nCT angiography (CTA) and a portal phase that is used to look at bowel perfusion. \nBoth phases can be combined in a split bolus technique, which saves one scan \nand is thus suitable for saving radiation dose in younger individuals. The course \nwill discuss the most appropriate protocols and will explain under which conditions \ncatheter angiography will remain necessary. Typical findings of vascular causes of \nacute abdomen will be discussed. Direct signs on CTA include stenosis, occlusion, \nvasospasm, aneurysms and extravasation. Indirect signs such as reduced bowel \nperfusion, bowel necrosis, post-ischaemic hyperperfusion, and collateral perfusion \nwill be illustrated. The typical findings of NOMI and other rarer vascular cause of \nacute abdomen will be demonstrated. By integrating clinical setting and imaging \nfindings a final diagnosis can be made in the vast majority of cases. \nLearning Objectives:\n1.  To learn about the importance of selecting the appropriate imaging technique \nin cases of acute abdomen to detect vascular causes.\n2.  To become familiar with the typical imaging appearance of the different vascular \ncauses of acute abdomen and their most important differential diagnosis.\n3.  To become familiar with potential pitfalls and problems of identifying vascular \ncauses of acute abdomen.\nAuthor Disclosure:\nM. Prokop: Research/Grant Support; Toshiba Medical Systems. Speaker; \nBracco, Bayer, Toshiba. \nA-430 15:00\nC. Interactive case discussion: how to proceed? \nA. Palkó; Szeged/HU (palkoand@gmail.com) \nThe goal of this problem-oriented, case-based presentation is to involve the audi-\nence in an interactive communication aimed at clarifying and clearly understanding \nthe role and clinical significance of imaging and image-guided intervention in the \ndiagnosis and treatment of abdominal vascular emergencies. We will discuss \nand solve not only typical but also unusual cases in order to introduce the proper \ndiagnostic algorithm providing the fastest possible treatment to the patient in these \nmost frequently very severe, potentially lethal conditions; in which time elapsing \nbetween onset of symptoms and correct diagnosis is critical from the point of view \nof successful therapy and chance of survival.\nLearning Objectives:\n1.  To become familiar with typical cases, illustrating the role of imaging modalities \nin the diagnosis and differential diagnosis of acute abdomen.\n2.  To consolidate knowledge of the selection of the appropriate imaging technique, \nimage interpretation and image based treatment recommendation.\n3.  To understand the most important information urgently needed for treatment \ndecisions and planning.\nAuthor Disclosure:\nA. Palkó: Advisory Board; Euromedic Intl. Consultant; Covidien. \n14:00 - 15:30 Room D2 \nOncologic Imaging: Follow-up of Systemic and Local Therapies \nCC 1419 \nFollow-up of thermal ablation (part I) \nModerator: \nW. Prevoo; Amsterdam/NL \nA-431 14:00\nA. The zone of cell death and collateral phenomena on cross-\nsectional imaging: from histopathology to the standardisation of terms \nA. Denys, P. Bize; Lausanne/CH (Alban.Denys@chuv.ch) \nThe field of image-guided ablation has expended recently with new ablation tech-\nniques like micro-wave, irreversible electroporation, cryoablation. Nevertheless, \nafter each treatment, whatever the technique used, we will leave in place in the \ntreated organ, a scar instead of the tumour. Follow-up of these treated areas are \ndone by radiologists using CT of MR or contrast enhanced ultrasound. Standardi-\nzation of terms has been done in 2003 by an international committee presided \nby Dr Goldberg. This allows reporting criteria identical from one center and from \noral medications for impotence. Differentiation among different forms of erectile \ndysfunction is mainly based on evaluation of Doppler waveform changes in the \ncavernosal arteries. Peyronie’s disease is the most frequent cause of penile indura-\ntion. Imaging is often required to evaluate the extension of the plaques, involvement \nof the penile septum, and relationship between the plaques and penile vasculature. \nIn patients with penile traumas, imaging allows accurate evaluation of albugineal \ntears, extra-albugineal and cavernosal hematomas, vascular lesions producing \nhigh-flow priapism and other pathological changes. Compared to US, MR imag-\ning has some advantages in identification of small albugineal tears, and is more \naccurate in identification of urethral or spongiosal involvement. Other situations \nin which penile imaging can be required are circumscribed or diffuse cavernosal \nfibrosis, tumours, priapism, severe inflammation, and evaluation of postsurgical \ncomplications. Most of these conditions are first investigated with US; MR is the \nimaging modality of choice for tumour staging. \nLearning Objectives:\n1.  To learn about the most relevant penile diseases that can be diagnosed by \nimaging.\n2.  To know the diagnostic roles of US, MRI and other imaging techniques.\n3.  To understand how imaging influences treatment and follow-up.\nA-427 15:00\nD. Interactive case discussion \nJ.O. Barentsz; Nijmegen/NL (J.Barentsz@rad.umcn.nl) \n14:00 - 15:30 Room D1 \nCLICK (Clinical Lessons for Imaging Core Knowledge): Never \nwithout Arteries \nCC 1418 \nAngina, non-occlusive mesenteric ischaemia (NOMI) \nand friends: vascular causes of acute abdomen \nModerator: \nO. Chan; London/UK \nA-428 14:00\nA. Clinical considerations \nP. Rogalla; T oronto, ON/CA (Patrik.Rogalla@uhn.on.ca) \nMesenteric ischaemia is a medical condition in which inflammation and injury of \nthe small intestine result from inadequate blood supply. Causes of the reduced \nblood flow can include changes in the systemic circulation (e.g. low blood pressure) \nor local factors such as constriction of blood vessels or a blood clot. Mesenteric \nischaemia leads to mediator release, inflammation, and ultimately infarction. Ab-\ndominal pain is out of proportion to physical findings. Early diagnosis is difficult, but \nearly conventional angiography and exploratory laparotomy are believed to have \nthe highest sensitivity, however, angiography represents a fairly invasive imaging \ntechnique and surgical intervention has its own limitation, in particular if clinical \nsuspicion is vague or repeatedly expressed. Mortality of the disease is dramatically \nhigh, ranging between 32% and 77%. In fact, the prognosis depends on prompt \ndiagnosis (less than 12-24 h and before gangrene) and early surgical intervention. \nMultislice CT with its ultra-fast acquisition modes, isotropic image resolution and \nmultiplanar reconstruction capabilities, its widespread availability and ubiquitous \napplicability may be regarded as the imaging modality of choice in patients with \nsuspected mesenteric ischaemic disease. \nLearning Objectives:\n1.  To learn about the frequency and importance of the vascular causes of an \nacute abdomen.\n2.  To learn about the differential diagnosis as well as the different vascular causes \nof acute abdomen.\n3.  To learn about prognosis, treatment and outcome of acute abdomen caused \nby vascular diseases.\nAuthor Disclosure:\nP. Rogalla: Research/Grant Support; Toshiba Medical Systems. \nA-429 14:30\nB. Imaging techniques and typical findings \nM. Prokop; Nijmegen/NL (M.Prokop@rad.umcn.nl) \nVascular causes of acute abdomen are best examined using computed tomography. \nUltrasound and MR are able to visualize some of the relevant findings but ultrasound \n00\n\nPostgraduate Educational Programme\nS1\nB\n C D E F G\nA\nSunday\n14:00 - 15:30 Room E1 \nMusculoskeletal \nRC 1410 \nHow I report \nModerator: \nM. Padrón; Madrid/ES \nA-434 14:00\nA. Soft tissue mass: US/MR \nC. van Rijswijk; Leiden/NL (C.S.P .van_rijswijk@lumc.nl) \nUltrasonography (US) is a readily available non-invasive technique that can be used \nfor the detection of a soft tissue mass. It gives a first impression of the size, location \nin relation to the fascia and consistency of soft tissue lesions. An important ability \nof US is the potential to differentiate between cystic and solid lesions; however, \nspecificity in further characterising a soft tissue mass is low. MR is the next imag-\ning modality to perform for the evaluation of soft tissue lesions. MR is accurate in \ndetermining size, confinement to or extension beyond the anatomic compartment \nof origin and the relationship to the neurovascular bundle and adjacent bone and \njoints. Although histopathological examination remains the gold standard, differen-\ntiation between malignant and benign soft tissue masses, indication of the grade of \nmalignancy and prediction of the histological diagnosis are challenging goals of MR \nimaging. As such, characterisation of soft tissue masses starts with interpretation of \nsignal characteristics on T1- and T2-weighted sequences. Combinations of signal \nintensities reveal the different tumour components (e.g. fat, water, and blood), and \nthus provide indirect information about the nature of soft tissue masses. Additional \nimaging parameters combined with clinical parameters, such as age, gender, etc. \nshould be evaluated for defining a differential diagnosis, such as multiplicity, loca-\ntion, origin (e.g. subcutaneous, intramuscular), size, shape, margins, peritumoural \noedema, bone involvement and rate of growth.\nLearning Objectives:\n1.  To become familiar with the strengths/weaknesses of US/MRI in assessing \nsoft tissue tumours.\n2.  To understand the US/MRI specific findings that aid diagnosis.\n3.  To learn a structured approach to reporting.\nA-435 14:30\nB. MR of vertebral body collapse \nR. Lalam; Oswestry/UK (radhesh.lalam@rjah.nhs.uk) \nIt is not uncommon for a reporting radiologist to come across vertebral body col-\nlapse in day-to-day practice. A number of imaging options are available to the \nradiologist to assess the nature of the vertebral body collapse. Vertebral body col-\nlapses are broadly divided into benign and malignant depending on the aetiology. \nBenign collapses are most often due to metabolic diseases such as osteoporosis \nand trauma. It is vital to be able to differentiate these two categories of vertebral \ninvolvement to initiate appropriate therapy. Radiographs have a low sensitivity and \nspecificity in differentiating these categories of vertebral body collapse. MRI, on the \nother hand, is excellent at differentiating between benign and malignant lesions on \nstandard imaging sequences. A number of features including retropulsion, T1 signal \ncharacteristics, clefts, soft tissue abnormalities, posterior element involvement and \ncontrast enhancement help in this differentiation. Advanced imaging protocols \nincluding diffusion and in/out of phase imaging are rarely needed. In some clinical \ncircumstances where the differentiation is not possible despite all these measures, \nCT scan, follow-up imaging and/or a biopsy may be necessary. \nLearning Objectives:\n1.  To be able to differentiate benign from malignant causes.\n2.  To learn about the changes of the vertebral body with time, disease progres-\nsion and therapy.\n3.  To learn a structured reporting approach.\nA-436 15:00\nC. MR of the unstable shoulder \nM. Zanetti; Zurich/CH (marco.zanetti@hirslanden.ch) \nStatic instabilities are defined by the absence of classic symptoms of instability and \nare associated with rotator cuff or degenerative joint disease. Dynamic instabili-\nties are subdivided in two main categories. The first category is characterised by \na history of trauma resulting in unidirectional anteroinferior instability, commonly \nassociated with a fibrous or osseous Bankart lesion that requires surgical repair \none country to another. Furthermore, it allows a more homogeneous literature \nand evaluation of success. Nevertheless, techniques are not all the same and the \ncellular and tissue damage in the tumour and around it in the healthy parenchyma \nare not identical and does not have the same evolution over time.\nLearning Objectives:\n1.  To understand histopathologic changes after various ablation techniques.\n2.  To become familiar with post-ablation imaging based on histo-pathologic cor-\nrelation of ablation zones in various organs.\n3.  To learn about the adequate terms for reporting and publishing on post-ablation \nimaging.\nA-432 14:30\nB. PET/CT for the evaluation of ablative therapy: Who? Where? \nWhen? Does it help? \nD. Deandreis; Villejuif/FR (Desiree.DEANDREIS@igr.fr) \nTumour ablative therapy is frequently used in clinical practice because of its safety \nand good tolerability. One issue is the lack of reliable imaging modality to assess \nefficacy. The purpose is to define the impact of FDG-PET/CT in this field. The fol-\nlowing items will be discussed: the typical post-therapeutic aspect on PET/CT, the \nbest PET criteria to define recurrence, the best candidate for PET/CT follow -up \nand the best timing point to assess response. Published data until now show that \nFDG-PET/CT is a useful tool in ablated liver tumours follow-up, detecting residual \ndisease easily and earlier than conventional imaging. Only limited reports evaluat-\ning the usefulness of FDG-PET/CT in lung lesions are available but the results \nare promising, showing a high negative predictive value of the technique during \nthe follow-up. Few data are available on bone lesions. In general, diffuse, periph-\neral, homogeneous FDG uptake in the treated lesion is related with inflammatory \nprocesses; on the other hand, heterogeneous and focal uptake is more frequently \nrelated to disease relapse. SUVmax (Standardised Uptake Value) is higher in case \nof persistent tumoural disease than in completely ablated lesions, but in some cases \nit is not a reliable indicator. Finally, the good timing after treatment still remains to \nbe defined but FDG-PET/CT should be performed at least 3-6 months after treat-\nment to avoid dubious or inconclusive findings due to inflammatory reaction that \nfrequently occurred during the first months.\nLearning Objectives:\n1.  To understand who are the best candidates for a PET/CT follow-up of ablation \ntherapies.\n2.  To learn about what is the optimal timing of PET/CT in the follow-up of ablative \ntherapies.\nA-433 15:00\nC. Everyday practice: MR and CT for evaluating response to thermal \nablation \nC. Dromain, C. Caramella, L. Vilcot, S. Bidault, F. Bidault, F. Deschamps; \nVillejuif/FR (dromain@igr.fr) \nThe aim of thermal ablation treatment is to generate an area of thermocoagula-\ntion whose diameter is larger or at least equivalent to that of the tumour. This \nnecrotic scar usually shrinks with time, but most often very slowly. Therefore, \ncriteria of response based on size measurement cannot be applied. The pattern \nof thermal ablation area is similar whatever the thermo-ablation technique used. \nOn CT imaging thermal ablation area are well circumscribed and oval shaped. \nAn extending ground-glass opacification, a cavitation or bubble lucendies can be \nobserved after thermal ablation of lung tumours. The criterion commonly used to \nassess the efficacy is the absence of enhancement in the thermal ablation necrosis \nwhich corresponds to tissue devoid of viable tumour. On MR imaging the thermo-\nablation areas is typically hyperintense on unenhanced T1, due to the presence \nof proteinaceous material, and hypointense on T2, explained by the dehydrating \neffect of thermal damage. Residual tumour is typically round shaped and located at \nthe periphery of necrotic area or in contact with large vessels. MR imaging allows \nearlier detection of residual liver tumour than CT imaging. Indeed, unenhanced \nMR images offer an excellent contrast between residual tumour with low signal \non T1 and high signal on T2 and between thermal ablation necrotic area with high \nsignal on T1 and low signal on T2.\nLearning Objectives:\n1.  To become familiar with the imaging aspects of successful ablation.\n2.  To learn about the main pitfalls of post-ablation imaging.\n3.  To consolidate knowledge of the imaging aspects of most common complica-\ntions.\n01\n\nPostgraduate Educational Programme\nS1\n C B D E F\n G\nA\nLearning Objectives:\n1.  To become familiar with current criteria.\n2.  To learn about imaging features which are highly specific for nodal disease.\n3.  To understand the diagnostic performance of cross-sectional imaging.\nAuthor Disclosure:\nW. Schima: Advisory Board; GE Healthcare. Speaker; Siemens. \nA-439 14:28\nB. DWI MR: what does it contribute? \nH.C. Thoeny; Berne/CH (harriet.thoeny@insel.ch) \nUp to date, lymph node staging is based on size and shape criteria only, however, \nmicrometastases can also be present in normal sized lymph nodes and nodes can \nbe enlarged due to inflammatory changes. New contrast agents in MRI such as \nultrasmall particles of iron oxide (USPIO) have substantially improved the diagnostic \naccuracy of lymph node staging compared to conventional MRI. Unfortunately, \nUSPIO are not commercially available, and therefore, new approaches to differ-\nentiate benign from malignant lymph nodes are required. Diffusion-weighted MRI \n(DWI) is a non-invasive method that provides tissue microstructural information, \nand several studies mainly in the pelvis have shown promising results for lymph \nnode detection and differentiation between benign and malignant nodes. These \nstudies reported sensitivities of 79-87% and specificities of 74-93% using the un-\nderlying apparent diffusion coefficient (ADC) value; lower ADCs were reported in \nmalignant nodes as compared to benign ones. In these studies, lymph nodes with \nshort axis diameter greater than 5 mm were included. It should be noted that there \nis an overlap between ADC values of benign and malignant nodes; no significant \ndifference in ADC was found in some studies. Further investigations on the use of \nADC in lymph node diagnosis including histopathological validation are needed \nto reduce the high rate of false positive nodes. The combination of USPIO with \nDWI might facilitate and improve lymph node staging in the future, provided, that \nUSPIOs will become available for clinical use.\nLearning Objectives:\n1.  To understand the principles of DWI of nodes.\n2.  To recognise the imaging appearance of nodes on DWI MRI.\n3.  To become familiar with studies evaluating the diagnostic performance of DWI \nMRI.\nA-440 14:51\nC. Nuclear medicine: PET and other nuclear medicine techniques \nP.L. Choyke; Bethesda, MD/US (pchoyke@nih.gov) \nRadionuclide methods have become increasingly important in the assessment of \nnodal disease. Broadly speaking, radionuclide methods can be characterised as \nthose involving sentinel node detection and those that image nodes throughout \nthe body. Sentinel node imaging is an established method of detecting nodes \ndraining tumours (e.g. breast, melanoma). FDG PET has recently become in-\ncreasingly important in nodal staging of cancers, particularly lung cancer, thyroid \ncancer and lymphoma. Increased uptake in lymph nodes is highly predictive of \nnodal involvement and portends a worse prognosis. The ability to localize nodes \non the CT portion of the study makes biopsy relatively straightforward. However, \nFDG PET is not infallible. For instance, false positive activity is seen in diseases, \nsuch as sarcoid and false negatives can occur in tumours such as prostate cancer \nand renal cancer. Thus, there has been interest in the development of new PET \nagents. For instance, FLT PET has been useful for distinguishing inflammation from \ntumour within nodes and various agents such as F-Choline and F-ACBC have been \nused to identify nodal metastases in prostate cancer. Additional agents have been \nproposed, however, FDG remains an excellent first imaging test for lymph node \nstaging and this is highly complemented by the use of FLT PET.\nLearning Objectives:\n1.  To learn which tumours are typically FDG-avid.\n2.  To understand the factors that contribute to the diagnostic performance of \nFDG-PET.\n3.  To become familiar with other nuclear imaging techniques for lymph node \nimaging.\nAuthor Disclosure:\nP. L. Choyke: Other; Research Agreements: GE, Siemens, Philips. \nPanel discussion:  \nWhen and how could imaging make diagnostic biopsy unnecessary? 15:14 \n(TUBS). The second category is known as atraumatic multidirectional bilateral re-\nhabilitation inferior capsular shift (AMBRI). This pattern of multidirectional instability \nis believed to be the result of atraumatic ligamentous and capsular laxity. Treatment \nis rehabilitation initially, followed by inferior capsular shift if indicated. The anterior \ninstability is characterised by avulsion of the labroligamentous complex from the \nanteroinferior aspect of the glenoid, which, with complete disruption of the scapular \nperiosteum, is termed a fibrous Bankart lesion. The presence of an associated \nadjacent glenoid rim fracture is referred to as an osseous Bankart lesion. Osseous \nBankart lesions can easily be missed on MR images; therefore, CT arthrography is \npreferred by some authorities. In post-traumatic posterior dislocation, tears occurring \nin the posterior labrum are referred to as a reverse Bankart lesion and impaction of \nthe anterosuperior humeral head are called reverse Hill-Sachs defect. Recurrent \n(atraumatic) posterior shoulder instability has to be distinguished from acute and \nchronic (locked) posterior dislocation. Recurrent (atraumatic) posterior instability \nis not related to trauma, but rather to laxity of supporting capsular and muscular \nstructures and/or to the shape of the bony glenoid or the labrum.\nLearning Objectives:\n1.  To learn about the specific imaging findings of instability.\n2.  To become familiar with the different types of shoulder instability.\n3.  To learn a structured approach to reporting.\n14:00 - 15:30 Room E2 \nOncologic Imaging \nRC 1416 \nThe essentials of lymph node imaging of solid \ntumours: what the radiologist needs to know \nA-437 14:00\nChairman’s introduction \nR.G.H. Beets-Tan; Maastricht/NL (r.beets.tan@mumc.nl) \nPositive lymph node status is an important predictor for a poor prognosis. Accu-\nrate nodal staging often influences the choice of treatment and outcome of these \npatients. However, detection of nodal infiltration by non-invasive imaging has been \nchallenging and to date FNA or biopsy has remained important to dictate treatment. \nNowadays, the combination of morphological and functional or metabolic information \nwith modern imaging technology offers us new perspectives. In this session, we \nwill learn about the present status of lymph node imaging using new generation \nCT, MRI or PET and become familiar with the strength and weaknesses of each.\nA-438 14:05\nA. The current criteria for nodal involvement on CT/MRI \nW. Schima; Vienna/AT (Wolfgang.Schima@khgh.at) \nIn a variety of diseases, such as metastatic disease, lymphoma and inflamma-\ntion, lymph node enlargement can be seen. Thus, lymph node characterisation is \nimportant to differentiate between benign and malignant disease. It is based on \nsize (short axis diameter) and morphologic criteria, such as shape, homogeneity, \nand contrast enhancement. For abdominal nodes, location-specific size criteria \napply (upper limit of normal: lower paraaortic 11  mm, upper paraaortic 9  mm, \ngastrohepatic ligament 8 mm, portocaval space 10 mm, retrocrural space 6 mm; \npelvic nodes 10 mm). However, in clinical practice, often a universal size threshold \nof 10 mm is used in abdominal imaging. In chest CT, an upper limit of normal of \n10 mm is universally applied. However, size criteria alone are unreliable: CT for \nlung cancer staging has a pooled sensitvity of 51% (i.e., false negative diagnoses \nof metastatic deposits in normal-sized nodes), and a specificity of 86% (i.e., false \npositive diagnoses due to enlarged reactive nodes). With MRI, the same size \ncriteria apply. However, additionally features such as central necrosis (T2w fatsat \nor gadolinium-enhanced images) are suggestive of metastasis (or suppurative \ninfection). Lymph node-specific USPIO MR agents can depict tumour deposits in \nsubcentimeter pelvic nodes. Unfortunately, they did not reach market approval. DWI \nis helpful in identifying in lymph nodes as they exhibit high SI with higher b-values. \nHowever, diffusion pattern of benign and malignant nodes overlap, so that ADC \nvalues do not aid in characterisation. Despite the use of modern MDCT and MRI \ntechniques, lymph node characterisation needs further improvement. \n02\n\nPostgraduate Educational Programme\nS10\nB\n C D E F G\nA\nSunday\nA-444 14:39\nPercutaneous nephrostomy (PCN) and ureteral stenting \nF. Orsi; Milan/IT (franco.orsi@ieo.it) \nPercutaneous minimally invasive interventions in the urinary tract needs a renal \naccess by means of percutaneous nephrostomy. Indications for percutaneous \nnephrostomy include urinary diversion for hydronephrosis, treatment of nephrolithi-\nasis, ureteral intervention (stent placement) and ureteroscopy. The most common \nextension of percutaneous nephrostomy is placement of an ureteral stent for \ntreating the obstructions. Transient haematuria is very common after percutaneous \nnephrostomy, but severe bleeding requiring transfusion or intervention is rare. Com-\nplications can be minimized by using the ultrasound guidance for the percutaneous \nrenal approach, meanwhile the rest of the procedure should be guided by fluoro \nimaging. Technique for percutaneous nephrostomy and anterograde ureteral stent \nplacement will be presented.\nLearning Objectives:\n1.  To become familiar with the indication for percutaneous nephrostomy in patients \nwith malignant urinary obstruction.\n2.  To learn about the technique, clinical results and complications of PCN and \nantegrade ureteral stenting.\nAuthor Disclosure:\nF. Orsi: Research/Grant Support; CELONOVA. Other; PROCTOR FOR \nDELCATH SYSTEM. \nA-445 14:57\nBiliary procedures \nM. Krokidis1, A.A. Hatzidakis2; 1Cambridge/UK, 2Iraklion/GR \n(mkrokidis@hotmail.com) \nPalliative Percutaneous Transhepatic Biliary Drainage (PTBD) is a therapeutic \nprocedure leading to drainage of the obstructed bile duct system. If endoscopy is not \npossible and if patient is inoperable, then the percutaneous treatment is indicated. \nDrainage of the bile ducts is performed with a small plastic multiple hole pigtail \ncatheter. Self-locking catheters are preferred in order to minimize the dislocation \nrisk. The percutaneous catheter is pushed through the malignant stricture, so that \nbile is draining through the catheter towards the bowel loops. Technical success \nrate of percutaneous biliary drainage can reach nearly 100% in experienced hands, \nwhile the major complications rate is usually lower than 5%. Clinical efficacy is \nusually lower, but still over 90%. The drainage procedure can be extended with \nthe placement of a permanent metallic stent, which keeps the stenosed biliary \nduct patent, without need for a catheter. Metallic biliary stents have been proved \nas the best palliative treatment of non-resectable malignant obstructive jaundice, \nallowing longer patency rates than plastic endoprostheses. The technique is safe, \nwith low-complication rate and procedure-related mortality between 0.8 and 3.4%. \nStill controversial remains in the timing between initial drainage and metallic stent \nplacement, as well as the question of balloon dilatation before stent insertion. There \nis evidence that if the initial transhepatic drainage is completed without causing any \nsevere complications, especially bleeding in form of haemobilia, primary metallic \nstenting can follow as a single-step procedure. \nLearning Objectives:\n1.  To become familiar with the indications for drainage in malignant biliary ob-\nstruction.\n2.  To learn about the technique, clinical results and complications of percutaneous \ncholangiography and biliary stenting.\nPanel discussion:  \nHow invasive can palliation be? When to say no to palliative \ntreatment? 15:15 \n14:00 - 15:30 Room F1 \nSpecial Focus Session \nSF 14a \nPalliative interventional techniques in cancer \nA-441 14:00\nChairman’s introduction \nK.A. Hausegger; Klagenfurt/AT (klaus.hausegger@lkh‑klu.at) \nThis session will focus on palliative cancer treatment. Four different topics (treatment \nof lytic bone lesions, treatment of malignant pleural effusions, treatment of maligang uri-\nnary obstruction and treatment of malignant biliary strictures) will be discussed. In ad-\ndition to that we also plan to discuss the ethical aspect of palliative treatment strategies.  \nSession Objectives:\n1.  To learn about different palliative techniques in cancer.\n2.  To understand when to indicate different palliative techniques.\n3.  To become familiar with the limitations of palliative techniques.\n4.  To learn when palliation does not help the patient.\nA-442 14:03\nCementoplasty of lytic bone metastasis \nA. Gangi, J. Garnon, G. Tsoumakidou, I. Enescu; Strasbourg/FR \n(gangi@rad6.u‑strasbg.fr) \nOsteolytic destruction of the vertebral body by metastasis from breast, renal, lung \nand bladder cancers, multiple myeloma and lymphomas are a source of debilitating \npain and disability. Due to the multifocal nature of these lesions, surgical treatment in \nthe form of vertebrectomy and strut grafting is rarely undertaken. Radiation therapy \ndoes not provide consolidation, is not always effective in relieving pain and its effects \nare generally delayed by 1-2 weeks after commencement of therapy. Percutaneous \nvertebroplasty with injection of cement allows for consolidation and restoration of \nvertebral body strength resulting in effective pain relief and stabilisation of the spine. \nThe procedure is palliative and does not address tumour progression and ablation. \nHence, it should be used as a complement to other treatment modalities for cancer. \nOnly painful metastasis and lesions affecting the stability of the spine should be \ntreated. In patients with destruction of the vertebral body with paravertebral tumour \nextension, vetebroplasty can be combined with thermal ablation (RFA, Cryoabla-\ntion) for reduction of tumour mass and consolidation of the vertebral body. Further, \nthe procedure can be performed at multiple levels thus addressing the multifocal \nnature of the disease process. However, it must be stressed that vertebroplasty is \nspecially indicated for management of local pain from metastastic disease and not \nfor diffuse back pain with multiregional involvement of the spine. Cementoplasty is \nused in other location of tumours with compression fracture. The best examples \nare: acetabular lytic tumours, femoral or tibial condyle pathological fractures. \nLearning Objective:\n1.  To learn about the indications, techniques, clinical results and complications \nof cementoplasty.\nA-443 14:21\nPleural drainage, pleurodesis \nF. Gleeson; Oxford/UK (fergus.gleeson@orh.nhs.uk) \nA significant number of patients present with and/or are symptomatic from pleural \neffusions. It is important for radiologists to be familiar with the means of assessing \neffusion size and aetiology, and the methods available for their drainage, including \npleurodesis. There are recognised complications from pleural drainage, and knowl-\nedge of the pleural anatomy and cause of these complications may help reduce \ntheir incidence. Following pleural drainage and pleurodesis, follow -up scanning \nmay be necessary, and knowledge of post-intervention appearances may help \ndetermine treatment success and disease relapse. This presentation will discuss \nthe aetiologies of effusions, their imaging appearances and the techniques used \nfor drainage and pleurodesis.\nLearning Objectives:\n1.  To become familiar with the indication for drainage of malignant pleural effu-\nsion.\n2.  To learn about the indications, technique and clinical results of pleurodesis.\n3\n\nPostgraduate Educational Programme\nS10\n C B D E F\n G\nA\ncharacteristics of a fibroadenoma can be followed in virtually every patient, but not \nin high risk patients. A biopsy is then mandatory. In general, breast MRI findings \nare reported using the BIRADS breast MRI lexicon. This lexicon provides a list of \nterms that can be used for the description of breast lesions. When familiar with \nthe terms, a certain set of descriptors will lead to a more or less specific lesion \nclassification, although this is still not easily reproduced between different readers \nas interreader variability is rather high. In any case, it is essential to keep in mind \nfor what purpose the MRI is made. It does no good to assess a 3 cm nodule in the \nbreast as probably malignant, if it is biopsy proven cancer. Moreover, tumour size \nfor a surgeon is different than for a medical oncologist.\nLearning Objectives:\n1.  To understand how to integrate conventional (mammography and US) findings \nin a breast MRI report.\n2.  To learn how to include morphological and kinetic information and why this \nneeds to be done thoroughly.\n3.  To become familiar with the necessary skills to compose a report on a breast \ncancer patient (staging, follow-up, relapse, etc).\nAuthor Disclosure:\nR. M. Mann: Speaker; Bayer Healthcare. \n14:00 - 15:30 Room G/H \nSpecial Focus Session \nSF 14b \nComprehensive CT cardiothoracic imaging: a new \nchallenge for radiologists \nA-449 14:00\nChairman’s introduction \nL. Bonomo; Rome/IT (lbonomo@rm.unicatt.it) \nOver the past few years, the use of CT in cardiovascular imaging has dramatically \nincreased, since technological developments have made it suitable for the two- \nand tthree-dimensional visualisation of the heart, and of large and small vessels, \ne.g. coronary arteries. Further development in terms of temporal resolution and \nanatomical coverage has allowed the simultaneous study of systemic arterial \ncirculation and pulmonary circulation on the same scan, with gradual reduction \nof exposure dose. There are several outcomes of this technological revolution. \nMorpho-functional information obtained for the entire chest in a single scanning \nmakes it possible to simultaneously assess the heart and the lungs. Investigating \ninteractions between these two systems, linked through embryological, anatomi-\ncal, mechanical, physiological, physiopathological, and therapeutic relations, is \namong the challenges of imaging today. In this Special Focus Session, three \npresentations will be given: the first presentation will discuss strategies that en-\nable minimising the radiation exposure imparted by dedicated ECG-synchronised \nimage acquisition protocols of the entire thorax, but still allow comprehensive \ndiagnostic evaluation of all aspects of heart-lung axis disorders; the second pres-\nentation will demonstrate that different clinical indications requiring a chest CT \nimaging may have underlying coronary or cardiac causes that are not clinically \nevident, while patients scheduled for thoracic surgery may present unexpected \nheart or coronary artery findings detectable at pre-operative CT; the third will give \nexamples of chest CT using a variety of protocols, ranging from a non-contrast \nscreening study to a highly sophisticated contrast-enhanced CT perfusion study. \nSession Objectives:\n1.  To understand the importance of looking at the heart on a CT scan of the chest.\n2.  To learn how to optimise integrated cardiothoracic imaging with CT.\n3.  To become familiar with the key imaging findings and learn how to report.\nA-450 14:05\nHow to optimise integrated cardiothoracic imaging with CT \nU.J. Schoepf; Charleston, SC/US (schoepf@musc.edu) \nThe advent of advanced, latest generation CT systems enables rapid image acquisi-\ntion of the entire chest with ECG synchronisation. This ability has substantially ex-\npanded our ability to non-invasively study the heart-lung axis and diseases thereof. \nHistorically, the relatively high radiation exposure associated with retrospectively \nECG-gated techniques on older generation CT systems had limited the more wide-\nspread application of this approach, especially in younger patients. This presentation \nwill discuss strategies that enable minimising the radiation exposure imparted by \ndedicated ECG-synchronised image acquisition protocols of the entire thorax, but \n14:00 - 15:30 Room F2 \nBreast \nRC 1402 \nHow I report \nModerator: \nA. Tardivon; Paris/FR \nA-446 14:00\nA. Mammography \nE. Azavedo; Stockholm/SE (edward.azavedo@ki.se) \nThe purpose is to plan a structured report of a Mammography Examination so that \nthe reader gets a clear message to make a clinical decision for management of \nthe case. Examples will be presented of different types of findings of which some \nwill be actionable and others will not warrant any action from a clinician. Relevant \nfindings will be reported in detail in order to get the message across to the reader. \nQuestions from the referring clinician must be answered with the help of the ob-\ntained images. Findings that are seen but do not warrant any actions may not be \nreported in detail and in some cases not reported at all or reported together within \na group of non-actionable findings. In cases of lesions that will warrant surgery, it \nis necessary to describe the extent of the disease to plan adequate type of surgery. \nExamples will be shown so that the audience can reflect on the important aspects \nto be noted and reported. Examples of rather concise reports that answer the refer-\nring clinician’s questions and substantial information on actionable imaging findings \nmust be reported with a clear message possibly without risks for misinterpretation.\nLearning Objectives:\n1.  To become familiar with the basic parts of a structured report.\n2.  To understand which information a clinician needs in a report of a breast cancer \npatient.\n3.  To learn how to compose a report on a patient with a BI-RADS 3 lesion.\nA-447 14:30\nB. Breast US \nJ. Camps Herrero; Valencia/ES (juliacamps@ono.com) \nBreast ultrasound is one of the main imaging modalities in breast radiology, it \nallows us to characterise lesions and also guide interventional procedures. The \nBI-RADS categorisation of ultrasonographic findings facilitates the diagnostic \napproach and also helps the radiologist to use a common language, understood \nnot only by the rest of the radiological community, but also by other breast cancer \nprofessionals. Ultrasound can be a diagnostic procedure in its own, but is mainly \na modality that characterises the findings of other modalities (mammography and \nMRI) and, as such, correlation between all these techniques is the mainstay of \neveryday clinical practice. This act of correlating and integrating the information \nof all modalities is what makes a breast radiologist a key actor in the diagnosis, \nstaging and follow-up of breast cancer and other benign or high risk entities. The \nfinal product of this integration will be the radiological report, the means by which \nwe convey all the information we have gathered through all the procedures to our \nclinical colleagues. This report shall also follow some composition rules in order \nto be clear and concise.\nLearning Objectives:\n1.  To become familiar with BI-RADS categories of breast US.\n2.  To learn how to integrate clinical information and radiological findings.\n3.  To learn how to compose a US report in a breast cancer patient.\nAuthor Disclosure:\nJ. Camps Herrero: Advisory Board; Bayer. \nA-448 15:00\nC. Breast MRI \nR.M. Mann; Nijmegen/NL (r.mann@rad.umcn.nl) \nBreast MRI is a dynamic examination that evaluates contrast extravasation within \nbreast tissue. The technique has a high sensitivity (>  95%) for breast cancer. It \nrequires both high-spatial resolution and reasonable temporal resolution as the \ncombination of morphological and dynamic assessment of lesions yields the highest \nspecificity. Because breast MRI is not a first line technique, mammography and \nultrasound are generally available. Findings from these examinations can thus \nbe used in the interpretation of breast MRI examinations and vice versa. It is also \nessential to be aware of the medical history of the woman scanned as this may \naffect the interpretation. For example, a probably benign breast nodule with all \n4\n\nPostgraduate Educational Programme\nS10\nB\n C D E F G\nA\nSunday\nAuthor Disclosure:\nE. J. R. van Beek: Advisory Board; Siemens Lung MRI. CEO; Quantitative \nClinical Trials Imaging Services, Inc. Speaker; Toshiba Medical Systems, Vital \nImages. \nPanel discussion:  \nIs a single CT scan technique and protocol feasible for all the \ncardiothoracic problems? 14:14 \n14:00 - 15:30 Room I/K \nGenitourinary \nRC 1407 \nContrast media safety: update \nA-453 14:00\nChairman’s introduction \nP. Reimer; Karlsruhe/DE (Peter.Reimer@klinik.uni‑karlsruhe.de) \nThe speakers in this course will update the audience on contrast media safety. The \nfirst speaker is covering new concepts of non-renal reactions to contrast media. \nAcute reactions within 1 h following contrast administration and late reactions after \n1 h up to 7 days following contrast administration typically occur more often after \nadministration of iodinated contrast media. Acute reactions are treated according to \ntheir symptoms while most late skin reactions are mild or moderate and self-limiting. \nData will be presented that patch and delayed reading intradermal tests may help \nguide patients. The second speaker will address NSF. The presentation will review \nclinical features, risk factors and prevention of NSF. Patients with GFR less than \n30 ml/min/1.73 m2 have increased risk of developing NSF. Low stability gadolinium \ncontrast media show the strongest association with NSF. Following existing guide-\nlines on use of gadolinium contrast agents minimizes the risk of NSF. Potential \nlong-term harm from gadolinium accumulation in the body is discussed. The last \nspeakers will cover contrast medium-induced nephropathy with more recently pub-\nlished guidelines related to that issue. The presentation will include the definition of \nCIN, the choice of contrast medium, and prophylactic measures. A recent change in \nESUR guidelines will be explained. The risk of CIN is considered significantly lower \nfollowing i.v. CM administration and patients referred for enhanced CT are genuinely \nat risk if they have an eGFR < 45 ml/min/1.73 m2. Both, volume expansion with isot-\nonic saline or sodium bicarbonate may be used for preventing CIN in at risk patients.  \nSession Objectives:\n1.  To discuss the safety steps to be taken before contrast administering.\n2.  To present the newest safety guidelines.\nA-454 14:05\nA. Acute non-renal reactions to contrast media: new concepts \nO. Clément; Paris/FR (olivier.clement@inserm.fr) \nAcute immediate hypersensitivity reactions occur within the hour following the \nadministration of contrast media. They can be seen with either Iodinated and \nGadolinium-based contrast agents. Over the last ten years, new concepts have been \nemerged in the way to understand, manage and explore hypersensitivity reactions. \nThe clinical appearance is best classified by the Ring and Messmer scoring, from \nGrade 1 (cutaneous and subcutaneous signs) to Grade 4 (cardiovascular arrest). \nThe mecanisms involve either true IgE-mediated hypersensitivity or non-allergic \nhypersensitivity. The differential diagnosis in favour of allergy is made on a triade: \nclinical signs (the more severe, the more chances to be allergic); elevated Try-\npase levels in the plasma (indicating mastocyte triggering); and positive skin tests \nperformed one month after the reaction. These new concepts induce important \nconsequences on the way to manage hypersensitivity reactions: be prepared to \ntreat adequately the patient, be prepared to draw blood after the reaction to dose \ntryptase levels, send the patient to a dedicated allergologist, forget about the \npreventive role of premedication against severe reactions.\nLearning Objectives:\n1.  To understand what are allergic and non-allergic hypersensitivity reactions.\n2.  To learn the clinical symptoms according to the Ring and Messmer classifica-\ntion.\n3.  To understand the importance of tryptase sampling and skin testing in the \nfollow-up.\nAuthor Disclosure:\nO. Clément: Board Member; French Society of Radiology. \nstill enable comprehensive diagnostic evaluation of all aspects of heart-lung axis \ndisorders. These include general measures such as individual adjustment of the \nx-ray tube voltage by manual or automated means, automated anatomical tube \ncurrent modulation, and image reconstruction using iterative algorithms. Strategies \nspecific to ECG-synchronized acquisitions consist in ECG-dependent tube current \nmodulation, use of prospectively ECG-triggered techniques, and ultra-high pitch \nimage acquisition, where clinically appropriate. Lastly, suitable approaches for \nimage post-processing and display will be discussed that aim at maximising the \ndiagnostic benefit for the comprehensive CT assessment of the heart-lung axis. \nLearning Objectives:\n1.  