{"paper_id":"a0f1f825-a057-408b-b9ba-dac63ea374c8","body_text":"Insights\ninto Imaging\nEducation and strategies in European radiology\nESGAR 2012 Book of Abstracts / Volume 3 / Supplement 2 / May 2012\nESGAR 2012 / June 12 – 15 / Edinburgh, United Kingdom\n23rd Annual Meeting and Postgraduate Course \n\nESGAR 2012\nEDINBURGH / UK\n23RD ANNUAL MEETING AND POSTGRADUATE COURSE\nEUROPEAN SOCIETY OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY\nR\nD\n G\n OS G\n CO\n S\n BOOK OF ABSTRACTS\nINCLUDES ABSTRACTS OF SCIENTIFIC PRESENTATIONS\nCENTRAL ESGAR OFFICE \nNeutorgasse 9\nAT – 1010 Vienna, Austria\nPhone: +43 1 535 89 27 \nFax:  +43 1 535 70 37\nE-Mail:  office@esgar.org\nwww.esgar.org\nMEETING PRESIDENT\nProf. Steve Halligan\nUniversity College London\nUniversity College Hospital\nLevel 2 Podium\n235 Euston Road\nUK – NW1 2BU London, United Kingdom\nJUNE 12 – 15\n\nIMPORTANT ADDRESSES / SPONSORS / CME\n S455\nIMPORTANT ADDRESSES \nORGANISING SECRETARIAT\nCentral ESGAR Office\nNeutorgasse 9\nAT – 1010 Vienna, Austria\nPhone: +43 1 535 89 27\nFax: +43 1 535 70 37\nE-Mail: office@esgar.org\nEXECUTIVE DIRECTOR\nMs. Brigitte Lindlbauer\nE-Mail: blindlbauer@esgar .org\nWEBSITE\nwww.esgar.org\nEXHIBITION MANAGEMENT\nMAW – Medizinische Ausstellungsgesellschaft\nFreyung 6\nAT – 1010 Vienna, Austria\nPhone: +43 1 536 63 35 or -34\nFax: +43 1 535 60 16\nE-Mail: maw@media.co.at\nCONFERENCE VENUE\nEdinburgh International Conference Centre\nThe Exchange\nUK – EH3 8EE Edinburgh, United Kingdom\nPATRONAGE\nBSGAR - British Society of Gastrointestinal \nand Abdominal Radiology\nDate of publishing: May 2012\nCME\nThe European Society of Gastrointestinal and Abdominal \nRadiology, ESGAR, is accredited by the European \nAccreditation Council for Continuing Medical Education \n(EACCME). The EACCME is an institution of the European \nUnion of Medical Specialists (UEMS), www.uems.be\nESGAR 2012 is designated for a maximum of 24 hours of \nEuropean external CME credits.\nSPONSORS\nESGAR wishes to gratefully acknowledge the support of its Corporate Members:\nThe Final Programme of ESGAR 2012 is available on the ESGAR website www.esgar.org\n\n\n S456\nTABLE OF CONTENTS\n S456\n \nTABLE OF CONTENTS\nScientifi c Sessions, Wednesday, June 13 (SS 1–SS 5) S461-S471\nScientifi  c Sessions, Thursday, June 14 (SS 6–SS 10) S 472-S482\nScientifi  c Sessions, Friday, June 15 (SS 11–SS 16) S483-S495\nAuthors’ index S496-S501\n\nCOMMITTEES\n S457\nESGAR PROGRAMME COMMITTEE\nCHAIRMAN\nY. Menu (Paris/FR)\nMEMBERS\nC. Ayuso (Barcelona/ES)\nR.G.H. Beets-Tan (Maastricht/NL)\nF. Caseiro Alves (Coimbra/PT)\nH. Fenlon (Dublin/IE)\nN. Gourtsoyiannis (Athens/GR)\nS. Halligan (London/UK)\nT. Helmberger (Munich/DE)\nS. Jackson (Plymouth/UK) \nA. Laghi (Latina/IT) \nL. Martí-Bonmatí (Valencia/ES) \nC. Matos (Brussels/BE)\nG. Morana (Treviso/IT)\nG. Mostbeck (Vienna/AT)\nA. Palkó (Szeged/HU)\nP. Prassopoulos (Alexandroupolis/GR)\nLOCAL ORGANISING COMMITTEE\nD.J. Breen (Southampton/UK)\nJ.A. Guthrie (Leeds/UK)\nS. Jackson (Plymouth/UK)\nC. Kay (Bradford/UK)\nH.-U. Laasch (Manchester/UK)\nA. Lowe (Bradford/UK)\nD.F. Martin (Manchester/UK)\nA. Phillips (Bath/UK)\nA. Roberts (Cardiff/UK)\nS.A. Taylor (London/UK)\nThis edition of the ESGAR 2012 Book of Abstracts \nwas language edited by:\nABSTRACT EDITOR\nS. Jackson (Plymouth/UK)\nESGAR MEETING PRESIDENT\nProf. Steve Halligan\nUniversity College London\nUniversity College Hospital\nLevel 2 Podium\n235 Euston Road\nUK – NW1 2BU London, United Kingdom\nESGAR EXECUTIVE COMMITTEE\nPRESIDENT\nF. Caseiro Alves (Coimbra/PT)\nPRESIDENT-ELECT\nL. Martí-Bonmatí (Valencia/ES)\nVICE PRESIDENT\nC. Matos (Brussels/BE)\nSECRETARY\nS. Jackson (Plymouth/UK)\nTREASURER\nA. Palkó (Szeged/HU)\nPAST PRESIDENT &\nPROGRAMME COMMITTEE CHAIRMAN\nY. Menu (Paris/FR)\nBY-LAWS COMMITTEE\nP. Prassopoulos (Alexandroupolis/GR)\nEDUCATION COMMITTEE\nH. Fenlon (Dublin/IE)\nMEMBERSHIP COMMITTEE\nR.G.H. Beets-Tan (Maastricht/NL)\nWORKSHOP COMMITTEE\nA. Laghi (Latina/IT)\nMEETING PRESIDENT\nS. Halligan (London/UK)\nPRE-MEETING PRESIDENT\nC. Ayuso (Barcelona/ES)\nPRE-PRE-MEETING PRESIDENT\nG. Mostbeck (Vienna/AT)\nFELLOWS REPRESENTATIVES\nT. Helmberger (Munich/DE)\n\nCOMMITTEES\n S458\nABSTRACT REVIEWING PANEL\nD. Akata (Ankara/TR)\nO. Akhan (Ankara/TR) \nC. Ayuso (Barcelona/ES)\nM.A. Bali (Brussels/BE) \nC. Bartolozzi (Pisa/IT)  \nR.G.H. Beets-Tan (Maastricht/NL) \nP. Boraschi (Pisa/IT) \nR. Bouzas (Vigo/ES) \nG. Brancatelli (Palermo/IT) \nD.J. Breen (Southampton/UK) \nJ.-M. Bruel (Montpellier/FR) \nF. Caseiro Alves (Coimbra/PT) \nC. Catalano (Rome/IT) \nJ. Cazejust (Paris/FR) \nN. Courcoutsakis (Alexandroupolis/GR)\nL. Crocetti (Pisa/IT) \nM. D’Onofrio (Verona/IT)\nE. Delabrousse (Besançon/FR)\nR.F. Dondelinger (Liège/BE) \nN. Elmas (Izmir/TR) \nH. Fenlon (Dublin/IE) \nB. Fox (Plymouth/UK) \nR.A. Frost (Salisbury/UK) \nA. Furlan (Pittsburgh, PA/US) \nP. Goffette (Brussels/BE) \nS. Gourtsoyianni (London/UK) \nL. Guimaraes (Porto/PT) \nJ.A. Guthrie (Leeds/UK) \nS. Halligan (London/UK) \nT. Helmberger (Munich/DE) \nP. Huppert (Darmstadt/DE) \nF. Iafrate (Rome/IT) \nS. Jackson (Plymouth/UK) \nM. Karcaaltincaba (Ankara/TR) \nC. Kay (Bradford/UK) \nS.H. Kim (Busan/KR) \nH.-U. Laasch (Manchester/UK) \nA. Laghi (Latina/IT) \nJ.S. Lameris (Amsterdam/NL) \nE. Leen (London/UK) \nP. Lefere (Roeselare/BE) \nM. Lewin (Paris/FR) \nJ.H. Lim (Seoul/KR) \nD.J. Lomas (Cambridge/UK) \nO. Lucidarme (Paris/FR) \nM. Maas (Maastricht/NL) \nF. Maccioni (Rome/IT) \nM. Maher (Cork/IE)\nD.E. Malone (Dublin/IE) \nR. Manfredi (Verona/IT) \nT. Mang (Vienna/AT) \nD. Marin (Durham, NC/US) \nB. Marincek (Cleveland, OH/US) \nL. Martí-Bonmatí (Valencia/ES) \nD.F. Martin (Manchester/UK) \nG.F. Maskell (Truro/UK) \nC. Matos (Brussels/BE) \nR.M. Mendelson (Perth, WA/AU) \nY. Menu (Paris/FR) \nG. Morana (Treviso/IT) \nM. Morrin (Dublin/IE) \nG. Mostbeck (Vienna/AT) \nE. Neri (Pisa/IT) \nB. Op De Beeck (Edegem/BE) \nA. Palkó (Szeged/HU) \nP.L. Pereira (Heilbronn/DE) \nP. Pokieser (Vienna/AT) \nP. Prassopoulos (Alexandroupolis/GR) \nM. Puckett (Torquay/UK) \nC. Ridereau-Zins (Angers/FR) \nG.A. Rollandi (Genoa/IT) \nS. Romano (Naples/IT) \nL.H. Ros Mendoza (Zaragoza/ES) \nE.J. Rummeny (Munich/DE) \nW. Schima (Vienna/AT) \nS. Schmidt-Kobbe (Lausanne/CH) \nO. Seror (Bondy/FR) \nS. Skehan (Dublin/IE) \nS. Somers (Dundas, ON/CA) \nM. Staunton (Limerick/IE) \nJ. Stoker (Amsterdam/NL) \nC. Stoupis (Maennedorf/CH) \nZ. Tarjan (Budapest/HU) \nS.A. Taylor (London/UK) \nS. Terraz (Geneva/CH) \nC. Triantopoulou (Athens/GR)\nV. Valek (Brno-Bohunice/CZ) \nD. Vanbeckevoort (Leuven/BE) \nV. Vilgrain (Clichy/FR) \nM.-P. Vullierme (Clichy/FR) \nD. Weishaupt (Zurich/CH) \nA. Wuttge-Hannig (Munich/DE) \nS.D. Yarmenitis (Maroussi/GR) \nC.J. Zech (Munich/DE)\n\nCOMMITTEES\nS459\nE-POSTER JURY\nD. Akata (Ankara/TR) \nO. Akhan (Ankara/TR)\nA.J. Aschoff (Kempten/DE) \nC. Ayuso (Barcelona/ES) \nM.A. Bali (Brussels/BE) \nR.G.H. Beets-Tan (Maastricht/NL) \nP. Boraschi (Pisa/IT) \nR. Bouzas (Vigo/ES) \nG. Brancatelli (Palermo/IT) \nF. Caseiro Alves (Coimbra/PT) \nJ. Cazejust (Paris/FR) \nN. Courcoutsakis (Alexandroupolis/GR) \nL. Crocetti (Pisa/IT) \nN. Elmas (Izmir/TR) \nA. Furlan (Pittsburgh, PA/US) \nL. Guimaraes (Viseu/PT) \nJ.A. Guthrie (Leeds/UK) \nS. Halligan (London/UK) \nF. Iafrate (Rome/IT) \nS. Jackson (Plymouth/UK) \nM. Karcaaltincaba (Ankara/TR) \nC. Kay (Bradford/UK) \nA. Laghi (Latina/IT) \nT. Lauenstein (Essen/DE) \nM. Lewin (Paris/FR) \nO. Lucidarme (Paris/FR) \nA. Madureira (Porto/PT) \nM. Maher (Cork/IE) \nD.E. Malone (Dublin/IE) \nR. Manfredi (Verona/IT) \nT. Mang (Vienna/AT) \nD. Marin (Durham, NC/US ) \nL. Martí-Bonmatí (Valencia/ES) \nD.F. Martin (Manchester/UK) \nC. Matos (Brussels/BE) \nG. Morana (Treviso/IT) \nM. Morrin (Dublin/IE) \nE. Neri (Pisa/IT) \nB. Op de Beeck (Edegem/BE) \nN. Papanikolaou (Heraklion/GR) \nP.L. Pereira (Heilbronn/DE) \nF. Pilleul (Lyon/FR) \nP. Pokieser (Vienna/AT) \nP. Prassopoulos (Alexandroupolis/GR) \nC. Ridereau-Zins (Angers/FR) \nS. Romano (Naples/IT) \nL.H. Ros-Mendoza (Zaragoza/ES) \nW. Schima (Vienna/AT) \nM. Staunton (Limerick/IE) \nC. Stoupis (Maennedorf /CH) \nZ. Tarjan (Budapest/HU) \nS.A. Taylor (London/UK) \nC. Triantopoulou (Athens/GR) \nV. Valek (Brno-Bohunice/CZ) \nD. Vanbeckevoort (Leuven/BE) \nJ. Venancio (Lisbon/PT) \nM.-P. Vullierme (Clichy/FR) \nD. Weishaupt (Zurich/CH) \nC.J. Zech (Munich/DE) \nM. Zins (Paris/FR) \n\nAuthors’ index Scientifi  c Sessions\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / WEDNESDAY, JUNE 13, 2012\n S461\nSS 1.03\nPotential complications at CT colonography in \nasymptomatic and symptomatic patients: national \nsurvey of Italy\nM. Ciolina\n1, F . Iafrate1, G. Iussich2, D. Regge2, M. Iannitti1,  \nP . Baldassari1, A. Pichi1, A. Laghi3;  1Rome/IT, 2Candiolo/IT, \n3Latina/IT\nPurpose: The purpose of this study was to retrospectively evaluate the \nincidence of complication related to CTC performed in both symptomatic and \nasymptomatic patients undergoing CTC during the period ranging from 2000 \nand 2010.\nMaterial and Methods: With a national survey, an e-mail questionnaire about \nserious adverse events of CT colonography was sent to all Italian Public Health \nCenters performing a daily CTC service. Technical parameters related to \ncomplications and kind of treatment needed for adverse events were also \ninvestigated. Collected data were analyzed and raw frequencies were \ndetermined.\nResults: All centers (13/13) interviewed, answered positively to the survey. \nAmong 13 centers, 40.121 CTC were performed. No deaths were reported. 39 \n(0.097%) patients experienced a complication during the procedure: 32 \nvasovagal self-limiting attack episodes (0.079%) and 7 bowel perforations \n(0.017%). In 4 (57%) cases, the site of perforation was within the rectum, in 3 \n(43%) cases within the sigmoid colon. No case of perforation within transverse, \nascending colon and caecum. Three of perforated patients had to undergo \nsurgery, while four patients had a conservative treatment. 4/7 cases of \nperforation had a conventional colonoscopy in the past seven days prior to \nCTC or on the same day of the exam.\nConclusion: In summary, we found a low rate of colonic perforations (0.017) \nthat were associated with CT colonography. The rate of occurrence of luminal \nperforation, however, was more than four times lower than equivalent rates \npublished for colonoscopy.\nSS 1.04\nNational survey of colonic imaging in the UK\nA. Lowe, A.D. Culverwell, S. Punekar, D. Prasad,  \nS. Stephenson, C. Jackson, C. Kay; Bradford/UK\nPurpose: The purpose of this study was to evaluate current provision of \ncolonic imaging in the UK NHS, to quantify radiologist and radiographer \nexperience and training, and to document current CTC technique and future \nplans for delivering colonic imaging services.\nMaterial and Methods: Postal questionnaires were sent to GI lead radiologists \nand radiology managers at UK hospitals between April 2011 and November \n2011. Comparison is made to a previous national survey in 2004.\nResults: Responses were obtained from 86 UK hospitals. There has been a \nsignificant increase in the percentage of centres and volume of CTC being \nperformed since 2004. Most reporters are GI sub-specialists, trained on formal \ncourses, but 40% are non-specialist and 18% have not been formally trained. \n60% of centres double read at least some of the examinations. 94% use \nautomated insufflation, 96% buscopan, 72% oral tagging. 54% use full \npurgation for all cases. 46% use iv contrast for all cases. 16% of centres have \nradiographers performing first read. Increasing demand is being managed by \ncreating more CT capacity by extended working into evenings and weekends \nand training more radiologists and radiographers to read CTC.\nConclusion: Role out of CTC into UK radiology departments since 2004 has \nbeen extensive and responsible. Technique is good with experienced, specialist \nradiologists providing the majority of final reports. In less experienced centres, \ndouble reading is frequently utilised. Issues remain around low volume in \ncentres and individuals and lack of formal training in a minority.\nSS 1.05\nHow do patients and doctors weight the relative \nimportance of false-positive and false-negative \ndiagnoses of cancer by CT colonography: discrete \nchoice experiment\nD. Boone\n1, S. Halligan1, N. Bell1, S. Zhu2, S. Mallett3, C. von \nWagner1, S.A. Taylor1, D. Altman3, R. Lilford2;  1London/UK, \n2Birmingham/UK, 3Oxford/UK\nPurpose: Receiver operator curve (ROC) analysis of radiological tests applies \nequal penalties for false-negative and false-positive diagnosis. We determined \nwhether patients and doctors also weight these errors equally.\nMaterial and Methods: 72 patients and 50 doctors completed a discrete \nchoice experiment of 20 individual questions, presented graphically on a \nlaptop. Each question posed 2 alternative radiological tests; CT colonography \nversus a “new” hypothetical scan that correctly diagnosed one additional \n11:00 - 12:30 Pentland\nScientific Session 1\nCT Colonography 1 - Implementation\nSS 1.01\nCTC: a comparative analysis of the actual costs with \ncurrent reimbursement rates provided by the National \nHealth Service\nR. Scandiffio, A. Mantarro, L. Faggioni, P . Bemi, P . Vagli,  \nI. Cavallini, E. Neri, C. Bartolozzi; Pisa/IT\nPurpose: The purpose of this study was to evaluate the economical impact of \nCTC on the National Healthcare System (NHS) by comparison of the CTC \nactual costs with the allocated reimbursement rates.\nMaterial and Methods: We estimated the actual costs of human resources, \nequipments and consumables (medical devices and drugs) employed to \nperform one CTC examination in our Unit. The costs of human resources were \ncalculated assuming an average CTC execution and reporting time of 30 and \n15 minutes, respectively. Radiological equipments encompass: PROTOCO~2~L \nColon Insufflator; 64-row CT scanner LightSpeed-VCT; Advantage Workstation \nGE-Healthcare. Medical staff included: one radiologist, one radiographer and \none nurse. Medical devices comprised: enema bag, administration set with \nsmall catheter and retention cuff CO~2~ delivery system for colonic insufflation, \n2 pairs of gloves, 2.5-mL syringe, needle cannula, push-fistula bandage, \npatient’s gown, shorts and sheets. Drugs included: 50 mL diatrizoate \nmeglumine+diatrizoate sodium solution (Gastrografin®); 250 mL water for \ninjection; lidocaine hydrochloride (Nefluan®); 20 mg hyoscine butylbromide \n(Buscopan®); 4 L carbon dioxide.\nResults: The actual costs for each category are as follows (Euros): medical \nstaff, 74.19; radiological equipments, 72.20; medical devices, 38.88; drugs, \n12.09. The sum of these items yields an overall cost of 197.40 Euros/\nexamination. By comparison, current NHS reimbursement amounts to 184.00 \nEuros, resulting in a hospital debt of 13.40 Euros/examination.\nConclusion: Current NHS reimbursement is unable to fully support the actual \ncost of CTC examinations, with consequent excessive expenditure of hospital \nresources.\nSS 1.02\nCT colonography versus colonoscopy or barium enema \nfor diagnosis of symptomatic colorectal cancer: \neconomic analysis from a multicentre randomised \ncontrolled trial\nS. Halligan\n1, G.L. Yao2, K. Wooldrage1, S. Zhu2, W. Atkin1, R. \nLilford2, T. Siggar Investigators1;  1London/UK, 2Birmingham/UK\nPurpose: The purpose of this study was to determine the cost-effectiveness \nof CT colonography (CTC) for diagnosis of symptomatic colorectal cancer \nusing real-world data obtained from 5384 patients participating in a multicentre \npragmatic randomised controlled trial (RCT).\nMaterial and Methods: Cancer detection rates were determined via two \nRCTs: barium enema (2527 patients) versus CTC (1047) and colonoscopy \n(1277) versus CTC (533). Resource costs for diagnostic procedures, the \nproportion of patients referred for subsequent investigations/treatment, and all \nassociated downstream costs (further diagnostic procedures, surgery, \noutpatient visits, treatment costs, hospital stay, etc.) were calculated on an \nindividual-patient basis. Cost per additional cancer detected was calculated \nvia intention-to-treat with bootstrapping for incremental cost-effectiveness.\nResults: Total mean and procedure costs were as follows: enema 444GBP \n(procedure cost 169GBP) versus CTC 512 (215); colonoscopy 651 (270) versus \nCTC 512 (215). The additional cost per colorectal cancer detected was \n21,333GBP for CTC versus enema (3 additional cancers per 1000 patients). \nCancer detection was similar for CTC versus colonoscopy, so cost per \nadditional cancer for colonoscopy was >100,000GBP . For CTC, the mean cost \nper additional primary extracolonic cancer was 1965GBP .\nConclusion: CTC is more cost-effective than barium enema. CTC is marginally \ncheaper than colonoscopy but with similar cancer detection rates; choice of \nprocedure will depend on other factors, including safety, acceptability and \ndetection of extracolonic tumors. Notably, CTC becomes cost-effective at the \nthreshold of 1 life saved per 26 extracolonic tumours detected.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / WEDNESDAY, JUNE 13, 2012\n S462\nSS 1.08\nPerforation rate in CT colonography: a systematic \nreview from literature\nD. Bellini, M. Rengo, D. Caruso, F . Vecchietti, M. Osimani,  \nA. Laghi; Latina/IT\nPurpose: The purpose of this study was to assess the perforation rate in CT \ncolonography and to evaluate methodological aspects and patients’ \ncharacteristics related to colonic perforation.\nMaterial and Methods: Methods for analysis and inclusion criteria were based \non PRISMA recomandations for systematic reviews and meta-analyses. \nMEDLINE, Cochrane, Sumsearch2 and Web of Science databases, from \ninception to September 2011, were searched for studies that reported \nperforation rate in Virtual Colonography. The evaluation of eligibility and the \nselection of articles were performed independently by two radiologists. From \neach primary study, reviewers abstracted the year of publication, the country \nwhere the study was performed, whether it was a single or multicenter study, \nnumber of patients, number of patients underwent CTC for screening and \nbecause symptomatic, whether manual or Automatic colon distention was \nperformed, number of patients perforated, center experience. Moreover, for \neach one of perforated patients, clinical data were extracted.\nResults: 188 articles were identified through database searching and after \nscreening process, 15 articles fulfilled eligibility criteria and were selected for \nqualitative synthesis. The number of patients enrolled per study ranged from \n262 to 21923, with a median of 9617. In 57700 CTC performed (44% for \nscreening, 50% because symptomatic), 21 patients (mean age 75) have been \nperforated with a perforation rate of 0.0298. Only 3 patients perforated \nunderwent CTC for screening.\nConclusion: While considered safer than optical colonoscopy, CT \ncolonography is not without risk, especially in symptomatic patients.\nSS 1.09\nWithdrawn by the authors\nSS 1.10\nRole of CT colonography in preoperative evaluation \nprior to laparoscopic surgery for complicated \ndiverticular disease\nR. Rizzati\n1, S. Tartari1, G. Anania2, M. Bassi1, M. Princivalle1, \nR. Righi1, G. Benea1;  1Lagosanto/IT, 2Ferrara/IT\nPurpose: The purpose of this study was to investigate the clinical value of CT \ncolonography (CTC) in the diagnosis of complicated diverticular disease in \norder to properly plan the laparoscopic surgery.\nMaterial and Methods: From January 2009 until November 2010, 49 patients \nscheduled for surgery for complicated diverticulitis, known or suspected, \nunderwent CTC. All patients were previously evaluated with optical colonoscopy \n(OC). Sensitivity in lesion location and detection was compared between OC \nand CTC and discrepancies analyzed. Accuracy of CTC in complicated \ndiverticulitis evaluation was determined.\nResults: A total of 49 patients with complicated diverticulitis were classified by \nCTC. OC was incomplete in 37/49 (26%) cases. Based on CTC assessment, \n10 cases of complicated diverticulitis were managed medically; 30 patients \nunderwent laparoscopic surgery for complicated diverticular disease. In 14 \npatients, CTC findings suggested an open surgery treatment due to adhesions, \nabscesses or fistulas. In diagnosis of complicated diverticular disease, CTC \nshowed 100% agreement regarding location and extent of the lesion and 90% \nsensitivity for complications. Furthermore, CTC detected 34 extracolonic \nfindings, 12 of whom had major clinical relevance.\nConclusion: CTC provides more detailed and precise depiction of complicated \ndiverticular disease compared to OC, allowing an appropriate and accurate \nmanagement of patient.\ncolorectal cancer or polyp (i.e. a lesser false-negative rate), raising sensitivity \nby 10% (from 85% to 95%) but at the expense of additional false-positive \ndiagnoses. The number of false-positives per additional cancer diagnosis was \nvaried for each question. The clinical consequences of false-positive diagnoses \nwere explained prior to the test. Participants indicated their preferred test for \neach question. Responses were collated and the “tipping-point” calculated for \neach group overall.\nResults: For 10% increase in cancer sensitivity, patients tolerated a mean \n47% (95%CI 39%-56%) increase in false-positives, equating to 2350 per \nadditional cancer detected. Doctors tolerated an additional 14% (95%CI 9%-\n21%), which equated to 700 per cancer. For an 10% additional polyp \ndetections, patients tolerated an additional 33% rise in false-positives \ncompared to 17% for doctors.\nConclusion: Patients (especially) and doctors regard false-negative diagnosis \nof colorectal cancer (and polyps) as overwhelmingly more important than \nfalse-positive diagnoses. Statistical analysis of radiological tests must take \nthis discrepancy into account if they are to truly reflect diagnostic benefit.\nSS 1.06\nUse of computed tomographic colonography (CTC) in \npatients older than 75 years\nD.A. Tiferes, A. Habr-Gama, J.G. Rodrigues, R.O. Perez,  \nI. Proscurshim, R. Blasbalg, R.P . Caldana; São Paulo/BR\nPurpose: The purpose of this study was to demonstrate the use of CTC in \npatients older than 75 years.\nMaterial and Methods: Retrospective analysis of 116 consecutive CTC \nexaminations performed in patients older than 75 years was undertaken. \nPerformance and outcome measures including colonoscopy referral, prevalence \nof lesions \u0003 10mm, significant extracolonic findings and complication rates were \nobtained by using a CTC database and review of medical records.\nResults: 35 males and 81 females, with ages ranging from 75 to 95 years \n(mean 81.2 years), underwent CTC for colorectal cancer screening (27.6%), \ndue to incomplete colonoscopies (33.6%) and for evaluation of gastrointestinal \nsymptoms (38.8%). Adequate technique (insufflation and bowel preparation) \nwas obtained in 93.2% (645 of 696) of the colonic segments evaluated. There \nwere no complications. Colonoscopy was indicated in 19% (22 of 116) of \npatients, using a 10 mm lesion size as threshold for referral. Sixteen of these \npatients underwent colonoscopy and/or surgery, with 15 patients harboring \nlesions \u0003 10 mm (11 invasive cancers and 4 advanced adenomas). The overall \nper-patient CTC positive predictive value was 93.8% (15 of 16). Significant \nextracolonic findings were seen in 12.9% (15 of 116) of patients, mostly \nconsisting of aortoiliac aneurysms (n=6).\nConclusion: CTC is a safe and effective modality for colorectal evaluation in \npatients older than 75 years. Based on CTC results, optical colonoscopy may \nbe ultimately avoided in over 80% of those patients.\nSS 1.07\nCTC in symptomatic patients: are we keeping negative \ncolonoscopies to a minimum?\nS.F . Kerr, D.J.M. Tolan, M. Sheridan; Leeds/UK\nPurpose: In many institutions, CTC has supplanted colonoscopy as first-line \ninvestigation for colonic neoplasia in symptomatic patients with comorbidity. \nHowever, published outcomes of CTC performance outside research trials are \nlacking. We reviewed our CTC experience in symptomatic patients with the \nprimary objective of establishing positive predictive value (PPV) for \nbenchmarking clinical practice during early service development.\nMaterial and Methods: All CTC examinations performed over a two-year \nperiod from May 2007 (i.e. 2-year minimum clinical follow up) were reviewed. \nFor those reporting a significant colonic abnormality (i.e. polyp \u00036mm; cancer; \nor indeterminate thickening), endoscopy and pathology reports were reviewed. \nCTC was performed with standard technique including intravenous contrast.\nResults: Of 1852 consecutive CTC examinations (median age 78), 337 \nreported a significant colonic abnormality. 70 had undergone previous \nincomplete colonoscopy and were excluded from further analysis. 215 had \nsubsequent colonoscopy and/or surgery; corresponding lesions were \nconfirmed in 167 and excluded in 32. Excluding 16 patients with inadequate \nsubsequent visualisation of the appropriate colonic segment, per-patient PPV \nof CTC was 83.9%. Seven patients were ultimately diagnosed with inflammatory \n(rather than neoplastic) lesions; categorising these as “false positive” reduces \nPPV to 80.4%. In total, 251 polyps \u00036mm and cancers were reported on CTC \nin 194 patients proceeding to colonoscopy and/or surgery; per-lesion PPV was \n85.7%.\nConclusion: PPV of CTC for significant colonic abnormalities is high and the \nnumber of subsequent negative colonoscopies is low.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / WEDNESDAY, JUNE 13, 2012\n S463\nMaterial and Methods: 46 liver tumours [hepatocellular carcinoma (22), \nmetastases (24)], with a mean tumour size of 30mm, in 37 patients with an \naverage age of 67 years were treated by multi-station percutaneous MWA over \n14 months. Post-ablation dual-phase CT was performed on average at 23 \ndays post-treatment and technical success assessed. Subsequent follow-up \nCTs have been performed. Data were collected prospectively.\nResults: 40 of 46 tumours (87%) were successfully treated by MWA. Sub-total \ntreatment occurred initially in eight tumours in seven patients. Sub-total \ntreatments were anticipated in one patient with two tumours in whom the \nprocedure was abandoned due to general anaesthesia difficulties. Of six \nunexpected sub-total treatments, three tumours underwent completion MWA, \nand one completion trans-arterial chemoembolization. Average length of \nimaging follow-up was 116 days (maximum 449 days). From tumours with \ncomplete ablations, there has been only one late local recurrence, detected at \n132 days post-ablation. Five patients died of progressive disease, at an \naverage of 245 days post-ablation.\nConclusion: Complete MWA was achieved in 40 of 46 (87%) tumours with an \naverage size of 30 mm. Early experience has led to a modified, multi-stationed \napproach with a trend to primary complete treatments later in this cohort.\nSS 2.04\nBiodegradable oesophageal stents: indications and \ncomplications in the management of malignant \noesophageal tumours\nD. Mullan, P . Kellati, H. Sheikh, H. Laasch; Manchester/UK\nPurpose: Oesophageal stents are well established in the management of \nmalignant oesophageal tumours and traditionally require covered, retrievable, \nmetal stents to avoid complicated mucosal embedment. Radiotherapy should \nnot be given with a metal stent in situ, requiring stent retrieval and nasogastric/\ngastrostomy insertion. Biodegradable oesophageal stents are a recent product \nindicated primarily for benign strictures. We report the novel use of non-\ncovered biodegradable stents in the management of malignant strictures, \nallowing concurrent radiotherapy with stent in situ. We discuss indications, \nimplications and complications.\nMaterial and Methods: Patients with oesophageal malignancy suitable for \nradical radiotherapy were referred for biodegradable stent insertion at a \nregional oncology centre. Prospective auditing allowed retrospective statistical \nreview of clinical data including symptoms, demographics, outcomes, \ncomplications and survival. All cases were performed under fluoroscopic \nguidance by a consultant radiologist.\nResults: 18 stents were inserted in 17 patients between 17/4/2009 and 9/8/2011. \nAll were placed immediately prior to radiotherapy. Two stents blocked with food/\nmucosal hyperplasia, one requiring gastrostomy and one preferring NG insertion \ndue to stent associated pain. 1 patient complained of pain alone, endoscopy \nshowing mucosal hyperplasia. 1 stent slipped requiring reinsertion.\nConclusion: Biodegradable stents inserted for potentially curable malignancy \nconfer the significant advantage of permitting concurrent radiotherapy whilst \nobtaining luminal expansion. This permits a psychologically significant oral diet \nand avoids the need for gastrostomy/nasogastric tube insertion. They do, however, \nseem prone to specific complications, such as pain and mucosal hyperplasia.\nSS 2.05\nRight-sided Wallflex stenting in patients with malignant \ncolonic obstruction: a single-centre prospective study\nI. Walton, B. Fox, P . Williams; Plymouth/UK\nPurpose: Self-expanding metallic stents (SEMS) have been used to relieve \nmalignant colonic obstruction as palliation or as an interim procedure to \nsurgical resection. There is a paucity of data related to colonic stent insertion \nin the proximal colon. We present the world’s largest single-centre 10-year \nprospective data to assess the outcomes in stented patients with right-sided \nlesions.\nMaterial and Methods: A total of 40 consecutive patients (45% women; mean \nage 76) were treated for right-side obstruction due to primary or recurrent \ncolon cancer with SEMS: 2 as an interim to surgery and 38 for palliation. A \nWallflex stent was used in all patients and inserted under combined endoscopic \nand fluoroscopic guidance.\nResults: Right-sided colonic stent deployment was attempted in all 40 patients \nwith 41 stents. SEMS was successfully deployed in 34 cases (85%) with two \ncomplete obstructions, one failure deployment, and an inaccessible obstructing \nlesion in three cases. There were no procedural complications (perforation, \nmigration). Clinical success was achieved in 30 of 34 cases (88%). Long-term \ncomplications included: a migration of a successfully deployed stent, and \nthree re-obstructions due to faecal blockage or tumour ingrowth. The remaining \npatients had normal bowel movements for the period of follow-up or until \nexpiration.\n11:00 - 12:30 Fintry\nScientific Session 2\nInterventional Radiology\nSS 2.01\nCT-perfusion technique, with evaluation of quantitative \nperfusion map, as an early predictor for tumour \nresponse to transarterial chemoembolization in patients \nwith HCC lesions\nP .A. Bonaffini, D. Ippolito, C. Talei Franzesi, C. Capraro,  \nR. Corso, S. Sironi; Monza/IT\nPurpose: The purpose of this study was to prospectively investigate the role \nof CT-perfusion (CT-p) technique in evaluation of perfusion changes in HCCs \nbefore and after transarterial chemoembolization (TACE) therapy.\nMaterial and Methods: Twenty-seven patients with cirrhotic liver disease and \nhistologically proved HCC were prospectively enrolled in our study. CT-p study \nwas performed on 16 multidetector CT (Brilliance 16, Philips, NL), dose \nexposure was 120 Kv, 80 mAs. In all cases, bolus injection of 50 ml of non-\nionic contrast agent (350 mgI/ml) at a flow rate of 6 ml/sec was performed and \nforty dynamic scans were acquired at a fixed table position. A dedicated \nperfusion software which generated a quantitative map of arterial and portal \nperfusion by means of colour scale was employed. The following perfusion \nparameters were assessed before and after TACE: hepatic perfusion (HP), \narterial perfusion (AP), blood volume (BV), hepatic perfusion index (HPI).\nResults: A complete HCC filling by lipiodol was found in 18 cases with \nfollowing perfusion parameters: HP 32.7±15.1 ml/sec/100gr; AP 38.4±8.8 ml/\nmin; BV 17.6±9.5 ml/100mg; HPI 96.2 ±7.5%. Corresponding value calculated \nin patients without residual tumor were: HP 13.6±6.3; AP 13.1±7; BV 6.8±4.8; \nHPI 13.6±9.2. A significant difference (p<0.001) was found for all parameters \nbetween residual viable tumor tissue (p<0.001) compared to successfully \ntreated lesion, due to the presence of residual arterial vascular structure in \nviable portion of treated HCC.\nConclusion: On the basis of the small patient population, this feasibility study \nshows that quantitative analysis of perfusion could provide an in vivo early \nbiomarker for predicting treatment response in patients with HCC lesions.\nSS 2.02\nSurvival after radiofrequency ablation and salvage \ntransplantation in patients with hepatocellular \ncarcinoma and Child-Pugh A cirrhosis\nO. Seror, G. N’Kontchou, M. Beaugrand, J.C. Trinchet,  \nY . Ajavon, N. Sellier; Bondy/FR\nPurpose: In patients with hepatocellular carcinoma (HCC) in Milan criteria, liver \ntransplantation (LT) may be the best therapeutic option. However, the shortage \nof grafts, leads to attempt liver resection (LR) or radiofrequency ablation (RFA) as \na first-line treatment for patients with Child-Pugh A cirrhosis.\nMaterial and Methods: We report results, obtained between 2000 and 2007 \nfrom a single center, involving 67 patients (mean age: 58 years) eligible for LT, \nwho were treated with RFA, followed by LT if there was recurrence or liver \nfailure.\nResults: RFA achieved complete ablation in 96% of nodules. No mortality \noccurred. During a post-RFA median follow-up of 48 months, 38 patients \nexperienced recurrence, corresponding to a 5-year recurrence rate of 58%. Of \nthese, 14 patients did not receive a transplant, because they fell outside the \nMilan criteria, 21 were transplanted, and 3 were treated by RFA after refusing \nLT. Binodularity (95% CI HR=2, 1.0–4.0; p=0.049) was the unique risk factor for \nrecurrence. By the study’s end-point, 24 patients had undergone LT. No HCC \nrecurrence occurred after LT. Among the 43 non-transplant patients, 12 died \ndue to HCC progression, and 27 were alive without detectable viable tumor. \nThe probability rates for 5-year overall and tumor-free survival were 74% and \n69%, respectively.\nConclusion: First-line RFA followed by salvage LT allows comparable survival \nfigures with a first-line LT, whist limiting the number of grafts.\nSS 2.03\nMicrowave ablation of liver tumours at 2.45 GHz with a \n1.8 mm applicator: radiological outcomes\nP .A. Patel, I.D.C. Wilson, C.N. Hacking, B. Stedman,  \nD.J. Breen; Southampton/UK\nPurpose: Little published data exist on outcomes following microwave ablation \n(MWA) at 2.45 GHz in human liver tumours. We have analysed our performance \nof percutaneous MWA assessing technical success and short-term outcomes.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / WEDNESDAY, JUNE 13, 2012\n S464\nSS 2.08\nComparison of percutaneous portal vein embolization, \nportal vein ligation and portal vein occlusion combined \nwith ipsilateral hepatic artery cannula implantation prior \nto major liver resection\nP . Pajor, O. Hahn, I. Dudas, A. Zsirka, T. Winternitz,  \nP .K. Kupcsulik; Budapest/HU\nPurpose: The purpose of this study was to evaluate the results of percutaneous \nportal vein embolisation (PVE), portal vein ligation (PVL) and portal vein ligation \ncombined with hepatic artery cannula implantation into the ipsilateral hepatic \nartery (PVL+can) prior to extended hepatectomy.\nMaterial and Methods: Between 2004 and 2012, hundred and twenty patients \npresenting with multiple or large liver metastases or large hepatocellular \ncarcinoma were included. The estimated residual liver volume (FLR) of these \npatients after the planned extended hepatectomy was less than 30% (normal \nliver), or 40% (cirrhotic liver). To increase the FLR, portal vein occlusion \ntechniques (39 PVE, 81 PVL alone, or PVL+can) were performed. They were \nevaluated with MDCT including volume assessment, before and 8 weeks after \nthese procedures.\nResults: 96/120 patients became resectable (PVE, PVL, PVL+can, 74.3%, \n80%, 88.5%). FLR increase 8 weeks after PVE, PVL or PVL+can was 17.6%, \n16.5%, 19%, the complication rate of the various portal occlusion techniques \nwere 4.5%, 3.6%, 11,5%, respectively. At least 4 segments were resected \nduring hepatectomy. Overall, postoperative morbidity and mortality rates were \n13% and 2.5%, respectively. Complication and mortality rates did not differ \nsignificantly in the 3 groups.\nConclusion: Patients with previously unresectable liver tumors can benefit \nfrom resection after all kinds of portal occlusion techniques. Although \ncomplication rate of portal occlusion combined with hepatic artery canulla \nimplantation is higher, more patients become resectable due to higher increase \nrate of FLR in this group.\nSS 2.09\nDynamic evaluation and quantification of \nmicrovascularization during degradable starch \nmicrospheres transarterial chemoembolisation (DSM-\nTACE) of HCC lesions: a feasibility study\nP . Wiggermann, W.A. Wohlgemuth, A.G. Schreyer, M. Loss, \nC. Stroszczynski, E. Jung; Regensburg/DE\nPurpose: The purpose of this study was to evaluate the time-dependent \nchanges of microvascularization in HCC lesions during DSM-TACE using \ncontrast enhanced ultrasound (CEUS).\nMaterial and Methods: A total of 64 CEUS examinations were performed (1-5 \nMHz, convex probe) in 8 selected patients who underwent DSM-TACE of HCC \nlesions. I.v. application of ultrasound contrast media was performed before \nand 24 h post-embolization. In addition, i.a. contrast application was performed \nvia the angiographic catheter right before and after the embolization and \nduring a follow-up time of 2 h every 30 min. The capillary perfusion was \nanalyzed using a dedicated perfusion software.\nResults: A reduced microvascularization was seen right after DSM-TACE in all \ncases. The reduction of PEAK, RBV (regional blood volume) and RBF (regional \nblood flow) compared to pre-embolization values was highly significant \n(p<0.001). During follow up, a stepwise revascularization of the lesions was \ndocumented: 90 min post embolization perfusion parameters were not \nsignificantly different from pre-embolization values.\nConclusion: In this feasibility study, capillary perfusion quantification of HCC \nlesions after DSM-TACE could be demonstrated using CEUS. It was possible \nto quantify for the first time the transient embolizing effect of DSM-TACE.\nSS 2.10\nMulti-centre survey of radiologically inserted \ngastrostomy feeding tube in the UK\nA. Lowe\n1, H.U. Laasch2, S. Stephenson1, C. Butterfield1,  \nM. Goodwin2, C. Kay1;  1Bradford/UK, 2Manchester/UK\nPurpose: The purpose of this study was to evaluate variance in current UK \npractice and clinical outcomes for direct percutaneous radiologically inserted \ngastrostomy (RIG).\nMaterial and Methods: A prospective UK multi-centre survey of RIG was \nperformed between October 2008 and August 2010.\nResults: Data from 684 patients were provided by 45 radiologists working at \n17 UK centres. 263 cases (40%) were performed with loop-retained catheter, \nand 346 (53%) with balloon-retained devises. 60% of all patients experienced \npain in the first 24 hours but settled in the majority thereafter. Early \ncomplications, defined as occurring in the first 24 hours, included: minor \nConclusion: Management of proximal malignant colonic obstruction with the \nWallflex device is safe and effective. Technical and clinical success is \nencouraging, with outcomes comparable to distal colonic stenting.\nSS 2.06\nSelective radioembolization with 90y microspheres for \nliver secondary lesions: our experience\nR. D’Angelo, F . Fiore, L. Aloj, C. Arrichiello, S. Lastoria,  \nV. Albino, F . Izzo; Naples/IT\nPurpose: The purpose of this study was to assess the safety and effectiveness \nof intra-arterial Y90 SIR sphere treatment in patients with liver metastasis.