{"paper_id":"a4149c50-c859-4820-8c4a-efc4b3e87d43","body_text":"A \nB C 2  \n/LYH\u00033URJUDPPH\u0003\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nDisclaimer \n \nThe ECR 2021 Book of Abstracts is published by the European Society of \nRadiology (ESR) and summarises the presentations accepted to be held online \nat the European Congress of Radiology 2021 (Vienna, Austria, March 3 - \nMarch 7, 2021). Abstracts were submitted by the authors warranting that good \nscientific practice, copyrights and data privacy regulations have been observed \nand relevant conflicts of interest declared. \n \nAbstracts reflect the authors' opinions and knowledge. The ESR does not give \nany warranty about the accuracy or completeness of medical procedures, \ndiagnostic procedures or treatments contained in the material included in this \npublication. The views and opinions presented in ECR abstracts and \npresentations, including scientific, educational and professional matters, do not \nnecessarily reflect the views and opinions of the ESR.  \n \nIn no event will the ESR be liable for any direct or indirect, special, incidental, \nconsequential, punitive or exemplary damages arising from the use of these \nabstracts. \n \nThe Book of Abstracts and all of its component elements are for general \neducational purposes for health care professionals only and must not take the \nplace of professional medical advice. Those seeking medical advice should \nalways consult their physician or other medical professional. \n \nIn preparing this publication, every effort has been made to provide the most \ncurrent, accurate, and clearly expressed information possible. Nevertheless, \ninadvertent errors in information can occur. The ESR is not responsible for \ntypographical errors, accuracy, completeness or timeliness of the information \ncontained in this publication. \n \nThe ECR 2021 Book of Abstracts is a supplement to Insights into Imaging \n(1869-4101) and published under Creative Commons Attribution 4.0 \nInternational License.  \n \n \n \nInsights Imaging (2021) 12 (Suppl 2): 75\nhttps://doi.org/10.1186/s13244-021-01014-5\nPublished Online: 13 June 2021 \n\n \n \n \nA \nB C 3  \n/LYH\u00033URJUDPPH\u0003\n \n \n \n \n \n  \n\u0003\nLive Programme \nClinical Trials in Radiology (CTiR) \nCoffee & Talk (open forum) Sessions (C) \nESR at Work Sessions \nEuropean Excellence in Education (E³) \nEuroSafe Imaging Sessions (EU) \nHands-on Workshop (HW) \nHealthcare Professionals in Focus (IF) \nJoint Sessions  \nMeets Sessions (Meets) \nMultidisciplinary Sessions (MS) \nNew Horizons Sessions (NH) \nPlenary Lectures (PL) \nProfessional Challenges Sessions (PC) \nRefresher Courses (RC) \nResearch Presentation Sessions (RPS) \nSpecial Focus Sessions (SF) \nState of the Art Symposia (SA) \nTransatlantic Course of ESR and RSNA (TC) \n \n::HGQHVGD\\\u000f\u00030DUFK\u0003\u0016\u0003\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0003\u0017\n7KXUVGD\\\u000f\u00030DUFK\u0003\u0017\u0003\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0003\u0015\u0018\n)ULGD\\\u000f\u00030DUFK\u0003\u0018\u0003\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0003\u0017\u001c\n6DWXUGD\\\u000f\u00030DUFK\u0003\u0019\u0003\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0003\u001a\u0013\n6XQGD\\\u000f\u00030DUFK\u0003\u001a\u0003\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0011\u0003\u001c\u0017\n\n \n \n \nA \nB C 4  \nWednesday \n/LYH\u00033URJUDPPH\u0003\n \n \n  \n:HGQHVGD\\\u000f\u00030DUFK\u0003\u0016\u0003\n\n \n \n \nA \nB C 5  \nWednesday \n/LYH\u00033URJUDPPH\u0003\n \n08:00-09:00 CHANNEL 2 \nResearch Presentation Session: Artificial \nIntelligence & Machine Learning \nRPS 205 \nArtificial intelligence (AI) in unmet clinical \nneeds \nModerator \nLuis Martí-Bonmatí; Valencia/ES  \n \nRPS 205-2 \nDeep learning algorithm to predict positive MRI of the sacroiliac joints \naccording to the ASAS definition in patients with recent axial \nspondyloarthritis \n*C. Martin*¹, A. Bordner¹, T. Aouad², C. Lopez Medina³, A. Molto¹, \nM. Dougados¹, H. Talbot², A. Feydy¹; ¹Paris/FR, ²Gif-Sur-Yvette/FR, \n³Cordoba/ES  \n \nPurpose: MRI of the sacroiliac joints (MRI-SIJ) is essential for Axial \nSpondyloarthritis early diagnosis. The bone marrow oedema (BME) ASAS \ndefinition of positive MRI-SIJ is used in cohorts, but the inter-reader agreement \nis unperfect. Our goal was to predict the MRI-SIJ status according to the ASAS \ndefinition in patients with early Axial Spondyloarthritis applying Artificial \nIntelligence and Machine Learning. \nMethods or Background: Baseline patients from the DESIR cohort with full \nagreement for MRI-SIJ status according to the central readers were initially \nincluded. We first manually segmented the iliac and sacrum bones in 51 \npatients (31 for training, 6 for validation and 14 for evaluation) to learn \nautomatic segmentation using 2 independent convolutional neuronal networks \n(U-Net). Then, we trained a neuronal network (ResNet-18) to detect slices with \nBME. The MRI-SIJ positivity in our model was defined by the presence of BME \nin at least 2 slices. For BME detection, we used 155 segmented MRI-SIJ (51 \nmanually and 104 automatically). We split these patients into 105 train, 14 \nvalidation and 36 evaluation. Correlation was studied using Matthews \ncorrelation coefficient. \nResults or Findings: Evaluation of segmentation found an Intersection Over \nUnion of 73% for the iliac and 56% for the sacrum between manual and \nautomatic. Correlation between central readers and our model was 0.78 for \nBME classification. \nConclusion: Our algorithm successfully segmented the iliac and sacrum \nbones and also achieved good results (0.78) for BME classification. \nLimitations: These results are still not as efficient as a trained radiologist, we \nare optimistic that future work will be able to reach it. \nEthics Committee Approval: The appropriate local medical ethical \ncommittees approved this study. \nFunding for this study: This study was conducted thanks to a grant from the \nSocieté Française de Rhumatologie and an ASAS Research Grant. \nAuthor Disclosures: \nAntoine Feydy: Nothing to disclose \nClementina Lopez Medina: Nothing to disclose \nMaxime Dougados: Nothing to disclose \nAdrien Bordner: Nothing to disclose \nAnna Molto: Nothing to disclose \nCharlotte Martin: Nothing to disclose \nTheodore Aouad: Nothing to disclose \nM. Hugues Talbot: Nothing to disclose \n \nRPS 205-3 \nAutomatic pancreas segmentation using a novel deep learning method: \nevaluation on both arterial and portal phases CT \n*W. Xiheng*, H. Xue, T. Qu, X. Li, S. Cheng, J. Zhengyu; Beijing/CN \n(happyxiheng@sina.com) \n \nPurpose: To present a novel deep learning method for automatic pancreas \nsegmentation and evaluate segmentation performance on both arterial and \nportal phases CT images. \nMethods or Background: We present a deep convolutional neural network \ncalled two-stage global-local progressive fusion network for pancreas \nsegmentation. The deep network is developed to combine global and local \ninformation of the pancreas through two modules: 1) global information guided \npancreas segmentation module; 2) local information refinement pancreas \nsegmentation module. The former guides the network to learn the position of \nthe pancreas in the abdomen, which effectively inhibits the interference of \nother suspected structures. The latter further optimizes the details of the local \ncontour of the pancreas learned by model. 179 patients with two phases \npreoperative CT images were retrospectively enrolled and were divided 139 for \ntraining, 20 for validation and 20 for testing. Dice similarity coefficient (DSC) \nwas the objective evaluation index. \nResults or Findings: The training and validation set had 95 males and 64 \nfemales, with the mean age of 53.2 years, and there were 14 males and 6 \nfemales in the testing set, with the mean age of 49.5 years. There were no \nsignificant differences either in gender or mean age of two groups (p=0.376 \nand 0.429, respectively). The present segmentation method was tested on the \nabove 20 testing set. We achieved high DSC of 0.894 and 0.906 on arterial \nand portal phases respectively, and there was no significant difference \nbetween the two phases (p=0.068). \nConclusion: The proposed two-stage global-local progressive fusion network \ncan achieve good performance of segmentation on both arterial and portal \nphase. \nLimitations: Multi-center validation is still required. \nEthics Committee Approval: Not applicable. \nFunding for this study: Not applicable. \nAuthor Disclosures: \nJin Zhengyu: Nothing to disclose \nWang Xiheng: Nothing to disclose \nXiuli Li: Nothing to disclose \nSihang Cheng: Nothing to disclose \nTaiping Qu: Nothing to disclose \nHuadan Xue: Nothing to disclose \n \nRPS 205-4 \nMultivariable diagnostic prediction model development study for gene \nexpression profile from MRI ADC radiomics with artificial neural networks \nin malignant breast lesions \nB. Baysal, H. Baysal, *M. B. Eser*, M. B. Do ÷an, O. Alimoglu; Istanbul/TR \n(bilgineser@hotmail.com) \n \nPurpose: The purpose of this study is to develop a virtual biopsy tool by \ndefining breast cancer with neural networks created based on MRI ADC \nradiomics. \nMethods or Background: This retrospective model development study \nincluded a consecutive cohort of patients with malign breast lesions operated \non from January 2015 to January 2020 in one tertiary university hospital. Of the \noperated 578 patients, 221 patients were included in this study. The mean \npatient age was 54±11 years, and 220/221 were women. Three sample size \nconfigurations were identified based on tumor size. Three observers \nsegmented tumors on ADC maps, and an agreement was evaluated using the \nDice coefficient. Predictors were determined as radiomics features (n = 851). \nFeature selection was based on intraclass correlation coefficient, coefficient \nvariance, variance inflation factor, and LASSO regression analyzes. Outcomes \nwere identified as 13 pathology results, including tumor histology, \nimmunohistochemical markers, and gene expression profiles. A multivariable \ndiagnostic prediction model was developed with artificial neural networks \n(ANN). Internal validation was performed using bootstrapping and cross-\nvalidation. ANN performance was presented as an area under the receiver \noperating characteristic curve (AUC) and accepted as successful if the AUC \n>0.85 and p-value <0.01. \nResults or Findings: The most noticeable results of this study are - many \nradiomics features are not stable (93-96%), the relationship between stable \nfeatures and outcomes is weak, and despite all, 16 of the 26 neural networks \ntrained over a 1 cm3 lesion size fulfill the binary classification task. \nConclusion: This study successfully trained neural networks that can \ndiagnose triple-negative and HER2-enriched breast malignant lesions over 1 \ncm3. This situation will be a potential development for both the patient and the \nclinician. \nLimitations: Retrospective study design \nEthics Committee Approval: Decision number: 2020/0303 \nFunding for this study: Not applicable \nAuthor Disclosures: \nBegumhan Baysal: Nothing to disclose \nOrhan Alimoglu: Nothing to disclose \nMehmet Bilgin Eser: Nothing to disclose \nHakan Baysal: Nothing to disclose \nMahmut Bilal Do÷an: Nothing to disclose \n \nRPS 205-5  \nLiver metastases changes analysis in CECT based on simultaneous deep \nlearning \nA. Szeskin, A. Dodi, S. Rochman, R. Lederman, L. Joskowicz, *J. Sosna*; \nJerusalem/IL \n(jacobs@hadassah.org.il) \n \nPurpose: To evaluate the performance of a novel method that simultaneously \nfinds and quantifies the changes of liver metastasis in contrast enhanced CT \n(CECT) between the current and the prior scans by deep learning \nclassification. \n\n \n \n \nA \nB C 6  \nWednesday \n/LYH\u00033URJUDPPH\u0003\n \nMethods or Background: We developed a novel deep learning changes \nanalysis method inputs the current and prior CECT scans and automatically \ndetects, segments and classifies the liver metastases. It uses a unique 3D U-\nNet classifier that simultaneously compares the scans and finds their \ndifferences. The network was trained on 68 pairs of clinical abdominal CECT \nscans from two institutions of patients with metastatic disease (colon, breast, \npancreas) acquired in the venous phase with a total of 2,042 liver lesions. We \nquantified the performance of our method and compared it to the standard \nstandalone approach trained on 102 scans of similar characteristics with a total \nof 1,739 liver metastases. We obtained manual delineations of the metastases \non all scans from an expert radiologist. We report the precision and recall for \nthe lesion detection and the Dice coefficient for the metastases segmentation. \nResults or Findings: The simultaneous method Precision/Recall outperforms \nthe standalone method by 5.5/4.1% and 20.5/2.2% for metastases of diameter \n>5mm and >10mm, respectively: simultaneous Precision/Recall of 0.76/0.75 \n(std=0.28/0.24) and 0.94/0.93 (std=0.13/0.16) vs. standalone Precision/Recall \nof 0.72/0.72 (std=0.26/0.19) and 0.78/0.91 (std=0.23/0.15) respectively. The \nsimultaneous segmentation method Dice coefficient also outperforms the \nstandalone method by 5.1% and 7.3% for metastases of diameter >5mm and \n>10mm, respectively: simultaneous 0.81 (std=0.2) and 0.88 (0.08) vs. \nstandalone 0.78 (std=0.1) and 0.82 (0.09), respectively. \nConclusion: Simultaneous deep learning detection and quantitative analysis \nof liver metastases follow-up changes analysis in CECT outperforms standard \nstandalone detection. \nLimitations: Data from two institutions, test set of 40 scans \nEthics Committee Approval: Yes \nFunding for this study: None \nAuthor Disclosures: \nRichard Lederman: Nothing to disclose \nLeo Joskowicz: Nothing to disclose \nAdi Szeskin: Nothing to disclose \nShalom Rochman: Nothing to disclose \nJacob Sosna: Nothing to disclose \nAviv Dodi: Nothing to disclose \n \nRPS 205-6 \nArtificial intelligence software for flagging intracranial haemorrhage on \nhead CT associated with reduction of mortality, readmission rate and CT \nturnaround time \n*D. Raskin*, C. Hoffmann, G. Twig, E. Konen, G. Yaniv; Ramat Gan/IL \n \nPurpose: To assess the effect of Artificial Intelligence for flagging patients with \nintracranial haemorrhage in emergent care setting on patient outcomes. \nMethods or Background: Data of all adult patients with diagnosis of ICH on \nhead CT , admitted to the institution's emergency department (ED) was \ncollected prior to integration of AI software and after. Study variables included \ndemographics, clinical data, imaging data, head CT report turnaround time and \ninpatient length of stay. The primary variable for outcomes was 30 and 120-day \nmortality. Secondary variables were 120 days readmission rate, inpatient \nlength of stay and head CT report turnaround time. \nResults or Findings: 648 patients were eligible for the analyzed period (299 \npre-AI, 349 Post-AI). Demographics, emergency severity score, type of ICH, \ncomplete blood count, comorbidities and smoking history were non-significantly \ndifferent between the groups. 30 and 120 day all-cause mortality were \nsignificantly reduced post-AI (27.3% vs 16.8%, 30.8% vs 20.5%, respectively, \np<0.005). Readmission rate was significantly reduced post-AI (0.37 vs 0.25, \np<0.05). Head CT report turnaround time was significantly reduced post-AI (8.2 \nvs 7.2, p<0.007). Inpatient length of stay showed a strong trend in time \nreduction post-AI (7.6 vs 7.2 days, p=0.1). \nConclusion: Implementation of AI software for flagging patients with ICH for a \nyear resulted in significant reduction of mortality, readmission rate and head \nCT report turnaround time. \nLimitations: A retrospective study conducted in a single center. \nEthics Committee Approval: The study was approved by Institutional Review \nBoard. \nFunding for this study: No funding \nAuthor Disclosures: \nEli Konen: Nothing to disclose \nChen Hoffmann: Nothing to disclose \nGilad Twig: Nothing to disclose \nDaniel Raskin: Consultant at Aidoc \nGal Yaniv: Consultant at Aidoc \n \nRPS 205-7 \nMulti-stage AI analysis system to support prostate cancer diagnostic \nimaging \nJ. Suchánek¹, L. Rundo¹, A. Mehan¹, C. Doran¹, A. R. Padhani², C. Kastner¹, \nT. Barrett¹, E. Sala¹, *A. W. Rix*¹; ¹Cambridge/UK, ²Northwood/UK \n(antony.rix@lucidamedical.com) \n \n \nPurpose: To investigate whether Artificial Intelligence (AI) techniques could \nimprove specificity, while maintaining sensitivity and NPV, of pre-biopsy MRI \nfor suspected prostate cancer. \nMethods or Background: An AI-based system was developed using a \nproprietary, multi-stage architecture, and trained using PROMISE12, NCI-ISBI \n2013 Challenge and PROSTATEx datasets, partitioned into training, validation \nand held-out test sets.Accuracy was evaluated on validation and held-out test \nsets, and compared with literature on radiologist interpretations and similar \nAI/CAD approaches. \nResults or Findings: As pre-biopsy rule-out test, the system identified patients \nwith Gleason•3+4 clinically significant prostate cancer (csPCa) with sensitivity \n93% (95% CI 82-100%), specificity 76% (64-87%), NPV 95% (88-100%), and \nAUC 0.92 (0.84-0.98), using biparametric MRI (bpMRI) data from the \nPROSTATEx combined validation and held-out test sets (80 patients, 35% \ncsPCa prevalence). Performance was higher on the 40-patient held-out test \nset. Equivalent sensitivity is reported for comparable AI/CAD systems at \nspecificities from 6%-42%. Radiologists at Likert/PI-RADS 3 thresholds \nachieved per-patient sensitivity 88-93%, specificity 18-68%, and NPV 76-\n97%.Target identification was evaluated through submission to the \nPROSTATEx Grand Challenge, a blinded test with 208 radiologist-identified \nlesions from 140 patients. The system identified lesions containing csPCa with \nAUC 0.84 using bpMRI data.For prostate gland segmentation, the system \nachieved 92% average Dice score on held-out test cases from the \nPROMISE12 dataset (10 patients), in line with the state-of-the-art. \nConclusion: The AI system showed promising performance and specificity, \nsuggesting it could help support exclusion of csPCa with high sensitivity and \nNPV, while assisting the identification of lesions to target for biopsy. \nLimitations: Methodological and dataset differences and test set size limit \ncomparisons. Further development, evaluation and regulatory approvals are \nplanned. \nEthics Committee Approval: Exempt. \nFunding for this study: Granta Innovation, Lucida Medical \nAuthor Disclosures: \nAntony William Rix: Founder at Granta Innovation Founder at Lucida Medical \nLeonardo Rundo: Consultant at Lucida Medical \nChristof Kastner: Nothing to disclose \nEvis Sala: Founder at Lucida Medical \nJakub Suchánek: Employee at Granta Innovation \nAman Mehan: Nothing to disclose \nChris Doran: Nothing to disclose \nTristan Barrett: Nothing to disclose \nAnwar R. Padhani: Nothing to disclose \n \nLive Q&A \n \n08:00-09:00 CHANNEL 3 \nEuroSafe Imaging Session  \nJointly organised by EuroSafe Imaging and IAEA \nEU 6 \nBuilding capacity and quality/safety \nawareness in Africa \nModerator \nGuy Frija; Paris/FR  \n \nEU 6-2 \nIntroduction (part 1) \nShaukat Abdulrazak; Vienna/AT  \n(S.Abdulrazak@iaea.org) \n \nEU 6-3 \nIntroduction (part 2) \nMay Abdel Wahab; Vienna/AT \n \nEU 6-4 \nIAEA policy in Africa \nPeter Johnston; Vienna/AT \n(p.johnston@iaea.org) \n \nLearning Objectives: \n1. To provide an overview of IAEA's efforts to promote radiation protection in \npatients in Africa. \n2. To understand the challenges and opportunities to improve patient safety in \nAfrica through the demonstration of successful examples. \n\n \n \n \nA \nB C 7  \nWednesday \n/LYH\u00033URJUDPPH\u0003\n \n3. To provide a roadmap for improving radiation protection of patient activities \nin Africa. \n \nEU 6-5 \nStrengthening radiology in Africa: the IAEA multifactorial approach \nDiana Paez; Vienna/AT \n \nLearning Objectives: \n1. To provide an overview of IAEA's capacity building activities in Africa. \n2. To learn how African countries can concretely benefit from IAEA support. \n3. To explore synergies between IAEA, ESR, and Africa. \n \nEU 6-6 \nAfrican Society of Radiology (ASR) expectations \nTarek El-Diasty; Mansoura/EG \n(teldiasty@hotmail.com) \n \nLearning Objectives: \n1. To understand the role of the African Society of Radiology in promoting \nquality and safety in radiology practice in Africa. \n2. To understand the needs of different African countries. \n3. To discuss methods of promoting the exchange of knowledge between \nAfrican countries via ESR and IAEA. \n \nEU 6-7 \nEuroSafe Imaging Star concept in Africa \nBoudjema Mansouri; Algiers/DZ \n(boudjema.mansouri@gmail.com) \n \nLearning Objectives: \n1. To integrate the AFROSAFE Rad Stars initiative into the AFROSAFE Rad \nradiation safety campaign (action plan 2019-2021). \n2. To define new criteria and rates adapted for the specificities of African \ncountries, the practice of medical imaging, and the implementation of radiation \nprotection. \n3. To learn about the impact of EuroSafe Imaging on the launch of AFROSAFE \nRad Stars. \n \nEU 6-8 \nIntroducing ESR iGuide Clinical Decision Support in Africa (part 1) \nDina Husseiny Salama; Cairo/EG \n(drdinahusseiny@yahoo.com) \n \nLearning Objectives: \n1. To become familiar with the experiences and the proactive actions in the \nimplementation of ESR iGuide in Africa. 2. To learn about the best \nmethodologies for learning CDS in Africa. 3. To understand the future \ndirections and suggestions towards a better clinical decision making in Africa. \n \nEU 6-9 \nIntroducing ESR iGuide Clinical Decision Support in Africa (part 2) \nMichael G. Kawooya; Kampala/UG \n \nLearning Objectives: \n1. To become familiar with the experiences and the proactive actions in the \nimplementation of ESR iGuide in Africa. 2. To learn about the best \nmethodologies for learning CDS in Africa. 3. To understand the future \ndirections and suggestions towards a better clinical decision making in Africa. \n \nLive Q&A \n \n08:00-09:00 CHANNEL 5 \nResearch Presentation Session: \nMusculoskeletal \nRPS 210 \nInnovative diagnostic techniques in \nmusculoskeletal radiology \nModerator \nMario Maas; Amsterdam/NL  \n \n \n \n \nRPS 210-2 \nHigh-resolution 3D MRI for chondrocalcinosis detection in the knee: a \nprospective cohort study comparing 7 Tesla and 3 Tesla MRI with CT \n*C. Germann*, J. Galley, A. L. Falkowski, S. Fucentese, C. W. Pfirrmann,  \nD. Nanz, R. Sutter; Zurich/CH  \n(christoph.germann@googlemail.com) \n \nPurpose: To assess the detection of chondrocalcinosis in knee joints with a \n3D Dual-Echo-Steady-State (DESS) sequence at 7T MRI in comparison to 3T \nMRI, versus CT as current cross-sectional imaging standard. \nMethods or Background: CT and 7T MRI (DESS) of knee joints in 42 patients \nwith radiographically known chondrocalcinosis (13 of 42 bilateral) were \nprospectively acquired for all included patients (N=55 knee joints). Additionally, \n3T knee-MRI (DESS) was performed (N=20 knee joints). Two fellowship-\ntrained musculoskeletal radiologists scored the images regarding presence \nand extent of cartilage calcification, diagnostic confidence level and sharpness \nof calcific deposits. As ultimate reference standard for calcifications, micro-CT \nof the menisci was acquired after knee arthroplasty procedure (N=1). \nNonparametric tests were used to compare the different modalities. A P-value \n<.05 was considered to represent statistical significance. \nResults or Findings: Compared to both 7T MRI and CT, 3T MRI detected \nsignificantly fewer cartilage calcifications (reader 1: P=.008; reader 2: P<.001). \nFor both readers, the diagnostic confidence was significantly higher for 7T MRI \nthan for 3T MRI (P<.001) and significantly higher for 7T MRI than for CT \n(P=.03). Both readers rated the delineation of calcific deposits significantly \nsharper in 7T MR images compared to either 3T MR) or CT (P<.001) images. \nMicro-CT in one patient suggested that standard-CT partly failed to detect \nmeniscal calcifications that could be identified both in 7T MRI and micro-CT. \nConclusion: 3D-DESS imaging at 7T MRI is superior at detection and \naccurate delineation of chondral calcific deposits compared to lower field \nstrength MRI and CT. \nLimitations: Ultimate Reference Standard (micro-CT) only for one patient \nDESS sequence at 3T and 7T not complete identical (due to SAR and SNR \nlimitations) \nEthics Committee Approval: approved study (cantonal ethics committee \nZurich, Switzerland) \nFunding for this study: No funding. \nAuthor Disclosures: \nJulien Galley: Nothing to disclose \nChristian Pfirrmann: Nothing to disclose \nAnna Falkowski: Nothing to disclose \nSandro Fucentese: Nothing to disclose \nDaniel Nanz: Nothing to disclose \nChristoph Germann: Nothing to disclose \nReto Sutter: Nothing to disclose \n \nRPS 210-3 \nComparison of a novel MRI technique that produces superior bone \ncontrast with 2D CT for the assessment of glenoid bone loss \n*H. Alizai*, D. Chen, J. Chang, H. B. Ellis, P. L. Wilson; Dallas, TX/US \n(hamzaalizai@gmail.com) \n \nPurpose: FRACTURE (FFE Resembling A CT Using Restricted Echo-\nspacing), a 3D gradient echo pulse sequence with restricted echo-spacing \ncombined with an automated post-processing is a technical innovation which \nprovides superior cortical and trabecular bone contrast on MRI.  \nThe objective of this study is to validate this technique in a cadaveric glenoid \nbone loss model using 2D-CT as the reference standard. \nMethods or Background: Glenoid fractures of varying sizes were \narthroscopically created in 10 cadaveric shoulders. 2D-CT and MRI \nFRACTURE (on 3T Philips Ingenia; Philips Healthcare, Best, Netherlands) \nwere performed on all 10 shoulders. The CT and MRI were presented in a \nblinded fashion to an experienced musculoskeletal radiologist for measurement \nof the glenoid fracture height and width. Paired t-tests were performed to \ncompare the measurements obtained on CT with those obtained on the MR \nFRACTURE images. \nResults or Findings: There was no statistically significant difference between \nCT and MRI in terms of the measured glenoid fracture height (P-value=0.54). \nThe mean height measured on CT was 23.40mm (SD=6.87) and on MRI was \n22.50mm (SD=7.28). Additionally, there was no statistically significant \ndifference between CT and MR in terms of the measured glenoid fracture width \n(P-value=0.86). The mean width on CT measured 7.50mm (SD=3.57) and on \nMRI measured 7.60mm (SD=3.50). \nConclusion: Measurements of glenoid fracture height and width on CT were \ncomparable with measurements obtained using the MR FRACTURE \ntechnique, which may obviate preoperative CT in patients with anterior \nshoulder instability. \nLimitations: Feasibility study with small number of subjects \nEthics Committee Approval: The study protocol was approved by the \ninstitutional research advisory panel. IRB approval was not required for this \ncadaveric model. \n\n \n \n \nA \nB C 8  \nWednesday \n/LYH\u00033URJUDPPH\u0003\n \nFunding for this study: The cadaveric shoulders were donated by Arthrex \n(Arthrex, Naples, FL, USA). Research funding provided by Scottish Rite \nHospital for Children. \nAuthor Disclosures: \nJoseph Chang: Nothing to disclose \nHamza Alizai: Nothing to disclose \nPhilip L Wilson: Nothing to disclose \nHenry B Ellis: Nothing to disclose \nDiana Chen: Nothing to disclose \n \nRPS 210-4 \nHigh-resolution US of the small but clinically relevant nerves travelling \nacross the posterior triangle of the neck \n*L. Tovt*¹, M. Pansecchi¹, F. Zaottini¹, R. Picasso¹, F. Pistoia¹, S. Sanguinetti¹, \nM. Miguel-Pérez², C. Martinoli¹; ¹Genoa/IT, ²Barcelona/ES \n \nPurpose: The aim of this study was to describe the anatomy and the US \nscanning technique of the small but clinically relevant nerves travelling across \nthe posterior triangle of the neck and to discuss the role of high frequency \ntransducers in evaluating pathologic conditions affecting them. \nMethods or Background: The anatomy of the suprascapular (SS), spinal \naccessory (SA), long thoracic (LT), phrenic (PH), supraclavicular (SC), great \nauricular (GA), lesser occipital (LO), and transverse cervical (TC) nerves was \ninvestigated in n=4 anatomical specimens and n=10 healthy volunteers by \nmeans of high frequency US transducers. N=7 patients with clinical symptoms \nsuggesting neuropathy of the aforementioned nerves were successively \nstudied. Among them, n=4 complained of pain and weakness in the shoulder \ngirdle, n=1 felt paresthesias at the base of the neck, n=1 experienced \nneuropathic pain around the retromandibular region and n=1 demonstrated \nscapular winging. \nResults or Findings: Cadaveric dissection successfully demonstrated the SS, \nSA, LT, PH, SC, GA, LO and TC. High-resolution US was able to track the \nanatomic course of the aforementioned nerves across the posterior triangle of \nthe neck in all the heathy volunteers. In patients with suspected neuropathy, \nUS demonstrated n=3 cases with enlarged SS in relation to Parsonage-Turner \nsyndrome; n=1 case of SS impingement against a paralabral ganglion cyst; \nand n=3 iatrogenic neuromas affecting the SA, GA and SC respectively. \nConclusion: An extensive knowledge of the anatomy of the posterior triangle \nof the neck and high frequencies probes are required to successfully \ninvestigate patients with suspect neuropathy affecting the locoregional nerves. \nLimitations: None \nEthics Committee Approval: The study was conducted in accordance with \nthe declaration of Helsinki. \nFunding for this study: None \nAuthor Disclosures: \nFederico Zaottini: Nothing to disclose \nCarlo Martinoli: Nothing to disclose \nLuca Tovt: Nothing to disclose \nMaribel Miguel-Pérez: Nothing to disclose \nMichelle Pansecchi: Nothing to disclose \n Sara Sanguinetti: Nothing to disclose \nRiccardo Picasso: Nothing to disclose \nFederico Pistoia: Nothing to disclose \n \nRPS 210-5 \nThe role of multidimensional hip anatomy in early joint space narrowing: \na multi-centric cross-sectional study \n*M. Klontzas*¹, E. Volitakis¹, Ü. Aydingöz², K. G. Chlapoutakis¹, \nA. H. Karantanas¹; ¹Heraklion/GR, ²Ankara/TR \n(miklontzas@gmail.com) \n \nPurpose: To use multivariate modelling in order to identify anatomical factors \nrelated to hip dysplasia or femoroacetabular impingement, which can lead to \nearly hip joint space narrowing. \nMethods or Background: A total of 897 hip CT examinations of 457 \nconsecutive patients <55 years old, were retrospectively examined. Age, joint \nspace width (JSW), center-edge (CE) angle, alpha angle, anterior acetabular \nsector angle (AASA) and neck-shaft angle (NSA) were recorded. Dysplasia \nand joint space (JS) narrowing were defined with CE angle <25o and \nJSW<0.15 cm, respectively. Multivariate linear regression analysis and two-\nstep supervised clustering were performed to identify factors and combinations \nof factors linked to early JS narrowing. \nResults or Findings: Anatomical factors were found to differentially affect \ndysplastic and non-dysplastic hips. In dysplastic hips (CE<25o), AASA \n(P<0.005) and CE angle (P<0.032) were the only significant predictors of JS \nnarrowing, neither of which was alone correlated to JSW, indicating that lateral \nand anterior dysplasia contribute together in early degeneration. In non-\ndysplastic hips (CE>25o), JSW was correlated to CE angle, AASA, NSA and \nage (P<0.001). However, in multivariate models only CE angle was \nindependently inversely related to JSW (B=-0.002, P<0.001) indicating the \nimportance of pincer-type impingement on early degeneration. Two-step \nclustering identified two relative patient clusters, one with low JSW, higher CE \nangle, lower NSA and higher AASA values and a second with normal JSW, low \nCE angle, high NSA and low AASA values (Silhouette measure 0.4). \nConclusion: Multidimensional anatomy differentially drives degeneration in \ndysplastic and non-dysplastic hips. Lateral and anterior dysplasia contribute \ntogether and pincer-type impingement contributes independently to early \ndegeneration. Finally, combinations of CE angle, NSA and AASA can predict \nJSW. \nLimitations: n/a \nEthics Committee Approval: Approved - University Hospital of Heraklion (Ref \nNo 882). \nFunding for this study: No funding received for this study \nAuthor Disclosures: \nMichail Klontzas: Nothing to disclose \nKonstantinos G. Chlapoutakis: Nothing to disclose \nEmmanouil Volitakis: Nothing to disclose \nÜstün Aydingöz: Nothing to disclose \nApostolos H. Karantanas: Nothing to disclose \n \nRPS 210-6 \nComparison of utility for image quality improvement between \ncompressed sensing with developed deep learning reconstruction and \nconventional parallel imaging in shoulder MR imaging \n*Y. Obama*¹, Y. Ohno¹, K. Yamamoto², A. Iwase¹, T. Ueda¹, K. Murayama¹, \nH. Toyama¹; ¹Toyoake/JP, ²Otawara/JP \n(y-obama@fujit-hu.ac.jp) \n \nPurpose: To prospectively and directly determine the capability of newly \ndeveloped deep learning reconstruction (DLR) for image quality improvement \non MRI obtained by conventional parallel imaging (PI) and compressed \nsensing (CS) in patients with various shoulder diseases. \nMethods or Background: Thirty consecutive patients with various shoulder \ndiseases underwent MRI at a 3T MR system by conventional PI and CS, and \neach MR data was reconstructed with and without DLR. To determinate \nquantitative image quality improvement of each acquisition with and without \nDLR, signal-to-noise ratio (SNR) of humeral head, percentage of coefficient of \nvariations (%CVs) and contrast-to-noise ratio (CNR) were determined by ROI \nmeasurements in all patients. For qualitative image quality assessment, two \nradiologists evaluated overall image quality, artifacts and diagnostic confidence \nlevel (DCL) by 5-point scoring system, and final value of each index was made \nby consensus of two readers. To compare the capability for reducing \nexamination time, all MR examination times were compared by Tukey’s HSD \ntest.  On qualitative image quality evaluation, inter- observer agreement of \neach index was firstly determined by weighted-kappa statistics. Then, all \nquantitative and qualitative indexes were compared among all methods by \nTukey’s HSD test or Wilcoxon’s signed rank test. \nResults or Findings: CS with and without DLR showed significantly shorter \nexamination times than conventional PI (p<0.05). Overall image quality and \nartifact could be significantly improved with applying DLR on shoulder MRI \nobtained by CS and PI (p<0.05), although diagnostic confidence had no \nsignificant influence by DLR. \nConclusion: CS is able to significantly reduce examination time than PI. \nMoreover, DLR can significantly improve image quality of shoulder MRI \nobtained by CS at a 3T system. \nLimitations: Sample size \nEthics Committee Approval: IRB comittee in Fujita Health University Hospital \nFunding for this study: Canon Medical Systems \nAuthor Disclosures: \nYuki Obama: Nothing to disclose \nKazuhiro Murayama: Grant Recipient at Canon Medical Systems \nKaori Yamamoto: Employee at Canon Medical Systems \nHiroshi Toyama: Grant Recipient at Canon Medical Systems \nTakahiro Ueda: Nothing to disclose \nYoshiharu Ohno: Grant Recipient at Canon Medical Systems \nAkiyoshi Iwase: Nothing to disclose \n \nRPS 210-7 \nEvaluation of MR-derived simulated CT-like images and simulated \nradiographs compared to conventional radiography in patients with \nsuspected rotator cuff injury \n*G. C. Feuerriegel*, F. Kopp, D. Pfeiffer, D. C. Karampinos, B. J. Schwaiger, \nM. R. Makowski, K. Woertler, A. S. Gersing; Munich/DE \n \nPurpose: To evaluate the diagnostic value of MR-derived CT-like images and \nsimulated radiographs compared with conventional radiographs in patients with \nsuspected rotator cuff injury. \nMethods or Background: In 23 patients with suspected rotator cuff injury \n(mean age 52.2±18years,13 women), 3T MR-imaging of the shoulder was \nperformed including a 3D T1-weighted gradient-echo sequence from which \nintensity-inverted CT-like images were derived. The inverted MRI-image \nvolumes were processed to achieve contrast enhancement and a cone-beam \n\n \n \n \nA \nB C 9  \nWednesday \n/LYH\u00033URJUDPPH\u0003\n \nforward projection algorithm was used to obtain simulated radiographs. \nCongruency of projections and image quality was graded using a 5-point \nLikert-scale. Two radiologists evaluated the simulated images and \ncorresponding conventional radiographs, performing measurements of the \nacromiohumeral distance(AHD) and critical shoulder angle(CSA), as well as \nassessing semi-quantitative scores in order to grade degenerative changes \nusing the Samilson-classification and the type of the acromion shape (Bigliani-\nclassification). \nResults or Findings: Measurements on simulated radiographs were \ncomparable to those on conventional radiographs with a substantial to almost \nperfect inter- and intrareader agreement ( ț=0.69-1.00 and ț=0.65-0.85, \nrespectively). Between MR-derived CT-like images in combination with \nsimulated radiographs and conventional radiographs a substantial agreement \nwas found regarding diagnostically relevant features, assessed on Y-and AP-\nprojections (CSA, mean+/- standard deviation 33°+/-3.3°, ț=0.84 and 0.69; \nAHD, mean+/-SD, 11.8 mm+/-1.9 mm, ț=0.95 and0.60; Samilson-score, \nț=0.77 and 0.77; Bigliani-score, ț=0.83 and 0.67, respectively). \nConclusion: The visualization and assessment of diagnostically relevant \nfeatures of shoulder joints was feasible using MR-derived CT-like images and \nsimulated radiographs and findings were comparable to those of conventional \nradiographs. CT-like images may provide additional information on osseous \nabnormalities without causing any radiation exposure. \nLimitations: Implementation of simulated radiographs into the clinical workflow \nmay be challenging because every patient needs an MRI and post-processing \nusing automated computerised algorithms is up to now time consuming. \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nBenedikt Jakob Schwaiger: Nothing to disclose \nMarcus R. Makowski: Nothing to disclose \nAlexandra Sophia Gersing: Nothing to disclose \nFelix Kopp: Nothing to disclose \nGeorg Constantin Feuerriegel: Nothing to disclose \nDaniela Pfeiffer: Nothing to disclose \nDimitrios C. Karampinos: Nothing to disclose \nKlaus Wörtler: Nothing to disclose \n \nLive Q&A \n \n09:15-10:15 CHANNEL 2 \nSpecial Focus Session \nSF 2 \nCranial nerves: the good, the bad, and the \nugly \nModerator \nElizabeth Loney; Halifax/UK  \n \nSF 2-2 \nThe good: cranial nerve anatomy \nJan Walther Casselman; Bruges/BE  \n(jan.casselman@azsintjan.be) \n \nLearning Objectives: \n1. To learn about cranial nerve anatomy. \n2. To understand which imaging techniques and sequences to use to best \nvisualise each nerve. \n3. To appreciate the path each nerve takes and adjacent structures which \nmight affect it. \nAuthor Disclosures: \nJan Walther Casselman: Speaker: Philips Healhtcare \n \nSF 2-3 \nThe bad: non-neoplastic pathology \nSimonetta Gerevini; Bergamo/IT \n(sgerevini@asst-pg23.it) \n \nLearning Objectives: \n1. To appreciate the wide range of non-neoplastic conditions which may affect \ncranial nerves. \n2. To become familiar with the best techniques and sequences to use to image \nsuch conditions. \n3. To see examples of such pathology in order to aid recognition if encountered \nduring ones own practice. \n \nSF 2-4 \nThe ugly: perineural tumour spread \nBernhard F. Schuknecht; Zurich/CH \n(bschuknecht@mri-roentgen.ch) \n \nLearning Objectives: \n1. To revise those conditions more likely to present with perineural tumour \nspread. \n2. To become familiar with the best techniques and sequences to use to image \nsuch conditions. \n3. To see examples of such pathology in order to aid recognition if encountered \nduring ones own practice. \n \nLive Q&A: Challenges and solutions when imaging cranial nerves \n \n09:15-10:15 CHANNEL 4 \nProfessional Challenges Session \nPC 6 \nRadiographers meeting the challenges of \nthe COVID-19 pandemic \nModerators \nCarst Buissink; Groningen/NL  \nGeorge Tsivtsivadze; Tbilisi/GE  \n \nPC 6-3 \nHow have our clinical practices changed due to COVID-19? \nMoreno Zanardo; Milan/IT \n(moreno.zanardo@unimi.it) \n \nLearning Objectives: \n1. To discuss the challenges in medical imaging brought about by the \npandemic. \n2. To highlight the approaches and actions being taken to return to normal \nclinical services. \n3. To understand the potential long-term effects of the outbreak on clinical \npractice. \n \nPC 6-4 \nTo look back on a year of COVID-19: the impact on radiographer \neducation \nPete Bridge; Liverpool/UK \n(Pete.Bridge@liverpool.ac.uk) \n \nLearning Objectives: \n1. To understand the ongoing educational challenges. \n2. To present staff and student experiences from the past year. \n3. To recognise what we have learned through a widespread move to online \nteaching, learning, and assessment. \nAuthor Disclosures: \nPete Bridge: Board Member: Medspace.VR \n \nPC 6-5 \nWell-being in the era of COVID-19 \nPaul Bezzina; Msida/MT \n(Paul.bezzina@um.edu.mt) \n \nLearning Objectives: \n1. To understand what well-being means in the COVID era. \n2. To explore strategies to help radiographers reflect and renew. \n3. To discuss the coping challenges of radiographers in adjusting to the crisis. \n \nLive Q&A: The impact of COVID on imaging practice \n \n \n \n \n \n \n \n \n\n \n \n \nA \nB C 10  \nWednesday \n/LYH\u00033URJUDPPH\u0003\n \n09:15-10:15 CHANNEL 5 \nResearch Presentation Session: Cardiac \nRPS 103 \nHow to further refine personal \ncardiovascular risk stratification \nModerator \nJordi Broncano; Córdoba/ES  \n \nRPS 103-2 \nExposure to environmental tobacco smoke estimated using the SHSES \nscale and the aortic valve calcification score in the group of patients with \narterial hypertension \n*P. Gac*, M. Poreba, G. Mazur, R. Poreba; Wroclaw/PL  \n(pawelgac@interia.pl) \n \nPurpose: Objective of the study was to determine the relationship between \nexposure to environmental tobacco smoke (ETS) estimated on the basis of the \nSHSES scale and the value of the aortic valve calcification score (AVCS) in \npeople suffering from arterial hypertension (AH). \nMethods or Background: 107 non-smokers with diagnosed and \npharmacologically managed hypertension (67.16±8.48 years) were qualified for \nthe study. The degree of exposure to ETS was assessed using the SHSES \nscale; cardiac computed tomography (CCT) was also performed. Using the \nSHSES scale, the following subgroups of patients were distinguished: A- not \nexposed to ETS (0 SHSES points, n=51), B- slightly exposed to ETS (1-3 \nSHSES points, n=14), C- moderately exposed to ETS (4-7 SHSES points, \nn=22) and D- significantly exposed to ETS (8-11 SHSES points, n=20). AVCS \nwas assessed semi-automatically, based on the multiplanar reconstruction \nfrom the non-contrast phase of the CCT. The Agatston algorithm was used. \nResults or Findings: AVCS value in the study group was 213.59±304.86. The \nAVCS was significantly lower in subgroup A than in subgroups C and D. In \nsubgroup A, the lack of aortic valve calcification was observed significantly \nmore frequently than in subgroup D. There was a positive correlation between \nthe number of SHSES points and AVCS (r=0.37, p<0.05). Based on the ROC \ncurve, the SHSES value was determined as the optimal cut-off point for the \nprediction of the absence of aortic valve calcification, amounting to 3 points. \nThe accuracy of SHSES<3 as the predictor of AVCS=0 was set at 62.18%. \nConclusion: In people with AH, there is an unfavourable relationship between \nthe amount of exposure to environmental tobacco smoke and AVCS. \nLimitations: Small study group size. Lack of blood cotinine concentration test. \nEthics Committee Approval: Local Bioethic committee approval. \nFunding for this study: Wroclaw Medical University \nAuthor Disclosures: \nRafal Poreba: Nothing to disclose \nMalgorzata Poreba: Nothing to disclose \nPawel Gac: Nothing to disclose \nGrzegorz Mazur: Nothing to disclose \n \nRPS 103-3 \nMeasurement techniques of epicardial adipose tissue in the diagnosis of \ncoronary heart disease \n*A. Dobrovolskij*¹, D. Austys², N. Valeviciene², R. Stukas²; ¹Mainz/DE, \n²Vilnius/LT \n(adobrovolskij@gmail.com) \n \nPurpose: Epicardial adipose tissue (EAT) is considered to be an important \nfactor in the development of cardiovascular diseases. Overall, observational \nstudies suggest a positive association between the EAT and coronary artery \ndisease (CAD). EAT depots are estimated by measuring thickness on different \nsites and volume. There is a lack of research regarding the comparison \nbetween different quantification methods of EAT in diagnostic of CAD. \nTherefore, we aimed to compare different EAT measurement techniques in \nprediction of CAD. \nMethods or Background: There were 127 CAD and 137 non-CAD adult \npatients investigated in this prospective study. The patients were selected \naccording to the length of interventricular septum (interval of 100±9.5 mm). \nVolume and thickness of EAT depots on ventricular free walls (6 locations) and \ngrooves (5 locations) were measured using cardiac magnetic resonance \ntomography images. The diagnostic ability of different EAT measurement \ntechniques was evaluated using receiver operating characteristic (ROC) \nanalysis. \nResults or Findings: Overall, EAT thickness (in all locations) and volume \nwere higher among patients with CAD (p<0.001). ROC analysis revealed that \nthe largest area under the curve (AUC) was observed in case of the mean \nvalue of EAT thickness measurements in interventricular and atrioventricular \ngrooves - 0.884. The AUC in case of EAT volume was 0.816, in case of EAT \nthickness on left and right ventricular free walls ranged between 0.524-0.656 \nand 0.561-0.704 respectively. \nConclusion: The most suitable EAT measurement in prediction of CAD was \nidentified to be the mean value of EAT thickness in interventricular and \natrioventricular grooves areas (cut-off value - 7.9 mm). The predictive power of \nEAT volume showed to be similar (cut-off value - 133,5 cm3), therefore, this \nmeasurement should also be considered in diagnostic of CAD. \nLimitations: n/a \nEthics Committee Approval: Ethics Committee approval provided. \nFunding for this study: n/a \nAuthor Disclosures: \nNomeda Valeviciene: Nothing to disclose \nRimantas Stukas: Nothing to disclose \nAndrej Dobrovolskij: Nothing to disclose \nDonatas Austys: Nothing to disclose \n \nRPS 103-4 \nVolume CT in different morphological types of Bicuspid Aortic Valve \n(BAV) disease as a part of personalized management \n*M. Nedevska*, N. Slavkova, V. V. Groudeva, E. Mihaylova; Sofia/BG \n(nedevska_maria@yahoo.com) \n \nPurpose: The aim of the study is to investigate how the specific morphological \nBAV phenotypes, aortic configuration, and hemodynamics, can be associated \nwith different patients’ outcome in BAV disease. \nMethods or Background: For this retrospective study, we used dynamic \nvolume CT with 320- detector- rows. Forty- five patients (20 – 72 years) with \nBAV disease, underwent ECG-gated cardiac CT. Multiphase reconstructions of \nthe aorta and the aortic valve were used as a gold standard. Valve morphology \nwas described according to the Sievers classification. Aortic dilatation pattern \nwas described according to Cluster classification. Aortic valve orifice area, \naortic regurgitation ( AR), AR fraction, left ventricular ejection fraction ( LVEF), \nand the extent of dilatation and hypertrophy of the left ventricle were quantified. \nResults or Findings: The analyses of the results show that the predominant \nmorphological phenotype of BAV is type 0- non- raphe type. 35 % of the \npatients had a valvular lesion with equal counts of aortic stenosis ( AS) and \naortic regurgitation ( AR). Aortic dilatation was seen in 62 % of the cases, \nmainly affecting the ascending aorta. In 44 % there was dilatation or \nhypertrophy of the left ventricle with low LVEF and disturbed pump function. 10 \n% of the patients underwent AVR ( Aortic valve replacement) or endoprosthetic \nsurgery. Further evaluation of the correlation between these parameters was \nmade. \nConclusion: BAV disease has huge heterogeneity in radiologic and clinical \nappearance. The precise study and understanding of the different \nmorphological types of BAV can give a new therapeutic and surgical approach, \nconsidering patients’ specific characteristics. \nLimitations: There are some limitations related to the relatively small number \nof patients and the retrospective nature of the study. \nEthics Committee Approval: It is approved by the local ethical committee. \nFunding for this study: Self funding \nAuthor Disclosures: \nVioleta Vassileva Groudeva: Nothing to disclose \nNia Slavkova: Nothing to disclose \nEvgeniya Mihaylova: Nothing to disclose \nMaria Nedevska: Nothing to disclose \n \nRPS 103-5 \nInflammation of remote myocardium in survivors with AMI: a CMR T2-\nmapping study \n*K. Xu*, Y-K. Guo; Chengdu/CN \n(382781403@qq.com) \n \nPurpose: This study aimed to assess the inflammation response in remote \nmyocardium after acute myocardial infarction (AMI) using T2-mapping and its \nrelationship with LV remodeling. \nMethods or Background: 54 AMI survivors were prospectively recruited and \nunderwent cardiac magnetic resonance scans 3 days and 3 months after AMI, \nrespectively. 25 healthy volunteers also completed the same scan. T2 \nmapping, late gadolinium enhancement and cine imaging were performed to \nmeasure T2 values in remote myocardium (T2remote values), enhanced size \nand LV functional parameters㸪respectively. LV remodeling was evaluated as \nthe change in LV end-diastolic volume (LVEDV) index at follow-up scan \ncompared with baseline. \nResults or Findings: Compared with T2 values in normal controls (39.44 ± \n2.05 ms), T2remote values of patients in baseline (40.20 ± 1.92 ms, P = 0.013) \nand follow-up scan (40.94 ± 2.20 ms, P < 0.01) were both higher. The \nT2remote values had a marginal increase in follow-up scan (0.5 ms, -0.2 ms - \n1.13 ms). Between the baseline and follow-up scans, ᶭT2remote values were \ncorrelated with ᶭLV eject fraction (r = -0.377, P = 0.005), ᶭLVEDV (r = 0.578, \nP < 0.001) and ᶭLV end-systolic volume (r = 0.538, P < 0.001). Furthermore, \n\n \n \n \nA \nB C 11  \nWednesday \n/LYH\u00033URJUDPPH\u0003\n \nᶭT2remote values were independently associated with LV remodeling in the \nmultivariable linear analysis ( ȕ = 0.539, P < 0.01). \nConclusion: T2-mapping techniques detects the inflammation response in \nremote myocardium after AMI, and the changes of inflammation (T2 values) \nare associated with LV remodeling. \nLimitations: None \nEthics Committee Approval: Institutional Review Board approval was \nobtained \nFunding for this study: This study was supported by the National Natural \nScience Foundation of China (81771887, 81771897,  \n81901712 and 81971586); the Program for New Century Excellent Talents in \nUniversity (No. NCET- \n13-0386); \nAuthor Disclosures: \nKe Xu: Nothing to disclose \nYing-Kun Guo: Nothing to disclose \n \nRPS 103-6 \nWho are the patients with MAD? \n*G. Grazzini*, S. Pradella, G. Zantonelli, M. Letteriello, C. De Amicis, M. \nMoroni, I. Fusi, M. Acquafresca, V. Miele; Florence/IT \n(grazzini.giulia@gmail.com) \n \nPurpose: Mitral annulus disjunction (MAD) is a structural abnormality. MAD \nhas been associated with mitral valve prolapse (MVP) and arrhythmias. The \naim of this study is to evaluate the association with MVP, cardiomyopathies \n(CMPs), and arrhythmias in patients with MAD who underwent cardiac \nmagnetic resonance (CMR). \nMethods or Background: From our Picture Archiving and Communication \nSystem, we searched for all complete CMR examinations performed between \nJanuary 2018 and December 2019. For each CMR, we analyzed cine steady-\nstate free processing images acquired in the 3-chamber and 4-chamber long-\naxis views identifying patients with MAD. Subsequently, all the sequences of \nthe selected CMR with MAD were analyzed evaluating any anomaly: \nventricular volumes, wall thicknesses, kinetics, presence of MVP, late \ngadolinium enhancement (LGE), T2, T1 and extracellular volume (ECV) \nvalues, and MAD morphology. The selected patients had been tested for the \nfollowing question: Did they have arrhythmias, MVP, or suspected CMP? \nResults or Findings: We evaluated 3000 CMR. The CMR-diagnoses were: \nmyocarditis 20%, heart attack 30%, suspected or confirmed cardiomyopathies \n20%, arrhythmias 15%, valvular diseases 10%, anatomical studies before/after \nsurgery 2%, others 3%. We selected 98/3000 CMR with MAD. All patients with \nMAD on CMR images had arrhythmias, 78% had a confirmed diagnosis of \nMVP, 45% had CMP. LGE was present in 44% of patients with MAD and \nnative T1 and ECV values were increased in the infero-lateral basal segments \nin 54% of cases. \nConclusion: MAD was present only in patients with arrhythmias often \nassociated with MVP or CMP and/ or LGE. In most cases, the T1 and ECV \nvalues in the maps were increased in the infero-lateral basal segments. \nLimitations: The main limitation is that this is a retrospective study. \nEthics Committee Approval: The ethics committee of our institution approved \nthis study. \nFunding for this study: No funding \nAuthor Disclosures: \nGiulia Zantonelli: Nothing to disclose \nMayla Letteriello: Nothing to disclose \nManlio Acquafresca: Nothing to disclose \nGiulia Grazzini: Nothing to disclose \nVittorio Miele: Nothing to disclose \nSilvia Pradella: Nothing to disclose \nMario Moroni: Nothing to disclose \nIsabella Fusi: Nothing to disclose \nCristian De Amicis: Nothing to disclose \n \nRPS 103-7 \nGender-related differences in the systemic right ventricular failure: a \ncross-sectional MRI study \nA. Gregov, T. Balasko Josipovic, M. Muršiü, *M. Hrabak Paar*; Zagreb/HR \n(majahrabak@gmail.com) \n \nPurpose: To detect gender differences in the morphology and function of the \nsystemic right ventricle (SRV) in patients with transposition of the great arteries \n(TGA). \nMethods or Background: Cine steady-state free precession cardiac MRI \nsequences were acquired using a 1,5T scanner in 25 patients with SRV (age \nrange 19-68, 13 males): 16 with atrial-switch repair for D-TGA and 9 with \ncongenitally-corrected TGA. SRV volumetry was performed using a standard \nprocedure. Mean longitudinal SRV strain was measured on a 4-chamber cine \nview, and mean circumferential SRV strain at three cine short-axis images \nbased on feature-tracking. Late-gadolinium enhancement (LGE) scanning was \nperformed in 22 patients and visually assessed. Numerical parameters of SRV \nfunction were compared between genders using independent samples T-test, \nwhereas differences in LGE were assessed using Chi-Squared test. \nResults or Findings: Male patients with SRV, compared to their female \ncounterparts, had significantly larger indexed SRV enddiastolic volume \n(139±47ml/m2 vs. 104±18ml/m2, p=0.025), lower SRV ejection fraction \n(39±13% vs. 52±5%, p=0.003) and SRV LGE more commonly present (9/12 \nvs. 1/10, p=0.002). Males had lower mean longitudinal SRV strain (-11.3±2,8% \nvs. -16.4±2.4%, p<0.001) and mean circumferential SRV strain in the basal (-\n11.0±2.9% vs. -15.3±2.6%, p<0.001) and midventricular plane (-10.5±4.1% vs. \n-14.8±4.0%, p=0.015). There was no significant age difference between males \nand females. \nConclusion: Results of this study suggest that male patients with SRV could \nhave worse parameters of SRV function compared to their female \ncounterparts, but that should be confirmed in a larger group of patients. \nLimitations: Limited number of patients, clinical differences between male and \nfemale patients have not been analyzed. \nEthics Committee Approval: Obtained. \nFunding for this study: This project has received funding from the Seed \nGrant funding programme of the European Society of Radiology (ESR) in \ncollaboration with the European Institute for Biomedical Imaging Research \n(EIBIR). \nAuthor Disclosures: \nAndrija Gregov: Nothing to disclose \nTihana Balasko Josipovic: Nothing to disclose \nMaja Hrabak Paar: Nothing to disclose \nMiroslav Muršiü: Nothing to disclose \n \nLive Q&A \n \n10:30-11:30 CHANNEL 2 \nE³ - ECR Master Class \nE³ 1026 \nCT in musculoskeletal imaging: tips and \ntricks \nModerator \nHatice Tuba Sanal; Ankara/TR  \n \nE³ 1026-2 \nA. Metal artifact reduction: does it work? \nAnagha P. Parkar; Bergen/NO  \n \nLearning Objectives: \n1. To describe how to optimise protocols for metal artifact reduction. \n2. To list the pitfalls related to metal type and to understand the strengths and \nweaknesses of CT vs MRI.  \n3. To explain how to implement metal artifact reduction effectively in clinical \npractice. \n \nE³ 1026-3 \nB. Bone marrow oedema (BME): can CT get it right? \nEmma Rowbotham; Leeds/UK \n \nLearning Objectives: \n1. To explain the usefulness of dual-energy assessment of bone marrow. \n2. To list the pitfalls in diagnosing BME on CT and to understand the strengths \nand weakness of CT vs MRI.  \n3. To explain how to implement dual-energy assessment of bone marrow \neffectively in clinical practice. \n \nE³ 1026-4 \nC. 4D-CT in musculoskeletal imaging \nPedro Augusto Gondim Teixeira; Nancy/FR  \n(p.teixeira@chru-nancy.fr) \n \nLearning Objectives: \n1. To describe how to optimise protocols for 4D-CT. \n2. To list the normal and pathological findings in joints.   \n3. To explain the pitfalls in 4D-CT. \nAuthor Disclosures: \nPedro Augusto Gondim Teixeira: Research Grant/Support: Canon Medical \nSystems \n \n \n \n\n \n \n \nA \nB C 12  \nWednesday \n/LYH\u00033URJUDPPH\u0003\n \nE³ 1026-5 \nD. Soft tissue applications of dual-energy CT (DECT) \nAndrea S. Klauser; Innsbruck/AT \n(andrea.klauser@i-med.ac.at) \n \nLearning Objectives: \n1. To describe how to optimise your protocol. \n2. To list the indications of DECT for soft tissue and to understand the \nstrengths and weakness of CT vs MRI.  \n3. To explain the pitfalls in DECT. \n \nLive Q&A \n \n10:30-11:30 CHANNEL 3 \nRefresher Course: Hybrid, Molecular and \nTranslational Imaging \nOrganised by ESHIMT \nRC 206 \nMonitoring therapeutic effects: response \ncriteria \nModerator \nGerald Antoch; Düsseldorf/DE  \n \nRC 206-2 \nA. Morphological response assessment: RECIST 1.1 \nMelvin D'Anastasi; Msida/MT  \n(melvin.danastasi@gov.mt) \n \nLearning Objectives: \n1. To understand the basic concepts of morphological therapy monitoring. \n2. To understand how RECIST 1.1 has simplified the previous criteria (RECIST \n1.0). \n3. To understand the limitations of morphological therapy monitoring. \nAuthor Disclosures: \nMelvin D'Anastasi: Advisory Board: Keosys Medical Imaging; Consultant: \nKeosys Medical Imaging \n \nRC 206-3 \nB. Molecular response assessment: from EORTC to PERCIST \nHelmut Prosch; Vienna/AT \n(helmut.prosch@meduniwien.ac.at) \n \nLearning Objectives: \n1. To understand the basic concepts of molecular therapy monitoring. \n2. To understand the limitations of molecular therapy monitoring. \n3. To learn of non-FDG tracer applications for therapy monitoring. \n \nRC 206-4 \nC. Monitoring immune-therapy: iRECIST and iPERCIST \nEgesta Lopci; Rozzano/IT \n(egesta.lopci@gmail.com) \n \nLearning Objectives: \n1. To understand the basic concepts of morphological therapy monitoring of \nimmune therapies. \n2. To understand the differences between various response criteria. \n3. To understand the limitations of the various response criteria. \nAuthor Disclosures: \nEgesta Lopci: Grant Recipient: AIRC, Italian Ministry of Health; Speaker: \nESMIT, MI&amp;T congressi; Other: Royalties \n \nLive Q&A: Implications for clinical workflows \n \n \n \n \n \n \n10:30-11:30 CHANNEL 4 \nESR meets India \nMeets 2 \nRadiology in India \nModerators \nMichael H. Fuchsjäger; Graz/AT  \nChellathurai Amarnath; Chennai/IN  \n \nMeets 2-3 \nTemporal lobe epilepsy imaging \nHemant Patel; Ahmedabad/IN \n(hemantmri@gmail.com) \n \nLearning Objectives: \n1. To understand the importance of imaging in partial focal seizures arising \nfrom the temporal lobe. \n2. To learn the imaging pearls for establishing the diagnosis of mesial temporal \nsclerosis on MR imaging. \n3. To discuss the updates on various advances in MR imaging such as T2 \nrelaxometry, hippocampal volumetry, and PET MRI. \n \nMeets 2-4 \nInterlude 1: Unity in diversity in India \n \nMeets 2-5 \nImaging of CNS infection: spectrum of usual and unusual aetiologies \nDeepak P. Patkar; Mumbai/IN \n(drdppatkar@gmail.com) \n \nLearning Objectives: \n1. To understand the imaging features of various CNS infections. \n2. To understand the role of various imaging modalities. \n3. To understand the role of advanced MRI sequences like perfusion and \nspectroscopy. \n4. To understand the pearls and pitfalls of various imaging techniques. \n5. To understand imaging findings to differentiate infections from other \ndifferentials. \n \nMeets 2-6 \nInterlude 2: A tour of the history of radiology in India \n \nMeets 2-7 \nEthics in radiology practice \nKunnummal Mohanan; Thrissur/IN \n(mohanankdr@gmail.com) \n \nLearning Objectives: \n1. To elaborate basic principles of medical ethics applied in radiology. \n2. To elaborate ethical principles and diagnostic imaging: over imaging and \nover diagnosis. \n3. To highlight about ethical principles and radiation protection. \n4. To inform about ethics in interventional radiology and fetal radiology. \n5. To highlight about ethics and innovative approaches in radiology. \n6. To highlight ethics and radiology research. \n7. To elaborate about ethics and the law. \n \nMeets 2-8 \nImaging in paediatric neurometabolic disease \nChellathurai Amarnath; Chennai/IN \n(amarrd02@yahoo.co.in) \n \nLearning Objectives: \n1. To review the classification of neurological metabolic diseases. \n2. To highlight the important MRI findings in paediatric leucodystrophies. \n3. To present some clues for differential diagnosis and an image-based \napproach. \n \nLive Q&A \n \n\n \n \n \nA \nB C 13  \nWednesday \n/LYH\u00033URJUDPPH\u0003\n \n10:30-11:30 CHANNEL 5 \nRefresher Course: Radiographers \nRC 414 \nImaging and protecting the foetus \nModerators \nLouise A. Rainford; Dublin/IE  \nDaniela Prayer; Vienna/AT  \n \nRC 414-3 \nA. Foetal ultrasound \nDavid Degiorgio; Msida/MT \n(degio16@gmail.com) \n \nLearning Objectives: \n1. To discuss the role of ultrasound in multiple pregnancies. \n2. To outline the presentation of normal anatomy and anomalies on ultrasound. \n3. To explore the challenges in imaging common foetal pathologies on \nultrasound. \n \nRC 414-4 \nB. Foetal MRI \nChristina Malamateniou; London/UK \n(christina.malamateniou@city.ac.uk) \n \nLearning Objectives: \n1. To discuss the current clinical applications of foetal MRI.  \n2. To outline the presentation of normal anatomy and anomalies on MRI. \n3. To explore the challenges and optimisation considerations in foetal MRI. \n \nRC 414-5 \nC. Protecting the foetus during emergency radiography \nShauna Murphy; Dublin/IE \n(shauna.murphy@ucd.ie) \n \nLearning Objectives: \n1. To highlight the importance of justification and record-keeping in \nradiographic pregnant patients in an emergency setting. \n2. To discuss the value of shielding the pregnant female in an emergency \nsetting. \n3. To present advice on exposure parameter optimisation in radiography of the \npregnant female in an emergency setting. \n \nLive Q&A \n \n \n11:45-12:45 CHANNEL 2 \nRefresher Course: Abdominal Viscera \nRC 501 \nColon cancer: a multidisciplinary \napproach \nModerator \nLennart K. Blomqvist; Stockholm/SE  \n \nRC 501-2 \nA. What are the expectations from the surgeon? \nDejan Ignjatovic; Oslo/NO  \n(dejan.ignjatovic@medisin.uio.no) \n \nLearning Objectives: \n1. To learn about the different surgical options for colon cancer. \n2. To learn the surgical nomenclature used for the different variants of surgical \nprocedures, in particular that related to the vasculature. \n3. To understand how anatomical vascular variants and lymph node \ninvolvement on CT can affect the surgical procedure. \n \n \n \n \nRC 501-3 \nB. My CT protocol for staging colon cancer \nMx J. Lahaye; Amsterdam/NL \n(MJ.Lahaye@gmail.com) \n \nLearning Objectives: \n1. To demonstrate the CT acquisition protocol relevant for staging of colon \ncancer that also allows demonstration of bowel vasculature. \n2. To learn about the vascular anatomy of the colon and nodal pathways as \nvisualised on CT. \n3. To understand how software post-processing can facilitate assessment and \ndemonstration of vascular anatomy and lymph node involvement. \n \nRC 501-4 \nC. Integrated staging and vascular assessment \nAnne Negaard; Lørenskog/NO \n(anne.negard@medisin.uio.no) \n \nLearning Objectives: \n1. To show how a structured report can illustrate local and distant staging in \ncolon cancer. \n2. To demonstrate how the vascular assessment is performed in the same \nexamination. \n3. To present typical cases that demonstrate the importance of assessment, \nboth in relation to the extent of disease as well as the vascular anatomy. \n \nLive Q&A \n \n11:45-12:45 CHANNEL 3 \nE³ - The Beauty of Basic Knowledge: \nUnderstanding MRI Technique and MRI \nSafety \nE³ 25A \nBasic principles and magnetic field \ninteractions \nModerators \nUrsula Reiter; Graz/AT  \nSiegfried Trattnig; Vienna/AT  \n \nE³ 25A-2 \nFrom the proton to the MR image: the principle of clinical MRI \nAndrew Webb; Leiden/NL \n(a.webb@lumc.nl) \n \nLearning Objectives: \n1. To understand how the hydrogen nuclei in our bodies respond to the main \nmagnet, the transmitting RF coil, and the magnetic field gradients. \n2. To understand how we form an image and how image artifacts can occur. \n3. To understand how to produce different contrasts in an MR image. \n \n \nE³ 25A-3 \nA systematic overview on MRI interactions with magnetic and electrically \nconductive material \nFritz Schick; Tübingen/DE \n \nLearning Objectives: \n1. To learn about the hardware components that generate different types of \nelectromagnetic fields. \n2. To learn about the interactions between the static magnetic field and \nmagnetic material. \n3. To learn about the interactions between time-varying electromagnetic fields \nand electrically conductive material. \n \nLive Q&A \n \n\n \n \n \nA \nB C 14  \nWednesday \n/LYH\u00033URJUDPPH\u0003\n \n11:45-12:45 CHANNEL 4 \nMultidisciplinary Session \nMS 2 \nFibrotic lung disease \nModerator \nNicola Sverzellati; Parma/IT  \n \nMS 2-2 \nClinical diagnosis and therapeutic options \nNazia Chaudhuri; Manchester/UK  \n \nLearning Objectives: \n1. To review the key clinical features of individual fibrotic lung disorders. \n2. To understand the prognostic and therapeutic implications of the differential \ndiagnosis among fibrotic lung disorders. \n3. To suggest appropriate pharmacologic therapy for patients with individual \nfibrotic lung disorders. \nAuthor Disclosures: \nNazia Chaudhuri: Advisory Board: Boehringer Ingelheim, Roche Ltd, Novartis; \nResearch Grant/Support: BI \n \nMS 2-3 \nRadiological and pathological diagnosis of diffuse fibrotic lung disease \n(part 1) \nMelanie Greaves; Manchester/UK \n(melanie.greaves@mft.nhs.uk) \n \nLearning Objectives: \n1. To learn about the key CT and histologic features of fibrotic lung diseases. \n2. To understand when clinic-radiological data is sufficient to make a correct \ndiagnosis and when additional lung biopsy is required.  \n3. To understand the value of multidisciplinary teams in the diagnosis and \nmanagement of patients with these conditions. \n \nMS 2-4 \nRadiological and pathological diagnosis of diffuse fibrotic lung disease \n(part 2) \nM. Angeles Montero-Fernandez; Manchester/UK \n(amonterofer@hotmail.com) \n \nLearning Objectives: \n1. To learn about the key CT and histologic features of fibrotic lung diseases. \n2. To understand when clinic-radiological data is sufficient to make a correct \ndiagnosis and when additional lung biopsy is required.  \n3. To understand the value of multidisciplinary teams in the diagnosis and \nmanagement of patients with these conditions. \n \nMS 2-5 \nMultidisciplinary case presentation \nNicola Sverzellati; Parma/IT \n \nLive Q&A \n \n11:45-12:45 CHANNEL 5 \nResearch Presentation Session: Neuro \nRPS 111 \nAdvances in neurovascular imaging for \nstroke management \nModerator \nAad van der Lugt; Rotterdam/NL  \n \nRPS 111-2 \nComparison between two commercial MR perfusion software systems for \nmechanical thrombectomy patient selection \n*S. Pistocchi*, D. Strambo, B. Bartolini, R. A. Meuli, P. Michel, V. Dunet; \nLausanne/CH  \n(silvia.pistocchi@chuv.ch) \n \n \nPurpose: Performance of different MR perfusion software in assessing and \nselecting patients with acute stroke and large vessel occlusion (LVO) for \nmechanical thrombectomy is unclear. We compared two commercial MRI \nsoftwares, Carestream in automated (package A) and semi-automated \n(package B) manner and Rapid (package C), for estimating core and \nhypoperfusion volumes, and its influence on patients’ treatment selection and \noutcome. \nMethods or Background: 144 MRI from patients with anterior circulation LVO \nwere retrospectively analyzed. All images were acquired on a Siemens VIDA \n3T system and post-processed with the three packages. Standard thresholds \nwere applied (core=ADC<620x10-6 mm2/sec; hypoperfusion=Tmax>6sec; \nmismatch=hypoperfusion/core). Concordance for core and hypoperfusion \nvolumes was assessed with the Lin’s test. Agreement for mismatch-based \npatients’ classification was assessed with the Gwet’s AC1 and clinical outcome \nwas compared between groups in patients who underwent late thrombectomy. \nResults or Findings: Mean core volume was higher in package C than in \npackages A and B (36.8±52.2 ml versus 22.7±38.7 ml and 19.1±35.3 ml, \nrespectively), while mean hypoperfusion volume was lower in package C than \nin packages A and B (84.5±74.0 ml versus 160.3±118.9 ml and 117.9±78.4 ml, \nrespectively). Mismatch ratio was above 1.8 in 89/142 (62.7%) using package \nC and in 130/142 (91.5%) patients using packages A-B, resulting in a \nmoderate agreement (Gwet’s AC1: 0.55 between C and A-B). Of 42 patients \nwho underwent a late thrombectomy with successful recanalization (TICI 2b/3), \n16 (38%) had a malignant mismatch profile using package C versus 2 (0.5%) \nand 3 (0.7%) using packages A and B. However, those 16 patients had a \nsimilar benefit than patients with a favorable mismatch profile. \nConclusion: MRI softwares for diffusion/perfusion analysis are not \ninterchangeable and may influence patients’ selection and outcome. \nLimitations: Monocentric, retrospective. \nEthics Committee Approval: Approved. \nFunding for this study: Not applicable. \nAuthor Disclosures: \nBruno Bartolini: Nothing to disclose \nVincent Dunet: Nothing to disclose \nReto Antoine Meuli: Nothing to disclose \nPatrik Michel: Nothing to disclose \nSilvia Pistocchi: Nothing to disclose \nDavide Strambo: Nothing to disclose \n \nRPS 111-3 \nCarotid plaque characteristics predict recurrent ischemic stroke - The \nPlaque At RISK study: a prospective multicenter study to identify high-\nrisk carotid plaques \n*D. H. K. Dam-Nolen*¹, M. Kassem², A. G. van der Kolk³, M. I. Liem ຾, D. Bos¹, \nP. J. Nederkoorn຾, J. Hendrikse³, A. Van Der Lugt¹, E. Kooi²; ¹Rotterdam/NL, \n²Maastricht/NL, ³Utrecht/NL, ຾Amsterdam/NL \n(h.nolen@erasmusmc.nl) \n \nPurpose: Stroke patients with symptomatic carotid artery stenosis are at high \nrisk for recurrent stroke. Currently, treatment decisions for carotid \nrevascularization are mainly based on degree of stenosis. However, other \nplaque characteristics might be better indicators of recurrent stroke, allowing \nfor more targeted intervention. The Plaque At RISK (PARISK) study aimed to \ninvestigate which carotid plaque characteristics improve the identification of \npatients with increased risk of recurrent ischemic stroke. \nMethods or Background: We included 240 patients with symptomatic 30-69% \nipsilateral carotid artery stenosis in the PARISK-study, a prospective \nmulticenter cohort study. MRI (carotid and brain) and MDCTA (carotid) were \nperformed at baseline and after 2 years. Participants were followed for 5 years. \nPrimary endpoint was a recurrent ipsilateral ischemic stroke or TIA. Secondary \nendpoint was the composite of recurrent ipsilateral ischemic stroke or TIA, \nand/or new ipsilateral ischemic brain lesions on follow-up MRI. Multivariable \nCox-proportional hazard models were used to assess associations of \nintraplaque hemorrhage (IPH), ulceration, calcification percentage, and total \nplaque volume with the outcomes. Next, we investigated the predictive \nperformance of these plaque characteristics by adding (combinations of) these \nmarkers to the clinically used Carotid Artery Risk (CAR) score. \nResults or Findings: IPH presence and total plaque volume were associated \nwith the primary (HR=3.32, 95%CI:1.11-9.91 respectively HR=1.18, \n95%CI:1.03-1.35) and secondary outcome (HR=3.33, 95%CI:1.44-7.69 \nrespectively HR=1.13, 95%CI:1.01-1.26). Ulcerations and calcification \npercentage were not significantly associated with the outcomes. Addition of \nIPH and total plaque volume to the CAR-score improved the model for the \nprimary and secondary outcome (C-statistic increased from 0.64-0.66 to 0.70-\n0.78). \nConclusion: IPH and total plaque volume are independent risk factors for \nrecurrent ischemic stroke or TIA in symptomatic patients with mild-to-moderate \ncarotid artery stenosis. \nLimitations: n/a \nEthics Committee Approval: Yes \nFunding for this study: Center for Translational Molecular Medicine, Dutch \nHeart Foundation \n\n \n \n \nA \nB C 15  \nWednesday \n/LYH\u00033URJUDPPH\u0003\n \nAuthor Disclosures: \nAad Van Der Lugt: Nothing to disclose \nAnja G. van der Kolk: Nothing to disclose \nMadieke I. Liem: Nothing to disclose \nDianne H. K. van Dam-Nolen: Nothing to disclose \nPaul J. Nederkoorn: Nothing to disclose \nEline Kooi: Nothing to disclose \nDaniel Bos: Nothing to disclose \nJeroen Hendrikse: Nothing to disclose \nMohamed Kassem: Nothing to disclose \n \nRPS 111-6 \nRecanalisation results of endovascular TRAP technique in acute \nischaemic stroke patients \n*M. Voormolen*, M. C. Niekel, T. van der Zijden, O. d'Archambeau, T. Jardinet, \nT. Van Thielen, L. Yperzeele, C. Loos, A. Mondelaers; Antwerp/BE \n(maurits.voormolen@uza.be) \n \nPurpose: Improvement of endovascular recanalization procedure in patients \nwith acute ischaemic stroke might result in better clinical outcome. \nCombination of stent retriever TRombectomy and catheter Aspiration during \nProximal flow rest by balloonguide catheter (TRAP technique) might increase \nrecanalisation rate with more complete recanalization, possibly resulting in \nbetter clinical outcome. Our goal was to assess safety and efficacy of \nendovascular recanalisation by TRAP technique in patients with acute \nintracranial thrombo-embolic occlusions in the anterior circulation. \nMethods or Background: Between January 2018 and July 2020, in our \nhospital 185 TRAP endovascular recanalisation procedures as first pass \nattempt were performed in patients with acute ischaemic stroke of anterior \ncirculation, involving 97 female (52%) and 88 male patients. Mean patient age \nwas 70 years (range 32-92). Mean NIHSS was 17 (range 6-25). Occluded \narteries were distal internal carotid (27%), M1 (54%), M2 (10%) and tandem \nlesions (9%). \nResults or Findings: Recanalisation by TRAP was achieved in 170 \nprocedures (92%). First pass recanalisation rate was 62%. Mean number of \npassages was 1,5 (range 1-4). Complete (TICI 3; 53%) and near complete \n(TICI 2B; 36%) was seen in 89%, fair recanalisation (TICI 2A) in 3% and no \nrecanalisation (TICI 1 & 0) in 8%. Median time from groin puncture to \nrecanalisation was 33 minutes (range 16-120). Six procedure related \ncomplications occurred (3%). Median NIHSS at 24 hours was 4 (range 1-20). \nMedian mRS at 3 months after stroke was 2 (range 0-6). \nConclusion: Endovascular recanalisation with stent retriever TRombectomy \nand Aspiration catheter during Proximal flow rest (TRAP) in patients with acute \nanterior circulation ischaemic stroke is safe and shows high rates of (near-\n)complete recanalization. \nLimitations: Single center not-randomised study; retrospective analysis. \nEthics Committee Approval: No ethics committee approval. \nFunding for this study: No funding for this study. \nAuthor Disclosures: \nMaurits Voormolen: Nothing to disclose \nCaroline Loos: Nothing to disclose \nAnnelies Mondelaers: Nothing to disclose \nMaarten Christian Niekel: Nothing to disclose \nOlivier d'Archambeau: Nothing to disclose \nLAetitia Yperzeele: Nothing to disclose \nThomas Jardinet: Nothing to disclose \nThomas Van Thielen: Nothing to disclose \nThijs van der Zijden: Nothing to disclose \n \nRPS 111-7 \nSemiquantitative assessment of iodine extravasation in acute ischaemic \nstroke after mechanical thrombectomy \n*X. Gao*, Q. Hui, B. Ming, C. C. Ma; Deyang/CN \n(724161276@qq.com) \n \nPurpose: This study aimed to use two easy and practical semiquantitative \nmethods to assess iodine extravasation and its association with haemorrhage. \nMethods or Background: Seventy-two patients with anterior artery \nobstruction were recruited. All patients underwent dual-energy CT scan \nimmediately after mechanical thrombectomy and CT or MRI scan at follow-up. \nWe divided these patients into two groups. Two semiquantitative methods were \nused to evaluate the simulated conventional CT. First, we evaluated the iodine \nextravasation areas by using the modified Alberta Stroke Program Early CT \nScore (mASPECTS). Then, we assessed the degree of iodine extravasation. \nSeveral clinical variables were collected. Student's T-test, Ȥ2/Fisher’s exact \ntest or Kruskal-Wallis analysis was performed. A logistic regression analysis \nand receiver operating characteristics curve analysis were performed. \nResults or Findings: There were 29 stroke patients having early or late \nhaemorrhage and 43 patients without haemorrhage transformation. There were \nsignificant differences between the two groups in mRS scores (P=0.018), \nmASPECTS (P㸺0.001) and the sign of dense iodine extravasation (P 㸺0.001). \nThe multivariate logistic regression analysis showed that dense iodine \nextravasation (P=0.024) was significantly associated with haemorrhage \ntransformation. The AUCs of the mASPECTS, score for dense iodine \nextravasation and their combination were 0.833, 0.839 and 0.850, respectively. \nThe cut-off for mASPECTS was 6 (sensitivity of 75.86% and specificity of \n81.40%). The sign of dense iodine extravasation in stroke patients for \npredicting haemorrhage showed a sensitivity of 72.41% and a specificity of \n88.37%. \nConclusion: For patients after successful mechanical thrombectomy, those \nwith a mASPECTS ”6 and/or positive sign of dense iodine extravasation are \nprone to develop haemorrhage and are associated with poor outcomes. \nLimitations: The sample is small. \nEthics Committee Approval: Registration number: ChiCTR1800015971 \nFunding for this study: Non. \nAuthor Disclosures: \nQingtao Hui: Nothing to disclose \nBin Ming: Nothing to disclose \nChun Chun Ma: Nothing to disclose \nXin Gao: Nothing to disclose \n \nRPS 111-8 \nThe correlation between the value of ultra-high-b-value DWI and \nglymphatic system function after ischaemic stroke \n*L. Lin*, C. F. Sun, X. Hao, C. Li, Y. M. Yang; Shanghai/CN \n(linly_1995@163.com) \n \nPurpose: It is believed that intracisternal dynamic contrast-enhanced MRI is \nan efficient, in-vivo method to evaluate glymphatic system function of whole \nbrain. In addition, ultra-high-b-value DWI (UHBV-DWI) is speculated to display \naquaporins function in some neural diseases, which is an important part in \nglymphatic system. We aim at demonstrating whether UHBV-DWI could \nevaluate glymphatic system function in ischaemic stroke. \nMethods or Background: Five Sprague-Dawley rats subjected to 90-min left \nmiddle cerebral artery occlusion were scanned by UHBV-DWI \n(b=2000,2500,3000,3500,4000,4500 s/mm2) and intracisternal Gd-DTPA \nenhanced MRI two weeks after surgery. ADC value were computed by the \nmono-exponential equation using GE Functool in GE Advanced Workstation. \nFor immunohistological studies, mouse anti-AQP4 (Servicebio, GB12529), \nrabbit anti-GFAP (Abcam, ab33922) primary antibodies and suitable secondary \nantibodies were used. \nResults or Findings: We found that T1 signal intensity of peri-lesion area \n(2510.00±227.26) was significantly higher than that of core-lesion area \n(1333.25±354.99) and that of contralateral-area (1560±137.06) at 24-hour after \nintracisternal Gd-DTPA injection, which meant contrast agent retention in this \nperi-ischaemic area. Secondly, there were obviously disordered, depolarized \nAQP4 and higher ADC value of UHBV-DWI in the same peri-lesion area \ncompared with contralateral side. \nConclusion: It concluded that delayed clearance of waste solution by \nglymphatic system in peri-ischaemic area that may associated with disordered, \ndepolarized AQP4. Moreover, UHBV-DWI as a non-invasive method could \nevaluate glymphatic system function after ischaemic stroke. \nLimitations: Further experiments are needed to study mechanisms of the \nassociation between ADC value of UHBV-DWI and glymphatic system function. \nEthics Committee Approval: Approved by Ethics Committee of Huashan \nHospital, Fudan University. \nFunding for this study: National Natural Science Foundation (No. 81771788). \nAuthor Disclosures: \nChanchan Li: Nothing to disclose \nXiaozhu Hao: Nothing to disclose \nCheng Feng Sun: Nothing to disclose \nLuyi Lin: Nothing to disclose \nYan Mei Yang: Nothing to disclose \n \nLive Q&A \n14:15-15:15 CHANNEL 2 \nSpecial Focus Session \nSF 9 \nMy three top tips for breast imaging \nModerator \nIsabelle Thomassin-Naggara; Paris/FR  \n \nSF 9-2 \nScreening with tomosynthesis \nSophia Zackrisson; Malmö/SE  \n(sophia.zackrisson@med.lu.se) \n\n \n \n \nA \nB C 16  \nWednesday \n/LYH\u00033URJUDPPH\u0003\n \n \nLearning Objectives: \n1. To understand why tomosynthesis is better than mammography for breast \ncancer screening. \n2. To appreciate the current scientific evidence of tomosynthesis in screening. \n3. To acknowledge what further steps are needed before implementation in \nscreening. \nAuthor Disclosures: \nSophia Zackrisson: Patent Holder: US patent no PCT/EP2014/057372; \nSpeaker: Siemens Healthcare AG \n \nSF 9-3 \nAutomated breast ultrasound \nRitse M. Mann; Nijmegen/NL \n(r.mann@rad.umcn.nl) \n \nLearning Objectives: \n1. To recognise artefacts specific to automated breast ultrasound (ABUS). \n2. To appreciate the value of multiplanar reconstruction and the coronal \nspiculation pattern. \n3. To gain insight into possible indications for ABUS. \nAuthor Disclosures: \nRitse M. Mann: Other: please copy from other \n \nSF 9-4 \nComplex cystic and solid lesions \nPanagiotis Kapetas; Vienna/AT \n(panagiotis.kapetas@meduniwien.ac.at) \n \nLearning Objectives: \n1. To understand the difference between complex cystic and solid lesions from \nother cystic lesions of the breast. \n2. To become familiar with complementary sonographic techniques for the \naccurate characterisation of cystic breast lesions. \n3. To be able to properly manage complex cystic and solid lesions of the \nbreast. \n \nSF 9-5 \nImaging the axilla \nIsabelle Thomassin-Naggara; Paris/FR \n(isabelle.thomassin@tnn.aphp.fr) \n \nLearning Objectives: \n1. To understand the clinical role of axillary staging. \n2. To learn the imaging features of abnormal lymph nodes and the criteria for \nbiopsy. \n3. To understand the importance of discriminating minimal vs advanced nodal \ndisease. \nAuthor Disclosures: \nIsabelle Thomassin-Naggara: Speaker: GE, canon, guerbet, hologic \n \nSF 9-6 \nContrast-enhanced spectral mammography \nEva M. Fallenberg; Munich/DE \n \nLearning Objectives: \n1. To understand the technical principles of contrast-enhanced spectral \nmammography. \n2. To understand the added value of information provided by contrast-\nenhanced spectral mammography. \n3. To become familiar with the information provided by contrast-enhanced \nspectral mammography and breast MRI regarding lesion morphology and \nenhancement. \nAuthor Disclosures: \nEva M. Fallenberg: Advisory Board: GE Bayer Siemens Guerbet; Research \nGrant/Support: DFG Guerbet GE ; Speaker: GE Siemens Guerbet Siemens \n \nSF 9-7 \nStereotactic-guided biopsy \nElisabetta Giannotti; Nottingham/UK \n \nLearning Objectives: \n1. To understand the indications for stereotactic-guided breast biopsy. \n2. To learn about the technical aspects of stereotactic biopsy. \n3. To understand the importance of marker clip placement post-biopsy. \n \nSF 9-8 \nUS-guided biopsy \nAlexandra Athanasiou; Athens/GR \n(aathanasiou@mitera.gr) \n \nLearning Objectives: \n1. To understand current indications, contraindications, and possible \ncomplications of US-guided biopsy. \n2. To be familiar with different available biopsy systems and to know which one \nto choose according to the clinical setting. \n3. To learn the most important technical tips for performing a US-guided biopsy \nsuccessfully. \n \nSF 9-9 \nMRI-guided biopsy \nGul Esen; Istanbul/TR \n(gulesenicten@gmail.com) \n \nLearning Objectives: \n1. To understand the importance of pre-biopsy preparation including patient \ninformation. \n2. To be familiar with how to relate lesion and needle positions. \n3. To appreciate tricks for targeting lesions in complicated locations \n(superficial, deep, retroareolar). \n \nSF 9-10 \nTreatment response and therapy monitoring \nChantal Van Ongeval; Leuven/BE \n(chantal.vanongeval@uzleuven.be) \n \nLearning Objectives: \n1. To learn what is important in the reporting of the treatment response. \n2. To understand the accuracy of mammography, ultrasound, and magnetic \nresonance in the monitoring of therapy. \n \nSF 9-11 \nPost-therapy evaluation \nJulia Camps Herrero; Valencia/ES \n(jcamps@riberasalud.es) \n \nLearning Objectives: \n1. To understand and learn the different phases of fat necrosis and its imaging \ncorrelates in all modalities. \n2. To know what to report in patients with breast implants and oncoplastic \nreconstructions. \n3. To learn the different appearances of breast cancer recurrence. \nAuthor Disclosures: \nJulia Camps Herrero: Advisory Board: Bayer, Becton-Dickinson \n \nLive Q&A \n \n14:15-15:15 CHANNEL 3 \nE³ - ECR Master Class \nE³ 326 \nCardiac imaging in arrhythmia and sudden \ncardiac death \nModerator \nPaulo Donato; Coimbra/PT  \n \nE³ 326-2 \nA. The role of cardiovascular magnetic resonance (CMR) in sudden \ncardiac death \nHubert Cochet; Bordeaux/FR  \n \nLearning Objectives: \n1. To become familiar with the pathophysiology of sudden cardiac death. \n2. To introduce CMR biomarkers to prevent sudden cardiac death. \n3. To learn how to perform and how to interpret CMR to prevent sudden \ncardiac death. \n \nE³ 326-3 \nB. Preventing sudden cardiac death with CT: pure theory or new \ndiagnostic paradigm? \nKatarzyna Gruszczynska; Katowice/PL \n \n \n \n \n\n \n \n \nA \nB C 17  \nWednesday \n/LYH\u00033URJUDPPH\u0003\n \nLearning Objectives: \n1. To learn what to look for on CT to prevent sudden cardiac death. \n2. To receive an overview of the existing evidence for performing cardiac CT in \nthis indication. \n3. To discuss the possible role of cardiac CT in preventing sudden cardiac \ndeath. \n \nE³ 326-4 \nC. Imaging to drive electrophysiology procedures \nAntonio Esposito; Milan/IT \n(esposito.antonio@hsr.it) \n \nLearning Objectives: \n1. To learn about the importance of early identification of potentially lethal \narrhythmias. \n2. To become familiar with the tips and tricks for successful CT/CMR in \npatients with arrhythmia. \n3. To understand the role of imagingin the planning of electrophysiological \nprocedures. \nAuthor Disclosures: \nAntonio Esposito: Speaker: Bayer \n \nLive Q&A: Should we screen, who should we screen, and how should we \nscreen in order to prevent sudden cardiac death? \n \n14:15-15:15 CHANNEL 5 \nCoffee & Talk (open forum) Session \nOrganised by EIBIR \nC 13 \nJoint EIBIR-EURAMED session on \nEuropean radiation protection research \nModerator \nChristoph Hoeschen; Magdeburg/DE  \n \nC 13-2 \nTalk from the MEDIRAD project: understanding and evaluating the health \neffects of low-dose ionising radiation exposure from diagnostic and \ntherapeutic imaging \nGuy Frija; Paris/FR  \n \nLearning Objectives: \n1. To learn about the MEDIRAD research project. \n2. To understand the risks of low-dose ionising radiation exposure. \n \nC 13-3 \nTalk from the SINFONIA project: developing comprehensive risk \nappraisal for the detrimental effects of radiation exposure on patients and \nhealthcare professionals (during the management of lymphoma or brain \ntumour patients) \nJohn Damilakis; Iraklion/GR \n \nLearning Objectives: \n1. To learn about the SINFONIA research project. \n2. To learn about risk appraisal for radiation exposure. \n \nC 13-4 \nTalk from the EURAMED rocc-n-roll project: developing a strategic \nresearch agenda for medical applications of ionising radiation and \nrelated radiation protection \nChristoph Hoeschen; Magdeburg/DE \n(christoph.hoeschen@ovgu.de) \n \nLearning Objectives: \n1. To learn about the EURAMED rocc-and-roll project. \n2. To appreciate the European radiation protection research efforts. \n \nLive Q&A \n \n \n \n \n15:30-16:30 CHANNEL 2 \nE³ - ECR Master Class \nE³ 1526 \nCone-beam, 4D, and more: new diagnostic \ntools for vascular diseases \nModerator \nTobias F. Jakobs; Munich/DE  \n \nE³ 1526-2 \nA. The role of intraprocedural perfusion assessment in peripheral arterial \ndisease \nJim A. Reekers; Amsterdam/NL  \n(jimreekers@xs4all.nl) \n \nLearning Objectives: \n1. To understand the technique of intraprocedural perfusion assessment. \n2. To learn how to target peripheral revascularisation therapy based on \nperfusion assessment. \n3. To discuss the value of using intraprocedural perfusion assessment on the \noutcome of endovascular therapy for peripheral artery disease. \nAuthor Disclosures: \nJim A. Reekers: Consultant: Philips medical \n \nE³ 1526-3 \nB. CT 4D imaging after endovascular aortic repair (EVAR) \nRüdiger Schernthaner; Vienna/AT \n(Ruediger.schernthaner@meduniwien.ac.at) \n \nLearning Objectives: \n1. To understand the challenges of imaging follow-up after TEVAR. \n2. To become familiar with the technique of 4D CT. \n3. To learn how to establish treatment recommendations based on 4D CT \nresults after TEVAR. \nAuthor Disclosures: \nRüdiger Schernthaner: Research Grant/Support: Siemens Healthineers \n \nE³ 1526-4 \nC. How cone-beam CT can change your practice in interventional \nradiology \nRaman Uberoi; Oxford/UK \n \nLearning Objectives: \n1. To understand the technique of cone-beam CT.  \n2. To learn about the role and applications of the cone-beam in the angio suite. \n3. To discuss the influence on daily clinical practice in interventional radiology. \n \nLive Q&A \n \n15:30-16:30 CHANNEL 4 \nSpecial Focus Session \nSF 5 \nHow to read a chest radiograph \nModerator \nMariaelena Occhipinti; Florence/IT  \n \nSF 5-2 \nThe lungs \nMiroslav Herman; Olomouc/CZ  \n(miroslav.herman@fnol.cz) \n \nLearning Objectives: \n1. To review the approach to focal and diffuse lung diseases at chest \nradiography. \n2. To appreciate the chest radiograph limitations for focal and diffuse lung \ndiseases. \n3. To demonstrate possible mistakes. \n \n \n \n\n \n \n \nA \nB C 18  \nWednesday \n/LYH\u00033URJUDPPH\u0003\n \nSF 5-3 \nThe hila and pulmonary vasculature \nArjun Nair; London/UK \n \nLearning Objectives: \n1. To appreciate the radiographic features of the structures forming the hila. \n2. To review the differences between pulmonary arteries and veins. \n3. To examine patterns of distribution of pulmonary flow. \nAuthor Disclosures: \nArjun Nair: Advisory Board: Aidence BV; Other: Part funded by BRC UCLH \n \nSF 5-4 \nThe heart and mediastinum \nJosé Vilar; Valencia/ES \n \nLearning Objectives: \n1. To review the normal mediastinal lines. \n2. To learn about the normal and abnormal mediastinal contour. \n3. To focus on the cardio-pericardial silhouette. \n \nSF 5-5 \nThe pleura and chest wall \nEduardo Jose Mortani Barbosa Jr.; Philadelphia, PA/US \n \nLearning Objectives: \n1. To learn about the signs of air and fluid accumulation in the pleural space. \n2. To appreciate how to distinguish pleural from extra-pleural lesions. \n3. To review the most common chest wall lesions. \nAuthor Disclosures: \nEduardo Jose Mortani Barbosa Jr.: Research Grant/Support: Siemens \nHealthineers \n \nLive Q&A: What not to miss in chest radiography? \n \n15:30-16:30 CHANNEL 5 \nResearch Presentation Session: Oncologic \nImaging \nRPS 116 \nNovel imaging biomarkers for assessment, \ntreatment response, and outcome \nprognostication of cancers \nModerator \nLale Umutlu; Essen/DE  \n \nRPS 116-2 \nGadoxetic acid MRI for the assessment of HCC response to Yttrium 90 \nradioembolization: correlation with histopathology \n*N. Vietti Violi*¹, J. Gnerre², S. Hectors², O. Bane², A. Law², I. Fiel², B. Taouli²; \n¹Lausanne/CH, ²New York, NY/US  \n(nviettivioli@gmail.com) \n \nPurpose: To assess the diagnostic performance of gadoxetate-enhanced MRI \nfor predicting complete pathologic necrosis (CPN) of hepatocellular carcinoma \n(HCC) after Yttrium 90 transarterial radioembolization (TARE), using \nhistopathology as the reference. \nMethods or Background: This retrospective study included 48 consecutive \npatients (M/F:36/12, mean age:62y) with HCC treated by TARE followed by \nsurgery (liver resection/transplantation:14/34). All patients underwent \ngadoxetate MRI ”90days of surgery. Two independent radiologists evaluated \nthe following criteria: % of necrosis on subtraction images obtained during late \narterial, portal venous and hepatobiliary phases, mRECIST, LI-RADS and \napparent diffusion coefficient (ADC). Data were correlated to % necrosis on \npathology. Inter-reader agreement for radiologic % necrosis was assessed \nusing interclass correlation coefficient (ICC). ROC and DeLong analyses were \nused to determine and compare prediction of CPN. Correlation between \nradiologic and pathologic % necrosis was assessed using Pearson correlation. \nResults or Findings: Histopathology demonstrated 71 HCCs (mean \nsize:2.8±1.7cm) including 42 with CPN, 22 with partial necrosis and 7 with no \nnecrosis. There was excellent inter-reader agreement for assessing radiologic \ndegree of necrosis (ICC:0.82-0.89). Percentage of tumor necrosis, mRECIST, \nLI-RADS were all significant (p <0.0001) predictors of CPN (AUC:0.80-0.82 for \nradiologic % necrosis and AUC:0.71-0.73 for mRECIST and LI-RADS), with a \nsignificant difference observed between subtraction and LI-RADS (p=0.04) for \nreader 2. ADC was not a significant predictor of CPN (AUC:0.63). Radiologic % \nnecrosis was significantly correlated to histopathologic degree of tumor \nnecrosis (r=0.66-0.8, p<0.0001). \nConclusion: Image subtraction, LI-RADS and mRECIST are all significant \npredictors of CPN in HCC treated with TARE, with superiority of subtraction \nover LI-RADS for one reader. Excellent correlation was found between \nradiologic and pathologic percentages of necrosis. \nLimitations: This study is limited by its relatively small sample size. \nEthics Committee Approval: This study was approved by local ethical \ncommittee. \nFunding for this study: No funding \nAuthor Disclosures: \nAmy Law: Nothing to disclose \nMre Octavia Bane: Nothing to disclose \nIsabel Fiel: Nothing to disclose \nNaik Vietti Violi: Nothing to disclose \nStephanie Hectors: Nothing to disclose \nBachir Taouli: Nothing to disclose \nJeffrey Gnerre: Nothing to disclose \n \nRPS 116-3 \nMetabolic and transcriptomic biomarkers to predict response to \nneoadjuvant chemotherapy and survival in oesophageal adenocarcinoma \n*K. G. Foley*¹, A. Lavery², E. Napier², D. Campbell², M. Eatock², R. Kennedy³, \nK. Bradley຾, R. Turkington²; ¹Llantrisant/UK, ²Belfast/UK, ³Craigavon/UK, \n຾Cardiff/UK \n(foleykg@cardiff.ac.uk) \n \nPurpose: 18F-fluorodeoxyglucose PET-CT may guide treatment decisions in \npatients with oesophageal adenocarcinoma (OAC). This study evaluated the \nadded value of maximum standardised uptake value (SUVmax) to a novel \nDNA-damage immune repair (DDIR) assay to improve pathological response \nprediction. The diagnostic accuracy of PET response and the prognostic \nsignificance of PET metrics for recurrence-free survival (RFS) and overall \nsurvival (OS) were assessed. \nMethods or Background: Retrospective, single-centre study of OAC patients \ntreated with neoadjuvant chemotherapy from 2003-2014. SUVmax was \nrecorded from baseline and repeat PET-CT after completion of pre-operative \nchemotherapy. Logistic regression models tested the additional predictive \nvalue of PET metrics combined with the DDIR assay for pathological response. \nCox regression models tested the prognostic significance of PET metrics for \nRFS and OS. \nResults or Findings: 113 patients were included; 25 (22.1%) were DDIR \npositive and 88 (77.9%) were DDIR negative. 69 (61.1%) were PET \nresponders (SUVmax reduction of 35%) and 44 (38.9%) were \nPET non-responders. After adding PET metrics to DDIR status, post-\nchemotherapy SUVmax (hazard ratio (HR)=0.75, p=0.02), SUVmax change \n(HR=1.04, p=0.003) and an optimum \nSUVmax reduction of 46.5% (HR=4.36, p=0.021) showed additional value for \npredicting pathological response. The optimised SUVmax threshold was \nindependently significant for \nRFS (HR=0.47, 95%CI 0.26-0.85, p=0.012) and OS (HR=0.51, 95%CI 0.26-\n0.99, p=0.047). \nConclusion: This study demonstrated the additional value of PET metrics, \nwhen combined with a novel DDIR assay, to predict pathological response in \nOAC patients treated with neoadjuvant \nchemotherapy. Furthermore, an optimised SUVmax reduction threshold for \npathological response was calculated and was independently significant for \nRFS and OS. \nLimitations: Retrospective, single-centre study \nEthics Committee Approval: Northern Ireland Biobank (NIB12-0032) \nResearch Ethics Committees Northern Ireland (ORECNI: 13/NI/0149). \nFunding for this study: The Gastrointestinal Cancer Research Charitable \nFund, The Cancer Research UK Experimental Cancer Medicine Centre \nInitiative, Invest Northern Ireland, Almac Diagnostics \nAuthor Disclosures: \nDavid Campbell: Nothing to disclose \nMartin Eatock: Nothing to disclose \nEoin Napier: Nothing to disclose \nKevin Bradley: Nothing to disclose \nAnita Lavery: Nothing to disclose \nKieran George Foley: Nothing to disclose \nRichard Kennedy: Patent Holder at Almac Diagnostics, Employee at Almac \nDiagnostics \nRichard Turkington: Research/Grant Support at Almac Diagnostics, Patent \nHolder at Queens University Belfast \n \n \n \n \n \n\n \n \n \nA \nB C 19  \nWednesday \n/LYH\u00033URJUDPPH\u0003\n \nRPS 116-4 \n68Ga-PSMA PET-CT for primary staging of prostate cancer and use of \nSUV Max as metastasis predictor \n*C. Gatica*, G. Chong, D. Barahona, D. Hasson, C. Silva; Santiago/CL \n(esperanza.troncoso@gmail.com) \n \nPurpose: The present study is based on a retrospective analysis of Gallium-\n68-labelled prostate-specific membrane antigen PET-CT (PET PSMA) \nperformed in newly diagnosed, treatment-naïve prostate cancer (PCa) patients \nprior to definitive treatment. \nTo correlate the SUV Max of the primary lesion and the rest of the staging \nparameters. \nMethods or Background: A retrospective study was conducted including \npatients with PCa staged with PSMA PET between 2014 and 2019 at our \ninstitution. The prostate specific antigen (PSA) and Gleason scores (GSC) \nvalues obtained from transrectal biopsies were collected, categorizing the \npatients by risk according to the D´Amico criteria.The SUV Max of the \ndominant prostate lesion for each patient and tumor spread were recorded. \nResults or Findings: 231 patients were included; 19 low risk, 105 \nintermediate and 107 high risk. 56 patients presented regional pelvic lymphatic \ninvolvement, 23 supra-pelvic lymphatic and 23 visceral and bone metastases. \nA significant difference was demonstrated in the medians of SUV Max per risk \ngroup (p <0.001). \nThe ROC curve analysis reveals an area under the curve of 0.79 for the \ndetection of bone metastases, and using a cut-off point of SUV Max of 16, a \nsensitivity of 0.82 and a specificity of 0.70 are obtained. \nConclusion: In patients with initial diagnosis of prostate cancer, 68Ga-PSMA \nPET CT is a relevant staging procedure by identifying nodal and/or distant \nmetastasis. \nThe SUV Max correlates with the probability of finding metastasis, which, \ntogether with PSA, could guide the biological behavior of the primary tumor \nand the need for more strict follow up. \nLimitations: Retrospective study \nEthics Committee Approval: Not required \nFunding for this study: Not required \nAuthor Disclosures: \nDaniela Barahona: Nothing to disclose \nDaniel Hasson: Nothing to disclose \nGuillermo Chong: Nothing to disclose \nConsuelo Gatica: Nothing to disclose \nClaudio Silva: Nothing to disclose \n \nRPS 116-5 \nGadolinium-loaded calcium phosphate nanoparticles for magnetic \nresonance imaging of primary hepatocellular carcinoma \n*N. Zhang*¹, C. Lu¹, Y. Du², J. Ji¹; ¹Lishui/CN, ²Hangzhou/CN \n(znn199109@126.com) \n \nPurpose: HCC is one of the most common diseases threatening human health \nworldwide. Timely diagnosis is extremely important. The aim of this study was \nto develop a novel MRI contrast agent for the targeting delivery of contrast to \nthe tumor position. \nMethods or Background: The MR imaging efficacy of A54-CaPNPs was \nconducted on the primary HCC models. \nResults or Findings: A54-CaPNPs showed a uniform distribution with a mean \ndiameter of about 30 nm (Fig.1). It exhibited higher longitudinal relaxivity (6.07 \nmM−1 s−1) than Gd-DTPA (3.56 mM−1 s−1) (Fig.1). The cellular uptake of the \nnanoparticles was in time-dependent manner. The fluorescence intensity of \nBel-7402 cells incubated with A54-CaP/DOX were stronger than those of \nHepG2 cells incubated A54-CaP/DOX or CaP/DOX (Fig.2). The MR imaging \nefficiency of A54-CaPNPs was studied in primary HCC models. The mice \ntreated with A54-CaPNPs exhibited an obviously bright contrast enhancement \nat the tumor position. The quantitative data suggested that the SNR of the \ntumor region began to increase after the injection of A54-CaPNPs, reaching \nmore than 1.99-fold enhancement at 1 h post injection, which was higher than \nthat of the Gd-DTPA group (Fig. 3B). \nConclusion: The prepared A54-CaPNPs may be a promising candidate as an \nMRI contrast agent for hepatic cancer diagnosis. \nLimitations: This research is only carried out at the cellular and animal level, \nand the actual efficacy is difficult to confirm. \nEthics Committee Approval: All the animal studies were performed in \naccordance with the guide- lines of the Ethical Committee of Zhejiang \nUniversity. The sur- gical procedures and experiment protocols were approved \nby the Committee for Animal Experiments of Zhejiang University. \nFunding for this study: This study was supported by the National Natural \nScience Foundation of China (No. 81901852, 81901848) and Experimental \nAnimal Science and Technology Projects of Zhejiang Province (No. \n2017C37178). \n \n \n \nAuthor Disclosures: \nYongzhong Du: Nothing to disclose \nJiansong Ji: Nothing to disclose \nNannan Zhang: Nothing to disclose \nChenying Lu: Nothing to disclose \n \nRPS 116-6 \nProspective study in patients with high-grade soft tissue sarcomas of \nextremities and trunk wall undergoing neoadjuvant treatment assessed \nwith MRI: correlation between ADC and pathologic response \n*C. Buonomenna*, R. Vigorito, A. Casale, A. Messina, C. Morosi, \nA. V. Marchianò; Milan/IT \n(buonomenna.ciriaco@gmail.com) \n \nPurpose: To correlate preoperative apparent diffusion coefficient (ADC) mean \nvalue with pathologic response, particularly with residual viable tumor, in adult \npatients with high-risk primary, localized soft-tissue sarcomas treated with \nneoadjuvant chemoradiation therapy followed by surgery in a prospective \nrandomized study \nMethods or Background: We evaluated 60 Patients with MRI at baseline \n(ADC0), after one cycle of chemotherapy (ADC1) and  before surgery (ADC3). \nPatients were studied at National Cancer Institute of Milan, with the same MR \nmachine and same protocol. Mean ADC value was obtained by manually \ndrawing a ROI around the margin of the whole lesion, on sections taken every \n5 mm, using Philips Intellispace software. The percentage of residual viable \ntumor was assessed on the surgical specimen by two pathologists. \nResults or Findings: We demonstrated a statistically significant increase of \nADC values between the baseline and after therapy in all group of Patients \n(mean ADC0: 1.58 ± 0.37; ADC1= 1.82 ± 0.41; ADC3= 1.98 ± 0.38). \nThe correlation between pathological variables and ADC3 was analyzed: \nADC3 was closely related to the percentage of residual viable tumor in an \ninversely proportional manner (Spearman’s coefficient: -0.43) and to the \npercentage of sclerohyalinosis, which is an histological pattern of response to \ntherapy, in a directly proportional way (Spearman’s coefficient: +0.55).    \nThe association between radiological response and ADC3 was studied: there \nwas a significant association between ADC3 and Choi criteria (p-value: 0.036) \nConclusion: In our study average ADC value has proven useful for the \nassessment of tumor cellularity in soft-tissue sarcomas, particularly of residual \nviable tumor after therapy.  \nIn clinical practice cellular changes precede morphologic changes so DWI may \nhelp to detect treatment response earlier than conventional imaging \nLimitations: The number of patients was relatively small; heterogeneity of \npatient population. \nEthics Committee Approval: Yes. \nFunding for this study: n/a \nAuthor Disclosures: \nAntonella Messina: Nothing to disclose \nCarlo Morosi: Nothing to disclose \nCiriaco Buonomenna: Nothing to disclose \nRaffaella Vigorito: Nothing to disclose \nAlfonso Vittorio Marchianò: Nothing to disclose \nAlessandra Casale: Nothing to disclose \n \nRPS 116-7 \nDual-layer spectral detector CT in comparison with FDG-PET/CT for the \nassessment of lymphoma activity \n*K. Gehling*, T. Mokry, F. L. Giesel, U. Haberkorn, H-U. Kauczor, T. F. Weber; \nHeidelberg/DE \n \nPurpose: In patients with malignant lymphoma, disease activity is \nrecommended to be assessed by FDG-PET/CT and the Deauville five-point \nscale (5-PS). With contrast-enhanced dual-layer spectral detector CT (SDCT), \niodine concentrations can be quantified to investigate lesion vascularization. \nThe purpose of this study was to explore the potential of iodine concentration \nas an alternative surrogate parameter for lymphoma disease activity by \ninvestigating its correlation with SUVmax and 5-PS. \nMethods or Background: 26 patients with malignant lymphoma were \nretrospectively analyzed. Portal venous phase contrast-enhanced SDCT and \nFDG-PET/CT had been performed within a time period of at most 3 months \nwithout interim treatment. CT attenuation values (AV), absolute iodine \nconcentrations (aIC), and iodine concentrations normalized to inferior vena \ncava (nIC) of lymphoma lesions were correlated with SUVmax using \nSpearman’s rank correlation coefficient. The performance of aIC and nIC to \ndetect lymphoma activity (defined as 5-PS > 3) was determined using receiver \noperating characteristics (ROC) curves. \nResults or Findings: 63 lesions were analyzed in total, and 32 lesions were \nconsidered active according to 5-PS. AV, aIC and nIC all correlated \nsignificantly with SUVmax. The strongest correlation was observed for nIC \n(Spearman ȡ=0.71; p<0.001). The highest area under the ROC curve \n(AUROC) for detecting lymphoma activity was observed for nIC \n(AUROC=0.814), providing sensitivity, specificity, and diagnostic accuracy of \n\n \n \n \nA \nB C 20  \nWednesday \n/LYH\u00033URJUDPPH\u0003\n \n75%, 81%, and 78%, respectively at a threshold of 0.30. ROC analysis for AV \n(AUROC=0.801) and aIC (AUROC=0.792) yielded similar results. \nConclusion: In malignant lymphomas, there is significant correlation between \nmetabolic activity as assessed by FDG-PET/CT and iodine concentration as \nassessed by SDCT. Iodine concentration shows promising diagnostic \nperformance for detecting lymphoma activity and may represent a potential \nimaging biomarker. \nLimitations: Not applicable \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nTheresa Mokry: Nothing to disclose \nHans-Ulrich Kauczor: Nothing to disclose \nFrederik L Giesel: Nothing to disclose \nKim Gehling: Nothing to disclose \nTim Frederik Weber: Nothing to disclose \nUwe Haberkorn: Nothing to disclose \n \nLive Q&A \n \n16:45-17:45 CHANNEL 2 \nJoint Session of the ESR and EORTC \nESR/EORTC \nTrials and tribulations: can imaging \nbiomarkers tell the whole bony story? \nModerator \nFrédéric E. Lecouvet; Brussels/BE  \n \nESR/EORTC-2 \nWB-MRI vs PET for imaging prostate cancer \nChristoph Berliner; Hamburg/DE  \n \nLearning Objectives: \n1. To learn about the techniques of whole-body MRI and PET for assessing \nbone metastases from prostate cancer. \n2. To appreciate the strengths and limitations of the techniques. \n3. To understand when to use these techniques in the clinic. \nAuthor Disclosures: \nChristoph Berliner: Other: ABX-CT-301expert panel (Phase III Study of F-18-\nPSMA-1007 vs F-18-Fluorocholine PET) \n \nESR/EORTC-3 \nThe impact, potentials, and possibilities of PET in breast cancer care \nLioe Fee de Geus-Oei; Leiden/NL \n(l.f.de_geus-oei@lumc.nl) \n \nLearning Objectives: \n1. To learn about the techniques of PET for assessing bone metastases from \nbreast cancer. \n2. To appreciate the strengths and limitations of the techniques. \n3. To understand when to use MRI vs PET techniques in the clinic. \n \nESR/EORTC-4 \nWB MRI in myeloma \nMarius E. Mayerhöfer; Vienna/AT \n(marius.mayerhoefer@meduniwien.ac.at) \n \nLearning Objectives: \n1. To learn about the techniques of whole-body MRI for assessing myeloma. \n2. To appreciate the strengths and limitations of the techniques. \n3. To understand when to use MRI for assessing myeloma in the clinic. \nAuthor Disclosures: \nMarius E. Mayerhöfer: Speaker: Siemens, BMS \n \nLive Q&A: WB-MRI vs PET for imaging bone: is there a right answer? \n \n \n \n \n \n16:45-17:45 CHANNEL 3 \nE³ - ECR Master Class \nE³ 726 \nRenal involvement in coronavirus infection \nModerator \nRaymond H. Oyen; Leuven/BE  \n \nE³ 726-2 \nA. Pathophysiology of the coronavirus on the kidney \nNicolas Grenier; Bordeaux/FR  \n(nicolas.grenier@chu-bordeaux.fr) \n \nLearning Objectives: \n1. To understand the impact of COVID-19 on renal function and the underlying \npathophysiology. \n2. To learn about the association of renal involvement and patient outcome. \n \nE³ 726-3 \nB. Renal imaging during the COVID-19 pandemic \nLorenzo E. Derchi; Genoa/IT \n(lorenzo.derchi1@gmail.com) \n \nLearning Objectives: \n1. To become aware of ways to organise renal imaging during the COVID-19 \npandemic. \n2. To learn the appearance of the kidneys and how best to depict them. \n3. To become familiar with what renal clinicians expect from radiologists during \nCOVID-19 pandemic. \n \nE³ 726-4 \nC. Renal sequelae of COVID-19 infection \nRiccardo Manfredi; Rome/IT \n(riccardo.manfredi@unicatt.it) \n \nLearning Objectives: \n1. To learn the spectrum of post COVID-19 chronic kidney changes. \n2. To learn how to follow up post COVID-19 chronic kidney changes. \n3. To understand the impact of COVID-19 on patients with pre-existing chronic \nrenal disease. \n \nLive Q&A: The impact of COVID-19 on the kidneys \n \n16:45-17:45 CHANNEL 4 \nNew Horizons Session \nNH 2 \nRadiology sequencing: massive radiomics \nanalysis in practice \nModerator \nEmanuele Neri; Pisa/IT  \n \nNH 2-2 \nRadiomics and phenotyping cancer \nNickolas Papanikolaou; Lisbon/PT  \n(nickolas.papanikolaou@research.fchampalimaud.org) \n \nLearning Objectives: \n1. To describe the radiomics principles and the concept of imaging phenotype. \n2. To show the radiomics pipeline. \n3. To explain the concept of deep learning radiomics. \nAuthor Disclosures: \nNickolas Papanikolaou: Advisory Board: Advantis Medical Imaging; Owner: \nMRIcons LTD \n \nNH 2-3 \nRadiomics: from research to clinics in cancer imaging \nStefano Trebeschi; Amsterdam/NL \n(s.trebeschi@nki.nl) \n \n \n\n \n \n \nA \nB C 21  \nWednesday \n/LYH\u00033URJUDPPH\u0003\n \nLearning Objectives: \n1. To show how to set up a radiomics study in oncology. \n2. To discuss the use of imaging data for radiomics validation in view of the \nGDPR. \n3. To discuss the exploitation of research results for the clinical implementation \nof radiomics. \n \nNH 2-4 \nLinking radiomics features to other omics data in clinical practice \nEvis Sala; Cambridge/UK \n \nLearning Objectives: \n1. To learn the concept of radiogenomics (how to link, heat maps, etc.). \n2. To review the potential applications of radiogenomics (radiomics vs \ngenomics, proteomics, metabolomics etc.). \n3. To discuss how to analyse such big data (imaging biobanks, large \nrepositories, etc.). \n \nNH 2-5 \nA research spot in radiomics: the EU EucanImage project \nKarim Lekadir; Barcelona/ES \n(karim.lekadir@ub.edu) \n \nLearning Objectives: \n1. To describe the EucanImage project. \nAuthor Disclosures: \nKarim Lekadir: Investigator: University of Barcelona; Research Grant/Support: \nEuCanImage H2020 \n \nLive Q&A: How to go beyond visual perception? \n \n16:45-17:45 CHANNEL 5 \nResearch Presentation Session: Physics \nin Medical Imaging \nRPS 113 \nThe ultimate goal: improvement of image \nquality \nModerator \nOsvaldo Rampado; Turin/IT  \n \nRPS 113-2 \nBin-combination-based noise reduction for metal artifact reduction in \nphoton-counting CT \n*P. M. Trapp*, A. Byl, L. Klein, S. Heinze, H-P. Schlemmer, S. Sawall, M. \nKachelrieß; Heidelberg/DE (philip.trapp@dkfz.de) \n \nPurpose: To counteract the noise increase observed in photon counting CT \n(PCCT) artifact reduction algorithms that are based on spectral bin \ncombinations. \nMethods or Background: PCCT simultaneously acquires several energy bins. \nCombinations of these bin images can be useful for artifact reduction, e.g. to \nreduce metal or beam-hardening artifacts. However, the image noise increases \nwhen the artifacts are reduced. We propose a cross bilateral filter that is \nguided by a low noise CT image, obtained by a noise minimizing bin \ncombination. The filter is applied to the above-mentioned artifact-reducing but \nnoisy bin combination, which additionally constrains the filter acting as second \nguide image. To validate our method, PCCT acquisitions of a pig cadaver and \npost-mortem specimens containing hip TEPs and dental implants were \nperformed on an experimental PCCT system (SOMATOM CounT, Siemens \nHealthineers) using 140 kV with two energy bins. \nResults or Findings: The processed images simultaneously provide high \ncontrast-to-noise-ratios (CNRs) and reduced metal artifacts. The spatial \nresolution is maintained since the cross bilateral filter does not filter across \nedges. In soft tissue of a head scan with dental implants, image noise was \nreduced by a factor of five by postprocessing with our cross bilateral filter \ncompared with the original artifact-reduced image. A self-guided bilateral filter \nachieved a noise reduction factor of two only. \nConclusion: A cross bilateral filter can effectively reduce image noise in PCCT \nacquisitions. Spectral data showing different traits like improved CNR or \nreduced artifacts are always available in PCCT. However, our method is not \nlimited to PCCT but can be applied whenever spectral data is available. \nLimitations: A spectral CT acquisition is necessary. \nEthics Committee Approval: The post-mortem experiments were approved \nby the local ethics committee (S-021/2020). \nFunding for this study: BMBF (grant number 13N14804, funding program: \nPhotonics Research Germany (KMU Innovative)). \nAuthor Disclosures: \nAchim Byl: Nothing to disclose \nLaura Klein: Nothing to disclose \nPhilip Maurice Trapp: Nothing to disclose \nSarah Heinze: Nothing to disclose \nHeinz-Peter Schlemmer: Nothing to disclose \nMarc Kachelrieß: Nothing to disclose \nStefan Sawall: Nothing to disclose \n \nRPS 113-3 \nModel observer assessment of photon-counting-detector coronary CT \nangiography and comparison with energy-integrating-detector CT \n*D. C. Rotzinger*¹, D. Racine¹, F. Becce¹, E. Lahoud², K. Erhard², S. A. Si-\nMohamed³, J. Greffier຾, R. A. Meuli¹, P. C. Douek³; ¹Lausanne/CH, ²Haifa/IL, \n³Lyon/FR, ຾Nimes/FR \n(david.rotzinger@chuv.ch) \n \nPurpose: To objectively evaluate photon-counting-detector (PCD) coronary CT \nangiography (CCTA) in vitro and investigate its image quality characteristics \ncompared with a clinical energy-integrating-detector (EID) CT system. \nMethods or Background: A dedicated coronary artery module inserted into an \nanthropomorphic thorax phantom was scanned at regular dose (10 mGy) on a \nprototype clinical PCD-CT and a clinically available EID-CT under various \nconditions of simulated patient size (small, medium, large). Images were \nreconstructed using a filtered back-projection algorithm with a soft-tissue \nkernel. We assessed noise and contrast-dependent spatial resolution with \nnoise power spectra (NPS) and target transfer functions (TTF), respectively. \nWe further computed detectability indexes (d’) of simulated non-calcified \natherosclerotic plaques (contrast difference=300 HU) using the non-\nprewhitening with eye filter model observer. \nResults or Findings: For all three patient sizes, PCD-CT provided markedly \nlower noise magnitude (33-37% lower NPS amplitude) and higher frequency \nnoise (sharper noise texture). Furthermore, PCD-CT provided consistently \nhigher spatial resolution than EID-CT (32-36% better TTF), depending on \npatient size. In the resultant d’ analysis, PCD-CCTA outperformed the clinical \nEID-CT system in all investigated experimental conditions, providing superior \ndetectability indexes. Of note, PCD-CT reached almost perfect detectability \n(accuracy§95%) for simulated plaques measuring as low as 0.5-mm-thickness \n(for small-sized patients), whereas EID-CT had slightly less accuracy ( §85%). \nConclusion: PCD coronary CT angiography is feasible not only for small or \nmedium-sized, but even for obese subjects. Furthermore, PCD-CCTA \noutperformed EID-CT in quantitative analysis and might enhance the \ndiagnostic accuracy by providing lower noise magnitude, markedly improved \nspatial resolution, and superior plaque detectability. \nLimitations: Only one radiation dose level and one iodine concentration were \nassessed. In addition, this study encourages further development of PCD-\nCCTA and in vivo validation. \nEthics Committee Approval: Not required. \nFunding for this study: No funding was received. \nAuthor Disclosures: \nSalim Aymeric Si-Mohamed: Nothing to disclose \nDamien Racine: Nothing to disclose \nDavid Christian Rotzinger: Nothing to disclose \nReto Antoine Meuli: Nothing to disclose \nPhilippe Douek: Nothing to disclose \nJoel Greffier: Nothing to disclose \nFabio Becce: Nothing to disclose \nElias Lahoud: Employee at Philips Medical Systems \nKlaus Erhard: Employee at Philips Medical Systems \n \nRPS 113-4 \nVirtual monoenergetic images from dual-energy CT: systematic \nassessment of task-based image quality performance for dual-source \ndual-energy CT \n*A. Euler*, D. Cester, M. Eberhard, T. Frauenfelder, H. Alkadhi; Zurich/CH \n \nPurpose: To systematically compare task-based image quality among virtual \nmonoenergetic images (VMI) and linear-blended images (LBI) from dual-\nsource dual-energy CT (DECT) as a function of contrast task, radiation dose, \npatient size, and lesion diameter. \nMethods or Background: A multisize image quality phantom \n(MercuryPhantom4.0) was repeatedly imaged on a 192-slice dual-source \nDECT at 100/Sn150kV and three radiation doses (5,10,15mGy). The phantom \ncontained a noise and a resolution module with inserts of different materials. \nBone and iodine inserts emulated a high-contrast task with and without iodine. \nA polystyrene insert served as low-contrast task. LBI and VMI at 40-190keV \nwere reconstructed. Noise and resolution properties were evaluated using the \nnoise power spectrum (NPS) and task-transfer function (TTF), respectively. \nTask-based image quality was determined by the detectability index (d’). \n\n \n \n \nA \nB C 22  \nWednesday \n/LYH\u00033URJUDPPH\u0003\n \nResults or Findings: Noise magnitude increased with increasing size and \ndecreasing radiation dose or VMI-level. It was higher for VMI at 40-60keV \ncompared to LBI. Differences in noise texture compared to LBI were found for \nvery low and very high VMI-levels (50 keV, 130-190keV). Resolution depended \non VMI-level for the low-contrast task with a shift to higher TTF frequencies \nwith decreasing VMI-level. No relevant difference in TTF shape was observed \nfor the high contrast tasks. D’ increased with increasing radiation dose or \nlesion diameter and decreasing size. For both high-contrast tasks, d’ was \nhigher for 40-80keV and lower at high keV-levels compared to LBI. For the low-\ncontrast task, d’ was higher at 70-90keV and lower at 40-60keV. \nConclusion: VMI at 70 to 90keV yielded comparable or improved task-based \nimage quality compared to linear-blended images. They could offer a balanced \nalternative independent of the imaging task. \nLimitations: Phantom study. Single dual-energy approach and vendor. \nEthics Committee Approval: Not needed because of the design as phantom \nstudy \nFunding for this study: No funding \nAuthor Disclosures: \nThomas Frauenfelder: Nothing to disclose \nMatthias Eberhard: Nothing to disclose \nDavide Cester: Nothing to disclose \nAndre Euler: Nothing to disclose \nHatem Alkadhi: Nothing to disclose \n \nRPS 113-5 \nIntegrated investigation of radiomic features reproducibility in NSCLC \npatients: the impact of scanner, x-ray tube voltage and strength of \nreconstruction algorithms in contrast-enhanced CT images \n*L. Rinaldi*¹, S. P. De Angelis¹, S. Raimondi¹, D. A. Origgi¹, A. Lascialfari², M. \nMariani², M. Cremonesi¹, M. Bellomi¹, F. Botta¹; ¹Milan/IT, ²Pavia/IT \n(lisa.rinaldi@ieo.it) \n \nPurpose: The influence of acquisition/reconstruction parameters on radiomic \nfeatures was systematically characterised in contrast-enhanced CT images of \n103 non-small-cell lung cancer (NSCLC) patients, focusing on parameter \nvariability observed at our Institute. \nMethods or Background: All patients were imaged at 2.5mm slice thickness, \non an OptimaCT660 (25 at 120kVp, 25 at 100kVp) and on a \nDiscoveryCT750HD scanner (26 at 120kVp, 27 at 100kVp), from GE-\nHealthcare, defining 4 populations. Each acquisition was reconstructed with \nFBP and 5 iterative strengths. For each reconstruction, 1414 features were \nextracted (Pyradiomics) from the contoured lesion considering non-\nfiltered(154), Wavelet-filtered(560) and LoG-filtered(700) images. Clinical \nsimilarity was evaluated with Chi-square and Wilcoxon rank-sum tests. Feature \ndifferences within scanners and voltages were evaluated with Wilcoxon rank-\nsum test. Concordance between different reconstruction settings was \nevaluated for each feature with Overall Concordance Correlation Coefficient \n(OCCC•0.85 defining good reproducibility). Using a multivariate mixed model, \nthe contribution of each acquisition/reconstruction parameter in feature \nvariation was investigated and p-value assessed.Combining univariate and \nmultivariate models, 4 behaviours were identified: OCCC •0.85-p-value<0.05 \n(group1), OCCC•0.85-p-value•0.05 (group2, most robust features), \nOCCC<0.85-p-value<0.05 (group3), OCCC<0.85-p-value •0.05 (group4, least \nrobust). \nResults or Findings: The 4 populations were clinically comparable. Scanner \nand voltage did not affect features significantly. Reconstruction algorithms \naffected significantly (OCCC<0.85) 16/154 (non-filtered images), 116/560 \n(Wavelet-filtered) and 22/700 (LoG-filtered) features. Most were in groups 1 \nand 3, characterised by significant trend with the algorithm strength, systematic \namong patients. Correction coefficients were derived from the multivariate \nmodel to reduce this dependency. \nConclusion: In our database, feature stability was influenced by \nreconstruction algorithms. Feature selection by univariate analysis may \nexclude potentially informative features which can be restored by integration \nwith correction factors from multivariate analysis. \nLimitations: Low patient number, few scanner types/vendors, manual \nsegmentation, feature repeatability not assessed. \nEthics Committee Approval: Approved(UID-2412) \nFunding for this study: Ministero della Salute-Ricerca Finalizzata(GR-2016-\n02362050) \n \n \n \n \n \n \n \n \n \n \n \nAuthor Disclosures: \nFrancesca Botta: Nothing to disclose \nManuel Mariani: Nothing to disclose \nSara Raimondi: Nothing to disclose \nMarta Cremonesi: Nothing to disclose \nSimone Pietro De Angelis: Nothing to disclose \nAlessandro Lascialfari: Nothing to disclose \nMassimo Bellomi: Nothing to disclose \nDaniela Anna Origgi: Nothing to disclose \nLisa Rinaldi: Nothing to disclose \n \nRPS 113-6 \nImage quality characterisation of a biplane angiographic equipment with \nmoving details and generalised spatio-temporal model observers \n*R. Villa*, N. Paruccini, V. Faccenda, P. Caricato, E. De Ponti; Monza/IT \n(raffaele.vill@gmail.com) \n \nPurpose: Characterise image quality performances of a biplane angiographic \nequipment, applying generalised spatio-temporal model observer with details in \nmotion. \nMethods or Background: Different clinical protocols, characterised by \ndifferent fps, dose levels and filtration, have been considered. Contrast media \nflow has been simulated with the moving component of the CIRS Dynamic \nThorax Phantom. Details of different diameters (diameter from 2 to 6 mm) have \nbeen used to simulate typical small vessels sizes and moved, with a speed \nranging from 2.5 to 10 mm/s, in order to simulate blood flow.Images have been \nprocessed with two different Model Observers in order to simulate the \nperceived clinical image quality in terms of contrast detectability: a Non-\nPrewhitening Eye filter (NPWE) with eye Spatio-temporal contrast sensitivity \nfunction and a Channelized Hotelling Observer (CHO) with Spatio-temporal \nGabor filters. Results have been compared with a series of 2AFC experiments \nperformed by trained observers. \nResults or Findings: Comparison with 2AFC experiments underline a good \nagreement (RMSE <20%) for each considered condition with both model \nobservers. \nResults suggest the validity of a dose reduction through an acquisition frame \nrate reduction, especially with fluoroscopy modalities that are characterised by \nhigher frame rate. \nConclusion: The agreement between the results of the implemented models \nand the 2AFC experiments underline the potential of simulating the perceived \nclinical image quality with mathematical observers. \nLimitations: Model Observer approaches required an high number of images, \nespecially with the proposed generalised models. \nEthics Committee Approval: Not required \nFunding for this study: Nothing \nAuthor Disclosures: \nElena De Ponti: Nothing to disclose \nRaffaele Villa: Nothing to disclose \nNicoletta Paruccini: Nothing to disclose \nPaolo Caricato: Nothing to disclose \nValeria Faccenda: Nothing to disclose \n \nRPS 113-7 \nEffect on image quality and dose reduction of a new deep learning \nreconstruction algorithm for CT compared with a hybrid and an advanced \nMBIR algorithms: a phantom study \n*J. Greffier*, D. Dabli, A. Hamard, J. Frandon, J-P. Beregi; Nimes/FR \n(joel.greffier@chu-nimes.fr) \n \nPurpose: To assess the impact on image quality and dose reduction of a new \nDeep Learning Image Reconstruction (DLR) algorithm compared to a hybrid \n(HIR) and an advanced model-based iterative reconstruction (MBIR) algorithm. \nMethods or Background: Data acquisitions were performed at six dose levels \n(CTDIvol: 15/10/7.5/5/2.5/1mGy) using a standard phantom designed for \nimage quality assessment. Raw data were reconstructed using three levels \n(Mild, Standard, Strong) of HIR (AIDR 3D), of MBIR (FIRST) and DLR (AiCE). \nNoise-power-spectrum (NPS) and task-based transfer function (TTF) were \ncomputed. Detectability index (d’) was computed to model the detection of a \nlarge mass in the liver and a small calcification. \nResults or Findings: NPS peaks were lower with DLR than with HIR or MBIR. \nThe average NPS spatial frequency was lower with DLR than HIR but higher \nthan MBIR for Standard and Strong levels. For acrylic insert, values of TTF50% \nwere higher with DLR than HIR and MBIR, except for Mild level. For bone \ninsert, values of TTF50% were higher with DLR than HIR but lower than MBIR. \nFor both simulated lesions, d’ values were higher with DLR than HIR and MBIR \n(except for Strong level). Using the Standard level, dose could be reduced by -\n78% for the small calcification and -59% for the large mass using DLR \ncompared to HIR. \nConclusion: The new DLR algorithm generates an image quality with less \nnoise and/or less smudged/smooth images and a higher detectability than the \n\n \n \n \nA \nB C 23  \nWednesday \n/LYH\u00033URJUDPPH\u0003\n \nHIR or MBIR algorithms, which supports its routine use in a dose optimization \nprocess. \nLimitations: Based on the AiCE limits for abdominal images, only a soft tissue \nkernel and a slice thickness 0.5-mm thick were used. \nEthics Committee Approval: Institutional Review Board approval was not \nrequired for this study because it’s a study phantom \nFunding for this study: No \nAuthor Disclosures: \nJean-Paul Beregi: Nothing to disclose \nAymeric Hamard: Nothing to disclose \nJulien Frandon: Nothing to disclose \nJoel Greffier: Nothing to disclose \nDjamel Dabli: Nothing to disclose \n \nLive Q&A \n \n18:00-19:00 CHANNEL 2 \nRTF - Radiology Trainees Forum \nTF \nHighlighted Lectures \nModerators \nMartin Reim; Tartu/EE  \nSaif Afat; Tübingen/DE  \n \nEU 6-2 \nIntroduction (part 1) \nMartin Reim; Tartu/EE \n(martin.reim@kliinikum.ee) \n \nLearning Objectives: \n1. To focus on the up-to-date radiological principles in the management of \nacute ischaemic stroke; the diagnostic approach and interventional radiology \nstrategies. \n2. To improve the understanding of myotendinous junction anatomy and its \nclinical/radiological importance. \n3. To encourage young radiologists in their on-call duty with tips from \nexperienced emergency specialist. \n \nEU 6-3 \nIntroduction (part 2) \nSaif Afat; Tübingen/DE \n(saif.afat@gmx.de) \n \nLearning Objectives: \n1. To focus on the up-to-date radiological principles in the management of \nacute ischaemic stroke; the diagnostic approach and interventional radiology \nstrategies. \n2. To improve the understanding of myotendinous junction anatomy and its \nclinical/radiological importance. \n3. To encourage young radiologists in their on-call duty with tips from \nexperienced emergency specialist. \n \nTF-5 \nStroke: from diagnosis to treatment \nAlan O'Hare; Dublin/IE \n(alanohare@beaumont.ie) \n \nLearning Objectives: \n1. To learn how to approach stroke from a radiology perspective: the \npossibilities, indications, and limitations. \n2. To appreciate and improve the collaboration to diagnose and treat the stroke \npatients in the most effective way. \n3. To understand the importance of timely diagnostic imaging studies and \naccess to interventional procedures. \n \nTF-6 \nMyotendinous junction anatomy and muscle injury \nAnagha P. Parkar; Bergen/NO \n \nLearning Objectives: \n1. To learn the detailed anatomy of the myotendinous junction and the clinical \nimportance of the injuries in that region. \n2. To appreciate the importance of small details in the anatomy and to improve \nthe knowledge of musculoskeletal radiology. \n3. To understand the possibilities and limitation in diagnosing muscular injuries. \nTF-7 \nMy first night on call: tips to overcome fear \nElizabeth Dick; London/UK \n \nLearning Objectives: \n1. To learn about the possible difficulties that young radiologist will face early in \ntheir career at emergency radiology departments and during the nervous first \non-call shifts. \n2. To appreciate the lessons learned from other professionals and to find out \nabout the tips and tricks to facilitate their on-call work. \n3. To understand how to achieve a more confident approach and avoid the \npossible mistakes that every radiologist might face while being on-call. \nAuthor Disclosures: \nElizabeth Dick: Speaker: Guerbet \n \nLive Q&A: What is the most critical knowledge that young radiologists \nshould take from your talk and this session? \n \n18:00-19:00 CHANNEL 3 \nRefresher Course: Paediatric \nRC 312 \nFluoroscopy: a mainstay state of the art in \npaediatric radiology \nModerator \nJohanna Aronniemi; Helsinki/FI  \n \nRC 312-2 \nA. Use of fluoroscopy in neonates with suspected gastrointestinal \npathology \nIngegerd Aagenaes; Oslo/NO  \n(iaagenes@ous-hf.no) \n \nLearning Objectives: \n1. To learn about the most common indications for fluoroscopy in non-\nurogenital queries in neonates. \n2. To become familiar with the technique, findings, and pitfalls for the most \ncommon fluoroscopy non-urogenital queries in the neonate. \n3. To discuss the best fluoroscopic approach in suspected bowel obstruction in \na neonate. \n \nRC 312-3 \nB. Gastrointestinal and other applications in the older child \nStéphanie Franchi-Abella; Le Kremlin-Bicêtre/FR \n(stephanie.franchi@aphp.fr) \n \nLearning Objectives: \n1. To learn about the most common indications for fluoroscopy in non-\nurogenital queries in infants and older children. \n2. To become familiar with the most common fluoroscopy queries in this patient \ngroup.  \n3. To discuss the most common findings and pitfalls. \n \nRC 312-4 \nC. Urogenital applications \nGiulia Perucca; Turin/IT \n(giuliaperucca@yahoo.it) \n \nLearning Objectives: \n1. To learn about the indications for fluoroscopy in urogenital queries in \nchildren. \n2. To become familiar with the technique in fluoroscopic urogenital queries. \n3. To discuss the most common findings and pitfalls. \n \nRC 312-5 \nD. When can ultrasound replace fluoroscopy? \nSimon G.F. Robben; Maastricht/NL \n(s.robben@mumc.nl) \n \nLearning Objectives: \n1. To learn about the indications for dynamic ultrasound studies. \n2. To become familiar with the technique of dynamic ultrasound. \n3. To discuss the most common pitfalls. \n \nLive Q&A: When can ultrasound imaging replace fluoroscopy? \n\n \n \n \nA \nB C 24  \nWednesday \n/LYH\u00033URJUDPPH\u0003\n \n \n18:00-19:00 CHANNEL 5 \nTransatlantic Course of ESR and RSNA \n(Radiological Society of North America): \nStroke Imaging and Endovascular \nTreatment: Now and the Future \nTC 128 \nCurrent status of stroke workup and \ntreatment \nModerators \nRaman Uberoi; Oxford/UK  \nAchala Vagal; Cincinnati, OH/US  \n \nTC 128-3 \nA. Current status of endovascular management of acute ischaemic \nstroke: evidence and guidelines \nRaman Uberoi; Oxford/UK \n(Raman.Uberoi@ouh.nhs.uk) \n \nLearning Objectives: \n1. To learn about current evidence of endovascular treatment in acute \nischaemic stroke. \n2. To become familiar with evidence-based guidelines (AHA/ASA and \nESO/ESMINT) in stroke treatment. \n \nTC 128-4 \nB. CT-based evaluation of acute stroke: advantages and challenges \nAchala Vagal; Cincinnati, OH/US \n(vagala@ucmail.uc.edu) \n \nLearning Objectives: \n1. To learn about the advantages and challenges of CT-based stroke imaging \nworkup. \n2. To become familiar with the pitfalls of CT perfusion imaging. \nAuthor Disclosures: \nAchala Vagal: Research Grant/Support: NIH, Cerenovus (Research grant, \nENDOLOW trial) \n \nTC 128-5 \nC. MRI-based evaluation of acute stroke: advantages and challenges \nMax Wintermark; San Francisco, CA/US \n \nLearning Objectives: \n1. To learn about the advantages of MRI-based stroke imaging workup. \n2. To become familiar with the challenges of MRI-based stroke imaging \nworkup. \n \nLive Q&A: Strategy for acute stroke imaging and intervention \n \n \n \n\n \n \n \nA \nB C 25  \n/LYH\u00033URJUDPPH\u0003\n \n \n \n \n  \n7KXUVGD\\\u000f\u00030DUFK\u0003\u0017\u0003\n \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 26  \n \n08:00-09:00 CHANNEL 2 \nState of the Art Symposium \nSA 1 \nMy future and me: personalised cardiac \nrisk stratification \nModerator \nGorka Bastarrika; Pamplona/ES  \n \nSA 1-2 \nScreening asymptomatic individuals: state of the evidence and future \ndirections \nRozemarijn Vliegenthart; Groningen/NL  \n(r.vliegenthart@umcg.nl) \n \nLearning Objectives: \n1. To become familiar with the evidence for CT calcium scoring in \nasymptomatic individuals. \n2. To learn about the current role of CT calcium scoring in primary prevention \nguidelines. \n3. To appreciate the issues of the wide-spread use of CT calcium scoring and \nfuture directions. \nAuthor Disclosures: \nRozemarijn Vliegenthart: Grant Recipient: Dutch Heart Foundation; Dutch \nResearch Council; Research Grant/Support: Institutional Research Grant, \nSiemens Healthineers; Other: Associate Editor, Eur J Radiology \n \nSA 1-3 \nStable chest pain and current guidelines \nGiuseppe Muscogiuri; Milan/IT \n(g.muscogiuri@gmail.com) \n \nLearning Objectives: \n1. To become familiar with the clinical indication of CCTA in patients with chest \npain.   \n2. To understand the clinical management of patients following CCTA results \nbased on the current guidelines. \n3. To understand the economic impact of CCTA in clinical practice following \nthe guidelines. \n4. To appreciate the impact of CCTA in terms of prognosis. \n \nSA 1-4 \nRisk stratification in the emergency department \nFabian Bamberg; Freiburg/DE \n(fabian.bamberg@uniklinik-freiburg.de) \n \nLearning Objectives: \n1. To learn about the role of cardiac CT in the emergency setting. \n2. To become familiar with the different findings in cardiac CT in the \nemergency setting. \n3. To understand the value of triple-rule-out CT scanning for risk stratification. \n4. To learn about embedding in a non-imaging cardiac risk stratification in the \nemergency setting. \nAuthor Disclosures: \nFabian Bamberg: Research Grant/Support: Siemens Healthineers, Bayer \nHealthcare; Speaker: Siemens Healthineers, Bayer Healthcare, Bracco \nDiagnostics \n \nSA 1-5 \nEmerging artificial intelligence biomarkers: above the current state of the \nart? \nCarlo N. De Cecco; Atlanta, GA/US \n(carlodececco@gmail.com) \n \nLearning Objectives: \n1. To learn about current and future applications of machine learning/artificial \nintelligence in cardiac imaging. \n2. To understand what is meant by the terms machine learning, deep learning, \nand radiomics in cardiac imaging. \n3. To appreciate some of the limitations of artificial intelligence biomarkers in \ncardiac imaging. \nAuthor Disclosures: \nCarlo N. De Cecco: Research Grant/Support: Siemens \n \nLive Q&A: How to match the best patient for the best test? \n \n08:00-09:00 CHANNEL 3 \nCoffee & Talk (open forum) Session \nC 4 \nRadiology in the cloud: advantages and \nthreats \nModerator \nLuis Martí-Bonmatí; Valencia/ES  \n \nC 4-2 \nTrustworthy radiology in the cloud \nIgnacio Blanquer; Valencia/ES  \n(iblanque@dsic.upv.es) \n \nLearning Objectives: \n1. To learn about the concept of trustworthiness in cloud services. \n2. To understand the different dimensions of trustworthiness. \n3. To understand the complexity of cloud services when dealing with the \nprocessing of sensitive data. \n \nC 4-3 \nData protection, cybersecurity, and GDPR in cloud radiology practice \nArnon Makori; Tel Aviv/IL \n \nLearning Objectives: \n1. To learn about the key requirements for data protection, cybersecurity, and \nGDPR relating to cloud-based radiology services. \n2. To understand the challenges of cybersecurity in cloud-based radiology \nservices. \n3. To understand how to evaluate data protection and GDPR compliance of \ncloud-based radiology services. \nAuthor Disclosures: \nArnon Makori: Advisory Board: Carestream \n \nC 4-4 \nPseudonymisation and full anonymisation \nKarine Seymour; Labège/FR \n(kseymour@medexprim.com) \n \nLearning Objectives: \n1. To understand the differences between full anonymisation and \npseudonymisation and the implications with respect to GDPR. \n2. To identify the roles and obligations of data controllers and data processors \nin the deidentification process. \n3. To become familiar with the confidentiality profiles defined by the DICOM \nstandard and existing solutions. \nAuthor Disclosures: \nKarine Seymour: Founder: Medexprim \n \nLive Q&A \n \n08:00-09:00 CHANNEL 5 \nProfessional Challenges Session \nPC 4 \nSafety challenges in everyday clinical \npractice \nModerators \nAndrew England; Salford/UK  \nBerit Verbist; Leiden/NL  \n \nPC 4-3 \nBenefit/risk communication to adult and paediatric patients: top tips \nJonathan Portelli; Msida/MT \n(jonathan.portelli@um.edu.mt) \n \n \n \n \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 27  \nLearning Objectives: \n1. To become familiar with benefit and risk communication for adult and \npaediatric patients. \n2. To appreciate opportunities to promote the effective communication of \nbenefit/risk. \n \nPC 4-4 \nMRI safety: recent incidents and continued opportunities to improve \nAnne Dorte Blankholm; Aarhus/DK \n(anneblan@rm.dk) \n \nLearning Objectives: \n1. To learn about recent incidents regarding MRI safety. \n2. To become familiar with opportunities for improving MRI safety within clinical \npractice. \nAuthor Disclosures: \nAnne Dorte Blankholm: Board Member: SMRT President Elect \n \nPC 4-5 \nEmbedding quality improvement in your everyday clinical practice \nMarie-Louise Ryan; Dublin/IE (marielouise.butler@gmail.com) \n \nLearning Objectives: \n1. To learn about quality improvement tools and strategies. \n2. To understand how to embed quality improvements within everyday clinical \npractice. \n \nPC 4-6 \nGDPR: confidentiality and patient safety considerations for radiographers \n*Andreas Strassl*, Christian Schneckenleitner; Vienna/AT \n(andreas.strassl@meduniwien.ac.at) \n \nLearning Objectives: \n1. To appreciate the legislative issues surrounding confidentiality and patient \nsafety. \n2. To understand patient safety issues pertinent to radiographers. \n \nLive Q&A: How to build a better safety culture among clinical \nradiographers? \n \n09:15-10:15 CHANNEL 2 \nE³ - Rising Stars Programme: Basic \nSessions \nOrganised by the ESOR \nBS 13 \nRadiologic anatomy: chest \nModerator \nFabian Rengier; Heidelberg/DE  \n \nBS 13-2 \nMediastinal \nMariaelena Occhipinti; Florence/IT \n \nLearning Objectives: \n1. To review the mediastinal anatomy according to old and new classifications. \n2. To define \"normal\" and \"abnormal\" mediastinal anatomy. \n3. To use radiologic anatomy to characterise mediastinal lesions and to stage \ntumours. \n \nBS 13-3 \nLungs \nCornelia M. Schaefer-Prokop; Amersfoort/NL \n(cornelia.schaeferprokop@gmail.com) \n \nLearning Objectives: \n1. To learn how to interpret mediastinal lines and contours in chest \nradiography. \n2. To become familiar with the \"signs\" in chest radiography helpful for \ndiagnosis. \n3. To learn about the normal appearance of lung parenchyma on CT and to \nuse the anatomy of the secondary lobule for analysis of chest diseases. \n \n \nBS 13-4 \nVasculature \nIva Zuza; Rijeka/HR \n \nLearning Objectives: \n1. To identify thoracic vascular structures on chest x-rays. \n2. To interpret chest vasculature, including aorta and coronary arteries, major \naortic branches, and pulmonary arteries and veins, by using multidetector CT \n(MDCT). \n3. To review and illustrate the most common variants and anomalies. \n4. To discuss the challenges and limitations in interpretation based on \nparticular CT scanning protocols. \n \nLive Q&A \n \n09:15-10:15 CHANNEL 4 \nRefresher Course: Musculoskeletal \nRC 110 \nUltrasound in musculoskeletal radiology \nModerator \nAndrew J. Grainger; Cambridge/UK  \n \nRC 110-2 \nA. Musculoskeletal ultrasound in the emergency department \nLuca M. Sconfienza; Milan/IT  \n(io@lucasconfienza.it) \n \nLearning Objectives: \n1. To explain the indications of musculoskeletal ultrasound in the emergency \ndepartment. \n2. To describe differential diagnostic considerations of musculoskeletal \nultrasound in the emergency department. \nAuthor Disclosures: \nLuca M. Sconfienza: Advisory Board: Pfizer; Speaker: Samsung Medison, \nEsaote SPA, Novartis, Abiogen, Janssen-Cilag \n \nRC 110-3 \nB. The role of ultrasound in the diagnosis of soft tissue tumours \nMaria Pilar Aparisi Gomez; Valencia/ES \n(pilucaparisi@yahoo.es) \n \nLearning Objectives: \n1. To explain the ultrasound findings of soft tissue tumours. \n2. To describe differentils in the diagnosis of soft tissue tumours by ultrasound. \n \nRC 110-4 \nC. Ultrasound elastography in musculoskeletal radiology \nAli Balci; øzmir/TR \n(alibalciradyolog@yahoo.com) \n \nLearning Objectives: \n1. To explain the techniques used in ultrasound elastography of the \nmusculoskeletal system. \n2. To describe ultrasound elastography findings in musculoskeletal radiology. \n \nLive Q&A: New clinical roles for musculoskeletal ultrasound \n \n09:15-10:15 CHANNEL 5 \nResearch Presentation Session: \nAbdominal Viscera \nRPS 101a \nAdvances in liver imaging \nModerator \nGiuseppe Brancatelli; Palermo/IT  \n \nRPS 101a-2 \nLI-RADS ancillary features favouring benignity: is there a role in LR-5 \nobservations? \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 28  \nD. S. Gagliano, *R. Cannella*, F. Vernuccio, M. Antonucci, G. Brancatelli; \nPalermo/IT  \n \nPurpose: The LI-RADS algorithm allows category downgrade in presence of \nancillary features (AFs) favoring benignity, even in observations that are \ndefinitively HCC (LR-5) according to major features. This study aims to assess \nthe role of AFs favoring benignity in LR-5 observations and their impact for \npossible category downgrade. \nMethods or Background: This retrospective study included 119 consecutive \ncirrhotic patients with at least one LR-5 observations imaged with gadoxetate \ndisodium-enhanced MRI between 2016 and 2020. Two blinded radiologists \nindependently evaluated the presence of AFs favoring malignancy, not HCC in \nparticular, favoring HCC in particular, and AFs favoring benignity. Category \ndowngrade was considered possible in presence of • 1 AF favoring benignity \nand no AFs favoring malignancy. Correlation between lesions size and number \nof AFs was assessed using the Spearman’s rank correlation coefficient. The \nCohen’s kappa (k) test was used to assess inter-reader agreement. \nResults or Findings: Final cohort included 162 LR-5 with a mean size of \n22.9±15.8 mm. Hepatobiliary phase hypointensity was the most common AF \namong LR-5 observations (R1: 87.7%; R2: 91.4%). AFs favoring benignity \nwere reported in 9 (5.5%) and 15 (9.2%) observations by R1 and R2, \nrespectively. Category downgrade was considered possible in only one (0.6%) \nobservation by each reader. There was a statistically significant correlation \nbetween observations size and number of AFs favoring malignancy (p<0.001), \nnot HCC in particular (p”0.001), and favoring HCC in particular (p<0.001). The \ninter-reader agreement ranged from poor to substantial (k=-0.03-0.74). \nConclusion: AFs favoring benignity can be encountered in LR-5 observations \nbut they have a marginal impact for possible category downgrade. \nLimitations: Retrospective study design, lack histopathological proof for all \nlesions. \nEthics Committee Approval: IRB-approved, informed consent was waived. \nFunding for this study: No funding was received for this study. \nAuthor Disclosures: \nFederica Vernuccio: Nothing to disclose \nMichela Antonucci: Nothing to disclose \nRoberto Cannella: Nothing to disclose \nDomenico Salvatore Gagliano: Nothing to disclose \nGiuseppe Brancatelli: Nothing to disclose \n \nRPS 101a-3 \nNon-contrast MRI for hepatocellular carcinoma detection: a systematic \nreview and meta-analysis: a potential surveillance tool? \nM. V. Chan, *R. Huo*, N. Trieu, A. Mitchelle, J. George, E. He, A. Lee, J. \nChang, J. Yang; Sydney/AU \n \nPurpose: This meta-analysis investigates the diagnostic performance of non-\ncontrast magnetic resonance imaging (MRI) for the detection of hepatocellular \ncarcinoma (HCC). \nMethods or Background: A systematic review was performed to May 2020 for \nstudies which examined the diagnostic performance of non-contrast MRI (multi-\nsequence or diffusion-weighted imaging (DWI)- alone) for HCC detection in \nhigh risk patients. The primary outcome was accuracy for the detection of \nHCC. Random effects models were used to pool outcomes for sensitivity, \nspecificity, positive likelihood ratio (LR) and negative LR. Subgroup analyses \nfor cirrhosis and size of the lesion were performed. \nResults or Findings: Twenty-two studies were included involving 1685 \npatients for per-patient analysis and 2128 lesions for per-lesion analysis. Multi-\nsequence non-contrast MRI (NC-MRI) using T2+DWI T1 sequences had a \npooled per-patient sensitivity of 86.8% (95%CI:83.9-89.4%), specificity of \n90.3% (95%CI:87.3-92.7%), and negative LR of 0.17 (95%CI:0.14-0.20). DWI-\nonly MRI (DW-MRI) had a pooled sensitivity of 79.2% (95%CI:71.8-85.4%), \nspecificity of 96.5% (95%CI:94.3-98.1%) and negative LR of 0.24 (95%CI:1.62-\n0.34). In patients with cirrhosis, NC-MRI had a pooled per-patient sensitivity of \n87.3% (95%CI:82.7-91.0%) and specificity of 81.6% (95%CI:75.3-86.8%), \nwhilst DWI-MRI had a pooled sensitivity of 71.4% (95%CI:60.5-80.8%) and \nspecificity of 97.1% (95%CI:91.9-99.4%). For lesions <2cm, the pooled per-\nlesion sensitivity was 77.1% (95%CI:73.8-80.2%). For lesions >2cm, pooled \nper-lesion sensitivity was 88.5% (95%CI:85.0-91.5%). \nConclusion: Non-contrast MRI has a moderate negative LR and high \nspecificity with acceptable sensitivity for the detection of HCC, even in patients \nwith cirrhosis and with lesions <2cm. Prospective trials to validate if non-\ncontrast MRI can be used for HCC surveillance is warranted. \nLimitations: There is a lack of prospective studies. Futhermore there is a lack \nof studies that subanalyse cirrhosis and steatosis which impact ultrasound but \nnor MRI. \nEthics Committee Approval: None required \nFunding for this study: None \nAuthor Disclosures: \nRuth Huo: Nothing to disclose \nMichael Vinchill Chan: Nothing to disclose \nEmily He: Nothing to disclose \nJessica Yang: Nothing to disclose \nAlice Lee: Nothing to disclose \nJeff Chang: Nothing to disclose \nAmer Mitchelle: Nothing to disclose \nNelson Trieu: Nothing to disclose \nJacob George: Nothing to disclose \n \nRPS 101a-4 \nMultivariate analysis of radiological predictors of Beta-catenin mutation \nstatus in hepatocellular carcinoma (HCC) according to the Liver Imaging \nReporting and Data System (LI-RADS) \n*J. Yousef*¹, R. Catania², B. Sholosh¹, S. Thangasamy¹, S. S. Monga¹, S. Wu¹, \nK. P. Chupetlovska¹, A. Furlan¹, G. Nebbia¹; ¹Pittsburgh, PA/US, ²Chicago, \nIL/US \n(yousefjm@upmc.edu) \n \nPurpose: In HCC, beta-catenin mutation is associated with a relatively \nfavorable prognosis and may be a promising target for future therapies. We \naimed to investigate the association between CT and MR imaging features and \nthe beta-catenin mutation status of HCC. \nMethods or Background: This retrospective HIPAA-compliant study included \n157 subjects with pathologically proven HCC and a contrast-enhanced CT \n(n=82) or MRI (n=75) performed within 1-year of pathology. The beta-catenin \nmutation status of each HCC was: “mutated”, n=22 (14%), “possibly mutated”, \nn=25 (16%); “wild”, n=110 (70%). Twenty-two imaging features were recorded \nby 2 experienced readers according to LI-RADS v2018; consensus was \nreached with a third experienced reader. Logistic regression analysis was used \nto compute the AUC for task 1 (“mutated” vs. “wild”) and task 2 (“mutated” or \n“possibly mutated” vs. “wild”). The AUC represents the percentage of case-\ncontrol pairs where the case has a higher logistic regression score than the \ncontrol (here case refers to “mutated”). The Odds Ratios (ORs) associated with \neach imaging feature were then calculated. \nResults or Findings: For task 1, the AUC value was 79.81% and the \npredictive features were tumor size (OR = 2.04, p <0.05) and corona \nenhancement (OR= 6.27, p < 0.1). For task 2, the AUC value was 71.69% and \nthe predictive features were tumor size (OR= 1.71, p <0.05), corona \nenhancement (OR= 4.11, p < 0.1), and presence of nodule-in-nodule (OR= \n9.16, p <0.1). Notably, the LI-RADS category was not predictive of the beta-\ncatenin mutation status. \nConclusion: Tumor size, corona enhancement, and nodule-in-nodule show \nsignificant association with beta-catenin mutation status of HCC. \nLimitations: Single-institutional data; relatively small cohort; qualitative \nimaging assessment \nEthics Committee Approval: IRB approved \nFunding for this study: None \nAuthor Disclosures: \nGiacomo Nebbia: Nothing to disclose \nRoberta Catania: Nothing to disclose \nSenthur Thangasamy: Nothing to disclose \nAlessandro Furlan: Nothing to disclose \nBiatta Sholosh: Nothing to disclose \nSatdarshan Singh Monga: Nothing to disclose \nJacob Yousef: Nothing to disclose \nShandong Wu: Nothing to disclose \nKalina Plamenova Chupetlovska: Nothing to disclose \n \nRPS 101a-5 \nOutcome of LR-3 and LR-4 observations without arterial phase \nhyperenhancement at Gd-EOB-DTPA-enhanced MRI follow-up \n*I. Viola*, F. Agnello, L. Rabiolo, F. Midiri, G. Micci, M. Galia; Palermo/IT \n(ilaria.viola4@gmail.com) \n \nPurpose: The aim is to retrospectively evaluate the outcome of LR-3 and LR-4 \nobservations without arterial phase hyperenhancement (APHE) and identify \nwhich features could predict LR-5 progression at Gd-EOB-DTPA enhanced \nMRI follow-up. \nMethods or Background: 49 cirrhotic patients with 55 LR-3 and 19 LR-4 \nwithout APHE were enrolled. LR-3 and LR-4 were classified as decreased, \nstable or increased in category at follow-up. Images were independently \nanalyzed by two abdominal radiologists. Presence or absence of major and \nancillary LI-RADS features, LIRADS category, and observation size were \nevaluated. Chi-square and Fischer’s exact test were used to assess if baseline \nLIRADS features and baseline diameter (< 10; • 10 mm) were associated with \nLR-5 progression of LR-3 and LR-4. P < .05 was considered statistically \nsignificant \nResults or Findings: Of 55 LR-3, 17 (31%) progressed to LR-5 at follow-up, 3 \n(6%) progressed to LR-4, 6 (11%) remained stable in category, and 29 (52%) \ndecreased in category. Of 19 LR-4, 8 (42%) progressed to LR-5 at follow-up, 4 \n(21%) remained stable in category and 7 (37%) decreased to LR-3. Major and \nancillary features were not significantly different among LR-3 and LR-4 that \nprogressed to LR-5 and those that remained stable or decreased in category at \nfollow-up. A diameter • 10 mm significantly increased LR-5 progression risk of \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 29  \nLR-3 (OR = 6.07; 95% CI: 0.12; 60.28]; P < .001), while LR-4 with a diameter • \n10 mm more likely become LR-5 at follow-up (OR = 8.95; 95% CI: 0.73; 111.8; \nP = .083]). \nConclusion: LR-3 and LR-4 observations without APHE were often \ndowngraded or remained stable in category on Gd-EOB-DTPA-enhanced MRI \nfollow-up. LR-3 and LR-4 observations with diameter  • 10 mm had an \nincreased risk of LR-5 progression. \nLimitations: No \nEthics Committee Approval: No \nFunding for this study: Not applicable \nAuthor Disclosures: \nIlaria Viola: Nothing to disclose \nGiuseppe Micci: Nothing to disclose \nMassimo Galia: Nothing to disclose \nFederico Midiri: Nothing to disclose \nFrancesco Agnello: Nothing to disclose \nLidia Rabiolo: Nothing to disclose \n \nRPS 101a-6 \nT1 reduction rate with Gd-EOB-DTPA for liver function mapping in MRI: \ncomparison between 1.5T and 3T in a cross-sectional comparative study \n*V. C. Obmann*, D. Catucci, A. Berzigotti, C. Gräni, L. Ebner, J. T. \nHeverhagen, A. Christe, A. T. Huber; Bern/CH \n(verena.obmann@insel.ch) \n \nPurpose: To compare MRI T1 reduction rates between 1.5T and 3T for liver \nfunction mapping in a large cross-sectional comparative study. \nMethods or Background: 287 consecutive patients with liver MRI and T1 \nmapping before and 20 minutes after intravenous (i.v.) GD-EOB-DTPA \nadministration were included (132 on 1.5T, 132 on 3T) between 09/2018–\n07/2019. Patients were grouped into no chronic liver disease, chronic liver \ndisease (CLD) and cirrhosis Child-Pugh A-C. T1 reduction rate was calculated \nas (native T1 – post contrast T1) / native T1 and compared between 1.5T and \n3T in every patient group using a Mann-Whitney U test with Bonferroni \ncorrection. The predictive value of T1 reduction rate and cutoff values to \npredict CLD and cirrhosis Child A-C were determined with a receiver operating \ncharacteristic (ROC) analysis. A p-value <0.05 was defined as statistically \nsignificant. \nResults or Findings: T1 reduction rates showed no significant difference \nbetween 1.5T and 3T in all patient groups: for no CLD the reduction rate was \n0.75 vs. 0.77 (p=0.623), for CLD 0.69 vs. 0.70 (p>0.999), for Child A 0.65 vs. \n0.65 (p>0.999), for Child B 0.61 vs. 0.56 (p=0.311) and for Child C 0.47 vs. \n0.49 (p>0.999). T1 reduction rate showed a good predictive value for CLD \n(AUC=0.83), cirrhosis Child A (AUC=0.81), Child B (AUC=0.84) and Child C \n(AUC=0.91), all with a p-value <0.05. \nConclusion: MRI T1 reduction rate allows an assessment of the liver function \nwith comparable values between 1.5T and 3T. \nLimitations: We acknowledge limitations to our study, mainly the retrospective \ncross-sectional design with a relatively small sample size of Child C patients \npresented, while all other groups were much bigger. \nEthics Committee Approval: Yes. \nFunding for this study: This project was funded by the Swiss National \nScience Foundation (SNF) grant # 320030_188591. \nAuthor Disclosures: \nJohannes T. Heverhagen: Nothing to disclose \nDamiano Catucci: Nothing to disclose \nVerena Obmann: Nothing to disclose \nChristoph Gräni: Nothing to disclose \nLukas Ebner: Nothing to disclose \nAndreas Christe: Nothing to disclose \nAdrian Thomas Huber: Grant Recipient at Swiss National Science Foundation \nAnnalisa Berzigotti: Nothing to disclose \n \nRPS 101a-7 \nDeep learning analysis of liver metastases changes in CECT \nA. Szeskin, A. Dodi, S. Rochman, R. Lederman, H. Fruchtman-Brot, Y. Azraq, \nL. Joskowicz, *J. Sosna*; Jerusalem/IL \n(jacobs@hadassah.org.il) \n \nPurpose: To compare reading of contrast enhanced CT (CECT) by \nradiologists to computer-aided reading using a novel method that \nsimultaneously analyzes the changes of liver metastasis between the current \nand the prior scans by deep learning classification. \n \n \n \n \n \n \n \n \nMethods or Background: We developed a novel deep learning changes \nanalysis method inputs the current and prior CECT scans and automatically \ndetects, segments and classifies the liver metastases. It uses a unique 3D U-\nNet classifier that simultaneously compares the scans and finds their \ndifferences. The network was trained on 68 pairs of scans with a total of 2,042 \nliver metastases.  We assessed 20 pairs (current and prior) of CECT scans of \npatients with metastatic liver disease (colon, breast, pancreas) acquired in the \nvenous phase. The total number of lesions was 461 (mean=11.5, std=7.8). \nTwo independent expert radiologists performed 40 readings (20 each) to \nassess disease status using RECIST 1.1 with two weeks between the \nconventional and the computer aided evaluations. Our reference standard was \ndefined by a third expert observer augmented with the computer-aided \ntechnique and blinded to the results of the other readers. \nResults or Findings: Conventional reading and computer aided reading by \nradiologists were in consensus regarding disease status in 32 readings (14 \nprogression, 8 stable, 10 partial response). In the other 8 readings, the \ncomputer aided reading by the radiologists made them change the disease \nstatus as defined in the reference standard to progression (6 readings) and \npartial response (2 readings). This was in agreement with the third reader \nevaluation. Automatic lesion detection and segmentations were rated as good \nor acceptable in 80% of the studies. \nConclusion: Automatic liver metastases change analysis by simultaneous \ncomparison deep learning can improve disease classification. \nLimitations: Studies from two institutions only \nEthics Committee Approval: Yes \nFunding for this study: None \nAuthor Disclosures: \nRichard Lederman: Nothing to disclose \nLeo Joskowicz: Nothing to disclose \nHila Fruchtman-Brot: Nothing to disclose \nAdi Szeskin: Nothing to disclose \nShalom Rochman: Nothing to disclose \nJacob Sosna: Nothing to disclose \nAviv Dodi: Nothing to disclose \nYusef Azraq: Nothing to disclose \n \nLive Q&A \n \n10:30-11:30 CHANNEL 2 \nRefresher Course: Genitourinary \nRC 307 \nThe role of MRI for each therapeutic option \nin prostate cancer follow-up \nModerator \nJonathan Richenberg; Brighton/UK  \n \nRC 307-2 \nA. After radiation therapy and surgery \nValeria Panebianco; Rome/IT  \n(valeria.panebianco@uniroma1.it) \n \nLearning Objectives: \n1. To understand the capabilities of MRI to identify prostate cancer recurrence \nafter radiotherapy and radical prostatectomy. \n2. To became familiar with the potential reporting/standardisation of prostate \ncancer recurrence after radiotherapy and radical prostatectomy. \n3. To learn the clinical impact of MRI and the optimal integration with the \ndifferent modalities. \n \nRC 307-3 \nB. After focal therapy \nJurgen J. Fütterer; Nijmegen/NL \n(jurgen.futterer@radboudumc.nl) \n \nLearning Objectives: \n1. To understand the capabilities of MRI to identify prostate cancer recurrence \nafter focal therapies. \n2. To became familiar with the potential reporting/standardisation of prostate \ncancer recurrence. \n3. To learn the clinical impact of MRI and the optimal integration with the \ndifferent modalities. \n \n \n \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 30  \nRC 307-4 \nC. During active surveillance \nFrancesco Giganti; London/UK \n \nLearning Objectives: \n1. To understand the role of mpMRI for low and intermediate risk prostate \ncancer during active surveillance (AS). \n2. To become familiar with the dedicated scoring (PRECISE) used to assess \nradiological change on serial mpMRI during AS. \n3. To be aware of the current limitations of PRECISE and how to tackle the \nchallenges ahead. \n \nLive Q&A: How to manage and standardise the prostate cancer follow-up \nwith MRI \n \n10:30-11:30 CHANNEL 3 \nSpecial Focus Session \nSF 20 \nClinical impact of artificial intelligence (AI): \nstatus report \nModerator \nElmar Kotter; Freiburg/DE  \n \nSF 20-2 \nAI in chest x-ray prioritisation: has it been useful? \nCarlos F. Muñoz-Nuñez; Valencia/ES  \n(carlos.munoznunez@gmail.com) \n \nLearning Objectives: \n1. To understand why prioritisation is useful in clinical practice. \n2. To learn how AI can support prioritisation of chest x-rays. \n3. To understand the limitations of AI-based prioritisation. \n \nSF 20-3 \nBenefits of AI challenges to clinical practice: algorithms that won and \nmade it to the clinic \nBram Van Ginneken; Nijmegen/NL \n(bram.vanginneken@radboudumc.nl) \n \nLearning Objectives: \n1. To learn about AI challenges and their organisation. \n2. To understand what happens with the data collected and algorithms created \nduring AI challenges. \n3. To learn about examples of AI algorithms that made it from challenges to the \nclinic. \nAuthor Disclosures: \nBram Van Ginneken: Research Grant/Support: Siemens Healthineers, Elekta, \nSectra, Novartis, Thirona, MeVis Medical Solutions, Delft Imaging; Share \nHolder: Thirona \n \nSF 20-4 \nResearch action in AI: a national pilot study in France, DRIM AI \nMarc Zins; Paris/FR \n(mzins@hpsj.fr) \n \nLearning Objectives: \n1. To understand the organisation of DRIM. \n2. To learn about the use cases addressed by DRIM. \n3. To understand what lessons can be derived from DRIM. \n \nLive Q&A: AI in practice and research: what are the next steps? \n \n \n \n \n \n \n \n10:30-11:30 CHANNEL 4 \nESR meets the Arabian Peninsula \nMeets 3 \nArabian Peninsula radiology: challenges \nand advances in regulations, education, \nand practice \nModerators \nMichael H. Fuchsjäger; Graz/AT  \nLamia Jamjoom; Jeddah/SA  \nSaqer AlTai; Muscat/OM \nUsama M.H. AlBastaki; Dubai/AE \n \nMeets 3-5 \nSaudi healthcare: new frontiers \nSattam Saud Lingawi; Jeddah/SA \n(dr_lingawi@yahoo.ca) \n \nLearning Objectives: \n1. To learn about the overall health affairs' changes planned in Saudi Arabia for \nvision 2030 and their impact on healthcare policymakers, providers, investors, \nand the general population.  \n2. To understand the health policies and practices' reforms in Saudi Arabia in \n2020 and Saudi Arabia's new era of international openness in collaboration \nwith international counterparts.    \n3. To appreciate the corrective measures in medicine in Saudi Arabia and the \nempowerment of youth, women, and qualified personnel in leadership, \nemphasising health awareness and education, active lifestyle, and preventive \nmeasures. \n4. To become familiar with Saudi Arabia's private sector enablement, \ninternational investors facilitation, and public-private-partnership (PPP) \nprogrammes, transferring medical operations from government-based to \nprivate-based, starting with radiological services, teleradiology, and artificial \nintelligence. \nAuthor Disclosures: \nSattam Saud Lingawi: Author: Health Strategic Transformation Center, Ministry \nof Health \n \nMeets 3-6 \nInterlude 1: Saudi Arabia to infinity and beyond \n \nMeets 3-7 \nRadiology education in Oman \nJokha Al Kalbani; Muscat/OM \n(jalkalbani@yahoo.com) \n \nLearning Objectives: \n1. To provide an introduction about the evolution of the radiology education in \nOman, lead both by the society and the members who are also trainers in the \nOmani post-graduate education board. \n2. To discuss the role of the Omani Radiology society in setting regulations and \nimaging guidelines as well as spreading the awareness on radiation protection \nand safe practice in collaborations with international bodies. \n3. To describe the international collaborations and emphasis on the role of the \nsociety in education and up-to-date conferences. \n4. To touch on the challenges and opportunities that the society is facing both \nlocally and internationally. \n5. To provide a short description of the society's plans and the timeline for \nachieving them. \n \nMeets 3-8 \nInterlude 2: Oman the past the current and the vision \n \nMeets 3-9 \nChallenges facing radiology in the United Arab Emirates and how to \ntackle them \nTaleb Almansoori; Al Ain/AE \n(taleb.almansoor@uaeu.ac.ae) \n \nLearning Objectives: \n1. To introduce the evolution of the radiology sector in the United Arab \nEmirates. \n2. To discuss the implementation of radiology science in undergraduate and \npost-graduate medical education. \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 31  \n3. To review the current residency programmes and the challenges being \nfaced to attract medical students into the field. \n4. To become familiar with the educational activities being organised for \nradiologists in the United Arab Emirates. \n \nMeets 3-10 \nInterlude 3: Cultural immersions and adventures in UAE \n \nLive Q&A \n \n10:30-11:30 CHANNEL 5 \nResearch Presentation Session: Hybrid, \nMolecular and Translational Imaging \nRPS 106 \nAdvances in hybrid and dual-modality \nimaging \nModerator \nSergios Gatidis; Tübingen/DE  \n \nRPS 106-2 \nProspective comparison between 18F-FDG PET/MRI, MRI, CT and bone \nscintigraphy for the detection of bone metastases in the initial staging of \nprimary breast cancer patients \n*N-M. Bruckmann*; Düsseldorf/DE  \n \nPurpose: To compare the diagnostic performance of 18F-FDG PET/MRI, MRI, \nCT and bone scintigraphy for the detection of bone metastases in the initial \nstaging of primary breast cancer patients. \nMethods or Background: A cohort of 154 therapy-naive patients with newly \ndiagnosed, histopathologically proven, breast cancer was enrolled in this study \nprospectively. All patients underwent a whole-body 18F-FDG PET/MRI, \ncomputed tomography (CT) scan, and a bone scintigraphy prior to therapy. All \ndatasets were evaluated regarding the presence of bone metastases. \nMcNemar chi² test was performed to compare sensitivity and specificity \nbetween the modalities. \nResults or Findings: Forty-one bone metastases were present in 7/154 \npatients (4.5%). Both 18F-FDG PET/MRI and MRI alone were able to detect all \nof the patients with histopathologically proven bone metastases (sensitivity \n100%; specificity 100%) and did not miss any of the 41 malignant lesions \n(sensitivity 100%). CT detected 5/7 patients (sensitivity 71.4%; specificity \n98.6%) and 23/41 lesions (sensitivity 56.1%). Bone scintigraphy detected only \n2/7 patients (sensitivity 28.6%) and 15/41 lesions (sensitivity 36.6%). \nFurthermore, CT and scintigraphy led to false-positive findings of bone \nmetastases in 2 patients and in 1 patient, respectively. The sensitivity of \nPET/MRI and MRI alone was significantly better compared with CT (p < \n0.00001, difference 43.9%) and bone scintigraphy (p < 0.00001, difference \n63.4%). \nConclusion: 18F-FDG PET/MRI and MRI are significantly better than CT or \nbone scintigraphy for the detection of bone metastases in patients with newly \ndiagnosed breast cancer. Both CT and bone scintigraphy show a substantially \nlimited sensitivity in detection of bone metastases. \nLimitations: The number of patients with bone metastases was small.The \nReference standard was also based on follow-up examinations using CT and \nMRI. \nEthics Committee Approval: This study was approved by the local ethics \ncommittee. \nFunding for this study: Funded by Deutsche Forschungsgemeinschaft \n(DFG). \nAuthor Disclosures: \nNils-Martin Bruckmann: Nothing to disclose \n \nRPS 106-3 \nUltrafast, low dose FDG oncologic whole-body PET/CT: phase 2 study \nfindings \n*M. I. Knopp*¹, C. L. Wright², Y-l. Hsieh², E. Ives², K. Binzel², E. Folefac², E. D. \nMiller², P. Kneuertz², M. V. Knopp²; ¹Cincinnati, OH/US, ²Columbus, OH/US \n(knopp.29@osu.edu) \n \nPurpose: To assess the clinical feasibility of ultrafast (2 min), low dose (185 \nMBq) FDG oncologic whole body imaging using digital PET/CT and adaptive \nregularized reconstruction in a Phase II prospective study. To perform a 2nd \nPhase II study at low FDG dose. \nMethods or Background: 105 patients with an oncologic disease were \nprospectively enrolled prior to therapeutic interventions and FDG digital PET \nimaging performed 60 - 75 min p.i. using both a conventional 90s per bed \nposition and investigational 9s per be position acquisition. The BMI was 29.5 \n+/- 6.8,  FDG dose 5.0 +/- 0.5 and glucose level 100.4 +/- 23.9. An organ, BMI \nadaptive regularized reconstruction was used for the ultrafast acquisition while \nthe 90s was performed using current system default settings. A blinded two \nreader, adjudicator visual and a quantitative assessment was performed. \nResults or Findings: Due to count sparsity, regularized adaptive \nreconstruction was essential and enabled all cases with a BMI <35 (82/82) to \nbe assessed as diagnostic. In the 23 cases with BMI >=35, 6 were classified as \nnon-diagnostic , 11 as limited and 8 as diagnostic. \nConclusion: Ultrafast wholebody PET/CT was shown to be feasible even at \nlow FDG dose with consistent diagnostic quality for patients with BMI <35. \nFurther optimization of the organ adaptive regularized reconstruction may \nresolve the challenges at very high BMI or a compensatory increase in \nacquisition time should enable a consistent diagnostic quality which then needs \nto be validated in a Phase III trial. \nLimitations: The selection of the adaptive PET reconstruction parameter were \nmanually set and not yet automatically assigned based on an algorithm or DLM \nwhich will be then used in the Phase III \nEthics Committee Approval: Approved IRB 2013H0393, NCT02283125 \nFunding for this study: ODSA TECH 13-060, WCIBMI Development Fund, \nNCI R01CA195513 \nAuthor Disclosures: \nChadwick Lewis Wright: Nothing to disclose \nEric D Miller: Nothing to disclose \nKatherine Binzel: Nothing to disclose \nMichelle I Knopp: Nothing to disclose \nEdmund Folefac: Nothing to disclose \nMichael Vinzenz Knopp: Nothing to disclose \nYu-lung Hsieh: Nothing to disclose \nEmma Ives: Nothing to disclose \nPeter Kneuertz: Nothing to disclose \n \nRPS 106-4 \nImaging locoregional lymph nodes in newly diagnosed breast cancer \npatients: comparison of PET/MRI, MRI and sonography \n*J. Morawitz*¹, N-M. Bruckmann¹, F. Dietzel¹, A-K. Bittner², S. Mohrmann¹, L. \nM. Sawicki¹, K. Herrmann², G. Antoch¹, J. Kirchner¹; ¹Düsseldorf/DE, \n²Essen/DE \n \nPurpose: To compare breast-MRI, whole-body MRI, whole-body 18F-FDG \nPET/MRI and axillary sonography for the detection of axillary lymph node \nmetastases in women with newly diagnosed breast cancer. \nMethods or Background: This prospective double-center study included 112 \npatients (mean age 53.04±12.6 years) with newly diagnosed breast cancer. \nPatients underwent dedicated breast-MRI in prone body position, whole-body \n(18F-FDG PET/)MRI in supine body position and axillary sonography. Datasets \nwere evaluated separately regarding nodal status (nodal+ vs. nodal-). \nHistopathology served as reference standard in all patients. The diagnostic \nperformance of breast-MRI, whole-body MRI, whole-body PET/MRI and axillary \nsonography in detecting nodal positive patients was tested by creating \nreceiver-operating-characteristic curves with a calculated area under the curve. \nSensitivity, specificity, positive predictive value, negative predictive value and \naccuracy were calculated for all four modalities. A McNemar test was used to \nassess differences. \nResults or Findings: Of all tested imaging modalities, whole-body PET/MRI \nshowed the highest ROC-AUC with a value of 0.892. The AUC for breast-MRI, \nwhole-body MRI and sonography were 0.782, 0.814 and 0.834, respectively. \nDifferences between the modalities were statistically significant, e.g. whole-\nbody PET/MRI vs. axillary sonography (p=0.013). PET/MRI showed highest \nsensitivity (81.8%, 95%-CI: 67.29-91.81%) while axillary sonography showed \nhighest specificity (96.7%, 95%-CI: 80.39-99.51%). Nevertheless, all modalities \nmissed some histopathologically proven axillary lymph node metastases. \nConclusion: 18F-FDG PET/MRI outperforms axillary sonography, breast-MRI \nand whole-body MRI in detecting axillary lymph node metastases. However, \ndiagnostic competence does not suffice to replace histopathological sampling \nof axillary lymph node in primary breast cancer staging. \nLimitations: Regarding reference standard, some samples were taken after \nneoadjuvant systemic therapy and therefore had to be evaluated \nretrospectively. \nEthics Committee Approval: All procedures performed were in accordance \nwith the ethical standards of the institutional research committee. \nFunding for this study: The study is funded by the Deutsche \nForschungsgemeinschaft (DFG). \nAuthor Disclosures: \nKen Herrmann: Nothing to disclose \nFrederic Dietzel: Nothing to disclose \nLino M Sawicki: Nothing to disclose \nJulian Kirchner: Nothing to disclose \nSvjetlana Mohrmann: Nothing to disclose \nGerald Antoch: Nothing to disclose \nAnn-Kathrin Bittner: Nothing to disclose \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 32  \nJanna Morawitz: Nothing to disclose \nNils-Martin Bruckmann: Nothing to disclose \n \nRPS 106-5 \nImpact of PET/CT on the management of patients with oesophagal \ncancer: results from a PET/CT registry study \n*C. P. Reinert*, J. Sekler, C. Gani, K. Nikolaou, C. la Fougère, C. Pfannenberg, \nS. Gatidis; Tübingen/DE \n(christian.reinert@med.uni-tuebingen.de) \n \nPurpose: To investigate the impact of PET/CT on clinical management in \npatients with oesophageal cancer and its link to overall survival (OS) in a real-\nworld setting. \nMethods or Background: A patient cohort with advanced oesophageal cancer \nundergoing PET/CT was prospectively enrolled in a registry study between \n04/2013 and 06/2019. Intended patient management prior and after PET/CT \nwas documented based on standardized questionnaire data. Management \nchanges after PET/CT were recorded including major changes concerning the \ntreatment goal (curative vs. palliative) and minor changes (therapy \nadjustments). OS was analyzed for subgroups with squamous cell carcinomas \n(SCC) or adenocarcinomas (AC) and stratified for extent of metastatic disease \nand treatment goals. \nResults or Findings: 257 patients (53 female;65.5±10.0yr.) were included. \nAfter PET/CT, major changes of intended therapy were observed in 34/257 \npatients (13.2%), from curative to palliative (8.2%), palliative to curative (1.9%) \nand from “not finally determined” to a curative (1.9%) or palliative (1.2%) \nconcept. Minor changes were found in 62/257 patients (24.1%). Invasive \nprocedures and additional imaging were intended in 70/257 (27.2%) and \n94/257 (36.6%) patients before PET/CT and 20/257 (7.8%) and 8/257 (3.1%) \npatients after PET/CT. Curative therapy concepts based on PET/CT were \nassociated with a longer OS (3.5yr.[95%CI 3.1-3.8yr.]) as compared to \npalliative concepts (0.9yr.[95%CI 0.6-1.2yr.];p<0.0001). Patients with SCC had \na worse prognosis (2.4yr.[95%CI 2.0-2.9yr.]) as compared to patients with AC \n(3.2yr.[95%CI 2.7-3.7yr.];p=0.01). \nConclusion: In patients with advanced oesophageal cancer, PET/CT has a \nsignificant impact on clinical management by improving the selection of \nindividualized treatment strategies and avoiding additional diagnostic \nprocedures. \nLimitations: Outcome data were not available for all patients. \nEthics Committee Approval: Reviewed and approved (Project number: \n064/2013B01) \nFunding for this study: Deutsche Forschungsgemeinschaft (DFG, German \nResearch Foundation) under Germany's Excellence Strategy - EXC 2180-\n390900677 \nJunior Clinician Scientist Program of the Medical Faculty of Tübingen \nAuthor Disclosures: \nKonstantin Nikolaou: Nothing to disclose \nCihan Gani: Nothing to disclose \nSergios Gatidis: Nothing to disclose \nJulia Sekler: Nothing to disclose \nChristian la Fougère: Nothing to disclose \nChristian Philipp Reinert: Nothing to disclose \nChristina Pfannenberg: Nothing to disclose \n \nRPS 106-6 \nBimodal instrument markers for magnetic particle and magnetic \nresonance imaging \n*F. Wegner*¹, S. Cremers², K. Lüdtke-Buzug¹, M. A. Koch¹, T. Friedrich¹, P. \nBorm², T. M. Buzug¹, J. Barkhausen¹, M. Ahlborg¹; ¹Lübeck/DE, \n²Düsseldorf/DE \n(franz.wegner@uksh.de) \n \nPurpose: To develop instrument markers that are visible in both, Magnetic \nParticle Imaging (MPI) and Magnetic Resonance Imaging (MRI). \nMethods or Background: The instrument markers are based on two different \niron oxide particle types: Resovist and Bayoxide E 8706. Varnishes containing \nonly Resovist or both Resovist and Bayoxide E 8706 were made and applied to \nsegments of standard nonmagnetic guide wires and catheters. Imaging \nexperiments were performed using a preclinical, commercial MPI scanner as \nwell as a 1 Tesla MRI system. In MPI, the guide wires were placed on a home-\nbuilt nonmagnetic phantom holder. For the MRI measurements, the guide \nwires were placed in a silicone vessel phantom which was filled with diluted \ngadolinium-based contrast agent (Gadovist, 1:200). \nResults or Findings: The bimodal markers were clearly visible in MPI and \nMRI. They caused circular signal voids in MRI and areas of high signal \nintensity in MPI. Both the signal voids as well as the areas of high signal \nintensity overrate the size of the markers. Markers containing Resovist alone \ncaused only small signal voids in MRI, not sufficient for a reliable visualization. \nConclusion: The developed instrument markers based on two different \nparticle types were reliably visible in MPI and MRI. This is a prerequisite for \nmonitoring vascular interventions with MPI/MRI hybrid systems. \nLimitations: We only investigated the markers under static conditions and did \nnot prove the biocompatibility. \nEthics Committee Approval: Not applicable. \nFunding for this study: This study was funded by the German Federal \nMinistry of Education and Research (BMBF) grant number 01DL17010A. \nAuthor Disclosures: \nFranz Wegner: Nothing to disclose \nSjef Cremers: Employee at Nano4Imaging \nKerstin Lüdtke-Buzug: Nothing to disclose \nThorsten M Buzug: Nothing to disclose \nPaul Borm: Founder at Nano4Imaging \nMartin A Koch: Nothing to disclose \nJörg Barkhausen: Nothing to disclose \nMandy Ahlborg: Nothing to disclose \nThomas Friedrich: Nothing to disclose \n \nRPS 106-7 \nFeasibility and performance of free-hand single-photon computed \ntomography/ultrasonography for preoperative parathyroid adenoma \nlocalization: a pilot study \n*M. Champendal*, M. Jreige, M. Nicod-Lalonde, J. A. Jorge, M. Matter, G. \nSykiotis, J. O. Prior; Lausanne/CH \n(Melanie.Champendal@hesav.ch) \n \nPurpose: To evaluate the feasibility of a new hybrid imaging modality, the free-\nhand single-photon computed tomography/ultrasonography (fhSPECT/US) for \npreoperative localization of parathyroid adenomas and to compare its \nperformance with standard imaging modalities: ultrasonography and \nSPECT/CT. \nMethods or Background: In this prospective pilot study, patients underwent \nsequentially ultrasound, parathyroid scintigraphy including SPECT/CT, and \nlastly fhSPECT/US allowing real-time fusion between US and gamma-camera \nimages manipulated free-handedly by the operator. Detection rates from each \nimaging modality were calculated and compared using McNemar’s test; the \ngold standard was the histopathology result, when available, otherwise it was \nthe imaging modality showing the highest detection rate. Challenges related to \nimage acquisition and technique were also analyzed using descriptive \nmethods. \nResults or Findings: Twelve patients were included. Sensitivity of \nfhSPECT/US was 58%(95%CI: 32–81%) and 44%(23–67%) on a per-patient \nand per-lesion basis, respectively. Sensitivity results for fhSPECT/US were \nlower compared to US 75%(47–91%) and 63%(39–82%) and SPECT/CT \n100%(75–100%) and 100%(81–100%), on per-patient and per-lesion basis, \nrespectively. fhSPECT/US was unable to detect 9 lesions in 5 patients due to \ndeep localization of lesions (>4.5 cm), lack of adequate image fusion due to \ntissue compression during US, limited spatial manipulation of the probe, and \nspread of detected activity. \nConclusion: The use of fhSPECT/US for the localization of parathyroid \nadenomas is clinically feasible, but requires technical improvements to \nincrease sensitivity, which is otherwise lower than US and SPECT/CT. \nTechnical limitations were identified and mainly related to the depth of \nadenoma localization and spatial manipulation of the SPECT mobile camera. \nLimitations: The sample size, the patient population (only sick patients) and \nthe absence of histology confirmation for all patients. Moreover, the \nfhSPECT/US imaging was not blinded to previous modalities results. \nEthics Committee Approval: This study has been approved by the local \nethics committee. \nFunding for this study: None \nAuthor Disclosures: \nJose A. Jorge: Nothing to disclose \nMaurice Matter: Nothing to disclose \nMario Jreige: Nothing to disclose \nJohn O Prior: Nothing to disclose \nGerasimos Sykiotis: Nothing to disclose \nMme Marie Nicod-Lalonde: Nothing to disclose \nMélanie Champendal: Nothing to disclose \n \nLive Q&A \n \n \n \n \n \n \n \n \n \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 33  \n11:45-12:45 CHANNEL 2 \nLancet Oncology Commission Session \nLancet Oncology \nEnsuring sustainable healthcare systems: \nThe Lancet Oncology Commission on \nMedical Imaging and Nuclear Medicine \nModerator \nDavid Collingridge; London/UK  \n \nLancet Oncology-3 \nGoals and scope of The Lancet Oncology Commission on Medical \nImaging and Nuclear Medicine \nMay Abdel Wahab; Vienna/AT  \n \nLearning Objectives: \n1. To provide information on the scope and aims of the project. \n2. To provide information on the data collection methodology. \n3. To provide an overview of the related efforts of the IAEA. \n \nLancet Oncology-4 \nGlobal utilisation of imaging and nuclear medicine in oncology \nAndrew Scott; Melbourne, VIC/AU \n \nLearning Objectives: \n1. To provide information on the results of the equipment and workforce global \nsurvey. \n2. To provide information on gaps identified in low- and middle-income \ncountries. \n3. To outline technology advances that can improve the delivery of imaging to \ncancer patients. \n \nLancet Oncology-5 \nHealth economic analysis of cancer imaging \nRifat Atun; Boston, MA/US \n \nLearning Objectives: \n1. To outline the methodology and results of health economics analysis for \nimaging in cancer at a global and country level. \n2. To outline the investment in imaging required for improved health outcomes. \n3. To present an investment case for cancer imaging. \n \nLancet Oncology-6 \nOverview and recommendations \nHedvig Hricak; New York, NY/US \n \nLearning Objectives: \n1. To provide a summary of results. \n2. To provide recommendations for policy and investment with respect to the \nimaging of cancer patients at country and global levels. \n3. To highlight how the commission's findings may aid in the implementation of \nthe 2017 Cancer Resolution \"Cancer prevention and control in the context of \nan integrated approach\". \nAuthor Disclosures: \nHedvig Hricak: Advisory Board: Johns Hopkins, University of Vienna, DKFZ; \nBoard Member: IBA \n \nLive Q&A \n \n11:45-12:45 CHANNEL 3 \nEuroSafe Imaging Session \nJointly organised by EuroSafe Imaging and the ECR \nPaediatric Subcommittee  \nEU 2 \nAvoiding or reducing ionising radiation in \nchildren: the ALARA principle \nModerator \nErich Sorantin; Graz/AT  \n \nEU 2-2 \nAn update on dose reduction techniques in paediatric CT and \nradiography \nErich Sorantin; Graz/AT  \n(erich.sorantin@medunigraz.at) \n \nLearning Objectives: \n1. To learn about the different technical possibilities. \n2. To understand how to improve the benefit/risk-ratio of children in \nradiography and CT. \n3. To become familiar with the relevant resources for radiation protection. \n \nEU 2-3 \nOrthopaedic imaging in children \nJeannette Kraft; Leeds/UK \n \nLearning Objectives: \n1. To learn how to limit the indications for CT in skeletal imaging. \n2. To learn about the possibilities of low-dose applications in skeletal imaging. \n3. To appreciate the important role of ultrasound or MRI for musculoskeletal \nimaging in children. \n \nEU 2-5 \nImaging lung diseases in children and adolescents: can we avoid CT? \nDiane M. Renz; Hannover/DE \n(Renz.Diane@mh-hannover.de) \n \nLearning Objectives: \n1. To appreciate the role of radiography. \n2. To become familiar with the role of ultrasound in lung imaging. \n3. To learn about the advantages of lung MRI. \n \nEU 2-6 \nAvoiding radiation in our smallest patients \nWillemijn M. Klein; Nijmegen/NL \n(willemijn.klein@radboudumc.nl) \n \nLearning Objectives: \n1. To learn about alternatives to radiography. \n2. To learn tips an tricks to minimise ionising radiation when needed. \n3. To learn the ALARA and image gently principles. \n \nLive Q&A \n \n11:45-12:45 CHANNEL 4 \nSpecial Focus Session \nSF 25 \nInterventional radiology (IR) treatment for \narterial occlusive disease and thrombo-\nembolic disease: lessons learned from \nhead to toe \nModerator \nElias N. Brountzos; Athens/GR  \n \nSF 25-2 \nRevascularisation in acute ischaemic stroke \nGregoire Boulouis; Paris/FR  \n \nLearning Objectives: \n1. To learn how to select suitable candidates for mechanical stroke \nthrombectomy (MST) on the basis of the clinical and imaging evaluation. \n2. To learn about basic techniques of MST and the most used tools. \n3. To learn about the results and complications. \nAuthor Disclosures: \nGregoire Boulouis: Advisory Board: Cerenovus 2020 \n \nSF 25-3 \nAorta and aortic branches interventions: current evidence \nViktor Bérczi; Budapest/HU \n(berczi@hotmail.com) \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 34  \n \nLearning Objectives: \n1. To learn about the indications, techniques, results, and complications of \ninterventions for isolated aortic stenoses. \n2. To learn about the indications for IR treatment of athero-occlusive lesions of \nthe innominate and subclavian arteries (aortic arch arteries). \n3. To understand the results of IR treatment of the athero-occlusive lesions of \nthe renal arteries. \n \nSF 25-4 \nHow to treat acute and chronic mesenteric ischaemia \nLorenzo Garzelli; Paris/FR \n \nLearning Objectives: \n1. To learn how to select patients with acute arterial mesenteric ischaemia for \nIR treatment on the basis of clinical and imaging evaluations. \n2. To understand the techniques used in IR treatment of acute arterial \nmesenteric ischaemia and to learn about the results and complications. \n3. To understand the indications for IR treatment of patients with chronic \nmesenteric ischaemia. \n4. To learn about the techniques, results, and complications of IR treatment for \nchronic mesenteric ischaemia. \n \nSF 25-5 \nEndovascular treatment of the diabetic foot: new techniques \nMarco Manzi; Padua/IT \n(marcodocmanzi@gmail.com) \n \nLearning Objectives: \n1. To learn about the indications of innovative arterial access for diabetic foot \nIR treatment, i.e. pedal access. \n2. To learn about the new tools for treating long total occlusions. \n3. To learn about the indications and techniques of lithotripsy. \n4. To understand the role of drug-eluting technology. \nAuthor Disclosures: \nMarco Manzi: Consultant: Abbott vascular, Angiodroid, BdBard,Boston Sc.,CID \nAlvimedica,Cook, Terumo \n \nLive Q&A: Are IR techniques evolving as the first-line treatment modality \nfor atheromatous disease? Are there any exceptions to the rule? \n \n11:45-12:45 CHANNEL 5 \nE³ - Rising Stars Programme: Basic \nSessions \nOrganised by the ESR \nBS 11 \nMusculoskeletal: lower extremities \nModerator \nMario Maas; Amsterdam/NL  \n \nBS 11-2 \nThe degenerative hip \nÜstün Aydingöz; Ankara/TR  \n(uaydingo@hacettepe.edu.tr) \n \nLearning Objectives: \n1. To learn about imaging methods in degenerative hip evaluation. \n2. To learn about imaging features in the degenerative hip. \n \nBS 11-3 \nThe degenerative knee \nJan L.M.A. Gielen; Antwerp/BE \n(jan.gielen@uza.be) \n \nLearning Objectives: \n1. To learn about imaging methods in degenerative knee evaluation. \n2. To learn about imaging features in the degenerative knee. \n \nBS 11-4 \nThe degenerative ankle \nApostolos H. Karantanas; Iraklion/GR \n(akarantanas@gmail.com) \n \nLearning Objectives: \n1. To learn about imaging methods in degenerative ankle evaluation. \n2. To learn about imaging features in the degenerative ankle. \n \nLive Q&A \n \n14:15-15:15 CHANNEL 2 \nJoint Session of the ESR and EFOMP \nESR/EFOMP \nHigh-field vs low-field MRI: time for a re-\nthink? \nModerators \nDavid J. Lurie; Aberdeen/UK  \nMarion Smits; Rotterdam/NL  \n \nESR/EFOMP-3 \nAdvantages of 0.5 Tesla and below: physics and technology \nAndrew Webb; Leiden/NL \n(a.webb@lumc.nl) \n \nLearning Objectives: \n1. To become familiar with the low-field MRI technology. \n2. To explore the advantages of low-field MRI. \n3. To understand the drawbacks of low-field MRI. \n \nESR/EFOMP-4 \nClinical benefits of low-field MRI \nMathieu Sarracanie; Allschwil/CH \n(mathieu.sarracanie@unibas.ch) \n \nLearning Objectives: \n1. To become familiar with the clinical applications of low-field MRI. \n2. To understand the benefits of low-field MRI of the heart.  \n3. To understand the disadvantages of low-field MRI for clinical application. \nAuthor Disclosures: \nMathieu Sarracanie: Founder: Hyperfine; Patent Holder: Hyperfine, Siemens \n \nESR/EFOMP-5 \nAdvantages of 7 Tesla and above: physics and technology \nDavid Brunner; Zurich/CH \n(david.brunner@skope.ch) \n \nLearning Objectives: \n1. To become familiar with the high-field MRI technology. \n2. To explore the advantages of high-field MRI. \n3. To understand the drawbacks of high-field MRI. \nAuthor Disclosures: \nDavid Brunner: Board Member: ISMRM Engineering Study Group; Employee: \nSkope MRT \n \nESR/EFOMP-6 \nClinical benefits of high-field MRI \nAnja van der Kolk; Utrecht/NL \n(A.G.vanderKolk@umcutrecht.nl) \n \nLearning Objectives: \n1. To become familiar with the clinical applications of high-field MRI. \n2. To understand the benefits of high-field MRI of the brain.  \n3. To understand the disadvantages of high-field MRI for clinical application. \n \nLive Q&A: Does clinical value scale with magnetic field strength? \n \n \n \n \n \n \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 35  \n14:15-16:30 CHANNEL 3 \nE³ - Rising Stars Programme: Case-Based \nDiagnosis Training \nCB \nCase-Based Diagnosis Training \nModerators \nSoraya Robinson; Vienna/AT  \nKlaus M. Friedrich; Vienna/AT  \n \nCB-3 \nLiver \nAsunción Torregrosa Andrés; Valencia/ES \n(asunsuso@gmail.com) \n \nCB-4 \nNeuro \nDaniela Prayer; Vienna/AT \n \nCB-5 \nMusculoskeletal \nFranz Kainberger; Vienna/AT \n \nCB-6 \nMaxillofacial \nSoraya Robinson; Vienna/AT \n(s.robinson@dzu.at) \n \nCB-7 \nGenitourinary \nMichael Toepker; Vienna/AT \n(mt@dz10.at) \n \nCB-8 \nInterlude: Air in the wrong place \nBurce Ozgen Mocan; Chicago, IL/US \n \nCB-10 \nHead and neck \nChristian Czerny; Vienna/AT \n(christian.czerny@meduniwien.ac.at) \n \nCB-11 \nChest \nHelmut Prosch; Vienna/AT \n(helmut.prosch@meduniwien.ac.at) \n \nCB-12 \nSpine \nKlaus M. Friedrich; Vienna/AT \n \nCB-13 \nGastrointestinal \nWolfgang Schima; Vienna/AT \n(wolfgang.schima@khgh.at) \n \nCB-14 \nBreast \nFleur Kilburn-Toppin; Cambridge/UK \n(fleur.kilburn-toppin@addenbrookes.nhs.uk) \n \n \n \n \n \n \n \n \n14:15-15:15 CHANNEL 5 \nResearch Presentation Session: Breast \nRPS 102 \nAdvances in breast cancer screening with \ndigital breast tomosynthesis (DBT), \nartificial intelligence (AI), and MRI \nModerator \nFredrik Strand; Stockholm/SE  \n \nRPS 102-2 \nUsing an AI system and breast density to quantify the short-term risk of \ninterval cancer in a large screening cohort \nA. J. Wanders¹, W. Mees¹, N. Janssen², M. U. Dalmis², A. Rodriguez Ruiz², I. \nSechopoulos², C. van Gils³, R. Mann², *J-K. Van Rooden*¹; ¹The Hague/NL, \n²Nijmegen/NL, ³Utrecht/NL  \n(j.vanrooden@hagaziekenhuis.nl) \n \nPurpose: To create a short-term breast cancer risk model combining the \nassessments of an artificial intelligence (AI) detection system and breast \ndensity (BD) to assess the risk of interval cancers (IC) in screening \nmammograms. \nMethods or Background: This nested case-control study included DM exams \nof 2332 IC cases of women that participated in the Dutch breast cancer \nscreening program, and a randomly selected group of 584 normal screening \ncontrols verified by at least 2 years of follow-up. For each mammogram, a \nscore 1-10 indicating the risk of presence of visible abnormalities was \ncomputed by an AI system (Transpara, Screenpoint Medical), and BD was \ncomputed using automated software. A neural network-based model was \ntrained combining the AI score and BD to predict the short-term risk of IC in \nscreening mammograms using 10-fold cross-validation. The area under the \nreceiver operating characteristics curve (AUC) of the AI system, breast density, \nand the risk model for selecting women at risk for developing IC at immediately \npreceding screening mammograms was estimated with 95% confidence \nintervals and compared using T-test for paired samples. \nResults or Findings: The AUC of the neural-network risk model to detect IC in \nscreening was 0.801 (0.774-0.827), higher (P<0.01) than the AI system or BD \nalone (0.741 (0.713-0.769) and 0.695 (0.660-0.730), respectively). At 90% \nspecificity, the risk model achieved a sensitivity of 49.7% (43.2%-56.2%), \nhigher (P<0.01) than the AI system or BD alone, (42.2% (37.1%-47.4%) and \n23.2% (16.1-30.3%), respectively). \nConclusion: Combining breast density and AI assessments improves the \nselection of women at risk for developing IC over either method alone, allowing \nfor the correct prediction of about half of the IC at 90% specificity. \nLimitations: The risk model needs validation on external cohorts. \nEthics Committee Approval: Approved by institutional review board \nFunding for this study: Not applicable \nAuthor Disclosures: \nWillem Mees: Nothing to disclose \nMehmet Ufuk Dalmis: Employee at ScreenPoint Medical \nCarla van Gils: Nothing to disclose \nAlejandro Rodriguez Ruiz: Employee at ScreenPoint Medical \nNatasja Janssen: Employee at ScreenPoint Medical \nRitse Maarten Mann: Consultant at ScreenPoint Medical \nAlexander J.T. Wanders: Nothing to disclose \nIoannis Sechopoulos: Nothing to disclose \nJan-Kees Van Rooden: Nothing to disclose \n \nRPS 102-3 \nUsing AI with single reading in screening: a simulation of the impact on \ntumour characteristics of detected cancers \nN. Janssen, S. van Winkel, A. Rodriguez Ruiz, N. Karssemeijer, I. \nSechopoulos, *R. Mann*; Nijmegen/NL \n(r.mann@rad.umcn.nl) \n \nPurpose: To compare the tumour characteristics of screen-detected cancers \nwhen one human reader is replaced by an artificial intelligence (AI) system in a \ndouble reading breast cancer screening program. \nMethods or Background: A consecutive cohort of 23,035 digital \nmammography exams with 159 screen-detected (SD), 48 interval (IC) and 62 \nnext-round-SD cancers (NRSD) was collected from the Dutch screening \nprogram. An AI system (Transpara, ScreenPoint Medical) processed all exams \nand assigned a recall/no recall decision at the same recall rate as a radiologist \n(3.0%). Histopathological types (invasive ductal/lobular carcinoma (IDC/ILC), \nductal carcinoma in situ (DCIS)), grade, and mean radiological size (95% CI) of \nall cancers were reported for double reading and single reading + AI. \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 36  \nResults or Findings: Double reading detected 159 SD, with mean size of \n13.6mm (95% CI:12.4-14.9mm). These were 61.0% IDC, 10.1% ILC, 19.5% \nDCIS, 7.5% other invasive and 1.9% unknown. Single reading + AI recalled \n179 cancers (154 SD, 15 IC, 10 NRSD), with mean size 14.2mm (95% CI:13.1-\n15.4mm) and 62% IDC, 12.8% ILC, 16.2% DCIS, 7.3% other invasive and \n1.7% unknown. Double reading and single reading + AI detected similar \nproportions of grade-3 cancers: 25% vs. 21.8% (p=0.48). The five SD that were \nmissed by single reading + AI were all grade-3, (3 DCIS, 1 ILC, 1 IDC). The 15 \nrecalled IC by single reader + AI were all invasive, and 20% were grade-3, \n33% grade-2, 40% grade-1 and 7% unknown. Of the 10 NRSD, 10% were \ngrade-3, 20% grade-2, 60% grade-1 and 10% unknown, with 1 DCIS. \nConclusion: Introducing AI in screening could lead to higher cancer detection \nrates with similar tumour characteristics as with double reading of \nmammograms. \nLimitations: No visual examination of identified AI findings was performed. \nEthics Committee Approval: Institutional review board. \nFunding for this study: Not applicable. \nAuthor Disclosures: \nSuzanne van Winkel: Nothing to disclose \nAlejandro Rodriguez Ruiz: Employee at ScreenPoint Medical \nNatasja Janssen: Employee at ScreenPoint Medical \nRitse Maarten Mann: Consultant at ScreenPoint Medical \nIoannis Sechopoulos: Nothing to disclose \nNico Karssemeijer: CEO at ScreenPoint Medical \n \nRPS 102-4 \nThe potential of AI to replace a first reader in a double reading breast \ncancer screening programme: a feasibility study \nN. Janssen¹, A. Rodriguez Ruiz¹, C. Mieskes², N. Karssemeijer¹, *S. H. \nHeywang-Köbrunner*²; ¹Nijmegen/NL, ²Munich/DE \n(sylvia.heywang@referenzzentrum-muenchen.de) \n \nPurpose: To evaluate the impact of replacing the double human reading of \ndigital mammograms (DM) with a single human reading and an artificial \nintelligence (AI) system in a breast cancer screening programme. \nMethods or Background: A randomly selected screening cohort of 2314 DM \nexams with 114 biopsy-proven screen-detected cancers was retrospectively \ncollected from a single center, which involved independent double human \nreading and consensus in case of disagreement. Normal mammograms were \ndefined as free of screen-detected cancer by double reading. No follow-up \ninformation about interval cancers was available. All exams were processed by \nan AI system (Transpara, ScreenPoint Medical), assigning an Exam Score 1-\n10 which represents an increasing risk of containing visible abnormalities. An \nAI-based screening scenario was retrospectively investigated in which the \nsecond reader was replaced with AI (operating at the same sensitivity). \nSpecificity and workload were compared between original double reading and \nthe AI-based scenario using a McNemar test. \nResults or Findings: Double human reading recalled 505 women to \nconsensus, with 112 detected cancers and 393 false positives (specificity \n82.1%, CI: 80.5-83.7). AI-based screening resulted in 550 recalled women to \nconsensus, with 112 detected cancers and 438 false positives (specificity \n80.1%, CI: 78.4-81.7, relative reduction compared to double reading of 2.0%, \nCI: -0.3-4.3%, P=0.08). \nConclusion: Replacing a human reader with AI in a double reading breast \ncancer screening programme could be an effective strategy to halve \nradiologists workload while maintaining the same sensitivity, particularly in \ncase of a shortage of readers. This strategy potentially comes at the cost of \nmore false positive cases sent to consensus. \nLimitations: Due to the retrospective character of this study, it was not \npossible to assess the benefit of AI in an actual screening setting. \nEthics Committee Approval: IRB approval was obtained \nFunding for this study: Not applicable \nAuthor Disclosures: \nSylvia H. Heywang-Köbrunner: Nothing to disclose \nAlejandro Rodriguez Ruiz: Employee at ScreenPoint Medical \nNatasja Janssen: Employee at ScreenPoint Medical \nChristoph Mieskes: Nothing to disclose \nNico Karssemeijer: CEO at ScreenPoint Medical \n \nRPS 102-5 \nThe potential for AI to replace a reader in a double reading breast cancer \nscreening programme \nS. van Winkel, N. Janssen, A. Rodriguez Ruiz, N. Karssemeijer, I. \nSechopoulos, *R. Mann*; Nijmegen/NL \n(r.mann@rad.umcn.nl) \n \nPurpose: To evaluate the impact of replacing the double human reading with a \nsingle human reading and an artificial intelligence (AI) system in a breast \ncancer screening programme. \nMethods or Background: A consecutive cohort of 23,035 digital \nmammography (DM) exams with 159 screen-detected (SD), 48 interval (IC) \nand 62 next-round SD cancers (NRSD) was collected from the Dutch screening \nprogramme, which involved double human reading. An AI system (Transpara, \nScreenPoint Medical) processed all cases, assigning a level of suspicion to \neach exam on a continuous scale. AI-based screening was retrospectively \ninvestigated in which the second reader was replaced with AI, using the human \nrecall rate as operating point. Sensitivity and recall rate were computed for the \nfirst reader, AI alone, AI-based screening and double reading. \nResults or Findings: The first reader recalled 694 cases (3.0%, CI = 2.8-\n3.2%), including 138 SD, 2 IC and 1 NRSD (sensitivity 52.4%, CI =46.3-\n58.5%). AI alone detected 127 SD, 14 IC and 10 NRSD (sensitivity 56.1%, CI = \n50.0-62.2%). There were 1012/23035 (4.4%) discrepant assessments between \nAI and the first reader. AI-based screening recalled 1200 cases (5.2%, 95% CI \n= 4.9-5.5%), detecting 154 SD, 15 IC and 10 NRSD (sensitivity 66.5%, CI = \n60.6-72.2%). Double reading (including consensus) recalled 724 cases (3.1%, \nCI = 2.9-3.4%), with 159 SD (sensitivity 59.1%, CI = 53.0-65.0%). \nConclusion: The use of AI as independent reader could halve the radiologists \nworkload and potentially increase sensitivity and lower recall rate, if an \neffective arbitration process can be implemented to assess discrepant exams. \nLimitations: Due to incomplete data we were unable to include all NRSD in \nthis series, hence the sensitivity of the AI system may be underestimated. \nEthics Committee Approval: Approved by the institutional review board \nFunding for this study: Not applicable \nAuthor Disclosures: \nSuzanne van Winkel: Nothing to disclose \nAlejandro Rodriguez Ruiz: Employee at ScreenPoint Medical \nNatasja Janssen: Employee at ScreenPoint Medical \nRitse Maarten Mann: Consultant at ScreenPoint Medical \nIoannis Sechopoulos: Nothing to disclose \nNico Karssemeijer: CEO at ScreenPoint Medical \n \nRPS 102-6 \nInterval breast cancer in a screening programme: comparison between \nwomen screened with two-dimensional digital mammography or \ntomosynthesis \n*C. Pulido Carmona*, S. Romero Martin, J. L. L. Raya Povedano, E. Elías \nCabot, M. Álvarez Benito; Cordoba/ES \n \nPurpose: Several studies have demonstrated that digital breast tomosynthesis \n(DBT) in the screening setting is associated with an increase of cancer \ndetection rates with fewer false-positive findings compared to two-dimensional \ndigital mammography (DM). However, the few studies published to date do not \nshow significant differences in the rate of interval cancers. The aim of this \nstudy is to determine if the rate of interval breast cancers differ for DM versus \nDBT. \nMethods or Background: Screening studies carried out in a screening unit \nfrom January 2015 to December 2016 were reviewed retrospectively. Different \nsources were examined in order to find the screening-detected cancers (if \ndiagnosed within 2 years of a positive screening examination) and interval \ncancers (if diagnosed withing 2  years of a negative screening examination). \nScreening outcomes such as interval cancer rate (ICR/1000 negative screens) \nand screening sensitivity were calculated. Moreover, cancers characteristics \nwere compared (DM inverval cancers vs. DBT interval cancers and, on the \nother hand, interval cancers vs. screening-detected cancers). \nResults or Findings: 43256 women were screened, 24863 with DM and \n18393 with DBT. 309 breast cancers were diagnosed: 247 were screening-\ndetected cancers and 62 interval cancers. The rate of interval cancers was \nhigher for DM than for DBT (1.94 vs. 0.76 per 1000 negative examinations, \np=.001). Screening sensitivity of DBT was higher than DM (87% vs. 75%, \np=.008). There were no significant differences in tumor charateristics between \ninterval cancers on DM versus DBT (p=.051-1). Nevertheless, there were \nsignificant differences  (p<.05) in tumor characteristics between interval \ncancers and screening-detected cancers showing worse prognosis \ncharacteristics the first ones. \nConclusion: The rate of interval cancers is lower for DBT than for DM. Interval \ncancers show worse prognosis characteristics in comparison with screening-\ndetected cancers. \nLimitations: Explained later \nEthics Committee Approval: No \nFunding for this study: None \nAuthor Disclosures: \nMarina Álvarez Benito: Nothing to disclose \nCristina Pulido Carmona: Nothing to disclose \nSara Romero Martin: Nothing to disclose \nEsperanza Elías Cabot: Nothing to disclose \nJose Luis Raya Povedano: Nothing to disclose \n \nRPS 102-7 \nRe-attendance in the second breast MRI screening round of the DENSE \ntrial and reasons for discontinuation \n \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 37  \n*S. G. A. Veenhuizen*, I. Laseur, M. F. Bakker, S. V. de Lange, R. M. \nPijnappel, W. B. Veldhuis, C. van Gils; Utrecht/NL \n(s.g.a.veenhuizen@umcutrecht.nl) \n \nPurpose: To describe determinants of re-attendance and reasons for \ndiscontinuation in the second screening MRI round of the DENSE trial among \nwomen with extremely dense breast tissue. \nMethods or Background: Of the women participating in the first screening \nround, we calculated the re-attendance rate in the second round according to \nsubgroups of patient characteristics. Women who discontinued MRI screening, \nwere asked to provide one or more reasons for this. \nResults or Findings: Women who had a negative mammography two years \nafter the first MRI screening round (4310/4783= 90.1%), were re-invited for \nMRI. The re-attendance rate was 71.8% among all women, and 79.7% among \nthose re-invited. The re-attendance rate was higher among women with higher \neducation, a healthier lifestyle, and women who experienced little or no pain, \ndiscomfort or anxiety at the first MRI. Re-attendance was lower in women with \na false-positive MRI in the first screening round (65.8%) than in women with a \nnegative MRI (74.5%, p-value=0.01). Women mostly mentioned MRI-related \ninconveniences as a reason to discontinue screening (43.7%). \nConclusion: Women of lower educational status, or who had an unpleasant \nMRI experience in the previous screening round were less likely to re-attend in \nanother screening round. More emphasis should be put on improving MRI \nexperience to increase the re-attendance rate in supplemental MRI screening. \nLimitations: 5.5% of the women did not re-attend mammography for unknown \nreasons and thus were not re-invited for MRI. \nEthics Committee Approval: Approved by Dutch Minister of Health, Welfare \nand Sport (2011/19); participants gave written Informed Consent. \nFunding for this study: UMC Utrecht, ZonMw, Dutch Cancer Society, Dutch \nPink Ribbon/A Sister’s Hope, Stichting Kankerpreventie Midden-West, Bayer \nAG Pharmaceuticals, and in kind by Volpara Health Technologies. \nAuthor Disclosures: \nStéphanie Vera de Lange: Author at UMC Utrecht \nCarla van Gils: Consultant at Bayer, Grant Recipient at All are mentioned in the \nabstract \nStefanie Gerlinda Anita Veenhuizen: Author at UMC Utrecht \nIsabelle Laseur: Author at UMC Utrecht \nWouter B. Veldhuis: Other at Imaging department UMC Utrecht \nRuud M Pijnappel: Other at Director at the LRCB \nMarije F. Bakker: Author at UMC Utrecht \n \nLive Q&A \n \n15:30-16:30 CHANNEL 2 \nESR Audit and Standards Session \nESR Audit \nThe role of clinical audit in radiology \nservice improvement \nModerator \nDavid C. Howlett; Eastbourne/UK  \n \nESR Audit-2 \nRadiology service improvement: what can be learned from industry? \nSteven Lee; Guildford/UK (steven.lee_1@philips.com) \n \nLearning Objectives: \n1. To understand the concepts of quality/service improvement. \n2. To appreciate the experience of industry in service improvement. \n3. To highlight the benefits for radiology departments of effective processes of \nquality improvement. \n \nESR Audit-3 \nThe EU Basic Safety Standards Directive and related clinical audit \nrequirements \nAlexandra Karoussou-Schreiner; Luxembourg/LU (alexandra.schreiner@ms.etat.lu) \n \nLearning Objectives: \n1. To appreciate the roles of HERCA and inspection. \n2. To highlight the importance of clinical audit as defined within the EU-BSS. \n3. To consider the findings and implications of ESR EU-BSS uptake surveys. \n \nESR Audit-4 \nDevelopment of European radiological clinical audit: the role of the \nnational societies \nAndrea G. Rockall; London/UK (a.rockall@imperial.ac.uk) \n \nLearning Objectives: \n1. To review the structure and function of the ESR national societies network. \n2. To appreciate the concepts of internal vs external audit and audit with \nexternal direction. \n3. To consider future development of pan-European radiology clinical audit \nnetworks. \n \nLive Q&A: Quality improvement and radiology: how to enhance clinical \naudit practice? \n \n15:30-16:30 CHANNEL 4 \nE³ - ECR Master Class \nE³ 226 \nRadiomics and radiogenomics in breast \ncancer \nModerator \nThomas H. Helbich; Vienna/AT  \n \nE³ 226-2 \nA. What is it and how does it work? \nKatja Pinker-Domenig; New York, NY/US  \n(pinkerdk@mskcc.org) \n \nLearning Objectives: \n1. To understand the definitions of radiomics and radiogenomics. \n2. To understand how the information is generated from images and genomics. \n3. To learn about the newest literature on the topic. \nAuthor Disclosures: \nKatja Pinker-Domenig: Board Member: EUSOBI; Research Grant/Support: \nResearch Grants: * Digital Hybrid Breast PET/MRI for Enhanced Diagnosis of \nBreast Cancer (HYPMED). H2020 - Research and Innovation Framework \nProgramme PHC-11-2015 # 667211-2. Role: Co-PI * A Body Scan for Cancer \nDetection using Quantum Technology (CANCERSCAN) H2020-FETOPEN-\n2018-2019-2020-01 # 828978. Role: Co-PI * Multiparametric 18F-\nFluoroestradiol PET/MRI coupled with Radiomics Analysis and Machine \nLearning for Prediction and Assessment of Response to Neoadjuvant \nEndocrine Therapy in Patients with Hormone Receptor+/HER2+ Invasive \nBreast Cancer. Jubilee Funds of the Austrian National Bank # Nr: 18207. Role: \nPI * Deciphering breast cancer heterogeneity and tackling the hypoxic tumor \nmicroenvironment challenge with PET/MRI, MSI and radiomics. The Vienna \nScience and Technology Fund # LS19-046. Role: PI   Katja Pinker is supported \nin part through the NIH/NCI Cancer Center Support Grant P30 CA008748 and \na grant from the Breast Cancer Research Foundation.; Speaker: - European \nSociety of Breast Imaging - Siemens Healthineers - IDKD 2019 \n \nE³ 226-3 \nB. Can it be clinically useful? \nMatthias Dietzel; Erlangen/DE \n \nLearning Objectives: \n1. To understand the current challenges in estimating prognosis in breast \ncancer. \n2. To appreciate when radiomics and radiogenomics can add to the clinical \npicture. \n3. To learn about their potential role for personalised medicine. \n \nE³ 226-4 \nC. AI-improved breast imaging \"omics\" \nRitse M. Mann; Nijmegen/NL \n(r.mann@rad.umcn.nl) \n \nLearning Objectives: \n1. To learn about the basic definitions of AI. \n2. To discuss the possible applications of AI beyond detection. \n3. To appreciate when the addition of AI may improve “omics”. \nAuthor Disclosures: \nRitse M. Mann: Advisory Board: Bayer, BD, Screenpoint, Transonic imaging, \nSiemens; Grant Recipient: Bayer, BD, Siemens, Screenpoint, Koning, \nMedtronic, Volpara, Seno medical \n \nLive Q&A: Are we ready to integrate prognostic imaging into the tumour \nboard? \n \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 38  \n15:30-16:30 CHANNEL 5 \nCTiR 1 \nClinical Trials in Radiology 1 \nModerators \nMarc Dewey; Berlin/DE  \nRegina G.H. Beets-Tan; Amsterdam/NL  \n \nCTiR 1-3 \nUtilization of coronary CT angiography across Europe in the last decade: \ninsights from the European ESCR MR/CT registry \n*J. Uhlig*¹, B. Foldyna², L. Lehmkuhl³, L. Natale ຾, R. Vliegenthart຿, J. Lotz¹, M. \nGutberlet๤; ¹Goettingen/DE, ²Boston, MA/US, ³Bad Neustadt/DE, ຾Roma/IT, \n຿Groningen/NL, ๤Leipzig/DE \n(johannes.uhlig@med.uni-goettingen.de) \n \nPurpose: To analyze the utilization of coronary computed tomography \nangiography (CTA) across Europe in the last decade. \nMethods or Background: The multinational, multicenter MR/CT Registry of \nthe European Society of Cardiovascular Radiology (ESCR) was queried for \nCTA studies performed for suspected coro nary artery disease (CAD) in adults \nbetween 1/2010 and 12/2019. CTAs, proportions between academic vs. non-\nacademic centers, patient and scan characteristics between 2010–2014 vs. \n2015–2019 were compared. \nResults or Findings: Overall, 215 sites submitted 64,387 coronary CTAs \n(mean 300 CTAs/site). The number of sites and cases/site increased by 76% \nand 46% from 2010-2014 to 2015-2019. While academic centers submitted \nmost records (53%) in 2010–2014, non-academic centers dominated the \nsecond study half (71% in 2015–2019). Initially, most CTAs were performed in \nelderly men (men: 60.3%; mean age: 60.4 years) with high (31%) and \nintermediate (63%) pretest probability, resulting in a relatively high prevalence \nof any CAD (42%) and multivessel disease (62%).From 2015-2019, 95% of \npatients had low or intermediate PTP with a slightly lower prevalence of any \nCAD (41%, p=0.03) but substantially less advanced disease (56% multivessel \ndisease, p<0.001). Overall image quality was excellent or good in 90.1% of \ncases at relatively low radiation exposure (median 5.7 mSv) and a low number \n(0.4%) of acute adverse scan-related events. \nConclusion: Coronary CTA is increasingly utilized across Europe, gradually \ndriven by non-academic centers. CTA-performing sites increasingly adhere to \nguidelines, reflected by the increasing use of coronary CTA for CAD exclusion \nin those with low and intermediate PTP. Despite widespread utilization, image \nquality and favorable acute safety profile are maintained. \nLimitations: Limitations include missing details on CAD extent, clinical patient \npresentation and long-term follow-up. \nEthics Committee Approval: Leipzig University IRB. \nFunding for this study: The ESCR MRCT Registry received unrestricted \neducational funding from Siemens, Bayer, Philips, and Bracco. \nAuthor Disclosures: \nLukas Lehmkuhl: Nothing to disclose \nMatthias Gutberlet: Speaker at Bayer HealthCare, Bracco Imaging, Siemens \nHealtCare, Philips Healthcare, GE Healthcare, Circle Health \nRozemarijn Vliegenthart: Nothing to disclose \nLuigi Natale: Nothing to disclose \nJohannes Uhlig: Speaker at Bayer Health \nBorek Foldyna: Nothing to disclose \nJoachim Lotz: Nothing to disclose \n \nCTiR 1-4 \nDiscussant \nMecit Kantarci; Erzurum/TR \n(akkanrad@hotmail.com) \nAuthor Disclosures: \nMecit Kantarci: Nothing to disclose \n \nCTiR 1-5 \nCoronary computed tomography versus invasive coronary angiography \nin patients with stable chest pain referred for invasive coronary \nangiography with intermediate pretest probability of coronary artery \ndisease (DISCHARGE): 1-year follow-up of an open-label, parallel-group, \nmulticentre trial \n*P. Maurovich-Horvat*¹, M. Bosserdt², K. F. Kofoed³, M. Dewey², on behalf of \nThe DISCHARGE Trial Investigators²; ¹Budapest/HU, ²Berlin/DE, \n³Copenhagen/DK \n(maurovich-horvat.pal@med.semmelweis-univ.hu) \n*No abstract available* \nAuthor Disclosures: \nKlaus F. Kofoed: Grant Recipient at Rigshospitalet, University Copenhagen, \nAP Møller og hustru Chastine McKinney Møllers Fond, Danish Heart \nFoundation, Danish Agency for Science, Technology and Innovation and \nCanon Medical Corporation Research/Grant Support at EU grant (EC-GA \n603266). \nPál Maurovich-Horvat: Research/Grant Support at EU grant (EC-GA 603266). \nOther at Neumann Medical Ltd. \nMarc Dewey: Patent Holder at Patent on fractal analysis of perfusion imaging \n(jointly with Florian Michallek, PCT/EP2016/071551, USA Notice of Allowance \n15/759,586) licensed to Florian Michallek and Marc Dewey. Research/Grant \nSupport at EU grant (EC-GA 603266). Grant Recipient at DFG (Heisenberg \nProgramme, BIOQIC, Fractal analysis myocardial perfusion, SPP-Radiomics), \nBerlin University Alliance, Berlin Institute of Health. Equipment Support \nRecipient at Institutional master research agreements with Siemens, General \nElectric, Philips and Canon. \non behalf of The DISCHARGE Trial Investigators: Research/Grant Support at \nEU grant (EC-GA 603266). \nMaria Bosserdt: Research/Grant Support at EU grant (EC-GA 603266). \n \nCTiR 1-6 \nDiscussant \nMichelle Williams; Edinburgh/UK \nAuthor Disclosures: \nMichelle Williams: Nothing to disclose \n \nCTiR 1-7 \nIncidental findings on routine preoperative unenhanced chest computed \ntomography prior to cardiac surgery in the multicenter randomized \ncontrolled CRICKET trial \n*W. G. Knol*¹, A. den Harder², L. de Heer², M. Polos³, P. Maurovich-Horvat³, T. \nLeiner², G. P. Krestin¹, A. Bogers¹, R. P. J. Budde¹; ¹Rotterdam/NL, \n²Utrecht/NL, ³Budapest/HU \n(w.knol@erasmusmc.nl) \n \nPurpose: To describe the prevalence of incidental findings when implementing \nroutine screening for aortic calcification using unenhanced computed \ntomography prior to cardiac surgery. \nMethods or Background: In the multicenter randomized controlled CRICKET \nstudy 862 adult patients scheduled for cardiac surgery were randomized 1:1 to \nundergo a preoperative unenhanced chest CT-scan in addition to standard of \ncare (SoC+CT) or standard of care (SoC) alone, which included a chest-\nradiograph. In this sub-analysis, all incidental findings on the chest radiograph \nand CT-scan were included if preoperative work-up or follow-up was required. \nResults or Findings: Incidental findings were observed in 11.0% (n=47, 95% \nCI [8.2% - 14.3%]) of patients in the SoC+CT group and in 3.7% (n=16, 95% CI \n[2.1% - 6.0%]) of patients in the SoC-group (p<0.001). In the SoC+CT group \nfurther preoperative work-up was required in 3.3% (n=14), vs 1.4% (n=6) in the \nSoC-group (p=0.07). In the SoC+CT-group, clinically relevant findings were \nobserved in 1.2% (n=5): a lung cancer urging change from surgery to a \npercutaneous approach (n=2); sarcoidosis (n=1); an aortic aneurysm requiring \nconcomitant surgery (n=1); and a patient with splenomegaly and liver cirrhosis, \nultimately leading to cancellation of surgery (n=1). In the remaining nine \npatients no consequent treatment was required. Follow-up was required in \n7.7% (n=33) of SoC+CT patients, because of pulmonary nodules (n=17), \npulmonary ground glass opacities (n=5), other pulmonary abnormalities (n=5), \nmediastinal  lymphadenopathy (n=1) or non-pulmonary findings (n=5). \nConclusion: In this population of patients scheduled for cardiac surgery the \naddition of routine CT-screening will lead to clinically relevant incidental \nfindings in 1.2% of patients. This comes at a cost of additional diagnostic \nimaging and the need to follow-up on incidental findings of unclear significance \nin about a tenth of patients. \nLimitations: n/a \nEthics Committee Approval: MEC-UMC Utrecht: 13-692/M \nFunding for this study: ZonMW-Grantno. [837001403] \nAuthor Disclosures: \nRicardo P. J. Budde: Nothing to disclose \nAnnemarie den Harder: Nothing to disclose \nWiebe G Knol: Nothing to disclose \nAd Bogers: Nothing to disclose \nTim Leiner: Nothing to disclose \nGabriel P. Krestin: Nothing to disclose \nLinda de Heer: Nothing to disclose \nPál Maurovich-Horvat: Nothing to disclose \nMiklos Polos: Nothing to disclose \n \nCTiR 1-8 \nDiscussant \nMonika Arzanauskaite; Liverpool/UK \nAuthor Disclosures: \nMonika Arzanauskaite: Nothing to disclose \n \n \n \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 39  \nCTiR 1-9 \nCombination of coronary computed tomography angiography and clinical \nprobability for the prediction of obstructive coronary artery disease: \ninternational, multicenter meta-analysis \n*V. Wieske*, O. N. behalf of Collaborative Meta-Analysis of Cardiac CT \n(COME-CCT) Consortium; Berlin/DE \n(viktoria.wieske@charite.de) \n \nPurpose: To investigate if the combination of coronary computed tomography \nangiography (CTA) and pragmatic clinical probability models improves the \nprediction of the presence of obstructive coronary artery disease (CAD). \nMethods or Background: Overall, 5332 patients who were clinically referred \nto invasive coronary angiography (ICA) with suspected CAD based on stable \nchest pain in 65 prospective diagnostic accuracy studies were included in this \nprospective multicenter analysis. Pragmatic estimation of clinical probability of \nobstructive CAD was based on age, sex, and chest pain type. The prediction \nmodels were compared using the area under the receiver-operating-\ncharacteristic curve (AUC). Multivariable logistic regression with a dataset-\nspecific random intercept to account for clustering was applied to the clinical \nprediction models. \nResults or Findings: Discriminative ability of the clinical prediction model \ndecreased with less typical chest pain (typical or atypical angina (AUC 0.70, \n0.68 to 0.71) vs. nonanginal or other chest discomfort (0.63, 0.60 to 0.65); p < \n0.001). CTA alone had a discriminative ability for CAD of 0.81 (0.80 to 0.82, p \n< 0.001). Adding CTA to the clinical COME-CCT prediction model resulted in a \nsignificantly improved diagnostic discrimination with an AUC of 0.86 (0.85 to \n0.87, p < 0.001). This improvement was equally seen in patients with typical or \natypical angina (0.85, 0.84 to 0.86, p < 0.001) and nonanginal or other chest \ndiscomfort (0.88, 0.86 to 0.89, p < 0.001). \nConclusion: Incorporating CTA into the clinical prediction results in a good \ndiscriminative ability for all types of chest pain. \nLimitations: This analysis did not include a physiologic assessment of the \nindividual relevance of obstructive CAD and the cohort represents those \nclinically referred to ICA. \nEthics Committee Approval: Individual studies included in the collaboration \nwere approved by the local ethics committees. \nFunding for this study: German Federal Ministry of Education and Research \n(01KG1110). \nAuthor Disclosures: \nViktoria Wieske: Nothing to disclose \nO N behalf of Collaborative Meta-Analysis of Cardiac CT (COME-CCT) \nConsortium: Research/Grant Support at Grant support from the FP7 Program \nof the European Commission for the randomized multicenter DISCHARGE trial \n(603266-2, HEALTH-2012.2.4.-2). \n \nCTiR 1-10 \nDiscussant \nMarton Kolossvary; Budapest/HU \n(martonandko@gmail.com) \nAuthor Disclosures: \nMarton Kolossvary: Nothing to disclose \n \n16:45-17:45 CHANNEL 2 \nSpecial Focus Session \nSF 7 \nMy three top tips: pearls and pitfalls in \nabdominal imaging \nModerator \nNikolaos Kartalis; Stockholm/SE  \n \nSF 7-2 \nLiver \nYves Menu; Paris/FR  \n \nLearning Objectives: \n1. To identify key imaging findings in the evaluation of the liver. \n2. To understand the importance of appropriately performed examination \nprotocols. \n3. To become familiar with the most common pitfalls and how to avoid them. \n \n \n \n \n \nSF 7-3 \nBile ducts \nMiriam Klauß; Heidelberg/DE \n \nLearning Objectives: \n1. To identify key imaging findings in the evaluation of the bile ducts. \n2. To understand the importance of appropriately performed examination \nprotocols. \n3. To become familiar with the most common pitfalls and how to avoid them. \n \nSF 7-4 \nPancreas \nCelso Matos; Lisbon/PT (celso.matos@fundacaochampalimaud.pt) \n \nLearning Objectives: \n1. To identify key imaging findings in the evaluation of the pancreas. \n2. To understand the importance of appropriately performed examination \nprotocols. \n3.To become familiar with the most common pitfalls and how to avoid them. \n \nSF 7-5 \nColon/rectum \nAndrea Laghi; Rome/IT (andrea.laghi@uniroma1.it) \n \nLearning Objectives: \n1. To identify key imaging findings in the evaluation of the colon and rectum. \n2. To understand the importance of appropriately performed examination \nprotocols. \n3. To become familiar with the most common pitfalls and how to avoid them. \nAuthor Disclosures: \nAndrea Laghi: Speaker: Bracco, Bayer, GE Healthcare, Merck \n \nSF 7-6 \nSpleen \nAli Devrim Karaosmanoglu; Ankara/TR \n(alidevrim76@yahoo.com) \n \nLearning Objectives: \n1. To identify key imaging findings in the evaluation of the spleen. \n2. To understand the importance of appropriately performed examination \nprotocols. \n3. To become familiar with the most common pitfalls and how to avoid them. \n \nSF 7-7 \nKidney \nKevin Murphy; Cork/IE \n \nLearning Objectives: \n1. To identify key imaging findings in the evaluation of the kidney. \n2. To understand the importance of appropriately performed examination \nprotocols. \n3. To become familiar with the most common pitfalls and how to avoid them. \n \nSF 7-8 \nAdrenal \nGiles Boland; Boston, MA/US \n(gboland@partners.org) \n \nLearning Objectives: \n1. To identify key imaging findings in the evaluation of the adrenal. \n2. To understand the importance of appropriately performed examination \nprotocols. \n3. To become familiar with the most common pitfalls and how to avoid them. \n \nSF 7-9 \nProstate \nHarriet C. Thoeny; Fribourg/CH \n(Harriet.thoeny@h-fr.ch) \n \nLearning Objectives: \n1. To identify key imaging findings in the evaluation of the prostate. \n2. To understand the importance of appropriately performed examination \nprotocols. \n3. To become familiar with the most common pitfalls and how to avoid them. \nAuthor Disclosures: \nHarriet C. Thoeny: Advisory Board: Bayer \n \nLive Q&A: How can we really avoid mistakes from imaging pitfalls? \n \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 40  \n16:45-17:45 CHANNEL 3 \nRefresher Course: Radiographers \nRC 114 \nCommunicating imaging justification \nModerator \nPaul Bezzina; Msida/MT  \n \nRC 114-3 \nA. The role of radiographers as practitioners \nShane J. Foley; Dublin/IE  \n(shane.foley@ucd.ie) \n \nLearning Objectives: \n1. To become familiar with the EU Basic Safety Standards (BSS) directive on \nthe role of the practitioner. \n2. To understand the role of radiographers as practitioners. \n3. To explore the future role of radiographers as practitioners. \n \nRC 114-4 \nB. Teamwork in the justification process \nKristin Bakke Lysdahl; Kongsberg/NO \n(Kristin.Bakke.Lysdahl@usn.no) \n \nLearning Objectives: \n1. To highlight the importance of radiographers working within a \nmultidisciplinary team. \n2. To provide practical advice for radiographers in performing justification. \n3. To present the different roles of radiographers as practitioner in different \ncountries. \n \nRC 114-5 \nC. The challenges of referral guideline implementation \nAmanda Martin; Manchester/UK \n \nLearning Objectives: \n1. To introduce the iRefer and ESR iGuide referral guidelines. \n2. To present the challenges in implementing referral guidelines for \nradiography. \n3. To discuss the advantages and limitations of referral guideline \nimplementation. \n \nLive Q&A: How best can we progress the issue of justification in the \ncurrent clinical environment? \n \n16:45-17:45 CHANNEL 5 \nResearch Presentation Session: Cardiac \nRPS 203 \nAdvanced new techniques in \ncardiovascular imaging \nModerator \nThomas Weikert; Basle/CH  \n \nRPS 203-2 \nSemi-supervised learning for vessel segmentation in coronary \nangiography \n*J-W. Hong*¹, C-K. Lee², Z-G. Qui¹, Z-Z. Li¹, P-H. Tseng¹; ¹Taipei/TW, \n²Hsinchu/TW  \n(page19920610@gmail.com) \n \nPurpose: Invasive coronary angiography (CAG) remains the gold standard for \ndiagnosing coronary artery disease (CAD). To determine treatment plans \nautomatically within the foreseeable future, the first step is vessel \nsegmentation. All current studies focus on supervised learning, where labeling \ntakes professionals lots of time. Semi-supervised learning (SSL) takes \nadvantage of adopting unsupervised learning from a huge amount of unlabeled \ndata. In this study, we are the first to design SSL for vessel segmentation to \nsurpass supervised learning performance. \nMethods or Background: Our SSL method is composed of the student and \nteacher models. Random data argumentation from contrast, brightness, \nsharpness, or additive Gaussian noise is utilized. In the same iteration, two \ndifferent parameters of the same argumentation input to the student and \nteacher models. We take the teacher prediction as a fake label to guide the \nstudent prediction and compute their consistency loss. If this image is labeled, \nthe segmentation loss between the label and the student prediction is \ncalculated. After updating the student model's weights, we update the teacher \nmodel’s weights by the exponential moving average method. Our data is \ncollected and labeled at National Taiwan University Hospital. \nResults or Findings: We utilize the DenseNet121 U-Net for our baseline using \nsupervised learning, including applying additional four times of data \naugmentation. On 50, 100, and 200 training labeled images for training, the F1-\nscore of supervised learning is 83.19%± 0.43%, 85.04% ± 0.25%, and 86.49% \n±0.20% under three-fold validation, respectively, while our proposed method \nimproves to 84.63%±0.84%, 86.97% ±0.35%, and 88.06%±0.14%. \nConlusion: With accurate vessel segmentation from SSL, our method with 100 \nlabels outperforms the supervised learning with 200 labels, saving half of \nrequired labels. \nLimitations: Validation using a higher number of labels, requiring further \nannotation. \nEthics Committee Approval: By NCTU-REC-109-014F \nFunding for this study: By MOST 109-2314-B-002-257-MY3 \nAuthor Disclosures: \nZhi-Gao Qui: Nothing to disclose \nChih-Kuo Lee: Nothing to disclose \nPo-Hsuan Tseng: Nothing to disclose \nZheng-Zhang Li: Nothing to disclose \nJhen-Wei Hong: Nothing to disclose \n \nRPS 203-4 \nCalcium scoring using virtual non-contrast images from a dual-layer \nspectral CT: comparison to real non-contrast data and evaluation of \nproportionality factor in a large patient collective \n*F. G. Gassert*, F. T. Gassert, C. E. von Schacky, M. R. Makowski, J. Nadjiri; \nMunich/DE \n \nPurpose: Determination of coronary artery calcium scoring (CACS) in non-\ncontrast computed tomography (CT) images has been shown to be an \nimportant prognostic factor in Coronary Artery Disease (CAD). The objective of \nthis study was to evaluate the accuracy of CACS from virtual non-contrast \n(VNC) imaging generated from spectral data in comparison to standard (true) \nnon-contrast (TNC) imaging in a representative patient cohort with clinically \napproved software. \nMethods or Background: 103 patients referred to coronary CTA with \nsuspicion of CAD were investigated on a dual-layer spectral detector CT \n(SDCT) scanner. CACS was calculated from both TNC and VNC images by \nsoftware certified for medical use. Patients with a CACS of 0 were excluded \nfrom analysis. \nResults or Findings: Mean age of the study population was 61±11 years with \n48 male patients (67%). Inter-quartile-range of clinical CACS was 22-282. \nCorrelation of measured CACS from true- and VNC images was high (0.95); p \n< 0.001. The slope was 3.83, indicating an underestimation of VNC CACS \ncompared to TNC CACS by that factor. Visual analysis of Bland-Altman \nplot&nbsp;of CACS showed good accordance of both methods after correction \nof VNC CACS by the above mentioned factor. \nConclusion: In clinical diagnostics of CAD, determination of CACS is feasible \nusing VNC images generated from spectral data obtained on a dual layer \nspectral detector CT. When multiplied by a correction factor results were in \ngood agreement with the standard technique. This could enable radiation dose \nreductions by obviating the need for native scans typically used for CACS. \nLimitations: CT based true non-contrast imaging was used as reference \nstandard. Artifacts caused by beam hardening and blooming could also occur \nin native scans. \nEthics Committee Approval: Approval of the Institutional Review Board had \nbeen obtained prior to this study \nFunding for this study: n/a \nAuthor Disclosures: \nFlorian Tilman Gassert: Nothing to disclose \nClaudio E. von Schacky: Nothing to disclose \nMarcus R. Makowski: Nothing to disclose \nFelix Gerhard Gassert: Nothing to disclose \nJonathan Nadjiri: Nothing to disclose \n \nRPS 203-5 \nA new software for automatic cardiac lesions identification and \nclassification based on CMR-LGE imaging analysis \n*G. Grazzini*, S. Pradella, M. Letteriello, C. De Amicis, P. Tortoli, S. Bettarini, \nS. Busoni, L. N. N. Mazzoni, V. Miele; Florence/IT \n(grazzini.giulia@gmail.com) \n \nPurpose: The aim of this study is to test a new semiautomated software \nFLORA (For Late gadOlinium enhanced aReas clAssification) developed to \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 41  \nidentify and distinguish ischemic from non-ischemic myocardial alterations on \ncardiac magnetic resonance late gadolinium enhancement (CMR-LGE) images \nand evaluate its accuracy in assessing the transmural extent of the ischemic \nlesions. \nMethods or Background: 120 patients undergone complete CMR were \nretrospectively selected (40 myocardial ischemic, 40 non-ischemic \ncardiomyopathies, and 40 negatives). For each patient, a radiologist selected a \nsingle slice of the short-axis-LGE sequence and segmented the epicardial and \nendocardial border. Subsequently, FLORA identified as pathological the pixels \nwith intensity higher than the automatic estimated threshold value (calculated \nusing two different methods: double-gaussian fit method and “fixed-shift” \nmethod). The pixel clusters overlapping the endocardial border with an \nextension>5 mm are classified as ischemic; the pixels without overlap as non-\nischemic; while the clusters with overlap<5mm as a mixed pattern. Finally, a \nquantitative estimate of the transmural extent is provided. \nResults or Findings: 120 patients, mean age52±34, male91. Considering the \nsoftware performance in lesions identification, only one false negative has \nemerged. Ischemic myocardial lesions have been correctly classified in \n85/95% (double-gaussian fit method/fixed-shift method). Non-ischemic \nchanges are correctly recognized in 70/82.7%. FLORA showed a very good \nagreement in the determination of the degree of transmurality with the \nradiologist (Cohen’s Ks 0.855/0.931). \nConclusion: The new semiautomated software FLORA showed very high \nsensitivity in the identification of myocardial LGE. It showed good agreement \nwith the radiologist in the classification of myocardial LGE correctly identifying \nmost ischemic lesions and a very good agreement in the determination of the \ndegree of transmurality. \nLimitations: FLORA can confuse some motion artifact patterns as LGE \nEthics Committee Approval: The ethics committee of our institution approved \nthis study \nFunding for this study: No funding \nAuthor Disclosures: \nMayla Letteriello: Nothing to disclose \nGiulia Grazzini: Nothing to disclose \nSilvia Bettarini: Nothing to disclose \nVittorio Miele: Nothing to disclose \nSilvia Pradella: Nothing to disclose \nLorenzo Nicola N Nicola Mazzoni: Nothing to disclose \nSimone Busoni: Nothing to disclose \nPaolo Tortoli: Nothing to disclose \nCristian De Amicis: Nothing to disclose \n \nRPS 203-6 \nPrecision of left ventricular cardiac output quantification among cine, 2D \nflow and 4D flow techniques \n*T. Emrich*¹, A. Kilburg², A. Ese², M. C. Halfmann², U. J. Schoepf¹, K-F. \nKreitner², A. Varga-Szemes¹; ¹Charleston, SC/US, ²Mainz/DE \n(tilman.emrich@gmail.com) \n \nPurpose: Cardiac output (CO) plays an important role in assessing health and \ndisease. CMR cine imaging is considered as reference standard for the \ndetermination of CO. 2D flow has been shown to have a good correlation with \ncine-based CO in a swine model, however, both methods tend to overestimate \ninvasive CO-measurement. The purpose of this study was to compare these \ntraditional CO-measurement methods to 4D flow-based assessment in healthy \nvolunteers. \nMethods or Background: In this prospective study, 49 healthy volunteers \n(28.0±7.1years,24 men) underwent CMR at 3T. Cine imaging was performed \nby a conventional GRAPPA accelerated bSSFP sequence, while 2D flow was \nassed using a conventional phase-contrast sequence with a VENC of 150 \ncm/s. A GRAPPA accelerated 4D flow-prototype was used to acquire 4D flow \ndatasets covering the aorta. Cine-based CO was calculated by multiplying left \nventricular stroke volume by the heart rate. Flow-based CO was expressed by \nmultiplying aortic forward flow by heart rate. \nResults or Findings: Mean cine-based CO (5.8±1.1l/min) was comparable to \nCO measured by 2D flow (5.7±1.0l/min, p=0.201). CO-measurements by 4D \nflow (5.4±0.9l/min) significantly underestimated CO in comparison to cine-\nbased CO (p=0.003; mean of differences -0.38l/min), and 2d flow-based CO \n(p<0.001, mean of differences -0.25 /min). However, 4D flow-based CO \nshowed good correlation and good to excellent agreement to cine \n(r=0.781,ICC=0.828) and 2D-flow based CO measurements \n(r=0.880,ICC=0.914). \nConclusion: 4D flow-based evaluation demonstrated systematic \nunderestimation of CO in comparison to standard clinical techniques, but \nshowed strong correlation and agreement. Recently published animal data \nsuggest that standard clinical techniques overestimate CO when compared to \ninvasive measurements, therefore further validation of 4D flow-based \nestimation of CO against invasive measurements are needed. \nLimitations: Application in healthy volunteers, no invasive correlation in this \nhealthy volunteers study. \nEthics Committee Approval: Approval number: 837.477.14 \nFunding for this study: Not applicable \nAuthor Disclosures: \nUwe Joseph Schoepf: Consultant at Bayer, Consultant at HeartFlow, \nConsultant at Guerbet, Consultant at Bracco, Consultant at Siemens \nHealthineers, Consultant at Elucid Bioimaging \nTilman Stephan Emrich: Speaker at Siemens Healthineers \nMoritz Christian Halfmann: Nothing to disclose \nAnton Kilburg: Nothing to disclose \nAmir Ese: Nothing to disclose \nKarl-Friedrich Kreitner: Nothing to disclose \nAkos Varga-Szemes: Research/Grant Support at Siemens Healthineers, \nConsultant at Elucid Bioimaging, Consultant at Bayer \n \nRPS 203-8 \nAutomated assessment of cardiac pathologies on cardiac MRI using T1-\nmapping and late gadolinium enhancement sequences with deep learning \n*C. E. von Schacky*, F. G. Gassert, S. Foreman, F. T. Gassert, J. S. Kirschke, \nK-L. Laugwitz, M. R. Makowski, J. Nadjiri; Munich/DE \n \nPurpose: A deep learning (DL) model that automatically detects cardiac \npathologies on cardiac MRI may help streamline diagnostic workflow. \nTherefore, the aim of this study was to develop a DL model to detect cardiac \npathologies on cardiac MRI using T1-mapping and late gadolinium phase \nsensitive inversion recovery (LGE) sequences. \nMethods or Background: Subjects in this retrospective study (n=200, age \n53.6 ± 19.9 years, 68 women) were either diagnosed with a cardiac pathology \n(n=137) including acute and chronic myocardial infarction, myocarditis, dilated \ncardiomyopathy, and hypertrophic cardiomyopathy, or classified as normal \n(n=63). Cardiac MR imaging included T1-mapping and LGE sequences. \nSubjects were split 65/15/20% for training, validation, and testing. The DL \nmodels were based on a pretrained DenseNet-161 and implemented in \nPyTorch. Performance was evaluated on the test set with sensitivity, specificity, \nand accuracy. Gradient-weighted class activation maps (Grad-CAMs) \nvisualized the decision-making process of the model. \nResults or Findings: On LGE images, the DL model achieved a sensitivity, \nspecificity, and accuracy of 100%, 38%, and 88%, respectively. On T1-\nmapping images, the DL model achieved a sensitivity, specificity, and accuracy \nof 78%, 54%, and 70%, respectively. Grad-CAMs demonstrated that the DL \nmodel focused on the myocardium and the cardiac pathology when evaluating \nan MR image. \nConclusion: The developed DL models were able to reliably detect cardiac \npathologies on cardiac MR images. The model that used T1-mapping images \nachieved an accuracy of 70%, while the model that used LGE images achieved \nan accuracy of 88%. The diagnostic performance of T1 mapping alone is \nparticularly of note since it does not require a contrast agent and can be \nacquired quickly. \nLimitations: No further characterization of the cardiac pathologies. \nEthics Committee Approval: The local ethics committee approved this \nretrospective study. \nFunding for this study: Supported by the Clinician Scientist Program at TUM. \nAuthor Disclosures: \nFlorian Tilman Gassert: Nothing to disclose \nClaudio E. von Schacky: Nothing to disclose \nJan S Kirschke: Nothing to disclose \nKarl-Ludwig Laugwitz: Nothing to disclose \nMarcus R. Makowski: Nothing to disclose \nFelix Gerhard Gassert: Nothing to disclose \nJonathan Nadjiri: Nothing to disclose \nSarah Foreman: Nothing to disclose \n \nLive Q&A \n \n18:00-19:00 CHANNEL 2 \nE³ - Advanced Courses: Neuro \nE³ 618 \nDemyelination potpourri or \"antibody-\nmediated autoimmunity\"? \nModerator \nTarek A. Yousry; London/UK  \n \nE³ 618-2 \nA. Circumventricular organs and neuromyelitis optica spectrum \ndisorders (NMOSD) \nMajda M. Thurnher; Vienna/AT  \n(majda.thurnher@meduniwien.ac.at) \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 42  \n \nLearning Objectives: \n1. To learn about circumventricular organs. \n2. To understand the imaging findings in NMOSD. \n3. To learn how to differentiate between demyelinating diseases. \n \nE³ 618-3 \nB. Multiple sclerosis (MS): views from the rooftop \nFrederik Barkhof; Amsterdam/NL \n \nLearning Objectives: \n1. To learn about the currently valid MS diagnostic criteria and how to use \nthem in clinical routine. \n2. To discuss the \"perfect\" MS protocol, including contrast use. \n3. To learn how and when to use artificial intelligence programs for MS. \n \nE³ 618-4 \nC. Acute disseminated encephalomyelitis (ADEM) and similar \nparainfectious syndromes \nAndrea Rossi; Genoa/IT \n(andrearossi@gaslini.org) \n \nLearning Objectives: \n1. To discuss the clinical background in ADEM and ADEM-related diseases. \n2. To learn the different imaging patterns in ADEM. \n3. To adopt the checklist for reporting in suspected ADEM. \nAuthor Disclosures: \nAndrea Rossi: Speaker: Telemedicine Clinic Academy \n \nLive Q&A \n \n18:00-19:00 CHANNEL 3 \nRefresher Course: Emergency Imaging \nRC 417 \nPenetrating injuries: understanding \nmechanisms and effects \nModerator \nMari T. Nummela; Helsinki/FI  \n \nRC 417-2 \nA. Penetrating injury: blades, bullets, and beyond \nNupur Verma; Gainesville, FL/US  \n \nLearning Objectives: \n1. To become familiar with knife/sharp object wounds and how to detect their \neffect on tissues. \n2. To understand the mechanism of injury at different velocities. \n3. To recognise the predictable and unpredictable trajectories of bullets and \nflying fragments within the body. \n \nRC 417-3 \nB. Penetrating injuries of the upper body: head, neck, chest, and upper \nlimbs \nKen Linnau; Seattle, WA/US \n(klinnau@u.washington.edu) \n \nLearning Objectives: \n1. To develop a systematic approach for reviewing the relevant structures in a \npatient with a surface wound. \n2. To recognise occult signs of penetrating injury. \n3. To learn how to help clinicians evaluate and re-evaluate a patient with a \npenetrating injury. \n \nRC 417-4 \nC. Penetrating injuries of the lower body: diaphragm, abdomen, pelvis, \nand lower limbs \nElizabeth Dick; London/UK \n \nLearning Objectives: \n1. To seek out constellations of obvious and occult injuries in pelvic penetrating \ntrauma, including neurovascular and perineal injuries. \n2. To become familiar with the spectrum of vascular injuries including active \nbleeding, pseudoaneurysms, dissection and thrombus formation, and \narteriovenous fistulas. \n3. To recognise where radiologists can add value and guide the surgical \napproach. \nAuthor Disclosures: \nElizabeth Dick: Speaker: Guerbet \n \nLive Q&A \n \n18:00-19:00 CHANNEL 4 \nResearch Presentation Session: \nInterventional Radiology \nRPS 109 \nImproving interventional radiology (IR) \nprocedure results through advanced \ntechnology \nModerator \nFrederic Deschamps; Villejuif/FR  \n \nRPS 109-2 \nMRI-guided percutaneous cryoablation of small renal masses: automated \n3D margin assessment using intraoperative MR-MR image fusion and \ncorrelation with local outcome \nN. S. de Jager¹, T. J. van Oostenbrugge¹, T. Paetz², S. F. M. Jenniskens¹, J. J. \nFutterer¹, H. F. Langenhuijsen¹, *C. G. Overduin*¹; ¹Nijmegen/NL, ²Bremen/DE  \n(kristian.overduin@radboudumc.nl) \n \nPurpose: To evaluate three-dimensional treatment margins of magnetic \nresonance imaging (MRI)-guided percutaneous cryoablation of small renal \nmasses (SRMs) and determine correlation with local outcome. \nMethods or Background: Retrospective analysis was performed on 31 \npatients who underwent percutaneous MRI-guided  cryoablation for 33 SRMs \n(size: 0.9-4.5 cm). Tumors and corresponding ice-ball volumes were \nsegmented on intraprocedural pre- and post-ablation MR images using \nSoftware Assistant for Interventional Radiology (SAFIR) software. After MRI-\nMRI co-registration, 3D ablation margins were automatically quantified. Minimal \nablation margin was defined as the smallest three-dimensional distance \nbetween the tumor and ice-ball surface, where negative values indicate \nincomplete coverage. Local tumor progression (LTP) after cryoablation was \nassessed on follow-up imaging. \nResults or Findings: Median follow-up was 16 months (range: 1-58). Local \ncontrol after cryoablation was achieved in 27 tumors (82%) and LTP occurred \nin 6 (18%) respectively. Minimal ablation margin was significantly smaller for \ncases with vs. without LTP (-6.9±3.5 vs. 2.6±1.7 mm, P<.001). No LTP was \nobserved in patients with a minimal margin >0 mm. Cases with LTP had \nsignificantly larger tumor diameters vs. those without LTP (4.1±0.5 vs. 2.9±0.9 \ncm, P=.003). All negative treatment margins occurred in tumors >3cm. No \nsignificant differences were found for other baseline parameters. \nConclusion: Minimal treatment margin appears a strong predictor of outcome \nafter MRI-guided cryoablation of SRMs. Radiologically complete coverage \n(smallest margin >0 mm) was associated with absence of local recurrence. \nIntraoperative use of automated 3D margin analysis can be a valuable tool in \npredicting therapy success during percutaneous renal cryoablation procedures. \nLimitations: Single-center retrospective study with limited sample size. \nEthics Committee Approval: This retrospective study was approved by the \nlocal IRB. Informed consent was waived. \nFunding for this study: None \nAuthor Disclosures: \nTim J. van Oostenbrugge: Nothing to disclose \nTorben Paetz: Nothing to disclose \nHans F. Langenhuijsen: Nothing to disclose \nChristiaan G Overduin: Nothing to disclose \nSjoerd Franciscus Maria Jenniskens: Nothing to disclose \nJurgen J. Futterer: Nothing to disclose \nDrs Nienke S. de Jager: Nothing to disclose \n \nRPS 109-3 \nMR-HIFU of uterine fibroids: intraprocedural visualization of the non-\nperfused volume with deep learning-based synthetic contrast-enhanced \nT1-weighted scans \n*J. D. J. Slotman*¹, L. W. Bartels², A. Zijlstra¹, J. van Osch¹, I. M. Nijholt¹, M. \nVan 'T Veer-Ten Kate¹, E. De Boer¹, R. d. van den Hoed¹, M. F. Boomsma¹; \n¹Zwolle/NL, ²Utrecht/NL \n(d.j.slotman@isala.nl) \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 43  \n \nPurpose: Gadolinium-free visualization of the non-perfused volume (NPV) \nafter MR-guided high intensity focused ultrasound (MR-HIFU) therapy of \nuterine fibroids, by synthesizing contrast-enhanced T1-weighted (CE-T1w) \nscans from diffusion weighted imaging (DWI) using deep learning. \nMethods or Background: BackgroundHitherto, there is still no method \navailable to intraprocedurally assess the NPV during MR-HIFU therapy for \nuterine fibroids, leading occasionally to unnecessarily long ablation procedures \nor sub-optimal treatment outcomes. Lack of the possibility to use a gadolinium-\nbased contrast agents between sonications inhibits intraprocedural evaluation \nof the NPV. Deep learning strategies could possibly allow gadolinium-free \nDWI-based imaging of the NPV. MethodsA deep learning image-to-image \ntranslator was trained on paired DWI/CE-T1w scans to generate synthetic CE-\nT1w scans that were validated on retrospective data. Four MR-HIFU \nradiologists independently and randomly assessed the technical success of the \nMR-HIFU procedure, based on the postprocedural synthetic and reference CE-\nT1w scan. Additionally, the radiologists were asked to estimate the NPV ratio \non both scans. \nResults or Findings: A total of 56 women were included with a paired DWI \nand CE-T1w scan acquired during screening, directly postprocedurally and \nafter 6 months follow-up. Absolute agreement between the synthetic and \nreference CE-T1w scans in assessment of technical success by radiologists \nwas 83%. No statistical differences were found between NPV ratio estimations \nbased on the synthetic and reference CE-T1w scans, and the true 3D \nmeasurements (p = 0.39). \nConclusion: Synthetic CE-T1w scans allow gadolinium-free visualization of \nthe NPV during or after MR-HIFU therapy. Ultimately, the use of these \nsynthetic CE-T1w scans may result in more efficient MR-HIFU treatments by \nshortening of procedure times and reducing the number of procedures with \nunsuccessful outcomes. \nLimitations: Retrospective analysis on prospectively acquired data. \nEthics Committee Approval: Local ethics committee approved this study. \nFunding for this study: None. \nAuthor Disclosures: \nMartijn F. Boomsma: Nothing to disclose \nErwin De Boer: Nothing to disclose \nJorik Derk Jan Slotman: Nothing to disclose \nRolf d. van den Hoed: Nothing to disclose \nAylene Zijlstra: Nothing to disclose \nLambertus W. Bartels: Nothing to disclose \nMiranda Van 'T Veer-Ten Kate: Nothing to disclose \nIngrid M. Nijholt: Nothing to disclose \nJochen van Osch: Nothing to disclose \n \nRPS 109-4 \nPredictive machine learning modelling of complication risk in CT-guided \nbiopsies: a prescription for improving procedure safety \n*E. J. M. Barbosa Jr.*, C. Murphy, H. Lee; Philadelphia, PA/US \n(eduardo.mortani@gmail.com) \n \nPurpose: CT guided transthoracic biopsy (CTTB) is a minimally invasive \nprocedure with demonstrated excellent diagnostic yield and low complication \nrate. We assessed a large CTTB cohort utilizing machine learning (ML) for \nprediction of procedural and patient factors associated with risk of \ncomplications. \nMethods or Background: We retrospectively identified 1487 CTTB patients in \na tertiary hospital (7-years interval), in this IRB approved investigation. We \ngathered and coded patient demographics, lesion location (lung, pleura, \nmediastinum, chest wall), type of biopsy (FNA vs core biopsy, with or without \nco-axial technique), number of passes, presence and severity of emphysema, \ndistance of aerated lung crossed, patient position on the table, whether the \nbiopsy side was dependent or not, and whether the needle approach was \ncloser to vertical or horizontal. Our outcomes were presence and severity \n(major, minor, none) of complications. Statistical analyses included univariate \nanalyses with chi-square, multivariate logistic regression (LR) and ML methods \nsuch as gradient boosted trees (GBT) and bootstrap random forest (BRF) with \ncross-validation. \nResults or Findings: Lung biopsies comprised 1249/1487 CTTBs. \nComplications occurred in 355/1487 (328/1487 minor, 26/1487 major); and \nincluded pneumothorax (261/1487), bleeding (92/1487) and air embolism \n(2/1487). Statistically significant predictors of complications were greater \ndistance of aerated lung crossed, needle approach vertical, number of passes \nand biopsy side non-dependent (FDR logworth 2.3 - 5.2), in this order. LR, \nGBT and RF accuracy ranged from 76% for risk of complications to 93% for \nprediction of major complications. \nConclusion: ML methods can not only accurately predict the likelihood of \nCTTB complications and their severity, but more importantly can identify that \ntechnical factors matter the most, while delineating specific factors, thereby \noffering a prescription to optimize procedural technique and patient safety. \nLimitations: Retrospective \nEthics Committee Approval: IRB approved \nFunding for this study: None \nAuthor Disclosures: \nEduardo Jose Mortani Barbosa Jr.: Research/Grant Support at Siemens, \nResearch Support, unrelated to this study \nHwan Lee: Nothing to disclose \nBA Christina Murphy: Nothing to disclose \n \nRPS 109-5 \nBiopsy and ablation percutaneous procedures on bone lesions: efficacy \nof an augmented reality navigation system compared to standard CT-\nguidance \n*G. Castiello*, E. Faiella, G. Pacella, C. Altomare, B. B. Beomonte Zobel, R. F. \nGrasso; Rome/IT \n(ge.castiello@gmail.com) \n \nPurpose: To assess the efficacy of an augmented reality navigation system \n(SIRIO) for percutaneous biopsies and ablative treatments of bone lesions. \nMethods or Background: Biopsy and ablation procedures of bone lesions \nwere retrospectively analyzed, comparing those performed using SIRIO with \nthose performed under common CT-guidance. Overall duration, number of CT \nscans and patient’s radiation dose were analyzed. In biopsy procedures, \nsensitivity and specificity were also analyzed. For all procedures the size of the \nlesions was evaluated, considering two classes according to a dimensional cut-\noff of 2 cm. Mann-Whitney U test was used for statistical analysis. \nResults or Findings: A total of 188 procedures on bone lesions were \nevaluated: 142 biopsies and 46 ablations. Of the biopsy procedures, 74 were \nperformed using SIRIO and 68 under standard CT-guidance; of the ablative \nprocedures 22 were performed using SIRIO and 24 under standard CT \nguidance. For biopsy procedures performed using SIRIO, we observed a \nsignificant reduction (p<0.05) in number of CT scans and radiation dose for \nboth size classes and a significant reduction in procedural duration for biopsies \nof lesions <2 cm. Biopsies under SIRIO guidance also showed a better \ndiagnostic efficacy. For ablations performed using SIRIO, we observed a \nsignificant reduction (p<0.05) in number of CT scans and in radiation dose for \nprocedures on lesions <2 cm. No complications were observed for biopsy \nprocedures; 3 cases of minor complications were observed for ablative \nprocedures under standard CT-guidance (12.5%). \nConclusion: SIRIO augmented reality navigation system is an effective tool to \nguide percutaneous biopsies and ablative treatments of bone lesions \ncompared to traditional CT-guidance methods. \nLimitations: n/a \nEthics Committee Approval: All methods and procedures were carried out \nfollowing the ethical standards of the institutional research committee and \ncomplied with the 1964 Helsinki declaration. \nFunding for this study: None \nAuthor Disclosures: \nGennaro Castiello: Nothing to disclose \nBruno Beomonte Beomonte Zobel: Nothing to disclose \nRosario Francesco Grasso: Nothing to disclose \nEliodoro Faiella: Nothing to disclose \nGiuseppina Pacella: Nothing to disclose \nCarlo Altomare: Nothing to disclose \n \nRPS 109-6 \nNon-invasive assessment of foot perfusion in a rabbit model of \natherosclerosis using dynamic volume perfusion CT with an upslope \nmethod \nS. Hur¹, *H. D. Min*², J. H. Lee², C. J. Yoon², W. S. Choi²; ¹Seoul/KR, \n²Seongnam-si/KR \n(hooney.min@gmail.com) \n \nPurpose: To evaluate the feasibility of non-invasively measuring foot perfusion \nusing dynamic volume perfusion CT with the upslope method in rabbit models \nof atherosclerosis. \nMethods or Background: New Zealand male rabbits were divided into two \ngroups: Dietary hypercholesterolemia induced atherosclerosis (n=10) and \nnormal diet control (n=20). A foot perfusion CT of the rabbit’s foot was \nperformed at baseline. After 5 minutes of rest, pressure cuff was applied to the \nleft thigh and inflated to 200 mmHg for 3 minutes. After cuff deflation, a second \nperfusion CT was scanned to assess perfusion response to hyperemia. A \ncolor-coded perfusion map was generated for each perfusion CT scan by using \nan in-house dedicated analysis software. The perfusion parameters of the left \nposterior tibial artery, plantar dermis and the ratio of dermal perfusion value \nbefore and after cuff-induced reactive hyperemia were analyzed. \nResults or Findings: There was no significant difference in the blood flow of \nplantar dermis between the atherosclerosis group and the control group at \nbaseline. Cuff-induced reactive hyperemia in healthy rabbits significantly \nincreased blood flow while atherosclerosis rabbits did not (ratio 0.97 vs. 1.69, \np<.001). \nConclusion: Foot perfusion CT not only provides a perfusion map of the foot \nbut also reveals impairment of reactive hyperemia in atherosclerosis rabbit \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 44  \nmodel. It may be a useful tool for quantitative and functional evaluation of \natherosclerotic peripheral arterial disease. \nLimitations: The study was limited in only measuring one areas of foot \nperfusion due to the small size of the rabbit feet and a single dominant artery in \nthe rabbit. \nEthics Committee Approval: The study was approved by the Institutional \nAnimal Care and Use Committee of Seoul National University Hospital. \nFunding for this study: The work was supported by Korea Health Technology \nR&D Project [HI18C0493] funded by the Ministry of Health & Welfare. \nAuthor Disclosures: \nJae Hwan Lee: Nothing to disclose \nWon Seok Choi: Nothing to disclose \nHooney D Min: Nothing to disclose \nChang Jin Yoon: Nothing to disclose \nSaebeom Hur: Nothing to disclose \n \nRPS 109-7 \nTargeting the Achilles' heel of C-arm computed tomography in \ntransarterial chemoembolization: evaluation of a novel motion correction \nalgorithm \n*L. S. Becker*, M. Gutberlet, S. K. Maschke, T. Werncke, C. Dewald, \nC. von Falck, B. C. Meyer, F. Wacker, J. B. Hinrichs; Hannover/DE \n \nPurpose: Evaluation of feasibility and impact on image quality of a motion \ncorrection 3D-reconstruction prototype technique for C-arm CT(CACT) during \ntransarterial chemoembolization(TACE). \nMethods or Background: We included 65 consecutive CACTs acquired \nduring TACE in 54 patients(47m,7 f; 67±11.3 years) from 01/2019-12/2019. All \noriginal CACT raw datasets (CACT_Org) underwent reconstruction with and \nwithout a prototype 3D-image reconstruction software to compensate for \nmotion (CACT_MC_bone), additional volume punching of high-contrast objects \nlike bones was performed(CACT_MC_no bone). Objective(image sharpness \nmetric) and subjective criteria were used to evaluate image quality. Subjective \ncriteria (3-point scale i and ii; 2-point scale iii-v) were assessed by two \nindependent readers: i)vessel geometry, ii)overall image quality(IQ), \niii)delineation of tumor feeders, iv)presence of foreign material induced \nartifacts, v)need for additional imaging. Friedman rank sum test and post-hoc \nanalysis using pairwise Wilcoxon signed-rank test were computed. Inter-\nobserver agreement was analysed using Cohen´s kappa. \nResults or Findings: Objective IQ as defined by an objective image \nsharpness metric, increased from 273.5±28 (CACTOrg) to 328.5±55.1 \n(CACTMC_bone) and 331±57.8 (CACTMC_no bone; all p<0.0001). These \nresults could largely be confirmed by the subjective analysis, which \ndemonstrated predominantly good and moderate inter-observer agreement, \nwith best agreement for CACTMC_no bone in all categories (e.g. vessel \ngeometry: CACT_Org=0.51, CACT_MC_bone=0.42, CACT_MC_no \nbone=0.69). \nConclusion: Application of a motion correction algorithm was feasible for all \ndata sets and led to a significant increase of both objective and subjective \nimage quality parameters, offering the opportunity to improve diagnostic work-\nup during TACE procedures. \nLimitations: Retrospective study at single center, manual bone segmentation \nEthics Committee Approval: Waived (retrospective) \nFunding for this study: None \nAuthor Disclosures: \nMarcel Gutberlet: Nothing to disclose \nBernhard C Meyer: Nothing to disclose \nChristian von Falck: Nothing to disclose \nCornelia Dewald: Nothing to disclose \nSabine Katharina Maschke: Nothing to disclose \nLena Sophie Becker: Nothing to disclose \nThomas Werncke: Nothing to disclose \nFrank Wacker: Nothing to disclose \nJan B Hinrichs: Nothing to disclose \n \nLive Q&A \n \n18:00-19:30 CHANNEL 5 \nHealthcare Professionals in Focus \nIF 1 \nResilient individuals: from chronic stress \nand burnout to happy, healthy, and \nresilient \n \nModerator \nM.G. Myriam Hunink; Rotterdam/NL  \n \nIF 1-2 \nFrom Big Bang to burnout \nWitte Hoogendijk; Rotterdam/NL  \n(w.hoogendijk@erasmusmc.nl) \n \nLearning Objectives: \n1. To understand how we are not adapted to the stressors of modern life. \n2. To appreciate the increase in chronic stress among healthcare providers \ndue to the pandemic. \n \nIF 1-3 \nStaying healthy, happy, and resilient during the pandemic \nColin P. West; Rochester, MN/US \n(West.Colin@mayo.edu) \n \nLearning Objectives: \n1. To appreciate the prevalence of chronic stress and burnout among \nhealthcare professionals. \n2. To understand what causes chronic stress and burnout. \n3. To appreciate the effect of the pandemic on levels of stress, anxiety, \ndepression, and burnout. \n4. To understand what you can do as an individual to become and stay \nhealthy, happy, and resilient. \n \nLive Q&A: Interventions at the individual level that cultivate resilience \nand well-being \nwith the participation of: Markus F. Berger; Nottwil/CH \n \n19:45-20:45 CHANNEL 2 \nSpecial Focus Session \nSF 1 \nMy three top tips for CT evaluation of lung \nparenchyma \nModerator \nAnagha P. Parkar; Bergen/NO  \n \nSF 1-2 \nHow to differentiate cystic diseases from emphysema \nPeter Beddy; Dublin/IE  \n \nLearning Objectives: \n1. To know what is normal aging. \n2. To understand the CT imaging criteria of emphysema. \n3. To know what defines a lung cyst. \n \nSF 1-3 \nHow to differentiate honeycombing from paraseptal emphysema \nJohny A. Verschakelen; Leuven/BE \n(johny.verschakelen@uz.kuleuven.ac.be) \n \nLearning Objectives: \n1. To understand the CT definition of paraseptal emphysema. \n2. To learn the definition of honey combing. \n3. To know the significance recognising honey combing. \n \nSF 1-4 \nHow to differentiate the main cystic diseases from one another \nAnastasia Oikonomou; Toronto, ON/CA \n(anastasia.oikonomou@sunnybrook.ca) \n \nLearning Objectives: \n1. To recognise the patterns of the commonest cystic lung diseases. \n2. To recognise the rarer diseases. \n3. To learn about the prevalence of the various diseases. \n \nSF 1-5 \nHow to differentiate bronchial dilatation from bronchiectasies \nHelmut Prosch; Vienna/AT \n \n \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 45  \nLearning Objectives: \n1. To learn the definition of bronchial dilatation. \n2. To learn the definition of bronchiectasies \n3. To learn what to report or recommend when there is uncertainty. \n \nSF 1-6 \nHow to differentiate solid from subsolid nodules \nFelix Doellinger; Berlin/DE \n(felix.doellinger@charite.de) \n \nLearning Objectives: \n1. To learn the definition and CT imaging criteria of solid nodules. \n2. To learn the definition and CT imaging criteria of subsolid nodules. \n3. To learn the difference in follow up of the nodules. \n \nSF 1-7 \nHow to differentiate intralobular and interlobular lines \nThomas Frauenfelder; Zurich/CH \n \nLearning Objectives: \n1. To learn the definition and CT imaging criteria of intralobular lines. \n2. To learn the definition and CT imaging criteria of interlobular lines. \n3. To understand why it is important to recognise these patterns. \n \nSF 1-8 \nHow to differentiate centrilobular and septal nodules \nCarole Ridge; Dublin/IE \n(caroleridge@hotmail.com) \n \nLearning Objectives: \n1. To learn the definition and CT imaging criteria of centrilobular nodules. \n2. To learn the definition and CT imaging criteria of septal nodules. \n3. To understand why it is important to recognise these patterns. \n \nSF 1-9 \nHow to differentiate ground glass from mosaic attenuation \nMarie-Pierre Revel; Paris/FR \n \nLearning Objectives: \n1. To learn the definition and CT imaging criteria of ground glass opacities. \n2. To learn the definition and CT imaging criteria of mosaic attenuation. \n3. To understand why it is important to recognise these patterns. \n \nLive Q&A \n \n19:45-20:45 CHANNEL 3 \nResearch Presentation Session: Head and \nNeck \nRPS 108 \nHead and neck emergencies and oncology \nModerator \nElizabeth Loney; Halifax/UK  \n \nRPS 108-2 \nClinical and prognostic significance of emergency MRI findings in neck \ninfections \n*J. Heikkinen*, J. Nurminen, J. Velhonoja, H. Irjala, T. Happonen, T. Soukka, \nK. Mattila, J. Hirvonen; Turku/FI  \n(jaheik4@gmail.com) \n \nPurpose: Due to superior soft-tissue contrast and ability to delineate \nabscesses, MRI has superior diagnostic accuracy in neck infections. We \nsought to determine the clinical and \nprognostic significance of various MRI findings, focusing on specific edema \npatterns. \nMethods or Background: We retrospectively reviewed imaging of 371 \npatients with clinically confirmed neck infection usingMRI scans performed with \na 3 Tesla MRI device during five years in a tertiary emergency \nradiologydepartment. We correlated various MRI findings, including \nretropharyngeal (RPE) and mediastinal edema (ME) and abscess diameter, to \nclinical findings and outcomes, such as the need for intensive care unit (ICU) \ntreatment and length of hospital stay (LOS). \nResults or Findings: 202 out of 371 patients (54%) with neck infection \nshowed evidence of RPE, and 81 out of 314 \npatients (26%) had ME. Both RPE (OR=7.9, p<0.001) and ME (OR=5.0, \np<0.001) were more prevalent in patients who required ICU treatment than in \nthose who did not. In a multivariate analysis, both RPE (p=0.004) and ME \n(p=0.014) predicted the need for ICU treatment, as well as maximal abscess \ndiameter (p<0.001) in patients with abscess. Presence of ME (p=0.001) and \nmaximal abscess diameter (p<0.001) were significant predictors of LOS. Even \nin patients with low CRP (<100 mg/L), RPE and ME predicted ICU irrespective \nof CRP. \nConclusion: In patients with neck infection, RPE, ME, and abscess diameter, \nas shown by emergency MRI \nare significant predictors of more severe disease. These specific edema \npatterns represent reactive non-suppurative edema. This prognostic value \nsupports the use of emergency MRI in patients with suspected neck infection. \nLimitations: One limitation is the retrospective nature of the study despite the \nlarge sample size. \nEthics Committee Approval: Permission from the hospital district board \nFunding for this study: Sigrid Juselius Foundation \nAuthor Disclosures: \nTero Soukka: Nothing to disclose \nTatu Happonen: Nothing to disclose \nJaakko Heikkinen: Nothing to disclose \nJarno Velhonoja: Nothing to disclose \nJussi Hirvonen: Nothing to disclose \nKimmo Mattila: Nothing to disclose \nHeikki Irjala: Nothing to disclose \nJanne Nurminen: Nothing to disclose \n \nRPS 108-3 \nPitfalls and normal PET-CT variants in head and neck oncology \n*L. d. A. Defendi*, R. Marques, L. Bezerra, M. M. Ouchar Sabino, L. Bisolo, H. \nTames, R. M. Loureiro, R. L. E. Gomes; São Paulo/BR \n(lariad@gmail.com) \n \nPurpose: Elucidate the current indications of Positron emission tomography \n(PET) with 2-[fluorine-18] fluoro-2-deoxy-D-glucose (FDG) in head and neck \ncancer; Review the technical aspects and recommendation of FDG-PET CT \nevaluation; Demonstrate false positive and false negative pitfalls of FDG-PET \nCT in oncology, as well as the most common artifacts that may be a confusing \nfactor. \nMethods or Background: Positron emission tomography (PET) with FDG is \nan effective tool in the diagnosis, staging, and follow-up of head and neck \ncancer. Nonetheless, the variable physiologic FDG uptake and distribution in \nthe neck, as well as inflammatory conditions and surgical changes can lead to \nmisinterpretation, especially in pos-treatment scenario. \nResults or Findings: Teaching cases will be used to illustrate the following \ntopics: \n1. PET-FDG Protocols and Recommendations \n2. False-positive Pitfalls: \n- Physiologic FDG uptake (Waldeyer’s ring and salivary glands; \nsternocleidomastoid, extra-ocular and mastication muscles; vocal cords; brown \nadipose tissue) \n- Benign conditions (thyroid nodules; Warthin tumor)  \n- Inflammatory or infectious FDG uptake (odontogenic sinusitis; \nsternoclavicular joint arthritis; calcified atherosclerotic plaques; rhinophyma; \ninjected facial fillers) \n- Postradiation changes \n- Postsurgical changes (unilateral cranial nerve palsy)  \n3. False-negative Pitfalls: \n- Lesion proximity to high metabolic areas; \n- Usual tumor presentation with low FDG uptake; \n- Necrotic lymph nodes. \n4. Artifacts \n- Dental hardware \nConclusion: Radiologists must be aware of the physiologic variations and \npitfalls in PET imaging analysis as well as pathophysiological mechanisms \nleading to potentially false-positive and false-negative assessments in head \nand neck cancer. \nLimitations: Education Exhibit \nEthics Committee Approval: Education Exhibit \nFunding for this study: No funding available \nAuthor Disclosures: \nLorena Bezerra: Nothing to disclose \nRafael Maffei Loureiro: Nothing to disclose \nLarissa de Andrade Defendi: Nothing to disclose \nHugo Tames: Nothing to disclose \nLouise Bisolo: Nothing to disclose \nMilena Maria Ouchar Sabino: Nothing to disclose \nRodrigo Marques: Nothing to disclose \nRegina Lúcia Elia Gomes: Nothing to disclose \n \n \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 46  \nRPS 108-4 \nQuantitative assessment of grade of sinonasal masses using apparent \ndiffusion coefficient values \n*V. S. Arunachalam*, S. Sharma, P. Sharma, P. Sherwani, U. Chauhan, M. \nTayal; Rishikesh/IN \n(drvenkat07@gmail.com) \n \nPurpose: The advent of widespread availability of advanced cross-sectional \nimaging has reignited the quest for objective non-invasive characterization of \nSinonasal malignancies. Aim: To compare the exponential(eADC) and true \napparent diffusion coefficient(ADC) values of high and low grade sinonasal \nneoplasms and identify imaging markers for quantitative assessment. \nMethods or Background: A retrospective observational study was conducted \nat our institute. A systematic search of case records was done in hospital \ninformation system using the keyword “sinonasal neoplasm” which yielded 54 \npatients over the period March, 2019 till June, 2020. Based on morphological \nimaging features, they were categorized as high and low grade sinonasal \nneoplasms. eADC and true ADC values were recorded from solid portions of \ntumour at three representative locations and average values calculated. \nResults or Findings: 66%(36) of the patients were males. Tumour \nheterogeneity on conventional images, susceptibility artifacts as well as \nheterogeneous contrast enhancement favoured categorization as high grade \ntumour. Average exponential ADC values of high and low grade sinonasal \nneoplasms were 0.471 and 0.287 respectively. Average True ADC values of \nhigh and low grade gliomas were 0.891 and 1.363*10(-3) respectively. \nIncreased cellularity of high grade lesions have contributed to lower ADC \nvalues. Heterogeneity due to necrosis, haemorrhage and calcification may be \nconfounding factors that have contributed to relatively higher eADC values. \nHistological correlation was done. \nConclusion: Comprehensive objective expression of tumour characteristics \nusing perfusion parameters, diffusion variables and quantitative susceptibility \nmapping values will provide an insight into understanding the molecular basis \nof carcinogenesis and predict biological behaviour. \nLimitations: 1) Single centre cross-sectional study. \n2) Changes in ADC values after treatment were not recorded. \nEthics Committee Approval: Yes \nFunding for this study: None \nAuthor Disclosures: \nMohit Tayal: Nothing to disclose \nUdit Chauhan: Nothing to disclose \nVenkata Subbaih Arunachalam: Nothing to disclose \nPoonam Sherwani: Nothing to disclose \nSmily Sharma: Nothing to disclose \nPankaj Sharma: Nothing to disclose \n \nRPS 108-5 \nFrailty is related to radiological sarcopenia and the occurrence of post-\noperative complications in cutaneous head and neck cancer patients \n*A. T. Zwart*, L. Kok, M. van Kester, R. Dierckx, G. de Bock, A. Van Der \nHoorn, G. Halmos; Groningen/NL \n(a.t.zwart@umcg.nl) \n \nPurpose: Radiological sarcopenia, or low quantity of skeletal muscle mass, is \nan important predictor for adverse clinical outcomes in mucosal head and neck \ncancer (HNC) patients, and so seems frailty. The aim was to analyse whether \nfrailty and skeletal muscle mass are related, and to analyse their impact on the \noccurrence of post-operative complications in a cutaneous HNC (cHNC) \npopulation. \nMethods or Background: cHNC patients with primary surgical treatment and \nCT or MRI neck imaging were included. The association between frailty, as \nmeasured with frailty indicators and a geriatric assessment, and skeletal \nmuscle mass was analysed with a logistic and linear regression analyses with \nrespectively radiological sarcopenia and skeletal muscle index (SMI) as \ndependent variables. To evaluate the impact of skeletal muscle mass on the \noccurrence of any-postoperative complications, also logistic regression \nanalysis was performed. Analyses were adjusted for relevant baseline \nassessments. \nResults or Findings: Fifty-seven patients were included with a mean age of \n77.1 (±9.0) years. Prevalence of radiological sarcopenia was 29.8% (n=17). \nThe G8 frailty indicator (OR 7.68, 95% CI 1.19–49.66, p=0.032), and medium \nto high malnutrition risk (OR 9.55, 95%CI 1.19–76.94), p=0.034) were \nindependently related to radiological sarcopenia. None of the frailty indicators \nor geriatric domains were related to SMI. The G8 frailty indicator (OR 6.56, \n95%CI 1.37–31.46, p=0.019) was an independent predictor for any-\npostoperative complications. \nConclusion: The G8 frailty indicator is related to radiological sarcopenia and \nthe occurrence of post-operative complications in cHNC patients. \nLimitations: Relatively small sample size. \nEthics Committee Approval: Patients were included after written informed \nconsent in the IRB approved OncoLifeS databiobank. Anonymized data were \nprovided in a protected environment. \nFunding for this study: The first author was awarded with a 3-years-PhD \nscholarship for excellent master students from the Graduate School of Medical \nSciences of the University of Groningen. \nAuthor Disclosures: \nGeertruida de Bock: Nothing to disclose \nLaurence Kok: Nothing to disclose \nAniek Thea Zwart: Nothing to disclose \nGyorgy Halmos: Nothing to disclose \nRudi Dierckx: Nothing to disclose \nAnouk Van Der Hoorn: Nothing to disclose \nMarloes van Kester: Nothing to disclose \n \nRPS 108-7 \nLaryngeal fractures patterns and associated soft tissue abnormality \n*K. Buch*, K. Takumi, H. Curtin, O. Sakai; Boston, MA/US \n(kbuch@partners.org) \n \nPurpose: Acute traumatic injuries to the larynx including fractures of the hyoid \nbone, cricoid and thyroid cartilage are uncommon injuries. The purpose of this \nstudy was to assess fracture and soft tissue patterns associated with laryngeal \ntrauma. \nMethods or Background: This was a retrospective review of patients with \nlaryngeal fractures who presented to two level I trauma centers and underwent \nCT imaging. Imaging findings including fractures of the cartilaginous structures \nof the larynx and hyoid bone, and soft tissue abnormalities including focal \nhematoma, edema with non-focal hemorrhage, and additional penetrating \ninjuries were recorded. Frequencies of fracture patterns were recorded. \nResults or Findings: Thyroid cartilage fractures were most frequently \nobserved occurring in 45/55 patients, cricoid fractures in 13/55 patients and \nhyoid fractures in 8/55 patients. Multi-site fractures were observed in 12/55 \npatients with thyroid-cricoid fractures occurring in 8/12 patients followed by \nthyroid-hyoid fractures in 2/12 patients. Most multi-site fractures occurred with \nfocal supraglottic hematomas (10/12), supraglottic edema and non-focal \nhemorrhage (11/12), and focal subglottic hematoma (5/12). All 13 cricoid \nfractures occurred with either focal supraglottic hematoma (7), focal subglottic \nhematoma (4), or edema with non-focal hemorrhage (13). \nConclusion: Thyroid cartilage fractures were the most frequently encountered \nfracture followed by cricoid cartilage fractures. Cricoid fractures always \noccurred with soft tissue abnormalities. Recognition of fracture patterns in the \nsetting of laryngeal trauma and associated patterns of soft tissue injury is \nimportant for practicing radiologists for early diagnosis of these conditions and \nreduction of associated morbidity. \nLimitations: This study has several limitations including relatively small \nsample size, retrospective study design, and lack of clinical followup for several \npatients. \nEthics Committee Approval: This study was approved by our institution's \nreview board \nFunding for this study: None \nAuthor Disclosures: \nKoji Takumi: Nothing to disclose \nKaren Buch: Nothing to disclose \nHugh Curtin: Nothing to disclose \nOsamu Sakai: Nothing to disclose \n \nRPS 108-9 \nɋomprehensive ɋT data analysis in midface trauma \n*O. Pavlova*, N. S. Serova, D. Davydov, S. K. Ternovoy; Moscow/RU \n \nPurpose: To assess the main criteria for comprehensive ɋT data analysis in \nmidface trauma. \nMethods or Background: A total of 115 patients with midface trauma (100%) \nwere admitted to the hospital in 24-48 hours after the injury. CT was performed \nusing Canon Aquilion One 640, CT data processing was performed using \nworkstation Vitrea Core. The examined criteria of CT data analysis included \norbital and sinuses volume measurements, evaluation of inferior orbital wall \ndefects, analysis of globe position and assessment of intraorbital and face soft \ntissue density. \nResults or Findings: Developed criteria for CT data analysis allowed to reveal \nadditional traumatic increased orbital volume in 22 patients (19%); additional \nenophthalmos in 9 patients (8%); determination of 4 types of inferior orbital wall \ndefects: small inferior orbital defects (n=19; 17%), moderate defects (n=33; \n29%), severe defects (n=40; 35%) and total defects (n=22; 19%); assessment \nof intraorbital and face soft tissue density: oedema (n=64; 56%), haematoma \n(n=10; 9%), atrophy (n=31; 27%), no changes (n=9; 8%), ɪ<.001. \nConclusion: The developed criteria for CT data analysis such as orbital and \nsinus volume measurements, inferior orbital wall defects evaluation, analysis of \nglobe position and assessment of intraorbital and face soft tissue density \nstatistically significantly increased the efficiency of diagnostics in midface \ntrauma in order to define the correct treatment tactics. \nLimitations: No \nEthics Committee Approval: Yes \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 47  \nFunding for this study: No \nAuthor Disclosures: \nSergey K Ternovoy: Nothing to disclose \nDmitry Davydov: Nothing to disclose \nNatalya S Serova: Nothing to disclose \nOlga Pavlova: Nothing to disclose \n \nLive Q&A \n \n19:45-20:45 CHANNEL 4 \nTransatlantic Course of ESR and RSNA \n(Radiological Society of North America): \nStroke Imaging and Endovascular \nTreatment: Now and the Future \nTC 228 \nPractical stroke imaging and mimics \nModerators \nJean-Pierre Pruvo; Lille/FR  \nAchala Vagal; Cincinnati, OH/US  \n \nTC 228-3 \nA. Stroke mimics and \"chameleons\": how to recognise them \nDidier Leys; Lille/FR \n \nLearning Objectives: \n1. To learn about the definitions of stroke mimics and chameleons. \n2. To understand the clinical challenges of stroke mimics. \n3. To become familiar with the imaging signs and differential diagnosis of \nstroke mimics \n \nTC 228-4 \nB. Practical review of stroke imaging and triage: within six hours and \nbeyond including wake-up strokes \nLotfi Hacein-Bey; Sacramento, CA/US \n(lhaceinbey@yahoo.com) \n \nLearning Objectives: \n1. To learn about optimal patient triage in acute ischaemic stroke in early and \ndelayed time windows. \n2. To understand stroke imaging in wake-up strokes and unknown onset time. \n3. To appreciate the importance of efficient workup and time metrics. \n \nTC 228-5 \nC. Interactive case presentation \n*Lotfi Hacein-Bey*; Sacramento, CA/US, Didier Leys; Lille/FR \n(lhaceinbey@yahoo.com) \n \nLearning Objectives: \n1. To learn how imaging can help in decision making in acute stroke. \n2. To consolidate the knowledge gained from the session with interactive \ncases. \n \nLive Q&A \n \n19:45-20:45 CHANNEL 5 \nResearch Presentation Session: Paediatric \nRPS 112 \nEvaluating new imaging techniques for \nchildren \nModerator \nOla Kvist; Stockholm/SE  \n \n \n \n \n \nRPS 112-2 \nFully-automated segmentation of neuroblastic tumours on multi-\nsequence MRI using convolutional neural networks \n*L. Cerda Alberich*, L. Marti-Bonmati; Valencia/ES  \n(leogibi230@gmail.com) \n \nPurpose: In this study, we proposed an automated method based on \nconvolutional neural networks (CNNs) for segmentation of neuroblastic \ntumours on multi-sequence magnetic resonance imaging (MRI). \nMethods or Background: T1-weighted (T1W), T2-weighted (T2W) and \nDiffusion-weighted (DW) MRI images were collected from 127 neuroblastoma \npatients from three different European hospitals. We developed a multi-\nparametric and multi-planar U-net and trained the network based on the two-\ndimensional multi-sequence MRI images in the training dataset. In order to \njustify the effectiveness of multi-sequence MRI images, we performed an \nexperiment with different inputs in a subset of randomly selected patients. We \nevaluated the model's performance by using a 5-fold cross-validation strategy \nand compared the results with other state-of-the-art solutions. \nResults or Findings: The Dice similarity coefficient (DSC) values of the \nmethod using only T1W, only T2W, only DW and a multi-sequence approach of \n5-fold cross-validation as different inputs were 0.732±0.064, 0.745±0.118, \n0.786±0.077 and 0.841±0.038, respectively. The average DSC of the internal \nvalidation using the multi-sequence strategy was 0.830. \nConclusion: To summarize, we successfully proposed a fully automatic \nsegmentation method of neuroblastic tumours based on CNNs and multi-\nsequence MRI images with accurate and stable performance. If further \nvalidated, our proposed method would be of use in clinical practice for \nmanagement of neuroblastoma cancer. \nLimitations: Future work with a lager sample would be necessary to further \nvalidate our model. In addition, the co-registration of T1W, T2W and DW \nimages is still challenging. A method to overcome this limitation may be \nproposed in future work. \nEthics Committee Approval: The study was approved by all the \ncorresponding Hospital's Ethics Committees. \nFunding for this study: PRIMAGE (PRedictive In-silico Multiscale Analytics to \nsupport cancer personalized diaGnosis and prognosis, empowered by imaging \nbiomarkers). Horizon 2020 | RIA (Topic SC1-DTH-07-2018) project with grant \nagreement no: 826494. \nAuthor Disclosures: \nLuis Marti-Bonmati: Nothing to disclose \nLeonor Cerda Alberich: Nothing to disclose \n \nRPS 112-6 \nCBF in term and preterm neonates: a pCASL study \n*E. Piccirilli*, V. Panara, M. Treddenti, V. Maruotti, M. Colasurdo, M. Caulo; \nChieti/IT \n(ele.piccirilli@gmail.com) \n \nPurpose: The aims of our study were to evaluate CBF using pCASL in \ndifferent brain regions in newborn babies of different gestational ages (GA) and \nhow GA affects CBF. \nMethods or Background: Brain MRI of 106 consecutive preterm and term \nneonates were included. The neonates were divided into 4 categories \naccording to their GA. A standardized elliptic ROI was manually placed on the \ncerebral perfusion maps in the cortex of the frontal (F), parietal (P) and \noccipital (O) lobe, in the thalamus (T) and in the cerebellum (C) of each \nhemisphere, using the T2 sequence as anatomical reference. A two-sample t-\ntest was applied to evaluate differences in CBF of each homologous ROI \nbetween hemispheres. Differences in CBF among ROIs (F, P, O, T and C) \nwere assessed with One-way ANOVA. Pearson's correlation coefficient was \ncalculated to evaluate the relationship between GA and mean CBF. Statistical \nanalysis was performed with IBM SPSS Statistics (p<0.05). \nResults or Findings: No significant hemispheric differences in CBF were \nobserved (p=0.3). There were significant differences in CBF between F and P \n(p=.009), F and T (p<0.05), P and T (p<0.05), P and C (p=0.046) and O and T \n(p<0.05). A significant correlation between GA and CBF was observed, with \noverall CBF increasing with GA (r=0.2, p=0.01). \nConclusion: We demonstrated differences in CBF values among different \ncerebral grey matter regions in newborns, independently of their GA. The T \nwas the region with the highest CBF, both in term and preterm neonates. \nMoreover, we demonstrated in vivo and non-invasively a significant correlation \nbetween CBF and GA. \nLimitations: Manual ROIs, which potentially included white matter as well. \nRetrospective study. \nEthics Committee Approval: Study approved by the Ethics Committee of our \nUniversity \nFunding for this study: No funding was received for this work \n \n \n \n \n \n\n \n \nThursday \n \nA \n/LYH\u00033URJUDPPH\u0003\n \nB C 48  \nAuthor Disclosures: \nValerio Maruotti: Nothing to disclose \nMauro Treddenti: Nothing to disclose \nEleonora Piccirilli: Nothing to disclose \nMarco Colasurdo: Nothing to disclose \nValentina Panara: Nothing to disclose \nMassimo Caulo: Nothing to disclose \n \nRPS 112-7 \nRAVE-T2/T1: feasibility of a new hybrid MR-sequence for free-breathing \nabdominal MRI in children and adolescents \n*K. Glutig*¹, F. H. Prüfer², K. T. Block³, H-J. Mentzel¹, M. M. Obmann²; \n¹Jena/DE, ²Basel/CH, ³New York, NY/US \n \nPurpose: To evaluate the feasibility of a RAVE-T2/T1 hybrid sequence for \nfree-breathing MRI of the abdomen in pediatric patients. \nThis is a modern three-dimensional radial sequence with fat saturation and \nblood flow suppression. During one measurement T2- and T1-weighted \ncontrasts are obtained in identical slice position. \nMethods or Background: 15 MRIs of children (age 4 weeks-18years) on a 3-\nT System (Skyra, Siemens) were retrospectivly reviewed. All patients \nunderwent standard axial T1 DIXON (4,06/1,24 TR/TE, 9° flip angle, TA 11 \nsec), T2 HASTE FS (1000/96 TR/TE, 130° flip angle, TA 85 sec) and RAVE-\nT2/T1 (1200 TR, 133 and 1,44 TE, 90/120° and 12° flip angle, TA 483 sec) of \nthe upper abdomen. MRI studies were analyzed by two pediatric radiologists \nusing a five-point Likert scale in five different categories: overall image quality, \nrespiratory motion artefacts, clarity of portal vein wall delineation, sharpness of \nhepatic margin and quality of fat suppression. Wilcoxon signed-rank test and \nsum scores of T1 and T2 sequences were used for evaluation. \nResults or Findings: The T2 weighted part of the RAVE-T2/T1 sequence was \nsignificantly better than the standard T2 HASTE sequence in all image quality \ncategories: overall image quality (2.17±0.7 vs 1.77±0,7), respiratory motion \nartefacts (3.83±0.4 vs 2.03±0.7), portal vein clarity (3.25±0.8 vs 2.23±0.7), \nhepatic margin sharpness (2.43±1,0 vs 1.8±0.7). There was no significant \ndifference in image quality for the T1 weighted sequences (for all p>0.05). \nConclusion: Abdominal MRI with new radial RAVE-T2/T1 hybrid sequence \nshowed higher image quality compared to a standard T2 HASTE sequence \nand equivalent image quality compared to a T1 DIXON sequence. The RAVE-\nT2/T1 hybrid sequence may be a good tool for pediatric abdominal imaging, \nparticularly for children with lung diseases due to the free breathing acquisition. \nLimitations: Not required. \nEthics Committee Approval: None \nFunding for this study: None \nAuthor Disclosures: \nKai Tobias Block: Nothing to disclose \nMarkus Obmann: Nothing to disclose \nHans-Joachim Mentzel: Nothing to disclose \nKatja Glutig: Nothing to disclose \nFriederike Helene Prüfer: Nothing to disclose \n \nRPS 112-8 \nQuantitative analysis of the effect of dose reduction on image metrics in \n18F-FDG PET/MRI in paediatric oncology \nU. Aydos, E. Balcı, S. Gülbahar Ate ú, U. O. Akdemir, *L. O. Atay*; Ankara/TR \n(l.ozlem.atay@gmail.com) \n \nPurpose: To evaluate the effect of reduced injected tracer activities on the \nquantitative image parameters of whole body 18F-FDG PET/MRI imaging in \npaediatric patients. \nMethods or Background: 77 oncological 18F-FDG PET/MRI examinations \nwere performed on 54 paediatric patients (standart injected activity: 1/2-dose \n[1.9 MBq/kg] and standart PET scan duration: 5 min per bed position). Lower \nactivity PET images (1/3-dose [1.2 MBq/kg] and 1/4-dose [0.9 MBq/kg]) were \nretrospectively simulated from the originally acquired list-mode data sets by \ndecreasing the count statistics. Objective quantitative parameters were \nassessed by measuring the SUVmax, SUVmean, SUVvar, SUVpeak, signal-to-\nnoise ratio (SNR) and contrast-to-noise ratios (CNR) in each PET data set. \nDifferences in quantitative parameters of simulated data sets were recorded as \nrelative percentage changes compared to the original data. \nResults or Findings: SNRs were found as significantly different among PET \ndata sets (p < 0.001) and showed gradually increasing image noise with \ndecreasing doses. CNRmax and CNRmin values did not show any significant \ndifferences among PET data sets (p = 0.152 and p = 0.259, respectively). In \nphysiologic organs, compared to original data set, mean relative deviations of \nSUVmax was below 10% and of SUVmean was below 1% at 1/3-dose data \nset. In FDG-avid lesions, compared to original data, the mean relative \ndeviations of SUVmean, SUVvar and SUVpeak were below 2% and of \nSUVmax was below 3% at 1/3-dose images. The relative deviations of \nSUVmax and SUVmean reached levels above 4% and 3% respectively and of \nSUVpeak reached levels up to above 9% at 1/4-dose images. \nConclusion: Our analysis showed that the reduction of injected activity to 1.2 \nMBq/kg can be feasible in paediatric oncologic PET/MRI, with a small relative \npercentage change in quantitative parameters. \nLimitations: Low activity images were simulated retrospectively. \nEthics Committee Approval: Yes \nFunding for this study: No \nAuthor Disclosures: \nUmit Ozgur Akdemir: Nothing to disclose \nErdem Balcı: Nothing to disclose \nLutfiye Ozlem Atay: Nothing to disclose \nUguray Aydos: Nothing to disclose \nSeda Gülbahar Ateú: Nothing to disclose \n \nRPS 112-9 \nComparative evaluation of MRI vs CT lung in paediatric patients with \nchronic lung disease \n*M. A. Fouad*, R. Ibrahim; Cairo/EG \n(mona.fouad@kasralainy.edu.eg) \n \nPurpose: to study the efficacy and role of MRI lungs in diagnosis/surveillance \nof paediatric patients with chronic lung disease in comparison to HRCT lung. \nMethods or Background: This cross-section prospective study included 35 \npediatric cases, 29 males (83%), and 6 females (17%), referred with a chronic \nchest complaint, for diagnosis or follow-up. Cases with HRCT evidence of \nchronic lung disease were included in the study. HRCT and MRI lungs were \ndone to all patients within a time interval of 3 days. CT and MRI images \nanalysis were evaluated separately and blindly by two pediatric radiologists \nwith 15 years’ experience. A comparative evaluation of the two studies was \ndone using the modified Bhalla scoring system. Then statistical analysis was \ndone. \nResults or Findings: All parameters of the modified Bhalla scoring system \nevaluated and all cases had bronchiectasis and bronchial wall thickening, \n88.6% had ground-glass densities. 57% had mucus plugs and mosaic \nattenuation, 51.4% had centrilobular nodules.  The mean scores were 11.2 \n(range 3-21, SD 5.3) for HRCT and 10.46 (range 4-20, SD 4.4) for MRI, with \nthe mean difference of 0.74 points. There was a strong positive correlation \nbetween both methods, with R(33)= 0.8366, and a significant P-value < \n0.00001. Findings of HRCT and MRI showed 78% complete agreement, A \ndifference of 1 point appeared in 18.3%.  Thus, the overall agreement between \nboth modalities was excellent. MRI helped in primary diagnosis for 54% of \ncases compared to CT in 91% of cases. \nConclusion: MRI lungs is a comparable technique to high-resolution CT in \npediatric cases, with a high agreement in bronchial disease evaluation, \ndetection of abscesses, and honeycombing, and beneficial for case \nsurveillance rather than primary diagnosis. \nLimitations: Limited number of cases. \nEthics Committee Approval: KasrAlainy ethical committee. \nFunding for this study: No fund received. \nAuthor Disclosures: \nRania Ibrahim: Nothing to disclose \nMona Ahmed Fouad: Nothing to disclose \n \nLive Q&A \n \n21:00-21:30 CHANNEL 2 \nPL 1 \nPlenary Lecture \nModerator \nMichael H. Fuchsjäger; Graz/AT  \n \nPL 1-2 \nACE2 - a rational front line therapy for COVID-19 \nJosef Penninger; Vancouver/CA  \n(josef.penninger@ubc.ca) \n \nLive Q&A \n \n \n \n \n\n \n \n \nA \nB C 49  \n/LYH\u00033URJUDPPH\u0003\n \n \n \n  \n)ULGD\\\u000f\u00030DUFK\u0003\u0018\u0003\n\n \n \n \nA \nB C 50  \nFriday \n/LYH\u00033URJUDPPH\u0003\n \n \n08:00-09:00 CHANNEL 2 \nE³ - ECR Master Class \nE³ 626 \nClinical impact of image quantification and \nartificial intelligence (AI) \nModerator \nThomas Beyer; Vienna/AT  \n \nE³ 626-2 \nA. The role of quantification in brain imaging \nRalf Buchert; Hamburg/DE  \n \nLearning Objectives: \n1. To learn quantification methods for brain metabolism and dementia. \n2. To outline reliable quantification methods for neuroinflammation. \n3. To discuss the added value of quantification. \n \nE³ 626-3 \nB. Quantitative imaging and AI in cardiovascular diseases \nNiek Prakken; Groningen/NL \n \nLearning Objectives: \n1. To outline machine learning techniques and metrics for cardiac imaging. \n2. To learn about quantification of cardiac and intravascular flow. \n3. To understand the value of quantitative cardiac imaging for myocardial \nischaemia. \n \nE³ 626-4 \nC. Quantitative imaging and radiomics in oncology \nGary Cook; London/UK \n \nLearning Objectives: \n1. To outline quantitative methods, radiomics, and machine learning in \noncological molecular imaging. \n2. To learn about potential targets and metrics as promising imaging \nbiomarkers.  \n3. To discuss the challenges of quantitative imaging and radiomics in oncology. \nAuthor Disclosures: \nGary Cook: Consultant: NanoMab, Serac Healthcare, Theragnostics Ltd \n \nLive Q&A: What can we quantify and what is clinically essential? \n \n08:00-09:00 CHANNEL 3 \nResearch Presentation Session: Chest \nRPS 104 \nArtificial intelligence (AI) and \ntechnological improvements in chest \nimaging \nModerator \nFergus Gleeson; Oxford/UK  \n \nRPS 104-2 \nAssessment of pneumothorax detection performance with and without \nthe aid of a deep-learning-based AI algorithm \nJ. M. Sabol¹, T. Zhang², *A. Baenen*², G. Rao², Z. Herczeg², B. Heckel², P. \nTegzes²; ¹Sussex, WI/US, ²Waukesha, WI/US  \n(alec.baenen@ge.com) \n \nPurpose: To evaluate clinician performance in detection of pneumothorax \n(PTX) on frontal chest radiographs with and without the aid of a deep-learning-\nbased AI system relative to standalone performance of the algorithm. \nMethods or Background: Presence of PTX in a 174-case dataset from 3 \ninternational sites was determined by two board certified radiologists with \ndiscrepancies arbitrated by a third. This challenging, enriched (48% positive) \ndataset included a range of PTX sizes (64% small/36% large) and co-\nmorbidities. Inferencing for PTX was performed using a commercially available \nAI system that uses frontal chest x-ray and PTX classification algorithms \ndeveloped from independent datasets of over 32k and 12.5k images \nrespectively.  Seven readers read each case twice: with and without the aid of \nAI in a Latin square crossover design with a 4-week washout period. Readers \nconsisted of thoracic Radiologist and resident, ER physician and resident, \nInternal Medicine resident, and two Nurse Practitioners. Multiple-reader \nmultiple-case ROC analysis was used to determine diagnostic accuracy of PTX \ndetection with and without the AI system. A sensitivity/specificity analysis was \nconducted from separate responses on presence/absence of PTX. \nResults or Findings: On this dataset, the AI system had standalone AUC, \nsensitivity, specificity performance of 0.941, 81%, and 96% respectively. \nWithout AI, the readers had equal sensitivity and specificity of 78.6%. With AI \nthese increased to 83.8% and 87.6% and AUC rose from 0.825 to 0.901 \n(p<0.036). For small PTX, improvement was markedly superior, AUC rising \n0.098 (p<0.018). \nConclusion: Analysis shows that an AI system significantly improves \nperformance of radiologists and bedside clinicians to detect PTX with most \nsignificant improvement for small PTX, enabling rapid intervention and \nimproved outcomes. \nLimitations: Outcome assessment of performance in clinical settings is \nrequired to validate these results. \nEthics Committee Approval: IRB oversight waived. \nFunding for this study: Not applicable. \nAuthor Disclosures: \nBeth Heckel: Employee at GE Healthcare \nPál Tegzes: Employee at GE Healthcare \nGireesha Rao: Employee at GE Healthcare \nAlec Baenen: Employee at GE Healthcare \nJohn M Sabol: Nothing to disclose \nTianhao Zhang: Employee at GE Healthcare \nZita Herczeg: Employee at GE Healthcare \n \nRPS 104-3 \nClinical evaluation of a deep learning-based, pneumothorax (PTX) \nclassification AI model on frontal chest x-ray images \n*R. Kurokawa*¹, K. Suzuki¹, A. Hagiwara¹, A. Baenen², Z. Herczeg³, P. \nTegzes຾, L. Török຾, N. Uetake¹, S. Aoki¹; ¹Tokyo/JP, ²Waukesha, WI/US, \n³Szeged/HU, ຾Budapest/HU \n \nPurpose: To evaluate the performance of a PTX classification AI model to \ndetect pneumothorax(es) of various sizes and locations. \nMethods or Background: A retrospective 400 images were formed from \npatients(>= 18 y/o). The dataset was derived from the clinical population within \nan international institution not represented in the training data used during \nmodel development. Ground truth for the presence, laterality, and size of a \nPTX was independently assessed by two radiologists. PTX size measurement \nfollows both the British Thoracic Society and American College of Chest \nPhysicians standards. Inferencing was then performed by a deep learning-\nbased algorithm developed from independent datasets of over 12,000 images. \nResults or Findings: Radiologists deemed PTX present in 42% of the dataset, \nwith laterality of right (48.5%), left (43.8%), and bilateral(7.7%). PTX size was \ndetermined to be small(37.3%), large (60.3%), and small + large(2.3%) in \nbilateral cases. The PTX classifier had an AUC of .978 (overall), .952 (small \nPTX),.994 (large PTX),.975 (Left PTX),.980 (right PTX) and .991 (bilateral \nPTX).  In addition, the PTX classifier had sensitivity of 94% (overall), 86% \n(small PTX), 99% (large PTX), and specificity of 91% (all).  The AI model \naccurately predicted the radiologist label using either the BTS and ACCP \nstandards, achieving an AUC of .796 and .797 respectively. A AUC of .950 was \nachieved when comparing the radiologist binary size label to model mask area \noutput. \nConclusion: The investigated AI model accurately localizes and quantifies \nPTX on frontal chest x-ray images originating from geographical regions not \nrepresented in training/testing data used during model development. \nLimitations: The model only recognizes PTX. \nEthics Committee Approval: This is an institutional review board approved \nstudy. \nFunding for this study: This is a collaborative study with GE healthcare \nAuthor Disclosures: \nRyo Kurokawa: Nothing to disclose \nShigeki Aoki: Grant Recipient at JSPS Kakenhi \nPál Tegzes: Employee at GE Healthcare \nAlec Baenen: Employee at GE Healthcare \nAkifumi Hagiwara: Grant Recipient at JSPS Kakenhi \nNozomu Uetake: Employee at GE Healthcare \nZita Herczeg: Employee at GE Healthcare \nKazuhiro Suzuki: Investigator at GE Healthcare \nLevente Török: Employee at GE Healthcare \n \n \n \n \n \n\n \n \n \nA \nB C 51  \nFriday \n/LYH\u00033URJUDPPH\u0003\n \nRPS 104-4 \nDiagnostic performance of a new reconstruction technique for dual-\nenergy CT (DECT) lung perfusion: preliminary experience in 58 patients \nJ. Pinilo¹, A. Hutt¹, J-B. Faivre¹, J. Labreuche¹, T. Flohr², B. Schmidt², A. \nDuhamel¹, J. Remy¹, *M. Remy-Jardin*¹; ¹Lille/FR, ²Forchheim/DE \n(martine.remy@chru-lille.fr) \n \nPurpose: To compare DECT lung perfused blood volume images generated \nwith monoenergetic subtraction (MonoE) with images obtained by three-\ncompartment decomposition (Lung PBV). \nMethods or Background: The inclusion criteria comprised: (a) a positive or \nnegative CT angiogram for acute PE; (b) obtained on the same CT unit (Force, \nSiemens Healthineers); (c) in the absence of lung infiltration or destruction. \nOver a two-year period, 28 consecutive patients with acute PE were eligible \n(Group 1); the first 30 consecutive patients with a negative angiogram for acute \nPE were selected (Group 2). From each data set, lung PBV images (i.e., the \nreference standard) and MonoE images, generated by subtraction of 40 keV \nand 190 keV monoenergetic images using a prototype software, were \nreconstructed. The inter-technique comparison was undertaken at a patient \n(n=58) and segment (n=1106; exclusion of 54 non-analyzable segments) level. \nResults or Findings: The distribution of scores of subjective image noise \nsignificantly differed between the two reconstructions (p<0.0001), with mild \nnoise in 58.6% (34/58) of MonoE vs 25.9% (15/58) of PBV images. Detection \nof perfusion defects was concordant in 1104 segments (no defect: n=968; \ndefects present: n=138) and discordant in 2 segments with a defect only \ndepicted on MonoE images. The gradient of attenuation between perfused \nareas and defects was significantly higher on MonoE images compared to \nLung PBV (77.7 ±20.0 HU vs 26.9 ±8.4 HU) (p<0.0001) with sharper edges in \n8.7% of defects. Fissures were precisely identified in 77.6% of patients (45/58) \non MonoE images while blurred (30/58; 51.7%) or not detectable (28/58; \n48.3%) on Lung PBV images. \nConclusion: MonoE perfusion imaging allows significant improvement in the \noverall image quality and detectability of PE-type perfusion defects. \nLimitations: Comparison was obtained by consensus between two readers. \nEthics Committee Approval: Waiver of patient informed consent \nFunding for this study: None \nAuthor Disclosures: \nThomas Flohr: Employee at Siemens Healthineers \nJean-Baptiste Faivre: Nothing to disclose \nJulien Labreuche: Nothing to disclose \nMartine Rémy-Jardin: Research/Grant Support at Siemens Healthineers \n Bernhard Schmidt: Employee at Siemens Healthineers \nJacques Remy: Research/Grant Support at Siemens Healthineers \nM. Alain Duhamel: Nothing to disclose \nJuliette Pinilo: Nothing to disclose \nAntoine Hutt: Nothing to disclose \n \nRPS 104-5 \nChest CT at x-ray dose using a novel noise-mitigating projection \ntechnique: diagnostic value for detecting pneumonia in \nimmunocompromised patients \n*P. Rogalla*, S. Carey, M. May, S. Ronghe, S. Kandel, F. Sanchez Tijmes; \nToronto, ON/CA \n(Patrik.Rogalla@uhn.ca) \n \nPurpose: To assess the diagnostic performance of ultra-low-dose CT using a \nnoise-mitigating projection technique (Thoracic Tomogram, TT) to detect \npneumonia in immunocompromised patients. \nMethods or Background: With ethics board approval, 35 \nimmunocompromised patients underwent a standard-of-care, low-dose CT \n(SOC) of the chest (120 kV, dose modulation) immediately followed by an \nultra-low-dose CT (135 kV, target dose 0.18 mSv/75 kg), processed using a \nnovel projection function in three planes with 2 cm thick slabs (TT) to suppress \nnoise while enhancing inherent image contrast. Two chest radiologists \nevaluated the TTs alone, and then the SOC-CT in the categories: (I) opacities \n<1cm, (II) opacities >1cm, (III) atelectasis, (IV) pleural effusion, (V) interstitial \npattern, on a scale of -4=confidently absent to +4=confidently present. Readers \nprovided a diagnosis (fungal, atypical, bacterial, non-specific) and ranked the \nsubjective image quality (1=non-diagnostic, 10=best). The interpretation time \nfor TTs and the DLPs were recorded. \nResults or Findings: Sensitivity, specificity, accuracy and AUC for reader 1/2 \nwas 72.2%/72.2%, 88.2%/88.2%, 80.0%/80.0% and 0.88/0.85 in category (I). \nReader 2 over-interpreted only 1 case in category (II) and (IV), and did not \nreport 4 minimal atelectases (III) and 6 cases of initial interstitial pattern \n(accuracy, 82.9%). There was no difference in diagnosis between TT and SOC \nor between readers. The mean image quality and DLP (mGy*cm) was 8.42 and \n19.1 for TT, and 9.42 and 103.0 for SOC-CT (p<0.05). The interpretation time \nfor reader 1 and 2 was 15.2s and 14.4s, respectively. \nConclusion: Ultra-low-dose chest CT at X-ray dose (2 views) provides nearly \nidentical diagnostic information to SOC-CT in immunocompromised patients in \nwhom detection of pneumonia is paramount, at one-fifth of the radiation dose. \nThe interpretation time appears similar to reading chest X-rays. \nLimitations: Applicable to lung only; sample size \nEthics Committee Approval: Approved. \nFunding for this study: Internal. \nAuthor Disclosures: \nFelipe Sanchez Tijmes: Nothing to disclose \nSean Carey: Nothing to disclose \nMary May: Nothing to disclose \nSonja Kandel: Nothing to disclose \nPatrik Rogalla: Nothing to disclose \nSandeep Ronghe: Nothing to disclose \n \nRPS 104-6 \nComparison of capability for distinguishing metastatic from non-\nmetastatic lymph nodes among computed DWI (cDWI), actual DWI (aDWI) \nand PET/CT in non-small cell lung cancer \n*Y. Ohno*¹, M. Yui², T. Yoshikawa³, D. Takenaka³, Y. Kassai², K. Murayama¹, \nH. Toyama¹; ¹Toyoake/JP, ²Ohtawara/JP, ³Akashi/JP \n(yohno@fujita-hu.ac.jp) \n \nPurpose: To directly compare the capability for distinguishing metastatic from \nnon-metastatic lymph nodes among computed DWI (cDWI) generated at \ndifferent b values, actual DWI (aDWI) and FDG-PET/CT in non-small cell lung \ncancer (NSCLC) patients. \nMethods or Background: 245 consecutive operable NSCLC patients (127 \nmen, 118 women; mean age 75 years) prospectively underwent aDWI with b \nvalue at 0 and 1000 s/mm2, FDG-PET/CT, surgical treatment and pathological \nand follow-up examinations.  In each subject, computed DWIs were generated \nat 400 (cDWI400), 600 (cDWI600) and 800 (cDWI800) s/mm2.  According to \npathological examination results, 114 metastatic nodes and 114 out of 2581 \nnon-metastatic nodes were measured contrast ratio (CR) on each computed \nDWI between each lymph node and chest wall muscle, ADC on actual DWI \nand SUVmax by ROI measurements.  To determine the feasible threshold \nvalue for each index on a per node basis, ROC analysis was performed.  Then, \ndiagnostic performance were compared among all methods by McNemar’s \ntest. \nResults or Findings: Area under the curve (AUC) of CR at cDWI600 \n(AUC=0.87, p<0.05) was significantly larger than that of CRs at cDWI400 \n(AUC=0.79), cDWI800 (AUC=0.83) and SUVmax (AUC=0.81).  In addition, \nAUC of cDWI800 was significantly larger than that of cDWI400 (p<0.05).   On a \nper node basis, accuracy of CR at cDWI600 (79.4%) were significantly higher \nthan that of others (p<0.05). \nConclusion: Computed DWI has a better potential for distinguishing \nmetastatic from non-metastatic lymph nodes than actual DWI or PET/CT in \nNSCLC patients.  