To learn how to select CT protocols that enable assessment of the heart-lung \naxis with the lowest possible radiation dose.\n2.  To become familiar with the ECG-synchronisation protocols for cardio-thoracic \nCT image acquisitions.\n3.  To understand strategies for image post-processing and displaying for evaluat-\ning diseases affecting the heart-lung axis.\nAuthor Disclosure:\nU. J. Schoepf: Consultant; Bayer, Bracco, GE, Medrad, Siemens. Grant \nRecipient; Bayer, Bracco, GE, Medrad, Siemens. Investigator; Bayer, Bracco, \nGE. Research/Grant Support; Bayer, Bracco, GE, Medrad, Siemens. Speaker; \nBayer, Bracco, GE, Medrad, Siemens. \nA-451 14:28\nCoronary artery imaging from a chest CT examination: when and how \nR. Marano; Rome/IT (riccardo.marano@rm.unicatt.it) \nThe continuous technological evolution of multi-detector CT scanner characterised \nby larger detector array with increased anatomical coverage per rotation, faster \nrotation and table speed, and shorter acquisition time have made reliable to perform \nchest imaging with reduced cardiac motion artifacts, improving the assessment \nof heart and contiguous structures in the course of routine thorax CT. Further, the \nlarger anatomic coverage of detectors and the availability of scan protocols with \nlower radiation dose have also made reliable to apply ECG-synchronization to chest \nCT study, and therefore to couple cardiac/coronary imaging with chest imaging. \nDifferent clinical queries requiring a chest CT imaging may underlie cardiac or coro-\nnary source that is not clinically evident; similarly, patients scheduled for thoracic \nsurgery, staging or studied in emergency setting may present unexpected heart \nor coronary artery findings that can be detected in the course of pre-operative CT \nor may change the treatment and prognosis. Therefore, the capability to perform \nthe assessment of both the heart and chest by a single diagnostic tool is becom-\ning progressively significant because the evaluation of the heart often can provide \nclinically relevant information in the course of routine or emergency chest CT that \nis not otherwise easily available.\nLearning Objectives:\n1.  To become familiar with the main clinical indications that could require assess-\nment of the heart and coronary arteries in the course of chest CT.\n2.  To learn how to recognise the normal and abnormal appearance of heart and \ncoronary arteries commonly observed on chest CT.\n3.  To learn about the acquisition protocol to couple chest CT with ECG-gated \ncardiac CT.\nA-452 14:51\nCardiopulmonary functional imaging from a chest CT examination: \nwhen and how \nE.J.R. van Beek; Edinburgh/UK (edwin‑vanbeek@ed.ac.uk) \nThe use of CT for chest diseases has rapidly expanded and now covers both \npulmonary and cardiac diseases. However, it is also increasingly realised that \nthese two organ systems have a direct impact on one another, and therefore we \nneed to address the fact that pathology in one system may well lead to changes \nin the other. This presentation will give examples of chest CT using a variety of \nprotocols, ranging from a non-contrast screening study to a highly sophisticated \ncontrast-enhanced CT perfusion study. It will give examples of findings in one \nsystem and its impact on the other. Furthermore, it will demonstrate the capability \nto gain information from standard CT examinations related to pulmonary function, \ncardiac function and how these may be used.\nLearning Objectives:\n1.  To understand the feasibility of CT based cardiopulmonary functional imaging.\n2.  To be able to grasp clinical scenarios where cardiopulmonary functional CT \nimaging may be helpful.\n3.  To be able to set the use of CT within a larger framework of imaging modalities.\n5\n\nPostgraduate Educational Programme\nS10\n C B D E F\n G\nA\n14:00 - 15:30 Room L/M \nPhysics in Radiology \nRC 1413 \nHybrid imaging systems \nModerators: \nD.G. Sutton; Dundee/UK \nJ. Votrubová; Prague/CZ \nA-457 14:00\nA. Clinical SPECT/CT and PET/CT \nT. Beyer; Zurich/CH (thomas.beyer@cmi‑experts.com) \nOver 16 years ago, Hasegawa (UCSF) and colleagues presented a prototype \nSPECT/CT-system comprising a clinical SPECT-camera in tandem with a clinical \nsingle-slice CT. The combined SPECT/CT was used to perform a small number of \nclinical studies, such as for quantitative estimation of radiation-dosimetry in brain \ncancer, whereby the CT data were used also to generate the SPECT attenuation-\ncorrection-factors (ACF). Since then, SPECT/CT has benefited a great deal from \nthe advances in CT-technology and several commercial combination designs are \navailable today. The clinical adoption of SPECT/CT in oncology and cardiology has \nbeen rapid. The proposal to combine PET with CT was made in the early 1990s by \nTownsend, Nutt et al. In addition to intrinsic image alignment, the anticipated benefit \nof PET/CT was to use the CT-images to derive the PET-ACF‘s. The first clinical \nprototype-PET/CT became operational in 1998 at the University of Pittsburgh. Since \nthen, PET/CT-technology has grown rapidly by incorporating new concepts of PET \nand multi-slice CT. Today almost all PET systems are sold with a CT attached with \nan installed base of over 5,000 PET/CT-systems worldwide. The improvement in \naccuracy of PET/CT compared with PET or CT for re-/staging averages 10-15% \nacross all cancers. Acquisition protocol standardization and cross-specialty training \nare two of the most important pre-requisites for adopting dual-modality imaging as \npart of state-of-the-art patient management. \nLearning Objectives:\n1.  To review the origins of SPECT/CT and PET/CT imaging systems.\n2.  To understand the basic principles and general clinical applications.\n3.  To speculate on trends in dual-modality PET- and SPECT-based imaging \ntechnology.\nAuthor Disclosure:\nT. Beyer: Employee; cmi-experts GmbH. Founder; cmi-experts GmbH. \nA-458 14:30\nB. Clinical MR/PET \nG. Antoch; Düsseldorf/DE (antoch@med.uni‑duesseldorf.de) \nMR/PET imaging has recently been introduced into clinical routine. Apart from \naddressing technical challenges, such as MR-based PET attenuation correction, \npotential indications for MR/PET are currently defined. These indications include \noncology, neurology and cardiology. Considering oncologic indications, MR/PET \nis - most probably - not going to replace PET/CT as the workhorse but will rather \nserve as an imaging modality for specific indications. As an example, the combina-\ntion of high soft-tissue contrast from MRI coupled with functional data from PET is \nbeneficial in imaging of soft-tissue tumours where local tumour assessment can \nbe combined with whole-body tumour staging in a single session. Indications such \nas breast tumours or prostate cancer potentially benefit from the combined MR/\nPET approach and studies evaluating these questions are underway. In neurology \nand cardiology, functional data from both imaging modalities, MR and PET, may \ncomplement one another and this is currently investigated for different indications. \nThis talk will address current indications of MR/PET imaging in the clinic based on \nthe available literature and own experience.\nLearning Objectives:\n1.  To become acquainted with the origins and evolution of MR/PET.\n2.  To be informed of the current applications.\nAuthor Disclosure:\nG. Antoch: Speaker; Bayer Healthcare, Nordion, Siemens. \nA-459 15:00\nC. Preclinical hybrid imaging \nN. Belcari; Pisa/IT (belcari@df.unipi.it) \nDuring the past decade, we have observed a growing interest in in-vivo imaging \ntechniques for small animals. On the shadow of the successful application of dual-\nA-455 14:28\nB. Nephrogenic systemic fibrosis: from pathophysiology to \nrecommendations \nH.S. Thomsen; Herlev/DK (henrik.thomsen@regionh.dk) \nGadolinium (Gd) belongs to the lanthanides in the periodic table, which all affect \ncollagen. The ability to hold Gd varies from chelate to chelate, non-ionic linear \nchelates being the weakest binders. Transmetalation (exchange of Gd with another \nion, e.g. zinc) leads to NSF, a horrifying very late adverse reaction to some Gd-\nCM. Since 2007, the various Gd-CM have been classified into 3 groups: high risk \n(of NSF), intermediate risk and low risk. The authorities have introduced several \nrestrictions on the use of high risk agents which be followed by every physician \nin EU. The agents are contraindicated in 1) patients with severely reduced renal \nfunction including dialysis, 2) acute renal insufficiency, 3) neonates and 4) pregnant \nwomen. They may only be used with caution in patients with moderately reduced \nrenal function and children less than 1 year old. There must be at least 7 days \nbetween 2 injections in those patients. Renal function must always be determined \nby laboratory methods before use of high risk agents. Women should stop lacta-\ntion for 24 h. These agents should never be given in higher doses than 0.1 mmol/\nkg per examination in any patient. For the intermediate and low-risk agents, the \nrestrictions are significantly less; they should only be used with caution in patients \nwith severely reduced renal function including dialysis. If a physician does not follow \nthese rules, he or she will have legal problems as they have - by the authorities - \nbeen introduced into the summary of product characteristics.\nLearning Objectives:\n1.  To understand the underlying pathophysiology.\n2.  To learn about the clinical implications of the recent recommendations/guide-\nlines.\n3.  To become familiar with legal issues.\nA-456 14:51\nC. Contrast medium-induced nephropathy and new guidelines \nF. Stacul; Trieste/IT (fulvio.stacul@aots.sanita.fvg.it) \nThe Contrast Media Safety Committee of the European Society of Urogenital Ra-\ndiology has updated its 1999 guidelines on contrast medium-induced nephropathy \n(CIN). Topics reviewed included the definition of CIN, the choice of contrast medium, \nand the prophylactic measures used to reduce the incidence of CIN. The definition \nof CIN is a complex topic and understanding of it continues to evolve. The CMSC \nconsidered appropriate to keep the definition agreed in 1999. However, nephrolo-\ngists recently agreed on a new definition. In the previous guideline, a number of \nrisk factors were listed (raised S-creatinine levels, particularly secondary to diabetic \nnephropathy, dehydration, congestive heart failure, age over 70 years, concurrent \nadministration of nephrotoxic drugs). The significance of these risk factors has \nbeen confirmed and new risk factors were added. The CMSC agreed that the risk \nof CIN is significantly lower following intravenous CM administration and concluded \nthat patients referred for enhanced CT are genuinely at risk if they have an eGFR \n< 45 ml/min/1.73m2. The previous CMSC guideline suggested the use of low or \niso-osmolar CM in patients with risk factors for CIN and the CMSC considered that \nthis previous guideline should not be changed. The CMSC considered that there is \nenough evidence to recommend that either volume expansion with isotonic saline \nor sodium bicarbonate may be used for preventing CIN in at risk patients, while the \nefficacy of NAC and other drugs in reducing the incidence of CIN remains unproven. \nLearning Objectives:\n1.  To become familiar with newest guidelines on contrast induced nephropathy \n(CIN).\n2.  To understand the future clinical implications of the new guidelines.\nAuthor Disclosure:\nF. Stacul: Advisory Board; GE Healthcare. Speaker; Bracco, GE Healthcare. \nPanel discussion:  \nWhat is the most appropriate radiological approach to patients with \nfalling eGFR and when should contrast media be administered and \nwhen should it not? 15:14 \n6\n\nPostgraduate Educational Programme\nS107\nB\n C D E F G\nA\nSunday\nweighting (and contrast enhancement administration), fat sat and DWI sequences \ncan be used to increase the confidence in differentiating the normal laryngeal soft \ntissues from neoplasms. MR time-resolution is, surely, its main limit. Ultrasound, \nthough limited by the ossified cartilages walls, may integrate cross-sectional im-\naging and clear doubts about tumour extra-laryngeal spread or provide a guide \nto FNAC. When reporting, the radiologist should be aware of the checklist of the \nkey points to address, and should also know how to navigate inside the volume \nof interest. Clinical findings, anatomic landmarks and tissue-decomposition are \ncritical elements in image interpretation.\nLearning Objectives:\n1.  To become familiar with the typical findings of T1-T4 laryngeal cancer.\n2.  To learn about the patterns of local nodal involvement.\n3.  To understand possible imaging pitfalls in staging.\nA-462 14:28\nB. Evaluation after surgery and non-surgical treatment: expected findings \nS. Bisdas; Tübingen/DE (sotirios.bisdas@med.uni‑tuebingen.de) \nWhen compared to primary tumour assessment, the effectiveness of cross-\nsectional imaging is rather limited in the follow -up of laryngeal cancer treated by \nchemoradiation or surgery. Endoscopic examination is relatively easy and yields \na satisfactory accuracy in detecting recurrent disease. Essential requirements \nfor the proper interpretation of the post-treated larynx include knowledge of the \ninitial tumour appearance, the applied surgical technique and/or the (neo)adjuvant \nchemoradiation therapy. The altered anatomy, the absence of symmetric landmarks \nand the additional changes in the normal tissue are expected findings, which should \nnot be misinterpreted as residual or recurrent tumour. At the glottic level, the post-\ntherapeutic changes are limited, but the paraglottic spaces may show increased \ndensity. Symmetric thickness of the walls of the laryngeal ventricles, the aryepiglot-\ntic folds and increased attenuation of the subcutaneous fat with thickening of the \nneck muscles are most pronounced during the first months after completion of the \nradiotherapy. On the other hand, variable asymmetric scar tissue with shortening \nof the larynx and alteration of the contrast-enhancement pattern are seen after \nconservative surgery. On contrary, total laryngectomy results in a smooth appear-\nance of the neopharynx with symmetric thickness (partly collapsed) and variable \nenhancement. Possible flap reconstructions present as fat planes running along \nthe neopharynx. Finally, transoral laser excision results in low soft tissue loss with \na limited range of changes. Among them, the frequently observed plaque-like \nlesions without contrast enhancement may be usually attributed to scar tissue.\nLearning Objectives:\n1.  To appreciate the expected imaging findings after surgery of laryngeal cancer.\n2.  To become familiar with imaging findings after non surgical treatment.\n3.  To know about the possible imaging pitfalls.\nA-463 14:51\nC. Cancer recurrence: how to address clinical dilemmas \nB. Verbist; Leiden/NL (b.m.verbist@lumc.nl) \nAs treatment choices for laryngeal cancer emphasize functional laryngeal preserva-\ntion if possible, not only accurate staging by imaging for optimal treatment planning \nis of utmost importance, but also strategies for early identification of recurrences are \nnecessary. Possible treatment options for laryngeal cancer are open or endoscopic \nsurgery, radiotherapy, including intensity modulated radiation therapy (IMRT) or \nimage-guided radiotherapy (IGRT) and eventually added induction or concomitant \nchemotherapy. Treatment changes will influence the detection of recurrent disease. \nCurative treatment of recurrent laryngeal cancer will require either conservation \nlaryngeal surgery or total laryngectomy. In this lecture, the diagnostic as well as \nthe therapeutic challenges of local recurrence of laryngeal cancer and/or regional \nnodal metastases will be discussed. The value and pitfalls of different imaging \ntechniques will be addressed and possible treatment options will be reviewed.\nLearning Objectives:\n1.  To understand the limitations of clinical examination.\n2.  To appreciate the value of different imaging techniques in the detection of \nrecurrence.\n3.  To become familiar with the imaging findings of recurrent laryngeal cancer.\nPanel discussion:  \nDiagnostic algorithms for diagnosis and follow-up of laryngeal \ncancer 15:14 \nmodality imaging in the clinical environment, such as combined PET-Computed \nTomography (CT) or SPETC/CT, the hybrid imaging modalities have been recently \ntransferred to small animal scanners. Nowadays, the possibility of easy integration \nof nuclear imaging techniques with other modality such as PET/SPECT/CT or PET/\nMR or has become a mandatory requirement in the design of small animal imaging \nsystems. The combination of different imaging modalities in the same scanner offers \nthe possibility to perform experiments more effectively than with a single modality \nonly. This is especially true when two modality scans are performed sequentially \nor simultaneously and without moving the animal. Present technologies for the \nconstruction of hybrid systems for small animals will be presented together with \nexamples of commercially available hybrid scanners. Looking at the next future, \nsmall animal PET/MR seems to be one of the most appealing perfect choice for \nhybrid imaging, combining the exquisite sensitivity of PET with the morphological/\nfunctional/spectroscopic high-resolution imaging of MR. The present major limitation \non the development of simultaneous PET/MR scanners is the non-insensitivity of \nPMTs to magnetic fields. A reliable solution could be the development of magnetic \nfield insensitive position-sensitive photodetectors. A brief overview of the present \nstatus of development of the detector technology for PET/MRI will be also presented. \nLearning Objectives:\n1.  To learn about hybrid imaging tools in animal imaging/pre-clinical research.\n2.  To understand possible clinical applications.\n14:00 - 15:30 Room N/O \nHead and Neck \nRC 1408 \nLaryngeal cancer and radiology \nA-460 14:00\nChairman’s introduction \nJ.E. Kabala; Bristol/UK (Julian.Kabala@UHBristol.nhs.uk) \nAround 89% of laryngeal cancer cases are estimated to be related to the com-\nbined effects of alcohol and smoking. The prevalence of these two risk factors \nstrongly influences the incidence of laryngeal cancer. This is highest in Central \nand Eastern Europe, around 8 per 100,000 population compared to around 5 \nper 100,000 in Western Europe. The disease is more common in males than \nfemales throughout Europe, with the highest ratio where the incidence is highest \n(around 25 males to 1 female in Lithuania and Portugal) and lowest ratio where \nthe incidence is lowest (around 6 males to 1 female in the UK, France and The \nNetherlands). The mucosal surface of the tumour is staged by direct inspection. \nMRI or CT is utilised to assess deep extension of the tumour (e.g. cartilage inva-\nsion) and inaccessible sites (e.g. subglottic region). Small localised superficial \ntumours may be successfully treated with radiotherapy or surgery (including laser \nexcision) alone. Advanced tumours require consideration of radical surgery and \nradiotherapy. Chemotherapy may modestly improve recurrence-free survival rates \nat the cost of increased toxicity. Salvage surgery and/or radiotherapy may have \nsome success in the event of recurrence following single modality treatment but \nusually has a poor outcome if the initial treatment has been combined surgery \nand radiotherapy. Chemotherapy may deliver a remission of variable duration \nin some patients. Functional imaging (fMRI, positron emission tomography) \nhas not yet become routinely established; but may ultimately provide some as-\nsistance particularly in the challenging imaging situation following intervention. \nSession Objectives:\n1.  To discuss the epidemiology.\n2.  To learn about the available diagnostic imaging modalities.\n3.  To become familiar with the available treatment options.\nA-461 14:05\nA. Staging of laryngeal cancer: pearls and pitfalls \nR. Maroldi; Brescia/IT (maroldi@med.unibs.it) \nLarynx can be analysed by imaging techniques that have some specific strengths \nbut also some limits. MSCT is very fast; it acquires a volume from which the proper \nview of the structures of interest can be extrapolated. MSCT provides detailed \ninformation on mineralised cartilages and fat spaces inside the larynx. The main \nvariant in the examination technique is the time-delay after contrast agent admin-\nistration (i.e. arterial vs. advanced venous phase). Subtle changes in soft tissues \nare difficult to detect on MSCT. MR, whose ability in separating tissue and detecting \neven mild oedematous changes or fibrosis, overcomes this limitation. More variants \nin the exploration of soft tissue-composition are possible with MR. Besides T2, T1 \n\nPostgraduate Educational Programme\nS1\n C B D E F\n G\nA\nA-466 14:28\nB. The importance of evidence-based practice for the future of \nadvanced practice in radiography \nA. England; Liverpool/UK (aengland@liverpool.ac.uk) \nAdvanced radiographic practice has dominated discussions within the radiographic \nprofession for over a decade. Within the UK, advanced practitioner roles are now \nwell established and continue to develop. With the number of advanced practitioners \nsteadily growing, there are increasing demands on training and education. With \nadvancements in practice questions have arisen regarding the need for evidence \nto prove competency, effectiveness and from which to base recommendations \nfor future practice. In the first half of the millenium, there were a series of reports \nproviding comparative data on the accuracy of radiographers undertaking advanced \npractice, e.g. barium enema investigations or plain radiographic reporting. Such \nstudies generally provided a comparison again the current standard, a report or \nexamination by a radiologist. Such comparisons can carry limitations as they were \nrarely multicentre in design and the true status of the patient was often unknown. \nTraining schemes were also highly heterogenous, they may have been in-house, \nvia short courses or as part of validated post-graduate degree programme. It was \noften difficult to apply published research findings locally and gain unequivocal \nsupport from our radiology and clinical colleagues. Questions have also arisen as \nto what role research evidence of past radiographic performance plays in driving \nfuture developments. This may be by expanding into new areas or the more wide-\nspread role out of existing practices nationally or internationally. This paper aims \nto discuss these issues and the likely contribution of evidence-based practice in \ncarving out the future of radiographic advanced practice.\nLearning Objectives:\n1.  To become familiar with examples of evidence-based practice in the area of \nadvanced practice and role development in radiography.\n2.  To understand the importance of such an evidence-based approach when \nconsidering the introduction of advanced roles in a clinical setting.\n3.  To gain an insight into the education and training requirements for advanced \npractice and role development.\nAuthor Disclosure:\nA. England: Employee; University of Liverpool. Research/Grant Support; \nNational Institute for Health Research. \nA-467 14:51\nC. The view from the European level \nG. Paulo; Coimbra/PT (graciano@estescoimbra.pt) \nTechnological evolution and new scientific developments have driven health care \nsector towards an unprecedented increase of its organizational complexity. One of \nthe major contributors for that increase was, without doubt, the influence of medical \nimaging technology development. This change of paradigm is obviously a key driver \nfor a (r)evolution in the daily practice of radiographers, because the radiographer is \nthe ultimate interface between patient and technology and the gatekeeper regarding \nradiation protection. This demands for a permanent focus on patient care and safety, \nbased on high-professional standards. To develop a profession, it is mandatory to \ndevelop the field of knowledge related to it. Evidence-based radiography practice \nis one of the best ways to achieve this desideratum, because it integrates the best \nresearch evidence with clinical knowledge and expertise, addressing the patient \nin a holistic way. It is necessary to build bridges between radiographer education \ninstitutions and clinical environments, combining efforts and promoting collaboration \nbetween radiographers from the academic and the clinical field. Radiographer role \ndevelopment and advanced practice is mandatory to develop more cost-efficient \nand cost-effective health systems. This is one of the most important pillars in the \nEU, once these systems are considered to be a central component of the Union’s \nhigh levels of social protection and contribute to social cohesion and social. Radi-\nographer advanced practice will definitely contribute to increase medical imaging \ndepartment’s workflow, decrease patient waiting time, allowing earlier diagnosis, \ndecrease length of hospital stay and therefore decreasing health expenditure, \ncontributing to economical growth.\nLearning Objectives:\n1.  To understand the influence of evidence-based practice on the future of the \nradiography profession in Europe.\n2.  To become familiar with the advantage of advanced practice and role develop-\nment in radiography in health systems.\n3.  To understand the benefits of advanced practice and role development in \nradiography for the patients.\nPanel discussion:  \nHow to use the EFRS guidance document on role development 15:14 \n14:00 - 15:30 Room P \nRadiographers \nRC 1414 \nTowards advancing and developing the role of \nradiographers \nA-464 14:00\nChairmen’s introduction \nS. Mathers1, D. Tscholakoff2; 1Aberdeen/UK, 2Vienna/AT (s.mathers@rgu.ac.uk) \nThe tasks and duties performed by radiographers in a modern imaging department \nare constantly evolving. The main drivers have been i) the relentless develop-\nment of technology in both the diagnostic and therapy fields and ii) the change \nin radiographer education leading to a graduate profession. The latter has lead \nto radiographers in some countries such as Netherlands and United Kingdom \nto develop their roles to carry out tasks which were previously performed by \nradiologists for example performing ultrasound and musculo-skeletal reporting. \nOne outcome of this process is all imaging staff, including radiographers and \nradiologists, work together as a team to provide a first class and timely service \nfor patients. Increasingly this change of practice is attracting interest from imag-\ning professionals across Europe. During this session, the history of radiographer \nrole development will be reported and current work practices explained. The need \nfor ongoing research and audit to support this change will be debated and the \nnecessity for robust education and governance to underpin this process will be \ndescribed. In conclusion, benefits of radiographer’s performing these roles will be \ndescribed from a European perspective, and the contribution of radiographers to \na modern health care service will be outlined. This will be supported by the Eu-\nropean Federation of Radiographer Societies (EFRS) document which has been \ndeveloped to explain role development areas which are possible and the education \nrequired to carry out these roles. This session will conclude with a panel discus-\nsion with opportunities for delegates to ask questions of our expert presenters. \nSession Objectives:\n1.  To appreciate the potential importance of advancing and developing the role \nof radiographers for the profession and for healthcare.\n2.  To become familiar with the level of activity across international societies in \nfostering this.\n3.  To understand the importance of such role developments meeting real clinical \nneeds.\nA-465 14:05\nA. The current status: a clinical perspective \nC. McLaren; London/UK (clare.mclaren@gosh.nhs.uk) \nCareer progression in radiography has historically been through management with \nexperienced radiographers leaving behind their clinical role. This loss of senior \nradiographer skills leaves a gap that can often be difficult to fill. We started to ad-\ndress this issue in the interventional radiology (IR) service at Great Ormond Street \nHospital in 2001. Our aim was to change the career structure for radiographers in \nIR, make the job more appealing, improve staff retention, and to develop skills that \nradiographers have, but don’t always get the chance to use. The role of clinical \nspecialist radiographer in IR has developed alongside that of nurses. The areas of \nrole extension were chosen to suit a radiographer’s skills and knowledge of fluor-\noscopy and imaging parameters. Initially, these included airway and oesophageal \nintervention and angiography. For this role to work well, you need a dedicated \nradiographer. New skills are required, for example, gaining patient consent for \nprocedures and presenting imaging findings at multi-disciplinary team meetings. \nAll aspects of IR are included in this role, including pre- and post-operative ward \nvisits and reporting. This role was fully supported by the IR consultants and most \nsenior consultants in the hospital, but did meet with initial opposition from some \nstaff. We have implemented dedicated operating lists for procedures undertaken \nby the clinical specialist radiographer and thereby streamlined the patient pathway.\nLearning Objectives:\n1.  To become familiar with the current status from the perspective of a radiogra-\npher in an advanced practice in a paediatric interventional role.\n2.  To understand the key factors that facilitate this advanced role, as well as the \nchallenges faced during implementation.\n3.  To become familiar with the impact that this advanced role has had on patient \ncare, interprofessional relationships and service delivery, in one institution.\n08\n\nPostgraduate Educational Programme\nS1\nB\n C D E F G\nA\nSunday\nLearning Objectives:\n1.  To understand the role of radiographs, US, CT and MRI.\n2.  To become familiar with the most common conditions that cause acute chest \npain and/or distress in children.\n3.  To appreciate the different differential diagnoses, depending on the age of the \npatient.\n4.  To understand the consequences of delaying in their diagnosis and treatment.\nA-470 15:00\nC. The role of the interventional radiologist in paediatric trauma \nJ.B. Karani; London/UK (johnbkarani@hotmail.com) \nOutcome data from trauma series have demonstrated improved patient survival by \nthe prompt diagnosis of the range of injuries and the recognition of life-threatening \nsequels, principally that of active arterial haemorrhage. Widely used trauma scoring \nsystems are applicable in the paediatric population although often the mechanisms \nand combination of injuries may differ from those encountered in adults. A CT \ndiagnosis of active haemorrhage demands early operative or non-operative inter-\nvention with embolisation or use of alternative endovascular techniques including \ndelivery of vascular stents. This principle is applicable to blunt or penetrating liver, \nsplenic, renal or pelvic trauma. It is also applicable in some cases to severe me-\ndiastinal vascular and limb trauma. Important caveats are firstly the use of CT in \nan overall trauma service and avoidance of any inappropriate irradiation. Second, \nin paediatric interventional practice due regard needs to be given to delivery of \nimplantable devices that may have adverse sequels in later life. Nevertheless the \ndemand for immediacy in intervention may outweigh any such consideration.This \npresentation will summarise the importance of CT technique and intervention in \nboth the early and the delayed sequels of trauma with an emphasis on abdominal \nand thoracic trauma.\nLearning Objectives:\n1.  To understand the role of CT, CTA and conventional angiography in the diag-\nnosis of traumatic vascular complications.\n2.  To understand the importance of vascular and non-vascular intervention fol-\nlowing trauma in children.\n14:00 - 15:30 Room Z \nSpecial Focus Session \nSF 14c \nAdvances in forensic radiology \nA-471 14:00\nChairman’s introduction \nG. Guglielmi; Foggia/IT (g.guglielmi@unifg.it) \nPost-mortem Computed Tomography has been recognised as a powerful technique \nto assist forensic pathologists in their post-mortem investigation. In particular, \nCT has proven to be useful in the recognition of bone structure, the detection of \nembolisms and the diagnostic of gross abnormalities of soft tissues. On the other \nhand, CT scan without injection of contrast agent cannot provide information \nabout abnormalities of the vascular bed of the viscera and lesions of the vascular \nsystem. In order to investigate post-mortem vascular system, a standardised CT-\nangiography is necessary. It consists in the acquisition of one native scan and \nthree angiographic phases during the perfusion of the body established with a \nmixture of paraffin oil and a specific oily contrast agent injected through the can-\nnulation of the femoral artery and vein by means of a device reproducing perfusion \nconditions in analogy to living patients. Based on post-mortem MDCT studies, a \nnew approach has been developed called virtual anthropology. In some cases \nof unidentified bodies, positive identification of the deceased can be obtained \nby adopting comparative or reconstructive criteria. These approaches permit as-\nsessment and determination of some important anthropological parameters: racial \nphenotype, age at death, sex and stature. More recently, MRI has been used to \naugment forensic investigation with an outlook into post-mortem studies applied on \nmusculoskeletal, cardiovascular and angiographic fields and in forensic imaging of \nthe living, such as cases of child abuse, survived strangulation and age estimation. \nSession Objectives:\n1.  To become familiar with the role of imaging in forensic pathology.\n2.  To learn how the use of a contrast medium may help the native scan to recog-\nnise vascular lesions.\n3.  To learn about the possibilities of MDCT in anthropological identification.\n14:00 - 15:30 Room Q \nPaediatric \nRC 1412 \nPaediatric emergencies \nModerator: \nV. Donoghue; Dublin/IE \nA-468 14:00\nA. The acute non-traumatic neurological patient: CT or MRI? \nE. Vázquez; Barcelona/ES (evazquez@vhebron.net) \nNeurological deficits in children are an urgent condition that depends significantly \non imaging for a prompt accurate diagnosis because significant overlap is present in \nclinical history, presentation and neurological examination. There are five major clini-\ncal categories of non-traumatic neuroemergencies: focal neurological deficit, head-\nache, increasing confusion, visual progressive deficit and progressive myelopathy. \nDifferent imaging modalities, such as ultrasound (neonates and infants), computed \ntomography (CT) or magnetic resonance imaging (MRI) are utilised dependent on \nage of the patient and neurologic symptoms. The purpose of the present lecture is \nto discuss the causes and imaging appearance of acute neurological conditions in \nchildhood, broadly categorised into stroke and stroke-mimics (infection, inflammatoy \ndemyelination, metabolic disorder, cerebral neoplasms or drug poisoning). A review \nof the main indications to perform a neuroimaging procedure in these children will \nbe undertaken as well as a differential diagnosis based on representative cases \nselected from the daily routine in a paediatric tertiary hospital. Practical algorithms \nwith the preferential use of either CT or MRI will be developed for each section. \nCT continues to be the first imaging modality in these patients with acute clinical \npresentations in many centers because it does not require sedation, even there \nis an accompanying radiation. MR imaging is nowadays better for imaging these \nchildren owing to the saved radiation, the more complete provided information and \nthe useful advanced techniques that can be used, such as diffusion imaging (DI), \nspectroscopy, arterial spin labelling (ASL) or susceptibility-weighted imaging (SWI).\nLearning Objectives:\n1.  To learn about the currently limited role of CT in the non-traumatic acute set-\nting.\n2.  To become familiar with radioprotection strategies and protocols adapted to \nchildren.\n3.  To consolidate the role of MRI as the modality of choice for acute non-traumatic \nneurologically ill children, with an emphasis on newer techniques.\n4.  To become familiar with imaging findings and the main differential diagnosis \nof acute neurological conditions in children.\nA-469 14:30\nB. Imaging of acute chest pain and/or distress in children \nC.E. de Lange; Oslo/NO (clange@ous‑hf.no) \nAcute chest pain in children is a common complaint in the emergency department, \nbut patients rarely present with significant distress or life-threatening symptoms \nrequiring immediate care or resuscitation. The most frequently reported cause is \nbenign musculoskeletal pain followed by respiratory and gastrointestinal causes, \nwhile cardiac causes are less frequent. A thorough clinical history and careful \nphysical examination will determine in most cases, the patients in need of further \ninvestigation to establish a diagnosis. In this regard, radiology plays an important \nrole, especially in the emergency setting in patients with more serious associated \nsymptoms like acute breathing difficulties, swallowing problems, fever or sepsis. \nWhen choosing the appropriate technique for investigation, the consequences of \nradiation exposure in children must be considered. Plain radiography and fluoros-\ncopy still remains the most important and frequently used tool to gain information \non various acute chest/pulmonary problems. Ultrasonography is the first choice \nfor diagnosis/ treatment of pleural effusions. Multidetector computed tomography \nand magnetic resonance imaging are mainly used for investigating pulmonary /\nmediastinal masses and congenital abnormalities of the great vessels and the \nlungs. This lecture will discuss the choice of imaging technique and urgency of \nradiological management depending on the symptoms and age of the patient. \nThe imaging characteristics of the different causes of acute chest pain and/or \ndistress in children will be reviewed, represented by the more common conditions \ninvolving the chest wall, respiratory tract, oesophagus and the heart, as well as \nless frequent causes such as tumours, manifestations of congenital malformations \nand non-accidental trauma.\n09\n\nPostgraduate Educational Programme\nS11\n C B D E F\n G\nA\nes: the use of criteria and characteristics specific to MSCT, or the transposition of \ntechniques used on dry bones in physical anthropology. It permits assessment and \ndetermination of some important anthropological parameters: racial phenotype, \nage at death, sex, stature. MSCT has many advantages over dry bone analysis: \none of its major assets in forensic anthropology is the elimination of lengthy bone \npreparation, which may sometimes cause anatomical damage, especially when \nbone is already fragile (high useful when bones are very burned or charred). MSCT \npresents numerous inherent advantages over plain x-rays, in particular the ability \nto provide three-dimensional information. Post-processing allows segmentation of \nan individual bone, which can be highly useful for its analysis. \nLearning Objectives:\n1.  To learn about the different paleo-pathological diagnoses and anthropological \nidentification of bone lesions with MSCT.\n2.  To learn about the possibilities of MSCT for comparative identification.\n3.  To understand reconstructive identification and the main techniques useful for \nage-at-death assessment and sex determination.\nA-475 14:59\nForensic MR imaging \nT.D. Ruder; Zurich/CH (thomas.ruder@irm.uzh.ch) \nOver the last decade, forensic imaging underwent enormous expansion and in many \ninstitutes across the world, pre-autopsy post-mortem CT or MR is now standard \npractice. Currently, CT is more widely used than MR in forensic imaging due to \nexamination time constraints, limited access to MR scanners, and the complexity \nof MR technology. Nevertheless, MR imaging can be of great utility in forensic \ninvestigations. This lecture provides a summary of forensic applications of MR \nimaging. This includes an introduction to normal post-mortem findings on MR, such \nas posterior fluid sedimentation and temperature-dependent alterations of image \ncontrast; a discussion of post-mortem musculoskeletal MR imaging in trauma cases, \nan outline of the current state-of-the-art in post-mortem cardiac MR with special \nemphasis on myocardial infarction; an overview of post-mortem MR angiography; \nand finally a synopsis of current applications and research efforts in forensic MR \nin living subjects, such as child abuse, survived strangulation and age estimation. \nLearning Objectives:\n1.  To learn about typical post-mortem alterations in MR imaging.\n2.  To become familiar with application of MR imaging in the post-mortem setting.\n3.  To understand the added value of post-mortem cardiac MR in cases of cardiac \ndeath.\nPanel discussion:  \nWhich imaging technique for which forensic scenario? 15:17 \n16:00 - 17:30 Room A \nInteractive Teaching Session \nE³ 1520 \nThoracic emergencies \nA-476 16:00\nA. Vascular \nE. Castañer; Sabadell/ES (ecastaner@tauli.cat) \nBased on representative cases, we will review the main causes of thoracic non-\ntraumatic vascular emergencies (acute aortic syndrome, pulmonary thromboem-\nbolism and haemoptysis); MDCT angiography has become the first-line imaging \ntest for the diagnosis of this entities. As acute aortic disease is the most common \nfatal condition in patients with chest pain, prompt recognition and treatment is \nof paramount importance, we will review the spectrum of acute aortic pathology \nfocusing on the distinctive findings of each entity (classic dissection, intramural \nhaematoma, and penetrating aortic ulcer) and upgrading the clues for their diagno-\nsis. Acute pulmonary embolism (PE) remains a common clinical challenge. MDCT \npulmonary angiography has become the first line imaging study in the diagnosis \nof PE because of its speed, accuracy, low-interobserver variability, and ability to \nprovide alternative diagnoses. We will review the role of MDCT in the evaluation of \nacute thrombotic PE: findings of acute PE (including how to evaluate the severity of \nan episode of PE at CT pulmonary angiography), some potential pitfalls as well as \nsome of the controversies in imaging young and pregnant patients. Massive hae-\nmoptysis is a life-threatening condition that is associated with a high mortality rate. \nHaemoptysis usually involves bleeding from the bronchial arteries or, less frequently, \nfrom non-bronchial systemic arteries. Haemoptysis of pulmonary arterial origin is \nA-472 14:05\nImaging in forensic medicine \nM. Thali; Zurich/CH (michael.thali@irm.uzh.ch) \nOver 15 years ago, the Virtopsy Project with its systematic integration of various \ntechnologies and modalities, such as photogrammetric 3D surface scanning, \ncomputer tomography and magnetic resonance scanning as well as in the area \nof clinical and post-mortem forensic medicine as well as post-mortem biopsy and \nangiography was perceived by professional circles as being revolutionary. After a \ndecade, these technologies have been integrated as an evolutionary process devel-\nopment in daily forensic practice. The almost completed documentation procedure \nin the post-mortem area has also influenced future image-based documentation \nand analysis processes in clinical forensic medicine.\nLearning Objectives:\n1.  To learn why imaging methods are becoming essential modalities in forensic \nmedicine.\n2.  To become familiar with the modalities that can be used in forensic imaging.\n3.  To learn what the future developments in forensic radiology and imaging will \nbe.