\nMaterial and Methods: Between 2005 and 2011, radioembolization was \nperformed in 83 patients with non-surgical liver metastases in progression \nafter chemiotherapy: 52 with colorectal tumor; 19 with breast cancer; 4 with \nmelanoma; 2 with NET; 2 with pancreas tumor; 2 with gastric tumor; 2 with \novarian tumor. The administered dose was calculated with Body Surface Area \nMethod (BSA). All patients underwent PET/TC before and after treatment. PET-\nY90 was performed to check the microspheres distribution. Work up included \nalso embolization of gastroduodenal artery and other arteries using micro-\ncoils. Shunting study was performed with TC 99MAA after positioning of \n3French microcatheter.\nResults: The mean administered dose was 1.55 GBq. The partial/complete \nresponse was achieved in 27 patients; in 42 was obtained stability and \nprogressive disease in 24 patients. No significant side-effects of treatment \nwere observed; 37 patients developed fever and can last up to a week. 43 \npatients also experienced abdominal pain controlled by oral analgesia. \nProphylaxis treatment was used for 1 month after with PPI.\nConclusion: Our experience suggests that radioembolization is effective and \nsafe for local treatment of non-surgical hepatic metastasis in progression after \nsystemic chemotherapy.\nSS 2.07\nRole of transarterial chemoembolization as bridging \nstrategy in T2 HCC patients on the waiting list\nI. Bargellini, E. Bozzi, G. Lorenzoni, P . De Simone, R. Cioni, \nF . Filipponi, C. Bartolozzi; Pisa/IT\nPurpose: The purpose of this study was to retrospectively evaluate long-term \noutcomes of T2 stage HCC patients who underwent orthotopic liver \ntransplantation (OLT) after transarterial chemoembolization (TACE), compared \nto patients transplanted without bridging therapy.\nMaterial and Methods: The study included 168 cirrhotic patients (147 male, \nmean age 55.8 years) with T2 HCC, who underwent OLT from 1996 to 2010. In \npatients treated by TACE, latest CT examination prior to OLT was reviewed to \nassess tumor response according to mRECIST. Patients were divided into \nthree groups: (A) no bridging therapy; (B) complete response (CR) after TACE; \n(C) partial response, stable or progressive disease after TACE. Overall (OS), \nrecurrence-free (RFS) and disease-free (DFS) survivals were calculated by \nKaplan-Meier analysis and compared by log-rank test.\nResults: Fifty-six patients were in group A, 60 patients in group B and 52 \npatients in group C; preprocedural data were comparable among groups. Five-\nyear OS, RFS and DFS were 75.2%, 92.7% and 73.2%, respectively. Survivals \nwere significantly higher in group B compared to group C and comparable \nbetween group A and B. Of interest, in tumors > 3cm, RFS and DFS censored \nfor periprocedural deaths (n=7) were higher in group B compared to group A \n(p=0.05).\nConclusion: In T2 transplanted patients, CR after pre-operative TACE \nrepresents a favorable prognostic indicator. TACE may be beneficial for T2 \npatients with overall tumor size >3cm.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / WEDNESDAY, JUNE 13, 2012\n S465\nResults: The mean value of Dmax obtained by surgical specimen was 50 mm \n(range 30-60) versus 63 mm (range 46-92) of Dmax measured through MDCT. \nIf the Dmax values were stratified in three groups (group 1 smaller than 40 mm, \ngroup 2 between 40 and 80 mm, group 3 bigger than 80 mm), a correlation \nwith MDCT results of 25%, 62% and 71%, respectively, was found.\nConclusion: MDCT is an accurate technique to obtain an appropriate \npreoperative definition of Dmax, within the limits of tumor bigger than 40 mm. \nThe revaluation of each case with Dmax smaller than 40 mm will supply \nadditional information about the discrepancy (retraction of the stomach \nfollowing immersion into formalin, diffusion in the submucosal layer).\nSS 3.03\nEvaluation of nine CT-signs in surgically proven internal \nhernia after gastric bypass, initially missed on CT\nJ. De Cock, D. Vanbeckevoort, L. Van Muylder, M. Lannoo, \nD. Bielen; Leuven/BE\nPurpose: Retrospective evaluation of nine CT-signs of internal herniation after \nlaparoscopic gastric bypass in 13 patients with surgically proven internal \nhernia where the diagnosis initially was missed.\nMaterial and Methods: We retrospectively evaluated the CT-scans of 13 \npatients who had complaints of long-lasting vague abdominal pain after \nundergoing a laparoscopic gastric bypass procedure. None of the patients \nwere initially diagnosed with internal herniation. Surgical exploration revealed \ninternal herniation in all 13 patients. We reevaluated the images using nine CT-\nsigns: swirled appearance of mesenteric fat or vessels, mushroom shape of \nthe hernia, mesenteric infiltration, the presence of reactive lymph nodes, \ntubular distal mesenteric fat surrounded by bowel loops, small-bowel dilatation, \nclustered loops of small bowel, small bowel other than duodenum posterior to \nthe mesenteric artery and right-sided location of the enterostomy.\nResults: Presence of the signs: Mesenteric swirl and mesenteric infiltration \nwere 100%. Mushroom shaped hernia and reactive lymph nodes were 77%. \nClustered loops of small bowel were 46%. Small-bowel dilatation was 38%. \nDisplaced enterostomy was 31%. Tubular distal mesenteric fat surrounded by \nbowel loops was 23%. Small bowel other than duodenum posterior to the \nmesenteric artery was 15%.\nConclusion: When a patient suffers from vague long-lasting abdominal \ncomplaints after gastric bypass, thorough investigation of the nine CT-signs \npresented above is mandatory in diagnosing internal herniation on an \nabdominal CT-scan.\nSS 3.04\nPost-operative ileus, abnormal bowel and overall \nradiologist impression are independent predictors for \nclinical anastomotic leak on CT\nK. Adams, D. Bosanac, A. Hansman, P . Peddu, S. Ryan,  \nS. Papagrigoriadis; London/UK\nPurpose: The purpose of this study was to investigate individual radiological \nfeatures as predictive factors for anastomotic leak detection in CT scans \nfollowing colorectal resections.\nMaterial and Methods: Patients were identified from a prospective database \nfrom 2005 to 2011 with surgically confirmed post-operative anastomotic leaks. \nThe control group (matched in 2:1 ratio) was selected from patients who were \nscanned with a suspicion of leak, but improved without operation. Four \ngastrointestinal radiologists reviewed anonymised CT scans, blinded to clinical \noutcome. Radiologists assessed for the overall impression of anastomotic \nleak, presence of leak features, and confidence level in their results.\nResults: 17 patients with confirmed anastomotic leaks and 36 control patients \nwere enrolled. No significant difference was observed in the sensitivity/\nspecificity between the radiologists in correct leak detection, with overall \ncorrect diagnosis in 81.4%. A leak prediction model was constructed with \nmultivariate binomial logistic regression with outcome classified as clinical \nleak. Leak, abnormal bowel wall and ileus were significant predictors (all \np<0.05). The prediction model produced an overall sensitivity 85.2%, specificity \n80.2% and ROC curve area of 87.3% (see graph). A correct leak prediction \nwas associated with a significantly higher confidence level: 7.09/10 when \nincorrect versus 8.50/10 when correct (p=0.02).\nConclusion: Diagnostic accuracy was significantly higher when radiologists \nhad a higher level of confidence in their diagnosis. Individual CT features have \nbeen used to create a risk prediction model for leak detection that improves \ndiagnostic accuracy above overall radiological impression alone.\nbleeding (1%), wound infection (3%), peritonism (2%) and tube misplacement \n(1%). Late complications, occurring between day 2 and day 30, included: mild \npain (30%), persisting peritonism (2%) and 30-day mortality of 1% (5/665). \n93% of cases were performed using gastropexy. Gastropexy decreased post-\nprocedural pain (p<0.001), but gastropexy-related complications occurred in \n5%. Post-procedure pain increased significantly as tube size increased \n(p<0.001). The use of balloon retention feeding tubes was associated with \nmore pain than the use of loop retention devices (p<0.001).\nConclusion: RIG is a relatively safe procedure with a mortality of 1%, with or \nwithout gastropexy. Pain is the commonest complication. The use of \ngastropexy, smaller tube sizes and loop retention catheters significantly \nreduced the incidence of pain. There was a gastropexy-related complication \nrate in 5% of patients. Neither pre-procedural antibiotics nor anti-MRSA \nprophylaxis affected the rate of wound infection.\n11:00 - 12:30 Sidlaw\nScientific Session 3\nLuminal GI tract\nSS 3.01\nSoftware-assisted evaluation of gastric motility in MRI \nimproves the assessment of functional parameters\nS. Bickelhaupt\n1, J.M. Froehlich1, R. Cattin2, S. Raible2,  \nH. Bouquet3, U. Bill3, M.A. Patak1;  1Zurich/CH, 2Biel/CH, \n3Bern/CH\nPurpose: Functional MRI of gastric motility is of high clinical relevance, e.g. for \ngastric-emptying disorders, but time-consuming due to the manual \nmeasurement. A newly developed software (Motasso) has proven valid for \nsemi-automatic measurement of small-bowel motility. The aim of this study \nwas to evaluate the feasibility of Motasso for the assessment of gastric motility \nby comparing it to manual measurements.\nMaterial and Methods: 10 patients (5 male/5 female; mean 41 years) were \nincluded in this study. MRI (1.5-T, Siemens-Sonata) was performed after \nstandardized preparation (3% Mannitol over 1 h). 2D (dynamic-T2-2D-\nFIESTA;TR253.8/TE1.89/FOV400/10mm slice) motility acquisitions covering the \nentire abdomen were performed in apnea. Image analysis for assessment of \ngastric motility was performed both manually and with the software in the \nproximal/distal corpus. The main characteristics (amplitude/frequency/diameter) \ndescribing gastric motility were compared using (paired) Student’s t-test.\nResults: 10 single regions-of-interest (5 in the proximal/5 in the distal corpus) \nwere measured by hand and with Motasso. All motility curves qualitatively \nmatched each other (10/10; 100%). No significant difference (p>0.05) was \nfound for amplitudes (mean: 18.17 mm, manual: 17.78 mm, Motasso), \ncontraction frequency (5.1/min, 4.7/min) and mean lumen diameters (34.12 \nmm, 33.13 mm). Mean duration for single measurement was significantly \n(p<0.001) lower with Motasso (6.40 min, manual: 1.40 min, Motasso). Mean \nmanual wave propagation was 0.68 mm/sec.\nConclusion: Motasso proves to be feasible for fast and accurate measurement \nof gastric motility in both the proximal and distal corpus. No significant \ndifferences between manual measurements and the software could be \nobserved. Motasso can help to reduce the time needed for assessment of \nrelevant characteristics in gastric motility and thus ease the clinical practice of \ngastric motility analyses.\nSS 3.02\nAccuracy of MDCT in preoperative definition of \nmaximum tumor diameter in patients with gastric \ncancer\nS. Guerrini, M.A. Mazzei, N. Salvini, P . Mercuri, N. Cioffi \nSquitieri, C. Vindigni, D. Marrelli, L. Volterrani;  Siena/IT\nPurpose: The maximum tumor diameter (Dmax) is a prognostic factor in \npatients with gastric cancer, considering its dependance on the depth of \ninvasion. The aim of our work has been to evaluate the accuracy of MDCT in \nthe preoperative definition of Dmax in patients with gastric cancer, assuming \nsurgical specimen measurements as gold standard, in order to obtain a pre-\nsurgery prognostic evaluation.\nMaterial and Methods: Pre-surgery CT examinations of 47 patients (mean \nage 53.5, range 48-71) with diagnosis of gastric cancer were evaluated \nretrospectively and in a blind fashion by a radiologist with expertise in the \noncologic field. The Dmax measured was obtained through 2D multiplanar \ncurved reconstruction (ADW 4.6 GE Healthcare). The results were compared \nwith macroscopic data after surgery.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / WEDNESDAY, JUNE 13, 2012\n S466\n(n=25), then combined with 45 non-digitating examinations (total=100), \nanonymised, and reviewed by two experienced GI radiologists (blinded). \nCertainty of digitation, LIG presence/absence, and perceived effects of \ndigitation were recorded. A statistician was involved during methods/results.\nResults: Qualitative data: 92% referrers visualised LIG in representative \nstudies, 69% and 62% felt study appreciation and patient consultation would \nimprove. Prospective study results: Significant overall interobserver agreement \n(Kappa 0.84) in confidence whether digitation occurred or not (false positive \n1%). LIG use: Both readers detected all digitation and that LIG were worn \n(sensitivity/specificity 100%); in 97% readers were confident about digitation \neffects. NG use: Digitation was detected with certainty in 66% and effects of \ndigitation were felt apparent in 18% (poor interobserver; Kappa 0.11). Certainty \nof digitation and its effects significantly improved (p<0.01 and <0.001, paired \nt-tests) with LIG compared to NG.\nConclusion: Clinicians value improved digitation visualisation in study \nappreciation and patient consultation and LIG use significantly improves \nvisualisation of digitation and its effects during evacuation proctography \ncompared to NG.\nSS 3.08\nIncidental focal colonic FDG uptake: correlation with \ncolonoscopic findings\nR.R. Nensey\n1, G. Bhatnagar1, H.S. Sidhu1, S.J. Higgins2,  \nT. Sulkin3;  1Plymouth/UK, 2Torquay/UK, 3Treliske/UK\nPurpose: The purpose of this study was to assess the incidence of focal FDG \nuptake in the colon in patients not known to have colorectal carcinoma and to \ndetermine the significance of these PET positive scans on follow-up \nendoscopy.\nMaterial and Methods: A retrospective data collection of the PET CT scans \nperformed on patients at Royal Cornwall hospital was reviewed. The study \nincluded data of 306 scans performed over 15 months between October 2008 \nand December 2009. Patients with known bowel pathology were excluded \nfrom the study.\nResults: Incidental FDG uptake within the colon was seen in 15 of the 306 patients. \nEndoscopy was subsequently performed on 9 of these cases, demonstrating an \nanomaly in the form of polyp or tumour. A further 2 incidental polyps were identified \non endoscopy which did not indicate corresponding increased FDG uptake on the \nPET scans. Malignant tumours were identified on 3 of these PET positive patients; \nthe sites being the rectum, sigmoid colon and caecum. The positive predictive \nvalue of PET for colonic disease from our study is 100%.\nConclusion: The positive predictive value of PET is 100% in detecting colonic \npathology. It is vital to systematically review the bowel on nuclear medicine \nscans and if positive, follow up of such cases must be performed with \nendoscopy and biopsy for early detection and appropriate management of \ncolonic pathology.\nSS 3.09\nSmall and large bowel MRI: can additional diffusion-\nweighted MR imaging improve diagnostic confidence?\nS. Kinner, S. Blex, M. Forsting, T.C. Lauenstein; Essen/DE\nPurpose: MR enterography and colonography are well accepted techniques \nfor the depiction of inflammatory and tumor diseases. Diagnostic confidence \nin some cases can be limited, especially in the presence of motion/breathing \nartifacts or suboptimal bowel distension. Diffusion-weighted imaging (DWI) is \nan emerging technique for abdominal MRI. Therefore, we aimed to evaluate if \nadditional DWI for bowel MRI can improve diagnostic confidence.\nMaterial and Methods: 18 patients underwent bowel MR because of \nsuspected or known IBD (n=9), tumor disease (n=6), unspecific abdominal \npain (n=2) and suspected graft-versus-host disease (n=1). MRI was performed \non a 1.5 T (Magnetom Avanto, Siemens). In addition to T2w and contrast-\nenhanced T1w data, DWI sequences in axial and coronal plane were collected \n(b = 50, 500, 1000). The diagnostic confidence for lesion detection with and \nwithout DWI was evaluated by two experienced radiologists using a 4-point \nLikert scale (1: certainly no lesion(s), 2: probably no lesion(s), 3: probably \nlesion(s), 4: certainly lesion(s)).\nResults: In 3 of 18 patients (17%), the diagnostic accuracy was improved by \nDWI. In two patients, readers changed diagnosis from “probable present \nlesion(s)” to “certain present lesion(s)”. In one patient, a cecal tumor was \ndiagnosed only on the basis of DWI. This diagnosis was subsequently \nconfirmed by endoscopy.\nConclusion: DWI of the bowel can provide additional information to the reader \nand should be performed routinely with every gastrointestinal MRI as it can \nimprove diagnostic confidence.\nSS 3.05\nA diagnostic accuracy meta-analysis of endoanal \nultrasound (EAUS) and magnetic resonance imaging \n(MRI) for Perianal Fistula Assessment\nM.R.S. Siddiqui\n1, H. Ashrafian2, P . Tozer1, N. Daulatzai1,  \nD. Burling1, A. Hart1, T. Athanasiou2, R.K. Phillips1;  1Harrow/UK, \n2London/UK\nPurpose: We present a systematic review of published literature comparing \nendoanal ultrasound with magnetic resonance imaging for the assessment of \nidiopathic and Crohn’s perianal fistulas.\nMaterial and Methods: Electronic databases were searched from January \n1970 to October 2010 for published studies in any language.\nResults: Six studies comparing endoanal ultrasound and magnetic resonance \nimaging for perianal fistulas were analysed. There were 293 fistulas in the \nultrasound group and 291 in the magnetic resonance group. The combined \nsensitivity and specificity of magnetic resonance for overall fistulas detected \nwere 0.90 (95% CI: 0.75-0.96) and 0.66 (95% CI: 0.48-0.80). There was \nsignificant heterogeneity between studies reporting on MRI (Q=52.39, df=5, \np=0.000, I2=90%). This compares to a sensitivity and specificity for endoanal \nultrasound of 0.88 (95% CI: 0.77-0.95) and 0.45 (95% CI: 0.24-0.67), \nrespectively. There was significant heterogeneity between studies (Q=49.28, \ndf=5, p=0.000, I2=90%).\nConclusion: From the available literature, the summarised performance \ncharacteristics for MRI may be interpreted as better than those for EAUS, but \nthe significant between-study heterogeneity precludes any firm conclusions \nbeing made for clinical practice. Future trials with improved study design \n(including prospective data collection and consideration of verification bias) \nmay help to further clarify the role of MRI in the assessment and treatment \nresponse monitoring of perianal fistulas (particularly in patients with Crohn’s \ndisease).\nSS 3.06\nClinical impact of defecographic images in patients with \nrectoanal intussusception  as a disorder of obstructed \ndefecation\nH.J. Jeon\n1, U.C. Park2, H.S. Park1, Y .J. Kim1, S.I. Jung1,  \nS.W. Park1;  1Seoul/KR, 2ChungJu/KR\nPurpose: Rectoanal intussusception (RAI) is a telescoping of the rectal wall \nduring defecation. This study was designed to characterize a defecographic \nimages and to evaluate clinical usefulness in a group of patients with RAI.\nMaterial and Methods: Anorectal physiologic studies were performed in 555 \npatients with chronic constipation. Studies included defecography (n=315), anal \nmanometry (n=237), anal EMG/PNTML (n=133) and colonic transit time study \nwith KUB film (n=85). With the use of pre-treatment proctographic images, \ncircumferential RAI was defined as first degree when detectable below the \nanorectal ring on straining, as second degree when it reached the dentate line \nand as third degree when it reached the anal verge. We analysed a correlation \nbetween the symptoms as obstructed defecation and the degree of RAI.\nResults: 138 patients (43.8 percent) were found to have RAI. The defecographic \nimages revealed 96 cases of RAI (70%) having associated anorectal pathology. \nRAI was of first degree in 101 (73%), of second degree in 21 (15%) and of third \ndegree in 16 patients (12%). The mean size of the intussusception was 2.5 cm \n(range 1.0-5.5 cm). RAI patients with mechanically obstructing intussusceptum \nevacuated slower and less completely than those with non-obstructing \nintussusceptum on evacuation proctography (P < 0.001). Patients with second \nand third degree RAI showed a significantly higher frequency of obstructed \ndefecation than in patients with first degree RAI (P < 0.01).\nConclusion: Present series with sub-classifying intussusception morphology \nprovided the important diagnostic ramification and clinical therapeutic profiles \nin RAI patients with functionally obstructed defecation.\nSS 3.07\nNovel method for improving digitation characterisation \nduring evacuating protography\nH.S. Sidhu, G. Bhatnagar, S.A. Jackson, B. Fox; Plymouth/UK\nPurpose: Some pelvic floor dysfunction patients digitate to facilitate \nevacuation; their ability to see digitation effects may improve their \nunderstanding/consultation. This study compares the use of newer lead-\nimpregnated gloves (LIG) to traditionally used normal/latex gloves (NG) during \nevacuating proctography in detecting digitation and perceived certainty of its \neffects.\nMaterial and Methods: Qualitative questionnaire to referrers was performed \nassessing the importance of digitation visualisation. Prospective randomised \nstudy was performed: digitating patients receiving either LIG (n=30) or NG \n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / WEDNESDAY, JUNE 13, 2012\n S467\nMaterial and Methods: Retrospective review of radiology database revealed \n36 patients with Whipple procedure who also had preoperative MRI with DWI. \nTwo reviewers blindly and independently assessed the DWI images. Four \nweeks later, they reviewed the remaining MRI sequences for size of mass, \ndouble duct sign (DD), pancreatic duct cut off (CO), and perivascular soft \ntissue cuffing (VC). Univariate and multivariate analyses were performed, using \nsurgical pathology as gold standard.\nResults: There was no difference in age or gender between the cancer (group \nA, n=13) and chronic pancreatitis (group B, n=23) groups. On univariate \nanalysis, the only finding that differentiated the two groups was size of mass. \nOn logistic regression, no conventional or DWI parameter was found to be \ndifferentiate the two groups. There was no significant lowering of ADC in both \nmass-like chronic pancreatitis and cancer, compared to rest of pancreas. \nFindings such as DD, CO and VC, which are typically associated with cancer, \nwere not useful in differentiating the two groups.\nConclusion: Conventional MRI and DWI are not useful in separating cancer \nfrom chronic inflammation. Neither entity causes substantial lowering of ADC.\nSS 4.03\nInitial evaluation of a new high-resolution diffusion-\nweighted MR sequence (ZoomEPI) for dedicated \nimaging of the pancreas\nN. Schramm\n1, W. Horger2, M.F . Reiser1, C.J. Zech1;  \n1Munich/DE, 2Erlangen/DE\nPurpose: The purpose of this study was to initially evaluate a new high-\nresolution DWI sequence (ZoomEPI) with a small field-of-view for dedicated \npancreas imaging.\nMaterial and Methods: In 30 patients who underwent an abdominal MR \nexamination on a 1.5T MR-system due to a clinical indication, a ZoomEPI \nsequence (Siemens, Erlangen, Germany) was acquired. In this sequence, a \nmodified excitation pulse based on bipolar planar gradient trajectories aims to \nreduce the echo train length. Two reviewers compared the ZoomEPI sequence \nto the standard single-shot EPI DWI sequence in consensus. Image quality \nand disturbance of aliasing artifacts were assessed utilizing a four-point scale \n(1: excellent, no artifacts; 2: good, few artifacts; 3: moderate, still diagnostic, \n4: non-diagnostic, heavy artifacts). Apparent diffusion coefficient (ADC) maps \nwere generated (b50, b800). For statistics, a t-test was applied.\nResults: The image quality of ZoomEPI was significantly better than that of \nstandard DWI with a mean score of 1.97 vs. 2.36 (p<0.01). The ZoomEPI was \njudged from excellent to non-diagnostic in 13/30 (43.3%), 12/30 (40%), 4/30 \n(13.3%) and 1/30 (3.3%) patients, respectively. Standard DWI was rated from \nexcellent to non-diagnostic in 4/30 (13.3%), 16/30 (53.3%), 7/30 (23.3%) and \n3/30 (10%) patients, respectively. Despite the small FOV, aliasing was not \nnoted in the ZoomEPI.\nConclusion: ZoomEPI imaging of the pancreas is feasible without disturbing \naliasing artifacts. Due to its higher image quality compared to the standard \nDWI sequence, it has the potential to further improve DWI of the pancreas.\nSS 4.04\nComparison of diffusion-weighted MR imaging and [68]\nGa-DOTATATE PET/CT in detecting neuroendocrine \ntumors of the pancreas\nC. Schmid-Tannwald, C. Schmid-Tannwald, R. Neumann,  \nA. Haug, N. Schramm, G.P . Schmidt, M.F . Reiser, C. Rist; \nMunich/DE\nPurpose: The purpose of this study was to compare diffusion-weighted MRI \nand DOTATATE-PET/CT in detecting pancreatic neuroendocrine tumors \n(NET).\nMaterial and Methods: 19 patients with pancreatic NET were retrospectively \nincluded who underwent MRI including DWI and DOTATATE-PET/CT within 6 \nweeks. Two blinded readers compared T2-weighted (T2w), T2w+DW-MRI, \nT2w+contrast-enhanced T1-weighted (CE-T1w) MR and PET/CT for NET \ndetection and confidence level. Sensitivity and confidence level of each review \nsession were compared. ADC of tumor and normal pancreatic tissue was \ncompared.\nResults: 9/25 (36%) and 15/25 (60%) NET were detected on T2w and T2w+DW-\nMRI by both observers, respectively. Observer 1 and 2 detected 15/25 (60%) \nand 16/25 (64%) NET on their review of T2w+CE-T1w, respectively, and all 25 \nNET (100%) were detected on PET/CT by both observers. Detection rate and \nconfidence level improved significantly by combined interpretation of T2w and \nDW-MRI or CE-T1w (p<0.05). There was no significant difference between NET \ndetection rate of T2w+DW-MRI and T2w+CE-T1w (p>0.05). Detection rate and \nconfidence level of PET/CT were significantly higher than MRI (p<0.04). Mean \nADC of NET (1.02+/-0.26 x 10-3 mm²/s) was significantly lower than mean ADC \nof normal pancreatic tissue (1.47 +/- 0.39 x 10-3 mm²/s).\nSS 3.10\nValue of CT colonography as preliminary study prior to \nlaparoscopic surgery in patients with colon \nmalignancies\nS. Tartari\n1, R. Rizzati1, G. Anania1, M. Bassi1, L. Scagliarini2, \nG. Benea1;  1Lagosanto/IT, 2Ferrara/IT\nPurpose: The purpose of this study was to assess the clinical value of CT \ncolonography (CTC) in the diagnosis and staging of colorectal cancer (CRC) in \npreoperative evaluation for laparoscopic surgery.\nMaterial and Methods: From January 2009 until November 2011, 113 patients \nscheduled for surgery for CRC underwent CTC. All patients were previously \nevaluated with optical colonoscopy (OC). Sensitivity in lesion location and \ndetection was compared between OC and CTC and discrepancies analyzed. \nAccuracy of CTC in CRC staging was determined.\nResults: A total of 113 CRC were found by CTC. OC was incomplete in 37/113 \n(26%) cases. There were 17 cases of discrepancy of lesion location correctly \nidentified by CTC and 7 polypoid (6-9 mm) lesions detected by CTC and \nmissed by OC. Based on CTC findings, 103 patients with CRC were managed \nlaparoscopically and 10 patients underwent conventional open surgery. \nSensitivity of CTC in TNM preoperative staging of patients with CRC resulted \nto be respectively 100%, 86% and 100%. Furthermore, CTC detected 34 \nextracolonic findings, 12 of whom had major clinical relevance.\nConclusion: CTC is a useful method for diagnosing CRC. It allows to determine \nlocal cancer progression and yields to detect synchronous lesions in the large \nbowel also in endoscopically inaccessible regions. Compared to OC, CTC is \nmore accurate in lesion location, making the laparoscopic surgical planning \nmore precise and safer.\n11:00 - 12:30 Tinto\nScientific Session 4\nPancreatic MRI\nSS 4.01\nDiffusion-weighted MRI in the characterization of \npancreatic fluid collections\nH. Rodrigues Duarte\n1, M. Arvanitakis2, M. Delhaye2,  \nM.A. Bali2, C. Matos2;  1Porto/PT, 2Brussels/BE\nPurpose: The purpose of this study was to measure the accuracy of diffusion-\nweighted MRI (DW-MRI) in the diagnosis of infected pancreatic fluid collections \n(PFCs).\nMaterial and Methods: Between January 2010 and November 2011, all \npatients with post-pancreatitis PFCs requiring transmural EUS-guided \ndrainage were prospectively included. Exclusion criteria were previous \ndrainage or surgery. Before the endoscopic procedure, patients underwent \nhigh b-value DW-MRI with ADC measurements. Infection was suspected in \ncases of high signal of PFC in DW-MRI and low ADC. After drainage, fluid was \nsent for bacteriological cultures and considered infected if these were positive \n(gold standard). Continuous values were expressed in median and range and \ncomparisons were performed using non-parametric tests.\nResults: 26 patients were included in the study. The underlying disease was acute \n(n=15, 58%) or chronic pancreatitis (n=11, 42%). Sensitivity, specificity, accuracy, \nnegative and positive predictive values of DW-MRI for predicting PFC infection \nwere, respectively, 55.5% (5/9), 94% (16/17), 80% (21/26), 80% (16/20) and 83% \n(5/6). Some of these values increased if we considered only patients without previous \nantibiotics (n=17) (respectively, 75%, 92%, 88%, 92% and 75%). Median ADC was \nsignificantly lower in infected PFCs (2.8 vs 1.1 x 10[-3]mm[2]/sec, p=0.045).\nConclusion: DW-MRI may provide additional information concerning PFC \nassessment before drainage. Results show high specificity and negative \npredictive values, which can help in excluding PFC infection and determining \ntime of drainage.\nSS 4.02\nDoes diffusion-weighted imaging help in the \ndifferentiation of mass-like chronic pancreatitis and \npancreatic cancer?\nK. Sandrasegaran, B. Tahir, M. Tann, T. Howard; \nIndianapolis, IN/US\nPurpose: Many patients with mass-like chronic pancreatitis, particularly in the \npancreatic head, undergo radical surgery, since it is not possible to \npreoperatively differentiate this entity from ductal adenocarcinoma. We wanted \nto investigate if DWI may help in this situation.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / WEDNESDAY, JUNE 13, 2012\n S468\nMaterial and Methods: Among the 130 diagnosed with PAI were included 37 \npatients with focal forms. Image analysis included parenchymal enlargement, \nsignal intensity abnormalities, enhancement, main pancreatic duct (MPD) \ndiameter and MPD focal narrowing, length of narrow stricture of the PD, \npresence of upstream dilatation from the stricture, multiple stenosis and \ndilatation of side branches. After secretin administration, the presence of the \n“duct penetrating” sign was evaluated as a problem-solving tool in the \ndifferential diagnosis between focal AIP and ductal adenocarcinoma. Median \nfollow-up was 23.9 (range 4.1-126.7) months.\nResults: At diagnosis, involvement of main pancreatic duct in the focal form of \nAIP showed a single stenosis in 27 (72.9%) patients, multiple stenosis in 10 \n(27.1%). The mean diameter of the length of the narrow stricture of the MPD \nwas 13.5 mm, whereas the mean value of the upstream dilatation from the \nstricture was 3.9 mm. The alteration in signal intensity of pancreatic parenchyma \nwas localized in the head in 18/37 (48.6%) patients, 10/37 (27.02%) in the \nbody and 9/37 (24.3%) in the tail. Dilatation of side branches was observed in \n17/37 (45.9%) patients.\nConclusion: After steroid treatment, there was a reduction in the size of \npancreatic parenchyma in 16/37 (43.2%) patients, normalization of signal \nintensity abnormalities in 12/37 (32.4%) and recurrence of disease in 5/37 \n(13.5%). 4 (10.8%) patients underwent resective surgery confirming the \nhistopathological diagnosis of AIP .\nSS 4.08\nMRCP evaluation of focal and diffuse forms of \nautoimmune pancreatitis\nF . Castelli, V. Di Paola, R. Negrelli, R. Manfredi, R. Pozzi \nMucelli; Verona/IT\nPurpose: The purpose of this study was to evaluate focal and diffuse forms of \nautoimmune pancreatitis (AIP) and description of the main characteristics at \ndiagnosis and follow-up through MR and MRCP .\nMaterial and Methods: We included in the study 130 patients with histological \ndiagnosis of AIP who underwent MRCP before and after steroid therapy. The \nanalysis considered: pancreatic volume, localization of the lesion, abnormal \nsignal intensity, enhancement of the parenchyma in the post-contrastographic \nphase, presence of stenosis of the main pancreatic duct (MPD), dilatation of \nthe secondary pancreatic ducts (SPD).\nResults: MRI showed a diffuse volumetric increase of the pancreas in 50/92 \n(54%) patients and a focal volumetric increase in 42/92 (46%). We observed \nchanges in signal intensity represented by hypointensity on T1 imaging in \n65/92 (70.6%) patients and hyperintensity on T2 imaging in 32/92 (35%); 51/92 \n(55.5%) patients showed parenchymal hypo-vascularization and 34/92 (37%) \nretention of medium of contrast in the late phase. There was a stenosis of MPD \nin 64/92 (69.5%) cases and a dilation of SPD in 36/92 (39%) patients. After \ntherapy, 39/92 patients (42.4%) showed restitutio ad integrum, 49/92 (53.3%) \nparenchymal atrophy, while 4/92 (4.3%) patients underwent surgery. After \nsecretin administration, the presence of the “duct penetrating-sign” was \nobserved in 33/92 (36%) patients.\nConclusion: MRCP is useful in the diagnosis, monitoring of the response to \ntherapy and evaluation of the different forms of AIP and of degree of ductal \ninvolvement.\nSS 4.09\nMultifocal branch-duct intraductal papillary mucinous \nneoplasms of the pancreas: MR imaging pattern and \nevolution over time\nF . Castelli, V. Di Paola, D. Bosetti, R. Manfredi, R. Pozzi \nMucelli; Verona/IT\nPurpose: The purpose of this study was to follow the evolution over time of \nmultifocal intraductal papillary mucinous neoplasms (BD-IPMN) of the side \nbranches by MRI.\nMaterial and Methods: We evaluated 155 patients with multifocal BD-IPMN \nexamined with MR/MRCP . Inclusion criteria: \u00032 BD-IPMN involving any site of \nthe parenchyma; communication with the main pancreatic duct (MPD) and \nprevious investigations by MRI/MRCP after at least six months. Median follow-\nup was 25.8 (range 12-217) months. Exclusion criteria: <12 months of follow-\nup (n=33) and patients without follow-up (n=14). The population is thus of 108 \npatients. Quantitative analyses were number of dilated side branches; \nmaximum diameter of the largest branch duct in the head and body-tail; \nmaximum diameter of MPD in the head and body-tail, annual change of the \nlargest lesion. Qualitative analyses were the presence of malformations/\nanatomical variants of the pancreatic ductal system; site of the lesions (head-\nuncinate process, body-tail, ubiquitous, bridge morphology); intraluminal \ndependent defects; mural nodules.\nConclusion: DW-MRI is a valuable adjunct to T2w and comparable to CE-T1w \nin detection of pancreatic NET and ADC measurements provide a quantitative \ndifferentiation between NET and normal pancreatic tissue. DOTATATE-PET/CT \nseems to improve significantly the detection of pancreatic NET compared to \nMRI.\nSS 4.05\nCystic pancreatic lesions: evaluation by diffusion-\nweighted 3T MR imaging with b-multiple SE-EPI\nF . Donati, P . Boraschi, R. Gigoni, F . Falaschi, C. Bartolozzi; \nPisa/IT\nPurpose: The purpose of this study was to evaluate the usefulness of diffusion-\nweighted 3T MR imaging with b-multiple SE-EPI in providing an objective \nvalue for the differentiation of cystic pancreatic lesions.\nMaterial and Methods: Fifty-two patients with cystic pancreatic lesions and \nten normal subjects underwent MR imaging at 3T (GE-DISCOVERY-MR750; \nGE-Healthcare). After the acquisition of axial T1w/T2w sequences and coronal \nMRCP , diffusion-weighted MR imaging was performed using an axial \nrespiratory-triggered spin-echo echo-planar sequence with multiple b-values \n(150, 500, 1000, 1500 sec/mm\n2) in all diffusion directions. ADC value was \ncalculated using a dedicated software fitting the curve obtained from the \ncorresponding ADC for each b value. Fitted ADC values were calculated by \ntwo observers in conference for each cystic pancreatic lesion and for normal \npancreatic parenchyma. Imaging results were correlated with surgery, ERCP , \nand/or imaging follow-up.\nResults: Final diagnoses included intraductal papillary mucinous tumor (IPMT, \nn=35), serous cystadenoma (n=10), and mucinous cystadenoma (n=7). Fitted ADC \nvalue was 1.33x10\n-3 mm2/sec for normal pancreatic parenchyma, 3.11x10-3 mm2/\nsec for IPMT, 2.50x10-3 mm2/sec for serous cystadenoma, 2.97x10-3 mm2/sec for \nmucinous cystadenoma. Fitted ADC values were significantly higher in mucinous \nneoplasms than in serous cystadenomas (p-less-than-0.05).\nConclusion: Our results suggest that diffusion-weighted 3T MR imaging with \nb-multiple SE-EPI may be helpful to differentiate mucinous from serous cystic \npancreatic lesions. Further investigations in larger series of patients are \nnecessary to confirm our preliminary data.\nSS 4.06\nThe utility of secretin-enhanced MRCP in diagnosing \nchronic pancreatitis\nK. Sandrasegaran, B. Tahir, M. Tann, T. Howard, F . Akisik; \nIndianapolis, IN/US\nPurpose: The purpose of this study was to assess the additional value of \nsecretin-enhanced MRCP over conventional MRCP in diagnosing ductal \nabnormalities in chronic pancreatitis.\nMaterial and Methods: Retrospective review found 140 patients with SMRCP \nand ERCP correlation within 3 months of each other. All studies were anonymized \nand the secretin-enhanced MRCP (group A) was separated from conventional 2D \nand 3D MRCP and T2-weighted images (group B). Groups A and B for each \npatient were assigned different and randomized case numbers. An experienced \nMRI radiologist graded image sets for no chronic pancreatitis using the Cambridge \nclassification, and for the certainty of diagnosis (1= definitely certain, 2 = \nmoderately certain, 3 = unsure). ERCP findings were taken as gold standard.\nResults: In diagnosing the presence of chronic pancreatitis, the sensitivity \n(95% CI) was significantly higher in group A [62.8% (46.7-77.0) compared to B \n[47.7% (32.5-63.3), p<0.01]. The specificity (95% CI) was also significantly \nhigher in group A compared to B [94.7 (88.0-98.3) vs. 87.3% (78.8-93.2), \np<0.01]. The percentage of definitely certain diagnosis was higher in group A \ncompared to group B (14%, p=0.03). In differentiating mild chronic pancreatitis \n(side branch disease only) from normal, the area-under-ROC curve (95% CI) \nwas higher for group A compared to group B [0.71 (0.61-0.79) vs. 0.54 (0.44-\n0.64), p<0.01].\nConclusion: The use of secretin significantly improves the accuracy and \nconfidence of diagnosing chronic pancreatitis, especially mild chronic \npancreatitis.\nSS 4.07\nStenosis of the main pancreatic duct in focal form of \nautoimmune pancreatitis: imaging findings on MR-\nMRCP and dynamic secretin-enhanced MRCP\nF . Castelli, R. Negrelli, V. Di Paola, R. Manfredi, R. Pozzi \nMucelli; Verona/IT\nPurpose: The purpose of this study was to evaluate the MR-MRCP imaging of \nfocal forms of autoimmune pancreatitis (AIP) and to describe ductal system \ninvolvement.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / WEDNESDAY, JUNE 13, 2012\n S469\nSS 5.02\nHistopathological influences on the efficacy of dynamic \ngadoxetate disodium-enhanced magnetic MRI in \nstaging liver fibrosis\nD.S. Feier\n1, R. Nolz2, J. Maresch2, C. Balassy2, R. Badea1,  \nA. Ba-Ssalamah2;  1Cluj-Napoca/RO, 2Vienna/AT\nPurpose: The purpose of this study was to evaluate the influence of histological \nparameters on the efficacy of dynamic gadoxetate disodium-enhanced (Gd-\nEOB-EDTA) MRI in staging liver fibrosis (LF) in patients with diffuse chronic \nliver diseases (CLD).\nMaterial and Methods: Between January 2009 and November 2011, we \nanalyzed retrospectively 80 consecutive patients (mean age 54.86 years, \n58.7% males) with histologically proven LF , who underwent dynamic contrast-\nenhanced 3 Tesla MRI (CE-MRI) with Gd-EOB-EDTA. The patients were divided \naccording to Metavir scoring system: F0 (n=17), F1 (n=10), F2 (n=12), F3 \n(n=11), F4 (n=26). The CE-MRI images were obtained blinded to histology \nbefore contrast injection and in the arterial (25 s), portal (70 s) and hepatocyte \nphase (20 min). Signal intensity of the liver in all phases was defined using \nregion-of-interest measurements and relative enhancement (RE) was \ncalculated.