Computed DWI would be better to be generated at \n600s/mm2 in this setting. \nLimitations: Not applicable \nEthics Committee Approval: Not applicable \nFunding for this study: Research grant from Canon Medical Systems \nCorporation. \nAuthor Disclosures: \nKazuhiro Murayama: Grant Recipient at Canon Medical SysteCorporation \nHiroshi Toyama: Grant Recipient at Canon Medical SysteCorporation \nDaisuke Takenaka: Nothing to disclose \nMasao Yui: Employee at Canon Medical SysteCorporation \nYoshimori Kassai: Employee at Canon Medical SysteCorporation \nTakeshi Yoshikawa: Nothing to disclose \nYoshiharu Ohno: Grant Recipient at Canon Medical SysteCorporation \n \nRPS 104-7 \nMismatch of predicted lung volume and CT-derived lung volume in a \ngeneral population cohort \n*H. J. Wisselink*, D. J. Steerenberg, G. J. Pelgrim, M. Rook, G. de Bock, R. \nVliegenthart; Groningen/NL \n(h.j.wisselink@alumnus.utwente.nl) \n \nPurpose: For lung transplantation, size of donor lungs should match the \nintended recipient. A size mismatch may increase morbidity or mortality. \nCurrently, size is predicted based on donor’s gender and height, but this model \nmay not adequately account for natural variation. We compared the predicted \ntotal lung capacity (TLC) with the total lung volume measured on inspiratory CT \n(TLV) in a general population study cohort. \nMethods or Background: For the current analysis, 400 participants were \nretrospectively selected from the ongoing ImaLife study. All underwent \ninspiratory CT scan (third generation dual-source CT [SOMATOM Force, \nSiemens Healthineers], 120 kVp, 20 ref mAs, slice thickness/increment \n1.0/0.7). TLV was measured with Pulmo3D (Siemens Healthineers). The \npredicted lung volume was calculated as TLC_male=(7.99 Âheight–7.08)Â1000 \nand TLC_female=(6.60Âheight–5.79)Â1000. TLC values were compared to a \nlinear multivariate model, using height, weight, gender, and age to predict TLV. \n\n \n \n \nA \nB C 52  \nFriday \n/LYH\u00033URJUDPPH\u0003\n \nResults or Findings: Mean±SD TLC was 6.5±1.2L, while TLV was 5.5±1.3L. \nThe difference between predicted and measured volumes was 1.2±1.2L for \nmen and 0.6±0.8L for women. \nR² for the (height-only) TLC models were -0.80 (male) and -0.21 (female), and \n0.46 for the multivariate model. \nConclusion: There is a substantial mismatch between predicted and \nmeasured lung volumes, predicted TLC being larger. A model that includes \nage and weight may better predict CT-derived lung volume. \nLimitations: No gold standard TLC was available; CT is performed in supine \nposition which may limit maximum inspiration. \nEthics Committee Approval: The institutional review board approved this \nstudy, and all participants signed informed consent. \nFunding for this study: ImaLife is supported by an institutional research \ngrant, Siemens Healthineers. The first author is supported by KNAW grant \nPSA-SA-BD-01. \nAuthor Disclosures: \nMieneke Rook: Nothing to disclose \nGeertruida de Bock: Nothing to disclose \nRozemarijn Vliegenthart: Research/Grant Support at Siemens Healthineers \nGert Jan Pelgrim: Nothing to disclose \nHendrik Joost Wisselink: Grant Recipient at KNAW \nDanielle J.D. Steerenberg: Nothing to disclose \n \nLive Q&A \n \n08:00-09:00 CHANNEL 5 \nRefresher Course: Head and Neck \nRC 208 \nDental imaging for general radiologists \nModerator \nEdith Vassallo; Msida/MT  \n \nRC 208-2 \nA. Dental variants: what the general radiologist needs to know \nAndy Whyte; Perth/AU  \n(andywhyte7@bigpond.com) \n \nLearning Objectives: \n1. To revise the anatomy of teeth and surrounding structures. \n2. To learn about commonly encountered dental variants. \n3. To become acquainted with how to image and report such findings. \n \nRC 208-3 \nB. Odontogenic cysts: sorting the wood from the trees \nNicholas Drage; Cardiff/UK \n \nLearning Objectives: \n1. To become familiar with different types of odontogenic cysts. \n2. To learn how best to image these lesions. \n3. To review those imaging features that help differentiate lesions from one \nanother. \n \nRC 208-4 \nC. Reporting orthopantomogram (OPT): what and what not to report \nKaan Orhan; Ankara/TR \n(call53@yahoo.com) \n \nLearning Objectives: \n1. To review indications for OPT and when to perform other imaging. \n2. To learn about artefacts on OPT and how to obtain better images. \n3. To understand which pathology to comment upon and why. \n \nLive Q&A: Personal pearls and pitfalls in reporting \n \n \n \n \n \n \n \n09:15-10:15 CHANNEL 2 \nJoint Session of the ESR and EFLM \nESR/EFLM \nClinical use cases for integrated \ndiagnostics for laboratory medicine and \nradiology \nModerators \nMichael H. Fuchsjäger; Graz/AT  \nMichael Neumaier; Mannheim/DE  \n \nESR/EFLM-3 \nCancer: personalised diagnostics in the detection of recurrence of \nmetastatic colorectal cancer (part 1) \nStefan O. Schönberg; Mannheim/DE \n \nLearning Objectives: \n1. To learn about novel approaches towards personalised cancer follow-up. \n2. To understand the importance of individualised diagnostic pathways adapted \nto the biological aggressiveness of cancer. \n3. To appreciate the advantages of integrated diagnostics in the detection of \nrecurrence of metastatic colorectal cancer. \n \nESR/EFLM-4 \nCancer: personalised diagnostics in the detection of recurrence of \nmetastatic colorectal cancer (part 2) \nMichael Neumaier; Mannheim/DE \n(michael.neumaier@medma.uni-heidelberg.de) \n \nLearning Objectives: \n1. To understand the clinical utility and merits of different methods for the \ncharacterisation of circulating nucleic acids in the blood. \n2. To learn, how synergistic workflow between radiology and laboratory \nmedicine will advance early detection of tumour recurrence. \n3. To understand, how epigenetic profiling in blood samples can assist in \nidentification of CUP syndromes and progeny of tumours. \n \nESR/EFLM-5 \nCardiovascular: personalised management of patients with acute chest \npain in the emergency department based on imaging and laboratory \nbiomarkers \nFabian Bamberg; Freiburg/DE \n(fabian.bamberg@uniklinik-freiburg.de) \n \nLearning Objectives: \n1. To understand the clinical challenge of acute chest pain management in the \nemergency department. \n2. To learn about the evidence of cardiac CT in this setting and appreciate its \nlimitations in the era of high sensitivity troponin assays. \n3. To define workflows that use laboratory and imaging parameter to manage \npatients with acute chest pain \nAuthor Disclosures: \nFabian Bamberg: Research Grant/Support: Bayer Healthcare, Siemens \nHealthineers; Speaker: Bayer Healthcare, Siemens Healthineers \n \nESR/EFLM-6 \nCOVID-19: prediction of prognosis based on laboratory data and chest \nCT \nSalvatore Cappabianca; Naples/IT \n(Salvatore.CAPPABIANCA@unicampania.it) \n \nLearning Objectives: \n1. To clarify the place of CT scanner in the management of COVID-19 patients. \n2. To define the possibilities of CT alone in the prediction of patients' outcome. \n3. To compare lung CT impairment with clinical data to increase performance \nin outcome prediction. \n \nESR/EFLM-7 \nTrauma: value of biomarkers of brain injury in the diagnosis of head \ntrauma \nAad van der Lugt; Rotterdam/NL \n(a.vanderlugt@erasmusmc.nl) \n \n \n \n\n \n \n \nA \nB C 53  \nFriday \n/LYH\u00033URJUDPPH\u0003\n \nLearning Objectives: \n1. To understand the differences between blood and imaging biomarkers in \nbrain injury.  \n2. To learn about the role of biomarkers in diagnosis and prognosis of brain \ninjury.  \n3. To understand the advantages of integrated diagnostics in head trauma. \n \nLive Q&A \n \n09:15-10:15 CHANNEL 4 \nEFRS meets Austria \nMeets 5 \nEmbracing our profession in Austria \nModerators \nCharlotte Beardmore; London/UK  \nSabine Weissensteiner; Vienna/AT  \n \nMeets 5-3 \nIntroduction: radiographers in Austria \nSabine Weissensteiner; Vienna/AT \n \nLearning Objectives: \n1. To introduce the radiography profession in Austria and the priorities of the \nnational society. \n2. To introduce Austria as a country, the Austrian lifestyle, and the Austrian \nculture. \n \nMeets 5-4 \nContinuing professional development for radiographers: criteria in \ntraining and education \nFritz Friedl; Vienna/AT \n \nLearning Objectives: \n1. To learn about the Austrian guidelines, the need for further education, and \ncontinuous professional development (CPD). \n2. To explore the use of dedicated software to support the CPD programme \nand the individual health professional/radiographer. \n3. To understand the challenges in implementing CPD guidelines and \nstandards. \n \nMeets 5-5 \nMasters programmes for Austrian radiographers \nSabine Leitner; Wiener Neustadt/AT \n \nLearning Objectives: \n1. To become familiar with the different degree programmes for radiographers \nin Austria. \n2. To consider the potential scope of practice for, and impact of, master's \ndegree graduates. \n3. To discuss the career challenges for master's degree graduates. \n \nMeets 5-6 \nInterlude: Austria: beyond ECR \n \nMeets 5-7 \nRadiographer research in Austria \nGerold Unterhumer; Vienna/AT \n \nLearning Objectives: \n1. To learn about radiographer research activity in Austria. \n2. To discuss research opportunities available to Austrian clinical and \nacademic radiographers. \n3. To explore future plans for growing radiographer research involvement in \nAustria. \n \n \n \n \n \n \n \n \n \n \nMeets 5-8 \nEvaluation of the eye lens dose in angiography \nAnna Suppnig; Klagenfurt/AT \n(anna.suppnig@gmx.at) \n \nLearning Objectives: \n1. To consider EU Council Directive 2013/59/Euratom in terms of eye lens \ndoses and dose measurement. \n2. To learn about the Austrian guidelines for eye lens dose. \n3. To explore the impact of eye lens dose measurement and methods for dose \nevaluation. \n \nMeets 5-9 \nMedAustron: cancer treatment with particle therapy and the \nradiographers' role \nHarald Hentschel; Wiener Neustadt/AT \n \nLearning Objectives: \n1. To introduce the use of particle therapy for cancer treatment. \n2. To identify the radiographers' role within particle therapy and the wider \nmultidisciplinary team. \n3. To consider future opportunities for radiographers involved in a particle \ntherapy service. \n \nLive Q&A \n \n09:15-10:15 CHANNEL 5 \nResearch Presentation Session: \nGenitourinary \nRPS 107 \nThe next generation of prostate \ninterventions using state-of-the-art \nimaging techniques \nModerator \nBernd Hamm; Berlin/DE  \n \nRPS 107-2 \nRemote-controlled manipulated transrectal biopsy of the prostate: a \npromising technique \nH. Raat¹, *R. Van Stiphout*¹, A. van Gorp¹, J. O. Barentsz²; ¹Roermond/NL, \n²Nijmegen/NL  \n(R.vanstiphout@lzr.nl) \n \nPurpose: MRI targeted prostate biopsy refers to an imaging targeted  “in-bore \n“technique rather than the traditional systematic approach  of a prostate biopsy \nwith TRUS (Trans Rectal UltraSound) . Different techniques have been \nestablished and are in use: cognitive fusion biopsy, ultrasound-MRI fusion \nbiopsy and MRI-guided-in-bore biopsy.  In the Netherlands the MRI fusion \ntechnique is the most popular although the MRI in-bore technique is the most \naccurate technique. \nMethods or Background: In-bore robot controlled prostate biopsy with de \nremote controlled manipulator in patients with PIRADS 4 or 5 lesions on \ndetection MRI.TRUS or MRI fusion technique have limitations in reaching all \nsuspect prostate lesions due to little size or not reachable locations such as \nvery lateral or anterieur location. Or lesions in very big prostates. \nResults or Findings: The manual in-bore technique is time-consuming and \ntherefore costly because the patient has to be moved in and out of the MRI \nseveral times. There is no risk of fusion or cognitive inaccuracy. With this \ndevice the radiologist is able to position the transrectal needleguide in the \ncontrol-room without moving the patient. We report our experience with a \nRemote Controlled Manipulator robot in the first 300+ patients. \nConclusion: The technique is feasible and less time-consuming than the \nmanual technique. It's cost-effective and the results are similar to manual MRI-\nguided-in-bore biopsy. \nLimitations: Patients must be MRI compatible and not claustrofobic. \nPatients endure head-first prone position for approximately 20 minutes. \nEthics Committee Approval: Approval is granted \nFunding for this study: There is no funding for this study \nAuthor Disclosures: \nRogier Van Stiphout: Nothing to disclose \nAlexander van Gorp: Nothing to disclose \nJelle O. Barentsz: Nothing to disclose \nHenricus Raat: Nothing to disclose \n\n \n \n \nA \nB C 54  \nFriday \n/LYH\u00033URJUDPPH\u0003\n \n \nRPS 107-3 \nMR directed biopsy (MRDB) for prostate cancer detection: in-bore vs MR-\ntransrectal ultrasound fusion technique, performed by the same \noperators \n*E. Messina*, R. Campa, S. Cipollari, M. Del Monte, C. Catalano,  \nV. Panebianco; Rome/IT \n(emanuele.messina@uniroma1.it) \n \nPurpose: To compare the difference in the detection of overall PCa and \ncsPCa of the in-bore (MRI-TB) and TRUS/MRI fusion prostate biopsy (FUS-\nTB), performed by the same operator. To compare MRI-TB and FUS-TB biopsy \nin terms of percentage of cancer per biopsy core and of number of cores per \nlesion. \nMethods or Background: 263 patients was retrospectively enrolled. Inclusion \ncriteria: age > 18 years old, high clinical suspicion for PCa (total PSA >4 \nng/mL, or >2,5 in patients with family history, and/or a positive DRE). All \npatients underwent multiparamentric MRI and patients were directed to MR \ndirected biopsy (MRDB) when PI-RADS score > 3. \nResults or Findings: Total number of biopsy targets was 393: 197/393 were \nbiopsied with the fusion technique and 196/393 with the in-bore technique. \nA total of 988 cores where taken: 542 with the fusion technique and 446 with \nthe in-bore biopsy.  \nNo statistical difference was found in terms of detection rate of patients \nbiopsied: CDR with the fusion technique was 62.4% (95% CI, 53.6 – 71.2) vs. \n63.2% (95% CI, 54.1 – 72.4) for patients who underwent in- bore biopsy. Mean \noverall cores-per-target number was 2.5, with no statistical difference between  \ntechinques (2.3 and 2.8, respectively, p > 0.05). In-bore biopsy was more \naccurate yielding a mean percentage of 59.4% (IQR 40.0% - 65.0%) vs. 29.0% \n(IQR 16.6% - 60.0%) obtained by fusion technique (wilcoxon test p-value < \n0.001). \nConclusion: No statistically significant difference was detected in terms of \ncancer detection rate comparing in-bore MRI and MRI-TRUS fusion targeted \nprostate biopsy. MRI-TB showed highest per-core malignant cells percentage \nand lower mean volume of the targets compared to FU-TB. \nLimitations: Lack of pathology based on radical prostatectomy specimens. \nSingle-institution retrospective study. \nEthics Committee Approval: Approved \nFunding for this study: Not applicable \nAuthor Disclosures: \nValeria Panebianco: Nothing to disclose \nStefano Cipollari: Nothing to disclose \nEmanuele Messina: Nothing to disclose \nRiccardo Campa: Nothing to disclose \nMaurizio Del Monte: Nothing to disclose \nCarlo Catalano: Nothing to disclose \n \nRPS 107-4 \nIn-bore MRI-guided prostate biopsy in a patient group with a high \nlikelihood of mpMRI findings: a single centre experience \n*S. Durmaz*¹, B. Coskun¹, M. Kılıc¹, E. Altınmakas¹, A. Onay², B. Çolako ÷lu¹, \nD. Cengiz¹, S. Akpek¹, M. Vural¹; ¹Istanbul/TR, ²Ankara/TR \n(drselahattindurmaz@gmail.com) \n \nPurpose: To determine the diagnostic yield of magnetic resonance imaging \n(MRI)-guided in-bore  biopsy  in patients with high likelihood multiparametric \nMRI (mpMRI) findings. \nMethods or Background: This retrospective study consisted of 277 Prostate \nImaging Reporting and Data System (PI-RADS) assessment category 4 and 5 \ntargets in 246 consecutive patients (mean, 65.7 years; median prostate-\nspecific antigen value, 7.75 ng/mL) who had undergone MRI-guided in-bore \nbiopsy at our institution between December 2012 and March 2020. Cohort was \nconsisted of primary (biopsy naive) (n=200) and secondary (had at least one \nnegative biopsy) (n=46) patients subset. Eighty-one patients who were \nunderwent RP as a definitive treatment, needle biopsy and RP specimen \nGleason scores were evaluated in terms of concordance. \nResults or Findings: In total, 277 targets biopsied from 246 patients and \noverall 216 cores were positive for prostate cancer. Overall PCa detection \nrates were 80.5% per patient (198/246) and 78% per target (216/277).  \nClinically significant prostate cancer (ISUP Gleason grade • 2) was found 63% \nof patients. Diagnosis of prostate cancer rate was 68% and 92% in cases \nclassified as PI-RADS assessment category 4 and 5, respectively.  \nA total of 81 patients (%32.9) underwent radical prostatectomy as a definitive \ntreatment in our cohort. Among these, there were upgrade in the ISUP grade in \n22 patients (27.2%), there were downgrade in 7 patients (8.6)% and \nconcordance in 52 patients (64.2%). \nA median of 3.2 cores was obtained per target and percentage of cancer \ninvolvement in positive biopsy cores was 53.2%. \nConclusion: MRI-guided in-bore prostate biopsy has a high detection rate of \ncsPCa in PI-RADS assessment category 4 and 5 targets.  Biopsy results were \nsatisfactory in terms of number of positive cores, cancer volume in positive \ncores and concordance of GS in needle biopsy and RP specimen. \nLimitations: Not applicable \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nEmre Altınmakas: Nothing to disclose \nBülent Çolako÷lu: Nothing to disclose \nMetin Vural: Nothing to disclose \nSergin Akpek: Nothing to disclose \nBilgen Coúkun: Nothing to disclose \nSelahattin Durmaz: Nothing to disclose \nMert Kılıc: Nothing to disclose \nDuygu Cengiz: Nothing to disclose \nAslihan Onay: Nothing to disclose \n \nRPS 107-5 \nReasons for missing clinically significant prostate cancer by targeted \nmagnetic resonance imaging/ultrasound fusion-guided biopsy \n*M. Klingebiel*, L. Schimmöller, T. Ullrich, C. Arsov, P. Albers, G. Antoch; \nDüsseldorf/DE \n(Maximilian.Klingebiel@med.uni-duesseldorf.de) \n \nPurpose: This study evaluates cases of csPCa missed by targeted biopsy (TB) \nand analyzes the diagnostic impact of a dditional systematic biopsies (SB) in a \nlarge patient collective. \nMethods or Background: Consecutive patients with 3T multiparametric MRI \nof the prostate and subsequent MRI/US fusion-guided TB plus 12-core US-\nguided SB from 01/2014 to 04/2019 were included in this study. Primary study \nendpoint was the analysis of cases with csPCa missed by TB. Secondary \nstudy endpoints were PCa detection and the correlation with clinical and MRI \nparameters. \nResults or Findings: In total 785 patients met the inclusion criteria. 342 \npatients had csPCa (median PSAD 0.29 ng/ml/cm3). In 42 patients (13%), \ncsPCa was detected only by SB. In 36 of these cases, the localization of the \npositive SB cores matched cancer suspicious regions (CRS) that were \npreviously described on mpMRI. Cases with csPCA missed by TB showed \ninsufficient MRI segmentation in 48%, insufficient lesion registration in 67% \nincluding 21% where the center of a larger or diffuse lesion was missed, and a \ngenerally small lesion size in 14%. Median PSAD of patients with nsPCa \ndetected by SB was 0.15 ng/ml/cm³. \nConclusion: Main reasons for missing csPCa by TB were insufficient prostate \nsegmentation (prostate boundary correlation) or imprecise lesion registration \n(lesion transfer, tracking or matching) during MRI/US fusion biopsy. \nConsequently, verification of MR image quality, exact MRI lesion assessment, \nand advanced biopsy experience may improve accuracy. Altogether, additional \nSB adds limited clinical benefit, especially in men with PSAD ”0.15 ng/ml/cm³. \nLimitations: The histopathologically non-blinded correlation of missed PCa for \nretrospective image review might be a source of bias. Moreover, no \npostoperative results after radical prostatectomy or follow-up of included \npatients evaluated in this study. \nEthics Committee Approval: Approved by local ethic committee. \nFunding for this study: No funding. \nAuthor Disclosures: \nMaximilian Klingebiel: Nothing to disclose \nTim Ullrich: Nothing to disclose \nChristian Arsov: Nothing to disclose \nPeter Albers: Nothing to disclose \nLars Schimmöller: Nothing to disclose \nGerald Antoch: Nothing to disclose \n \nRPS 107-6 \nMRI and clinical validation of transperineal laser ablation of benign \nprostatic hyperplasia in outpatient settings: an alternative effective \ntreatment suitable for the COVID-19 outbreak \nG. Manenti, T. Perretta, A. Calcagni, D. Ferrari, S. Vidali, *C. Ryan*, F. R. \nFraioli, D. D'Amato, R. Floris; Rome/IT \n \nPurpose: Transperineal laser ablation (TPLA) of the prostate is a novel, mini-\ninvasive option for men with lower urinary tract symptoms (LUTS) due to \nbenign prostate hyperplasia (BPH). The aim is assessing the impact of US-\nguided TPLA regarding urodynamic improvement and sexual function, \nmonitoring clinical data, post-procedural complications and define imaging \nfindings using 3T multi-parametric MRI. \nMethods or Background: Prospective interventional pilot study in patients \naffected by LUTS due to benign prostatic obstruction (BPO) treated by TPLA. \n44 men aged 50 or older with moderate to severe LUTS and history of \nrefractory, intolerance or poor compliance to medical therapies. Clinical \nmeasurements included PSA, Flow rate estimation, US post-voiding volume, \nsexual function, SHIM Questionnaire, Quality of Life questionnaire. Adverse \n\n \n \n \nA \nB C 55  \nFriday \n/LYH\u00033URJUDPPH\u0003\n \nevents were evaluated using Clavien-Dindo scale. Volume changes were \nmeasured by 3T MRI and automatic segmentation software at 1 year follow-up \nResults or Findings: Erectile and ejaculatory functions were maintained in all \npatients. MRI assessed the changes over time with a 53% reduction of \nadenoma volume and 71% of ablated area with clinical and functional \nimprovement in all cases. The overall adverse event rate was 7%. \nConclusion: Clinical monitoring and 3T mpMR imaging at 1-year follow-up \nconfirms US-guided TPLA as a safe, manageable and effective treatment for \nLUTS. Due to its mini-invasive technique, it should be considered a problem-\nsolving treatment for BPH patients during a COVID 19 outbreak \nLimitations: A further investigation with a long-term prospective multi-centric \nstudy is necessary. Another limitation is the lack of comparison studies with \ngold-standard therapies. \nEthics Committee Approval: Procedures were conducted accordingly with \nthe ethical standards of the institutional research committee, in accordance \nwith the guidelines of the Declaration of Helsinki. \nFunding for this study: This study has not received any funding. \nAuthor Disclosures: \nTommaso Perretta: Nothing to disclose \nDonatella Ferrari: Nothing to disclose \nAntonello Calcagni: Nothing to disclose \nGuglielmo Manenti: Nothing to disclose \nSofia Vidali: Nothing to disclose \nDejanira D'Amato: Nothing to disclose \nColleen Ryan: Nothing to disclose \nRoberto Floris: Nothing to disclose \nFederico Romeo Fraioli: Nothing to disclose \n \nRPS 107-7 \nRates of infection post-MRI guided target trans-rectal prostate biopsy \n(TRUS) during the COVID-19 pandemic \n*P. Tansey*, P. Beddy, N. Sheehy, J. F. Meaney; Dublin/IE \n(paultansey1990@gmail.com) \n \nPurpose: Rates of infection post MRI guided target Trans-rectal prostate \nbiopsy (TRUS) are increasing globally. During the COVID-19 pandemic from \nMarch to September 2020 as per national guidelines to help reduce hospital \nadmissions, we changed our practice to targeted biopsies only rather than the \ntraditional target and 12 core method at our institution. Given the reduction in \ncore biopsies it is presumed that this may lead to a reduction in the overall \nrates of infections. The purpose of this study is to evaluate the rate of \ninfections between the target only biopsies from March to September 2020, to \nthe target/systematic biopsies from the same period in 2019. \nMethods or Background: This study was carried out at St James’s Hospital \nRadiology department. A search was performed using NIMIS for patients who \nunderwent MRI guided targeted TRUS biopsies. Once identified, Electronic \nPatient Records (EPR) was used to follow-up complications post procedure. \nThis was identified by emergency department admissions; outpatient letters or \nnotes from the Urology clinical nurse specialist who acted as the point of \ncontact for patients post procedure. \nResults or Findings: A total of 120 target biopsies were performed in the \n2020 period, 4 of which developed infections. In comparison, 97  \ntarget/systematic biopsies were performed in the 2019 period, 3 of which were \nassociated with infections. There was no significant reduction in the rates of \ninfection between the target and target/systematic groups with a non-significant \np value of 0.9206. \nConclusion: We found that the post TRUS biopsy infection rates are in \nkeeping with those found internationally. There was no significant reduction in \nthe rates of infection between the target and the target/systematic biopsy \ngroup. \nLimitations: Size of patient cohort. \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nPeter Beddy: Nothing to disclose \nNiall Sheehy: Nothing to disclose \nPaul Tansey: Nothing to disclose \nJames F Meaney: Nothing to disclose \n \nLive Q&A \n \n10:45-11:15 CHANNEL 2 \nPL 2 \nPlenary Lecture \nModerator \nMichael H. Fuchsjäger; Graz/AT  \n \nPL 2-2 \nHow to live well and thrive on performance \nThomas Bubendorfer; Monaco/MC  \n(thomas@bubendorfer.com) \n \nLive Q&A \n \n11:45-12:45 CHANNEL 2 \nJoint Session of the ESR and ESTRO \nESR/ESTRO \nMR-guided radiation therapy of \ngynaecological cancer \nModerators \nRegina G.H. Beets-Tan; Amsterdam/NL  \nHenrike G. Westerveld; Amsterdam/NL  \n \nESR/ESTRO-3 \nFunctional MRI for cervical cancer \nEvis Sala; Cambridge/UK \n \nLearning Objectives: \n1. To review the role of functional MRI in the treatment selection of patients \nwith cervical cancer. \n2. To understand the role of functional MRI in radiotherapy treatment planning. \n3. To learn about the potential of functional MRI in assessing treatment \nresponse and predicting outcome. \n \nESR/ESTRO-4 \nA first experience with the MR-linac in gynaecological tumours \nLuca Boldrini; Rome/IT \n(lucaboldrini@hotmail.it) \n \nLearning Objectives: \n1. To become familiar with MR-linac gynaecological cancer treatment.  \n2. To learn about hybrid MR-guided adaptive treatment approaches. \n3. To discuss possible future developments and opportunities. \nAuthor Disclosures: \nLuca Boldrini: Advisory Board: Victoria IBA; Consultant: Varian Medical \nSystems, ViewRay Inc; Patent Holder: 202020000005950; Speaker: ViewRay \nInc. \n \nESR/ESTRO-5 \nMR anatomy of the uterus, cervix, and pelvic floor: all you need to know \nfor accurate contouring \nStephanie Nougaret; Montpellier/FR \n \nLearning Objectives: \n1. To review the basic anatomy of the uterus, cervix, and pelvic floor. \n2. To understand the relevant anatomy prior to radiotherapy for the treatment \nof uterine cancers.  \n3. To understand the relevant anatomy prior to radiotherapy in the setting of \npelvic relapse. \n \nESR/ESTRO-6 \nImage-guided adaptive brachytherapy in gynaecological tumours \nRemi Nout; Rotterdam/NL \n \nLearning Objectives: \n1. To become familiar with the concepts and methodology of MRI-based \nimage-guided adaptive brachytherapy. \n2. To review the key clinical outcomes when using this technique. \n3. To discuss the possible future developments and opportunities. \nAuthor Disclosures: \nRemi Nout: Grant Recipient: Dutch Cancer Society, Dutch Research Council, \nElekta, Varian, Accuray \n \nLive Q&A: MR-guided radiation therapy of gynaecological cancer: how \nshould radiologists and radiotherapists work in synergy? \n \n\n \n \n \nA \nB C 56  \nFriday \n/LYH\u00033URJUDPPH\u0003\n \n11:45-12:45 CHANNEL 3 \nRefresher Course: Neuro \nRC 511 \nEpilepsy imaging \nModerator \nHorst Urbach; Freiburg/DE  \n \nRC 511-2 \nA. How to investigate epilepsy \nHorst Urbach; Freiburg/DE  \n(horst.urbach@uniklinik-freiburg.de) \n \nLearning Objectives: \n1. To understand the pathophysiology of epilepsy. \n2. To learn how to image epilepsy in clinical practice. \n3. To become familiar with advanced MRI in epilepsy management. \n \nRC 511-3 \nB. How to report malformations of the cortical development \nPia C. Maly Sundgren; Lund/SE \n \nLearning Objectives: \n1. To understand the pathophysiology of cortical development. \n2. To recognise the malformations of cortical development. \n3. To learn how to report the malformations of cortical development. \n \nRC 511-4 \nC. How to image first seizure in adults? \nJérome Hodel; Paris/FR \n \nLearning Objectives: \n1. To learn how to optimise imaging protocol in patients with first seizure. \n2. To understand the specific value of arterial spin labelling (ASL) in such \npatients. \n3. To learn how to distinguish between acute stroke, stroke mimics and seizure \nusing MRI. \n \nLive Q&A: Would artificial intelligence bridge the gap in intractable \nepilepsy? \n \n11:45-12:45 CHANNEL 4 \nESR meets Austria \nMeets 1 \nBeats in the mountains \nModerators \nMichael H. Fuchsjäger; Graz/AT  \nRosemarie Forstner; Salzburg/AT  \n \nMeets 1-3 \nIntroduction \nWolfgang Schima; Vienna/AT \n(wolfgang.schima@khgh.at) \n \nLearning Objectives: \n1. To learn about what makes hearts beat faster in Austria.  \n2. To understand major risks in the mountains. \n3. To appreciate hearing the land of music. \n \nMeets 1-4 \nCardiac risk profiling in sports \nChristian Loewe; Vienna/AT \n(christian.loewe@meduniwien.ac.at) \n \nLearning Objectives: \n1. To learn about sudden cardiac death in mountain hiking. \n2. To understand cardiac risk factors in sports activities. \n3. To appreciate coronary CTA in cardiac risk profiling. \nAuthor Disclosures: \nChristian Loewe: Author: BRACCO Springer; Speaker: Siemens Healthineers \n \nMeets 1-5 \nAlpine emergency room management \nHelmut Schöllnast; Graz/AT \n \nLearning Objectives: \n1. To learn about the most frequent trauma cases in alpine regions. \n2. To understand imaging algorithms in shock room management. \n3. To appreciate multidisciplinary case reviews. \n \nMeets 1-6 \nHearing loss and modern implant rehabilitation \nGerlig Widmann; Innsbruck/AT \n(gerlig.widmann@i-med.ac.at) \n \nLearning Objectives: \n1. To learn about various hearing implants. \n2. To understand relevant preoperative conditions. \n3. To appreciate imaging in the postoperative evaluation of implants. \n \nLive Q&A: Open your heart, don't break, listen \n \n11:45-12:45 CHANNEL 5 \nResearch Presentation Session: \nRadiographers \nRPS 114 \nQuality improvement in radiography \nModerators \nMark F. McEntee; Cork/IE  \nMonique Brink; Nijmegen/NL  \n \nRPS 114-2 \nA retrospective clinical audit on the quality of positioning standards in \nplain film radiography \n*C. Nepomuceno*, M-L. Ryan, T. Neville, J. Poto þnik, L. Walsh, A. Toohey, \nV. Douglas, L. A. Rainford; Dublin/IE \n(chelsea.nepomuceno@ucdconnect.ie) \n \nPurpose: Clinical audit is designed to compare current practices to a proven \nstandard, enabling healthcare providers (HCPs) to improve the quality of \npatient care. While there are established methods of quality assurance in \nradiography e.g. reject analysis, there is an absence of literature pertaining to \nthe quality of reported images and radiography/radiology consensus. This \nstudy aimed to address the paucity of research on the standards of reported \nradiographs. \nMethods or Background: Radiology reported images were collated from 4 \nclinical sites governed by 2 HCPs, with 51 radiography staff, 10+ radiologists. \nEach HCP provided access to 200 images for 5 different radiographic \nprojections: Antero-posterior (AP) ankle, lateral knee, AP shoulder, lateral \nelbow and wrist. Images were prepared for review (n=2000) and 5 radiography \nobservers with one common to both HCPs scored each image for radiographic \npositioning using a four-point scale: 0) Unacceptable, 1) Borderline Acceptable, \n2) Definitely Acceptable, and 3) Very Good. Images indicating optimal \npositioning were provided to the observers.Observer findings were analysed \naccumulatively for each radiographic projection and each HCP. Inter-observer \nand intra-observer differences were calculated. \nResults or Findings: The results identified a substantial proportion of X-rays \nhad suboptimal positioning, 36.3% recorded scores of 1 or below. Additionally, \nthere were significant differences related to the perception of quality between \nthe observers, demonstrating the subjective nature of image quality review. \nConclusion: Preliminary data has evidenced over one-third of reported images \nare borderline acceptable at best.  Further research is warranted into \nradiography practice and how radiographers and radiologists judge diagnostic \nacceptability to inform future reject analysis developments and protocols. \nLimitations: A larger study is recommended to include a greater number of \nclinical sites and radiographic examination types. \nEthics Committee Approval: An institutional waiver from full ethics was \nconfirmed. \nFunding for this study: Global Diagnostics Ireland \nAuthor Disclosures: \nLaura Walsh: Nothing to disclose \nTom Neville: Nothing to disclose \nAndrea Toohey: Nothing to disclose \nChelsea Nepomuceno: Nothing to disclose \n\n \n \n \nA \nB C 57  \nFriday \n/LYH\u00033URJUDPPH\u0003\n \nLouise A. Rainford: Nothing to disclose \nVicki Douglas: Nothing to disclose \nJaka Potoþnik: Nothing to disclose \nMarie-Louise Ryan: Nothing to disclose \n \nRPS 114-3 \nRadiographers' view on image quality: does years of experience or \ncountry of practice influence image quality assessment \n*E. Kjelle*¹, A. K. Schanche², L. Hafskjold¹; ¹Kongsberg/NO, ²Drammen/NO \n(elin.kjelle@usn.no) \n \nPurpose: The aim of this study was to explore differences in radiographer's \nassessment of image quality based on years, or country of clinical practice. \nMethods or Background: A questionnaire with 20 cases (plain radiography \nimage and referral text) was made available to radiographers at the EFRS \nresearch HUB during ECR 2020. The cases were divided into three categories, \nbased on the European guidelines of image quality, \"Acceptable\"(8), \"Could be \nacceptable\"(11), \"Should be rejected\"(11). Respondents assessed the image \nand text and decided whether to keep or reject the image. If  an image was \nrejected the respondent gave a reason for rejection from a list of alternatives. \nIn addition, respondents could elaborate on their choice (both keep and reject) \nin free text. R was used to perform 2-tailed chi-squared tests to explore \ndifference between groups. \nResults or Findings: Of the 546 radiographers visiting the online research \nHUB, 81 radiographers participated in this survey, a response rate of 15%. 62 \nof these were practicing in Europe, and 46 had practiced as a radiographers \nfor >10 years. Radiographers with <10 years clinical practice kept 65% of \nimages compared to 62% among radiographers with >10 years clinical \npractice. Comparing country of practice, radiographers in European countries \nkept 64% of the images compared to 61% among radiographers from the rest \nof the world. Comparing the groups based on image quality category gave no \nsignificant difference in reject rate. \nConclusion: This study showed that there was no significant difference in the \nnumber of rejected images comparing years and country of practice among \nradiographers. \nLimitations: The number of respondents from countries outside Europe was \nsmall weakening the analyses for place of clinical practice. \nEthics Committee Approval: The Norwegian Center for Research Data \n(Ref:987929) approved this study. \nFunding for this study: No funding given \nAuthor Disclosures: \nLinda Hafskjold: Nothing to disclose \nAnn Kristin Schanche: Nothing to disclose \nElin Kjelle: Nothing to disclose \n \nRPS 114-4 \nOptimisation of the AP abdomen projection in large patients \n*S. Gatt*, J. L. Portelli, F. Zarb; Msida/MT \n(sharon.gatt.16@um.edu.mt) \n \nPurpose: To identify optimal exposure parameters, delivering the lowest \nradiation dose while maintaining images of diagnostic quality for the AP \nabdomen projection in large patients. \nMethods or Background: The study was composed of two phases. Phase 1: \nan anthropomorphic phantom (20cm AP abdominal diameter) was repetitively \nradiographed adding 15 layers (1cm thick) of fat reaching a maximum AP \ndiameter of 35cm. For every 5cm thickness, images were taken at 10kVp \nintervals (80kVp-120kVp). DAP, mAs and measurements of SNR and CNR \nwere recorded. Phase 2: image quality evaluation of resultant images by \nradiographers and radiologiststhrough Absolute VGA. VGA scores were \nanalysed using VGC curves. \nResults or Findings: Increasing kVp from 80kVp to 110kVp was found to be \nthe optimal kVp setting for AP abdominal diameters: < 20cm (with a 56.5% \ndecrease in DAP and 76.2% in mAs); >20 <25cm (with a 54.2% decrease in \nDAP and 76.2% decrease in mAs) and >25 < 30cm (with a 29.2% decrease in \nDAP and 59.7% decrease in mAs). Increasing the kVp from 80kVp to \n120kVp was found to be the optimal kVp setting for AP abdominal diameter < \n30 > 35 cm (with a 50.7% decrease in DAP and 73.4% decrease in mAs). All \nthis while maintaining images of diagnostic quality. \nConclusion: Tailoring the exposure parameters for large patients in \nradiography of the abdomen results in a significant dose reduction while still \nmaintaining diagnostic image quality. \nLimitations: Using an anthropomorphic phantom.  \nkVp setting was the only parameter investigated.  \nThe simulation of fat in large patients is still not 100% equivalent to its \ndistribution. \nEthics Committee Approval: University of Malta Research and Ethics \nCommittee (UREC), reference number: 2623_27082019_Sharon Gatt. \nFunding for this study: No specific grant from any funding agency in the \npublic, commercial or non-profit sectors was received. \n \nAuthor Disclosures: \nSharon Gatt: Nothing to disclose \nJonathan Loui Portelli: Nothing to disclose \nFrancis Zarb: Nothing to disclose \n \nRPS 114-5 \nWeight vs age comparison of diagnostic reference levels for paediatric \nbody computed tomography examinations \n*A. Cestnik*¹, N. Mekis², I. Delakis¹; ¹Doha/QA, ²Ljubljana/SI \n(acestnik@sidra.org) \n \nPurpose: European guidelines recommend the use of weight groups for the \ndevelopment of paediatric diagnostic reference levels (DRLs) for body \nComputed Tomography (CT) examinations. However, patient weight is not \nalways as readily available as age. The purpose of our study was to investigate \ndifferences in using age vs. weight groupings when developing paediatric \nDRLs for CT body examinations at our hospital. \nMethods or Background: Our hospital is the only tertiary paediatric hospital in \nthe country. The CT scanners are Definition Flash (Siemens Healthcare) and \ndose information is automatically collected with a dose management system \n(Radimetrics, Bayer). Patient age was extracted from PACS and patient weight \nfrom our radiology information system. Data collected was from 120 abdomen \nand 320 chest CT exams of children at different ages/weights. Data was \nfiltered carefully to ensure exam consistency. Median CTDIvol and DLP values \nwere calculated, and weight distributions were produced for different age \ngroups. \nResults or Findings: DRLs developed with either weight or age groupings \nwere comparable at younger patient ages (<4y) for chest and abdomen CT \nexams. At older ages, the distribution of weights was skewed towards higher \nvalues for abdominal CT exams and lower values for chest CT exams. As a \nresult, median CTDIvol and DLP values for older age groups were slightly \nhigher for abdomen CT exams and lower for chest CT exams, than for their \nrespective weight groups. \nConclusion: Calculating DRLs based on age groups for body CT exams was a \nreasonable alternative to using weight groups at our site only for younger ages \n(<4y). At older ages, weight groupings must be used because the distribution \nof patient weight is skewed, likely due to demographics or referral pathology. \nLimitations: Hospital has one type/vendor of CT scanners \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nNejc Mekis: Nothing to disclose \nIoannis Delakis: Nothing to disclose \nAnja Cestnik: Nothing to disclose \n \nRPS 114-6 \nEffect of body weight on iodination for human foetal post-mortem micro-\nCT imaging \n*I. C. Simcock*, S. C. Shelmerdine, N. Sebire, O. J. Arthurs; London/UK \n(ian.simcock@gosh.nhs.uk) \n \nPurpose: Micro-CT is a novel imaging technique allowing high resolution \ndiagnostic imaging in early gestational fetuses.  Internal soft tissue contrast is \nimparted through submersion of the fetus in an exogenous contrast agent (i.e. \npotassium tri-iodide (I2KI)) which passively diffuses through the foetal skin.  \nOptimal timing of foetal submersion is vital for adequate organ visualisation but \ncan be variable.  The aim of this study was to explore the relationship between \nfoetal size and iodination timing. \nMethods or Background: In this 1year, single centre, prospective study, all \nfetuses referred for micro-CT imaging were placed in 2.5% Iodine solution \n(100g KI and 50g I2 in 1000ml water, diluted 1:1 with 10% formalin) and \nscanned on a NIKON (Tring, UK) micro-CT scanner at regular intervals until \nfully iodinated.  Fetuses were excluded if a delay in the examination time, \ninsufficient I2KI or weakened solution was used.  Foetal body weight and \ngestational age were evaluated against contrast immersion time. \nResults or Findings: In total, 157 fetuses (gestational weights 5 – 298g) were \nexamined. There was a linear relationship between body weight and immersion \ntime with correlation coefficient R2 0.64. Total iodination time could be \npredicted using the formula time(days) = 0.03 x body weight(grams) + 2.2 \n(foetal weight 50g equates to adequate contrast immersion time of~3.7 days). \nConclusion: Post-mortem foetal body weight can be used to estimate the \nrequired contrast immersion time in preparation for micro-CT using a simple \nformula. This can help plan suitable time for scanning in a busy imaging \nservice. \nLimitations: Alternative concentrations of I2KI solution and higher body \nweights could be investigated. \nEthics Committee Approval: Ethical approval gained (13/LO/1994 \n+17/WS/0089). \nFunding for this study: Supported by National Institute for Health Research, \nMedical Research Council, Royal College of Radiologists, Great Ormond \nStreet Hospital Children’s Charity and NIHR GOSH BRC. \n\n \n \n \nA \nB C 58  \nFriday \n/LYH\u00033URJUDPPH\u0003\n \nAuthor Disclosures: \nIan C. Simcock: Nothing to disclose \nNeil Sebire: Nothing to disclose \nSusan Cheng Shelmerdine: Nothing to disclose \nOwen Arthurs: Nothing to disclose \n \nRPS 114-7 \nPlaque inflammation-related metabolism and plaque features of \ninstability: an initial exploration using corresponding PET/CT and MRI \nslices \n*N. Giannotti*¹, J. McNulty², S. J. Foley², S. Murphy², M. Marnane², G. Horgan², \nE. Kavanagh², M. J. O'Connell², P. Kelly²; ¹Dublin/IE, Sydney/AU, ²Dublin/IE \n(nicola.giannotti@sydney.edu.au) \n \nPurpose: The current assessment of carotid atherosclerotic lesions is based \non luminal stenosis measurements; however, histopathologic studies \ndemonstrate that morphological plaque characteristics of instability and \ninflammation may be associated with an increased risk for cerebrovascular \nevents. Magnetic Resonance Imaging (MRI) and Positron Emission \nTomography (PET) may identify patients at a higher risk to develop ischaemic \ncerebrovascular events. This study investigated whether plaque 18Fluoro-\ndeoxy-glucose/PET (18F-FDG/PET) uptake is associated with plaque MRI \nfeatures such as volume, intra-plaque haemorrhage, lipid accumulation, \ncalcification, fibrotic cap (FC) thinning at selected corresponding locations. \nMethods or Background: Inclusion criteria were: speech/motor TIA or non-\nsevere stroke (Rankin ”3);  ipsilateral carotid stenosis •50%;  age •50 years; \ncarotid plaque MRI and 18FDG-PET/CTA performed. The MRI slice showing \nthe largest accumulation of lipid was selected for the analyses; consequently, \nselected MRI carotid plaque morphological features were semi-automatically \nquantified. The maximum standardised uptake value (SUVmax) was measured \non co-registered PET/CT images at the corresponding slice using the carotid \nbifurcation as a reference. \nResults or Findings: Twenty-five symptomatic patients (72% men, mean age \n65 years) were included in the analysis. Age showed a correlation with plaque \ncalcium volume (p=0.001). In males, plaques were thicker (p=0.04) and \npresented greater lipid accumulation (p=0.013). FC volume was larger in males \n(p=0.018), smokers (p=0.026), and in patients with hypertension (p=0.089). \nSUVmax was correlated with increased plaque lipid accumulation at \ncorresponding slices (p=0.001). \nConclusion: This study demonstrated novel correlations of non-invasive \nimaging biomarkers of inflammation-related plaque metabolism with \nmorphological MRI markers of plaque instability. If replicated, our findings may \nsupport the application of combined MRI and PET to detect vulnerable plaque \nin future clinical practice and randomised trials. \nLimitations: None \nEthics Committee Approval: Full institutional review board approval \nFunding for this study: Irish Health Research Board; \nIrish Institute of Radiography and Radiation Therapy Board \nAuthor Disclosures: \nNicola Giannotti: Nothing to disclose \nGillian Horgan: Nothing to disclose \nSean Murphy: Nothing to disclose \nMichael Marnane: Nothing to disclose \nJonathan McNulty: Nothing to disclose \nMartin Joseph O'Connell: Nothing to disclose \nEoin Kavanagh: Nothing to disclose \nShane J Foley: Nothing to disclose \nPeter Kelly: Nothing to disclose \n \nLive Q&A \n \n14:15-15:15 CHANNEL 2 \nESR QuADRANT Session \nJointly organised by the ESR Audit and Standards \nSubcommittee and EuroSafe Imaging \nESR QuADRANT \nQuality improvement through audit in \ndiagnostic radiology, radiotherapy, and \nnuclear medicine: a European project on \nbehalf of the European Commission \nModerator \nDavid C. Howlett; Eastbourne/UK  \n \nESR QuADRANT-2 \nIntroduction \nDavid C. Howlett; Eastbourne/UK (david.howlett@nhs.net) \n \nLearning Objectives: \n1. To appreciate the importance of clinical audit. \n2. To review the role of audit within the EU-BSS. \n3. To examine audit-related initiatives within the ESR. \n \nESR QuADRANT-3 \nThe European Commission perspective \nGeorgi Simeonov; Luxembourg/LU \n \nLearning Objectives: \n1. To understand the background of the European Commission. \n2. To understand the background of the tender. \n3. To consider the desired outcomes of QuADRANT. \n4. To appreciate the role of clinical audit in enhancing patient care. \n \nESR QuADRANT-4 \nAims, scope, and overview of the project \nDavid C. Howlett; Eastbourne/UK (david.howlett@nhs.net) \n \nLearning Objectives: \n1. To review the structure of the project. \n2. To examine the timelines and outputs of the work packages. \n3. To consider the challenges and potential benefits for QuADRANT. \n \nESR QuADRANT-5 \nFindings and output from the initial workshop \nAdrian Brady; Cork/IE (adrianbrady@me.com) \n \nLearning Objectives: \n1. To discuss the proceedings of the initial QuADRANT workshop. \n2. To highlight key outcomes and recommendations. \n3. To consider how this workshop will drive remaining work packages. \n \nLive Q&A: How to further integrate clinical audit into European radiology \npractice? \n \n14:15-15:15 CHANNEL 3 \nE³ - Advanced Courses: How to Improve \nYour Expertise in Cardiothoracic Imaging \nE³ 1319 \nCardiovascular imaging in pregnancy \nModerator \nJean-Nicolas Dacher; Rouen/FR  \n \nE³ 1319-2 \nA. Pulmonary embolism: optimising patient's selection and radiation \nprotection \nChristian Loewe; Vienna/AT  \n(christian.loewe@meduniwien.ac.at) \n \nLearning Objectives: \n1. To learn how to adapt CT acquisition protocol during pregnancy. \n2. To become familiar with alternative imaging techniques. \n3. To become familiar with alternative diagnoses. \nAuthor Disclosures: \nChristian Loewe: Author: BRACCO Springer; Speaker: Siemens Healthineers \n \nE³ 1319-3 \nB. Acute aortic disease in pregnancy \nRicardo P.J. Budde; Rotterdam/NL \n(r.budde@erasmusmc.nl) \n \nLearning Objectives: \n1. To learn about risk factors and prevalence of acute aortic syndromes during \npregnancy. \n2. To learn how to adapt CT acquisition protocol during pregnancy. \n3. To become familiar with alternative imaging techniques. \n \n\n \n \n \nA \nB C 59  \nFriday \n/LYH\u00033URJUDPPH\u0003\n \nE³ 1319-4 \nC. Imaging peripartum cardiomyopathy and other cardiac complications \nAlexis Jacquier; Marseille/FR \n \nLearning Objectives: \n1. To learn about prevalence and clinical presentation of cardiomyopathy \nduring pregnancy. \n2. To learn an appropriate diagnostic algorithm. \n3. To become familiar with prognosis and outcome. \n \nLive Q&A \n \n14:15-15:15 CHANNEL 4 \nCoffee & Talk (open forum) Session \nOrganised by the EORTC \nC 10 \nSetting up and managing imaging trials \nModerator \nNandita M. deSouza; Sutton/UK  \n \nC 10-2 \nChallenges of introducing imaging biomarkers as end-points into clinical \ntrials \nAnouk Neven; Brussels/BE  \n(anouk.neven@eortc.org) \n \nLearning Objectives: \n1. To learn what requirements are necessary for clinical trial end-points. \n2. To appreciate the difficulties in introducing imaging biomarkers as end-\npoints. \n3. To understand what needs to be addressed to overcome the challenges. \n \nC 10-3 \nHow do I share my trial data? \nMarion Smits; Rotterdam/NL \n(marion.smits@erasmusmc.nl) \n \nLearning Objectives: \n1. To learn what is needed when archiving data for external use. \n2. To appreciate the challenges of setting up an accessible image archive. \n3. To understand the limitations. \nAuthor Disclosures: \nMarion Smits: Consultant: Parexel Ltd (fees paid to institution); Speaker: GE \nHealthcare (honorarium paid to institution) \n \nC 10-4 \nWhat is the shelf-life of imaging data? \nLuc Bidaut; Lincoln/UK \n(luc.bidaut@ieee.org) \n \nLearning Objectives: \n1. To learn about the use of quantitative imaging data for comparative studies \nover time. \n2. To appreciate the speed of the evolution of imaging technology. \n3. To understand the pitfalls of quantitative analysis from banked data. \n \nLive Q&A \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n15:30-16:30 CHANNEL 2 \nRefresher Course: Physics in Medical \nImaging \nRC 113 \nBlue skies and current trends in digital \nradiography (DR), computed tomography \n(CT), and interventional radiology (IR) \nModerator \nJonas Andersson; Umeå/SE  \n \nRC 113-2 \nA. Updates and future perspectives of DR technology \nJuha Peltonen; Helsinki/FI  \n(Juha.Peltonen@hus.fi) \n \nLearning Objectives: \n1. To learn about existing DR technologies. \n2. To learn about the state of the art in DR imaging. \n3. To predict future developments in DR imaging. \nAuthor Disclosures: \nJuha Peltonen: Owner: Fieldie Oy \n \nRC 113-3 \nB. Updates and future perspectives of MG technology \nIoannis Sechopoulos; Nijmegen/NL \n(ioannis.sechopoulos@radboudumc.nl) \n \nLearning Objectives: \n1. To learn about existing MG technologies. \n2. To learn about the state of the art in MG imaging. \n3. To predict future developments in MG imaging. \nAuthor Disclosures: \nIoannis Sechopoulos: Research Grant/Support: Siemens Healthcare, \nScreenPoint, Sectra Benelux, Volpara Solutions, Canon Medical; Speaker: \nSiemens Healthcare \n \nRC 113-4 \nC. Updates and future perspectives of CT technology \nMarc Kachelrieß; Heidelberg/DE \n(marc.kachelriess@dkfz.de) \n \nLearning Objectives: \n1. To learn about existing CT technologies. \n2. To learn about the state of the art in CT imaging. \n3. To predict future developments in CT imaging. \n \nRC 113-5 \nD. Updates and future perspectives of IR and angiography technology \nNicholas Marshall; Leuven/BE \n(nicholas.marshall@kuleuven.be) \n \nLearning Objectives: \n1. To learn about existing IR technologies. \n2. To learn about the state of the art in IR. \n3. To predict future developments in IR. \nAuthor Disclosures: \nNicholas Marshall: Research Grant/Support: Siemens Healthineers \n \nLive Q&A: What can we expect from new detectors, equipment designs, \nand post-processing/reconstruction? \n \n \n \n \n \n \n \n \n \n\n \n \n \nA \nB C 60  \nFriday \n/LYH\u00033URJUDPPH\u0003\n \n15:30-16:30 CHANNEL 4 \nSpecial Focus Session \nSF 8 \nThe most challenging bowel requests and \nhow to deal with them \nModerator \nMarc Zins; Paris/FR  \n \nSF 8-2 \nIntestinal anastomosis: a leak or not a leak? That is the question \nDamian J.M. Tolan; Leeds/UK  \n(djmtolan@doctors.org.uk) \n \nLearning Objectives: \n1. To learn about the diagnostic performance of imaging methods for detecting \nanastomotic leaks after GI surgery. \n2. To learn about the optimal CT imaging protocol. \n3. To understand the treatment of anastomotic leakages and indications for \nabscess drainage. \nAuthor Disclosures: \nDamian J.M. Tolan: Grant Recipient: UK NIHR Intact Trial \n \nSF 8-3 \nObstructed defecation syndrome? Just do MRI-defecography \nLuis Curvo-Semedo; Coimbra/PT \n(curvosemedo@gmail.com) \n \nLearning Objectives: \n1. To learn about the main functional anatomic landmarks in the radiological \nevaluation of obstructed defecation syndrome. \n2. To address the diagnosis of anorectal dyssynergia with an emphasis on how \nimaging techniques such as dynamic pelvic floor MRI and evacuation \nproctography complement and enhance the role of anorectal physiology. \n3. To understand how to use structured reporting methods for MRI of the pelvic \nfloor in clinical practice. \n \nSF 8-4 \nInternal hernia? Not always going along with bowel obstruction \nSabine Schmidt Kobbe; Lausanne/CH \n(sabine.schmidt@chuv.ch) \n \nLearning Objectives: \n1. To learn about the clinical findings and the radiological evaluation of the \nmost common internal hernias. \n2. To learn about the optimal CT imaging protocol. \n3. To specifically discuss the challenging diagnosis of collapsed closed-loop \nform of small bowel obstruction from internal hernia. \n \nLive Q&A: How to improve diagnostic performance in challenging bowel \nrequests? \n \n15:30-16:30 CHANNEL 5 \nCTiR 2 \nClinical Trials in Radiology 2 \nModerators \nMarc Dewey; Berlin/DE  \nRegina G.H. Beets-Tan; Amsterdam/NL  \n \nCTiR 2-3 \nDiagnostic accuracy of a convolutional neural network assessment of \nsolitary pulmonary nodules compared with PET/CT and DCE-CT \n*J. R. Weir-Mccall*¹, E. Debruyn², S. Harris³, N. Qureshi¹, R. Rintoul¹, F. \nGleeson຾, F. J. Gilbert¹; ¹Cambridge/UK, ²Chicago, IL/US, ³Southampton/UK, \n຾Oxford/UK \n(jw2079@cam.ac.uk) \n \nPurpose: Solitary Pulmonary Nodules (SPNs) measuring 8-30 mm in diameter \nrequire further work-up to determine likelihood of malignancy. The purpose of \nthe current study was to examine the diagnostic performance of a Lung Cancer \nPrediction Convolutional Neural Network (LCP-CNN) in nodules found on CT \ncompared to current clinical work-up. \nMethods or Background: This study was a post-hoc analysis of the SPUTNIK \ntrial.  This prospective multi-centre study compared the diagnostic accuracy of \ndynamic contrast-enhanced computed tomography (DCE-CT) with positron \nemission tomography (PET/CT) in SPNs measuring 8–30 mm in diameter.  The \nLCP-CNN was designed and validated in an external cohort of non-contrast \nCTs. LCP-CNN risk scores were generated from the non-contrast CT images \nfrom the DCE-CT. The gold standard was histology or 2-years of follow-up. The \narea under the ROC curves (AUROC) when predicting cancer diagnosis were \ncalculated using LCP-CNN score, SUVmax and DCE-CT maximum \nenhancement as predictive variables and compared using DeLongs test. \nResults or Findings: 270 (68.3±8.8 years old, 49% female) participants \nunderwent PET/CT and DCE-CT with CT data available centrally for AI-\nanalysis. The nodule size was 15.8±5.5mm, with 61% malignant.  Malignant \nnodules had a higher SUVmax (6.38±5.35 vs 1.95±1.83, p<0.001), a greater \ndegree of enhancement (61.4±58.3 vs 34.7±25.4HU) and a higher LCP-CNN \nscore (78.0±22.6 vs 41.4±29.2, p<0.001). The accuracy of the LCP-CNN on \nthe non-contrast CT (AUROC= 0.83 (95%CI 0.79;0.88)) was superior to DCE-\nCT (AUROC= 0.76 (95% CI 0.69;0.82), p=0.03), and equivalent to PET/CT \n(AUROC= 0.86 (95%CI 0.81;0.90, p=0.35)). \nConclusion: A LCP-CNN algorithm provides an AUROC equivalent to PET/CT \nin the diagnosis of solitary pulmonary nodules. Routine incorporation of this \ninto clinical practice may speed time to diagnosis with less resource utilization. \nLimitations: Higher rate of malignancy than in screening trials \nEthics Committee Approval: Approved \nFunding for this study: NIHR HTA Programme (grant no: 09/22/117) \nAuthor Disclosures: \nElise Debruyn: Nothing to disclose \nFiona J. Gilbert: Nothing to disclose \nFergus Gleeson: Shareholder at Shareholder in Optellum \nJonathan R. Weir-Mccall: Nothing to disclose \nRobert Rintoul: Nothing to disclose \nScott Harris: Nothing to disclose \nNagmi Qureshi: Nothing to disclose \n \nCTiR 2-4 \nDiscussant \nMark O. Wielpütz; Heidelberg/DE \n(wielpuetz@uni-heidelberg.de) \nAuthor Disclosures: \nMark O. Wielpütz: Grant Recipient at Vertex, Boehringer Ingelheim \n \nCTiR 2-5 \nCost-effectiveness of MRI screening for women with extremely dense \nbreast tissue \n*A. Geuzinge*¹, M. F. Bakker², E. Heijnsdijk¹, N. van Ravesteyn¹, W. B. \nVeldhuis², R. M. Pijnappel², R. Mann³, C. van Gils², H. J. de Koning¹; \n¹Rotterdam/NL, ²Utrecht/NL, ³Nijmegen/NL \n*No abstract available* \nAuthor Disclosures: \nCarla van Gils: Grant Recipient at Bayer AG Pharmaceuticals \nNicolien van Ravesteyn: Nothing to disclose \nEveline Heijnsdijk: Nothing to disclose \nAmarens Geuzinge: Nothing to disclose \nHarry J. de Koning: Nothing to disclose \nWouter B. Veldhuis: Nothing to disclose \nRitse Maarten Mann: Nothing to disclose \nRuud M Pijnappel: Nothing to disclose \nMarije F. Bakker: Nothing to disclose \n \nCTiR 2-6 \nDiscussant \nFiona J. Gilbert; Cambridge/UK \n(fjg28@cam.ac.uk) \nAuthor Disclosures: \nFiona J. Gilbert: Speaker at GE Healthcare \n \nCTiR 2-7 \nQuality of life outcomes from a randomized controlled trial comparing \ndrug-coated balloon to conventional balloon angioplasty for below-the-\nknee arteries in patients with critical limb ischaemia \n*B. S. Tan*, Z. Kun Da, A. Patel, F. Irani, D. Matchar, N. Sivapragasam, \nU. Pua, L. Sum, K. H. Tay; Singapore/SG \n \nPurpose: To report the quality of life (QOL) results of a randomized controlled \ntrial comparing drug-coated balloon (DCB) to conventional angioplasty (PTA) \nfor below-the-knee (BTK) arteries in patients with critical limb ischemia (CLI). \nMethods or Background: In this investigator-initiated, dual centre, blinded, \nrandomized controlled trial (NCT02129634), 138 patients (93 males) with mean \nage of 62.6 years (std=9.9), were randomized to either DCB (n=70) or PTA \n\n \n \n \nA \nB C 61  \nFriday \n/LYH\u00033URJUDPPH\u0003\n \n(n=68). 94.2% of the patients had diabetes and 52.9% had end stage renal \nfailure (ESRF). QOL measured with the EQ-5D over the follow up period of 12 \nmonths were compared between the 2 groups after adjustment for baseline \nutility scores. \nResults or Findings: Baseline QOL were similar in both groups. There was no \nsignificant difference in adjusted QALY gained at 12 months in both groups. \nThe 6-month target lesion angiographic primary patency (primary endpoint) \n(DCB 42.9% vs PTA 38.2%, p=0.475) and 12-month limb salvage rate (DCB \n75.0% vs PTA 84.6%, p=0.163.) were not statistically significant. The 12-month \namputation-free survival (AFS) was however better in the PTA group (DCB \n58.6% vs CB 77.9%, log rank test p = 0.012). \nConclusion: The use of DCB angioplasty for BTK interventions for CLI did not \nshow superiority in the QALY gained at 12 months compared to PTA \nangioplasty. The 6-month angiographic patency of target lesion and 12-month \nlimb salvage rate were also similar. AFS was however significantly different at \n12 months, in favor of the PTA group. \nLimitations: The operators were not blinded and ascertainment bias cannot \nbe excluded. \nEthics Committee Approval: Yes. \nFunding for this study: National Medical Research Council, Singapore \nAuthor Disclosures: \nDavid Matchar: Nothing to disclose \nNirmali Sivapragasam: Nothing to disclose \nLeong Sum: Nothing to disclose \nKiang Hiong Tay: Nothing to disclose \nFarah Irani: Nothing to disclose \nZhuang Kun Da: Nothing to disclose \nBien Soo Tan: Nothing to disclose \nAnkur Patel: Nothing to disclose \nUei Pua: Nothing to disclose \n \nCTiR 2-8 \nDiscussant \nStevo Duvnjak; Odense/DK \n(duvnjak.stevo@gmail.com) \nAuthor Disclosures: \nStevo Duvnjak: Nothing to disclose \n \nCTiR 2-9 \nBrain atrophy and endovascular treatment effect in acute ischaemic \nstroke \n*S. Luijten*¹, A. van Es², Y. Roos³, C. B. L. M. Majoie³, R. van Oostenbrugge ຾, \nW. Van Zwam຾, D. Dippel¹, A. Van Der Lugt¹, D. Bos¹; ¹Rotterdam/NL, \n²Leiden/NL, ³Amsterdam/NL, ຾Maastricht/NL (s.luijten@erasmusmc.nl) \n*No abstract available* \nAuthor Disclosures: \nAad Van Der Lugt: Grant Recipient at Dutch Heart Foundation, Dutch Brain \nFoundation, The Netherlands Organisation for Health Research and \nDevelopment, Health Holland Top Sector Life Sciences & Health, Stryker \nEuropean Operations BV, Thrombolytic Science, LLC, Penumbra, Medtronic \nand Cerenovus for new trials in acute stroke treatment \nSven Luijten: Nothing to disclose \nCharles Bernardus Lucia Maria Majoie: Shareholder at Nico.lab Grant \nRecipient at CVON/Dutch Heart Foundation, European Commission, TWIN \nFoundation and Stryker \nDiederik Dippel: Grant Recipient at Dutch Heart Foundation, Dutch Brain \nFoundation, The Netherlands Organisation for Health Research and \nDevelopment, Health Holland Top Sector Life Sciences & Health, Stryker \nEuropean Operations BV, Thrombolytic Science, LLC, Penumbra, Medtronic \nand Cerenovus for new trials in acute stroke treatment \nAdriaan van Es: Nothing to disclose \nWillem Van Zwam: Grant Recipient at Cerenovus® and Stryker® \nYvo Roos: Grant Recipient at CVON/Dutch Heart Foundation Shareholder at \nNico.lab \nRobbert van Oostenbrugge: Nothing to disclose \nDaniel Bos: Nothing to disclose \n \nCTiR 2-10 \nDiscussant \nJohan Van Goethem; Antwerp/BE \n(johan.vangoethem@uantwerpen.be) \nAuthor Disclosures: \nJohan Van Goethem: Nothing to disclose \n \n \n \n \n16:45-17:45 CHANNEL 2 \nMultidisciplinary Session \nMS 1 \nVenous thromboembolic disease \nModerator \nGerard O'Sullivan; Galway/IE  \n \nMS 1-2 \nHaematology management in VTE: which patients for intervention, which \npatients for conservative? My clinical perspective \nRuth Gilmore; Galway/IE  \n \nLearning Objectives: \n1. To describe why some patients are more suitable for intervention and others \nless so. \n2. To discuss the anticoagulation management around catheter directed \nthrombolysis and why fibrinogen even matters. \n3. To discuss anticoagulation regimes post op and when to choose low \nmolecular weight heparin vs warfarain vs NOAC. \n \nMS 1-3 \nPatient selection and interventional options in deep vein thrombosis \nDouglas Mulholland; London/UK \n(doug2057@gmail.com) \n \nLearning Objectives: \n1. To understand which patients I am keen to treat and why. \n2. To show which treatment options I favour. \n3. To share my worst disaster in DVT intervention and how we managed it. \n \nMS 1-4 \nPatient selection and interventional options in pulmonary embolus? \nStephen T. Kee; Dublin/IE \n(stephentkee@gmail.com) \n \nLearning Objectives: \n1. To understand which patients I am keen to treat and why. \n2. To show which treatment options I favour. \n3. To share my worst disaster in PE intervention and how we managed it. \n \nMS 1-5 \nPrecise, patient-directed imaging in DVT and PE \nCarsten Arnoldussen; Maastricht/NL \n \nLearning Objectives: \n1. To describe the various imaging modalities for DVT and PE. \n2. To describe my preferred modalities for DVT and PE. \n3. To discuss future directions, particularly with respect to MRV and thrombus \naging. \n \nMS 1-6 \nMultidisciplinary case presentation \nGerard O'Sullivan; Galway/IE \n(gerard.osullivan2@hse.ie) \nAuthor Disclosures: \nGerard O'Sullivan: Advisory Board: Medtronic Philips; Consultant: BSCI COOK \nMEDTRONIC BD WHITESWELL CREGANNA VETEX MARVAO; Patent \nHolder: VETEX ; Share Holder: VETEX Orthosensor \n \nLive Q&A \n \n \n \n \n \n \n \n \n \n\n \n \n \nA \nB C 62  \nFriday \n/LYH\u00033URJUDPPH\u0003\n \n16:45-17:45 CHANNEL 5 \nResearch Presentation Session: Oncologic \nImaging \nRPS 216 \nProtocol optimisation and quality control \nfor advanced oncologic imaging \ntechniques \nModerator \nHelmut Ringl; Vienna/AT  \n \nRPS 216-2 \nDose to oncologic patients in multi-phase CT examination: a single-\ncentre survey \n*P. De Marco*, D. A. Origgi; Milan/IT  \n(paolo.demarco@ieo.it) \n \nPurpose: Aim of this work is to evaluate effective dose to oncologic patients in \nmulti-phase CT examinations. \nMethods or Background: 18987 staging and follow-up examinations \nperformed at our institution from January 2018 to September 2020 on 2 \ndifferent scanners were collected with a dose-tracking software (Radimetrics, \nBayer HealthCare) and were filtered and aggregated according to body part \nexamined and number of acquisitions for each examinations.Numbers of \nexaminations and relative frequency (RF) of the number of phases are \nreported.Effective doses (E) obtained from organ doses were calculated by the \nsoftware, results are presented as median and interquartile ranges (IQR). \nResults or Findings: 8275 Chest-Abdomen-Pelvis (CAP) examinations \npresented E of 13.6, 21.0, 26.9 and 33.5 mSv, for 1 to 4 phases respectively \nand a RF of 27%,22%,26% and 25% each (IQR 11.2-16.8, 16.5-26.2, 21.9-\n35.2, 26.2-43.9 mSv). 901 Abdomen exams performed with 4 (62%) or 5 (38%) \nphases, had E of 28.6 and 36.1 mSv, respectively (IQR 20.8-37.5 and 28.0-\n49.0 mSv), while 1972 Abdomen-Pelvis showed E of 10.4, 18.7, 26.9 and 33.0 \nmSv for 1(22%), 2(14%), 3 (26%) and 4 (38%) phases (IQR 8.1-13.9, 14.2-\n23.7, 21.2-35.4, 26.0-42.4 mSv). 3495 single-phase Chest exams had an \neffective dose of 7.6 mSv (IQR 6.0-9.7 mSv). 4344 Head-CAP examinations \nwith 2 phases on the head and 1-to-4 phases on the body (RF 17%,24%,34% \nand 25%) exposed patients to median E of 17.5, 24.4, 30.5 and 36.8 mSv as \nnumber of phases increase (IQR 14.7-21.4, 19.9-30.2, 25.1-37.7, 29.6-46.1 \nmSv). \nConclusion: Oncologic patients undergoing multi-phase CTs are exposed to \nsignificant doses: considering the high numbers of examinations performed \nduring the diagnostic and therapeutic path, the need of optimization is highly \nrelevant and poses challenges to medical physicists, radiologists and \nradiographers involved. \nLimitations: None. \nEthics Committee Approval: Not required. \nFunding for this study: None. \nAuthor Disclosures: \nDaniela Anna Origgi: Nothing to disclose \nDipl.-Phys. Paolo De Marco: Nothing to disclose \n \nRPS 216-3 \nAssessment of repeatability, robustness and performances of T2-\nmapping based radiomics features: a comparative study \n*A. Crombe*¹, X. Buy¹, F. Han², S. Toupin³, M. Kind¹; ¹Bordeaux/FR, ²Los \nAngeles, CA/US, ³Saint-Denis/FR \n \nPurpose: MRI-based radiomics features are sensitive to several acquisition \nand post-processing parameters, including the signal intensity harmonization \ntechnique (IHT). Our aim was to investigate if a quantitative T2-mapping could \nhelp overcoming this issue. \nMethods or Background: Twenty-six healthy adult volunteers prospectively \nunderwent two abdominal MRI-scans at 1.5-T (MAGNETOM Aera) including \nradial TSE multi-echo T2-mapping (prototype) and classical TSE T2-WI with \nprospective motion correction. Six volumes-of-interest (VOIs) were manually \ndrawn (liver, kidney, pancreas, muscle, bone, spleen). After sequences co-\nregistration, initial T2-WIs were further post-processed with two IHTs: \nstandardization and histogram-matching (HM) providing four paired datasets \n(initial T2-WI, standardized T2-WI, HM T2-WI and T2-mapping). The VOIs \nwere propagated on all sequences to extract 45 RFs from MRI-1 and MRI-2 of \neach dataset. The influence of the datasets on RF values, test-retest \nreproducibility of RFs (through intra-class correlation coefficient [ICC]), \nrobustness of RFs over multiple segmentations and correlations between k-\nmeans clustering labels and the six segmented tissues depending on the RFs \ndataset (through adjusted-Rand-index [ARI]) were investigated. \nResults or Findings: 41/45 (91.1%) RFs were significantly influenced by the \ndatasets (p-values range:<0.0001-0.192). The T2-sequence and/or its post-\nprocessing was the most influent factor on the repeatability of RFs (F-\nvalue=174.9, p-value<0.0001). In the six tissues, the test-retest ICCs from T2-\nmapping displayed intermediate values between initial T2-WI (lowest \nreproducibilities) and HM T2-WI (highest reproducibilities). The number of \nrobust RFs was: 38/45 (84.4%) with HM T2-WI, 35/45 (77.8%) with \nstandardized T2-WI and T2-mapping and 28/45 (62.2%) with initial T2-WI. The \nbest discrimination of tissues was reached with the T2-mapping and the worse \nwith HM T2-WI (ARI=0.624 and 0.152, respectively). \nConclusion: The best compromise between repeatability, robustness and no \nloss of information was obtained with the T2-mapping. \nLimitations: No phantom; single-center; number of volunteers \nEthics Committee Approval: IRB-approved \nFunding for this study: None \nAuthor Disclosures: \nXavier Buy: Nothing to disclose \nAmandine Crombe: Nothing to disclose \nSolenn Toupin: Employee at Siemens healthineers \nMichèle Kind: Nothing to disclose \nFei Han: Employee at Siemens Healthineers \n \nRPS 216-4 \nSubsolid nodule detection in low-dose photon-counting CT of the chest \n*E. Wehrse*, L. T. Rotkopf, P. Mayer, C. P. Heussel, C. H. Ziener, S. Delorme, \nM. Kachelrieß, H-P. Schlemmer, S. Sawall; Heidelberg/DE \n(e.wehrse@dkfz-heidelberg.de) \n \nPurpose: To evaluate the potential of photon-counting (PC) CT for the \ndetection of subsolid nodules (SN) in low-dose chest acquisitions compared to \nconventional energy-integrating (EI) CT. \nMethods or Background: A model of lung parenchyma with SN was \nmeasured using an experimental CT equipped with an EI and a PC detector \n(SOMATOM CounT, Siemens Healthineers). The model consisted of 20 slices \nof polyurethane foam (-770 HU at 120 kV), placed in a semi-anthropomorphic \nthorax phantom (QRM Möhrendorf). In computationally generated randomly \ndistributed positions, 0.7 mm holes were inserted and filled with a mixture of a \nwater-based gel and palmitic-acid-based foam. Dose-matched acquisitions \n(CTDIvol,32cm  2.7 mGy) at 120 kV were performed using both detectors. \nReconstruction was performed on a 1024×1024 matrix using a slice thickness \nof 1 mm and a B70f kernel. Two board-certified radiologists and three residents \nassessed the image stack with the task of identifying all SN. A nodule was \nconsidered correctly identified if the user clicked within 2.5 mm of the correct \nnodule position. \nResults or Findings: Image noise was 85 HU in PC and 120 HU in EI images \nat the same dose and resolution. In total, 103 nodules were placed in the \nphantom (-340 ±120 HU). Lesion-based sensitivity is considerably higher in PC \n(median 51%, range 26-69%), compared to EI CT (median 40%, range 10-\n56%), leading to a relative increase of sensitivity of 25%. Specificity was \n>99.0% for both detectors. \nConclusion: Our results demonstrate the advantages of PC CT compared to \nEI CT, i.e. lower noise-levels and higher contrast-to-noise ratios at constant \ndose. This translates into an increase of accuracy in the detection of SN in low-\ndose chest CT. \nLimitations: The influence of lung parenchyma texture, nodule shapes and \nsizes remains to be investigated. \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nClaus Peter Heussel: Nothing to disclose \nChristian Herbert Ziener: Nothing to disclose \nStefan Delorme: Nothing to disclose \nLukas Thomas Rotkopf: Nothing to disclose \nPhilipp Mayer: Nothing to disclose \nHeinz-Peter Schlemmer: Nothing to disclose \nMarc Kachelrieß: Nothing to disclose \nStefan Sawall: Nothing to disclose \nEckhard Wehrse: Nothing to disclose \n \nRPS 216-5 \nOptimisation of contrast medium volume for abdominal CT in oncologic \npatients: a prospective comparison between fixed and lean body weight-\nadapted dosing protocols \n*B. Bracci*, M. Zerunian, G. Guido, F. Pucciarelli, C. Rucci, M. Polici, E. \nLucertini, A. Laghi; Rome/IT \n \nPurpose: Patient body size represents the main determinant of parenchymal \nenhancement and by adjusting the contrast medium (CM) dose to patient \nweight may be a more appropriate approach to avoid a patient over dosage of \n\n \n \n \nA \nB C 63  \nFriday \n/LYH\u00033URJUDPPH\u0003\n \nCM. Thus, we aims to compare the performance of fixed-dose and lean body \nweight (LBW)-adapted contrast medium dosing protocols, in terms of image \nquality and parenchymal enhancement. \nMethods or Background: One-hundred cancer patients undergoing \nmultiphasic abdominal CT were prospectively enrolled in this multicentric study \nand randomly divided in two groups: patients in fixed-dose group (n=50) \nreceived 120 mL of CM (Iomeprol 350 mg/mL) while in LBW group (n=50) the \namount of CM was computed according to the patient’s LBW. Signal-to-noise \nratio (SNR), contrast-to-noise-ratio(CNR) and contrast enhancement index \n(CEI) were compared in the two groups on arterial and portal-venous phase in \nsplanchnic organs. \nResults or Findings: LBW protocol group received a significantly lower \namount of CM (103.47 ± 17.65 mL vs 120.00 ± 0.00 mL, P<0.001). Arterial \nkidney SNR and CNR and pancreatic CNR were significantly higher in LBW \ngroup (all P”0.004). LBW group provided significantly higher arterial liver, \nkidney, and pancreatic CEI and portal-venous phase kidney CEI (all P ”0.002).  \nSignificantly lower portal-venous SNR and CNR were observed in LBW-Group \n(all P”0.020). \nConclusion: LBW-adapted CM administration for abdominal CT reduces the \nvolume of injected CM and improves both image quality and parenchymal \nenhancement. In patients affected by chronic diseases should be evaluated the \noption to standardize an LBW-adapted protocol in order to reduce the risks of \nacute kidney failure caused by contrast medium. \nLimitations: Small population sample. \nEthics Committee Approval: Study approved by local institutional review \nboard; informed consent received from all patients. \nFunding for this study: No. \nAuthor Disclosures: \nFrancesco Pucciarelli: Nothing to disclose \nCarlotta Rucci: Nothing to disclose \nMarta Zerunian: Nothing to disclose \nBenedetta Bracci: Nothing to disclose \nAndrea Laghi: Nothing to disclose \nMichela Polici: Nothing to disclose \nGisella Guido: Nothing to disclose \nElena Lucertini: Nothing to disclose \n \nRPS 216-6 \nProposal for an improved HCC-diagnostic protocol for perfusion-CT \nquantification \n*K. Ekert*¹, M. Horger¹, W. Thaiss²; ¹Tübingen/DE, ²Ulm/DE \n \nPurpose: To refine the perfusion-CT (PCT) examination-protocol in patients \nwith liver cirrhosis and suspected hepatocellular carcinoma (HCC) capable to \nreplace 3-4-phase contrast-enhanced-CT while keeping diagnostic accuracy \nand qualitative assessment of tumor enhancement patterns (wash-in/wash-out) \nat a comparable radiation dose. \nMethods or Background: 123 liver PCT examinations were evaluated \nretrospectively in 76 patients (mean age 64.8 ± 10.0 years, 6 female) between \nOctober 2015 and December 2016 for suspected HCC. PCT (temporal-\nresolution 1.5sec/80kVp/100mAs for 40sec) was used and arterial liver \nperfusion (ALP), portal-venous perfusion (PVP) and hepatic perfusion index \n(HPI) were quantified. Two additional spiral data sets after 80 sec were \nincluded to generate subtraction maps for arterial phase (AP, 18.5sec post \ninjection), early (EPVP, 40sec) and late portal-venous phase (LPVP, 86sec), \nas well as LPVP minus EPVP to quantify wash-out. \nResults or Findings: 141 lesions were analyzed. In 10 examinations no HCC \nwas found at PCT. HCCs could be identified and characterized by wash-in and \nwash-out enhancement patterns as well as in terms of ALP (mean 45.6 22.9 \nmL/100mL/min), PVP (7.8 14 mL/100mL/min) and HPI (88.1 18.9%). Dose \nlength product for perfusion-CT was 1003±89 mGy x cm, resulting in a mean \neffective dose of 15.05 mSv and standard abdominal four phase CT \nexamination of 16.75 mSv. \nConclusion: Perfusion-CT with added late phase imaging can provide the \ninformation necessary to characterize and diagnose HCC without the need for \nadditional equilibrium phase acquisitions with comparable radiation dose to \nstandard abdominal three or four phase CT and additional perfusion-based \ntumor characterization. \nLimitations: There was no histologic proof of HCC, but indirect confirmation by \nnon-invasive imaging and follow-up. \nEthics Committee Approval: This retrospective study was approved by the \nethics committee. \nFunding for this study: No funding received. \nAuthor Disclosures: \nMarius Horger: Author at senior author \nKaspar Ekert: Nothing to disclose \nWolfgang Thaiss: Nothing to disclose \n \nRPS 216-7 \nImpact of attenuation correction CT parameters on PET reconstruction \n*K. Binzel*, C. L. Wright, M. V. Knopp; Columbus, OH/US \n \nPurpose: In vivo validation of equivalence of ultra-low dose attenuation CT for \nclinical PET reconstruction. \nMethods or Background: Five canines underwent 18F-FDG PET imaging on \na next-generation digital photon counting system (Philips Vereos). 75 minutes \npost-injection a 90 second/bed PET acquisition was performed over the whole \nbody. Multiple CT series were acquired for validation. First, the standard \nprotocol utilizing 120kVp, 150mAs, 4 and 2 mm slice thickness followed by \nultra-low dose (uLD) acquisition with 80kVp, 20 (n=3) or 25 (n=2) mAs, at \n4mm. The same PET acquisition was reconstructed using each different CT \nseries. \nResults or Findings: Blinded review found no significant differences in image \nquality or hot spot conspicuity among the differently reconstructed PETs. Using \nthe full dose 4mm CT corrected PET images as reference, there was an \naverage of 0.6% and 0.2% difference in SUVmean for background regions \nmeasured on the uLD 4mm and full dose 2mm corrected PET images, \nrespectively. One subject had two hot lymph nodes with SUVmax \nmeasurements of 4.56, 4.49, and 4.56 for the first and 4.35, 4.31, and 4.35 for \nthe second, for the full dose 4mm, uLD 4mm, and full dose 2mm corrected PET \nimages, respectively. \nConclusion: To enable CT radiation dose reduction in PET, the use of ultra-\nlow dose CT in this in vivo intra-individual analysis revealed a negligible impact \non PET visualization and quantification. \nLimitations: As repeat CTs in patients would not be ethical, this assessment \nwas limited to a small number of canine subjects. Prospective trials will help \nvalidate the results. \nEthics Committee Approval: All imaging was performed with approval of the \nUniversity Institutional Animal Care and Use Committee \nFunding for this study: 5R01EB022134-04 and Ohio Third Frontier OSDA \nTECH 09-028 and 13-060 grants \nAuthor Disclosures: \nChadwick Lewis Wright: Nothing to disclose \nKatherine Binzel: Nothing to disclose \nMichael Vinzenz Knopp: Nothing to disclose \n \nRPS 216-8 \nInfluence of the low-dose CE-MDCT scanning protocol parameters on the \nresults of pancreatic ductal adenocarcinoma radiomic analysis \n*V. Tikhonova*, I. Gruzdev, E. V. Kondratyev, G. Karmazanovsky; Moscow/RU \n(vdovenkobc28@mail.ru) \n \nPurpose: The key to the CT-diagnosis of pancreatic ductal adenocarcinoma \n(PDAC) is to achieve the greatest possible contrast difference between intact \npancreatic parenchyma and tumor. According to world literature low-dose CT \nprotocol improves the visibility of pancreatic cancer compared to the standard \nprotocol. The purpose of this study was to investigate the dependence of \ntextural features of pancreatic ductal adenocarcinoma on using standard and \nlow-dose CT protocol. \nMethods or Background: The study included 52 consecutive patients with \nhistologically confirmed PDAC who underwent CE-MDCT using standard (120 \nkV) or low-dose (100 kV) scanning protocols. We compared radiomics features \nof the same histological grade PDAC between standard and low-dose \nprotocols using unenhanced, arterial, venous, and delayed-phase of the CT-\nscan. \nResults or Findings: We calculated 52 radiomics features in all types of \nPDAC grade differentiation for unenhanced, arterial, venous, and delayed-\nphase MDɋT scans. We found that less than half of the radiomic features differ \nstatistically significantly when using different protocols in all types of tumor \ndifferentiation. Kurtosis was the most sensitive and specific parameter of \nradiomics for preoperative PDAC grade prediction. The diagnostic accuracy of \nthis feature did not depend on the kV change in the patient's CT protocol. \nConclusion: The use of a low-dose CT protocol doesn’t affect for PDAC grade \nprediction. \nLimitations: The study was single-centred with standardised CE-CT protocols. \nEthics Committee Approval: Informed consent was obtained from all patients \nfor using  data of their studies in the clinical trial.  \nThe institutional review board approved this prospective study. \nFunding for this study: The reported study was funded by Russian \nFoundation for Basic Research according to the research project ʋ 20-315-\n90092. \nAuthor Disclosures: \nEvgeny V Kondratyev: Nothing to disclose \nValeriya Tikhonova: Grant Recipient at The reported study was funded by \nRussian Foundation for Basic Research according to the research project ʋ \n20-315-90092. \nGrigory G. Karmazanovsky: Nothing to disclose \nIvan Gruzdev: Nothing to disclose \n \nLive Q&A \n \n\n \n \n \nA \nB C 64  \nFriday \n/LYH\u00033URJUDPPH\u0003\n \n18:00-19:00 CHANNEL 2 \nE³ - ECR Master Class \nE³ 1726 \nPost-treatment emergencies in oncologic \npatients \nModerator \nDigna R. Kool; Amsterdam/NL \n \nE³ 1726-2 \nA. Chest \nHelmut Prosch; Vienna/AT  \n \nLearning Objectives: \n1. To become familiar with the modern approach to malignant chest tumour \ntherapy. \n2. To learn how to differentiate clinically important complications. \n3. To understand how to look for the early signs of severe and urgent \nconditions. \nAuthor Disclosures: \nHelmut Prosch: Advisory Board: Boehringer Ingelheim, MSD, Roche; Speaker: \nBoehringer Ingelheim, Roche, BMS, MSD, AstraZeneca, Novartis \n \nE³ 1726-3 \nB. Abdomen \nRaffaella Basilico; Chieti/IT \n(rbasilic@unich.it) \n \nLearning Objectives: \n1. To learn about different therapies used in abdominal tumours. \n2. To become familiar with possible complications. \n3. To understand the effectiveness of imaging modalities in the evaluation of \nemergent complications. \n \nE³ 1726-4 \nC. How can interventional radiologists help in the management of \noncological treatment complications? \nKrzysztof K. Pyra; Lublin/PL \n(k.pyra@poczta.fm) \n \nLearning Objectives: \n1. To understand the role of interventional radiology in modern tumour therapy \nand the complications. \n2. To become familiar with interventional techniques used in the treatment of \ncomplications of different tumour therapies. \n3. To learn which tumour therapy complications can be treated with \ninterventional radiology. \n \nLive Q&A: What is the impact of complication findings on the continued \nmanagement of oncologic patients? \n \n18:00-19:00 CHANNEL 3 \nJoint Session of the ESR and EIBIR \nESR/EIBIR \nFunding the future of research in artificial \nintelligence (AI) and cardiac imaging: \nreports from the ESR Research Seed Grant \nprojects \nModerators \nMarc Dewey; Berlin/DE  \nGabriel P. Krestin; Rotterdam/NL  \n \nESR/EIBIR-3 \nReliability of cardiothoracic ratio as an estimate of cardiac enlargement \ncompared to gold standard MRI \nMonika Arzanauskaite; Liverpool/UK \n \n \nLearning Objectives: \n1. To learn about the reliability of cardiothoracic ratio as an estimate of cardiac \nenlargement. \n2. To learn about the project progress. \n \nESR/EIBIR-5 \nMRI-assessed myocardial deformation of the systemic right ventricle in \npatients with transposition of the great arteries: a cross-sectional study \nMaja Hrabak Paar; Zagreb/HR \n(maja.hrabak.paar@mef.hr) \n \nLearning Objectives: \n1. To learn about MRI-assessed myocardial deformation. \n2. To learn about the project progress. \nAuthor Disclosures: \nMaja Hrabak Paar: Grant Recipient: This project has received funding from the \nSeed Grant funding programme of the European Society of Radiology (ESR) in \ncollaboration with the European Institute for Biomedical Imaging Research \n(EIBIR) \n \nESR/EIBIR-4 \nRISK: risk maps using T2 mapping and diffusion MR sequences of the \nprostate \nMirjam Lenz; Cologne/DE \n \nLearning Objectives: \n1. To learn about risk maps using T2 mapping and diffusion MR sequences. \n2. To learn about the project progress. \nAuthor Disclosures: \nMirjam Lenz: Employee: Philips GmbH Innovative Technologies (K. \nSonnabend, R. Shahzad); Research Grant/Support: ESR Seed Grant \n \nESR/EIBIR-6 \nMR-based biomarkers of tumour hypoxia \nIeva Kurilova; Amsterdam/NL \n(i.kurilova@nki.nl) \n \nLearning Objectives: \n1. To learn about AI-driven MR-based imaging of tumour hypoxia. \n2. To learn about the project progress. \nAuthor Disclosures: \nIeva Kurilova: Research Grant/Support: ESR/EIBIR Research Seed Grant \n \nESR/EIBIR-7 \nValue of cardiac magnetic resonance imaging derived temporal \nmyocardial strain pattern for non-invasive diagnosis of myocarditis \nFabian C. Laqua; Greifswald/DE \n \nLearning Objectives: \n1. To learn about spatio-temporal cardiac motion patterns. \n2. To learn about the project progress. \nAuthor Disclosures: \nFabian C. Laqua: Research Grant/Support: European Society of Radiology and \nEuropean Institute for Biomedical Imaging Research; Share Holder: FCL holds \nshares of companies developing and/or selling soft- and hardware in the field \nof artificial intelligence and machine learning \n \nESR/EIBIR-8 \nImpact of myocardial motion on the relationship between transmitral flow \nand left ventricular filling rates \nClemens Reiter; Graz/AT \n(Clemens.Reiter@medunigraz.at) \n \nLearning Objectives: \n1. To learn about compressed sensing whole-heart 4D-Flow imaging. \n2. To learn about the project progress. \n \nESR/EIBIR-9 \nCT-based radiomics analysis to predict malignancy in patients with \nintraductal papillary mucinous neoplasm (IPMN) of the pancreas \nDavid Tobaly; Clichy/FR \n \nLearning Objectives: \n1. To learn about T-based radiomics analysis in cancer. \n2. To learn about the project progress. \nAuthor Disclosures: \nDavid Tobaly: Research Grant/Support: Eibir \n \n \n \n\n \n \n \nA \nB C 65  \nFriday \n/LYH\u00033URJUDPPH\u0003\n \nESR/EIBIR-10 \nTowards automated TNM-staging of NSCLC in FDG-PET/CT: evaluation of \ncombined deep learning strategies \nThomas Weikert; Basle/CH \n(thomasjohannes.weikert@usb.ch) \n \nLearning Objectives: \n1. To learn about the integration of an algorithm for automated detection of \ncancer. \n2. To learn about the project progress. \n \nLive Q&A \n \n18:00-19:00 CHANNEL 4 \nResearch Presentation Session: Head and \nNeck \nRPS 208 \nThyroid imaging and otology/audiology \nModerator \nBerit Verbist; Leiden/NL  \n \nRPS 208-2 \nApplication of medical 3D printing in cochlear implantation for precise \nelectrode array placement: a prospective study \n*S. Agarwal*, M. Grover, M. Bagarhatta, A. Prakash; Jaipur/IN  \n(srishtiagarwal243@gmail.com) \n \nPurpose: 3D printing consists of a software technology that can generate \ncomputational model from a patient’s data. We have used this technology for \nthe estimation of an individual's cochlear duct length as a basis for electrode \nselection. \nMethods or Background: 3D models of cochlea are created by entering an \nindividual’s pre-operative manually segmented cochlear DICOM images from \nHRCT temporal bone and converting it into STL format.  A 3D printer then \nfabricates the STL files and fuses successive 2D layers of material. The \noutcome data represents the exact anatomy and a proportionately increased \nsize of the cochlea as that present in the particular individual. All relevant data \nprotection regulations are complied with. \nResults or Findings: Our study included 42 patients from age 0 to 3 years \nreferred during the year 2016 to 2018, with bilateral profound to severe \nsensorineural hearing loss with normal cochlear anatomy on HRCT temporal \nbone and normal MRI brain. 3D cochlea were printed for each patient and \npersonalized length of electrode array were evaluated. The cochlear duct \nlength were compared to that based upon a two-dimensional CT image. The \nlength predicted by 3D prints were significantly better (p < 0.01) than that \ncalculated by two dimensional CT images, taking postoperative insertion depth \nas gold standard.  \nThe patients were followed up for at least 2 years and pre and post operative \nMeaningful Auditory Integration Scale Score were assessed. \nConclusion: 3D model of cochlea helps: Open new dimensions in education in \nperceiving human cochlear anatomy. Precise intracochlear electrode array \nplacement. Provides a person centric treatment and thus a better prognosis on \nan individual level. \nLimitations: The small sample size is a limitation. \nEthics Committee Approval: Approved by ethical committee. \nFunding for this study: Not applicable \nAuthor Disclosures: \nAparna Prakash: Nothing to disclose \nMeenu Bagarhatta: Nothing to disclose \nMohnish Grover: Nothing to disclose \nSrishti Agarwal: Nothing to disclose \n \nRPS 208-4 \nDoes shear wave elastography definitively characterize TIRADS 3 and 4 \nnodules? An efficient resolution to Pandora's box of numbers \n*S. B. Grover*¹, L. Garg¹, S. Patra¹, H. Grover², C. Chintamani¹, G. Khanna¹; \n¹New Delhi/IN, ²New York, NY/US \n(shabnamgrover@yahoo.com) \n \nPurpose: The present study aimed to assess diagnostic performance of \npreviously published shear wave elastography (SWE) values for predicting \nmalignancy in ACR-TIRADS 3 & 4 suspicious thyroid nodules using \ncytology/histopathology as gold standard. Secondary purpose was to \ndetermine our own SWE value cut-offs for characterizing thyroid nodules as \nbenign or malignant. \nMethods or Background: In this  IRB approved study, 60 patients with \nTIRADS 3 or 4 nodules diagnosed on conventional ultrasound, were further \nevaluated  by Shear Wave Elastography (SWE), using a Siemens S-3000 \nscanner. In patients with multiple nodules, single most suspicious nodule was \ninterrogated. Lesions were classified into benign or malignant, using previously \npublished SWE cut-off value of 85.2 kPa with higher values indicating \nmalignancy. FNAC/histopathology was considered as gold standard. Statistical \nanalysis was performed for sensitivity, specificity, NPV, PPV and diagnostic \naccuracy (DA) of the latter SWE values. ROC curve was retrospectively \nconstructed from the SWE values as correlated with histopathology in our \ncohort and our own cut-off value for SWE was computed. \nResults or Findings: By ACR criteria 29 nodules were TIRADS 3 and 31 were \nTIRADS 4. Using established SWE cut-offs, 27 were classified as benign and \n33 as malignant. FNAC/histopathology revealed 28 as benign and 32 as \nmalignant. Using published SWE cut-offs, sensitivity, specificity, PPV, NPV and \nDA was 81.3%, 96.4%, 96.3%, 81.8% and 88.3% respectively. The SWE value \ndetermined from our cohort was 74 kPa, with sensitivity, specificity, PPV, NPV \nand DA of 96.9%, 85.7%, 88.6%, 96.0% and 91.7% respectively. \nConclusion: For TIRADS 3 and 4 nodules, SWE has a good diagnostic \naccuracy and the lower SWE cut-off value obtained in our study differs \nsignificantly from previous studies (p<0.05), with superior sensitivity, NPV and \ndiagnostic accuracy. \nLimitations: Small sample size \nEthics Committee Approval: Yes \nFunding for this study: None \nAuthor Disclosures: \nChintamani Chintamani: Nothing to disclose \nSayantan Patra: Nothing to disclose \nShanam Bhandari Grover: Nothing to disclose \nGeeika Khanna: Nothing to disclose \nHemal Grover: Nothing to disclose \nLovish Garg: Nothing to disclose \n \nRPS 208-5 \nTIRADS, SRE and SWE in Indeterminate thyroid nodule characterization: \nwhat is more effective? \n*D. Fresilli*, I. Celletti, G. Polti, E. Polito, G. T. Lucarelli, P. Pacini, O. Guiban, \nV. Cantisani, C. Catalano; Rome/IT \n(daniele.fresilli@hotmail.it) \n \nPurpose: To assess Strain Ratio (SRE) and Shear Wave Elastography (SWE) \naccuracy alone and with TIRADS classification, for the risk stratification of \nindeterminate thyroid nodules. \nMethods or Background: 128 Patients with 128 indeterminate nodules \ncandidates for thyroidectomy underwent pre-operative staging neck ultrasound \nand were classified according to K-TIRADS score. Subsequently, semi-\nquantitative (SRE) and quantitative (SWE expressed in kPa) elastosonographic \nevaluation was performed and compared with post-thyroidectomy histology. \nDiagnostic performance of each method, alone and in combination, was \nassessed with 2x2 contingency tables and ROC curve analysis. In order to \nmaximize the SRE and SWE sensitivity and specificity, their cut-off values were \ncalculated using the Liu test. Bonferroni test was used to evaluate statistically \nsignificant differences with a p value <0.05. \nResults or Findings: Sensitivity, specificity, PPV and NPV were respectively \n71.4%, 82.4%, 62.5%, 87.5% for K-TIRADS baseline US, 85.7%, 94.1%, \n85.7%, 94.1% for SRE and 57.1%, 79.4%, 53.3%, 81.8% for SWE (kPa \nexpressed). SRE evaluation showed the best diagnostic accuracy compared to \nthe SWE (kPa expressed) (p <0.05) and to the K-TIRADS (p> 0.05). The \nassociation of SRE with conventional ultrasound with K-TIRADS score \nincreased sensitivity (92.9% vs 71.4%) but decreased the specificity than \nconventional US alone (76.5% vs 82.4%). \nConclusion: Strain US-Elastography can be associated with K-TIRADS US \nexamination in the thyroid nodule characterization with indeterminate cytology; \nin fact, adding the SRE to K-TIRADS assessment increases its sensitivity and \nnegative predictive value. However, further multicenter studies on larger \npopulation are warranted. \nLimitations: Inter-operator variability, small study population and cases when \nit wasn't possibile the elastosonographic evaluation (big thyroid nodules, \npresence of large calcifications or large fluid areas). \nEthics Committee Approval: All procedures performed were in accordance \nwith the ethical standards of the institutional and/or national research \ncommittee. \nFunding for this study: n/a \nAuthor Disclosures: \nDaniele Fresilli: Nothing to disclose \nPatrizia Pacini: Nothing to disclose \nIlaria Celletti: Nothing to disclose \nOlga Guiban: Nothing to disclose \nGiorgia Polti: Nothing to disclose \nEleonora Polito: Nothing to disclose \n\n \n \n \nA \nB C 66  \nFriday \n/LYH\u00033URJUDPPH\u0003\n \nGiuseppe Tiziano Lucarelli: Nothing to disclose \nVito Cantisani: Nothing to disclose \nCarlo Catalano: Nothing to disclose \n \nRPS 208-6 \nNon-EPI PROPELLER DWI sequence on MRI to depict cholesteatoma in \nchildren with non-operated chronic ear disease \n*K. Lebel*¹, S. Daniel², M. Duval², C. Saint-Martin²; ¹Sherbrooke, QC/CA, \n²Montreal, QC/CA \n(kianalebel@gmail.com) \n \nPurpose: To show usefulness of non-EPI diffusion sequence to depict \ncholesteatoma in children with otoscopic evaluated high risk of cholesteatoma. \nMethods or Background: A prospective study evaluated the accuracy of non-\nEPI diffusion sequences to depict cholesteatoma in pediatric chronic ear \ndisease, in the absence of prior ear surgery. 1.5 Tesla MRIs of consecutive \npatients were compared to pediatric ENT follow-up exams if MRI was negative \nfor cholesteatoma, and to pathology post-surgery if MRI was positive for \ncholesteatoma. \nResults or Findings: 32 pediatric patients (15 males, 17 females), mean age \n11.4 years  (16 months-17 years) with chronic ear disease underwent non-EPI \ndiffusion sequence (n=40). 2 patients (n=5) were excluded due to susceptibility \nartifacts from unremovable devices. Unilateral positive restricted diffusion was \nfound on 7/35 examinations and confirmed on pathology to be cholesteatoma \nin 6.  False positive diffusion restriction was due to superimposed acute \ninfection and resolved on repeat MRI after antibiotics. One false negative \ndiffusion sequence was due to the small size and the tegmen location of the \ncholesteatoma. The 22 patients with negative diffusion sequence (25 MRIs), \nwere followed clinically for a mean of 39 months (3-60 months), with stable \naudiology tests, further healing and spontaneous closure of the tympanic \nmembrane perforation in 14 patients or further tympanoplasty in six. Two \npatients were lost during follow-up. \nConclusion: In children with high otoscope suspicion of cholesteatoma, non-\nEPI Diffusion sequence has high sensitivity (85.7%) and very high specificity \n(96.3 %) to identify cholesteatoma. Hence, we suggest CT indication could be \nnarrowed to patients with positive MRI, prior to cholesteatoma surgery, in order \nto decrease overall unnecessary radiation. \nLimitations: This study included only 32 patients. \nEthics Committee Approval: Yes \nFunding for this study: None \nAuthor Disclosures: \nKiana Lebel: Nothing to disclose \nSam Daniel: Nothing to disclose \nMelanie Duval: Nothing to disclose \nChristine Saint-Martin: Nothing to disclose \n \nRPS 208-7 \nDIXON-T2WI magnetic resonance imaging at 3 Tesla outperforms \nconventional imaging for thyroid eye disease \n*A. Ollitrault*, F. Charbonneau, M-L. Herdan, O. Berges, K. Zuber, L. \nGiovansili, P. Launay, J. Savatovsky, A. Lecler; Paris/FR \n(alexis.ollitrault@gmail.com) \n \nPurpose: To determine the diagnostic performances of a single DIXON-T2WI \nsequence compared to a conventional protocol including T1-, T2- and fat-\nsuppressed T2-weighted MRI at 3T when assessing thyroid eye disease \n(TED). \nMethods or Background: This prospective single-center study enrolled \nparticipants presenting with confirmed TED from April 2015 to October 2019. \nThey underwent an MRI, including a conventional protocol and a DIXON-T2WI \nsequence. Two neuro-radiologists, blinded to all data, read both datasets \nindependently and randomly. They assessed the presence of extraocular \nmuscle inflammation, enlargement, fatty degeneration or fibrosis as well as the \npresence of artifacts. A Wilcoxon signed-rank test was used. \nResults or Findings: 206 participants were enrolled (135/206 [66 %] women, \n71/206 [34 %] men, age 52,3 +/- 13,2 years). DIXON-T2WI was significantly \nmore likely to detect at least one inflamed EOM as compared to the \nconventional set: 248/412 (60 %) vs 228/412 (55 %) eyes, p=0.02. DIXON-\nT2WI was more sensitive and specific than the conventional set for assessing \nmuscular inflammation: 100% versus 94.7 % and 71.2 % versus 68.5 %, \nrespectively. DIXON-T2WI was significantly less likely to show major or minor \nartifacts as compared to FS T2WI: 20/412 (5 %) versus 109/412 (27 %) eyes, \np<0.001 and 175/412 (42 %) versus 257/412 (62 %) eyes, p<0.001. \nConfidence was significantly higher with DIXON-T2WI than with the \nconventional set: 2.35 versus 2.24, p=0.003. \nConclusion: DIXON-T2WI showed higher sensitivity and specificity and \nshowed fewer artifacts than a conventional protocol when assessing TED, in \naddition to higher self-reported confidence. \nLimitations: The study was achieved in a single tertiary center specialized in \nophthalmological imaging, using an optimized 3T MRI device, which might \nprevent the generalizability of our results. \nMoreover, no “true” reference standard exists for assessing orbital \ninflammation in TED. \nEthics Committee Approval: Approved \nFunding for this study: None \nAuthor Disclosures: \nFrédérique Charbonneau: Nothing to disclose \nAlexis Ollitrault: Nothing to disclose \nKévin Zuber: Nothing to disclose \nHerdan Marie-Laure Herdan: Nothing to disclose \nPauline Launay: Nothing to disclose \nLama Giovansili: Nothing to disclose \nOlivier Berges: Nothing to disclose \nJulien Savatovsky: Nothing to disclose \nAugustin Lecler: Nothing to disclose \n \nRPS 208-8 \nPercutaneous laser ablation of benign thyroid nodules: a five year follow-\nup study \n*M. Squarcia*, M. Mora, G. Aranda, I. Halperin, F. Hanzu; Barcelona/ES \n(squarcia@clinic.cat) \n \nPurpose: The aim of the present study was to evaluate the efficacy of the \nlaser ablation (LA) -moving shot technique( LA-MLIEI) during a 5-years follow-\nup and to identify possible predictors of the final outcome. \nMethods or Background: Prospective study. Thirty outpatients (23 women/7 \nmen) with benign symptomatic thyroid nodules were assigned to LA-MLIEI, \nbetween 2012- 2015. A single LA session was performed under real-time \nultrasound (US) guidance using a 1064nm continuous wave laser at 3W.US \nevaluation was performed after LA-MLIEI at 1 week, 1-, 3-, 6-, and 12 months \nand thereafter annually till 5 years. \nResults or Findings: Two distinct groups of patients were observed during \nfollow-up: responders 67% (n: 20) and non-responders 33% (n: 10) ones to \nLA-MLIEI. The responders group initiated reduction at 1 month, with remission \nof symptoms and presented a 50% V reduction ( V) at 3 months of treatment, \nwith a maximum response at 24 months, showing stability until the end of the \nstudy follow-up. The non-responder group presented a V of less than 50% at \n12 months, showing a tendency to >50% V at 24 - 36 months, and \nsubsequent regrowth and need for surgical treatment in 30% of this group. \nHigher total administered energy/V (J/V) and nodule V ” 20 ml were correlated \nwith a greater V. No severe adverse effects were observed. \nConclusion: LA with multiple fractional discharges and single fiber is a safe \nand inexpensive technique with minimal variability that allows rapid reduction \nafter treatment and a stable response at 5 years. \nLimitations: Relatively small numer of patients. \nEthics Committee Approval: The study was approved by the l ethic \ncommitiee of Hospital Clinic Barcelona. \nFunding for this study: No fund recived. \nAuthor Disclosures: \nFelicia Hanzu: Nothing to disclose \nGloria Aranda: Nothing to disclose \nIrene Halperin: Nothing to disclose \nMireia Mora: Nothing to disclose \nMattia Squarcia: Nothing to disclose \n \nLive Q&A \n \n18:00-19:30 CHANNEL 5 \nHealthcare Professionals in Focus \nIF 2 \nResilient organisations: the role of the \norganisation in ensuring employee vitality, \nengagement, and productivity \nModerator \nM.G. Myriam Hunink; Rotterdam/NL  \n \nIF 2-2 \nEmployee silence and employee voice as well-being factors in building \nresilient organisations \nAnthony Montgomery; Thessaloniki/GR  \n(monty5429@hotmail.com) \n \nLearning Objectives: \n1. To learn about how employee silence/voice contributes to burnout among \nhealthcare professionals.  \n\n \n \n \nA \nB C 67  \nFriday \n/LYH\u00033URJUDPPH\u0003\n \n2. To better connect clinical practice and healthcare professional well-being in \ndeveloping preventive interventions. \n3. To become familiar with possible interventions at the organisational level \nthat reduces employee silence and enables sharing about work practices. \n \nIF 2-3 \nFrom chronic stress to vitality and engagement \nArnold Bakker; Rotterdam/NL \n(bakker@essb.eur.nl) \n \nLearning Objectives: \n1. To understand the role of job demands and resources on employee \nwellbeing. \n2. To understand the role of psychological safety and meaning to employee \nengagement. \n3. To shift the focus from the prevention of chronic stress towards positive work \nexperience. \n4. To appreciate the need of a systems approach in healthcare organisations. \n \nIF 2-4 \nHow to create a resilient organisation \nDiane Sliwka; San Francisco, CA/US \n(diane.sliwka@ucsf.edu) \n \nLearning Objectives: \n1. To learn about interventions at the organisational level that promote well-\nbeing. \n2. To understand what effects can be expected from organisational \ninterventions.  \n3. To appreciate the complexity of developing a program to foster \norganisational resilience. \n4. To appreciate the increase in complexity due to the pandemic. \n \nIF 2-5 \nEconomic considerations \nStijntje Dijk; Rotterdam/NL \n(s.dijk@erasmusmc.nl) \n \nLearning Objectives: \n1. To understand the economic consequences of chronic stress and burnout \namong healthcare providers. \n2. To appreciate the widespread economic effects of burnout. \n3. To recognise that prevention can lead to enormous cost-savings. \n \nLive Q&A: Interventions at the organisational level \n \n19:45-20:45 CHANNEL 2 \nE³ - Rising Stars Programme: Basic \nSessions \nOrganised by the ESR \nBS 8 \nBreast imaging \nModerator \nFrancesco Sardanelli; San Donato Milanese/IT  \n \nBS 8-2 \nInflammation and benign lesions \nTamar Sella; Jerusalem/IL  \n(tamarse@hadassah.org.il) \n \nLearning Objectives: \n1. To present current imaging techniques to evaluate breast inflammation and \nbenign lesions. \n2. To demonstrate the most important imaging findings. \n \nBS 8-3 \nLesions of uncertain malignant potential (B3) \nMihai Lesaru; Bucharest/RO \n \nLearning Objectives: \n1. To become familiar with the most common imaging findings in B3 lesions. \n2. To identify the most appropriate imaging modality. \n \nBS 8-4 \nMalignant lesions \nChristiane K. Kuhl; Aachen/DE (ckuhl@ukaachen.de) \n \nLearning Objectives: \n1. To present current imaging techniques to evaluate malignant breast lesions. \n2. To demonstrate the most important imaging findings. \nAuthor Disclosures: \nChristiane K. Kuhl: Speaker: Guerbet, Bayer, Bracco \n \nLive Q&A \n \n19:45-20:45 CHANNEL 3 \nSpecial Focus Session \nSF 19 \nBig data use and governance: top tips for \nradiographers \nModerators \nHans-Ulrich Kauczor; Heidelberg/DE  \nMaryann Hardy; Bradford/UK  \n \nSF 19-3 \nWhat can big data tell us about our clinical services? Leveraging data \nfrom the Scottish National PACS \nJonathan McConnell; Glasgow/UK \n \nLearning Objectives: \n1. To understand the types of data and data assimilations undertaken.  \n2. To become familiar with the analysis processes. \n3. To consolidate knowledge about the outcomes and impact of big data \nanalysis.  \n4. To learn how radiographers can get involved with similar initiatives. \n \nSF 19-4 \nHow do you manage and protect all that data? Learning from multicentre \nstudies \nMark F. McEntee; Cork/IE \n(mark.mcentee@ucc.ie) \n \nLearning Objectives: \n1. To understand data protection principles, data security, and encryption.  \n2. To appreciate the processes for data sharing  \n3. To learn about the communication between systems when a patient opts-out \nof data sharing. \n \nSF 19-5 \nArtificial intelligence (AI): data-driven decision making in imaging \nRobin Decoster; Brussels/BE \n \nLearning Objectives: \n1. To learn about the applications of AI for radiography. \n2. To become familiar with the data-driven decisions. \n3. To consolidate knowledge about ethics ad responsibilities for AI decision-\nmaking.  \n4. To understand the potential augmentation of the radiographer’s role. \n \nLive Q&A: Should radiographers evolve to be clinical imaging \ncomputer/data scientists? \n \n \n \n \n \n \n \n \n \n \n \n \n\n \n \n \nA \nB C 68  \nFriday \n/LYH\u00033URJUDPPH\u0003\n \n19:45-20:45 CHANNEL 4 \nTransatlantic Course of ESR and RSNA \n(Radiological Society of North America): \nStroke Imaging and Endovascular \nTreatment: Now and the Future \nTC 328 \nEndovascular treatment \nModerators \nJean-Pierre Pruvo; Lille/FR  \nRaman Uberoi; Oxford/UK  \n \nTC 328-3 \nA. Endovascular treatment of acute ischaemic stroke: practical pearls \nAnsgar Berlis; Augsburg/DE \n(ansgar.berlis@klinikum-augsburg.de) \n \nLearning Objectives: \n1. To learn about endovascular treatment in ischaemic stroke. \n2. To understand the different approaches of endovascular treatment. \n3. To appreciate the importance of efficient workup and time metrics in \nangiosuite. \nAuthor Disclosures: \nAnsgar Berlis: Consultant: Microvention, Stryker, Medtronic; Speaker: \nPenumbra, Phenox, Medtronic \n \nTC 328-4 \nB. Where to perform and how to organise a thrombectomy \nJeremy Heit; Stanford, CA/US \n \nLearning Objectives: \n1. To learn about the number of persons and regulatory recommendations. \n2. To understand the optimal organisation in angiosuite and workflow. \n3. To appreciate the implications and management for continuity of care. \nAuthor Disclosures: \nJeremy Heit: Advisory Board: iSchemaView; Consultant: Medtronic and \nMicroVention \n \nTC 328-5 \nC. Interactive discussion with illustrative cases of endovascular \nthrombectomy (Part 1) \nAnsgar Berlis; Augsburg/DE \n(ansgar.berlis@klinikum-augsburg.de) \n \nLearning Objectives: \n1. To learn about the tricks and tips of endovascular treatment using illustrative \ncases. \n2. To appreciate the optimal time metrics in angiosuite. \n3. To become familiar with the different approaches (stent retriever, ADAPT) \nand challenging cases (tandem occlusions, distal occlusions). \n \nAuthor Disclosures: \nAnsgar Berlis: Consultant: Microvention, Stryker, Medtronic; Speaker: \nPenumbra, Phenox, Medtronic \n \nTC 328-6 \nC. Interactive discussion with illustrative cases of endovascular \nthrombectomy (Part 2) \nGregoire Boulouis; Paris/FR \n \nLearning Objectives: \n1. To learn about the tricks and tips of endovascular treatment using illustrative \ncases. \n2. To appreciate the optimal time metrics in angiosuite. \n3. To become familiar with the different approaches (stent retriever, ADAPT) \nand challenging cases (tandem occlusions, distal occlusions). \nAuthor Disclosures: \nGregoire Boulouis: Advisory Board: Cerenovus 2020 \n \nTC 328-7 \nC. Interactive discussion with illustrative cases of endovascular \nthrombectomy (Part 3) \nJeremy Heit; Stanford, CA/US \n \nLearning Objectives: \n1. To learn about the tricks and tips of endovascular treatment using illustrative \ncases. \n2. To appreciate the optimal time metrics in angiosuite. \n3. To become familiar with the different approaches (stent retriever, ADAPT) \nand challenging cases (tandem occlusions, distal occlusions). \nAuthor Disclosures: \nJeremy Heit: Advisory Board: iSchemaView; Consultant: Medtronic and \nMicroVention \n \nLive Q&A \n \n19:45-20:45 CHANNEL 5 \nNew Horizons Session \nNH 1 \nVisualising obesity: the new epidemic \nModerator \nAntonia Arjonilla; Madrid/ES  \n \nNH 1-3 \nBrain alterations \nAnna Maria van Opstal; Leiden/NL  \n \nLearning Objectives: \n1. To review the state-of-the-art neuroimaging research for alterations of eating \nbehaviours in obesity and relation to emotions. \n2. To describe grey and white matter alterations in obesity. \n3. To assess neuroinflammation in obesity by DTI. \n4. To try to define how bariatric surgery can reverse obese related effects in \nthe brain. \n \nNH 1-4 \nThoracic CT in obesity \nSusan J. Copley; London/UK \n \nLearning Objectives: \n1. To establish a strategy for improving quality imaging of chest plain films and \nchest CT. \n2. To identify chest CT imaging biomarkers with prognostic implications. \n3. To show the correlation between obesity and mosaic attenuation, end \nrespiratory air trapping and tracheal shape. \n4. To determine reversibility of signs of airway inflammation after bariatric \nsurgery. Lung CT as a marker of clinical improvement. \n \nNH 1-5 \nCardiovascular imaging \nRozemarijn Vliegenthart; Groningen/NL \n \nLearning Objectives: \n1. To achieve technical optimisation of CT cardiovascular studies in obese \npopulation. \n2. To provide a strategy for optimising contrast injection (total amount and rate) \nand improve vessel conspicuity. \n3. To review the association of obesity with coronary disease, hypertension, \natrial fibrilation and heart failure. \n4. To be aware of the obesity paradox. \n \nNH 1-6 \nFatty liver and beyond \nFederica Vernuccio; Palermo/IT \n(federicavernuccio@gmail.com) \n \nLearning Objectives: \n1. To learn about liver function capacity in obesity. \n2. To learn what NAFLD is and why it is clinically important. \n3. To assess the feasibility of non-invasive monitorisation of fat after bariatric \nsurgery. \n4. To become familiar with the quantification of liver fat with MRI and proton \ndensity fat fraction (PDFF). \n \nLive Q&A: What do you think should be the role of radiology in the \nobesity epidemic? Should we lead the pursuit to universal access to \nadequate diagnostic imaging techniques for the obese population? \n \n\n \n \n \nA \nB C 69  \nFriday \n/LYH\u00033URJUDPPH\u0003\n \n21:00-21:30 CHANNEL 2 \nPL 3 \nPlenary Lecture \nModerator \nMichael H. Fuchsjäger; Graz/AT  \n \nPL 3-2 \nShaping the future of healthcare in the COVID-19 era: partnering with you \nfor intelligent efficiency \nKieran Murphy; Chalfont St Giles/UK  \n \n \n\n \n \n \nA \nB C 70  \n/LYH\u00033URJUDPPH\u0003\n \n \n \n  \n6DWXUGD\\\u000f\u00030DUFK\u0003\u0019\u0003\n\n \n \n \nA \nB C 71  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \n \n08:00-09:00 CHANNEL 2 \nEFOMP Workshop: New European Quality \nControls for State-of-the-Art Innovations in \nRadiology and Artificial intelligence: The \nRole of the Medical Physicist \nEF 1 \nEuropean quality controls (QC) in \ndiagnostic and interventional radiology \nModerator \nLucie Sukupova; Prague/CZ  \n \nEF 1-2 \nIntroduction \nPaddy Gilligan; Dublin/IE  \n(PGilligan@materprivate.ie) \n \nLearning Objectives: \n1. To learn the concept of new QC protocols. \n2. To understand the opportunities provided by the standardisation of QC \nprotocols in the optimisation process. \n3. To become familiar with how the new protocols can be implemented in a \npractical manner. \n \nEF 1-3 \nDeveloping a QC protocol in digital breast tomosynthesis \nRuben van Engen; Nijmegen/NL \n(r.vanengen@lrcb.nl) \n \nLearning Objectives: \n1. To learn why a QC protocol is necessary in breast tomosynthesis. \n2. To understand the concepts of the new QC protocol, its challenges and \nlimitations, and its relevance to diagnostic accuracy and safety. \n3. To become familiar with how the new protocol can be implemented in a \npractical manner. \n \nEF 1-4 \nDeveloping a QC protocol in interventional systems \nAnnalisa Trianni; Trento/IT \n(annalisa.trianni@apss.tn.it) \n \nLearning Objectives: \n1. To learn why a QC protocol is necessary in modern interventional systems. \n2. To understand the concepts of the new QC protocol, its challenges and \nlimitations, and its relevance to diagnostic accuracy and safety. \n3. To become familiar with how the new protocols can be implemented in a \npractical manner. \n \nEF 1-5 \nDeveloping a QC protocol in PET/CT and PET/MRI \nRoberta Matheoud; Novara/IT \n \nLearning Objectives: \n1. To learn why a QC protocol is necessary in modern hybrid systems. \n2. To understand the concepts of the new QC protocol, its challenges and \nlimitations, and its relevance to diagnostic accuracy and safety. \n3. To become familiar with how the new protocols can be implemented in a \npractical manner. \n \nLive Q&A \n \n \n \n \n \n \n \n08:00-09:00 CHANNEL 3 \nProfessional Challenges Session \nPC 1 \nSubspecialisation vs despecialisation \nModerator \nAdrian Brady; Cork/IE  \n \nPC 1-2 \nCurrent clashes in interventional radiology \nLaura Crocetti; Pisa/IT  \n(laura.crocetti@med.unipi.it) \n \nLearning Objectives: \n1. To learn about the current landscape of the organisation of interventional \nradiology services in different European countries. \n2. To discuss the need of further subspecialisation within interventional \nradiology. \n3. To understand how education is organised and could be improved to train \ninterventional radiologists. \n \nPC 1-3 \nRole of new professional profiles: the role of a consultant radiographer \nreporting plain-film radiographs within a clinical imaging team \nRobert Milner; Rotherham/UK \n(Robert.Milner1@nhs.net) \n \nLearning Objectives: \n1. To learn about how a plain-film radiographer reporting service can be safely \ndeveloped. \n2. To understand how a hospital can think outside the box and embrace new \nways of working with no additional risk to patients or staff. \n3. To appreciate how radiographers and radiologists can work together to free \nup the radiologist’s time for other activities and to provide a plain-film \nradiographer-led service that is amongst the best and most responsive in the \nUK. \n \nPC 1-4 \nWhat do the \"customers\" referring physicians or patients want and how \nto provide it? \nCaroline Justich; Vienna/AT \n(cjustich@me.com) \n \nLearning Objectives: \n1. To learn about the patients’ questions, behaviour, and needs when they \ncome into a radiology department.  \n2. To understand what is necessary to support patients and doctors, what \ninformation is expected, that patients are no longer silent consumers and are \nnow active decision makers, and to understand the needs of the referring \ndoctors.  \n3. To appreciate that patients want to be supported but also want to cooperate \nwith their doctors to identify symptoms and needs as fast as possible, and to \nreceive the right diagnose and medication as soon as possible.  \n4. To become familiar with digital solutions and tools to help patients and \ncolleagues with the right information and data. \n \nPC 1-5 \nAre \"imaging specialists\" in other disciplines a threat to radiology? \nHans-Ulrich Kauczor; Heidelberg/DE \n \nLearning Objectives: \n1. To consolidate knowledge about the value and uniqueness of general and \nsubspecialised radiology. \n2. To appreciate the added value of multidisciplinary teams with shared \nexpertise. \n3. To learn about the opportunities of radiologists in future workflow scenarios. \nAuthor Disclosures: \nHans-Ulrich Kauczor: Research Grant/Support: Siemens, Philips, Bayer; \nSpeaker: Philips, Astra Zeneca, MSD; Boehringer Ingelheim \n \nLive Q&A: How to implement subspecialisation into a department: \nperspectives for large and small departments \n \n\n \n \n \nA \nB C 72  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \n08:00-09:00 CHANNEL 5 \nResearch Presentation Session: GI Tract \nRPS 101b \nThe cutting edge of GI imaging \nModerator \nMonique Maas; Amsterdam/NL  \n \nRPS 101b-2 \nPrognostic significance of MRI-detected mesorectal fat thickness in \nrectal cancer: a risk factor for distance metastasis \n*P. Tripathi*, Z. Li, Y. Shen, X. Hu, D. Hu; Wuhan/CN  \n \nPurpose: We primarily aimed to investigate relationship between MRI-detected \nmesorectal fat and BMI. Furthermore, investigate the impact of MRI-detected \nmesorectal fat distant metastasis in patients with rectal cancer. \nMethods or Background: Post-operative T3 rectal cancer patients without \nprevious treatment from July 2016 to December 2019 were enrolled for this \nstudy. Two blinded radiologists evaluated MRI-detected extramural vascular \ninvasion, MRI-detected depth of tumor extension, MRI-detected mesorectal fat \nthickness, area within mesorectum, mesorectum thickness and fat buffer \nthickness. The results along with other clinical characteristics were then \ncorrelated with distant metastases to determine the risk factors. Cox regression \nanalysis was used to estimate independent risk factors for disease-free \nsurvival (DFS). \nResults or Findings: In 77 patients (58.9±11.69 years), 33 patients were \nconfirmed to be mrEMVI-positive. The mesorectal thickness, area within \nmesorectum, area inside rectum, fat buffer area and BMI were 4.79 ± 2.86mm, \n2708 ± 513.29mm2, 951.88 ± 288.42mm2, 1756.42 ± 448.56mm2 and 22.43 ± \n3.70kg/m2 respectively. Area within mesorectum (p=0.02), area inside rectum \n(p=0.05) and fat buffer area (p=0.02) showed significant correlation with BMI.  \nMultivariate analysis revealed only MRI-detected mesorectal fat thickness to be \nsignificantly associated with distant metastasis. A 3-year disease-free survival \nrates were 97.2% and 9.5% (P௘<0.001) in patients with mesorectal fat thickness \n>3.32mm and <3.32mm groups. \nConclusion: Area within mesorectum, area inside rectum and fat buffer area \nhas significant correlation with BMI. MRI-detected mesorectal fat thickness is \nan independent risk factor for distant metastasis in rectal cancer. 3-year \ndisease-free survival rates were lower in the patients with thin mesorectal fat. \nLimitations: 1. Small sample size. \n2. Single centre sample. \nEthics Committee Approval: This study was approved by the appropriate \ninstitutional review board. \nFunding for this study: National Natural Science Foundation of China under \nGrant number 81571642, 81701657, 81771801 and 81801695. \nAuthor Disclosures: \nXuemei Hu: Nothing to disclose \nPratik Tripathi: Nothing to disclose \nZhen Li: Nothing to disclose \nYaqi Shen: Nothing to disclose \nDaoyu Hu: Nothing to disclose \n \nRPS 101b-3 \nCrohn's disease: the correlation between US and MR-enterography - our \nexperience \n*J. Miranda Bautista*¹, J. Llorente Peris¹, R. E. Buongermini¹, S. Lanzarote \nVargas¹, P. Otermin Barrera¹, E. de Miguel Campos¹, P. Menéndez Fernández-\nMiranda²; ¹Madrid/ES, ²Santander/ES \n(mirandabautistajuan@gmail.com) \n \nPurpose: The objectives of this study were to outline the influence of intestinal \nultrasonography in the initial assessment and follow-up of patients with \nCrohn´s disease and to compare the findings statistically with MR \nenterography features (gold standard), in view of a potential subsequent \nimplementation in the algorithms of these patients in our hospital. \nMethods or Background: Between 2015 and 2019, 100 cases with suspected \nor confirmed diagnosis of Crohn's disease were treated in our Institute. Most of \nthem underwent an MR enterography and posterior ultrasonography over a \nperiod of 15 days.  In this prospective study, morphological and doppler \nfindings, together with semiquantitative parameters in contrast-enhanced \nultrasonography were assessed to quantify the extent of the affected \nsegments, the degree of inflammatory activity and diagnosis of extraluminal \ncomplications. \nResults or Findings: The concordance in disease activity and extension had \nKappa values of 0.711 and 0.854, respectively. The mean mural thickness with \nMRI was 5.8, and with echo 5.2 mm. To diagnose mucosal ulcers, fistulae, \nabscess, and stenosis it showed a Kappa value of 0.66, 0.807, 1 and 0.647, \nrespectively. Grade II/III color Doppler signal showed a sensitivity of 67% and a \nspecificity of 98% in the diagnosis of disease activity (MaRIA Index >7). In \ncontrast-enhanced US, patients with a MaRIA index <7 showed a mean AUC \nof 116.17 compared to 503.79 if MaRIA index > 7. \nConclusion: In patients with Crohn's disease, bowel US is an imaging \ntechnique whose diagnostic possibilities are in some ways comparable to \nthose of MR. Its excellent accessibility, lower price, and better tolerance forces \nus to consider it as a profitable alternative in the assessment of inflammatory \nactivity in this long-term disease. \nLimitations: No limitations \nEthics Committee Approval: Scientific study approved \nFunding for this study: Not required \nAuthor Disclosures: \nRafael Emilio Buongermini: Nothing to disclose \nPablo Menéndez Fernández-Miranda: Nothing to disclose \nJuan Miranda Bautista: Nothing to disclose \nSilvia Lanzarote Vargas: Nothing to disclose \nPaula Otermin Barrera: Nothing to disclose \nJavier Llorente Peris: Nothing to disclose \nEnrique de Miguel Campos: Nothing to disclose \n \nRPS 101b-4 \nA proposal for a new prognostic grading system in achalasia using \ndynamic barium swallow: the FBF score \n*G. Fontanella*¹, S. Borrelli², A. Festa¹, S. De Lucia¹, C. A. T. Manganiello¹; \n¹Benevento/IT, ²Atripalda/IT \n(giovanni.fontanella@hotmail.com) \n \nPurpose: To develop and evaluate a new radiographic scoring system, the \nFBF score, allowing for more accurate, clinically oriented prognostic grading in \nachalasia. \nMethods or Background: We developed our FBF Scoring System by profiling \nthe three achalasia subtypes described in the clinical/manometric Chicago \nClassification (I, Hypotonic; II, Panpressurizing; III, Spastic) into three \nequivalent radiographic grades, using five morphodynamical findings (bird-\nbeak sign, dilatation, hypotonia, stasis, spasm) as scoring criteria.Between \nJune 2017 and June 2020, 141 patients (mean age 59.2, 60.2% male) already \ndiagnosed with achalasia at manometry, were evaluated with Dynamic Barium \nSwallow, reviewed in blind by two radiologists with GI experience, then graded \nusing our FBF Score. Radiographic grading accuracy and sensitivity were \nevaluated using manometry data as gold standard. The five scoring criteria \nwere each evaluated for sensitivity and specificity with regard to each \nradiological grade. \nResults or Findings: Our FBF score allowed us to predict the \nclinical/manometric subtype with high accuracy, with sensitivity values reaching \n91.3% for Subtype III, 95.4% for Subtype II and 98.03% for Subtype I, the latter \nbeing correctly diagnosed in 50/51 patients with FBFs •8 (presence of at least \n4 combined radiographic findings). Spasm showed high specificity in Subtype \nIII (95.65%), while stasis resulted in high sensitivity for Subtype II (93.18%). \nConclusion: Radiographic grading of achalasia using FBF score has shown to \nbe highly sensible and accurate when compared to the manometry results, \nespecially in Subtypes II and III. FBF score implementation might allow more \nprecise morphodynamical analysis, structured reporting and better overall \ndiagnostic support to manometry, patient stratification and therapeutic choices. \nLimitations: This study is monocentric, patient number is limited (141). \nEthics Committee Approval: Our study received ethical committee approval, \neach patient signed informed consent before examinations \nFunding for this study: No funding was received for this work. \nAuthor Disclosures: \nCarmine Augusto Tommaso Manganiello: Nothing to disclose \nSimona Borrelli: Nothing to disclose \nGiovanni Fontanella: Nothing to disclose \nAndrea Festa: Nothing to disclose \nSilvio De Lucia: Nothing to disclose \n \nRPS 101b-5 \nThe heterogeneity of skewness in T2w-MR images of locally advanced \nrectal cancer relates with a response to neo-adjuvant chemoradiotherapy \nA. Bevilacqua, F. Coppola, *M. Mottola*, S. Lo Monaco, A. Cattabriga, A. \nGuido, F. Di Fabio, L. Ricciardiello, R. Golfieri; Bologna/IT \n(margherita.mottola@unibo.it) \n \nPurpose: To investigate how the heterogeneity of skewness (HoS) in locally \nadvanced rectal cancer (LARC) imaged with T2 weighted (T2w) MRI before \nneo-adjuvant chemoradiotherapy (nCRT) can allow predicting responder \npatients based on the Tumour Regression Grade (TRG). \nMethods or Background: Forty patients with LARC diagnosis undergo 1.5T-\nMRI before nCRT. Regions of Interest (ROIs) are manually segmented in all \nslices of the tumour’s site on the oblique axial T2w sequences. Based on the \nTRG assigned at the histopathological inspection of the surgical resection \nsamples, the dataset is split into 15 responders (Rs) and 25 non-responders \n\n \n \n \nA \nB C 73  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \n(NRs), having TRG=[0,1] and TRG=[2,3], respectively. HoS in LARC is \ncomputed on T2w values stemming from the measures of local asymmetry of \neach voxel. One-tail Wilcoxon rank-sum test (p<0.05) is considered to assess \nR and NR separability. Median values and interquartile ranges (IQRs) are \nconsidered to evaluate how the pre-therapy heterogeneity varies between Rs \nand NRs. \nResults or Findings: HoS of Rs patients has a lower variance (IQR=0.15) \nthan HoS of NRs ones (IQR=0.46), although median HoS has an opposite \nbehaviour, being higher in Rs groups (4.08) than in NRs one (3.68). This yields \nRs and NRs groups to be clearly separated (p~10-5), with non-overlapping \nIQRs. \nConclusion: In pre-therapy LARC imaged with T2w MRI, the higher the HoS, \nthe better the response to nCRT. In addition, while the Rs group shows a \nhomogeneous behaviour, the group of NRs is spread over a wider \nheterogeneity range, probably due to a higher variability of tumour \ncharacteristics. \nLimitations: This study includes a limited number of patients, but the clear \nseparation between R and NR highlights the promising role of heterogeneity, to \nbe confirmed increasing the number of patients considered. \nEthics Committee Approval: n° 842/2020/Oss/AOUBo \nFunding for this study: not Applicable \nAuthor Disclosures: \nAlessandra Guido: Nothing to disclose \nSilvia Lo Monaco: Nothing to disclose \nRita Golfieri: Nothing to disclose \nArrigo Cattabriga: Nothing to disclose \nFrancesca Di Fabio: Nothing to disclose \nMargherita Mottola: Nothing to disclose \nLuigi Ricciardiello: Nothing to disclose \nFrancesca Coppola: Nothing to disclose \nAlessandro Bevilacqua: Nothing to disclose \n \nRPS 101b-6 \nSingle versus split dose of Iohexol for fecal tagging in CT colonography \n*A. Meshcheryakov*, O. Pugacheva, N. Gurova, S. Morozov; Moscow/RU \n(aim.radiologist@gmail.com) \n \nPurpose: The purpose of this study is to compare the quality of fecal tagging \nand patients' tolerance for CT colonography (CTC) with nonionic iohexol \niodinated oral contrast agents in single versus split dose. \nMethods or Background: 60 adults with no symptoms were enrolled in this \nstudy (mean age, 72,3 years; 23 men). All patients were randomly assigned \n(1:1 ratio) to receive a single dose of 50 mL of iohexol 350 for fecal tagging or \na split dose (25 mL + 25 mL). All other preparation components remained \nconstant. Endpoints were the quality of fecal tagging and tolerance to the \nassigned bowel preparation regimen. Fluid attenuation (HU values) and \nhomogeneity (SD values) analysis of residual colonic fluid was performed. \nAdditionally was scored a volume of residual colonic fluid and solid stool using \na previously validated 4-point scale. A Wilcoxon's matched pairs test, and the \nMann-Whitney test was used for comparison of the cohorts. \nResults or Findings: The mean fluid attenuation was higher with single-dose \niohexol (849 ± 298 HU) compared with split-dose (714 ± 335 HU) (p = 0.02). \nThe homogeneity of fecal tagging was 92 and 85 HU for groups 1 and 2, \nrespectively (p = 0.12). The mean total colonic fluid score was 2.3, with a \nsingle dose and 2.5 with a split dose (p = 0.53), and the mean total colonic \nstool score was 1.5  and 1.7 respectively (p = 0.72). Tolerance was \nsignificantly better in the single-dose group (p=0,03). \nConclusion: Single dose iohexol 350 improves fecal tagging quality compared \nwith spit dose with higher residual fluid attenuation and elevates patient \nacceptability. \nLimitations: Our study's main limitation is the relatively small patient cohort. \nEthics Committee Approval: The study was approved by the local ethics \ncommittee. \nFunding for this study: No funding for this study. \nAuthor Disclosures: \nSergey Morozov: Nothing to disclose \nAndrey Meshcheryakov: Nothing to disclose \nOlga Pugacheva: Nothing to disclose \nNadezda Gurova: Nothing to disclose \n \nRPS 101b-7 \nRectal cancer with complete endoscopic response after neoadjuvant \ntherapy: what is the meaning of a positive MRI? \n*M. J. Gollub*, J. Das, D. D. B. Bates, J. L. Fuqua III, J. S. Golia, S. Javed-\nTayyab, V. Paroder, I. Petkovska, J. Garcia-Aguilar; New York, NY/US \n(gollubm@mskcc.org) \n \nPurpose: To determine the short-term outcomes of discordant tumor \nassessments between DWI-MRI and endoscopy in patients with treated rectal \ncancer when tumor-bed diffusion restriction is present (“+DWI”). \nMethods or Background: In this HIPPA compliant, IRB-approved \nretrospective study, rectal MRI and endoscopic reports were reviewed for \npatients with locally advanced primary rectal adenocarcinoma (LARC) treated \nwith chemoradiotherapy or total neoadjuvant therapy and imaged between \nJanuary 2016 and December 2019. Eligible patients had a +DWI and \nendoscopy within 2 weeks of each other. True positive MRI were those with \ntumor on endoscopy and/or biopsy (TPa) or in whom endoscopy was negative \nfor tumor, but subsequent 3-month follow up endoscopy and DWI were both \npositive (TPb). The positive predictive value of DWI-MRI was calculated on a \nper-scan and per patient basis. DWI negative MRI exams were not explored in \nthis study. \nResults or Findings: 397 patients with nonmetastatic primary LARC were \nanalyzed. After exclusions, 90 patients had 98 follow-up rectal MRI studies with \n+DWI. 76 patients underwent 80 MRI scans and had concordant findings at \nendoscopy (TPa). 17 patients underwent 18 MRI scans and had discordant \nfindings at endoscopy (FP); among these, 4 scans in 4 patients were initially \nfalse positive (FP) but follow up MRI remained +DWI and the endoscopy \nturned concordantly positive (TPb). PPV was 0.86 per scan and per patient. In \n4/18 (22%) scans and 4/17 (23%) patients with discordances, MRI detected \ntumor regrowth before endoscopy. \nConclusion: Although most +DWI exams discordant with endoscopy are false \npositive, 22% will reveal that DWI-MRI detects tumor recurrence before \nendoscopy. \nLimitations: Retrospective \nEthics Committee Approval: Memorial Sloan Kettering Cancer Center IRB \nFunding for this study: None \nAuthor Disclosures: \nVicky Paroder: Nothing to disclose \nSidra Javed-Tayyab: Nothing to disclose \nJulio Garcia-Aguilar: Nothing to disclose \nMarc Jeffrey Gollub: Nothing to disclose \nDavid Dawson Bartlett Bates: Nothing to disclose \nJ. Louis Fuqua III: Nothing to disclose \nIva Petkovska: Nothing to disclose \nJennifer S. Golia: Nothing to disclose \nJeeban Das: Nothing to disclose \n \nLive Q&A \n \n09:15-10:15 CHANNEL 2 \nRefresher Course: Vascular \nRC 415 \nVasculitis and inflammation in arteries \nModerator \nElias N. Brountzos; Athens/GR  \n \nRC 415-2 \nA. Vasculitis and inflammation in peripheral arteries \nThorsten Bley; Würzburg/DE  \n(bley_t@ukw.de) \n \nLearning Objectives: \n1. To learn about classification and aetiology. \n2. To understand radiological imaging techniques and differential diagnosis.  \n3. To review the treatment options. \nAuthor Disclosures: \nThorsten Bley: Advisory Board: Roche / Chugai / Novartis; Grant Recipient: \nDeutsche Forschungsgemeinschaft, DFG; Research Grant/Support: Siemens; \nSpeaker: Roche / Chugai / Novartis \n \nRC 415-3 \nB. Vasculitis and inflammation in neurocranial arteries \nHans Kortman; Tilburg/NL \n \nLearning Objectives: \n1. To learn about radiological imaging techniques. \n2. To understand aetiology and differential diagnosis. \n3. To become familiar with the treatment options. \n \nRC 415-4 \nC. Nuclear imaging of vasculitis and inflammation in arteries \nJames Howard; Manchester/UK \n(james.howard@mft.nhs.uk) \n \n \n\n \n \n \nA \nB C 74  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \nLearning Objectives: \n1. To discuss the nuclear medicine options of inflammatory arterial disease. \n2. To provide optimal nuclear medicine strategies for subacute and chronic \ninflammatory disease of the arteries. \n3. To become familiar with the signs of inflammatory vs non-inflammatory \ndisease of the arteries. \n \nLive Q&A \n \n09:15-10:15 CHANNEL 4 \nSpecial Focus Session \nSF 17 \nMale erectile dysfunction (ED) \nModerator \nBoris Brkljaþiü; Zagreb/HR  \n \nSF 17-2 \nWhat the urologists expect from the radiologist? \nNicola Pavan; Trieste/IT  \n(nicpavan@gmail.com) \n \nLearning Objectives: \n1. To understand the clinical correlations between imaging and erectile \ndysfunction. \n2. To understand the clinical indication for imaging studies. \n3. To analyse how imaging is influencing the clinical management of a patient \nwith erectile dysfunction. \n \nSF 17-3 \nPenile Doppler \nPaul S. Sidhu; London/UK \n(paulsidhu@btinternet.com) \n \nLearning Objectives: \n1. To understand and learn to perform a dynamic penile Doppler US. \n2. To analyse the spectral Doppler waveforms in erectile dysfunction. \n3. To learn about the usefulness of a Doppler US in priapism. \n4. To obtain an overview of other abnormalities of the penis seen on US. \nAuthor Disclosures: \nPaul S. Sidhu: Advisory Board: Samsung Inc; Consultant: ITREAS ; Speaker: \nBracco, Siemens \n \nSF 17-4 \nRole of MRI \nLaurence Rocher; Le Kremlin-Bicêtre/FR \n \nLearning Objectives: \n1. To assess penile MRI adequate protocols regarding the suspected \npathology. \n2. To become familiar with normal MRI findings in flaccidity and erectile status. \n3. To identify pathological findings such as Peyronie's disease, fibrosis, or rare \ntumours involved in erectile dysfunction. \n \nSF 17-5 \nInterventional radiology in diagnosis and management of ED \nCharles Tapping; Oxford/UK \nAuthor Disclosures: \nCharles Tapping: Investigator: Merit Medical; Speaker: Boston Scientific \n \nLive Q&A: What is the role of imaging and image-guided interventions in \nerectile dysfunction? \n \n \n \n \n \n \n \n \n \n \n09:15-10:15 CHANNEL 5 \nResearch Presentation Session: Artificial \nIntelligence & Machine Learning \nRPS 105 \nArtificial intelligence (AI) and COVID-19 \nModerator \nErik R. Ranschaert; Tilburg/NL  \n \nRPS 105-2 \nFully automatic COVID-19 lung and pneumonia lesion segmentation from \nCT images \n*I. Shiri*¹, H. Arabi¹, Y. Salimi¹, A. Sanaat¹, A. Akhavanalaf¹, G. Hajianfar², D. \nAskari², K. R. Kalantari², H. Zaidi¹; ¹Geneva/CH, ²Tehran/IR  \n(isaac.sh92@gmail.com) \n \nPurpose: We present a deep learning (DL)-based automated whole lung and \nCOVID-19 pneumonia infectious lesions (COLI-Net) detection and \nsegmentation from chest CT images \nMethods or Background: We prepared 2178 ( 347’259, 2D slices) and 170 \n(16’890, 2D slices) volumetric CT images along with their corresponding \nmanual segmentation of lungs and lesions, respectively, in the framework of a \nmulti-center/multi-scanner study. All images were cropped, resized and the \nintensity values clipped and normalized. A residual network (ResNet) with non-\nsquare Dice loss function built upon TensorFlow was employed. The accuracy \nof lung and COVID-19 lesions segmentation was evaluated on an external RT-\nPCR positive COVID-19 dataset (7’333, 2D slices) collected at five different \ncenters. To evaluate the segmentation performance, we calculated different \nquantitative metrics, including radiomic features. \nResults or Findings: The mean Dice coefficients were 0.98±0.011 (95% CI, \n0.98-0.99) and 0.91±0.038 (95% CI, 0.90-0.91) for lung and lesions \nsegmentation, respectively. The mean relative Hounsfield unit differences were \n0.03±0.84% (95% CI, -0.12 – 0.18) and -0.18±3.4% (95% CI, -0.8 - 0.44) for \nthe lung and lesions, respectively. The relative volume difference for lung and \nlesions were 0.38±1.2% (95% CI, 0.16-0.59) and 0.81±6.6% (95% CI, -0.39-2), \nrespectively. Most radiomic features had a mean relative error less than 5% \nwith the highest mean relative error achieved for the lung for the Range first-\norder feature (-6.95%) and least axis length shape feature (8.68%) for lesions. \nConclusion: We developed an automated deep learning-guided three-\ndimensional whole lung and infected regions segmentation in COVID-19 \npatients in order to propose a fast, consistent, robust and human error immune \nframework for lung and pneumonia lesion detection and quantification. \nLimitations: Not applicable \nEthics Committee Approval: This retrospective study was conducted with \ninstitutional review board approval. \nFunding for this study: Swiss National Science Foundation under grant \nSNRF 320030_176052. \nAuthor Disclosures: \nDariush Askari: Nothing to disclose \nAmirhossein Sanaat: Nothing to disclose \nHossein Arabi: Nothing to disclose \nGhasem Hajianfar: Nothing to disclose \nHabib Zaidi: Nothing to disclose \nAzadeh Akhavanalaf: Nothing to disclose \nYazdan Salimi: Nothing to disclose \nIsaac Shiri: Nothing to disclose Nothing to disclose \nKiara Rezaei Kalantari: Nothing to disclose \n \nRPS 105-3 \nDiagnostic performance of a deep learning model ensemble for the \ndetection of COVID-19 pneumonia on chest radiographs \n*Z. T. J. Sim*, C. H. Tan, Y. Ting, W. Huang, X. Xu, Y. Feng, X. Lei, Y. Cui, S. \nT. Wong; Singapore/SG \n(jordansim92@gmail.com) \n \nPurpose: During the Coronavirus disease-19 (COVID-19) pandemic, chest \nradiographs (CXRs) are the mainstay of initial radiological investigation in \nmanagement. Artificial Intelligence (AI) algorithms for COVID-19 pneumonia \ndetection may perform well but can degrade significantly when deployed in the \nreal-world setting. This study is the first to test a trained COVID-19 pneumonia \nCXR detection model in real world setting as a proof-of-value. \nMethods or Background: An ensemble of seven models (RadiLogic) was \ndeveloped from 112,120 CXRs from the NIH Chest-14 open-source dataset, \nand fine-tuned using CXRs from patients suspected of COVID-19 pneumonia. \nTwo senior radiologists with more than 10 years of clinical experience provided \nthe reference standard. RadiLogic was thereafter integrated into the daily \nworkflow, prioritising CXRs for expedited reporting. Area under the receiver \n\n \n \n \nA \nB C 75  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \noperating characteristic curve (AUC), F1 score, sensitivity and specificity were \ncalculated to characterise diagnostic performance. \nResults or Findings: A total of 9,381 unique CXRs were included in the \ndatasets. For the deployment dataset, RadiLogic achieved an AUC of 0.95 \n(95% Confidence Interval [CI]: 0.92, 0.96) corresponding to a specificity of 97% \n(95% CI: 0.97, 0.98) and sensitivity of 79% (95% CI: 0.72, 0.84). No significant \ndegradation of diagnostic performance was encountered as a result of \nRadiLogic deployment, while turn-around-time for abnormal CXR reports were \nreduced by 20%. \nConclusion: In real-world clinical deployment, our ensemble of seven deep \nlearning models expedites reporting of COVID-19 pneumonia while preserving \ndiagnostic performance. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nYingnan Cui: Nothing to disclose \nXiaofeng Lei: Nothing to disclose \nYonghan Ting: Nothing to disclose \nCher Heng Tan: Nothing to disclose \nYangqin Feng: Nothing to disclose \nWeimin Huang: Nothing to disclose \nSum Thai Wong: Nothing to disclose \nXinxing Xu: Nothing to disclose \nZheng Ting Jordan Sim: Nothing to disclose \n \nRPS 105-4 \nDevelopment of an artificial intelligence method to detect COVID-19 \npneumonia in computed tomography images based on multi-planar \nreconstruction and convolutional neural networks \nH. M. Karakas¹, *G. Yildirim*¹, Y. A. Ozkaya², E. Sener²; ¹Istanbul/TR, \n²Ankara/TR \n(dr.gulsah.yildirim@gmail.com) \n \nPurpose: This study was aimed to construct an artificial intelligence system \nbased on convolutional neural network algorithms to detect COVID-19 \npneumonia on high resolution CT images. This system was built to assist \nradiologists in rapid and confident diagnosis of infected cases during high \nvolume conditions of pandemic, and also to quantify disease-related lesion \nburden in multifactorial prognostic analyses. \nMethods or Background: In this retrospective and single-center study, a CNN \nmodel was developed to extract visual features from volumetric chest CT \nexams for the detection of COVID-19. Dataset was acquired between March \n2020 and July 2020. CT images of 573 RT-PCR proven COVID-19 patients \nwere extracted from local PACS system.  Images were randomly annotated by \nthree experienced radiologists for known lesions of COVID-19 pneumonia (i.e. \nground glass opacity and consolidation). Consequently, lesion contours in 407 \nstudies were manually selected. Anisotropic Image volumes were first \nconverted to isotropic volumes and axial, sagittal, and coronal images and \nlabels were generated using Multi Planar Reconstruction techniques. These \nperpendicular data sets were trained individually using U-Net architecture. \nObtained models are applied consecutively to a volumetric CT scan and \nsuspicious lesions are extracted by intersecting the findings from three different \nplanes. \nResults or Findings: The multiplanar models achieved an accuracy of 92.42% \non average. The specificity is found to increase from 78.68% to 88.24% when \nmultiplanar findings were merged compared to using outputs from axial plane \nonly. \nConclusion: The artificial intelligence model can accurately detect typical \nCOVID-19 pneumonia lesions. Analyzing CT datasets from all three isoviews is \nfound to increase specificity compared to using axial view alone. \nLimitations: The method is validated for typical findings of COVID-19; \nindeterminate atypical findings are beyond the scope of this study. \nEthics Committee Approval: Aproval no:  2020-11-10T15_07_21. \nFunding for this study: None \nAuthor Disclosures: \nEmre Sener: Nothing to disclose \nGulsah Yildirim: Nothing to disclose \nHakki Muammer Karakaú: Nothing to disclose \nYasar Alper Ozkaya: CEO at Simplex Information Technologies Co. \n \nRPS 105-5 \nArtificial intelligence services' impact on radiologist's performance in the \ncontext of the COVID-19 pandemic \n*T. Logunova*, A. E. Andreychenko, V. Klyashtorny, K. M. Arzamasov, A. \nVladzymyrskyy, S. Morozov; Moscow/RU \n(logunova.tatiana@gmail.com) \n \nPurpose: COVID-19 pandemic has led to an essential increase of chest CT \nexaminations that necessitates to urgently report a large amount of studies in \nlimited time with limited human resources. The purpose of the study is to \ndetermine impact of the introduction of AI-services analyzing chest CTs for \nCOVID-19 related findings on the radiologists workflow and performance. \nMethods or Background: Comparative analysis of the time intervals between \nloading a CT study into RIS and validation of the report by a radiologist in RIS \nwas performed; the assessment of the accuracy was estimated by comparing \nthe number of clinically significant discrepancies between radiologist and \nexpert radiologist during clinical audit, expressed as a percentage of the total \nnumber of audited studies. In total, we analyzed the relevant parameters in \n128,350 chest CT studies (36,358 studies were timely analyzed by AI) \nacquired and reported in the period from April 30 to August 31, 2020 in \nMoscow in total by 578 radiologists. \nResults or Findings: The results of multivariate regression analysis revealed \nthat group of radiologists periodically receiving timely results of an AI-service \nprocessed study on 7 minutes faster than group without AI (p<0.001). The \nnumber of discrepancies between radiologist and expert radiologist before and \nafter the introduction of the AI-service did not reveal statistically significant \ndifferences (p> 0.05). \nConclusion: Introduction of the AI-services into the radiologists workflow to \nanalyze chest CT during the COVID-19 pandemic increases the productivity of \nthe radiologist, reducing the report turn-around-time, without significantly \naffecting the accuracy of interpretation. \nLimitations: The reported results and conclusions are preliminary as the study \ndata collection is still on-going. \nEthics Committee Approval: This study is based upon the results of the \nregistered study (https://clinicaltrials.gov/ct2/show/NCT04489992). \nFunding for this study: Internal. \nAuthor Disclosures: \nSergey Morozov: Nothing to disclose \nAnna Evgenevna Andreychenko: Nothing to disclose \nTatiana Logunova: Nothing to disclose \nAnton Vladzymyrskyy: Nothing to disclose \nVladislav Klyashtorny: Nothing to disclose \nKirill Mihajlovich Arzamasov: Nothing to disclose \n \nRPS 105-6 \nA deep learning approach to automatically segment CT manifestations of \nCOVID-19 and non-COVID-19 pneumonia \nF. Meng¹, *R. Shahzad*², H. Liu³, F. Thiele², H. Zhang¹, M. Perkuhn²; \n¹Changchun/CN, ²Cologne/DE, ³Wuhan/CN \n(rahil.shahzad@uk-koeln.de) \n \nPurpose: To develop a deep learning based automatic framework to segment \nCOVID-19 and non-COVID-19 manifestation in non-contrast computer \ntomography (NCCT) of the chest, and compare the performance with reference \nannotations from radiologists. \nMethods or Background: A total of 493 CT scans of 477 patients were \nretrospectively included. 240 consecutive patients with positive RT-PCR for \nCOVID-19 were collected from Wuhan No 1 Hospital. 237 community acquired \npneumonia (CAP) patients were selected from the First Hospital of Jilin \nUniversity between January 2019 and April 2020. As reference standard, CT \nmanifestations of pneumonia were manually annotated by a radiologist. A 3D \nU-net deep learning model was trained and evaluated on 394 NCCT of 380 \npatients using 5-fold-cross-validation. Model performance was tested on an \nindependent set of 99 NCCT of 97 patients. The segmentation accuracy of the \nmodel against the reference standard was evaluated using dice similarity \ncoefficient (DSC) and volume correlation (r). \nResults or Findings: The training set consisted of 198 COVID-19 and 196 \nCAP scans. Average model performance over the 5-folds was DSC=0.75 on \ntraining and DSC=0.63 on validation data. On the test set with 50 COVID-19 \nand 49 CAP, overall DSC was 0.60 (range 0-0.91) and volume correlation \nr=0.96. For the COVID-19 subset, DSC was 0.70 (range 0.03-0.91) and r=0.95. \nFor CAP cases, DSC was 0.49 (range 0.06-0.86) and r=0.97. \nConclusion: The deep learning model can accurately detect and segment the \nCT manifestations of COVID-19 and CAP patients as compared to manual \nreference standard. Such a volumetric quantification is helpful for monitoring \ninfection status. \nLimitations: n/a \nEthics Committee Approval: The local ethics committee approved this \nretrospective study \nFunding for this study: n/a \nAuthor Disclosures: \nRahil Shahzad: Employee at Philips Healthcare \nHaifeng Liu: Nothing to disclose \nHuimao Zhang: Nothing to disclose \nFanyang Meng: Nothing to disclose \nFrank Thiele: Employee at Philips Healthcare \nMichael Perkuhn: Employee at Philips Healthcare \n \nLive Q&A \n \n\n \n \n \nA \nB C 76  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \n10:30-11:30 CHANNEL 2 \nE³ - ECR Master Class \nE³ 126 \nUpdate of diffusion-weighted MRI \nModerator \nSören Rafaelsen; Vejle/DK  \n \nE³ 126-2 \nA. Technical aspects of diffusion-weighted imaging (DWI) \nHero K. Hussain; Beirut/LB  \n(hh141@aub.edu.lb) \n \nLearning Objectives: \n1. To learn about the strengths and shortcomings of different DWI techniques. \n2. To understand how to integrate and optimise DWI in MRI protocols. \n3. To be able to avoid pitfalls in DWI sequencies. \n \nE³ 126-3 \nB. DWI of abdominal organs \nDamiano Caruso; Rome/IT \n(dcaruso85@gmail.com) \n \nLearning Objectives: \n1. To learn how to integrate DWI in your abdominal MRI protocol. \n2. To understand the diagnostic value of DWI for abdominal pathologies. \n3. To be able to deal with technical difficulties of DWI in the upper abdomen. \n \nE³ 126-4 \nC. DWI of pelvic organs \nEvis Sala; Cambridge/UK \n \nLearning Objectives: \n1. To understand the correct implementation of DWI for pelvic imaging. \n2. To learn how to avoid imaging artefacts in pelvic DWI. \n3. To become familiar with typical findings and pitfalls of pelvic DWI. \n \nLive Q&A \n \n10:30-12:45 CHANNEL 3 \nHands-on Workshop: Cardiac CT \nHW \nReady? Set! Cardiac CT! \nHW-1 \nCardiac CT: indications and how to select your patients \nMarc Dewey; Berlin/DE  \n(dewey@charite.de) \n \nLearning Objectives: \n1. To understand proper indications for the performance of cardiac CT. \n2. To develop a systematic approach to select patients for cardiac CT. \n3. To learn about use of pretest probability. \nAuthor Disclosures: \nMarc Dewey: Prof. Dewey has received grant support from the FP7 Program of \nthe European Commission for the randomized multicenter DISCHARGE trial \n(603266-2, HEALTH-2012.2.4.-2). He also received grant support from \nGerman Research Foundation (DFG) in the Heisenberg Program (DE 1361/14-\n1), graduate program on quantitative biomedical imaging (BIOQIC, GRK \n2260/1), for fractal analysis of myocardial perfusion (DE 1361/18-1), the \nPriority Programme Radiomics for the investigation of coronary plaque and \ncoronary flow (DE 1361/19-1 [428222922] and 20-1 [428223139] in SPP \n2177/1). He also received funding from the Berlin University Alliance \n(GC_SC_PC 27) and from the Digital Health Accelerator of the Berlin Institute \nof Health. Prof. Dewey is European Society of Radiology (ESR) Research \nChair (2019–2022) and the opinions expressed in this article are the author’s \nown and do not represent the view of ESR. Per the guiding principles of ESR, \nthe work as Research Chair is on a voluntary basis and only remuneration of \ntravel expenses occurs. Prof. Dewey is also the editor of Cardiac CT, \npublished by Springer Nature, and offers hands-on courses on CT imaging \n(www.ct-kurs.de). Institutional master research agreements exist with Siemens, \nGeneral Electric, Philips, and Canon. The terms of these arrangements are \nmanaged by the legal department of Charité – Universitätsmedizin Berlin. \nProfessor Dewey holds a joint patent with Florian Michallek on dynamic \nperfusion analysis using fractal analysis (PCT/EP2016/071551). \n \nHW-2 \nCases \nViktoria Wieske; Berlin/DE  \nA case with normal coronary arteries (no plaques, no stenosis). \nA case with plaque(s) but without significant stenosis. \nA case with one-vessel disease. \n \nHW-3 \nCoronary arteries: anatomy and calcium scoring \nRozemarijn Vliegenthart; Groningen/NL \n(r.vliegenthart@umcg.nl) \n \nLearning Objectives: \n1. To understand normal coronary anatomy and coronary anomalies. \n2. To develop a systematic approach for the evaluation of calcium score and \ncoronary arteries. \n3. To learn about plaque and stenosis evaluation. \nAuthor Disclosures: \nRozemarijn Vliegenthart: Grant Recipient: Institutional Research Grant, \nSiemens Healthineers; Netherlands Organisation for Scientific Research; \nDutch Heart Foundation \n \nHW-4 \nCases \nGiuseppe Muscogiuri; Milan/IT \n(g.muscogiuri@gmail.com) \nA case with benign anomalous origin of coronary artery. \nA case with malign anomalous origin of coronary artery. \nA case of a patient with high values of calcium score and multivessel CAD. \n \nHW-6 \nCTA: patient preparation and how to perform cardiac CT \nViktoria Wieske; Berlin/DE \n(viktoria.wieske@charite.de) \n \nLearning Objectives: \n1. To understand why it is important to achieve a low and steady heart rate for \ncardiac CT. \n2. To develop a systematic approach for preparing your patient for cardiac CT. \n3. To learn about the use and importance of beta-blockers and nitroglycerin in \nthe context of cardiac CT. \nFunding for this study: \nGrant support from the FP7 Program of the European Commission for the \nrandomized multicenter DISCHARGE trial (603266-2, HEALTH-2012.2.4.-2). \n \nHW-7 \nCases \nMatthias Rief; Berlin/DE \n(matthias.rief@charite.de) \nA case with motion artifacts/non-diagnostic segment or vessel. \nA case with high heart rate but good image quality. \nA case with two-vessel disease. \nFunding for this study: \nDr. Rief received grant support from German Research Foundation (DFG) in \nthe Priority Programme Radiomics for the investigation of coronary plaque \n(Deutsche Forschungsgemeinschaft (DFG) - Projektnummer 428222922 in \nSPP 2177/1). Institutional master research agreements exist with Siemens, \nGeneral Electric, Philips, and Canon. The terms of these arrangements are\n \nmanaged by the legal department of Charité – Universitätsmedizin Berlin. \n \nHW-8 \nAnalysis and CT report: how to systematically report and manage cardiac \nand non-cardiac findings \nRozemarijn Vliegenthart; Groningen/NL \n(r.vliegenthart@umcg.nl) \n \nLearning Objectives: \n1. To understand why it is important to systematically look for cardiac and non-\ncardiac findings. \n2. To develop a systematic approach to analyze cardiac and non-cardiac \nfindings. \n3. To learn how not to miss important cardiac and non-cardiac findings. \n \n \n \n \n\n \n \n \nA \nB C 77  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \nAuthor Disclosures: \nRozemarijn Vliegenthart: Grant Recipient: Institutional research grant, Siemens \nHealthineers; Netherlands Organisation for Scientific Research; Dutch Heart \nFoundation \n \nHW-9 \nCases \nFirdaus A.A. Mohamed Hoesein; Utrecht/NL \nA case with relevant extra-cardiac finding in abdomen. \nA case with relevant extra-cardiac finding in the thorax. \nA case with relevant cardiac finding. \n \n10:30-11:30 CHANNEL 4 \nResearch Presentation Session: \nMusculoskeletal \nRPS 110 \nDeep learning and novel imaging \napplications in musculoskeletal radiology \nModerator \nMarc-André Weber; Rostock/DE  \n \nRPS 110-2 \nMultitask deep learning for simultaneous detection, segmentation, and \nclassification of bone tumours on x-ray \n*C. E. von Schacky*, N. Wilhelm, V. Schäfer, Y. N. Leonhardt, C. Knebel, M. R. \nMakowski, K. Wörtler, R. Burgkart, A. S. Gersing; Munich/DE  \n \nPurpose: To use multitask deep learning for simultaneous detection, \nsegmentation, and classification of bone tumors on x-ray. \nMethods or Background: In this retrospective study bone tumors on x-rays \nprior to treatment were analyzed in patients (n=934, age 33.2±19.3y, 419 \nwomen) diagnosed with benign (n=673) and malignant (n=261) bone lesions \nusing histopathology as standard of reference. Overall, 16 tumor entities were \nincluded: osteochondromas, enchondromas, chondroblastomas, osteoid \nosteomas, NOFs, giant cell tumors, chordomas, haemangiomas, simple and \naneurysmatic bone cysts, fibrous dysplasia, chondrosarcomas, \nosteosarcomas, Ewing’s sarcomas, plasma cell myelomas, and b cell NHLs.  \nBounding box placements and segmentations were performed by a radiology \nresident and reviewed by a fellowship-trained musculoskeletal radiologist. \nPatients were split 70%(n=654)/15%(n=140)/15%(n=140) for training, \nvalidation, testing. The multitask DL model was based on ResNeXt-101 \nimplemented in PyTorch. Classification predictions are improved by the \ninformation of detection and segmentation, and vice versa thus capitalizing on \nknowledge gained by conducting each of the three tasks. \nResults or Findings: The multitask model achieved 83% accuracy for the \nclassification of bone lesions as malignant or benign on the test set. The model \nachieved an accuracy of 51% for correct subclassification into one in 16 tumor \nentities, placed 82% of the bounding boxes correctly with an intersection over \nunion of 0.52±34, and had an average dice score of 0.60±37 for \nsegmentations. \nConclusion: Multitask deep learning allowed for accurate detection, \nsegmentation, and classification of bone tumors on x-ray. Multitask deep \nlearning may improve accuracy by capitalizing on knowledge gained by \nconducting different tasks simultaneous. \nLimitations: No external validation set was used. \nEthics Committee Approval: This study was approved by the local \ninstitutional review and informed consent was waived. \nFunding for this study: This work was supported by the Clinician Scientist \nProgram at Technische Universität München (Kommission für Klinische \nForschung, KKF). \nAuthor Disclosures: \nNikolas Wilhelm: Nothing to disclose \nClaudio E. von Schacky: Nothing to disclose \nRainer Burgkart: Nothing to disclose \nMarcus R. Makowski: Nothing to disclose \nValerie Schäfer: Nothing to disclose \nAlexandra Sophia Gersing: Nothing to disclose \nCarolin Knebel: Nothing to disclose \nYannik Niklas Leonhardt: Nothing to disclose \nKlaus Wörtler: Nothing to disclose \n \n \n \n \nRPS 110-3 \nUltrahigh-resolution ultrasound in systemic sclerosis: an evaluation of \ndigital and nailfold perfusion with a 33-9MHz probe \n*M. Pansecchi*¹, L. Tovt¹, F. Zaottini¹, R. Picasso¹, F. Pistoia¹, S. Sanguinetti¹, \nM. Miguel-Pérez², C. Martinoli¹; ¹Genoa/IT, ²Barcelona/ES \n \nPurpose: The aim of this study was to investigate the role of spectral analysis \nperformed by mean of ultra-high frequency US in the evaluation of the \nperipheral vascular bed of Systemic sclerosis (SSc) patients. \nMethods or Background: An US machine equipped with 33-9 MHz and 18-5 \nMHz transducers was employed to study both of n=33 patients with SSc and \nn=34 healthy controls. On both hands we calculated the proximal resistive \nindex (pRI) and the peak systolic velocity (PV) of the second interdigital artery \norienting the 18-5 MHz transducer along the long axis of the vessel, on the \npalmar aspect of the third interdigital space. Distal resistive index (dRI) was \ncalculated performing Doppler spectral analysis at the level of a nailfold \narteriole of the third finger employing a proprietary technology based on \nDoppler technology and integrated within the ultrasound system [Superb \nMicrovascular Imaging®(SMI)] which allows visualization and sampling of \nmicrovascular flows. \nResults or Findings: Detection and sampling of nailfold vessels flow resulted \ngenerally easier in volunteers than in patients. Amongst patients, it was \npossible to collect dRI in n=26 cases whereas PV and pRI were obtained in \nn=32 of them. Compared to controls, patients demonstrated significant lower \nPV and higher dRI, whereas no differences were shown in pRI. \nConclusion: US spectral analysis is able to detect the disease-related \nvariation in distal flow parameter in SSc patients. Further studies with larger \nseries are needed to validate the use of high-resolution US in the investigation \nof the SSc peripheral vasculopathy. \nLimitations: Further studies with larger series are needed to validate the use \nof high-resolution US in the investigation of the SSc peripheral vasculopathy \nEthics Committee Approval: The study was conducted in accordance with \nthe declaration of Helsinki. \nFunding for this study: None \nAuthor Disclosures: \nCarlo Martinoli: Nothing to disclose \nLuca Tovt: Nothing to disclose \nMaribel Miguel-Pérez: Nothing to disclose \nMichelle Pansecchi: Nothing to disclose \nSara Sanguinetti: Nothing to disclose \nRiccardo Picasso: Nothing to disclose \nFederico Pistoia: Nothing to disclose \nFederico Zaottini: Nothing to disclose \n \nRPS 110-4 \nDevelopment of deep learning models to differentiate atypical lipomatous \ntumours and lipomas on MR images \n*D. W. Kramp*, C. E. von Schacky, T. Tomov, F. Navarro, C. Knebel, M. R. \nMakowski, K. Wörtler, S. Foreman, A. Gersing; Munich/DE \n \nPurpose: To develop deep learning (DL) models to differentiate atypical \nlipomatous tumors (ALTs) from lipomas on MRI. \nMethods or Background: Patients included in this study (N=109, age \n54.8±14.5 years, 58 women) were diagnosed with lipomas (N=64) or ALTs \n(N=45), using histology and analysis of the murine double minutes (MDM2) \ngene as standard of reference. Preoperative MR imaging included T2w and \nT1w sequences, and a fat-suppressed T1w sequence with contrast \nenhancement (T1fsgd). For final and independent testing, 20% of the patients \nwere randomly selected and removed from the dataset. Training and validation \nwas performed on the remaining 80% using 3-fold cross validation. \nSegmentations were performed by a radiology resident to be used as input to \nthe models. In addition, preoperative MR images were assessed by one board-\ncertified radiologist and specialist for musculoskeletal imaging with over 25 \nyears of experience and two radiology residents, blinded to histological and \nclinical data. A final diagnosis ALT/Lipoma was determined using standard MR \nimaging characteristics (septation, tumor diameter, presence of nodular \ncomponents or contrast enhancement). \nResults or Findings: The DL model achieved a sensitivity/specificity/accuracy \nof 89%/85%/86% on T1w images; 67%/67%/67% on T2w images; and \n80%/56%/64% on T1fsgd images. The overall sensitivity/specificity/accuracy of \nthe resident readings was 78%/77%/77% and 89%/100%/95% of the \nmusculoskeletal specialist readings. \nConclusion: A DL model developed to differentiate ALTs from lipomas on \npreoperative MR images achieved 89% sensitivity at 85% specificity. \nCompared to a musculoskeletal specialist, the DL model had the same \nsensitivity at a lower specificity. Compared to resident readings, the DL model \nhad a higher sensitivity and higher specificity. This model may aid radiologists \nin diagnostic workflow to differentiate ALTs from lipomas. \nLimitations: Limited sample size. \nEthics Committee Approval: Approval of the institutional review board. \nFunding for this study: Clinician Scientist Program (KKF) at TUM. \n \n\n \n \n \nA \nB C 78  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \nAuthor Disclosures: \nClaudio E. von Schacky: Nothing to disclose \nAlexandra Gersing: Nothing to disclose \nMarcus R. Makowski: Nothing to disclose \nTim Tomov: Nothing to disclose \nCarolin Knebel: Nothing to disclose \nDaniel Wolfgang Kramp: Nothing to disclose \nFernando Navarro: Nothing to disclose \nKlaus Wörtler: Nothing to disclose \nSarah Foreman: Nothing to disclose \n \nRPS 110-5 \nDiagnosis of joint invasion in patients with malignant bone tumours: \nvalue and reproducibility of direct and indirect signs on MR imaging \n*J. H. W. Bodden*, J. Neumann , A. Fingerle, M. Rasper, C. Knebel, K. Specht, \nC. Bollwein, A. S. Gersing, K. Wörtler; Munich/DE \n(jannis.bodden@tum.de) \n \nPurpose: To evaluate the performance and reproducibility of new and \npreviously described MR imaging features in the diagnosis of joint invasion (JI) \nby malignant bone tumors. \nMethods or Background: Pretherapeutic MR examinations of patients \nwith(n=24) and without(n=24) pathologically proven JI by bone tumors (n=46 \nsarcomas,n=2 metastases) were independently assessed by three readers, \nblinded for pathologic outcome. Tumors were located at the shoulder(n=7), \nhip(n=14) or knee(n=27). On MR images, direct (intrasynovial tumor \ntissue(ITT), intraarticular destruction of cartilage/bone, invasion of \ncapsular/ligamentous insertions) and indirect signs (tumor size, signal \nalterations of epiphyseal/transarticular bone(bone marrow replacement/edema-\nlike), synovial contrast enhancement, joint effusion) of JI were assessed. \nAssociations between imaging features and presence of JI were investigated \nusing exact logistic regression models. Sensitivities, specificities, positive(PPV) \nand negative predictive values(NPV) were calculated, and inter- and intra-\nreader reproducibility was determined using Fleiss' and Cohen's ț. \nResults or Findings: JI could be diagnosed with a sensitivity of 92%-100% \nand a specificity of 88%-100%, with direct visualization of ITT and destruction \nof intraarticular bone as the best predicting signs(OR •21.25,P<0.01, for each \nreader). Direct visualization of ITT was also highly \nreliable(sensitivity,specificity,PPV,NPV:92%-100%), with excellent inter- and \nintrareader reproducibility (ț=0.95). Epiphyseal bone marrow replacement and \nsynovial contrast enhancement were the most sensitive indirect signs (87%-\n96%), but lacked specificity(29%-54%). By combining direct signs with high \nspecificity, sensitivity was increased(96%) and specificity(100%) was \nmaintained. \nConclusion: Joint invasion by malignant bone tumors can reliably be \nassessed on preoperative MR images with excellent sensitivity, specificity and \nreproducibility. Direct visualization of ITT and destruction of intraarticular bone \nwere most valuable, while indirect signs were less reliable. Combining multiple \nspecific signs may further increase the sensitivity while maintaining high \nspecificity. \nLimitations: Limitations include possible reader bias and cohort size. \nEthics Committee Approval: Ethics committee approved this study. \nFunding for this study: No external funding sources. \nAuthor Disclosures: \nKatja Specht: Nothing to disclose \nMichael Rasper: Nothing to disclose \nAlexandra Sophia Gersing: Nothing to disclose \nAlexander Fingerle: Nothing to disclose \nCarolin Knebel: Nothing to disclose \nJannis Hubert Wilhelm Bodden: Nothing to disclose \nChristine Bollwein: Nothing to disclose \nKlaus Wörtler: Nothing to disclose \nJan  Neumann : Nothing to disclose \n \nRPS 110-7 \nSuprapatellar fat pad MRI abnormalities in asymptomatic subjects: what \nis normal? \n*A. Cosentino*¹, R. Richard¹, M. Baron², H. Babel², J. Favre², P. Omoumi²; \n¹Rennaz/CH, ²Lausanne/CH \n \nPurpose: To study the prevalence of supra-patellar fat pad (SPFP) MRI \nalterations in a cohort of asymptomatic subjects, in correlation with a wide \nrange of clinical/radiological evaluations, including muscle performance tests \nand physical activity data. \nMethods or Background: We prospectively included 110 asymptomatic \nsubjects from 07.2019 to 09.2020 as part of a cohort study. Inclusion criteria \nwere no knee pain in the last year. Exclusion criteria were any previous knee \ndisorder/procedure, including osteoarthritis. Subjects underwent knee \nradiographs, low-dose posture radiographs [EOS®], 3T MRI, clinical \nexamination including quadriceps and hamstrings performance tests and \nphysical activity quantification, monitored digitally for 1 week. Study groups \nwere based on presence/absence of SPFP alterations: hyperintensity and \nmass effect (qualitative evaluation, 3 radiologists in consensus) on fluid-\nsensitive sequences. Correlations were tested with a total of 55 \ncategorical/continuous clinical/radiological variables, including SPFP relative \nT2-signal, trochlear/patellar and lower-limb morphologic measurements. Mann-\nWhitney and Chi-squared test were used to compare sub-groups. \nResults or Findings: SPFP alterations were common in asymptomatic \nsubjects: 57% (63/110) hyperintensity and 37%(41/110) mass effect, with 27% \n(30/110) of subjects showing both. Among the 55 variables tested, a \ncorrelation was found only between SPFP mass-effect and increasing patellar \ntilt angle (p=0.02); SPFP hyperintensity and younger age (p=0.04). No other \nradiological, clinical or physical activity variable showed correlation with the \nSPFP alterations. \nConclusion: SPFP high signal abnormality and mass effect are common \nfindings at knee MRI of asymptomatic subjects (57% and 37%, respectively). \nTheir presence was correlated with only one parameter related to patello-\nfemoral morphology, and age (for isolated SPFP hyperintensity). No other \ncorrelations were found, including with muscle power or physical activity. \nTherefore, they most likely represent normal variants and care should be taken \nnot to overcall them as pathological findings. \nLimitations: No histopathology. \nEthics Committee Approval: Yes \nFunding for this study: Yes \nAuthor Disclosures: \nMargaux Baron: Nothing to disclose \nJulien Favre: Nothing to disclose \nHugo Babel: Nothing to disclose \nRaphaël Richard: Nothing to disclose \nAurelio Cosentino: Nothing to disclose \nPatrick Omoumi: Nothing to disclose \n \nLive Q&A \n \n10:30-11:30 CHANNEL 5 \nSpecial Focus Session \nSF 26 \nRecent developments in diagnosing \ncongenital and acquired vascular and \nlymphatic disorders in children: when, \nhow, and why? \nModerator \nWillemijn M. Klein; Nijmegen/NL  \n \nSF 26-2 \nTreatment of vascular disorders in children \nAnne Marie Cahill; Philadelphia, PA/US  \n(CAHILL@email.chop.edu) \n \nLearning Objectives: \n1. To learn about the indications for conservative and interventional treatment. \n2. To understand the potential applications and techniques of interventions. \n3. To discuss the risks and limitations. \n \nSF 26-3 \nDiagnosing lymphatic disorders in children \nPär Gerwins; Uppsala/SE \n(par.gerwins@akademiska.se) \n \nLearning Objectives: \n1. To learn about typical lymphatic pathologies in children. \n2. To learn about the techniques of MR lymphography. \n3. To discuss the appropriate work-up of lymphatic disorders. \n \nSF 26-4 \nInterventional treatment of lymphatic disorders \nRalph Gnannt; Zurich/CH \n(ralph.gnannt@usz.ch) \n \nLearning Objectives: \n1. To learn about the indications for conservative and interventional treatment. \n2. To understand the potential applications and techniques of interventions. \n3. To discuss the risks and limitations. \n \n\n \n \n \nA \nB C 79  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \nLive Q&A: How to optimise diagnosis and treatment of lymphatic and \nvascular disorders in children? \n \n11:45-12:45 CHANNEL 2 \nSpecial Focus Session \nSF 22 \nMy three top tips in post-mortem imaging \n(PMI) \nModerator \nRick R. van Rijn; Amsterdam/NL  \n \nSF 22-2 \nPost-mortem imaging: how to do it \nJeroen Kroll; Maastricht/NL  \n(j.kroll@mumc.nl) \n \nLearning Objectives: \n1. To discuss the role of post-mortem imaging. \n2. To discuss the organisational and logistic issues you will experience. \n3. To discuss the added value of trained post-mortem radiographers. \n \nSF 22-3 \nFoetal and perinatal PMI \nOwen J. Arthurs; London/UK \n \nLearning Objectives: \n1. To understand how to choose the best imaging modality. \n2. To learn about normal post-mortem changes. \n3. To practice \"safe\" image interpretation. \n \nSF 22-4 \nPaediatric PMI \nGuillaume Gorincour; Marseille/FR \n(guillaume.gorincour@gmail.com) \n \nLearning Objectives: \n1. To review and explain the scope of post-mortem foetal ultrasound. \n2. To describe a simple technique of perinatal post-mortem angio-CT. \n3. To show the relevance of PMCT in suspected neonaticide. \nAuthor Disclosures: \nGuillaume Gorincour: Advisory Board: AGFA Healthcare; Consultant: Philips \nUltrasound; Employee: Imadis Teleradiologie; Founder: IMAGE 2; Share \nHolder: DeepLink Medical; Other: Scientific Director / Imadis Teleradiologie \n \nSF 22-5 \nAdult neuro PMI \nThomas Ruder; Berne/CH \n \nLearning Objectives: \n1. To understand how post-mortem changes mimic or modify the appearance \nof pathology on PMI. \n2. To learn how reporting PMI can improve your clinical radiology reports. \n3. To become familiar with the potential for knowledge transfer between PMI \nand clinical radiology. \n \nSF 22-6 \nAdult trauma and musculoskeletal PMI \nKrzysztof Wozniak; Krakow/PL \n(mpwoznia@cyf-kr.edu.pl) \n \nLearning Objectives: \n1. To present issues referring to PMCT evaluation of victims of transportation \naccidents leading to forensic medical reconstruction of the critical event. \n2. To deliver examples of PMCT documentation of firearm injuries giving the \nopportunity for reconstruction of the track(s) of the projectile. \n3. To show results of PMCT-Angiography evaluation of stab wounds as the \nbackground of medico-legal reconstruction of injury tracks and the course of \nthe critical event. \n \nSF 22-7 \nAdult chest PMI \nSue Kearney; Preston/UK \n(Susan.kearney@lthtr.nhs.uk) \n \nLearning Objectives: \n1. To recognise CTPM appearances of various cardiothoracic diseases and \nhow to use this information to offer a cause of death for the coroner. \n2. To learn about the use of lung ventilation and coronary angiography. \n3. To understand the limitations of CTPM and when to consider invasive \nautopsy. \n \nSF 22-8 \nAdult abdomen PMI \nSarah Heinze; Heidelberg/DE \n(Sarah.Heinze@med.uni-heidelberg.de) \n \nLearning Objectives: \n1. To learn about typical post-mortem abdominal changes. \n2. To recognise the common pitfalls of abdominal post-mortem imaging. \n3. To understand that special knowledge for post-mortem imaging is \nnecessary. \n \nLive Q&A: PMI: complement or replacement of autopsy? \n \n11:45-12:45 CHANNEL 4 \nCoffee & Talk (open forum) Session \nOrganised by the ESR Value-Based Radiology \nSubcommittee \nC 5 \nCommunicating with patients: adding \nvalue to the patient’s first encounter with \nradiology \nModerator \nAdrian Brady; Cork/IE  \n \nC 5-2 \nI'm the patient, not an inanimate object: talk to me! \nJudy Birch; Poole/UK  \n \nLearning Objectives: \n1. To learn about the importance of radiologists listening to their patients. \n2. To appreciate the need to inform patients about their care at the appropriate \nlevel, taking into account their history and what they say. \n3. To understand the need for radiologists to prepare background information \nfor patients. \n \nC 5-3 \nUltrasound: we're touching the patients, why not talk to them too? \nElena E. Drakonaki; Iraklion/GR (drakonaki@yahoo.gr) \n \nLearning Objectives: \n1. To appreciate the importance of a good level of communication between the \nradiologist and the patient during US examinations. \n2. To discuss the pros and cons of communicating the results of the US scan \nto the patient. \n3. To understand the challenges associated with verbal and non-verbal \ncommunication during US scanning. \n \nC 5-4 \nInterventional radiology: if we don't explain what we're doing, who else \nshould? \nAdrian Brady; Cork/IE (adrianbrady@me.com) \n \nLearning Objectives: \n1. To learn the responsibility of the interventional radiologist to explain \nprocedures to patients. \n2. To appreciate how direct explanations can alleviate patient anxiety. \n3. To understand that interventional radiology represents a valuable \nopportunity to engage directly with patients. \n \nLive Q&A \n \n\n \n \n \nA \nB C 80  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \n11:45-12:45 CHANNEL 5 \nResearch Presentation Session: \nEmergency Imaging \nRPS 217 \nTriaging and investigating patients in a \npandemic: added value from ultrasound? \nModerator \nMariano Scaglione; Castel Volturno/IT  \n \nRPS 217-2 \nOutpatient CT-centre for emergency triage of COVID-19 patients: local \nexperience from Saint Petersburg \n*M. Cherkashin*, N. Berezina, A. Nikolaev, D. I. Kuplevatskaya, V. \nKuplevatsky, D. Lisovets, A. Boikov; Saint Petersburg/RU  \n(mikhail.a.cherkashin@gmail.com) \n \nPurpose: To discuss organizational principles of outpatient CT-based triage \nemergency center \nMethods or Background: Novel coronavirus infection characterized by great \ninfluence on healthcare systems all over the world. During first peak, number of \npatients was devastating and  clinical decisions were restricted by system \ncapacity. Hospital's emergency departments were full with COVID-patients, \nambulances spent a lot of hours in lane for patient's hospitalization. In April \n2020 on City level we've started with outpatient triage. Centers were equipped \nby CT, crash-cart, vital monitor and defibrillator, oxygen. There were consultant \nphysician, radiographer and medical receptionist inside. Radiologists assess \nimages remotely.  Patients were admitted by ambulance in CT-center, \nassessed by consultant physician and based on chest CT results (severity of \ndisease) and clinical status, decisions for hospitalization were conducted. Due \nto hazardous environment all staff were equipped by Level 2 PPE and strong \ninfection control procedures were implemented. \nResults or Findings: Since April until November 2020, 37537 suspected and \nlaboratory tested COVID patients were triaged. We've used local radiology \npneumonia severity classification (CT 1-4 points). Patients with CT 1-2 points \nand good clinical performance were way back to home for observation by \nambulatory physician, patients with CT 3-4 points and dyspnea, SpO2 less \nthan 94%, comorbidity etc were admitted at the hospital. During 7 months \n21986 patients with COVID pneumonia  were diagnosed. We've hospitalized \n5532 moderate-to-severe and critical patients, 32005 were referred for home \ntreatment. \nConclusion: Based on our study results we propose some sentences: \noutpatient COVID-19 patients triage with computed tomography is the \nacceptable strategy in respiratory pandemic environment; CT-triage is the fast \ntool for clinical decision; infection control is the key point for medical staff \nsafety. \nLimitations: It's ongoing study with interim results \nEthics Committee Approval: Study was approved by LEC \nFunding for this study: Hospital based funding \nAuthor Disclosures: \nAlexey Boikov: Nothing to disclose \nMikhail Cherkashin: Nothing to disclose \nNatalia Berezina: Nothing to disclose \nAleksey Nikolaev: Nothing to disclose \nVladimyr Kuplevatsky: Nothing to disclose \nDmitry Lisovets: Nothing to disclose \nDaria Igorevna Kuplevatskaya: Nothing to disclose \n \nRPS 217-3 \nImproving efficacy and efficiency in an emergency unit by using the \nradiology department as the entry door of COVID-19 patients from the \nprimary care network \nJ. M. Plasencia Martinez, *M. Lozano Ros*, P. Fabuel Hernández, M. d. C. \nSánchez Ayala, G. Pérez Hernández, J. M. M. Garcia Santos; Murica/ES \n(marina.lozano93@gmail.com) \n \nPurpose: To reduce COVID-19 risk of contagion in non-respiratory patients in \nour ED, we implemented a circuit to perform immediate chest X-rays (CXR) on \npossible/confirmed COVID-19 patients in home confinement and telephone \nfollow-up by GPs with an unfavorable evolution, without sending the patient to \nthe ED. \nMethods or Background: We classified patients into:- G1: entrance through \nHigh Resolution Radiology Supply (HRRS). Normal CXR - back home.- G2: \nentrance through HRRS. Pneumonic findings on CXR - ED. - G3: repiratory \npatients entrying directly through ED.We consider as duration of the process in \nG1, the period between the CXR appointment time and report validation by \nradiologists; and in G2 and G3, the period between the arrival of the patient to \nED admission and the report signing by the emergency doctor. IBM Statistics \nSPSS 22 version program was used. Anova test with Bonferroni correction, \nKruskal-Wallis test and Chi2 test were applied. Statistically significant \ndifferences were considered when P<0.05. \nResults or Findings: From March 26th to April 17th, the number of respiratory \npatients attended by HRRS (419) and directly by ED (439) were similar. 65% \n([325 G1+1 G2+228 G3]/849) of patients returned back home.G1 patients \n(0:41 ± 1:05h) stayed in hospital significantly less time than G2 and G3 \nsubjects (5:25 ± 3:08h and 5:36 ± 4:36h; P <0.001), even when G2 and G3 \npatients were forwarded home (3:36 ± 2:58 h and 3:50 ± 3:16 h; P <0.001).G2 \npatients were hospitalized (84/93; 90.3%) more frequently than G3 (203/439; \n46.2%, P <0.001). \nConclusion: A straightforward HRRS could triage and decrease respiratory \npatients at ED during COVID-19 pandemic, reduce waiting times and yield fast \nadmission decisions. \nLimitations: Not having all clinical and radiological follow-up data of patients. \nEthics Committee Approval: Yes \nFunding for this study: No \nAuthor Disclosures: \nMaría del Carmen Sánchez Ayala: Nothing to disclose \nMarina Lozano Ros: Nothing to disclose \nJuana María Plasencia Martinez: Nothing to disclose \nJose Maria Garcia Santos: Nothing to disclose \nPablo Fabuel Hernández: Nothing to disclose \nGloria Pérez Hernández: Nothing to disclose \n \nRPS 217-5 \nPoint-of-care lung ultrasound and echocardiography simulation module \nfor training frontline physicians to triage and monitor coronavirus \npatients \n*G. Bartal*, T. Avziz, I. Harel, A. Shouval, V. Levin, R. Weiss; Tel Aviv-Yafo/IL \n(gbartal@gmail.com) \n \nPurpose: POCUS (point-of-care ultrasound) is considered an alternative to \nchest radiography and echocardiography in COVID-19 patients. POCUS is \nbedside, quick for use, repeatable, low cost, and radiation-free. Training \nfrontline and intensive care physicians to rapidly acquire POCUS skills can be \ncritical for the success of COVID-19 patient management. Our aim was to \ndevelop and implement POCUS virtual reality simulator for hands on training of \nnon-radiologists. \nMethods or Background: Based on published COVID-19 lung ultrasound \nimaging findings, the simulated ultrasound image have been designed to \nvisualize the typical COVID-19 findings, with a variety of patient lung \npathologies, from mild to severe.  Soon after the lung ultrasound module was \nadapted the existing echocardiography simulation module was modified and \nembedded into the new comprehensive simulation system. The current module \nincludes unique lung ultrasound and Echocardiography clinical cases of \npatients suspected or diagnosed with COVID-19. In addition, the module is \nhands on and comprises COVID-19 rich ultrasound educational library material \nthat includes videos and protocols from key opinion leaders. \nResults or Findings: The COVID-19 POCUS module was released in only \ntwo weeks of fast-tracked development and installed on dozens of Ultrasound \nMentor simulators (Simbionix, 3D Systems Healthcare) worldwide. In certain \ncountries, mobile training units were designated to train physicians  to triage \npatients using POCUS. Eventually, the rapid development of the simulated \nmodule helped to improve and to expand patient care during Pandemic. \nConclusion: Lung Ultrasound and echocardiography simulation and training \nsolution allowed efficient, swift, and validated recruitment of primary and \nintensive care physicians to triage and to follow-up COVID-19 patients using \nPOCUS techniques in the course of the Pandemic. Evaluation of clinical results \nand physicians’ satisfaction using validated questionnaires is underway. \nLimitations: Retrospective design. \nEthics Committee Approval: Not required \nFunding for this study: No funding. \nAuthor Disclosures: \nIris Harel: Employee at Simbionix 3DSysteHealthcare \nVictor Levin: Employee at Simbionix 3DSysteHealthcare \nAssaf Shouval: Employee at Simbionix 3DSysteHealthcare \nRan Weiss: Employee at Simbionix 3DSysteHealthcare \nGabriel Bartal: Consultant at Simbionix 3DSysteHealthcare \nTal Avziz: Employee at Simbionix 3DSysteHealthcare \n \nRPS 217-7 \nCan ultrasound alone suffice in the evaluation of acute abdomen in \nadults: a comparative ultrasound versus computed tomography \n(hospital-based) study \n*S. Awasthi*, V. Gupta, S. B. Grover; Greater Noida/IN \n(swatiawasthi.cool08@gmail.com) \n \n\n \n \n \nA \nB C 81  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \nPurpose: The objective of this study was to compare the sensitivity of \nUltrasound (US) and Computed tomography (CT) in evaluation of acute \nabdomen and to assess whether Ultrasound alone will suffice in majority \nsituations, so that radiation exposure may be minimized. \nMethods or Background: This institutional review board approved \nprospective observational study comprised of 50 adult patients with acute \nabdomen. The exclusion criteria were trauma and pregnancy. US and CT (non-\ncontrast and contrast enhanced) were performed by standard protocol in all \npatients. \nResults or Findings: The average exposure from the PACS database for \nacute abdomen CT protocol, was found to be 10mSv. Although the overall \nsensitivity of US was 78% and that of CT was 96% with significant difference (p \nvalue – 0.01), the sensitivity of US compared to CT in diagnosing common \netiologies of acute abdomen namely ac ute cholecystitis, acute appendicitis, \nintestinal obstruction, acute pancreatitis and ureteric calculi sensitivity did not \ndiffer significantly (p value of 1.00, 0.47, 0.50, 0.06, 1.00 respectively). CT was \nnecessary only in patients with retro-caecal appendicitis, bowel obstruction \ncases for defining the transition point and in patients with acute pancreatitis to \nobtain the CT Severity index. \nConclusion: We propose that US should remain the primary imaging modality \nin all patients of acute abdomen in order to prevent radiation exposure, \nespecially as it was found to have a sensitivity comparable to CT, in majority of \nthe clinical situations. Moreover, it is a more cost-effective investigation. \nTherefore, CT should be reserved only for the minority of clinical situations \nwhere US is significantly inconclusive. We propose to extend the study for a \nlarger cohort of patients. \nLimitations: Small sample size \nEthics Committee Approval: Yes \nFunding for this study: Not Applicable \nAuthor Disclosures: \nShabnam Bhandari Grover: Nothing to disclose \nSwati Awasthi: Nothing to disclose \nVishal Gupta: Nothing to disclose \n \nRPS 217-8 \nHigh-resolution ultrasonographic (HRUS) evaluation of subglottic \ndiameter for preanesthetic estimation of endotracheal tube diameter \n*N. Neha*, R. Rastogi, V. Pratap; Moradabad/IN \n(neha11aug@gmail.com) \n \nPurpose: Endotracheal intubation which is a prerequisite for variety of surgical \nprocedures is mainly governed by the narrowest diameter of the upper airway. \nSize of the endotracheal tube can be calculated by physical indices or \ninvasively by laryngoscopy. Over-size tubes lead to airway injuries while under-\nsize tubes leads to inadequate ventilation. High-resolution ultrasonography \n(HRUS) not only allows objective measurement of airway dimensions but is \nalso noninvasive & cheap technique. This study aimed to:  \n•Determine the accuracy of HRUS-determined diameter compared with \nendotracheal tube diameter used clinically during the procedure. \nMethods or Background: The study was carried on 25 patients appearing for \npreanesthetic check-up for elective surgery. HRUS was performed on these \npatients using a high-frequency, linear-array probe. The subglottic, transverse, \ntracheal diameter was measured just inferior to true vocal cords at the level of \ncricoid arch. The diameter of endotracheal tube used clinically during the \nanaesthesia was be noted along with the endotracheal tube diameter \ndetermined by physical indices.The diameters thus obtained by three methods \nwere then matched with each other to determine the accuracy of the HRUS \ndetermined diameter. \nResults or Findings: The age of the patients ranged from 3rd to 6th decade. \nThe accuracy of HRUS determined subglottic diameter is approximately 75% in \npatients below the age of 50years. \nConclusion: HRUS is a safe and reliable imaging tool for preanesthetic \ndetermination of subglottic diameter for ET insertion.  \nClinical Relevance  \nThough in experienced hands, HRUS-determined subglottic diameter may not \nbe significantly useful in decreasing the number of attempts required for \ndetermination of clinically-useful ET diameter yet it may be definitely useful for \ntrainees / residents / inexperienced hands and in times of emergency, thus \nreducing the morbidity related with intubation \nLimitations: None \nEthics Committee Approval: None \nFunding for this study: None \nAuthor Disclosures: \nRajul Rastogi: Nothing to disclose \nNeha Neha: Nothing to disclose \nVijai Pratap: Nothing to disclose \n \n \n \n \n \nRPS 217-9 \nChest x-ray in the emergency department during COVID-19 pandemic \ndescending phase in Italy: correlation with patients’ outcomes \n*D. Cozzi*, C. Moroni, E. Cavigli, A. Bindi, M. Albanesi, S. Luvarà, P. Nazerian, \nV. Miele; Florence/IT \n(dilettacozzi@gmail.com) \n \nPurpose: The aims of the study are: to estimate admission chest X ray (CXR) \naccuracy during the pandemic descending phase; to identify specific CXR \nfindings strictly associated with COVID-19 infection and to correlate lung \ninvolvement of admission CXR with patients’ outcome. \nMethods or Background: We prospectively evaluated the admission CXR of \n327 patients accessed to our institute during the Italian pandemic descending \nphase (April-July 2020). For each CXR were searched: ground glass \nopacification (GGO), consolidation (CO), reticular-nodular opacities (RNO), \nnodules, excavations, pneumothorax, pleural effusion, vascular congestion and \ncardiac enlargement. For lung alterations was defined the predominance \n(upper/basal, focal/diffuse, central7peripheral, etc.). Then radiologists \nassessed if CXRs were suggestive or not for COVID-19 infection. For COVID-\n19 patients a prognostic score was applied and correlated with the patients’ \noutcome. \nResults or Findings: CXR showed 83% of specificity and 60% of sensitivity. \nGGO, CO, RNO and a peripheral, diffuse and basal prevalence showed good \ncorrelation with COVID-19 diagnosis. A logistic regression analysis pointed out \nGGO and a basal or diffuse distribution as independent predictors of COVID-\n19 diagnosis. The prognostic score showed good correlation with the patients’ \noutcome. \nConclusion: In our study, admission CXR showed a fair specificity and a good \ncorrelation with patients’ outcome. GGO and others CXR findings showed a \ngood correlation with COVID-19 diagnosis. Besides GGO and a diffuse or \nbibasal distribution resulted independent variables highly suggestive for \nCOVID-19 infection. \nLimitations: Our study has several limitations. First, authors lack interobserver \nagreement in the diagnostic evaluation and in the prognostic scoring of the \nCXR (all decisions were reached collegially). Also, we evaluated only \nadmission CXR and we lack follow up imaging. \nEthics Committee Approval: Yes (rif. CEAVC 17104) from the Ethics \nCommittee of our Hospital in Florence. \nFunding for this study: None \nAuthor Disclosures: \nAlessandra Bindi: Nothing to disclose \nVittorio Miele: Nothing to disclose \nSilvia Luvarà: Nothing to disclose \nEdoardo Cavigli: Nothing to disclose \nPeiman Nazerian: Nothing to disclose \nChiara Moroni: Nothing to disclose \nDiletta Cozzi: Nothing to disclose \nMarco Albanesi: Nothing to disclose \n \nLive Q&A \n \n14:15-15:15 CHANNEL 2 \nISRRT meets Singapore \nMeets 6 \nRadiography (imaging and therapy) \nservices in Singapore \nModerators \nDonna Newman; Fargo, ND/US  \nNapapong Pongnapang; Bangkok/TH  \n \nMeets 6-3 \nIntroduction to Singapore's healthcare system and the radiography \nprofession \nDenise Choong Ai Wen; Singapore/SG \n(president@ssr.org.sg) \n \nLearning Objectives: \n1. To learn about Singapore's population and healthcare concerns. \n2. To learn about the structure and financing of Singapore's health system. \n3. To understand the radiography profession as part of Singapore's healthcare \nsystem. \n \n \n \n\n \n \n \nA \nB C 82  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \nMeets 6-4 \nRadiology services in Singapore \nMichael Ong Kah Leong; Singapore/SG \n(michael_ong@nuhs.edu.sg) \n \nLearning Objectives: \n1. To become familiar with the types of radiography and radiation therapy \nservices provided in Singapore. \n2. To understand how Singapore's population accesses radiology services \n \nMeets 6-5 \nThe Allied Health Professions Council (AHPC) and regulation of \nprofessionals \nGabriel Leong Kok Wah; Singapore/SG \n \nLearning Objectives: \n1. To understand the rationale for Singapore's AHPC and how radiographers \nand radiation therapists are regulated. \n2. To obtain an overview of the radiography career opportunities in Singapore \nand hiring difficulties. \nAuthor Disclosures: \nGabriel Leong Kok Wah: Employee: Changi General Hospital \n \nMeets 6-6 \nSingapore's radiography education system \nTan Chek Wee; Singapore/SG \n(chekweetan@nuhs.edu.sg) \n \nLearning Objectives: \n1. To learn about the history and current status of Singapore's radiography \neducation system. \n2. To appreciate how we are preparing for professional challenges in the \nfuture. \n \nLive Q&A \n \n14:15-15:15 CHANNEL 3 \nE³ - The Beauty of Basic Knowledge: \nBreast \nE³ 24B \nBasis of breast ultrasound and \nmultimodality readings \nModerators \nPanagiotis Kapetas; Vienna/AT  \nKaren Kinkel; Chêne-Bougeries/CH  \n \nE³ 24B-3 \nPractical ultrasound of the breast: how I do it \nAlexandra Athanasiou; Athens/GR \n(aathanasiou@mitera.gr) \n \nLearning Objectives: \n1. To learn about patient positioning and image quality control. \n2. To understand the value of colour Doppler ultrasound and elastography. \n3. To learn about applying ultrasound breast imaging reporting and data \nsystems (BIRADS). \n \nE³ 24B-4 \nIntegrating ultrasound findings into the final mammography report \nEva M. Fallenberg; Munich/DE \n \nLearning Objectives: \n1. To understand how to assess concordance between mammography and \nultrasound results. \n2. To learn to give a final recommendation (no further action required, short-\nterm follow-up, biopsy, other imaging modality, etc.). \nAuthor Disclosures: \nEva M. Fallenberg: Advisory Board: Siemens Bayer Guerbet; Board Member: \nEUSOBI DRG; Research Grant/Support: GE Guerbet Siemens; Speaker: GE \nSiemens Bayer Guerbet \n \nLive Q&A \n \n14:15-15:15 CHANNEL 5 \nResearch Presentation Session: Vascular \nRPS 115 \nModern techniques in vascular \ndiagnostics \nModerator \nKrzysztof K. Pyra; Lublin/PL  \n \nRPS 115-4 \nContrast-enhanced ultrasound perfusion patterns, risk factors, and \nserum lipid signatures of vulnerable carotid plaque in predicting stroke: a \ncohort study of carotid stenosis in Chinese patients \n*H. Yunqian*, M. Chen; Shanghai/CN  \n \nPurpose: To investigate the correlation between contrast-enhanced ultrasound \n(CEUS) perfusion patterns, Risk factors and serum lipid signatures of carotid \nartery plaques with the degree of carotid stenosis. \nMethods or Background: We screened 2039 patients with plaque of the \ncarotid ultrasound From March to June in 2018 years. A total of 80 patients \nwere enrolled with who underwent CEUS, CTA or DSA, complete \nquestionnaires(including demographics and Risk factors), and serum lipid \ntesting. Exclusion criteria were age<18 or>85 years, plaque thickness less than \n1.5mm, have a history of myocardial infarction in two weeks. The CEUS \nperfusion pattern were divided into plaque base entering and surface entering \nmode. \nResults or Findings: The 50 participants with hypertension consisted of 32 \n(59.3%) males and 18 (69.2%) females. The 28 participants with plaque \nsurface entering mode by the CEUS perfusion pattern. Based on our previous \nstudy that the contrast agent enhancement levels and the CEUS perfusion \npatterns in plaque were significantly associated with the degree of carotid \nstenosis (P<0.05), we found hypertension and increasing apolipoprotein E \nconcentration were significantly associated with plaque surface entering mode \nby the CEUS perfusion pattern (P<0.05). \nConclusion: The contrast agent mainly infuses from the surface to the interior \nof the plaque on CEUS are indicative of vulnerable carotid plaques, prior to \nthat, hypertension and increasing apolipoprotein E concentration may cause \nthe variation of the Contrast-enhanced perfusion patterns. Together these \nfactors may provide evidence of vulnerable plaques in those with carotid artery \nstenosis. \nLimitations: This study was a retrospective, single-center study. We only \nassessed the neovascularization of plaques qualitatively, via direct \nobservation. \nEthics Committee Approval: The study protocol was approved by the \nInstitutional Ethics Review Committee and written informed consent was \nobtained from all participants. \nFunding for this study: No external funding was provided for this study. \nAuthor Disclosures: \nHuang Yunqian: Nothing to disclose \nMan Chen: Nothing to disclose \n \nRPS 115-5 \nAre the morphological indices of the vertebrobasilar system heritable? A \ntwin study \n*L. Szalontai*¹, Z. Jokkel¹, T. Horvath¹, M. Piroska¹, B. Forgo², D. L. Tarnoki¹, \nA. Tarnoki¹; ¹Budapest/HU, ²Örebro/SE \n \nPurpose: Asymmetrical vertebral artery (VA) flow and diameter are common \nfindings and are often left dominant. This can result in asymmetrical blood flow \nin the basilar artery (BA), which may cause bending of the artery over time. \nThis study investigated whether the variation of the different vertebrobasilar \nmorphological indices that influence flow characteristics might be inherited. \nMethods or Background: We analyzed 200 cerebral MRI scans of healthy \nCaucasian twins (100 pairs). Self-reported questionnaires were used for \nzygosity classification and to collect detailed risk factors. All twins underwent \ntime-of-flight MRI. We reconstructed a 3D mesh of the posterior circulation \nfrom the start of the V4 segment to the basilar top (ITK snap) and subsequently \nanalyzed the morphology of the vertebrobasilar system with an in-house \nsoftware written in Python. The phenotypic variance of the different \nmorphological parameters was decomposed into heritability (A), shared (C), \nand unshared (E) environmental effects (ACE analysis). \nResults or Findings: VA V4 segment diameter, curvature, tortuosity were \nmainly influenced by shared (C) and unshared (E) environmental factors. \nModerate BA heritability was found for length (A: 63% ; 95%CI: 45,7-75,2%) \n(E: 37% ; 95%CI: 24,8-54,3%) and volume (A: 60,1%; 95%CI:42,4-73,2%) (E: \n39,9%; 95%CI: 26,8-57,6%), while the torsion of both arteries showed no \nheritability and were only influenced by unshared environment. \n\n \n \n \nA \nB C 83  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \nConclusion: The length and volume of the BA showed moderate genetical \ninfluence. However, most of the measured morphological indices were \ninfluenced by shared and unshared factors, which may highlight the complex \nhemodynamic background of the vertebrobasilar system. \nLimitations: ToF-MRI may produce artifacts that can influence measurements. \nEthics Committee Approval: The study protocol conforms to the ethical \nguidelines of the 1975 Declaration of Helsinki and the study protocol has been \npriorly approved by the Semmelweis University Ethical Committee (TUKEB \n264/2019). \nFunding for this study: Not applicable. \nAuthor Disclosures: \nDavid Laszlo Tarnoki: Nothing to disclose \nBianka Forgo: Nothing to disclose \nMarton Piroska: Nothing to disclose \nTamas Horvath: Nothing to disclose \nZsofia Jokkel: Nothing to disclose \nAdam Tarnoki: Nothing to disclose \nLászló Szalontai: Nothing to disclose \n \nRPS 115-6 \nEstimated false lumen arc length is associated with late adverse events \nin uncomplicated type-B aortic dissection \nM. J. Willemink¹, M. Codari¹, G. Mistelbauer¹, *J. Hop*², A. M. H. Sailer¹, V. \nTurner¹, V. Hinostroza¹, D. Mastrodicasa¹, D. Fleischmann¹; ¹Stanford, CA/US, \n²Groningen/NL \n(j.f.hop@umcg.nl) \n \nPurpose: A recent study showed that the circumferential angle of the false \nlumen (FL) is independently associated with late adverse events (LAEs) in \npatients with uncomplicated type-B aortic dissection (uTBAD), even when \nadded to a multivariable model that includes maximum aortic diameter. \nAlthough these results are promising, the circumferential-angle of the FL is \ndifficult to measure. We aimed to assess whether the easy-to-measure FL-arc-\nlength has the potential to replace circumferential angle and maximum aortic \ndiameter for LAEs prediction in uTBAD-patients. \nMethods or Background: uTBAD-patients who underwent a CTA ”2 weeks \nafter dissection were retrospectively included. The conventional Cox \nregression model included 1 clinical feature (presence of connective tissue-\ndisease (CTD)) and 4 imaging features: FL-circumferential-angle, maximum \naortic diameter, total FL-outflow volume, and number of identifiable \nintercostals. Estimated FL-arc-length was calculated \nas(Max_Aortic_diameter*pi*False_lumen_circumferential_angle)/360. LAE was \ndefined as aortic aneurysm formation, rapid aortic growth, aortic rupture, \nbranch vessel ischemia, or death. Multivariable Cox-regression models were \ncreated with estimated FL-arc-length. \nResults or Findings: 83 patients (mean age 54±16 years) were included and \n14 (15%) patients had CTD. Median follow-up was 850 days (interquartiles \n247-1824) and 33 (40%) patients developed LAEs. The conventional \nmultivariable Cox-model showed hazard ratios (HRs) of 1.10(1.02-1.18), \np=0.015 for maximum aortic diameter and 1.03(1.01-1.05), p=0.003 for FL-\ncircumferential-angle. The multivariable model was updated by replacing \nmaximum aortic diameter and FL-circumferential-angle with estimated FL-arc-\nlength, resulting in a HR of 1.05(1.03-1.08)/mm, p<0.001. Model performance \nwas similar with area under the curves of 0.738(0.632-0.844) for the original \nmodel and 0.733(0.627-0.839) for the updated model. \nConclusion: Our multicenter study showed that estimated FL-arc-length is \nsignificantly associated with LAEs and has the potential to replace FL-\ncircumferential-angle and maximum aortic diameter in risk prediction of \nuTBAD-patients. \nLimitations: Retrospective study; FL-arc-length was estimated; \nEthics Committee Approval: IRB-approved \nFunding for this study: American Heart Association \nAuthor Disclosures: \nDominik Fleischmann: Research/Grant Support at Siemens Healthineers \nVirginia Hinostroza: Nothing to disclose \nMarina Codari: Nothing to disclose \nGabriel Mistelbauer: Grant Recipient at cool IT GmbH \nValery Turner: Shareholder at Segmed, Inc \nAnna M. H. Sailer: Nothing to disclose \nMartin J. Willemink: Grant Recipient at Philips Healthcare Consultant at \nArterys, Inc, Shareholder at Segmed, Inc \nDomenico Mastrodicasa: Nothing to disclose \nJoost Frederik Hop: Nothing to disclose \n \nRPS 115-7 \nCT-derived pulmonary vascular metrics predict COVID-19 patients’ \nprognosis \nS. Schiaffino¹, A. Cozzi¹, *M. Codari*², C. Bnà³, M. Cariati¹, A. Carriero ຾, A. \nVanzulli¹, L. M. Sconfienza¹, F. Sardanelli¹; ¹Milan/IT, ²Stanford, CA/US, \n³Brescia/IT, ຾Novara/IT \n(mcodari@stanford.edu) \n \nPurpose: To evaluate the prognostic significance of CT-derived vascular and \nlung parenchymal features combined with clinical data acquired at emergency \ndepartment (ED) admission of COVID-19 patients. \nMethods or Background: Patients with RT-PCR-confirmed SARS-CoV-2 \ninfection and unenhanced chest CT performed on ED admission from six \nhospitals were included, their outcome (discharge or death) being retrieved \nalongside clinical data (demographics, comorbidities, laboratory examinations), \nchest CT features (parenchymal involvement extent/progression, crazy paving, \npleural effusion, lymphadenopathies), and CT-derived vascular metrics \n(pulmonary artery and ascending aorta diameters). Univariate analysis (Mann-\nWhitney U test), support vectors machines (SVM) and neural networks (NN) \nwere used to build a mortality-predicting model, with a 85%:15% training-\nvalidation/test dataset split. \nResults or Findings: Out of 897 patients (68% males, median age 66 years, \ninterquartile range [IQR] 55–77 years), 229 (26%) patients died after a median \n7 days hospitalization (IQR 4–11), dead patients showed higher pulmonary \nartery diameter than discharged patients (29.0 versus 27.0 mm, p<0.001), and \nhigher median aortic diameter (36.6 mm versus 34.0 mm, p < 0.001). We used \n10 input features selected after least absolute shrinkage and selection operator \nregression (sex, age, pulmonary consolidations, crazy paving pattern, \nparenchymal involvement extent, pulmonary artery and aortic diameters, pre-\nexistent cardiovascular disease, oncological history, chronic kidney \ninsufficiency) to build our mortality predictive model. Best predictive model was \nobtained using NN and yielded an area under the curve of and 0.844 (precision \n0.680, recall 0.567) in the testing set. Pulmonary artery diameter was the third \nmost important predictor after age and parenchymal involvement extent. \nConclusion: Pulmonary artery maximum diameter showed significant \ndifference between discharged and dead patients, sizably contributing to \nprognosis-predictive model \nLimitations: Retrospective study performed during a pandemic peak. \nEthics Committee Approval: Obtained for each center. \nFunding for this study: Partial support by the Italian Ministry of Health. \nAuthor Disclosures: \nAndrea Cozzi: Nothing to disclose \nClaudio Bnà: Nothing to disclose \nFrancesco Sardanelli: Advisory Board at Bracco Group, Advisory Board at \nBayer Healthcare, Speaker at General Electric Healthcare \nSimone Schiaffino: Other at Bracco Imaging, Speaker at General Electric \nHealthcare \nMarina Codari: Nothing to disclose \nAngelo Vanzulli: Nothing to disclose \nLuca Maria Sconfienza: Nothing to disclose \nMaurizio Cariati: Nothing to disclose \nAlessandro Carriero: Nothing to disclose \n \nRPS 115-9 \nPreoperative cerebral small vessel disease and carotid near-occlusion \nare independently associated with cerebral hyperperfusion after carotid \nendarterectomy \n*X. Fan*¹, Z. Lai¹, T. Lin¹, H. You¹, J. Wei¹, Z. Li², F. Feng¹; ¹Beijing/CN, \n²Shanghai/CN \n(18801122923@163.com) \n \nPurpose: To determine whether preoperative cerebral small vessel disease \n(SVD) and carotid near-occlusion are associated with cerebral hyperperfusion \n(CH) after carotid endarterectomy (CEA). Another purpose was to explore the \nrisk factors for the further development of cerebral hyperperfusion syndrome \n(CHS) in patients diagnosed with CH. \nMethods or Background: Consecutive patients with carotid stenosis who \nunderwent CEA between May 2015 and September 2020 were included. CH \nwas defined as a cerebral blood flow increase of more than 100% compared \nwith preoperative values on arterial spin labelling images. The grade or the \nnumber of four cerebral SVD markers (white matter hyperintensities(WMHs), \nlacunes, perivascular spaces and cerebral microbleeds) was evaluated based \non preoperative MRI. The presence of carotid near-occlusion was defined by \ncomputed tomography angiography. \nResults or Findings: A total of 50 patients were included and CH was \nobserved in 12 patients(24%). Logistic regression analysis revealed that \nWMHs (OR=2.46, 95% CI [1.36-4.45], p=0.003), lacunes (OR=1.76, 95% CI \n[1.17, 2.64], p=0.007) and carotid near-occlusion (p<0.01) were independently \nassociated with postoperative CH. CHS was occurred in 5(41.67%) of the 12 \npatients diagnosed with CH. The maximum systolic blood pressure  within 24h \nafter surgery of 5 CHS patients was significantly higher than that of the other 7 \npatients (p=0.045). \nConclusion: In patients with carotid stenosis, preoperative WMHs, lacunes \nand carotid near-occlusion can identify patients at risk of CH after CEA. Strict \ncontrol of blood pressure might be the key point to prevent the progression of \nCHS. \nLimitations: First, the sample size was relatively small. Secondly, our \nconclusions were specifically appliable to patients undergoing CEA under \ngeneral anesthesia. \n\n \n \n \nA \nB C 84  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \nEthics Committee Approval: This study was approved by the Medical Ethics \nCommittee of the Peking Union Medical College Hospital. \nFunding for this study: This study was funded by the Beijing Natural Science \nFoundation grant (L182067). \nAuthor Disclosures: \nFeng Feng: Nothing to disclose \nZhichao Lai: Nothing to disclose \nJuan Wei: Nothing to disclose \nXiaoyuan Fan: Nothing to disclose \nZheng Li: Nothing to disclose \nHui You: Nothing to disclose \nTianye Lin: Nothing to disclose \n \nLive Q&A \n \n15:30-16:30 CHANNEL 2 \nRefresher Course: Chest \nRC 404 \nThoracic manifestations of COVID-19 \nModerator \nAnnemiek Snoeckx; Antwerp/BE  \n \nRC 404-2 \nA. Acute findings and late sequelae \nNicola Sverzellati; Parma/IT  \n \nLearning Objectives: \n1. To recognise acute findings on radiographs and CT. \n2. To evaluate late findings on CT. \n3. To gain confidence in identifying imaging patterns, even when PCR is \nnegative. \n \nRC 404-3 \nB. COVID-19: a vascular pulmonary disease \nMarie-Pierre Revel; Paris/FR \n(marie-pierre.revel@aphp.fr) \n \nLearning Objectives: \n1. To learn about pulmonary vascular injury and thrombosis in COVID-19. \n2. To understand the evolution of vascular pathology in the lungs. \n3. To learn about optimal imaging protocols for patients in intensive care. \nAuthor Disclosures: \nMarie-Pierre Revel: Other: travel support from guerbet, lecture fee from MSD \n \nRC 404-4 \nC. COVID-19 in patients with pre-existing lung diseases \nThomas Frauenfelder; Zurich/CH \n \nLearning Objectives: \n1. To distinguish current pathology from pre-existing lung anomalies. \n2. To understand how underlying lung disease affects prognosis in COVID-19. \n3. To know when to plan follow-up after COVID-19. \n \nLive Q&A \n \n15:30-16:30 CHANNEL 3 \nEFRS Workshop \nEFRS WS \nRadiographers and patient-centred care \nModerators \nCharlotte Graungaard Falkvard; Frederiksberg/DK  \nErik Briers; Hasselt/BE  \n \nEFRS WS-3 \nWhat constitutes patient-centred care in medical imaging? \nRodrigo García Gorga; Sabadell/ES \n \n \n \n \nLearning Objectives: \n1. To define the keys concepts of patient-centred care. \n2. To outline the potential benefits of patient-centred care for patients. \n3. To identify the challenges and opportunities for successfully implementing \npatient-centred care. \n \nEFRS WS-4 \nSuccessfully achieving optimal patient experience within medical \nimaging \nLouise Harding, Paula Park; Warrington/UK \n(louise.harding1@nhs.net), (paula.park@nhs.net) \n \nLearning Objectives: \n1. To understand how implementing a quality improvement methodology can \nassist in improving radiographic practice and team work. \n2. To appreciate how patient centred care can impact on radiographic practice \nand patient experience. \n3. To understand how radiography research can translate into implementing \nchanges in clinical practice. \n \nEFRS WS-6 \nWhat patients require from their experience within a radiology \ndepartment \nCheryl Cruwys; Glanges/FR \n \nLearning Objectives: \n1. To appreciate the patient's requirements when attending imaging \nexaminations. \n2. To consider how patients can contribute to implementing more patient-\ncentred approaches. \n3. To identify the future challenges and opportunities for delivering patient-\ncentred care within medical imaging. \nAuthor Disclosures: \nCheryl Cruwys: Founder: Breast Density Matters UK \n \nEFRS WS-7 \nWhat can the EFRS do at a European level to promote patient-centred \ncare? \nAndrew England; Salford/UK \n(a.england@keele.ac.uk) \n \nLearning Objectives: \n1. To outline the role of the EFRS in promoting patient-centred care. \n2. To explain the EFRS initiatives for promoting patient-centred care across \nEurope. \n3. To appreciate other opportunities for developing and promoting patient-\ncentred care within individual organisations. \n \nLive Q&A: Patient-centred care is not a barrier to improving departmental \nefficiency \n \n15:30-16:30 CHANNEL 4 \nCoffee & Talk (open forum) Session \nOrganised by EIBIR \nC 12 \nInnovations in breast imaging: keys to \nfunding success \nModerator \nGabriel P. Krestin; Rotterdam/NL  \n \nC 12-2 \nInnovation in the diagnosis of breast cancer using ultrasound and diffuse \noptics \nPietro Panizza; Milan/IT  \n \nLearning Objectives: \n1. To learn about the developments of the SOLUS research project. \n2. To learn about and understand the benefits of combined use of ultrasound \nand optical tomography. \n \n \n \n\n \n \n \nA \nB C 85  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \n \nC 12-3 \nDigital hybrid breast PET/MRI for enhanced diagnosis of breast cancer \nThomas H. Helbich; Vienna/AT \n \nLearning Objectives: \n1. To learn about the development of the HYPMED research project. \n2. To learn about and understand the benefits of digital hybrid PET/MR in \nbreast cancer imaging. \nAuthor Disclosures: \nThomas H. Helbich: Grant Recipient: bracco, guerbet, siemens, hologic, bard, \nnovomed \n \nC 12-4 \nThe impact of breast MRI on surgical planning and reoperation rate \nFrancesco Sardanelli; San Donato Milanese/IT \n(francesco.sardanelli@unimi.it) \n \nLearning Objectives: \n1. To learn about the MIPA clinical study. \n2. To understand the impact of breast MRI on surgical planning and \nreoperation rates. \nAuthor Disclosures: \nFrancesco Sardanelli: Advisory Board: Bayer, Bracco, General Electric; \nEquipment Support Recepient: General Electric \n \nC 12-5 \nFunding opportunities under Horizon Europe \nPeter Gordebeke; Vienna/AT \n(pgordebeke@eibir.org) \n \nLearning Objectives: \n1. To learn about Horizon Europe. \n2. To learn about European research funding opportunities. \n \nC 12-6 \nEIBIR's support services: key for funding success \nPamela Zolda; Vienna/AT \n(pamela.zolda@myesr.org) \n \nLearning Objectives: \n1. To learn about EIBIR's support services. \n2. To understand how EIBIR can increase funding success. \n \nLive Q&A \n \n15:30-16:30 CHANNEL 5 \nStudent Session \nS 1 \nBest of ECR Student Abstract  \nSubmission \nModerator \nDragos Negru; Iasi/RO  \n \nS 1-2 \nDynamic changes of the functional connectome during foetal brain \ndevelopment observed in utero via MRI \n*A. Taymourtash*, E. Schwartz, K-H. Nenning, D. Prayer, G. Kasprian, G. \nLangs; Vienna/AT  \n(athena.taymourtash@meduniwien.ac.at) \n \nPurpose: A comprehensive quantitative analysis of functional foetal brain \ndevelopment in-utero, can advance the study of pathologies without the \nconfounding effects of postnatal experiences, allowing for early prevention, \ndetection, and intervention starting even before birth. In this work, we model \nfoetal functional connectome development with a focus on thalamo-cortical \nconnectivity derived from in-utero MRI. \nMethods or Background: Resting-state fMRI were acquired from 72 singleton \nfetuses between 19 and 39 weeks of gestation. We addressed the technical \nchallenges inherent to in-utero imaging such as motion contamination, signal \nnon-uniformity, and low SNR with established image processing methods. \nSubject-specific functional connectivity maps were obtained by correlating the \naverage time-course of the BOLD signal within cortical ROIs. After \ncomputational quality control of the resulting matrices, we excluded 24 subjects \nand modelled the longitudinal development of functional connectivity with a \nlinear and a sigmoid model. The accuracy of the models was evaluated via \nbootstrapping over 1000 iterations. \nResults or Findings: We found a significant increase of functional thalamo-\ncortical connectivity after 28th GW compared to before 26th GW, consistent \nwith prior work regarding the invasion and penetration of the thalamocortical \nafferents into the cortical plate (mean Adjusted-R2: linear=0.175; \nsigmoid=0.148). The development of cortico-cortical connectivity was \nsymmetric and the functional symmetry of the brain was decreased with \nincreasing gestational age (P<0.01) \nConclusion: Recent advancements in functional MRI enabled the examination \nof functional connectivity development of a human fetus, in-utero. However, \noptimization of the imaging sequences and meticulous post-processing \nincluding mitigation of motion-related artifacts and age-specific segmentation \nwere necessary to link FC measures to the developmental changes of the \nfoetal brain. \nLimitations: We compared two predefined models for the functional \nconnectome development, and only healthy subjects were included. \nEthics Committee Approval: Yes. \nFunding for this study: European Union's Horizon 2020 grant agreement \nNo.765148. \nAuthor Disclosures: \nMister Karl-Heinz Nenning: Nothing to disclose \nGeorg Langs: Nothing to disclose \nAthena Taymourtash: Nothing to disclose \nErnst Schwartz: Nothing to disclose \nDaniela Prayer: Nothing to disclose \nGregor Kasprian: Nothing to disclose \n \nS 1-4 \nQuantification of peak blood flow velocity by four-dimensional flow and \ntwo-dimensional phase-contrast MRI compared with echocardiography: a \nmeta-analysis \n*K. Xu*, Y-K. Guo; Chengdu/CN \n(382781403@qq.com) \n \nPurpose: Accurate measurement of peak blood velocity is required for the \nclinical evaluation, diagnosis, and therapeutic management of cardiovascular \ndiseases.  