\nA-473 14:23\nAdvances in post-mortem CT angiography \nS. Grabherr; Lausanne/CH (Silke.Grabherr@chuv.ch) \nPerforming a postmortem, MDCT-scan has become routine in some forensic insti-\ntutes, especially in Switzerland. In order to investigate the vascular system, different \ntechniques of post-mortem CT-angiography have been tested. Multi-phase post-\nmortem CT-angiography (MPMCTA) is a recently developed standardised technique \nwhich allows investigating the vascular system of human bodies similarly than in \nclinical CT-angiography. It consists in the performance of one native CT-scan and \nthree angiographic phases (arterial, venous and dynamic phase). Data acquisition \nis performed after and during the perfusion of the body with a mixture of paraffin oil \nand the oily contrast agent Angiofil via a special perfusion device called Virtangio. \nDifferent studies have already proofed that the use of this method increases the \nsensitivity of the radiological exam significantly, especially concerning the detec-\ntion of lesions of the vascular system and soft tissue. Depending on the findings, \nthe sensitivity of the post-mortem CT-angiography is even higher than the one of \nconventional autopsy. Therefore, the performance of pre-autopsy MPMCTA has \nalready become a new gold standard, especially in cases in which the source of \na haemorrhage should be detected or a modified vascular anatomy is the result \nof a surgical intervention. However, there are still some diagnoses that have to be \nconfirmed by conventional autopsy. In order to investigate the limits and advantages \nof post-mortem CT-angiography, an international working group has been created \nin 2012. The aim of this group is also to create recommendations for the indication \nof the exam and for the interpretation of the images.\nLearning Objectives:\n1.  To consolidate knowledge of the advantages and limits of post-mortem CT \nangiography.\n2.  To understand the method of multi-phase post-mortem CT angiography and \nthe indication for its performance.\n3.  To become familiar with the objectives and latest achievements of the Technical \nWorking Group of Post-mortem Angiography Methods (TWGPAM).\nAuthor Disclosure:\nS. Grabherr: Research/Grant Support.\nA-474 14:41\nVirtual anthropology and forensic identification using MDCT \nF. Dedouit; T oulouse/FR (fabded2@hotmail.com) \nThe applications of Multi Slice Computed Tomography (MSCT) in anthropology, \npaleoanthropology, bioarcheology and paleopathology are grouped under the term \npaleoradiology. In recent years, a new approach has been developed called virtual \nanthropology, based on post-mortem MSCT studies. In some cases of unidentified \nbodies, both investigations can be carried out simultaneously through a single \nMSCT acquisition. The first analysis identifies causes of death, possible pre-existing \ndisease processes and non-lethal abnormalities, while the second detects criteria \npotentially useful for positive identification of the deceased, based on comparative \nand reconstructive identification criteria. The comparative reconstruction is based \non detection of surgical material, variants of normal radiological appearances, and \npre-existing abnormalities whether congenital or acquired (permitting a complete \npaleopathological study), and ante-mortem MSCT images can be compared with \npost-mortem images. Reconstructive identification is based on two main approach-\n0\n\nPostgraduate Educational Programme\nS111\nB\n C D E F G\nA\nSunday\nA-479 16:05\nA. State-of-the-art techniques in 2013 \nT. Mang; Vienna/AT (thomas.mang@meduniwien.ac.at) \nComputed tomographic colonography (CTC) is a reliable technique for the detec-\ntion and classification of neoplastic and non-neoplastic lesions of the colon. It is \nbased on a thin-section CT dataset of the cleansed and gas-distended colon, \nacquired in the prone and supine positions. Tagging of faecal residuals with orally \nadministered contrast media is generally recommended. For screening CTC, low-\ndose CT scanning protocols without IV contrast should be used. For diagnostic \nCTC, the use of IV contrast media and standard dose protocols for one scanning \nposition is recommended for the evaluation of extra-colonic organs, particularly in \npatients with known colorectal cancer. Although CTC is considered to have a high \nsafety profile, there could be a very small risk for complications such as perfora-\ntions, bleeding, or cardiac events associated with the procedure. The risk can be \nminimized by adhering to recommended technical standards. Two-dimensional \nand three-dimensional views are used, in combination, for image interpretation. \nColonic findings are characterised by their morphology, by their attenuation charac-\nteristics and by their mobility. Knowledge of the CTC imaging features of common \ncolonic lesions and artifacts is necessary to characterise findings and to avoid \npitfalls. Computer-aided detection (CAD) algorithms automatically highlight polyp \n“candidates,” based on morphologic criteria. Used as a second reader, CAD has \nbeen shown to reduce the number of perceptual errors by pointing out possible \nabnormalities that might otherwise have been missed. CAD should be applied by \nradiologists only after they have been sufficiently trained in unassisted evaluation \nof CTC and the use of CAD.\nLearning Objectives:\n1.  To become familiar with an optimised technique and how it can be optimised \nfor specific patient groups.\n2.  To briefly describe basic interpretation and the role of CAD.\n3.  To understand the most common interpretative pitfalls and potential complica-\ntions, and how they can be avoided.\nA-480 16:28\nB. How to set up a service \nP. Lefere; Roeselare/BE (radiologie@skynet.be) \nImplementation of CT colonography (CTC) is a complicated and delicate proc-\ness, requiring consideration of several aspects. First, there is a need of intensive \ntraining, covering both the technical approach of CTC and the different aspects of \ninterpretation. CTC workshops (ESGAR) are being organised since many years \nthroughout Europe. They play a crucial role in the basic learning process by dealing \nwith the several technical aspects and challenges of interpretation. They also allow \nfor a personal contact with the international CTC-faculty. More recently, advanced \nworkshops for experienced CTC-radiologists are being organised allowing for \nrefinement of existing knowledge. As part of the learning process, independent \ndouble reading is a valuable option in the start up to avoid false-negative and \nfalse-positive findings, to refine the lessons learned during the workshops and \nto deal with difficult cases. Efficient CTC-implementation also relies upon the \nsmooth performance of an experienced and well-organised CTC-team, consisting \nof administrative workers, radiographers and radiologists. The goal is to offer a \npatient-friendly and efficient diagnostic work up to both the patient and the clinician \nin a cost-effective way. Rigorous adoption of indications and contra-indications of \nCTC is a very important part of this process. Different approaches are necessary \naccording to the patient or suspected pathology. At the end, the barium enema \nshould be considered obsolete and totally replaced by an efficient combination of \nCTC and other imaging options, such as ultrasound, regular abdominal CT, and MR \nimaging. This lecture will present the options for CTC implementation in flow charts.\nLearning Objectives:\n1.  To appreciate the need for training prior to CTC and understand the role of \ntraining courses and double reporting.\n2.  To become familiar with ways of maximising service efficiency, including cost \neffectiveness, and how best to replace the barium enema.\n3.  To appreciate the differences in approach from setting up a service for older \nsymptomatic patients to setting up colorectal cancer screening.\n4.  To learn a basic audit framework.\nAuthor Disclosure:\nP. Lefere: Board Member; Co-founder of Virtual Colonoscopy Teaching Centre. \nOther; Collaboration for education in CTC with Bracco, Vital Images (Toshiba) \nand iCAD. \nrare, estimated at less of 10% of haemoptysis cases. MDCT angiography permits \nnoninvasive, rapid, and accurate assessment of the cause and consequences of \nhaemorrhage into the airways and helps guide subseqüent management.\nLearning Objectives:\n1.  To become familiar with the main causes of thoracic vascular emergencies.\n2.  To understand the role of MDCT angiography in thoracic emergencies.\n3.  To learn about the radiological signs in vascular thoracic emergencies and its \nimpact on the management of these patients.\nA-477 16:45\nB. Pulmonary \nC.M. Schaefer-Prokop; Amersfoort/NL (cornelia.schaeferprokop@gmail.com) \nAcute respiratory failure can have multiple underlying causes including infection, \nfluid overload, immunological diseases or exacerbation of pre-existing lung disease. \nSince the clinical symptoms are nonspecific, imaging plays an important role. The \nfirst imaging method is mostly the chest radiograph, easy to access and to obtain, \nbut non-diagnostic in many cases. (HR)CT offers more possibilities to define the \ndifferential diagnosis. Option of this interactive workshop will be to get familiar \nwith the spectrum of diseases that can cause acute respiratory failure and learn \nabout key findings in radiography as well as CT to reduce the differential diagno-\nsis. The interaction between preexisting lung disease, clinical information (e.g., \nchemotherapy, rheumatoid arthritis, COPD) and imaging findings will be discussed \nby clinical case studies. Emphasis will be put on the patient on “intensive care”. \nOptions but also limitations of imaging findings will be illustrated. \nLearning Objectives:\n1.  To learn about the role of imaging in severe attacks of obstructive lung disease.\n2.  To become familiar with direct and indirect signs of pleural disease causing \nrespiratory failure with special emphasis on the intensive care patient.\n3.  To learn about imaging features that are helpful for the differential diagnosis \nof pulmonary consolidations causing respiratory failure.\n4.  To understand the interaction of comorbidity, age and extent of pulmonary \ndisease resulting in severe respiratory failure and the role of imaging in it.\n16:00 - 17:30 Room B \nGI Tract \nRC 1501 \nCT colonography: when the ‘new’ becomes \n‘ordinary’ \nA-478 16:00\nChairman’s introduction \nA. Laghi; Rome/IT (andrea.laghi@uniroma1.it) \nCT Colonography (CTC) is a well-established modality for colonic imaging, already \nimplemented in several diagnostic-imaging departments worldwide. In order to be \ncompetitive and to fulfill clinical requirements, radiologists should provide an high-\nquality service. State-of-the-art techniques should be used to maximize diagnostic \nperformances, to improve patient comfort and to minimize potential risks. The 2012 \nESGAR Consensus will be presented and discussed in order to provide the attend-\nees with the newest information on CTC techniques, including bowel preparation, \nfluid/faecal tagging, colonic distention, scanning protocols and reading approaches. \nA second important issue is the organization of the service. Radiologists interested \nin CTC should be aware of how to start a service. This means to be informed about \nmarketing strategies to general public and other physicians (i.e. gastroenterolo-\ngists, primary care physicians, etc). as well as about the additional tools needed to \nsuccessfully run and to improve a CTC service. Concepts of quality control in CTC \nwill be introduced and known data about quality issues in CTC will be presented. \nThe main objective at this time is the definition of possible metrics for assessing \nquality in CTC: some parameters will be derived from those experimented and \ncurrently used for conventional colonoscopy, but some others, completely different \nand specifically tailored for CTC should be created ex-novo. Finally, it is important \nto establish good relationships with gastroenterologists, since most of the goals \nare common. CTC and colonoscopy are, in fact, complimentary techniques and \nthe joint use of both the techniques will result in a clear benefit for our patients. \nAuthor Disclosure:\nA. Laghi: Speaker; Bracco, General Electric Healthcare, Im3d. \n\nPostgraduate Educational Programme\nS112\n C B D E F\n G\nA\n3.  To become familiar with an imaging algorithm for diagnostic approaches, and \ndifferent strategies.\nA-483 16:20\nB. Paediatric adrenal tumours \nP.-H. Vivier; Rouen/FR (pierre‑hugues.vivier@chu‑rouen.fr) \nAdrenal lesions may occur as a result of neoplasms, haemorrhage, infection, or \ncysts. Adrenal masses in children may present with an asymptomatic adrenal mass \nlesion, an endocrinopathy, a hypertensive or metabolic crisis or a paraneoplastic \nsyndrome. Neuroblastoma is the most common extracranial solid neoplasm in \nchildren, accounting for 10% of all paediatric neoplasms, and 15% of all childhood \nmortality from neoplasms. The median age at diagnosis is about 16 months, and \n95% of cases are diagnosed by 7 years of age. It may be seen also antenatally \nor in the newborn period. About half of the patients have metastatic disease at \ndiagnosis. Ultrasound is usually the first imaging examination performed. Extension \nassessment requires 123I-mIBG-scintigraphy, chest x-ray and abdominal CT or MRI. \nFluorodeoxyglucose positron-emission tomography is useful in neuroblastomas \nwhich fail to or weakly accumulate mIBG. Proper terms allow correct staging \naccording to the 2011 Consensus Report from the International Neuroblastoma \nRisk Group. Two stages of localised disease are differentiated on whether image-\ndefined risk factors (IDRFs) are or are not present. IDRFs are features detected \nwith imaging at the time of diagnosis. Less aggressive medullary tumours include \nganglioneuroblastoma, ganglioneuroma and pheochromocytoma. Neoplasms \nthat arise from the adrenal cortex are rare in children and include adrenocortical \ncarcinoma and adenoma.\nLearning Objectives:\n1.  To become familiar with the different adrenal tumours in paediatrics.\n2.  To learn how imaging can help in differentiating neuroblastoma from Wilm’s \ntumour.\n3.  To understand the value of adequate examinations for the initial workup of \nadrenal tumours.\nA-484 16:40\nC. Prenatal detection of GU diseases \nF.E. Avni; Lille/FR (favni@skynet.be) \nDuring this course, the participants will learn how to evaluate the fetal GU tract in \nutero; the criteria used in order to diagnose GU malformation will be detailed and \nillustrated. The in utero management of uropathies will be explained. Also, the \nimportance of MR imaging as a complementary examination will be discussed. The \nrole of imaging in counselling parents will be explained. Furthermore, the postnatal \nwork-up will be addressed and the potential role of each imaging examination \nwill be evaluated leading to a standardised approach. Finally, the rationale of this \nmanagement will be discussed in the light of up to date scientific data.\nLearning Objectives:\n1.  To learn how to assess the diagnostic criteria of foetal uropathies.\n2.  To learn how to apply a standardised post-natal approach.\n3.  To understand the rationale behind a standardised approach.\nA-485 17:00\nD. Interactive case discussion \nM. Claudon; Vandoeuvre‑lès‑Nancy/FR (m.claudon@chu‑nancy.fr) \n16:00 - 17:30 Room D1 \nCLICK (Clinical Lessons for Imaging Core Knowledge): Never \nwithout Arteries \nCC 1518 \nWhen every step counts: imaging and management \nof peripheral arterial occlusive disease (PAOD) \nModerator: \nJ.F.M. Meaney; Dublin/IE \nA-486 16:00\nA. Clinical considerations \nM. Schillinger; Vienna/AT (m.schillinger@imed19.at) \nIndications for interventional treatment of peripheral artery disease mainly depend \non clinical considerations. Precise knowledge on patients’ clinical background, \nA-481 16:51\nC. Interaction with gastroenterologists: friends or enemies? \nA. Graser1, C. Hassan2; 1Munich/DE, 2Rome/IT \n(Anno.Graser@med.uni‑muenchen.de) \nCT colonography is ready to be used on a larger scale. The examination is well \naccepted by patients and provides accurate depiction of the large bowel. It has a \nhigh sensitivity in the detection of relevant polyps and may help to pre-select pa-\ntients who need to undergo subsequent colonoscopy for resection of such findings. \nHowever, conflicts of interest may exist between radiology and gastroenterology as \nthey now “compete” for the same patients. This presentation will discuss political \nissues involved in one modality being used by different subspecialties. It will also \nfocus on ways to create fruitful cooperations, communicate findings, recommend \nfurther tests and follow -ups, and unite the forces of both disciplines in order to \nbenefit our patients. Indications to CT colonography and colonoscopy will also be \ndiscussed. Participants in the session will learn about when and how to best use \nCTC, and when to refer patients to colonoscopy.\nLearning Objectives:\n1.  To understand what the gastroenterologists wants to know when referring their \npatients for CTC in both symptomatic and screening patients.\n2.  To learn how to formulate local polyp reporting guidelines and how best to \nintegrate the service with the needs of patients.\n3.  To propose the most effective method for integrating endoscopic and CTC \nservices, minimising competition and maximising cooperation.\nAuthor Disclosure:\nA. Graser: Advisory Board; Pfizer Pharma. Consultant; Siemens AG Healthcare. \nGrant Recipient; Bayer Healthcare. Speaker; Siemens AG Healthcare, Bracco \nAG. \nPanel discussion:  \nHow to create an efficient CTC team? 17:14 \n16:00 - 17:30 Room C \nUrogenital Imaging \nCC 1521 \nPaediatrics \nModerator: \nM. Claudon; Vandoeuvre‑lès‑Nancy/FR \nA-482 16:00\nA. Imaging strategies for children: urinary tract infection and vesico-\nureteral reflux \nM. Riccabona; Graz/AT (michael.riccabona@medunigraz.at) \nUTI is a common query in paediatric uroradiology. As treatment strategies based \non new insights into pathophysiology have changed, the role of imaging had to be \nrevised. The imaging algorithm, techniques and some examples of common find-\nings in childhood UTI will be presented in the light of this new concept and imaging \npotential; particularly age-related aspects and different strategies (“bottom-up” vs. \n“top-down” approach) are discussed. Infants and children with UTI are commonly \nprimarily assessed by ultrasound (US). A dedicated detailed US study in a well-\nhydrated patient including post-void assessment often answers all queries neces-\nsary for managing, particularly if Power Doppler and contrast-enhanced voiding \nurosonography for assessment of vesico-ureteric reflux (VUR) are applied. Urinary \ntract malformations, signs for upper tract involvement, complications and even \n(indirect signs for) VUR can be reliably assessed in most cases. Only for evalu-\nation of scaring (and equivocal US findings) DMSA scintigraphy and increasingly \nMRI - also for assessment of sonographically insufficiently addressable complica-\ntions - are used. Voiding cystourethrography (VCUG) remains the gold standard \nfor VUR assessment, particularly if a functional modified technique is applied and \nce-VUS is not available. However, as VCUG is invasive with considerable radiation \nburden, thorough justification and patient selection is mandatory. CT (and IVU) \nare used only exceptionally, most commonly for the work-up of UTI complicated \nby or associated with childhood urolithiasis, or for complications and differential \ndiagnosis if MRI is not available. \nLearning Objectives:\n1.  To learn about the information provided by ultrasonography, MRI and nuclear \nmedicine examinations.\n2.  To become familiar with the technique and indications for micturating cysto-\nurethrogram and contrast-enhanced voiding urosonography.\n\nPostgraduate Educational Programme\nS113\nB\n C D E F G\nA\nSunday\nLearning Objectives:\n1.  To become familiar with typical cases illustrating the role of different imaging \nmodalities in the diagnosis and differential diagnosis of PAOD.\n2.  To consolidate knowledge of the selection of the appropriate imaging technique, \nimage interpretation and image based treatment recommendation.\n3.  To understand the needs and principles in modern multidisciplinary manage-\nment of PAOD.\n16:00 - 17:30 Room D2 \nOncologic Imaging: Follow-up of Systemic and Local Therapies \nCC 1519 \nFollow-up of thermal ablation (part II) \nModerator: \nP.L. Pereira; Heilbronn/DE \nA-489 16:00\nA. Follow-up imaging of thermal ablative therapies for lung tumours \nA.R. Gillams; London/UK (alliesorting@gmail.com) \nRoutine imaging follow-up uses pre- and post-contrast enhanced CT with compari-\nson to previous imaging. Factors assessed include size, shape, density, cavitation \nand enhancement. The normal ablation zone initially increases in density and may \nincrease a little in size but after 3 months consistently reduces in size. An increase in \nthe size of the ablation zone, a change in the shape of the ablation zone indicating \nan increase in one area, or the development of nodular enhancement, >  10 HU, \nindicates local tumour progression. Early diagnosis provides the best opportunity \nfor re-treatment and long-term tumour control. A baseline CT study is required \nwithin the first 4-6 weeks post ablation. Thereafter, routine interval scanning is at \n2-4 month intervals depending on the aggressiveness of the cancer, e.g. primary \nlung, melanoma and most sarcoma metastases require two monthly assessment. \nColorectal metastases are assessed three monthly, more indolent tumours may \nbe scanned 4 monthly. Delayed complications include pneumothorax, effusion and \ninfection. CT features of infection are enlargement of the ablation zone which may \nfill with fluid containing pockets of gas, the development of smooth rim enhancement \nand oedema in the surrounding parenchyma. Infected cavitating ablation zones, like \nother chronic infective cavitating lesions, may recruit a systemic collateral circula-\ntion and this can result in large volume haemoptysis. Some authors recommend \nPET-CT but this modality is poor at detecting small volume disease and carries a \nheavy financial and radiation burden. It does have an advantage in assessing the \nsignificance of borderline hilar and mediastinal lymphadenopathy.\nLearning Objectives:\n1.  To consolidate knowledge of imaging aspect of successful ablation.\n2.  To become familiar with the main pitfalls of post-ablation imaging.\n3.  To learn about the imaging aspects of most common complications.\nAuthor Disclosure:\nA. R. Gillams: Speaker; CoVidien. \nA-490 16:30\nB. Follow-up imaging of percutaneous local treatment of bone tumours \nF. Deschamps, G. Farouil, T. de Baere; Villejuif/FR (Frederic.Deschamps@igr.fr) \nThermal ablation techniques (radiofrequency and cryotherapy) are increasingly \nused to treat bone metastases. No post-procedure imaging is required for palliative \nintent because the success can be clinically assessed. However, post-procedure \nimaging is crucial if a local tumour control is expected or if a local complication is \nsuspected. CT is routinely used. It allows depicting any fracture on the treatment \nsite but the ablation zone as well as any residual tumour is usually poorly seen. \nSize increase and/or contrast enhancement within the ablation zone at CT is \nconsidered as incomplete treatment but is often lately discovered. On the other \nhand, MRI accurately determines the extent of the ablation zone and is probably \nthe best imaging technique to depict any residual tumour as well as any damage \nto the surrounding tissue. Indeed, it has been demonstrated that the correlation \nbetween the diameter of coagulation necrosis and lesion size at MRI is strong. \nNevertheless, there are some limitations with MRI: the post-procedure imaging find-\nings are often unknown and there is a poor reproducibility in MRI protocols between \nthe different hospitals and radiologists. In order to avoid a huge heterogeneity for \nthe follow-up, standardised protocol must be used not only for post-procedure \nimaging but also for the pre-op MRI. Moreover, fluorine-18-fluorodeoxyglucose \npositron emission tomography (FDG-PET) is another tool for early diagnosis of \nincomplete treatment that consists in a peripheral increased focus uptake activity. \ntherefore, is crucial. The following issues have to be considered: a. clinical stage \nof peripheral artery disease. This mainly includes the differentiation between \npatients with intermittent claudication and critical limb ischaemia. Interventional \nrevascularization is an option for patients with intermittent claudication, it is a must \nfor patients with critical limb ischaemia. b. Knowledge on patients comorbidities \nare essential in estimating the potential risk of any interventional procedures, this \nincludes cardio-pulmonary comorbidities, renal disease, thyroid disorders and \ndisorders of coagulation. c. Patients concomitant medication has to be considered \nto decide whether peri- and post-procedure standard medication can be used. In \nconclusion, clinical considerations have to be carefully evaluated prior to all inter-\nventional vascular procedures in patients with peripheral artery disease. \nLearning Objectives:\n1.  To become familiar with clinical diagnosis and classification of peripheral \narterial occlusive disease.\n2.  To learn about the most important clinical differential diagnosis.\n3.  To learn about the importance of imaging for treatment decision-making and \nplanning.\nA-487 16:30\nB. Imaging techniques and typical findings \nT. Leiner; Utrecht/NL (t.leiner@umcutrecht.nl) \nBoth CTA and MRA are highly valuable non-invasive imaging techniques in the \nclinical management of patients with peripheral arterial occlusive disease. This part \nof the refresher course will focus on the role of CTA and MRA in the diagnostic \nand interventional pathway of patients with suspected peripheral arterial occlusive \ndisease, i.e. indications for imaging. The presentation will discuss relevant technical \ndevelopments in CT and MR technology that facilitate routine high-quality imaging \nstudies. In addition, the most commonly used imaging protocols will be discussed \nas well as the relative merits and shortcomings of CTA and MRA in specific patient \npopulations. Furthermore, typical findings and relevant literature and guidelines \nas well as clinical recommendations will be reviewed with regard to evidence of \nclinical utility of both techniques.\nLearning Objectives:\n1.  To learn about state-of-the art MR angiographic imaging of the peripheral \narteries (including modern non-enhanced techniques).\n2.  To learn about state-of-the art CT angiographic imaging of the peripheral \narteries (including modern dose-saving techniques).\n3.  To become familiar with the appropriate selection of the right patient for the \nright imaging test.\nAuthor Disclosure:\nT. Leiner: Grant Recipient; The Netherlands Organisation for Health Research \nand Development. Research/Grant Support; My department receives research \nsupport from Philips Healthcare, Bracco, Bayer Healthcare. Speaker; Philips \nHealthcare, Bracco, Bayer Healthcare, GE Healthcare, Lantheus Medical. \nA-488 17:00\nC. Interactive case discussion: how to deal with the results? Typical \ncases, pitfalls, and what is next? \nL.P. Lawler; Dublin/IE (llawler@mater.ie) \nSuitably skilled diagnostic and interventional radiologists, with an interest in car-\ndiovascular disease, are a major healthcare asset with a potential large contribu-\ntion to make to the public health challenge of PAOD. Contemporary high-quality \ninvasive and non-invasive 2D and 3D angiographic studies are user-friendly for \ndisplay, distribution and interpretation. However, radiologists must seek to provide \na ‘value-added’ that is above and beyond simple descriptors of the images pro-\nduced. Open and endovascular algorithms for PAOD are relatively straightforward \nand uniform but the imaging studies should seek to align themselves with local \npractice actively guide the patient selection and therapeutic approach. Similarly, \nthe radiologist needs to be versed in the post-surgical appearances and the report \nnarrative should reflect the local vernacular of practice. When available through \nEPR and PACS comprehensive reports seek to reconcile ABIs, Doppler, CTA, MRA \nand DSA studies in a succinct conclusion that guides management and problem \nsolving. Furthermore, we need to be insightful to the comparative advantages and \nlimitations of each modality to avoid pitfalls in interpretation. In this presentation, I \nshall seek to illustrate and discuss a multimodality and multidisciplinary approach. \nThere will be case discussion including all modalities, optimal imaging protocols \nand 3D processing. A range of therapeutic interventions and post-operative ap-\npearances will be addressed including features of complications. I hope to com-\nmunicate an approach which acknowledges the central role of radiologists in the \nmodern care pathway of PAOD.\n\nPostgraduate Educational Programme\nS114\n C B D E F\n G\nA\n2.  To learn about current developments with a clinical focus on who should \nundergo what and when, what kind of CT exam to use in order to triage \nemergency patients to the appropriate therapy options.\nA-493 16:15\nA. Imaging of the most frequent emergencies of the upper abdomen \nC.J. Zech; Basle/CH (CZech@uhbs.ch) \nThe causes of frequent non-traumatic emergencies in the upper abdomen include \noncological and inflammatory diseases or diseases related to cholestasis. Although \nUS often is the first line modality to examine patients with acute abdominal diseases, \nthe findings for treatment decisions are in many cases assessed by dedicated \nMDCT protocols. A monophasic venous enhanced-CT usually provides a robust \nand broad overview and enables the evaluation of many diseases. Nevertheless, in \nsome clinical instances, the addition of arterial phase images is warranted. This is \nmainly the case when acute bleeding or occlusion/pathologies related to the arterial \nvessels like mesenteric occlusion is suspected. Additional plain CT images can be \nhelpful in when patients had previous surgery or in cases biliary stone disease is \nsuspected. MRI usually plays only a minor role in imaging of abdominal emergen-\ncies, with the clear exception of MRCP to evaluate the biliary system to decide \nabout the indication of a therapeutic ERCP. Since MRCP protocols can be set up \nand acquired quickly and usually allow the very adequate evaluation of the biliary \nand pancreatic ductal system, it should be offered also for emergency patients. \nInterventional radiology can offer usually effective treatment options for patients \nwith emergencies of the upper abdomen.\nLearning Objectives:\n1.  To become familiar with dedicated MDCT protocols.\n2.  To learn about other types of imaging such as US and MR.\n3.  To learn about typical and atypical imaging findings.\nA-494 16:35\nB. Imaging of the most frequent emergencies of the gastrointestinal tract \nM. Zins, I. Boulay-Coletta; Paris/FR (mzins@hpsj.fr) \nAcute abdominal pain due to gastrointestinal (GI) tract pathology is one of the most \nfrequent causes of patient presentation to the emergency room. Rapid and accurate \ndiagnosis is crucial for applying appropriate treatment. US and CT have emerged \nas the most accurate non-invasive imaging tools for emergent evaluation of acute \nabdominal pain. This lecture will detail the typical and atypical imaging features \nand the respective indications of US and CT in the most frequent emergencies of \nthe GI tract including appendicitis, diverticulitis, small and large bowel obstruction, \nbowel ischaemia and infection.\nLearning Objectives:\n1.  To become familiar with dedicated MDCT protocols.\n2.  To learn about other types of imaging such as US and MR.\n3.  To learn about typical and atypical imaging findings.\nA-495 16:55\nC. Imaging of the most frequent emergencies of the genitourinary tract \nL.E. Derchi; Genoa/IT (derchi@unige.it) \nThis presentation will deal with three of the most common and important acute \nproblems of the GU system: testicular and ovarian torsion and the renal colic. US is \nthe technique of choice in patients with acute scrotum and is able to identify torsion \nin up to 86% - 94% of cases. Tips and tricks to improve diagnostic accuracy and \nrecognize possible false negatives will be presented. Difficulties can be encountered \nalso in identifying ovarian torsion, and the role of US, CT and MRI in this field will \nbe addressed, stressing the need for accurate correlation of clinical and radiological \nfindings to reach the correct diagnosis. MDCT is the gold standard examination \nin patients with suspected renal colics, being able to recognize presence, loca-\ntion and size of the obstructing stone  (s) in virtually all cases, or to identify other \npathologic conditions which are responsible for the patient’s symptoms. However, \nstone disease is frequent, recurrent and often affects patients of relatively young \nage; then, radiation exposure concerns have to be taken into account. Protocols \nusing US as the first approach can solve up to 75% of cases, reserving MDCT \nonly for those which are undetermined after US. The US examination techniques \nto be used in these situations will be addressed.\nLearning Objectives:\n1.  To become familiar with dedicated MDCT protocols.\n2.  To learn about other types of imaging such as US and MR.\n3.  To learn about typical and atypical imaging findings.\nPanel discussion:  \nHow to speed up your diagnoses? 17:15 \nIt is a reproducible imaging technique that also allows depicting other metastases \nlocation or disease progression.\nLearning Objectives:\n1.  To learn about the post-ablation aspects, according to the ablation technique \nused.\n2.  To consolidate knowledge of the imaging aspects of successful ablation on \nvarious types of follow-up imaging, including CT and MRI.\nA-491 17:00\nC. Follow-up imaging of thermal ablative therapies for kidney tumours \nD.J. Breen; Southampton/UK (David.Breen@uhs.nhs.uk) \nThe imaging follow-up of renal tumour ablation is critical as this represents defini-\ntive treatment of primary, curable carcinoma. Functional imaging such as FDG-\nPET plays no role due to the poor FDG-avidity of a large proportion of clear cell \ncarcinomas. Diligent post-contract CT or MR assessment remains the mainstay \nof follow -up remembering that papillary/chromophobe carcinomas are notori-\nously hypovascular. Careful subtraction MR imaging or dual energy CT are useful \ntechniques for highlighting the usually crescentic marginal or peripheral nodular \ndisease that indicates a subtotal treatment. Late arterial phase imaging with brisk \ncontrast injection technique (at >=  5 m/s) is the best method to detect any such \nresidual disease. Given improved image guidance and treatment dosimetry with \ntechniques such as cryoablation subtotal treatment rates should now be well below \n5% in experienced centres, if not negligible. Studies have suggested that there is a \nsmall but persistent late local recurrence rate of ~5% with current RFA technique. \nSuch recurrences usually declare themselves as enhancing marginal nodules at \nthe edge of the otherwise involuting ablation zone. These recurrences have been \nreported at anything from 1 to 4 years post treatment. Comparitively cryoablation \nseries report trivial rates of late local recurrence, effectively in equipoise with sur-\ngical resection. Where the tumour mass is non-enhancing, gradually involuting, \ndemonstrates a peri-tumoural 'halo' artefact in the adjacent fat and a subjacent, \nadequate wedge of cortical infarction recurrences are barely ever detected. These \nfeatures are now establishing themselves as makers of complete and effective \nrenal tumour ablation.\nLearning Objectives:\n1.  To learn about the post-ablation aspects, according to ablation technique used.\n2.  To become familiar with the imaging aspect of successful ablation.\n3.  To appreciate the imaging aspect of most common complications.\nAuthor Disclosure:\nD. J. Breen: Consultant; Microsulis Medical Ltd. , Galil Medical Ltd. \n16:00 - 17:30 Room E1 \nEmergency Radiology \nRC 1517 \nER: comprehensive imaging of non-traumatic \nabdominal emergencies \nA-492 16:00\nChairman’s introduction: logistics and management of critical \npatients with abdominal complaints \nS. Wirth, M.F. Reiser; Munich/DE (swirth@med.uni‑muenchen.de) \nEmergency Radiology is a very rapidly growing field of modern radiology and \nof major importance in patient care. In particular, the number of CT examina-\ntions has still been continuously rising during the last decade because CT is \nfast, easily available, provides high-resolution cross sectional images and is \nthus playing a key role for patients with emergent abdominal complaints. How-\never, every modality plays its own important role even when indications may \nchange with today‘s possibilities. An excellent co-operation with referring \nphysicians remains indispensible. Thus, radiologists need to have a concise \nunderstanding of specific pathologies and have to get used to being involved \nmore deeply into choosing the appropriate imaging way. On one hand, the pro-\ncedures have to be standardised to a maximum but the trend towards personal-\nized medicine may be helpful to overcome some of the remaining limitations. \nSession Objectives:\n1.To learn about requirements for abdominal imaging for an emergency radiol-\nogy department.\n\nPostgraduate Educational Programme\nS11\nB\n C D E F G\nA\nSunday\ncrucial knowledge to interpret these MRI’s adequately. Using anatomical landmarks, \nAI is divided as 1) anterior impingement, with a subdivision in anteromedial and \nanterolateral impingement and 2) posterior impingement, also divided in posterior \nand posteromedial impingement. The specific clinical and radiological features are \nshown. Although plain film is mainstay in daily practice AI is not easily detected. \nGuidelines on improving use of plain film are provided. Also value of easy to perform \nadditional plain films with low costs are explained. Since MR is thought essential \nin workup of chronic ankle pain, guidelines for standardised interpretation and \nreporting are provided. Together with demonstrating the typical imaging features, \nthe reading radiologist is comfortable to be able to provide the surgeon with the \nnecessary answers. In our daily practice, MRI holds several orthopaedic limita-\ntions, which are discussed. MDCT of both ankles, in neutral and maximal plantar \nflexion are thought of important additional value. Typical MDCT features of various \nAI subtypes are displayed. When radiologists are able to closely interact with the \nclinical colleagues, optimal care in chronic ankle pain can be provided.\nLearning Objectives:\n1.  To understand impingement mechanisms of the ankle.\n2.  To become familiar with anterior and posterior ankle impingement.\n3.  To learn about the typical imaging findings.\n4.  To appreciate the strength and weaknesses of different imaging modalities.\nA-499 16:51\nHip \nK. Wörtler; Munich/DE (woertler@roe.med.tum.de) \nFemoroacetabular impingement (FAI) results from abnormal contact between the \nfemoral neck and the acetabular rim. The two basic mechanisms of FAI are cam \nand pincer impingement. Cam impingement is by far more common, is caused by \nosseous abnormalities of the femoral head-neck junction and leads to damage of \nthe anterosuperior labrum and articular cartilage. Pincer impingement is character-\nised by acetabular overcoverage or abnormal retroversion of the acetabulum and \nprovokes a typical pattern of injuries of the anterosuperior labrum and the poster-\noinferior joint surface. Both conditions are thought to initiate premature osteoarthritis \nand thus have gained increasing attention over the last decade. Plain radiography \nand MR imaging represent important tools for the diagnosis and preoperative plan-\nning of patients with FAI with a view to depiction and quantification of predisposing \nosseous abnormalities and definition of the extent of joint damage. It is however \nimportant to keep in mind, that the diagnosis always has to be based on clinical \nfindings and cannot be established solely on the basis of imaging findings. This \ncourse will focus on imaging features, which support the diagnosis of cam and \npincer type FAI, the strenght and weaknesses of different imaging modalities, and \nthe potential impact of radiological findings on clinical decisions.\nLearning Objectives:\n1.  To understand impingement mechanisms of the hip.\n2.  To become familiar with cam and pincer type femoroacetabular impingement \n(FAI).\n3.  To learn about the typical imaging findings.\n4.  To appreciate the strength and weaknesses of different imaging modalities.\nPanel discussion:  \nForm or function: is impingement a clinical or imaging diagnosis? 17:14 \n16:00 - 17:30 Room F1 \nSpecial Focus Session \nSF 15a \nTraumatic brain injury \nA-500 16:00\nChairman’s introduction \nA. Rovira-Cañellas; Barcelona/ES (alex.rovira@idi‑cat.org) \nTraumatic brain injury (TBI) is a leading cause of death and disability worldwide. \nEvery year, about 1.5 million people die and several million receive emergency \ntreatment for this cause. In clinical practice, the severity of TBI is generally classified \nas severe, moderate, or mild according to the level of consciousness measured with \nthe Glasgow Coma Scale (GCS). Nonetheless, the increasing use of early sedation, \nintubation, and ventilation in more severely injured patients has decreased the value \nof the GCS for classification purposes. Alternatively, and particularly in these more \nsevere patients, TBI can be classified according to morphological criteria based on \nCT or MRI studies. Although MRI may be more sensitive for detecting small white \nmatter lesions in later phases following TBI, CT remains the examination technique \n16:00 - 17:30 Room E2 \nState of the Art Symposium \nSA 15 \nImaging impingement syndromes \nA-496 16:00\nChairman’s introduction \nC.W.A. Pfirrmann; Zurich/CH \nThe Latin word “impingere” means to thrust, to strike or to dash against some-\nthing. Impingement in the musculoskeletal system has received considerable \nattention as an important mechanism for causing damage to joints and tendons. \nImpingement refers to a dynamic, abnormal contact between two anatomic \nstructures. Because of the dynamic component, the diagnosis of an impinge-\nment based on imaging alone may not be possible. Some predisposing factors \nlike a cam deformity at the proximal femur, leading to femoroacetabular im-\npingement are well known. However, in other conditions, such as subacromial \nimpingement at the shoulder joint, imaging findings may be much less evident. \nSession Objectives:\n1.  To learn about the role of imaging for the diagnosis of impingement syndromes.\n2.  To understand what the clinician needs to know from the radiologist.\n3.  To learn the diagnostic value of different imaging modalities to answer the \nclinical questions.\nAuthor Disclosure:\nC. W. A. Pfirrmann: Advisory Board; Advisory Board Orthopaedic Diagnostics, \nSiemens. \nA-497 16:05\nShoulder \nP. Robinson; Leeds/UK (Philip.Robinson@leedsth.nhs.uk) \nThe anatomy, biomechanics and function of the shoulder girdle means that this \narea is extremely vulnerable to developing impingement syndromes both from \nathletic use and normal degenerative processes. The shoulder girdle anatomy \nwill be reviewed in the context of the proposed theories concerning causes or \nassociated causes of internal and external impingement syndromes. Imaging as-\nsessment will focus on ultrasound and MRI demonstration of the normal anatomy \nand relevant variations in normal. In external impingement syndormes, the relation-\nship of the rotator cuff, overlying bursae and coracohumeral arch is the centre for \nboth primary (morphological abnormality of the arch or rotator cuff) and secondary \n(micro or macro glenohumeral instability) causes. Imaging abnormalities of the \narch, rotator cuff and bursae will be presented for both ultrasound and MRI and \ntheir relevance to clinical findings and subsequent management of impingement \nwill be discussed. In internal impingement, a brief overview of the theories for \nposterosuperior and anterosuperior impingement will be presented. Anterosuperior \nimpingement is not as well recognised as other impingement syndromes but the \nmechanism and imaging findings will be presented. Despite the differing theories \nfor posterosuperior impingement, there are a common group of imaging features \nthat occur. These imaging findings will be illustrated but because the areas affected \ninclude the glenoid labrum, capsule and undersurface of the rotator cuff the imaging \nfocus will be on MRI (including arthrography) rather than ultrasound which cannot \naccurately assess this region. \nLearning Objectives:\n1.  To understand impingement mechanisms of the shoulder.\n2.  To become familiar with external and internal shoulder impingement.\n3.  To learn about the typical imaging findings.\n4.  To appreciate the strength and weaknesses of different imaging modalities.