\nResults: RE correlated strongly with fibrosis (r=-0.65, p<0.0001), moderately \nwith necro-inflammatory activity (r=-0.41, p=0.002) and iron load (r=-0.21, \np=0.05) but not with steatosis (r=-0.12, p=0.32). In multivariate analysis, only \nfibrosis independently influenced the values of RE (p<0.0001). The predicted \nRE cut-off values were: 1.30 for F\u00031 (AUROC=0.97, Se=100%, Sp=91%, \nPPV=76.9%, NPV=100%), 1.27 for F\u00032 (AUROC=0.96, Se=81%, SP=98%, \nPPV=95.6%, NPV=91.2%), 1.12 for F\u00033 (AUROC=0.98, Se=92.3%, Sp=97.5%, \nPPV=97.2%, NPV=93%) and 0.93 for F=4 (AUROC=0.93, Se=91%, Sp=88%, \nPPV=100%, NPV=83%). Discordance between RE and fibrosis stage was \nobserved in 22 (27.9%) patients.\nConclusion: CE-MRI is accurate in staging LF in CLD patients. Steatosis, \ninflammation and iron load have no influence on the RE.\nSS 5.03\nQualitative evaluation of liver fibrosis using gadoxetate \ndisodium-enhanced MRI in patients with diffuse liver \ndiseases\nD.S. Feier\n1, R. Nolz2, J. Maresch2, C. Balassy2, R. Badea1,  \nA. Ba-Ssalamah2;  1Cluj-Napoca/RO, 2Vienna/AT\nPurpose: The purpose of this study was to assess if gadoxetate disodium-\nenhanced MRI (Gd-EOB-EDTA CE-MRI) using quality scores is able to predict \nadvanced liver fibrosis (LF) in patients with chronic liver diseases (CLD).\nMaterial and Methods: We analyzed retrospectively 95 consecutive patients \n(mean age 54.18 years, 62.1% males) with histologically proven LF , who \nunderwent dynamic 3 T CE-MRI with Gd-EOB-EDTA. A single expert \npathologist assessed LF according to Metavir system. F0-2 (n=45, 47.4%) was \nconsidered insignificant LF and F3-4 (n=50, 52.6%) as advanced LF . The CE-\nMRI images were obtained blinded to histology before contrast injection and in \nhepatocyte phase (20 min). We assessed three new scores: enhancement \nhomogenity (EnH, 1=homogenous, 0=inhomogenous), enhancement quality \nscore (EnQS) and excretion quality score (ExQS, 0=none, 1=poor, 2=sufficient, \n3=good, 4=excellent).\nResults: LF correlated strongly with EnQ score (r=-70, p<0.0001), moderately \nwith ExQ score (r=-0.41, p<0.0001) and EnH (r=0.35, p=0.0008). Independently, \nadvanced LF can be predicted by a EnQS <=3 with an AUROC=0.90 [Se=93.8% \n(83.1-98.7), Sp=73.3% (58.1-85.4), PPV=79.6%, NPV=91.5%], by ExQS<=2 \nwith an AUROC=0.72 [Se=36.73% (23.4-51.7), Sp=97.78% (88.2-99.9), \nPPV=94.8%, NPV=58.2%] and by EnH with an AUROC=0.67 [Se=40.82% (27-\n55.8), Sp=93.33% (81.7-98.6), PPV=87.2%, NPV=58.7%]. Together, the three \nscores are able to predict advanced LF with an AUROC=0.92 [Se=79.59% \n(65.7-89.8), Sp=93.33% (81.7-98.6), +LR=11.33, -LR=0.26, PPV=92.6%, \nNPV=77.4%]. The interobserver agreement and reliability was very good for all \nthree scores: EnQS (k=0.84, ICC=0.91), ExQS (k=0.91, ICC=0.91), EnH (k=0.80, \nICC=0.87).\nConclusion: The degree of liver parenchymal enhancement and the extent of \nbiliary excretion of Gd-EOB-EDTA CE-MRI imaging are reliable predictors of \nLF in CLD patients.\nResults: At diagnosis, the mean value of cystic lesions of the side branches \nwas 7.09. The mean diameter of the cystic lesions was 13.7 mm. The mean \ndiameter of the MPD was 3.6. At follow-up, the mean number of cystic lesions \nof the branch-duct was 7.76 (p<0.05). The mean diameter of the cystic lesions \nwas 13.9 (p<0.05). The mean diameter of the MPD was 3.7. Intraluminal filling \ndefects in the side branches were seen in 18/108 (16.6%) patients; mural \nnodules in 3/108 (2.7%) patients.\nConclusion: Multifocal BD-IPMN shows a very slow growth and evolution \nover time.\nSS 4.10\nDetermination of pancreatic cancer extent using CT and \nMRI: implications for neoadjuvant treatment planning\nO. Zakharova, G.G. Karmazanovsky; Moscow/RU\nPurpose: A R0 resection is dependent on accurate preoperative staging. \nThere is still no consensus on the single best diagnostic modality. The inverse \nrelationship of tumor size and prognosis has been noted in many studies; 80-\n85% of patients are treated palliatively or neoadjuvantly. The high rate of \nduodenal invasion suggests a risk of duodenal undercoverage with highly \nconformal radiotherapy.\nMaterial and Methods: To analyze the accuracy of CT and MRI in determining \nPC extent, we performed a retrospective analysis of CT and MRI scans and \npathohistological reports of 174 cases of PC after pancreatoduodenectomies \n(2006-2011). We compared tumor size measurements of PC evaluated on CT \nand MRI with those in the pathological reports.\nResults: Our study demonstrated sensitivity, specificity, and accuracy of \ncontrast enhanced MDCT of 86%, 75%, and 83.3%, respectively, with a PPV \nof 96% and NPV of 100%. The sensitivity, specificity, and accuracy of MRI \nreaches approximately 75%, 50%, and 74.3%, respectively, with a PPV of \n98.1% and NPV of 94.4%. In 124 patients (71.3%), tumor size reported by \npathologist surpassed one claimed by CT and MRI studies (p<0.001).\nConclusion: The values of sensitivity, specificity and accuracy in PC detection \nspeak in favor of MDCT as the single best diagnostic modality. Surgeons and \noncologists need to keep in mind that MDCT and MRI have a tendency to \nunderestimate the size of PC. This has important implications for neoadjuvant \ntreatment planning.\n11:00 - 12:30 Moorfoot\nScientific Session 5\nLiver 1: Diffuse disease\nSS 5.01\nEvaluation of spleen stiffness with acoustic radiation \nforce impulse: a comparison with  histology in the \nassessment of liver fibrosis\nP . Cabassa, F . Sogaro, L. Sottocornola, M. Ravanelli,  \nA. Rossini, R. Maroldi; Brescia/IT\nPurpose: The purpose of this study was to evaluate the spleen stiffness in \npatients affected by chronic hepatopathy by means of acoustic radiation force \nimpulse (ARFI) and to match the results with the fibrosis grade, assessed by \nliver biopsy.\nMaterial and Methods: 51 consecutive patients affected by chronic \nhepatopathy (mainly HCV) underwent ARFI of the spleen and liver biopsy. \nAccording to Knodell’s index, 25 patients were classified F1, 14 F3 and 12 F4. \n33 healthy volunteers represented the control group. All the studies were \nperformed by two radiologists. Every study included a median of 5 ARFI \nmeasurement. Mean ARFI velocities (in m/s) were statistically compared. \nDiagnostic performance of ARFI in assessing different grades of liver fibrosis \nwas assessed by ROC analysis. Inter- and intra-observer variability was also \ncalculated using Bland-Altman plot.\nResults: Spleen ARFI values were significantly different among healthy \nvolunteers and F1-F4 patients (p<0.001), F1 versus F3-F4 patients (p<0.001) \nand F1-F3 versus F4 patients (p<0.001). There was no significant difference \namong healthy volunteers and F1 patients. ROC analysis showed a good \nperformance of ARFI in differentiating mild (F1) from severe (F3-F4) fibrosis \n(AUROC 0.8). The differentiation between F3 and F4 fibrosis resulted to be \ndifficult. Inter- and intra-observer agreement was good.\nConclusion: The stiffness of the spleen is increased in case of fibrosis. ARFI \ncan differentiate mild (F1) from severe (F3-F4) fibrosis. ARFI of the spleen can \nbe another noninvasive technique in the discrimination of the severity of liver \nfibrosis.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / WEDNESDAY, JUNE 13, 2012\n S470\nfrom manually drawn ROIs in the liver. ROIs were automatically coregistered \nonto the repeated scans. Reproducibility indices (RI) were calculated by Bland-\nAltman analysis (defined as 1.96.SD of paired differences/mean value).\nResults: Mean elasticity was 2.33±0.76 kPa (patients) and 1.65±0.15 kPa \n(volunteers). Mean viscosity was 2.28±0.59 Pa.s (patients) and 1.76±0.22 \n(volunteers). RI did not differ significantly between patients and volunteers. \nMean RI of elasticity for all participants was 8.2%, 18.5% and 24.0% for ISR, \nWDR and BWR, respectively. For viscosity, RIs were 17.7%, 28.6% and \n27.9%.\nConclusion: Elasticity showed better reproducibility than viscosity. The \nbetween-weeks reproducibility analysis shows that a change in liver tissue \nelasticity of more than 20% indicates a significant change, implying disease \nprogression or regression.\nSS 5.07\nComparison of MR elastography and US elastography in \nassessment of hepatic fibrosis\nJ. Yoon, J.M. Lee, J.K. Han, B.I. Choi; Seoul/KR\nPurpose: The purpose of this study was to compare liver stiffness values in \npatients who underwent liver fibrosis using MR and US elastography, and to \nevaluate diagnostic performance between two examinations.\nMaterial and Methods: For 5 months from 2011 Aug, 39 patients underwent \nMRE/USE and liver operation (n=37) or percutaneous biopsy (n=2). Hepatic \nfibrosis was graded by using Metavir score [F0-1 (n=21), F3 (n=4) and F4 \n(n=14)]. 6 mean liver stiffness values were averaged at USE. Mean liver stiffness \nvalue at MRE was an averaged value on 4 consecutive MRE images. For the \nassessment of concordance between USE/MRE, regression model was used \nand Pearson correlation coefficient was obtained. ROC analysis was performed \nbetween groups to assess diagnostic performance.\nResults: At MRE, mean liver stiffness values in F0-1, F3, F4 were 1.76, 4.16 \nand 5.99, respectively. At USE, mean liver stiffness values were 4.74, 13.0, \n44.9, respectively. Two exams showed moderate correlation (p=0.69), R2 was \n0.61 (p<0.001). Correlation coefficients between two exams and Metavir score \nwere 0.83 (MRE) and 0.81 (USE). As for differentiation of group F0-1 and F2-4, \nboth showed 100% sensitivity and 95.2% specificity (MRE: Az >2.17, USE: Az \n>6.84). According to F0-3 versus F4 differentiation, MRE showed 100% \nsensitivity and 80% specificity (Az>2.2) and USE showed 92.9% sensitivity \nand 92% specificity (Az>10.16).\nConclusion: MR/US elastography were concordant in hepatic fibrosis \nevaluation. Mean liver stiffness values at both exams showed good correlation \nwith Metavir score.\nSS 5.08\nThe role of abdominal MR susceptibility-weighted \nimaging in diagnosing advanced liver fibrosis in patients \nwith chronic liver diseases: a feasibility study\nC. Balassy\n1, D.S. Feier2, G. Reiter1, B. Kiefer3, Y . Dai4,  \nS. Witoszynskyj1, A. Ba-Ssalamah1;  1Vienna/AT,  \n2Cluj-Napoca/RO, 3Erlangen/DE, 4Shanghai/CN\nPurpose: The purpose of this study was to assess the diagnostic value of \nsusceptibility-weighted imaging (SWI) in detecting advanced liver fibrosis (LF) \nin patients with chronic liver diseases (CLD).\nMaterial and Methods: Thirty-seven consecutive patients (mean age 55 \nyears, 58.7% males) with histologically proven LF , who underwent abdominal \nSWI on a 3 Tesla MR scanner between January and November 2011, were \nanalyzed retrospectively. A single expert pathologist assessed LF according to \nthe Metavir system. F0-2 (n=20, 54.1%) was considered no-to-moderate \nfibrosis and F3-4 (n=17, 45.9%) as advanced fibrosis. The SWI measurements \nwere evaluated with readers blinded to histology and clinical data. Normalized \nliver-to-muscle signal intensity ratios (LMR) were defined using region-of-\ninterest measurements on SWI images.\nResults: Log-transformed LMR values correlated strongly with LF (r=-0.75, \np<0.0001), and moderately with necro-inflammatory activity (r=-0.45, p=0.004) \nand iron load (r=-0.33, p=0.04), but not with steatosis (r=0.2, p=0.23). In \nmultiple regression analysis, LF and iron load independently influenced LMR \nvalues (p<0.0001). Together, LF and iron load explained 62% of the variance in \nLMR values (R[2]=0.62, p<0.001). The two parameters explained 58% of the \namount of R[2], with LF as the largest contributor. The area under ROC curve \nfor the diagnosis of advanced LF (F3-4) was 0.86 [sensitivity=66.7% (38.4-\n88.2), specificity=90.0% (70.8-98.9), +LR=7.33, -LR=0.37, PPV=33.8%, \nNPV=80.0%].\nConclusion: SWI is a promising non-invasive tool to detect advanced LF in \nCLD patients. LF is the main predictor of LMR, but iron load has an influence \non these values.\nSS 5.04\nPerformance of liver stiffness measurement by Acoustic \nRadiation Force Impulse (ARFI) for the diagnosis of liver \nfibrosis\nV. Cartier, J. Boursier, J. Lebigot, O. Adib, I. Fouchard,  \nS. Michalak, C. Aube; Angers/FR\nPurpose: The purpose of this study was to evaluate the performance of ARFI \nfor the diagnosis of liver fibrosis.\nMaterial and Methods: 98 patients were prospectively included. For each \npatient, 10 shear wave velocity measurements (m/s) were performed with ARFI \nin the right lobe, 10 in the left lobe, using an Acusson S2000 ultrasound \nsystem. The fibrosis stage was assessed by liver biopsy according to the \nMetavir F scoring. Cut-offs and diagnostic accuracies were calculated for \ndifferent diagnostic targets of fibrosis and for the different sites of \nmeasurement.\nResults: The population was constituted of 58% of men and the mean age \nwas 54±13 years. The etiology of the liver disease was: alcohol (n=14), virus \n(n=26), dysmetabolic (n=43), other (n=15). The Metavir score was: F0/1: n=46, \nF2: n=24, F3: n=19, and F4: n=9. 30 valid measurements were obtained for all \nthe patients. The cut-off and the diagnosis accuracy for \u0003F2 fibrosis were: \n1.80m/s and 67.3% in the right lobe, 1.75m/s and 73.5% in the left lobe; for \n\u0003F3 fibrosis: 1.94m/s and 77.6% in the right lobe, 2.08m/s and 80.6% in the \nleft lobe; and for F4 fibrosis: 2.17m/s and 84.7% in the right lobe, 2.30m/s and \n79.6% in the left lobe.\nConclusion: ARFI has a high feasibility and good performances for the non-\ninvasive diagnosis of liver fibrosis. Systematic use of ARFI during any \nabdominal ultrasound examination could be useful to detect patients with \nundiagnosed fibrosis.\nSS 5.05\nIs measurement of liver elasticity and liver iron content \nof value to identify high-risk patients with Gaucher \ndisease?\nA.E. Bohte\n1, L. Van Dussen1, E.M. Akkerman1, A.J. Nederveen1, \nR. Sinkus2, M. Maas1, J.M. Aerts1, C.E.M. Hollak1,  \nP .L.M. Jansen1, J. Stoker1;  1Amsterdam/NL, 2Paris/FR\nPurpose: Long-term liver-related complications of Gaucher disease (GD) \ninclude fibrosis and increased risk to develop hepatocellular carcinoma (HCC). \nSplenectomy is a known risk factor for the development of liver pathology in \nGD. Moreover, accumulation of iron in Gaucher cells in the liver has been \ndescribed. No adequate diagnostic tools exist to identify at-risk GD patients. \nWe evaluated the potential usefulness of iron measurement, MR elastography \n(MRE) and Fibroscan of the liver in patients with GD.\nMaterial and Methods: Twenty participants were included (16 male; mean \nage 48, range 24-70): 6 splenectomized GD patients (high-risk) and 7 non-\nsplenectomized GD patients (low-risk) who were matched for age and gender \nwith 7 healthy controls. All underwent liver iron concentration (LIC) measurement \nat 1.5T (Gandon, T2*), MRE at 3T and Fibroscan. For MRE, an SE-EPI sequence \n(TR/TE=420/40 ms; acquisition time 70s) was used. Groups were compared \nwith non-parametric tests.\nResults: Mean MRE values were 2.5 kPa (range 2.37-2.64) for high-risk GD \nand 1.67 kPa (range 1.31-2.12) for low-risk GD (p=0.006). Mean Fibroscan \nstiffness values were 8.1 kPa (range 3.5-10.5) for high-risk GD and 5.2 kPa \n(range 3.4-7.2) for low-risk GD (p=0.045). Low-risk GD did not differ significantly \nfrom controls for MRE and Fibroscan. LIC did not differ significantly between \nthe groups.\nConclusion: MRE and Fibroscan can be used to monitor liver elasticity in \npatients with GD. We found no apparent role for LIC measurements.\nSS 5.06\nReproducibility of magnetic resonance elastography of \nthe liver at 3T\nA.E. Bohte\n1, A.J. Nederveen1, P .F .C. Groot1, A. De Niet1, R. \nSinkus2, P .L.M. Jansen1, J. Stoker1;  1Amsterdam/NL, 2Paris/FR\nPurpose: To measure the reproducibility of MR elastography of the liver.\nMaterial and Methods: 15 healthy volunteers and 13 patients with viral \nhepatitis B/C and liver fibrosis (17 male; mean age 34±12 years) were scanned \nfour times at 3T: twice while in the same position (intrascan reproducibility, \nISR), once after repositioning (within-day reproducibility, WDR), and once 2-4 \nweeks later (between-weeks reproducibility, BWR). Mechanical waves were \napplied to the chest with a coil-driven vibrating (50 Hz) piston. An SE-EPI \nsequence was used from which axial elasticity and viscosity maps were \ngenerated (TR/TE=420/40 ms; 7 slices, voxel size 4x4x4mm; acquisition time \n70s with breath holds). Elasticity (kPa) and viscosity (Pa.s) values were derived \n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\n S471\nSCIENTIFIC SESSIONS / WEDNESDAY, JUNE 13, 2012\nSS 5.09\nValue of 1H MRS and chemical shift MR imaging in \nquantitative analysis and follow-up of fatty liver\nF . Yuan, B. Song; Chengdu/CN\nPurpose: The purpose of this study was to investigate the value of [1]H \nmagnetic resonance spectroscopy (MRS) and chemical shift MR imaging \ntechniques in quantifying fat content and monitoring treatment effects for fatty \nliver at follow-up examinations on 3.0 T MR system.\nMaterial and Methods: 26 patients with confirmed fatty liver disease were \nexamined with proton MRS and chemical shift-based fat suppression MR \nsequences (Dixon and triple-echo Dixon) on 3.0 T MR at baseline and 3, 6 \nmonths after treatment, respectively. Fat index (FI) of Dixon and the fat index \nstar (FI*) of triple-echo Dixon, the relative lipid content 1 (RLC1) and relative \nlipid content 2 (RLC2) of MRS were calculated. Fatty liver index (FLI) was \nreferred to the standard which was calculated from triglycerides (TG), gamma-\nglutamyl-transferase (GGT), waist circumference and body mass index (BMI). \nStatistical analysis was performed for the correlation between MR measured \nvalues and FLI.\nResults: Significant positive correlation was demonstrated between MR \nimaging techniques measured values (FI, FI*, RLC1,RLC2) and FLI. There was \nstatistical difference between FI, RLC1, RLC2 and FLI at baseline and 3, 6 \nmonths after treatment, respectively (p<0.05), while the statistical difference \nwas found between FI* and FLI only at baseline and 6 months after treatment \n(p<0.05).\nConclusion: [1]H MRS and chemical shift-based fat suppression MR \ntechniques can not only quantitatively measure liver fat content, but also \ndynamically evaluate the therapeutic effects. Dixon technique is more stable, \nwhile proton MRS is more accurate.\nSS 5.10\nEarly detection of liver steatosis by magnetic resonance \nimaging in rats infused with glucose and lipids and \ncorrelation to insulin levels\nG. D’Assignies\n1, C. Kauffmann2, G. Soulez2, B. Van Beers1, \nV. Vilgrain1, V. Poitou2, A. Tang2;  1Clichy/FR, 2Montreal, QC/CA\nPurpose: The purpose of this study was to investigate the accuracy of 1.5 T \nMR imaging, 1H-MR spectroscopy and histological techniques to detect liver \nsteatosis in three rat phenotypes assigned to an experimental glucolipotoxic \nmodel or a control group, and to correlate fat fraction assessed by MR \ntechniques with insulin plasma level.\nMaterial and Methods: Thirty-two rats [thirteen 2-mo-old (young) Wistar (YW), \nsix 6-mo-old (old) Wistar (OW) and thirteen Goto-Kakizaki (GK)] fed a standard \ndiet were assigned to a 72-h intravenous infusion of glucose and Intralipid fat \nemulsion or a saline infusion. Plasma insulin levels were measured. Steatosis \nwas quantified with multiecho MRI, 1H-MRS and histology as fat fractions \n(FF).\nResults: A significant correlation was found between multipoint Dixon MRI-FF \nand 1H-MRS-FF (r = 0.81, P < 0.01) and a weaker correlation was found \nbetween histology and 1H-MRS fat fractions (r = 0.60, P < 0.01). MRS and MRI \naccurately distinguished YW and GK rats receiving the glucose + Intralipid \ninfusion from those receiving the saline control, whereas histology did not. A \nsignificant correlation was found between MRI-FF or 1H-MRS-FF and insulin \nplasma level (r = 0.63, p < 0.01; r = 0.57, P < 0.01).\nConclusion: MRI and 1H-MRS may be more sensitive to measure early-onset \nliver steatosis than histopathology in an experimental glucolipotoxic rat model. \nFat fraction assessed with MR was correlated to plasma insulin level.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / THURSDAY, JUNE 14, 2012\n S472\nSS 6.03\nValue of 3T MRI in evaluating the mucosal involvement \nin Crohn’s disease\nR. Scandiffio, E. Neri, L. Faggioni, C. Bartolozzi; Pisa/IT\nPurpose: The purpose of this study was to determine the diagnostic accuracy \nof 3T MRI in detecting mucosal involvement in Crohn’s disease.\nMaterial and Methods: Twenty-seven patients with known or suspected \nCrohn’s disease underwent 3T small bowel MRI. All patients were evaluated \nafter oral assumption of water solution. Acquisition protocol included Fast \nImaging Employing Steady State Acquisition (FIESTA), Single-Shot FSE and \ncontrast-enhanced dynamic study with Liver Acquisition with Volume \nAcquisition (LAVA). Aphtoid ulcers, pseudopolyps, fold thickening and \ndistortion were the target of mucosal evaluation. Endoscopic examination and \nhistopathological examination in patients who undergone surgery were \nconsidered as gold standard. Statistical significance was calculated with the \nFisher exact test; sensibility and specificity of the MRI examination have been \nalso calculated.\nResults: Mucosal abnormalities were identified in 11 patients (42%); 2 \nexaminations (8%) resulted as false negative (p=0.00002). All patients with \nmucosal abnormalities detected by MRI examination had active/severe \ndisease. Sensitivity and specificity of MRI were 100% and 85%, respectively.\nConclusion: This preliminary experience shows an high diagnostic accuracy \nof 3T MRI in detecting mucosal abnormalities in Crohn’s diseases; this \nrepresents an added value of MRI in the clinical assessment of the severity of \nthe disease.\nSS 6.04\nSoftware-supported evaluation of small-bowel motility \nin MRI for faster and more reliable diagnoses\nS. Bickelhaupt\n1, J.M. Froehlich1, R. Cattin2, S. Raible2,  \nH. Bouquet3, U. Bill3, F . Merz3, M.A. Patak1;  1Zurich/CH,  \n2Biel/CH, 3Bern/CH\nPurpose: Functional analyses of small-bowel motility by MRI have been \nperformed by hand, which is potentially subjective and time-consuming. A \nnewly developed software (Motasso) permits semi-automatic measurement of \nsmall-bowel diameter over time, thus displaying motility. The aim was to \nvalidate the software prototype comparing it to manual measurements.\nMaterial and Methods: 45 patients (18 male/27 female; mean 48 years) were \nincluded. MRI (1.5-T, Siemens-Sonata) was performed after standardized \npreparation. 2D (dynamic-T2-2D-FIESTA) motility acquisitions covering the \nentire small bowel were performed in apnea (27 s). Image analysis for \nassessment of small-bowel motility was performed both manually and with the \nsoftware. The time consumption and main curve characteristics were compared \nusing Student’s t-test, the level of scattering of individual measurements using \nBland-Altman.\nResults: 91 single regions of interest were analysed three times by hand and \nthree times with Motasso, each measurement done by another expert. Overall \n92% of the motility curves qualitatively matched each other. No significant \nintraindividual difference (p>0.05) was found for peristaltic frequencies (mean: \n4.14/min, manual: 4.22/min, Motasso). Amplitudes (5.14 mm, 5.57mm) and \nmean lumen diameters (17.39mm, 14.68mm) slightly but significantly differed \ndue to systematic differences in the definition of the bowel wall. Mean duration \nfor single analysis was significantly (p<0.01) lower with Motasso (6.25 min, \nmanual 1.30min, Motasso). The scattering differed significantly (p<0.01) \nbetween the methods.\nConclusion: The use of Motasso proves highly reliable, fast and accurate \nmeasurement of small bowel motility. Curve characteristics and peristaltic \nmotility frequencies of manual and software-supported analyses did not differ \nsignificantly, while the measurement precision and the time needed for \nmeasurement differed significantly in favor of Motasso.\nSS 6.05\nDoes quantified small bowel motility supplement the \nability of conventional anatomical MRI markers to \npredict Crohn’s disease activity?\nA. Menys, F . Odille, M. Rodriguez-Justo, I. Proctor, M. \nNovelli, S. Punwani, D. Atkinson, S. Halligan, S.A. Taylor; \nLondon/UK\nPurpose: The purpose of this study was to investigate the benefit of adding \nquantified small bowel motility to a validated MRI model of Crohn’s disease \nactivity.\nMaterial and Methods: 23 Crohn’s patients (mean age 35, 15 female) \nunderwent MR enterography (Axial and coronal TrueFISP , HASTE, post-\ngadolinium VIBE images and coronal TrueFISP cine motility) and endoscopic \n11:00 - 12:30 Pentland\nScientific Session 6\nSmall bowel MRI in Crohn’s disease\nSS 6.01\nQuantification of small bowel motility in stricturing \nCrohn’s disease using dynamic MRI\nA. Menys, E. Helbren, J. Makanyanga, N. Bell, S. Halligan, \nD. Atkinson, S.A. Taylor; London/UK\nPurpose: The purpose of this study was to quantify small bowel motility within \nand upstream of Crohn’s disease-related strictures.\nMaterial and Methods: A previously validated non-rigid registration-based \nsoftware algorithm was used to quantify small bowel wall motion acquired \nduring coronal FISP sequence (20 second breath hold, TR-4ms, TE-1.7ms, \nslice thickness 10 mm, 1 slice/0.8 sec) in 34 Crohn’s patients with stricturing \ndisease (14 female, mean age 36) undergoing MR enterography. Linear ROIs \nwere placed within the stricture (S), immediately upstream (pre-stricture-PS) \nand in normal bowel (N). ROIs were automatically propagated through the time \nseries by the software and motility quantified, expressed as a Jacobian derived \nmotility metric. Motility between locations was compared by paired Wilcoxon-\nRank test. The PS bowel was divided into dilated and non-dilated groups \n(dilated = >50% increase in luminal diameter compared to normal bowel) and \nmotility compared using Wilcoxon’s rank-sum test.\nResults: Mean motility within PS, S and N segments was 0.32, 0.16 and 0.38, \nrespectively. There were significant differences between PS and S (p=0.0003), \nS and N (p=3.6e[-7]), but not N and PS (p=0.06). However, dilated PS had \nsignificantly reduced motility (mean=0.28) compared to non-dilated PS bowel \n(mean=0.44, p=0.01).\nConclusion: Small bowel motility is reduced in Crohn’s strictures as would be \nexpected. However, dilated segments of pre-stricture bowel also show \nabnormal reduced motility possibly representing a failure of small bowel \npropulsion and contributing to patient symptoms.\nSS 6.02\nCorrelation between global small-bowel motility in MRI \nand local disease activity in patients with Crohn’s \ndisease\nS. Bickelhaupt\n1, J.M. Froehlich1, R. Cattin2, S. Raible2, U. Bill3, \nH. Bouquet3, M.A. Patak1;  1Zurich/CH, 2Biel/CH, 3Bern/CH\nPurpose: Crohn’s disease (CD) is an inflammatory bowel disease (IBD) \ncharacterized by local severe inflammation. Previous studies revealed reduced \nsmall-bowel motility in affected tissue measured at the terminal ileum. The aim \nwas to evaluate the influence of local disease activity on global small-bowel \nmotility in patients with CD based on histopathology.\nMaterial and Methods: 15 healthy individuals (11 male, 4 female; mean 44 \nyears) and 15 patients with histopathologically proven active CD (10 female, 4 \nmale; mean 37 years) were included in this IRB-approved retrospective study. \nMRI (1.5 T, Siemens Sonata) was performed after a 1 h preparation of 1000 cc \nmannitol solution (3%). Cine T2-2D-FIESTA (TR 283.3/TE 1.89/FOV400/10 mm \nslice) motility acquisitions were performed in apnea. Image analysis for \nassessment of gastric motility was performed using a dedicated MR motility \nassessment software (Motasso) in 3 randomly chosen areas of the small-bowel \noutside the known CD-affected hot spots. The main characteristics (frequency, \namplitude, diameter) were compared using Student’s t-test and one-way \nANOVA.\nResults: 3 randomly chosen regions of interest were analyzed with Motasso in \neach participant. Patients with active-46913 revealed both significantly \n(p<0.01) reduced contraction-frequency (active-CD: 2.86/min;healthy: 4.53) \nand contraction-amplitude (6.71mm;10.14mm) compared to healthy \nindividuals. Mean bowel-lumen diameter was only slightly, but significantly \n(p=0.04) larger in patients with active-CD (16.91mm) compared to healthy \nparticipants (14.79mm).\nConclusion: Small-bowel motility in patients with active-CD seems to be \nglobally influenced by the local activity of the disease. Both contraction-\nfrequency and contraction-amplitude were significantly reduced compared to \nhealthy individuals, while the mean lumen-diameter was slightly increased. \nThis suggests an influence of humoral factors related to (chronic-)\ninflammation.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / THURSDAY, JUNE 14, 2012\n S473\nConclusion: MR enterography provides an excellent correlation regarding the \ndisease behavior (Vienna and Montreal classification) for patients with Crohn’s \ndisease. This represents an extremely important prerequisite for therapeutical \nplanning concerning surgery or pharmaceutical therapy.\nSS 6.08\nMagnetic resonance imaging is correlated to faecal \ncalprotectin level in the evaluation of small bowel and \ncolonic Crohn’s disease\nD. Pendse, J. Makanyanga, E. Atkins, A. Menys, S. Bloom, \nS. McCartney, S. Punwani, S. Halligan, S.A. Taylor; London/UK\nPurpose: Crohn’s disease management requires knowledge of overall disease \nburden. A new MRI score of Crohn’s disease activity was tested against \nreference standards of global activity: Harvey Bradshaw index (HBI) and faecal \ncalprotectin.\nMaterial and Methods: 34 patients (15 male), median age 33 (range 17-78), \nwith known or suspected Crohn’s disease underwent MR enterography [axial/\ncoronal HASTE, TrueFisp and post gadolinium coronal VIBE/THRIVE at 1.5 T \n(n=24) or 3 T (n=10)]. On the same day, HBI questionnaire and faecal \ncalprotectin were measured. Two observers qualitatively graded bowel wall \nthickness, mural T2 signal, mesenteric oedema, T1 enhancement and colonic \nhaustral loss from 0 (normal) to 3 (most abnormal) for the jejunum, proximal \nileum, terminal ileum and colon (6 segments). Each individual small bowel and \ncolonic segmental score was multiplied according to the length of disease in \nthat segment (0-5 cm x1, 6-15 cm x1.5, and \u000316 cm x2). For each of \nlymphadenopathy, comb sign, abscesses and fistula, a score of 5 was added \nif present. The relationship between MRI score, calprotectin and HBI was \nevaluated using Kendall’s rank correlation.\nResults: The mean MRI activity score was 15 (range 0-61.5) and was \nsignificantly correlated with calprotectin, Kendall’s tau b=0.42, p=0.0009, but \nnot with HBI, Kendall’s tau b=0.006, p=1.\nConclusion: Global Crohn’s disease activity measured using a qualitative MRI \nscore is correlated to the faecal calprotectin level. MRI is useful for the global \nassessment of Crohn’s disease activity.\nSS 6.09\nCorrelating faecal calprotectin with small bowel MRI: a \nretrospective analysis\nG. Bhatnagar, H.S. Sidhu, K. Woolson, C. Edwards, M. Puckett; \nTorbay/UK\nPurpose: There is no gold standard test for comprehensive assessment of \nCrohn’s disease (CD). Small bowel MRI (SBMR) and faecal calprotectin (FC) \nare emerging tools. Understanding the relationship of these two tests will \nenhance our ability to stage disease activity in CD.\nMaterial and Methods: Patients attending Torbay Hospital with SBMR and FC \nsamples within 35 days of each other were retrospectively assessed. SBMR \nwere analysed using several criteria that were individually compared to FC.\nResults: The study included 16 patients (5 normal, 11 abnormal FC). All \npatients with elevated FC had abnormal SBMR (p=0.05). More than half the \npatients with normal FC had abnormal SBMR (p=0.05). Statistical analysis by \nFischer’s exact test for count data of specific SBMR findings such as number \nof abnormal segments, wall thickness of abnormal segments and enhancement \nof abnormal segments amongst others did not demonstrate any significant \nrelationship.\nConclusion: SBMR in patients with abnormal FC is always abnormal. This \nmay prove to be a cost-effective finding in restaging CD by obviating the need \nfor repeat SBMR in cases of deranged FC. SBMR may be abnormal in cases \nof normal FC. This finding suggests that SBMR is a more sensitive test of \ndisease activity in CD and may represent the new gold standard. Some \nlimitations of this retrospective analysis such as inconsistent temporal \ncorrelation between FC and SBMR as well as small sample size are \nrecognised.\nSS 6.10\nAssessment of small bowel inflammation, stenosis and \ncomplications in patients with Crohn’s disease on \nanti-TNF treatment using serial MRI scans\nJ.A.W. Tielbeek, M. Löwenberg, C.Y . Ponsioen, G. D’Haens, \nJ. Stoker; Amsterdam/NL\nPurpose: The purpose of this study was to assess the evolution of small bowel \ndisease activity and complications in Crohn’s disease patients treated with \nanti-TNF agents using serial MRI scans.\nterminal ileal (TI) biopsy within 4 weeks (mean 5 days). TI motility (Motil) was \nquantified using validated software which measures bowel wall displacement \nbased on non-rigid registration, expressed as the mean jacobian standard \ndeviation. Two observers in consensus applied a validated MRI score of activity \nto the TI based on grading (0-3) mural thickness, T2 signal, contrast \nenhancement, and perimural oedema (scores totalled, tMRI). TI biopsies were \nassigned an acute inflammatory score (eAIS, 0-6) based on the presence of \nulceration and neutrophil infiltration. On statistical advice, univariate analysis \nassessed the association between eAIS and both tMRI and Motil independently. \nA multivariate analysis with backward selection assessed the benefit of adding \nMotil to the tMRI model’s ability to predict eAIS.\nResults: There was a significant association between tMRI and eAIS (Reg \nCoeff=0.28, p=0.002) and negative association between Motil and eAIS (Reg \nCoeff=-0.49, p=0.02). However, there was no significant advantage in eAIS \nprediction by adding Motil to the tMRI model (p=0.6).\nConclusion: Small bowel motility is negatively associated with Crohn’s disease \nactivity, but may not add to existing anatomical MRI biomarkers.\nSS 6.06\nSoftware-assisted MRI assessment of gastric motility in \npatients with active Crohn’s disease\nS. Bickelhaupt\n1, J.M. Froehlich1, R. Cattin2, S. Raible2,  \nH. Bouquet3, U. Bill3, M.A. Patak1;  1Zurich/CH, 2Biel/CH, \n3Bern/CH\nPurpose: Humoral mediators released during inflammation in Crohn’s disease \n(CD) may influence gastrointestinal motility beyond the affected areas. This \ncould affect the functionality of other gastrointestinal organs, e.g. the stomach. \nThus, the aim was to evaluate the systemic influence of local disease activity \non gastric motility in MRI in patients with histopathologically proven active-\nCD.\nMaterial and Methods: 10 individuals (6 healthy and 4 with histologically \nproven active-CD, 6 female/4 male, mean age 40y) were included in this IRB-\napproved, retrospective study. MRI (1.5-T, Siemens Sonata) was performed \nafter a 1-h preparation of 1000 cc Mannitol solution (3%). Cine T2-2D-FIESTA \n(TR 283.3/TE 1.89/FOV 400/10 mm) motility acquisitions were performed in \napnea. Gastric motility analyzed in the corpus image analysis for gastric \nmotility was performed using a dedicated MR motility assessment software \n(Motasso). The main characteristics (frequency, amplitude, diameter, \npropagation) were compared using Student’s t-test.\nResults: Overall contraction frequency was not significantly (p>0.05) reduced \nin patients with active-CD (1.7/min) compared to healthy individuals (1.9/min). \nYet, further comparison revealed several significant (p<0.05) differences in the \nmotility characteristics with a reduced wave propagation speed (healthy: 2.36 \nmm/sec; active-CD: 0.25 mm/sec), contraction amplitude (22.74 mm; 13.84 \nmm) and mean diameter (36.38 mm; 17.45 mm) in patients with histologically \nproven active-CD.\nConclusion: Gastric motility patterns were significantly altered in patients with \nactive-CD. Contraction waves propagated significantly slower and with lower \namplitudes in patients with active-CD compared to healthy individuals, though \nthe gastric contraction frequency was not significantly reduced. This might \nreflect the influence of inflammatory mediators on gastric motility.\nSS 6.07\nCorrelation of MRI with surgery regarding disease \nbehavior (Vienna classification) in patients with Crohn’s \ndisease\nG. Schill, L.M. Dendl, C. Stroszczynski, A.G. Schreyer; \nRegensburg/DE\nPurpose: The purpose of this study was to correlate the radiological \nassessment of Crohn’s disease (CD) based on magnetic resonance \nenterography (MRE) with the surgical and histological assessment using the \nVienna and Montreal classification score.\nMaterial and Methods: We retrospectively assessed the MRE in 76 \nconsecutive patients with known CD who had a MRE and surgery with a 2 \nweeks time period. Based on MRE, the diagnosis of abscess, fistula, \nconglomerate tumor, and stenosis was documented. For surgery and histology, \nthe surgeon who performed the procedure as well as a pathologist did the \nVienna and Montreal scoring regarding the subgroups B1 (non-stricturating, \nnon-penetrating), B2 (stricturating) and B3 (penetrating).\nResults: We found an excellent correlation (k=0.937) regarding the correct \nscoring assessment for disease behavior (B score). We found the highest \nsensitivity (96 %) for stenosis assessment and the highest specificity (95%) for \nfistulas. We calculated the highest positive predictive value for conglomerate \ntumors (95%) and the highest negative predictive value (98%) for abscesses. \nAll correlations and results were statistically highly significant.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / THURSDAY, JUNE 14, 2012\n S474\nResults: We found a kappa value on 0.73 (95% CI: 0.61-0.87) for the sub-\nclassification between the two methods. The kappa value in classifying early \nversus advanced T3 rectal tumours was 0.91 (95% CI: 0.81-1.00). There were \nno differences in mean maximal tumour outgrowth measured on TRUS, 5.3 \nmm (95% CI: 4.1-6.7 mm) and on MRI, 6.4 mm (95% CI: 4.9-7.9 mm).\nConclusion: There is a good agreement between TRUS and MRI in the \npretreatment sub-classification of T3 tumours and a very good agreement in \nclassifying tumors as early and advanced. TRUS can be used to predict \nadvanced rectal cancers and thus be helpful if chemoradiation is considered in \npatients with contraindications to MRI.\nSS 7.03\nRectal tumour volume delineation using T2-weighted \nand diffusion-weighted MRI: implications of observer \nagreement for radiotherapy planning\nF . Regini, R. Cardoso De Melo, N. Griffin, J. Parikh,  \nG. Charles-Edwards, G. Rottenberg, M. Leslie, A. Gaya,  \nV. Goh; London/UK\nPurpose: The purpose of this study was to determine if observer agreement \nfor tumor volume delineation is better for DW-MRI than T2W MRI.\nMaterial and Methods: 27 consecutive patients (15 male, 12 female, mean \nage 66.9, range 27.1-88.8 years) underwent 1.5 T MRI (Siemens) prior to \nchemoradiation (45 Gy in 25 fractions; oral capecitabine 850 mg/m[2]), \nincluding T2W (TR=6600 ms, TE=90 ms, NEX=2, ST=6 mm) and DW-MRI \n(TR=3000 ms, TE=77 ms, NEX=4, ST=6 mm, b=0-100-800 s/mm[2]) axial \nsequences. 3D tumor volume (cm[3]) was measured by VOI analysis by two \nindependent readers for the T2W and b800 DWI axial images (OsiriX 3.9). T2 \nand DW-MRI tumor volumes were compared using Mann-Whitney test. \nObserver agreement was assessed using Bland-Altman statistics. Significance \nwas at 5%.\nResults: Artefacts precluded DWI analysis in 1 patient. In the remaining 26 \npatients evaluated, median (range) in cm[3] for the T2W and DWI (b=800) \nvolumes was 47.24 (7.57-267.68) and 47. 