This meta-analysis aimed to objectively examine the agreement and \ncorrelation between four-dimensional (4D) flow magnetic resonance imaging \n(MRI) and traditional two-dimensional (2D) phase contrast (PC) MRI with the \nreference standard of echocardiography (echo) for measuring peak blood \nvelocity in the cardiac valve and great arteries and assess if this technology \noffers an advantage over the traditional 2D method. \nMethods or Background: We systematically searched for studies that \nevaluate the degree of correlation and agreement between 4D flow MRI or 2D \nPC MRI and echo retrieved from PubMed, Embase and Cochrane Library. We \nconducted a meta-analysis to determine the peak velocity pooled bias with \n95% limits of agreement (LoA) and correlation coefficient (r) for 4D flow MRI \nand 2D PC MRI compared with echo. \nResults or Findings: Ten studies that compared 4D flow MRI with echo and \ntwelve studies that compared 2D PC MRI with echo were included. 4D flow \nMRI showed an underestimation with bias and 95% LoA of −0.09 (−0.41, 0.23) \nm/s while 2D PC MRI showed a poorer agreement with an underestimated bias \nand 95% LoA of -0.25 (-0.53, 0.03). 4D flow MRI and 2D PC MRI showed a \nstrong correlation with R = 0.80 (95% CI 0.75, 0.84 ) p < 0.001 and R = 0.83 \n(95% CI 0.79, 0.87) p < 0.001, respectively \nConclusion: 4D flow MRI potentially provides improved assessment for peak \nvelocity compared with traditional 2D methods and can therefore be \nconsidered an important complement to echo in the clinic with high agreement, \nparticularly in those patients with complex blood flow patterns. \nLimitations: None \nEthics Committee Approval: Institutional Review Board approval was not \nrequired \nFunding for this study: None \nAuthor Disclosures: \nKe Xu: Nothing to disclose \nYing-Kun Guo: Nothing to disclose \n \nS 1-5 \nPerioperative deep learning assessment of kidneys and renal tumours \nJ. Glavis-Bloom, T-L. Bui, *E. Lebby*, A. Sasani, M. bardis, C. Chahine, S. \nCramer, P. Chang, R. Houshyar; Orange/US \n(elebby@hs.uci.edu) \n \nPurpose: Partial nephrectomy and percutaneous ablation, increasingly utilized \nto treat small renal masses, require precise preoperative imaging \ninterpretation. We sought to develop and evaluate a convolutional neural \nnetwork (CNN), a type of deep learning artificial intelligence, that can \naccurately determine renal tumour and kidney volumes via segmentation on \nsingle-phase computed tomography (CT). ௗ \n\n \n \n \nA \nB C 86  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \nMethods or Background: CT images of 319 patients were retrospectively \nanalyzed. Two distinct CNNs were developed for (1) bounding cube \nlocalization of the right and left hemi-abdomen and (2) segmentation of renal \nparenchyma and tumour within each bounding cube. Training was performed \non a randomly selected cohort of 269 patients. CNN performance was \nevaluated on the remaining 50 patients using Sorensen–Dice coefficients and \nPearson correlation coefficients. Experiments were performed on a GPU-\noptimized workstation with a single NVIDIA GeForce GTX Titan X (12GB, \nMaxwell architecture).ௗ \nResults or Findings: Median Dice coefficients for kidney and tumour \nsegmentation were 0.970 and 0.816, respectively; Pearson correlation \ncoefficients between CNN-generated and human-annotated estimates for \nkidney and tumour volume were 0.998 and 0.993 (p < 0.001), respectively. \nEnd-to-end trained CNNs were able to perform renal parenchyma and tumour \nsegmentation on a new test case in an average of 5.6 seconds. \nConclusion: Deep learning is capable of rapidly and accurately detecting and \nsegmenting kidneys and renal tumours on single-phase contrast-enhanced CT \nscans and calculating tumour and renal volumes. \nLimitations: Our CNN’s performance was affected by inclusion of many \nkidneys with complex cysts, some of which may have been misinterpreted as \nsolid renal lesions. \nEthics Committee Approval: The University of California, Irvine Institutional \nReview Board approved this study. \nFunding for this study: Cancer Research Trainee Grant, Department of \nRadiology, University of California Irvine School of Medicine \nAuthor Disclosures: \nMichelle bardis: Nothing to disclose \nAli Sasani: Nothing to disclose \nElliott Lebby: Nothing to disclose \nScott Cramer: Nothing to disclose \nChantal Chahine: Nothing to disclose \nRoozbeh Houshyar: Nothing to disclose \nJustin Glavis-Bloom: Nothing to disclose \nPeter Chang: Shareholder at Avicenna.ai, a medical imaging startup, Founder \nat Avicenna.ai, a medical imaging startup \nThanh-Lan Bui: Nothing to disclose \n \nS 1-7 \nOpinion of medical students regarding the current medical teaching \nmethodology and trends in medical research practice in Romania: results \nand implications for the field of radiology \n*R. C. Anicai*¹, M-A. Gaman²; ¹Iasi/RO, ²Bucharest/RO \n(anicairobert98@gmail.com) \n \nPurpose: To our knowledge, med-students’ opinions regarding the current \nmedical teaching methodology/ research trends in Romania have not been \nassessed so far. \nMethods or Background: Cross-sectional, multicentric study. Using a social-\nmedia platform, we distributed a survey during 01/09/2020-31/10/2020 to med-\nstudents from 11 Romanian universities. Calculated sample size: 376 \nrespondents (population=15000; 95% CI; 5% margin of error). \nResults or Findings: 400 med-students responded: 301(75.25%) females, \n99(24.75%) males (P-value<0.001), 233(58.25%) enrolled in preclinical \n(2nd/3rd) and 167(41.75%) in clinical years (4th/5th/6th)[P-value<0.001]. \n55.0%(N=220) evaluated the teaching system at 3/5. 40.75%(N=163) believed \nthe biggest drawback of med-school is the exaggerated focus on theoretical \nknowledge versus practical aspects. 79.17%(N=316) viewed attending lectures \nas useless if they only listened to presentation slides being read without any \ninteraction with the lecturers. If faced with the decision to reapply to med-\nschool, 43.75%(N=175) would choose another field. 62.25%(N=250) said \noptimal practical/laboratory classes should last 50-100 minutes. \n55.25%(N=221) reported that <10 students should partake in a lab \nsimultaneously. 88.00%(N=352) considered practical examples/training the \nbest way of learning. 49.25%(N=197) believed med-school focuses too much \non memory. 38.50%(N=154) thought med-schools could have done more to \nadapt the teaching system to the students’ needs and 49.75%(N=199) \nconsidered their training was deficient during the COVID-19 pandemic. \n50.50%(N=202) thought research is important, 42.75%(N=171) believed there \nis a medium level of student engagement in research, 52.75%(N=211) \nanswered that physicians should engage in research in addition to clinical \nduties only if wishing to pursue academic careers. 34.25%(N=137) of the \nrespondents want to pursue a career in Romania. Implications/responses \nregarding the teaching of Radiology will be presented at ECR-2021. \nConclusion: Universities should aim to improve the current teaching \nmethodology and involve med-students in research, including in Radiology. \nLimitations: Not applicable. \nEthics Committee Approval: Not applicable. \nFunding for this study: Not applicable. \nAuthor Disclosures: \nRobert Constantin Anicai: Nothing to disclose \nMihnea-Alexandru Gaman: Nothing to disclose \n \nS 1-8 \nCan we stimulate medical students’ evidence-based and cost-effective \ndiagnostic reasoning in radiology? Impact of a Choosing Wisely \napproach \n*C. V. Souza Freire*, G. F. Saffe, M. E. R. d. A. D. d. Pinho, M. E. B. De Siervi, \nC. Freitas Lins; Salvador/BR \n(camilafreire17.2@bahiana.edu.br) \n \nPurpose: To assess a Choosing Wisely (CW) approach complementary to the \nteaching of Radiology as a strategy of early incentive to evidence-based and \ncost-effective reasoning in medical curriculum. \nMethods or Background: CW approach was developed in parallel with \nRadiology classes for second-year medical students by student mentors of \nradiology, who are more advanced students previously trained by a Radiology \nprofessor. The chosen recommendations were inserted through clinical \nproblems in theoretical classes by the professor and in reviews by mentors. \nAfter case discussion and following steps to diagnosis, feedback guided by \nbest evidence and cost-effective strategies was provided. One semester later, \nstudents were invited to answer an evaluation questionnaire. Written informed \nconsent was obtained from all subjects. \nResults or Findings: 148 students (21±3 years, 59% female) participated in \nthe study. 94% considered the approach “above average” or “excellent” to its \npurpose. 94% considered their interest “above average” or “excellent” in the \nproposed activities. 84% rated its efficiency as “above average” or “excellent”. \n96% defined it as “above average” or “excellent” as a didactic tool. 98% \nconsidered the approach “above average” or “excellent” to assist them in \nreflecting on cost-effective diagnostic reasoning. Additionally, 77% rated the \nCW approach “above average” or “excellent” on contributing to their \nperformance on radiology exams. \nConclusion: CW approach was highly well-rated by students since it \nencourages the development of early critical and conscious diagnostic \nreasoning. This approach has the potential to generate future physicians who \nmake wiser evidence-based and cost-effective decisions regarding imaging \ndiagnosis. \nLimitations: This is a cross-sectional study; further investigation is required to \nmeasure the longitudinal impact of this strategy. \nEthics Committee Approval: Ethical approval was obtained from the Ethics \nCommittee of the University where this study was developed (CAAE: \n28196820.6.0000.5544). \nFunding for this study: This research received no external funding. \nAuthor Disclosures: \nMaria Eduarda Rodrigues de Araújo Dantas de Pinho: Nothing to disclose \nGabriela Fagundes Saffe: Nothing to disclose \nMaria Eduarda Barreto De Siervi: Nothing to disclose \nCarolina Freitas Lins: Nothing to disclose \nCamila Verônica Souza Freire: Nothing to disclose \n \nS 1-9 \nBrain effects of transcutaneous vagal nerve stimulation: a meta-analysis \nof neuroimaging evidence \n*R. Rajiah*, K. Takahashi, Q. Aziz, J. Ruffle; London/UK \n(r.rajiah1@uni.bsms.ac.uk) \n \nPurpose: Dysfunction of the autonomic nervous system is placed at the centre \nof disease pathophysiology for many conditions spanning numerous body \nsystems. Considering the pivotal role of the vagus nerve to the brain’s central \nautonomic network, transcutaneous vagal nerve stimulation (tVNS) has been \nproposed as a novel therapeutic intervention to restore disease-driven \nautonomic disruption. However, the effect of tVNS on the brain remains \nunclear - a significant rate limiting step in its prospective use. We aimed to \nidentify the reproducible neural correlates of tVNS by meta-analysis. \nMethods or Background: A total of 157 studies were identified from the Web \nof Science and PubMed databases, 4 of which were appropriate for \nneuroimaging-based statistical analysis, comprising 60 subjects (17 male, 27 \nfemale, gender in 16 subjects not provided) aged 18-65. Using activated \nlikelihood analysis estimation, we established brain activity changes from tVNS \nstatistically contrasted to both null and sham stimulation. \nResults or Findings: tVNS consistently increased activity in the bilateral \ninsula, left thalamus, bilateral frontal pole, bilateral anterior cingulate cortex, \nright putamen, bilateral caudate and bilateral central opercular cortex and \nreduced activity in the bilateral parahippocampal gyri, bilateral hippocampi, \nbilateral temporal occipital fusiform gyrus and right posterior cingulate cortex \n(all p<0.005 or lower). \nConclusion: We provide the first meta-analytic map of tVNS brain effects by \ncoalescence of all relevant prior brain imaging in healthy subjects and illustrate \nthat numerous brain regions demonstrate a change in their activity sequential \nto tVNS. Considering the functional importance of these brain structures in \nregulating emotion, pain processing and autonomic activity, these findings \ncould provide a physical correlate for the therapeutic effects observed in prior \nresearch. Further exploration to better elucidate these mechanisms is \nwarranted. \n \n\n \n \n \nA \nB C 87  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \nLimitations: Limited number of studies were used. \nEthics Committee Approval: Not applicable. \nFunding for this study: Not applicable. \nAuthor Disclosures: \nKazuya Takahashi: Nothing to disclose Nothing to disclose \nessor Qasim Aziz: Nothing to disclose Nothing to disclose \nRebekah Rajiah: Nothing to disclose Nothing to disclose \nJames Ruffle: Nothing to disclose Nothing to disclose \n \nLive Q&A \n \n16:45-17:45 CHANNEL 2 \nNew Horizons Session \nNH 3 \nThera(g)nostics \nModerator \nClemens C. Cyran; Munich/DE  \n \nNH 3-2 \nThera(g)nostics: what is it all about? \nFrederik L. Giesel; Heidelberg/DE  \n \nLearning Objectives: \n1. To become familiar with basic hypotheses of thera(g)nostics.  \n2. To understand the underlying mechanisms of target selection for imaging \nand therapy.  \n3. To know about the most relevant clinical fields for theragnostic concepts.  \n4. To learn about the key translational challenges of thera(g)nostics towards \nclinical care. \n \nNH 3-4 \nMolecular biomarkers for immuno-imaging \nElisabeth de Vries; Groningen/NL \n(e.g.e.de.vries@umcg.nl) \n \nLearning Objectives: \n1. To learn about the concept of imaging biomarkers. \n2. To become familiar with the basics of immuno-imaging. \n3. To know about the most relevant clinical applications of immuno-imaging. \n4. To understand the main challenges and limitations of immuno-imaging for \nclinical translation. \nAuthor Disclosures: \nElisabeth de Vries: Advisory Board: Sanofi, Daiichi Sankyo, NSABP, Pfizer, \nMerck (Institutional financial support for advisory boards); Research \nGrant/Support: Amgen, Genentech, Roche, AstraZeneca, Synthon, Servier, \nNordic Nanovector, G1 Therapeutics, Bayer, Chugai Pharma, CytomX \nTherapeutics, Radius Health, Regeneron,  Servier (Institutional Financial \nsupport for clinical trials or contracted research); Other: (Co)-chair RECIST \ncommittee, Member ESMO-MCBS Working Group,  Chair ESMO Cancer \nMedicines Committee, Member Royal Netherlands Academy of Arts &amp; \nSciences, Member supervisory board Netherlands Comprehensive Cancer \nOrganisation (Non-financial interests, including non remunerated activities) \n \nLive Q&A: Does hybrid imaging improve patient outcome? \n \n16:45-17:45 CHANNEL 4 \nE³ - ECR Master Class \nE³ 426 \nAutoimmune thoracic diseases \nModerator \nSujal R. Desai; London/UK  \n \nE³ 426-2 \nA. Relapsing polychondritis \nWalter de Weever; Leuven/BE  \n(walter.dewever@uzleuven.be) \n \n \n \nLearning Objectives: \n1. To learn about the pathophysiology and clinical manifestations of this \ndisease. \n2. To learn when to suggest this diagnosis on CT. \n3. To review the other causes of tracheobronchial wall thickening. \n \nE³ 426-3 \nB. Alveolar proteinosis \nAnastasia Oikonomou; Toronto, ON/CA \n(anastasia.oikonomou@sunnybrook.ca) \n \nLearning Objectives: \n1. To learn about the CT manifestations of alveolar proteinosis. \n2. To review the other causes of crazy paving on CT. \n3. To be aware of infectious complications, especially superinfection by \nNocardia. \n \nE³ 426-4 \nC. Goodpasture syndrome and differentials \nAnand Devaraj; London/UK \n \nLearning Objectives: \n1. To learn about the pathophysiology and the clinical manifestations of this \ndisease. \n2. To learn about CT signs of intra-alveolar haemorrhage. \n3. To review the other causes of intra-alveolar haemorrhage. \nAuthor Disclosures: \nAnand Devaraj: Advisory Board: Boehringer Ingelheim; Employee: Brainomix \n \nLive Q&A \n \n16:45-17:45 CHANNEL 5 \nResearch Presentation Session: Neuro \nRPS 211 \nInfections in neuroradiology \nModerator \nMajda M. Thurnher; Vienna/AT  \n \nRPS 211-2 \nNeurological imaging manifestations in COVID-19 patients \n*M. M. A. Rezk*¹, H. E. Elsikhry², K. M. Zaki², I. AboShady², B. Alkandari²; \n¹Cairo/EG, ²Kuwait/KW  \n(medical1430@yahoo.com) \n \nPurpose: To figure out the neuroradiological findings in COVID-19 \nMethods or Background: A retrospective study include adult hospitalized \npatients with PCR-positivity for SARS-CoV-2, undergoing neuroimaging   \nbetween March and November, 2020, were included. All examinations were \nsystematically re-evaluated by 3 readers then descriptive statistics were \ncalculated. \nResults or Findings: 300 patients with COVID-19 underwent neuroimaging. \nFrequent findings include intra-axial susceptibility abnormalities, ischemic and \nmacrohemorrhagic manifestations, olfactory bulb signal abnormalities, \nprominent perioptic nerve spaces, and enhancement of the parenchyma, \nleptomeninges, cranial nerves and spinal nerves . \nConclusion: Patients with COVID-19 had a wide spectrum of vascular and \ninflammatory involvement of both the central and peripheral nervous system. \nLimitations: Subject to systematic confounders. \nThe lack of a control group. \nEthics Committee Approval: Yes \nFunding for this study: No \nAuthor Disclosures: \nHisham Elsayed Elsikhry: Nothing to disclose \nIslam AboShady: Nothing to disclose \nKamal Mahmoud Zaki: Nothing to disclose \nMahmoud M. A. Rezk: Nothing to disclose \nButhaina Alkandari: Nothing to disclose \n \nRPS 211-3 \nAdapting the UK biobank brain MRI protocol and analysis pipeline to \nmulti-organ imaging of COVID-19 survivors \n*L. Griffanti*, M. Cassar, B. Raman, N. Filippini, F. Alfaro-Almagro, F. Sheerin, \nS. Neubauer, K. L. Miller, S. M. Smith; Oxford/UK \n \n\n \n \n \nA \nB C 88  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \nPurpose: To adapt the UK Biobank brain MRI acquisition protocol and \nanalysis pipeline in order to evaluate the effects of COVID-19 as part of a \nmultiorgan assessment. \nMethods or Background: SARS-CoV-2 infection has been shown to damage \nmultiple organs, including the brain. Multiorgan MRI can provide further insight \non the repercussions of COVID-19 on organ health, but requires balance \nbetween data acquisition and scan duration. We adapted the UK Biobank brain \nMRI protocol to produce high quality images while being suitable as part of a \nmultiorgan MRI exam. The analysis pipeline includes new imaging-derived \nphenotypes (IDPs) designed to assess the effects of COVID-19. This was \nperformed in 58 COVID-19 patients post-hospital discharge and 25 controls in \nthe C-MORE study. \nResults or Findings: The protocol acquires high resolution T1, T2-FLAIR, \ndiffusion weighted images, susceptibility weighted images and arterial spin \nlabelling in 17 minutes. The automated imaging pipeline derives 263 IDPs, \nassessing brain anatomy (including olfactory bulb volume and intensity), \nperfusion and microstructural integrity. In the C-MORE study, these \nquantitative measures were consistent with clinical radiology reports. Our \nexploratory analysis revealed an increased burden of white matter \nhyperintensities and reduced mean diffusivity in the posterior thalamic \nradiations and sagittal stratum of COVID-19 survivors. These differences were \nmore prominent in patients who received organ support. \nConclusion: The protocol is now used in the ‘PHOSP-COVID Post-\nhospitalisation COVID-19’ study: a UK national consortium to understand and \nimprove long-term health outcomes. The pipeline is widely applicable and will \nhelp us understand the short and long-term effects of COVID-19. \nLimitations: Small sample size, exploratory analysis. \nEthics Committee Approval: Ethics approval and consent from all \nparticipants were obtained. \nFunding for this study: NIHR Oxford and Oxford Health Biomedical Research \nCentre, Oxford British Heart Foundation Centre of Research Excellence, UK \nResearch Innovation and Wellcome Trust. \nAuthor Disclosures: \nKarla L. Miller: Nothing to disclose \nStefan Neubauer: Patent Holder at Co-author of the patents for calculating T1 \n(ShMOLLI) in the heart, liver and abdomen: US patent 61/630,508 licensed to \nPerspectum and US patent 61-630,510 licensed to Perspectum. Shareholder \nin Perspectum. SN was a board member and consultant to Perspectum until \n2019. \nFidel Alfaro-Almagro: Nothing to disclose \nBetty Raman: Nothing to disclose \nStephen M. Smith: Nothing to disclose \nMark Cassar: Nothing to disclose \nFintan Sheerin: Nothing to disclose \nNicola Filippini: Nothing to disclose \nLudovica Griffanti: Nothing to disclose \n \nRPS 211-4 \nIn vivo imaging of microglia activation using proton magnetic resonance \nspectroscopy in immunocompetent patients with acute toxoplasmosis: \npreliminary results \n*A. Garkowski*¹, B. Kubas¹, M. HładuĔski¹, J. Zajkowska¹, A. Moniuszko-\nMalinowska¹, O. Zajkowska², M. Kondrusik¹, U. Lebkowska¹; ¹Białystok/PL, \n²Warsaw/PL \n(adam.garkowski@gmail.com) \n \nPurpose: It is alleged that the healthy person's immune system keeps the \nparasite Toxoplasma gondii (T. gondii) latent from causing illness, and it is \ncommonly said that T. gondii infection is either asymptomatic or cause mild, \nself-limited illness in the immunocompetent people. However, many recent \nepidemiological studies suggest that in immunocompetent persons T. gondii \ninfection is associated with a range incidence of neuropsychiatric disorders. \nHowever, there have not been any studies assessing the impact of T. gondii \ninfection in immunocompetent patients on the central nervous system (CNS) \nusing imaging techniques. We aimed to assess the impact of acute T. gondii \ninfection on the CNS in immunocompetent persons using proton magnetic \nresonance spectroscopy (1H-MRS). \nMethods or Background: Thirteen patients with an acute toxoplasmosis and \neight healthy volunteers (control group, with excluded T. gondii infection) have \nbeen involved in the study. 1H-MRS examinations were performed with \nrepetition time (TR)ௗ=ௗ2000 ms, and echo time (TE)ௗ=ௗ30 ms (3.0-T MRI \nscanner). Single voxels were positioned bilaterally in the basal ganglia, frontal, \ntemporal and occipital lobes. \nResults or Findings: We found a statistically significant increase of the mI/Cr \nratio within the right frontal lobe  (p=0.024), right basal ganglia (p=0.019) and in \nthe left temporal lobe (p=0.043) in the patients with acute toxoplasmosis.  We \nalso observed significantly reduced Glx/Cr ratio in the left occipital lobe \n(p=0.033) and reduced NAA/Cr ratio within right (p=0.032), and left basal \nganglia (p=0.001). \nConclusion: These metabolie alterations in patients with acute toxoplasmosis \nsuggest the presence of microglia activation with neuronal dysfunction, and \nadditionally glutamine-glutamate dysregulation. \nLimitations: The sample size of patients in our study was small, which may \naffects the statistical results. \nEthics Committee Approval: Ethics committee approval obtained \nFunding for this study: Medical University of Białystok \nAuthor Disclosures: \nAnna Moniuszko-Malinowska: Nothing to disclose \nBoĪena Kubas: Nothing to disclose \nJoanna Zajkowska: Nothing to disclose \nOlga Zajkowska: Nothing to disclose \nMarcin HładuĔski: Nothing to disclose \nMaciej Kondrusik: Nothing to disclose \nUrszula Lebkowska: Nothing to disclose \nAdam Garkowski: Nothing to disclose \n \nRPS 211-6 \nThe impact of the COVID-19 pandemic on adult diagnostic \nneuroradiology in Europe \n*M. Smits*¹, M. W. Vernooij¹, N. Bargallo I Alabart², A. Ramos Gonzalez³, \nT. A. Yousry຾; ¹Rotterdam/NL, ²Barcelona/ES, ³Madrid/ES, ຾London/UK \n(marion.smits@erasmusmc.nl) \n \nPurpose: The purpose of this study was to understand the impact the Covid-\n19 pandemic has or has had on the work, training, and wellbeing of \nprofessionals in the field of diagnostic Neuroradiology. These insights may be \nused to prepare or improve strategies for similar situations and address \npotential needs and worries that arose from the crisis. \nMethods or Background: A survey (SurveyMonkey) was emailed to all ESNR \nmembers and associates as well as distributed via professional social media \nchannels. The survey was held in the Summer of 2020 when the first wave had \nsubsided in most of Europe while the second wave was not yet widespread. \nThe questionnaire featured a total of 46 questions on general demographics, \nthe crisis phase, the exit phase, the current situation, and the numbers of \nCovid-19 patients. \nResults or Findings: 167 responses were received from 48 countries (Italy \n12%, Spain 10%, Netherlands 9%) mostly from Neuroradiologists (72%), \nfollowed by General Radiologists (16%) and Residents (9%). Most commonly \napplied safety measures (>80%) were regular cleaning, distancing measures, \nand screening patients for infection. While 81% felt safe at work, fewer than \n50% had sufficient personal protection equipment during the entire crisis. Only \n22% had access to a fully equipped work station at home. 61% felt (much) \nworse during the crisis. Main worries concerned personal health and safety \n(72%), adapting to Covid-19 operational changes, non-work obligations (35%), \npersonal finances (27%), job security (20%), and impact on research \nobligations (15%) and academic career advancement (11%). 78% followed \nonline courses/congresses and 73% considered these a viable alternative for \nthe future. \nConclusion: The Covid-19 pandemic substantially affected professional life as \nwell as personal wellbeing of Neuroradiologists throughout Europe. \nLimitations: 45 (27%) responses were from 23 countries outside Europe. \nEthics Committee Approval: n/a \nFunding for this study: None. \nAuthor Disclosures: \nTarek A. Yousry: Nothing to disclose \nMeike W. Vernooij: Nothing to disclose \nAna Ramos Gonzalez: Nothing to disclose \nNuria Bargallo I Alabart: Nothing to disclose \nMarion Smits: Consultant at Parexel Ltd. (reviewer fees paid to institution) \nSpeaker at GE Healthcare (fees paid to institution) \n \nRPS 211-7 \nA destructive duo-spinal tuberculosis in human immunodeficiency virus \n(HIV) positive patients \n*B. Rathi*, A. Bellamkondi, M. Bagarhatta, K. Mehndiratta; Jaipur/IN \n(bhaveshrathi9@gmail.com) \n \nPurpose: Extrapulmonary (EP) TB have been largely associated with the HIV \nepidemic in which musculoskeletal system is the most common site with spinal \ninvolvement seen in 50% of cases. The classic destruction of disc space in \nspinal tuberculosis, leading to kyphosis and neurological impairment, become \napparent months after initial spinal involvement.Therefore radiological \nexaminations remains the primary tool for early diagnosis and guiding surgical \ntreatment to avoid the siginificant morbidity associated with it. \nMethods or Background: A Prospective comparative study of 50 spinal \ntuberculosis patients (confirmed by response to anti-tubercular treatment,ATT) \nin a tertiary care hospital were included after obtaining written informed \nconsent.Among which 20 were HIV positive and 30 were HIV negative.The \npatients underwent a neurological examination,CD4 count, plain radiograph \nand MRI spine (standard protocol). \nResults or Findings: There was no significant difference between HIV-\npositive and HIV-negative spinal TB patients with regard to demographic data \n(age and sex),the number of vertebrae involved(p=0.4) and site of \n\n \n \n \nA \nB C 89  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \ninvolvement(paradiscal being most common).In terms of neurological outcome, \nhiv positive [16 (80%) had stage 1 and 4(20%) had stage 2 neurology] while \nhiv negative [12(40%) had stage 1 and 8(60%) had stage 2 \nneurology](p=0.005) which were statistically significant.Gibbus was seen in 8 \nHIV-positive and 21 HIV-negative patients (p=0.03). The median Cobb angle \nwas 10 degree for hiv positive and 20 degree hiv negative patients (p<0.05). \nThe amount of epidural abscess formation was greater in hiv positive \ncompared to hiv negative where the mean abscess volume was 8.2±2 cm3 in \nHIV-positive and 2.8±1.2cm3 in HIV negative patients (p=0.03). \nConclusion: Hence larger epidural abscess formation with less vertebral body \ndestruction was seen in hiv positive while the degree of vertebral body \ndestruction and kyphosis was more in hiv negative patients. \nLimitations: Small sample size \nEthics Committee Approval: Taken \nFunding for this study: Nil \nAuthor Disclosures: \nMeenu Bagarhatta: Nothing to disclose \nKuldeep Mehndiratta: Nothing to disclose \nBhavyansh Rathi: Speaker at NIL \nAshwini Bellamkondi: Nothing to disclose \n \nRPS 211-8 \nCOVID-19 targeting the CNS in the Egyptian population: how MRI can be \nuseful \n*A. M. R. Khalil*, T. M. Dawoud; Tanta/EG \n \nPurpose: Thorough neurological assessment of positively proven COVID Ǧ19 \npatients who had neurological deficits by 1.5 Tesla MRI in Egyptian hospitals & \nquarantine centres to exclude CNS complications. \nMethods or Background: The recent pandemic of COVID Ǧ19 caused by \nSARSǦCoVǦ2 has turned the world into chaos owing to its high rate of \ntransmissions among population. Recently viewed neurological manifestations \namong Egyptian patients with COVID Ǧ19 who were hospitalized in quarantine \ncentres. Ataxia, disturbed consciousness and convulsions should be further \nevaluated by MRI for CNS involvement by SARS ǦCoVǦ2. As we are in a \nlearning phase of how COVIDǦ19 can target the CNS so, it is quite difficult to \npredict any particular diagnostic neurological test to ascertain the high Ǧrisk \nCOVIDǦ19 patients.This prospective study was conducted on 127 positive RT-\nPCR of SARS-COV-2 who were hospitalized in quarantine centres. MRI was \nperformed by 1.5 Tesla MRI unit and images were reviewed on PACS by two \nindependent trainee neuroradiologists with (10 years’ experience for each). \nResults or Findings: Ninety-one men (71.6%) and thirty-six women (28.3%) \nmet the inclusion criteria, with a mean age of 52 years ± 10 (standard \ndeviation) (age range, 12–78 years). The commonest neurological \nmanifestations were disturbed conscious level (75.5%), agitation (9%) and \ncoma (15.5%). The most frequent MRI findings were signal abnormalities \nlocated in the medial temporal lobe (43%), multifocal white matter hyperintense \nareas seen in FLAIR sequence with associated haemorrhagic areas (30%), \nischemic lesions (22%) and microhaemorrhages were also noted. \nConclusion: During the current pandemic of COVID-19, radiologists should be \naware of wide spectrum of MRI signs of CNS involvements with COVID-19. \nLimitations: patients on mchanical ventilation \npatients had metallic prothesis (incompatable for MRI) \nEthics Committee Approval: The research is approved by ethical commitee \nof Tanta University  (33481/9/12) \nFunding for this study: No funding for this study \nAuthor Disclosures: \nAlaa Mohammed Reda Khalil: Nothing to disclose \nTamer Mahmoud Dawoud: Nothing to disclose \n \nLive Q&A \n \n18:00-19:00 CHANNEL 2 \nMultidisciplinary Session \nMS 3 \nSarcoma \nModerator \nJasminka Igrec; Graz/AT  \n \nMS 3-2 \nThe role of pathology to diagnose soft tissue tumours \nBernadette Liegl-Atzwanger; Graz/AT  \n \n \n \nLearning Objectives: \n1. To describe the role of the pathologist in the multidisciplinary approach to \nsoft-tissue tumours. \n2. To learn about the changes in WHO 2020. \n3. To understand the role of molecular pathology in soft tissue sarcomas. \n \nMS 3-3 \nAdded value of MRI in soft tissue sarcoma \nJasminka Igrec; Graz/AT \n(Jasminka.Igrec@klinikum-graz.at) \n \nLearning Objectives: \n1. To describe the role of radiology in the multidisciplinary approach to soft-\ntissue tumours. \n2. To demonstrate the imaging possibilities of advanced MRI imaging \ntechniques in sarcoma imaging. \n3. To discuss the current use and future role of advanced imaging MRI \ntechniques in sarcoma imaging. \n \nMS 3-4 \nThe dilemma of surgical margins: what do we need to solve it? \nAndreas Leithner; Graz/AT \n(andreas.leithner@medunigraz.at) \n \nLearning Objectives: \n1. To describe the role of the orthopaedic surgeon in the multidisciplinary \napproach to soft-tissue tumours. \n2. To discuss the new challenges in operative treatment of patients with \nsarcoma. \nAuthor Disclosures: \nAndreas Leithner: Research Grant/Support: Johnson&amp;Johnson; \nAlphamed; Implantec \n \nMS 3-5 \nChallenges in immunotherapy in sarcoma \nJoanna Szkandera; Graz/AT \n \nLearning Objectives: \n1. To describe the role of the oncologist in the multidisciplinary approach to \nsoft-tissue tumours. \n2. To explain how immunotherapy works. \n3. To verify in which sarcoma subtypes immunotherapy should be used. \n \nMS 3-6 to MS 3-8 \nMultidisciplinary case presentation (part 1), (part 2) and (part 3) \nIva Brcic; Graz/AT \n(iva.brcic@medunigraz.at) \nMarko Bergovec; Graz/AT \n(marko.bergovec@medunigraz.at) \nJasminka Igrec; Graz/AT \n(Jasminka.Igrec@klinikum-graz.at) \n \nLive Q&A \n \n18:00-19:00 CHANNEL 3 \nE³ - ECR Master Class \nE³ 1126 \nAcute ischaemic stroke in the era of \nmechanical thrombectomy \nModerator \nHorst Urbach; Freiburg/DE  \n \nE³ 1126-2 \nA. Mechanical thrombectomy in 2021 \nAnsgar Berlis; Augsburg/DE  \n(ansgar.berlis@klinikum-augsburg.de) \n \nLearning Objectives: \n1. To learn about the clinical evidence of mechanical thrombectomy. \n2. To become familiar with the technical aspects of mechanical thrombectomy.  \n3. To understand the importance of appropriate training. \nAuthor Disclosures: \nAnsgar Berlis: Consultant: Microvention, Stryker, Medtronic; Speaker: \nPenumbra, Phenox, Medtronic \n\n \n \n \nA \nB C 90  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \n \nE³ 1126-3 \nB. The role of vascular imaging \nFrédéric Clarençon; Paris/FR \n(frederic.clarencon@psl.aphp.fr) \n \nLearning Objectives: \n1. To know how to perform CT and MRI angiography.  \n2. To report vascular occlusion and collaterality.  \n3. To become familiar with recanalization prognosis. \nAuthor Disclosures: \nFrédéric Clarençon: Board Member: Artedrone; Consultant: Medtronic; \nSpeaker: Balt, Penumbra, Stryker \n \nE³ 1126-4 \nC. The role of brain imaging \nOmer Eker; Lyon/FR \n \nLearning Objectives: \n1. To learn how to report ischaemia (necrosis and penumbra) using CT and \nMRI. \n2. To learn how to identify patients at risk of haemorrhage. \n3. To become familiar with post-thrombectomy follow-up. \nAuthor Disclosures: \nOmer Eker: Advisory Board: Johnson &amp; Johnson; Consultant: BALT, \nSTRYKER; Speaker: BALT \n \nLive Q&A \n \n18:00-19:00 CHANNEL 4 \nEuroSafe Imaging Session \nEU 5 \n\"Yield the shield\": new approaches and \nchallenges in the use of gonadal shielding \nduring radiography in children \nModerator \nGuy Frija; Paris/FR  \n \nEU 5-2 \nIntroduction \nDonald P. Frush; Durham, NC/US  \n(donald.frush@duke.edu) \n \nLearning Objectives: \n1. To provide summary justification for revisiting routine gonadal shielding \nduring abdomiopelvic radiography in children: domain covered and why are we \ndoing this. \n2. To present the outline of topics to be covered: roles, challenges, and models \nfor change. \n3. To introduce the speakers and their qualifications. \n \nEU 5-3 \nThe past journey of gonadal shielding and the role of regulation and the \nU.S. radiologist \nDonald P. Frush; Durham, NC/US \n(donald.frush@duke.edu) \n \nLearning Objectives: \n1. To learn the background of gonadal shielding during radiography and the \nefforts and organisations currently involved in the United States.  \n2. To become familiar with the role of the US radiologist in changes in practice \nof routine gonadal shielding. \n3. To understand the current regulations and guidance for the use of gonadal \nshielding in the U.S. \n \nEU 5-4 \nThe current reasons for change and the role of regulation and the \nEuropean radiologist \nJoanna Kasznia-Brown; Taunton/UK \n \nLearning Objectives: \n1. To learn about the scientific evidence supporting a change in practice for \nroutine gonadal shielding. \n2. To become familiar with the role of the European radiologist to changes in \npractice of routine gonadal shielding.  \n3. To understand the current regulations and guidance for the use of gonadal \nshielding in Europe. \n \nEU 5-5 \nFront-line culture, challenges, and strategies for change: European \nperspective \nJoana Santos; Coimbra/PT \n(joanasantos@estescoimbra.pt) \n \nLearning Objectives: \n1. To learn about the role of the radiographer/technologist community in \nEurope for routine gonadal shielding (certification, training, licensing etc.).  \n2. To appreciate the complexities in changes to practice, including \npatient/caregiver engagement. \n3. To identify successful models and ongoing efforts for change in practice. \n \nEU 5-6 \nFront-line culture, challenges, and strategies for change in shielding \npractice: U.S. perspective \nRebecca Marsh; Denver, CO/US \n(REBECCA.MARSH@CUANSCHUTZ.EDU) \n \nLearning Objectives: \n1. To learn about the role of the radiographer/technologist community in \nEurope for routine gonadal shielding (certification, training, licensing etc.). \n2. To appreciate the complexities in changes in practice, including \npatient/caregiver engagement. \n3. To identify the salient ongoing efforts and suggest models for change in \nshielding practice. \n \nLive Q&A: \"Easier said than done?\" \n \n18:00-19:30 CHANNEL 5 \nHealthcare Professionals in Focus \nIF 3 \nThe science of meditation and \nmindfulness \nModerator \nM.G. Myriam Hunink; Rotterdam/NL  \n \nIF 3-2 \nThe effectiveness of mindfulness meditation \nM.G. Myriam Hunink; Rotterdam/NL  \n(m.hunink@erasmusmc.nl) \n \nLearning Objectives: \n1. To learn about the origins of mindfulness and how it relates to meditation, \nyoga, and the martial arts. \n2. To appreciate the effects on the brain and body of practicing mindfulness or \nsimilar practices. \n3. To learn about the results of randomized controlled trials studying \nmindfulness and related interventions. \nAuthor Disclosures: \nM.G. Myriam Hunink: Investigator: PI DESTRESS study ; Research \nGrant/Support: American Diabetes Association Netherlands Organization for \nHealth Research and Development German Innovation Fund Netherlands \nEducational Grant (&#39;&#39;Studie Voorschot Middelen&#39;&#39;) Gordon \nand Betty Moore Foundation; Other: Royalties for textbook from Cambridge \nUniversity Press \n \nIF 3-3 \nThe effect of the pandemic and what can help \nLeonieke Kranenburg; Rotterdam/NL \n(l.kranenburg@erasmusmc.nl) \n \nLearning Objectives: \n1. To understand the effect of the pandemic on chronic stress and burnout \namong healthcare professionals. \n2. To learn about the results of mindfulness and similar interventions in dealing \nwith stress, anxiety depression, and burnout. \n \nLive Q&A: Mindfulness: Hope or hype? \n\n \n \n \nA \nB C 91  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \n \n19:45-20:45 CHANNEL 2 \nTransatlantic Course of ESR and RSNA \n(Radiological Society of North America): \nStroke Imaging and Endovascular \nTreatment: Now and the Future \nTC 428 \nThe future strategy for stroke \nthrombectomy \nModerators \nJean-Pierre Pruvo; Lille/FR  \nRaman Uberoi; Oxford/UK  \nAchala Vagal; Cincinnati, OH/US \n \nTC 428-4 \nA. Addressing workforce needs: who and how to train specialists \nHans van Overhagen; The Hague/NL \n(h.voverhagen@hagaziekenhuis.nl) \n \nLearning Objectives: \n1. To learn about the number and type of specialists trained. \n2. To understand the global organisation of stroke interventionists and \nneurologists. \n3. To appreciate the future potential number of cases. \n \nTC 428-5 \nB. The future for stroke thrombectomy: what is next? \nMahesh V. Jayaraman; Providence, RI/US \n(MJayaraman@Lifespan.org) \n \nLearning Objectives: \n1. To learn about the subgroups that were not studied in the recent stroke \ntrials. \n2. To become familiar with use of artificial intelligence in stroke. \n \nTC 428-6 \nC. New innovations in stroke thrombectomy techniques and technology \nStephan Meckel; Linz/AT \n \nLearning Objectives: \n1. To understand the limitations of current devices and techniques. \n2. To appreciate the evolution in stroke thrombectomy technology. \n3. To understand how the different devices and techniques may improve \noutcomes. \n \nLive Q&A \n \n19:45-20:45 CHANNEL 3 \nRefresher Course: Imaging Informatics \nRC 205 \nHow artificial intelligence (AI) has changed \nradiology \nModerator \nElmar Kotter; Freiburg/DE  \n \nRC 205-2 \nA. How to integrate AI into the clinical workflow \nTim Leiner; Utrecht/NL  \n(t.leiner@umcutrecht.nl) \n \nLearning Objectives: \n1. To learn how different AI systems can be integrated to support the \nradiological workflow. \n2. To understand the benefits of integrating AI systems into the clinical routine. \n3. To learn the challenges related to the AI workflow. \nAuthor Disclosures: \nTim Leiner: Founder: Quantib-U; Research Grant/Support: Pie Medical, Medis, \nPhilips Healthcare, Bayer AG; Other: Department of Radiology of Utrecht \nUniversity Medical Center receives royalties from Sectra AB \n \nRC 205-3 \nB. AI in automated organs segmentation \nAna Jiménez-Pastor; Valencia/ES \n(anjipas@gmail.com) \n \nLearning Objectives: \n1. To learn how AI has enabled automated image analysis through human-like \nperformance in segmentation. \n2. To appreciate the main AI network architectures allowing for multiple-organs \nsegmentation. \n3. To understand novel techniques for automated lesions segmentation. \nAuthor Disclosures: \nAna Jiménez-Pastor: Employee: QUIBIM SL \n \nRC 205-4 \nC. AI in detection and classification applied to workflow prioritisation \nRamin Khorasani; Boston, MA/US \n \nLearning Objectives: \n1. To learn how we can make use of AI to optimise radiology workflow. \n2. To appreciate the impact of AI in real productivity metrics of radiologists. \n3. To understand the trustworthiness of AI for first-reads and worklists \nprioritisation. \n \nLive Q&A \n \n19:45-20:45 CHANNEL 4 \nE³ - Rising Stars Programme: Basic \nSessions \nOrganised by the ESOR \nBS 14 \nRadiologic anatomy: head and neck \nModerator \nMinerva Becker; Geneva/CH  \n \nBS 14-2 \nNeck spaces \nNikoleta I. Traykova; Plovdiv/BG  \n \nLearning Objectives: \n1. To learn the anatomy of the neck spaces. \n2. To discuss the current imaging techniques for their evaluation. \n3. To describe the imaging appearance of the most common pathological \nfindings. \n \nBS 14-3 \nTemporal bone \nJan Walther Casselman; Bruges/BE \n(jan.casselman@azsintjan.be) \n \nLearning Objectives: \n1. To learn which technique is best suited to visualise specific anatomical \nstructures of the temporal bone. \n2. To recognise the clinically most important anatomical structures of the \nmiddle and inner ear. \n3. To learn how the anatomical structures of the temporal bone appear in the \ntransverse, coronal, and double oblique plane. \nAuthor Disclosures: \nJan Walther Casselman: Speaker: Philips Healthcare / Cefla s.a. \n \nBS 14-4 \nLarynx \nRoberto Maroldi; Brescia/IT \n(roberto.maroldi@unibs.it) \n \n \n \n \n\n \n \n \nA \nB C 92  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \nLearning Objectives: \n1. To understand the anatomy and signals of the cartilage framework of the \nlarynx. \n2. To learn the surgical subdivision of the paraglottic space of the larynx into its \nkey compartments. \n3. To learn the anatomy and signals of the muscles within the larynx. \n \nLive Q&A \n \n19:45-20:45 CHANNEL 5 \nResearch Presentation Session: \nRadiographers \nRPS 214 \nThe radiography profession: a life-long \nlearning experience \nModerators \nCharlotte Beardmore; London/UK  \nLorenzo Preda; Milan/IT  \n \nRPS 214-3 \nThe occupational and psychological impact of COVID-19 on \nradiographers in Ireland in 2020 \n*J. Creedon*¹, A. O'Loughlin¹, S. J. Foley²; ¹Cork/IE, ²Dublin/IE \n(creedonjill@gmail.com) \n \nPurpose: This research aims to evaluate the impact of covid-19 on \nradiographers \nand radiology services in Ireland over time. This includes but is not exclusive to \npersonal protective \nequipment (PPE) availabilities, workload changes, inadvertent exposures to \ncovid-19 and \nradiographers’ mental health concerns. \nMethods or Background: Imaging is required for assessing the severity and \ndisease progression of covid-19 both in the Emergency Department (ED) and \nin an inpatient capacity. Radiographers are in frequent direct contact with both \nconfirmed positive and suspected infected persons, placing them at an \nincreased risk of exposure to the virus. The impact of covid-19 on \nradiographers in Ireland was evaluated through means of a two-stage \nelectronic questionnaire distributed six weeks apart. This method focussed on \ncollating radiographers’ perspectives on working conditions during the initial \ncovid-19 response (March, 2020) with those during the ending of initial \nemergency measures in Ireland (May, 2020). \nResults or Findings: 646 survey responses were received and all six Irish \nhealth regions represented. Most radiographers (77%) reported having \nadequate PPE available, however almost 50% were inadvertently exposed to \ncovid-19 positive patients without appropriate PPE. This was attributed to poor \ncommunication and testing. Anxiety levels reduced substantially six weeks into \nthe crisis period although obvious distress was noted among some \nrespondents. Burnout symptoms were reported by 40% of radiographers and \n30% reported considering changing jobs or retiring, both credited to the covid-\n19 outbreak. \nConclusion: Clear communication regarding changing protocols and patients’ \ninfectious status are essential to safeguard radiographers and to minimise the \ninduction of anxiety and distress. Staff mental health concerns must be \naddressed and burnout symptoms identified to prevent long term negative \nconsequences of the covid-19 pandemic on radiographers and radiology \nservices. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nJill Creedon: Nothing to disclose \nAnne O'Loughlin: Nothing to disclose \nShane J Foley: Nothing to disclose \n \nRPS 214-4 \nRadiotherapy education in the EU: the impact on practitioners’ mobility \nand patient safety \n*J. G. Couto*¹, S. L. McFadden², P. McClure², P. Bezzina¹, C. Hughes²; \n¹Msida/MT, ²Jordanstown/UK \n(jose.g.couto@um.edu.mt) \n \n \nPurpose: Previous research showed that the lack of regulation of therapeutic \nradiography education across the EU leads to differences in education \nprogrammes and competence level between member states. The current study \naimed to understand the impact of these differences on professional mobility \nand patient safety. \nMethods or Background: Interviews with stakeholders (local and migrant \nprofessionals, clinical managers, educators, students and professional \nassociation representatives) from Finland, Poland, Portugal and United \nKingdom (due to disparate education characteristics) were used in this \nqualitative cross-sectional study. Thematic analysis was performed using \nNVivo (v.12). \nResults or Findings: Stakeholders (n=30) suggested that a combination of \nseveral characteristics have an impact on the quality of education and \ncompetency level i.e. programme duration, academic level, specialisms \ncovered, RT-specific training, staffing and teaching methods. Differences in \neducation hinder professional mobility from some countries. Other factors \nimpacting mobility included: workforce scarcity or excess, registration process, \nlanguage, personal and family reasons, professional growth and salary. The \nstandardisation of education could improve mobility across countries, however, \ndiversity in education enables an overall growth of the profession. Participants \nbelieve that professional mobility does not compromise patient safety, but \nregulatory bodies and employers are essential in ensuring staff competence. \nSome programmes lack RT-specific training, compromising safety even within \nthe same country of graduation. Diversity in the workforce, evidence-based \npractice, risk assessment, and multidisciplinarity improve care, while language \nissues can compromise safety. \nConclusion: Stakeholders should consider the programme characteristics \nmentioned above when designing educational programmes to improve patient \ncare and safety and facilitate professionals’ mobility. \nLimitations: A larger sample of countries would improve the picture of \neducation across Europe. \nEthics Committee Approval: This study was approved by the Research \nEthics Committee at Ulster University. \nFunding for this study: Part of the SAFE EUROPE project, funded by the \nERASMUS+ Programme. \nAuthor Disclosures: \nCiara Hughes: Nothing to disclose \nPatricia McClure: Nothing to disclose \nSonyia Lorraine McFadden: Nothing to disclose \nPaul Bezzina: Nothing to disclose \nJose Guilherme Couto: Nothing to disclose \n \nRPS 214-5 \nAnticipating the role of touchless technologies within diagnostic \nradiography: results of an international questionnaire \n*A. England*¹, J. D. Thompson², E. Littler³, J. Tugwell-Allsup ຾, E. Edwards¹; \n¹Keele/UK, ²Manchester/UK, ³Warrington/UK, ຾Bangor/UK \n(a.england@keele.ac.uk) \n \nPurpose: Digital healthcare technology is evolving at a rapid rate. Touchless \ntechnologies (TT), involving gestures and voice commands, are being \nincorporated into daily life. The aim of this study was to survey the anticipated \nrole of TTs within diagnostic radiography. \nMethods or Background: An online questionnaire was developed, piloted and \ndeployed to radiographers as part of an international radiology congress. \nEligible respondents were radiographers, either qualified or in-training. The \nsurvey covered ten themes relating to the role of TTs, including perceptions of \nexamination scenarios where TTs might be useful. Results were analysed \nusing descriptive and inferential statistics, together with thematic analysis. \nResults or Findings: 155 radiographers completed the survey. 100 (64.9%) \nwere female and clinical experience ranged from 0 to 40 (mean 13.5) years. 54 \n(35.1%), had a Bachelor’s degree, with respondents being from 23 different \ncountries (five continents). 121 (79.1%) respondents personally owned or \nintended to purchase TTs. 89 (84.8%) of respondents indicated that they would \nuse TTs, if available on current imaging equipment. 25 (16%) respondents \nreported that they have access to TTs within their departments. 88 (81.5%) \nand 67 (65%) respondents reported that they saw voice and gesture controls \nas being key in improving exam efficiency. \nConclusion: Participants anticipate a positive role for touchless technologies \nwithin diagnostic radiography. Access to such technology is not yet widely \navailable. Voice activated technologies were favoured over gesture-based aids \nfor improvements in examination efficiency. \nLimitations: Questionnaires were delivered only in English and as such would \nhave limited responses from non-native English speaking countries.  \nResponses were not received from all countries, particularly those in South \nAmerica and as such results cannot be considered as being fully global. \nEthics Committee Approval: This project was approved by the University of \nSalford. \nFunding for this study: This project received no funding. \n \n \n \n\n \n \n \nA \nB C 93  \nSaturday \n/LYH\u00033URJUDPPH\u0003\n \nAuthor Disclosures: \nEmma Edwards: Nothing to disclose \nJenna Tugwell-Allsup: Nothing to disclose \nAndrew England: Nothing to disclose \nEmily Littler: Nothing to disclose \nJohn David Thompson: Nothing to disclose \n \nRPS 214-6 \nAn understanding of Irish radiographers' opinions on the implementation \nof artificial intelligence into radiography practice \n*M-L. Ryan*, J. McNulty; Dublin/IE (marielouise.ryan@ucd.ie) \n \nPurpose: Artificial Intelligence (AI) is on the cusp of revolutionizing \nradiography internationally. Literature has raised positive aspects, challenges \nand concerns from different medical imaging professionals. The purpose of this \nwork was to understand Irish radiographers understanding of AI, their opinions \non implementation, education required and effects on the profession. \nMethods or Background: A web-based questionnaire was designed, and all \nIrish public and private hospitals were contacted to participate, together with \nsocial media promotion. Participation was anonymous and voluntary. \nResults or Findings: 318 Irish radiographers participated. 95% of \nrespondents were comfortable working with technology. 93.2% were familiar \nwith the concept of AI and  76.6% with the concept of machine learning. 65% \nof respondents agreed that implementing AI would be an opportunity to \nredefine the radiographers role. 70.2% of respondents agreed that AI will \nenhance the quality of service provided by radiographers. 47.6% of \nrespondents had some ethical concerns about AI, with a large majority (80.6%) \nsaying AI should be regulated by national legislation. 94.71% of respondents \nnoted it was important for radiographers to be involved IN AI tool development, \nwith 68.3% having moderate trust in AI tools. Regarding education, 19.6% had \nsome AI training. 83% felt that training should occur at undergraduate level, \nwith 66.5% suggesting CPD.36.1% felt that AI will have a significant impact on \nthe profession within the next 5 years. A large majority (86.16%) were \nfavorable to AI implementation in radiography practice in Ireland. \nConclusion: Whilst support for AI integration is largely positive, discussion \nneed to happen around key areas such as trust, ethical concerns and \nregulation. \nLimitations: Data is self-stated opinion only, which is a common bias in survey \nresearch. \nEthics Committee Approval: This project was reviewed in line with the \ninstitutional Ethics Review process. \nFunding for this study: No specific funding. \nAuthor Disclosures: \nMarie-Louise Ryan: Nothing to disclose \nJonathan McNulty: Nothing to disclose \n \nRPS 214-7 \nAn investigation of radiographers’ perceptions of the scope of advanced \npractice roles in radiography \n*D. Catania*¹, N. Giannotti², A. Roletto¹, M. D. Davis³; ¹Milan/IT, ²Sydney/AU, \n³Dublin/IE (cataniadiego@hotmail.com) \n \nPurpose: This study investigated how advancements in radiography practice \nare perceived by European radiographers and how advanced roles are \ncurrently practiced internationally. The information provided baseline data to \nassist in determining how barriers to professional role advancements may be \nreduced. This insight is to be used to progress role development opportunities \nwithin Radiography, with the aim of optimising professional work practice post \nCOVID-19. \nMethods or Background: An online survey containing fifteen questions was \ndeveloped and administered via the EFRS Research Hub2020. The survey \nincluded questions on participants’ demographics, education, active \nmemberships, current radiography skills, advanced radiography practice roles \navailable and how these roles could be progressed in their country of work and \nthe main positives for advancing roles. \nResults or Findings: Eighty-three participants completed and submitted the \nsurvey. The majority of participants were members of the European Federation \nof the Radiography Societies or European Society of Radiology. More than half \nof the participants considered reporting X-rays as one of the main \nadvancements for the radiography profession, this was followed by being \npromoted as a clinical specialist (22%) and delivery of intravenous \nadministration (22%). The majority of the participants stated that advanced \npractice roles should be supported by postgraduate studies (22%) and \ncollaboration with radiologists/in-house training (17% respectively). \nConclusion: An insight into radiographers’ perceptions of advanced practice \nwas achieved. The advancements in radiography practice identified have the \npotential to assist radiology departments to streamline processes and optimise \nthe necessary resources to provide a comprehensive response to the continual \nincrease in use of medical imaging globally and to respond efficiently to \nhealthcare demands, as the COVID-19 pandemic continues, in its’ aftermath \nand as Radiology services recover overtime. \nLimitations: None \nEthics Committee Approval: Obtained in the form of an exemption from full \nethical review \nFunding for this study: None \nAuthor Disclosures: \nDiego Catania: Nothing to disclose \nNicola Giannotti: Nothing to disclose \nAndrea Roletto: Nothing to disclose \nMichaela Dawn Davis: Nothing to disclose \n \nLive Q&A \n \n21:00-21:30 CHANNEL 2 \nPL 4 \nPlenary Lecture \nModerator \nMichael H. Fuchsjäger; Graz/AT  \n \nPL 4-2 \nA global perspective on oncologic imaging: why should we care? \nHedvig Hricak; New York, NY/US  \nAuthor Disclosures: \nHedvig Hricak: Advisory Board: University of Vienna, Johns Hopkins, DKFZ; \nBoard Member: IBA \n \nLive Q&A \n \n \n\n \n \n \nA \nB C 94  \n/LYH\u00033URJUDPPH\u0003\n \n \n  \n6XQGD\\\u000f\u00030DUFK\u0003\u001a\u0003\n\n \n \n \nA \nB C 95  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \n \n08:00-09:00 CHANNEL 2 \nResearch Presentation Session: \nGenitourinary \nRPS 202 \nBeyond conventional breast imaging \nModerator \nAlexandra Athanasiou; Athens/GR  \n \nRPS 202-3 \nDCE-MRI radiomics analysis in differentiating luminal A and luminal B \nbreast cancer molecular subtypes \n*O. Lafcı*, P. S. Öztekin, P. Celepli, P. N. N. Ko úar; Ankara/TR  \n(oguz-oguzz@hotmail.com) \n \nPurpose: The aim of the present study was to investigate the association \nbetween Luminal A and Luminal B molecular subtypes and radiomics features \nof dynamic contrastǦenhanced magnetic resonance imaging (DCE ǦMRI) in \npatients with invasive ductal cancer. \nMethods or Background: 73 patients with histopathologically proven invasive \nductal cancer (IDC) were selected. Tumors were classified into molecular \nsubtypes: Luminal A (ER-positive and/or progesterone receptor (PR)-positive, \nhuman epidermal growth factor receptor type 2 (HER2) -negative, proliferation \nmarker Ki-67< 20) and Luminal B (ER-positive and/or PR-positive, HER2-\npositive or HER2-negative with high Ki-67 •20). A total of 81 tumoral lesions \nwere evaluated on T1-weighted fat-suppressed sagittal post-contrast late-\nphase MRI images after the required \"pre-process\" steps and 3D segmentation \nwere made. 43 radiomics features including: 1 conventional, 4 shape, 6 \nhistogram, 7 Gray Level Co-occcurance Matrix (GLCM), 11 Gray Level Run \nLength Matrix (GLRLM), 3 Neighborhood Gray Level Difference Matrix \n(NGLDM), 11 Gray Level Zone Length Matrix (GLZLM) were extracted by using \nthe software LIFEX. \nResults or Findings: A statistically significant difference was found in \nradiomics properties including Histogram-skewness; Shape volume, voxel; \nGLCM-energy, entropy.log2, entropy.log 10; GLRLM-GLNU, RLNU, HGRE; \nNGLDM-Busyness; GLZLM-SZE, GLNU, HGZE, ZLNU between two different \nmolecular subtypes. \nConclusion: Radiomics properties that may distinguish Luminal A and Luminal \nB molecular subtypes of IDC were determined.  The radiomics features were \nthought to reflect the intratumoral heterogeneity in molecular subtypes. It has \nbeen predicted that the characterization of Luminal A and Luminal B tumors \nmay be made non-invasively by radiomics analysis. \nLimitations: Retrospective study design, the limited number of patients, one \ncenter study \nEthics Committee Approval: Approved by the local ethics committee. \nFunding for this study: None \nAuthor Disclosures: \nPelin Seher Öztekin: Nothing to disclose \nPinar Celepli: Nothing to disclose \nO÷uz Lafcı: Nothing to disclose \nPinar Nercis Nercis Koúar: Nothing to disclose \n \nRPS 202-4 \nShear wave and strain elastography to reduce unnecessary biopsies in \nbreast cancer diagnostics \n*A. Pfob*¹, R. G. Barr², T. Bruckner¹, C. Büsch¹, Z. Alwafai³, C. S. Balleyguier ຾, \nD-A. Clevert຿, V. F. Duda๤, M. Gonçaloເ, I. Gruberແ, M. Hahnແ, P. Kapetas๥, \nR. Ohlinger³, M. J. Rutten¹0, M. Tozaki¹¹, S. Wojcinski¹², G. Rauch¹³, J. Heil¹, \nM. Golatta¹; ¹Heidelberg/DE, ²Ravenna, OH/US, ³Greifswald/DE, ຾Villejuif/FR, \n຿Munich/DE, ๤Marburg/DE, ເCoimbra/PT, ແTuebingen/DE, ๥Vienna/AT, \n¹\n0'S-Hertogenbosch/NL, ¹¹Kagoshima/JP, ¹²Bielefeld/DE, ¹³Berlin/DE \n(andre.pfob@med.uni-heidelberg.de) \n \nPurpose: Minimally invasive biopsies are indicated to rule out malignancy for \nall unclear breast lesions with >2% likelihood of malignancy (BI-RADS© 4 or \nhigher). Biopsies find up to 90% of lesions to be benign, which causes \nunnecessary physical and psychological distress for patients and costs for \nhealth care systems. We evaluated the feasibility of combining shear wave and \nstrain elastography (2D-SWE + SE), a new ultrasound technique, to \nrecategorize BI-RADS© 3 or 4 lesions to reduce the number of unnecessary \nbiopsies without impairing the breast cancer detection rate. \nMethods or Background: We analyzed prospective, multicenter, international \ndata from 1288 women with breast lesions rated by conventional 2D B-mode \nUS as BI-RADS© 3 to 4c undergoing 2D-SWE and SE. All patients underwent \nhistopathologic evaluation which was the reference standard. Reduction of \nunnecessary (benign) biopsies after recategorizing with 2D-SWE + SE and \nmissed malignancies were the outcome measures. A maximum of 2% missed \ntumors after recategorizing was the safety endpoint analogous to BI-RADS© 3 \ndefinition by ACR. \nResults or Findings: Histopathologic evaluation showed malignancy in 368 of \n1288 lesions.  \nFollowing the traditional BI-RADS© assessment, 53.80% (495 of 920 patients) \nunderwent an unnecessary biopsy (biopsy in benign lesion). \nAfter recategorizing BI-RADS© 4a lesions with 2D-SWE + SE (2D-SWE cut-off \n3.70 m/s), 34.78% (320 of 920 patients) underwent an unnecessary biopsy - \nunnecessary biopsies were reduced by 35.35% (320 vs. 495). Malignancies in \nthe new BI-RADS© 3 cohort were missed in 1.96% (12 of 612 patients). \nConclusion: In breast cancer diagnostics, adding 2D-SWE + SE with a cutoff \nof 3.70 m/s could help reduce the number of unnecessary minimally invasive \nbiopsies by approximately 35%, avoiding treatment burden for patients, \nproviders and health care systems. \nLimitations: Not applicable \nEthics Committee Approval: Yes:S-429/2015 \nFunding for this study: Siemens Medical Solutions USA, Inc \nAuthor Disclosures: \nMarkus Hahn: Nothing to disclose \nMitsuhiro Tozaki: Nothing to disclose \nChristopher Büsch: Nothing to disclose \nDirk-André Clevert: Nothing to disclose \nMichael Golatta: Nothing to disclose \nThomas Bruckner: Nothing to disclose \nSebastian Wojcinski: Nothing to disclose \nRalf Ohlinger: Nothing to disclose \nPanagiotis Kapetas: Nothing to disclose \nZaher Alwafai: Nothing to disclose \nMatthieu J.C.M. Rutten: Nothing to disclose \nAndré Pfob: Nothing to disclose \nInes Gruber: Nothing to disclose \nGeraldine Rauch: Nothing to disclose \nCorinne S. Balleyguier: Nothing to disclose \nManuela Gonçalo: Nothing to disclose \nVolker F. Duda: Nothing to disclose \nJoerg Heil: Nothing to disclose \nRichard G. Barr: Nothing to disclose \n \nRPS 202-5 \nAccuracy and reproducibility of contrast-enhanced mammography (CEM) \nin the assessment of response to neoadjuvant chemotherapy (NAC) in \nbreast cancer patients with calcifications in the tumour bed \n*V. Iotti*, S. Ravaioli, V. Marchesi, G. Besutti, M. Ragazzi, M. Revelli, R. \nVacondio, P. Giorgi Rossi, P. Pattacini; Reggio Emilia/IT \n(valentina.iotti@ausl.re.it) \n \nPurpose: To evaluate CEM accuracy and reproducibility in the detection and \nmeasurement of residual tumor after NAC in BC patients with calcifications in \nthe tumor bed, using pathological examination of the surgical specimen as the \nreference standard. \nMethods or Background: All consecutive BC patients receiving NAC from \n2012 to 2020 who presented pathological calcifications in the tumor bed at \ndiagnosis and underwent CEM before and after NAC, were included. The \npathological reference standard included presence/absence, size, and type \n(invasive and/or in-situ) of residual tumor. CEM were retrospectively reviewed \nby two independent radiologists, describing absence/presence and size of \nresidual disease according to contrast enhancement (CE) only and to CE plus \ncalcification. Discordant cases were discussed with a third radiologist. \nResults or Findings: Of the 36 included patients (median age 52 years), 28 \n(77.8%) had invasive and 5 (13.9%) in-situ only residual carcinoma at \npathology of surgical specimen.  \nCEM sensitivity for invasive residual tumor increased (from \n85.7%,95%CI=67.3-96%, to 96.4%,95%CI=81.7-99.9) and specificity \ndecreased (from 62.5%,95%CI=24.5-91.5% to 14.3%,95%CI=0.4-57.9%) when \nconsidering CE+calcifications instead of CE-only; in the detection of in-situ only \nresidual tumor, false negatives decreased (from 3 to 0) and false positives \nincreased (from 1 to 2).  \nFor residual tumor detection the inter-reader reproducibility was 100%. \nConsidering CE+calcifications versus CE-only, the concordance in residual \ntumor diameter estimation between CEM and pathology increased (R2 from \n0.38 to 0.45), reflecting a decrease in underestimations, while inter-reader \nconcordance decreased (R2 from 0.79 to 0.66). \nConclusion: CEM allows a direct combined evaluation of CE and calcification \nin the tumor bed after NAC.  \nThe evaluation of CE+calcification showed higher sensitivity and decreased \nunderestimation of residual tumor size than considering CE-only, but  \nworsened specificity. \nLimitations: Retrospective imaging classification; small sample. \nEthics Committee Approval: AVEN Ethic Committee (n.2020/0119203). \nFunding for this study: None. \nAuthor Disclosures: \n\n \n \n \nA \nB C 96  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \nMatteo Revelli: Nothing to disclose \nValentina Iotti: Speaker at GE Healthcare, Consultant at Bayer \nPierpaolo Pattacini: Nothing to disclose \nMoira Ragazzi: Nothing to disclose \nVanessa Marchesi: Nothing to disclose \nRita Vacondio: Nothing to disclose \nPaolo Giorgi Rossi: Nothing to disclose \nGiulia Besutti: Nothing to disclose \nSara Ravaioli: Nothing to disclose \n \nRPS 202-6 \nApplicability of the Kaiser score clinical decision rule to contrast-\nenhanced mammography (CEM) interpretation of breast lesions: a \ncomparison with interpretation according to the BI-RADS \n*A. A. Marzogi*¹, P. Clauser², I. Biondi ü Špoljar³, A. Korajac², P. Kapetas², \nT. H. Helbich², P. A. Baltzer²; ¹Makkah/SA, ²Vienna/AT, ³Zagreb/HR \n(alaamarzogi@live.com) \n \nPurpose: The objective of this study was to test the applicability of the Kaiser \nScore (KS) in the characterization of breast lesions detected at contrast \nenhanced mammography (CEM) and compare its results to ínterpretation \naccording to BI-RADS. \nMethods or Background: IRB-approved retrospective, cross-sectional, single-\ncenter study. Patients who underwent CEM (1 ml/kg of iodine contrast medium \n(400 mgI/ml) between July-2018 and October 2020 were included. Exclusion \ncriteria were absence of histology (reference standard), no delayed-phase \nimage (cranio-caudal view of the side of pathology acquired after the four \nstandard projections). Two radiologists (8 and 5 years of breast imaging \nexperience), blinded to patient data and histopathology results, evaluated the \nbreast lesions and separately assigned KS and BI-RADS. A ROC-curve \nanalysis was performed. \nResults or Findings: Among 200 patients who underwent CEM, 116 lesions \nwere included (70 malignant (60%), 46 benign (40%)). The areas under the \ncurve (AUC) using the KS and BI-RADS for Reader 1 were 82% (95% \nconfidence interval (CI): 73.8% to 88.5%) and 72.0% (95% CI: 63.6% to \n80.5%) (p < 0.05), respectively. For Reader 2 the AUC using the KS and BI-\nRADS were 83.7% (95% CI: 75.7 % to 89.9%), and 71.7% (95% CI: 62.6% to \n79.7%) (p < 0.05), respectively. The KS´s AUC was superior to BI-RADS for \nboth readers (p < 0.05). \nConclusion: The KS is applicable to lesions detected on CEM and showed a \nsuperior accuracy compared to interpretation according to BI-RADS. \nLimitations: No. \nEthics Committee Approval: IRB-approved \nFunding for this study: No \nAuthor Disclosures: \nPascal A.T. Baltzer: Nothing to disclose \nIva Biondiü Špoljar: Nothing to disclose \nAlaa Abdulrahman Marzogi: Nothing to disclose \nAida Korajac: Nothing to disclose \nThomas H. Helbich: Nothing to disclose \nPanagiotis Kapetas: Nothing to disclose \nPaola Clauser: Speaker at for siemens healthcare gmbh \n \nRPS 202-7 \nA multimodal hybrid 18F-FDG PET/MRI radiomics model discriminating \nbiological properties of malignant and benign breast lesions \n*V. Romeo*¹, P. Clauser², P. Kapetas², P. A. Baltzer², S. Rasul², P. Gibbs³, \nK. Pinker-Domenig³, R. A. Woitek ຾, T. H. Helbich²; ¹Naples/IT, ²Vienna/AT, \n³New York, NY/US, ຾Cambridge/UK \n(valeria.romeo@unina.it) \n \nPurpose: To develop an artificial intelligence (AI)-based radiomics model \napplied to simultaneous 18F-FDG PET/MRI for differentiation of malignant and \nbenign breast lesions. \nMethods or Background: In this IRB-approved, prospective, single institution \nstudy, 102 patients with 120 breast lesions (BI-RADS 0, 4/5: 101 malignant, 19 \nbenign) detected by ultrasound and/or mammography were included and \nunderwent hybrid 18F-FDG PET/MRI of the breast. Quantitative parameters \nand radiomics features (first, second, higher order) were extracted from \ndynamic contrast-enhanced (tumor Mean Transit Time (MTT), Volume \nDistribution, Plasma Flow), diffusion-weighted (DWI) (tumor ADCmean and \ncontralateral breast parenchyma), PET (tumor SUVmax, mean and minimum, \nSUVmean of ipsi- and contralateral breast parenchyma) and T2-weighted \nimaging. Different AI models were developed using a fine gaussian support \nvector machine (SVM) classifier with a 5-fold cross validation, using different \ncombinations of quantitative parameters and radiomics features to obtain the \nhighest accuracy for breast cancer diagnosis. The performance of the best \nradiomics model was compared with that of expert readings by a radiologist \nand a nuclear medicine physician using the McNemar test. \nResults or Findings: Eight radiomics models were developed. The integrated \nmodel combining MTT and ADCmean of breast lesion with radiomics features \nextracted from PET and ADC images obtained the highest accuracy for breast \ncancer diagnosis (AUC 0.983, accuracy: 94.8%, sensitivity:95.3%, specificity: \n94.3%, PPV:94.3%, NPV:95.3%). The performance of the SVM classifier was \nbetter (AUC 0.983) but not significantly different from the performance of the \nexpert radiologist and nuclear medicine physician (AUC 0.868, p=0.508). \nConclusion: An AI-based radiomics model combining quantitative perfusion \nand DWI parameters with radiomics features extracted from simultaneous 18F-\nFDG PET/MRI images characterizes malignant and benign breast lesions with \nhigh accuracy. \nLimitations: Small sample size \nLack of external validation \nUnbalanced distribution of benign and malignant breast lesions \nEthics Committee Approval: IRB-approved \nFunding for this study: EU grant \nAuthor Disclosures: \nPascal A.T. Baltzer: Nothing to disclose \nKatja Pinker-Domenig: Nothing to disclose \nValeria Romeo: Research/Grant Support by the ESOR \"Bracco Fellowship\" \nThomas H. Helbich: Grant Recipient at EU Grant \nRamona Anna Woitek: Nothing to disclose \nSazan Rasul: Nothing to disclose \nPanagiotis Kapetas: Nothing to disclose \nPeter Gibbs: Nothing to disclose \nPaola Clauser: Speaker at Siemens \n \nRPS 202-8 \nMRI radiomics signatures for the prediction of risk of breast cancer \nrecurrence: correlation with genomic recurrence scores \nC. Rossi¹, A. Bitencourt¹, P. Gibbs², R. Lo Gullo², *I. Daimiel Naranjo*², \nJ. V. M. Horvat², S. Thakur², E. A. Morris², K. Pinker-Domenig²; ¹Sao Paulo/BR, \n²New York, NY/US \n \nPurpose: To correlate radiomic features from breast MRI and Oncotype DX \nrecurrence scores (RS) in patients with early-stage estrogen-recpetor (ER)-\npositive/human epidermal growth factor receptor 2 (HER2)-negative invasive \nbreast cancer. \nMethods or Background: This was a retrospective study between November \n2016-September 2018. Inclusion criteria were: early-stage breast ER-\npositive/HER2-negative breast cancer, axillary node-negative, pre-treatment \nbreast MRI, and available Oncotype DX RS. Exclusion criterion was insufficient \nimage quality preventing radiomics analysis. Dynamic contrast-enhanced \n(DCE) images were reviewed and three-dimensional tumor segmentation for \nradiomics analysis (first post-contrast T1-weighted sequence) was performed. \nRadiomics parameters were calculated using publicly available CERR \nsoftware, and measures of accuracy, including sensitivity, specificity, negative \npredictive value (NPV) and positive predictive value (PPV), were estimated. \nOncotype DX recommendations for stratification were used: Low-risk (little-no \nbenefit from chemotherapy): patients>50 years; RS ”25. Patients”50 years; \nRS”15; Intermediate-risk (chemotherapy may be offered): patients ”50 years; \nRS=16-25; high-risk (candidates for chemotherapy) RS •26. \nResults or Findings: 175 tumors were analyzed. Oncotype DX RS comprised \n87 low-risk cases, 67 intermediate-risk cases and 21 high-risk cases. \nSignificant differences were found between low/intermediate-risk (154) and \nhigh-risk (21) cases for 12 radiomics features. After minority class size \nboosting via adaptive synthetic sampling, LASSO regression was used to \ndetermine the top five parameters for model development: robust median \nabsolute deviation(first order), hgce (NGLDM), joint max(GLCM), zp(SZM) and \nlzlgle (SZM). A support vector-machine model with 5-fold cross-validation \nyielded 86.5% accuracy, 98.6% sensitivity, 76.0% specificity, 80.5% PPV and \n95.9% NPV. \nConclusion: Radiomics signatures from DCE-MRI showed high accuracy \nidentifying patients at high-risk of recurrence and could be used as non-\ninvasive alternative to genomic RS to select patients who will benefit from \nchemotherapy. \nLimitations: Small sample size. Single center data. \nEthics Committee Approval: IRB-approved. Informed consent was waived. \nFunding for this study: NIH/NCI Cancer Center Support Grant(P30 \nCA008748). Breast Cancer Research Foundation. \nAuthor Disclosures: \nJoao Vicente Machado Horvat: Nothing to disclose \nCarolina Rossi: Nothing to disclose \nAlmir Bitencourt: Nothing to disclose \nKatja Pinker-Domenig: Nothing to disclose \nElizabeth A. Morris: Nothing to disclose \nRoberto Lo Gullo: Nothing to disclose \nSunitha Thakur: Nothing to disclose \nPeter Gibbs: Nothing to disclose \nIsaac Daimiel Naranjo: Nothing to disclose \n \nLive Q&A \n \n\n \n \n \nA \nB C 97  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \n08:00-09:00 CHANNEL 3 \nJoint Session of the ESR and EFSUMB \nESR/EFSUMB \nNew options of diagnosis and treatment in \nMSK ultrasound \nModerators \nDirk André Clevert; Munich/DE  \nVito Cantisani; Rome/IT  \n \nESR/EFSUMB-3 \nUltrasound-guided MSK interventional procedures: what is the evidence? \nLuca M. Sconfienza; Milan/IT \n(io@lucasconfienza.it) \n \nLearning Objectives: \n1. To understand the basic methods for ultrasound-guided MSK interventional \nprocedures. \n2. To show the interventional techniques in the major joints. \n3. To present the current evidence on the main ultrasound-guided MSK \ninterventional procedures. \nAuthor Disclosures: \nLuca M. Sconfienza: Advisory Board: Pfizer; Speaker: Samsung Medison, \nEsaote SPA, Abiogen, Novartis, Janssen-Cilag \n \nESR/EFSUMB-4 \nApplication of ultrasound in intra-articular pathology \nEsperanza Naredo; Madrid/ES \n(enaredo@ser.es) \n \nLearning Objectives: \n1. To review the main intra-articular indications for musculoskeletal ultrasound \n(including injections). \n2. To exemplify the main ultrasound-evaluable intra-articular pathologies \n3. To present the standardised ultrasound assessment of these pathologies. \n \nESR/EFSUMB-5 \nApplication of ultrasound in extra-articular pathology \nDaniela Fodor; Cluj-Napoca/RO \n(dfodor@umfcluj.ro) \n \nLearning Objectives: \n1. To review the main extra-articular indications for musculoskeletal ultrasound. \n2. To exemplify the tendon, enthesis, and muscle pathology. \n3. To present the current knowledge in these pathologies. \n \nESR/EFSUMB-6 \nUS elastography in MSK: is there a role? \nElena E. Drakonaki; Iraklion/GR \n(drakonaki@yahoo.gr) \n \nLearning Objectives: \n1. To present the basic technique of EUS in MSK. \n2. To present the current indications in MSK based on the recent EFSUMB \nguidelines. \n3. To discuss future directions and potential applications in MSK. \n \nLive Q&A \n \n08:00-09:00 CHANNEL 5 \nMultidisciplinary Session \nMS 4 \nRectal cancer treatment: which are the \nclinically relevant questions? \nModerator \nRegina G.H. Beets-Tan; Amsterdam/NL  \n \n \n \nMS 4-2 \nFrom the surgeons \nGeerard L. Beets; Amsterdam/NL  \n \nLearning Objectives: \n1. To understand the relevant clinical questions. \n2. To learn about the current status of rectal cancer surgery and organ \npreservation. \n3. To learn what we can expect in the years to come. \n \nMS 4-3 \nFrom the radiation oncologists \nCorrie Marijnen; Amsterdam/NL \n \nLearning Objectives: \n1. To become familiar with the various neoadjuvant treatment strategies (long \nor short course chemoradiotherapy, induction, or consolidation chemo). \n2. To learn about the value of these strategies in the era of organ preservation. \n \nMS 4-4 \nMultidisciplinary case presentation \nRegina G.H. Beets-Tan; Amsterdam/NL \n(r.beetstan@nki.nl) \n \nLive Q&A \n \n09:15-10:15 CHANNEL 2 \nE³ - ECR Master Class \nE³ 1226 \nArtificial intelligence (AI) applications in \nthe growing body \nModerator \nTomas Sakinis; Oslo/NO  \n \nE³ 1226-2 \nA. In times of limited data \nTomas Sakinis; Oslo/NO  \n(sakinis.tomas@gmail.com) \n \nLearning Objectives: \n1. To understand the basic principles of big data collection. \n2. To learn about the organisation of big data. \n3. To discuss the challenges in obtaining and managing big data in the \npaediatric population. \nAuthor Disclosures: \nTomas Sakinis: CEO: Artificial Intelligence AS; Owner: Artificial Intelligence AS \n \nE³ 1226-3 \nB. Neuroimaging \nStavros Stivaros; Manchester/UK \n(Stavros.Stivaros@manchester.ac.uk) \n \nLearning Objectives: \n1. To understand the principles of AI applications in paediatric neuroimaging. \n2. To learn about how deep learning networks can be used for segmentation, \ndetection, and characterisation in paediatric neuroimaging. \n3. To discuss the challenges of AI in paediatric neuroimaging. \n \nE³ 1226-4 \nC. Current and emerging chest applications \nSteven Schalekamp; Nijmegen/NL \n \nLearning Objectives: \n1. To understand the current spectrum of available AI applications for chest \nradiology. \n2. To learn about the emerging AI applications within pediatric chest radiology. \n3. To discuss the future directions of AI in pediatric chest radiology. \n \nLive Q&A: How can paediatric radiologists keep up with adult \nradiologists in applying AI to clinical practice? \n \n \n \n\n \n \n \nA \nB C 98  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \n09:15-10:15 CHANNEL 5 \nSpecial Focus Session \nSF 21 \nLung cancer screening implementation in \nEurope: where are we now? \nModerator \nAnnemiek Snoeckx; Antwerp/BE  \n \nSF 21-2 \nPivotal aspects for a successful lung cancer screening programme \nAnnemiek Snoeckx; Antwerp/BE  \n(Annemiek.Snoeckx@uza.be) \n \nLearning Objectives: \n1. To describe those key elements that are essential for lung cancer screening \nprogrammes to be successful and impact on the care of those who are \npotentially screened. \n2. To highlight the multifaceted role of radiologists in a lung cancer screening \nprogramme. \n \nSF 21-3 \nCroatia \nAnte Marusic; Zagreb/HR \n(ante.marusic@kbc-zagreb.hr) \n \nLearning Objectives: \n1. To demonstrate the complexity of preparation, implementation, and \nmanagement of a national lung cancer screening program (LCS). \n2. To demonstrate the structure of the national LCS in Croatia through \nintegrated care. \n3. To demonstrate the applied quality control in the ongoing LCS in Croatia. \n \nSF 21-4 \nHungary \nAnna Kerpel-Fronius; Budapest/HU \n(kerpel.anna@gmail.com) \n \nLearning Objectives: \n1. To learn about implementing screening from a one-centre study to several \ninstitutions. \n2. To understand Hungary-specific aspects of screening. \n3. To become familiar with the Hungarian LDCT LCS implementation \nprogramme. \n \nSF 21-5 \nPoland \nMariusz Adamek; Gdansk/PL \n(mariusz.adamek@gmail.com) \n \nLearning Objectives: \n1. To demonstrate how a nationwide programme may originate from a couple \nof local screening programmes. \n2. To indicate the importance of proper structuring of a programme. \n3. To become familiar with the cloud-based AI-powered platform created for \nthe Polish programme. \nAuthor Disclosures: \nMariusz Adamek: Advisory Board: Medtronic; Share Holder: NovellusDx \n \nSF 21-6 \nRussia \nSergey Morozov; Moscow/RU \n \nLearning Objectives: \n1. To learn about the different stages of implementing a lung cancer screening \nprogramme in Russia. \n2. To show the role of artificial intelligence in lung cancer screening. \n3. To identify the transition problems from a pilot project to a large-scale \nprogramme and possible solutions. \nAuthor Disclosures: \nSergey Morozov: Advisory Board: Philips, Agfa; CEO: CDT Moscow; Speaker: \nSiemens \n \n \n \nSF 21-7 \nFrance \nMarie-Pierre Revel; Paris/FR \n(marie-pierre.revel@aphp.fr) \n \nLearning Objectives: \n1. To provide an overview of the ongoing lung cancer screening studies in \nFrance. \n2. To learn about the pilot programme conducted in the Somme district. \n3. To explain how French radiologists are getting prepared for large scale \nscreening. \nAuthor Disclosures: \nMarie-Pierre Revel: Other: lecture fees from MSD Francen Travel support from \nGuerbet \n \nSF 21-8 \nGermany \nClaus Peter Heussel; Heidelberg/DE \n \nLearning Objectives: \n1. To provide an update on the lessons learned from LC-screening in Germany \nso far. \n2. To understand the German-specific aspects of screening organisation and \nradiation protection and funding. \n3. To become familiar with the German LC-screening future. \n \nSF 21-9 \nUnited Kingdom \nAnand Devaraj; London/UK \n \nLearning Objectives: \n1. To understand the current progress in lung cancer screening implementation \nin the UK. \n2. To understand training and radiology requirements for reading in the UK. \n3. To review the challenges and successes of implementation to date. \nAuthor Disclosures: \nAnand Devaraj: Advisory Board: Boehringer Ingelheim; Employee: Brainomix \n \nLive Q&A: What are the remaining obstacles for LCS implementation? \n \n10:30-11:30 CHANNEL 2 \nRefresher Course: Breast \nRC 102 \nBreast tomosynthesis in screening: where \ndo we stand? \nModerator \nSophia Zackrisson; Malmö/SE  \n \nRC 102-2 \nA. Implementation of DBT in screening in the US \nEmily Conant; Philadelphia, PA/US  \n(Emily.Conant@pennmedicine.upenn.edu) \n \nLearning Objectives: \n1. To review the US retrospective studies on DBT in screening. \n2. To understand how DBT works in different screening settings. \n3. To be oriented about the current use of DBT in screening in the US. \nAuthor Disclosures: \nEmily Conant: Advisory Board:  Hologic, Inc.; Research Grant/Support:  \nHologic, Inc. \n \nRC 102-3 \nB. Evidence from the prospective trials of DBT \nNehmat Houssami; Sydney, NSW/AU \n \nLearning Objectives: \n1. To review the prospective trials of DBT. \n2. To discuss the strengths and limitations of DBT in screening. \n3. To understand what evidence is needed to implement DBT in a population \nscreening setting. \n \n \n \n\n \n \n \nA \nB C 99  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \nRC 102-4 \nC. Optimisation of reading DBT: an overview \nIoannis Sechopoulos; Nijmegen/NL \n(ioannis.sechopoulos@radboudumc.nl) \n \nLearning Objectives: \n1. To learn about the different reading protocols that can be used in DBT \nscreening. \n2. To learn how different reading strategies may impact detection, recalls, and \nreading time. \n3. To learn about possible approaches to optimise DBT reading. \nAuthor Disclosures: \nIoannis Sechopoulos: Research Grant/Support: Siemens Healthcare, \nScreenPoint, Sectra Benelux, Volpara Solutions, Canon Medical; Speaker: \nSiemens Healthcare \n \nLive Q&A: Has the time come to introduce screening with DBT in \nEurope? \n \n10:30-11:30 CHANNEL 3 \nState of the Art Symposium \nSA 3 \nAssessment of incidental and screen-\ndetected pulmonary nodules \nModerators \nMathias Prokop; Nijmegen/NL  \nIeneke Hartmann; Rotterdam/NL  \n \nSA 3-3 \nDiagnosis and overdiagnosis of subsolid nodules \nArjun Nair; London/UK \n \nLearning Objectives: \n1. To become familiar with the characteristics of subsolid nodules and their risk \nof cancer. \n2. To learn about the differential diagnosis of subsolid nodules. \n3. To understand current management strategies for the diagnosis, \nclassification, and follow-up of subsolid nodules. \nAuthor Disclosures: \nArjun Nair: Advisory Board: Aidence BV; Other: Part funded by BRC UCLH \n \nSA 3-4 \nDiagnosis and follow-up of solid nodules \nAnna Rita Larici; Rome/IT \n(annarita.larici@unicatt.it) \n \nLearning Objectives: \n1. To become familiar with the characteristics of solid nodules and their risk of \ncancer. \n2. To learn about the differential diagnosis of solid nodules. \n3. To understand current management strategies for the diagnosis, \nclassification, and follow-up of solid nodules. \n \nSA 3-5 \nRadiomics and AI performance in lung nodule assessment \nGuillaume Chassagnon; Paris/FR \n \nLearning Objectives: \n1. To become familiar with the deep learning methods used and their \npossibilities. \n2. To learn what the current state-of-the-art applications of AI are in detection,  \nclassification, and follow-up of pulmonary nodules. \n3. To appreciate what the impact of these advancements may be on the role of  \nradiologists. \n \nLive Q&A: The requirements of a nodule MDT board \n \n10:30-11:30 CHANNEL 4 \nESR meets Armenia \nMeets 4 \nBlooming radiology in an ancient nation \nModerators \nMichael H. Fuchsjäger; Graz/AT  \nKostan Galumyan; Yerevan/AM  \n \nMeets 4-3 \nIntroduction: History of Armenian radiology \nKostan Galumyan; Yerevan/AM \n(kostmed@rambler.ru) \n \nLearning Objectives: \n1. To learn about the history and current state of radiology in Armenia. \n2. To learn about the educational system and opportunities for residents in \nArmenia. \n3. To get acquainted with typical clinical cases in Armenian radiology practice. \n4. To become familiar with the achievements of radiology and its perspectives \nin Armenia. \n \nMeets 4-4 \nInterlude 1: Armenian folk music \n \nMeets 4-5 \nPracticing modern radiology in Armenia \nHovhannes Vardevanyan; Yerevan/AM \n(hovovar@gmail.com) \n \nLearning Objectives: \n1. To learn about specific cases predominantly observed in Armenia. \n2. To become familiar with everyday workflow of Armenian radiological clinics. \n3. To learn about the difficulties faced by radiologists in Armenia. \n \nMeets 4-6 \nInterlude 2: Armenian folk dances \n \nMeets 4-7 \nNew opportunities for radiology residents \nMeri Talanyan; Yerevan/AM \n(marytalanyan@gmail.com) \n \nLearning Objectives: \n1. To learn about challenges of radiology residents in Armenia. \n2. To become familiar with residency programmes and opportunities. \n \nMeets 4-8 \nInterlude 3: Armenian culinary treats \n \nMeets 4-9 \nFuture vision of Armenian radiology \nNarek Matinyan; Yerevan/AM \n(matinyan@doctor.com) \n \nLearning Objectives: \n1. To learn about perspectives for improving radiological practice in different \nregions of Armenia. \n2. To learn about the potential of artificial intelligence in Armenian radiology. \n3. To become familiar with new ideas for radiology education. \n \nLive Q&A: New paths for growth of the Armenian radiology \n \n \n \n \n \n \n \n \n \n \n\n \n \n \nA \nB C 100  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \n10:30-11:30 CHANNEL 5 \nResearch Presentation Session: \nGenitourinary \nRPS 207 \nUp-to-date reporting and data systems \n(RADS) in the pelvis \nModerator \nSubramaniyan Ramanathan; Doha/QA  \n \nRPS 207-2 \nDiagnostic performance of ultrasound based ACR O-RADS versus IOTA \nsimple rules risk (SRrisk) calculation tool for malignancy risk \nstratification of adnexal pathology \n*S. B. Grover*, S. Patra, H. Grover, P. Mittal, G. Khanna; New Delhi/IN  \n(shabnamgrover@yahoo.com) \n \nPurpose: The aim of this study was to compare the diagnostic performance \nbetween ultrasound (US) based ACR O-RADS (ovarian-adnexal reporting and \ndata system) & IOTA simple rules risk (SRrisk) calculation tool score for \nassigning malignancy risk in patients with adnexal pathology. \nMethods or Background: In this Institutional Review Board approved \nprospective study, 102 consenting patients with adnexal tumors were recruited. \nAll patients underwent US examination on the same equipment, by two \ndifferent evaluators: first & second author. O-RADS risk category & IOTA \nSRrisk calculation tool score was assigned to each tumor by consensus. \nReference standard was histopathology obtained from biopsied/operated \ntumors; for the rest, it was a biannual survey for 12 months. Sensitivity, \nspecificity, positive & negative predictive values, & diagnostic accuracy was \ncompared between both risk stratification systems. \nResults or Findings: Of the evaluated tumors, 40 were benign & 62 were \nmalignant. O-RADS risk classification could be applied to all evaluated tumors, \nIOTA SRrisk was not applicable in two of the evaluated tumors. Overall \nsensitivity, specificity, PPV & NPV for ACR O-RADS was found to be 100%, \n55%, 77.5% & 100%, while for IOTA SRrisk calculation tool it was 90%, 80%, \n87.1% & 84.2% respectively. Diagnostic accuracy for IOTA SRrisk calculation \ntool was 86%, for ACR O-RADS, 82.6%. \nConclusion: Both ACR O-RADS & IOTA SRrisk calculation tool classification \nshow good diagnostic performance for malignancy risk stratification of adnexal \ntumors. Although, diagnostic accuracy of IOTA SRrisk calculation tool is better \nthan ACR O-RADS, the latter is superior for prediction of benignity. Definitive \nclassification of benignity is critical, since these tumors need only conservative \nmanagement. \nLimitations: The limitation in our study was a relatively small sample size and \npatients being evaluated from a single Institution. \nEthics Committee Approval: Yes. \nFunding for this study: Not Applicable \nAuthor Disclosures: \nSayantan Patra: Nothing to disclose \nShabnam Bhandari Grover: Nothing to disclose \nGeetika Khanna: Nothing to disclose \nHemal Grover: Nothing to disclose \nPratima Mittal: Nothing to disclose \n \nRPS 207-5 \nPreoperative detection of VI ǦǦRADS score 5 reliably identifies extravesical \nextension of urothelial carcinoma of the bladder and predicts significant \ndelayed time to cystectomy \nM. Bicchetti, *M. Pecoraro*, F. Del Giudice, E. Messina, C. Catalano, V. \nPanebianco; Rome/IT \n(pecoraro.martina1@gmail.com) \n \nPurpose: (I)To determine VIǦRADS score 5 accuracy in predicting locally \nadvanced bladder cancer (BCa), to identify those patients who could avoid the \nmorbidity of deep TURBT in favour of histological sampling ǦTUR prior to radical \ncystectomy (RC). (II)To explore the predictive value of VI ǦRADS score 5 on \ntimeǦtoǦcystectomy outcomes. \nMethods or Background: We retrospectively reviewed patients’ ineligible or \nrefusing cisplatinǦbased combination neoadjuvant chemotherapy who \nunderwent mpMRI of the bladder prior to staging TURBT followed by RCfor \nmuscleǦinvasive BCa. Sensitivity, specificity, PPV and NPV were calculated for \nVIǦRADS score 5 vs. score 2–4 cases to assess the accuracy of mpMRI for \nextravesical BCa detection (•pT3). VIǦRADS scoreperformance was assessed \nby ROC curve analysis. Ȁ statistic was calculated for mpMRI and pathological \ndiagnostic agreement.The risk of delayed TTC was assessed using \nmultivariable logistic regression model. \nResults or Findings: 149 T2–T4a, cN0–M0 patients included. VI ǦRADS 5 \ndemonstrated sensitivity, specificity, PPV and NPV, in detecting extravesical \ndisease of 90.2% (95% CI 84–94.3), 98.1% (95% CI 94–99.6), 94.9% (95% CI \n89.6–97.6) and 96.4% (95% CI 91.6–98.6). The AUC was 94.2% (95% CI \n88.7–99.7) and interǦreader agreement was Ȁinter 0.89. Mean (SD) TTC was \n4.2 (2.3) and 2.8 (1.1) months for score 5 vs 2–4, (P<0.001). VI ǦRADS score 5 \nindependently increased risk of delayed TTC (odds ratio 2.81, 95% CI 1.20–\n6.62). \nConclusion: VIǦRADS is valid and reliable in differentiating patients with \nextravesical disease from those with muscle Ǧconfined BCa before TURBT. \nDetection of VIǦRADS 5 was found to predict significant delay in TTC \nindependently from other clinicopathological features. \nLimitations: (I)Retrospective single centre study with a limited number of \nobserved locally advanced cases. (II)diagnostic performance and the effect of \npredicting factors (ORs) could be influenced by the sample size. \nEthics Committee Approval: EC approved \nFunding for this study: Not applicable \nAuthor Disclosures: \nEmanuele Messina: Nothing to disclose \nMarco Bicchetti: Nothing to disclose \nValeria Panebianco: Nothing to disclose \nMartina Pecoraro: Nothing to disclose \nFrancesco Del Giudice: Nothing to disclose \nCarlo Catalano: Nothing to disclose \n \nRPS 207-6 \nORADS: a winding road of standardisation and an aid in differentiating \nbenign ovarian masses from malignant ones - how and why? \n*S. K. Kale*, S. Sharma, S. Rahman, A. M. Nizar, S. Khan; Bengaluru/IN \n(drsudhir.kale@asterhospital.com) \n \nPurpose: To familiarize radiologist with Ovarian-Adnexal Reporting and Data \nSystem (O-RADS). \nORADS will lead to standardization in reporting, higher accuracy in \nclassification of lesion as malignant or benign, and to provide a basic \nmanagement recommendation. \nMethods or Background: Most of the incidentally detected ovarian lesions are \ncystic, benign and asymptomatic and often resolve spontaneously. Only few \novarian lesions are suspicious and rarely malignant. USG is a preliminary \nimaging tool but may have different interpretations among radiologists \nregarding complexity. Classifying them according to risk of malignancy can \ndecrease the number of further unnecessary imaging. \nResults or Findings: Ovarian-Adnexal Reporting is a new and effective \nlexicon which uses a non-invasive, readily available, cheap imagining modality \nUSG to suggest likelihood of malignancy and providing guidance for \nmanagement. \nConclusion: Unlike other lexicon O-RADS is developed for the patient at \naverage risk of malignancy which increases sensitivity of detection of ovarian \ncarcinoma. \nLimitations: Not applicable \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nSayana Rahman: Nothing to disclose \nSukrity Sharma: Nothing to disclose \nSaarah Khan: Nothing to disclose \nSudhir Kumar Kale: Nothing to disclose \nAjmal Mohamed Nizar: Nothing to disclose \n \nRPS 207-7 \nRevisiting O-RADS: an illustrated guide with magnetic resonance \ncorrelation \n*L. d. A. Defendi*, V. M. Brito, F. M. A. Coelho, E. E. Dutenhefner, A. Talans, \nR. Baroni; São Paulo/BR \n(lariad@gmail.com) \n \nPurpose: 1. Conduct a brief review of American and European guidelines on \ndiagnosis and management of adnexal lesions; \n2. Describe the imaging features of main benign and malignant adnexal lesions \non ultrasound (US) and magnetic resonance (MRI); \n3. Review the O-RADS lexicon  \n4. Illustrate the risk classification system with teaching cases \nMethods or Background: A reliable imaging method to approach adnexal \nlesions would reduce the number of unnecessary laparotomies in benign \ncases. O-RADS is a recently published classification of malignancy risk that \npresents a standardized lexicon to describe the sonographic aspects of lesions \ninvolving the ovaries or tubes. Magnetic resonance imaging is widely used in \nthe follow-up of adnexal lesions and in cases of diagnostic doubts since it is \nhighly sensitive in assessing their features and thus determining their \nmalignancy. \n\n \n \n \nA \nB C 101  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \nResults or Findings: The following topics will be discussed:1. Review of \nAmerican and European guidelines: GI-RADS Risk Classification,O-RADS Risk \nClassification, ADNEx MR Scoring System, ACOG Practice Bulletin on \nEvaluation and Management of Adnexal Masses2. MRI protocols - evaluation \nof the female pelvis3. O-RADS risk classification system: Understanding the \nlexicon, Illustrated O-RADS categories4. Sonographic findings with MRI \ncorrelations: Endometrioma, Hydrosalpinx, Ovarian torsion mimicking adnexal \ntumor, Fibroma, Teratoma, Cystadenofibroma, Serous Cystadenoma, Serous \nCystadenocarcinoma, Mucinous cystadenoma, Endometrioid carcinoma, \nSerous Mucinous Borderline tumor, Imature teratoma, Leydig cell tumor5. \nCurrent state of the literature regarding O-RADS use \nConclusion: Radiologists must be familiar with the imaging aspects of various \nadnexal lesions and the proposed risk classification systems to ensure an \naccurate diagnosis and avoid unnecessary surgical procedures. \nLimitations: Educational Exhibit \nEthics Committee Approval: Educational Exhibit \nFunding for this study: This Educational Exhibit did not receive funding. \nAuthor Disclosures: \nFernando Morbeck Almeida Coelho: Nothing to disclose \nVanessa Mizubuti Brito: Nothing to disclose \nEliane Eliza Dutenhefner: Nothing to disclose \nAley Talans: Nothing to disclose \nRonaldo Baroni: Nothing to disclose \nLarissa de Andrade Defendi: Nothing to disclose \n \nLive Q&A \n \n11:45-12:45 CHANNEL 2 \nRTF Quiz \nBeating heart of radiology \nModerators \nMarco Francone; Rome/IT  \n(marco.francone@uniroma1.it) \nChristian Loewe; Vienna/AT  \n(christian.loewe@meduniwien.ac.at) \nAuthor Disclosures: \nChristian Loewe: Author: BRACCO Springer; Speaker: Siemens Healthineers \n \n11:45-12:45 CHANNEL 3 \nRefresher Course: Oncologic Imaging \nRC 416 \nCancer becoming a chronic disease: role \nof imaging and radiomics \nModerator \nMelvin D'Anastasi; Msida/MT  \n \nRC 416-2 \nA. Imaging surveillance: the pros and the cons \nChristiane K. Kuhl; Aachen/DE  \n(ckuhl@ukaachen.de) \n \nLearning Objectives: \n1. To understand which imaging techniques are suitable for cancer \nsurveillance. \n2. To learn when to perform surveillance imaging in different cancers. \n3. To become familiar with the limitations of surveillance imaging. \nAuthor Disclosures: \nChristiane K. Kuhl: Speaker: Guerbet, Bracco, Bayer \n \nRC 416-3 \nB. Early detection of prostate cancer recurrence \nHebert Alberto Vargas; New York, NY/US \n \nLearning Objectives: \n1. To understand the clinical impact of early recurrence detection. \n2. To learn the role of MRI for early lesion detection. \n3. To learn the complementary value of PET. \n \n \n \nRC 416-4 \nC. Radiomics for outcome prediction and prognostication \nGeorg Langs; Vienna/AT \n \nLearning Objectives: \n1. To become familiar with radiomics analysis techniques in oncologic imaging. \n2. To understand the concept and methodologies for image-based outcome \nprediction. \n3. To learn how to integrate radiomics results and clinical-risk models for \nprognostication. \nAuthor Disclosures: \nGeorg Langs: Employee: contextflow GmbH; Founder: contextflow GmbH; \nResearch Grant/Support: Novartis, Siemens Healthineers, NVIDIA; Share \nHolder: contextflow GmbH \n \nLive Q&A: How to generate evidence for imaging in cancer surveillance? \n \n11:45-12:45 CHANNEL 4 \nESR eHealth and Informatics \nSubcommittee Session \nJointly organised with the ESR Patient Advisory Group \n(ESR-PAG) \nESR eHealth \nHow to enhance radiologist-patient \ncommunication through IT \nModerators \nBirgit Bauer; Abensberg/DE  \nPeter Mildenberger; Mainz/DE  \n \nESR eHealth-3 \nUsing patient portals for communicating with patients \nChristoph D. Becker; Geneva/CH \n \nLearning Objectives: \n1. To understand the communication needs of patients and radiologists. \n2. To learn how patient portals are used to collect patient data and consent. \n3. To know how patient portals can help to communicate results. \n \nESR eHealth-4 \nHow to enhance patients' perception of radiology \nBirgit Bauer; Abensberg/DE \n \nLearning Objectives: \n1. To understand how to use patient portals for the communication with \npatients. \n2. To understand how patients perceive radiology and how to enhance \npatient's perception of radiology. \n3. To learn how technology can help radiologists to team up with patients. \n \nESR eHealth-5 \nTeaming up with our patients \nElmar Kotter; Freiburg/DE \n(elmar.kotter@uniklinik-freiburg.de) \n \nLearning Objectives: \n1. To learn how IT can be used to reduce information collection from the \npatient. \n2. To understand the principle of chatbots and to analyse their potential value \nfor radiology. \n3. To explain how reports adapted to patients needs can be derived from \nstandard reports. \n \nLive Q&A: Communication between patients and radiologists in five \nyears \n \n \n \n\n \n \n \nA \nB C 102  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \n11:45-12:45 CHANNEL 5 \nResearch Presentation Session: Paediatric \nRPS 212 \nNew insight into classical problems in \npaediatric radiology \nModerator \nThekla von Kalle; Stuttgart/DE  \n \nRPS 212-2 \nBone marrow quantitative MRI in children with leukaemia \n*N. Kriventsova*, D. Kupriyanov, P. Menshchikov, D. Litvinov, G. Novichkova, \nG. Tereshchenko; Moscow/RU  \n(nataliastrumila@gmail.com) \n \nPurpose: The aim of this study was to establish a normal bone marrow FF \nvalues in healthy children and changes in this parameter in patients with acute \nleukemia (AL). \nMethods or Background: Our research contained 16 healthy volunteers from \n7 to 16 years (median of age 13.1±2.9 years) and 17 patients with acute \nleukemia from 4 to 17 years (median of age 11.5±2.7 years). The study was \nperformed using Philips Achieva 3T MRI scanner. FF values in both patient \nand control groups were evaluated using 2 methods: mDixon-Quant (TR = 6.5 \nms, 6 echo times starting from TE = 1.2 ms with 0.8 ms increment, coronal \nslices which include Ilium) and proton single-voxel MR spectroscopy (PRESS, \nTE/TR = 39/2000 ms ). Spectroscopic voxels in size of 10×10×10 mm were \nlocated in the right Ilium bone. FF values were quantified using built-in Philips \nconsole programs for both methods. \nResults or Findings: The FF in the bone marrow of healthy volunteers by the \nmethod of mDixon-Quant was 45.66% ± 10.27%, and by spectroscopy – \n36.07% ± 12.22%. In children with the AL, the content of fat decreases sharply \nto 3.08% ± 2.6% in mDixon-Quant and to 3.14% ± 3.0% in spectroscopy. \nDifference between the parameters of healthy volunteers and patients with \nleukemia according to each method was statistical significance by T-test \n(p”0.01). Two methods had strong correlation (Pearson's r = 0,82, p<0,05). \nConclusion: Bone marrow fat fraction values in patients with acute leukemia \n(AL) is significantly lower than in healthy children. mDixon-Quant and \nspectroscopy are effective for estimating the fat fraction in the bone marrow. \nLimitations: No limitations \nEthics Committee Approval: The study was approved by the Ethics \nCommittee. \nFunding for this study: The study was not funded \nAuthor Disclosures: \nDmitry Litvinov: Nothing to disclose \nPetr Menshchikov: Nothing to disclose \nGalina Tereshchenko: Nothing to disclose \nGalina Novichkova: Nothing to disclose \nDmitry Kupriyanov: Nothing to disclose \nNataliia Kriventsova: Nothing to disclose \n \nRPS 212-3 \nThe bright bronchus sign in in-vivo foetal MRI of congenital lung lesions: \na multi-center study \n*F. Prayer*¹, A. Mehollin-Ray², C. Cassady², G. Gruber³, A. Scharrer¹, A. \nHojreh¹, H. Prosch¹, D. Prayer¹, G. Kasprian¹; ¹Vienna/AT, ²Houston, TX/US, \n³Krems an der Donau/AT \n \nPurpose: To characterize the 'bright bronchus sign' (BBS) in in-vivo fetal MRI \nof a multi-center cohort of fetuses with congenital lung lesions. \nMethods or Background: For this retrospective multi-center study, 292 \nfetuses and 381 fetal MRI scans were allocated to two groups: group A with, \nand group B without postnatal CT and/or pathologic lesion workup. Fetal MRI \nscans were reviewed for the BBS, i.e. a tubular or branching T2-hyperintense \nstructure close to the pulmonary vessels within a lung lesion.  