\nA-498 16:28\nAnkle \nM. Maas; Amsterdam/NL (m.maas@amc.nl) \nAnkle impingement (AI) is an important cause of chronic ankle pain. AI is a painful \nmechanical limitation of full-ankle movement, secondary to osseous and/or soft-\ntissue pathology. Radiologists are frequently encountered with requests for MRI of \nthe ankle, an investigation that needs to answer important preoperative questions. \nThe presence of multiple ligaments, tendons and joint extensions make interpre-\ntation of MRI challenging. Anatomy of this small joint is considered difficult, yet \n5\n\nPostgraduate Educational Programme\nS116\n C B D E F\n G\nA\nspectroscopy and functional MRI have been shown to hold great promises in this \nindication, since they enable quantification of neuronal suffering, injury of the white \nmatter or physical and functional disconnection of critical brain areas. Lesions of \nthe mesencephalon, thalamus, corpus callosum and diffuse destruction of the white \nmatter secondary to increased intracranial pressure often lead to an unfavorable \nevolution. A method for reliable prognostication of outcome in severe TBI could \nbe developed by integrating clinical and neuroimaging information. This aim will \nrequire a large multicenter study using a harmonized imaging protocol and com-\nmon clinical data elements.\nLearning Objectives:\n1.  To understand the value of diffusion tensor imaging and MR spectroscopy in \nsevere cases.\n2.  To understand the role of these techniques in early- and late-phase diagnosis \nand treatment follow-up.\n3.  To learn about the lesion patterns associated with favourable and unfavourable \noutcomes.\nAuthor Disclosure:\nD. Galanaud: Consultant; Olea Medical, La Ciotat, France. \nA-504 16:59\nCerebrovascular trauma: diagnosis and therapy \nT. Krings; T oronto, ON/CA (timo.krings@uhn.ca) \nVascular injury of the head and neck region is a rare and often life-threatening \ncomplication of head or neck trauma and is due to two major pathomechanisms: \npenetrating or blunt trauma. Both the arterial and the venous site of the CNS \nvasculature can be involved, the latter one being often overlooked. Concerning \narterial lesions, depending on how many layers of the arterial vessel are affected \nand on the spatial relationship to adjacent structures, dissections, false aneurysms \nor arteriovenous fistulae may develop. On the venous side, dural tears, compressive \neffects on pial veins and a deranged clotting system may lead to delayed venous \nthrombosis. In this lecture clinical and imaging findings, as well as diagnostic and \ntreatment strategies in these lesions are described. \nLearning Objectives:\n1.  To learn about the classification of the different types of cerebrovascular trauma.\n2.  To become familiar with vascular emergencies requiring urgent treatment.\n3.  To become familiar with treatment strategies in cerebrovascular trauma.\nPanel discussion:  \nRole of neuroimaging in traumatic brain injury in 2013 17:17 \n16:00 - 17:30 Room F2 \nSpecial Focus Session \nSF 15b \nDigital breast tomosynthesis \nA-505 16:00\nChairman’s introduction \nG. Gennaro; Padua/IT (gisella.gennaro@ioveneto.it) \nIn the past two decades, important progresses have been obtained by manufac-\nturers in development of digital breast tomosynthesis (DBT), a 3D breast imaging \ntechnique which aims to overcome inherent limitations of mammography associ-\nated with normal breast tissue superimposition. Several retrospective studies \nhave demonstrated DBT potentials in reducing both false negatives and false \npositives compared to standard mammography. Nowadays, commercial DBT \nsystems are facing on the market, with different technical solutions in terms of both \nphysical parameters which control DBT acquisition, and reconstruction algorithms. \nMoreover, several clinical questions are still open about the actual applications \nof tomosynthesis in clinical practice. Different scenarios have been considered, \neither proposing DBT to replace mammography, or to be used as an adjunct to \nmammography, together with other diagnostic tools, like mammography extra-views \nor ultrasound. One concern about the real use of DBT regards its impact on the \nclinical workflow, caused by the strong increase in the amount of DBT images to \nbe reviewed compared to the current standard of care in breast imaging; one pos-\nsible solution comes from computer-aided detection (CAD), which could support \nlesion detection, as well as speed up radiologists’ reviewing time. This session aims \nto cover the tomosynthesis subject, including all the aspects mentioned above. \nSession Objectives:\n1.  To understand the physical parameters and reconstruction methods which \ndetermine digital breast tomosynthesis (DBT) image quality.\nof choice in the acute phase. However, both CT and conventional MRI fall short in \naccurate prediction of outcome, because of their inability to depict the full extension \nof brain injury and because they offer qualitative rather than quantitative information. \nIn the last few years, advanced MR techniques such as diffusion tensor imaging \n(DTI) and proton MR spectroscopy (MRS) have been used to provide quantitative \nassessment of the extent of brain damage and have been proposed as markers \nof axonal injury and to predict long-term outcome. Outcome prediction is important \nbecause it has an impact on the choice of specific treatment methods, on deciding \nwhether or not to withdraw treatment, and on counseling patients and relatives.  \nSession Objectives:\n1.  To understand the role of neuroradiology in the initial assessment.\n2.  To appreciate the role of conventional and non-conventional imaging tech-\nniques in the diagnosis and monitoring of primary and secondary traumatic \nlesions of the brain.\n3.  To learn about the prognostic value of neuroimaging.\n4.  To become familiar with the various types of cerebrovascular traumas and \ntheir treatment options.\nAuthor Disclosure:\nA. Rovira-Cañellas: Advisory Board; NeuroTec, Bayer AG. Board Member; \nNeuroradiology, Am J Neuroradiol. Consultant; Novartis. Research/Grant \nSupport; Bayer AG. Speaker; Bayer AG, Novartis, Sanofi-Aventis. \nA-501 16:05\nAcute brain trauma: CT vs MRI \nM. Muto; Naples/IT (mutomar2@gmail.com) \nTraumatic brain injury is a common condition related to multiple mechanism of action \nof the traumatic vector axis that can cause mild clinical abnormality up to dramatic \nand urgent situation that needs to be treated surgically in emergency. Multiple clas-\nsification has been published to correlate clinical findings, with risk factors trying to \ndefine with category of patients needs to be image. Loss of consciousness is an \nimportant clinical criteria to decide about CT evaluation or not. Focal contusion, \nlacero-contusion, epidural-subdural haematoma, post-traumatic subarachnoid \nhemorrhage, subtentorial and infrafalx haematoma, skull fractures are all conditions \neasily visible with CT and the semeiotic of this finding is well established also with \nMR. Clinical evaluation of those patients is also sometimes problematic related to \nthe fact that we are dealing with unstable polytrauma patients. The real diagnostic \nproblem are patients with coma state and minimal CT abnormality in which a diffuse \naxonal injury must be suspected and confirm by MR examination showing typical \nabnormal signal intensity at the level of the cortical-subcortical junction or at the \nlevel of the brainstem. The evolution and the follow -up of those patients can be \nperformed either by CT or MR in relation to type of injury. MR perfusion can also give \nmore information about the recovery of normal vascular supply in trauma patients.\nLearning Objectives:\n1.  To understand the role of neuroradiology in the management of brain trauma \npatients.\n2.  To learn about the correlation between neuroradiological features and clinical \nfindings.\n3.  To understand the importance of imaging follow-up.\nA-502 16:23\nNew imaging techniques in the detection and quantification of brain \ndamage \nS. Sunaert; Leuven/BE (Stefan.Sunaert@uz.kuleuven.ac.be) \nThis talk will cover the use of new magnetic resonance imaging techniques in the \ndetection and quantification of brain damage. Susceptibility weighted imaging has \nbecome standard in the detection of microbleeds and diffuse axonal injury. More \nsubtle changes in brain function and connectivity can be studied by the combination \nof fMRI, resting state fMRI and diffusion tensor imaging. These can be used at the \nstage of diagnosis, but also have a role in the prediction of outcome and follow-up \nof brain plastic changes after injury. \nLearning Objectives:\n1.  To consolidate knowledge of new advanced imaging techniques.\n2.  To learn about quantifying brain damage using these techniques.\n3.  To understand the challenges of performing MR examinations in these patients.\nA-503 16:41\nAdvanced imaging of brain trauma: outcome prediction \nD. Galanaud; Paris/FR (galanaud@gmail.com) \nDetermining the prognosis of a patient with severe traumatic brain injury (TBI) \nat the acute phase remains challenging. MRI is now considered the method of \nchoice to address this issue. Sequences such as diffusion tensor imaging, MR \n\nPostgraduate Educational Programme\nS11\nB\n C D E F G\nA\nSunday\nview) and the increased workload and possibly fatigue to the radiologists. CAD has \nbeen shown to reduce radiologists‘ false negatives in screening mammography. It \ncan be expected that CAD may be useful for DBT interpretation. DBT in clinical use \nis still at an early stage. Although the impact of CAD on DBT interpretation has not \nbeen reported, some important issues associated with CAD use can be expected \nbased on the experiences in screening mammography. In this talk, the potential \nusefulness of CAD in DBT and the issues as observed from the reported prospective \nstudies of CAD use in the clinic will be discussed, including the potential impact of \noff-label use (i.e., CAD systems approved as second reader used as concurrent or \nfirst reader), user training, and quality assurance of CAD performance. Because of \nthe increased reading time for DBT, there will be an even stronger tendency that \nradiologists may want to use CAD as a concurrent or even first reader to improve \nworkflow. To have a CAD system for such intended use, much more stringent \nrequirements for the standalone performance of the CAD system and properly \ndesigned studies to evaluate its impact as a concurrent or first reader should be \nrequired before the CAD system can be approved for clinical use with DBT.\nLearning Objectives:\n1.  To learn about the challenges of DBT interpretation in clinical practice.\n2.  To understand the potential impact of computer-aided detection on DBT.\n3.  To learn about CAD as a second reader to improve DBT sensitivity.\n4.  To appreciate CAD as a concurrent reader to improve DBT workflow.\nPanel discussion:  \nDigital breast tomosynthesis: replacing or just supporting standard \nmammography? 17:14 \n16:00 - 17:30 Room G/H \nNeuro \nRC 1511 \nEpilepsy: a lack of knowledge can be dangerous \nModerator: \nM.A. Papathanasiou;  Athens/GR \nA-509 16:00\nA. Anatomy of the limbic system \nT.A. Yousry; London/UK (t.yousry@ucl.ac.uk) \nThe anatomy of the limbic lobe and system can be seen as being composed of \n2 main structures: the limbic and the intralimbic gyri. 1. The limbic gyrus is com-\nposed of the subcallosoal gyrus anteriorly, followed in an arc by the cingulated \ngyrus, isthmus and finally the parahippocampal gyrus. The latter is composed \nof 2 parts: i) a posterior narrow segment, the superior surface of which is called \nsubiculum, and ii) a more voluminous anterior segment, also known as the piriform \nlobe. The latter consist of the anterior part of the uncus and the entorhinal area. \n2. The intralimbic gyrus arches within the limbic gyrus. It is divided into 3 parts: i) \nanterior (prehippocampal rudiment); ii) superior (indisium griseum); and iii) inferior \n(hippocampus). The latter consist of 2 lamina rolled inside each other: the cornu \nammonis and the dentate gyrus, with the cornu ammonis consisting of 4 neuronal \nfields (CA1-4). We will review the MRI characteristics of these structures and their \nrelationships with each other, using 1.5 T, 3 T and 9.4 T high field imaging. At the \nend of this lecture, you will know the major subdivisions of the limbic lobe/system \na will be able to identify them on MRI.\nLearning Objectives:\n1.  To learn the components of the limbic system.\n2.  To understand the structure of the hippocampus proper.\n3.  To become familiar with the imaging characteristics at 1.5 T, 3 T, and 9.4T.\nAuthor Disclosure:\nT. A. Yousry: Advisory Board; Biogen Idec. Author; T Yousry. Board Member; \nEuropean Eadiology. Research/Grant Support; MS Society of Great Britain \nand Northern Ireland, MRC, Wellcome Trust, Stroke Association, British \nHeart Foundation, UCL/UCLH Biomedical Research Centre, Biogen Idec, \nGlaxoSmithKline, Novartis. Speaker; ESOR, King Abdullah Medical City. \nA-510 16:30\nB. Temporal lobe epilepsy \nI.N. Pronin; Moscow/RU (pronin@nsi.ru) \nNeuroimaging is essential in the work-up of patients with temporal lobe epilepsy \n(TLE) because in majority of the cases, the structural lesions causally related to \nthe epilepsy are small and the success of the surgery is directly dependent on the \n2.  To learn about DBT clinical performance and potential clinical applications.\n3.  To understand if CAD could be successfully applied compensate for the time \nrequired to review DBT images.\nA-506 16:05\nOptimisation of image acquisition and reconstruction in DBT \nM.J. Yaffe, J.G. Mainprize; T oronto, ON/CA (Martin.Yaffe@sri.utoronto.ca) \nDigital breast tomosynthesis (DBT) is an extension of digital mammography (DM) \nand is typically built on a DM platform. To accomplish tomosynthesis image acquisi-\ntion, the x-ray tube moves over a range of angles about a pivot point located above \nthe digital detector to obtain a series of low-dose digital projection radiographs. \nThe detector may be stationary or (in the isocentric design) also rotate about the \npivot point. The x-ray tube may temporarily halt as each projection is acquired or \nmay move continuously during acquisition. From the set of projection images, an \nalgorithm reconstructs a quasi three-dimensional representation of the x-ray at-\ntenuation properties of the breast tissues. As in CT, the reconstruction algorithm \nmay be based on an iterative approach or employ Fourier methods or filtered back \nprojection. Constraints may be applied to speed or simplify the reconstruction. The \nreconstructed images are often viewed as a “movie-loop” where adjacent x-y planes \n(parallel to the x-ray detector) are displayed sequentially. Because a complete \nrange of angular data is not obtained, the dataset is highly undersampled, giving \nrise to artefacts. Typically in DBT, the spatial resolution in the x-y plane is quite \nhigh while it is coarser in the z (x-ray tube to detector) direction. The quality of \nthe reconstructed image and the dose to the breast are dependent on the angular \nrange and number of projections, the dose used per projection and the perform-\nance of the x-ray detector and electronics. In this presentation an approach to \noptimization will be discussed. \nLearning Objectives:\n1.  To understand DBT principles.\n2.  To learn about DBT acquisition and optimisation.\n3.  To understand DBT reconstruction algorithms.\n4.  To become familiar with radiation dose from DBT.\nAuthor Disclosure:\nM. J. Yaffe: Equipment Support Recipient; GE Healthcare. J. G. Mainprize: \nEquipment Support Recipient; GE Healthcare. \nA-507 16:28\nCurrent role of DBT in diagnostic imaging \nS. Zackrisson, K. Lång, A. Tingberg, P. Timberg, D. Förnvik, M. Dustler, \nI. Andersson; Malmö/SE (sophia.zackrisson@med.lu.se) \nThe sensitivity of mammography for the detection of breast cancer is less than \noptimal. One of the main reasons is that a 3D structure (the breast) is projected \non to a 2D plane (radiographic image) meaning that the normal breast tissue \ncan conceal a tumour especially if the breast tissue is “dense”. Digital breast \ntomosynthesis, DBT, is a three-dimensional radiographic technique which may \nreduce the impact of overlapping tissues in breast cancer detection. The aims \nof this presentation are: 1. to describe the potential impact of DBT on sensitivity \nand specificity of breast cancer detection. 2. To illustrate limitations of DBT and its \nimpact on image interpretation time and effort. 3. To discuss if DBT is applicable to \nscreening. A review of the current literature and studies on diagnostic and screen-\ning DBT will be presented. DBT is a promising tool in breast imaging. However, \nfurther evidence from the ongoing trials is needed to establish its place in breast \ncancer diagnosis and screening.\nLearning Objectives:\n1.  To understand the potential impact of DBT on sensitivity and specificity of \nbreast cancer detection.\n2.  To appreciate limitations of DBT and its impact on image interpretation time \nand effort.\n3.  To understand if DBT is applicable to screening.\nAuthor Disclosure:\nS. Zackrisson: Research/Grant Support; Swedish Cancer Foundation, Swedish \nResearch Council. \nA-508 16:51\nClinical aspects of computer aided detection and diagnosis in DBT \nH.-P. Chan; Ann Arbor, MI/US (chanhp@umich.edu) \nDigital breast tomosynthesis (DBT) can potentially increase the sensitivity and \nreduce recall rate in breast cancer screening. However, the chance of oversight \nmay not be negligible because of the very large search space (~50-80 slices per \n7\n\nPostgraduate Educational Programme\nS118\n C B D E F\n G\nA\nA-513 16:05\nA. Coronary CTA in patients with severe arrhythmias and high heart rate \nC. Loewe; Vienna/AT (christian.loewe@meduniwien.ac.at) \nBeside all advances in scanner technology, heart rate remains a critical issue for \ncoronary CTA and motion artifacts due to cardiac function represent still the most \nfrequent reason for limited diagnostic image quality in cardiac CTA. Thus, heart rate \ncontrol by medical treatment is standard of care for cardiac CTA. The target heart \nrate is defined depending on the scanner system used and ranged below between \n60 and 70 bpm. However, there are patients and conditions, where a heart rate \ncontrol is not possible or not successful, whereas a relevant proportion of CTA’s \nare performed in patients with heart rates higher than the target frequency including \nchildren, emergency patients, patients suffering from severe COPD and/or heart \ntransplant recipients. Scanning at higher heart rates has severe implications for \nscan protocol selection and on dose saving strategies. During this presentation, \npossibilities for heart rate control beyond beta blockers should be discussed and \nexamination strategies for patients with high heart rates will be presented. Different \nto high heart rates and even more critical with regard to image quality is arrhythmia. \nDue to the complexity of cardiac synchronization, a CT suite is not the place for \ncardiac resynchronization, whereas the indication to CTA has to be reevaluated \ndepending on referring diagnosis and severity of arrhythmia. Since there are patients \nundergoing CTA because of arrhythmia including patients prior to ablation treatment, \nstrategies for examination and image reconstruction in case of arrhythmic patients \nhave to be established and will be presented during this presentation.\nLearning Objectives:\n1.  To understand the criteria for optimal patient selection and preparation to \nachieve best results.\n2.  To learn about acquisition techniques in patients with arrhythmias and tachy-\ncardia.\n3.  To become familiar with the post-processing techniques available for optimising \nimages quality following the scan.\nAuthor Disclosure:\nC. Loewe: Board Member; steering committee member B;S (Apixaban studies). \nInvestigator; investigator in different multicenter trials sponsored by BMS, \nGuerbet, GE Healthcare, Bayer. Speaker; speaker for Siemens, Bracco, GE \nHealthcare, Bayer, Guerbet, Covidien. \nA-514 16:28\nB. Severe coronary calcinosis and stents: tips and tricks in image \nacquisition and interpretation \nF. Pugliese1, A. Rossi2; 1London/UK, 2Trieste/IT (francesca.pugliese@libero.it) \nCardiac computed tomography (CT) has become a widely available diagnostic tool \nused in a range of heart conditions. The commonest application of this technique \nis the evaluation for coronary artery patency (coronary CT angiography) in patients \nwith chest pain. When coronary arteries are heavily calcified, or post-coronary \nangioplasty with stent implantation, diagnostic problems can occur. In these \ncircumstances, the evaluation of the coronary arteries on CT is hampered by the \noccurrence of high-density artefacts caused by calcifications and stent struts. These \nartefacts may preclude the appropriate assessment of the coronary lumen. The \npresence of motion artefacts in the dataset, or image noise in very large patients \nmay exacerbate the problem. In this scenario, accurate patient selection and \npreparation remain key to ensure that the diagnostic yield of the cardiac CT study \nis good. Optimisation of scan parameters (kV, mAs), contrast injection protocol and \nuse of appropriate post-processing techniques (e.g. dedicated convolution filters) \nplay an important role in daily clinical practice. Recent technical developments \ninclude dual-energy scan techniques and gemstone spectral detector systems that \nacquire simultaneously high and low kilovoltage datasets. This is done to achieve \ntissue differentiation. In principle, by using monochromatic image reconstruction \nthe effect of high-density artefacts may be decreased. Using a similar principle \nhigh-density structures can be subtracted from the image. The introduction of \niterative reconstruction algorithms may play a role because these algorithms are \ntheoretically more accurate in the modeling of physical noise and tissue geometries. \nLearning Objectives:\n1.  To understand the challenge of calcification and stents when performing \ncoronary CTA.\n2.  To become familiar with technical features that maximise image quality in this \npatient group.\n3.  To be aware of the accuracy of coronary CTA in stented or calcified vessels \nwith the optimum imaging techniques.\naccuracy of these lesions’ identification. For this reason, there has been ongoing \ninterest in utilising new advanced imaging techniques to improve the ability to \nidentify, diagnose, characterise and delineate the epilepsy cause. Structural high-\nresolution MRI commonly reveals the structural basis of partial seizures. In a case \nwith TLE, there are different disorders such as hippocampal sclerosis, long-term \nepilepsy-associated tumours, focal cortical dysplasias, vascular malformations, \nencephalitis, gyral scarring and so on. Functional imaging, however, can demon-\nstrate the pathophysiological processes that occur in epilepsy. MRS allows the \n“in vivo” assessment of brain metabolism on the basis of investigation of various \ncerebral metabolites involved in a variety of neuronal processes that occur in TLE. \nDWI and DTI are sensitive tools to identify microstructural changes and integrity in \nthe white brain matter. fMRI offers the possibility to assess the physiologic proc-\nesses of neuronal activity to be measured in terms of local brain volume, flow, and \noxygen saturation. The traditional radiotracer methods such as SPECT and PET \nhave been used in attempt of noninvasive assessment of cerebral blood flow and \nenergy metabolism caused by neuronal activity. MEG increases the MRI sensitivity \nin detection of subtle or invisible epileptogenic foci on structural MRI. \nLearning Objectives:\n1.  To become familiar with MR-characteristics of neoplastic and non-neoplastic \ncauses of temporal lobe epilepsy.\n2.  To learn about optimised imaging protocol.\n3.  To appreciate the potential impact of modern MR-imaging techniques to \nimprove visualisation of structural brain changes.\nA-511 17:00\nC. fMRI in epilepsy \nN. Bargalló; Barcelona/ES (bargallo@clinic.ub.es) \nFunctional MRI (fMRI) is a non-invasive tool that is capable to detect the subtle \nhomodynamic changes produced in regional brain activation. The main fMRI \nclinical application until now is localisation and evaluation of brain eloquent areas \nin surgical planning of brain pathology. fMRI application in epilepsy patients are \nlanguage lateralization, memory function assessment and localisation of ictal and \ninterictal BOLD changes. There are several factors that can influence the results \nof a fMRI experiment such as the scan noise for the rest condition, the simplicity \nof the task performance, the monitoring of the experiment during the exam, how to \nachieve a real baseline condition and the most important, to use the most specific \nparadigm that would activate the selected brain areas. In practical approach, one \nmust be aware that sometime fMRI studies are applied in paediatric or impaired \ncognitive epilepsy population when deciding the language or memory paradigm, \nand is recommended to use multiple and feasibility tasks to assure the results. \nfMRI for language lateralization is currently used in the clinical practice and pro-\nvides comparable results to the intracarotid amobarbital test (IAT). In fMRI studies \nfor memory function assessment, results show changes in epileptic patients, but \nfurther studies are required to validate this technique to an individual level. A new \napplication is ictal or interictal fMRI with EEG recorded that provide more detailed \ninformation about simultaneously electrographic and homodynamic changes in \nthe seizure process, with encouraging results for epileptogenic area localisation \nand propagation patterns. \nLearning Objectives:\n1.  To become familiar with the application and limitations of fMRI.\n2.  To appreciate technical aspects and interpretation of fMRI for language locali-\nsation and memory testing.\n3.  To consolidate of advanced fMRI applications.\n16:00 - 17:30 Room I/K \nCardiac \nRC 1503 \nCardiac CT and MRI in difficult patients: what to do? \nA-512 16:00\nChairman’s introduction \nM. Hamilton; Bristol/UK (Mark.Hamilton@UHBristol.nhs.uk) \nWhat is a difficult patient? It is perhaps easier to state that an easy patient is a 70 kg \nmiddle-aged healthy adult. Why? Slim, can breath hold, calm, has a slow steady \nsinus rhythm with no sinus arrhythmia. Almost everyone else can be a problem. \nAnxiety, obesity, breathlessness, arrhythmia, small size, high heart rates can all \ncause problems and may require the examination to be modified accordingly. This \nsession will assist you to get the best out of your patients and scanner. \n\nPostgraduate Educational Programme\nS119\nB\n C D E F G\nA\nSunday\nLearning Objectives:\n1.  To become familiar with technical dose parameters in CT.\n2.  To understand how to assess patient dose.\n3.  To be informed about the role of diagnostic reference levels in CT.\nA-517 16:30\nB. New frontiers in CT: functional and spectral imaging \nN. Pelc; Stanford, CA/US (pelc@stanford.edu) \nRecent advances have generated renewed interest in dual energy CT and CT-\nperfusion imaging. This presentation will discuss the basic principles, and the \nstrengths and limitations of the techniques and implementations of multi-energy \nmethods for material characterisation, and of CT methods for imaging tissue per-\nfusion. Conventional CT measures the linear attenuation coefficient at one energy \nand cannot uniquely identify tissue. Multi-energy imaging measures attenuation \nat different energies to more fully characterise materials. An important limitation \nis that in the diagnostic energy range, the attenuation is dominated by only two \ninteractions (Compton and photoelectric). While there can be residual ambiguity, \nspectral CT still provides important information. Measurements at two spectra \ncan be achieved using multiple kVp and/or filtration or with detectors with energy \ndiscrimination. These various approaches to obtain energy dependent measure-\nments have different dose efficiency and different sensitivity to subject motion. The \nsimplest method to process the multi-energy data reconstructs CT images from each \nspectrum and performs the multi-energy analysis on the reconstructed images. A \nsomewhat preferred method performs energy dependent processing on the raw \nprojections prior to reconstruction. Hybrid methods are now available. To measure \nperfusion with CT, images are acquired dynamically following the injection of a \ncontrast agent and physiological models are used to convert the measured contrast \nagent concentration to perfusion estimates. Both dual energy and perfusion CT \nacquire multiple images, and so issues of radiation dose are relevant. Acquisition \nprotocols can be optimised to mitigate these concerns.\nLearning Objectives:\n1.  To learn about new developments in functional and spectral CT imaging.\n2.  To learn about impact on patient dose.\nAuthor Disclosure:\nN. Pelc: Advisory Board; Samplify, Inc. Board Member; RTR, Inc. Research/\nGrant Support; GE Healthcare. Shareholder; GE. \nA-518 17:00\nC. New image reconstruction techniques \nJ. Sijbers; Antwerp/BE (jan.sijbers@ua.ac.be) \nThe purpose of this presentation is to provide insight into novel reconstruction \ntechniques in computed tomography and to discuss their impact on dose. Next \nto very fast, analytic reconstruction methods, iterative algebraic reconstruction \nmethods are emerging, which are computationally much more demanding, but far \nmore flexible and promising. These methods often exploit prior knowledge to either \nincrease image quality or reduce dose. A short overview of standard and emerging \ntechniques will be given. Compared to analytic reconstruction methods, iterative \nreconstruction algorithms have the potential to reduce patient dose. Moreover, \nthese methods are suited for multiple acquisition geometries. Thanks to the avail-\nability of parallel processing hardware and efficient computational tools, iterative \nreconstruction methods are becoming increasingly popular. Future developments \nare promising for dose reduction as well as quality improvement of CT images. \nLearning Objectives:\n1.  To understand the principles of iterative reconstruction techniques in CT.\n2.  To learn about novel algorithms.\n3.  To learn about the impact on patient dose.\nA-515 16:51\nC. Cardiac MRI: possible problems and how to avoid them \nE. Mershina; Moscow/RU (elena_mershina@mail.ru) \nLack of movement artifacts is one of major prerequisites for getting good image \nquality in cardiac MR. Data acquisition should be synchronized with patient’s ECG \nor pulse. Special attention should be paid to good quality of ECG recordings and \nrecognition of artifacts related to influence of permanent and alternating magnetic \nfields during examination. It is more difficult to perform cardiac MRI in patients \nwith atrial fibrillation or frequent extrasystoli then in ones with sinus rhythm. In \npatients with arrhythmia prospective ECG synchronization should be used instead \nor retrospective one or special antiarrhythmic protocols may be designed. Breath-\ning artifacts usually are not a problem for cardiac MRI because most sequences \nare acquired during a single breath-hold. Using SSFP and parallel imaging allows \nto obtain a complete set of cine MR images through the whole heart in 1-8 short \nbreath-hold periods. Possible way to perform successful examinations in difficult \npatients, especially the ones with heart failure, is a technique of real-time cardiac \nMR. To meet the challenges and the benefits of cardiac MRI one must balance \nthe constraints of signal-to-noise ratio, contrast-to-noise ratio, spatial and tempo-\nral resolution, scan time and image quality. Radiologist performing cardiac MRI \nshould be aware of specific flow artifacts which are more prominent in case of 3 T \nsystems. They should not be misinterpreted as inracardiac masses or abnormal \nflow jets. Late-enhancement studies with Gd are very dependent on correct selec-\ntion of TI time. Modern MR scanners allow getting good cardiac images even in \nvery difficult cases.\nLearning Objectives:\n1.  To learn the importance of patient selection and preparation in achieving high \nquality scans.\n2.  To understand the practical techniques available for performing a successful \nscan in difficult patients such as those with arrhythmia or poor breath-holding \nability.\n3.  To learn how imaging parameters can be changed for optimal results.\nPanel discussion:  \nWhen to scan and when not to? How can we make the best of what \nwe have? 17:14 \n16:00 - 17:30 Room L/M \nPhysics in Radiology \nRC 1513 \nNovel developments in CT and their impact on dose \nModerators: \nM. Prokop; Nijmegen/NL \nV. Tsapaki; Athens/GR \nA-516 16:00\nA. Patient dose assessment in CT \nP.C. Shrimpton; Didcot/UK (paul.shrimpton@hpa.org.uk) \nCT remains a particular focus for efforts in radiological protection owing to its steadily \nincreasing clinical application and the relatively high patient doses. Dosimetry is \nan essential element within good CT practice in order to allow the assessment of \ntypical radiation risks in support of the justification of procedures, and the routine \nmonitoring and comparison of typical doses in pursuit of the optimisation of patient \nprotection. The practical basis for dosimetry in contemporary CT remains the \n(updated) CT dose index (CTDI100), measured in either free air or the standard \nCT dosimetry phantoms. These latter measurements underpin the dose indicators \ncommonly displayed by the CT scanner: volume-weighted CT dose index (CTDIvol) \nand dose-length product (DLP). Whereas these quantities are not patient doses, \nthey nevertheless provide useful characterisation of each CT exposure in order \nto allow comparison of practice and facilitate improvements in patient protection. \nTypical levels of CTDIvol and DLP at each CT centre, periodically determined as \nthe mean values observed for representative samples for each patient group and \ntype of examination (and associated clinical indication), should be adopted as local \ndiagnostic reference levels (DRLs). These should be subject to periodic review \nand compared with both corresponding national DRLs and also practice at other \nCT centres in pursuit of optimised patient protection. When required, estimates of \ntypical organ and effective doses to reference patients from standard CT examina-\ntions can be made on the basis of appropriate dose coefficients normalised to the \ndose indicators (CTDIair, CTDIvol or DLP). \n\nPostgraduate Educational Programme\nS12\n C B D E F\n G\nA\nA-521 17:00\nC. CT and MRI of the neck: how to address key clinical questions \nD. Farina; Brescia/IT (nappaje@yahoo.it) \nAccurate assessment of neck pathology requires a systematic approach which \nstarts from the application of appropriate scanning strategies. MRI of the neck \ncan be challenging, due to intrinsic difficulties posed by the anatomy of this region. \nScans may be severely degraded by motion artefacts because neck immobility \nis simultaneously affected by breathing, swallowing, coughing. Magnetic field in-\nhomogeneities, particularly marked at the junction between supra- and infrahyoid \nneck may result in very poor fat suppression and gross anatomic distortion on \nDWI. Spatial and, even more, contrast resolution are somehow weakened by the \ndistance between the neck coil and its target. All these drawbacks can be efficiently \ncontrolled selecting alternative coils, sequences, acquisition parameters if the \noperator is sufficiently flexible to tailor the protocol to the patient. CT is overall less \ndemanding, however, appropriate management of acquisition phases (particularly \nplain and arterial phase) may optimise the information provided by the technique. \nKnowledge of the anatomy of the neck is pivotal to image interpretation: the \nspace-based classification offers a shortcut to diagnosis because once the space \nof origin of the lesion is established, the list of differentials invariably narrows. The \ndiscrimination between solid, cystic or fatty content (relatively easy on both MRI \nand CT) offers further clues to the diagnosis. Furthermore, the identification of the \nspace of origin of the lesion allows to predict its pattern of growth and its relation-\nships with vessels and nerves. All these information is what the clinician needs to \nknow to plan further diagnostic steps and therapy. \nLearning Objectives:\n1.  To understand key clinical questions.\n2.  To learn how to do a structured reading of the CT and MRI scans of the head \nand neck.\n3.  To become familiar with reporting in order to address the needs of the clinician.\n16:00 - 17:30 Room P \nRadiographers \nRC 1514 \nHybrid imaging technologies \nModerators: \nC.D. Claussen; Tübingen/DE \nC. Malamateniou;  London/UK \nA-522 16:00\nA. Recent developments \nS. Rep; Ljubljana/SI (sebastijan.rep@guest.arnes.si) \nPositron emission tomography (PET) and single photon emission computed \ntomography (SPECT) systems are used to image accumulation and distribution \nof radiopharmaceuticals to provide physiological information for diagnostic and \ntherapeutic purposes. However, these images often lack sufficient anatomical \ndetail, a fact that has triggered the development of a new technology termed hybrid \nimaging. Hybrid imaging is a term to describe the combination of x-ray computed \ntomography (CT) systems and magnetic resonance imaging (MR) with nuclear \nmedicine imaging devices (PET and SPECT systems) in order to provide the tech-\nnology for acquiring images of anatomy and function in a registered format during \na single imaging session with the patient positioned on a common imaging table. \nThere are two primary advantages to this technology. First, the x-ray transmission \nimages acquired with CT can be used to perform attenuation correction of the PET \nand SPECT emission data. In addition, the MR and CT anatomical images can be \nfused with the PET and SPECT functional images to provide precise anatomical \nlocalisation of radiopharmaceuticals. Technology and problems common to SPECT/\nCT and PET/CT are respiratory motion, quantification, radiation dose considera-\ntions, CT-based attenuation correction, contrast CT or metallic parts and motion \nbetween or during studies. Advances in SPECT and PET include the introduction \nof a new PET and SPECT scintillators and processing software. In general, the \ncombination of PET or SPECT with CT or MRI may lead to new insights in research \nand novel clinical applications. \nLearning Objectives:\n1.  To become familiar with the basic principles of hybrid imaging.\n2.  To learn about the newest techniques in hybrid imaging.\n3.  To understand the potential technical implications of the use of hybrid imaging.\n16:00 - 17:30 Room N/O \nHead and Neck \nRC 1508 \nPerforming and reporting head and neck \nexaminations: how should I do it? \nModerator: \nK. Šurlan Popovič;  Ljubljana/SI \nA-519 16:00\nA. Sinonasal CT scans: technique and evaluation \nH.B. Eggesbø; Oslo/NO (h.b.eggesbo@medisin.uio.no) \nComputed tomography (CT) is the primary modality in paranasal sinus imaging. \nIn “screening sinus CT” radiation dose can be as low as 20  mAs. However, opti-\nmal imaging of rhinosinusitis, fungal sinusitis, and tumour needs radiation dose \n> 50 mAs. Additional imaging techniques that are mandatory are: 1. axial volume \nuptake in order to keep dental filling artefacts to the axial plane. Coronal volume \nuptake cause dental filling artefacts into the maxillary sinuses and can obscure \nodontogenic cause to maxillary sinusitis. 2. Image reformation in several planes \naxial/coronal/sagittal/oblique is valuable to delineate pathology. 3. Bone algorithm \nis standard, but additional soft tissue algorithm can detect small calcifications in \na fungus ball (mycetoma), high attenuation of pus-filled sinuses and inspissated \nmucus in allergic fungal sinusitis, and fatty tissue obliteration outside the sinuses \nin invasive fungal sinusitis. 4. Slice thickness should be no more than 3 mm, while \n0.625 mm is optimal for evaluating bone erosion or odontogenic cause to sinusitis. \nApproach to a systematical interpretation: 1. Development of the 4-paired sinuses. \n2. Pneumatisation variants that may interfere with mucociliary transport: concha \nbullosa, agger cells, infraorbital cells, and large ethmoid bulla. Sphenoethmoidal \ncells and anterior clinoid process pneumatisation may contain the optic nerve. 3. \nAnatomical variants: nasal septum deviation, accessory maxillary sinus ostium \n(often misinterpreted as surgical procedure), low ethmoid roof/deep olfactory \nfossa that can cause cranial perforation during surgery. 4. Last and important, to \ndiscriminate sporadic findings from conditions that need follow-up as inflammatory \npatterns of chronic rhinosinusitis, fungal sinusitis and tumours.\nLearning Objectives:\n1.  To learn how to perform a state-of-the-art CT examination of the sinuses.\n2.  To understand how to evaluate and what to report on CT examinations of the \nsinuses.\nA-520 16:30\nB. Temporal bone: CT and MRI \nM.M. Lemmerling; Gent/BE \nCT examination of the temporal bone: temporal bone CT scans should be performed \nin a reproducable way. Axial reconstructions are made in the plane of the lateral \nsemicircular canal, and coronal reconstructions exactly perpendicular to this plane. \nThin-sliced images are postprocessed using high-resolution algorithms. MR exami-\nnation of the temporal bone: the challenge is to perform a complete examination. \nThe standard version of such an exam starts with axial T2-weighted images of the \nbrain and posterior fossa, and axial T1- and heavily T2-weighted images covering \nthe temporal bone. After intravenous injection of gadolinium axial and coronal T1-\nweighted images are performed. Temporal bone report on CT and MRI. Structured \nreporting is the result of structured viewing. In the evaluation of the middle ear on \nCT examinations, it is best to follow the sound wave on the axial images (from \ntympanic membrane over malleus, incus and stapes to oval window) than inspect \nthe fissula antefenestram region and the oval window. The inner ear is evaluated \nfrom cranially to caudally (semicircular canals, vestibule and vestibular aqueduct, \ncochlea and cochlear aqueduct). The facial canal, carotid canal and jugular fossa are \nfinally evaluated. On the coronal images, one should at least inspect the intactness \nof tegmen tympani and the bony cover of the lateral semicircular canal. On MRI, \nafter viewing the brain images, one best first tries to detect abnormal enhancing \ninner ear structures on the gadolinium-enhanced T1-weighted images, and than \nexplains them using the heavily T2-weighted images.\nLearning Objectives:\n1.  To learn how to perform a state-of-the art CT and MRI examination of the \ntemporal bone.\n2.  To learn how to create a complete temporal bone report.\n0\n\nPostgraduate Educational Programme\nS121\nB\n C D E F G\nA\nSunday\n16:00 - 17:30 Room Q \nPaediatric \nRC 1512 \nPaediatric MSK radiology: what is important? \nModerator: \nM. Raissaki; Iraklion/GR \nA-525 16:00\nA. Scoliosis: what the radiologist needs to know \nJ.-F. Chateil, S. Missonnier; Bordeaux/FR \n(jean‑francois.chateil@chu‑bordeaux.fr) \nDisorders of the spinal posture are common in children and adolescents. Scoliosis \nmay be primitive, structural, particularly during adolescence; during this period, \ncareful follow-up is mandatory, because worsening is frequent. Scoliosis can also \nbe secondary, and imaging is important to find a cause and adapt management. \nAmong the aetiologies, radiologist must recognize spine malformations, dysplastic \nand neuromuscular scoliosis. In addition, scoliosis may also be secondary to a \nprimitive lesion, tumour-related or not, whether the initial disease could be within \nthe spinal canal, spinal or paravertebral. The initial clinical examination is essential, \nand must be completed first with AP and lateral full spine x-rays, if possible with a \nlow dose device (flat panel, slot-scanning system), keeping in mind that follow-up \nwith repetitive exposures may be necessary. Reproducible measures of different \ncurvatures help to assess the overall static spine and the importance of scoliosis with \nCobb angle. The assessment of axial rotation can be obtained through 3D simula-\ntions. Morphologic evaluation of the spine is mandatory: if a secondary scoliosis \nis suspected, the research to aetiology needs to perform CT or MRI, depending \non the clinical signs. Similarly, these explorations are useful in the preoperative \nassessment when surgical treatment is necessary. \nLearning Objectives:\n1.  