22 (3.68-251.00), respectively, for \nReader One and 44.67 (11.63-249.36) and 43.79 (6.70-291.54) for Reader Two. \nT2 volumes were slightly larger but not significantly different from DWI volumes: \nmedian 43.77 versus 42.44, P=0.92 for Reader One; median 42.25 versus \n40.09, P=0.68 for Reader Two. Mean difference (95% limits of agreement) for \nT2 and DWI was -0.89 (-29.95 to +28.16) and +2.57 (-23.04 to +28.19), \nrespectively, indicating slightly better inter-observer agreement for DWI.\nConclusion: Slightly better inter-observer agreement for volume delineation \nwas noted for high b-value DWI, related to better conspicuity.\nSS 7.04\nWall deformity in preoperative distinction between T1-T2 \nand T3-T4 staging of colorectal cancer\nN. Flor, M. Mezzanzanica, P . Rigamonti, M. Peri, F . Sardanelli, \nG. Cornalba; Milan/IT\nPurpose: To predict colorectal cancer (CRC) T stage using preoperative \ncontrast-enhanced computed tomography colonography (CE-CTC).\nMaterial and Methods: Sixty-nine patients with 75 CRC underwent CE-CTC. \nTwo readers evaluated on 3D views three different types of wall deformity (WD) \ndue to the CRC: < 25% of the lumen; between 25% and 50% (apple core); and \n\u000350%. Each category was associated with a T stage: < 25%, T1; between \n25% and 50%, T2; \u000350%, T3 or T4. Standard of reference: pathology. This \nstudy was approved by IRB.\nResults: Pathology: T1 (n = 5), T2 (n = 12), T3 (n = 45),T4a (n = 8) and T4b (n = \n5). The detection rate of CRC was 100% (75/75). Mean CRC’s largest diameter \nwas 49 ± 20 mm (range 10-110), 19 mm for T1, 40 mm for T2, 52 mm for T3 \nand 64 mm for T4. The bowel preparation and colon distension were adequate \nin 62/69 (90%) and 67/69 patients (97%), respectively. Intra- and interobserver \nreproducibility for WD was almost perfect (k = 1 and k = 0.88, respectively). \nSensitivity of WD for T stage \u00033 was 0.96 (56/58, 95% CI 0.88-0.96), specificity \n0.71 (12/17, 95% CI 0.44-0.90), PPV 0.92 (56/61, 95% CI 0.82-0.97), NPV 0.86 \n(12/14, 95% CI 0.57-0.98) and accuracy 0.91 (68/75, 95% CI 0.82-0-96). \nTwenty out of 69 patients had at least one synchronous polyp \u00036 mm.\nConclusion: The presence of WD \u000350% (apple core type) is highly predictive \nof stage T3 or higher.\nMaterial and Methods: We performed a retrospective study of patients with \nCrohn’s disease who had undergone serial MRI scans (T1- and T2-weighted \nsequences) while receiving anti-TNF treatment. Patients were grouped as \nclinical responders or non-responders. Stricturing lesions were evaluated \nusing simplified scoring systems of inflammation (Steward et al.) and stenosis \n(Fornasa et al.). Complications were scored evaluating penetrating lesions, \nabscesses and/or fistulas.\nResults: Forty-two MRI scans were evaluated in 13 clinical non-responders \nand 8 responders. In all patients, median inflammation scores decrease from \n10 (range 6–15) on initial MRI to 8 (range 1–13) on follow-up MRI (p=0.168). In \nthe responder group, 86% had reduced inflammation on follow-up MRI \n(p=0.0571). In this group, the first MRI detected complicated disease in 25% \nof the patients which resolved at follow-up MRI. Severity of stenosis was \nsignificantly reduced between serial MRI scans (p=0.0148). In the non-\nresponder group, only 23% showed decreased inflammatory scores (non-\nsignificant). Severity of stenosis, stricturing and penetrating lesions was \nunchanged as indicated by serial MRI scans.\nConclusion: A reduction in both small bowel inflammation and inflammatory \nstenosis on serial MRI scans correlates with clinical responses to anti-TNF \ntreatment. MRI can be used as a complementary approach to measure \ntransmural healing in order to improve the clinical management in Crohn’s \ndisease patients.\n11:00 - 12:30 Fintry\nScientific Session 7\nTumour staging\nSS 7.01\nDCE-MRI correlates with tumor: free resection margins \nin recurrent rectal cancer\nM. Gollub\n1, K. Cao2, D. Gultekin1, D. Kuk1, M. Gonen1,  \nM. Sohn1, L. Schwartz1, P . Paty1;  1New York, NY/US, \n2Beijing/CN\nPurpose: The purpose of this study was to explore whether pre-operative \nDCE-MRI correlates to clinical outcome variables in patients who undergo \nsurgical treatment for recurrent rectal carcinoma.\nMaterial and Methods: A retrospective study of DCE-MRI in patients with \nrecurrent rectal cancer was performed after obtaining an IRB waiver. We queried \nPACS from 1998 until 2008, to allow 3-year follow up. Using patient medical \nrecords, we determined which exams were done for recurrent disease. We \nexplored the correlation between K[trans], Kep, Ve and AUC 90 and 180 seconds \nwith time to re-recurrence [TTR], overall survival [OS] and margin status. The \nsurgeons were blinded to DCE findings. Univariate Cox PH models were used \nfor TTR and OS, while univariate logistic regression was used for margin status.\nResults: One-hundred sixty-eight patients underwent MRI for recurrence. \nMajor exclusions included: treatment prior to MRI, n=38; second recurrence, \nn=30 and medical treatment only, n=28. Among the remaining 47 patients, 27 \nwent directly to surgery. Fourteen of these had positive margins. K[trans] (OR \n0.03: CI: 0.001, 0.826, p=0.0382) and Kep (OR 0.19: CI: 0.039, 0.938, p= \n0.0415) were inversely correlated with positive margins. In 20 patients \nundergoing neoadjuvant treatment, a correlation between AUC 90 and TTR \nwas noted (HR 1.191, CI: 1.003, 1.413, p=0.0456).\nConclusion: A direct correlation was found between K[trans], Kep and clear \nresection margins. Such information might be helpful for treatment \nindividualization.\nSS 7.02\nAgreement between transrectal ultrasound and MRI in \nprediction of depth of extramural tumor spread in rectal \ntumours\nS.R. Rafaelsen, C. Vagn-Hansen, T. Sørensen, J. Pløen,  \nA. Jakobsen; Vejle/DK\nPurpose: The purpose of this study was to evaluate the agreement between \ntransrectal ultrasound (TRUS) and MRI in sub-classification of T3 tumours.\nMaterial and Methods: From January 2010 to December 2011, 68 consecutive \npatients with T3 tumours were included in this study. The mean age of the \npatients was 67.5 years (range: 33-91 years). The tumours were all >T2 on \nTRUS. The sub-classification was defined as T3a with a penetration of the \nrectal wall from 0 to 1 mm, T3b 1-5 mm, T3c 6-15 mm, T3d >15 mm: early T3 \nas T3ab and advanced tumours as T3cd (>5 mm). The TRUS findings were \nblinded to two experienced radiologist who did the interpretation of the MRI \nimages and measured the depth of extramural tumour spread.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / THURSDAY, JUNE 14, 2012\n S475\nResults: A total of 34 patients were pN0, and 19 pN+. Gadofosveset-MRI \ncorrectly staged 42 patients (sensitivity 84%,specificity 76%, PPV 67%, NPV \n90%); 3 pN+ patients were understaged, 8 pN0 were overstaged. FN findings \nwere due to: N+ node obscured by adjacent vessel (n = 1); microscopic tumour \ncells too small to detect with MRI (n = 2). FP findings were due to: interpretation \nerrors that could be corrected by the expert reader (n = 3), decreased \ngadofosveset uptake in presacral/peri-vascular nodes (n = 4) and absence of \ngadofosveset-uptake eci (n = 1).\nConclusion: The previously reported high accuracy was sustained in this \nsecond cohort and was reproducible by non-expert radiologists. Understanding \nthe pitfalls is crucial for clinical implementation. Pitfalls mainly occur due to \nreaders’ inexperience and insufficient uptake of gadofosveset in nodes located \nbetween vessels (in the upper mesorectum).\nSS 7.08\nAre p53 and c-erb-B2 expression useful as adjuvant \ntools in staging gastric adenocarcinoma by MDCT and \nMRI?\nR. Mateus Marques, J. Dias, L. Fernandes, P . Mendonça,  \nP . Santos, J. Esteves, L. Costa, F . Pina, M. Oliveira,  \nJ. Guedes Da Silva, A. Caldeira Fradique; Lisbon/PT\nPurpose: P53 and c-erb-B2 have been proposed as indicators of poor prognosis \nin gastric adenocarcinoma (GA), while MDCT and MRI may understage the \ndisease. The purpose of this study is to evaluate a relationship between the \nexpression of these cellular markers and differences between staging by imaging \nand according to pathological studies or clinical progression.\nMaterial and Methods: Between January 2009 and December 2011, 64 \npatients with GA underwent p53 and c-erb-B2 measurements by biopsy or \nsurgery. P53 expression was divided into three levels and c-erb-B2 values \nwere divided between negative and positive. Results were compared by \nlogistical regression and Chi-square statistics with differences between clinical \n(CIS) or nodal (NIS) staging by imaging and clinical or nodal staging (CS and \nCNS) obtained by surgery or clinical progression.\nResults: The results of P53 levels were low in 38 patients, moderate in 10 \npatients and high in 15 patients. C-erb-B2 was negative in 49 patients and \npositive in 10 patients. Differences in staging were 50% (CIS/CS) and 56.2% \n(NIS/CNS). Chi-square statistics revealed a p value of .481 and 0.705, \nrespectively, for differences between CIS/CS ( lower level of p value, 153 \nobtained for high p53 expression) and NIS/CNS. Cellular markers measurements \ncorrectly increased CIS in 6.9% and NIS in 3.5%.\nConclusion: P53 and c-erb-B2 measurements increased CIS and NIS with \nMDCT or MRI, but such improvement was not statistically significant, so their \nuse as adjuvant tools needs further evaluation.\nSS 7.09\nWithdrawn by the authors\nSS 7.10\nValue of 3D FSE-Cube sequence at 3T MRI in pre-\noperative local staging of rectal cancer\nR. Scandiffio, E. Neri, L. Faggioni, A. Mantarro, R. Balestri, \nC. Bartolozzi;  Pisa/IT\nPurpose: To compare a standard T2w imaging based on 2D acquisitions with \n3D FSE-Cube sequence in the local staging of rectal cancer at 3T MRI.\nMaterial and Methods: Eleven patients with rectal cancer were prospectively \nevaluated at 3T MRI. Sagittal, coronal, axial and oblique 2D T2w FSE images \nwere obtained. An additional 3D T2 FSE-Cube sequence was performed after \nthe 2D sequences. Each 3D data set was processed with multiplanar and \ncurved planar reconstructions. Two experienced radiologists, using respectively \n2D or 3D sequences, evaluated T and N parameters, with specific attention to \nmeasurement of the distance between the lesion and puborectal muscle and \nmesorectal fascia, and lesion extension. Linear Cohen k values were calculated \nto quantify agreement between MRI and histopathological data. Image quality \nwas evaluated using a linear qualitative scale.\nResults: Global sensitivities for T parameters were 56% and 64% for 2D and \n3D images, while N category lesion accuracy values were 53% and 56%, \nrespectively. Accuracy in measuring the distance from pubo- rectal muscle to \nlesion border was 60% and 100% for 2D and 3D, respectively. Image quality \nwas considered very good on 2D images, and good on 3D images.\nConclusion: No significant differences between 2D and 3D images were \nobserved for T and N staging. However, T2w FSE-Cube demonstrated higher \naccuracy than 2D in determining the distance between the lesion and the \npubo-rectal muscle, which represents a key factor in planning surgical \nresection.\nSS 7.05\nMRI morphology after transanal endoscopic \nmicrosurgery for patients with rectal cancer\nM.H. Martens\n1, M. Maas1, L. Heijnen1, D.M. Lambregts1, \nJ.W.A. Leijtens2, F .C.H. Bakers1, V.C. Cappendijk1, G.L. \nBeets1, R.G.H. Beets-Tan1;  1Maastricht/NL, 2Roermond/NL\nPurpose: Patients with early rectal cancer or a good response after \nchemoradiation (CRT) are sometimes treated with transanal endoscopic \nmicrosurgery (TEM). Follow-up of TEM-patients includes MRI. This study aims \nto describe the rectal wall MRI morphology during short-term and long-term \nfollow-up after TEM.\nMaterial and Methods: A total of 36 patients were included with at least one \npost-operative TEM. For 17 patients multiple consecutive MRIs were available; \n29 patients had a primary TEM and 7 had TEM after CRT.\nResults: Three morphological patterns on MRI after TEM could be identified: (1) \nrectal wall thickening with or without fibrosis, (2) a notch at the TEM location, and \n(3) irregular delineation of the rectal wall. In eight cases, edema was present \nduring short-term follow-up and remained present during long-term follow-up in \npatients with TEM after CRT. Wall thickening with or without fibrosis was \nobserved in 24 patients and remaind consistent during long-term follow-up. A \nnotch was observed in 15 patients and persisted during long-term follow-up in \n83%. Sixteen patients had irregular delineation of the rectal wall, only during \nshort-term follow-up. Six luminal recurrences occured; three patients had wall \nthickening, two a notch, and five patients had an irregular rectal wall.\nConclusion: Three patterns on MRI were identified after TEM. Radiologists \ncan monitor these patients more accurately, which is important at a time when \nminimal invasive techniques are emerging.\nSS 7.06\nHigh-resolution magnetic resonance imaging  versus \ncomputed tomography for preoperative local staging of \ncolon cancer\nE. Rollvén, T. Holm, E. Lörinc, B. Glimelius, L. Blomqvist; \nStockholm/SE\nPurpose: To study high-resolution T2-weighted MRI versus CT for preoperative \nlocal staging of colon cancer with surgery and histopathology as reference \nstandard.\nMaterial and Methods: Twenty-eight patients with a total of 29 tumours were \nincluded. Patients were examined on a 1.5 T MR unit using a phased array body \ncoil. T2 turbo spin-echo high-resolution sequences were performed in three \nplanes at the site of the tumour. CT was performed using a protocol for metastasis \nstaging. The examinations were independently evaluated by two gastrointestinal \nradiologists using criteria adapted to imaging for prediction of T- and N-stages \nand extramural venous invasion. Based on the T-stage, tumours were divided \ninto locally advanced (T3cd-T4) and not locally advanced (T1-T3ab). Surgical \nand histopathological findings served as reference standard.\nResults: With MRI, T-stage, N-stage and extramural venous invasion were \ncorrectly predicted for each observer in 90 and 93%, 72 and 69%, 82 and 78% \nof cases, respectively. With CT, the corresponding results were 79 and 76%, \n72 and 72%, and 78 and 67%. For MRI, interobserver agreements were 0.79, \n0.10 and 0.76. For CT, the corresponding results were 0.64, 0.66 and 0.22.\nConclusion: Locally advanced colon cancer can be distinguished from not \nlocally advanced by both high-resolution MRI and CT. MRI may have an \nadvantage in identifying certain prognostic factors such as T-stage and \nextramural venous invasion.\nSS 7.07\nGadofosveset-enhanced MRI for nodal staging in rectal \ncancer: pitfalls and learning curve\nM.H. Martens, D.M.J. Lambregts, L. Heijnen, M. Maas,  \nV.C. Cappendijk, F .C. Bakers, G.L. Beets, R.G.H. Beets-Tan; \nMaastricht/NL\nPurpose: Nodal staging in rectal cancer remains a diagnostic challenge. In a \nrecent pilot study, we have shown good performance for MRI using \ngadofosveset contrast in expert hands (sensitivity 80%, specificity 97%). The \naim of the present study is to investigate whether the high accuracy will be \nsustained in clinical setting with non-expert radiologists.\nMaterial and Methods: A total of 53 patients underwent standard MRI (T2W-\nFSE) for treatment planning and gadofosveset-MRI. Sixteen underwent (5x5 \nGy+) immediate surgery, 37 underwent chemoradiation, a restaging MRI and \nsurgery. Patients were scored as cN0/N+ based on the presence/absence of \nnodal gadofosveset enhancement on the pre-surgical MRI. Histology was the \ngold standard. In case of FP/FN findings, the scan was re-evaluated by an \nexpert reader and compared in detail with histology.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / THURSDAY, JUNE 14, 2012\n S476\nSS 8.03\nSingle-energy low-voltage arterial phase scanning for \nthe detection of adenocarcinoma of the pancreas.\nM.C. Ambrosetti, G.A. Zamboni, E. Zivelonghi, C. Cavedon, \nR. Pozzi Mucelli; Verona/IT\nPurpose: To test a single-energy low-voltage protocol for detecting pancreatic \nadenocarcinoma.\nMaterial and Methods: A total of 26 patients with pathology-proven pancreatic \nadenocarcinoma underwent MDCT with arterial phase at 80 kV on a 64-row \nscanner and were compared to a similar group of 26 patients scanned with a \n120 kV arterial phase protocol. Except for tube voltage, all other scan \nparameters were constant. Scans were compared for quantitative image \nparameters (attenuation and standard deviation in liver, pancreas, aorta and \ntumour), CTDI and DLP using an unpaired t test. Image noise values for each \nprotocol (SD of the HU from 3 ROIs drawn outside the body) were compared \nusing an unpaired t test. Effective dose for each protocol was estimated with \nTLD measurements on an anthropomorphic phantom.\nResults: The mean attenuation was significantly higher at 80 kV in the aorta (525.6 \n± 126.8 vs. 292.9 ± 87.4 HU), liver (94.4 ± 17.8 vs. 75.3 ± 14 HU) and normal \npancreas (162.1 ± 42 vs. 89.9 ± 19.7 HU) (all p < 0.0001), while no significant \ndifference was observed for adenocarcinoma (67.8 ± 39.2 vs. 50.5 ± 20.5 HU; p = \nn.s.). CTDI and DLP were significantly lower at 8 kV (6.0 ± 1 vs. 9.7 ± 2.8 mGy, and \n184.6 ± 40.3 vs. 369.6 ± 133.4 mGy x cm, respectively; all p < 0.0001). Tumour \nconspicuity (HUpancreas-HUtumour) was significantly higher at 80 kV (94.2 ± 39.3 \nvs. 39.5 ± 22HU; p < 0.0001). Mean image noise was significantly higher at 80 kV \n(12.3 ± 3.6 vs. 9.5 ± 2.9 HU; p < 0.0001). Estimated effective dose was significantly \nlower at 80 kV (0.157 vs. 0.201 mSv; p = 0.0083).\nConclusion: The use of 80 kV arterial-phase for abdominal CT increases the \nconspicuity of adenocarcinoma, thus potentially improving its identification.\nSS 8.04\nDual energy CT perfusion in pancreatic carcinoma\nM. Klauß, W. Stiller, M. Kieser, J. Werner, H.U. Kauczor,  \nL. Grenacher; Heidelberg/DE\nPurpose: The purpose of this study was to evaluate the feasibility of dual-\nenergy (DE)-CT perfusion in pancreatic carcinoma.\nMaterial and Methods: A total of 21 patients with histologically proven \npancreatic carcinoma were examined prospectively with a 64-slice dual-\nsource CT using a dynamic sequence of 34 acquisitions (80/140 kV~p~; \n270/49 mAs; collimation of 14×1.2 mm) every 1.5 s after i.v. injection of 80 ml \nof iodinated contrast material (370 mg/ml, flow rate 5 ml/s). Image data of 80 \nkV~p~ and linearly blended 120 kV~p~-equivalent (M0.3) DE-perfusion \nacquisitions were evaluated with a body-perfusion CT tool (Siemens Medical \nSolutions, Erlangen, Germany) for estimating perfusion, permeability, and \nblood volume and parameter maps. These parameters were calculated to \nROIs in carcinoma and healthy tissue.\nResults: In all 21 patients, DE-CT perfusion was feasible, and tumor as well as \nhealthy tissue was covered. All carcinomas could clearly be identified in the \ncolor-coded perfusion maps. Calculated values of perfusion, permeability and \nblood volume were lower in pancreatic carcinomas compared to healthy \npancreatic tissue - 120 kV~p~-equivalent (M0.3): 0.23 ± 0.03 vs. 0.88 ± 0.04 \nmin[-1] (p < 0.0001); [0.49 ± 0.07] vs. [0.66 ± 0.06]*0.5 min[-1] (p = 0.06), and \n0.44 ± 0.06 vs. 1.22 ± 0.12 min[-1] (p < 0.0001); 80 kV~p~: 0.22 ± 0.04 vs. 0.81 \n± 0.05 min[-1] (p < 0.0001), [0.37 ± 0.04] vs. [0.70 ± 0.05]*0.5 min[-1] (p < \n0.0001), and 0.51 ± 0.08 vs. 1.37 ± 0.18 min[-1] (p = 0.0001). There were no \nsignificant differences between 120 kV~p~-equivalent and 80kV~p~-DE-\nacquisition regarding the difference between healthy and carcinoma tissue \n(perfusion: 0.65 ± 0.05 vs. 0.59 ± 0.06 min[-1] (p = 0.47), permeability: [0.17 ± \n0.09] vs. [0.33 ± 0.08]*0.5 min[-1] (p = 0.21), blood volume 0.79 ± 0.13 vs. 0.86 \n± 0.17 (p = 0.72).\nConclusion: DECT perfusion of the pancreas is feasible. Use of 120 kV~p~-\nequivalent DECT perfusion image data combines the advantages of increased \n(iodine) contrast at low kV~p~ (80) with the low noise at high kV~p~ (140) and \ncould improve the delineation of pancreatic carcinomas in clinical use.\nSS 8.05\nNew CT findings in severe acute pancreatitis that \ncorrelate with clinical outcome\nK. Sandrasegaran, B. Tahir, M. Tann, T. Howard; \nIndianapolis, IN/US\nPurpose: Recently, new concepts of severe acute pancreatitis (SAP) have \nemerged, including disconnection of main pancreatic duct and peripancreatic \nfat necrosis. We wanted to determine which imaging criteria best predicted \nmedium-term outcome (<6 months) in SAP .\n11:00 - 12:30 Sidlaw\nScientific Session 8\nPancreatic CT\nSS 8.01\nIntraductal papillary mucinous neoplasm with an \nassociated invasive carcinoma:   image findings and \ndiagnostic performance of MDCT for important \nprognostic factors\nJ.H. Kim, H.W. Eun, J.Y . Lee, J.M. Lee, J.K. Han, B.I. Choi; \nSeoul/KR\nPurpose: Approximately, 30% of Intraductal papillary mucinous neoplasm \n(IPMN) have an associated invasive carcinoma (IPMC). To investigate imaging \nfindings and diagnostic accuracy of MDCT for important prognostic factors in \nsurgically proven IPMC.\nMaterial and Methods: During 10 years, 38 patients with surgically proven \nIPMC were included in the study. Two radiologists retrospectively accessed \nmorphological types, tumor size, duct size and mural nodule. They also \naccessed T and N stage and graded perineural invasion focus on five routes: \nplexus pancreaticus capitalis-I,R1; PLX-II, R2; along gastroduodenal artery, \nR3; along splenic artery, R4; posterior of pancreatic body, R5. Statistical \nanalyses were performed using ROC analysis, McNemar test and Fisher’s \nexact test. The \u0003 statistics was used for interobserver agreement.\nResults: Morphological types included main duct (29%), combined (47%) and \nbranch duct (24%). Tumor size (3.9 + 2 cm) on CT was not statistically different \nfrom pathologic size (3.8 + 2 cm, p = 0.582). The main duct was 11.5 + 6.2 mm. \nMural nodule was detected in 74%. Accuracy for the T stage was 73.7% and \n68.4% and N stage was 68.4% and 76.3% with moderate agreement (\u0003 = \n0.636, \u0003 = 0.708). AUC (Az) for perineural invasion was 0.868 and 0.821. The \nsensitivity, specificity and positive predictive value were 100%, 71.4% and \n55.5%, and 90%, 71.4% and 52.9%. Interobserver agreement was moderate \n(\u0003 = 0.659). Cancer located in the head commonly invades route 1 to 3, whereas \ncancer in the body and tail commonly invades route 4 or 5 (p = 0.002).\nConclusion: Main duct dilatation and mural nodule are common findings for \nIPMC. CT plays major roles in IPMN, not only in differentiating IPMC but also \npredicting important prognostic factors.\nSS 8.02\nDiagnostic performance of MDCT for prediction of \nimportant prognostic factors in resectable pancreatic \ncancer\nJ.H. Kim, S.H. Kim, H.W. Eun, J.Y . Lee, J.M. Lee, J.K. Han, \nB.I. Choi; Seoul/KR\nPurpose: T-stage, N-stage, tumor size, vascular invasion and perineural \ninvasion are most important prognostic factors for resectable pancreatic \ncancer. The purpose was to investigate the diagnostic accuracy of MDCT for \nthese prognostic factors.\nMaterial and Methods: This study group consisted of 111 patients with \nsurgically resected pancreatic cancer who underwent preoperative dynamic \nCT during 10 years. Two radiologists retrospectively and independently \naccessed T-, N-stage, size, vascular invasion and graded perineural invasion \nusing three-point scale focus on 5-routes; plexus pancreaticus capitalis I, R1; \nPLX-II, R2; along the gastroduodenal artery, R3; along the splenic artery, R4; \nposterior region of pancreatic body, R5. Statistical analyses were performed \nusing the ROC analysis, McNemar test, paired T-test and Fisher’s exact test. p \nvalue < 0.05 was considered significant. The \u0003 statistics was used to determine \ninterobserver agreement.\nResults: The accuracy for T-stage was 82.9% and 77.5% with moderate \ninterobserver agreement (\u0003=0.732). The accuracy for node metastasis was \n59.5% and 55.0% with fair agreement (\u0003=0.597). Diagnostic accuracy for \nvascular invasion was 94% and 92%. The Az for diagnostic performance \nregarding perineural invasion was 0.733 and 0.66 with moderate agreement \n(\u0003=0.770). The cancer located in head commonly invade routes 1-3, whereas \ncancer located in body and tail commonly invade route 4 or 5 (p<0.0001). \nTumor size on surgical specimen (3.4cm+1.46) is statistically larger than tumor \nsize on CT (3.2cm +1.41, p=0.001). The nodular growth pattern was statistically \nlarger than tumor size on CT (p=0.013).\nConclusion: CT is very useful for preoperative evaluation of T-stage, perineural \ninvasion, and vascular invasion in pancreatic cancer, but limited evaluation for \nN-stage. CT, which plays a major role in patient with pancreatic cancer, not \nonly accesses preoperative respectability by means of T-stage and vascular \ninvasion, but also predicts important prognostic factors.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / THURSDAY, JUNE 14, 2012\n S477\nConclusion: Our study confirms in a large series of patients that the previously \ndescribed MDCT criteria are seen in most cases. Yet, conversely to pathological \nhypothesis, we have not shown a strong association between CDHP and \nminor papilla abnormalities.\nSS 8.08\nCan MDCT predict the resection status after \npancreaticoduodenectomy   for pancreatic \nadenocarcinoma?\nO. Zakharova, G.G. Karmazanovsky; Moscow/RU\nPurpose: The completeness of resection for pancreatic cancer (PC) has a \npowerful prognostic significance for recurrence and survival. 3D-CT is an \naccurate predictor of resectability for PC. The aim is to figure out whether it \ncan prevent an R+ resection.\nMaterial and Methods: Retrospective analysis of CT scans and \npathohistological reports of 89 cases of PC after Whipple procedures was \nperformed. We conducted a comparative analysis of demographic, clinical, \nintraoperative and pathologic characteristics of the two groups of patients: \nwith R0 and R1 resections. The tested specifications included: sex, age, size \nof tumor (CT and morphology), TNM stage, evaluation of vessel involvement \n(using 3D reconstructions) and tumor grade.\nResults: R0 resections were found in 76 (85.4%) patients (group A). R1 surgical \nmargins were detected in 13 (14.6%) cases (group B). There were no R2 \nresections in our study. The accuracy of 3D-CT in determining an R0 resection \nwas 85%. Patients who underwent vascular resections were more likely to \nhave had an R1 resection. In group B, the average size of tumor was 30.4 ± 3,7 \nmm (p < 0.05); four (30.8%) patients had circumferential involvement of a \nmajor vessel of more than 180 degrees (p < 0.05).\nConclusion: MDCT is the most reliable method used for PC staging. In up to \n15%, irresectability is only seen during surgery. 3D-CT imaging increases the \ndiagnostic accuracy of vascular invasion. To avoid unnecessary laparotomies, \nit is important to properly interpret CT data.\nSS 8.09\nAcute pancreatitis: evaluation by using diffusion-\nweighted MR imaging with parallel imaging technique \nand multiple b gradient factor values\nP . Boraschi, F . Donati, R. Gigoni, G. Gherarducci, F . Pacciardi, \nF . Falaschi, C. Bartolozzi; Pisa/IT\nPurpose: To determine the usefulness of diffusion-weighted MR imaging (DW-\nMRI) with parallel imaging technique and multiple b-gradient-factor values in \npatients with acute pancreatitis (AP).\nMaterial and Methods: A series of 25 patients with clinical diagnosis of AP \nunderwent MR imaging with 1.5 T device (Signa HDxt,GE Healthcare). After the \nacquisition of axial T1/T2w sequences and coronal MRCP , DW-MRI was \nperformed using an axial breath-hold single-shot spin-echo echo-planar \nsequence (parallel imaging factor,3); the values of b-factor were set at 0, 300, \n500, 700 and 1000s/mm[2]. All DW images were blindly interpreted. Qualitative \nevaluation was performed by consensus reading of two reviewers who \nevaluated the presence or absence of AP and complications. Quantitative \nevaluation was performed by two other radiologists in conference who \ncalculated mean ADC values for each patient using a b-value of 500s/mm[2].\nResults: DWI could detect acute pancreatitis as persistent bright signal \nintensity at different b-gradient-factor values. The reviewers were able to \ndifferentiate inflammation from necrotic and hemorrhagic tissue and identified \npossible causes of AP (choledocholithiasis and pancreas divisum) on MR \nimages in 11/25 cases. Furthermore, the mean pancreatic ADC value in the AP \ngroup was significantly lower than in the normal control group (p less than \n0.05).\nConclusion: DW-MRI with parallel imaging technique and multiple b-gradient-\nfactor values can assess the manifestations of acute pancreatitis using no \ncontrast material and has the potential of becoming a powerful tool for the \nevaluation and follow-up of these patients.\nSS 8.10\nDoes image registration influence tumour perfusion \nvalues?\nS. Kandel\n1, H. Meyer2, P . Rogalla1;  1Toronto, ON/CA, 2Berlin/DE\nPurpose: To evaluate whether image registration in CT perfusion influences \nperfusion values in pancreatic cancer.\nMaterial and Methods: A total of 23 patients with pancreatic cancer underwent \nperfusion CT imaging of the pancreas on a 320-slice dynamic volume CT \nscanner (Toshiba) using 16 cm detector coverage with 0.5 mm primary slice \nthickness. The dynamic CT protocol consisted of 17 low-dose volumetric scans, \nMaterial and Methods: A total of 61 patients with SAP were retrospectively \nevaluated for site, presence and % volume of pancreatic and peripancreatic \nfat necrosis and signs of infection. The imaging findings were correlated with \nthe occurrence of mortality (n = 2), systemic morbidity (organ failure, DIC) (n = \n36), local morbidity (persistent pancreatic fistula, colonic perforation) (n = 25), \nlength of hospital stay and number of surgical operations required. Multivariate \ngeneralized linear model analysis was performed.\nResults: The mean age was 48.1 years (range 18 to 81), and there were 37 \nmales and 24 females. Local morbidity was correlated significantly with the \npresence of main duct disconnection (p = 0.04), peripancreatic fat necrosis (p \n= 0.02) and size of collection > 10 cm (p = 0.01). Initial length of stay correlated \nwith necrosis of >30% of pancreas (p = 0.01), and presence of duct \ndisconnection (p = 0.05). Number of operations required correlated with duct \ndisconnection (p = 0.03). CT findings did not correlate with mortality or \nsystemic morbidity.\nConclusion: The presence of peripancreatic fat necrosis >10 cm in the widest \ndimension and main duct disconnection significantly affect medium-term \nmorbidity and need to be included in radiology reports, in addition to the extent \nof glandular necrosis.\nSS 8.06\nCorrelation of CT scores and acute kidney injury in \nsevere acute pancreatitis\nZ. Li, B. Song; Chengdu/CN\nPurpose: To investigate the correlation between MDCT severity scores and \nthe presence of acute kidney injury (AKI) in patients with severe acute \npancreatitis (SAP).\nMaterial and Methods: 119 SAP patients with confirmed AKI in 42 were \nretrospectively included. Contrast-enhanced MDCT scan was performed for \nall patients and 75 had repeated CT scans. The imaging findings including \npancreatic size, necrosis, retroperitoneal inflammatory exudation, and other \norgan involvements were observed, based on which Balthazar’s CT score, CT \nseverity index (CTSI) and extrapancreatic inflammation on CT (EPIC) score \nwere calculated. The correlation between CT Severity indexes, clinical scores \n(APACHE II and Ranson Score) and final clinical outcomes were statistically \nanalyzed.\nResults: SAP patients with AKI were associated with markedly increased \nincidence of multiple organ dysfunction (88.1%) and high mortality (47.6%). \nUnclear delineation between renal cortex and medulla, and pancreatic/\nperipancreatic hemorrhage suggested AKI. In SAP patients with AKI, the CT \nseverity indexes showed significantly closer correlation with APACHE II and \nRanson scores than in patients without AKI. EPIC score showed the largest \narea under the ROC curve (AUC = 0.903) than CTSI (AUC = 0.721) and \nBalthazar scores (AUC = 0.571). CT findings of exudates reduction and \nencapsulation were predictive for AKI recovery.\nConclusion: EPIC score is better correlated with clinical scores in predicting \nthe presence of AKI in SAP patients; however, it is significantly less sensitive \nthan APACHE II Score in reflecting the dynamic changes of AKI.\nSS 8.07\nCystic dystrophy in heterotopic pancreas: MDCT \nfindings in a large series and possible association with \nminor papilla abnormalities\nM. Wagner, M. Vullierme, V. Rebours, P . Ruszniewski,  \nV. Vilgrain; Clichy/FR\nPurpose: Cystic dystrophy in the heterotopic pancreas (CDHP) is a \ncomplication of pancreatic heterotopia mostly associated with alcoholism. The \npurpose was to describe MDCT features of CHDP and to analyze its association \nwith minor papilla abnormalities as described by Klöppel in 2007.\nMaterial and Methods: A total of 82 patients, with a CDHP confirmed on \nendoscopic ultrasonography and a triple-phase MDCT on the upper abdomen, \nwere retrospectively included. The following imaging findings were recorded: \nsize and location of cysts, duodenal wall thickness, pancreatic abnormalities \nand inflammatory changes.\nResults: Typical findings of CDHP were observed in 95% (78/82). Among \nthem, CDHP was mostly located in the second part of the duodenum (72/78, \n92%). Mean thickness of the duodenal wall was 22.6 mm. Cysts were multiple \nin 90%, (mean number 2.9) and measured between 2 and 60 mm. Pancreas \nabnormalities were depicted in 74.5% (58/78) (calcifications: 10% (8/78), \ndilatation of main pancreatic duct in 15.5% (12/78) or both in 49% (38/78)). \nSantorini duct dilatation and/or calcification in minor papilla was present in \n35% (27/78). Calcifications in the minor papilla without calcification in the \nmajor papilla were only observed in three patients (4%). Inflammatory changes \nwere found in 88.5% (69/78).\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / THURSDAY, JUNE 14, 2012\n S478\nResults: All examinations were technically feasible and well tolerated. The \nmean image quality for the automated processed examinations was rated \nhigher for all categories and showed statistically significant difference in \nassessment of image contrast (mean~automated~ 4.6 vs. mean~manual~ 4.1) \nand presentation of target organ (mean~automated~ 4.4 vs. mean~manual~ \n4.0) (p < 0.05). The diagnostic confidence was 4.6/3.9 (p < 0.05), respectively. \nMean examination time was 25.24 min in the automatically and 21.05 min in \nthe manually processed examinations.\nConclusion: Despite higher examination time, the automated MR scanner \nuser interface shows an increase in image quality and diagnostic confidence. \nThe innovation of new optimized MR sequences should carry the potential for \ntime-saving strategies.\nSS 9.03\nDifferentiating small \u0001I 1 cm) focal liver lesions as \nmetastases or cysts by means of computed \ntomography: a case study to illustrate a fuzzy logic-\nbased method to quantify uncertainty in radiological \ndiagnosis\nR. Girometti\n1, F . Fabris2, A. Sgarro2, S. Pullini1, G. Zanella3, \nG. Como1, L. Cereser1, C. Zuiani1, M. Bazzocchi1;  1Udine/IT, \n2Trieste/IT, 3Palmanova/IT\nPurpose: To illustrate a fuzzy logic-based method to quantify uncertainty in \nradiological diagnosis.\nMaterial and Methods: We enrolled 22 oncologic patients with 50 focal liver \nlesions \u00021 cm detected at 64-row computed tomography (CT), proven to be \ncysts (n = 20) or metastases (n = 30). Two readers with 15 (R1) and 5 (R2) years \nof experience independently reviewed CT images. For each lesion, they \nexpressed the diagnosis of metastasis as a certainty level (C) within the interval \n[0,1] (certainty in the alternative diagnosis of cyst was assumed to be 1-C). \nAfter cross-tabulating data according to the gold standard, table cells were \nconsidered as fuzzy subsets and complementary certainty values as their \ndegrees of memberships. Accordingly, we estimated per-lesion diagnostic \nperformance of readers both on usual crisp (C \u0003 0.51) and fuzzy basis.\nResults: Uncertainty mainly increased the crisp subset of false-positive cases: \nfrom 0 to 0.8 (R1) and from 1 to 2.4 (R2). The difference between crisp and \nfuzzy diagnostic performance was larger for the less experienced reader: \nsensitivity, specificity, PPV, NPV and accuracy were 90.0, 100, 100, 87.0 and \n94.0% versus 90.0, 96.0, 97.1, 86.5 and 92.4% for R1 and 93.3, 95.0, 96.6, \n90.5 and 94% versus 94.0, 88.0, 92.1, 90.7 and 91.6% for R2, respectively.\nConclusion: Radiological diagnosis can be expressed as a fuzzy degree \nmembership to weight the impact of readers’ uncertainty on crisp diagnostic \nperformance. One potential application is to test the readers’ competency.\nSS 9.04\nIn vivo and ex vivo intravoxel incoherent motion and \ndynamic contrast-enhanced MRI in pancreatic ductal \nadenocarcinoma: correlation with histologic parameters\nP . Lucchesi, M.A. Bali, T. Metens, P . Demetter, L. Verset,  \nC. Matos; Brussels/BE\nPurpose: To quantify changes in dynamic contrast-enhanced (DCE)-MR \nperfusion and intravoxel incoherent motion-diffusion coefficients obtained in \npancreatic ductal adenocarcinoma (PDA) in vivo and IVIM-diffusion coefficients \nex vivo. To determine whether these quantitative parameters correlate to each \nother and if there is a correlation between IVIM-diffusion coefficients and \nfibrosis or microvascular density (MVD).\nMaterial and Methods: DCE-MR perfusion and IVIM (9 b value) were performed \nat 1.5 T in ten patients with PDA. IVIM was repeated on specimens after surgery. \nThe ADC, the perfusion fraction f and the pure diffusion D were calculated in vivo \nand ex vivo. The obtained values were tested for significant differences between \nin vivo and ex vivo and were correlated with fibrosis content and MVD counts. \nDCE-MR quantitative parameters derived from one-compartment (OC) and two-\ncompartment (TC) models were correlated with IVIM parameters.\nResults: The in vivo signal decay was biexponential, whereas the ex vivo \nsignal decay was monoexponential. In comparison to in vivo measurements, a \nsignificant reduction of f, D and ADC was found in ex vivo PDA (p = 0,05). No \ncorrelation between DCE-MR perfusion and IVIM parameters was found. IVIM \nparameters were not significantly correlated with fibrosis and MVD.\nConclusion: In PAD, in vivo ADC values are strongly influenced by perfusion. \nQuantitative DCE-MR perfusion parameters and IVIM parameters most \nprobably represent different physiological processes and in our series no \nsignificant correlation with MVD or fibrosis could be demonstrated.\nacquired over 66 seconds during 3 breath-hold periods. Rigid image registration \nwas performed by using the volume with the highest aortic attenuation as \nreference. All other volumes were visually matched with the pancreatic lesion \nserving as the volumetric region of interest. Following registration to correct for \nmotion, maximum-slope and Patlak analysis technique were applied. Values for \ntumour perfusion and blood volume before and after volume registration were \nstatistically compared using the paired T test.\nResults: The average ROI used for analysis was 79 mm[2]. Tumour perfusion \nand blood volume were 0.37 ml x 100 ml[−1] x min[−1] (SD: 0.05) and 36.7 \nml/100 mg (SD: 22.9) without, and 0.33 ml x 100 ml[−1] x min[−1] (SD: 0.02) \nand 18.8 ml/100 mg (SD: 7.17) with image registration, the difference was \nstatistically not significant for maximum slope perfusion (10.8%), but significant \nfor blood volume (48.9%, p < 0.001).\nConclusion: Image registration influences perfusion results in pancreatic \ncancer dependent on the analysis technique and degree of volumetric \nmisregistration from breathing motion, and thus may be recommended in \nupper abdominal perfusion imaging.\n11:00 - 12:30 Tinto\nScientific Session 9\nGI MRI & CT\nSS 9.01\nPreliminary study on the optimal acquisition time for \nhepatobiliary phase MR imaging enhanced with Gd-\nBOPTA\nF . Yuan, B. Song; Chengdu/CN\nPurpose: The purpose of this study was to investigate the optimal acquisition \ntime for Gd-BOPTA-enhanced hepatobiliary phase MR imaging in healthy \nvolunteers with normal liver function.