Postnatal CTs \nwere reviewed for bronchial obstruction. BBS frequency in different lung \nlesions, gestational ages, and sensitivity, specificity, PPV, NPV and acccuracy \nof the BBS with regard to bronchial obstruction on CT were analyzed. \nResults or Findings: In group A (64 fetuses, 96 MRI scans), BBS was found \nat 23+6 (20+1 - 38+3) GW in one of 25 congenital pulmonary airway \nmalformation, 14 of 15 bronchial atresia, 9 of 17 bronchopulmonary \nsequestration, two of six hybrid lesion, and none of one bronchogenic cyst \ncases. Sensitivity, specificity, PPV, NPV, and accuracy of the BBS for isolated \nor BPS-associated  bronchial obstruction were 64.9%, 95.7%, 96.0%, 62.9%, \nand 76.7%, respectively. In group B (228 fetuses, 285 fetal MRI scans), BBS \nwas found at 26+6 (19+2 to 36+3) GW in 57 of 75 BA, 55 of 74 BPS, seven of \n55 CPAM, six of eleven HL, two of nine BC, and four of four CHAOS cases. \nConclusion: The BBS is a frequent and highly specific fetal MR image marker \nof isolated or bronchopulmonary sequestration-associated bronchial \nobstruction, and may improve prenatal differential diagnosis of congenital lung \nlesions. \nLimitations: Fetal MRI scans from different centers were retrospectively \nreviewed by different radiologists. \nEthics Committee Approval: This study was approved by the respective \ninstitutional review boards. \nFunding for this study: This study received no funding. \nAuthor Disclosures: \nHelmut Prosch: Nothing to disclose \nFlorian Prayer: Nothing to disclose \nAnke Scharrer: Nothing to disclose \nChristopher Cassady: Nothing to disclose \nAmy Mehollin-Ray: Nothing to disclose \nAzadeh Hojreh: Nothing to disclose \nGerlinde Gruber: Nothing to disclose \nDaniela Prayer: Nothing to disclose \nGregor Kasprian: Nothing to disclose \n \nRPS 212-4 \nContrast-free MRI protocol for pituitary assessment in children with \ngrowth or puberty disorders \n*M. Michali Stolarska*¹, A. Tukiendorf², A. Zacharzewska-Gondek¹, J. \nChrzanowska², J. Jacków¹, J. Bladowska¹; ¹Wrocław/PL, ²Wroclaw/PL \n(marta.michali@gmail.com) \n \nPurpose: Most of the pituitary MRI examinations in children with growth or \npuberty disorders (GPD) might not require gadolinium-based contrast agent \n(GBCA) administration. \nMethods or Background: Retrospective single-center study that includes re-\nanalysis of contrast-enhanced pituitary MRI examinations of a group of children \ntreated in a tertiary reference center.The group of 567 patients met the \nfollowing inclusion criteria: age below 18 years; growth or puberty disorders. \nMRI examinations were divided into: Part1 - before contrast administration \n(reference group) and Part2 - after contrast administration. The differences in \nthe visibility of focal lesions between groups were statistically analyzed. \nResults or Findings: The overall frequency of Rathke's cleft cysts was 11.6%, \nectopic posterior pituitary 3.5% and microadenomas 0.9%. Lesions visible \nbefore contrast administration accounted for 85% of cases. Lesions, which \nwere not visible before and diagnosed only after contrast injection accounted \nfor only 0.18% of all patients. Statistical analysis showed the advantage of \nantero-posterior (AP) pituitary dimension over other criteria in determining the \nappropriateness of using contrast in pituitary MRIs. The AP dimension was the \nmost significant factor in logistic regression analysis: OR=2.23, 95%CI, 1.35 to \n3.71, p-value=0.002 and in ROC analysis: AUC:72.9% with cut-off value 7.5 \nmm, with sensitivity/specificity rates: 69.2%/73.5%. \nConclusion: In most cases, the use of GBCA in pituitary MRI in children with \nGPD is unnecessary.  \nThe advantages of GBCA omission include: shortening the time of MRI \nexamination and of general anesthesia; saving time for other examinations, \nthus increasing the availability of MRI for waiting children and acceleration in \ntheir further clinical management. \nLimitations: First, it has a retrospective design; second, none of our patients \nunderwent surgery, therefore histopathological confirmation of the diagnoses \nmade by MRI was not possible. \nEthics Committee Approval: Local ethics committee approval - opinion No. \n117/2019 \nFunding for this study: None \nAuthor Disclosures: \nMarta Michali Stolarska: Nothing to disclose \nAndrzej Tukiendorf: Nothing to disclose \nJagoda Jacków: Nothing to disclose \nJoanna Chrzanowska: Nothing to disclose \nAnna Zacharzewska-Gondek: Nothing to disclose \nJoanna Bladowska: Nothing to disclose \n \nRPS 212-6 \nDoes sevoflurane sedation or intravenous propofol administration in \nchildren lead to “pseudo” leptomeningeal enhancement in the brain on 3-\nTesla MRI? \n*K. Khandwala*, K. Hilal, S. S. M. Anwar, F. Khan, S. Rashid; Karachi/PK \n \nPurpose: The rationale of our study is prominent leptomeningeal contrast \nenhancement (LCME) is noted on MRI in some sedated children, but based on \nclinical notes and CSF analysis, they neither were acutely ill nor exhibited \nmeningeal signs. Our study aims to find out whether sevoflurane sedation or \npropofol anesthesia in children leads to ‘pseudo’ LCME on 3 Tesla MRI. \nMethods or Background: A retrospective cross sectional study was \nconducted in which MRI examinations performed for pediatric patients (aged 0-\n8 years) on a 3 Tesla system were reviewed. The degree of leptomeningeal \n\n \n \n \nA \nB C 103  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \ncontrast enhancement (LCME) was graded and evaluated by two radiologists. \nInterobserver scores were calculated by using Cohen’s Kappa. Correlations \nwere assessed using Pearson’s correlation test. \nResults or Findings: A total of 63 pediatric patients were ultimately included. \n42 patients were sedated with sevoflurane, 15 were anesthetized with propofol \nand 6 with a combination of both. There were statistically significant and \ninverse moderate correlations between patient age and LCME grade, and \nbetween weight and LMCE grade (r 0.35 each, P<0.05). Neither the type of \nanesthesia administered (sevoflurane vs propofol) nor the sedation dosage or \nduration significantly correlated with the LMCE grade. Almost perfect \ninterobserver agreement (Kappa: 0.83) was found between the two radiologists \nfor degree of LCME. \nConclusion: Pseudo LMCE is relatively common on post contrast MR imaging \nof children sedated by intravenous propofol or inhalational sevoflurane, and \ntherefore should not be mistaken for meningeal pathology. We found that this \neffect inversely correlates with age and weight. This phenomenon may be \nattributable to the immaturity of younger children’s vasculature or increased \npermeability of the blood brain barrier, but needs to be studied further with \nlarger prospective cohorts. \nLimitations: Retrospective single center study, with selection biases. \nEthics Committee Approval: Taken. \nFunding for this study: None. \nAuthor Disclosures: \nKiran Hilal: Nothing to disclose \nKumail Khandwala: Nothing to disclose \nFaheemullah Khan: Nothing to disclose \nShayan Sirat Maheen Anwar: Nothing to disclose \nSaima Rashid: Nothing to disclose \n \nRPS 212-7 \nAudit of yield of magnetic resonance imaging in idiopathic scoliosis \n*A. T. Foran*, M. Hanley, D. Mulholland, S. Ryan; Dublin/IE \n \nPurpose: Adolescent Idiopathic Scoliosis(IS) relates to a curvature of the \nspine with an unknown aetiology that occurs in 1-5.4% of children. Established \nguidelines for the use of MRI in AIS do not exist.  Some literature proposes that \nall children with idiopathic scoliosis should have MRI with a yield of significant \nfindings up to 15%. Others recommend MRI for specific indications only such \nas an atypical curve, curves of a significant magnitude or those with clinical \nneurological findings on examination \nMethods or Background: We performed a retrospective review of patients \nundergoing an initial MRI for AIS over a 4 year period to assess the yield of \nperforming MRI in these patients. We included patients aged 12 -16, referred \nthrough the National Scoliosis referral pathway to our service. We also \nidentified clinical findings or risk factors that may be associated with a positive \nfinding. We categorised patients by the King-Moe Classification and the Lenke \nClassification. \nResults or Findings: 159 MRIs performed for presumed adolescent idiopathic \nscoliosis were identified during the 4 year period November 2015-November \n2019. 18 of these had positive findings including Chiari I malformation, syrinx, \ncerebellar tonsillar ectopia and spondylolisthesis. \nConclusion: Indications for MRI scanning in presumed adolescent idiopathic \nscoliosis remains unclear. 9% of patients in our cohort had clinical findings \nwhich could potentially change management. Based on these findings it seems \nreasonable to perform an MRI in this patient population to assess for \nunderlying abnormalities to help guide management decisions. \nLimitations: Our study is limited as it is a retrospective study. \nEthics Committee Approval: Local approval from the ethics committee was \nobtained for this audit. \nFunding for this study: None \nAuthor Disclosures: \nAnn Therese Foran: Nothing to disclose \nStephanie Ryan: Nothing to disclose \nDouglas Mulholland: Nothing to disclose \nMarion Hanley: Nothing to disclose \n \nRPS 212-8 \nUltrasound (US) and magnetic resonance imaging (MRI) predictive role of \nlong-term medical outcome in native liver survivor patients with biliary \natresia (BA) after kasai portoenterostomy (KP) \n*M. Caruso*, F. Di Dato, R. Liuzzi, C. Mollica, V. Romeo, G. Vallone, P. P. \nMainenti, R. Iorio, S. Maurea; Naples/IT (caruso.martina90@gmail.com) \n \nPurpose: To assess the role of US and MRI in predicting long-term medical \noutcome in native liver survivor patients with BA after KP. \nMethods or Background: BA, a progressive fibro-obliterative bile duct \ndisease, leads to cirrhosis in absence of KP and/or liver transplantation. \nPatient follow-up includes clinical and laboratory parameters and abdominal \nUS. MRI has also been proposed. Twenty-four retrospectively enrolled patients \nwere divided in two groups according to clinical and laboratory data at initial \nevaluation after KP (median follow-up =9.7 years) as with ideal (Group 1; \nn=15) or non-ideal (Group 2; n=9) medical outcome. All patients were re-\nevaluated after 4 years using clinical and laboratory indices. US and MRI \nstudies were qualitatively analyzed assessing imaging signs suggestive of \nchronic liver disease. \nResults or Findings: At re-evaluation, 6 patients (40%) of Group 1 changed \ntheir medical outcome in non-ideal (Group 1A); the other 9 patients (60%) \nremained ideal (Group 1B). The AUC was 0.84 and 0.87 for US and MRI \nscores to predict long-term medical outcome with the best cut-off value score \n>4 for both modalities (p=0.89). In patients of Group 1, the mean time to \nchange the medical outcome in non-ideal at re-evaluation was 43.5+/-2.3 \nmonths. In Group 2, 6 (67%) patients showed a clinical disease progression, \nwhile the other 3 (33%) patients were unchanged as non-ideal status. \nConclusion: In BA patients with ideal medical outcome after KP, US and MRI \nstudies may both predict long-term medical outcome change. \nLimitations: The study population is small, but BA is a relatively rare disease \nand the correlative availability of the imaging studies is limited. A larger, \nrandomized prospective trial should be addressed. \nEthics Committee Approval: The local Institutional Review Board approved \nthe study, the need for informed consent was waived. \nFunding for this study: None. \nAuthor Disclosures: \nFabiola Di Dato: Nothing to disclose \nValeria Romeo: Nothing to disclose \nRaffaele Liuzzi: Nothing to disclose \nPier Paolo Mainenti: Nothing to disclose \nGianfranco Vallone: Nothing to disclose \nCarmine Mollica: Nothing to disclose \nRaffaele Iorio: Nothing to disclose \nMartina Caruso: Nothing to disclose \nSimone Maurea: Nothing to disclose \n \nLive Q&A \n \n14:15-15:15 CHANNEL 2 \nSpecial Focus Session \nSF 12 \nLiver transplantation: imaging and \nintervention \nModerator \nAndrzej Cieszanowski; Warsaw/PL  \n \nSF 12-2 \nPreoperative: what to know \nValérie Vilgrain; Clichy/FR  \n \nLearning Objectives: \n1. To learn how imaging impacts on clinical decision making for liver \ntransplantation. \n2. To understand the selection criteria for transplantation in HCC patients. \n3. To appreciate the role of biopsy and interventional radiology in pre-\ntransplant patient management. \n \nSF 12-3 \nPostoperative and follow-up: what to expect and what goes wrong \nRossano Girometti; Udine/IT \n(rgirometti@sirm.org) \n \nLearning Objectives: \n1. To appreciate the early and late complications of liver transplantation. \n2. To understand the role of multimodality imaging for the diagnosis. \n3. To understand the prognostic factors that may change patient management. \n \nSF 12-4 \nThe role of interventional radiology in treating complications \nAllan Bloom; Jerusalem/IL \n(allan@hadassah.org.il) \n \nLearning Objectives: \n1. To learn about the complications of liver transplantation that are treatable \nthrough interventional radiology. \n2. To understand the clinical results emphasising the failure rates of IR \ntechniques. \n3. To appreciate the future direction of IR in the liver. \n \nLive Q&A: Can radiology expand its role for patient management? \n\n \n \n \nA \nB C 104  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \n14:15-15:15 CHANNEL 3 \nRefresher Course: Cardiac \nRC 203 \nThe radiologist at the centre of the heart \nteam \nModerator \nTim Leiner; Utrecht/NL  \n \nRC 203-2 \nA. The value of CT/MRI in non-surgical cardiac valve replacement \nRodrigo Salgado; Antwerp/BE  \n(rodrigo.salgado@uza.be) \n \nLearning Objectives: \n1. To understand the clinical indications for transcatheter interventions in \ndifferent cardiac valves. \n2. To understand the difficulties in correctly assessing cardiac valvular \nanatomy and its therapeutic implications. \n3. To correctly identify and report key issues which may influence procedural \nsuccess and patient prognosis. \n \nRC 203-3 \nB. Diagnosing native and prosthetic heart valve endocarditis: how can \nthe radiologist help? \nGudrun Feuchtner; Innsbruck/AT \n(Gudrun.Feuchtner@i-med.ac.at) \n \nLearning Objectives: \n1. To understand the aetiology and clinical presentation of endocarditis.  \n2. To understand the current guidelines for diagnosis and treatment and the \nrole of CT/MRI imaging. \n3. To become familiar with common and uncommon imaging presentations of \nendocarditis and its pitfalls. \nAuthor Disclosures: \nGudrun Feuchtner: Advisory Board: Sanofi Aventis, Amgen \n \nRC 203-4 \nC. The radiologist as a member of the heart team: what the guidelines say \nand future perspectives \nJean-Nicolas Dacher; Rouen/FR \n(jndacher@gmail.com) \n \nLearning Objectives: \n1. To understand the role of multidisciplinary heart teams. \n2. To learn how heart teams are implemented in the current guidelines. \n3. To evaluate the current position of the radiologist, and the challenges ahead. \nAuthor Disclosures: \nJean-Nicolas Dacher: Consultant: Takeda, Bayer, Microport; Investigator: \nTakeda Shire,  Microport; Speaker: Siemens, GE HealthCare, Bayer \n \nLive Q&A: How to empower the radiologist’s clinical role in the setting of \na heart team? \n \n14:15-15:15 CHANNEL 5 \nResearch Presentation Session: Physics \nin Medical Imaging \nRPS 213 \nPatient dose: the neverending story \nModerator \nIoannis Sechopoulos; Nijmegen/NL  \n \nRPS 213-2 \nDose reduction in photon-counting CT by ultra-high resolution \nacquisitions compared to today’s iterative reconstructions: combined \nbenefits of the “iodine effect” and the “small pixel effect” \n*S. Sawall*, L. Klein, E. Wehrse, C. Amato, J. Maier, C. H. Ziener, H-P. \nSchlemmer, S. Heinze, M. Kachelrieß; Heidelberg/DE  \n(stefan.sawall@dkfz.de) \nPurpose: To evaluate the potential noise/dose-reduction of an ultra-high \nresolution (UHR) photon-counting (PC) detector compared to today’s iterative \nreconstructions of energy-integrating (EI) data. \nMethods or Background: Images of an abdomen phantom with different sizes \nequipped with iodine vials were acquired at the SOMATOM CounT (Siemens \nHealthineers, Germany) CT system, an experimental CT housing an EI and a \nPC detector. 120 kV acquisitions were performed at matched CTDI with tube \ncurrents between 35 to 300 mAs using the EI detector and the UHR-mode of \nthe PC detector. Resolution-matched reconstructions of EI data were \nperformed using an iterative reconstruction (SAFIRE strength 1-5) while the PC \ndata were reconstructed using filtered backprojection (FBP). The “small pixel \neffect” predicts a noise-reduction in the PC images and the “iodine effect” an \nincreased iodine contrast in PC data. Noise and contrast-to-noise ratio (CNR) \nwere compared to conventional FBP reconstructions of EI data at the same \ndose and spatial resolution. All results are verified in a post-mortem \nangiography study. \nResults or Findings: UHR acquisitions allow for a dose reduction of 58% \ncompared to EI-FBP at the same dose and resolution. EI-SAFIRE \nreconstructions allow for a dose reduction of 25%-87%. The noise level found \nin UHR reconstructions is similar to EI-SAFIRE(2) while the CNR is similar to \nEI-SAFIRE(3) due to the “iodine effect”. These results hold for all phantom \nsizes and were confirmed in a post-mortem angiography study. \nConclusion: Thanks to the iodine effect and the small pixel effect, photon-\ncounting UHR allow for a dose-reduction similar to iterative reconstructions \nwhile using conventional FBP thereby providing classical, well-defined image \nquality metrics. \nLimitations: No patient data are available since the described experiments \nwould require multiple measurements. \nEthics Committee Approval: The post-mortem experiments were approved \nby the local ethics committee (S-021/2020). \nFunding for this study: Not applicable. \nAuthor Disclosures: \nLaura Klein: Nothing to disclose \nChristian Herbert Ziener: Nothing to disclose \nSarah Heinze: Nothing to disclose \nCarlo Amato: Nothing to disclose \nHeinz-Peter Schlemmer: Nothing to disclose \nMarc Kachelrieß: Nothing to disclose \nStefan Sawall: Nothing to disclose \nEckhard Wehrse: Nothing to disclose \n Joscha Maier: Nothing to disclose \n \nRPS 213-3 \nRadiation risk minimising tube current modulation (rmTCM) for x-ray \ncomputed tomography \n*J. Maier*¹, L. Klein¹, S. Sawall¹, C. Liu², A. Maier², M. Lell³, M. Kachelrieß¹; \n¹Heidelberg/DE, ²Erlangen/DE, ³Nuremberg/DE \n \nPurpose: Tube current modulation (TCM) aims at minimizing radiation dose \nwhile maintaining image quality. In contrast to clinical implementations that are \nbased on the minimization of the mAs product, this study investigates the \npotential of modulating the tube current to minimize the radiation risk instead. \nMethods or Background: TCM adjusts the tube current during gantry rotation \nas well as along z-direction. In today’s clinical CT systems, the modulation \ncurve is determined according to the patient attenuation that is estimated either \nfrom the topogram or by an online feedback loop. To extend the concept of \nTCM to also take into account the radiation risk, additional prior knowledge of \nthe dose distribution is necessary. Here, we use the deep dose estimation \n(DDE) algorithm that estimates patient-specific dose distributions, and thus the \neffective dose, in real-time using a neural network. Including DDE in the \nconventional optimization routine allows to determine a TCM curve that \nminimizes the radiation risk. The performance of the proposed approach was \nevaluated for clinical CT simulations using different tube voltages, different \nanatomical regions, and different scan trajectories. \nResults or Findings: Compared to a conventional TCM that minimized the \nmAs product, rmTCM is able to reduce the effective dose by about 12% on \naverage for 70 kV scans, 8% for 120 kV scans, and 7% for 150 kV scans. In \nany case, the highest effective dose reductions of up to 20% were achieved in \nthe thorax region. \nConclusion: Recent developments in the field of deep learning, such as the \ndeep dose estimation, open new options for automatic TCM. Using this \nadditional prior knowledge allows to modulate the tube current to minimize the \neffective dose, and thus, to further reduce the radiation risk of CT \nexaminations. \nLimitations: Na \nEthics Committee Approval: Na \nFunding for this study: Na \n \nAuthor Disclosures: \nChang Liu: Nothing to disclose \nLaura Klein: Nothing to disclose \nAndreas Maier: Nothing to disclose \n\n \n \n \nA \nB C 105  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \nMichael Lell: Nothing to disclose \nMarc Kachelrieß: Nothing to disclose \nStefan Sawall: Nothing to disclose \nJoscha Maier: Nothing to disclose \n \nRPS 213-4 \nThe VCT_BREAST virtual clinical trial for 2D and 3D x-ray breast imaging \nand dosimetry \n*G. Mettivier*¹, A. Sarno¹, K. Bliznakova², A. Hernandez³, X. Jia ຾, Y. Lai຾, \nB. Golosio຿, M. C. Staffa¹, J. M. Boone³; ¹Naples/IT, ²Varna/BG, ³Sacramento, \nCA/US, ຾Dallas, TX/US, ຿Cagliari/IT \n(mettivier@na.infn.it) \n \nPurpose: We present the VCT_BREAST project, for the realization of virtual \nclinical trials (VCTs) for imaging and dosimetry research in breast computed \ntomography (BCT), digital breast tomosynthesis (DBT) and digital \nmammography (DM). \nMethods or Background: VCT_BREAST is an ongoing Monte Carlo (MC) \nbased VCT project for performing in-silico x-ray examinations of the breast. \nVirtual imaging of the compressed or uncompressed breast is simulated using \nimaging techniques that closely replicate clinical exams in terms of breast \nanatomy, system geometry, x-ray spectrum, imaging detection process and \nabsorbed dose. The MC simulations replicate the 2D or 3D exam and run on \nboth a CPU platform and a GPU OpenCL based cross-platform adopting GPU \naccelerating engines for simulation of the imaging datasets and 3D maps of the \nglandular dose. Patient-derived, anatomically realistic, computational \nphantoms of the uncompressed breast are generated using a tissue \nclassification algorithm on BCT images. Correspondingly, we derived \ncompressed breast models, via a computational tissue compression process. \nThe dataset comprised 150 voxelized 3D breast phantoms and 60 compressed \nphantoms. Additional patient-like phantoms will be generated following a data \naugmentation scheme, by means of a machine learning computational \nnetwork. \nResults or Findings: Glandular dose distributions and virtual exams for BCT, \nDBT and DM were simulated using exemplary patient-derived anatomically \nrealistic breast phantoms with different characteristics (shape, size and \nglandularity) derived from clinical BCT scans. \nConclusion: VCT_BREAST aims at VCTs for technology assessment and \ninnovation in particular in DBT and BCT.  This work presents the first VCT \nproject for combined 2D and 3D x-ray breast imaging on a cohort of virtual \npatients, showing the present status of the project focused on the development \nof the software and hardware platform  as well as assessing its overall \nperformance. \nLimitations: No \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nXu Jia: Nothing to disclose \nMaria Carla Staffa: Nothing to disclose \nJohn M. Boone: Nothing to disclose \nBruno Golosio: Nothing to disclose \nYoufang Lai: Nothing to disclose \nKristina Bliznakova: Nothing to disclose \nGiovanni Mettivier: Nothing to disclose \nAntonio Sarno: Nothing to disclose \nAndrew Hernandez: Nothing to disclose \n \nRPS 213-5 \nPrimary results of large-scale size-specific dosimetry in chest \nradiography \n*A. S. L. Dedulle*, N. Fitousi, H. Bosmans; Leuven/BE \n(an.dedulle@qaelum.com) \n \nPurpose: Although the need for personalized dosimetry in Computed \nTomography has been highlighted in literature, it has not been extensively \ninvestigated in projection radiography. In earlier work we have shown how to \nestimate a water equivalent diameter (WED) from DICOM-tags in projection \nimages. This study presents the first results using this WED to select size-\nspecific dose conversion factors. \nMethods or Background: Chest posterior-anterior radiographies performed \nbetween 2015 and 2019 (2671 examinations) were extracted with a dose \nmanagement software (DOSE, Qaelum) and the WED was estimated. Patient-\nspecific effective dose and organ doses (lungs, breasts, thyroid) were \ncalculated by applying size-specific conversion factors. The conversion factors \nwere generated from 44 voxel models of various sizes using a dedicated \nMonte Carlo framework. \nResults or Findings: The estimated WED ranged from 19cm to 38cm \n(median:26cm). Mean patient-specific effective dose was 12±3 ȝSv \n(range:6ȝSv-36ȝSv), with increasing dose for increasing WED (p<0.05). If, as \nroutinely done, only 1 standard-size conversion factor would be used, the \nincrease would be steeper and only attributed to the increase of dose area \nproduct (DAP) for larger patients. Lung dose was the highest among the \norgans investigated (range:13ȝSv-81ȝSv), followed by the thyroid dose \n(range:3ȝSv-31ȝSv) and both correlated with WED (R2=0.59-0.80). The breast \ndose (range:3ȝSv-12ȝSv) had weak correlation with WED: R2 of 0.01 (males) \nand 0.23 (females), which can be linked to the position of breast closer to the \ndetector and the corresponding shielding effect. \nConclusion: A novel methodology made large-scale size-adjusted dosimetry \nfor chest radiography feasible, by using only information available through \ndose management systems. Evaluating the patient-specific effective dose for \ndifferent sizes shows the limitation of older methods that were only based on \nthe change in exposure parameters. \nLimitations: Not applicable. \nEthics Committee Approval: Not applicable. \nFunding for this study: PhD grant VLAIO [HBC.2016.0233]. \nAuthor Disclosures: \nAn Saskia Luc Dedulle: Employee at Qaelum NV, Research/Grant Support at \nVLAIO grant (HBC.2016.0233) \nHilde Bosmans: Founder at Qaelum NV, Board Member at Qaelum NV \nNiki Fitousi: Employee at Qaelum NV \n \nRPS 213-6 \nImpact of dose reduction and iterative reconstruction on spectral \nperformance of a dual-source CT system: task-based image quality and \niodine quantification assessment \n*D. Dabli*, J. Frandon, P. Akessoul, A. Belaouni, A. Hamard, J-P. Beregi, \nJ. Greffier; Nîmes/FR \n(Djamel.Dabli@chu-nimes.fr) \n \nPurpose: To assess the impact of dose reduction and the use iterative \nreconstruction (ADMIRE) on image quality in low-energy virtual monochromatic \nimages (VMIs) and on iodine quantification from a Dual-source Dual Energy \nCT (DSCT). \nMethods or Background: Two CT phantoms were scanned with a third \ngeneration DSCT using classical parameters of abdomen-pelvic examination \nfor three dose levels (CTDIvol: 11/8/5 mGy). Raw-data were reconstructed \nusing Filtered Back Projection (FBP) and two levels of ADMIRE (A3/A5). The \nnoise-magnitude and noise-texture was assessed using the Noise power \nspectrum (NPS) and the spatial resolution using the task-based transfer \nfunction (TTF), for six low energy levels on VMIs. The iodine concentration \naccuracy was assessed with four different concentrations (2, 5, 10, 15 mg/ml) \nusing root-mean-square deviation (RMSDiodine). \nResults or Findings: Noise-magnitude was reduced between 40 to 70 keV by \n-80%±1%, -83%±1% and -86%±1% with FBP; A3 and A5, respectively. The \nmean spatial frequency of the NPS peaked at 70 keV and decreased as \nADMIRE level increased. TTF values at 50% were highest at 40 keV and \nshifted towards lower frequencies as the keV increased. The difference \nbetween the measured and theoretical concentrations increased for 5 mGy \nlevel at 2 and 5 mg/ml. The RMSDiodine were similar for 11 and 8 mGy (0.35 \nmg/ml) and increased at 5 mGy (0.42 mg/ml). \nConclusion: At low keV on VMIs, the study confirmed that iterative \nreconstruction reduced the noise magnitude, improved the spatial resolution. \nNo effect of ADMIRE on iodine quantification accuracy but this accuracy \ndecreased at low dose for low iodine concentration. \nLimitations: One of the five kVp pairs available on this DSCT for a single \nstandard reconstruction kernel was used and no assessment of the phantom \nsizes impact. \nEthics Committee Approval: Not concerned. \nFunding for this study: No funding. \nAuthor Disclosures: \nJean-Paul Beregi: Nothing to disclose \nAymeric Hamard: Nothing to disclose \nJulien Frandon: Nothing to disclose \nJoel Greffier: Nothing to disclose \nPhilippe Akessoul: Nothing to disclose \nAsmaa Belaouni: Nothing to disclose \nDjamel Dabli: Nothing to disclose \n \nRPS 213-7 \nLens dose measurement during CT exams with new plastic scintillation \ndosimetry system \n*C. Popotte*¹, M. Munier², D. Paul³; ¹Strasbourg/FR, ²Entzheim/FR, ³Lyon/FR \n \nPurpose: Assess the dose delivered to the lens during CT exams in real time. \nMethods or Background: Plastic scintillation dosimeters (PSD) from \nFibermetrix company where used on a Somatom Edge (Siemens) CT scan in \norder to monitor the following dose indexes CTDIvol and DLP, and absorbed \ndose. As the lens diameter vary between 6,5mm and 9mm, especially \naccording to the patient’s age, the influence of acquisition parameters on the \ndose received in the lens area was evaluated with plastic scintillating point \ndosimeters ranging from 5mm to 15mm of length. IVIscan® PSD and CT \n\n \n \n \nA \nB C 106  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \ndisplayed dose indexes were compared for routine skull CT exams and for \nabout 40 anthropomorphic phantom acquisitions. \nResults or Findings: Discrepancies up to +50% between the measured dose \nby the IVIscan® PSD and the CTDIvol calculated by the CT scan were \nobserved for patients receiving CT scans in the lens area. An investigation \nusing IVIscan® measurements tools allowed to identify the origin of these \ndiscrepancies as mA modulation with patient positioning issues. When \nchanging the pitch for the anthropomorphic phantoms from 0,6 to 1,5 the dose \nrelative standard variation was, for a 15mm long point PSD, 1,9% and 6,9% \nrespectively. Same measurements realized with a 5mm long point PSD \nshowed a relative standard variation of 2,7% and 8,9% respectively. Using a \n5mm long point PSD, variations up to 30% were observed in the lens region \nwith a pitch of 1,5. \nConclusion: The study showed that sometimes dose variations in the lens \narea cannot be assessed by the usual dose indexes. \nLimitations: Based on these results, further investigations has to be carried \nusing point PSD to get a closer understanding of dose variations in the lens \narea depending on both anatomical and physical parameters. \nEthics Committee Approval: Approved. \nFunding for this study: None. \nAuthor Disclosures: \nChristian Popotte: Nothing to disclose \nMme. Mélodie Munier: Founder at Fibermetrix \nDidier Paul: Nothing to disclose \n \nLive Q&A \n \n15:30-16:30 CHANNEL 2 \nESR EIBALL Session \nESR EIBALL \nNavigating an imaging biomarker from \nconcept into the clinic \nModerator \nNandita M. deSouza; Sutton/UK  \n \nESR EIBALL-2 \nLaunching a biomarker (Biomarker x) successfully into clinical practice \nMarion Smits; Rotterdam/NL  \n(marion.smits@erasmusmc.nl) \n \nLearning Objectives: \n1. To learn what makes a successful biomarker. \n2. To appreciate the necessary steps and processes required. \n3. To understand the pathway used in the case of a successfully launched \nbiomarker. \nAuthor Disclosures: \nMarion Smits: Consultant: Parexel Ltd, honorarium paid to institution; Speaker: \nGE Healthcare, honorarium paid to institution \n \nESR EIBALL-3 \nGlobal networking to promote biomarker development and use \nXavier Golay; London/UK \n \nLearning Objectives: \n1. To learn about the relevant groups involved in biomarker development and \nvalidation. \n2. To appreciate the on-going networking activities. \n3. To understand the gaps in knowledge and how networking could address \nthem. \nAuthor Disclosures: \nXavier Golay: CEO: Gold Standard Phantoms \n \nESR EIBALL-4 \nExploiting artificial intelligence (AI) for rapid biomarker development, \nvalidation, and interpretation \nAngel Alberich-Bayarri; Valencia/ES \n \nLearning Objectives: \n1. To learn how AI has the potential for identifying and validating biomarkers. \n2. To appreciate the role of AI in data driven interpretation. \n3. To understand the limitations in AI-driven biomarker interpretation. \nAuthor Disclosures: \nAngel Alberich-Bayarri: CEO: QUIBIM S.L. \n \nLive Q&A: When should imaging biomarkers be used as decision-support \ntools? \n \n15:30-16:30 CHANNEL 3 \nE³ - ECR Master Class \nE³ 826 \nImplants in the head and neck \nModerator \nAlexandra Borges; Lisbon/PT  \n \nE³ 826-2 \nA. Otological implants \nBerit Verbist; Leiden/NL  \n(b.m.verbist@lumc.nl) \n \nLearning Objectives: \n1. To become familiar with the types and locations of otological implants. \n2. To learn about optimal imaging strategies for such implants. \n3. To become acquainted with the key imaging features to report. \nAuthor Disclosures: \nBerit Verbist: Research Grant/Support: insitutional: Cochlear, Advanced \nBionics \n \nE³ 826-3 \nB. Cosmetic facial implants \nPolly Richards; London/UK \n \nLearning Objectives: \n1. To become familiar with the types of compounds used in cosmetic facial \nimplants. \n2. To learn about the types of procedures patients may have undergone. \n3. To recognise the relevant imaging features and post-procedural \ncomplications. \n \nE³ 826-4 \nC. 3D printed implants in the skull: what's new and what's required? \nMaurice Mommaerts; Brussels/BE \n \nLearning Objectives: \n1. To learn about differing types of dental and maxillofacial implants. \n2. To be familiar with the imaging appearance of such implants. \n3. To understand what the surgeon wants to know in your report. \n \nE³ 826-5 \nCase presentation \nAlexandra Borges; Lisbon/PT \n(borgalexandra@gmail.com) \n \nLive Q&A \n \n15:30-16:30 CHANNEL 4 \nProfessional Challenges Session \nPC 5 \nThe state-of-the-art of everyday radiation: \nbenefit-risk communication \nModerators \nPaddy Gilligan; Dublin/IE  \nCatherine Owens; London/UK  \n \nPC 5-3 \nThe patient has a right to know: what the EU Directive 2013/59 tells us \nCarmel J. Caruana; Msida/MT \n(carmel.j.caruana@um.edu.mt) \n \n \n \n \n \n\n \n \n \nA \nB C 107  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \nLearning Objectives: \n1. To learn about the ethical and legal rights and obligations for patients and \nstaff regarding risk. \n2. To understand who has to communicate the benefit-risk information. \n3. To become familiar with how the new standards can be implemented in a \npractical manner. \n \nPC 5-4 \nThe patient's perspective is all that matters: what do they need to hear? \nErik Briers; Hasselt/BE \n(erikbriers@telenet.be) \n \nLearning Objectives: \n1. To learn why a patient-centred approach is important. \n2. To understand the guidelines and the recommendations of the ESR patient \nadvisory group. \n3. To become familiar with how the new standards can be implemented in a \npractical manner for different patient groups. \n \nPC 5-5 \nCommunicating risks with parents and caretakers of paediatric patients \nElly Castellano; London/UK \n(elly.castellano@rmh.nhs.uk) \n \nLearning Objectives: \n1. To learn the importance of the communication of benefit-risk information to \nthis sensitive group. \n2. To understand the challenges and how they might be overcome. \n3. To become familiar with how the above can be achieved in a practical \nmanner. \n \nPC 5-6 \nRadiation risk in pregnancy: what should the woman be informed of? \nFranz Kainberger; Vienna/AT \n \nLearning Objectives: \n1. To learn the importance of the communication of benefit-risk information to \nthis radiosensitive cohort. \n2. To understand the challenges and how they might be overcome. \n3. To become familiar with how the above can be achieved in a practical \nmanner. \n \nLive Q&A: Do we need to improve our risk communication skills? How? \n \n15:30-16:30 CHANNEL 5 \nResearch Presentation Session: Chest \nRPS 204 \nBody composition, COVID-19, and \ninterstitial diseases in chest imaging \nModerator \nJürgen Biederer; Heidelberg/DE  \n \nRPS 204-2 \nCan sarcopenia on preoperative chest computed tomography predict \ncancer-specific and all-cause mortality following pneumonectomy for \nlung cancer? A bi-institutional study \nF. Troschel¹, *F. J. Fintelmann*², T. Muley³, F. Eichhorn³, T. D. Best², A. \nTroschel², H. Winter³, H. A. Gaissert², C. P. Heussel³; ¹Münster/DE, ²Boston, \nMA/US, ³Heidelberg/DE  \n \nPurpose: Sarcopenia on preoperative computed tomography (CT) has been \nassociated with overall survival (OS) following pneumonectomy for non-small \ncell lung cancer (NSCLC). We hypothesized that thoracic sarcopenia \nindependently predicts worse cancer-specific survival (CSS) and OS. \nMethods or Background: This retrospective cohort study included \nconsecutive pneumonectomies for primary NSCLC performed at \nMassachusetts General Hospital and Heidelberg University Hospital from 2010 \nto 2018. Muscle cross-sectional area was quantified on standard preoperative \nchest CT at three thoracic vertebral levels (T8, T10 and T12). Sarcopenia was \ndefined as two standard deviations below the muscle cross-sectional area at \nT10 of healthy controls. Time-to-event analyses adjusted for age, body mass \nindex, Charlson Comorbidity Index, forced expiratory volume in 1 second in % \npredicted, induction therapy, sex, smoking status, tumor stage, and laterality \nwere performed. The likelihood-ratio test was used to assess whether the \naddition of sarcopenia improved model fit. \nResults or Findings: 367 included patients were predominantly male with a \nmedian age of 62 years. Most patients underwent standard pneumonectomy \nfor stage IIIA (46%) and squamous cell histology (58%). Sarcopenia was \npresent in 104 patients (28%). After a median follow-up of 20.5 months \n(interquartile range, 9.2-46.9), 183 of 367 patients (50%) had died and 133 \ndeaths (72.7%) were due to cancer. Sarcopenia was associated with shorter \nCSS (hazard ratio [HR] 1.7, p=0.008) and OS (HR 1.7, p=0.003). Sarcopenia \nimproved model fit (p=0.009). \nConclusion: This bi-institutional study demonstrates that sarcopenia on \npreoperative chest computed tomography is an independent risk factor for CSS \nand OS following pneumonectomy for NSCLC. \nLimitations: First, retrospective design. Second, imbalance between the two \ncenters with one contributing significantly more patients. Third, inability to \ninclude race/ethnicity because this variable is not commonly collected in \nEurope. \nEthics Committee Approval: Yes \nFunding for this study: None \nAuthor Disclosures: \nThomas Muley: Nothing to disclose \nFlorian Eichhorn: Nothing to disclose \nClaus Peter Heussel: Nothing to disclose \nFabian Troschel: Nothing to disclose \nTill D. Best: Nothing to disclose \nFlorian J. Fintelmann: Grant Recipient at American Roentgen Ray Society \nHauke Winter: Nothing to disclose \nHenning A. Gaissert: Nothing to disclose \nAmelie Troschel: Nothing to disclose \n \nRPS 204-3 \nThe impact of chest CT body composition parameters on clinical \noutcomes in COVID-19 patients \n*G. Besutti*¹, M. Pellegrini¹, M. Ottone¹, E. Bonelli¹, G. Ligabue², M. Cantini², \nG. Guaraldi², P. Giorgi Rossi¹, P. Pattacini¹; ¹Reggio Emilia/IT, ²Modena/IT \n \nPurpose: To evaluate the impact of chest CT body composition parameters at \nemergency room presentation on COVID-19 outcomes and disease severity. \nMethods or Background: All consecutive COVID-19 patients who underwent \nchest CT at the emergency room from 27/02/2020 to 13/03/2020 were \nincluded. Pectoralis muscle density (MD), and total, visceral, and intermuscular \nadipose tissue areas (TAT, VAT, and IMAT) at T7-T8 vertebrae were \nretrospectively measured on chest CT and included in models adjusted for sex, \nage, and calendar period. Outcomes were: C-reactive protein (CRP), oxygen \nsaturation (SO2), and CT disease extension at presentation, hospitalization, \nmechanical ventilation (MV) and/or death, death within 45 days. \nResults or Findings: We included 318 patients (median age 65.7 years, \nfemales 37.7 %); 205 (64.47%) hospitalizations and 58 (18.24%) deaths \noccurred, and 97 (30.5%) patients died or needed MV. Decreased MD was a \nrisk factor for hospitalization and MV/death, with a borderline effect on death \n(OR for the first vs last quartile=1.409;95%CI=0.399-4.973). Increased TAT, \nVAT, and IMAT were risk factors for hospitalization and MV/death, with a \nborderline effect of VAT and IMAT on death (OR for the last vs first \nquartile=3.096;95%CI=0.809-11.852, OR for the last vs first \nquartile=1.615;95%CI=0.431-6.053, respectively). All these parameters were \nsimilarly associated with worst SO2 and CT disease extension, while the \nassociation with CRP was stronger for VAT. Mediation analysis showed that \napproximately 3% of the effect of age on death was mediated by decreased \nMD. \nConclusion: Sarcopenia and ectopic fat accumulation are associated with \nCOVID-19 severity and outcomes. VAT is associated with inflammatory \nreaction in COVID-19. Sarcopenia appears to be one of the mechanisms for \nthe extremely strong effect of age on COVID-19 mortality. \nLimitations: Observational single-center study; height was not available hence \nskeletal muscle index was not calculated. \nEthics Committee Approval: AVEN (number:2020/0045199). \nFunding for this study: None. \nAuthor Disclosures: \nPierpaolo Pattacini: Nothing to disclose \nMassimo Pellegrini: Nothing to disclose \nGuido Ligabue: Nothing to disclose \nEfrem Bonelli: Nothing to disclose \nMichele Cantini: Nothing to disclose \nPaolo Giorgi Rossi: Nothing to disclose \nGiulia Besutti: Nothing to disclose \nMarta Ottone: Nothing to disclose \nGiovanni Guaraldi: Nothing to disclose \n \n \n \n \n\n \n \n \nA \nB C 108  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \nRPS 204-4 \nPost-COVID-19 interstitial lung syndrome (P-COILS): HRCT findings after \nsix months \n*D. Cozzi*, E. Cavigli, C. Moroni, A. Bindi, S. Luvarà, V. Luzzi, S. Tomassetti, \nV. Miele; Florence/IT \n(dilettacozzi@gmail.com) \n \nPurpose: Chronic-pulmonary HRCT changes after COVID-19 remains \nunexplored.The aim of the study is to describe HRTC interstitial changes \noccurring 6-months after the admission for COVID-19. \nMethods or Background: This is a single-center interim-analysis of a larger \nprospective-multicenter-national trial involving 12 Italian referral centers for \nILDs. We describe the first cases enrolled in September-October 2020 at \nCareggi University Hospital, Florence(IT).A team of dedicated-thoracic \nradiologists evaluated at 6-months all patients that recovered from COVID-\n19.The presence of significant lung involvement was defined accordingly to \ncurrent “interstitial-lung-abnormalities” definition as non-dependent \nabnormalities affecting more than 5%of any lung zone. \nResults or Findings: Finally 89 HRCT were evaluated: 49/89(55%) had a \ncomplete remission from lung involvement. Of the 40 subjects(45%) with \npersistent changes at HRCT, we found 22(24.7%)with subpleural-lines and \n21(23.6%)with interstitial thickening with perilobular pattern.Ground-glass-\nopacities were still appreciable in 14 (15.7%)and traction bronchiectasis in \n13(14.6%).Only 3(3.4%)had a OP-like pattern and 1.1% a UIP-like fibrosis.One \npatient(1.1%) had cystic changes in lower lobes. \nConclusion: These preliminary results show that almost a half(45%) of \npatients that recovered from COVID-19 have persistent HRCT changes 6-\nmonths after the acute infection.A small minority(1%) present with the typical \nUIP pattern observed in IPF.The vast majority presents with \nsubpleural/perilobular lines, mild ground-glass and signs of fibrotic changes \n(traction bronchiectasis), possible expression of the slowly-healing OP/DAD \npattern observed in the acute phase. \nLimitations: These are preliminary-descriptive results of a limited-number of \ncases from a national trial still ongoing.The trial was designed to define the risk \nfactors for development of long-term-pulmonary sequelae of COVID-19, detect \npossible novel biomarkers for disease progression(including BAL and \nhistopathology assessment).The clinical meaning of the observed HRCT \nchanges remains unclear: we can’t exclude that the minority of UIP pattern \ndetected might be expression of a pre-existing non-recognized UIP/IPF. \nEthics Committee Approval: Yes(Ref.PCOILS) \nFunding for this study: None \nAuthor Disclosures: \nAlessandra Bindi: Nothing to disclose \nVittorio Miele: Nothing to disclose \nSilvia Luvarà: Nothing to disclose \nSara Tomassetti: Nothing to disclose \nEdoardo Cavigli: Nothing to disclose \nValentina Luzzi: Nothing to disclose \nChiara Moroni: Nothing to disclose \nDiletta Cozzi: Nothing to disclose \n \nRPS 204-5 \nPulmonary cysts as a diagnostic indicator of Birt-Hogg-Dubé syndrome \nin patients with renal cell carcinoma \n*A. H. Ashok*, T. J. Sadler, S. Scullion, S. Karia, J. Babar, S. J. Marciniak, \nG. Stewart, E. Maher, M. T. A. Wetscherek; Cambridge/UK \n \nPurpose: Birt–Hogg–Dubé syndrome (BHD) is an autosomal dominant \ndisorder, characterised by skin fibrofolliculomas, lung cysts, spontaneous \npneumothorax and increased risk of renal cell carcinoma(RCC). The incidence \nof BHD in RCC has not been systematically evaluated in previous studies. The \npurpose of our study was  to assess the presence of pulmonary cysts in \npatients who underwent nephrectomy for RCC as a potential indicator of BHD \nsyndrome. \nMethods or Background: We retrospectively assessed the presence of lung \ncysts on chest CT of all patients with records of nephrectomy for RCC in the \npast 6 years. We investigated if the patients fulfilled the diagnostic criteria in \nthe European BHD Consortium statement (1 major criteria: genetically \nconfirmed Folliculin germline mutation, or two minor criteria: multiple/lower \nzone predominant lung cysts, and either age <50 years-old at diagnosis of \nRCC, multiple/bilateral RCC, or particular RCC histology). \nResults or Findings: Among the 1288 patients with RCC, 120 (9.3%, age at \ntime of diagnosis 61±11 years, M:F 88:32) had at least one pulmonary cyst. \nTwenty-seven patients (2.1%) fulfilled the BHD consortium criteria: three cases \nhad genetically confirmed BHD, while 24 patients (1.9%) met at least two minor \ncriteria: <50 years old at the time of diagnosis (n=20), multifocal or bilateral \nRCC (n=4), mixed type tumour at histology (n=2). Further genetic evaluation in \npatients with suspicious imaging appearance of BHD is in progress. \nConclusion: This is the first study to investigate the incidence of BHD in a \nlarge cohort of RCC. Although BHD remains a rare condition, patients with a \ncombination of RCC and pulmonary cysts may need further clinical and genetic \nworkup and radiologists should be aware of this diagnosis. \nLimitations: Genetic data not available in all patients. \nEthics Committee Approval: This work was approved as service \nimprovement project. \nFunding for this study: None \nAuthor Disclosures: \nTimothy Sadler: Nothing to disclose \nEamonn Maher: Nothing to disclose \nStephen Scullion: Nothing to disclose \nMaria Teodora Antuaneta Wetscherek: Nothing to disclose \nSumit Karia: Nothing to disclose \nJudith Babar: Nothing to disclose \nAbhishekh Hulegar Ashok: Nothing to disclose \nStefan J. Marciniak: Nothing to disclose \nGrant Stewart: Nothing to disclose \n \nRPS 204-6 \nThe effects of anticoagulant treatment on thromboembolic lesions at \nCTPA in patients with acute pulmonary embolism with an ultimate \ndiagnosis of CTEPH \n*N. J. Braams*¹, G. Boon², F. de Man¹, P. den Exter², L. Kroft², L. F. Beenen¹, \nF. Klok², H. J. Bogaard¹, L. J. Meijboom¹; ¹Amsterdam/NL, ²Leiden/NL \n(n.braams@amsterdamumc.nl) \n \nPurpose: Chronic thromboembolic pulmonary hypertension (CTEPH) is \ndescribed as the most severe consequence of acute pulmonary embolism \n(APE). However, signs of chronic PE may already be present at the APE CT \npulmonary angiogram (CTPA), which may predispose for CTEPH. The effect of \nanticoagulant treatment on various thromboembolic lesions is yet unknown.  \nWe aimed to investigate the effect of anticoagulant treatment on various \nthromboembolic lesions at CTPA in patients with APE with an ultimate \ndiagnosis of CTEPH. \nMethods or Background: We analyzed baseline CTPA (i.e. at APE diagnosis) \nand follow-up CTPA in 41 patients with CTEPH (cases) and 124 patients \nwithout CTEPH at follow-up (controls). All patients received anticoagulant \ntreatment. Segmental pulmonary arteries were scored as normal or affected \n(as defined by a total occlusion by thrombus, central thrombus, mural \nthrombus, web or tapered pulmonary artery) by experienced chest radiologists. \nResults or Findings: Central thrombi resolved after anticoagulant treatment \nfor APE, while mural thrombi or total occlusions by thrombi either resolved or \ntransformed to a web or tapered pulmonary vessel at follow-up. Webs and \ntapered pulmonary arteries did not resolve at follow-up and were only present \nin the CTEPH group at baseline. In addition, the number of webs and tapered \npulmonary arteries increased at follow-up in CTEPH patients (resp. from 18 to \n33% and 9 to 19%; both p<0.001), probably as remnants of central thrombi, \nmural thrombi or total occlusion by thrombi at baseline. \nConclusion: None of the webs and tapered segmental pulmonary arteries \nresolved after anticoagulant treatment for APE. Therefore, webs and tapered \nsegmental pulmonary arteries indicate chronic morphology, and should raise \nawareness for CTEPH in patients with persistent dyspnea after anticoagulant \ntreatment for acute PE. \nLimitations: Not applicable \nEthics Committee Approval: Not applicable \nFunding for this study: Research grant Actelion Pharmaceuticals \nAuthor Disclosures: \nNatalia Joanna Braams: Nothing to disclose \nPaul den Exter: Nothing to disclose \nErik Klok: Nothing to disclose \nL.J.M. Kroft: Nothing to disclose \nHarm Jan Bogaard: Nothing to disclose \nFrances de Man: Nothing to disclose \nL. J. Meijboom: Nothing to disclose \nL.F.M. F.M. Beenen: Nothing to disclose \nGudula Boon: Nothing to disclose \n \nRPS 204-7 \nSystematic review and meta-analysis of CT-derived bronchial parameters \n*I. Dudurych*¹, S. Muiser¹, N. McVeigh², H. Kerstjens¹, M. van den Berge¹, M. \nde Bruijne³, R. Vliegenthart¹; ¹Groningen/NL, ²Dublin/IE, ³Rotterdam/NL \n \nPurpose: CT-derived bronchial parameters are obtained via diverse \nmethodologies with conflicting results among various populations. To \ndetermine the current methods for bronchial parameters we conducted a \nsystematic review, and pooled bronchial parameters for never-smoking, \nsmoking, asthma and COPD populations to determine reference values. \nMethods or Background: MEDLINE and Embase databases were \nsystematically searched (last date 13th October 2020). Methodologic data from \nstudies were summarised. Bronchial parameters of Percentage Wall Area \n(WA%), Wall Thickness (WT), square root of the wall area at hypothetical \nairway at internal perimeter of 10mm (Pi10) and Luminal Area (Ai) were pooled \naccording to population and compared. \n\n \n \n \nA \nB C 109  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \nResults or Findings: The methodologic review included 162 articles, of which \n61 were included for meta-analysis. Most studies (85/162 articles) used \nmultiplanar reconstruction for bronchial parameter measurement. Full-Width \nHalf-Max algorithm was used the most (46/162 articles). Upper and lower lobe \n3rd generation airways were most studied. The largest populations were \ncurrent-smokers (14,926) and patients with COPD (12,618), followed by \nasthma (2,542) and never-smoking (1,045) populations. Mean pooled \nparameters were as follows: Pi10 (mean SD 3.97±0.39mm), WT \n(2.39±0.83mm) and Ai normalised to Body Surface Area (12.46±4mm²) and \nwere generally larger in never-smokers, while COPD had the largest WA% \n(63.34±7.42%, n=5,563). WA% discriminated between all populations (all \ncomparisons p <0.001) with the exception for comparison between current-\nsmoking and asthma populations(p=0.11). \nConclusion: Bronchial parameters are derived with diverse methodology, with \na focus on larger airways in the COPD and smoker populations. The most \ndiscriminative bronchial parameter was percentage wall area for all but \nsmoking vs asthma populations. \nLimitations: Pooled analysis assumes a normal distribution. There was \ninsufficient information for subgroup (e.g. sex, age) analysis. \nEthics Committee Approval: Not applicable. \nFunding for this study: Project funded by by IMDI (Innovative Medical \nDevices Initiative)/ZonMW (Netherlands Organisation for Health Research and \nDevelopment). \nAuthor Disclosures: \nIvan Dudurych: Nothing to disclose \nMarleen de Bruijne: Nothing to disclose \nSusan Muiser: Nothing to disclose \nMaarten van den Berge: Nothing to disclose \nRozemarijn Vliegenthart: Nothing to disclose \nNiall McVeigh: Nothing to disclose \nHuib Kerstjens: Nothing to disclose \n \nLive Q&A \n \n16:45-17:45 CHANNEL 2 \nSpecial Focus Session \nSF 13 \nCan we limit gadolinium use in \nneuroimaging? \nModerator \nAlejandro Rovira-Cañellas; Barcelona/ES  \n \nSF 13-2 \nGadolinium: an environmental issue \nGerard Stroomberg; Nieuwegein/NL  \n(stroomberg@riwa.org) \n \nLearning Objectives: \n1. To learn about the potential toxic effect of environmental free gadolinium. \n2. To appreciate that gadolinium is an emerging contaminant in water \nresources. \n3. To understand the need of monitoring gadolinium distribution in tap waters. \n \nSF 13-3 \nGadolinium deposition: an update \nDragan A. Stojanov; Nis/RS \n(drstojanov@gmail.com) \n \nLearning Objectives: \n1. To learn about the mechanisms involved in gadolinium deposition in the \nbrain. \n2. To understand stability differences of the types of gadolinium chelates and \ntheir relationship to gadolinium deposition in the brain. \n3. To learn about the potential long-term adverse health effects of gadolinum \ndeposition in the brain. \n \nSF 13-4 \nI don't need gadolinium \nTarek A. Yousry; London/UK \n \nLearning Objectives: \n1. To understand the rationale for reducing repetitive injections of gadolinium-\nbased contrast agents. \n2. To identify clinical situations in which gadolinium-based contrast agents \nhave no added value for diagnostic and monitoring purposes. \n3. To learn about the potential of unenhanced MRI techniques with quantitative \nimage analysis to obtain gadolinium-analog information. \n \nSF 13-5 \nI always need gadolinium \nNicoletta Anzalone; Milan/IT \n(anzalone.nicoletta@hsr.it) \n \nLearning Objectives: \n1. To appreciate the excellent safety profile and tolerance of gadolinium-based \ncontrast agents. \n2. To learn that there is no documented clinical risk related with gadolinium \ndeposition in the brain. \n3. To learn about the added clinical value of gadolinium MRI for diagnosis and \nmonitoring purposes in different neurologic disorders. \nAuthor Disclosures: \nNicoletta Anzalone: Consultant: bracco, Bayer; Speaker: Bracco, Bayer \n \nLive Q&A: Towards practice harmonisation \n \n16:45-17:45 CHANNEL 3 \nCoffee & Talk (open forum) Session \nOrganised by EuroSafe Imaging \nC 15 \nImage quality and dose: a practical guide \nfor radiologists \nModerators \nWerner R. Jaschke; Innsbruck/AT  \nAnnalisa Trianni; Trento/IT  \n \nC 15-3 \nImage quality in CT: the medical physicist's perspective \nAnnalisa Trianni; Trento/IT \n(annalisa.trianni@apss.tn.it) \n \nLearning Objectives: \n1. To learn how to quantify image quality. \n2. To appreciate the relation between dose and image quality. \n3. To understand how image reconstruction influences image quality. \n \nC 15-4 \nImage quality in CT: the radiologist's perspective \nMathias Prokop; Nijmegen/NL \n(mathias.prokop@radboudumc.nl) \n \nLearning Objectives: \n1. To learn how to assess image quality and how to avoid artefacts. \n2. To appreciate the important role of image quality and diagnostic accuracy. \n3. To understand that an appropriate image quality can be achieved at rather \nlow dose levels for many clinical tasks. \nAuthor Disclosures: \nMathias Prokop: Patent Holder: 4D noise suppression, licensed to Canon \nMedical Systems; Research Grant/Support: Canon Medical Systems, Siemens \nHealthineers; Speaker: Canon Medical Systems, Siemens Healthineers \n \nC 15-5 \nLung cancer screening using CT \nMatthys Oudkerk; Groningen/NL \n \nLearning Objectives: \n1. To learn how to optimise CT protocols for lung cancer screening. \n2. To appreciate the important role of dose reduction. \n3. To understand the risks associated with screening by CT. \nAuthor Disclosures: \nMatthys Oudkerk: Author: NEJM , Lancet etc Nelson study; Board Member: \nInstitute of Diagnostic Accuracy; Employee: University of Groningen; Grant \nRecipient: KNAW, ERC,Horizon 2020, etc \n \nLive Q&A \n \n\n \n \n \nA \nB C 110  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \n16:45-17:45 CHANNEL 5 \nResearch Presentation Session: \nInterventional Radiology \nRPS 209 \nLiver oncology \nModerator \nDimitrios Filippiadis; Athens/GR  \n \nRPS 209-2 \nBalloon occluded TACE (B-TACE) vs DEM-TACE for HCC: a single center \nretrospective case control study \nP. Lucatelli, *B. Rocco*, G. De Rubeis, M. Corona, L. Teodoli, A. Cannavale, \nP. G. Nardis, M. Bezzi, C. Catalano; Rome/IT  \n(biancarocco.br@gmail.com) \n \nPurpose: Compare oncological results and safety profile of balloon micro-\ncatheter transarterial chemoembolization (b-TACE) and drug-eluting-\nmicrosphere (DEM-TACE) in patients with hepatocellular-carcinoma (HCC) \nMethods or Background: This is a case-control, retrospective, single-center \nstudy. Between January-2015/March-2019, 149 patients with 226 HCC were \ntreated, 22 patients (35 HCC) with b-TACE and 127 with DEM-TACE (191 \nHCC). Embolization protocol was standardized (sequential 100±25 and 200±25 \nȝm microspheres). Results were evaluated by modified-responseevaluation-\ncriteria-in-solid-tumor [mRECIST] at 1, 3-6 and 9-12 months and time to \nrecurrence after complete response [TTR] at 1 years. Cox’s regression \nweighted with tumor dimensions was performed. Adverse events (AEs) were \nrecorded \nResults or Findings: mRECIST oncological response at all time points (1, 3-6 \nand 9-12 months) for both treatments were similar, with the exception of \nObjective response rate at 9-12months. Objective response at 1 and 3-6 \nmonths between b-TACE vs DEM-TACE [23/35(65.7%) vs 119/191(62.3%), \n21/29(72.4%) vs 78/136(57.4%) (p>0.05), respectively]. \nOn the contrary, at 9-12 months, it was significantly higher in b-TACE \nsubgroup than \nDEM-TACE (15/19[78.9%] vs 48/89[53.9%], p=0.05).  TTR for complete \nresponse at \n1 year had a better trend for b-TACE vs DEM-TACE (278.0 days [196.0-342.0] \nvs 219.0 days [161.0-238.0], OR 0.68 [0.4-1.0],p=0.10). The use of balloon \nmicrocatheter reduced the relative risk of the event of recurrence by 0.63 \n[CI95% 0.38-1.04]; p=0.07). No significant differences were found in AEs rate \nConclusion: b-TACE showed a trend of better oncological response over \nDEM-TACE with and longer TTR with a similar adverse events rate, in patients \npresenting with larger tumors \nLimitations: The nature of the study is retrospective and observational without \nrandomization; groups were not homogenous, though this limitation was \novercome by weighting differences as co-variate in statistical analysis. \nEthics Committee Approval: This study was approved by ethical review \nboard of our institution \nFunding for this study: No fundings were received \nAuthor Disclosures: \nBianca Rocco: Nothing to disclose \nMario Bezzi: Nothing to disclose \nMario Corona: Nothing to disclose \nGianluca De Rubeis: Nothing to disclose \nPier Giorgio Nardis: Nothing to disclose \nAlessandro Cannavale: Nothing to disclose \nLeonardo Teodoli: Nothing to disclose \nPierleone Lucatelli: Nothing to disclose \nCarlo Catalano: Nothing to disclose \n \nRPS 209-4 \nFeasibility of intra-arterial Lu-177 DOTA TATE peptide receptor \nradionucleotide therapy in metastatic neuroendocrine tumours with liver \ndominant disease \n*M. Palaniswamy*, M. Uthappa; Chennai/IN \n(drmohnishp@gmail.com) \n \nPurpose: Purpose was to assess the safety, tolerability and efficacy of intra \narterial Lu-177 DOTA TATE therapy in patients with liver dominant metastasis \nin well differentiated NETS. \nMethods or Background: Four patients with well differentiated NET liver \ndominant metastasis4 cycles of 200mCi of Lu-177 DOTATATE therapy intra \narterially at interval of 8 weeks Through selective hepatic arterial \ncatheterization. All patients received bilobar hepatic arterial infusions in the \nsame sitting. All patients were administered aminoacid infusions for 4-6 hours \nstarting pretherapy and continued post therapy infusions for nephroprotection. \nPlan to cover with long acting octeotide therapy was instituted in case of \nendocrine crisis.Their complete blood counts, liver function, renal function and \ncoagulation profiles were assessed within 2 weeks prior to each treatment \ncycle, in the immediate post therapy period and within 6 weeks post treatment. \nRadiological assessment and tumor markers were also assessed pre and post \ntreatment. \nResults or Findings: Significant reduction in serum chromogranin A levels  \nPartial reduction in size and tracer uptake in all patients were noted.  \nNone of the patients experienced any acute side effects or unexpected \ncomplication during therapy or in the immediate post therapy period .  \nNo radiation induced lung injuryor renal toxicity seen during the course of \ntherapy and even after the last cycle.  \nLiver functions remained stable with improved quality of life. \nConclusion: Three patients showed partial response. One patient showed \nstable disease (PERCIST)  \nSurvival benefits will be evaluated after 1 year of follow up. \nLimitations: Patients with Renal disease could not be included in the study \nEthics Committee Approval: Approved \nFunding for this study: It was funded by the hospital. \nAuthor Disclosures: \nMohnish Palaniswamy: Consultant at Gleneagles Global Health City \nM.C. Uthappa: Consultant at Gleneagles Global Health City \n \nRPS 209-5 \nTransarterial chemoembolisation in patients with hepatocellular \ncarcinoma: impact of low-dose doxorubicin on post-embolisation \nsyndrome and overall survival \n*A. A. A. Bessar*; Zagazig/EG \n(ahmedawadbessar@gmail.com) \n \nPurpose: Introduction: No chemotherapeutic agents have been standardized \nfor transarterial chemoembolization (TACE). Moreover, doxorubicin, the most \ncommonly chemotherapeutic agent has no standard optimal dosage in TACE \nprocedures. \nObjectives: To compare effects of low versus currently used doses of \ndoxorubicin in TACE on post-embolization syndrome (PES) and overall survival \n(OAS) in advanced hepatocellular carcinoma (HCC) patients. \nMethods or Background: Patients and methods: Prospective interventional \nstudy between 10/2014 and 3/2018 on patients with primary HCC, on top of \ncirrhosis due to hepatitis C infection, who underwent palliative TACE. Patients \nwere divided into 2 groups: group A received 50 mg and group B received 100 \nmg of doxorubicin TACE. The outcomes were PES, individual manifestations of \nPES, time-to-be free from PES, and tumor response to TACE at 1-, 3-, and 6-\nmonth post-procedure, and OAS. \nResults or Findings: Results: Twenty-eight patients received 68 TACE \nprocedures with 15 (Group A) and 13 (Group B) patients palliated with 50mg \nand 100mg of doxorubicin, respectively. Mean age at first procedure was 58.9 \n(±6.8) years. Males constitute 85.7% of patients and 27 (96.4%) patients had \nrepeated TACE. visual analgesia score and pain duration were significantly \ndifferent between both groups (Pޒ0.0001). Median duration of fever was \nshorter in Group A than Group B (p=0.003). No statistically differences \nbetween the 2 groups in tumor response to TACE and OAS. Doxorubicin dose \nwas statistically correlated with duration of pain, fever, VAS score and \nvomiting. \nConclusion: Conclusion: Lower dose of doxorubicin was associated with \nfewer PES symptoms and duration compared with 100 mg without effects on \ntumor response nor OAS. \nLimitations: Not specified \nEthics Committee Approval: Not specified \nFunding for this study: Not specified \nAuthor Disclosures: \nAhmed Awad Abdelaziz Bessar: Nothing to disclose \n \nRPS 209-6 \nCirculating tumour cells in hepatocellular carcinoma under interventional \nradiological treatment: cTACE vs MWA \n*T. J. Vogl*, L. Riegelbauer, E. Oppermann, H. Ackermann, S. Stein, W. \nBechstein, M. Juratli; Frankfurt/DE \n(t.vogl@em.uni-frankfurt.de) \n \nPurpose: To investigate the short-term dynamics of circulating tumor cells \n(CTCs) in patients with hepatocellular carcinoma (HCC) under conventional \ntransarterial chemoembolization (cTACE) or microwave ablation (MWA). The \nshort-term dynamics were compared with the clinical course of the patients \nusing a novel method for the isolation and detection of CTCs. \nMethods or Background: Blood samples from 18 patients with HCC who \nunderwent cTACE (n=8) or MWA (n=10) were analyzed. Intravenous blood \nwas taken before and immediately after the radiological interventions to isolate \nCTCs and quantify them by flow cytometry. CTCs were considered to be those \ncells that were negative for the marker CD45 and positive for the markers \n\n \n \n \nA \nB C 111  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \nASGPR, CD146, and CD274 (PDL1). Follow-up studies of up to 2 years after \nthe radiological intervention were evaluated. \nResults or Findings: The number of CTCs after radiological intervention \n(post=0.9 CTCs/ml of blood) was on average lower than that before therapy \n(pre=1.2 CTCs/ml of blood). The number of CTCs decreased more in patients \ntreated with MWA (0.4 CTCs/ml of blood) than in those who received cTACE \n(0.2 CTCs/ml of blood). The 2-year survival rate in the group receiving cTACE \n(37.5% died) was lower than that in MWA patients (0% died). \nConclusion: The therapeutic benefit of cTACE and MWA in patients with HCC \nis emphasized by decreasing CTCs and the clinical course of the patients. \nLimitations: Small sample size \nEthics Committee Approval: The study was approved by the ethical \ncommittee \nFunding for this study: No funding \nAuthor Disclosures: \nLInda Riegelbauer: Nothing to disclose \nMazen Juratli: Nothing to disclose \nThomas J. Vogl: Nothing to disclose \nWolf Bechstein: Nothing to disclose \nStefan Stein: Nothing to disclose \nElsie Oppermann: Nothing to disclose \nHanns Ackermann: Nothing to disclose \n \nRPS 209-8 \nEfficacy and safety of TACE combined with sorafenib plus immune \ncheckpoint inhibitors for the treatment of intermediate and advanced \nTACE-refractory hepatocellular carcinoma: a retrospective study \n*L. Zheng*, S. Fang, F. Wu, Z. Zhao, J. Ji; Lishui/CN \n(zhengliyun@zju.edu.cn) \n \nPurpose: The study aims to retrospectively investigate the efficacy and safety \nof sorafenib combined with TACE (TACE+Sor) vs. TACE+Sor plus immune \ncheckpoint inhibitors (TACE+Sor+ICIs) in treating intermediate and advanced \nTACE-refractory hepatocellular carcinoma. \nMethods or Background: From January 2016 to June 2020, 51 eligible \npatients with intermediate or advanced TACE-refractory HCC received \nTACE+Sor (n=29) or TACE+Sor+ICIs (n=22). The differences in tumor \nresponse, adverse events, progression-free survival, and overall survival were \ncompared between the two groups. Factors affecting PFS and OS were \ndetermined by Cox regression. \nResults or Findings: The DCR was higher in the TACE+Sor+ICIs group than \nin the TACE+Sor group (81.82% vs 55.17%, P=0.046). Compared with the \nTACE+Sor group, PFS and OS were prolonged in the TACE+Sor+ICIs group \n(mPFS: 16.26 vs 7.30 months, P<0.001; mOS: 23.3 vs 13.8 months, P=0.012). \nMultivariate analysis showed that BCLC stage, alpha-fetoprotein and treatment \nwere independent factors of PFS; BCLC, Child-Pugh class, ablation after \ndisease progression and treatment were independent predictive factors of OS. \nFour patients in the TACE+Sor+ICIs group and three patients in the TACE+Sor \ngroup suffered from dose reduction or interruption (18.18% vs 10.34%, \nP=0.421). \nConclusion: The therapeutic schedule of TACE+Sor+ICIs demonstrated \nefficacy and safety in advanced TACE-refractory HCC. \nLimitations: As a retrospective study, it has all of the defects inherent to this \ntype of study design. For example, the background of patients, including \nfinancial capability, education, and cognition of liver cancer, have an impact on \nthe choice of therapy by patients and physicians. In addition, the limitation of \nthe sample size of patients and the length of follow-up also had a significant \nimpact on the outcome. \nEthics Committee Approval: approved by the ethics committee of Lisui \nHospital, Zhejiang University, China. \nFunding for this study: National Natural Science Foundation of China \n(81803778); Zhejiang Natural Science Foundation/exploration project Q \n(LQ20H160055) \nAuthor Disclosures: \nFazong Wu: Author at conducted all experiments, analyzed the data and wrote \nthe manuscript \nShiji Fang: Author at conducted all experiments, analyzed the data and wrote \nthe manuscript \nJiansong Ji: Author at conducted all experiments, analyzed the data and wrote \nthe manuscript \nLiyun Zheng: Speaker at designed the study and revise this manuscrip \nZhongwei  Zhao: Author at conducted all experiments, analyzed the data and \nwrote the manuscript \n \nLive Q&A \n \n18:00-19:00 CHANNEL 2 \nCoffee & Talk (open forum) Session \nC 6 \nProfessional regulation and opportunities \nacross Europe \nModerator \nCharlotte Beardmore; London/UK  \n \nC 6-2 \nProfessional regulation: a tool or a barrier for harmonisation and free \nmovement \nLouise A. Rainford; Dublin/IE  \n(louise.rainford@ucd.ie) \n \nLearning Objectives: \n1. To gain an overview of the role of professional regulators. \n2. To appreciate how professional regulators function and the importance of \ntheir work. \n3. To understand professional regulatory implications regarding free movement \nand qualification recognition. \n \nC 6-3 \nHarmonisation of professional knowledge, skills, and competencies \nacross Europe \nAndrew England; Salford/UK \n(a.england@keele.ac.uk) \n \nLearning Objectives: \n1. To learn about the differences in professional knowledge, skills, and \ncompetencies for radiographers across Europe. \n2. To appreciate the need for harmonising knowledge, skills, and competencies \nacross Europe. \n3. To understand the methods for harmonising knowledge, skills, and \ncompetencies. \n \nC 6-4 \nThe EU Basic Safety Standards (BSS) directive: progressing or restricting \nthe harmonisation of the radiographer profession across Europe \nJoana Santos; Coimbra/PT \n(joanasantos@estescoimbra.pt) \n \nLearning Objectives: \n1. To understand radiographers' responsibilities and duties according to the EU \nBasic Safety Standards (BSS) directive. \n2. To gain an overview of the BSS radiographer’s radiation protection role \nacross countries. \n3. To become familiar with different countries strategies in order to promote the \nharmonisation of the radiographer profession. \n \nC 6-5 \nThe Nordic continuing professional development (CPD) system: a tool to \nfacilitate harmonisation and free movement \nClaus Brix; Frederiksberg/DK \n(Claus@radiograf.dk) \n \nLearning Objectives: \n1. To learn about how CPD can be used to support ongoing and post \nqualification development of the profession. \n2. To understand the necessary importance of CPD in the development of \nclinical skills. \n3. To become familiar with the work and implementation of CPD in Nordic \ncountries. \n \nLive Q&A \n \n \n \n \n \n \n\n \n \n \nA \nB C 112  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \n18:00-19:00 CHANNEL 3 \nSpecial Focus Session \nSF 15 \nHow to succeed in brachial plexus imaging \nModerator \nFelix P. Kuhn; Zurich/CH  \n \nSF 15-2 \nHigh-resolution ultrasound: techniques and pitfalls \nCarlo Martinoli; Genoa/IT  \n(55904@unige.it) \n \nLearning Objectives: \n1. To learn about the technical possibilities in high-resolution ultrasound. \n2. To understand the potential pitfalls. \n3. To appreciate the possibilities to extend and improve your ultrasound skills. \n4. To become familiar with different clinical cases. \n \nSF 15-3 \nMRI protocol optimisation: different information from different MR \nsequences (incl. DTI) \nCarlos Torres; Ottawa, ON/CA \n(catorres@toh.on.ca) \n \nLearning Objectives: \n1. To learn about the different types of MR pulse sequences to assess the \nbrachial plexus. \n2. To understand how to improve your MR protocols. \n3. To appreciate what information can be extracted from different MR \nsequences (incl. DTI). \n4. To become familiar with 3D high-resolution imaging. \n \nSF 15-4 \nMRI in clinical routine: radiological/clinical correlation \nSimonetta Gerevini; Milan/IT \n(gerevini.simonetta@hsr.it) \n \nLearning Objectives: \n1. To learn about the correlation between image findings and the clinical \npresentation. \n2. To understand the importance of pertinent clinical information. \n3. To appreciate the additional information which you may be able to provide to \nyour clinical colleagues. \n4. To become familiar with different clinical cases. \n \nSF 15-5 \nCase review: a particularly interesting case (part 1) \nFelix P. Kuhn; Zurich/CH \n \nSF 15-6 \nCase review: a particularly interesting case (part 2) \nCarlo Martinoli; Genoa/IT \n(55904@unige.it) \n \nSF 15-7 \nCase review: a particularly interesting case (part 3) \nCarlos Torres; Ottawa, ON/CA \n(catorres@toh.on.ca) \n \nLive Q&A: How to find your way in this complex anatomy \n \n18:00-19:00 CHANNEL 4 \nResearch Presentation Session: Vascular \nRPS 215 \nVascular and interventional radiology \nModerator \nViktor Bérczi; Budapest/HU  \n \n \nRPS 215-2 \nThe majority of major amputations after resuscitative endovascular \nballoon occlusion of the aorta are associated with pre-admission trauma \n*S. R. Levin*, A. Farber, P. Burke, T. Brahmbhatt, A. Richman, K. Twomey, J. \nSiracuse; Boston, MA/US  \n(scott.levin@bmc.org) \n \nPurpose: Resuscitative endovascular balloon occlusion of the aorta (REBOA) \nis potentially life-saving.  However, reports of associations with limb loss and \nmortality have called its safety into question.  We aimed to evaluate patient and \nhospital characteristics associated with major amputation and mortality among \npatients undergoing REBOA. \nMethods or Background: The U.S. National Trauma Data Bank (2015-2017) \nwas queried for patients who presented to trauma centers and underwent \nREBOA.  We determined associations with major amputation and in-hospital \nmortality. \nResults or Findings: A total of 316 patients underwent REBOA.  Mean age \nwas 45±20 years.  Most patients presented to Level I trauma centers (72%) \nafter blunt injuries (79%) with an average injury severity score (ISS) of 31±15, \nindicating major trauma.  In 15 patients (5%), there were 18 major amputations \n– 7 above-knee and 11 below-knee.  Eleven amputations were either traumatic \namputations (73%) or mangled limbs requiring amputation within 24 hours \n(27%).  Among remaining amputations, 71% were associated with ipsilateral \nvascular/orthopedic extremity injuries.  Comparing patients with and without \namputations, demographics/comorbidities and hospital characteristics were \nsimilar.There were 110 deaths (35%).  Amputation prevalence was similar \nbetween patients who died vs. survived (3.6% vs. 5.3%, P=.5).  Prehospital \ncardiac arrest (OR 8.47,95% CI 1.47-48.66), penetrating vs. blunt trauma (OR \n5.5,95% CI 1.05-28.82), decreased Glasgow Coma Scale score (OR 1.18,95% \nCI 1.05-1.32), increased age (OR 1.06,95% CI 1.03-1.1), and increased ISS \n(OR 1.05,95% CI 1-1.1) were associated with higher mortality. \nConclusion: Despite concerns about prohibitive limb complications of REBOA, \nbaseline injuries appear to be the primary cause of limb loss.  Injury type and \nseverity, as well as initial hemodynamic derangements were associated with \nmortality after REBOA. \nLimitations: Retrospective study. \nEthics Committee Approval: The Boston University Institutional Review \nBoard and American College of Surgeons Committee on Trauma approved this \nstudy. \nFunding for this study: Not applicable. \nAuthor Disclosures: \nPeter Burke: Nothing to disclose \nKathryn Twomey: Nothing to disclose \nJeffrey Siracuse: Nothing to disclose \nTejal Brahmbhatt: Nothing to disclose \nScott Ross Levin: Nothing to disclose \nAaron Richman: Nothing to disclose \nAlik Farber: Nothing to disclose \n \nRPS 215-3 \nComputed tomography in extracorporeal membrane oxygenation \n(ECMO): scan techniques, normal findings, and complications \n*H. Çelik*¹, J. Weir-McCall², A. Barker², L. L. D'Errico², T. H. Yu², S. Sultana², \nI. R. Okam², S. K. B. Agrawal²; ¹Izmir/TR, ²Cambridge/UK \n(hakkicelikmd@gmail.com) \n \nPurpose: To review the principles of performing computed tomography (CT) in \nextracorporeal membrane oxygenation (ECMO), and review the normal \nfindings of patients on ECMO, and complications related to this. \nMethods or Background: ECMO is a modified cardiopulmonary bypass to \nsupport life, permitting further treatment and recovery during severe cardiac or \npulmonary failure. Due to the artificial circulatory environment of patients on \nECMO, this can provide unique challenges in obtaining diagnostic quality CT \nimages. Further complications are not uncommon. For this review, CT scans \nfrom over 200 patients acquired over three years were reviewed to curate the \nbest exemplars of cases with complications related to ECMO. \nResults or Findings: This review will cover the basics of ECMO, including the \ndifferences between venovenous (VV) and venoarterial (VA) ECMO and it will \nequip the reader with scanning techniq ues. We will then examine the expected \nnormal range of findings post-initiation of ECMO therapy and a range of \ncomplications arising from this process. \nThe most frequent complication during ECMO is haemorrhage.  \nA variety of complications can occur during cannulation, including vessel \nperforation with haemorrhage, arterial dissection, pseudoaneurysm formation, \ncardiac injury, and incorrect cannula location. Pleural effusion, pneumothorax, \npneumomediastinum, hemomediastinum, hemopericardium, and subcutaneous \nemphysema can be seen due to traumatic cannula insertion or malpositioned \ncannula. \nClot formation in the circuit is a common complication. Systemic \nthromboembolism due to thrombus formation within the extracorporeal circuit is \na complication that can be devastating.  \nCT images exemplifying these findings will be shared in the presentation. \n\n \n \n \nA \nB C 113  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \nConclusion: Complications related to ECMO are not uncommon, some of \nwhich can be life-threatening. Awareness of normal CT findings, and these \ncomplications is essential for the accurate and early detection of these. \nLimitations: Not applicable \nEthics Committee Approval: Not applicable \nFunding for this study: No funding received for this study. \nAuthor Disclosures: \nHakki Çelik: Nothing to disclose \nJonathan Weir-McCall: Nothing to disclose \nLuigia Luigia D'Errico: Nothing to disclose \nSadia Sultana: Nothing to disclose \nSanjay Kumar Bobby Agrawal: Nothing to disclose \nIkenna Raymond Okam: Nothing to disclose \nTak Houng Yu: Nothing to disclose \nAllanah Barker: Nothing to disclose \n \nRPS 215-4 \nRetrograde peroneal artery approach to infra-inguinal arterial chronic \ntotal occlusion \n*L. Patrone*¹, G. Falcone², T. Bisdas³, D. Akhtar¹, F. Fanelli², E. Blessing ຾; \n¹London/UK, ²Florence/IT, ³Athens/GR, ຾Karlsbad/DE \n(Lorenzo.patrone@nhs.net) \n \nPurpose: The aim of this study is to assess the feasibility, safety and \neffectiveness of retrograde PA access and to provide some technical details on \nthe effective use and management of this retrograde access. \nMethods or Background: We retrospectively analyzed 137 consecutive \npatients (137 limbs) (84 males [61,3%]; median age, 76,8± 10,9 years old; \nrange 44-94 years) who underwent endovascular recanalization of infra-\ninguinal arteries for symptomatic PAD-CLTI using a retrograde PA access in \ncase of a failed antegrade attempt. The target of the recanalization via the PA \naccess was the superficial femoral artery (SFA) and/or popliteal artery in 58 pts \n(42,3%), the peroneal artery and/or the tibio-peroneal trunk in 25 patients \n(18,2%), and both segments in 54 pts (39,4%). \nResults or Findings: The retrograde puncture of the PA was successful in \n98,5% cases. In 8,8% cases backflow was obtained but the intraluminal \ndelivery of the guidewire failed. The supplemental use of the retrograde \napproach allowed a successful retrograde lesion crossing in 90,5 % of the \npatients. In all these cases to deliver adjunctive therapy (including plain balloon \nangioplasty, drug eluting balloons, bare metal stents, drug eluting stents, \natherectomy) was possible, as from operators’ choice.  \nIn the majority of the cases (92,7 %) a sheat-less approach was pursued while \nin 7,3% of cases a 4Fr sheath was inserted. At the final angiogram \nhaemostasis at puncture site was successfully achieved in 137 cases (100%).  \nThe total rate of retrograde puncture-related complication rate was 2,2%. \nConclusion: The retrograde recanalization of infra-inguinal arterial CTO via \nthe peroneal access is a safe and effective bailout technique, useful in the \nmost challenging cases of recanalization of the infra-inguinal vessels. \nLimitations: Retrospective study. \nEthics Committee Approval: Not needed \nFunding for this study: No \nAuthor Disclosures: \nErwin Blessing: Consultant at Abbott, Shockwave, Cardinal Health \nFabrizio Fanelli: Consultant at Philips, Cook \nLorenzo Patrone: Consultant at Abbott, Terumo, Pathfinder Medical, \nShockwave \nDaoud Akhtar: Nothing to disclose \nGiammarco Falcone: Nothing to disclose \nTheodosios Bisdas: Consultant at Shockwave, Medtronic \n \nRPS 215-5 \n3D-arterial analysis software and CEUS in the assessment of severity and \nvulnerability of carotid atherosclerotic plaques in comparison with CTA \nand histology \n*D. Fresilli*, G. Polti, E. Polito, G. T. Lucarelli, O. Guiban, S. Cardaccio, P. \nPacini, V. Cantisani, C. Catalano; Rome/IT \n(daniele.fresilli@hotmail.it) \n \nPurpose: To assess multiparametric Ultrasound (US) efficacy in the evaluation \nof carotid plaque vulnerability and stenosis measurement. \nMethods or Background: 134 patients with carotid plaques to undergo \nendarterectomy were enrolled. All carotid plaques were evaluated  with Color-\nDoppler-US, CEUS and 3D ultrasound using 3D Arterial analysis software and \nwere compared with CTA for estimating carotid stenosis and with histology  for \nthe plaque vulnerability assessment. 3D-Arterial Analysis provided a colour \nmap based on plaque vulnerability and a volumetric stenosis evaluation. \nResults or Findings: 94 vulnerable plaques at histological examination were \nidentified. CDUS, 3D-Arterial Analysis software, CEUS and CTA were able to \ndetect 77, 84, 82 and 82 vulnerable plaques respectively, with a sensitivity of \n82%, 89%, 87% and 87% and a specificity of 90% for CDUS and 100% for \nCTA, CEUS and 3D Arteriale Analysis. CTA has identified 84 severe stenosis \nof which 83 were correctly evaluated by 3D-Arterial Analysis software and \nCEUS, with a sensitivity of 99% and specificity of 100% and 71 by CDUS with \na sensitivity of 85% and specificity of 80%. \nConclusion: The preliminary results of our study confirm that the integration of \nthe new ultrasound softwares, CEUS and 3D Arterial Analysis, to the eco-\ncolor-Doppler examination can improve the management of the carotid plaque. \nHowever, further studies with larger populations are needed in order to \nestablish whether they can be useful to direct the patient towards surgical \nprocedures and / or can be a screening tool to stratify early those patients who \ncould develop vulnerable plaques. \nLimitations: Large 3D probe size, sulfur allergy and sampling bias. \nEthics Committee Approval: All procedures performed were in accordance \nwith the ethical standards of the institutional and/or national research \ncommittee. \nFunding for this study: n/a \nAuthor Disclosures: \nDaniele Fresilli: Nothing to disclose \nPatrizia Pacini: Nothing to disclose \nSara Cardaccio: Nothing to disclose \nOlga Guiban: Nothing to disclose \nGiorgia Polti: Nothing to disclose \nEleonora Polito: Nothing to disclose \nGiuseppe Tiziano Lucarelli: Nothing to disclose \nVito Cantisani: Nothing to disclose \nCarlo Catalano: Nothing to disclose \n \nRPS 215-6 \nCarotid plaque score associated with the presence and severity of \ncoronary atherosclerosis \n*Y. Tang*, M. Chen, H. Yunqian; Shanghai/CN \n(yhtangsz@163.com) \n \nPurpose: To determine whether carotid plaque score(CPS) counted by the \nnumber of ultrasound-detected plaques and carotid intima-media \nthichness(IMT) are associated with the presence and severity of coronary \natherosclerosis. \nMethods or Background: 153 patients were enrolled in this study with \nconfirmed or suspected coronary heart disease who were scheduled to \nundergo coronary angiography and carotid ultrasound. CPS was calculated by \nsummation of the number of plaques in the common, bifurcation, and internal \ncarotid artery segments. Measurements of the right and left commom carotid \nfar wall approximately 1cm proximal to the carotid bifurcation were taken to \nderive carotid IMT and the thicker one was recorded. Coronary severity was \nevaluated by Gensini score and the number of diseased coronary arteries. The \ncorrelation of CPS and carotid IMT with the presence and severity of coronary \natherosclerosis was assessed. \nResults or Findings: Patients with diseased coronary arteries had higher CPS \nthan those with no diseased coronary artery, P<0.01. According to Gensini \nscore tertiles  CPS in  low Gensini score group was significantly lower than that \nin middle-high Gensini score group (0.94±1.10 vs 1.74±1.59, p=0.002). \nHowever, although the carotid IMT of  middle-high Gensini score group was \nincreased , there was no statistically significant difference in the carotid IMT \nbetween different Gensini score groups. Logistic regression analysis showed \nthat CPS was independently associated with the severity of coronary \natherosclerosis (OR=1.637, 95%CI: 1.149-2.333, p=0.006). \nConclusion: CPS calculated by summation of the number of plaques was \nrelated to the presence and severity of Coronary Atherosclerosis. CPS \ndetection has potential value for noninvasively identifying the severity of \ncoronary atherosclerosis. \nLimitations: This was a cross-sectional study with a small sample size, which \nmight partially account for some statistically non-significant correlations. \nEthics Committee Approval: This study protocol was approved by the clinical \nethics committee. \nFunding for this study: n/a \nAuthor Disclosures: \nYuhua Tang: Nothing to disclose \nHuang Yunqian: Nothing to disclose \nMan Chen: Nothing to disclose \n \nRPS 215-7 \n3D-printing for preoperative planning and modeling of physician-modified \nbranched stent-grafts for the complex treatment of the aortic arch \nthoracic aneurysms: one centre's experience \n*M. WojtuĔ*, M. P. Kawa, P. Rynio, P. Gutowski, A. Falkowski, A. \nKazimierczak, T. JĊdrzejczak, Ł. Wójcik, S. Waligórski; Szczecin/PL \n(wojtunmaciek@gmail.com) \n \nPurpose: Study was to sum up own experience, outcomes of thoracic \nendovascular aortic repair(TEVAR) for anatomically-complicated aneurysms in \naortic arch using three-dimensional(3D)printing to guide application of \nphysician-modified branched stent-grafts.This innovative procedure was \n\n \n \n \nA \nB C 114  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \ndeveloped in our Cardio-Vascular DiseasesCenter located in University \nHospital of PomeranianMedicalUniversity in Szczecin,Poland. Our institution is \ntertiary referral clinical centre for patients with complex aortic pathology.Our \ngroup previously performed 3Dprinting application for modeling physician-\nmodified branched stent-grafts for treatment of AAA in 35patients, permitting \nour surgeons and radiologists were familiarized to this technology that aids \nplanning,reduces time of surgery,decreasing intra-and post-operative \ncomplications,augmenting recovery. However,there was lack of knowledge \nwhether 3Dprinting can be used to help guide treatment of aortic arch \naneurysms,that are highly complicated pathology. \nMethods or Background: Patients with aortic arch aneurysms were treated in \nour center.Preoperative angio-CT from all 10patients were prospectively \ncollected and digitally reconstructed using dedicated software.Next,  3D-model \nof aortic arch aneurysm was printed,according to corresponding angio-\nCT.Furthermore, physician-modified branched stent-grafts were prepared as \nindicated by personalized 3D-printedAorta model. \nResults or Findings: All angio-CTimages matched with their 3D-printed \nmodels were discussed among vascular-and cardio-surgeons, vascular-trained \nradiologist before and after TEVAR,whether anatomical reliability of 3Dmodels \nwas sufficient.Due to preoperative existence of 3D-printed models the \npersonally-tailored stent-grafts modified by physicians in the operating room \ncould be made without significant errors. \nConclusion: We demonstrated utility and feasibility of a 3D-printed template of \naortic arch in construction of fenestrated modified stent-grafts.Complex \nprocedure was technically successful. 