To learn about the aetiology of scoliosis.\n2.  To become familiar with imaging findings, measurements and follow-up.\n3.  To understand how to report imaging findings.\nA-526 16:30\nB. Benign bone tumours and pseudotumours in children: the pitfalls \nK.J. Johnson; Birmingham/UK (karl.johnson@bch.nhs.uk) \nWhile assessing any bone lesion in a child, the first consideration is in determin-\ning whether it is pathological or a normal variant. For those pathological lesions, \nit is then very important to determine those that are aggressive/malignant and \nthose that are benign. This presentation will highlight those features that classify \na bone tumour as being benign. In addition, the spectrum of imaging abnormalities \nwhich may mimic tumour (so-called pseudo-tumours) will also be discussed. The \nimportance of good quality radiographs as the initial modality of choice will be il-\nlustrated and reference to the need and value of other modalities as required in the \ndiagnostic pathway will be covered. The presentation will emphasise the different \nradiological findings which would be expected depending on the age of the child. \nThe importance of recognising post-traumatic changes and pathological fractures \nwhich occur as a consequence of an underlying bony lesion will be considered. \nThe aim is to provide an illustrative review of an approach to a skeletal lesion, \nrecognising normal variants, identifying typical benign lesions and understanding \ntheir relationship with trauma and infection.\nLearning Objectives:\n1.  To recognise the most common benign bone tumours and pseudotumours.\n2.  To understand the differences between benign bone and pseudo tumours and \nmalignancies in children.\n3.  To understand imaging modalities that could help in the differential diagnosis \nof benign bone tumours and pseudo tumours in children.\nA-527 17:00\nC. Congenital bone dysplasias \nA.C. Offiah; Sheffield/UK (amaka.offiah@nhs.net) \nBy the end of the session, delegates will understand the radiological investigations \nthat should be performed when a dysplasia is suspected. The latest classifica-\ntion system will be reviewed and the requirements of the radiology report will be \nhighlighted. Delegates will be led through the process of interpreting the imaging, \nA-523 16:30\nB. Clinical applications \nT. Lindner; T ernitz/AT (63629@fhwn.ac.at) \nHybrid imaging is not anymore a specialty for research purposes only. It is more and \nmore coming into clinical routine and in the last few years, multimodality devices \nhave started replacing single modality imaging devices in the clinical workflow. The \nfirst part of the presentation will be a short overview of the devices and technologies \nused for hybrid imaging in human medicine. Starting from a short introduction of \nSPECT-CT, the main part will be the PET-CT and a little introduction to the topic of \nMR-PET. The main topics covered here are the main indications in clinical routine, \nlike oncology (primary tumours and metastasis), metabolic disorders, cardiac \npathologies, etc. The second part presented are the major benefits and drawbacks \nof hybrid-imaging devices. The topics covered are the overall costs, the logistics, \nthe availability of the devices, a short overview of the radiation dose to which the \npatient is exposed in the different devices and the diagnostic outcome. In this part \nalso, a comparison to single modality devices is given, including two single acquisi-\ntions on two devices for retrospective hybrid imaging (Image Fusion). The last part \npresented are clinical case studies. Here, the major part is also a comparison of \nsingle modalities to hybrid imaging. In this part, the presented benefits and draw-\nbacks will be shown on examples of real clinical patients in the daily workflow. In \nthe end, a conclusion is given and also a future outlook of methods coming into \nclinical routine in the next few years.\nLearning Objectives:\n1.  To become familiar with the major clinical applications of hybrid imaging.\n2.  To understand its benefits and drawbacks compared with a single modality.\n3.  To become familiar with some case studies.\nA-524 17:00\nC. Trends in radiography education \nP. Hogg; Manchester/UK (P .Hogg@salford.ac.uk) \nEducational challenges continue to be difficult to address and with an emphasis on \nhybrid imaging and radiographer/nuclear medicine technologist (NMR/T) roles, this \npresentation will explore some of these issues. Practice varies significantly between \nand within European countries. Legal and cultural challenges can be difficult to \novercome and our ambition here should lie with enhancing the patient experience \nwhilst maximizing physical and human resource. Legal restrictions in some countries \ndo not allow NMTS to make x-ray exposures and clearly a change in law would be \nnecessary to redress this. Roles need to - to reflect the nature of hybrid imaging. For \ninstance, after SPECT acquisition, a decision may need to be taken to justify CT. \nEmphasizing the importance of patient experience, such decisions should be taken \nappropriately by suitably trained NMR/Ts / radiographers acting in an advanced \ncapacity. Alongside, NMR/Ts making x-ray exposures, justifying CT imaging after \nSPECT would require people to think differently and accept change and how it \nmay impact into their professional group. Extending from a focus on imaging, the \nhybrid department would need to centrally embrace the end user more than ever \nbefore. An example is illustrated for oncology, where the nuclear medicine and \noncology teams would need to work more closely. This will require multi-professional \nworking in which the NMR/T should play an important role in patient diagnosis and \nmanagement. Returning to curriculum design, it is worth noting that the skills and \nknowledge required for effective team working will need instilling. \nLearning Objectives:\n1.  To understand the impact on education.\n2.  To learn how these new requirements can be met by changes in the curriculum \nof educational institutions in Europe.\n3.  To understand what further changes in European laws, research infrastructure, \nand collaboration might be required to strengthen and protect the introduction \nof hybrid imaging in clinical practice.\n\nPostgraduate Educational Programme\nS12\n C B D E F\n G\nA\nby use of examples of the most common conditions from several of the broad \ngroups of dysplasias.\nLearning Objectives:\n1.  To understand the role of the radiologist in diagnosing congenital bone dys-\nplasias.\n2.  To understand how to classify bone dysplasias.\n3.  To become familiar with reporting radiological studies related to bone dyspla-\nsias.\nAuthor Disclosure:\nA. C. Offiah: Other; Committee Member Skeletal Dysplasia Group for Teaching \nand Research. \n2\n\nPostgraduate Educational Programme\nS12\nB\n C D E F G\nA\nMonday, March 11\n3\n\nPostgraduate Educational Programme\nS12\n C B D E F\n G\nA\nA-531 08:35\nAbdomen \nS.G.F. Robben; Maastricht/NL (s.robben@mumc.nl) \nThe most efficient way to learn is to make many mistakes and to be corrected \nshortly thereafter. Preferably without serious damage to the patient. Eventually, \nthe summation of these mistakes is called “experience”. The retention rate of this \nway of learning exceeds the retention rate of lectures (like this) many times. Until \nnow, this method has only been incorporated in medical curricula in virtual environ-\nments (for obvious reasons). \nLearning Objectives:\n1.  To become familiar with the most important differential diagnoses.\n2.  To learn about imaging strategies for children.\n3.  To understand the role, importance of, and information obtained, from ultra-\nsonography.\nA-532 08:58\nCNS \nB. Bernardi, T. Verdolotti; Rome/IT (bruno.bernardi@opbg.net) \nThree main categories of error are responsible for the majority of “missed” or \nmisinterpreted observation on diagnostic radiology: system-related (latent or \ntechnical, error), radiologist-related (active error in recognition, interpretation and/\nor judgment due to lack of knowledge in specific fields or to many other factors), or \na combination of both. In this lecture are presented active errors leading to missed \ndiagnosis, the most feared event for pediatric neuroradiologists but also a great \nopportunity for learning. Learning from errors requires a critical appraisal of our \nradiological practice and the implementation of a change aimed at improving our \nperformance, also through multidisciplinary meeting, particularly useful in paedi-\natric neuroradiology In the first months of life, MRI evaluation of the brain requires \nspecific knowledge about its normal development and optimised sequences for age \nand strength of the MR system; an insufficient satisfaction of such conditions may \nresult in failing to detect a lesion, in incorrect interpretation of a normal structure \nas a pathological finding or vice versa. In other cases, the abnormal finding is \nrecognised but its interpretation is incorrect. This is sometimes due to an incorrect \ntransmission of the clinical history or to the report of an earlier examination that can \nbe misleading. The increasing complexity of MRI of the CNS with ever increasing \nexpectations, the rarity of some neurological diseases and the spread of diseases \npreviously unusual in our Country, through migration and tourism, may be other \nsources of diagnostic errors. \nLearning Objectives:\n1.  To understand the significance of MR findings in a developing brain.\n2.  To learn how to avoid misinterpretations of easily detectable MR abnormalities.\n3.  To become familiar with the differential diagnosis of uncommon diseases.\nA-533 09:21\nMusculoskeletal \nK. Rosendahl; Bergen/NO (karen.rosendahl@helse‑bergen.no) \nThe role of skeletal imaging is to detect, and possibly quantify, any bone involve-\nment to secure a correct diagnosis, to search for complications to treatment and \nto guide further management. Growing bone is challenging, as bone structure, \nshape and size changes continuously until skeletal maturity. The numerous normal \nvariants of growth which may mimic pathology have been accurately described \nradiographically, but little is known on the appearances on magnetic resonance \nimaging (MRI). Thus, radiography remains an important method with a high spe-\ncificity for a number of diseases through “pattern recognition”. Its low sensitivity for \ncartilage, bone marrow and soft tissue involvement, however, has opened the way \nfor additional techniques, such as ultrasound, MRI, computed tomography (CT) and \nnuclear imaging. Mistakes do occur along the whole chain of events involved in \nimaging; from choosing the most appropriate modality and image protocol, to image \nprocessing, analysis and communication of the results. During this lecture, we will \nfocus on controversies regarding US screening programmes for developmental \ndysplasia of the hip, discuss some of the limitations of ultrasound in the assessment \nof soft tissue lesions, and of MRI in the assessment of juvenile idiopathic arthritis. \nLearning Objectives:\n1.  To become familiar with the various controversies regarding US screening \nprogrammes for developmental dysplasia of the hip.\n2.  To understand the value of ultrasonography in the study of the musculoskeletal \nsystem.\n3.  To learn how and when to use MRI for investigations and differential diagnosis.\n08:30 - 10:00 Room A \nInteractive Teaching Session \nE³ 1620 \nAcute abdominal inflammatory disorders \nA-528 08:30\nA. Colitis and enterocolitis \nD.J.M. Tolan; Leeds/UK (djmtolan@doctors.org.uk) \nThe imaging related to colitis and enterocolitis relies on detection of thickening and \nabnormal enhancement or blood flow to the large or small bowel. The main imaging \nmodalities in day to day use are ultrasound, CT and MRI. However, these augment \nendoscopic assessment which is the primary diagnostic evaluation of choice for \nbiopsy and histological confirmation. Imaging allows non-invasive global assess-\nment of the bowel and a search for complications, particularly outside the lumen \n(such as perforation, abscess or fistula). The patient clinical status and disease \ndistribution influence the likely differential diagnosis as much as the imaging signs. \nThis includes the length of symptoms and immune status as much as the degree of \nwall thickening, pattern of enhancement and location of the abnormality. Particular \nimaging signs include pneumatosis, a variety of enhancement patterns and extra \nintestinal features such as ascites. Specific conditions that will be covered include \ninflammatory bowel disease (Crohn’s disease vs ulcerative colitis), the immune \ncompetent patient (gastroenteritis and pseudomembranous colitis) immunocom-\npromised patient (neutropoenic enterocolitis and CMV colitis) as well as ischaemia.\nLearning Objectives:\n1.  To know how to choose the appropriate imaging modality.\n2.  To become familiar with the patterns of distribution and appearance in imaging.\n3.  To learn how to differentiate ischaemia from inflammation.\nA-529 09:15\nB. Liver and bile ducts \nC.D. Becker; Geneva/CH (Christoph.Becker@hcuge.ch) \nObstruction of the extra- or intra-hepatic bile ducts may occur in stone disease and \na variety of other benign or malignant pathologic conditions and may be complicated \nby acute cholangitis and pyogenic liver abscess. We review the role of the different \nradiologic techniques that are used in the context of obstructive jaundice and its \ncomplications and discuss the advantages and shortcomings of each modality with \nregard to the clinical situation and treatment.\nLearning Objectives:\n1.  To know the advantages of each imaging technique.\n2.  To become familiar with the findings in infrequent infections.\n3.  To learn how to study obstructive jaundice.\n08:30 - 10:00 Room B \nSpecial Focus Session \nSF 16a \nMy most beautiful mistakes in paediatric radiology \nA-530 08:30\nChairman’s introduction \nP. Tomà; Rome/IT (paolo.toma@opbg.net) \nThe only way that we can avoid making the same mistakes again is to learn from \nthem. The prevalence of errors in medical diagnosis has received increasing \nattention. Learning from mistakes is important to maintain and improve the qual-\nity of care and patient safety. The invited experts will focus on a single area of \npaediatric radiology. An expert is a person who has made all the mistakes that \ncan be made in a very narrow field. The interpretation of imaging in children is \nchallenging and requires knowledge of the normal appearance of the maturing \nanatomic structures that change with age. Special attention needs to be given to \nradiation protection in paediatric radiology: the speakers will examine all aspects. \nSession Objectives:\n1.  To become familiar with growth and development of newborns to teens.\n2.  To become familiar with the main pitfalls in paediatric radiology.\n4\n\nPostgraduate Educational Programme\nS125\nB\n C D E F G\nA\nMonday\nA-536 09:10\nC. GU complications in patients with spinal cord damage \nS. Agarwal; Wrexham/UK (sanaga28@hotmail.com) \nSpinal cord damage is a complex and devastating condition arising from trauma, \ntumours, ischaemia, infection and congenital causes. The management and \nfollow-up of these patients pose several challenges unique to this particular \ngroup. Urinary tract complications are one of the commonest causes of morbidity \nand mortality in these patients, the incidence of which has significantly reduced in \nrecent decades but remains as one of the important systems to follow-up and man-\nage. Primary problem relates to bladder dysfunction (neurogenic bladder), which \nin turn causes upper urinary tract complications such as reflux, hydronephrosis, \ninfection and stone formation, eventually leading to renal failure if left unmonitored \nand untreated. Pathophysiology of neurogenic bladder is complex and the clinical \nfindings depend on the level and the extent of cord damage, however, some basic \nunderstanding is paramount for management of these patients. Ultrasound scan \nand plain radiographs have been the main modalities for regular follow-up of upper \nurinary tract in these patients. Imaging difficulties due to obesity, constipation, im-\nmobility, deformities and prosthesis are common occurrence. The development of \nradionuclide, CT and MR imaging with continuous progress in the scanning and dose \nradiation techniques have enabled us to commonly use them during management \nof the complications. Routine use of these techniques for follow-up and monitoring \ncan be limited by availability, logistics and radiation involved.\nLearning Objectives:\n1.  To understand the pathophysiology of urinary tract problems in patients with \nspinal cord damage.\n2.  To become familiar with the urinary tract complications associated with this \ngroup of patients.\n3.  To understand the role of different modalities and common problems during \nimaging.\nA-537 09:30\nD. Interactive case discussion \nS.K. Morcos; Sheffield/UK (morcsk2@aol.com) \n08:30 - 10:00 Room D1 \nCLICK (Clinical Lessons for Imaging Core Knowledge): Never \nwithout Arteries \nCC 1618 \nThe fast and the furious: vascular trauma resulting \nfrom traffic accidents \nModerator: \nU. Linsenmaier; Munich/DE \nA-538 08:30\nA. Clinical considerations \nH. Hoppe; Berne/CH (hanno.hoppe@gmail.com) \nThe majority of blunt thoracic aortic injuries (BTAI) results from deceleration trauma. \nThereof, 70% are caused by motor vehicle crashes and 13% by motorcycle acci-\ndents. Accordingly, the incidence of BTAI is high in fatal traffic injuries and increases \nwith age. It is rare in the paediatric population. The most common site of BTAI is \nthe medial aspect of the lumen distal to the origin of left subclavian artery where \ninjury is found in about 93% of hospital admissions and in about 80% of autopsy \nstudies. This is due to a high pressure combined with rotational forces exerting \nstress at the aortic isthmus. The most common type of injury is false aneurysm \n(58%), followed by dissection (25%) and intimal tear (20%). Most patients with BTAI \ndie at the scene. For patients reaching the hospital, timely imaging is essential for \ndefinitive management since risk for rupture of contained aortic injury is highest \nwithin the first 24 hours. Regarding treatment of BTAI, there is a paradigm shift \nfrom open repair to endovascular repair. In selected patients with minor grade aortic \ninjuries, nonoperative management has been applied. Modern treatment options \nhave resulted in improvement of survival. \nLearning Objectives:\n1.  To learn about the frequency and importance of arterial involvement in decel-\neration trauma.\n2.  To know more about the differential diagnosis as well as the different localisa-\ntions of arterial lesions.\n3.  To learn about prognosis, treatment and outcome after arterial involvement.\nPanel discussion:  \nHow have you changed or improved yourself after recognising your \nmistakes? 09:44 \n08:30 - 10:00 Room C \nUrogenital Imaging \nCC 1621 \nThe usual, the unusual and the dangerous \nModerator: \nS.K. Morcos;  Sheffield/UK \nA-534 08:30\nA. Imaging of renal trauma \nV. Logager; Copenhagen/DK (VILOE@heh.regionh.dk) \nApproximately, 10% of all trauma admissions have kidney injuries. According to \nthe American Association of Surgeons in Trauma (AAST), blunt traumas can be \ngraded in a 5-point Renal Injury Scale. (Moore EE, Shackford SR, Pacher HL et.al. \nOrgan Injury Scaling: Spleen, Liver and Kidney. J. Trauma 1989;29:1664-1666). On \nthe basis of the patient‘s clinical findings an imaging algorithm is set. In general, \npatients that are normotensive with microscopic haematuria have less than 0.2% \nrisk of serious kidney damage and imaging is unnecessary, whereas patients with \neither: A) gross haematuria or B) microscopic haematuria and blood pressure less \nthan 90 mmHg or occasionally C) microscopic haematuria and positive result of \ndiagnostic peritoneal lavage will require imaging. Contrast-enhanced CT is the way \nto go. Imaging should be in 3 phases (cortico medullary, delayed 3-5 min and late \nphase (more than 10 min). Image reading should be a multiplanar approach. Most of \nthe findings do not require surgical intervention, the rest does. On the basis of case \npresentations, findings will be analysed, discussed and correlated to the patient‘s \nclinical status and treatment possibilities, including where and which signs to look \nfor. Which modality could be used to solve the diagnostic problem when the clinical \npicture does not fit with the radiological picture. Always expect the unexpected.\nLearning Objectives:\n1.  To learn how to recognise and describe the different types of traumatic renal \ninjuries.\n2.  To learn how to correlate these image findings with clinical severity.\n3.  To understand treatment possibilities.\nA-535 08:50\nB. Postoperative anatomy and complications after GU interventions \nH.C. Thoeny; Berne/CH (harriet.thoeny@insel.ch) \nRadical prostatectomy, cystectomy with various forms of urinary diversion, and hys-\nterectomy including pelvic lymph node dissection as well as (partial) nephrectomy \nare the most frequent surgical procedures performed in patients with urogenital \nmalignancies. Familiarity with normal postoperative imaging features and potential \ncomplications are important to avoid misinterpretation to ensure appropriate post-\noperative management. Although complications are relatively rare in experienced \ncenters, it is important to be aware of early (< 1 month) and late (> 1 month after \nsurgery) post-operative complications for the respective intervention including \nanastomotic leaks, fluid collections (urinoma, lymphocele, abscess, haematoma), \nalterations in bowel motility, vascular complications, fistulas, sepsis, wound infec-\ntion, urinary infection, ureteral strictures, calculi, etc. in order to initiate appropri-\nate treatment. Furthermore, these patients have to undergo regular radiological \nfollow-up to detect recurrence as early as possible. It is important to be aware of \nthe typical location of recurrence and to know the appropriate imaging methods \nand techniques to make needed to make correct and timely diagnosis. In patients \nwith bladder and renal cancer as well as gynaecological malignancies, CT is the \nmethod of choice to detect recurrence. In patients with prostate cancer suspicious \nfor local recurrence, MR imaging is superior to CT, however CT is the method of \nchoice when lymph node, organ or bone metastases are suspected.\nLearning Objectives:\n1.  To become familiar with expected imaging findings after (partial) nephrectomy, \nileal bladder substitute and radical prostatectomy.\n2.  To understand common complications after surgery.\n3.  To learn where and how to detect tumour recurrence.\n\nPostgraduate Educational Programme\nS126\n C B D E F\n G\nA\nLearning Objectives:\n1.  To learn about HIFU in breast tumours.\n2.  To become familiar with the post-HIFU aspects of various types of imaging.\nA-542 09:00\nB. Pre- and post- imaging appearance of breast lesion excision \nsystem (BLES) lesions \nS.D. Allen; Sutton/UK (steven.allen@rmh.nhs.uk) \nThe breast lesion excision system (BLES) has evolved as a breast radiological \ntechnology over the last decade and is now in widespread use in Europe and \nacross the world. It was designed as a large biopsy device but more recently due \nto its unique capability to obtain a single large breast tissue specimen in only a few \nseconds by utilising a radiofrequency cutting and cauterising wave, it has increas-\ningly been explored in the therapeutic setting. It is easy to use under ultrasound or \nmammographic guidance with procedures taking a similar length of time to that of \na vacuum biopsy, and with patient preparation and anaesthetic essentially identi-\ncal. The technical aspects of performing these procedures will be detailed as well \nas its use specifically to perform excisional biopsies. This is limited by patient and \nlesional factors, all of which will be discussed in more detail. Following a BLES, \nthe post procedure appearances need to be considered in order that follow -up \nimaging can be interpreted accurately. Risks and complications of this procedure \nare outlined as well as a discussion made of the latest papers in this field that may \nsuggest future applications and developments.\nLearning Objectives:\n1.  To understand the mechanism of the BLES technique.\n2.  To become familiar with the post-BLES aspects of various types of imaging.\nA-543 09:30\nC. Common features and pitfalls in imaging the treated breast \nJ. Camps Herrero; Valencia/ES (juliacamps@ono.com) \nDuring the past years, it has been shown that there is not a single disease entity \ncalled “breast cancer”. There are different subtipes that entail diverse recurrence \nrisks, this is is the first issue to take into account, and patients will be stratified \naccordingly before any follow-up is planned. Imaging findings in a patient treated \nfor breast cancer will depend on the type of treatment: breast conserving therapy \n(BCT), mastectomy (and all the reconstructive techniques) radioteraphy and \nminimally invasive techniques. In order to differentiate between fat necrosis and \nother common post-treatment changes from relapse, it is important to know the \ntimeline when all these changes take place and also schedule the follow-up imag-\ning procedures accordingly. Another important issue to take into account are the \nlimitations and indications of the different modalities (mammography, ultrasound \nand MRI). Although ultrasound and mammography have traditionally been used \nin the follow-up of these patients, MRI is beeing used more and more often due \nto its superior multiplanar capabilities and the functional information not supplied \nby the other techniques.\nLearning Objectives:\n1.  To learn about the post-surgical and post-radiation therapies aspects of the \nbreast and their timing.\n2.  To learn about how to diagnose a recurrence in the treated breast and its \ndifferential diagnoses.\n3.  To become familiar with the imaging findings of post-ablation (RFA) of breast.\nAuthor Disclosure:\nJ. Camps Herrero: Advisory Board; Bayer. \n08:30 - 10:00 Room E1 \nGI Tract \nRC 1601a \nDiagnosis and staging of esophageal cancer \nA-544 08:30\nChairman’s introduction \nZ. Tarján; Budapest/HU (ztarjan@gmail.com) \nOesophageal cancer is more frequent in western countries. Squamous cell car-\ncinoma occurs in the upper and middle third, adenocarcinoma is typical in the \ndistal third and EG junction. The diagnosis is based on endoscopy with biopsy. \nA-539 09:00\nB. Imaging techniques and typical findings \nH. Alkadhi; Zurich/CH \nArterial injury may occur after blunt or penetrating trauma. The clinical outcome \nof patients with traumatic vascular injury depends on a rapid diagnosis and repair \nof injury. But despite recent advances in the prehospital care, CT technology \nand therapy, trauma to the arteries (and particularly to the aorta) continues to be \nassociated with a considerable morbidity and mortality. Imaging of the arteries in \nthe emergency setting remains a challenging imaging practice, requiring broad \nknowledge of the attending radiologist.\nLearning Objectives:\n1.  To learn about the importance of selecting the appropriate imaging technique \nto allow for the detection of arterial involvement in trauma patients.\n2.  To become familiar with the typical image appearance of arterial involvement \nin trauma patients.\n3.  To learn about the most important findings and diagnoses for treatment plan-\nning.\nA-540 09:30\nC. Interactive case discussion \nR. Morgan; London/UK (robert.morgan@stgeorges.nhs.uk) \nThis session will discuss the main types of vascular trauma arising from motor \nvehicle accidents. The imaging strategies for the trauma patient will be presented. \nMain focus points of the session will include the diagnosis and management of \naortic trauma by endografts, and the role of embolisation for the management of \nvisceral orfan trauma. \nLearning Objectives:\n1.  To become familiar with typical cases illustrating the role of appropriate imaging \nmodalities in the assessment of patients after deceleration trauma.\n2.  To consolidate knowledge of the selection of the appropriate imaging technique, \nimage interpretation and image based treatment recommendation.\n3.  To understand the most important information urgently needed for treatment \ndecisions and planning.\nAuthor Disclosure:\nR. Morgan: Advisory Board; Angiodynamics. Consultant; Cook. \n08:30 - 10:00 Room D2 \nOncologic Imaging: Follow-up of Systemic and Local Therapies \nCC 1619 \nFollow-up of local treatments of breast cancer \nModerator: \nM.H. Fuchsjäger;  Graz/AT \nA-541 08:30\nA. MRI-guided HIFU therapies in the breast \nM. Sklair-Levy; T el Aviv/IL (mirisklair@gmail.com) \nMagnetic resonance high-intensity focused ultrasound is an innovative, non-invasive \ntumour ablation technique. MRI and focused ultrasound are combined allowing real-\ntime anatomic guidance and temperature mapping during treatment. MRI-guided \nFUS treatment is performed under local anesthesia with analgesic and sedative \nagents to reduce pain, unnecessary motion, and claustrophobia. Imaging:T2-W \nimages to define the tumour. T1-weighted with-contrast to verify efficacy after MRg-\nFUS. MRI-guided FUS ablation of breast cancer to date, most protocols have been \ntreat-and-resect protocols, FUS ablation followed by surgery. Results of studies is \nvariable with histopathologic analysis demonstrating complete tumour necrosis in \n20% to 100% of patients treated. There are only a few FUS ablation studies where \ntreated tumour tissue was left in situ after ablation, without a following surgery. All \npatients tolerated the MRI-guided FUS procedure well, and only minor complica-\ntion, a skin burn, was reported. Several issues need to be further investigated for \nsuccessful cancer treatment with MR-guided focused Ultrasound, including patient \nselection criteria, definition of treatment margins and optimal transducer technology. \nIn summary, FUS ablation has the potential to become an important modality for \nnon-invasive image-guided treatment of localised breast cancer. Multiple phase I \nstudies have proven MRI-guided and US-guided FUS ablation of breast cancer to \nbe technically feasible and safe. \n\nPostgraduate Educational Programme\nS127\nB\n C D E F G\nA\nMonday\na good modality for predicting the efficacy of neoadjuvant chemotherapy/chemora-\ndiotherapy for advanced oesophageal cancer. The two most important prognostic \nindicators for OC are depth of tumour penetration and the number of malignant \nlymph node metastases. The 5-year survival rate for patients with tumours remain-\ning in the oesophageal wall and without nodal involvement is approximately 40%.\nLearning Objectives:\n1.  To learn about optimised EUS, MDCT and PET-CT techniques for esophageal \ncancer staging.\n2.  To critically review those imaging findings impacting on patient management \nwith regard to palliation, radiation therapy and surgery.\n3.  To understand the potential of imaging prognostic markers.\nA-547 09:21\nC. Treatment response \nB. Mahon; Birmingham/UK \nThe last decade has seen a change in the therapy of patients with oesophageal \ncancer. For many years, the standard therapy for locally advanced lesions has \nbeen surgical resection. However, overall survival for patients with locally advanced \ntumours after resection remains poor, with a five-year survival rate between 10% \nand 20%. Most patients still present with an advanced tumour stage; therefore, \nmultimodal therapy regimens have been introduced, some using neo-adjuvant \nchemotherapy or chemo-radiotherapy followed by radical resection, whereas others \nuse adjuvant protocol. Imaging therefore can potentially play an important role in \nassessing for tumour response. Being able to measure this response to treatment \ncan determine subsequent treatment. Conventional staging tools such as CT are \noften undertaken to predict responses to neo-adjuvant therapy, however how \nuseful is this? The higher resolution technique of endoscopic ultrasound is often \nundertaken as a primary staging tool, however can it provide any useful information \nafter neo-adjuvant treatment? Positron emission tomography have shown promising \nresults in the early selection of responders and non-responders during the course \nof neo-adjuvant therapy, allowing physicians to alter the treatment plan accordingly, \nhowever remains a relatively expensive investigation. This is explored together with \npractical examples of each modality along with potential pitfalls. \nLearning Objectives:\n1.  To learn the normal post-surgical and post-radiation therapy imaging findings \nand criteria and to differentiate between these and local recurrence.\n2.  To become familiar with anatomical and functional imaging criteria to assess \ntreatment response.\n3.  To learn the rationale for follow-up of patients after definitive or neo-adjuvant \nchemoradiotherapy.\nPanel discussion:  \nCross-sectional techniques: developing an integrated imaging \nalgorithm in oesophageal cancer 09:44 \n08:30 - 10:00 Room E2 \nOncologic Imaging \nRC 1616 \nComplications of cancer treatment and the \ndetection of recurrences \nA-548 08:30\nChairman’s introduction \nM. Laniado; Dresden/DE (michael.laniado@uniklinikum‑dresden.de) \nOne of the complications after curative treatment of cancer patients that affect \npatients’ prognosis is a local or distant recurrence. In the absence of a distant \nrecurrence, the patient with a local recurrence still has a chance for cure if it is \ndetected in an early curable state. Here is where imaging plays a crucial role. \nTreatment effects from surgery, chemo- or radiotherapy, however, provide a dif-\nficult ground for imaging evaluation. Late toxicity effects such as inflammation and \nfibrosis confound imaging appearances of a recurrence and expose the radiologists \nto a diagnostic dilemma. This session will address the different imaging findings of \ntreatment sequelae in head and neck, liver, pancreas and rectal cancer patients \nand will give an understanding of how various imaging methods can differentiate \nbetween treatment-related effects and active tumour regrowth.\nAuthor Disclosure:\nM. Laniado: Consultant; Janssen Pharmaceutica N. V. \nHowever, barium studies are frequently used as a first line exam for patients with \noesophageal complaints for assessing both morphology and motility. Only surgical \nresection including all associated nodes at a very early stage has been shown to \nimprove survival rates. Dilatation and stent placement, endoscopic laser ablation \nand external-beam radiation therapy alone or together with chemotherapy are \ntypically used as palliation to relieve dysphagia and decrease tumour burden. The \nmain purpose of the staging is to select patients suitable for surgical resection or \nselect early mucosal cancers suitable for endoscopic treatment. There is unique \nlymphatic anatomy of the oesophagus, as lymphatic vessels in the lamina propria \nmake it possible to have lymph node metastases from superficial T1 tumours. The \nnumber of the positive nodes correlates with survival. There is often direct drain-\nage of the submucosal lymphatic plexus into the thoracic duct facilitating systemic \nmetastases. Tumours invading the pleura, peritoneum, pericardium and diaphragm \nare resectable, while aorta, carotid arteries, azygos vein, trachea, left main broncus \nand vertebral body invasion and distant metastatic disease precludes curative \nsurgical resection. Involved celiac lymph nodes are considered distant metastases \nfor squamous cell carcinoma, but N1 disease for esophageal adenocarcinoma. \nSize, viability, stage and resectability may change after therapy, therefore needs \naccurate assessment by radiology for further therapeutic decisions.\nA-545 08:35\nA. Diagnosis \nM. Krokidis; Cambridge/UK (mkrokidis@hotmail.com) \nOesophageal cancer is the sixth leading cause of death from cancer worldwide. \nMore than 90% of oesophageal cancers are either squamous-cell carcinomas or \nadenocarcinomas. Approximately, three quarters of all adenocarcinomas are found \nin the distal oesophagus, whereas squamous cell carcinomas are more evenly \ndistributed between the middle and lower third. The cervical oesophagus is an \nuncommon site of disease. The pathogenesis of oesophageal cancer remains \nunclear. At the time of the diagnosis of oesophageal cancer, more than 50% of \npatients have either unresectable tumours or visible metastases on imaging. The \nmost common symptom of presentation is dysphagia which is present in > 70% of \nthe cases; odynophagia may also be present in a smaller percentage of patients. \nThe patients are usually presented also with significant weight loss which appears \nto be also an important prognostic factor of the outcome of the disease. Diagnosis \nis based on the findings of a contrast swallow- which is usually the first exam to be \nperformed; oesophageal cancer may present as polypoid, infiltrative, varicoid, or \nulcerative lesions. Endoscopy usually confirms the findings of the swallow study, \nrevealing the presence of a mass and offering the possibility of taking biopsy sam-\nples. Endoscopic ultrasound is the imaging method that is used for local staging \nand CT and PET-CT are used to determine the presence of metastatic disease. \nIn case of presence of enlarged lymphnodes, fine needle aspiration or even open \nbiopsy may be performed.\nLearning Objectives:\n1.  To become familiar with the pros and cons of each of the main diagnostic imag-\ning modalities available when assessing a patient with suspected esophageal \ncancer.\n2.  To learn the basic imaging findings of esophageal cancer through each modality \nwith emphasis on local disease.\n3.  To understand the pitfall in diagnosis and staging of tumours located in the \ngastroesophageal junction.\nA-546 08:58\nB. Staging \nV. Válek; Brno/CZ (vlvalek@med.muni.cz) \nImaging technology including EUS, PET, MDCT and MRI is suggested for the \nstaging of esophageal cancer. “T” characteristics are assessed with EUS, overall \naccuracy is 72% - 90%, the accuracy decreases after neoadjuvant therapy. MDCT \ncan define the local extent of tumour. Aortic invasion is suggested when tumour \ncontacts over 90% of the circumference of the vessel (accuracy 59% - 82%). MRI \nprovides little advantage over CT, CT and MR cannot distinguish between T1 \nand T2. EUS with fine-needle biopsy provides the best modality for assessing LN \n(sensitivity, 85%; specificity, 97. Accuracy for N staging showed no significant dif-\nference (66% for EUS, 68% for PET, and 63% for CT). Most common locations for \nmetastatic “M” disease from oesophageal adenocarcinoma involve the liver, lung, \nand bone. For the evaluation of distant metastases, PET has a higher sensitivity \nthan CT. An operable tumour has been defined as of radiological stage T1-3, N0 or \n1, M0, with a primary length of ²5 cm. In \"T\" staging, EUS could play an important \nrole in the choice of candidates for endoscopic and surgical treatment. However, it \nremains unclear how to best select patients for a non-operative approach. PET is \n\nPostgraduate Educational Programme\nS128\n C B D E F\n G\nA\npost-treatment anatomy as well as the typical patterns of distribution both of post-\ntreatment and recurrent disease is essential. In the initial stage, an important role \nof imaging is to target areas for biopsy confirmation of locally recurrent disease. CT, \nMRI as well as PET/CT hybrid imaging with 18 F-fluorodeoxyglucose as a tracer all \nindividually have their important role in the work-up. If anterior resection has been \nperformed, endorectal ultrasonography is an additional option for evaluation of the \nanastomosis in these patients. For treatment planning of recurrent rectal cancer, \ndiagnostic imaging is presented by the radiologist in a multidisciplinary conference \nto make sure that the information brought by the images is used to select the best \npossible treatment for the patient. In this presentation, the role of different imaging \ntechniques for diagnosis of locally recurrent rectal cancer and challenges based on \ndifferentiation of recurrent disease from post treatment changes will be discussed.\nLearning Objectives:\n1.  To understand the role of CT, PET and MRI in the surveillance of patients after \nrectal cancer surgery.\n2.  To become familiar with the imaging changes of the irradiated and resected \ntumour bed.\n3.  To understand the diagnostic algorithm for early detection of a local recurrence \nin the treated tumour bed.\nPanel discussion:  \nHow to differentiate between treatment sequelae and active disease  09:44 \n08:30 - 10:00 Room F1 \nAbdominal Viscera/GI Tract \nRC 1601b \nAbdominal MRI: standard and advanced protocols \nin clinical settings \nModerator: \nM.A. Patak; Zurich/CH \nA-552 08:30\nA. Fistula in ano \nA. Gupta; London/UK (arungupta1@nhs.net) \nMRI is a fundamental part of perianal fistula evaluation in any patient in whom \nsurgical or biological therapy is being considered. This lecture will explain what \nrole MRI plays in the management and how MRI should be performed optimally. \nHardware requirements, the choice of sequences to use, interpretation of the MRI \nscan and the significance of the findings will be discussed. The future directions \nof MRI scanning will also be reviewed.\nLearning Objectives:\n1.  To learn optimised MRI state-of-the-art protocols to image patients with fistula \nin ano.\n2.  To understand of the role of imaging in fistula classification and staging, im-\npact on therapeutic decision-making, assessment of activity and in treatment \nmonitoring.\n3.  To describe how to provide an optimal MRI fistula report.\nA-553 09:00\nB. Pelvic floor disease \nM. Bazot, L. Jarboui, I. Thomassin-Naggara, F. Haab, E. Darai; Paris/FR \n(marc.bazot@tnn.aphp.fr) \nPelvic floor disease (PFD), including pelvic organ prolapse (POP), urinary inconti-\nnence, defaecatory dysfunction, and pelvic floor relaxation is a common condition. \nPhysical examination is the first step to determine the presence of PFD but has \nlimitations. MR imaging performed in decubitus position after rectal opacification \nby sonographic gel is an excellent imaging modality for evaluation of PFD. Static \nMRI using sagittal, axial, and coronal T2-weighted MRI sequences provides de-\ntailed informations of pelvic organs and pelvic floor anatomy. Dynamic MRI using \nrapid T2/T1 MRI sequences in midsagittal plane are performed at rest, squeezing, \nstraining, and defecation, and must be repeated two or three times. Images are \nreviewed with cine for evaluation of anterior (cystocele), middle (uterine, vaginal, \nor apex prolapse), posterior (rectocele), and peritoneal prolapses (peritoneocele, \nenterocele, sigmoidocele). Competition between these different compartments is \ncommon. The use of reference lines (pubococcygeal, H and M lines) is helpful for \nimage evaluation. MRI has excellent clinical correlation and can be associated with \nother modalities (ultrasonography, electrophysiologic examinations) depending \nA-549 08:35\nA. Head and neck cancer \nL. Oleaga Zufiría; Barcelona/ES (lauraoleaga@gmail.com) \nIdentification of recurrent tumour in the post-therapy setting is often challenging. It is \nessential to have a baseline study for monitoring changes and evaluating possible \nrecurrences. After surgery, there is distortion of the anatomy, the fat planes are lost, \nfunctional lymphadenectomy may be associated with muscle resection, resection \nof the jugular vein or grafting, therefore, it is essential to know this data to properly \nanalyze the images. The immediate postoperative baseline study after surgery \nshould be performed between 4 and 6 weeks after surgery. When radiotherapy \nis performed, there is loss of fat planes, significant edema in the mucosa and in \nsubcutaneous tissue. The recommended baseline study should be obtained at 3 \nmonths after a completion of radiation therapy. The imaging methods used for the \nstaging and follow-up of head and neck tumours varies between centres. CT is the \nmost commonly used imaging technique, however, at some institutions MRI or PET \nare used to detect tumour recurrence after therapy, either surgery or chemo/radia-\ntion. Distinction between post-treatment changes and recurrent or residual tumour \nmight be difficult to assess on imaging. A soft tissue mass present in the baseline \nstudy that decreases in size, should be considered treatment-related changes. If the \nmass increases in size, it is suggestive of persistent or recurrent tumour. A new onset \nmass in the follow-up study should be considered as recurrence. Late complications \ndue to chemo/radiation include soft-tissue necrosis, osteochondronecrosis, carotid \natherosclerosis, myelopathy, nerve paralysis secondary to fibrosis and sarcomas.