\nMaterial and Methods: A total of 48 healthy volunteers (29 males, 19 females) \nwere recruited. They were scanned using a 3.0 T MR system with gradient-\necho 3D fast acquisition sequence prior to and at 40 min, 60 min and 90 min, \nrespectively, after injection of Gd-BOPTA. The SNR, CR, %Enhancement~SNR~ \nand %Enhancement~CR~ of liver, left/right hepatic duct, gallbladder and \ncommon bile duct were measured in each phase and statistically analyzed \nusing repeated measures ANOVA.\nResults: (1) The SNR and CR of liver and left hepatic duct showed the highest \nvalue at 60 min after Gd-BOPTA injection, while at 90 min for gallbladder and \ncommon bile duct (p < 0.05). There were no significant differences for SNR and \nCR of right hepatic duct among the three delay times (p = 0.61 and p = 0.69), \nbut the highest mean value still appeared at 60 min. (2) The %Enhancement~SNR~ \nand %Enhancement~CR~ of liver and left/right hepatic duct showed the \nhighest value at 60 min after injection, while at 90 min for gallbladder and \ncommon bile duct. However, only %Enhancement~SNR~ and \n%Enhancement~CR~ of gallbladder and %Enhancement~SNR~ of common \nbile duct showed statistical significance.\nConclusion: For individuals with normal liver function, the optimal acquisition \ntime to obtain hepatobiliary phase images of liver and hepatic duct after \ninjecting Gd-BOPTA is at 60 min, while that for gallbladder and common bile \nduct is at 90 min.\nSS 9.02\nPotential benefits from a novel automated MR scanner \nsoftware interface in liver MR imaging in terms of \nexamination efficiency and image quality\nC. Kloeters\n1, L. Umutlu1, C. Mönninghoff1, A. Sombetzki2,  \nG. Antoch2, M. Schlamann1, M. Forsting1, T.C. Lauenstein1;  \n1Essen/DE, 2Düsseldorf/DE\nPurpose: To analyze an automated MRI algorithm in patients with contrast-\nenhanced liver examinations in terms of examination efficiency and image \nquality.\nMaterial and Methods: Seventy-eight patients (34-75 years, mean: 53.2 \nyears) were prospectively included in the study and randomized to one of the \nfollowing scanners: 1.5 T MAGNETOM Aera including a completely automated \nuser interface or a 1.5 T MAGNETOM Avanto with manually operated scanner \nsoftware. Two blinded readers rated the image quality of the contrast-enhanced \nMR liver examination in terms of angulations/FOV, image contrast, image \nnoise, artifacts and presentation of the target organ from “excellent” (5) to \n“insufficient” (1). The degree of diagnostic confidence to depict liver lesions \nwas rated from “certain” (5) to “uncertain” (1). Additionally, total examination \ntime was recorded. A Chi-square and U test were used for analysis.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / THURSDAY, JUNE 14, 2012\n S479\nresponders (n = 12) compared with poor responders (n = 18) (25.90% ± \n25.58% vs. 9.99% ± 15.83%, P < 0.05), yielding AUC = 0.752 when ROC curve \nwas drawn. The best cutoff value was 10% increase for early ADC change, and \nthe sensitivity and specificity to find good responders were 75% and 72.2%. \n8/9(88.9%) patients with decreased ADC value at the 1st week were poor \nresponders. All four (100%) patients with early tumor wall thickness decreasing \n\u000310% were good responders.\nConclusion: Change of ADC value as early as 1st week was found following \ntreatment related with tumor regression at the end of short-term treatment in \nGI cancer patients. Early changes of ADC value and tumor wall thickness can \nhelp to pick up some good/poor responders. This project is supported by the \nNational Natural Science Foundation of China, No. 81071129.\nSS 9.08\nNon-occlusive mesenteric ischemia: CT features and \ntheir prognostic values\nM.A. Mazzei, F .G. Mazzei, G. Imbriaco, S. Guerrini,  \nE. Foderà, M. Centra, D. Marrelli, L. Volterrani; Siena/IT\nPurpose: Non-occlusive mesenteric ischemia (NOMI) is the most lethal form of \nacute mesenteric ischemia (58-70%) because of the poor understanding of its \npathophysiology, its mild and nonspecific symptoms and signs at imaging, \nwhich often delay the diagnosis. The purpose of our work has been to evaluate \nCT appearances in 16 patients with NOMI, to recognize their CT characteristic \nfeatures and their prognostic values.\nMaterial and Methods: Twenty-two abdominal CT examinations of 16 patients \n(14 males and 2 females, mean age of 73 years, range 49-88) with a confirmed \ndiagnosis of NOMI were retrospectively reviewed , randomly and individually \nby two radiologists (with 9 and 3 years’ experience in abdominal imaging, \nrespectively) to evaluate mesenteric findings (mesenteric vessel caliber: \nnormal, increased, reduced; fat stranding; fluid; pneumatosis), vessel features \n(diameter of superior mesenteric artery, superior mesenteric vein and inferior \nvena cava), loop findings (thickness and degree of attenuation of bowel wall; \ncontent: gasless or dilated; pneumatosis of bowel wall) and findings of \nperitoneal cavity (fluid and air).\nResults: Global mortality was 50% (8/16 patients). The reduction of caliber of \nmesenteric vessels and the paper thin appearance of bowel walls were significantly \nassociated with higher mortality (p = 0.05 and p = 0.084, respectively).\nConclusion: Considering its characteristic features, the CT evaluation of \npatients with a clinical suspicion of NOMI could be useful to provide possible \nprognostic information.\nSS 9.09\nMRI in the evaluation of acute abdominal pain\nS. Byott1, I. Harris2;  1Manchester/UK, 2Preston/UK\nPurpose: To analyse the diagnostic accuracy and efficacy of MRI in the diagnosis \nof patients under the age of 60 years presenting with an acute abdomen.\nMaterial and Methods: A 3-year prospective analysis from January 2009 to \nDecember 2011 was performed. Patients presenting with acute abdominal \npain were imaged using MRI when ultrasound was inappropriate or non-\ndiagnostic. Non-contrast HASTE coronal and axial sequences were performed. \nPatients presenting with renal colic were excluded. A minimum of 6-week \nfollow up was made, with correlation between MR findings and surgical data \nto ascertain diagnostic accuracy.\nResults: A total of 92 cases were included in the study. MRI was positive for \nacute surgical pathology in 19 patients and negative in 65, while 8 scans \ndemonstrated acute pathology not requiring surgery. In the MR-negative \ngroup, 59 were discharged without surgery, 6 had negative laparoscopy and 2 \nhad subsequent readmissions without requiring surgical intervention. In the \nMR-positive group, 17 patients had surgery confirming MR findings, while 2 \npatients were treated conservatively. Nine different types of pathology were \ndiagnosed by MRI including appendicitis, abdominal collections, caecal \nvolvulus, small bowel obstruction, large bowel obstruction, Crohn’s stricture, \nsplenic injury, colitis and pancreatitis. MRI demonstrated a 100% efficacy in \nterms of diagnosis of pathology requiring surgical intervention.\nConclusion: MRI is a safe, readily available and effective way to diagnose \nacute abdomen and should be the investigation of choice for patients of an \nage prone to radiation.\nSS 9.05\nParenchymal enhancement in MDCT of the abdomen: \niso-osmolar versus low-osmolar contrast media\nM. Rengo, D. Caruso, D. Bellini, M. Maceroni, C.N. De Cecco, \nM. Osimani, A. Laghi; Latina/IT\nPurpose: To evaluate if a noninferior liver and pancreas parenchymal \nenhancement can be obtained injecting an iso-osmolar contrast at a lower \niodine dose than a low-osmolarity contrast medium.\nMaterial and Methods: A total of 120 patients were prospectively randomized \ninto two groups. Group A received 650 mgI/kg of (lean body weight) LBW of \niodixanol [320]. Group B received 750 mgI/kg of LBW of iomeprol [400]. \nAttenuation values were measured at the level of the aorta, portal vein, liver \nand pancreas parenchyma on unenhanced, portal and equilibrium enhanced \nphases. A noninferiority analysis and analysis of variance (ANOVA) were \nperformed to compare the two groups.\nResults: A total of 56 patients were included in group A and 57 in group B. No \nsignificant differences were found between the two groups for liver and \npancreas parenchymal enhancement. Mean liver CEI values for group A and B \nwere respectively 51.8 (± 7.8) and 50.4 (± 10.9), during portal phase, and 28.4 \n(± 6.7) and 32.8 (± 7.5), during equilibrium phase. Mean pancreas CEIs were \n44.4 (± 7.3) / 42.7 (± 11.6) and 29.1 (± 3.2) / 31.2 (± 8.9), respectively, for portal \nand equilibrium phases. No inferiority, in terms of contrast enhancement, \nresulted for the iso-osmolar CM compared to the low-osmolar one.\nConclusion: According to these results, we assume that a lower amount of \niso-osmolar CM may be injected to obtain an equal parenchymal enhancement \nof a low-osmolar CM.\nSS 9.06\nVisceral fat volume and its association with mesenteric \npanniculitis\nT. Meulman, N. Van Putte-Katier, O. Elgersma, T.R. Hendriksz; \nDordrecht/NL\nPurpose: Recent studies have improved the understanding of adipose tissue \nand its active role in inflammatory mesenteric and intestinal disease. Little is \nknown on the role of adipose tissue in the pathophysiology of mesenteric \npanniculitis. The purpose of this study was to determine whether increased \nmesenteric adipose tissue plays a role in mesenteric panniculitis.\nMaterial and Methods: As part of a large hospital-based prevalence study on \nmesenteric panniculitis, a nested case-control study was conducted. A total of \n94 patients (70% male) with mesenteric panniculitis were compared to 94 \nindividuals matched by gender and age. Total, subcutaneous and visceral fat \nvolumes were measured on 10 x 5 mm contiguous CT slices around the level \nof the umbilicus. A fat-density mask was constructed to include pixels with \nattenuation values ranging from -190 -to -30 Hounsfield units.\nResults: The mean age of individuals in both groups was 66,6 + 11,2 years. \nPersons with mesenteric panniculitis had a larger total fat volume (mean 2257 \nml vs. 2121 ml, p = 0.038), visceral fat volume (mean volume 1037 ml vs. 923 \nml, p = 0.024) and borderline significant higher BMI (26,9 kg/m[2] vs. 26,2 kg/\nm[2], p = 0.061). Subcutaneous fat volume was not significantly different \nbetween groups.\nConclusion: Significant higher levels of visceral fat exist in patient with \nmesenteric panniculitis compared to individuals without mesenteric \npanniculitis. Further research is necessary to correlate these findings to the \nendocrine and metabolic functions of visceral fat in mesenteric panniculitis.\nSS 9.07\nApparent diffusion coefficient and tumor wall thickness \nin short-term treatment evaluation of gastrointestinal \ncancers: value of early changes on MR imaging\nK. Cao, L. Tang, N. Wang, X. Li, Y . Sun, Y . Li, X. Zhang; \nBeijing/CN\nPurpose: To assess the early changes of apparent diffusion coefficient (ADC) \nand tumor wall thickness on MRI during treatment of gastrointestinal (GI) \ntumors, and investigate their abilities in short-term treatment evaluation.\nMaterial and Methods: A total of 30 newly diagnosed GI cancer patients who \nsubsequently received chemotherapy or chemoradiation therapy were enrolled. \nMR scans were performed before, 1st week and 4-6th week after therapy \nstarted. Tumor wall thickness and ADC value were measured. Those with \n\u000330% regression in tumor wall thickness post-treatment were regarded as \ngood responders. ROC were used to evaluate the abilities of ADC and \nthickness in differentiating good/poor responders.\nResults: ADC values increased significantly at both early and post-treatment \npoints (P < 0.05). Tumor wall thickness showed significant decrease at the later \nperiod. On early MRI, greater increase in ADC value was found in good \n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / THURSDAY, JUNE 14, 2012\n S480\n11:00 - 12:30 Moorfoot\nScientific Session 10\nHepatocellular carcinoma\nSS 10.01\nThe value of gadobenate dimeglumine-enhanced MR \nimaging with dynamic and hepatobiliary phases in the \ncharacterization of small (\u00022cm) nodular hepatic arterial \nphase enhancing: only lesions identified at contrast-\nenhanced CT in liver cirrhosis\nE. Quaia, L. De Paoli, E. Pantano, B. Cabibbo, M.A. Cova; \nTrieste/IT\nPurpose: The purpose of this study was to assess the value of gadobenate \ndimeglumine (Gd-BOPTA)-enhanced MR imaging in the characterization of \nsmall (\u00022cm) nodular hepatic arterial phase enhancing (HAPE), only lesions \nidentified at contrast-enhanced CT in patients with liver cirrhosis.\nMaterial and Methods: This prospective study was approved by the ethics \ncommittee and informed consent was obtained from all patients. We recruited \n125 cirrhotic patients (age: 68 ±12.36 years) who revealed up to five HAPE, \nonly nodular lesions (\u00022cm) at contrast-enhanced CT. All patients were \nscanned by MR imaging before and after Gd-BOPTA injection during hepatic \narterial (HAP), portal venous (PVP), equilibrium (EP), and hepatobiliary phase \n(HP). Lesion characterization was based on MR imaging features considered \ntypical for hepatocellular carcinoma (HCC) (n=34), imaging follow-up (n=105), \nor histology (n=12). Two experienced radiologists (5 and 10 years) analyzed the \nMR images in consensus, and multivariable logistic regression was conducted \nto test the significance of the MR image findings with HCC diagnosis.\nResults: One hundred fifty-one HAPE-only lesions were identified, including \n115 benign nodules and 36 HCCs. PVP-EP washout and HP hypointensity not \ncombined (OR 263.48, 95% confidence intervals, CIs: 25.14–2761.25; P<.05) \nor combined with T2 hyperintensity (OR 327.43; 95% CIs: 28.19–3802.23; \nP<.05) or HAP hyperintensity (OR 256.43; 95% CIs: 24.49–2685.65; P<.05) on \nmultivariable analysis were related to malignancy diagnosis.\nConclusion: Small HAPE-only lesions in cirrhotic patients are mainly benign \nand may be characterized by Gd-BOPTA-enhanced MR imaging.\nSS 10.02\nC-arm CT tumour-to-liver contrast in patients with HCC: \nintraindividual comparison of three protocols\nC. Koelblinger, W. Schima, V. Berger-Kulemann, J. Lammer; \nVienna/AT\nPurpose: The purpose of this study was to compare the effect of three different \nprotocols on the tumour-to-liver contrast (TLC) of HCCs using C-arm CT \n(CACT).\nMaterial and Methods: After signed informed consent, 16 patients (15 male, 1 \nfemale; mean age 65 years), treated with TACE for HCC, were included in this \nprospective IRB approved study. Three different CACT protocols were acquired in \neach patient in random order. Therefore, a 5F catheter was placed in the common \nhepatic artery and diluted (100 mg iodine/ml) contrast medium (CM) was injected \nwith a flow of 4 ml/s. With the early acquisition, CACT protocol (EA) acquisition, \nwhich lasted 8 s, started 4 s after the start of contrast medium application (total CM: \n48 ml). With the intermediate acquisition, CACT protocol (IA) acquisition started with \na delay of 8 s (total CM: 64 ml). With the late acquisition, CACT protocol (LA) \nacquisition started with a delay of 12 s (total CM: 80 ml). One experienced radiologist \nmeasured the TLC by placing ROIs within the liver parenchyma and the tumor. A \ntotal of 33 HCCs, which had been proven by pre-interventional MDCT or MRI, were \nevaluated. Univariate analysis of variance was used for statistical analysis.\nResults: Mean TLC was 184 HU for EA, 254 HU for IA, and 245 HU for LA. IA \nand LA were significantly superior to EA (p<.01).\nConclusion: Compared to 4 s delay, TLC of HCC using CACT is significantly \nimproved using 8 s or 12 s delay.\nSS 10.03\nDual-energy CT for detection of hepatocellular \ncarcinoma (HCC) incidentally diagnosed during \npathological workup in patients with liver cirrhosis after \nliver transplantation\nC.M. Sommer, J. Schmoee, T. Longerich, P . Schirmacher,  \nM. Mieth, P . Schemmer, N. Bellemann, U. Stampfl,  \nH.U. Kauczor, B. Radeleff, W. Stiller; Heidelberg/DE\nPurpose: The purpose of this study was to quantitatively define image quality \nof contrast-enhanced dual-energy CT for detection of hepatocellular carcinoma \n(HCC) incidentally diagnosed during pathological workup in patients with liver \ncirrhosis after liver transplantation.\nSS 9.10\nAbdominal and soft tissue abscess: diagnostic ultility of \ndiffusion-weighted MRI in children and young adults\nH. Neubauer, I. Platzer, V. Mueller, T. Meyer, J. Liese,  \nH. Koestler, D. Hahn, M. Beer; Wuerzburg/DE\nPurpose: To evaluate detectability and imaging characteristics of abscess \nformations on diffusion-weighted MRI (DWI) in children and young adults.\nMaterial and Methods: Seventeen patients (11 females, age 13 ± 6 years, \nrange 1 - 21 years) with suspected abdominal or soft-tissue abscess underwent \nroutine MRI including diffusion-weighted free-breathing single-shot echo \nplanar imaging. Seventeen randomly chosen age-matched patients with non-\npurulent abdominal free fluid collections served as controls. Mean ADC values \nwere measured for abscess, muscle, liver, spleen and kidney tissue as well as \nfor various body fluids.\nResults: All abdominal (n = 9) and soft tissue (n = 8) fluid collections were \nidentified on diffusion-weighted images. Twelve of 13 confirmed abscess \nformations showed an ADC < 1.0 ×10[-3] mm[2]/s with a mean value of 0.80 ± \n0.38 mm[2]/s. One tuberculous soft-tissue abscess had a higher ADC of 1.85 \n×10[-3] mm[2]/s. There were no false-positive findings in the control group.\nConclusion: Diffusion-weighted MRI reliably detects fluid collections in \npaediatric patients and distinguishes between abscess and non-purulent fluid \ncollections. DWI facilitates free-breathing rapid image acquisition without the \nneed of i.v. contrast application and constitutes a particularly useful choice in \npaediatric imaging.\nSS 9.11\nComparison between opaque and transparent \ndistension of the colon in multidetectorCT enteroclysis \nin intestinal endometriosis detection\nE. Biscaldi, S. Ferrero, V. Remorgida, G.A. Rollandi;  Genoa/IT\nPurpose: To compare the effectiveness of two multidetectorCT enteroclysis \n(MDCTe) protocols, with opaque or transparent distension of the colon, in the \nassessment of nodule detection and in evaluation of intestinal infiltration.\nMaterial and Methods: A total of 96 consecutive patients (mean age 28 years), \nwith a strong suspicion of deep infiltrating endometriosis, were assigned \nalternatively to opaque (48)/transparent (48) colon distension.The intestinal \npreparation and CT protocol were standardised: contrast-enhanced MDCT (64 \nrows), portal phase. The opaque distension was performed by retrograde enema \nof tap water (2000 cc) with 80 cc of iodinated contrast (to reach a density of 250-\n300 HU), and the transparent distension was done with tap water alone.Two expert \nradiologists, blinded, investigated the intestinal nodule detectability (scoring \nnodules as ‘well’ or ‘not well’ detectable), and the colon (rectum/sigmoid/other \nsegments) infiltration. The diagnosis of infiltration was made on consensus. All \npatients underwent surgery and the results were compared to MDCTe.\nResults: Transparent MDCTe: the radiologists in 19/48 patients detected 17 \nsigmoid and 10 rectal nodules, 1 sigmoid polyp and 1 cecal lesion. All infiltrating \nnodules were scored as ‘well detectable’. At surgery, in 21 positive patients, \nMDCTe missed (3) small serosal nodules not infiltrating. Opaque distension \ndetected endometriosis in 18 patients, and 15 sigmoid and 9 rectal nodules. Three \nof 24 nodules scored as ‘not well detectable’ were misinterpreted, and 1 sigmoid \nnodule was missed. Sensibility, specificity, PPV and NPV were: in transparent \ndistension 91, 100, 100 and 93%; in opaque distension 82, 100, 100 and 87%. \nThe mean X-ray dose was similar in both protocols.\nConclusion: The transparent enteroclysis is more effective in parietal nodule \ndetection: the window between hypodense lumen and hyperdense wall highlights \nthe detectability of lesions. The hyperdense lumen in opaque distension limits \ndetection of both mucosa and small penetrating nodules.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / THURSDAY, JUNE 14, 2012\n S481\nConclusion: DWI is a useful imaging sequence for detection of HCC in \ncirrhosis. A correct prediction of the grade of HCC is not possible preoperatively \nbecause of the overlap of the ADC values.\nSS 10.06\nSingle-energy low-voltage arterial phase scanning \nincreases conspicuity of hypervascular lesions of the \nliver: an intra-patient study\nG.A. Zamboni, M.C. Ambrosetti, E. Zivelonghi, C. Cavedon, \nR. Pozzi Mucelli; Verona/IT\nPurpose: The purpose of this study was to compare a intra-patient single-\nenergy low-voltage arterial-phase protocol and a 120 kV protocol for detecting \nhypervascular focal liver lesions (hFLL).\nMaterial and Methods: 27 patients with chronic liver disease and \u00031 hFLL \nunderwent abdominal MDCT with 80 kV arterial phase (test group) on a 64-row \nscanner. This was compared to a previous 120 kV scan. Mean interscan \ninterval was 139 days; lesions were not treated between exams. Scans were \ncompared for attenuation and standard deviation in the liver, aorta and largest \nhFLL, image noise, CNR, CTDI and DLP (paired t-test). Effective dose for each \nprotocol was estimated with TLD measurements on an anthropomorphic \nphantom.\nResults: All scans were of diagnostic quality, according to the reporting \nradiologist. Mean attenuation was significantly higher at 80 kV than at 120 kV \nin aorta (501.7±148.3 vs 273.6±82.9 HU), liver (78.5±14.3 vs 60.9±11.9 HU) \nand hFLL (160.0±32.2 vs 107.9±23.2 HU; all p<0.0001). CTDI and DLP were \nsignificantly lower at 80 kV (6.4±0.4 vs 12.96±4.3 mGy and 194.3±27.5 vs \n405.4±117.4 mGy cm, respectively; all p<0.0001). Lesion conspicuity \n(HU~nodule~ -HU~liver~) was significantly higher at 80 kV (83.8±35.5 vs \n48.8±21.5 HU; p=0.0008). Mean image noise was significantly higher at 80 kV \n(12.3±3.6 vs 8.5±2.4 HU; p<0.0001). Lesion CNR was not significantly different \nbetween the two protocols. Estimated effective dose was significantly lower at \n80 kV (0.157 vs 0.201 mSv; p=0.0083).\nConclusion: The use of a 80-kV arterial phase protocol for abdominal CT \nincreases conspicuity of hFLL, possibly improving identification, while allowing \nsignificant dose reduction.\nSS 10.07\nValidation of diagnostic criteria using gadoxetic acid-\nenhanced and diffusion-weighted MR imaging for small \nHCC (\u00022.0 cm)\nS.H. Kim, W.J. Lee, M.J. Park, J. Hwang, M.H. Lee, J.H. Lim; \nSeoul/KR\nPurpose: The purpose of this study was to validate usefulness of MRI criteria \nusing combined gadoxetic acid-enhanced MRI and diffusion-weighted imaging \n(DWI) for diagnosis of small HCC \u00022 cm.\nMaterial and Methods: One hundred and eight patients who had pathologically \nproven 102 HCCs and 23 benign nodules (21 dysplastic nodules and 2 \nregenerative nodules, \u00022.0 cm) detected during surveillance with MDCT \nunderwent liver MRI including the gadoxetic acid-enhanced imaging and DWI. \nIndex MR criteria for HCC were: (1) arterial hyperenhancement and hypointensity \non hepatobiliary phase (HBP) with/without hyperintensity on DWI; (2) \nhypovascular nodule with hyperintensity on DWI; (3) arterial hyperenhancement \nand either iso- or hyperintensity on HBP , with hyperintensity on DWI and (4) \nhyperintensity only on DWI. According to the MR criteria, MRI findings for \nHCCs and benign nodules were independently classified by two reviewers.\nResults: On MDCT, 64 HCCs (62.7%) showed typical enhancement pattern for \nHCC. Eighty-three HCCs (82.4%) showed arterial hyperenhancement and \nhypointensity on HBP , and hyperintensity on DWI. For each observer, 101 \n(99.0%) and 100 HCCs (98.0%) were discernible with MR criteria, respectively. \nThree dysplastic nodules also fitted into MR criteria, thus specificity was \n90.9% for both observers. The remaining benign nodules were seen as \nhypointense only on HBP . The kappa value for two observers was 0.904 for \nlesion categorization, indicating excellent inter-observer agreement.\nConclusion: With the proposed HCC criteria based on combined gadoxetic \nacid-enhanced MRI and DWI, it is possible to reliably diagnose HCC \u0002 2.0 cm, \nincluding early hypovascular HCC.\nMaterial and Methods: This prospective study had two inclusion criteria: (I) \nCT examination comprising dual-energy acquisition in the arterial phase (AP-\nDEA), and non-enhanced, venous and late phase acquisitions each in single-\nenergy technique 24 h before liver transplantation, and (II) incidentally \ndiagnosed HCCs in explanted livers with hyperdense correlates in AP-DEA. \nNine patients (8 men; mean age 58.9±7.9 years) with 13 HCCs (mean diameter \n1.6±0.8 cm) were included. Mean MELD score was 10.0±1.3 and mean AFP \nlevel was 15.0±19.2 IU/ml. From AP-DEA, four datasets were evaluated: \n80kVp, 120kVp-equivalent, optimum-contrast and pure-iodine image datasets. \nAttenuation and image noise of liver parenchyma, HCC, and aorta as well as \nHCC-to-liver-parenchyma contrast-to-noise ratio (CNR) were compared.\nResults: For HCC, highest attenuation and image noise was found in 80kVp \ndatasets, and lowest in pure-iodine datasets (147.8±33.1 HU vs. 56.6±26.7 HU \n[P<0.001] and 21.6±6.2 HU vs. 9.0±4.3 HU [P<0.001]). For HCC, attenuation \nwas significantly higher in optimum-contrast compared to 120kVp-equivalent \ndatasets (123.2±30.7 HU vs. 108.2±21.3 HU [P<0.001]). HCC-to-liver-\nparenchyma CNR was significantly higher in pure-iodine and optimum-contrast \ndatasets compared to 80kVp datasets (5.2±3.2 and 4.0±2.3 vs. 2.6±1.4 [both \nP<0.001]). CNR was significantly higher in pure-iodine compared to 120kVp-\nequivalent datasets (5.2±3.2 vs. 3.3±1.9 [P<0.001]).\nConclusion: Combination of optimum-contrast and pure-iodine datasets \ndemonstrated best quantitative image quality for detection of HCC.\nSS 10.04\nDifferentiating mass-forming intrahepatic \ncholangiocarcinoma from atypical hepatocellular \ncarcinoma using gadoxetic acid-enhanced MRI\nY . Chong, W.J. Lee, S.H. Kim, H. Rhim, M.J. Park, J.H. Lim, \nH.J. Park; Seoul/KR\nPurpose: The purpose of this study was to examine the differential features of \nmass-forming intrahepatic cholangiocarcinoma (ICC) from atypical hypovascular \nhepatocellular carcinoma (HCC) on gadoxetic acid-enhanced MRI.\nMaterial and Methods: IRB approved this retrospective study and waived \ninformed consent. Seventy patients with pathologically proven ICCs (35) and \nhypovascular atypical HCCs (35) who had undergone preoperative gadoxetic \nacid-enhanced MRI were enrolled. Images were analyzed as to the shape of \nthe lesions and the presence of hyperintensity on the T1-weighted image \n(T1WI) and hypo- or hyperintense areas on the T2-weighted image (T2WI). In \naddition, images were analyzed as to the presence of linear hyperintensity or \nmultifocal tiny hyperintense foci on T2WI and the presence of rim enhancement \nduring early dynamic phases and a central enhancement with hypointense rim \n(target appearance) on 10-min and 20-min hepatobiliary phase image. The \nsignificance of these findings was determined by the X[2] test.\nResults: Univariate analysis revealed that the following significant parameters \nfavor ICC or hypovascular HCC: Presence of T2 hypo- and hyperintense areas \nand target appearance on the 10-min hepatobiliary phase for ICC; presence of \nT2 linear hyperintensity and multifocal hyperintense foci for hypovascular HCC \n(P<0.05). Multivariate analysis revealed that only target appearance on 10-min \nhepatobiliary phase was predictive of ICC (P=0.002, 85.7%). However, the \ntarget appearance was also observed in all six scirrhous HCCs.\nConclusion: Target appearance on 10-min hepatobiliary phase is the best \npredictor for identifying mass-forming ICC on gadoxetic acid-enhanced MRI.\nSS 10.05\nComparison of diffusion-weighted imaging with dynamic \ncontrast enhanced MRI for detection of HCC in cirrhosis\nN. Kalra, S. Shankar Mp, P . Singh, R. Srinivasan, A. Duseja, \nY . Chawla, N. Khandelwal; Chandigarh/IN\nPurpose: The purpose of this study was to compare diffusion-weighted \nimaging (DWI) with dynamic contrast-enhanced MRI (DCEMRI) for detection of \nHCC in cirrhosis using a 3-T MRI scanner.\nMaterial and Methods: 20 consecutive cirrhotics with focal liver lesions on \nUS were enrolled. Patients underwent MRI which included T1-, T2-weighted \nimaging, DCEMRI, and axial DWI (b values 0, 100, 500 and 1000 mm[2]/sec). \nTwo radiologists independently evaluated the DWI and DCEMRI and were \nblinded to each other. Average apparent diffusion coefficient (ADC) values \nwere calculated from the lesions. Findings on DCEMRI were taken as the gold \nstandard. FNA was taken from the lesions seen on DCEMRI.\nResults: DWI had a sensitivity of 95% (CI 95%), accuracy of 95% and positive \npredictive value of 100%. There was high degree of agreement (kappa value= \n0.898) between DWI and DCEMRI. ADC values of well, moderately and poorly \ndifferentiated HCC showed decreasing trend but ‘p’ value (0.118) was \nstatistically insignificant.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\n S482\nSCIENTIFIC SESSIONS / THURSDAY, JUNE 14, 2012\nSS 10.10\nUsefulness of gadoxetic acid (Gd-EOB-DTPA, Primovist) \nin the detection and characterization of indeterminate \nliver nodules in cirrhotic patients studied with \ngadobutrol (Gd-DTPA, Gadovist)\nE. Ballesteros, D. Gil-Bello, J. Martin, M.J. Prieto, M. Solà, \nA. Malet, J. Puig; Sabadell/ES\nPurpose: The purpose of this study was to evaluate the usefulness of Gd-\nEOB-DTPA (Primovist[R]) in the detection and characterization of indeterminate \nliver nodules in cirrhotic patients studied with Gd-DTPA (Gadovist[R]).\nMaterial and Methods: 19 patients (13 men, 6 women; mean age: 65 years) \nwith 28 liver nodules classified as indeterminate on gadobutrol-enhanced MRI \nstudies underwent gadoxetic acid-enhanced MRI. The diagnosis was reached \nby biopsy (n=17) and/or by imaging characteristics (n=11). Nodules were \nclassified as hypointense, isointense or hyperintense in the portal venous \nphase in gadobutrol-enhanced MRI studies and in the hepatobiliary phase in \ngadoxetic acid-enhanced MRI. We correlated the signal intensity in the \nhepatobiliary phase with the diagnosis and compared the number of nodules \ndetected with the two techniques, both overall and in the portal venous phase \nin gadobutrol studies versus in the hepatobiliary phase in gadoxetic acid \nstudies. Student’s t-tests and Chi-square tests were used for different \nvariables, as appropriate.\nResults: The nodules (mean size: 14 mm) were hepatocellular carcinomas \n(HCC, n=17), dysplastic nodules (DN, n=10) and an adenocarcinoma (n=1). We \nfound no relation between the signal intensity of the nodules in the hepatobiliary \nphase in gadoxetic acid studies and the diagnosis. More lesions were detected \nin the hepatobiliary phase of gadoxetic acid studies (n=32) than in the portal \nvenous phase of gadobutrol studies (n=9, p<0.05).\nConclusion: Gadoxetic acid-enhanced MRI does not differentiate between \nHCC and DN, but it detects more lesions than gadobutrol-enhanced MRI.\nSS 10.08\nLiver perfusion CT for noninvasive assessment of \nresponse to sorafenib therapy in patients with advanced \nHCC: preliminary findings\nL. Faggioni, P . Vagli, F . Pancrazi, R. Sacco, E. Neri,  \nC. Bartolozzi;  Pisa/IT\nPurpose: The purpose of this study was to assess treatment response to \nsorafenib therapy in patients with advanced HCC by means of perfusion CT \n(pCT).\nMaterial and Methods: Ten patients with a total of 16 previously diagnosed \nHCC underwent liver pCT immediately before the beginning of sorafenib \ntherapy and one month thereafter. pCT was carried out on a 64-row CT scanner \n(LightSpeed VCT, GE Healthcare, Milwaukee, WI) with a 4-cm longitudinal \ncoverage on the target lesion. Using dedicated software, regions of interest \nwere traced inside the HCC and in the surrounding liver parenchyma, and the \nfollowing perfusion parameters were computed: blood flow (BF), blood volume \n(BV), mean transit time (MTT), hepatic arterial fraction (HAF), and permeability-\nsurface product (PS). Serum alpha-fetoprotein levels (\u0001FP) were also measured \nimmediately prior to each pCT scan.\nResults: Baseline BF , BV, HAF , and PS were significantly higher, and MTT \nvalues were significantly lower in HCC lesions than in the surrounding liver \nparenchyma (p<0.01). At 1-month pCT follow up, in all patients, \u0001FP was \nsignificantly reduced at baseline, while MTT values were significantly higher \n(8.98±2.86 vs 5.15±1.87 seconds, p=0.0097). A statistically significant inverse \ncorrelation was also found between baseline MTT and post-treatment \u0001FP \nreduction (r=-0.6685, p=0.0125).\nConclusion: In patients with advanced HCC under sorafenib therapy, MTT \nprolongation at 1-month pCT follow up can be used as a marker of biochemical \ntreatment response. Baseline MTT could predict treatment response in patients \ncandidate to sorafenib therapy.\nSS 10.09\nMeasurement of CT attenuation of various tumor \nportions in Lipiodol-retaining hepatocellular carcinomas \non CT images of low and high tube voltages: usefulness \nof dual energy CT\nW.J. Lee, S. Shin, S.B. Shin, J. Kim; Seoul/KR\nPurpose: The purpose of this study was to determine usefulness of DECT in \ndetecting viable tumor portion (VTP) in Lipiodol-retaining HCCs by measuring \nCT attenuation of various TPs including VTP , necrotic TP (NTP), and Lipiodol-\nretaining TP (LTP) on CT images of low and high tube voltages.\nMaterial and Methods: Thirty HCC patients treated with TACE, who had \nsuspected VTP clinically and underwent follow-up DECT, formed our study \npopulation. Three-phase DECT was performed with Somatom Definition Flash, \nof which HAP was obtained 18 sec after peak aortic enhancement (300 mgI/\nmL, 0.6 g/kg, 30 sec injection duration). HU of five groups (19 VTPs, 14 NTPs, \n22 LTPs, 30 livers, and 30 aortas) was measured on HAP images of 80 kVp and \n140 kVp. Attenuation ratio (AR=HUs of 80 kVp/HUs of 140 kVp) of these groups \nwas calculated.\nResults: HUs of LTP , aorta, VTP , liver, and NTP on HAP images of 80 versus \n140 kVps were 2328.35±574.31 versus 963.12±405.11, 516.65±70.63 versus \n206.95±24.75, 199.57±54.93 versus 99.07±18.03, 91.05±17.14 versus \n70.55±8.77, and 52.22±18.72 versus 44.89±14.97, and corresponding ARs \nwere 2.56±0.41, 2.49±0.06, 1.99±0.25, 1.29±0.15, and 1.16±0.14. All ARs \nwere different with statistical significance (p<0.001) except two occasions (LTP \nvs. aorta and liver vs. NTP). All ARs of VTPs were above 1.54, while those of \nNTPs were below 1.41.\nConclusion: ARs were related to iodine contents of each group, and particularly \nVTP was successfully differentiated from NTP using AR. Accordingly, DECT \ncould be useful in detecting VTP in Lipiodol-retaining HCCs only with HAP .\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / FRIDAY, JUNE 15, 2012\n S483\nSS 11.03\nDetection of colorectal cancer at CT colonography\nP . Simons1, L. Van Steenbergen2, M. De Witte1,  \nM. Janssen-Heijnen1;  1Venlo/NL, 2Eindhoven/NL\nPurpose: CTC is a less burdensome alternative for colonoscopy in excluding \ncolorectal cancer (CRC) in symptomatic patients. We evaluated the proportion \nof patients who underwent CTC in whom CRC was missed.\nMaterial and Methods: Patients who underwent CTC in the VieCuri Medical \nCentre, Venlo, The Netherlands, in the period 1-1-2007 to 1-1-2011 were \nmerged with all cases of CRC recorded in the population-based Eindhoven \nCancer Registry between 1-1-2007 and 1-7-2011 to identify all patients who \nhad undergone CTC less than 2 years before CRC has been diagnosed. A \nmissed cancer was defined as a patient being diagnosed with CRC, whereas \nsuspicious colonic mass, indeterminate lesion or polyp >1 cm was not found \nin the CTC report.\nResults: In 53 out of 1857 patients who underwent CTC, CRC was diagnosed. \nOf these, 40 patients were suspected for CRC and 5 patients were diagnosed \nwith large polyps on CTC. In 5 patients with an indeterminate mass, further \ninvestigation confirmed malignancy. One cancer in the coecum was missed \nbecause of poor distension. Two cancers, one located in the distal rectum and \none in the ascending colon, were missed. Sensitivity of CTC for CRC was 94% \n(95% CI 88-100%). The true miss rate, excluding the inadequate distended \nstudy, was 2 out of 53 (3.8%).\nConclusion: This study shows that the miss rate for CTC is low, which means \nthat CTC is accurate in excluding CRC.\nSS 11.04\nComparison study of 2-day versus 4-day limited bowel \npreparation regimens for fecal-tagging CT colonography\nK. Meric, N.U. Bakal, E. Yencilek, G. Kilicoglu, M.M. Simsek, \nO. Cakir;  Istanbul/TR\nPurpose: The aim of this study was to compare tagging efficacy and the \namount of residual stool and residual fluid in 2-day versus 4-day limited bowel \npreparation regimens using barium-based fecal-tagging agent in incomplete \nconventional colonoscopy patients.\nMaterial and Methods: Sixty consecutive patients were prospectively enrolled \nand randomly divided into 2-day and 4-day low-residue diet groups. We used \nbarium sulfate suspension for fecal tagging and Bisacodyl for stool softening. \nTwo radiologists graded residual stool (5=< >=6 mm and 1:none/scattered to \n4:>50% circumference), residual fluid (1:no fluid to 4:>50% AP diameter) and \ntagging efficacy for stool (1:untagged to 5:100% tagged) using a system \nadapted from Taylor et al. Following CTC, a questionnaire was administered for \ninvestigating patient experience of the reduced laxative tagging regimen. \nStatistical analysis was performed between 2 groups using the Mann-Whitney \nU test.\nResults: There was no significant difference between 2-day and 4-day \npreparation group for residual stool, residual fluid and fecal tagging efficacy. In \nall patients, there was statistically difference for residual stool and residual fluid \nbetween right hemi-colon and left hemi-colon.The fecal tagging efficacy was \n87.6% for >=6 mm residual stool in all colonic segments. Patient acceptability \nin 2-day preparation was higher than 4-day preparation.\nConclusion: Two-day limited bowel preparation regimen for fecal-tagging \nCTC offers the patient a well-tolerated preparation and improves high fecal-\ntagging efficacy.\nSS 11.05\nCTC after fecal tagging: comparison between supine-\nonly and prone/supine approach\nD. Caruso\n1, M.M. Maceroni1, F . Vecchietti1, D. Bellini1,  \nM. Rengo2, A. Laghi1;  1Latina/IT, 2Rome/IT\nPurpose: The purpose of this study was to retrospectively compare double \nprone/supine scans and single supine scan in a population of patients prepared \nwith fecal tagging and to evaluate the feasibility of performing CTC studies \nonly on the supine scan.\nMaterial and Methods: Two radiologists in consensus evaluated only the \nsupine scans of 20 patients, with 30 endoscopically proved polyps (from 6mm \nto 12mm), chosen from our database. After one month, prone and supine \nscans of the same dataset were evaluated. All patients were prepared for CTC \nwith a dedicated low-residue diet. Fecal tagging was performed by the oral \nadministration of a fixed amount of 200 ml of Gastrografin at major meals \nstarting three days before the examination. We evaluated sensitivity, specificity \nand mean reporting time for the two approaches.\n11:00 - 12:30 Pentland\nScientific Session 11\nCT Colonography 2 - Technical performance\nSS 11.01\nDetection of extracolonic pathology by CT colonography \nin symptomatic patients: clinical consequences and \noutcomes versus colonoscopy or barium enema: \nmulticentre randomised controlled trial\nS. Halligan\n1, K. Wooldrage1, E. Dadswell1, C. Von Wagner1, \nC. Kay2, J. Wardle1, R. Lilford3, W. Atkin1, T. Siggar \nInvestigators1;  1London/UK, 2Bradford/UK, 3Birmingham/UK\nPurpose: CT colonography (CTC) simultaneously examines the colorectum \nand extracolonic organs. We performed a multicentre randomised controlled \ntrial to quantify the frequency and clinical consequences of extracolonic \nfindings.\nMaterial and Methods: 8484 symptomatic patients referred for barium enema \nor colonoscopy were registered at 21 centres. 