\nLearning Objectives:\n1.  To learn about the possible range of late toxicity effects after surgery and \nchemoradiotherapy of the neck.\n2.  To become familiar with the imaging findings after surgery and chemoradio-\ntherapy.\n3.  To understand which imaging method to use to differentiate between treatment \nsequelae and remaining tumour.\nA-550 08:58\nB. Liver and pancreatic cancer \nC. Catalano; Rome/IT (Carlo.Catalano@uniroma1.it) \nIn the recent past, there have been significant improvements in the treatment of \ncancer, including liver and pancreatic tumours. Surgery provides excellent results \nin liver and pancreatic cancer, although early and late complications must always \nbe taken into account. Percutaneous treatments have several advantages over \nsurgery, above all the minimal invasiveness; nevertheless, there might be com-\nplications, although less common as compared to surgery. In the assessment of \nearly complications, namely abscess formation and bleeding, US and especially \ncontrast enhanced CT provide the best results. All patients undergoing surgery or \npercutaneous treatments should undergo strict follow-up with imaging modalities. \nIn both liver and pancreatic cancer, recurrency must be considered, especially if \nthe tumour at the time of treatment is at an advanced stage; for this purpose, the \nradiologist should exactly know the type of procedure the patient was submitted \nin order to avoid misinterpretation determined by surgical material or granuloma-\ntous components. In all cases, it is crucial, for the assessment of recurrencies, \ncomparative studies that allow to detect even minimal modification. In this respect, \nfunctional studies play an important role: PET-CT already has a well defined role, \nwhile diffusion weighted and perfusion MR is gaining importance. In all cases, the \ncombination of different imaging modalities and correct clinical information help in \nthe diagnosis, allowing early detection of complications and recurrencies.\nLearning Objectives:\n1.  To become familiar with the imaging of complications following pancreatic \nsurgery and liver chemotherapy and/or radiotherapy.\n2.  To understand how these changes can conceal or mimic active disease.\n3.  To learn how to distinguish post-treatment changes from residual or recurrent \ndisease.\nA-551 09:21\nC. Rectal cancer \nL.C.O. Blomqvist; Stockholm/SE (lennart.k.blomqvist@ki.se) \nTreatment of rectal cancer is multi-modality based and continuously improved. De-\nspite reduction of recurrence rates, local recurrence of still occurs in about 5-10 % \nof patients. Complications of rectal cancer treatment, such as anastomotic leakage \noccur in about 10 % of patients. Neoadjuvant treatment with chemo- and/or radio-\ntherapy also induces changes in the pelvic tissues that challenge the diagnosis of \nlocally recurrent disease. To make correct diagnosis, knowledge about the normal \n\nPostgraduate Educational Programme\nS129\nB\n C D E F G\nA\nMonday\nA-556 08:35\nA. Postoperative spine \nL. van den Hauwe, J.W. Van Goethem, C. Venstermans, F. De Belder, \nP.M. Parizel; Antwerp/BE (lucvdhauwe@mac.com) \nThe increase in the number of surgical spinal procedures is reflected by the \nincrease in post-operative imaging studies (conventional x-rays, CT, and MRI). \nImaging assessment of the spine after surgery is complex and depends on several \nfactors, including the age and anatomy of the patient, indication for and type of \nsurgery performed, biomaterials used, time elapsed since the surgical procedure, \nand - most importantly - the duration and the nature of the post-surgical syndrome. \nAdequate understanding of the various surgical techniques (both instrumented \nand non-instrumented), coupled with an appropriate awareness of the possible \ncomplications - acute and late - is vital when interpreting post-operative studies. \nNormal post-operative findings as well as imaging findings in acute complications \n(haematoma, spondylodiscitis) and the failed back surgery syndrome (recurrent \ndisc herniation vs epidural fibrosis) will be discussed.\nLearning Objectives:\n1.  To become familiar with the appropriate imaging technique in the postoperative \nspine.\n2.  To learn how to differentiate between normal and abnormal postoperative \nfindings.\n3.  To recognise the most common postoperative complications.\nA-557 08:58\nB. Indications for vertebroplasty \nA. Gangi, J. Garnon, G. Tsoumakidou, I. Enescu; Strasbourg/FR \n(gangi@rad6.u‑strasbg.fr) \nPercutaneous vertebroplasty is a therapeutic, image-guided procedure that involves \ninjection of radio-opaque cement (methyl methacrylate) into a painful, collapsed \nvertebral body to consolidate it, in an effort to relieve pain and provide stability. \nCementoplasty can be considered for five specific indications: 1. osteoporotic frac-\ntures: vertebroplasty has become the standard of care for osteoporotic fractures; 2. \npainful bone tumours: osteolytic destruction of the vertebral body by metastases are \na source of debilitating pain and disability; 3. aggressive vertebral hemangiomas: \nin patients with haemangiomas localised to the bone only, vertebroplasty for direct \nvascular embolisation with stabilization can be performed. However, haemangi-\nomas, with epidural and/or paravertebral involvement, sclerotherapy (ethibloc or \nalcohol) is preformed first, followed two weeks later by vertebroplasty; 4. painful \nvertebral fractures associated with osteonecrosis (Kummel’s disease); 5. traumatic \nvertebral fractures in young patients associated to an augmentation technique \n(Stentoplasty). In combination with bone surgery and others: conditions in which \nanterior stabilization of the vertebral body is required prior to or after posterior \nsurgical stabilization or epidural decompression. The absolute contraindications \nto the performance of vertebroplasty are uncorrectable coagulopathy, presence of \nvertebral osteomyelitis, discitis or infection of the overlying skin, systemic infection, \nand presence of free posterior wall fragment with or without retropulsion associated \nwith spinal canal stenosis and/or neurological symptoms, asymptomatic vertebral \ncompression fractures and prophylaxis for osteoporosis. Following spinal trauma, \nvertebral burst fractures with disco-ligamentous disruption require surgical stabiliza-\ntion and are not indicated for vertebroplasty alone.\nLearning Objectives:\n1.  To consolidate knowledge of the actual indications for vertebral augmentation.\n2.  To understand the contraindications and limitations.\n3.  To become familiar with the algorithm of patient selection.\n4.  To understand the best timing for vertebral augmentation.\nA-558 09:21\nC. Percutaneous treatment of spinal diseases \nM. Muto; Naples/IT (mutomar2@gmail.com) \nSpine pain is a very common problem in western country. It is very important to find \na correct clinical and diagnostic approach to understand the source of the pain. \nX-ray, CT and MR can give a wide spectrum of finding helping clinicians to choose \nthe best mini-invasive treatment. Beside vertebral body fractures, herniated disk, \nspinal canal stenosis and degenerative facet joint disease are the major cause \nof spine pain. Multiple percutaneous disk treatment are available and the choice \nof the device is made in relation of the type of herniated disk and clinical finding. \nThe presence of cono-cauda syndrome, hyperalgic sciatica and progressive foot \ndroop represent an urgent indication to surgery. Percuatneous disk treatment can \nbe apply also to cervical disk disease. Radiofrequency facet joint ablation, perig-\non clinical setting. MRI is essential when choosing conservative versus surgical \ntreatment (multicompartment POP, pelvic floor relaxation, incidental pathologic \nconditions).\nLearning Objectives:\n1.  To learn the clinical indications and the optimised dynamic MR imaging protocol \nfor investigating pelvic floor disease in patients.\n2.  To understand common and uncommon findings related to the posterior, \nmiddle and anterior compartments and how they impact on subsequent patient \nmanagement.\n3.  To understand how to introduce MRI into a pelvic floor therapy and how to \nbest integrate with conventional techniques.\nA-554 09:30\nC. Suspected biliary tumour \nC. Matos; Brussels/BE (cmatos@ulb.ac.be) \nMagnetic Resonance (MR) imaging has been accepted as a major non-invasive \ndiagnostic modality for investigating the bile ducts. MR imaging with MR cholan-\ngiopancreatography (MRCP) may be used as a replacement for diagnostic endo-\nscopic retrograde cholangiopancreatography (ERCP) and has gained acceptance \nby gastroenterologists, surgeons and general practicionners because of its high \nsuccess rate and because of the ability to project a virtual cholangiogram image \ndisplay. Comprehensive MR imaging of biliary tumours should a) show the size \nand location of a primary lesion and assess the longitudinal and radial extent of \nbile duct involvement, b) enable the characterisation of biliary stenosis, c) show \ninvolvement of the hepatic artery and lobar branches and of portal vein and lobar \nbranches for the purpose of surgical planning, d) depict the presence and extent \nof liver invasion and lobar atrophy and hypertrophy and e) enable the detection \nof regional lymph nodes and metastases. To achieve this, MR imaging should be \nperformed at high field strength, using multichannel, phased-array coils, paral-\nlel imaging technology and ideally before any biliary drainage procedure. This \nlecture will emphasize the importance of a comprehensive protocol that includes \nT2-weighted imaging and MRCP, gadolinium-enhanced T1-weighted imaging, and \ndiffusion-weighted imaging. Imaging characteristics that may indicate a specific \ndiagnosis of biliary tumour will be described.\nLearning Objectives:\n1.  To learn the basic MRI technique for patients with suspected biliary tumour.\n2.  To understand advanced imaging protocols for both structural and functional \nimaging of the bile ducts, and when these are indicated.\n3.  To understand the MR imaging findings which best differentiate benign from \nmalignant disease, and how to produce an optimised report.\n08:30 - 10:00 Room G/H \nNeuro \nRC 1611 \nSpine: update on postoperative imaging and \nminimally invasive procedures \nA-555 08:30\nChairman’s introduction \nJ. Van Goethem; Antwerp/BE (johan.vangoethem@ua.ac.be) \nSpinal surgery has evolved significantly over the past decades. From simple dis-\ncectomies and laminectomies over herniectomies and posterior fusions we now \nhave a plethora of open, classic surgical procedures, fusion procedures, artificial \ndiscs and posterior elements devices. More importantly minimally invasive proce-\ndures, started with vertebroplasties but nowadays also including more complex \nprocedures and even transcutaneous fusion surgery is available. Scientific studies \nthat support the use of some of these procedures are still scarce and sometimes \nonly anecdotal information is available. Imaging in these patients is sometimes \ncomplex and depends not only on the patients’ complaints but also on the type of \nprocedure and time lapse since the intervention.\nAuthor Disclosure:\nJ. Van Goethem: Consultant; Zimmer Spine. \n\nPostgraduate Educational Programme\nS130\n C B D E F\n G\nA\nA-561 08:58\nB. PE in oncologic patients \nB. Ghaye; Brussels/BE (benoit.ghaye@uclouvain.be) \nOncologic patients have a 4 to 6 times increased risk of venous thromboembolism \n(VTE) compared to the general population. The risk is further increased in patient \nundergoing new antitumoural treatments. VTE decreases the overall survival by \nthree times in this population, making it important to be detected by the radiolo-\ngists. Most of those VTE episodes are clinically suspected by the clinician and are \nincidentally found on follow -up oncologic thoracic CT. Unfortunately, radiologists \nfail to report 30 to 75% of pulmonary embolism (PE) in clinical routine. New CT \nsoftware or technical refinements should help the radiologists to detect PE on \noncologic thoracic CT. Radiologists have also to look for other types of pulmonary \nembolism in cancer patients, including tumoural and exogeneous materiel (i.e. \ncement, catheter, radioactive seeds) embolism.\nLearning Objectives:\n1.  To learn about the increased risk of venous thromboembolism.\n2.  To understand the means of recognising peripheral PE, including CAD and \nnew software tools.\n3.  To learn how to deal with clinically unsuspected PE, both for reporting and \ntreatment.\nA-562 09:21\nC. PE during pregnancy and puerperium \nM.-P. Revel; Paris/FR (marie‑pierre.revel@htd.aphp.fr) \nThe risk of venous thromboembolism (VTE) is especially increased during the \nthird trimester antepartum and the first 6 weeks post-partum. VTE remains the \nfirst cause of maternal death in developed countries. There is no validated clinical \nprobability scoring system for VTE in\npregnancy and puerperium and a negative D-dimer test is insufficient to rule out \nVTE. Thus, all patients require further diagnostic tests, accounting for the low preva-\nlence of VTE in most reported series. Fetal radiation dose is considered negligible \nwith both ventilation perfusion (V/Q) scan and computed tomography pulmonary \nangiography (CTPA). The latter provides high maternal breast radiation dose, but \nallows alternative diagnosis, such as post-partum pneumomediastinum, a cause \nof chest pain after vaginal delivery. CT may also help detecting mild pulmonary \noedema, in dyspneic patients developing peripartum cardiomyopathy. Compres-\nsion ultrasound of the legs and magnetic resonance imaging are alternative tests \navoiding radiation exposure, but require further investigation when negative. \nCompression ultrasound is the first-line test in women with symptomatic leg. In the \nremaining patients, V/Q scan is recommended if chest x-ray is normal, in patients \nfree of pulmonary disease and is diagnostic in 80%  of cases. CT angiography is \nperformed if chest x-ray is abnormal or V/Q scan is not diagnostic. CT parameters \nrequire adjustment to avoid excessive breast radiation exposure during CTPA. \nTo optimise pulmonary arteries opacification, CTPA should not be performed at \ndeep inspiration, to avoid increasing inferior vena caval flow and the return of non-\nopacified blood to the right atrium. \nLearning Objectives:\n1.  To learn more about the increased risk of venous thromboembolism.\n2.  To appreciate the pros and cons of US, CT, MR and scintigraphy.\n3.  To learn about specific diagnostic algorithms.\nPanel discussion:  \nPulmonary embolism work-up in 2013 09:44 \n08:30 - 10:00 Room L/M \nSpecial Focus Session \nSF 16c \nMaking homogeneous the reading in HCC \nA-563 08:30\nChairman’s introduction \nC. Bartolozzi; Pisa/IT (carlo.bartolozzi@med.unipi.it) \nManagement and prognosis of HCC patients is strongly dependent on early \ndiagnosis, definition of tumour extension and on an efficient communication with \nreferring clinicians. Thus, radiologists need to be aware of the implications of \ntheir own interpretation and reporting of imaging findings. International guidelines \nangliar and interarticular steroid injection can also be performed helping patients \nwith spine pain to reduce drugs dependence. The position of interspinous spacer \ncan be apply in patients with low back pain, degenerative disk disease and spinal \ncanal stenosis associated also to spino-plasty giving a redistribution of axial load \non the lumbar spine elements.\nLearning Objectives:\n1.  To understand the clinical indications for percutaneous treatment of spinal \ndiseases.\n2.  To know what diagnostic modality to suggest.\n3.  To become familiar with the different percutaneous techniques available.\nPanel discussion:  \nMinimally invasive spinal procedures: the radiologist’s future role? 09:44 \n08:30 - 10:00 Room I/K \nChest \nRC 1604 \nPulmonary embolism: guidelines and best practice \nthroughout Europe \nA-559 08:30\nChairman’s introduction \nM. Rémy-Jardin; Lille/FR (martine.remy@chru‑lille.fr) \nOwing to substantial advances in CT technology during the past decade, the routine \nanalysis of pulmonary arteries down to the subsegmental level is now possible and \nCT is considered the reference standard for the imaging diagnosis of pulmonary \nembolism. This imaging modality has also seen its impact extended to the prognostic \napproach of acute pulmonary embolism and is widely available throughout Europe. \nDespite high rates of awareness and adoption of management guidelines in the \nradiological community, radiologists have variable degrees of conformance with \nthese recommendations, reflecting the variable degrees of conformance also seen \namong clinicians and the variable categories of patients in whom this diagnosis \nis suspected or incidentally recognised. Full implementation of guidelines has the \npotential to reduce the number of CT examinations, and thus to decrease not only \nradiation exposure and health care costs. The purpose of this refresher course is \nto emphasize the benefits and limitations of guidelines as actually implemented in \nroutine clinical practice throughout Europe. \nA-560 08:35\nA. Pioped 1-2-3: what have we learned so far? \nC. Engelke; Göttingen/DE (c.engelke@med.uni‑goettingen.de) \nThe goal of this refresher course is to summarize the published data from the three \nlarge National Heart, Lung and Blood Institute-sponsored prospective multicenter \nstudies on the diagnosis of acute pulmonary venous thromboembolism (VTE) - the \n„Prospective Investigations of Pulmonary Embolism Diagnosis“ (PIOPED I to III): 1.  \nthe „Prospective Investigation of Pulmonary Embolism Diagnosis“ (PIOPED I) study \non the diagnostic accuracy of scintigraphy, 2.  the „Pulmonary Embolism Diagnosis \n(PIOPED) II trial on the diagnostic accuracy of multi-detector row pulmonary CT \nangiography (PCTA) and 3.  the „Prospective Investigation of Pulmonary Embolism \nDiagnosis III“ trial on the diagnostic accuracy of gadolinium-enhanced magnetic \nresonance angiography (Gd-MRA) as diagnostic tolls in patients with suspected \nacute VTE. While the results of the PIOPED I study supported the first-line use \nof V/Q lung scanning in the diagnostic evaluation of patients with suspected VTE \nbefore CTA could be developed to become a widely available reliable diagnostic \ntool the results of each study with its conceptual details are now set into current \nperspective and the evolution of PCTA to become the imaging reference standard in \nthe diagnosis of acute VTE is outlined. Furthermore, the current status of Gd-MRA \nof pulmonary arteries and peripheral veins is outlined. The course\nwill discuss the recommendations of all PIOPED studies and open the discussion \nfor current clinical applications of all three modalities in this patient group.\nLearning Objectives:\n1.  To appreciate the results of Pioped 1-2-3 in the light of technological refine-\nments in 2013.\n2.  To become familiar with the pros and cons of CT versus MR.\n3.  To understand the residual potential indications of scintigraphy.\n\nPostgraduate Educational Programme\nS131\nB\n C D E F G\nA\nMonday\ncan offer additional features like hyperintensity in high b-value DWI images and \nT2w images or missing hepatobiliary uptake to help for the differential diagnosis. \nOther entities which can pose difficulties are small pseudolesions, which are usually \ndepicted as hypervascular areas or small hemangioma. In cirrhotic liver, the most \ncommon cause for pseudolesions are small ap-shunts. Beside the late vascular \nimages and hepato-biliary phase images, morphology and shape of this entity is \noften characteristic. Hepatic haemangioma is a rarely seen lesion in cirrhotic livers. \nA certain proportion of large HCCs also present with atypical vascular features. In \nthese cases, image-guided biopsy is needed to establish the diagnosis.\nLearning Objectives:\n1.  To learn about common tricks and traps in interpreting atypical findings in HCC \nsurveillance.\n2.  To learn about the key elements for homogeneous reading and reporting in \n‘atypical’ HCC.\n3.  To understand the key role that specific findings reported by radiologists have \nin determining patient management.\nAuthor Disclosure:\nC. J. Zech: Advisory Board; Bayer. Speaker; Bayer, Bracco, Siemens. \nA-566 09:11\nHow to evaluate tumour response to therapies \nJ. Ricke; Magdeburg/DE (Jens.Ricke@med.ovgu.de) \nAssessing tumour response in HCC is extremely challenging. First, previous studies \nsuch as the SHARP trial have demonstrated that systemic treatment with targeted \nmolecules such as Sorafenib (the only approved drug as of today) cannot be \nevaluated based on established morphologic size criteria such as RECIST or WHO \nalone. In SHARP and other studies, response criteria based on tumour size did not \ncorrelate with overall survival. Thus, response criteria adding tumour perfusion as a \nvariable such as EASL or, not supported by appropriate evidence today, mRECIST \nneed to be considered. In addition, all criteria at hand today have been developed \nfor systemic approaches, in theory targeting all lesions simulatenously. In HCC, \nlocoregional treatments are well accepted specifically in the intermediate tumour \nstages. These techniques are staged approaches that may often be repeated over \ntime. Thus, tumour growth at a given time point may not necessarily correlate with \nprognosis since the lesion in question may not even have been targeted yet by \nthe therapy. In this lecture, response criteria established for HCC will be reviewed \nand their appropriateness for clinical use or as study endpoints will be discussed.\nLearning Objectives:\n1.  To understand imaging findings after HCC locoregional and systemic treat-\nments.\n2.  To learn about the current guidelines for defining HCC response to treatment.\n3.  To learn about the key elements of homogeneous reading and reporting after \nHCC treatment.\nA-567 09:29\nInformation technology: the practical impact on the management of \nHCC patients \nI. Bargellini; Pisa/IT (irenebargellini@hotmail.com) \nThe need for more quantifiable and standardised data is advocated in oncologic \nimaging, for clinical practice and research purposes. The Liver Imaging Reporting \nand Data System (LI-RADS®), adopted by the ACR in March 2011, represents a \nstep forward in the standardization of liver findings, in the attempt 1) to reduce vari-\nability in lesion interpretation and omissions of relevant information, 2) to improve \ncommunication with clinicians, patient management and outcome monitoring, and \n3) to enable performance auditing and quality assurance. With the adoption of \nstandardised categories, liver CAD (computer-aided diagnosis) may become an \nintriguing reality. CAD enables automated cataloguing of lesions, each lesion be-\ning displayed with size, kinetics, ADC, and segmental localisation, thus facilitating \ncomparison of serial exams. Cataloguing also provides a solid basis for potential \nresearch database. In later years, new software have been developed providing \nsimple, automated workflows for routine oncology reading. These user-friendly \nplatforms facilitate comparisons among different imaging modalities over time and \nprovide auto-measurements for reproducible tumour response evaluation accord-\ning to different criteria (RECIST, WHO, tumour volume, SUV quantification). They \nenable to collect and share results in a structured manner, automatically storing \nmeasurements captured during reading and providing an overview of the findings \nfor easy exporting or dictation. Management of HCC patients requires a continuous \nintegration between imaging findings and clinical data. Development of specifically \ndesigned interactive database is required to gather all the clinical, radiological and \nhave been developed to provide confident non-invasive diagnosis of HCC in the \nsetting of liver cirrhosis, according to typical imaging findings. However, atypical \nenhancement patterns may be frequently encountered in HCC nodules, and \ntheir understanding, interpretation and reporting may be challenging, requir-\ning the need for adjunctive information, such as diffusion characteristics and \nhepatobiliary function of the nodules. On the other hand, strict and continuous \nfollow-up is essential in HCC patients, and treatment outcome represents a strong \nprognostic indicator. However, understanding of tumour response to treatment \nrequires knowledge of the different findings after percutaneous, transarterial and/\nor systemic therapies. The development of specific cataloguing systems for focal \nliver lesions, the improvement and standardization of imaging criteria to assess \ntumour response to therapy and the creation of specific software and platforms \nfor oncologic follow-up may facilitate the radiologist’s daily workflow, yet improving \nhomogeneity and consistency in image interpretation. The session will provide \nan up-to-date overview of typical and atypical findings in liver imaging and di-\nagnostic criteria to assess tumour response and will focus on the importance of \nstandardization for efficient reporting and communication with referring clinicians. \nSession Objectives:\n1.  To become familiar with common and uncommon findings in HCC and with \nupdated guidelines in HCC diagnosis and follow-up.\n2.  To understand how interpretation and reporting in HCC influence patient \nmanagement.\n3.  To learn about recent developments in computer-aided reporting.\nA-564 08:35\nHCC diagnosis: how to report ‘typical’ findings \nC. Ayuso; Barcelona/ES (cayuso@clinic.ub.es) \nDiagnosis of early stage HCC is a key point with prognostic and patient survival \nimplications, thus it is crucial to have standardised reports for clinical and research \npurposes, being aware that specificity is the goal in the diagnosis of HCC. Any \ncategorization as “possible” or “probable” HCC will require pathologic confirmation \nto avoid wrong treatment indications. Any new hepatic nodule ³ 1 cm detected by \nscreening US, whether hypo or hyperechoic, in a population at risk of HCC is sus-\npicious to be an HCC and deserves a cross-sectional dynamic study. CEUS can \nrecognize the \"wash-in wash-out\" HCC profile, but it may overlap with the vascular \nprofile of intrahepatic cholangiocarcinoma. Thus, AASLD recommends to examine \nthese lesions under dynamic MR or MDCT to get a confident HCC diagnosis. Most \nof HCCs > 2 cm show arterial enhancement followed by wash-out in the portal/\ndelayed phase that makes possible to detect the lesion as hypointense/hypodense \ncompared to the surrounding liver. The term \"wash-out\" would be desirable to be \nstated only when extracellular contrast medium is used for MR to avoid confusion \nin the application of non-invasive criteria when hepatobiliary contrast agents are \nused and lesions are hypointense on the delayed venous and/or hepatobiliary \nphases. Fatty metamorphosis and pseudocapsule have low sensitive without any \nadditional diagnostic improvement over dynamic studies. DWI has shown high \nsensitivity but any strong data on specificity is yet available. Differentiation of very \nearly distinctly and indistinctly nodular HCC types is by now not feasible by means \nof imaging techniques.\nLearning Objectives:\n1.  To learn about AASLD/EASL imaging criteria for non-invasive diagnosis of \nhepatocellular carcinoma.\n2.  To understand the need for standardised interpretation and reporting in HCC \nsurveillance.\n3.  To learn the current terminology in HCC reporting.\nA-565 08:53\nHow to interpret and report ‘atypical’ findings \nC.J. Zech; Basle/CH (CZech@uhbs.ch) \nIn imaging, the depiction of arterial hypervascularisation and venous wash-out is \nthe hallmarks of non-invasive HCC diagnosis. However, the findings in patients \nwith liver cirrhosis or longstanding chronic hepatitis B or C often include unclear \nor atypical findings. The aim of imaging is to sensitively and specifically make the \ndiagnosis of typical HCC nodules on the one hand, and provide the differential \ndiagnosis of unclear and atypical cases on the other hand. Very often untypical \nnodular findings represent early forms of carcinogenesis - from uncomplicated \nregenerative nodules to early HCCs. The edge between benign and malignant \nis hard to determine - however, it seems that high-grade dysplastic nodules are \nusually regarded as pre-malignant lesions. On the other hand, it is known that also \nsmall overt HCC (< 2 cm) often also does not show typical vascular features. MRI \n\nPostgraduate Educational Programme\nS132\n C B D E F\n G\nA\nof the head and neck. In addition, the radiologist should be aware of ‚key‘ find-\nings with direct impact on treatment choice. This approach will be demonstrated \nusing clinical examples from daily practice, focusing on oropharynx/oral cavity \nand larynx/hypopharynx. Since so many specialists are involved in care of these \npatients, structured radiological reporting is strongly recommended. Based on the \nimaging finding, it is (usually) possible to conclude the report with a ‚radiological‘ \nTN (M)-stage which serves as proposal towards the head and neck tumour board.\nLearning Objectives:\n1.  To learn how to make a choice between CT and MRI.\n2.  To understand which imaging findings should be assessed to obtain a radio-\nlogical TN-stage.\n3.  To become familiar with structured radiological reporting of head and neck \ntumours.\nA-570 09:00\nDetection of tumour recurrence in head and neck cancer: challenges \nand pitfalls \nM. Becker; Geneva/CH (minerva.becker@hcuge.ch) \nThe purpose of this lecture is to provide a simplified, systematic approach on \nhow to detect tumour recurrence on MRI, PET/CT and PET/MRI examinations of \npatients treated for head and neck squamous cell carcinoma. First, the radiologist \nwill be familiarized with the relevant imaging findings of post-therapeutic expected \ntissue alterations with a special focus on their temporal relationship. Then a brief \ndiscussion of common complications affecting the soft tissues, vasculature and \nbony structures will follow. A systematic review will include key radiologic features of \nosteoradionecrosis, soft-tissue necrosis, neck fibrosis and scar tissue mimicking tu-\nmour recurrence. Typical radiologic findings of tumour recurrence will be discussed \nwith an emphasis on the early detection of lesions, their appearance on different \nimaging modalities and the added value of multimodality fusion or hybrid imaging \ntechniques. The potential pitfalls of post-therapeutic image interpretation and how \nto avoid them will be equally addressed. Major emphasis will be put on what the \nclinician needs to know and on how to report the findings in a comprehensive way.\nLearning Objectives:\n1.  To appreciate the spectrum of expected tissue alterations after therapy and \ntheir temporal relationship.\n2.  To understand the imaging aspects of common complications after therapy.\n3.  To become familiar with key imaging features of tumour recurrence.\n4.  To learn the potential pitfalls in post-therapeutic image interpretation and how \nto avoid them.\nA-571 09:20\nLocoregional treatment failure in head and neck cancer: causes and \nclinical implications \nR. Maroldi, P. Nicolai; Brescia/IT (maroldi@med.unibs.it) \nIt is estimated that 50-60% of patients with locally advanced squamous cell carci-\nnoma (SCC) of the head and neck receiving a multimodal treatment will develop \nlocoregional and/or distant relapse within 2 years. Therefore, surveillance and \ntreatment planning in this cluster of patients is a demanding activity for a head \nand neck multidisciplinary team. Although there are some subtle differences in \nthe pattern of recurrence in relation to the primary site and the type of treatment \n(surgical vs. non-surgical), relapse of the disease more frequently involves the \nprimary site than the neck, although both sites can be affected at the same time. \nThe reasons for treatment failure at the primary site in surgically treated patients \ncan be the presence of inadequate surgical margins, perineural spread, or vascular \nembolisation. Regional failures can occur in a previously dissected neck or in an \nuntreated field. There is general consensus in the literature that surgery is the \ntreatment offering the best rescue chance in recurrent SCC of the head and neck. \nThis possibility is higher in laryngeal cancer than in the oral cavity, oropharyngeal, \nand hypopharyngeal localisations. In early lesions of the larynx, conservative \nsurgical techniques can be considered an oncologically sound alternative to total \nlaryngectomy. Salvage surgery is instead feasible in 20%-40% of patients with \nrecurrent SCC of the oral cavity, oropharynx, and hypopharynx. Irrespective of the \nprimary treatment, patients require a compulsory follow-up which should combine \nclinical examination, including endoscopy with narrow-band imaging, and imaging \ntechniques, with the intent to early diagnose recurrences.\nLearning Objectives:\n1.  To understand the most frequent causes of local and regional post-treatment \nrelapses.\n2.  To become familiar with the indications and options for salvage surgery and \nnon-surgical procedures.\nsurgical data for each single patient, thus facilitating communication among clini-\ncians, decision making and outcome analysis.\nLearning Objectives:\n1.  To understand the need for new systems to improve standardization of reading \nand reporting.\n2.  To learn about now tools and software for managing oncologic patients.\n3.  To understand the added value of computer technology in the management \nof HCC patients.\nPanel discussion:  \nCase-based discussion: a practical demonstration of how \ninterpretation and reporting affect patient management 09:47 \n08:30 - 10:00 Room N/O \nSpecial Focus Session \nSF 16b \nHead and neck cancer battle: the power of imaging \nstudies \nA-568 08:30\nChairman’s introduction \nV. Vandecaveye; Leuven/BE (vincent.vandecaveye@uz.kuleuven.ac.be) \nOrgan sparing surgery and radiation treatment such as intensity modulated radio-\ntherapy (IMRT) - often combined with chemotherapy - have enhanced the need \nfor advanced imaging in the head and neck in the pre- and post-treatment head \nand neck; including CT, (functional) MRI, PET/CT and PET/MRI. The radiologist \nplays an indispensable role as a consultant to the clinician for appropriate staging \nof the deep tumour extension in the pretreatment setting and characterisation and \nstaging of indeterminate (sub)mucosal and nodal lesions in the post-treatment \nsetting.The vast progression in anatomical, functional and hybrid diagnostic mo-\ndalities raises many questions and potential problems for daily clinical practice: \nwhich imaging technique is most suitable, also taking into account cost-benefit? \nHow should the report be structured in order to reach the demands of the clinician? \nMoreover, increasing knowledge is required from the radiologist regarding treatment, \npatterns of tumour spread and treatment failure and the appearance of tumour \nrecurrence versus expected - and often treatment induced - tissue changes that \nmay mimic tumoural recurrence. As such, key points to provide accurate and cost-\nefficient oncologic imaging in the pre- and post-treatment head and neck include \nknowledge of the several treatment types and their indications and most frequent \ncauses and patterns of treatment failure, knowledge of imaging features that dif-\nferentiate malignant from benign lesions, knowledge of proper implementation of \nimaging techniques according to the indication and the ability to deliver a compre-\nhensible and structured report enabling both diagnosis and treatment planning. \nSession Objectives:\n1.  To learn how to choose the optimal imaging modality for head and neck cancer \nstaging and detection of tumour recurrence.\n2.  To understand which elements are key to writing a structured radiological \nreport in diagnosis and staging.\n3.  To become familiar with the imaging features of tumour relapse versus com-\nplications in the post-treatment neck.\n4.  To understand the clinical role of imaging in post-treatment patient manage-\nment.\nA-569 08:35\nBuilding blocks for locoregional staging of head and neck tumours \nF.A. Pameijer; Utrecht/NL (f.a.pameijer@umcutrecht.nl) \nIn the head and neck, squamous cell carcinoma is by far the most prevalent histol-\nogy. As in any cancer, correct pretherapeutic TNM-staging is an important factor in \ntreatment planning of head and neck neoplasms. This is a multidisciplinary effort. \nWhile the otolaryngologist uses endoscopy to evaluate the mucosal surface, it is \nthe radiologist‘s role to describe the deep extent of lesions. CT or MRI has become \nessential for pre-therapeutic staging of these tumours. In this era of cost concern, \nit seems to be a good principle to do one cross-sectional study that accurately \nanswers the clinical questions. The relative value of CT and MRI in this aspect \nwill be discussed. The role of PET CT (MR) in primary staging is evolving. To be \nan effective consultant, the radiologist‘s report should contain information needed \nby the treating physician (surgeon and/or radiation oncologist). Therefore, it is \nhelpful if the radiologist is aware of tumour spread patterns in the various subsites \n\nPostgraduate Educational Programme\nS133\nB\n C D E F G\nA\nMonday\nA-574 09:30\nC. Cardiac MRI in ischaemic heart disease \nJ. Bremerich; Basle/CH (jbremerich@uhbs.ch) \nCardiac MRI is a powerful tool for assessment and management of ischaemic \nheart disease. It provides a lot of relevant data and thus requires structured and \nstandardised reporting. In ischaemic heart disease, cardiac MRI provides data on \n1. cardiac structure such as thrombus, aneurysm or pericardial effusion, 2. car-\ndiac function such as left and right ventricular ejection fraction, 3. flow in valvular \ndysfunction and 4. enables tissue characterisation to define presence and extent \nof infarction as well as to identify differential diagnoses, e.g. myocarditis or Takot-\nsubo cardiomyopathy. Standardised reporting should be categorised into cardiac \nstructure, function, tissue characterisation (usually referred to as late gadolinium \nenhancement) and extracardiac findings. Tables with normal values for female \nand male patients are helpful. In many institutions, the report is signed by both, \na radiologist and a cardiologist which underlines the shared responsibility and \nenhances acceptance from referring physicians. Cardiac MR is a powerful tool for \nassessment of ischaemic heart disease. Structured reporting including tables with \nnormal values is helpful to present the enormous quantity of data in a clear fashion. \nSignatures from both, radiologist and cardiologist are helpful to demonstrate shared \nresponsibility and complementary expertise.\nLearning Objectives:\n1.  To know when to do cardiac MRI in ischaemic heart disease.\n2.  To become familiar with protocols of cardiac MRI and image processing.\n3.  To learn about a structured reporting approach to cardiac MRI.\n08:30 - 10:00 Room Q \nComputer Applications \nRC 1605 \nImproving workflow efficiency and quality \nA-575 08:30\nChairman’s introduction \nD. Caramella; Pisa/IT \nThe question that this refresher course is aimed to answer is the following: will \nnovel IT tools really improve quality and efficiency in daily radiological practice? \nIn fact, since the early installations of PACS, IT tools have been primarily consid-\nered as productivity tools rather than enabling technologies for fostering quality \nin medical care. The three distinguished lecturers in this course will address the \nfollowing topics: improving quality and efficiency of computerised order entry \nthrough decision support, improving quality and efficiency of reporting by structure \nand templates, improving quality and efficiency of dose management through \nexchange between modalities and registries. They will cover all aspects of the \nradiological workflow: from the selection of the diagnostic procedure, to the opti-\nmization of the acquisition parameters, to the efficient reporting of diagnostic and \nnon-diagnostic data (such as radiation dose). They will demonstrate how newly \nadapted IT tools may provide assistance throughout the radiological workflow, with \npotentially enormous gains in terms of safety for the patient and quality assurance. \nSession Objectives:\n1.  To highlight the need for IT tools to ensure quality control.\n2.  To understand how to collect data concerning radiation dose.\n3.  To learn about the integration of contrast media injectors into PACS.\nA-576 08:35\nA. Improving quality and efficiency of computerised order entry \nthrough decision support \nP. Mildenberger; Mainz/DE (peter.mildenberger@unimedizin‑mainz.de) \nCommunication of orders is a logical and relevant extension to integrated infor-\nmation systems in healthcare. The electronic communication of orders and the \nentry (OE) into RIS improves the workflows. But quality improvements require \nadditional efforts to link order-entry-solutions with health knowledge for ordering \nthe appropriate imaging procedure. These Clinical Decision Support (CDS) tools \nshould be based on generally accepted and implemented criteria, e.g. evidence-\nbased medicine. It is known that the acceptance of such systems, if successful \nand efficient implementation are given, is very good. IT concepts for CDS are well \nknown, standards for classifications are available, but semantic interoperability is \nstill an developing area. Actually, clinical information systems provide different levels \nof integration of OE and CDS. Further developments could be an implementation \n3.  To understand the role of imaging in decision-making concerning local and \nregional recurrences.\nPanel discussion:  \nAdvanced imaging in clinical practice: how does it help the patient? 09:50 \n08:30 - 10:00 Room P \nCardiac \nRC 1603 \nHow I report \nModerator: \nR. Vliegenthart;  Groningen/NL \nA-572 08:30\nA. Chest x-ray in cardiac disease \nM.B. Rubens; London/UK (m.rubens@rbht.nhs.uk) \nThe chest x-ray is a fundamental investigation in the management and follow-up of \nall patients with known or suspected heart disease. As in all areas of clinical practise, \nan organised approach to the patient is paramount and the following sequential \napproach is proposed: 1. Extra-cardiac analysis. This requires assessment of the \nquality of the radiograph, assessment of situs, scrutiny of the bones and soft tissues \nfor features of previous interventions, syndromes and systemic diseases, inspec-\ntion of the upper abdomen and assessment of the aortic and azygous arches. 2. \nPhysiological analysis. This concerns analysis of the pulmonary vasculature. The \npossible vascular patterns are normal, increased (these are pulmonary venous \nhypertension, pulmonary arterial hypertension, plethora and systemic supply to the \nlungs), decreased and uneven. Each of these patterns has a precise physiological \nmeaning. 3. Anatomic analysis. This concerns the cardiovascular silhouette. The \nCXR may suggest specific chamber enlargement; this should be interpreted in the \ncontext of the pulmonary vascular pattern. The shape and size of the aortic arch \nand central pulmonary arteries and any abnormal calcification may also be diag-\nnostically useful. Finally, the cardio-thoracic ratio may provide important prognostic \ninformation, as may sequential changes in heart size. \nLearning Objectives:\n1.  To be aware of the indications for performing a chest x-ray in patients with \ncardiac disease.\n2.  To become familiar with the most important and relevant findings for the \ndiagnosis of cardiac disease.\n3.  To learn about a structured approach to reading chest x-ray in cardiac patients.