5384 eligible patients were \nconsented and randomised to CTC or default in a 1:2 ratio. We determined the \nfrequency of extracolonic findings, number and nature of subsequent \ninvestigations, and ultimate diagnosis. Extracolonic cancers were matched \nwith national registries.\nResults: 1748 CTC examinations were analysed: 1042 (59.6%) had \u00031 \nextracolonic finding (1,945 individual findings), rising with age (p<0.0001). 149 \npatients (8.5%) underwent subsequent investigation, 52 of whom (34%) \nunderwent multiple procedures, 32 (21.5%) underwent surgery. 79 extracolonic \nneoplasms were diagnosed, 29 malignant. Overall, neoplasia was diagnosed \nin 79 (4.5%) patients having CTC, malignant in 29 (1.7%). Positive predictive \nvalue of symptoms for extracolonic disease was low. The proportion of patients \ndiagnosed with extracolonic cancers or dying did not differ significantly \nbetween procedures within 3 years of randomisation. 14 (0.8%) patients had \nextracolonic abdomino-pelvic cancer diagnosed within 3 years of apparently \nnormal CT colonography.\nConclusion: Most symptomatic patients have extracolonic findings on CTC, \napproximately 2% malignant. Surprisingly, offering CTC as a primary procedure \ndoes not significantly increase the proportion of patients diagnosed with \nextracolonic malignancy at 3 years when compared with colonoscopy or \nbarium enema.\nSS 11.02\nPreliminary 2D reading of CTC studies on the iPad2®: \ncomparison with a conventional desktop workstation\nL. Faggioni, E. Neri, P . Vagli, S. Angeli, L. Cini, E. Picano,  \nD. Caramella, C. Bartolozzi; Pisa/IT\nPurpose: The purpose of this study was to evaluate the effectiveness of the \niPad2[®] as a mobile device for 2D reading of CTC datasets.\nMaterial and Methods: We retrospectively reviewed 37 CTC examinations \nperformed in a colorectal cancer screening setting, for a total of 68 polyps \nsized between 5 mm and 26 mm. All datasets were wirelessly imported in \nDICOM format on an iPad2[®] 64GB (Apple Inc, Cupertino, CA) running OsiriX \nHD[®] (www.osirix-viewer.com) from a Macintosh desktop computer (iMac[®] \n3.06GHz) connected to our hospital PACS and running OsiriX 4.0. Two \nexperienced raters read CTC datasets independently on the iMac[®] and on \nthe iPad2[®]. Detection rate and segmental localization of lesions were \nrecorded for each CTC dataset as well as the time needed for complete \nreading of each CTC examination. Image quality was also visually assessed \nusing a three-point scale (1=poor, 2=fair, 3=good).\nResults: All lesions detected on the iMac[®] were also identified on the \niPad2[®], and their segmental localization was correctly assessed in 100% of \ncases. Image quality was good with both devices, while image reading time \nwas longer on the iPad2® than on the iMac[®] (6.24±2.32 vs 4.06±2.28 \nminutes, respectively [mean±standard deviation], p<0.05).\nConclusion: The iPad2[®] allows to effectively display all colonic lesions \ndetected on the iMac[®], at the expense of a longer image reading time, \nsuggesting that the iPad2[®] is more suitable for preliminary 2D reading than \nfor primary reporting of CTC examinations.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / FRIDAY, JUNE 15, 2012\n S484\nSS 11.08\nComputer-aided detection (CAD) for CT colonography: \nincremental benefit for inexperienced over experienced \nreaders\nD. Boone\n1, S. Halligan1, S. Mallett2, O. Hrydziuszko2,  \nJ. McQuillan1, S.A. Taylor1, D. Altman2;  1London/UK, 2Oxford/UK\nPurpose: Computer-assisted detection (CAD) is known to be useful for both \ninexperienced and experienced readers of CT colonography (CTC). We aimed \nto quantify the incremental benefit for inexperienced over experienced \nreaders.\nMaterial and Methods: 16 experienced (mean 264 validated cases) and 10 \ninexperienced radiologists read 102 individual CTC cases (56 with polyps), \nwith and without CAD assistance, with temporal separation between \ninterpretations. Diagnostic accuracy was determined via comparison to a joint \nendoscopic/radiological reference standard. The primary outcome was a per-\npatient analysis of the change in polyp sensitivity + specificity with/without \nCAD (all polyp diameters; weighted 3:1 in favour of sensitivity), adjusted for \nprevalence. Meta-analysis was used to average across the two reader groups. \n500 bootstraps were used to calculate 95% confidence intervals for this \nabstract; 1999 will be presented.\nResults: The difference between inexperienced and experienced readers was \n8.6 (95%CI 0.6, 16.9): % change in sensitivity with CAD was 14.3 (7.0, 20.8) for \ninexperienced, 4.7 (0.2, 9.4) for experienced. % change in specificity was -5.8 \n(-11.3, -0.7) for inexperienced, -2.8 (-5.7, 0.4) for experienced. The incremental \nbenefit for inexperienced readers was greatest for 6mm+ polyps; 12.53 (5.07, \n19.7) versus experienced readers.\nConclusion: Both inexperienced and experienced readers benefit significantly \nfrom CAD. Overall, the incremental benefit for inexperienced readers is \napproximately 4x that for experienced readers. This appears to be because \ninexperienced readers are relatively poorer at detecting polyps 6 mm or \nlarger.\nSS 11.09\nComputer-aided detection (CAD) for CT colonoscopy: \npolyp size estimation and clinical patient categorization\nG. Iussich\n1, L. Correale2, C. Senore2, N. Segnan2,  \nD. Campanella1, C. Laudi1, G. Galatola1, D. Regge1;  \n1Candiolo/IT, 2Turin/IT\nPurpose: The purpose of this study was to compare polyp size measurement \nas determined by CAD-assisted CTC interpretation with endoscopic \nvisualization.\nMaterial and Methods: We performed a secondary analysis of a prospective \ntrial comparing diagnostic performance of first and second reader CAD (CAD1 \nversus CAD2) where FOBT positive patients underwent both CTC and \ncolonoscopy. Polyps size was measured on 2D images for CAD2 and CAD1, \nand at CC with open biopsy forceps. Agreement was evaluated using \ndescriptive statistics and Bland-Altman methodology.\nResults: Colonoscopy found 285 all size lesions in 125 patients (reference \nsize: 2-100 mm). Of these, 145 were found by CAD2 and 129 by CAD1. There \nwas no significant difference between colonoscopy and CTC size estimation \nboth for CAD2 (mean difference: -0.23 mm, P=0.4) and CAD1 (mean difference: \n-0.6 mm, P=0.2). Intervals of agreement between colonoscopy and CTC were \n(-6.5; 6.5-mm) for CAD2 and (-5.4; 5.4-mm) for CAD1. When simulating a 3-risk \nclasses (polyps > 9 mm, referral to colonoscopy; polyps 6-9 mm, CTC \nsurveillance and polyps < 6 mm, not reported), 10-18% of patients with \nadvanced adenomas at colonosopy were placed into the surveillance class. \nPreview and finish\nConclusion: For both CAD reading modes, CTC polyp size was not different \nfrom colonoscopy reference size. However, stratifying patients into 3-risk \nclasses, 10-18% of patients with advanced adenoma could have polypectomy \ndelayed at least 3 years.\nSS 11.10\nComputed-aided detection software in CT \ncolonography: effect in training of novice readers\nD. Bellini, D. Caruso, M. Rengo, F . Vecchietti, M. Maceroni, \nA. Laghi; Latina/IT\nPurpose: The purpose of this study was to evaluate the influence of computer-\naided detection (CAD) in the learning process of five inexperienced readers, \nusing 3D fly-through as first approach.\nMaterial and Methods: We retrospectively selected 50 patients, all positive \nfor polypoid lesions, for a total of 150 polyps endoscopically confirmed, with a \ndiameter between 6 mm and 40 mm (mean diameter 8.6 mm). Five doctors \nwith any previous experience in CT colonography reading were enrolled.  \nResults: All patients with optimal distention and tagging on both supine and \nprone scans and negative for polyps could be evaluated on supine scans only. \nIn the four patients positive for polyps at supine scan, the combined evaluation \nof prone scan was necessary in order to improve lesion conspicuity.\nConclusion: Performing CTC only on supine position seems to be a feasible \napproach, in patients prepared with fecal tagging and with good colonic \ndistention and with negative findings. This will reduce the dose to the patients \nand the reporting time.\nSS 11.06\nThe use of sodium picosulphate to prepare the patient \nfor CT colonography\nI. Lefere\n1, M. Lefere1, P . Lefere2, S. Gryspeerdt2, C. Silva3,  \nA. Rodrigues3;  1Leuven/BE, 2Hooglede/BE, 3Funchal/PT\nPurpose: The purpose of this study was to assess the efficacy of a CTC \npreparation based on sodium picosulphate.\nMaterial and Methods: 510 patients undergoing CTC and optical colonoscopy \nwere prepared with 2 days of a low residue diet, augmented the day before \nCTC with a clear liquid diet, fecal tagging and cleansing with sodium \npicosulphate and bisacodyl. Quality of preparation was assigned a score 1-3: \nscore 1, failed preparation with non-tagged stool hampering interpretation; \nscore 2, non-tagged or inhomogeneous stool making primary 3D read difficult, \nbut not hampering 2D interpretation; score 3, clean colon with homogeneous \ntagging allowing primary 3D interpretation. Per-patient sensitivity, specificity, \npositive (ppv) and negative (npv) predictive values with 95% confidence \nintervals (95%CI) were calculated for lesions \u0003 6 mm.\nResults: This preparation enabled primary 3D read in the majority of patients. \nOn the same day, optical colonoscopy was performed in all patients without \nadditional preparation. Score 1 was assigned to 9 patients (1.8%), score 2 to \n40 patients (7.8%) and score 3 to 461 patients (90.4%). Non-tagged stool \ncaused a false positive \u00036mm in 3 patients. For all lesions \u0003 6 mm, CTC \nobtained a per-patient sensitivity, specificity, ppv and npv of 95.6% (87-98.9% \n95%CI), 93.9% (91.1-95.9% 95%CI), 71.7% (61.2-80.4% 95%CI), and 99.3% \n(97.7-99.8% 95%CI), respectively. CTC diagnosed all patients with advanced \nneoplasia \u0003 6mm. There were no major side effects.\nConclusion: This preparation based on fecal tagging and sodium picosulphate \nproved successful for polyp detection.\nSS 11.07\nEffect of training, experience and computer-aided \ndetection (CAD) on CT colonography interpretation\nG. Iussich\n1, L. Correale2, P . Falco2, C. Senore2, N. Segnan2, \nD. Campanella1, F . Iafrate3, E. Neri4, A. Laghi5, D. Regge1;  \n1Candiolo/IT, 2Turin/IT, 3Rome/IT, 4Pisa/IT, 5Latina/IT\nPurpose: The purpose of this study was to assess performance of radiologists \nusing a double reading with CAD as a first reader (DR CAD-FR) after a 2-day \nspecific training program and to correlate readers performance with their level \nof experience in CT colonography (CTC).\nMaterial and Methods: 12 radiologists entering the educational training had \ndifferent levels of experience (>300 studies, very experienced; 100-300, \nmoderately experienced; <100, inexperienced). During the course, 46 training \ncases were interpreted and discussed by experts. Day 3 was dedicated to a \nfinal test including 30 cases read using DR CAD-FR (only CAD-prompts \nevaluation followed by unassisted review for mass detection). Per-patient and \nper-polyp sensitivity and specificity were calculated. Receiver operating \ncharacteristic (ROC) curve was generated for each reader. Relationship \nbetween prior experience in CTC and correct case classification were assessed \nusing logistic regression statistics.\nResults: 14/30 cases were positive. There were a total of 24 polyps\u00036-mm. \nCAD sensitivity was 88% (21/24); there was an average of 11 false positives \nper scan. Across all readers, per-patient sensitivity was 75% (95% CI: 68-\n81%). Reader specificity ranged from 75 to 100%. ROC curve values varied \nbetween 0.79 and 0.98. Average per-polyp sensitivity was 58% (range: 29-\n75%). Per-polyp sensitivity of very experienced readers was significantly \ngreater than that of moderate experienced readers (P=0.04) and low \nexperienced readers (P=0.03).\nConclusion: A 2-day structured training probably does not reduce performance \ngap between very experienced and less experienced readers. Additional \ntraining is, therefore, required.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / FRIDAY, JUNE 15, 2012\n S485\nConclusion: The increase of mean tumor ADCs correlates with good response \nto CRT; tumor response more likely occurs in pts who report higher LPI values \non D-CE-MR analysis during treatment with respect to pre-treatment.\nSS 12.03\nComparison of diffusion-weighted imaging MR and \nFDG-positron emission tomography for the prediction of \npathologic response  to neoadjuvant therapy in patients \nwith locally advanced rectal cancer\nD. Ippolito, P .A. Bonaffini, L. Monguzzi, C. Trattenero,  \nC. Capraro, S. Sironi; Monza/IT\nPurpose: The purpose of this study was to evaluate the correlation between \nthe changes of SUVmax and of apparent diffusion coefficient (ADC) before and \nafter neoadjuvant therapy, in order to predict therapy response in patients with \nlocally advanced rectal cancer (LARC).\nMaterial and Methods: Thirty patients with LARC who underwent CRT were \nrecruited for our study. All patients underwent a whole body 18FDG-positron \nemission tomography (PET)/CT scan and a pelvic MR examination including \ndiffusion-weighted imaging (DWI) for staging (PET/CT1RM1) and after the \nchemoradiation therapy (PET/CT2RM2). Histopathologic analysis of rectal \nspecimen, according to Tumour Regression Grade (Mandard’s criteria), was \nused as standard reference. MR and PET-CT images were analyzed and \nmeasurements of ADC values and SUVmax were performed. Diagnostic \nperformance for selection of complete responders (TRG 1-2) and overall \ndiagnostic accuracy for each item were calculated.\nResults: After neoadjuvant therapy, all patients were submitted to surgery. \nAccording to Mandard’s criteria, 21 tumors showed complete (TRG1) or \nsubtotal regression (TRG2) and were classified as responders; 9 tumors were \nclassified as non-responders (TRG 3, 4 and 5). In all patients, mean value of \nSUVmax in PET/CT1 was higher than those of PET/CT2 (p<0.001), whereas \nmean ADC value was lower in RM1 than RM2 (p<0.001) with a significant \npercentage decrease of values after the treatment (p<0.005). The best \npredictors’ cut-off values for TRG response were: SUVmax of 4.4 and ADC of \n1.28x10[3]mm[2]/s, with sensitivity, specificity, accuracy, negative predictive \nvalue, and positive predictive value of 77.3%, 88.9%, 80.7%, 61.5%, and \n94.4%, respectively.\nConclusion: MR DWI and FDG-PET/CT have a complementary diagnostic role \nin follow up of patients with LARC who underwent chemoradiation therapy, by \ndifferentiating fibrosis from viable tumor tissue.\nSS 12.04\nComparison between diffusion-weighted-based \nvolumetry and apparent diffusion coefficient in the \nassessment of response in patients with rectal cancer \ntreated with neo-adjuvant therapy\nS.F . Carbone, M. Palumbo, V. Ricci, T. Carfagno, S. Lazzi,  \nL. Pirtoli, L. Volterrani; Siena/IT\nPurpose: The purpose of this study was to assess the diagnostic accuracy of \nvolumetry based on diffusion-weighted imaging (VDWI) and apparent diffusion \ncoefficient (ADC) in the evaluation of response in patients with rectal cancer \ntreated with chemoradiotherapy (CRT).\nMaterial and Methods: We retrospectively examined 25 patients (mean age \n67.8 years) with rectal cancer, who have performed MRI before and after 45 ± \n15 days of the CRT after undergoing anterior resection of the rectum. After \nsurgery, ypTN and tumor regression grading (TRG) according to Mandard \nclassification were obtained. We considered responders’ patients with TRG \n1-2 or with a negative follow-up recurrence in the next 6 months (only three \ncases). Two radiologists, in consensus and using commercial software, have \nextrapolated pre- and post-CRT VDWI of the lesions and calculated the ADC.\nResults: ADC did not show significant differences between responders and \nnon-responders (p = 0.078 pre-CRT, p = 0.101 post-CRT); the VDWI of \nresponders was significantly lower in both pre-CRT (p = 0.0065) and in post-\nCRT (p = 0.0058) compared to non-responders of VDWI. The accuracy in the \nevaluation of response was of 68% and 92%, respectively, for the ADC and \nVDWI.\nConclusion: The VDWI is more reliable than to assess the response to CRT in \npatients with rectal cancer.\nEach reader examined the same case, at first, without CAD, and after two \nmonths, to reduce the recall bias, assisted by the analysis software CAD. For \neach reader, either for the first or the second reading, five testing sessions over \n2 weeks were set up, each one with 10 exams for a total of 30 polyps per \nsession. For each polyp, readers expressed the degree of diagnostic \nconfidence. After all, we performed per-polyp analysis including calculation of \ndetection and false-positive rates.\nResults: Polyps detection rate calculated from all reader and for all analysis, \nrace from 69% (without CAD) to 81% (with CAD, P value< 0.05). Using \nMcNemar test to compare single analysis session, with and without CAD, no \nstatistically significant differences were found (P value >0.05).\nConclusion: CAD software increases polyp detection rate and, for novice \nreaders, seems to reduce the number of false positives. However, the curves \nobtained from analysis with and without CAD show similar shape (CAD does \nnot change the learning curve).\n11:00 - 12:30 Fintry\nScientific Session 12\nGI tract malignancy: treatment response\nSS 12.01\nThe predictive value of ultrasound elastography to \nresponse in patients with rectal cancer treated with \nchemoradiation\nS.R. Rafaelsen, C. Vagn-Hansen, T. Sørensen, J. Lindebjerg, \nJ. Pløen, A. Jakobsen; Vejle/DK\nPurpose: The current literature has described several predictive markers in rectal \ncancer patients treated with chemoradiation, but so far none have been validated \nfor clinical use. The purpose of the present study was to compare quantitative \nelastography based on ultrasound measurements in the course of chemoradiation \nwith tumour response based on the Mandard classification (TRG).\nMaterial and Methods: From April 2010 to October 2011, we prospectively \nexamined 24 patients with rectal cancer planned for high-dose \nradiochemotherapy. Surgery was performed after the end of treatment. A \nbaseline ultrasound elastography scan was performed prior to chemoradiation \nand followed by re-scan two and six weeks after initiation of the treatment. The \nelastography shear wave velocity was compared to the TRG score.\nResults: The baseline mean tumour elasticity was 3.12 m/s (95% CI: 2.9–3.4). \nTwo and six weeks after start of chemoradiation, the velocities were 2.21 m/s \n(95% CI: 1.9-2.5) and 1.97 m/s (95% CI: 1.7-2.2), respectively, p < 0.0001. \nPatients with a tumour TRG 1 response had a tumour elasticity of 2.37 m/s \n(95% CI: 1.8–2.9) after six weeks. In patients with TRG > 1, the velocity was \n1.76 m/s (95% CI: 1.3–2.2) after six weeks, p < 0.05.\nConclusion: Ultrasound elastography seems to hold predictive information as \nto response to chemoradiation. It also seems able to identify scar tissue after \ntreatment.\nSS 12.02\nDW-MRI and D-CE-MR: evaluation of the response in \nrectal cancer before, during and after neoadjuvant \ntreatment\nR. Del Vescovo, R. Cazzato, F . Giurazza, R.F . Grasso,  \nB. Beomonte Zobel; Rome/IT\nPurpose: The purpose of this study was to evaluate the response of rectal \nadenocarcinoma to chemoradiation therapy (CRT) calculating changes of apparent \ndiffusion coefficients (ADCs) before, during and after treatment and to correlate \nwith the changes of dynamic contrast-enhanced MR (D-CE-MR) values.\nMaterial and Methods: We enrolled 25 patients (pts) with primary rectal \ncarcinoma who were undergoing preoperative CRT. DWI and D-CE-MR were \nperformed with a 1.5-T system in all patients before, during and after \npreoperative CRT. All patients underwent histopathologic postoperative \nstaging. ADC values were calculated through the specific formula, while tumor \nperfusion was calculated by a semiquantitative perfusion software (DYCHO), \ndeveloped on Matlab. We evaluated the changes of ADCs and D-CE-MR \ndividing patients into two groups: not-downstaged group (not-responders, NR) \nand downstaged group (responders, R) at histologic postoperative staging.\nResults: 6 patients were NR while 19 patients were R. Pretreatment ADC \nvalues were significantly low; we observed a progressive increasing of ADC \nvalues during treatment in R, while there was no significant ADCs increase in \nthe NR (p = 0.003). The R showed 48% increase of local peak intensity (LPI) \nwith respect to LPI before treatment; on opposite, the NR showed 18% \ndecrease of LPI compared to LPI before treatment.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / FRIDAY, JUNE 15, 2012\n S486\nMaterial and Methods: 40 patients with locally advanced rectal cancer who \nwere treated with chemoradiation (CRT) and surgery were included. T2-\nweighted images were acquired at 1.5 T before and 8 weeks after CRT. The \ncalculated signal intensities in tumor voxels were normalized to the mean \nsignal intensity of the obturator internus muscle. The relative T2-weighted \nsignal intensity (rT2wSI) distribution in the tumor was characterized by the \ndescriptive parameters. Receiver operating characteristic curves were used to \ndetermine the diagnostic performance. The tumor regression grade (TRG) was \nused as a reference standard.\nResults: CRT induced a significant decrease of circa 50% in all rT2wSI \ndescriptives for complete responders (TRG1). This drop was significantly \nhigher compared to incomplete response groups (TRG2–TRG4). The highest \ndiagnostic performance for identification of complete responders was found \nfor the \u000295[th] percentile, \u0002SD and \u0002mean of the rT2wSI with accuracies of \n92%, 90% and 82%, respectively.\nConclusion: Quantitative assessment of the CRT-induced changes in the \ntumor T2-weighted signal intensity can be of high diagnostic value for selection \nof complete responders after CRT for rectal cancer. With this additional \ninformation, a radiologist can select complete responders more accurately and \nthis can facilitate less invasive treatment after CRT.\nSS 12.09\nMonitoring treatment response in oncology: does \nreshuffling of radiologist’s tasks to radiologist assistants \nimpact diagnostic performance?\nA.M.H. Sailer, D. Douwes, V.C. Cappendijk, F .C. Bakers,  \nJ.E. Wildberger, A.G. Kessels, R.G.H. Beets-Tan; Maastricht/NL\nPurpose: Decision making whether or not cancer (chemo)therapy needs to be \ncontinued is based on precise but time consuming RECIST-measurements on \nconsecutive CTs. The aim of our study was to evaluate whether it is feasible to \nfree radiologist’s time by reshuffling the task to radiology assistants and \nwhether it would reduce diagnostic performance.\nMaterial and Methods: 177 measurements on baseline and 2 consecutive \nCTs in 20 patients were performed following RECIST1.1: (A) According to the \nstandard practice where several radiologists read scans random of all patients; \n(B) According to the experimental setting where a technician with CT-unit \nexperience of >10yrs reads all scans, based on the radiologist’s 1[st] \nmeasurements, blinded to their results. Measurements of arm A was taken as \nreference standard and compared with B. Intraclass correlation coefficient was \ncalculated as well as the coefficient of determination based on a linear \nregression model.\nResults: RECIST-measurements performed according to the single-reading of \nradiology assistant (B) showed a high correlation with standard clinical practice \nreading (A): ICC 0,961, R² 0,924; SD 4 mm for difference between A&B. \nSensitivity and specificity for radiology assistant for assessing progressive \ndisease was 100% and 94%, respectively.\nConclusion: RECIST-measurements by a single-reader radiology assistant is \nfeasible and equal in performance to the radiologists’ measurements in \nstandard practice. This could impact the way radiologists may work, opening \nways to reshuffle important but time consuming tasks and free radiologists’ \ntime.\nSS 12.10\nThe change of 18FDG uptake in lymph nodes after \nneoadjuvant chemotherapy as a predictor of malignant \ninvolvement in patients with esophageal carcinoma: a \nPERCIST study\nP . Fencl, T. Harustiak, M. Zemanova; Prague/CZ\nPurpose: To determine whether metabolic activity, measured by PERCIST \nprotocol before and after neoadjuvant chemotherapy, is able to predict the \nabsence of malignant involvement in surgical specimens of lymph nodes.\nMaterial and Methods: 51 patients (pts) with esophageal carcinoma or carcinoma \nof esophageal-gastric junction were prospectively investigated on High Definition \nPET/CT scanner by 18FDG-PET/CT at base line (BL) and after finishing three \ncourses of therapy (ChT3). All pts underwent surgical treatment 113 days (median) \nafter BL, i.e. 7.1 (median) weeks after ChT3. The findings in histological specimens \nof lymph nodes were correlated to 18FDG-PET/CT stage. For negative stage was \ntaken all negative findings on BL and positive ones on BL, if neoadjuvant \nchemotherapy induced complete metabolic response (CMR) at ChT3.\nResults: At ChT3, using maximal 18FDG uptake as response criterion, \nsensitivity (SE), specificity (SP), and accuracy (ACC) were 37.5%, 74.1%, and \n56.9%, respectively. Using total lesion glycolysis as response criterion, SE, SP , \nand ACC were 37.5%, 81.5%, and 60.8%, respectively. On both tests, there \nwere 15 false negative findings (FN) at ChT3, but 11 out of 15 FN investigations \nwere FN even at BL, representing 73.3% of all FN.\nSS 12.05\nWithdrawn by the authors\nSS 12.06\nCould the magnetic transfer ratio play a role to evaluate \npost-radiation fibrosis in rectal cancer management?\nM.H. Martens\n1, D.M.J. Lambregts1, N.K. Papanikolaou2, R.G. \nRiedl1, A. Zur Hausen1, L.A. Heijnen1, M. Maas1,  \nG.L. Beets1, R.G.H. Beets-Tan1;  1Maastricht/NL,  \n2Heraklion/GR\nPurpose: Magnetization transfer is a MR technique that utilizes differences in \nthe magnetization interaction of free, ‘unbound’ water protons and \nmacromolecular-bound protons. The effect of magnetization transfer is \nquantified by determining the magnetization transfer ratio (MTR). The \nhypothesis is that fibrosis shows a higher MTR than normal tissue and/or \ntumour. The aim of this study was to evaluate if MTR may be used to identify \nfibrosis and differentiate it from normal rectal wall/tumour in rectal cancer \npatients treated with chemoradiotherapy.\nMaterial and Methods: 11 patients who were treated with chemoradiotherapy \nreceived a standard axial T2W-MRI. A single axial MTR slice was obtained at the \nformer tumour location. In two additional patients, MRI including MTR was obtained \nfrom the surgical resection specimens. Whole-mount histological sections with \nSirius-red staining were used as the reference to determine the areas of fibrosis.\nResults: There was a good correlation between the areas of fibrosis as \nvisualized on the T2 images and the areas of increased MTR on the MTR \nmaps. The normal rectal wall had an average MTR of 16.9% (0-35.6), as \ncompared to 31.9% (15.1-40.5) for the areas of fibrosis (p=0.001). The areas of \nfibrosis on the whole-mount sections with Sirius-red staining correlated well \nwith the MTR maps of the two surgical specimens.\nConclusion: Our preliminary results show that MTR discriminates fibrosis from \nother tissue. This could be promising for the unsolved dilemma of interpreting \npost-radiation fibrosis in rectal cancer.\nSS 12.07\nAccurate identification of complete responders after \nCRT for rectal cancer with endoscopy and MRI\nM. Maas\n1, D.M. Lambregts1, J.W. Leijtens2, M. Sosef3,  \nK.W. Hulsewé4, G.L. Beets1, R.G. Beets-Tan1;  \n1Maastricht/NL, 2Roermond/NL, 3Heerlen/NL, 4Sittard/NL\nPurpose: Chemoradiation (CRT) for rectal cancer leads to complete tumor \nresponse (CR) in 15-25%. Accurate identification of a CR is necessary to allow \nfor less invasive treatment (e.g. local excision or wait&see). Standard imaging \ncannot accurately identify a CR. The aim was to evaluate the accuracy of \nendoscopy for identification of a CR and compare it to T2W- and diffusion-\nweighted MRI (DWI).\nMaterial and Methods: 20 patients who underwent CRT and T2W-MRI+DWI and \nendoscopy 8 weeks after completion of CRT were included. One reader scored the \nT2W images followed by immediate evaluation of the DWI images with the T2W \nimages at his disposal. A second reader scored the endoscopy images. Readers \nwere blinded for histology and each others’ results. Scoring was performed with a \nconfidence level score (0=definitely residual tumour, 4=definitely CR).\nResults: Of the 20 patients, 9 had residual tumour and 11 had CR. The AUCs \nfor T2W-MRI, T2+DWI and endoscopy were 0.65, 0.65 and 0.91, respectively. \nCorresponding sensitivities and specificities were 36% and 78% for T2W, 46% \nand 89% for T2+DWI and 73% and 89% for endoscopy.\nConclusion: Endoscopy is more accurate in identifying a CR after CRT than \nMRI(+/-DWI), mainly because of a higher sensitivity, which corrects for \nunderstaging of a CR with MRI. MRI remains crucial to evaluate the presence \nof any extramural tumour/N+. A combination of endoscopy and MRI+DWI is \ntherefore recommendable to identify patients with a CR post-CRT, making less \ninvasive treatment after CRT feasible.\nSS 12.08\nQuantitative assessment of changes in the T2-weighted \nMR signal intensity in the tumor for detection of \ncomplete response after chemoradiation for rectal \ncancer\nM. Maas, E. Kluza, E. Rozeboom, M.H. Martens, J. Slenter, \nD.M. Lambregts, G.L. Beets, R.G.H. Beets-Tan; Maastricht/NL\nPurpose: The purpose of this study was to determine the diagnostic value of \nthe change in signal intensity of the tumour on T2-weighted MR images after \nneoadjuvant chemoradiotherapy for identification of complete response \n(yT0N0) in rectal cancer patients.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / FRIDAY, JUNE 15, 2012\n S487\nSS 13.03\nApparent diffusion coefficient (ADC) in discriminating \nbetween solid benign and malignant focal liver lesions \n(FLLs) with diffusion-weighted imaging (DWI): \ncomparison of ADC thresholding versus normalized \nADC thresholding and lesion-to-liver ADC ratio\nS. Pullini, R. Girometti, L. Cereser, G. Como, C. Zuiani,  \nM. Bazzocchi; Udine/IT\nPurpose: The purpose of this study was to compare the diagnostic performance \nof three different methods of ADC estimation in differentiating solid benign and \nmalignant FLLs.\nMaterial and Methods: We included forty-five patients with 75 FLLs detected \non a 1.5 T system, and proven to be malignant and benign in 55 and 20 cases, \nrespectively (cysts/haemangiomas excluded). During separate reading \nsessions, two readers in consensus evaluated DWI images and the ADC map. \nFLLs were assessed as benign or malignant: (a) according to the threshold \nestablished by a receiver operating characteristic (ROC) analysis, without \n(ADC-T) and with (ADC-TS) normalization for the spleen, respectively; (b) by \ncalculating the lesion-to-liver ADC ratio (ADC-R; cut-off <1). End-points for the \nthree methods were the positive- and negative-predictive value (PPV, NPV) for \nmalignancy and the area under the curve (AUC) values.\nResults: ADC threshold for malignancy was 1.06 x10-³ mm²/sec for ADC-T \nand 1.27 x10-3 mm²/sec for ADC-TS. ADC-T, ADC-TS and ADC-R showed \nhigh PPV (89.2%, 84.6% and 78.1%, respectively), but low NPV (42.1%, \n38.9% and 30.2%, respectively). AUCs of ADC-T (0.70) and ADC-TS (0.65) \nwere higher as compared to that of ADC-R (0.55), showing a significant \ndifference between ADC-T and ADC-R (p<0.01). Main source of false-negative \ncases was hepatocarcinoma (22-30/55).\nConclusion: Normalizing FLLs ADC for the spleen or providing the ADC-R did not \nimprove the diagnostic performance of ADC-T, which is limited by a low NPV.\nSS 13.04\nPredictive value of liver MRI parameters in patients with \nliver  metastases of neuroendocrine tumors\nW. Sommer, P .M. Paprottka, F . Ceelen, M.F . Reiser,  \nD. Theisen; Munich/DE\nPurpose: The aim of this study was to define pretherapeutic MRI predictors for \ntreatment response of radioembolization in patients with hepatic metastases \nfrom neuroendocrine tumors.\nMaterial and Methods: In 45 patients with proven hepatic metastases of \nneuroendocrine tumors (NET), MRI examinations were performed at baseline \nin all patients, consisting of standard T1w and T2w sequences as well as post-\ncontrast sequences. The following imaging predictors were defined: patient \nage and gender, proliferation marker Ki-67, tumor load in the liver (%), \nvascularisation of metastases, tumor necrosis, hemorrhage and fluid-fluid \nlevels. As primary endpoint, we defined the progression-free survival (PFS) \nusing RECIST criteria in MRI follow-up examinations. The effect of the \npredictors on the PFS has been analyzed using Kaplan-Meier statistics.\nResults: The mean PFS was 699 days (95% CI 326-964). Hypovascular \nmetastases showed significant earlier progress (255 vs. 727 days; p<0.01). A \nproliferation marker <2% (G1) was significantly associated with a longer PFS \nthan a proliferation marker between 2 and 20% (G2) or >20% (G3) (p<0.001). \nPatient age, gender, tumor load in the liver, tumor necrosis, hemorrhage as well \nas radioreceptor status of pre-SIRT did not show any impact on PFS \n(p>0.05).\nConclusion: Selective internal radiation therapy in neuroendocrine tumors turns \nout to be most efficient in hypervascular tumors with low proliferation index. \nTumor-liver-ratio as well as radioreceptor status do not have influence on the \nprogression-free survival in contrast to other therapeutic options in NETs.\nSS 13.05\nHigh sensitivity of diffusion-weighted MRI for the \ndetection of liver metastases from neuroendocrine \ntumors compared with T2-weighted and dynamic \ngadolinium-enhanced MRI, using surgical and \nhistological findings as a standard of reference\nG. D’Assignies\n1, P . Fina2, O. Bruno1, M. Ronot1, M.P . Vullierme1, \nV. Paradis1, A. Sauvanet1, V. Vilgrain1;  1Clichy/FR, 2Rome/IT\nPurpose: The purpose of this study was to assess and compare the sensitivity \nof diffusion-weighted (DW) MR imaging for the detection and characterization \nof liver metastases from neuroendocrine tumors (NET) to T2-weighted fast \nspin-echo (T2WFSE) and dynamic gadolinium-enhanced MRI, using surgical \nand histopathological findings as the standard of reference.\nConclusion: Despite using High Definition PET/CT scanner in all standardized \ninvestigations, 18FDG-PET/CT was not able to exclude malignant involvement \nof lymph nodes due to low sensitivity of the test even at BL and inability to \nprove residual malignancy when metabolic activity decreased to the CMR level \non ChT3.\n11:00 - 12:30 Sidlaw\nScientific Session 13\nFocal Liver Lesions: Imaging assessment\nSS 13.01\nThe spectrum of imaging and aetiological factors in \nfocal nodular hyperplasia presenting in the paediatric \npopulation\nA. Deganello, R. Inchingolo, M. Samyn, M. Sellars,  \nP .A. Kane, J. Karani; London/UK\nPurpose: Focal nodular hyperplasia (FNH) is a rare benign liver tumour in \nchildren. Previous studies have described an increased incidence of FNH in \npatients treated for cancer or in the presence of congenital or acquired vascular \ndisorders. The aim of this study is to set a light on the risk factors and \nradiological features of FNH in a large paediatric population.\nMaterial and Methods: Single-centre retrospective clinical, radiological and \nhistopathological review of children diagnosed with FNH between January \n1990 and April 2011.\nResults: A total of 25 children (52% females) with FNH were identified. Median \nage at presentation was 9 years. 36% had no associations and 12% had a \npreviously treated extra-hepatic malignancy. A congenital portosystemic shunt \nwas detected in 40%. One child had a surgical portocaval shunt created \nfollowing acute Budd Chiari Syndrome. The lesion was unifocal in 60% and \nmultifocal in 40%; a central scar was identified in 36% of the cases. All patients \ntreated for cancer had multiple lesions; solitary lesions were found in all except \none of the patients with sporadic FNH and in 54% of the patients with \nportosystemic shunts.\nConclusion: Portosystemic shunts and treated malignancy are recognised \nrisk factors for the development of FNH in children, the underlying link being a \ncongenital or acquired alteration of the portal venous flow. Recognising the \nfeatures of FNH and its predisposing factors leads to appropriate diagnosis \nand treatment.\nSS 13.02\nAdded value of Gd-EOB-DTPA-enhanced hepatobiliary \nphase MRI of solid focal hepatic lesions: a ROC analysis\nM. Haimerl\n1, I. Platzek2, C. Nießen1, A.G. Schreyer1, E.M. Jung1, \nC. Stroszczynski1, P . Wiggermann1;  1Regensburg/DE, \n2Dresden/DE\nPurpose: The purpose of this study was to determine the added value of \nhepatobiliary phase images in the Gd-EOB-DTPA-enhanced MRI in the \ndifferentiation of solid focal hepatic lesions.\nMaterial and Methods: 84 patients underwent Gd-EOB-DTPA-enhanced MR \nexaminations. 64 patients had malignant focal hepatic lesions proven by \nhistology (HCC: n= 34, metastases: n=30), 20 patients had benign liver lesions \n(FNH: n=14, hemangioma: n=3, adenoma: n=3). Five radiologists independently \nreviewed three sets of MR images using a score from 1 (benign) to 5 (malignant): \nset 1, unenhanced T1- and T2-weighted; set 2, unenhanced T1- and T2- \nweighted + gadoxetic acid-enhanced dynamic images; set 3, set 2 + \nhepatobiliary phase images.\nResults: Diagnostic accuracy, compared using the area under the alternative \nfree-response receiver operating characteristic curve (A~Z~), was significantly \nimproved by the addition of gadoxetic acid-enhanced dynamic images: A~Z~ \nin set 1 was 0.708, A~Z~ in set 2 was 0.833. With the addition of the \nhepatobiliary phase, A~Z~ value was 0.941 in set 3.\nConclusion: Hepatobiliary phase images obtained after Gd-EOB-DTPA-\nenhanced dynamic MRI may improve the differentiation of focal hepatic \nlesions.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / FRIDAY, JUNE 15, 2012\n S488\nConclusion: Regardless of the ADC evaluation method, NPV was low, while \nthe PPV was high, especially by comparing lesion and parenchymal ADCs with \nADC-R2. However, the use of an ADC threshold provided higher diagnostic \nperformance in terms of AUC.\nSS 13.08\nAccuracy of visual assessment versus apparent \ndiffusion coefficient quantification in differentiating \nmalignant and solid benign focal liver lesions with \ndiffusion-weighted imaging\nR. Girometti, M. Del Pin, S. Pullini, L. Cereser, G. Como,  \nM. Bazzocchi, C. Zuiani; Udine/IT\nPurpose: The purpose of this study was to compare the accuracy of diffusion-\nweighted imaging (DWI) visual analysis (VA) versus the apparent diffusion \ncoefficient quantification (ADC-Q) in assessing malignancy of solid focal liver \nlesions (FLLs).\nMaterial and Methods: Two radiologists in consensus retrospectively \nassessed as benign or malignant 50 FLLs (16 benign, 24 malignant) on 32 \npatients examined on a 1.5 T. Two different methods were used in separate \nreading sessions: (a) VA of signal intensity on DWI images at b=800 sec/mm2 \nand ADC-map; (b) lesion ADC measurement on the ADC-map. Reference \nstandard included histology and follow-up confirmation of a consensus panel \ndiagnosis. We estimated the accuracy for malignancy of both methods and the \nADC-Q threshold as assessed by a receiver operating characteristic (ROC) \nanalysis.\nResults: Because of 20 false-negative hepatocarcinoma, VA showed lower \naccuracy than ADC-Q (52.0% vs. 68.0%). However, stratified accuracy for \nmetastases was higher than VA (75.0 vs. 66.7%). ADCs and signal features of \nmalignant and benign FLLs largely overlapped.\nConclusion: VA performed worse than ADC-Q for hepatocarcinoma, and \nbetter for metastases, possibly in relation with the T2-shine-through \nphenomenon. Overall, the accuracy of both methods was limited because of \nthe overlap in visual appearance and ADC values between solid benign and \nmalignant FLLs.\nSS 13.09\nHypervascular liver lesion at dual-energy CT: \nenhancement evaluation at different tube voltages\nP . Cabassa, A. Colleoni, A. Scrimieri, R. Maroldi; Brescia/IT\nPurpose: The purpose of this study was to compare attenuation values of \nhypervascular liver lesion with 80 kvp-images, 140 kvp-images and with \nweighted-average (WA) simulated 120 kvp-images, using dual energy CT \n(DECT).\nMaterial and Methods: 58 patients (47 male) underwent (in a 6 months period) \nprospectively abdominal DECT for suspected or known hypervascular lesions. \nAn arterial phase with DE technique (80Kvp, 140Kvp and WA) and a venous \nacquisition (120 kvp) were performed. Arterial images were obtained after a \nstandard triggered threshold. The attenuation values were calculated using \nROIs placed in arterial DE images on 6 different areas: lesion, aorta, psoas \nmuscle, subcutaneous fat, healthy right and left liver. The LLR (lesion-to-liver \nratio) and the CNR (contrast-to-noise ratio) were calculated independently by \ntwo radiologists: CNR by (ROI lesion - ROI healthy liver)/(SD subcutaneous fat) \nand LLR by mean value of the lesion/mean value of healthy liver. Student-t test \nwas used for statistical analysis.\nResults: Twenty lesions were detected. The mean attenuation values of the \nlesions were 157.19±55.26 HU for 80kv-images, 86.51±19.21 HU for 140Kv-\nimages, 109.51±26.69 HU in WA images. LLR was 2.48 in 80Kv-images, 1.55 \nin 140Kv-images (p<0.005) and 1.89 in WA images (p=0.003). The mean CNR \nwas 3.40 in 80Kv-images, 1.27 in 140Kv-images (p<0.005) and 2.51 in WA \nimages (p=0.21).\nConclusion: 80 kvp images demonstrated a higher LLR than acquired images \nat 140kvp and at WA-120KvP . The 80KVp images could be used in clinical \npractice to better evaluate hypervascular liver lesions.\nSS 13.10\nPhase contrast computed tomography of focal liver \nlesions using a conventional X-ray source\nA.A. Fingerle\n1, M. Willner2, J. Herzen2, P .B. Noël1, D. Hahn2, \nE. Drecoll1, D. Münzel1, E.J. Rummeny1, F . Pfeiffer2;  \n1Munich/DE, 2Garching/DE\nPurpose: The purpose of this study was to evaluate grating-based phase \ncontrast computed tomography (PCCT) for the detection and characterization \nof ex vivo focal liver lesions in comparison to standard absorption-based \ncomputed tomography and histopathology.\nMaterial and Methods: Forty-one patients with 162 liver metastases from \nNET underwent MR imaging including DW, T2WFSE, and dynamic gadolinium-\nenhanced MR imaging. Images were retrospectively reviewed by two \nindependent abdominal radiologists for the detection and characterization of \nliver metastases. MR findings were compared to histopathological and \nintraoperative ultrasound findings on a lesion-by-lesion basis to determine the \nsensitivity of each MR sequence, alone and combined.\nResults: There was excellent agreement for lesion characterization between \nobservers 1 and 2 for the per-lesion analysis. DW-MR was more sensitive \n(Se=71.6%; 95% CI: 64.2-78.0 and Se=71.0%; 95% CI: 63.6-77.4 for \nobservers 1 and 2, respectively) than T2-weighted fast spin-echo, and dynamic \ngadolinium-enhanced MR (Se=55.6%; 95% CI: 47.9-63.0, and Se=47.5%; \n95% CI: 34.0-55.2 for observer 1 and Se=55.6%; 95% CI: 47.9-63.0 and \nSe=48.1%; 95% CI: 40.6-55.8 for observer 2). The sensitivity of the three types \nof sequences combined was 80.3% (95% CI: 73.2-85.8) for both observers.\nConclusion: DW-MR imaging was more sensitive for detecting and \ncharacterizing liver metastases from NET than T2WFSE and dynamic \ngadolinium-enhanced MR imaging. We, therefore, recommend performing this \nsequence in patients for preoperative disease staging.\nSS 13.06\nEnteric and pancreatic neuroendocrine liver metastasis: \ncomparison of vascular behavior on triple-phase MDCT\nG. D’Assignies, F . Cuccioli, M.P . Vullierme, M. Ronot,  \nO. Bruno, V. Vilgrain; Clichy/FR\nPurpose: The purpose of this study was to describe vascular behavior of liver \nmetastases (LM) from enteropancreatic neuroendocrine tumor (EPNET) and to \nlook for differences between enteric (ENLM) and pancreatic (PNLM) \nneuroendocrine liver metastases and to identify the best phase for their \ndetection.\nMaterial and Methods: 78 patients with pathologically proven EPNETs and \nuntreated liver metastases were retrospectively analyzed. 559 LM were seen \non triple-phase (non-contrast, arterial and portal) MDCT and characterised as \nhypo, iso or hyper-attenuating on each phase. Best phase for lesion depiction \nwas evaluated per patient.\nResults: 45 patients (58%) had LM from pancreatic origin and 33 (42%) from \nenteric origin. On non-contrast-enhanced phase, PNLM were hypoattenuating \nin 189 (72%), whereas 105 (34%) ENLM were hypoattenuating (p < 0.05). 385 \nLM (69%) were hypervascular on arterial phase, including 201 ENLM (68.7%) \nand 184 PNLM (70%, ns). The classical pattern (hypervascularity on arterial \nphase and hypoattenuation on portal venous phase) was present in 50 patients \n(64%) including 31 patients (40%) with other vascular behaviors. Best phase \nfor tumor depiction was portal venous phase for ENLM (19 patients, 58%) and \narterial phase for PNLM (36 patients, 80%).\nConclusion: Neuroendocrine LM were hypervascular on arterial phase in only 2/3 \nof cases. Nearly half of patients with hypervascular LM also had other CT patterns. \nBoth portal venous and arterial phases are important for LM depiction.\nSS 13.07\nComparison of three methods of apparent diffusion \ncoefficient evaluation in assessing solid focal liver \nlesions with diffusion-weighted imaging (DWI)\nR. Girometti, S. Pullini, L. Cereser, M. Del Pin, G. Como,  \nM. Bazzocchi, C. Zuiani; Udine/IT\nPurpose: The purpose of this study was to compare the performance in \ndiagnosing focal liver lesions (FLLs) malignancy of the apparent diffusion \ncoefficient thresholding (ADC-T) method versus two variants of the lesion-to-\nliver ADC ratio (ADC-R).\nMaterial and Methods: Examinations were performed on a 1.5 T system. \nAnalysis was applied to 50 FLLs proven to be malignant and benign in 34 and \n16 cases, respectively. Cysts and haemangiomas were excluded from the \nanalysis. We estimated the positive-predictive value (PPV) and negative-\npredictive value (NPV) for malignancy of ADC-T and two variants of the ADC-R, \ncalculated without (ADC-R1) and with (ADC-R2) the inclusion of the \nparenchymal ADC standard deviation value, respectively. An ADC-R < 1 was \nconsidered as malignant. A receiver operating characteristic (ROC) analysis \nwas performed to establish ADC-T threshold for malignancy and to compare \nthe areas under the curve (AUC).\nResults: The ADC-T threshold for malignancy was \u00021.09x10\n-3 mm2/sec. PPV \nand NPV were 87.5% (95%C.I.: 74.4-94.7) and 50.0% (95%C.I.: 35.7-64.3) for \nADC-T versus 75.0% (95%C.I.: 60.4-85.7) and 36.7% (95%C.I.: 23.9-51.5) for \nADC-R1 versus 90.9% (95%C.I.: 78.5-96.8) and 38.5% (95%C.I.: 25.4-53.3) \nfor ADC-R2, respectively. Most false-negative FLLs were represented by \nhepatocellular carcinoma. ADC-T showed an AUC (0.71) significantly higher \n(p<0.05) than ADC-R1 (0.56), but not than ADC-R2 (0.61).\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / FRIDAY, JUNE 15, 2012\n S489\nintensity in the liver parenchyma were observed in 14/22 ITBL patients. Fitted \nADC values of liver parenchyma in ITBL group were significantly lower than \nthose in normal control group (p-less-than-0.05).\nConclusion: In liver recipients with ITBLs, MRC and DW-MRI at 3T reveal \ncharacteristic features that may allow differentiation from other complications \nafter liver transplantation.\nSS 14.03\nContrast-enhanced MR perfusion of solid pancreatic \nlesions: utility of time-signal intensity curves\nF . Donati, P . Boraschi, R. Gigoni, G. Gherarducci, F . Pacciardi, \nF . Falaschi, C. Bartolozzi; Pisa/IT\nPurpose: The purpose of this study was to evaluate the usefulness of time-\nsignal intensity curve (TSIC) using dynamic contrast-enhanced MR perfusion \nof solid focal pancreatic lesions.\nMaterial and Methods: Twenty patients without pancreatic disease and forty-five \nwith pathologically confirmed pancreatic lesions (ductal adenocarcinoma, n=23; \nendocrine tumor, n=6 with 9 lesions; focal chronic pancreatitis, n=13; autoimmune \npancreatitis, n=3) underwent MRI at 1.5T device. Dynamic contrast-enhanced MR \nperfusion consisted of a 3D axial free-breathing LAVA sequence (TR/TE, 2.28 ms/1.05 \nms; 10.0 mm thk/-0.0 mmsp; matrix, 128x128; 0.75 NEX; 1 second) repeated up to 5 \nminutes. A dose of 7 mL gadobenate-dimeglumine (Gd-BOPTA; MultiHance) with 20 \nmL saline flush was injected at 4 mL/sec. MR perfusion images were processed by \ntwo radiologists in conference that classified five TSIC shapes: type 1 (quick \nenhancement and quick decay followed by slowly decaying); type 2 (slow enhancement \nfollowed by slow constant enhancement); type 3 (fast enhancement followed by signal \nplateau); type 4 (fast enhancement followed by slowly decaying plateau); type 5 (quick \nand marked enhancement followed by slow constant decay).\nResults: All 20 patients with normal pancreas presented a TSIC-type 1. TSIC-type 2 \nwas observed in all 23 ductal adenocarcinomas and in 1 endocrine tumor; TSIC-type \n3 was recognized in 13 patients with focal chronic pancreatitis and in 16 post-\nobstructive chronic pancreatitis; TSIC-type 4 was identified in all cases of autoimmune \npancreatitis, and TSIC-type 5 in the 8 lesions of 5 patients with endocrine \nneoplasms.\nConclusion: Dynamic contrast-enhanced MR perfusion using TSIC could \nimprove the diagnosis of solid focal pancreatic lesions.\nSS 14.04\nImproved detection of cholesterol gallstones using dual \nenergy CT: results in an anthropomorphic phantom \nmodel\nR.W. Bauer, S. Hohertz, J. Schulz, M.C. Larson, T. Vogl; \nFrankfurt am Main/DE\nPurpose: Cholesterol gallstones elude detection on regular 120 kV CT scans. \nThe potential of dual energy CT (DECT) post-processing for the correct \nclassification of gallstones in an anthropomorphic phantom model was \nassessed.\nMaterial and Methods: 34 gallstones with known chemical composition (11 \npure cholesterol, 12 non-cholesterol, 11 cholesterol core and non-cholesterol \nshell) were put into a standard plastic specimen container functioning as \nartificial gallbladder and then into a water-filled cylindrical acrylic glass \nphantom with a diameter of 32 cm that contained porcine organs and spine to \nsimulate noise levels of a human abdomen. DECT scans were performed with \na first-generation Dual Source scanner (Definition, Siemens). DECT prototype \npost-processing software was used to selectively highlight cholesterol \ninformation by color overlay. 80 kV, 140 kV grayscale images and color-coded \nimages were analyzed for the presence and characteristics of gallstones.\nResults: Pure cholesterol stones were not visible at 140 kV, 6/11 were not \ndetected at 80 kV, but all were detected on post-processed color-coded DE \nimages. Non-cholesterol stones appeared hyperdense on grayscale images \nand were visible on both the 140 kV and 80 kV series. The appearance of core/\nshell stones was best defined at 80 kV; however, the conspicuity of cholesterol \nparts was more pronounced on color-coded images.\nConclusion: DECT post-processing allowed for reliable identification of \ncholesterol gallstones in this anthropomorphic phantom simulating a human \nabdomen. This may be beneficial in patients with abdominal pain and no \nprimary finding on regular abdominal CT.\nMaterial and Methods: Formalin-fixed liver specimens with benign and \nmalignant focal liver lesions were scanned with an experimental grating-based \nPCCT setup using a conventional X-ray tube (ENRAF Nonius rotating anode \nX-ray tube, single photon counting detector Pilatus II, Dectris). Tube voltage \nwas 35 pkV, tube current 70 mAs. Phase contrast and conventional absorption \nCT data were obtained. The reconstructed images were correlated with \nhematoxylin and eosin staining of the specimens and compared for imaging \nfeatures like contrast, lesion delineation and depiction of internal structures.\nResults: Grating-based PCCT images of ex vivo focal liver lesions show a \nmarked improvement of soft-tissue contrast compared to standard absorption \nCT. In PCCT images, lesion delineation is significantly improved and internal \nstructures are visible.\nConclusion: When introduced to the clinic, grating-based phase contrast \ncomputed tomography has the potential to be a valuable tool for the \ncharacterization of structural information of focal liver lesions.\n11:00 - 12:30 Tinto\nScientific Session 14\nBiliary imaging\nSS 14.01\nUltra-high-field imaging of the biliary tract at 7 Tesla: \ninitial results of Gd-EOB-DTPA-enhanced MRCP\nA. Fischer, O. Kraff, S. Orzada, M.E. Ladd, L. Umutlu,  \nT.C. Lauenstein; Essen/DE\nPurpose: The aim of this study was to assess the feasibility and diagnostic \npotential of imaging of the biliary tract using biliary secreted Gadoxetic acid at \n7 Tesla in comparison to T2-weighted MRCP at 3 Tesla.\nMaterial and Methods: 10 healthy volunteers were examined on a 7T whole-\nbody MR system using a custom-built 8-channel body coil. The following \nsequences were included: T1w 3D FLASH VIBE, 3D FLASH with inversion \nrecovery, and T2w TSE in coronal orientation. For dynamic imaging, Gadoxetic \nacid was administrated with a clinical standard dosage. Acquisition of a \ndynamic series started after 20, 70, and 120 seconds with additional \nacquisitions performed at 5, 10, 15, 20, 25 and 30 minutes after injection. All \nvolunteers underwent a non-enhanced T2-weighted MRCP on a 3T MR \nsystem.\nResults: Dynamic contrast-based MRCP at 7T showed a homogeneous \ndepiction of the intra- and extrahepatic biliary tract. While T1w 3D VIBE \nimaging provided a moderate delineation of the biliary tract, it also yielded near \nisointense liver tissue and vasculature. In contrast, 3D FLASH imaging with \ninversion recovery enabled a high-quality assessment of the biliary duct due to \na strong saturation of hepatic tissue and vessels. T2w TSE showed only poor \nto moderate image quality.\nConclusion: Our results demonstrate the feasibility of contrast-enhanced \nimaging of the biliary tract at 7 Tesla. In particular, 3D FLASH MRI with inversion \nrecovery enabled high-quality assessment of the biliary tract.\nSS 14.02\nIschemic-type biliary lesions after orthotopic liver \ntransplantation: evaluation with MR cholangiography \nand diffusion-weighted MR imaging at 3T\nP . Boraschi, F . Donati, R. Gigoni, F . Filipponi, F . Falaschi,  \nC. Bartolozzi; Pisa/IT\nPurpose: The purpose of this study was to determine the usefulness of MR \ncholangiography (MRC) and diffusion-weighted MR imaging (DW-MRI) at 3T for \nevaluating ischemic-type biliary lesions (ITBLs) in liver transplant recipients.\nMaterial and Methods: Twenty-two liver transplant patients with ischemic \nchanges of the biliary tree at ERCP/PTC underwent MRI at 3T device (GE-\nDISCOVERY MR750;GE-Healthcare). After acquisition of T1w/T2w images, \nMRC was performed through thin-slab 3D-FRFSE and thick-slab SSFSE T2w \nsequences. DW-MRI of the liver was performed using an axial respiratory-\ntriggered spin-echo echo-planar sequence with multiple b-values (150, 500, \n1000, 1500 s/mm\n2) in all diffusion directions. Two blinded observers reviewed \nall images in consensus and recorded the presence of biliary and liver \nabnormalities. ADC values of liver parenchyma in ITBL group and normal \ncontrol group (n=10) were, respectively, calculated using a dedicated software \nfitting the curve obtained from the corresponding ADC for each b-value.\nResults: Abnormal findings of bile ducts were observed in all patients; the \nmost common findings were intrahepatic bile duct dilatation (22/22), strictures \ninvolving hepatic bifurcation (20/22), extrahepatic biliary wall thickening (20/22) \nand sludge/stone formation (17/22). DW-MRI areas of persistent high signal \n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / FRIDAY, JUNE 15, 2012\n S490\nResults: There was no difference in incidence of chronic pancreatitis or \ndivisum between the SOD (n=43) and non-SOD (n=27) groups. MRCPS \nparameters of maximum PD caliber, time to maximum PD caliber, maximum \nDFC, and time to maximal DFC did not correlate with the presence of SOD or \nseverity of elevation of manometric pressure (all p>0.05).\nConclusion: Previous reports had suggested a correlation between MRCPS \nparameters and SOD. We did not find such a correlation.\nSS 14.08\nRadiological features of malignancy combined with \ninflammation in pancreatobiliary system\nK. Jee, S.A. Lee, M. Park; Cheonan/KR\nPurpose: The purpose of this system was to evaluate the radiological features \nand clinical findings of chronic inflammation combined with malignancy in \npancreatobiliary systems.\nMaterial and Methods: For 10 years, pathologically and clinically confirmed \nchronic inflammation combined with malignancy in pancreatic (n = 6) and \nbiliary (n = 20) systems were evaluated about radiological and clinical findings. \nMean age was 63.8 and male to female ratio was 21 to 5. Radiological \nexaminations of CT (n = 26), ERCP (n = 19), MRCP (n = 19) and EUS (n = 6) \nwere done. Clinical records were evaluated.\nResults: Biliary cases were RPC with cholangioca (n = 12) and biliary \nintraepithelial neoplasm (n = 5), IPMT with stones (n = 2), cholangioca with \nclonorchis infestation (n = 1). 70% of RPC were in left lobe. Radiological tumor \ndetectability was 55% with six bile ductal wall thickening and five mass-forming \npatterns. CA 19-9 was elevated in 52.9 %. Pancreatic cases were carcinoma  \n(n = 5) and pancreatic intraepithelial neoplasm (n = 1) with chronic pancreatitis. \nP-duct dilatation showed all, parenchymal atrophy in five and calcification/\nstones in three. Tumor detectability was 83%. Lymph node enlargement in 68% \nbut all were pathologically negative. CA 19-9 was elevated in 80%.\nConclusion: Pancreatobiliary ductal malignancy could have combined chronic \ninflammation and reveals multistep process of malignant change. Serial \nimaging and tumor marker follow-up can be helpful for early diagnosis of \npancreatobiliary malignancy in underlying chronic inflammation.\nSS 14.09\nThe role of diffusion-weighted imaging and ADC values \nin the evaluation of hilar strictures\nM. Alkhouri\n1, J. James2, L. Brits3, A. Sanderson1, A. Milson1, \nJ.V. Macpherson1;  1Devon/UK, 2Plymouth/UK, 3Milton Keynes/UK\nPurpose: The purpose of this study was to assess the role of diffusion-weighted \nimaging (DWI) in the evaluation of hilar strictures and to correlate the apparent \ndiffusion coefficient (ADC) values of the obstructing lesion with the final diagnosis.\nMaterial and Methods: Patients who had an MRCP with DWI showing a hilar \nstructure were included. The area of bile duct obstruction was assessed for \nhigh signal on b=800 DWI. If identified, the ADC value for that area was derived \nfrom the ADC map in x10-³mm²/s by two observers. Statistical analysis was \nperformed. The final diagnosis was reached by tissue diagnosis, follow-up \nimaging of appropriate clinical course. Correlation was made between the final \ndiagnosis and the ADC value.\nResults: 19 patients with hilar stricture were identified from 2009 to 2011 with \nfollow up of 4-26 months: 16 with malignancy and 3 with benign disease. \nThere were 8 cholangiocarcinomas, 3 gallbladder carcinomas, 5 liver \nmetastases, 2 benign anastomotic strictures and 1 Mirizzi’s. 10 patients had a \ntissue diagnosis. Two observers derived the ADC value and it ranged from \n0.774 to 1.256 in the cholangiocarcinoma, 0.736-1.290 for gallbladder \ncarcinoma and 0.470-1.281 for metastases. The one case of small cell \ncarcinoma had the lowest ADC values at 0.470 and 0.481. No high signal \ncausing obstruction on b=800 DWI compared to adjacent normal structures \nwas seen in the benign cases.\nConclusion: DWI is useful in the evaluation of hilar strictures, by differentiating \nbenign from malignant strictures.\nSS 14.10\nAttenuation value of gall bladder fluid on multidetector \ncomputed tomography in acute unspecified pancreatitis: \ncomparison with normal control group\nC.S. Choi, S.H. Bae, E.J. Yun, D.Y . Yoon, Y .L. Seo, K.J. Lim, \nS. Baik, A. Han; Seoul/KR\nPurpose: The purpose of this study was to retrospectively compare the \ncomputed tomography (CT) attenuation value (HU) of gall bladder (GB) fluid in \npatients with acute unspecified pancreatitis with those of normal control group.\nMaterial and Methods: From January 2009 to April 2011, 59 consecutive \npatients with acute unspecified pancreatitis and 59 normal control subjects \nSS 14.05\nDual energy CT in patients with acute RUQ pain: is it \npossible for virtual non-enhanced images to replace \ntrue non-enhanced images?\nY .H. Lee, S.N. Moon, D.M. Kang, S.H. Wee, S.W. Im; Iksan/KR\nPurpose: The purpose of this study was to determine whether virtual non-\nenhanced (VNE) images derived from dual energy computed tomography (DECT) \nreplace true non-enhanced (TNE) images in patients with acute RUQ pain.\nMaterial and Methods: Among the 93 patients who had acute RUQ pain \nunderwent MDCT including non-enhanced scan and dual phases enhanced \nscans. Total 58 patients with surgically and ultrasonographically proven gallstones \nor bile duct stones were selected. Portal phase enhanced CT images were \nobtained using DE technique. For quantitative analysis, CT numbers were \nmeasured on the stone, liver and GB. Contrast to noise ratio (CNR) of stone to liver \nand stone to bile was tested with a Student’s t-test. Effective radiation doses were \ncalculated. For qualitative analysis, two blinded readers independently compared \nthe image qualities and artifact for VNE and TNE images.\nResults: TNE images showed significantly higher mean CT numbers (p<0.05) than \nVNE images. CNR of stone to bile was significantly higher in VNE images than TNE \nimages (p<0.05). Stone size was not significantly different between the TNE and VNE \nimages (p<0.05). By skipping the TNE images, we could reduce the radiation dose \nabout 30%. The image quality and artifacts of VNE were not significantly different from \nthat of TNE (P<0.05) images. Interobserver agreement of showed good (k=0.687).\nConclusion: DECT provides high-quality VNE images, which can be used as \nreasonable alternative to TNE images, in patient with gallstones or radioopaque \nbile duct stones.\nSS 14.06\nEarly biliary decompression prior to preoperative \nstaging of hilar and extrahepatic cholangiocarcinomas: \nWhat happens?\nE.S. Lee, J.Y . Lee, S.H. Kim, J.M. Lee, J.K. Han, B.I. Choi; \nSeoul/KR\nPurpose: The purpose of this study was to compare the accuracy of \npreoperative CT before and after biliary decompression in the evaluation of \nlocal tumor extent and resectability of hilar and extrahepatic cholangiocarcinomas \nusing surgery and histological results as the reference standard.\nMaterial and Methods: Thirty-six patients who had undergone surgery due to \nhilar or extrahepatic cholangiocarcinomas from June 2006 to December 2009 \nwere included in this study. All of them underwent triple-phase before and after \nendoscopic or percutaneous biliary decompression prior to the surgery. Three \nexperienced radiologists independently and blindly evaluated the pre-\ndecompression and post-decompression CT images separately in terms of \nBismuth type of tumor, the presence of involvement of second order branch of \nintrahepatic ducts, the presence of intrapancreatic CBD involvement, lymph \nnode metastasis, and tumor resectability. Diagnostic accuracy was calculated \nand compared between pre- and post-decompression CT scans. For statistical \nanalysis, the McNemar test was used.\nResults: Mean diagnostic accuracies were significantly lowered after biliary \ndecompression for Bismuth type (P=0.01), second-order branch involvement \nof IHD (P=0.007), and intrapancreatic CBD involvement (P=0.001). However, \nmean accuracies were not significantly changed after biliary decompression \nfor lymph node metastasis (P > 0.05) and resectability (P > 0.05).\nConclusion: Early biliary decompression prior to preoperative staging CT influenced \non the evaluation of local tumor extent of hilar or extrahepatic cholangiocarcinomas. \nHowever, it did not influence on the determination of resectability.\nSS 14.07\nThe utility of secretin-enhanced MRCP in diagnosing \npancreatic sphincter of Oddi dysfunction\nK. Sandrasegaran, M. Tann, F . Akisik; Indianapolis, IN/US\nPurpose: The purpose of this study was to assess the usefulness of secretin-\nenhanced MRCP in diagnosing sphincter of Oddi dysfunction (SOD), defined as \nbasal sphincteric pressure of > 40 mmHg. Theoretically, the presence of SOD should \nresult in persistently distended main pancreatic duct and reduced rate of entry of \nexocrine fluid into the duodenum, following intravenous secretin stimulation.\nMaterial and Methods: Retrospective review found 70 patients with SMRCP and \nERCP manometric measurements, without intervening sphincteric therapy. MRCP \nwas performed using 1.5 T MRI (Magnetom Harmony or Avanto, Siemens, Erlangen, \nGermany) using previously published protocol (Sandrasegaran et al. AJR 2010;195:42). \nAll patients had 300 mL of oral ferumoxsil (GastroMark, Mallinckrodt Inc, St Louis) prior \nto MRCP , ensuring a dark duodenal luminal signal at baseline. Studies were \nanonymized and independently reviewed by two reviewers for the dynamic changes \nin pancreatic duct (PD) caliber and semiquantitative measurement of duodenal fluid \ncontent (DFC) during SMRCP (Cappeliez et al. Radiology 2000;312:358).\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / FRIDAY, JUNE 15, 2012\n S491\nConclusion: Our results demonstrate the benefits and the limitations of an \nincrease of magnetic field strength from 1.5 T to 3 T to 7 T, offering improved \nand highly detailed delineation of anatomical and vascular structures in T1w \nimaging.\nSS 15.03\nRole of diffusion-weighted MR imaging in detection of \nhepatic abscesses and their differentiation from non-\ninfected fluid collections in the liver\nC. Schmid-Tannwald\n1, R. Neumann1, C. Schmid-Tannwald1, \nA. Oto2, M.F . Reiser1, K. Nikolaou1, C. Rist1;  1Munich/DE, \n2Chicago, IL/US\nPurpose: The purpose of this study was to evaluate the role of diffusion-\nweighted MRI (DW-MRI) in differentiation between hepatic abscesses versus \nbiloma.\nMaterial and Methods: In this retrospective study, 22 abscesses and 27 \nbilioma in 27 patients who underwent abdominal MRI including DW-MRI were \nincluded. Two independent observers reviewed T2-weighted (T2w) images \nalone, T2w images with DW-MR images and T2w images together with \ncontrast enhanced T1-weighted (CET1w) images at three different sessions to \ndetect liver abscesses and biloma based on a confidence scale. Sensitivity, \nconfidence level and mean ADC values of abscesses and biloma were \ncalculated and compared.\nResults: Detection of abscesses improved significantly by combining T2w images \nwith DW-MRI [both observer: 21/22 (95.5%), p<0.01] or with T1CE images \n[observer 1: 21/22 (95.5%), observer 2: 22/22 (100%), p<0.01] in comparison to \nT2w images alone [observer 1: 11/22 (50%) and observer 2: 12/22 (54.4%)]. 20/27 \n(74.0%) and 18/27 (66.6%) biloma were dected on T2w images by observer 1 and \n2, respectively. Observer 1 and observer 2 detected more biloma on their review \nof T2w+DW-MRI [observer 1: 23/27 (85.2%), p=0.006, observer 2: 24/27 (88.9%), \np=0.008]. The detection rate significantly improved by combining T2w images \nwith CET1w images [both observer: 26/27 (96.3%), p<0.001]. Mean ADC of \nabscesses was significantly lower (0.83±0.24x10[-3]mm²/s) compared to mean \nADC of biloma (2.25±0.6x10[-3]mm²/s, p<0.001).\nConclusion: DW-MRI is a valuable adjunct to T2w images to detect and differentiate \nhepatic abscesses from non-infected fluid collections in the liver. Furthermore, ADC \nmeasurements may help to distinguish liver abscesses from biloma.\nSS 15.04\nDiffusion-weighted imaging of the liver: value of \napparent diffusion coefficient and influence of region of \ninterest\nJ.P . Filipe, L. Curvo-Semedo, C. Marques, F . Caseiro-Alves; \nCoimbra/PT\nPurpose: The purpose of this study was to investigate the usefulness of \ndiffusion-weighted imaging (DWI) in the differential diagnosis of hepatic \ndisease, by measuring apparent diffusion coefficient (ADC) of hepatic \nparenchyma and focal liver lesions (FLL), and the influence of region of interest \n(ROI) characteristics in the results.\nMaterial and Methods: Ninety-three patients were retrospectively evaluated \nand 90 lesions were analyzed: 14 hepatocellular carcinomas (HCC), 18 \nmetastases, 10 focal nodular hyperplasias (FNH), 4 adenomas, 30 hemangiomas \nand 14 cysts. ADC was measured in liver parenchyma with ROIs in four \nsegments and in FLL, using three circular centimetric ROIs and one ROI \nencompassing the full lesion area (b-values of 50 and 700 s/mm[2]). Reference \nstandard was the histopathological data or, alternatively, a consensus between \nimaging methods, follow-up and clinical history. ADCs were statistically \ncompared, with P<0.05 being significant.\nResults: Mean ADCs (×10[−3]mm[2]/s) were 1.45, 1.28, 1.25 (normal, cirrhotic, \nsteatotic parenchyma) and 1.16, 1.18, 1.30, 1.64, 1.89, 2.77 (metastases, \nHCCs, adenomas, FNHs, hemangiomas, cysts). ADCs of malignant lesions \nwere significantly lower than all benign lesions but with overlap between \nmalignant and solid benign lesions. The AUC for malignancy determination \nwas 0.94 (89.7% sensitivity, 90.6% specificity), for a cut-off ADC of 1.43. No \nsignificant differences were found between ROI sampling methods in \nhomogeneous lesions.\nConclusion: ADC measurements are useful in differentiating normal from \npathological liver parenchyma and in the characterization of FHLs. The ROI \nsize does not influence ADC measurements in homogeneous lesions.\nwere enrolled in this study. The control group was consisted of normal healthy \npopulation. Disease patients were 43 males and 16 females with average age \nof 44.8 years. Normal control subjects were 33 males and 26 females with \naverage age of 49.8 years. The CT scanner was 16 channel multidetector \nMx8000 (Phillips, Haifa, Israel) with automated modulation of mAs with fixed \n120 kVp. We measured HU in the central portion of GB with region of interest \n(ROI) of 2cm[2] in portal phase on DICOM images. Student t-test and Chi-\nsquare test were employed as statistical methods. p-value less than 0.05 was \nconsidered as statistically significant.\nResults: HU of GB fluid in disease patients was 23.74 ±10.44 and that in \ncontrol group was 17.66 ± 8.19 ( p= 0.001 ). HU over 30 was observed in 15 in \nacute pancreatitis compared with 3 in control group. No difference between \ntwo groups in age and sex distribution was observed.\nConclusion: GB fluid attenuation of disease patients was higher than those of \ncontrol group. Probably, calcium bilirubinate crystal juice might be one of \ncauses of acute unspecified pancreatitis.\n11:00 - 12:30 Moorfoot\nScientific Session 15\nLiver 2\nSS 15.01\nDoes diffusion-weighted imaging contribute to \ndifferentiation of benign and malignant portal vein \nthrombus?\nK. Sandrasegaran, B. Tahir, F . Akisik, M. Tann;  \nIndianapolis, IN/US\nPurpose: The purpose of this study was to determine whether diffusion-\nweighted imaging (DWI) adds to the differentiation of benign from malignant \nportal vein thrombus (PVT) in cirrhotic patients.\nMaterial and Methods: Retrospective review of MRI examinations was \nperformed for reports containing phrase “portal vein thrombus”. PVT was \nconsidered tumor thrombus (n=15) if it progressed in distribution in <3 months \nin the presence of HCC, or there was tumor thrombus on portal vein cytology. \nBland thrombus was diagnosed if PVT remained stable for >12 months follow \nup (n=19). Images were analyzed by two radiologists, blinded to follow up, for \nsignal intensity on DWI of PVT compared to liver (hypo, iso or hyperintense) \nand ADC measurements of PVT, HCC and unaffected liver.\nResults: MRI parameters that were significant on logistic regression analysis \nwere distance of thrombus from HCC (p<0.01), arterial enhancement of PVT \n(p<0.01), venous enhancement of PVT (p=0.04), and size of HCC (p<0.01). \nSignal characteristics of PVT on DWI, ADC measurements of PVT, ADC ratios \nof PVT to liver were not significant. The presence of at least two of three MRI \nfindings, (a) distance from tumor to PVT of < 5 cm, (b) HCC size of > 10 cm, \nand (c) arterial enhancement of PVT, had a sensitivity of 100% (95% CI 78-\n100%) and specificity of 90% (95% CI 55-98%) for malignant PVT.\nConclusion: DWI does not add to the differentiation of malignant and benign \nPVT.\nSS 15.02\n1.5 Tesla versus 3 Tesla versus 7 Tesla abdominal MRI: \nthe more Tesla, the better?\nL. Umutlu, S. Maderwald, A. Fischer, M. Forsting,  \nM.E. Ladd, O. Kraff, T.C. Lauenstein; Essen/DE\nPurpose: The aim of this study was to investigate and to compare the \ndiagnostic ability of 1.5, 3 and 7 Tesla in vivo abdominal MRI.\nMaterial and Methods: 12 volunteers were examined on a 1.5 T, 3 T and 7 T \nMR system with equivalent FOV and acquisition times including: (1) T1w fs 2D \nand (2) 3D FLASH, (3) T1w fs VIBE, (4) T1w 2D i.-and-op. phase, (5) True-FISP \nand (6) T2w TSE. Qualitative image analysis was performed regarding (1) \noverall image quality, (2) delineation of abdominal vasculature, (3) delineation \nof the biliary duct system and (4) image impairment. For correlation of signal \nintensities, regions-of-interest were assessed in parenchymatous organs.\nResults: Overall image quality was rated comparably high for T1w imaging in \nall three field strengths, with 7T T1w MRI showing its superiority in the \nassessment of non-enhanced abdominal vasculature due to a hyperintense \nvessel-signal (mean1.5T 1.2, mean3T 1.2, mean7T 3.6). T2w TSE showed a \nstatistical significant strong impairment in 7 T MRI (mean1.5T 3.4, mean3T 3.5, \nmean7T 1.5). Quantitative image analysis revealed an increase in the mean \norgan signal from 1.5 T to 3 T of 1.45 on average (p=0.04) with a mild further \nincrease from 3 T to 7 T (1.19).\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / FRIDAY, JUNE 15, 2012\n S492\nevaluated liver image quality. Signal intensity (SI) of the right and left liver lobe were \nmeasured for unenhanced and enhanced images using a a 1-cm2 manual ROI. A \nStudent’s t-test was used to demonstrate significant difference.\nResults: No significant difference in mean image quality was observed \n(p>0.05). Liver SI on enhanced images was significantly lower (p<0.05) than on \nunenhanced images.\nConclusion: Gd-EOB-DTPA affects DWI at low b values resulting in a SI \nreduction. The SI modification could influence the perfusion fraction quantification \napplying intravoxel incoherent motion (IVIM)-based biexponential analysis.\nSS 15.08\nLow-tube-voltage, intermediate-tube-current \nmultidetector liver CT with sinogram affirmed iterative \nreconstruction (SAFIRE) algorithm for detection of \nhypervascular hepatocellular carcinoma\nM.H. Yu, J.M. Lee, J. Yoon, J.H. Baek, J.K. Han, B.I. Choi; \nSeoul/KR\nPurpose: The purpose of this study was to assess the image quality, lesion \nconspicuity and radiation dose of sinogram affirmed iterative reconstruction \n(SAFIRE) compared with filtered back projection (FBP) for low-tube-voltage \n(80-kVp), intermediate-tube-current (300-mA) liver CT for detection of \nhypervascular hepatocelluar carcinoma (HCC).\nMaterial and Methods: 126 patients suspected of having HCCs who \nunderwent multiphasic liver CT using dual-energy scanning (300 mAs for each \n80-kVp tube) were included. The late arterial scans of one tube (half-dose) \nwere reconstructed with FBP , iterative reconstruction in image space (IRIS) \nand 5 difference SAFIRE percentage sets (S1-S5), respectively, and then \ncompared with corresponding full-dose virtual scans (mixed ratio of 0.5: \n600mA) with FBP . Quantitatively, image noise; contrast-to-noise ratio (CNR) \nrelative to muscle for the liver, aorta, portal vein; CNR of lesion- to-liver were \nassessed. Qualitatively, two abdominal radiologists scored image noise, vessel \nsharpness, lesion conspicuity and overall image quality in consensus. The \nresults of image assessment were compared among FBP , IRIS and SAFIRE.\nResults: The image noise on SAFIRE was significantly lower and CNRs on \nSAFIRE were significantly higher than on FBP (p<0.001). CNR of lesion-to-liver \non SAFIRE (S5) was significantly higher than on both IRIS and full-dose FBP \n(p<0.05). For all qualitative analysis, half-dose SAFIRE acquired higher score \nthan FBP and similar score to full-dose FBP . Mean CTDI~vol~ for half-dose \nlate arterial scans was 2.63 mGy.\nConclusion: Half-dose 80-kVp liver CT protocol with SAFIRE may increase \nimage quality and maintain diagnostic accuracy at reduced radiation dose, \ncompared with full-dose protocol with FBP .\nSS 15.09\nRadiation dose in multiphasic CT of the liver using \nfiltered back projection and iterative reconstruction: \nhow low can we go while preserving diagnostic \naccuracy?\nS.T. Schindera, D. Odedra, H. Mehrez, P . Rogalla;  \nToronto, ON/CA\nPurpose: The purpose of this study was to compare image quality and diagnostic \naccuracy at different radiation dose levels with filtered back projection (FBP) and \niterative reconstruction (IR) for multiphasic CT of the liver.\nMaterial and Methods: Two liver phantoms with simulated HCC during the \narterial and portal-venous phase were designed. Both phantoms contained 12 \ntumors with four diameters (5, 10, 15 and 20 mm) and three tumor-to-liver contrast \nvalues (±10, ±20 and ±40HU). A fat ring was added to the phantoms to mimic a \nmedium size patient (total diameter, 30 cm). The phantoms were scanned using \nstandard abdominal imaging protocol [120 kVp; standard deviation (SD) value 15]. \nLow dose protocols were acquired at 70, 60, 50, 40, 30 and 20% of the standard \nprotocol. CT data sets were reconstructed with FBP and IR (AIDR 3D, Toshiba). \nImage noise was measured and contrast-to-noise ratio (CNR) of the tumors was \ncalculated. Tumor detection was performed by two readers.\nResults: IR reduces image noise by 45-66% and increases CNR by 82-204% \ncompared to FBP depending on the dose level and enhancement phase. \nSensitivity for tumor detection of the standard protocol was maintained while \nlowering the dose to 70% with FBP and to 40% with iterative reconstruction in \nboth simulated phases.\nConclusion: The radiation dose of arterial and portal-venous hepatic CT can \nbe reduced up to 30% with FBP and up to 60% with IR technique while \npreserving diagnostic accuracy.\nSS 15.05\nIs a liver size measurement as accurate as automated \nvolumetry for predicting hepatomegaly? Preliminary \nresults on liver transplant patients\nS. Nougaret\n1, H. Addley2, S. Al Sharif3, S. Fujii4, B.P . Gallix1, \nC. Reinhold3;  1Montpellier/FR, 2Cambridge/UK,  \n3Montreal, QC/CA, 4Tottori/JP\nPurpose: The aim of our study was to compare several liver length \nmeasurements and liver automated volumetry on CT to liver weight in order to \nfind an easy and accurate method to assess hepatomegaly on CT. Indeed, \nautomated volumetry needs trained users and dedicated software. In clinical \npractice, it may be desirable to have a simple method for rapid estimation of \nhepatomegaly.\nMaterial and Methods: We compared, in forty liver pretransplant patients, \nautomated CT volumetry to liver weight on pathology to describe the correlation \nbetween weight and automated volumetry. For each patient, we measured on \nCT craniocaudal, maximal transverse, midclavicular, oblique craniocaudal at \nthe level of the hepatic veins and maximal oblique craniocaudal lengths and \ncompared these results liver weight on pathology.\nResults: There was a statistically excellent positive correlation (r[2]= 0.95[0.90-\n0.98], p<.0001) between liver volume and liver weight. The regression line was \ny = 0.94x+40, where x and y indicate the measured weight and volume, \nrespectively. 