\nA-573 09:00\nB. Coronary CTA \nF. Wolf; Vienna/AT (florian.wolf@meduniwien.ac.at) \nCardiac CT is a relatively young discipline in the era of computed tomography espe-\ncially due to the fast and still on going technical developments. Using standardised \nprotocols performed by well-trained technicians and reported by well-trained and \nexperienced radiologists, cardiac CT quickly can become a routine examination. \nBeside the coronaries cardiac function with wall motion, myocardial perfusion, \nvalvular disease and pericardial pathologies can be imaged with cardiac CT. \nDepending on the indication, the optimal imaging protocol has to be chosen. A \ncardiac CT exam is planned with or without coronary calcium scoring. Retrospective \nECG gating or prospective ECG triggering is selected to image the heart during \nthe whole cardiac cycle or only in a predefined phase of the cardiac cycle. The \ncontrast media protocol depends on the body weight of the patient as well as the \nimaging protocol and indication. Reading and reporting of cardiac CT exams should \nbe done in a standardised way - this ensures not to miss any important pathology \nand facilitates the fast orientation of the clinicians within the report. Moreover, im-\nportant non-cardiac findings should also be included in the report. This presentation \nwill show in a step-by step approach how to perform a perfect cardiac CT exam \ntailored to the individual patient and how to read and report the important cardiac \nand non-cardiac findings in a standardised way. The presentation will be finished \nwith some clinical cases and the respective reports.\nLearning Objectives:\n1.  To appreciate the scope of information needed by a referring physician from \na coronary CTA examination.\n2.  To become familiar with protocols of cardiac CT and image processing.\n3.  To learn a structured approach to reading cardiac CT examinations.\n\nPostgraduate Educational Programme\nS134\n C B D E F\n G\nA\n08:30 - 10:00 Room Z \nJoint Session of the ESR and EFSUMB \nAdvances in diagnostic ultrasound: better results \nthrough cooperation \nModerators: \nL.E. Derchi; Genoa/IT \nF. Piscaglia; Bologna/IT \nA-579 08:30\nIntroducing the EFSUMB: the world’s largest ultrasound society \nN. Gritzmann; Vienna/AT (norbert.gritzmann@gmail.com) \nThe acronym EFSUMB is explained. The membership is presented. The committees \nand the educational portal are discussed. The individual benefit being an EFSUMB \nmember is presented. The potential fields of collabration of the societies are ad-\ndresssed. The European Course Book and the Euroson schools are presented. \nThe guidelines regarding CEUS are addressed.\nLearning Objectives:\n1.  To learn about the work and responsibility of the different committees.\n2.  To understand the membership basis and objectives of the EFSUMB.\n3.  To learn about the benefits for ultrasound societies and individual members.\n4.  To learn about the educational tools of the EFSUMB.\nA-580 08:48\nESR/EFSUMB collaboration: a newly established platform for joint \ndevelopment of ultrasound in radiology and clinical specialties \nL.E. Derchi; Genoa/IT (derchi@unige.it) \nThe European Society of Radiology has established a working group on ultrasound \nwith the aim of promoting advances in ultrasonography within the radiological com-\nmunity. Liaising with other societies in this field is one of the goals of the working \ngroup: the first move in this direction has been to meet with the European Federation \nof Societies in Ultrasound in Medicine and Biology in order to know each others, \nto identify common problems and to work together. It has been decided to meet \non an annual basis and to held joint sessions at meetings of the two societies. \nThe title of this session: “Advances in diagnostic ultrasound: better results through \ncooperation” demonstrates that sharing experiences gained from different points of \nview is felt by both parties as the best way to enhance knowledge and to ameliorate \nour practices in order to offer the best service to our patients.\nLearning Objectives:\n1.  To learn about the goals of the ESR Working Group on Ultrasound.\n2.  To understand the cooperative agreement between the ESR and EFSUMB.\n3.  To learn about the initial results of the cooperation between the two societies.\nA-581 09:06\nImage fusion and intervention \nT. Lorentzen; Herlev/DK (tlo@dadlnet.dk) \nImage fusion can be carried out between all image modalities provided they are \ngeometrically consistent. Fusion ultrasound (FUS) is the application of image fu-\nsion, where dynamic ultrasound (US) images are presented simultaneously with \ncorresponding images obtained from a previously acquired CT, CT/PET or MRI \nvolume. The first step on a FUS procedure is to load a dataset (CT, CT/PET or MRI) \ninto the US-system by means of an USB-memory stick, a CD-ROM, a hard drive, or \nvia the network cable and a DICOM query/retrieve connection to PACS. A magnetic \nfield is created around the patient by a magnetic transmitter and position sensors \nmounted on the US-transducer enable definition of the actual three-dimensional \ntransducer position. Definition of three points defines a plane, by which alignment \n(registration) can be established between an US-image and the corresponding slice \nfrom the uploaded dataset of the previously acquired CT-exam. The US-exam is \ncarried out as usual and images are shown in real-time (master) side-by-side and \nsimultaneously with the corresponding dynamic virtual CT-image (slave). Small liver \nmetastases for US-guided biopsy or US-guided ablation ablation might in some \ncases be difficult to find with conventional US, and in this situation FUS can often \nprovide a helpful guide to the correct lesion area. Finally, in some cases, a biopsy \nmight be avoided either due to agreement between a suspicious tumour finding on \nCT and subsequent fusion with contrast enhanced US that confirms the tumour or \nbecause the subsequent fusion provides a benign explanation to the CT finding.\nof interoperability profiles and the representation of CDS knowledge in web-based \nservices of non-commercial organisations.\nLearning Objectives:\n1.  To understand the relationship of decision support tools and evidence-based \nmedicine.\n2.  To learn how decision support tools can be implemented for requesting radio-\nlogical studies.\n3.  To appreciate potential effects of decision support tools on workflow efficiency.\nAuthor Disclosure:\nP. Mildenberger: Founder; GeSITmbH. Speaker; Bracco. \nA-577 08:58\nB. Improving quality and efficiency of reporting by structure and templates \nN. Dugar; Doncaster/UK (Neelam.Dugar@gmail.com) \nWhat does radiology report quality and structure/template mean from a patient’s \nand a clinical perspective will be discussed. How radiologists can use technology \nand informatics to optimise and to improve report quality and reporting efficiency. \nWe are aware that electronic transfer of reports to the requester is hugely important \nfor timely management of patients. Vendor neutral standards for transfer of radiol-\nogy reports in a multivendor environment will be discussed. Role of documents \nstandards like CDA, pdf and also current messaging standards like HL7v2, to \nsupport transfer of reports between multi-vendor systems will be touched upon. \nReport templates both from electronic document standard perspective and clinical \nperspective will be discussed.\nLearning Objectives:\n1.  To learn about clinical requirements for structured reports.\n2.  To become familiar with the IT requirements for report templates.\n3.  To appreciate the potential to generate data for evidence-based radiology.\nA-578 09:21\nC. Improving quality and efficiency of dose management through \nexchange between modalities and registries \nE. Vaño; Madrid/ES (elivano@terra.es) \nThe European directive on Medical Exposures requires the assessment and \nevaluation of patient doses, especially in procedures involving high doses to the \npatient. In the current draft of the new directive of Basic Safety Standards, some \nrequirements on patient dosimetry in diagnostic and interventional radiology have \nbeen reinforced: x-ray systems should provide dosimetric information with the \ncapability to be transferred to the examination report (for all CT and interventional \nsystems). Diagnostic reference levels (DRLs) shall be reviewed regularly. These \nrequirements will push the industry and the users to develop better strategies to \nevaluate patient doses, to transfer these values to the patient reports (contributing \nto the patient dose tracking system) but also to do available software to process \nthese dosimetric data and to do some automatic analysis. This analysis should \ninclude: a) periodic calibration factors for patient dose quantities, b) automatic \ndetection of high dose values (especially relevant for interventional procedures), c) \nstatistical analysis to update DRLs and to do comparisons with the existing ones, \nand d) suggest corrective actions to fulfill the quality assurance programs and the \nclinical audit requirements. DICOM radiation dose structured reports are represent-\ning a significant advantage but more efforts will be necessary for the automatic \nprocess of the relevant data contained in the report, to verify that the radiological \nrisk is acceptable and to suggest, if appropriate, corrective actions to improve the \nclinical practice. Without these last steps, patient dosimetry efforts and European \nregulations for radiation safety could only have a moderate impact.\nLearning Objectives:\n1.  To learn about current European regulation requirements and standards on \npatient dosimetry.\n2.  To become familiar with the dose reporting evolution and dose structured \nreporting.\n3.  To appreciate the potential for dose analysis and reporting as well as future \nregistries.\nPanel discussion:  \nWill novel IT tools really improve quality and efficiency in daily \nradiological practice? 09:44 \n\nPostgraduate Educational Programme\nS135\nB\n C D E F G\nA\nMonday\n10:30 - 12:00 Room A \nInteractive Teaching Session \nE³ 1720b \nMusculoskeletal emergencies \nA-584 10:30\nA. Axial skeleton \nE. Llopis; Valencia/ES (ellopis@hospital‑ribera.com) \nThe purpose of this interactive course on axial skeleton is to overview spine \nemergency lesions in order to improve prognosis on acutely compromised cord. \nFirst, how to select the best protocol depending on clinical scenarios. Second, to \nanalyse key signs for each anatomic location: intradural-intramedullary, intradural-\nextramedullary and extramedullary lesions and third to become familiar with \nMRI specific findings for spinal infection, tumour cord compression, trauma and \npostsurgical complications. \nLearning Objectives:\n1.  To understand the principal indications for emergency spinal imaging.\n2.  To be able to analyse the pros and cons of each imaging modality in spinal \ntrauma: how, why, when?\n3.  To become familiar with key MRI findings in spinal infection, tumour cord \ncompression and other non-traumatic spine disorders.\n4.  To become familiar with the main emergency complications following spinal \nsurgery.\nA-585 11:15\nB. Peripheral skeleton \nV.N. Cassar-Pullicino; Oswestry/UK (Victor.Pullicino@rjah.nhs.uk) \nIn this interactive session focussing on peripheral musculoskeletal lesions pre-\nsenting to the Accident and Emergency Department, we will review the strengths \nand weaknesses of the imaging modalities applied to chosen bone, joint and soft \ntissue lesions. The imaging-based approach will strengthen the understanding of \nthe different pathological entities which vary from trauma to infection in both the \npaediatric and adult age groups.\nLearning Objectives:\n1.  To learn when and how to use the different imaging modalities in acute skeletal \nlesions.\n2.  To learn about the US and MRI findings in infection.\n3.  To understand the value of MDCT in acute MSK lesions.\n10:30 - 12:00 Room B \nInteractive Teaching Session \nE³ 1720a \nPitfalls in pelvic imaging \nA-586 10:30\nA. Pitfalls in MRI of the pelvis \nE. Sala; New York, NY/US (salae@mskcc.org) \nThere are several MRI pitfalls that should be recognised when imaging the female \nand male pelvis. MRI appearances of uterus and ovaries are dependent on the \nphase of menstrual cycle/use of exogenous hormone therapy. Normal post-surgical \nand post-radiation appearances of the pelvis can sometime mimic tumour recur-\nrence. It is important to become familiar with these appearances in order to avoid \npotential pitfalls. One very common pitfall is differentiation of transient myometrial \ncontraction from adenomyosis. Interrogation of all imaging planes over the dura-\ntion of the entire MRI examination can be useful to distinguish between the two, \nalthough myometrial contractions can last up to 45 min. Choice of correct imaging \nplane is crucial for precise classification of uterine anomalies (coronal oblique) and \naccurate evaluation of parametrial invasion (axial oblique) in patients with cervical \ncancer. Both dynamic contrast-enhanced MRI and diffusion weighted MRI improve \nthe accuracy of MRI in evaluation of the malignant pelvic conditions. However, \ncertain pitfalls related to each technique should be recognised in order to avoid \nmisinterpretation. It is crucial to be familiar with the anatomy of the uterovesical \n(UV) ligament as it is often the site of pelvic lymphoma (such as bladder or cervix \nlymphoma). However, some benign conditions such as endometriosis can involve \nLearning Objectives:\n1.  To understand the technical aspects of image fusion with ultrasound (US) and \nother imaging modalities (most frequently CT or MRI).\n2.  To learn how to align two sets of data, obtained through different axial imaging \ntechniques, with one another and perform live US scanning, where the fused \nimage follows the live US.\n3.  To understand how a lesion, even when invisible, can be targeted for US-\nguided, using CT and MRI image fusion.\nA-582 09:24\nThe EFSUMB non-liver CEUS guidelines \nF. Piscaglia, S. Marinelli, E. Terzi; Bologna/IT (fabio.piscaglia@unibo.it) \nGiven the many new organs studied by CEUS, EFSUMB decided to publish in \n2012 the update of its clinical recommendations on CEUS separately for hepatic \nand non-hepatic applications. These are based on comprehensive literature sur-\nveys and/or on expert committee reports and/or on the views of a panel of experts \nauthors, providing a recommendation level (RL) for each indication based on the \nLevels of Evidence provided by the Centre for Evidence-Based Medicine, Oxford \n(UK). Worth to remind that most of daily routine non-hepatic applications continue \nto be off-label and patients should be informed and must consent to the investiga-\ntion. In general, microbubble contrast agents are very safe with an extremely low \nincidence of side effects. Herein, the most important non-hepatic applications of \nCEUS from guidelines are listed. One very important issue is the use of CEUS in \npaediatrics. In this setting, CEUS has several advantages, a) lack of any radiation \nexposure, b) excellent safety, c) easy repeatability to monitor potentially evolving \nsituations, d) user friendly approach, allowing parents to stand aside and in contact \nwith their examinee children and e) no need for sedation or general anesthesia to \nobtain a relaxed lying patient. The main applications are the characterisation of \npancreatic masses, distinguishing between solid and cystic, the assessment of local \ncomplications of Chron disease, the identification of renal parenchymal ischaemia \nor infarction, the assessment of blunt minor abdominal trauma to ascertain the ab-\nsence of parenchyma injuries, the identification of endoleaks in treated abdominal \naortic aneurysms and several others. \nLearning Objectives:\n1.  To learn about new guidelines and clinical recommendations on the use of \ncontrast enhanced ultrasound in non-liver applications, which were released \nby the EFSUMB in 2012.\n2.  To learn about the process of producing the document.\n3.  To learn, based on the evidence, which organs are suitable for CEUS in daily \npractice, and which are only suitable for research using CEUS.\nAuthor Disclosure:\nF. Piscaglia: Advisory Board; Bayer. Board Member; Bayer. Consultant; Bracco. \nSpeaker; Bayer, Siemens.\nA-583 09:42\nThe EFSUMB/WFUMB liver-CEUS guidelines \nM. Claudon; Vandoeuvre‑les‑Nancy/FR (m.claudon@chu‑nancy.fr) \nThe present document describes the third iteration of recommendations for the \nuse hepatic of contrast-enhanced ultrasound (CEUS) and contrast-specific imaging \ntechniques which were introduced ten years ago in Europe and Canada. Time has \nmoved on, and the need for worldwide guidelines on the use of contrast-enhanced \nultrasound (CEUS) in the liver has become apparent. WFUMB (World Federation \nfor Ultrasound in Medicine and Biology) and EFSUMB (European Federation of \nSocieties for Ultrasound in Medicine and Biology) initiated further discussions in \n2010, in conjunction with the AFSUMB (Asian Federation of Societies for Ultrasound \nin Medicine and Biology), AIUM (American Institute of Ultrasound in Medicine), \nASUM (Australasian Society for Ultrasound in Medicine), FLAUS (Federation \nof Latin American Societies for Ultrasound) and ICUS (International Contrast \nUltrasound Society) to bring the 2008 liver guidelines up-to-date, recognizing the \nfact that contrast agents are now licensed in many parts of the world, including \nAustralasia, Brazil, Canada, China, Europe, India, Japan and Korea. The content of \nthese international liver guidelines includes general considerations on CEUS, char-\nacterisation of focal liver lesions (FLL) in non-cirrhotic and cirrhotic liver, portal vein \nthrombosis, FLL biopsy guided by CEUS, detection of FLL by both transabdominal \nand intraoperative approaches, monitoring of abative tratement, liver transplanta-\ntion, contrast quantification and monitoring of systemic treatment of malignancies.\nLearning Objectives:\n1.  To learn about the current practice of contrast enhanced ultrasound (CEUS) \nworldwide.\n2.  To learn how the CEUS international guidelines were established.\n3.  To learn about the main indications for CEUS in cases of liver disease.\n\nPostgraduate Educational Programme\nS136\n C B D E F\n G\nA\nis an increasing disease in the elder population, primary hyperparathyreoidism is \nthe most common systemic metabolic bone disease following osteoporosis with \nan incidence of 21-25 cases/100.000 population/year, and Paget`s disease has a \nprevalence of 10% in the population elder than 80 years. Therefore it is challenging \nfor the radiologist to be familiar with these diseases.To understand the radiologic \nchanges of metabolic bone diseases it is necessary to have knowledge about \ntheir pathophysiology and pathologic anatomy. In most cases of osteomalacia, \nhyperparathyreoidism, renal osteodystrophy and Paget`s disease the diagnosis \ncan be made with conventional radiography and scintigraphic bone scan. The use \nof advanced radiologic techniques (CT,MRI,PET) is limited, because there are \nhitherto only few experiences and a lack of specific patterns, in contrast to x-rays \nwith an overwhelming fundus of more or less specific findings. \nLearning Objectives:\n1.  To understand the basic pathophysiology of metabolic and endocrine bone \ndiseases.\n2.  To become familiar with the most typical imaging findings of metabolic and \nendocrine diseases.\n3.  To appreciate specific imaging patterns and to discuss the value of different \nimaging techniques.\n16:00 - 17:30 Room C \nGI Tract \nRC 1901 \nCross-sectional imaging of colitis \nA-590 16:00\nChairman’s introduction \nS.A. Taylor; London/UK (csytaylor@yahoo.co.uk) \nCross-sectional imaging is playing an increasing role in the diagnosis, staging \nand follow-up of colitis. Often the radiologist diagnoses colitis on cross-sectional \nimaging, and the clinician requires the most likely diagnosis. Alternatively, imaging \nis used to assess the severity of a known colitis and monitor treatment response. \nThis session will describe state of the art protocols for assessing the inflamed colon \nusing CT, MRI and USS. The common aetiologies of colitis will then be discussed \nand tips and tricks as to how to limit the differential diagnosis presented. Finally, the \nrole of cross-sectional imaging in the management of inflammatory bowel disease \n(IBD) will be described with emphasis on disease activity. An integrated approach \nto imaging patients with colonic IBD will be presented.\nA-591 16:05\nA. What protocol to use? \nS. Schmidt; Lausanne/CH (sabine.schmidt@chuv.ch) \nThe role of cross-sectional imaging in the diagnosis of colitis is increasing following \nrecent technologic advances. Prior colonic cleansing is usually not required, unlike \nin CTC. However, careful attention to examination technique is essential, since \ncollapsed colon may suggest colonic wall thickening, thus mimicking colitis. When \nusing CT or MRI, adequate luminal distension is required, while this optional in US \nwhere direct compression of the bowel aids diagnosis. Recommended imaging \nprotocols will be discussed. CT remains the work horse for imaging suspected colitis, \nespecially in emergency settings. It is widely available and facilitates rapid data \nacquisition with excellent spatial resolution aiding image interpretation. Intravenous \ncontrast-medium administration can reveal the typical target sign of colitis, which \ncan easily be differentiated from other wall patterns, such as diffuse enhancement, \nseen in cancer. MRI does not expose patients to radiation and provides excellent \ntissue contrast facilitating the detailed analysis of the inflamed colonic wall. Both \nconventional and diffusion-weighted sequences provide functional non-invasive \nassessment of the severity of colitis and monitoring of treatment responses, es-\nsential in Crohn patients. Colonic US is safe, well tolerated and, in general, freely \navailable, although it requires specific operator expertise. It simultaneously provides \nmorphological and functional information. Absent peristalsis and wall thickening \nin acute colitis usually reduce intraluminal air, thus facilitating colonic assessment \ncompared to healthy subjects. Akin to CT and MRI, the three colonic wall layers \nare differentiated and pericolonic findings can be assessed. However, US can be \nlimited by patient‘s body habit and the radiologist‘s practical experience. \nLearning Objectives:\n1.  To become familiar with the role of colonic distension prior to imaging of \nsuspected or known colitis.\n2.  To understand typical CT, MRI and US protocols.\n3.  To highlight the pros and cons of CT, MRI and US.\nthe UV-fold and invade both bladder and uterine wall. Certain MRI features can \nbe helpful in making the correct diagnosis. \nLearning Objectives:\n1.  To become familiar with normal variations in MRI appearances of female pelvis \nresulting from physiologic conditions (e.g. different phases of menstrual cycle) \nand treatments (including exogenous hormone therapy, surgery and radiation) \npotentially mimicking disease.\n2.  To discuss the role of correct MR imaging plane in avoiding potential mis-\nclassification of uterine anomalies and parametrial invasion in patients with \ncervical cancer.\n3.  To recognise certain pitfalls related to dynamic contrast-enhanced MRI and \ndiffusion weighted MRI.\nA-587 11:15\nB. Pitfalls in pelvic ultrasound \nK. Kinkel; Chêne‑Bougeries/CH (karen.kinkel‑trugli@wanadoo.fr) \nPitfalls of sonographic findings in the pelvis can be related to technical issues, \ninterpretation errors or due to the patient’s specific condition or pathology. Com-\nmon problems consist of insufficient bladder filling, misinterpretation of posterior \nenhancement or shadowing according to the anatomical structure and pathology \nof a size that goes beyond the field of view of the probe. Organ specific problems \nwill be illustrated in interactive questions particularly for the uterus and the ovaries.\nLearning Objectives:\n1.  To become familiar with anatomical variants, potentially mimicking disease.\n2.  To learn about common pitfalls in pelvic ultrasound.\n12:30 - 13:30 Room N/O \nThe Beauty of Basic Knowledge: Head and Neck \nMC 24E \nTemporal bone: so beautiful, yet so complicated \nA-588 12:30\nTemporal bone: so beautiful, yet so complicated \nB. De Foer; Wilrijk‑Antwerp/BE (bert.defoer@gza.be) \nThe complex temporal bone anatomy will be reviewed, as specifically visualized \non the two most important imaging techniques for temporal bone imaging, CT and \nMRI. The use of adapted imaging techniques for various clinical conditions, indica-\ntions and questions will be discussed and illustrated. The issue of CBCT versus \nMDCT in temporal bone imaging will be discussed and different MRI protocols \nadapted to various clinical conditions, indications and questions will be highlighted. \nThe most important pathological issues in the external ear, middle ear and inner \nwill be demonstrated including congenital, tumoural, infectious and inflammatory \npathologies. In the middle ear, special attention will be paid to chronic middle ear \ninfection, cholesteatoma and otodystrophies. In the inner ear, special attention will \nbe paid to the broad scala of pathology of the vestibulocochlear nerve.\nLearning Objectives:\n1.  To become familiar with temporal bone anatomy.\n2.  To learn how to choose and tailor imaging techniques according to clinical \npresentation.\n3.  To appreciate the most common pathologies affecting the three main compart-\nments of the temporal bone.\n12:30 - 13:30 Room P \nThe Beauty of Basic Knowledge: Musculoskeletal Imaging \nMC 25E \nMetabolic/endocrine disease \nA-589 12:30\nMetabolic/endocrine disease \nJ. Freyschmidt; Bremen/DE (freyschmidt@radiologie‑freyschmidt.de) \nSystemic metabolic bone diseases in the narrower sense include osteoporosis, \nosteomalacia, hyperparathyreoidism and renal osteodystrophy. But also Paget`s \ndisease is traditionally counted among the metabolic diseases, although it has \ninflammatory roots. In this course osteoporosis will not be discussed. Osteomalacia \n\nPostgraduate Educational Programme\nS137\nB\n C D E F G\nA\nMonday\n16:00 - 17:30 Room D2 \nContrast Media \nRC 1906 \nHow I optimise contrast media administration \nModerator: \nW. Semmler; Heidelberg/DE \nA-594 16:00\nA. CT \nP. Leander; Malmö/SE (peter.leander@med.lu.se) \nThere are different reasons for optimising contrast media (CM) use in computed \ntomography (CT). The first and maybe most obvious is to obtain a highly diagnos-\ntic procedure and we are all familiar with terms as, e.g. arterial and portovenous \nphase. Different CM phases in CT is to high extent based upon an understanding \nof the pharmacokinetics of iodinated CM. As small water-soluble non-protein bound \nmolecules these CM are distributed by the blood circulation and throughout the \nextracellular space. With modern CT-systems there are often more CM phases \nemployed in protocols for gaining even more information, e.g. tumour vascularity, \npancreatic parenchymal enhancement and mucosal delineation. In early CT, mostly \nof technical reasons, protocols seldom took advantage of using lower voltage than \n120 kV. As iodine is not ideal for the photon spectrum obtained from such high \nenergy, nowadays lower kV is more often included in protocols. Another important \nreason for optimisation of CM use is the risk of CM-induced nephropathy (CIN) and \nhow this could be balanced but still obtaining diagnostic information. By taking all \nabove into consideration, the lecture will give an overview about the patient, CM, \nscanning factors and CM enhancement. The lecture will give few protocols, if any, \nready to bring home, but instead understanding with “longer half-live” how CM \nprotocols are setup on the basis of factors as CM distribution, iodine attenuation, \nrisk of adverse events, and more. By this approach, one can become familiar and \nunderstand any CM protocol for CT.\nLearning Objectives:\n1.  To understand the pharmacokinetics of iodinated contrast media.\n2.  To learn about patient, contrast medium and scanning factors associated with \ncontrast enhancement and scan timing.\n3.  To become familiar with protocols for optimised contrast enhancement.\nA-595 16:30\nB. MRI \nG.M. Bongartz; Basle/CH (gbongartz@uhbs.ch) \nContrast media for Magnetic Resonance Imaging are mainly based on Gadolinium \n(Gd) or other metallic compounds like Iron (Fe) or Manganese (Mn). All of these \ndo not actively alter the magnetic signal upon intravascular application but rather \nenhance relaxivity of neighbouring molecules. The impact of all contrast media \nfor MRI on the signal intensity is strong and thus the overall amount of contrast \nmedia given is much less compared with iodinated contrast media. Gd is by far \nmost frequent in clinical use. Due to its toxicity it must be fixed in stable chelates. \nRecently, Nephrogenic Systemic Fibrosis (NSF) as an unexpected side-effect of \nGd-compounds in renally impaired patients has been detected and led to certain \nGd-specific restrictions or contraindications for medical use. As a key consequence, \nrestrictive use of Gd compounds in renally impaired patients is mandatory, which \nmeanwhile let the disease more or less disappear. Special preparations of Gd \ncompounds enable tissue-specific application (like hepatocyte-specific contrast). \nFollowing the injection of this contrast media, both documentation of the vascular \nperfusion as well as of cellular activity is possible. Similarly, Fe compounds may \nbe applied to characterise the reticulo endothelial system. Mechanisms for contrast \nand examples for typical application will be given.\nLearning Objectives:\n1.  To understand the differences between iodinated contrast agents and gado-\nlinium chelates and their impact on contrast medium administration.\n2.  To learn about injection and scanning protocols for optimised vascular and \nparenchymal enhancement.\n3.  To review the influence of tissue-specific contrast media on the injection and \nscanning protocols.\nAuthor Disclosure:\nG. M. Bongartz: Research/Grant Support; Bayer Healthcare Switzerland. \nA-592 16:28\nB. Differentiating between the causes of colitis \nB. Gallix; Montpellier/FR (b‑gallix@chu‑montpellier.fr) \nThe final diagnosis of the type of colitis is based on clinical and laboratory data and \ncolonoscopic and biopsy findings. However, information provided by endoscopy \nis limited to the mucosal surface. Cross-sectional imaging techniques, such as \nultrasound, computed tomography, and magnetic resonance, are widely used to \nassess patients with non-specific abdominal pain and are gaining acceptance for \nthe assessment of patients with suspected acute or chronic colitis. Cross-sectional \nstudies are useful alternative tools not only in the assessment of bowel wall ab-\nnormalities, but also for the assessment of extraluminal alterations. Differentiating \nbetween the causes of colitis is based on the location of involvement, extent and \nappearance of colonic wall thickening, extraluminal changes, and type of com-\nplications encountered. When chronic inflammatory colitis suspected, imaging \nhelp to distinguish ulcerative colitis from Crohn colitis. Infectious types of colitis \nshare the features of wall thickening, pericolonic stranding, and various degrees \nof ascites according to the severity of the disease. Pseudomembranous colitis \ndemonstrates marked wall thickening and, occasionally, skip areas but is associ-\nated with broad-spectrum antibiotic treatment or chemotherapy. Neutropenic colitis \nis characterised by right-sided colonic and ileal involvement, whereas ischaemic \ncolitis is characterised by vascular distribution pattern and history. Diverticulitis is \na focal asymmetric process with fascial thickening and inflamed diverticula. The \ndiagnosis of ischaemic colitis is suspected when the distribution of the colon wall \ninvolvement follow the vascular. The ischaemic changes are commonly segmental \nespecially on left colon in elderly patients.\nLearning Objectives:\n1.  To learn the most common cause of colitis through cross sectional imaging in \nboth immune competent and immune compromised patients.\n2.  To become familiar with differentiating infectious, inflammatory, ischaemic and \nautoimmune conditions based on cross sectional imaging criteria.\n3.  To understand the limitations of cross sectional imaging in differentiating \nbetween its causes.\nA-593 16:51\nC. The role of cross-sectional imaging in colonic inflammatory bowel \ndisease \nJ. Rimola; Barcelona/ES (jrimola@clinic.ub.es) \nEndoscopy is currently considered the reference standard for the evaluation of co-\nlonic disease activity in patients with inflammatory bowel disease (IBD). However, it \nonly allows evaluation of the mucosal surface and is not always complete. It cannot, \ntherefore, help to estimate the depth of involvement of transmural inflammation and \nextraluminal complications, both characteristics of IBD. An evolving role of cross-\nsectional imaging for the evaluation of patients with IBD is increasingly recognised, \nespecially in the setting of Crohn’s disease (CD) since the cross-sectional imaging \nhas demonstrated to have a high diagnostic accuracy not only for assessing the \npresence and extension of luminal disease but also for evaluating the CD-related \nacute or chronic complications. Available evidence suggests that ultrasound, \ncomputed tomography and magnetic resonance have similar and high diagnostic \naccuracy for the detection of disease activity, location, severity, and complica-\ntions, particularly for penetrating and stricturing lesions which are characteristic \nof CD. Thus, the choice of the technique for assessing CD may be influenced by \nlocal availability or expertise. In case of ulcerative colitis, cross-sectional imaging, \nalthough less evaluated, may also be helpful in certain circumstances. There is \nevidence indicating that cross-sectional imaging is a problem-solving tool as alter-\nnative to endoscopy whenever tissue sampling is not required, that can provide a \nvaluable guidance for performing medical and surgical treatment with maximized \nefficacy and safety. Overall, findings from crosss-sectional imaging accurately \nreflect disease activity and provide reliable information for decision-making and \npatient care optimization. \nLearning Objectives:\n1.  To learn the optimised examination protocols for ulcerative colitis and colonic \nCrohn’s disease in the acute, subacute and chronic disease setting.\n2.  To describe criteria for the assessment of disease activity through CT, MRI \nand ultrasound.\n3.  To outline an integrated approach to the use of cross sectional imaging in \ncolonic inflammatory bowel disease.\nAuthor Disclosure:\nJ. Rimola: Advisory Board; Genentech. Research/Grant Support; Abbott. \nPanel discussion:  \nThe role of cross-sectional imaging in the diagnosis and follow-up of \ncolitis 17:14 \n\nPostgraduate Educational Programme\nS138\n C B D E F\n G\nA\nLearning Objectives:\n1.  To become familiar with the techniques used in standard MR.\n2.  To learn about the strengths/weaknesses of standard MR along with diagnostic \nproblems related to anatomical variation.\nA-599 16:28\nB. CT arthrography \nC.W.A. Pfirrmann; Zurich/CH \nWith modern multidetector CT scanners, CT arthrography with multiplanar recon-\nstruction in high resolution is possible. CT arthrography is performed with intra-\narticular injection of non-diluted iodinated contrast material. CT arthrography of \nvirtually any joint from head to toe is possible. There are several indications and \nadvantages for CT arthrography. Imaging time with CT arthrography is much faster \nthan MR. This is especially advantageous for anxious patients. Also for patients with \nclaustrophobia, CT is often a better option. CT arthrography has the advantage of \nhigh contrast between cartilage and contrast material. Therefore, CT arthrography \nmay be superior in defining cartilage defects. In the postoperative patient, artefacts \nfrom metal may be present in or near the joint. With CT arthrography, these arte-\nfacts are often less pronounced, compared to MR imaging. Assessment of bony \nstructures may be easier with CT arthrography compared to MR arthrography. \nSmall osseous fragments, such as glenoid rim fractures may be difficult to see with \nMR arthrography, with CT these fragment or calcifications may be easily seen. CT \narthrography is a valuable alternative in patients that have a contraindication for \nMR imaging. For example, the diagnosis of a meniscal tear is possible in the same \nway using CT arthrography as with MR imaging. In the shoulder, CT arthrography \nis well suitable for the assessment of labral lesions, cartilage damage and rotator \ncuff tendons using the same diagnostic criteria as with MR arthrography.\nLearning Objectives:\n1.  To become familiar with the techniques used in CT arthrography.\n2.  To learn about the strengths/weaknesses of CT arthrography.\nAuthor Disclosure:\nC. W. A. Pfirrmann: Advisory Board; Advisory Board Orthopaedic Diagnostics, \nSiemens. \nA-600 16:51\nC. MR arthrography \nJ. Kramer; Linz/AT (kramer@ctmri.at) \nMR arthrography (MRA) is a relatively simple procedure, requires no anesthesia, \nand is essentially devoid of complications. With some experience, it is easy to per-\nform and is a strong aid in patients when conventional MR exams dont provide the \nneeded information for sufficient therapy. MRA, by virtue of its ability to demonstrate \naccurately intra-articular structures and especially pathologic alterations of these \nstructures (e.g. labral lesions - shoulder, hip; partial articular-sided cuff tears), adds \nan important component to the radiologist’s armamentarium. Although not appropri-\nate for all patients, MRA plays an important role in the evaluation of patients with \nsuspected intra-articular pathology who have equivocal clinical and conventional \nMR imaging findings. However, even nowadays, clinical use of MRA is limited due \nto several reasons: the conversion of a non-invasive procedure into an invasive, \nalbeit minimally invasive, procedure; increased cost and time required to perform \nMRA compared with conventional MR imaging; and the need to obtain patient’s \nconsent for performing a MRA exam since the use of intra-articular gadolinium \ncompounds has not yet been approved generally. By the way, the experience to \nperform MRA’s has to be part of radiologoists training program.\nLearning Objectives:\n1.  To become familiar with the techniques used in MR arthrography.\n2.  To learn about the strengths/weaknesses of MR arthrography.\nPanel discussion:  \nWhich imaging technique for which clinical scenario? 17:14 \nA-596 17:00\nC. PET/CT \nX. Montet; Geneva/CH (xavier.montet@hcuge.ch) \nOptimisation of iodinated contrast media administration during PET-CT acquisi-\ntion. When a CT scan of a combined PET/CT is performed as a full diagnostic CT, \nincluding iodinated contrast media administration, the diagnostic quality of the \nexaminatioin is improved. Nevertheless, the possibility that contrast-enhanced CT \nused for attenuation correction may introduce errors in the standardised uptake \nvalue (SUV) will be discussed during this lecture. Different optimised contrast-\nenhanced CT protocols will then be discussed.\nLearning Objectives:\n1.  To become familiar with the role of contrast-enhanced CT in PET/CT.\n2.  To understand the influence of CT contrast-enhancement on attenuation cor-\nrection of PET images.\n3.  To learn about the importance of adequately timing the injection of CT and \nPET agents for optimal PET/CT.\n16:00 - 17:30 Room E1 \nMusculoskeletal \nRC 1910 \nIntra-articular imaging \nA-597 16:00\nChairman’s introduction \nA.H. Karantanas; Iraklion/GR (akarantanas@gmail.com) \nIntraarticular imaging is a difficult task because of the small size of the anatomic \nstructures and the curved shape of the articular surfaces. Technological advances \nduring the past two decades have improved our ability of imaging the joints. The \nmost important of them include high-field MRI scanners and MDCT technology. \nCommon joint disorders afflicting wide age groups include degeneration, inflamma-\ntion and trauma. Early depiction of disease allows accurate treatment planning in \ntrauma, early suppression of inflammation in rheumatologic disorders, and monitor-\ning of degeneration in osteoarthritis. Depiction of early signs of disease activity or \nrecurrence improves the efficiency of newer treatments. The importance of updated \nimaging is highlighted by the fact that new surgical techniques are applied in the \ncartilage and meniscus. Modern imaging allows clear depiction of the involved joint \nstructure: synovium, articular cartilage, labrum and subchondral bone. The high \nspatial and contrast resolution provided currently with MRI and CT highlights find-\nings which are clinically irrelevant. Radiologists should be familiar with the technical \nprerequisites for achieving a high-quality examination, as well as the pitfalls and \nvariants that might simulate disease. Thorough knowledge of the above will allow \nthe application of the proper imaging technique in each individual clinical scenario.\nA-598 16:05\nA. Standard MR techniques \nC. Faletti; Turin/IT (falettic@atlink.it) \nIn the evaluation of the muscoloscheletric apparatus and in particular that of os-\nteoarticular pathology, it is essential that the magnetic resonance examination be \nmodulated on the basis of clinical requirements. That is the most suitable plane and \nsequence to evidence the underlying mechanisms/alterations at the source of the \nsymptomatology has been chosen. Basically, the structures that are to be evidenced \nare represented by fibrous-connective tissue, cartilage, synovial tissue and bone \nand the modifications that may be caused on these by the varying pathologies must \nbe taken into consideration. The morphology of the structure is best defined with \nthe use of spin-echo sequences, in particular that of T1/PD-T2 weighted images. \nThe sequences that exploit the suppression of fat, or fat-water separation, do seem \nto be the most suitable for a panoramic and comprehensive evaluation of the joint \nunder study, as the various components may be observed in such a way so as to \nmake a complete and satisfactory primary diagnostic codification on the underlying \nproblem. Depending on the individual requirements, specific sequences may be \nadded, such as those that give more detailed information/evaluation of cartilage \ndamage, or a better view of flogistic synovial processes, with, for example, the \nenhancement of a paramagnetic contrast medium. Diagnostics may be hampered \nby the use of lower magnetic fields, such as permanent magnets. Also in this case, \nthe solution is a modulation of the various characteristics of the different sequences \nand the intrinsic possibilities of the equipment available.\n\nPostgraduate Educational Programme\nS139\nB\n C D E F G\nA\nMonday\n111In-DTPA-octreotide has a substantial value in detection, diagnosis and staging \nof NET and more particular in gastroenteropancreatic NETs. Newer SSR-binding \nradiopharmaceuticals have been developed for PET, mainly with gallium-68 as ra-\ndiolabel, with higher affinity and more advantageous pharmacokinetics. When used \nwith high-resolution and rapid-throughput multimodal whole body imaging of modern \nPET/CT cameras these tracers provide the current state of the art SSR imaging. \nWe will also discuss the clinical value of metabolic tracers, such as [18F]-FDG for \nglucose metabolism imaging, [18F]-DOPA and [11C]-HTP ([11C]5-hydroxytryptophan) \nfor amino acid metabolism imaging. The clinical merits and indications of these \ntracers will be explained. The continuously evolving quest to develop tracer for \nother receptor systems expressed on NETs will be illustrated, e.g. bombesin, VIP, \nCCK and glucagon-like peptide receptor ligands. Finally, the role of imaging as \nselection for metabolic and peptide receptor radionuclide therapy will be discussed.\nLearning Objectives:\n1.  To learn about the cellular properties of GEP-NET used in molecular imaging.\n2.  To become familiar with the different modalities and new tracers being used.\n3.  To learn about the performance of the different methods available.\nA-604 16:51\nC. Anatomical imaging: transabdominal US, endoscopic US, MDCT \nand MRI. What is the most appropriate imaging approach? \nV. Vilgrain, M.-P. Vullierme, P. Ruszniewski, A. Sauvanet; Clichy/FR \n(valerie.vilgrain@bjn.aphp.fr) \nGastroenteropancreatic neuroendocrine tumours (GEP-NETs) are a heterogeneous \ngroup of neoplasms that arise from cells of the diffuse neuroendocrine system and \nmay present with a wide spectrum of clinical presentations. Their prognosis is mainly \nrelated to their biology, proliferation and differentiation. The main goals of imaging \nare the diagnosis and the staging of these tumours. Diagnostic challenge is very \ndifferent in functional tumours where clinical presentation and laboratory parameters \nare of utmost importance and in non-functional tumours where imaging may show \ncharacteristic features such as hypervascularization and calcifications. Staging is \nalso essential as locoregional involvement and distant metastases (such as liver \nmetastases) may change the therapeutic approach and are major prognostic fac-\ntors. Multimodal work-up including morphological imaging modalities with CT, MR \nimaging, and endoscopic ultrasound being the most useful and functional imaging \nis needed. The latter includes somatostatin receptor scintigraphy, FDG PET and \nmore recent functional tools such as PET using 68Ga and 18 F-DOPA. Imaging may \nalso play a role in assessing prognosis in combination with tumour differentiation \nand tumour proliferation obtained from pathologic examination. Last, imaging is \nuseful in evaluating tumour response after treatment. Although surgery remains \nthe only potentially curative therapy for patients with primary GEP-NETs, other \navailable treatments include chemotherapy, interferon, somatostatin analogues, \nand targeted therapies. Imaging criteria rely not only on changes in tumour size \nbut also on internal tumour changes.