14 patient presented hepatomegaly on pathology predicted on \nevery cases on automated volumetry. Using liver size measurements, the \nmaximal oblique craniocaudal length was best correlated to liver weight \n(r2=0.80[0.72-0.85], p<.0001). According to ROC curve, a maximal oblique \ncraniocaudal length of over 175 mm was associated with hepatomegaly \n(sensitivity 90%, specificity 87%, AUC= 0.91[0.85-0.95], p=0.0001).\nConclusion: Automated volumetry is a reliable method to predict liver weight. \nHowever, in clinical practice, maximal oblique craniocaudal could be used to \neasily predict hepatomegaly.\nSS 15.06\nGadoxetate-enhanced MRI after liver resection for \nhepatocyte damage quantification\nS. Bickelhaupt\n1, C. Kim-Fuchs2, D. Candinas2, P . Studer2, \nJ.M. Froehlich1, M.A. Patak1;  1Zurich/CH, 2Bern/CH\nPurpose: Intraoperative handling procedures during liver resection may \ninevitably result in damaged liver tissue slightly larger than the usual resection \nsurface. Its assessment and quantification might be crucial in patients with \npreoperatively calculated borderline liver volumes. The aim was to determine \nthe feasibility of evaluating hepatocyte damage using hepatocyte-specific \ncontrast (Primovist®, Gd-EOB, Schering, Berlin, Germany) as an MRI marker \nfor viable hepatocytes after liver resection.\nMaterial and Methods: 15 patients were prospectively included in this study \nprior to elective liver resection. Gadoxetate-enhanced MRI (3T, Verio, Siemens, \nErlangen Germany) was performed 3-7 days after surgery. T1-w GRE (Vibe) \nseries were acquired after contrast administration. SNR of the resection border \nwas compared to healthy liver rim and the area of non-viable tissue was \ncompared with a standardized intraoperative area measurement. The paired \nStudent’s t-test was used statistically.\nResults: 2 patients dropped out, 12 of the remaining 13 patients showed \nsufficient image quality for measurement. Mean MRI resection surface was \n75.65cm[2] (±28.65, depending on resection modality). Mean contrast \nenhancement was significantly reduced (p<0.05) in the tissue next to the \nresection surface (mean SNR: 67.95 ±29.05) compared to healthy liver rim \n(mean SNR: 81.79 ±35.96).\nConclusion: After liver resection, contrast enhancement at the resection \nborder was significantly reduced suggesting an intraoperative affection of \nremaining liver tissue. Gadoxetate as a surrogate marker of tissue viability thus \nseems a promising approach.\nSS 15.07\nLiver diffusion-weighted imaging (DWI) on 3-T MRI: \nGd-EOB-DTPA effects on low b value images\nC.N. De Cecco\n1, M. Rengo1, M. Maceroni2, P . Lucchesi1,  \nG. Muscogiuri1, A. Laghi2;  1Rome/IT, 2Latina/IT\nPurpose: The purpose of this study was to evaluate Gd-EOB-DTPA effects on \nlow b value diffusion-weighted imaging (DWI) of the liver.\nMaterial and Methods: Twenty consecutive patients were studied with a 3 T MRI \n(Discovery MR750, General Electrics). A multi-b DWI sequence (b-values: 0, 10, 20, \n30, 50, 70, 100 s/mm\n2) was acquired with respiratory trigger before and after the \nadministration of Gd-EOB-DTPA (0.025 mmol/kg) using the following parameters: \nET 65.1 ms, RT 667 ms, NSA 2, thickness 5.0 mm, gap 1 mm. Two blinded radiologist \n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / FRIDAY, JUNE 15, 2012\n S493\nMaterial and Methods: 23 patients underwent ultrasound-navigated biopsies \nor interventions using V Nav image fusion of live fundamental ultrasound with \nceCT, ceMRI or CEUS, which were acquired before the intervention. A CEUS \ndata set was acquired in all patients. An image fusion was established for \nCEUS and CT or CEUS and MRI using anatomical landmarks in the area of the \ntargeted lesion. The definition of a virtual biopsy line with navigational axes \ntargeting the lesion was achieved by the usage of sterile trocar with a magnetic \nsensor embedded in its distal tip employing a dedicated navigation software \nfor real-time needle tracking.\nResults: In all 10 biopsies of suspect lesions of the liver, a histological \nconfirmation was achieved with a puncture from extrahepatic subcostal. We \nalso used V Nav, a biopsy of the abdominal wall (metastasis) and for \nradiofrequency ablations (4 ablations). In 8 cases of inflammatory abdominal \nlesions, 9 percutaneous drainages were successfully inserted.\nConclusion: Percutaneous biopsies and drainages, even of small lesions \ninvolving complex access ways, can be accomplished with high success rate \nusing 3D real-time image fusion together with real-time needle tracking.\nSS 16.03\nThe diagnostic value of small bowel wall vascularity \nafter sulfur hexafluoride-filled microbubble injection in \nthe differentiation of inflammatory and fibrotic stenoses \nin patients with Crohn’s disease\nE. Quaia, B. Cabibbo, T. Stocca, E. Pantano, M.A. Cova; \nTrieste/IT\nPurpose: The purpose of this study was to assess the value of small bowel \nwall vascularity on contrast-enhanced US to differentiate inflammatory from \nfibrotic stenoses in patients with Crohn’s disease (CD).\nMaterial and Methods: Twenty-two patients (10 male and 12 female; mean \nage ± SD, 45.12 ± 13.25 years; range 23-63) with a biopsy-proven diagnosis of \nCD involving at least one ileal loop (wall thickness >5mm) were included. In \neach patient, the thickest ileal loop segment was scanned by contrast-\nenhanced US after sulfur hexafluoride-filled microbubble injection, and digital \ncine-clips (60 secs) were stored. Echo signal was quantified in grey-scale \nlevels (0-255) by a manually drawn ROI encompassing the bowel wall. The \npercentage of enhancement compared to baseline, time to peak enhancement, \nand area under curve were quantified.\nResults: All patients revealed diffuse transparietal contrast enhancement, \nexcept for 5 patients with fibrotic stenosis who revealed contrast enhancement \nlimited to the submucosa (n=3) or absent enhancement (n=2). Inflammatory \nversus fibrotic stenoses did not differ in the percentage of enhancement (46.43 \n± 5.67 36.81 ± 17.38 vs 43.25 ± 4.99%; P>.05) and in the time to peak \nenhancement (9.28 ± 4.42 vs 14.5 ± 7.33 secs; P>.05), while differed in the area \nunder the enhancement curve (1148.51 ± 474.15 vs 680.69 ± 274.36; P<.05).\nConclusion: Bowel wall vascularity quantitation on contrast-enhanced US \nmay differentiate inflammatory from fibrotic stenoses in patients with CD based \non the area under the enhancement curve.\nSS 16.04\nContrast-enhanced ultrasound for differential diagnosis \nof suspected GvHD in patients after allogeneic \ntransplantation\nL.M. Dendl, G. Schill, C. Stroszczynski, E. Jung, A.G. Schreyer; \nRegensburg/DE\nPurpose: GvHD is a serious complication in patients after allogeneic \ntransplantation presenting with unspecific symptoms. Early differential \ndiagnosis of GvHD (vs. viral or bacterial enteritis) is highly important. Recently, \nwe detected penetration of microbubbles through the bowel wall as a \ndiagnostic indicator for GvHD. In this study, we evaluate contrast-enhanced \nultrasound (CEUS) as a new differential diagnostic tool in GvHD.\nMaterial and Methods: We examined 23 patients with abdominal symptoms \nafter allo-SCT. All patients underwent CEUS with particular attention to \npenetration of the intravenously applied microbubbles in the bowel lumen. The \nresulting examinations were documented digitally.\nResults: Out of 17 patients with confirmed GvHD of the GI tract, 14 showed \npenetration of the intravenously applied microbubbles into the bowel lumen, \nleading to a sensitivity and specificity of 82% and 100% for transmural bubble \npenetration for GvHD of the GI-Tract, since the patients without GvHD of the \nGI tract showed no transmural bubble penetration. In patients with viral or \nbacterial infections of the GI tract, no transmural penetration of the \nmicrobubbles into the bowel lumen was observed.\nConclusion: Using CEUS showing microbubble penetration as a criterion for \nGvHD of the GI-Tract, a negative predictive value of 67%, and a positive \npredicative value of 100% was calculated. Therefore, we consider CEUS as an \nexcellent differential diagnostic tool in patients with the suspicion of GvHD.\nSS 15.10\nComprehensive evaluation of liver changes in primary \nsclerosing hepatitis using MRI\nJ. Kovac, B. Banko, G. Lilic, M. Kratovac Dunjic,  \nR. Milenkovic, R. Jesic, R. Maksimovic; Belgrade/RS\nPurpose: The purpose of this study was to evaluate magnetic resonance \nimaging (MRI) findings in the patients with primary sclerosing cholangitis (PSC) \nand to determine the value of diffusion-weighted imaging in the assessment of \nliver fibrosis.\nMaterial and Methods: The following MRI findings were reviewed in 32 \npatients: periportal hyperintensity (T2-weighted hyperintensity around portal \nvenous branches), lymphadenopathy, splenomegaly, ascites, morphological \nliver changes and magnetic resonance cholangiopancreatography (MRCP) \nfindings. Apparent diffusion coefficient (ADC) was calculated for six locations \nin the liver for b=800 s/mm[2].\nResults: Periportal hyperintensity was observed in 10 patients (31.2%). \nLymphadenopathy was noted in 31% and signs of portal hypertension in 55.5% of \npatients. The most common morphological liver change was left lobe hypertrophy \n(30.8%), while spherical liver shape was observed in 2 patients. 78.6% of patients \nhad bile duct irregularities, with left and right hepatic stenoses occurring most \nfrequently (67.8%). The mean ADCs (x10[-3]mm[2]/s) were significantly different at \nstages \u0002II versus \u0003III. There was significant negative correlation between ADCs and \nhistological stage (\u0004=- 0.749, p<0.001). Areas under receiver operating characteristic \ncurves were 0.899 (stage\u0003II) and 0.936 (stage\u0003III).\nConclusion: MRI should be used as a part of standard diagnostic protocol in \nthe evaluation of disease progression in PSC patients.\n11:00 - 12:30 Carrick Suite\nScientific Session 16\nUltrasound\nSS 16.01\nIntraoperative high-resolution linear contrast-enhanced \nultrasound (IOUS) for the detection of \nmicrovascularization of malignant liver lesions before \nsurgery or radiofrequeny ablation\nE. Jung, A. Agha, J. Rennert; Regensburg/DE\nPurpose: The aim of this study was to evaluate the value of linear contrast-\nenhanced intraoperative ultrasound (CE-IOUS) to improve detection of \nmalignant liver lesions before surgery or radiofrequency ablation (RFA).\nMaterial and Methods: 50 patients were included for surgery of malignant \nliver tumors [mean age 61 years (19-80); male n=35, female n=15], suffering \nfrom HCC (n=15), colorectal liver metastasis (n=28), CCC (n=2) or other malign \nliver lesions (n=5). Preoperative CE-CT (n=38), CE-MRI (n=23) or PET-CT (n=8) \nconfirmed hepatic tumor manifestation. Before undergoing surgery, \nintraoperative conventional (IOUS) as well as CE-IOUS was performed by one \nexperienced examiner in all cases using multifrequency linear probes (6-9 \nMHz, 6-15 MHz). CE-IOUS was performed after bolus injection of 5 ml up to \n15 ml SonoVue® (Bracco, Italy). Digitally stored images of CE-IOUS were \ncompared with fundamental B-Scan and preoperative imaging (CE-CT, CE-\nMRI and PET-CET).\nResults: In 28 of 50 patients (56%), additional lesions were found using CE-\nIOUS (mean tumor size 8 mm, range 4-12 mm). This required a change of \nsurgical strategy or an intraoperative RFA in 27 patients (54%). Modification of \ntherapy due to additionally found liver lesions was statistically significant.\nConclusion: This is the first study using contrast-enhanced ultrasound with high \nresolution linear probes for intraoperative detection of malignant liver lesions. \nCompared to preoperative imaging and also conventional IOUS, more than 40% \nadditional lesions were found leading to therapeutic consequences of patients.\nSS 16.02\nVolume navigation with contrast-enhanced ultrasound \nand image fusion for percutaneous interventions: first \nresults\nL.M. Dendl, E. Jung, C. Stroszczynski, A.G. Schreyer; \nRegensburg/DE\nPurpose: The purpose of this study was to assess the feasibility and efficiency \nof biopsies and interventions using ultrasound (US) volume navigation (V Nav) \nwith real-time needle tracking and real-time image fusion with contrast-\nenhanced (ce) CT, MRI or US.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / FRIDAY, JUNE 15, 2012\n S494\nSS 16.07\nUltrasound in clinically equivocal appendicitis: the real \nworld experience\nN.D. Grunshaw\n1, P .L.S. Cheong2;  1Barrow in Furness/UK, \n2Darlington/UK\nPurpose: Whilst imaging can reduce the negative appendicectomy rate, a \nvariety of strategies exist. Much of the available data relates to CT and comes \nfrom specialist centres. In our institution, clinical review remains the primary \nassessment, imaging reserved for clinically equivocal cases. The purpose of \nthis study is to review the value of ultrasound in reducing negative \nappendicectomy in clinically equivocal cases in a District General Hospital \nsetting.\nMaterial and Methods: Review of 8 years ultrasound in clinically equivocal \nappendicitis was performed. CT was used as secondary test. Final outcome \nwas determined by case note review and operative histology. All examinations \nwere performed by one operator, appendicitis was diagnosed on the basis of \nappendiceal thickening (>6mm) and periappendiceal inflammatory change. \nReview was performed of histology of non-imaged appendicectomies during \nthe same period.\nResults: 265 cases were identified. Ultrasound sensitivity was 83%, specificity \n92%, PPV 75%, NPV 95%, LR+ 10.3, LR- 0.19. The normal appendix was \nvisualised in 25% of negatives. In 16%, ultrasound suggested significant \nalternative diagnoses. This strategy together with clinical re-evaluation resulted \nin only 7 (3%) normal appendices being removed compared with 19% in the \nnon-imaged group. Overall CT usage was 14%.\nConclusion: Primary ultrasound can significantly reduce the negative \nappendicectomy rate and necessity for CT scanning in clinically equivalent \nappendicitis. The reduction in false negative appendicetomy rate is such that \nwider use of a primary ultrasound imaging strategy should be considered.\nSS 16.08\nPretherapeutic histological evaluation of gastric \nsubmucosal tumour by endoscopic ultrasound-guided \nfine needle aspiration\nK. Akahoshi, M. Oya, Y . Motomura, M. Kubokawa, S. Itaba, \nJ. Gibo, K. Komori, N. Nakama, M. Yamada, Y . Minoda,  \nK. Tokumaru; Iizuka/JP\nPurpose: Diagnosis of gastric submucosal tumour (SMT) using EUS imaging \nalone is very difficult. EUS-guided fine needle aspiration (EUS-FNA) is a \npromising technique to obtain tissue samples with minimal risks. The aim of \nthis study was to evaluate the efficacy and accuracy of EUS-FNA in the \ndiagnosis of gastric SMT.\nMaterial and Methods: From September 2002 to November 2011, 165 \nconsecutive EUS-FNAs of gastric hypoechoic solid SMT diagnosed by \nstandard EUS were evaluated prospectively. The reference standards for the \nfinal diagnosis were surgery (n=98), or clinical follow-up (n=67). Additionally, \nimmunophenotyping of specimens obtained by EUS-FNA and surgical \nresection specimens were compared.\nResults: In 5 cases, puncture was not performed because of anatomical \nproblems. The diagnostic rate of the gastric hypoechoic solid SMT was 86% \n(137/160). The diagnostic rate according to the tumour size and location was \n75% (59/79) in less than 2 cm, 97% (66/68) in 2-5 cm, and 92% (12/13) in 5 cm \nor more, 79% (23/29) in the lower portion, 86% (77/90) in the middle portion, \nand 90% (37/41) in the upper portion. In 92 surgically resected cases, the \ndiagnostic accuracy of EUS-FNA using immunohistochemical analysis of \ngastric hypoechoic solid SMT was 96% (88/92). No major complications were \nencountered.\nConclusion: EUS-FNA with immunohistochemical analysis is an effective and \naccurate method in the pretherapeutic diagnosis of gastric SMT, irrespective \nof tumor size and location.\nSS 16.05\nWash out of hypervascular malignant lesions on CEUS: \nquantification using a semiquantitative index\nL. Sottocornola, P . Cabassa, M. Ravanelli, A. Giardini,  \nR. Maroldi; Brescia/IT\nPurpose: The purpose of this study was to quantify the wash out of malignant \nliver lesions at CEUS, using a semiquantitative index.\nMaterial and Methods: From the institutional database of focal liver lesions \nstudied with CEUS 103 hypervascular lesions were retrospectively analysed. \nInclusion criteria were: histologically proven malignant lesions; at least 12 \nmonths of follow up for benign lesions (with adequate imaging); no previous \n(<3 months) treatments with chemotherapy or TACE/RF . CEUS was performed \nwith 2.4 ml of SonoVue with dedicated software (contrast coherent imaging). \nOne significant frame (in bitmap format) of portal phase was chosen for each \nlesion and analysed by software (AdobePhotoshop 7.0). Two circular defined \nregions of interest (ROI) for each image were drawn encompassing the lesion \nand the adjacent normal parenchyma. Sonography videotape intensity (VI) was \nmeasured in gray-scale levels (0-255) through histogram analysis for each ROI. \nBackground VI was set at the same level for each image. A semiquantitative \nindex (VItumor–VIliver/VIliver) was calculated. Results were compared with the \nfinal diagnosis and statistically analysed.\nResults: Final diagnosis was: 54 HCCs, 10 cholangiocarcinomas, 19 \nmetastasis and 20 benign lesions (mainly FNH). A statistically significant \ndifferent index was found between benign and malignant lesions (p<0.005). \nAmong malignant lesions, the index was significant different between HCCs \nand CCCs/metastasis (p<0.005) but not between CCCs and metastases.\nConclusion: CCCs and metastasis shows a different quantifiable wash out \nthan HCCs. This could help in the discrimination among focal liver lesions in \ndifferent scenarios.\nSS 16.06\nShould sonographers or radiologists perform ultrasound \nscans of the gallbladder?\nH.Y . Leung, Z. Toumi, K.G. Pursnani; Lanchashire/UK\nPurpose: The purpose of this study was to evaluate the reliability of ultrasound \nscan (USS) performed by sonographers and radiologist in detecting \ngallstones.\nMaterial and Methods: Patients were identified by retrieving all \ncholecystectomies operation notes of a single surgeon (May 2005-November \n2011). The accuracy, sensitivity and specificity of USS performed by \nsonographers and radiologists in identifying gallstones were evaluated by \ncomparing with histology and operative report.\nResults: Among 515 patients identified (393 female, 76%), 444 were included \n(91 have insufficient data available). Median age was 51 (range 16-90). \nSonographers performed 339 USS (76%). The overall sensitivity, specificity \nand accuracy were 97.2% (95% confidence interval, CI, 95.6-99.8%), 25.0% \n(95% CI 12.8–37.3%) and 89.4%, respectively. Positive and negative predictive \nvalues were 91.4% and 52.2%, respectively. Positive and negative likelihood \nratios were 1.30 and 0.11, respectively. The prevalence of gallstone in our \nstudy population was 89.2%. Radiologists and sonographers have no \nsignificantly different (p>0.05) sensitivity (97.0% vs. 97.3%), specificity (40.2% \nvs.18.2%) and accuracy (89.7% vs. 89.3%). Radiologists had significantly \nhigher specificity than sonographers among female patients (50.0% vs. 11.8%, \np<0.01), while sensitivity and accuracy were similar and not significantly \ndifferent. No significant difference was observed in male patients. The \nsensitivity and positive predictive value of detecting gallbladder polyp were \n66.7% and 40%, respectively (n=6).\nConclusion: Sensitivity and accuracy in this study were comparable, but \nspecificity was lower than previous reports. Recommendation: Radiologist \nrepeats USS if female patient has negative result reported by sonographer.\n\nDOI: 10.1007/s13244-012-0171-2\nScientific SessionsAuthors’ index\nSCIENTIFIC SESSIONS / FRIDAY, JUNE 15, 2012\n S495\nSS 16.09\nDiagnostic performance of  contrast-enhanced \nultrasound and MDCT in the characterization of focal \nliver lesions: comparison between readers with different \nlevels of experience\nR. Basilico, E. Rodolfino, V. Calamita, A.R. Ferri,  \nA.R. Cotroneo;  Chieti/IT\nPurpose: The purpose of this study was to assess the diagnostic performance \nof contrast-enhanced ultrasound (CEUS) and MDCT in the diagnosis of focal \nliver lesions by comparing readers with different levels of experience.\nMaterial and Methods: 130 focal liver lesions, studied by means of CEUS and \nMDCT, were randomly reviewed by two readers with 10 and 3 years of \nexperience in both CEUS and MDCT studies. They scored the lesions as \nbenign, malignant or uncertain and gave the most likely etiologic diagnosis on \neach imaging modality, being unaware of the clinical history of the patients. \nFinal diagnosis was based on pathology, confirmatory imaging and on at least \n6-month imaging follow up.\nResults: Final diagnoses were 40 benign lesions (20 hemangiomas, 9 FNHs, 4 \nfocal steatosis areas, 4 focal fatty sparing, 1 abscess, 1 adenoma, 1 \nregenerative nodule) and 90 malignancies (73 metastases, 15 HCCs, 2 \ncholangiocarcinomas). For both readers, CEUS showed higher diagnostic \nperformance than MDCT in differentiating benign from malignant lesions. The \nmost experienced reader correctly characterized 125/130 lesions on CEUS \nand 128/130 on MDCT; the less experienced reader correctly characterized \n110/130 on CEUS and 105/130 on MDCT.\nConclusion: The diagnostic performance of CEUS and MDCT in the \ncharacterization of focal liver lesions depends on the observer’s level of \nexperience. Less experienced reader better characterized liver lesions by \nmeans of CEUS than MDCT due to the capability of CEUS to easily differentiate \nbenign from malignant lesions.\nSS 16.10\nLow dose CT for renal calculi: detection rate of \ngastrointestinal findings\nJ. Sammon, P . McLaughlin, M. Twomey, S. O’Neill, S.A. Hayes, \nO.J. Flanagan, M. Maher; Cork/IE\nPurpose: Unenhanced helical CT of the abdomen and pelvis (CT KUB) is the \ndiagnostic test of choice in patients with suspected renal tract calculi. The \npurpose of this study is to assess the impact of a mean dose reduction of 83% \n(p<0.0001) on the ability to detect additional abdominal findings.\nMaterial and Methods: Following ethical approval, 30 patients referred for \nclinically indicated CT KUB (57% male) consented to undergo an additional \nlow-dose (LD) CT KUB as well as a conventional dose (CD) CT KUB. The LD \nCT KUB protocol was designed to have an effective dose of 0.5 mSv (mean \ndose 0.49±0.12mSv), the equivalent of an abdominal radiograph. All LD images \nwere reconstructed with 70% adaptive statistical iterative reconstruction \n(ASIR). The CD and LD images were reviewed by two radiologists who recorded \nadditional gastrointestinal findings as well as the presence or absence of \ncalculi on both sets of images.\nResults: There were 23 additional findings on CD imaging (n=4 were clinically \nimportant). Only 13 (56%) of the additional findings were detected on LD \nimaging (P<0.0019); sensitivity 56.5% (95%CI 0.36-0.76). None of the 4 \nclinically important findings were detected.\nConclusion: LD CT KUB imaging using ASIR may allow adequate detection of \nrenal calculi; however, our study demonstrates a significant difference in the \nidentification of relevant abdominal findings and the failure to diagnose \nclinically important abdominal findings in the emergent setting.\n\nS496\nAuthors’ index Scientifi  c Sessions\n\nAUTHORS‘ INDEX\nAuthors’ index Scientific Sessions\nDOI: 10.1007/s13244-012-0171-2\nS497\nA\nAdams K.: SS 3.04\nAddley H.: SS 15.05\nAdib O.: SS 5.04\nAerts J.: SS 5.05\nAgha A.: SS 16.01\nAjavon Y .: SS 2.02\nAkahoshi K.: SS 16.08\nAkisik F .: SS 4.06, SS 14.07, SS 15.01\nAkkerman E.: SS 5.05\nAl Sharif S.: SS 15.05\nAlbino V.: SS 2.06\nAlkhouri M.: SS 14.09\nAloj L.: SS 2.06\nAltman D.: SS 1.05, SS 11.08\nAmbrosetti M.: SS 8.03, SS 10.06\nAnania G.: SS 1.10, SS 3.10\nAngeli S.: SS 11.02\nAntoch G.: SS 9.02\nArrichiello C.: SS 2.06\nArvanitakis M.: SS 4.01\nAshrafian H.: SS 3.05\nAthanasiou T.: SS 3.05\nAtkin W.: SS 1.02, SS 11.01\nAtkins E.: SS 6.08\nAtkinson D.: SS 6.01, SS 6.05\nAube C.: SS 5.04\nB\nBa-Ssalamah A.: SS 5.02, SS 5.03,  \nSS 5.08\nBadea R.: SS 5.02, SS 5.03\nBae S.: SS 14.10\nBaek J.: SS 15.08\nBaik S.: SS 14.10\nBakal N.: SS 11.04\nBakers F .: SS 7.05, SS 7.07, SS 12.09\nBalassy C.: SS 5.02, SS 5.03, SS 5.08\nBaldassari P .: SS 1.03\nBalestri R.: SS 7.10\nBali M.: SS 4.01, SS 9.04\nBallesteros E.: SS 10.10\nBanko B.: SS 15.10\nBargellini I.: SS 2.07\nBartolozzi C.: SS 1.01, SS 2.07, SS 4.05, \nSS 6.03, SS 7.10, SS 8.09, SS 10.08, \nSS 11.02, SS 14.02, SS 14.03\nBasilico R.: SS 16.09\nBassi M.: SS 1.10, SS 3.10\nBauer R.: SS 14.04\nBazzocchi M.: SS 9.03, SS 13.03,  \nSS 13.07, SS 13.08\nBeaugrand M.: SS 2.02\nBeer M.: SS 9.10\nBeets-Tan R.: SS 7.05, SS 7.07, SS 12.06, \nSS 12.07, SS 12.08, SS 12.09\nBeets G.: SS 7.05, SS 7.07, SS 12.06,  \nSS 12.07, SS 12.08\nBell N.: SS 1.05, SS 6.01\nBellemann N.: SS 10.03\nBellini D.: SS 1.08, SS 9.05, SS 11.05,  \nSS 11.10\nBemi P .: SS 1.01\nBenea G.: SS 1.10, SS 3.10\nBeomonte Zobel B.: SS 12.02\nBerger-Kulemann V.: SS 10.02\nBhatnagar G.: SS 3.07, SS 3.08, SS 6.09\nBickelhaupt S.: SS 3.01, SS 6.02,  \nSS 6.04, SS 6.06, SS 15.06\nBielen D.: SS 3.03\nBill U.: SS 3.01, SS 6.02, SS 6.04,  \nSS 6.06\nBiscaldi E.: SS 9.11\nBlasbalg R.: SS 1.06\nBlex S.: SS 3.09\nBlomqvist L.: SS 7.06\nBloom S.: SS 6.08\nBohte A.: SS 5.05, SS 5.06\nBonaffini P .: SS 2.01, SS 12.03\nBoone D.: SS 1.05, SS 11.08\nBoraschi P .: SS 4.05, SS 8.09, SS 14.02, \nSS 14.03\nBosanac D.: SS 3.04\nBosetti D.: SS 4.09\nBouquet H.: SS 3.01, SS 6.02, SS 6.04, \nSS 6.06\nBoursier J.: SS 5.04\nBozzi E.: SS 2.07\nBreen D.: SS 2.03\nBrits L.: SS 14.09\nBruno O.: SS 13.05, SS 13.06\nBurling D.: SS 3.05\nButterfield C.: SS 2.10\nByott S.: SS 9.09\nC\nCabassa P .: SS 5.01, SS 13.09, SS 16.05\nCabibbo B.: SS 10.01, SS 16.03\nCakir O.: SS 11.04\nCalamita V.: SS 16.09\nCaldana R.: SS 1.06\nCaldeira Fradique A.: SS 7.08\nCampanella D.: SS 11.07, SS 11.09\nCandinas D.: SS 15.06\nCao K.: SS 7.01, SS 9.07\nCappendijk V.: SS 7.05, SS 7.07, SS 12.09\nCapraro C.: SS 2.01, SS 12.03\nCaramella D.: SS 11.02\nCarbone S.: SS 12.04\nCardoso De Melo R.: SS 7.03\nCarfagno T.: SS 12.04\nCartier V.: SS 5.04\nCaruso D.: SS 1.08, SS 9.05, SS 11.05, \nSS 11.10\nCaseiro-Alves F .: SS 15.04\nCastelli F .: SS 4.07, SS 4.08, SS 4.09\nCattin R.: SS 3.01, SS 6.02, SS 6.04,  \nSS 6.06\nCavallini I.: SS 1.01\nCavedon C.: SS 8.03, SS 10.06\nCazzato R.: SS 12.02\nCeelen F .: SS 13.04\nCentra M.: SS 9.08\nCereser L.: SS 9.03, SS 13.03, SS 13.07, \nSS 13.08\nCharles-Edwards G.: SS 7.03\nChawla Y .: SS 10.05\nCheong P .: SS 16.07\nChoi B.: SS 5.07, SS 8.01, SS 8.02,  \nSS 14.06, SS 15.08\nChoi C.: SS 14.10\nChong Y .: SS 10.04\nCini L.: SS 11.02\nCioffi Squitieri N.: SS 3.02\nCiolina M.: SS 1.03\nCioni R.: SS 2.07\nColleoni A.: SS 13.09\nComo G.: SS 9.03, SS 13.03, SS 13.07, \nSS 13.08\nCornalba G.: SS 7.04\nCorreale L.: SS 11.07, SS 11.09\nCorso R.: SS 2.01\nCosta L.: SS 7.08\nCotroneo A.: SS 16.09\nCova M.: SS 10.01, SS 16.03\nCuccioli F .: SS 13.06\nCulverwell A.: SS 1.04\nCurvo-Semedo L.: SS 15.04\nD\nD’Angelo R.: SS 2.06\nD’Assignies G.: SS 5.10, SS 13.05,  \nSS 13.06\nD’Haens G.: SS 6.10\nDadswell E.: SS 11.01\nDai Y .: SS 5.08\nDaulatzai N.: SS 3.05\nDe Cecco C.: SS 9.05, SS 15.07\nDe Cock J.: SS 3.03\nDe Niet A.: SS 5.06\nDe Paoli L.: SS 10.01\nDe Simone P .: SS 2.07\nDe Witte M.: SS 11.03\nDeganello A.: SS 13.01\nDel Pin M.: SS 13.07, SS 13.08\nDel Vescovo R.: SS 12.02\nDelhaye M.: SS 4.01\nDemetter P .: SS 9.04\nDendl L.: SS 6.07, SS 16.02, SS 16.04\nDi Paola V.: SS 4.07, SS 4.08, SS 4.09\nDias J.: SS 7.08\nDonati F .: SS 4.05, SS 8.09, SS 14.02,  \nSS 14.03\nDouwes D.: SS 12.09\nDrecoll E.: SS 13.10\nDudas I.: SS 2.08\nDuseja A.: SS 10.05\nE\nEdwards C.: SS 6.09\nElgersma O.: SS 9.06\nEsteves J.: SS 7.08\nEun H.: SS 8.01, SS 8.02\nF\nFabris F .: SS 9.03\nFaggioni L.: SS 1.01, SS 6.03, SS 7.10, \nSS 10.08, SS 11.02\n\nAUTHORS‘ INDEX\nAuthors’ index Scientific Sessions\nDOI: 10.1007/s13244-012-0171-2\nS498\nFalaschi F .: SS 4.05, SS 8.09, SS 14.02, \nSS 14.03\nFalco P .: SS 11.07\nFeier D.: SS 5.02, SS 5.03, SS 5.08\nFencl P .: SS 12.10\nFernandes L.: SS 7.08\nFerrero S.: SS 9.11\nFerri A.: SS 16.09\nFilipe J.: SS 15.04\nFilipponi F .: SS 2.07, SS 14.02\nFina P .: SS 13.05\nFingerle A.: SS 13.10\nFiore F .: SS 2.06\nFischer A.: SS 14.01, SS 15.02\nFlanagan O.: SS 16.10\nFlor N.: SS 7.04\nFoderà E.: SS 9.08\nForsting M.: SS 3.09, SS 9.02, SS 15.02\nFouchard I.: SS 5.04\nFox B.: SS 2.05, SS 3.07\nFroehlich J.: SS 3.01, SS 6.02, SS 6.04, \nSS 6.06, SS 15.06\nFujii S.: SS 15.05\nG\nGalatola G.: SS 11.09\nGallix B.: SS 15.05\nGaya A.: SS 7.03\nGherarducci G.: SS 8.09, SS 14.03\nGiardini A.: SS 16.05\nGibo J.: SS 16.08\nGigoni R.: SS 4.05, SS 8.09, SS 14.02, \nSS 14.03\nGil-Bello D.: SS 10.10\nGirometti R.: SS 9.03, SS 13.03, SS 13.07, \nSS 13.08\nGiurazza F .: SS 12.02\nGlimelius B.: SS 7.06\nGoh V.: SS 7.03\nGollub M.: SS 7.01\nGonen M.: SS 7.01\nGoodwin M.: SS 2.10\nGrasso R.: SS 12.02\nGrenacher L.: SS 8.04\nGriffin N.: SS 7.03\nGroot P .: SS 5.06\nGrunshaw N.: SS 16.07\nGryspeerdt S.: SS 11.06\nGuedes Da Silva J.: SS 7.08\nGuerrini S.: SS 3.02, SS 9.08\nGultekin D.: SS 7.01\nH\nHabr-Gama A.: SS 1.06\nHacking C.: SS 2.03\nHahn D.: SS 9.10, SS 13.10\nHahn O.: SS 2.08\nHaimerl M.: SS 13.02\nHalligan S.: SS 1.02, SS 1.05, SS 6.01, \nSS 6.05, SS 6.08, SS 11.01, SS 11.08\nHan A.: SS 14.10\nHan J.: SS 5.07, SS 8.01, SS 8.02,  \nSS 14.06, SS 15.08\nHansman A.: SS 3.04\nHarris I.: SS 9.09\nHart A.: SS 3.05\nHarustiak T.: SS 12.10\nHaug A.: SS 4.04\nHayes S.: SS 16.10\nHeijnen L.: SS 7.05, SS 7.07, SS 12.06\nHelbren E.: SS 6.01\nHendriksz T.: SS 9.06\nHerzen J.: SS 13.10\nHiggins S.: SS 3.08\nHohertz S.: SS 14.04\nHollak C.: SS 5.05\nHolm T.: SS 7.06\nHorger W.: SS 4.03\nHoward T.: SS 4.02, SS 4.06, SS 8.05\nHrydziuszko O.: SS 11.08\nHulsewé K.: SS 12.07\nHwang J.: SS 10.07\nI\nIafrate F .: SS 1.03, SS 11.07\nIannitti M.: SS 1.03\nIm S.: SS 14.05\nImbriaco G.: SS 9.08\nInchingolo R.: SS 13.01\nIppolito D.: SS 2.01, SS 12.03\nItaba S.: SS 16.08\nIussich G.: SS 1.03, SS 11.07, SS 11.09\nIzzo F .: SS 2.06\nJ\nJackson C.: SS 1.04\nJackson S.: SS 3.07\nJakobsen A.: SS 7.02, SS 12.01\nJames J.: SS 14.09\nJansen P .: SS 5.05, SS 5.06\nJanssen-Heijnen M.: SS 11.03\nJee K.: SS 14.08\nJeon H.: SS 3.06\nJesic R.: SS 15.10\nJung E.: SS 2.09, SS 13.02, SS 16.01,  \nSS 16.02, SS 16.04\nJung S.: SS 3.06\nK\nKalra N.: SS 10.05\nKandel S.: SS 8.10\nKane P .: SS 13.01\nKang D.: SS 14.05\nKarani J.: SS 13.01\nKarmazanovsky G.: SS 4.10, SS 8.08\nKauczor H.: SS 8.04, SS 10.03\nKauffmann C.: SS 5.10\nKay C.: SS 1.04, SS 2.10, SS 11.01\nKellati P .: SS 2.04\nKerr S.: SS 1.07\nKessels A.: SS 12.09\nKhandelwal N.: SS 10.05\nKiefer B.: SS 5.08\nKieser M.: SS 8.04\nKilicoglu G.: SS 11.04\nKim-Fuchs C.: SS 15.06\nKim J.: SS 8.01, SS 8.02, SS 10.09\nKim S.: SS 8.02, SS 10.04, SS 10.07,  \nSS 14.06\nKim Y .: SS 3.06\nKinner S.: SS 3.09\nKlauß M.: SS 8.04\nKloeters C.: SS 9.02\nKluza E.: SS 12.08\nKoelblinger C.: SS 10.02\nKoestler H.: SS 9.10\nKomori K.: SS 16.08\nKovac J.: SS 15.10\nKraff O.: SS 14.01, SS 15.02\nKratovac Dunjic M.: SS 15.10\nKubokawa M.: SS 16.08\nKuk D.: SS 7.01\nKupcsulik P .: SS 2.08\nL\nLörinc E.: SS 7.06\nLöwenberg M.: SS 6.10\nLaasch H.: SS 2.04, SS 2.10\nLadd M.: SS 14.01, SS 15.02\nLaghi A.: SS 1.03, SS 1.08, SS 9.05,  \nSS 11.05, SS 11.07, SS 11.10, SS 15.07\nLambregts D.: SS 7.05, SS 7.07,  \nSS 12.06, SS 12.07, SS 12.08\nLammer J.: SS 10.02\nLannoo M.: SS 3.03\nLarson M.: SS 14.04\nLastoria S.: SS 2.06\nLaudi C.: SS 11.09\nLauenstein T.: SS 3.09, SS 9.02, SS 14.01, \nSS 15.02\nLazzi S.: SS 12.04\nLebigot J.: SS 5.04\nLee E.: SS 14.06\nLee J.: SS 5.07, SS 8.01, SS 8.02, SS 14.06, \nSS 15.08\nLee J.: SS 8.01, SS 8.02, SS 14.06\nLee M.: SS 10.07\nLee S.: SS 14.08\nLee W.: SS 10.04, SS 10.07, SS 10.09\nLee Y .: SS 14.05\nLefere I.: SS 11.06\nLefere M.: SS 11.06\nLefere P .: SS 11.06\nLeijtens J.: SS 7.05, SS 12.07\nLeslie M.: SS 7.03\nLeung H.: SS 16.06\nLi X.: SS 9.07\nLi Y .: SS 9.07\nLi Z.: SS 8.06\nLiese J.: SS 9.10\nLilford R.: SS 1.02, SS 1.05, SS 11.01\nLilic G.: SS 15.10\nLim J.: SS 10.04, SS 10.07\nLim K.: SS 14.10\nLindebjerg J.: SS 12.01\nLongerich T.: SS 10.03\nLorenzoni G.: SS 2.07\nLoss M.: SS 2.09\nLowe A.: SS 1.04, SS 2.10\n\nAUTHORS‘ INDEX\nAuthors’ index Scientific Sessions\nDOI: 10.1007/s13244-012-0171-2\nS499\nLucchesi P .: SS 9.04, SS 15.07\nM\nMönninghoff C.: SS 9.02\nMünzel D.: SS 13.10\nMaas M.: SS 5.05, SS 7.05, SS 7.07,  \nSS 12.06, SS 12.07, SS 12.08\nMaceroni M.: SS 9.05, SS 11.05,  \nSS 11.10, SS 15.07\nMacpherson J.: SS 14.09\nMaderwald S.: SS 15.02\nMaher M.: SS 16.10\nMakanyanga J.: SS 6.01, SS 6.08\nMaksimovic R.: SS 15.10\nMalet A.: SS 10.10\nMallett S.: SS 1.05, SS 11.08\nManfredi R.: SS 4.07, SS 4.08, SS 4.09\nMantarro A.: SS 1.01, SS 7.10\nMaresch J.: SS 5.02, SS 5.03\nMaroldi R.: SS 5.01, SS 13.09, SS 16.05\nMarques C.: SS 15.04\nMarrelli D.: SS 3.02, SS 9.08\nMartens M.: SS 7.05, SS 7.07, SS 12.06, \nSS 12.08\nMartin J.: SS 10.10\nMateus Marques R.: SS 7.08\nMatos C.: SS 4.01, SS 9.04\nMazzei F .: SS 9.08\nMazzei M.: SS 3.02, SS 9.08\nMcCartney S.: SS 6.08\nMcLaughlin P .: SS 16.10\nMcQuillan J.: SS 11.08\nMehrez H.: SS 15.09\nMendonça P .: SS 7.08\nMenys A.: SS 6.01, SS 6.05, SS 6.08\nMercuri P .: SS 3.02\nMeric K.: SS 11.04\nMerz F .: SS 6.04\nMetens T.: SS 9.04\nMeulman T.: SS 9.06\nMeyer H.: SS 8.10\nMeyer T.: SS 9.10\nMezzanzanica M.: SS 7.04\nMichalak S.: SS 5.04\nMieth M.: SS 10.03\nMilenkovic R.: SS 15.10\nMilson A.: SS 14.09\nMinoda Y .: SS 16.08\nMonguzzi L.: SS 12.03\nMoon S.: SS 14.05\nMotomura Y .: SS 16.08\nMueller V.: SS 9.10\nMullan D.: SS 2.04\nMuscogiuri G.: SS 15.07\nN\nN’Kontchou G.: SS 2.02\nNakama N.: SS 16.08\nNederveen A.: SS 5.05, SS 5.06\nNegrelli R.: SS 4.07, SS 4.08\nNensey R.: SS 3.08\nNeri E.: SS 1.01, SS 6.03, SS 7.10,  \nSS 10.08, SS 11.02, SS 11.07\nNeubauer H.: SS 9.10\nNeumann R.: SS 4.04, SS 15.03\nNießen C.: SS 13.02\nNikolaou K.: SS 15.03\nNoël P .: SS 13.10\nNolz R.: SS 5.02, SS 5.03\nNougaret S.: SS 15.05\nNovelli M.: SS 6.05\nO\nO’Neill S.: SS 16.10\nOdedra D.: SS 15.09\nOdille F .: SS 6.05\nOliveira M.: SS 7.08\nOrzada S.: SS 14.01\nOsimani M.: SS 1.08, SS 9.05\nOto A.: SS 15.03\nOya M.: SS 16.08\nP\nPacciardi F .: SS 8.09, SS 14.08\nPajor P .: SS 2.08\nPalumbo M.: SS 12.04\nPancrazi F .: SS 10.08\nPantano E.: SS 10.01, SS 16.03\nPapagrigoriadis S.: SS 3.04\nPapanikolaou N.: SS 12.06\nPaprottka P .: SS 13.04\nParadis V.: SS 13.05\nParikh J.: SS 7.03\nPark H.: SS 3.06, SS 10.04\nPark M.: SS 10.04, SS 10.07, SS 14.08\nPark S.: SS 3.06\nPark U.: SS 3.06\nPatak M.: SS 3.01, SS 6.02, SS 6.04,  \nSS 6.06, SS 15.06\nPatel P .: SS 2.03\nPaty P .: SS 7.01\nPeddu P .: SS 3.04\nPendse D.: SS 6.08\nPerez R.: SS 1.06\nPeri M.: SS 7.04\nPfeiffer F .: SS 13.10\nPhillips R.: SS 3.05\nPicano E.: SS 11.02\nPichi A.: SS 1.03\nPina F .: SS 7.08\nPirtoli L.: SS 12.04\nPløen J.: SS 7.02, SS 12.01\nPlatzek I.: SS 13.02\nPlatzer I.: SS 9.10\nPoitou V.: SS 5.10\nPonsioen C.: SS 6.10\nPozzi Mucelli R.: SS 4.07, SS 4.08, SS \n4.09, SS 8.03, SS 10.06\nPrasad D.: SS 1.04\nPrieto M.: SS 10.10\nPrincivalle M.: SS 1.10\nProctor I.: SS 6.05\nProscurshim I.: SS 1.06\nPuckett M.: SS 6.09\nPuig J.: SS 10.10\nPullini S.: SS 9.03, SS 13.03, SS 13.07, \nSS 13.08\nPunekar S.: SS 1.04\nPunwani S.: SS 6.05, SS 6.08\nPursnani K.: SS 16.06\nQ\nQuaia E.: SS 10.01, SS 16.03\nR\nRadeleff B.: SS 10.03\nRafaelsen S.: SS 7.02, SS 12.01\nRaible S.: SS 3.01, SS 6.02, SS 6.04,  \nSS 6.06\nRavanelli M.: SS 5.01, SS 16.05\nRebours V.: SS 8.07\nRegge D.: SS 1.03, SS 11.07, SS 11.09\nRegini F .: SS 7.03\nReinhold C.: SS 15.05\nReiser M.: SS 4.03, SS 4.04, SS 13.04, \nSS 15.03\nReiter G.: SS 5.08\nRemorgida V.: SS 9.11\nRengo M.: SS 1.08, SS 9.05, SS 11.05, \nSS 11.10, SS 15.07\nRennert J.: SS 16.01\nRhim H.: SS 10.04\nRicci V.: SS 12.04\nRiedl R.: SS 12.06\nRigamonti P .: SS 7.04\nRighi R.: SS 1.10\nRist C.: SS 4.04, SS 15.03\nRizzati R.: SS 1.10, SS 3.10\nRodolfino E.: SS 16.09\nRodrigues A.: SS 11.06\nRodrigues Duarte H.: SS 4.01\nRodrigues J.: SS 1.06\nRodriguez-Justo M.: SS 6.05\nRogalla P .: SS 8.10, SS 15.09\nRollandi G.: SS 9.11\nRollvén E.: SS 7.06\nRonot M.: SS 13.05, SS 13.06\nRossini A.: SS 5.01\nRottenberg G.: SS 7.03\nRozeboom E.: SS 12.08\nRummeny E.: SS 13.10\nRuszniewski P .: SS 8.07\nRyan S.: SS 3.04\nS\nSørensen T.: SS 7.02, SS 12.01\nSacco R.: SS 10.08\nSailer A.: SS 12.09\nSalvini N.: SS 3.02\nSammon J.: SS 16.10\nSamyn M.: SS 13.01\nSanderson A.: SS 14.09\nSandrasegaran K.: SS 4.02, SS 4.06,  \nSS 8.05, SS 14.07, SS 15.01\nSantos P .: SS 7.08\nSardanelli F .: SS 7.04\nSauvanet A.: SS 13.05\nScagliarini L.: SS 3.10\nScandiffio R.: SS 1.01, SS 6.03, SS 7.10\n\nAUTHORS‘ INDEX\nAuthors’ index Scientific Sessions\nDOI: 10.1007/s13244-012-0171-2\nS500\nSchemmer P .: SS 10.03\nSchill G.: SS 6.07, SS 16.04\nSchima W.: SS 10.02\nSchindera S.: SS 15.09\nSchirmacher P .: SS 10.03\nSchlamann M.: SS 9.02\nSchmid-Tannwald C.: SS 4.04, SS 15.03,\nSchmid-Tannwald C.: SS 4.04, SS 15.03,\nSchmidt G.: SS 4.04\nSchmoee J.: SS 10.03\nSchramm N.: SS 4.03, SS 4.04\nSchreyer A.: SS 2.09, SS 6.07, SS 13.02, \nSS 16.02, SS 16.04\nSchulz J.: SS 14.04\nSchwartz L.: SS 7.01\nScrimieri A.: SS 13.09\nSegnan N.: SS 11.07, SS 11.09\nSellars M.: SS 13.01\nSellier N.: SS 2.02\nSenore C.: SS 11.07, SS 11.09\nSeo Y .: SS 14.10\nSeror O.: SS 2.02\nSgarro A.: SS 9.03\nShankar Mp S.: SS 10.05\nSheikh H.: SS 2.04\nSheridan M.: SS 1.07\nShin S.: SS 10.09, SS 10.09\nSiddiqui M.: SS 3.05\nSidhu H.: SS 3.07, SS 3.08, SS 6.09\nSiggar Investigators T.: SS 1.02, SS 11.01\nSilva C.: SS 11.06\nSimons P .: SS 11.03\nSimsek M.: SS 11.04\nSingh P .: SS 10.05\nSinkus R.: SS 5.05, SS 5.06\nSironi S.: SS 2.01, SS 12.03\nSlenter J.: SS 12.08\nSogaro F .: SS 5.01\nSohn M.: SS 7.01\nSolà M.: SS 10.10\nSombetzki A.: SS 9.02\nSommer C.: SS 10.03\nSommer W.: SS 13.04\nSong B.: SS 5.09, SS 8.06, SS 9.01\nSosef M.: SS 12.07\nSottocornola L.: SS 5.01, SS 16.05\nSoulez G.: SS 5.10\nSrinivasan R.: SS 10.05\nStampfl U.: SS 10.03\nStedman B.: SS 2.03\nStephenson S.: SS 1.04, SS 2.10\nStiller W.: SS 8.04, SS 10.03\nStocca T.: SS 16.03\nStoker J.: SS 5.05, SS 5.06, SS 6.10\nStroszczynski C.: SS 2.09, SS 6.07,  \nSS 13.02, SS 16.02, SS 16.04\nStuder P .: SS 15.06\nSulkin T.: SS 3.08\nSun Y .: SS 9.07\nT\nTahir B.: SS 4.02, SS 4.06, SS 8.05,  \nSS 15.01\nTalei Franzesi C.: SS 2.01\nTang A.: SS 5.10\nTang L.: SS 9.07\nTann M.: SS 4.02, SS 4.06, SS 8.05,  \nSS 14.07, SS 15.01\nTartari S.: SS 1.10, SS 3.10\nTaylor S.: SS 1.05, SS 6.01, SS 6.05,  \nSS 6.08, SS 11.08\nTheisen D.: SS 13.04\nTielbeek J.: SS 6.10\nTiferes D.: SS 1.06\nTokumaru K.: SS 16.08\nTolan D.: SS 1.07\nToumi Z.: SS 16.06\nTozer P .: SS 3.05\nTrattenero C.: SS 12.03\nTrinchet J.: SS 2.02\nTwomey M.: SS 16.10\nU\nUmutlu L.: SS 9.02, SS 14.01, SS 15.02\nV\nVagli P .: SS 1.01, SS 10.08, SS 11.02\nVagn-Hansen C.: SS 7.02, SS 12.01\nVan Beers B.: SS 5.10\nVan Dussen L.: SS 5.05\nVan Muylder L.: SS 3.03\nVan Putte-Katier N.: SS 9.06\nVan Steenbergen L.: SS 11.03\nVanbeckevoort D.: SS 3.03\nVecchietti F .: SS 1.08, SS 11.05, SS 11.10\nVerset L.: SS 9.04\nVilgrain V.: SS 5.10, SS 8.07, SS 13.05, \nSS 13.06\nVindigni C.: SS 3.02\nVogl T.: SS 14.04\nVolterrani L.: SS 3.02, SS 9.08, SS 12.04\nvon Wagner C.: SS 1.05, SS 11.01\nVullierme M.: SS 8.07, SS 13.05, SS 13.06\nW\nWagner M.: SS 8.07\nWalton I.: SS 2.05\nWang N.: SS 9.07\nWardle J.: SS 11.01\nWee S.: SS 14.05\nWerner J.: SS 8.04\nWiggermann P .: SS 2.09, SS 13.02\nWildberger J.: SS 12.09\nWilliams P .: SS 2.05\nWillner M.: SS 13.10\nWilson I.: SS 2.03\nWinternitz T.: SS 2.08\nWitoszynskyj S.: SS 5.08\nWohlgemuth W.: SS 2.09\nWooldrage K.: SS 1.02, SS 11.01\nWoolson K.: SS 6.09\nY\nYamada M.: SS 16.08\nYao G.: SS 1.02\nYencilek E.: SS 11.04\nYoon D.: SS 14.10\nYoon J.: SS 5.07, SS 15.08\nYu M.: SS 15.08\nYuan F .: SS 5.09, SS 9.01\nYun E.: SS 14.10\nZ\nZakharova O.: SS 4.10, SS 8.08\nZamboni G.: SS 8.03, SS 10.06\nZanella G.: SS 9.03\nZech C.: SS 4.03\nZemanova M.: SS 12.10\nZhang X.: SS 9.07\nZhu S.: SS 1.02, SS 1.05\nZivelonghi E.: SS 8.03, SS 10.06\nZsirka A.: SS 2.08\nZuiani C.: SS 9.03, SS 13.03, SS 13.07, \nSS 13.08\nZur Hausen A.: SS 12.06\n\nJUNE 4 - 7\nESGAR 2013BARCELONASPAIN\nEuropean\nSociety\nof Gastrointestinal\nand Abdominal\nRadiology\nwww.esgar.org","source_license":"CC-BY-4.0","license_restricted":false}