\nLearning Objectives:\n1.  To learn how to recognise the specific imaging features of GEP-NET.\n2.  To learn about the strengths and weaknesses of the different imaging modali-\nties.\n3.  To understand the optimal use of the different imaging modalities in relation \nto tumour localisation and staging.\nPanel discussion:  \nThe future of hybrid imaging 17:14 \n16:00 - 17:30 Room F1 \nSpecial Focus Session \nSF 19 \nTablet-computers in radiology: friend or foe? \nA-605 16:00\nChairman’s introduction \nE. Neri; Pisa/IT (emanuele.neri@med.unipi.it) \nTablets in radiology represent a novelty. Since the introduction of the tablets in the \nmarket, the radiological field has been probably the first medical discipline to dis-\ncover the many advantages of these devices. In fact, many applications for image \nmanagement have been made available on the apps stores (Apple and Android), \nand let radiologists and non-radiologists to handle DICOM images on the Tablet, \na part of the patient’s record. However, the emerging applications are driving the \nprocess from the simple DICOM image viewing to the full integration of the Tablet \n16:00 - 17:30 Room E2 \nOncologic Imaging \nRC 1916 \nGastro-entero-pancreatic neuro-endocrine tumours \n(GEP-NET): a multidisciplinary update \nA-601 16:00\nChairman’s introduction \nC. Matos; Brussels/BE (cmatos@ulb.ac.be) \nSince a large number of neuroendocrine cells may undergo malignant transforma-\ntion, gastroenteropancreatic neuroendocrine tumours (GEP-NET) are a heterogene-\nous group of cancers that differ in their biology and clinical presentation. Diagnosis \nof these tumours has been improved by advances in pathology and classification, \nand by tumour imaging with the combined use of structural imaging techniques and \nfunctional imaging techniques. Multimodality imaging is increasingly recognised \nnot only in detecting and staging disease but also in characterising biological \npatterns of lesions that may be relevant to the selection and delivery of therapy. \nIn this refresher course, the complex nature of GEP-NET and the intrinsic uses \nand limitations of each diagnostic imaging modality will be underlined. Insights to \nhybrid structural and molecular imaging techniques will be provided and discussed.\nA-602 16:05\nA. Tumour biology, pathogenesis and classification \nB. Wiedenmann; Berlin/DE (bertram.wiedenmann@charite.de) \nNeuroendocrine tumour cells are characterised by the coexpression of neuronal \nand epithelial proteins and cellular organelles such as synaptic vesicles containing \nsynaptophysin of neurons and intermediate filaments/cytokeratins of the epithelial \ncells. Based on presence of secretory vesicles and the continous, uncontrolled \nvesicular release of biogenic amines, neuropeptides and hormones, patients suffer \nin half of the cases of socalled functional symptoms and syndromes. Examples are \nthe carcinoid syndrome (excessive release of serotonine) or the Zollinger-Ellison \nsyndrome (excessive release of gastrin). Activation or inhibition of certain G-protein \ncoupled receptors (e.g. somatostatin receptors) or channel proteins (R-type calcium \nchannels) can lead to the control of the hypersecretion or socalled functionality \nof the affected patients. Medical interference with signal transduction pathways \ninvolving tyrosine kinase receptors as such mTor and channel proteins can lead \nto an inhibition of cellular and tumour growth. These observations have led to the \nestablishment of new therapies, especially for pancreatic NETs using especially \nmTor and tyrosine kinase inhibitors. Whereas the tumourigenesis is unknown in the \ncase of sporadic NETs, hereditary NETs appear to develop via a menin mutation \nthrough the intermediate stage of hyplasia before they develop the full metastatic \npotential. Based on the above given tumour biological and histopatholical find-\nings, a rather robust classification for NETs has been developed by the European \nNeuroendocrine Tumour Society (ENETS) using a TNM-classification together \nwith a grading-system. Furthermore, the formerly used terms such as APUDOMa, \nNeurocrestoma, Carcinoid., etc have been largely replaced by the meanwhile \ngenerally accepted term neuroendocrine tumour.\nLearning Objectives:\n1.  To learn about basic aspects of GEP-NET biology, pathogenesis and clas-\nsification.\n2.  To understand the epidemiology and current treatment options.\n3.  To become familiar with rational clinical management.\nAuthor Disclosure:\nB. Wiedenmann: Advisory Board; Novartis, Pfizer, IPSEN. Consultant; Lexicon \nPharmaceuticals. Investigator; Novartis, IPSEN. Speaker; Novartis, Pfizer, \nIPSEN. \nA-603 16:28\nB. The current role of nuclear medicine techniques \nC.M. Deroose; Leuven/BE (christophe.deroose@uzleuven.be) \nThis presentation will focus on the pivotal role of nuclear medicine in the diagnosis \nand treatment of neuroendocrine tumours (NETs). The metabolic and molecular \nimaging capabilities of both positron emission tomography (PET) and single \nphoton emission tomography (SPECT) have made a great impact in the clinical \nmanagement patients with these tumours. One of the post-prominent posterchilds \nof molecular imaging in oncology is scintigraphy of the somatostatin receptor (SSR). \n\nPostgraduate Educational Programme\nS140\n C B D E F\n G\nA\nsecond solution can continue to function after disconnecting from the network. It is \nundeniable that portable devices will become a major component of our technical \nenvironment and will significantly change workflow and clinical practice. Current \nsolutions may not be adequate yet for routine diagnostic tasks but they provide \nconvenient mobile solutions for on-call and remote consultations. \nLearning Objectives:\n1.  To understand the DICOM readers available for tablet-computers.\n2.  To become familiar with the different approaches to DICOM reading (local vs \nremote) and the PACS/tablets integration.\n3.  To appreciate the pros and cons of DICOM image-reading with tablet-com-\nputers in regards to image quality and displays.\nA-609 16:59\nMobile teleradiology with tablet-computers: a critical appraisal \nE.R. Ranschaert; ‚s‑Hertogenbosch/NL (ranschaert@telenet.be) \nOver the past few years several applications and viewers have been developed \nfor smartphones and tablet computers with the purpose of using them for remote \nreviewing and interpretation of radiology images. With tablet computers such as \nthe iPad, DICOM images can be viewed from any location within or outside the \nhospital. Other key clinical applications include reviewing images with patients at \ntheir bedside, teleconsulting with and distribution of images to colleagues. The \nusefulness and accuracy of mobile devices is however still limited by hard- and \nsoftware. Their use for reviewing patient information also introduces new questions \nabout issues, such as security, confidentiality, integrity, availability and account-\nability. These issues and potential solutions will be discussed in more detail during \nthis presentation. \nLearning Objectives:\n1.  To learn about mobile teleradiology within and outside the hospital.\n2.  To become familiar with the potential risks of mobile teleradiology (data security, \nconfidentiality, etc).\nPanel discussion:  \nAre we ready and confident enough to use tablet-computers in \nclinical practice? How and when? 17:17 \n16:00 - 17:30 Room F2 \nBreast \nRC 1902 \nBreast ultrasound \nModerator: \nM. Müller‑Schimpfle;  Frankfurt a. Main/DE \nA-610 16:00\nA. Physics and practical aspects of high-quality hand-held and \nautomated breast US \nM.H. Fuchsjäger; Graz/AT (michael.fuchsjaeger@medunigraz.at) \nUltrasound (US) is the adjunct method of choice to mammography in breast imaging. \nOver the past two decades, US technology has undergone profound advancements \nand refinements. US has therefore become an assessment tool with a defined field \nof indications as well as a unique set of diagnostic descriptors for breast lesion \ndifferentiation. The ACRIN 6666 study has demonstrated the special benefit of US \nin patients at risk with dense breast tissue. The BI-RADS lexicon for Ultrasound, \nin its second edition, expanded the role of breast US. Further enhancement of \nimage quality as well as the recent advent of automated breast US has even \nfueled scientific discussions of a potential role of US for breast cancer screening. \nAutomated breast US, which is based on computed generation of a 3D imaging \ndata set obtained from many parallel 2D images, offers a different approach with \na variety of benefits. Images are obtained by the sonographer in standardised \nfashion, whole breast data sets can be reviewed at any time after the examination, \nreducing operator dependence, and image fusion with, i.e. MRI is easily possible. \nThe basic physical background, the significance as well as important aspects of \npractical use of hand-held and automated breast US will be explained and illustrated \nby respective imaging examples. Emphasis will be laid on strengths and potential \nweaknesses of both US technologies with regard to breast imaging.\nLearning Objectives:\n1.  To understand the physics of hand-held and whole breast US.\n2.  To become familiar with the practical technique of hand-held and whole breast \nUS.\n3.  To appreciate the clinical applications of hand-held and whole breast US \nincluding automated screening.\nwith the PACS, allowing the handling of a full patient’s record and presumably the \npossibility to report. In view of this rapid technological development again radiology \nfall in the middle of storm and is asked to find solution to problem: are the Tablets \nsuitable to read and report DICOM images? And which kind of images (CT, MRI, \nx-ray, etc).? How can we manage the portability of patient’s data (security issues, \ndata loss, etc).? Which will be the impact on teleradiology? All these issues will \nbe addressed by the panel of experts that will speak in the special focus session. \nSession Objectives:\n1.  To give an overview of current tablet-computer technology and its practical \nuse in radiology.\n2.  To discuss the pros and cons of using tablet-computers.\n3.  To analyse specific and critical areas of utilisation (DICOM images reading \nand teleradiology).\nA-606 16:05\nTablet-computers: a technical overview \nJ. Fernandez-Bayó; Sabadell/ES (jFernandezB@tauli.cat) \nSince their introduction in 2001, tablet PCs have evolved extensively. They have \nbecome very popular, filling the gap between laptop computers and smart mobile \nphones. We will review technical aspects like the processors, storage space and \nmemory, size and weight, connectivity and networking, software, autonomy, and \nbattery life in different devices. Special focus will be on the displays and different \npossible uses in radiology.\nLearning Objectives:\n1.  To learn about PC evolution: from desktops, to laptops and tablets.\n2.  To appreciate the portability of a tablet-computer.\n3.  To become familiar with the hardware features with a specific focus on displays \nand networks.\nA-607 16:23\nRadiological features of the tablet-computer \nP. Sacco1, L. Faggioni2; 1Siena/IT , 2Pisa/IT (lfaggioni@sirm.org) \nTablet devices are more and more becoming a part of everyday life, with portability, \nversatility, connectivity, and user-friendliness being their main advantages. Hospital \ninformatisation and filmless radiology have led to an efficient standardisation of \ndigital images generated by the various imaging modalities, which has further \ncatalysed the diffusion of mobile devices in health enterprises. The high screen \nresolution, high wireless connection speed and large processing power of current \ntablets allow displaying medical images with a sufficient quality for image review \nand analysis in clinical practice. Retrieving examinations from the PACS, accessing \nradiology information systems, reporting, taking notes and memos, and sending \nmessages are only some of the many possible uses of tablets. Today radiologists \ncan choose from a lot of apps and web services available on tablets, such as \nlearning resources (e.g. textbooks, journal articles, atlases, databases, lessons \nand podcasts), tools for remote connectivity (e.g. file sharing, audio- and videocon-\nferencing, instant messaging), apps and tools designed to create presentations, \nprocess images, and review cases. For these reasons tablets can often provide a \nconvenient, fast and versatile alternative to laptops. Examples of applications of \ntablets in radiology will be presented and discussed.\nLearning Objectives:\n1.  To appreciate the radiological features available on a tablet-computer.\n2.  To become familiar with radiological atlases, databases, social networks.\n3.  To learn how the tablet-computer can help at a congress and prepare presenta-\ntions.\nA-608 16:41\nReading DICOM images on the tablet \nO. Ratib; Geneva/CH (osman.ratib@hcuge.ch) \nThe purpose is to review the different techniques allowing review and evaluation \nof DICOM images on hand-held tablets and mobile devices. Mobile devices such \nas smart phones and touchscreen tablets have taken the market by storm and are \nbecoming major players in medical informatics providing convenient solution for \nphysicians on the move. The resolution and processing power of these devices allow \nnowadays displaying medical images with sufficient resolution for image review and \nanalysis in clinical practice. There are however different types of software solutions \nthat can be implemented for such tasks. Two major different design are: (1) online \nweb-based applications where the device serves as a “thin-client” to display images \nrendered and manipulated on a remote computer and (2) local applications that \nreside on the mobile device and can run independently after images have been \ndownloaded on the device. The first solution requires the user to be constantly \nconnected to the network to be able to display and manipulate images, while the \n\nPostgraduate Educational Programme\nS141\nB\n C D E F G\nA\nMonday\nvasculopathies (atherosclerotic and hypertensive small vessel disease, CADASIL, \nFabry’s disease, Susac’s syndrome), multiple sclerosis and variants, primary and \nsystemic vasculitis, sarcoidosis, adult forms of leukoencephalopathies, trauma and \nradio chemotherapy, and acquired metabolic conditions (hepatic encephalopathy, \nalcoholism), among others. While it is recognised that a combination of findings \nfrom clinical history, physical examination, and laboratory tests is commonly \nrequired to correctly establish a firm and clear aetiological diagnosis of T2-HI, a \ndetailed analysis of different MRI features should also be considered essential: e.g. \nlesions shape, size, and distribution; contrast-uptake; and associated structural \nlesions (microbleeds, infarcts, spinal cord, brainstem and cerebellar involvement, \nlarge-vessel disease). In addition to these conventional MRI-based features, non-\nconventional MR techniques (diffusion, MR spectroscopy, and perfusion) may also \nprovide in some cases useful diagnostic information. Knowledge of these features \nwill assist the diagnostic work-up of patients presenting with T2-HI and should be \nconsidered a first step to take full advantage of the potential of MRI, and in doing \nso should result in a reduced chance of misdiagnoses and facilitate the correct \ndiagnosis of sometimes treatable disorders. \nLearning Objectives:\n1.  To learn about recognition patterns that might be helpful in suggesting the \nmost likely etiology of brain multifocal T2 lesions.\n2.  To understand the role of spinal cord imaging in the differential diagnosis.\n3.  To appreciate a neuroradiologic diagnostic strategy for multiple white matter \nlesions of unknown origin.\nAuthor Disclosure:\nA. Rovira-Cañellas: Advisory Board; NeuroTEC, Bayer-Schering Pharma. \nBoard Member; American Journal of Neuroradiology, Neuroradiology. Research/\nGrant Support; Bayer-Schering Pharma. Speaker; Bayer-Schering Pharma, \nSanofi-Aventis, Biogen Idec, Novartis. \nA-614 16:30\nB. New developments in the diagnosis of multiple sclerosis \nF. Barkhof; Amsterdam/NL (f.barkhof@vumc.nl) \nAlthough the diagnosis of multiple sclerosis (MS) can be made on clinical grounds \nalone, MRI is frequently used to demonstrate dissemination in time (DIT) or \nspace (DIS) in patients presenting with a clinically isolated syndrome (CIS) sug-\ngestive of MS or to provide prognostic information early in the disease course. In \nthe 2010 updated criteria, DIS can be demonstrated by the presence of one or \nmore asymptomatic T2 lesions in minimally 2 of 4 crucial anatomical locations: \njuxtacortical, periventricular, infratentorial or in the spinal cord. Compared to the \n2005 revision of the McDonald criteria, a second reference MRI after 30 days is \nno longer required for demonstration of DIT; new T2 and/or gadolinium-enhancing \nlesions on follow-up MRI compared to the baseline scan, but irrespective of the \ntiming of this baseline scan, are sufficient for DIT. In fact, simultaneous presence \nof asymptomatic gadolinium-enhancing and non-enhancing lesions at any time is \nsufficient for demonstration of DIT, even at presentation. MS can thus be diagnosed \naccording to the 2010 revisions of the McDonald criteria based on a single scan \nin patients with a typical CIS.\nLearning Objectives:\n1.  To understand the 2010 revision of the McDonald criteria for MS.\n2.  To become aware of MRI red-flags in the diagnostic process.\n3.  To become familiar with new developments in pulse-sequences and field-\nstrength.\n4.  To understand how to use spinal cord imaging in a diagnostic setting.\nA-615 17:00\nC. Imaging of MS treatment-related complications \nM.M. Thurnher; Vienna/AT (majda.thurnher@meduniwien.ac.at) \nThe findings of recently published studies on MTR and diffusion in white matter in \nMS and other white matter diseases further strengthen the key position of magnetic \nresonance imaging (MRI) not only in diagnostic work-up of all forms of suspected \ndemyelinating diseases, but also in post-treatment monitoring. Until 2005, progres-\nsive multifocal leukoencephalopathy (PML) was exclusively reported in patients \nwith AIDS or in immunosuppressed patients with malignant diseases. In 2004, \nthe α-antegrin inhibitor Natalizumab (Tysabri®) was introduced for the treatment \nof relapsing-remitting MS. Soon after that, cases of PML have been described in \nmultiple sclerosis (MS) patients treated with natalizumab. Current studies suggested \nthat 1 in 1,000 persons would develop PML after approximately 18 months of treat-\nment. Furthermore, PML was also reported in a patient with Chron‘s disease treated \nwith natalizumab. Immune reconstitution inflammatory syndrome (IRIS) has been \nalso reported in natalizumab-associated PML. IRIS is a syndrome that emerges \nwhen the immune system recovers after an immune deficiency state. Typical for \nA-611 16:30\nB. Complicated cysts and complex-cystic lesions: differentiation and \nmanagement \nG. Rizzatto1, C.F. Weismann2; 1Gorizia/IT , 2Salzburg/AT \n(christian.weismann@inode.at) \nAt ultrasound (US) cysts are categorized as simple, complicated or complex. \nA complicated cyst contains low-level internal echoes or intracystic debris that \nshifts with changes in patient position. In some cases, the content is thicker and \nsimulates a hypoechoic solid mass. The term complicated only describes the US \nappearance and does not indicate that pus or blood is responsible for the internal \nechoes. Complicated cysts do not contain solid mural nodules. Only in some \ncases of inflammation, there may be a thickened wall, generally uniform. History \nand clinical examination may be very helpful. Color flow mapping (CFM) may add \nfurther information and elastography can solve the problem showing the typical \naspect of fluid containing masses. A solid component places the cystic lesion into \nthe category of complex breast cysts. Complex patterns include irregular thickened \nwalls, intracystic masses, thickened septa and discrete solid component. Masses \nmay be predominantly solid with only small cystic foci. Complex cystic masses \nhave a substantial chance of malignancy, up to 30 percent. Again history may be \nuseful as long as CFM. But there is a general agreement that aspiration and/or core \nbiopsies are mandatory. Multiple samples must be acquired in different locations. \nIf pathology report is discordant with US findings patients can be further evaluated \nwith magnetic resonance or US follow-up. \nLearning Objectives:\n1.  To learn about the US appearance of complicated cysts and complex-cystic \nlesions.\n2.  To consolidate knowledge on differential diagnosis for these respective lesions.\n3.  To understand the diagnostic algorithm for a work-up of these lesions.\nA-612 17:00\nC. The use of ultrasound in the evaluation of the nipple-areolar complex \nR. Salvador; Barcelona/ES (rafasalvador@telefonica.net) \nNipple and areola can be well examined by any clinician. Ultrasonography can \nadd new findings mostly related to the main ducts merging at the retroareolar \nregion. A thorough description of the anatomical aspects of the region, and its \npathologicaal benign and maalignant conditions will be described. Duct ectasia, \ninfection, ductal papillomas, hyperplasia, and DCIS, as well as Paget disease of \nthe nipple and some other skin pathologies can arise in this area of the breast. A \ndescription of the US techniques to review the region, including the use of Doppler \nUS, Elastography, 3D ultrasound so called Automated Breast Ultrasound Scan \n(ABVS) and other techniques that have been used not only to diagnose, but to \ntreat some diseases. US ductography and pecutaneous sampling or excision of \npapillomas will also be done. \nLearning Objectives:\n1.  To understand the normal anatomy of the nipple-areolar complex.\n2.  To become familiar with conditions commonly affecting the nipple-areolar \ncomplex.\n3.  To appreciate the value of US for diagnosis and management of these condi-\ntions.\nAuthor Disclosure:\nR. Salvador: Advisory Board; Member of the Medical Advsory Board of Philips \nHealthcare. \n16:00 - 17:30 Room G/H \nNeuro \nRC 1911 \nMultiple sclerosis: 2013 update \nModerator: \nE. Tali; Ankara/TR \nA-613 16:00\nA. Differential diagnosis of multiple T2-HI white matter lesions \nA. Rovira-Cañellas; Barcelona/ES (alex.rovira@idi‑cat.org) \nFocal white matter T2 hyperintense lesions (T2-HI) are commonly observed MRI \nabnormalities not only in the elderly, but also in middle age and young patients. In \naddition to physiological ageing brain changes, a large list of different disorders \nshould be considered in patients presenting with T2-HI such as hypoxic-ischaemic \n\nPostgraduate Educational Programme\nS142\n C B D E F\n G\nA\ncongenital bronchial abnormality. In cystic fibrosis, bronchiectasis is one of the \nkey features of lung involvement. Bronchiectasis can present with a variety of \nnon-specific clinical symptoms, including hemoptysis, cough, and hypoxia. Bron-\nchiectasis is defined as localised or diffuse irreversible dilatation of the cartilage-\ncontaining airways or bronchi. The imaging gold standard for bronchiectasis is \nthin-section CT. Morphologic criteria on thin-section CT scans include bronchial \ndilatation with respect to the accompanying pulmonary artery (signet ring sign), \nlack of tapering of bronchi, and identification of bronchi within 1 cm of the pleural \nsurface. Bronchiectasis may be classified as cylindric, varicose, or cystic, depending \non the appearance of the affected bronchi. It is often accompanied by bronchial \nwall thickening, mucoid impaction, and small-airways abnormalities. Besides CT, \nnowadays MRI of the lung is able to image the relevant morphological features of \nbronchiectasis. In addition, functional changes due to bronchiectasis can be studied. \nLearning Objectives:\n1.  To learn more about the imaging findings in bronchiectasis, especially at MRI.\n2.  To appreciate the role of imaging in primary diagnosis, surveillance and therapy \nmonitoring.\n3.  To become familiar with the role of imaging in surgical planning.\n16:00 - 17:30 Room N/O \nHead and Neck \nRC 1908 \nTemporal bone: imaging the most common \nsymptoms and signs \nModerator: \nT. Beale; London/UK \nA-619 16:00\nA. Conductive hearing loss: what’s behind it? \nA. Trojanowska; Lublin/PL (agnieszka30@yahoo.com) \nNew computed tomography techniques and new magnetic resonance sequences \nhave led to an important improvement in temporal bone imaging. Computed to-\nmography is the method of choice for imaging of conductive hearing loss, which \ncan be caused by several factors, including developmental anomalies, middle ear \ninflammation, tumours, and temporal bone fractures. However, in some cases, \nmagnetic resonance imaging can add important information. High-resolution \ncomputed tomography plays a critical role in the evaluation and management of \nconductive hearing loss. It is possible to demonstrate osteolysis, osteosclerosis and \ndemineralization changes in otic capsule and ossicular chain. CT and MR may also \nvisualize tumour, post-inflammatory changes in tympanic cavity and temporal bone \ntrauma. MR is especially helpful when evaluating the presence of cholesteatoma \nin the middle ear and mastoid. Because of the ability of CT to demonstrate the \ndetailed anatomy of temporal bone, thorough diagnosis of congenital malformations \nand anatomical variants is possible.\nLearning Objectives:\n1.  To review the most common causes of conductive hearing loss.\n2.  To become familiar with the imaging findings in patients with conductive hearing \nloss.\n3.  To differentiate the most frequent causes of conductive hearing loss.\nA-620 16:30\nB. Sensorineural hearing loss: a challenge for radiologists \nJ. Casselman1, B. De Foer2; 1Bruges/BE, 2Antwerp/BE \n(jan.casselman@azbrugge.be) \nMR is the modality of choice in patients with sensorineural hearing loss (SNHL) \nand the complete auditory pathway from the cochlea to the auditory cortex must be \nstudied in these patients. The labyrinth, internal auditory canal (IAC) and cerebel-\nlopontine angle (CPA) are best studied using submillimetric heavily T2W images, \nshowing the intralabyrinthine fluid and nerves. But submillimetric Gd-enhanced T1W \nimages or 3D-Flair images remain more sensitive. The auditory pathway in the brain-\nstem is best studied with a multi-echo sequence (m-FFE/medic/merge) or T2W TSE \nsequence and the auditory cortex is best studied on T2W TSE images. The most \nfrequent pathology in the labyrinth is: labyrinthitis, intralabyrinthine schwannoma, \ncongenital malformation, post-traumatic lesions. Unenhanced (trauma, hemorrhagic \nlabyrinthitis) and Gd-enhanced T1W images are needed in these patients and both \nsubmillimetric T2W images and CT images are needed in the pre-operative work-up \nof cochlear implant candidates. Cochleovestibular schwannomas, meningiomas, \nepidermoid tumours and facial nerve neuritis are the most frequent lesions detected \nin the IAC and CPA. Contrast-enhancement is crucial in these patients although \nthe IRIS phenomenon, as the patent deteriorates clinically, the PML lesions on MR \nenlarge and increased gadolinium enhancement can be seen within days to weeks. \nIn this lecture, imaging characteristics and typical patterns of therapy-associated \nPML in MS and IRIS will be discussed. \nLearning Objectives:\n1.  To become familiar with therapy options in multiple sclerosis (MS).\n2.  To understand therapy induced complications.\n3.  To understand the pathophysiology of immune reconstitution inflammatory \nsyndrome (IRIS).\n4.  To become familiar with imaging findings in IRIS.\n16:00 - 17:30 Room I/K \nChest \nRC 1904 \nPhenotypes in obstructive airway disease: how \nshould I image, analyse and report? \nModerator: \nP.A. Gevenois; Brussels/BE \nA-616 16:00\nA. Asthma and associated conditions \nP.-Y. Brillet; Bobigny/FR \nAsthma is a chronic inflammatory disorder of the airways responsible for recurrent \nepisodes or airflow limitation. It is associated with airway hyperresponsiveness \nand remodelling. The role of CT is limited to patients with severe disease or for \ndifferential diagnosis. CT is important for the diagnosis of associated conditions \n(mainly, allergic bronchopulmonary aspergillosis and Churg Strauss syndrome). \nSpecial attention should be paid to acquisition protocols in young patients. Usual \nfindings include bronchial (thickening of bronchial wall, decrease of lumen and distal \nbronchiectasis) and bronchiolar (mucoid impactions, air trapping) abnormalities. \nThe role of imaging for characterisation of phenotypes will be discussed.\nLearning Objectives:\n1.  To learn more about the imaging findings in asthma and associated conditions, \nespecially with low-dose and expiratory CT.\n2.  To appreciate the potential to grade the severity of the disease from CT.\n3.  To learn how to report findings indicative of asthma and associated conditions.\nAuthor Disclosure:\nP. -Y. Brillet: Speaker; Novartis. \nA-617 16:30\nB. Chronic obstructive pulmonary disease (COPD) \nN. Sverzellati; Parma/IT (nicolasve@tiscali.it) \nChronic obstructive pulmonary disease (COPD) is one of the leading causes of mor-\nbidity and mortality worldwide. It is a heterogeneous disease affecting the airways, \nthe parenchyma as well as the vasculature with different severity during the course \nof the disease. Computed tomography (CT) with aid of dynamic expiratory scanning \nhas become the standard modality to visualize and objectively quantitate emphy-\nsema and airways disease. Differentiating between an emphysema-predominant \nand an airway-predominant phenotype via CT may clearly impact follow-up strategy \nand therapeutic decision making in clinical practice. It is also important to realize \nthat a low-dose CT examination allows now a complete phenotypical definition of \nCOPD. In addition, recent evidences suggest that both CT and magnetic reso-\nnance imaging (MRI) may provide useful measures of the presence and severity \nof pulmonary vascular disease for clinical correlation. \nLearning Objectives:\n1.  To learn more about the imaging findings in COPD, including low dose and \nexpiratory CT.\n2.  To become familiar with the concept of CT phenotyping: airway obstruction \nvs. alveolar destruction.\n3.  To appreciate the radiological findings of remodelling of airways and pulmonary \nvasculature.\nA-618 17:00\nC. Cystic fibrosis and other bronchiectatic diseases \nM.U. Puderbach; Heidelberg/DE (m.puderbach@dkfz.de) \nSeveral different diseases go along with the development of bronchiectasis. \nBronchiectasis may result from chronic infection, proximal airway obstruction, or \n\nPostgraduate Educational Programme\nS143\nB\n C D E F G\nA\nMonday\nhyperechoic muscular fascia, while perforating veins traverse muscular fascia and \nconnect deep with superficial veins. B-mode depicts anatomic detail (relevant to \nvenous wall, valves, diameter, intraluminal content, course, tributaries). Retrograde \nflow (reflux) which is the diagnostic hallmark of CVI, is detectable by Color Dop-\npler; however, reflux is more reliably and quantitatively assessed by Pulsed-Wave \nDoppler. Reflux-provoking maneuvers include Valsalva (for proximal deep veins \nand saphenofemoral junction), Parana maneuver and distal manual compression \nwith rapid release. Automatic inflation/deflation devices ensure more standardised \nand reproducible compression, but are not routinely used. Reflux lasting more \nthan 0.5 seconds in superficial and perforating veins (and more than 1.0 second \nin deep veins) is indicative of insufficiency. In addition to its role for the diagnosis, \nfor venous mapping and for postoperative evaluation, US is an integral part of the \nmodern interventional treatments of CVI. In this context, US is indispensable for \npatient selection, intraprocedural guidance and follow-up. \nLearning Objectives:\n1.  To become familiar with normal venous anatomy the indications for imaging \nand the US techniques.\n2.  To learn about the typical and atypical appearances of venous pathology.\n3.  To understand the potential pitfalls and limitations of US.\nA-624 16:28\nB. Rare venous diseases of the lower extremities \nM. Greiner1, P. Lemasle1, A. Bisdorff-Bresson2; 1Neuilly sur Seine/FR, 2Paris/FR \n(milka.greiner1@free.fr) \nRare venous diseases of the lower extremities are challenging to diagnose due to \ntheir numerous and heterogeneous presentations and their lack of knowledge. They \ncan be parted in: 1) local and simple venous malformations which can be truncular \nsuch as persistance of marginal, sciatic, lateral embryonic veins, venous aneurysms \nor extra truncular. The later are low-flow venous malformations and carry a high risk \nof recurrence when stimulated by trauma, hormonal changes or non-appropriate \ntreatment. 2) Complex vascular malformations in which complete understanding \nof the malformation is needed before venous treatment. They are rare disorders \nof vascular development, present at birth but not always early diagnosed. They \nare often more complex than they appear. They include glomuvenous malforma-\ntions, Klippel-Trénaunay Syndrome and other combined malformations without \narterio-venous shunt. The differential diagnosis with regional or diffuse high-flow \nmalformations with arterio-venous shunt such as Parkes-Weber Syndrome is not \nalways easy and traditional eponyms have become obsolete. This topic highlights \nthe differences in clinical appearance which allow the diagnosis in most of the cases, \nthe place of the imaging study which confirms the diagnosis and which is important \nbecause in all these anomalies imaging instead of biopsy is now the standard for \ndiagnostic confirmation and the main decision makings. Rare venous diseases of \nthe lower limbs have to be known in order to establish appropriate treatment and \nfollow-up and to avoid disastrous therapeutic consequences.\nLearning Objectives:\n1.  To become familiar with anatomic variants.\n2.  To learn about anatomy with specific congenital disorders, such as persistent \nsciatic vein Klippel Trenaunay-Weber syndrome.\n3.  To become familiar with differential diagnosis and pitfalls in the diagnosis of \nthe above conditions.\nA-625 16:51\nC. CT venography and MR venography \nG. O’Sullivan, D.G. Lohan; Galway/IE (gerard.osullivan2@hse.ie) \nBoth CT and MR venography are assuming greater significance in assessing \nparticularly central venous structures prior to endovenous intervention. Obviously, \nthey are both more expensive and less widely available than ultrasound and should \nnot be used on every patient. Therefore, which patients should undergo CTV or \nMRV? In our institution, it is only symptomatic patients with limb swelling, ulcera-\ntion, or significant post-thrombotic syndrome sequelae who merit either of these \ntechniques. A detailed discussion of CT and MR-imaging parameters, contrast \nmedia injection protocols and flow dependent and independent techniques will \nbe undertaken. A variery of pitfalls and artefacts can cause misinterpretation and \nthese will be discussed with examples.\nLearning Objectives:\n1.  To learn about its indications and pros and cons compared to US.\n2.  To become familiar with imaging parameters, contrast media protocols and \nflow dependent and flow independent techniques.\n3.  To become familiar with pitfalls and artefacts that affect correct evaluation of \nimaging findings after endovascular treatments.\nT2W-images are needed to confirm the presence of all nerve branches in the \nIAC and to distinguish epidermoid cysts from arachoid cysts. Multiple sclerosis, \ninfarction, tumour and trauma are the lesions which are most often found along \nthe central auditory pathway (brainstem/cortex). Contrast administration and DWI \nimages are needed in the acute setting. In mixed hearing loss (sensorineural and \nconductive), otosclerosis must be excluded on CT. The above-mentioned imaging \ntechniques and pathology will be illustrated and discussed.\nLearning Objectives:\n1.  To learn which imaging techniques should be used.\n2.  To become familiar with the different causes of sensorineural hearing loss.\n3.  To recognise and differentiate the imaging findings in the most frequent causes \nof sensorineural hearing loss.\nA-621 17:00\nC. Tinnitus and vertigo: diagnostic algorithm \nR.B. de Bondt; Zwolle/NL (rbjdebondt@gmail.com) \nTinnitus: a buzzing or ringing in the ear, may be pulsatile or non-pulsatile, subjec-\ntive or objective. Evaluation of patients with tinnitus requires a detailed history to \ndetermine if the patient also has hearing loss, vertigo, or headaches; a complete \nmedical examination including a neurologic and ENT examination with audiologic \nevaluation. Accurate distinction of these entities and strategies determines the most \nappropriate imaging study. Vertigo: dizziness, is classified central or peripheral \nand might originate from different pathology of which the location is very difficult \nto differentiate on clinical examination. Therefore, a systemic radiological work up \nis mandatory based on the clinical setting. Imaging strategies - which modality \nwhen to use - and imaging protocols will be discussed. Most common pathology \nresponsible for tinnitus or vertigo will be displayed.\nLearning Objectives:\n1.  To learn the most common causes.\n2.  To understand imaging strategies.\n3.  To become familiar with typical imaging findings.\n16:00 - 17:30 Room P \nVascular \nRC 1915 \nLower extremity venous insufficiency \nA-622 16:00\nChairman’s introduction \nD.J. West; Stoke‑on‑Trent/UK (davidwest@veincentre.com) \nVenous disease is very common and potentially lethal. In the United States, a first \nVTE happens in approximately 1 in every 1000 persons each year. This rises to \n500 per 1000 at the age of 80. Leg ulcers resulting from superficial and/or deep \nvenous insufficiency occur in approximately 1% of population at some time in \ntheir lives usually over 65 years. Varicose veins adversely affect the quality of life \nof approaching 50% of the population. Rare venous disorders are challenging \nto diagnose and treat. Despite all this, venous disease is the cinderella among \nvascular diseases and too little attention is paid to its accurate management and \nappropriate treatment. Consequently, there are inumerable unnecessary deaths \nfrom VTE and untold distress from chronic ulceration which is still managed primarily \nby bandaging. Interventional radiologists are well trained and equipped to make a \nmajor impact in the management of most venous disease. It is a challenging and \nrewarding area and well suited to an introduction to “real” clinical care.\nAuthor Disclosure:\nD. J. West: Owner; veincentre ltd. \nA-623 16:05\nA. Venous anatomy and ultrasound \nH. Moschouris; Piraeus/GR (hipmosch@in.gr) \nChronic venous insufficiency (CVI) is a common vascular disease with significant \nclinical impact. Physical examination is not always adequate for the diagnosis \nand for the assessment of the extent of CVI; therefore, imaging investigation (with \nultrasonography-US, as the primary modality) is very often required. US exami-\nnation is performed with legs in a dependent position. Veins are interrogated in \na segmental manner from groin to foot, with a linear, high frequency transducer. \nLower limb veins can be divided in three systems, which can be readily appreci-\nated by US: superficial and deep veins lie respectively, above and beneath the \n\nPostgraduate Educational Programme\nS144\n C B D E F\n G\nA\nbe needed to reach the right diagnosis. Unnecessary overuse of these imaging \nmodalities, and the subsequent family anxiety that ensues from this overuse, should \nbe avoided with careful analysis of the x-ray and clinical findings. \nLearning Objectives:\n1.  To learn about normal variants in the neonatal and paediatric musculoskeletal \nsystem.\n2.  To familiarise oneself with the imaging appearances of common normal vari-\nants.\n3.  To understand how to differentiate between normal variants and disease.\n4.  To learn how to integrate age, location and clinical history with the radiological \nfeatures before establishing a diagnosis.\nPanel discussion:  \nWhich imaging modality is best for planning endovascular \nmanagement? 17:14 \n16:00 - 17:30 Room Q \nPaediatric \nRC 1912 \nNormal variants in paediatric imaging: not to be \nconfused with disease \nModerator: \nØ.E. Olsen; London/UK \nA-626 16:00\nA. Brain \nA. Rossi; Genoa/IT (andrearossi@ospedale‑gaslini.ge.it) \nThe paediatric central nervous system is a complex structure undergoing rapid \ndevelopment. As such, there is a rapid, continuous modification of what is “normal” \nin relation with age and the stage of development. Knowledge of the normal patterns \nof brain development in the clinically relevant ages from 0 to 18 years is necessary \nto interpret neuroimaging findings correctly. Knowledge of embryology and normal \nvariants is also greatly helpful. MR imaging equipment and parameters need to \nbe adjusted and optimisation for paediatric studies. Pitfalls often occur from the \nmisunderstanding of normal conditions, that are perceived as abnormal based on \na comparison with the appearance of the normal brain in adults. This includes, for \ninstance, the evaluation of the brain in the first 2-3 years of life during the course \nof the process of myelination. A summary of the most frequent conditions that may \nlead to misinterpretation of findings will be provided here. \nLearning Objectives:\n1.  To learn about normal variants in the neonatal and child’s brain.\n2.  To understand the typical imaging characteristics of normal variants that should \nsuffice for correct interpretation.\n3.  To become familiar with the differentiation between normal variants and dis-\nease.\nA-627 16:30\nB. Chest and abdomen \nS.G.F. Robben; Maastricht/NL (s.robben@mumc.nl) \nMany radiologists are reluctant to examine children because: a) they cry, b) do not \nlisten, c) struggle, d) urinate, vomit and loose their stools all over the place, e) have \nannoying parents and f) demonstrate an enormous amount of normal variations. \nThis is the rationale of the existence of paediatric radiologists. This refresher course \nintends to clarify item f). Unfortunately items a-e cannot be changed. \nLearning Objectives:\n1.  To learn about normal variants in the neonatal and paediatric chest and abdo-\nmen.\n2.  To familiarise oneself with the imaging appearances of common normal vari-\nants.\n3.  To understand how to differentiate between normal variants and disease.\nA-628 17:00\nC. Musculoskeletal \nF. Saez; Bilbao/ES (fersaez@seram.org) \nThe skeleton of a child is a developing system with a variety of changing normal \nappearances. Imaging studies, especially plain films, are requested for many \nclinical reasons, and the radiologist is in the position to determine if an image is \na normal finding or we are dealing with a lesion. The way physis and epiphysis \ngrow, ossify, and fuse constitutes a great source of physiologically bizarre appear-\nances, which the radiologist must be familiar with. This talk will concentrate on the \nplain film diagnosis of some of the most common musculoskeletal variants. Other \nimaging modalities will also be shown when appropriate for the case. Irregularities, \nasymmetries, partial fusions, hypo- or hyper-dense bone areas, accessory bones, \nprominent normal structures, external artifacts, and potential fracture lines are the \nmost often encountered pseudolesions. A defective radiological technique may also \nbe potentially misleading. Patient age, location of the supposed “abnormality” and \nlack of significant local symptoms are key factors. Usually plain films, correlated with \nregional clinical findings, are the only imaging method that is required. However, in \ncertain doubtful situations, ultrasound, CT, MRI, Bone Scan, or even biopsy, may","source_license":"CC-BY-4.0","license_restricted":false}