3D  \nmodels would make a great contribution on surgical planning and \nintraoperative modification of branched stent-grafts in patients with \nanatomically-complicated aneurysms. However,further radiological research \nand reconstruction imaging techniques development are needed.Especially, \ndedicated study is required for advanced assessment and accuracy of 3D-\nprinted models. \nLimitations: Without limitations. \nEthics Committee Approval: Retrospective study, approved. \nFunding for this study: There was no special funding. \nAuthor Disclosures: \nMaciej WojtuĔ: Nothing to disclose \nArkadiusz Kazimierczak: Nothing to disclose \nMilosz P. Kawa: Nothing to disclose \nŁukasz Wójcik: Nothing to disclose \nSzymon Waligórski: Nothing to disclose \nPiotr Gutowski: Nothing to disclose \nAleksander Falkowski: Nothing to disclose \nPaweł Rynio: Nothing to disclose \nTomasz JĊdrzejczak: Nothing to disclose \n \nLive Q&A \n \n18:00-19:30 CHANNEL 5 \nHealthcare Professionals in Focus \nIF 4 \nMake your own resilience and well-being \nplan \nModerators \nMichael H. Fuchsjäger; Graz/AT  \nM.G. Myriam Hunink; Rotterdam/NL  \n \nIF 4-2 \nKeynote speaker: Surviving in times of chaos: creating your personal \nresilience/well-being plan \nPeter Moskowitz; Palo Alto, CA/US  \n \n \n \n \n \n \n \n \n \n \n19:45-20:45 CHANNEL 2 \nE³ - Rising Stars Programme: Basic \nSessions \nOrganised by the EFRS \nBS 1 \nChallenges in cross-sectional imaging \nModerator \nCarst Buissink; Groningen/NL  \n \nBS 1-2 \nTechnical challenges in MRI: overcoming metal artefacts \nJean-Philippe Dillenseger; Strasbourg/FR  \n \nLearning Objectives: \n1. To provide an overview of the most common metal artefacts in MRI. \n2. To highlight the importance of limiting the impact of metal artefacts on safety \nand diagnosis. \n3. To provide practical suggestions on how to limit artefacts in MRI. \n \nBS 1-3 \nChallenges in contrast administration to vulnerable patients in CT \nCathrine Helgestad Kristiansen; Oslo/NO \n(Cathrine.Helgestad.Kristiansen@ahus.no) \n \nLearning Objectives: \n1. To learn how to identify vulnerable patients. \n2. To identify the challenges in contrast administration to paediatric and elderly \npatients. \n3. To provide strategies for reducing the risks in the administration of contrast \nto vulnerable patients. \n \nBS 1-4 \nAn overview of technical and  \nphysical artefacts in ultrasound \nBarbara Kraus; Vienna/AT \n(barbara.kraus@fh-campuswien.ac.at) \n \nLearning Objectives: \n1. To provide an overview of the most common artefacts in US. \n2. To highlight the importance of limiting the impact of artefacts on diagnosis. \n3. To provide practical suggestions on how to limit artefacts in US. \n \nLive Q&A: How to ensure quality control in cross-sectional imaging in \ndaily practice? \n \n19:45-20:45 CHANNEL 3 \nE³ - ECR Master Class \nE³ 1626 \nWhole-body MRI (and PET/MRI) \nModerator \nDavide Prezzi; London/UK  \n \nE³ 1626-2 \nA. Metastatic bone prostate cancer \nFrédéric E. Lecouvet; Brussels/BE  \n \nLearning Objectives: \n1. To define imaging strategies in newly diagnosed, recurrent, and advanced \ndisease. \n2. To learn to use MET-RADS-P guidelines for whole-body MRI acquisition, \nreading, and response assessment. \n3. To illustrate recent therapeutic advances: i.e. oligometastatic disease and \nprecision medicine approaches. \n \nE³ 1626-3 \nB. Multiple myeloma \nIoana G. Lupescu; Bucharest/RO \n(ilupescu@gmail.com) \n\n \n \n \nA \nB C 115  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \n \nLearning Objectives: \n1. To become aware of the value of whole-body MRI in myeloma. \n2. To understand current imaging protocols. \n3. To learn about its roles: detect, monitor, and provide prognostic information. \n \nE³ 1626-4 \nC. Lymphoma \nMarius E. Mayerhöfer; Vienna/AT \n(marius.mayerhoefer@meduniwien.ac.at) \n \nLearning Objectives: \n1. To introduce the role of whole-body MRI and PET/MRI for imaging \nlymphoma subtypes. \n2. To know its value for detection, assessment of response, and prognosis. \n3. To understand the current advantages and limitations of whole-body MRI \nand PET/MRI. \nAuthor Disclosures: \nMarius E. Mayerhöfer: Speaker: Siemens, BMS \n \nLive Q&A \n \n19:45-20:45 CHANNEL 4 \nResearch Presentation Session: \nEmergency Imaging \nRPS 117 \nThe emergency department sees some of \nthe most complex patients: how radiology \ncan help \nModerator \nElika Kashef; London/UK  \n \nRPS 117-3 \nAccuracy of MRI imaging for acute abdominal pain in pregnancy \n*B. Buckley*, M. C. Murphy, F. Delaney, T. Geoghegan, C. G. Cronin; \nDublin/IE  \n \nPurpose: The aim of this study is to quantify the accuracy of MRI in detecting \nacute appendicitis in a pregnant population in a single tertiary referral centre. \nMethods or Background: A retrospective review was carried out of all MRI \nabdomen studies performed on pregnant patients for assessment of \nappendicitis between 2017 and 2020. All MRI reports were reviewed for the \npresence of appendicitis or identification of a normal appendix, its size and the \npresence of secondary signs of inflammation. These were compared with intra-\noperative reports and histology where available, follow up outpatient records \nand clinical notes. \nResults or Findings: Between 2017 and 2020, 22 MRI abdomens we \nperformed on pregnant patients for the assessment of acute appendicitis. Of \nthese, 7 patients were identified at time of MRI to have acute appendicitis with \n6 of those undergoing appendectomy with confirmed acute appendicitis on \nhistology reports. 1 patient was reported to have a normal visualised appendix \nwhich was subsequently demonstrated to be acute appendicitis on histology. \nThis yielded an accuracy in diagnosis of 93% with a sensitivity of 85% and \nspecificity of 95%. The appendix was not visualised in 10 patients. \nConclusion: MRI is a safe and highly accurate tool for the assessment of \nacute appendicitis in pregnancy. Our institution demonstrated an accuracy of \n93% in diagnosing acute appendicitis at time of MRI with a high negative \npredictive value of 95%. \nLimitations: None. \nEthics Committee Approval: Not required. Completely anonymised data. \nFunding for this study: None. \nAuthor Disclosures: \nCarmel Geraldine Cronin: Nothing to disclose \nTony Geoghegan: Nothing to disclose \nMark Conal Murphy: Nothing to disclose \nBryan Buckley: Nothing to disclose \nFrancis Delaney: Nothing to disclose \n \nRPS 117-4 \nMultidetector-row CT (MDCT) findings in patients with non-occlusive \nmesenteric ischaemia (NOMI): influence of vasoconstrictive agents \n*A. B. Topolsky*, O. Pantet, L. Liaudet, J-F. Knebel, A. Denys, S. Schmidt; \nLausanne/CH \n \nPurpose: To find out if there is an influence of vasoconstrictive agents (VCA) \non MDCT signs of vasoconstriction and bowel ischemia detected in patients \nwith non-occlusive mesenteric ischemia (NOMI). \nMethods or Background: This 8-years single-center retrospective study \nincluded all patients with histopathologically proven NOMI and MDCT \nexamination performed ”48h prior to surgical management. Two blinded \nradiologists jointly reviewed the MDCT examinations for presence and \ndistribution of bowel ischemia signs, abdominal organ infarct, mesenteric \nvessels size and regularity, and ancillary vascular findings.VCA administration, \nclinical and biochemical data, risk factors, and outcome were subsequently \nretrieved.Subgroups comparisons were performed. \nResults or Findings: Of the 90 patients (59 males, mean age 65), 44.4% \n(n=40) had received VCA before MDCT. \nOverall mortality was 32% (n=29), with no significant difference between \ngroups (p>0.05). \nIn the VCA group, superior mesenteric artery (SMA) caliber was significantly \nsmaller (p=0.014) and vasoconstriction of its branches was more \ncommonplace (p=0.048). Although neither the presence nor the extent of \nbowel ischemia significantly correlated with VCA administration, abdominal \norgan infarcts were more frequent (p=0.005) and involved more organs \n(p=0.016). \nThe VCA group had lower mean arterial pressure (p=0.006) and lower \nhemoglobin levels (p<0.001). Inflammatory biomarkers, namely leukocytosis \n(p=0.005) and CRP (p<0.001), were significantly higher. Of the tested organ-\nfailure biomarkers, only serum creatinine (p<0.012) and urea (p<0.036) differed \nsignificantly, while there was no difference for serum lactate and other arterial-\nblood gas test results. \nConclusion: VCA administration in NOMI patients is associated with more \nsevere SMA vasoconstriction and abdominal organ infarct, without decreased \nsurvival. \nLimitations: This is a single-center retrospective study. \nEthics Committee Approval: This single-centre retrospective study was \napproved by our institutional ethics committee. \nFunding for this study: None. \nAuthor Disclosures: \nAlban Denys: Nothing to disclose \nJean-François Knebel: Nothing to disclose \nOlivier Pantet: Nothing to disclose \nAntoine Blagoev Topolsky: Nothing to disclose \nLucas Liaudet: Nothing to disclose \nSabine Schmidt: Nothing to disclose \n \nRPS 117-5 \nThoraco-abdominopelvic CT in the evaluation and follow-up of trauma \npatients admitted to the emergency department: a single-institute \nexperience \n*D. D. Ekizalio÷lu*, E. Güler, A. Z. Öcek, M. Songür Kodik, M. Harman, \nN. Elmas; øzmir/TR \n(duygudogaeao@gmail.com) \n \nPurpose: To investigate the frequency, imaging findings, and follow-up of adult \npatients who were admitted to the emergency department(ED) due to trauma \nand had CT of the thorax, abdomen, and pelvis(CT-TAP). \nMethods or Background: CT-TAP scans of patients who were admitted to the \nED due to trauma between January 2019 and January 2020 were \nretrospectively evaluated. Trauma-related imaging findings were investigated. \nThe hospitalization and interventions that the patients underwent were \nsearched from the electronic medical records. The patients who had follow-up \nCT-TAP were identified and the examinations were reviewed. \nResults or Findings: A total of 985 trauma patients who had CT-TAP in the \nED were identified. In 436 patients (44.3%)(150 women, 286 men; mean age \n47±19 years) trauma-related imaging findings were detected. 549(55.7%) \npatients (161 women, 388 men; mean age 41±17 years) had normal CT-TAP. \nBone injury was the most commonly identified imaging finding as it was \npositive in 334 out of 436 patients (76.6%). Lung injury was detected in 85 \n(19.5%) and pneumothorax was found in 77 (17.7%) patients. 68 (15.6%) \npatients had retroperitoneal hemorrhage, 31 (7.1%) had splenic injury and 29 \n(6.7%) had liver injury. Presence of bone injury was associated with both \nthoracic and abdominopelvic injuries; however these associations were \nmoderate according to effect size (ES=0.402, ES=0.306, p<0.001, \nrespectively). 201 (46.1%) patients with trauma-related imaging findings were \nhospitalized. There was progression in the follow-up CTs of 40 (9.2%) patients. \n74 (17%) cases underwent radiological or surgical intervention. \nConclusion: Trauma-related imaging findings were detected in 44.3% of the \npatients who had CT-TAP in the ED. Bone injury was the most commonly \nidentified imaging finding. \nLimitations: The retrospective design and the lack of comparison with clinical \nfindings of trauma. \nEthics Committee Approval: It was approved by institutional review board. \nFunding for this study: None. \n \n\n \n \n \nA \nB C 116  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \nAuthor Disclosures: \nMeltem Songür Kodik: Nothing to disclose \nDuygu Do÷a Ekizalio÷lu: Nothing to disclose \nNevra Elmas: Nothing to disclose \nAslı Zeliha Öcek: Nothing to disclose \nEzgi Güler: Nothing to disclose \nMustafa Harman: Nothing to disclose \n \nRPS 117-6 \nAn audit on the use of CT angiography for cases of suspected acute \naortic syndrome referred from the emergency department in an Irish \nteaching hospital \n*D. T. Ryan*, C. Doherty, B. Snow, J. Morrow, R. Macdermott, D. Murphy; \nDublin/IE \n(davidtryan@hotmail.com) \n \nPurpose: Acute aortic syndrome (AAS) is a common presentation to ED with \nCT angiography (CTA) being the investigation of choice. Despite having a \ndefined protocol in our institution, deviation from this is common. We audited \nthe use of CTA for cases of suspected AAS, looking at the protocols used, \nradiation dose and positivity rate. \nMethods or Background: Retrospective study of 106 consecutive CTA \nrequests referred from our Emergency Department (ED) for possible AAS from \nMarch 2019 – January 2020. We excluded patients with multiple scans (e.g. \nCT pulmonary angiograms or CT brains), those who underwent dedicated \ncardiac CTs and non-ED requests. We audited protocols used, radiation dose \nand positivity rate. \nResults or Findings: 106 cases of suspected AAS were included. The \naverage age was 62 years old with a male predominance (64%). 69% of \nstudies included a shortened scan range, such as the thorax only. 29% omitted \na delayed phase, incorporating just a non-contrast (NC) and arterial phase. \n4.7% were positive for AAS. 26% had another cause for symptoms such as \npneumonia or pulmonary emboli. 24% had clinically significant incidental \nfindings such as lung cancers or adrenal masses. Average effective dose for \nall scans was 15.6mSv and for our original triphasic CT thorax, abdomen and \npelvis (TAP) protocol was 23.5mSv. The delayed phase was non-contributory \nin all positive AAS cases. Changing to just a NC thorax (for intramural \nhaematoma assessment) and arterial phase TAP has achieved a new average \naffective dose of 11.7mSv or dose reduction of 50%. \nConclusion: We propose standardising CTA protocols for suspected cases of \nacute aortic syndrome to a non-contrast thorax and arterial phase TAP to \noptimise dose, without decreasing diagnostic yield. \nLimitations: Retrospective study, excluded those with multiple scans, small \nsample size. \nEthics Committee Approval: Approved \nFunding for this study: None \nAuthor Disclosures: \nBarbara Snow: Nothing to disclose \nCathal Doherty: Nothing to disclose \nDavid Thomas Ryan: Nothing to disclose \nJoseph Morrow: Nothing to disclose \nRoisin Macdermott: Nothing to disclose \nDavid Murphy: Nothing to disclose \n \nRPS 117-7 \nRetroperitoneal haematoma: from the CT room to the interventional \nradiology suite \n*D. Herrán De La Gala*, T. Cobo Ruiz, D. Castanedo Vázquez, J. Azcona \nSáenz, P. Menéndez Fernández-Miranda, A. Pérez del Barrio, E. Julián \nGómez, J. Jordá Lope, B. García Martínez; Santander/ES \n(herrandario@gmail.com) \n \nPurpose: To review the retroperitoneal anatomy and its appearance on CT. \nTo describe the appropriate CT protocol for evaluating retroperitoneal \nhematomas. \nTo review the different etiologies of retroperitoneal hematoma. \nTo describe imaging pitfalls that can lead to false positives and false negatives \nin evaluating active bleeding. \nMethods or Background: The retroperitoneum it’s a space delimited \nanteriorly by the posterior parietal peritoneum and posteriorly by the posterior \nabdominal wall. It can be divided in three spaces: anterior pararenal space, \nperirenal space and posterior pararenal space. Retroperitoneal hemorrhage \ncan be the source of significant but clinically occult blood loss. There are \ndifferent conditions that can lead to retroperitoneal hematoma (RH) and we \nmust address the presence or absence of active bleeding on CT imaging. \nResults or Findings: Trauma is the leading cause of RH. In the absence of \ntrauma history, underlying conditions must be scrutinized in order to justify the \nhematoma: iatrogenic, abdominal aorta aneurysms, inferior vena cava rupture, \nrenal or suprarenal lesions, hemorrhagic pancreatitis or, lastly, spontaneous \nretroperitoneal bleeding. It is recommended to evaluate RH in multi-phase CT \nscan, where non-enhanced acquisitions are key. Evaluating the presence of \nactive bleeding is imperative to discuss whether the patient might benefit from \nendovascular treatment or not. \nConclusion: -Non-enhanced CT scan is imperative while evaluating RH. \n-Describing and assessing the RH distribution maybe useful in finding its origin. \n-In the absence of trauma history, we must search for underlying conditions \nthat can justify the RH. \n-Describing the presence of active bleeding and its possible origin helps in \nevaluating the need for endovascular treatment. \nLimitations: Not applicable \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nAmaia Pérez del Barrio: Nothing to disclose \nPablo Menéndez Fernández-Miranda: Nothing to disclose \nJuan Jordá Lope: Nothing to disclose \nJavier Azcona Sáenz: Nothing to disclose \nTeresa Cobo Ruiz: Nothing to disclose \nBeatriz García Martínez: Nothing to disclose \nDavid Castanedo Vázquez: Nothing to disclose \nElena Julián Gómez: Nothing to disclose \nDarío Herrán De La Gala: Nothing to disclose \n \nRPS 117-8 \nPerceive the \"invisible\": enhancing the visibility of foreign body in soft \ntissue injuries in x-ray \n*W. Tam*; Leeds/UK \n(tws_winnie19972004@hotmail.com) \n \nPurpose: Foreign bodies (FB) injuries can cause serious complications if \nunremoved (1,2,3). The visibility of low-density FBs, in which soft-tissue has a \nsimilar density to, making FB detections  difficult in x-ray. The aim is to \ninvestigate how to enhance the contrast between the two, and in turn, increase \nthe chance of FBs recognition. \nMethods or Background: A literature review, evaluating if there is an up-to-\ndate advice on this matter. Literature on non-medical x-ray usage was also \nconsulted to learn if medical imaging can utilise some of these techniques to \naid detection. \nResults or Findings: The availability of up-to-date literature on imaging \ntechnique for FB injuries is limited. The contrast between the FB and its \nsurrounding soft-tissue must be higher than the just-noticeable-difference-\nthreshold of human eyes for distingushment. The just-noticeable-difference-\nthresholds for monochrome is 0.08 (4,5), compares to 0.025, 0.026 and 0.023 \nfor red, blue and green respectively (6). By colourising monochromic images, a \nsmaller difference between shades can be perceived and potentially aids the \ndifferentiation of FBs to their surrounding soft-tissue. Fovea, the area that \nprovides the sharpest vision, only contains colour-detecting photoreceptors (7). \nThus, pseudocolour enhances the subtle differences (8,9), and increases the \nlikelihood for FBs identifications. Pseudocolour is widely used in non-medical \nx-ray images to assist detection (10,11,12). \nConclusion: There are no evidence-based suggestions on imaging technique \nfor low-density FB injuries. Pseudocolour is commonly used in other industries \nfor detection. Shockingly, an extremely limited amount of literature is currently \navailable on the potential of pseudocolour in medical images, further research \nis urgently needed. \nLimitations: The amount of literature reviewed was not optimal due to the \ninsufficient literature availability. But this signified the need of further \ninvestigation, for the sake of best patient care and profession advancement. \nEthics Committee Approval: Na \nFunding for this study: Na \nAuthor Disclosures: \nWinnie Tam: Nothing to disclose \n \nLive Q&A \n \n19:45-20:45 CHANNEL 5 \nCoffee & Talk (open forum) Session \nOrganised by the ESR Subcommittee on \nUndergraduate Education \nC 1 \nAttracting the next generation of \nradiologists: exploring ways forward \nModerator \nLaura Oleaga Zufiría; Barcelona/ES  \n \n\n \n \n \nA \nB C 117  \nSunday \n/LYH\u00033URJUDPPH\u0003\n \nC 1-2 \nFuture radiologists: the importance of early engagement \nSofia Gourtsoyianni; Athens/GR  \n(sgty76@gmail.com) \n \nLearning Objectives: \n1. To be aware of the different strategies of early engagement across Europe. \n2. To appreciate the benefits and challenges to effective early engagement. \n \nC 1-3 \nUndergraduate radiology societies: the UK experience in bringing \ntogether future radiologists \nJim Zhong, Rosemary Ho; Leeds/UK \n \nLearning Objectives: \n1. To learn the role and process of setting up undergraduate radiology \nsocieties. \n2. To appreciate the benefits of early engagement through undergraduate \nsocieties. \n \nC 1-4 \nUndergraduate and postgraduate degrees: do they bring undergraduates \ninto radiology? \nVicky J. Goh; London/UK \n(vicky.goh@kcl.ac.uk) \n \nLearning Objectives: \n1. To be aware of undergraduate and postgraduate degrees involving \nradiology. \n2. To understand if these are effective in bringing doctors into radiology. \nAuthor Disclosures: \nVicky J. Goh: Research Grant/Support: Siemens Healthcare \n \nC 1-5 \nCurrent ESR education initiatives: an update \nCarlo Catalano; Rome/IT \n(Carlo.Catalano@uniroma1.it) \n \nLearning Objectives: \n1. To be aware of ESR's activities in attracting new doctors into radiology. \n2. To be aware of ESR's activities for radiologists in training. \n \nLive Q&A: Attracting the next generation: how to achieve more in \nEurope? \n \n \n\n \n A \nB \nC \n 118  \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\u0003\nOn-Demand Programme \n \n \nE³ - Rising Stars Programme: Basic Sessions (BS) \nE³ - Rising Stars Programme: Student Sessions (S) \nE³ - The Beauty of Basic Knowledge (E³) \nE³ - European Diploma Prep Sessions (E³) \nSpecial Focus Sessions (SF) \nState of the Art Symposia (SA) \nProfessional Challenges Sessions (PC) \nCoffee & Talk (open forum) Session (C) \nRefresher Courses (RC) \nResearch Presentation Sessions (RPS) \nE³ - Advanced Courses (E³) \nEFOMP Workshop (EF) \nEuroSafe Imaging Sessions (EU) \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 119  \n \nE³ - Rising Stars Programme: Basic \nSessions \nOrganised by the EFRS \nBS 2 \nIntroducing elastography \nBS 2-1 \nUltrasound elastography techniques \nMalene Roland Vils Pedersen; Vejle/DK  \n(malene.roland.vils.pedersen@rsyd.dk) \n \nLearning Objectives: \n1. To explain the principles of elastography technique in US. \n2. To discuss the advantages and disadvantages of the different types of \nelastography techniques in US. \n3. To provide practical tips and tricks in the application of the technique \n \nBS 2-2 \nMRI elastography techniques \nClaude Portanier Mifsud; Msida/MT  \n \nLearning Objectives: \n1. To explain the principles of elastography technique in MRI. \n2. To discuss advances in MR elastography. \n3. To provide practical tips and tricks in the application of the technique. \n \nBS 2-3 \nClinical applications of elastography \nAllison McGee; Dublin/IE \n \nLearning Objectives: \n1. To indicate clinical areas for elastography examinations. \n2. To indicate clinical indications of elastography examinations. \n3. To consider the associated risks of elastography techniques. \nAuthor Disclosures: \nAllison McGee: Employee: Employee of an Educational Institution; Speaker: \nInvited to contribute to ECR 2021 \n \n \nE³ - Rising Stars Programme: Basic \nSessions \nOrganised by the EFRS \nBS 3 \nRadiation dose and image quality \noptimisation \nBS 3-1 \nPatient shielding in diagnostic radiography: is it effective? \nNejc Mekis; Ljubljana/SI  \n \nLearning Objectives: \n1. To explain the difference between in-plane and out-of-plane shielding. \n2. To explain the pros and cons of shielding. \n3. To provide an updated overview of position statements on shielding. \n \nBS 3-2 \nPrinciples of radiation dose optimisation \nJoana Santos; Coimbra/PT  \n(joanasantos@estescoimbra.pt) \n \nLearning Objectives: \n1. To emphasise the need for radiation dose optimisation. \n2. To discuss the role of diagnostic reference levels (DRLs) in the dose \noptimisation strategy. \n3. To understand the importance of radiation dose monitoring. \n \nBS 3-3 \nImage quality evaluation methods \nMark F. McEntee; Cork/IE \n(mark.mcentee@ucc.ie) \n \nLearning Objectives: \n1. To provide an overview of image quality requirements in diagnostic imaging. \n2. To become familiar with the available image quality assessment methods. \n3. To become aware of appropriate image quality analysis. \n \n \nE³ - Rising Stars Programme: Basic \nSessions \nOrganised by the EFRS \nBS 4 \nEquality, diversity, and inclusion (EDI) \nissues for radiography \nBS 4-1 \nAn introduction to the concept \nLouise A. Rainford; Dublin/IE \n(louise.rainford@ucd.ie) \n \nLearning Objectives: \n1. To introduce the Athena Swan. \n2. To understand the importance of the Athena Swan for radiography. \n3. To emphasise how the Athena Swan can impact positively on radiography \ntraining centres. \n \nBS 4-2 \nApplication within radiography curricula \nRuth Strudwick; Ipswich/UK  \n(r.strudwick@uos.ac.uk) \n \nLearning Objectives: \n1. To incorporate EDI in radiography curricula. \n2. To discuss EDI considerations, including clinical skills labs and clinical. \n3. To demonstrate the impact on the student code of conduct. \n \nBS 4-3 \nEnsuring appropriate patient care in the clinical environment \nKaren Knapp; Exeter/UK \n(K.M.Knapp@exeter.ac.uk) \n \nLearning Objectives: \n1. To discuss EDI policies in the clinical environment. \n2. To understand the requirements of CPD to support clinical radiographers \nand appreciate the topic. \n3. To safeguard patient rights. \n \n \nE³ - Rising Stars Programme: Basic \nSessions \nOrganised by the EFRS \nBS 5 \nRadiography: raising the profile of our \nprofession \nBS 5-1 \nBeing a professional: the EFRS perspective and why it matters \nJonathan McNulty; Dublin/IE  \n(jonathan.mcnulty@ucd.ie) \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 120  \nLearning Objectives: \n1. To discuss radiography as a profession. \n2. To understand the importance of being a professional. \n3. To be aware of the EFRS perspective of radiographers as professionals. \n \nBS 5-2 \nUsing social media to inform others about our profession \nGraciano Paulo; Coimbra/PT  \n(graciano@estescoimbra.pt) \n \nLearning Objectives: \n1. To provide an overview of what social media is, what is available, and how \nto identify which is the best for promoting the profession. \n2. To learn how to maximise social media use in promoting radiography \namongst health professionals. \n3. To learn how to maximise social media use in promoting radiography \namongst the general public. \n \nBS 5-3 \nA radiographers' perspective: the importance of highlighting the role of \nradiographers to patients \nCharlotte Beardmore; London/UK \n(CharlotteB@sor.org) \n \nLearning Objectives: \n1. To discuss the relevance of the radiographer's role within the health care \nsystem. \n2. To highlight issues patients may have in distinguishing between radiology \nand radiography. \n3. To discuss whether the radiographer's responsibility is in satisfying the \npatient's expectations. \n \n \nE³ - Rising Stars Programme: Basic \nSessions \nOrganised by the ESR \nBS 6 \nAbdominal viscera: liver imaging \nBS 6-1 \nBenign liver lesions \nAndrea Laghi; Rome/IT  \n(andrea.laghi@uniroma1.it) \n \nLearning Objectives: \n1. To present current imaging techniques for evaluation of benign liver lesions. \n2. To describe the typical features of benign liver lesions. \nAuthor Disclosures:  \nAndrea Laghi: Speaker: Bracco, GE Healthcare, MSD, Bayer, Guerbet \n \nBS 6-2 \nMalignant liver lesions \nIoana G. Lupescu; Bucharest/RO  \n(ilupescu@gmail.com) \n \nLearning Objectives: \n1. To present the current imaging techniques for evaluation of malignant liver \nlesions. \n2. To become familiar with the typical findings of malignant liver lesions. \n \nBS 6-3 \nMRCP: state-of-the-art diagnosis of the biliary system \nAhmed Ba-Ssalamah; Vienna/AT \n(ahmed.ba-ssalamah@meduniwien.ac.at) \n \nLearning Objectives: \n1. To present technical aspects and indications of MRCP. \n2. To become familiar with the typical MRCP findings in benign and malignant \nbiliary diseases. \n \n \nE³ - Rising Stars Programme: Basic \nSessions \nOrganised by the ESR \nBS 7 \nGenitourinary \nBS 7-1 \nImaging of the uterus \nRiccardo Manfredi; Rome/IT  \n(riccardo.manfredi@unicatt.it) \n \nLearning Objectives: \n1. To learn about the uterine anatomy. \n2. To present the current imaging techniques for the evaluation of the uterus. \n3. To demonstrate the most important findings of common uterine pathologies. \n \nBS 7-2 \nImaging of the adnexa \nSanja Stojanovic; Novi Sad/RS  \n \nLearning Objectives: \n1. To learn about the adnexa anatomy. \n2. To present the current imaging techniques for the evaluation of the adnexa. \n3. To demonstrate the most important findings of adnexal pathologies. \n \nBS 7-3 \nImaging gynaecological emergencies \nRosemarie Forstner; Salzburg/AT \n(r.forstner@salk.at) \n \nLearning Objectives: \n1. To present current imaging techniques for the evaluation of gynaecological \nemergencies. \n2. To illustrate the spectrum of imaging features in gynaecological \nemergencies in non- pregnant and pregnant women. \n \n \nE³ - Rising Stars Programme: Basic \nSessions \nOrganised by the ESR \nBS 9 \nCardiovascular imaging \nBS 9-1 \nAcute coronary artery syndrome \nMaja Pirnat; Maribor/SI  \n \nLearning Objectives: \n1. To present current imaging techniques to evaluate the coronary arteries. \n2. To demonstrate the most important imaging findings. \n \nBS 9-2 \nImaging in non-ischaemic cardiomyopathy \nJens Bremerich; Basle/CH  \n(jens.bremerich@usb.ch) \n \nLearning Objectives: \n1. To present the imaging techniques to evaluate the myocardium. \n2. To demonstrate the most important findings. \n \nBS 9-3 \nAortic dissection \nKarl-Friedrich Kreitner; Mainz/DE \n(Karl-Friedrich.Kreitner@unimedizin-mainz.de) \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 121  \nLearning Objectives: \n1. To present the imaging techniques to evaluate the aorta. \n2. To demonstrate the most important findings. \n \n \nE³ - Rising Stars Programme: Basic \nSessions \nOrganised by the ESR \nBS 10 \nNeuroradiology \nBS 10-1 \nStroke \nE. Turgut Tali; Ankara/TR  \n(turgut.tali@gmail.com) \n \nLearning Objectives: \n1. To learn about imaging features in haemorrhagic stroke. \n2. To learn about imaging features in ischaemic stroke \n \nBS 10-2 \nInfection and demyelinating diseases \nLaura Oleaga Zufiría; Barcelona/ES  \n(lauraoleaga@gmail.com) \n \nLearning Objectives: \n1. To learn about imaging features in brain infections. \n2. To learn about imaging features in demyelinating diseases. \n \nBS 10-3 \nTumours \nMarion Smits; Rotterdam/NL \n(marion.smits@erasmusmc.nl) \n \nLearning Objectives: \n1. To learn about imaging features in benign tumours. \n2. To learn about imaging features in neoplastic disorders. \nAuthor Disclosures: \nMarion Smits: Consultant: Parexel Ltd, honorarium paid to institution; Speaker: \nGE Healthcare, honorarium paid to institution \n \n \nE³ - Rising Stars Programme: Basic \nSessions \nOrganised by the ESOR \nBS 12 \nRadiologic anatomy: abdomen \nBS 12-1 \nSmall bowel \nStuart A. Taylor; London/UK  \n \nLearning Objectives: \n1. To appreciate the embryological development of the small bowel. \n2. To learn about the anatomy of the small bowel relevant to radiological \nimaging. \n3. To understand the pitfalls of the normal small bowel appearance during \nimaging interpretation. \nAuthor Disclosures: \nStuart A. Taylor: Consultant: alimentiv \n \nBS 12-2 \nAnorectal \nAndrás Palkó; Szeged/HU  \n(palkoand@gmail.com) \n \n \n \nLearning Objectives: \n1. To review the normal anatomy of the anorectum. \n2. To learn how well depicted the different anatomical landmarks of the \nanorectum are with different available imaging methods. \n3. To discuss the clinical scenarios for which it is necessary to be aware of the \nanatomy of the anorectum. \n \nBS 12-3 \nPeritoneum and mesentery \nPanos K. Prassopoulos; Thessaloniki/GR \n(pprasopo@auth.gr) \n \nLearning Objectives: \n1. To review the radiologic anatomy of peritoneal ligaments, mesenteries, and \nomenta on cross-sectional imaging. \n2. To describe the most clinically important peritoneal compartments and fluid \ncollections. \n3. To discuss the key role of anatomy in the dissemination of malignancies or \nthe restriction of inflammatory processes in the abdomen. \n \n \nE³ - Rising Stars Programme: Student \nSession \nS 2 \nStudent Session 2 \nS 2-1 \nMachine learning can predict left ventricular dilatation in non-gated \ncontrast enhanced CT thorax \n*A. Asif*, P. F. P. Charters, B. J. Hudson, J. C. L. Rodrigues; Bath/UK  \n \nPurpose: The study purpose was to determine the diagnostic accuracy of a \nfully automated machine-learning (ML) derived tool at detecting left ventricular \n(LV) dilatation on non-ECG gated contrast-enhanced CT of the thorax relative \nto contemporaneous cardiac magnetic resonance (CMR) gold-standard. \nMethods or Background: Consecutive patients (n=77) with contrast-\nenhanced CT thorax and CMR within a 30-day interval were included. LV \ndilatation was defined against age, sex and body surface area (BSA) indexed \nnormal values with analysis by a Cardiac Radiologist using cmr42 (Circle \nCardiovascular Imaging Inc., Calgary, Canada). All CTs were sent for \nautomated ML-derived analysis that segments the ventricular chambers, \npresenting maximal LV diameter from trans-axial images (Imbio, Minneapolis, \nUSA). Area under the receiver operator curve (AUC-ROC) analysis identified \nthe automated LV diameter thresholds with •90% sensitivity and highest \nspecificity and •90% specificity with highest sensitivity. \nResults or Findings: Automated CT analysis was feasible in all patients (45 \nmen, 32 women, age 61±14 years, mean CT-CMR interval 10±8 days). \nRelative to CMR gold standard, 45% (35/77) had LV dilatation and 23% (18/77) \nhad RV dilatation. AUC-ROC for automated absolute LV diameter was 0.712 \n(95% CI 0.59-0.83), p=0.001: absolute LV diameter >41.9mm 91% sensitive \nand 28% specific for LV dilatation and absolute LV diameter >52.4mm 91% \nspecific and 51% sensitive. Automated LV diameter indexed to BSA improved \nperformance (AUC-ROC 0.738 (95% CI 0.62-0.85), p<0.0001: indexed LV \ndiameter >20.8mm 91% sensitive and 21% specific for LV dilatation and \nindexed LV diameter >28.0mm 91% specific and 49% sensitive. \nConclusion: Automated ML-derived analysis of non-ECG gated contrast \nenhanced CT thorax compares favourably with detecting LV dilatation relative \nto CMR gold standard and could be applied routinely to screen for dilated \ncardiomyopathy. \nLimitations: Retrospective, single centre. \nEthics Committee Approval: Approved by trust audit committee. \nFunding for this study: Nil \nAuthor Disclosures: \nPia Charters: nothing to disclose \nAshar Asif: Nothing to disclose \nBenjamin James Hudson: Nothing to disclose \nJonathan Rodrigues: Other: RUH is a Centre of Excellence for Imbio with use \nof Imbio without charge \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 122  \nS 2-2 \nDual-layer spectral detector CT to study the correlation between \npericoronary adipose tissue and coronary artery stenosis \n*L. X. Zhu*, Y. Dang, X. Lu, Y. Hou; Shenyang/CN  \n \nPurpose: To investigate the relationship of pericoronary adipose tissue with \ncoronary artery stenosis in patients with coronary heart disease on dual-layer \nspectral detector CT㸦SDCT㸧 \nMethods or Background: Retrospectively collected 99 patients who used \nSDCT to perform coronary CTA on suspected coronary heart disease. \nAccording to random block design 㸪all patients were divided into three groups \naccording to the degree of coronary artery stenosis: normal (no stenosis), no \nsignificant stenosis (the degree of stenosis was < 50%) and significant stenosis \n(the degree of stenosis was • 50%) with 33 persons in each group. Compare \nthe effect of lesion stenosis on pericoronary adipose tissue 㸦PCAT㸧㸪\nquantitatively evaluate the narrowest part of the lesion pericoronary adipose \ntissue: fat attenuation index (FAI40kev), attenuation index (PCATi40keV = \n(CTFAI40keV - CTSAT40keV) / CTSAT40keV, SAT: subcutaneous adipose \ntissue)㸪spectral curve slope (ȜHU= (CTFAI40keV - CTFAT70keV) /30), \neffective atomic number (Eff-Z) and epicardial fat volume (EFV). \nResults or Findings: Each index of PCAT was related to the degree of \ncoronary artery stenosis. The difference in PCAT index between the normal \ngroup and the significant group, the non-significant group and the significant \ngroup were statistically significant, while the EFV difference between the \nnormal group and the non-significant group, the normal group and the \nsignificant group were statistically significant. Both FAI40kev and ȜHU were \nstatistically significant in the significant stenosis group (P <0.05). \nConclusion: This study showed that the PCAT and EFV indicators based on \nSDCT were significantly different between the normal and atherosclerotic \ngroups and between the groups with different atherosclerotic degrees. Based \non FAI40kev and ȜHU was a risk factor for significant coronary stenosis. Its \nassociation with significant coronary stenosis was better than EFV. \nLimitations: Single-center small sample research, small sample size \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nXiaomei Lu: Nothing to disclose \nYuxue Dang: nothing to disclose \nYang Hou: Nothing to disclose \nMA Long Xiao Zhu: Nothing to disclose \n \nS 2-3 \nDiagnostic models for detection of intrauterine growth restriction and \nplacental insufficiency severity, based on magnetic resonance imaging of \nplacenta \nB. Moradi, E. Tabibian, M. A. Kazemi, M. Shirazi, M. Chavoshi, *S. Rashedi*; \nTehran/IR \n \nPurpose: Placental insufficiency is regarded as the primary cause of \nintrauterine growth restriction (IUGR). Here we aimed to provide a diagnostic \nmodel based on different parameters of placental MRI to detect IUGR, as well \nas the severity of placental insufficiency. \nMethods or Background: We included 44 fetuses with appropriate weight for \ngestational age (AGA) and 46 singleton pregnancies with documented IUGR \ndefined as the estimated fetal weight (EFW) below the 10th percentile. By \nusing Doppler ultrasonography, IUGR cases were divided into two groups: 1. \nIUGR with severity signs: birth weight<3rd centile, or cerebroplacental \ncentile<5th, or abnormal umbilical/uterine artery pulsatile index; and 2. Non-\nsevere IUGR without any of this criterion. For all of the three groups, MRI was \nperformed (T1, T2, and diffusion-weighted sequences), and its parameters \nwere compared between AGA and IUGR and two IUGR groups. Two \ndiagnostic models consisting of significant predictors were developed, and their \nperformance was investigated with accuracy metrics. \nResults or Findings: The severity signs were detected in 25 (54.3%) IUGR \ncases. All demographic characteristics were almost equal and comparable \namong the groups. The diagnostic model for the differentiation of IUGR from \nAGA revealed an acceptable performance (area under the receiver operating \ncharacteristic curve(AUC)=0.794). Moreover, the logistic regression model for \ndetection of the severity signs was even better with AUC=0.842 and consisted \nof three main predictors: I. Placental Infarct Percent> 10% (OR=8.26[95% CI: \n1.54 - 44.23], p=0.014); II. Placental Shape (plate-like vs. globular) (OR= \n5.80[95% CI: 1.35 - 24.75], p=0.018); and III. Placental Area>5400mm2 \n(OR=3.21 [95% CI: 0.63 - 16.37], p=0.016). \nConclusion: MRI parameters can differentiate IUGR from AGA and, more \nprecisely, assess the placental insufficiency severity in IUGR fetuses. \nLimitations: The major limitation of this study was the limited sample size. \nEthics Committee Approval: n/a \nFunding for this study: None. \n \n \nAuthor Disclosures: \nBehnaz Moradi: Nothing to disclose \nSina Rashedi: Nothing to disclose \nElnaz Tabibian: Nothing to disclose \nMahboobeh Shirazi: Nothing to disclose \nMohammadreza Chavoshi: Nothing to disclose \nMohammad Ali Kazemi: Nothing to disclose \n \nS 2-4 \nAssociation between tears of the posterior root of the medial meniscus \nand far posterior femoral condyle osteoarthritis \n*S. S. Ashok*, R. Sebro, M. Uriell; Philadelphia, PA/US \n \nPurpose: Evaluate whether tears of the posterior horn of the medial meniscus \nroot ligament (PHMM RL) are associated with osteoarthritis of the far posterior \nfemoral condyles (FPFC). \nMethods or Background: Retrospective review of 1158 patients who \nunderwent arthroscopy identified 49 patients with PHMM RL attachment tears. \nReview of preoperative MRI studies identified advanced osteoarthritis involving \nthe medial and lateral FPFC. Controls (n=48) had no meniscal tears confirmed \nby arthroscopy. Cases and controls were age- and sex-matched 1:1. One case \nwas excluded due to absence of control. The International Cartilage Research \nSociety (ICRS) MRI cartilage grade was recorded for medial and lateral FPFC. \nAssociations were evaluated using univariate and multivariable conditional \nlogistic regression analyses. \nResults or Findings: There were 10 men (20.8%) in each case and control \ngroup with median age 53 years (range, 21–67). Medial FPFC ICRS Grade 2 \nor higher lesions were present in 34 (70.8%) cases and 16 (33.3%) controls. \nLateral FPFC ICRS Grade 2 or higher lesions were present in 24 (50%) cases \nand 14 (28.2%) controls. Increased BMI was associated with PHMM RL tears \n(OR=1.11, 95% CI [1.01, 1.22], P = 0.020). MRI was 81.2% (39/48) sensitive \nand 91.2% (44/48) specific for detection of PHMM RL tears. PHMM RL tears \nwere associated with Grade 2 or higher medial FPFC osteoarthritis (OR=10.00, \n95% CI (2.34, 42.78), P < 0.001). This association remained after adjusting for \nBMI (OR=11.79, 95% CI [2.46, 56.53], P = 0.002). An association between \nPHMM RL tears and lateral FPFC osteoarthritis persisted after adjusting for \nBMI (OR =3.00, 95% CI [1.07, 8.37], P = 0.036). \nConclusion: PHMM RL tears are associated with advanced osteoarthritis of \nthe FPFC. Radiologists identifying FPFC osteoarthritis should look carefully for \nPHMM RL tears. \nLimitations: None. \nEthics Committee Approval: IRB approval. \nFunding for this study: None. \nAuthor Disclosures: \nBA Samantha Sharon Ashok: Nothing to disclose \nMatthew Uriell: Nothing to disclose \nRonnie Sebro: Nothing to disclose \n \nS 2-5 \nStudy of knee anatomical variables as risk factors predisposing to \nanterior cruciate ligament injury using MRI morphometry \n*S. G. Maheshwari*, R. S. Kuber, A. Kharat, R. Arkar; Pune/IN \n \nPurpose: The anterior cruciate ligament (ACL) is the most frequently injured \nligament of the knee and some people are at greater risk of tearing their ACL \nthan others. \nObjectives: \nTo assess anatomic variables of distal femur and proximal tibia morphology \nsuch as medial and lateral condyle width, intercondylar notch width, notch \nindex,tibial platue slopes and depth respectively between the anterior cruciate \nligament(ACL)injured and non- injured patient on conventional MRI. Are these \nvariables risk factors for ACL injury? \nMethods or Background: Case-control study of ACL injured and non-injured \npatients presented to Department of Radiology at D Y Patil Medical college, \nPune. Knee MRIs of 450 patients were studied (225 cases of ACL injured and \n225 controls with normal ACL) after matching for age, sex and predisposing \nfactor. Distal femoral and proximal tibia morphology was studied with respect to \ndifferent parameters on multiplanar MRI. Statistical analysis was done and \nOdds ratio calculated. \nResults or Findings: In this group,there was significant bony morphology \ndifference between ACL injured and non-injured patients. Significant difference \nof bicondylar width (P=0.004) and intercondylar notch width (P=0.001) between \nmale and female patients were noted. Among the male group between injured \nand non-injured ACL patients there was significant difference notch width index \n(P=0.001), medial posterior tibial slope (P=0.007) and medial plateau depth \n(P=0.003) are noted. There is narrower notch width in ACL injured men respect \nto non-injured. (Odd Ratio=3.02-cases compared OR=5.2-control). There were \nno significant differences lateral posterior tibial slopes. \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 123  \nConclusion: From this study we concluded that ACL injured men have \nnarrower notch width index and shallow medial tibia depth and steeper MPTS \nwhich appear important risk factors. Identifying these risk factors helps in \nstratification non-intervention and intervention strategies of ACL injuries. \nLimitations: Previous Surgery, Septic-Hemophilic and Degenerative arthritis \naltering knee anatomy. \nEthics Committee Approval: Yes \nFunding for this study: None \nAuthor Disclosures: \nRajesh S Kuber: Nothing to disclose \nAmit Kharat: Nothing to disclose \nSagar Ganeshprasad Maheshwari: Nothing to disclose \nRahul Arkar: Nothing to disclose \n \nS 2-6 \nAssociation between enlarged perivascular spaces and cerebral blood \nflow, brain volume, and cardiovascular disease risk in elderly \n*S. Liu*, B. Hou, H. You, Y. Zhu, C. Ma, Z. Zuo, F. Feng; Beijing/CN \n \nPurpose: To evaluate the association between enlarged perivascular spaces \nin basal ganglia (BG-EPVS) and gray matter volume (GMV), GM cerebral \nblood flow (GM-CBF), and cardiovascular disease (CVD) risk in cognitively \nintact elderly individuals. \nMethods or Background: 285 participants were recruited with the criteria of \nage•55-year-old, MMSE score•27, right handedness, and free of brain \ndisorders. MRI was performed at 3T using pseudo-continuous arterial spin \nlabeling and sagittal T1-weighted sequence for GM-CBF and GMV analysis. \nImages from a subset of the participants (set A; n=254) were used to \ninvestigate the relationship between the severity of BG-EPVS and GMV/GM-\nCBF, while images from another subset (set B; n=254) were used to reveal the \nrelationship between the severity of BG-EPVS and the CVD risk. The BG-\nEPVS was identified according to standards for Reporting Vascular changes \non neuroimaging. Ten-year CVD risk for individuals was determined from \nFramingham risk score. Based on CVD, participants were divided into a high-\nrisk group (>20% risk) and a low-risk group ( ”20% risk) for statistical analysis. \nResults or Findings: In subset A, severe BG-EPVS was associated with \nsignificantly decreased GMV and GM-CBF in multiple cortical regions, such as \nthe frontal and temporal gyrus (P<0.05), but increased CBF in the bilateral \ncaudate nucleus and putamen (P<0.05). In subset B, participants with severe \nBG-EPVS had higher CVD risk than participants with mild BG-EPVS (66.1% \nvs. 46.0%; P=0.009). \nConclusion: In cognitively intact elderly individuals, severe BG-EPVS was \nassociated with increased CVD risk and widespread changes in GMV and GM-\nCBF. Early identification of BG-EPVS could be useful for better understanding \nthe pathophysiology of EPVS-related diseases. \nLimitations: This cross-sectional analysis did not make allowances for causal \ninferences. \nEthics Committee Approval: Peking Union Medical College Hospital \nFunding for this study: Chinese Academy of Medical Sciences Innovation \nFund for Medical Sciences \nAuthor Disclosures: \nFeng Feng: Nothing to disclose \nSirui Liu: Nothing to disclose \nHui You: Nothing to disclose \nChao Ma: Nothing to disclose \nYicheng Zhu: nothing to disclose \nZhentao Zuo: Nothing to disclose \nBo Hou: Nothing to disclose \n \nS 2-7 \nAlterations in selected regions of brain white matter with the biomarker \nanisotropy fraction derived from the diffusion tensor in patiens with \nclinical diagnosis of post-traumatic stress disorder \n*K. E. Abundiz Bibiano*, C. V. Baena; Mexico City/MX \n \nPurpose: To identify alterations in selected brain white matter regions with the \nbiomarker anisotropy fraction derived from the diffusion tensor in military \npersonnel with a clinical diagnosis of post-traumatic stress disorder (PTSD). \nMethods or Background: Cross-sectional, as well as cases and controls. \nMilitary personnel who were exposed to high impact events with clinical \ndiagnostic criteria for PTSD and healthy controls not belonging to the armed \nforces. Total sample of 35 patients with a clinical diagnosis of PTSD and 20 \nhealthy patients, non-probabilistic sample for convenience from January to \nDecember 2018 with simple magnetic resonance imaging of the skull with \nacquisition of conventional sequences and the advanced diffusion tensor \nsequence and quantify the fraction of anisotropy. \nResults or Findings: In a group of 20 healthy controls, the measurements of \nthe anisotropic fraction biomarker derived from the diffusion tensor had a \nnormal distribution according to the Kolmogorov-Smirnov statistic, the controls \nwith positive alcoholism differed from those with negative alcoholism at the T. \nLong level. Right upper [0.54 +/- 0.01 versus 0.53 +/- 0.009, p = 0.03]. In the \ngroup of cases, there was no difference in the means of the biomarker in any \nregion according to the severity of stress as chronic or acute. With the \nexception of the left prefrontal cortex, in all other regions the means of the \nbiomarker differ significantly between cases and controls, with greater \naccentuation at the level of the hippocampus and amygdala. \nConclusion: We can conclude that there is a decrease in the anisotropy factor \nin patients with post-traumatic stress disorder compared to healthy patients, \nmarkedly at the level of the amygdala and hippocampus. \nLimitations: No ONE \nEthics Committee Approval: Approved. \nFunding for this study: NO oNE \nAuthor Disclosures: \nKarla Estela Abundiz Bibiano: Nothing to disclose \nClaudia Viviana Baena: Nothing to disclose \n \nS 2-8 \nAnalysis of compression real-time strain elastography efficacy in \ndifferentiation of functional and inflammatory colonic diseases in \nchildren \n*E. A. Paleonaya*¹, N. J. Nelassov², M. Morgunov², T. Korkoshka², A. Palenui², \nA. Zubov¹, O. Eroshenko², A. Nechaeva²; ¹Donetsk/UA, ²Rostov/RU \n \nPurpose: To assess if transabdominal ultrasound-based compression real-\ntime strain elastography in children help  to differentiate functional/inflammatory \ncolonic pathology in acute stage. \nMethods or Background: 79 children (mean age 9.8+1.4 years) were \nexamined. There were 20 healthy children (1-st subgroup) without any signs of \nintestinal disorders and values of fecal calprotectin (FC) <50 μg/g and 59 \nchildren with clinical presentation of colonic pathology (25 with normal values \nof FC (<50 μg/g; 2-d subgroup), 24 with borderline levels of FC (50–120 μg/g; \n3-d subgroup), 9 with elevated values of FC (>120 μg/g; 4-th subgroup) and \nwith verified by colonoscopy diagnosis of IBD). RTE measurements were \nperformed during exam of ascending, transverse and descending colon at the \nsites of detection of mostly affected colonic segments. The outcome of RTE \nwas classified according to a colorimetric categorical classification method \nproposed by Giannetti A. et al (2013). \nResults or Findings: In all healthy children RTE revealed category 1B of wall \nstiffness (normal colonic wall stiffness). 84.0% of children in subgroup 2 had \nnormal intestinal wall stiffness (1B), indicating the presence of functional \npathology. 83.3% of children in 3-d subgroup had 2BA category of wall \nstiffness, which is characteristic for either functional pathology or remission \nstage of IBD. In patients of 4-th subgroup in 88.9% of cases was found 1A \ncategory of wall stiffness (stiff colonic wall). While using FC as comparator \nsensitivity and specificity of RTE in separation of children with IBD from others \nin acute stage of disease appeared to be 88.9% and 98.0% (p=.0001). \nConclusion: RTE can effectively differentiate functional and inflammatory \ncolonic pathology in children in acute stage of disease. \nLimitations: During the study, the limitations were not violated. \nEthics Committee Approval: The ethics Committee approved the study. \nFunding for this study: The research was not funded. \nAuthor Disclosures: \nA. Zubov: Investigator: the research process \nPalenui A. Andrew Palenui: Investigator: the research process \nNikolai J Nelassov: Investigator: the research process \nMaxim Morgunov: Investigator: the research process \nO. Eroshenko: Investigator: the research process \nTatiana Korkoshka: Investigator: the research process \nElisaveta Andrevna Paleonaya: Author: The Research \nA. Nechaeva: Investigator: the research process \n \n \nE³ - Rising Stars Programme: Student \nSession \nS 3 \nStudent Session 3 \nS 3-1 \nThe breast is yet to come: review of symptomatic recall to screening. Our \nexperience at the South East Scotland Breast Screening Centre \n*N. Tai*, G. P. Babu, E. G. Breaden, B. Coiley, H. Dissanayake, B. Ingabire, \nY. Papadopoulos, L. Street; Edinburgh/UK  \n \nPurpose: In Scotland, breast screening is offered to women (50-70 year-old) \ntriennially. Women are recalled for mammographic abnormalities and \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 124  \nsymptoms. This audit project aimed to review the effectiveness of the current \napproach to symptomatic recall. A secondary objective was to establish an \neffective GP referral pathway for women who report symptoms at screening. \nMethods or Background: Review of a database of 47,340 screenings \nbetween November 2017 and October 2018 identified 2,132 recall cases; 166 \nwere symptomatic. Data analysis was performed to categorise symptoms into \nlumps, discharge, dimpling and non-specific causes. Excel was used to \nstatistically analyse percentage of cases in each symptom category. \nInformation on GP referrals was obtained from patient records. \nResults or Findings: Symptomatic recall rate was 7.8% (166 symptomatic \nrecalls out of 2132 recall cases). 51% of symptomatic women reported lumps, \n6% discharge, 25% dimpling and 18% non-specific. Positive predictive value \nfor cancers was low at 2.4% (only 4 out of 166 symptomatic women) with all \nlesions visible mammographically. Only 49% of symptomatic patients were \nassigned to the appropriate patient pathway ie. referral to GP. \nConclusion: Outcome of study showed that no cancers detected from \nsymptomatic recalls were occult mammographically. We established that the \ncurrent approach to symptomatic recall is not cost-effective. Additionally, \nwomen face emotional stress when recalled for screening assessments. A \nstandardised approach to symptomatic recall was lacking across various \nscreening centres and this evidence has helped us develop one. This also \nenabled education and training of mammographers to assign women to \nappropriate GP referral pathways. The project outcomes have been accepted \nnationally and is being incorporated into practice. \nLimitations: There was an exclusion of a small number of cases due to \ntechnical reasons but this was not statistically significant. \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nBeth Coiley: Nothing to disclose \nLara Street: Nothing to disclose \nEllen Grace Breaden: Nothing to disclose \nYasmina Papadopoulos: Nothing to disclose \nHathsu Dissanayake: Nothing to disclose \nBenissa Ingabire: Nothing to disclose \nGauri Priya Babu: Nothing to disclose \nNatalie Tai: Nothing to disclose \n \nS 3-2 \nHow branching scenario tool can transform and improve radiology \neducation? A cross-sectional study \n*M. E. B. De Siervi*, M. E. R. d. A. D. d. Pinho, G. F. Saffe, C. V. Souza Freire, \nC. Freitas Lins; Salvador/BR  \n \nPurpose: To evaluate the application of “Branching Scenario” as an interactive \ntool for teaching radiology for medical students. \nMethods or Background: “Branching scenario” was developed by student \nmentors of radiology guided by a radiologist through H5P plug-in and it was \nmade available weekly by Moodle platform to medical students. This tool is \nbased on a clinical case followed by multiple-choice questions about the \nprobable diagnosis and the imaging tests to be requested. The chosen answer \ndetermines the following question that will be seen in order to dialogue with the \nclinical-radiological reasoning developed by the student. After that, feedback is \nreceived about the adequacy of answers and cost-conscious handling for the \ncase. After one semester, students were invited to answer an evaluation \nquestionnaire. Written informed consent was obtained from all subjects. \nResults or Findings: 147 students (21±3 years, 59% female) participated in \nthe study. From that sample, 89% considered the digital platform’s clarity to \napproach radiology above the average or excellent. 87% expressed to have \nfacility to use the platform. 80% considered Branching Scenario as a helpful or \nvery helpful tool in order to take correct conduct with their patients in their \nfuture medical practice. 89% considered that the digital interactive platform \ncontributed to the realization of academic tests. 91% considered that \nassociation between clinical cases and radiology enabled greater learning. \nConclusion: “Branching Scenario” tool allows the creation of clear and \ninteractive radiological contents that can increase the learning potential of \nstudents. \nLimitations: This is a descriptive study, further investigation would be required \nto measure the impact of the tool. \nEthics Committee Approval: Ethical approval was obtained from the Ethics \nCommittee of the University where this study was developed (CAAE: \n28196820.6.0000.5544). \nFunding for this study: Not applicable. \nAuthor Disclosures: \nMaria Eduarda Rodrigues de Araújo Dantas de Pinho: Nothing to disclose \nGabriela Fagundes Saffe: Nothing to disclose \nMaria Eduarda Barreto De Siervi: Nothing to disclose \nCarolina Freitas Lins: Nothing to disclose \nCamila Verônica Souza Freire: Nothing to disclose \n \nS 3-3 \nPhotoacoustic imaging in evaluating early intestinal ischemia and \nreperfusion injury with rat models \n*R. Wang*; Yunnan/CN \n \nPurpose: It is still a challenge to distinguish whether the damaged intestine is \nviable or not in the treatment of acute mesenteric ischemia. In this study, \nphotoacoustic imaging (PAI) was used to observe the activity of intestinal \ntissue after ischemia and reperfusion injury in rats. \nMethods or Background: Forty male SD rats were randomly divided into four \ngroups: sham operated (SO) group, 1 h ischemia group, 2 h ischemia group \nand ischemia-reperfusion (I/R) group. In the ischemia group, superior \nmesenteric artery was isolated and clamped for 1 h and 2 h, respectively. In I/R \ngroup, after ischemia for 1 hour, the clamp was removed and reperfused for 1 \nhour. Immediately after the establishment of the animal model, PAI \nexamination was performed. After PAI examination, the small intestine was \ncollected for histopathology. \nResults or Findings: The PAI derived parameters of 2 h ischemia group were \nsignificantly different from those of SO group and I/R group (P<0.05). The \nlevels of Hb, HbR, map760 and map 840 were increased in different degrees in \nischemia group, especially in 2 h ischemia group (compared with SO group, \nP<0.01). In immunohistochemistry, compared with SO group, BAX increased \nsignificantly in 2 h ischemia group (P<0.01). TUNEL staining showed that the \nnumber of apoptotic positive nuclei in 2 h ischemia group was significantly \nhigher than that in SO group (P<0.05). \nConclusion: PAI can be used as an effective tool to detect acute intestinal \nischemia injury and quantitatively evaluate tissue viability. \nLimitations: The main limitation of our study is that the intestinal I/R model \nwith mesenteric artery ligation can not fully simulate simulate clinical intestinal \nischemia. \nEthics Committee Approval: Approved by Animal Ethics Committee of \nKunming Medical University. \nFunding for this study: Supported by National Natural Science Foundation of \nChina (NSFC Grants 82060313 and 81760316). \nAuthor Disclosures: \nRui Wang: Nothing to disclose \n \nS 3-4 \nPercutaneous microwave ablation (MWA) of small-sized hepatocellular \ncarcinoma (HCC) under CT-guidance \n*H. Adwan*, T. J. Vogl; Frankfurt am Main/DE \n \nPurpose: To evaluate the safety and efficacy of CT-guided percutaneous \nmicrowave ablation (MWA) as a potentially curative treatment for small-sized \n(”2 cm) Hepatocellular carcinoma (HCC) according to therapy response, \nsurvival and complication rates. \nMethods or Background: In our study, we retrospectively included 87 patients \n(16W and 71M, mean age: 63.8±10.8yrs) with 130 small HCC lesions, which \nwere treated by CT-guided MWA. All cases were evaluated according to \ndiameter, post-ablation volume, technical success, complete ablation rate, \ntherapy response, overall survival (OS) rates, progression-free survival (PFS) \nrates, complication rate. For evaluation of response to MWA treatment MRI \nwas performed post-ablation. \nResults or Findings: The mean axial diameter of the tumor and post- ablation \nvolume were 1.4 cm and 32.6 mL, respectively. We have achieved 100% \ntechnical success in all abations. Complete ablation was achieved in 97.7% \n(127/130) of the tumors. The median follow-up time was 2.75 years. In this \nperiod, 4.6% (4/87) of the patients developed local tumor progression (LTP) \nand 36.8% (32/87) of the patients developed intrahepatic distant recurrence \n(IDR). The 1-, 3-, and 5-year OS rates were 94.3%, 66.4% and 53.8%, \nrespectively. The 1-, 3-, and 5-year PFS rates were 70.5%, 46.4% and 33%, \nrespectively. The rate of complications was 4.6% (4/87). There were no peri-\nprocedural deaths reported. \nConclusion: CT-guided MWA seems to be an effective and safe treatment for \nsmall-sized HCC. Patients with small-sized HCC, that underwent percutaneous \nMWA had a long OS time as well as low rates of LTP and complications. \nLimitations: Retrospective study. \nEthics Committee Approval: Our study was approved. \nFunding for this study: No funding. \nAuthor Disclosures: \nThomas J. Vogl: Nothing to disclose \nHamzah Adwan: Nothing to disclose \n \nS 3-5 \nCommon and distinct grey matter alterations in adolescent major \ndepressive and bipolar disorders \n*X. Long*; Chengdu/CN \n \nPurpose: Adolescence (10–19 years) is a crucial period for developing \naffective disorders such as major depressive disorder (MDD) and bipolar \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 125  \ndisorder (BD). Although dysfunction of some emotion-related brain areas is \nimplicated in these two diseases, the structural alterations in adolescent \npatients are inconsistent, and the neural correlate similarities and differences \nbetween adolescent MDD and adolescent BD patients remain unclear. \nMethods or Background: Meta-analyses of whole-brain voxel-based \nmorphometry findings were conducted in adolescent MDD and adolescent BD \npatients separately, followed by a quantitative meta-analytic comparison of the \ntwo groups. \nResults or Findings: Sixteen studies of a total of 263 adolescent MDD and \n263 adolescent BD patients were included in the current meta-analysis. \nConjunction analysis showed greater volumes in the right caudate nucleus in \nboth groups of adolescent patients. On the other hand, adolescents with MDD \nhad greater middle frontal gyrus, orbital frontal gyrus, amygdala, and striatum \nvolumes. Smaller volumes of the insula and superior frontal gyrus were only \nobserved in adolescents with BD compared to healthy adolescent controls. \nConclusion: Our findings confirmed that an increase of the grey matter \nvolume in the right caudate nucleus may be a common pattern underlying \nadolescent MDD and BD, while disease-specific grey matter alterations in the \nfronto-limbic circuitry may reflect their different neural bases. This study \nunveiled important differences and conjunctions between adolescent MDD and \nBD and specific biomarkers of the two groups. \nLimitations: We did not perform meta-regression analyses of treatment status, \nmood states, and illness duration. \nEthics Committee Approval: NA, not applicable \nFunding for this study: This study was supported by the National Natural \nScience Foundation of China (Grant Nos. 81971595 and 81771812), the \nInnovation Spark Project of Sichuan University (No. 2019SCUH0003) and \n1·3·5 project for disciplines of excellence–Clinical Research Incubation Project, \nWest China Hospital, Sichuan University (No. 2020HXFH005). \nAuthor Disclosures: \nXipeng Long: Nothing to disclose \n \nS 3-6 \nClinical reasoning and radiology: untapped potential for medical students \n*J. C. Lui*, C. Chew; Glasgow/UK \n \nPurpose: Neurological cases used to create an interactive online resource \nwith Storyline© to enhance the Neurology teaching. Students choose required \ninformation within history, examination, management and investigation. Each \ndecision in the diagnostic process is evaluated, illustrating how differential \ndiagnosis changes. Immediate feedback is provided with each choice. The key \ninvestigation, CTBrain, can be reviewed repeatedly. Each case concludes with \nmanagement, a summary slide and 3 reflective questions. \nMethods or Background: Modern clinical medicine is increasingly reliant on \nRadiology. It is important we teach our students the role it plays in the \ndiagnostic process. The combination of Clinical Stories with Radiology is a \npotent way to teach Clinical Reasoning. We present our initial experience using \nStoryline© to interactively guide the student to work through a patient’s \npresentation, clinical findings, investigations, imaging (where appropriate!) and \nresults to arrive at a diagnosis. \nResults or Findings: This learning resource has been extremely well received \nby students. Feedback comments include: “Good thinking about how the \nhistory/presentation can change when different or new factors were added into \nconsideration”; “Good systematic approach to learning”; “Relevant to real \ncases ”; “Easy to know where to improve” \nConclusion: Clinical Reasoning has been linked with Patient Safety and is \nnow mandated by the GMC to be included explicitly in the medical school \ncurriculum. While it is ubiquitous to how doctors perform their job and arrive at \nthe diagnosis, there is as yet no consensus on exactly how best to teach this \nimportant subject. Radiology, together with computing software produced an \nonline, interactive learning resource to teach Clinical Reasoning has proved \nextremely popular with the students. The student co- author found the process \nvery fulfilling. The student input ensured the material is relevant and student-\ncentric. \nLimitations: None \nEthics Committee Approval: Not required \nFunding for this study: None \nAuthor Disclosures: \nJessica Claresta Lui: Nothing to disclose \nCindy Chew: Nothing to disclose \n \nS 3-7 \nSelecting optimal kernels for QCT using phantom simulation results \n*Z. Artyukova*, A. Petraikin, K. Akhmad, D. Semenov, A. Smorchkova,  \nN. Kudryavtsev, F. A. Petriaikin, S. Morozov; Moscow/RU \n \nPurpose: Compare kernels (CT convolution algorithms) with varying degrees \nof beam hardening correction for QCT study in phantom modeling and in \npatients. \nMethods or Background: The studies were performed on a 64-row scanner. \nWe use kernels for a body with (FC08) and without (FC17) beam hardening \ncorrection. The semi-anthropomorphic phantom with a wide range of K2HPO4 \n(50-550 mg/ml) was used. Asynchronous QCT was used to determine the \nbone mineral density (BMD). Additionally, we analyzed QCT data of five \npatients who had normal BMD of «femoral neck» and «total hip» regions. \nResults or Findings: When we compared a BMD dependency measured by \nQCT vs preset value for the kernels FC08 and FC17 in phantom study, we did \nnot discover any statistically significant difference in slope angle of inclination \nand intercept of the regression lines (p>0.05) for the range of 50-200 mg/ml. \nWhen scanning was performed with the FC17 kernel for the range of 250-550 \nmg/ml, the difference in slope of the regression lines was significant (p <0.05) \nand there was no difference when comparing the intercept (p = 0.10). Based \non the data from the phantom study, the results of scanning five patients (right \nand left hip, n=10) were simulated and compared with the initial data. The use \nof the FC08 kernel led to the insignificant mean underestimation of BMD, \nassessed by the T-score (-0.24±0.02 SD), while the use of the FC17 kernel led \nto the significantly more pronounced (p <0.05) decrease in BMD (-0.94±0.07 \nSD). \nConclusion: For asynchronous QCT body filters with beam hardening \ncorrection kernels should be chosen (FC08). Kernels without beam hardening \ncorrection (FC17) can lead to the significant underestimation of BMD results. \nLimitations: No limit \nEthics Committee Approval: Not subject \nFunding for this study: The reported study was funded by RFBR ʋ20-015-\n00260. \nAuthor Disclosures: \nSergey Morozov: Nothing to disclose \nKate Akhmad: Nothing to disclose \nZlata Artyukova: Nothing to disclose \nNikita Kudryavtsev: Nothing to disclose \nAlexey Petraikin: Nothing to disclose \nDmitry Semenov: Nothing to disclose \nAnastasiia Smorchkova: Nothing to disclose \nFedor Alekseevich Petriaikin: Nothing to disclose \n \nS 3-8 \nA retrospective observational study on spectrum of inferior vena cava \nand renal vein anomalies: embryologic and surgical considerations \n*V. Varadharaj*, R. Ramachandran, K. Athiyappan, V. Sai; Chennai/IN \n \nPurpose: To demonstrate various congenital anomalies of inferior vena cava \nand its tributaries with embryological correlation and surgical consideration, \nwhich aided in further course of management. \nMethods or Background: CT-Philips brilliance 16 and GE revolution EVO-\n128. Single Centre based Retrospective imaging analysis of congenital \nanomalies of IVC and its tributaries in all age groups for a period of five years \nfrom 2016-2020. Congenital anomalies of the inferior vena cava (IVC) and its \ntributaries have become more commonly recognized in asymptomatic patients. \nThe embryogenesis of IVC is a complex process involving the formation of \nseveral anastomosis between three paired embryonic veins. The result is the \nnumerous variations in the basic venous network of the abdomen and pelvis. \nAlthough most of the IVC anomalies are clinically silent and are usually \ndiscovered incidentally on abdominal imaging, aberrations may be responsible \nfor significant hemorrhage or damage to vascular structures during surgeries. \nAberrant vessels may be mistaken for lymphadenopathy and may be biopsied. \nHence, accurate characterization of systemic venous anomalies plays a vital \nrole in the appropriate selection of surgical approach or interventional \nprocedure. \nResults or Findings: The overall incidence of congenital anomalies of IVC \nand its tributaries were found to be 0.4% with incidence of each subtype as \nfollows: 1. Interruption of IVC - 5.2% , 2. Retro aortic left renal vein-33.3% \n3.Duplication of IVC- 1.3% , 4. Circumaortic left renal vein- 1.7% , 5.Left IVC- \n5.2% , 6.Retrocaval ureter- 33%, 7.Absent infra renal segment of the IVC- \n0.0% \nConclusion: IVC anomalies are commonly encountered due to increased use \nof cross sectional imaging modalities. A working knowledge of IVC and renal \nvein anomalies is essential in designing an effective treatment plan from \ninterventional standpoint and to avoid diagnostic pitfalls. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nKumaresh Athiyappan: Author: Guidance \nVenkata Sai: Author: Guidance \nRajoo Ramachandran: Author: Guidance \nVinu Varadharaj: Author: Principal investigator \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 126  \n \nE³ - Rising Stars Programme: Student \nSession \nS 4 \nStudent Session 4 \nS 4-1 \nA nomogram strategy for identifying the subclassification of IDH1 \nmutation and ATRX expression loss in in low-grade gliomas \n*S. Wu*¹, X. Zhang², Z. Yao¹, Y. Zhang¹, T. Qiu¹, Y. Ren¹; ¹Shanghai/CN, \n²Xi'an/CN  \n \nPurpose: To construct a radiomics nomogram based on multiparametric MR \nfor noninvasively determining molecular status of isocitrate dehydrogenase 1 \nmutation (IDH1(+)) and loss of nuclear alpha thalassemia/mental retardation \nsyndrome XǦlinked expression (ATRX(–)) in patients with low Ǧgrade gliomas \n(LGGs). \nMethods or Background: A total of 111 eligible LGG patients LGG patients \nwith IDH1(+) (nௗ=ௗ76) and IDH1(–) (n = 35), divided into a training set (n = 78) \nand a validation set (n = 35) for IDH (+) prediction task. LGG patients with \nIDH1(+) were further subclassified into two subtypes of ATRX(–) (n = 38) and \nATRX(+) (n = 38) for the ATRX (-) prediction task. 250 radiomic features were \nextracted on each tumor volume of interest from T2 fluid-attenuated inversion \nrecovery (T2 FLAIR), contrast-enhanced T1 weighted imaging, arterial spin \nlabeling (3D-ASL)-derived cerebral blood flow (CBF), DWI-derived apparent \ndiffusion coefficient (ADC), and exponential ADC (eADC). Then, a radiomics \nsignature was selected using Elastic Net regression model. Combined with \nclinical risk factors, a radiomics nomogram was constructed based on a \nmultivariate logistic regression model. \nResults or Findings: The presented radiomics nomogram exhibited promising \ndiscrimination for IDH mutation (C-index: training sets= 0.881, validation \nsets=0.9) and ATRX expression loss (C-index: training sets= 0.863, validation \nsets=0.840). The favorable calibration and decision curve analysis indicated its \nclinical usefulness. \nConclusion: The presented nomogram combining multiparametric radiomics \nfeatures and with clinical risk factor are favorable in identifying molecular \nsubtypes of IDH1 and ATRX in LGGs. \nLimitations: Relatively small population. \nEthics Committee Approval: Approved by the Ethics Review Board of our \nhospital. \nFunding for this study: Science and Technology Support Project for Medicine \nsponsored by Science and Technology Commission of Shanghai Municipality; \nContract grant number: 18411967300. \nAuthor Disclosures: \nZhenwei Yao: Nothing to disclose \nYan Ren: Nothing to disclose \nXi Zhang: Nothing to disclose \nYong Zhang: Nothing to disclose \nShiman Wu: Nothing to disclose \nTianming Qiu: Nothing to disclose \n \nS 4-2 \nAdvantage of 3D over 2D dense neural network architecture for the MRI-\nbased classification of focal liver lesions \n*R. Stollmayer*, B. K. Budai, M. Boostani, Z. Tánczik, B. Körmendy,  \nE. Hartmann, I. Kalina, V. Bérczi, P. N. Kaposi-Novák; Budapest/HU  \n \nPurpose: To compare the accuracy of 2D dense convolutional networks (2D-\nDenseNets) vs. 3D-DenseNets trained on multi-sequence MRI-scans for the \nclassification of focal liver lesions. \nMethods or Background: In this study, we retrospectively collected T2W, \ngadoxetate disodium-enhanced portal venous phase and hepatobiliary phase \nMRI scans from patients with focal nodular hyperplasias (FNH), hepatocellular \ncarcinomas (HCC) or metastases (MET). The final dataset consisted of n=33 \nFNHs, n=42 HCCs and n=35 METs. Three axial slices of each tumor were \nselected and the corresponding sequences of each slice were combined into \nthree-channel JPG files and used as input for a 2D-DenseNet264 network. To \ntrain a 3D-DenseNet264 model, the scans of each tumor were stacked 4D Nifti \nfile inputs. The trained models were tested on 10 tumors from each class. \nPrediction accuracies of the models were compared using receiver operating \ncharacteristic curve (AUROC), specificity, sensitivity, positive predictive values \n(PPV), negative predictive values (NPV), and f1 scores for each class. \nResults or Findings: Average AUROC values of 0.79 and 0.84 were achieved \nusing the 2D vs. the 3D model. Mean PPV, sensitivity, NPV, specificity and f1 \nscores were 0.73, 0.73, 0.87, 0.87, 0.73 for the 2D model and 0.88, 0.87, 0.94, \n0.93, 0.86 for the 3D model. \nConclusion: Our results indicate that 3D-DenseNets are superior to 2D-\nDenseNets for the multi-sequence MRI-based classification of focal liver \nlesions. \nLimitations: The current study is limited by the number of cases used for \nmodel training and validation. \nEthics Committee Approval: The study has been approved by the \ninstitutional ethics committee of our university (SE-RKEB 136/2019). \nFunding for this study: The authors received no funding for this study. \nAuthor Disclosures: \nPál N. Kaposi-Novák: Nothing to disclose \nErika Hartmann: Nothing to disclose \nIldikó Kalina: Nothing to disclose \nRóbert Stollmayer: Nothing to disclose \nViktor Bérczi: Nothing to disclose \nZsófia Tánczik: Nothing to disclose \nMehdi Boostani: Nothing to disclose \nBettina Katalin Budai: Nothing to disclose \nBorbála Körmendy: Nothing to disclose \n \nS 4-3 \nDeep convolutional neural network for predicting kidney tumour \nmalignancy \n*A. Obuchowski*, B. O. Klaudel, R. Karski, B. Rydzi Ĕski, M. Glembin, P. Jasik, \nP. Syty; GdaĔsk/PL \n \nPurpose: According to the statistics, up to 15-20% of removed solid kidney \ntumors turn out to be benign in postoperative histopathological examination, \ndespite having been identified as malignant by a radiologist. The aim of the \nresearch was to limit the number of unnecessary nephrectomies of benign \ntumors. \nMethods or Background: We propose a machine-aided diagnostic system for \nkidney tumor malignancy identification that can serve as a second opinion \nsource to prevent potentially unnecessary surgical procedures. CT images of a \ncross-section of a tumor were used to identify tumor malignancy. The system \nutilizes a deep convolutional neural network as a feature extractor. The \nnetwork was trained on approximately 15,000 CT images of arterial phase \ncoming from 349 solid kidney tumors. We introduced medical image \ncolorization to improve the knowledge transfer, as the network was pretrained \non natural RGB images. We used subtype max-pooling to map predicted \nhistopathological subtype to malignant/benign classification, to improve the \nnetwork’s accuracy over binary classification. \nResults or Findings: The algorithm achieved F1-score of 90% and accuracy \nof 87% for the identification of benign and malignant tumors. Achieved \nspecificity of 100% was essential to the study, as the goal of the research was \nto help reduce the number of tumors misdiagnosed as malignant. We \ndiscovered that image colorization can improve accuracy up to 10 pp. \nConclusion: We present a machine-aided diagnostic system to classify \nmalignancy of renal tumors. Our method has proved to be a valuable source of \nsecond opinion assisting in the decision whether or not nephrectomy should be \nperformed. \nLimitations: We are planning to explore how the colorization affects images \ncoming from other domains. \nEthics Committee Approval: Ethics committee approval was not required. \nFunding for this study: \"e-Pionier - wykorzystanie potencjału uczelni \nwyĪszych na rzecz podniesienia innowacyjno Ğci rozwiązaĔ ICT w sektorze \npublicznym\" \nAuthor Disclosures: \nBartosz RydziĔski: Nothing to disclose \nPaweł Syty: Nothing to disclose \nBarbara Olga Klaudel: Nothing to disclose \nPatryk Jasik: Nothing to disclose \nMateusz Glembin: Nothing to disclose \nAleksander Obuchowski: Nothing to disclose \nRoman Karski: Nothing to disclose \n \nS 4-4 \nTeaching ultrasound-guided peripheral venous catheter placement \nthrough immersive virtual reality: an explorative pilot study \n*N. L. Andersen*, R. Overgaard Jensen, S. Posth, C. Laursen, R. Jørgensen, \nO. Graumann; Odense/DK \n \nPurpose: Immersive virtual reality (IVR)-based training is gaining ground as an \neducational tool in healthcare. Combining IVR with well-established \neducational methods could potentially increase competency and autonomy in \nultrasound (US)-guided peripheral venous cannulation. The aim of this study \nwas to examine the impact of adding IVR training to a course in US-guided \nperipheral venous cannulation. \nMethods or Background: Medical students from University of Southern \nDenmark without former standardized US education were recruited voluntarily \nto participate in a pilot study, designed as a randomized controlled trial. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 127  \nPrimary outcome was the proportion of successful peripheral venous \ncannulations in a phantom. Secondary outcomes included the proportion of \nsurface punctures on the phantom and procedure time. Participants (n=19) \nreceived e-learning on basic US before randomization to either IVR (n=10) or \nno further training (n=9). The additional IVR training consisted of 10 virtual \nscenarios on US-guided peripheral venous catheter (PVC) placement. \nParticipants were subsequently assessed in peripheral venous cannulation by \na blinded supervisor. \nResults or Findings: The proportion of successful peripheral venous \ncannulations in the IVR group was 100%, 80%, and 40% for the 1st, 2nd, and \n3rd PVC, respectively. In total, 73% of their cannulations were successful. In \nthe control group, the proportion of successful cannulations was 44%, 22%, \nand 0% for the 1st, 2nd, and 3rd PVC, respectively. In total, 22% of their \ncannulations were successful. The proportion of successful cannulations was \nsignificantly higher in the IVR group compared to the control group for the 1st \nand 2nd PVC and in total. \nConclusion: This pilot study showed that the proportion of successful \nperipheral venous cannulations significantly increased after e-learning and IVR \ntraining on US-guided PVC placement on a phantom compared to e-learning \non its own. \nLimitations: Not applicable \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nOle Graumann: Nothing to disclose \nRasmus Jørgensen: Nothing to disclose \nStefan Posth: Nothing to disclose \nNanna Lind Andersen: Nothing to disclose \nRune Overgaard Jensen: Other: CEO and co-founder of VitaSim, the company \nproviding materials and software for the study. \nChristian Laursen: Nothing to disclose \n \nS 4-5 \nThe status of diversity in canadian radiology: where we stand and what \ncan we do about it \n*K. Lebel*¹, E. Hillier², L. B. Spalluto³, W. W. Yap ຾, K. Keglowitsch², K. Darras ຿, \nC. J. Yong-Hing຿; ¹Sherbrooke, QC/CA, ²Edmonton, AB/CA, ³Nashville, TX/US, \n຾Abbotsford, BC/CA, ຿Vancouver, BC/CA \n \nPurpose: 1) Review the current data on gender, race and indigenous \nrepresentation in the Canadian field of radiology 2) Review proposed solutions \nand strategies in the current litterature to increase diversity in the field of \nradiology \nMethods or Background: Radiology has been identified as one of the medical \nfields with the least gender, racial, and ethnic diversity. Despite the \ndemonstrated benefits of gender and race diversity in medicine, including \ninnovation, empathy and improved patient outcomes, diversity in radiology in \nCanada is still lacking. Many solutions for national associations and radiology \ndepartments to improve diversity (gender, racial and indigenous) have been \nproposed. We review the current literature and available data on diversity \nwithin radiology in Canada, including the status of gender, race/ethnicity, and \nIndigenous people. We also present potential solutions to increase diversity. \nResults or Findings: In 2019, women represented around 63% of current \nmedical canadian graduates. However, within Canadian radiology practices, \nonly 31.6% of radiologists are women. Women are also underrepresented in \nacademic positions and the widening gender gap is present at higher academic \nranks, indicating that women may not advance through academic hierarchies \nat the same pace as men. Although data on racial diversity in Canadian \nradiology practices is currently lacking, the representation of visible minorities \nin the general Canadian population is not reflected across Canadian radiology \npractices. Similarly, despite the Canadian Truth and Reconciliation \nCommission calling for action to increase the number of Indigenous healthcare \nworkers, Indigenous people remain underrepresented in medicine and \nradiology. \nConclusion: The importance of increasing diversity in radiology has gained \nrecognition in recent years. Leadership commitment is required to implement \nthese programs to increase diversity in radiology in Canada with the ultimate \ngoal of improving patient care. \nLimitations: None \nEthics Committee Approval: Not necessary \nFunding for this study: None \nAuthor Disclosures: \nKiera Keglowitsch: Nothing to disclose \nLucy B Spalluto: Nothing to disclose \nMedical Elizabeth Hillier: Nothing to disclose \nKiana Lebel: Nothing to disclose \nCharlotte J. Yong-Hing: Nothing to disclose \nWan Wan Yap: Nothing to disclose \nKathryn Darras: Nothing to disclose \n \nS 4-6 \nEvaluation of dysphagia in patients with head and neck cancer after \ntreatment by real-time magnetic resonance imaging based on \ncompressed sensing \n*G. Xiaobin*; Kunming/CN \n \nPurpose: To investigate the use of real-time magnetic resonance imaging (RT-\nMRI) based on compressed sensing(CS) in the evaluation of swallowing \nfunction in patients with head and neck cancer after treatment. \nMethods or Background: Fifty patients with dysphagia after the treatment of \nhead and neck cancer were examined by RT-MRI and video fluoroscopic \nswallowing studies (VFSS) combined with Swallowing-Related Quality of Life \nQuestionnaire (SWAL-QoL) and flexible endoscopic evaluation of swallowing \n(FEES), the location and changes of dysphagia were quantitatively analyzed. \nResults or Findings: RT-MRI equally revealed dysphagia compared to VF \nand FEES and correlated well with the SWAL-QoL. Only RT-MRI allowed \nprecise time measurements and identification of the respective tissue \nmorphology. The time of swallowing, oral delivery time and hyoid bone forward \ndisplacement measured by RT-MRI were different from the reference values. \nConclusion: RT-MRI is safe and equally capable as VFSS to identify the \ncause of dysphagia in patients with head and neck cancer after \ntreatment.Advantages of RT-MRI include visualization of soft tissue, more \nreliable timing analysis, and lack of X-ray exposure. To provide a new \nevaluation index and theoretical basis for human swallowing function, and \ncontribute to improve dysphagia caused by head and neck tumors and \ntreatment. \nLimitations: There is no more in-depth analysis of the causes of dysphagia \ncombined with pathology. \nEthics Committee Approval: The ethical committee of Yunnan Cancer \nHospital reviewed and approved the research plan. \nFunding for this study: Supported by The National Natural Science \nFoundation of China㸦NSFC㸧 (Project No.: 81760316) \nAuthor Disclosures: \nGuo Xiaobin: Nothing to disclose \n \nS 4-7 \nInfrapopliteal endovascular intervention and the angiosome concept: \nintra-operative real-time assessment of foot regions blood volume guides \nand improves direct revascularisation \n*J. Ma*; Beijing/CN \n \nPurpose: There is no consensus for determining which vessel should be \nrevascularized in patients with multiple diseased infrapopliteal arteries. We \nconducted a study to assess whether direct revascularization (DR) will lead to \nbetter perfusion improvement than indirect revascularization (IR). \nMethods or Background: We performed a prospective single-center \nobservational cohort study in patients treated in the Department of Vascular \nSurgery of Peking Union Medical College Hospital from November 2016 to \nApril 2019. Twenty-seven patients treated with endovascular intervention were \nincluded. The intraoperative parenchymal blood volume of different foot \nregions was obtained for each patient using C-arm CT before and after \nintervention. \nResults or Findings: The intervention procedure significantly increased the \noverall blood volume (48.95 versus 81.97 ml/1000 ml, p=0.002). Patients with \ndirect revascularization had a 197% blood volume increase while patients with \nindirect revascularization had a 39% increase (p=0.028). The preoperative \nblood volume was higher in patients with mild symptoms than in patients with \nsevere symptoms (58.20 versus 30.45 ml/1000 ml, p=0.039). \nConclusion: Overall blood volume can rise significantly after the intervention. \nRevascularizing the supplying vessel of the ischemic area directly will result in \nbetter perfusion improvement than restoring blood supply through the collateral \ncirculation. Preoperative blood volume is associated with preoperative \nsymptoms. \nLimitations: First, this was a prospective observational cohort study with a \nlimited sample size. In addition, deviations existed because of foot deformation \nduring the endovascular procedure and movement during image acquisition. \nEthics Committee Approval: The study was approved by the ethics \ncommittee of Peking Union Medical College Hospital. \nFunding for this study: This study has received funding by Non-profit Central \nResearch Institute Fund of Chinese Academy Of Medical Science, Beijing \nMunicipal Science and Technology Commission \"clinical application of capital \ncharacteristics\" and National College Students' Innovation and \nEntrepreneurship Training Program. \nAuthor Disclosures: \nJiangyu Ma: Nothing to disclose \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 128  \nS 4-8 \nLinear mixed-effects models for estimation of pulmonary metastasis \ngrowth rate: implications for CT surveillance in patients with sarcoma \n*U. Isidro*¹, L. O'Brien², R. Sebro¹; ¹Philadelphia, PA/US, ²Waterville, ME/US \n \nPurpose: No data exist on optimal surveillance interval for chest CT for \ndetecting metastases in sarcoma patients. This study aimed to estimate \npulmonary metastasis growth rate. \nMethods or Background: Retrospective review of 95 sarcoma patients with \npulmonary metastases treated at an academic tertiary-care center from 2000-\n2019. Age, sex, primary tumor size, grade, subtype, size and volume of the \npulmonary metastasis over successive chest CT scans were recorded. \nMultivariate linear mixed-effects models with random effects for each \npulmonary metastasis and patient were used to estimate pulmonary metastasis \ngrowth rate and volume doubling time. \nResults or Findings: Maximal primary tumor size and patient age at \ndiagnosis, tumor grade, and tumor type were not statistically significant \npredictors of pulmonary nodule growth. Chemotherapy decreased rate of \npulmonary nodule growth. 95% of untreated pulmonary metastases are \nexpected to grow less than 6 mm in 6.4 months. There was significant \nintrapatient and interpatient variation in pulmonary metastasis growth rate. \nVolume doubling time for pulmonary metastases assuming an exponential \nmodel was 143 days. \nConclusion: Assuming a 2 mm nodule is the smallest reliably detectable \nnodule by CT, the data suggest an untreated pulmonary metastasis is \nexpected to grow to 8 mm in 8.4 months. Tumor size, grade and sarcoma \nsubtype did not significantly alter pulmonary metastasis growth rate; \nchemotherapy slowed the growth rate. \nLimitations: Retrospective study of patients treated at a single tertiary care \nacademic institution and subject to ascertainment bias. All sarcoma subtypes \nwere not represented. All metastases were not histologically diagnosed via \nbiopsy. There was heterogeneity in chemotherapy regimens administered. The \nsmall sample size limits ability to detect small differences between pulmonary \nmetastasis growth rate for sarcoma subtypes. \nEthics Committee Approval: Reviewed and approved by the local IRB. \nSigned informed consent from each patient was waived. \nFunding for this study: None \nAuthor Disclosures: \nUlysses Isidro: Nothing to disclose \nRonnie Sebro: Nothing to disclose \nLiam O'Brien: Nothing to disclose \n \n \nE³ - The Beauty of Basic Knowledge: \nBreast \nE³ 24A \nBasics of mammography \nE³ 24A-1 \nCookbook for image analysis and interpretation \nAnne Tardivon; Paris/FR  \n(anne.tardivon@curie.net) \n \nLearning Objectives: \n1. To learn to assess mammographic image quality and mammographic breast \ndensity. \n2. To recognise and name the main imaging findings using the breast imaging \nreporting and data system (BIRADS) lexicon. \n \nE³ 24A-2 \nDifferences in mammography techniques and image analysis \nSophia Zackrisson; Malmö/SE  \n(sophia.zackrisson@med.lu.se) \n \nLearning Objectives: \n1. To learn about the technique and purpose of tomosynthesis compared to \ndigital mammography. \n2. To understand the differences in reading a screening and diagnostic \nmammography. \n3. To become familiar with work-up possibilities after a positive screening \nmammography, taking into account psychological consideration. \nAuthor Disclosures:  \nSophia Zackrisson: Patent Holder: US patent no PCT/EP2014/057372; \nSpeaker: Siemens Healthcare AG \n \n \nE³ - The Beauty of Basic Knowledge: \nBreast \nE³ 24C \nBasics of breast MRI \nE³ 24C-1 \nWhen is breast MRI indicated and what protocol to use? \nRitse M. Mann; Nijmegen/NL  \n(r.mann@rad.umcn.nl) \n \nLearning Objectives: \n1. To become familiar with the guidelines for accepted indications of breast \nMRI. \n2. To learn the basic protocol for screening and diagnostic breast MRI. \nAuthor Disclosures: \nRitse M. Mann: Other: copy \n \nE³ 24C-2 \nHow to read breast MRIs \nFederica Pediconi; Rome/IT  \n(federica.pediconi@uniroma1.it) \n \nLearning Objectives: \n1. To understand morphological and kinetic findings. \n2. To learn the value of diffusion-weighted imaging. \n3. To learn about reporting by using the breast imaging reporting and data \nsystem (BIRADS). \n \n \nE³ - The Beauty of Basic Knowledge: \nBreast \nE³ 24D \nBasics of interventional breast imaging \nE³ 24D-1 \nUltrasound-guided interventional imaging: when and how? \nMary C. Mahoney; Cincinnati, OH/US  \n(mahonemc@ucmail.uc.edu) \n \nLearning Objectives: \n1. To learn about cyst aspiration and biopsy techniques. \n2. To understand the contraindication and complications. \n3. To understand the correlation between imaging and pathology. \nAuthor Disclosures:  \nMary C. Mahoney: Board Member: RSNA, ACR; Other: Editorial Board CDR \n \nE³ 24D-2 \nWhen and how to biopsy under mammographic guidance? \nDragana Djilas-Ivanovic; Sremska Kamenica/RS  \n(djilas.dr@gmail.com) \n \nLearning Objectives: \n1. To learn about the techniques and limitations. \n2. To become familiar with the quality control of stereotactic- or tomosynthesis-\nguided breast biopsy. \n \nE³ 24D-3 \nWhen and how to biopsy under MRI guidance? \nPascal A.T. Baltzer; Vienna/AT \n \nLearning Objectives: \n1. To learn about the techniques and limitations. \n2. To become familiar with the quality control of MRI-guided breast biopsy. \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 129  \n \nE³ - The Beauty of Basic Knowledge: \nBreast \nE³ 24E \nHow to deal with common clinical breast \nsymptoms \nE³ 24E-1 \nThe acute painful breast \nMihai Lesaru; Bucharest/RO  \n \nLearning Objectives: \n1. To learn about the choice of imaging modality. \n2. To understand the management options and treatment of common breast \nlesions causing pain, including mastitis. \n \nE³ 24E-2 \nHow to manage nipple discharge \nIsabelle Thomassin-Naggara; Paris/FR  \n(isabelle.thomassin@tnn.aphp.fr) \n \nLearning Objectives: \n1. To identify causes of nipple discharge unrelated to the breast or physiology. \n2. To learn about the choice and sequence of imaging modalities to identify \nbreast lesions causing nipple discharge. \n3. To understand the spectrum of common benign and malignant breast \nlesions in relation to nipple discharge. \nAuthor Disclosures:  \nIsabelle Thomassin-Naggara: Speaker: GE, Hologic, Guerbet, canon; Other: \nSiemens \n \n \nE³ - The Beauty of Basic Knowledge: \nUnderstanding MRI Technique and MRI \nSafety \nE³ 25B \nStatic magnetic fields \nE³ 25B-1 \nMRI at high-field strengths: advantages and clinical challenges \nAnja van der Kolk; Utrecht/NL  \n(A.G.vanderKolk@umcutrecht.nl) \n \nLearning Objectives: \n1. To get familiar with the advantages when moving to higher filed strength. \n2. To know the clinical benefits of higher field strengths. \n3. To understand the challenges of higher field strengths. \n \nE³ 25B-2 \nMRI safety: risks with static magnetic fields \nJacques Felblinger; Lyon/FR  \n(j.felblinger@chu-nancy.fr) \n \nLearning Objectives: \n1. To understand the risks of attraction for ferromagnetic material. \n2. To understand the risks of torque for ferromagnetic material. \n3. To understand how the manufacturer evaluates medical devices in MRI \nconditions. \nAuthor Disclosures:  \nJacques Felblinger: Founder: Healtis \n \n \nE³ - The Beauty of Basic Knowledge: \nUnderstanding MRI Technique and MRI \nSafety \nE³ 25C \nTime varying electromagnetic fields \nE³ 25C-1 \nCoils: important players in MRI \nFranz Schmitt; Erlangen/DE  \n(schmittfranz53@gmail.com) \n \nLearning Objectives: \n1. To understand the difference between transmit and receive coils. \n2. To understand why local receive coils provide a better image quality, i.e. \nsignal-to-noise ratio. \n3. To understand the importance of local multi-receive coils for accelerated \nMRI. \nAuthor Disclosures:  \nFranz Schmitt: Consultant: Flywheel.io \n \nE³ 25C-2 \nMRI safety: risks with high frequency and gradient fields \nSiegfried Trattnig; Vienna/AT  \n(siegfried.trattnig@meduniwien.ac.at) \n \nLearning Objectives: \n1. To learn about the risks associated with high frequency field, in particular the \ndifferent types of burns. \n2. To learn how to avoid high frequency burns in clinical MRI examinations. \n3. To understand the risks of peripheral nerve stimulation and how to avoid \nthem. \n \n \nE³ - The Beauty of Basic Knowledge: \nUnderstanding MRI Technique and MRI \nSafety \nE³ 25D \nMRI in the presence of implants \nE³ 25D-1 \nSequence techniques and protocols \nReto Sutter; Zurich/CH  \n \nLearning Objectives: \n1. To recognise the common types of metal-induced artifacts in MRI and to \nidentify the diagnostic pitfalls. \n2. To apply effective basic techniques for reducing MRI metal artifacts in turbo \nspin echo sequences and fat saturated sequences. \n3. To learn about the advanced techniques reducing through-plane distortions \nin MRI and their clinical impact. \nAuthor Disclosures:  \nReto Sutter: Author: Breitenseher Publisher; Other: Balgrist University Hospital \nhas an academic research collaboration with Siemens Healthineers and \nBalzano Informatik. \n \nE³ 25D-2 \nMRI implant safety assessments \nNadia Oberhofer; Bozen/IT  \n(NADIA.OBERHOFER@sabes.it) \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 130  \nLearning Objectives: \n1. To understand and learn how to minimise the risk related to active electronic \nimplants in an MRI environment. \n2. To understand and learn how to minimise the risk related to passive \nimplants in patients and staff in an MRI environment. \n3. To understand the role of equipment choices in reducing the risk related to \nimplants in an MRI environment. \nAuthor Disclosures:  \nNadia Oberhofer: Equipment Support Recipients: Metrasens, Kopp \nDevelopment \n \n \nE³ - The Beauty of Basic Knowledge: \nUnderstanding MRI Technique and MRI \nSafety \nE³ 25E \nWorking in the MRI environment \nE³ 25E-1 \nIntraoperative/interventional MRI: methods and applications \nAndreas Melzer; Leipzig/DE  \n(andreas.melzer@uni-leipzig.de) \n \nLearning Objectives: \n1. To learn about the technological prerequisites for interventional and \nintraoperative MRI, including MRI systems overviews, requirements, and \nrecommendations for safe use. \n2. To become familiar with the safety of interventional and surgical devices in \nthe MRI environment. \n3. To learn about appropriate workflow and enabling equipment handling for \neffective and safe MRI-guided procedures. \nAuthor Disclosures:  \nAndreas Melzer: Grant Recipient: EU FP7, H2020 and BMBF; Investigator: EU \nFP7, H2020 and BMBF; Research Grant/Support: EU FP7, H2020 and BMBF \n \nE³ 25E-2 \nMRI safety education and awareness \nTitti Owman; Lund/SE  \n(Titti.Owman@gmail.com) \n \nLearning Objectives: \n1. To understand the importance of MRI safety education and why it must be \nrepeated and updated regularly. \n2. To clarify who needs MRI safety education, the different levels of education, \nand how to create an efficient and sufficient educational organisation. \n3. To discuss how to improve awareness of the MRI safety risks and the \nnecessity of reporting incidents. \n \n \nE³ - European Diploma Prep Sessions \nE³ 123 \nGastrointestinal and abdominal \nE³ 123-1 \nA. Hepatobiliary system \nGiuseppe Brancatelli; Palermo/IT  \n(gbranca@yahoo.com) \n \nLearning Objectives: \n1. To become familiar with the imaging features of diffuse liver diseases. \n2. To understand the imaging features of focal liver lesions. \nAuthor Disclosures:  \nGiuseppe Brancatelli: Consultant: Bayer; Speaker: Bayer, GE \n \nE³ 123-2 \nB. Pancreas and spleen \nAndreas Schreyer; Brandenburg/DE \n(andreas.schreyer@mac.com) \n \nLearning Objectives: \n1. To understand the anatomy, normal variants and congenital disorders of the \npancreas. \n2. To become familiar with the causes and imaging features of benign and \nmalignant pancreatic tumours. \n3. To understand the imaging features of acute and chronic pancreatitis and its \npotential complications. \n4. To learn the causes and imaging features of focal and diffuse splenic \nabnormalities. \nAuthor Disclosures:  \nAndreas Schreyer: Advisory Board: Takeda; Consultant: Bayer Vital GmbH; \nShare holder: Siemens Healthineers; Speaker: Bayer Vital GmbH, Siemens \nHealthineers \n \nE³ 123-3 \nC. Imaging of the gastrointestinal tract \nSiobhan A. Whitley; Bury St Edmunds/UK \n \nLearning Objectives: \n1. To become familiar with the anatomy, normal variants, and congenital \ndisorders of the gastrointestinal tract. \n2. To understand the imaging features of the most commonly encountered \ncauses of an acute abdomen. \n3. To learn typical radiological manifestations of inflammatory, infective, and \nischaemic bowel diseases. \n4. To become familiar with the staging of tumours of the gastrointestinal tract \nand to understand the role of different imaging modalities in diagnosing and \nstaging. \n \n \nE³ - European Diploma Prep Sessions \nE³ 223 \nNeuro \nE³ 223-1 \nA. Congenital and white matter disorders of the brain \nAndrea Rossi; Genoa/IT  \n(andrearossi@gaslini.org) \n \nLearning Objectives: \n1. To understand the development, normal anatomy, and normal variants of \nthe brain. \n2. To become familiar with common congenital disorders of the brain and \nneurocutaneous syndromes. \n3. To learn the imaging features and differential diagnoses of white matter \ndisease, inflammation, and neurodegeneration. \n \nE³ 223-2 \nB. Neurovascular disorders and trauma of the brain \nMeike Vernooij; Rotterdam/NL  \n(m.vernooij@erasmusmc.nl) \n \nLearning Objectives: \n1. To become familiar with the normal anatomy and normal variants of the \ncraniocervical arterial and venous system. \n2. To learn the causes and imaging features of stroke, haemorrhage, and other \ncommon vascular lesions of the brain, and their relevance to interventional \nneuroradiology. \n3. To understand the imaging features of traumatic injury to the brain. \nAuthor Disclosures: \nMeike Vernooij: Board Member: ESNR \n \nE³ 223-3 \nC. Tumours of the brain and spine \nMajda M. Thurnher; Vienna/AT \n(majda.thurnher@meduniwien.ac.at) \n \nLearning Objectives: \n1. To understand the normal anatomy and normal variants of the spine, spinal \ncord, and nerve roots. \n2. To learn about the imaging features of benign and malignant tumours of the \nneurocranium. \n3. To become familiar with the imaging features of benign and malignant \ntumours of the spine. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 131  \n \nE³ - European Diploma Prep Sessions \nE³ 323 \nPrinciples of imaging and radiation \nprotection \nE³ 323-1 \nA. Principles of computed tomography \nElly Castellano; London/UK  \n(elly.castellano@rmh.nhs.uk) \n \nLearning Objectives: \n1. To understand the physical basis of image formation of computed \ntomography and of the physics of helical, multidetector, and dual-source CT. \n2. To learn the scale of Hounsfield units and the principle of window centre and \nwidth. \n3. To become familiar with modern CT technology. \n4. To understand the principles of optimising CT protocols with a focus on \npatient dose reduction. \n \nE³ 323-2 \nB. Principles of magnetic resonance imaging \nDominique Sappey-Marinier; Lyon/FR  \n(Dominique.Sappey-Marinier@univ-lyon1.fr) \n \nLearning Objectives: \n1. To become familiar with the physical basis of image formation in MRI \nincluding the principles of pulse sequences and relaxation times. \n2. To become familiar with the typical appearance of tissues, organs, and main \npathological processes of the most commonly used sequences in MRI. \n3. To learn typical artefacts on MRI and to discuss their respective causes. \n4. To understand absolute or relative contraindications against MRI and safety \nissues in the MR environment with regard to patients and staff. \n \nE³ 323-3 \nC. Radiation protection \nJohn Damilakis; Iraklion/GR \n \nLearning Objectives: \n1. To understand the phenomena of x-ray interaction with matter and their \neffect on image quality and dose. \n2. To provide an overview of patient and staff dosimetry in diagnostic and \ninterventional radiology. \n3. To understand the basic principles of radiation protection as outlined by the \nICRP (International Commission on Radiological Protection). \n4. To become familiar with the concepts and tools for dose management in \nradiology with regard to adult and paediatric patients. \n \n \nE³ - European Diploma Prep Sessions \nE³ 423 \nChest \nE³ 423-1 \nA. Fundamentals of chest imaging \nOkka Hamer; Regensburg/DE  \n(okka.hamer@klinik.uni-regensburg.de) \n \nLearning Objectives: \n1. To learn the anatomy, including normal \"lines and stripes\", of the lung \nparenchyma, mediastinum, and pleura, and to confidently identify these on \nradiographs. \n2. To gain an in-depth understanding of the signs of chest radiography \npathology. \n3. To learn about differential diagnoses and pitfalls in chest radiography. \nAuthor Disclosures: \nOkka Hamer: Speaker: Boehringer-Ingelheim, Roche \n \n \n \nE³ 423-2 \nB. Inflammation of the lung \nDaria Manos; Halifax, NS/CA  \n \nLearning Objectives: \n1. To understand the imaging features and differential diagnoses of diffuse \nfibrotic lung disease. \n2 To learn the common causes of acute and chronic diffuse airspace disease. \n3. To become familiar with thoracic diseases in immunocompetent, and \nimmunocompromised patients. \n \nE³ 423-3 \nC. Lung and pleural malignancy \nPeter Beddy; Dublin/IE \n \nLearning Objectives: \n1. To become familiar with the differentiation of solitary and multiple pulmonary \nnodules and benign and malignant neoplasms. \n2. To become familiar with the imaging features of pleural malignancy. \n3. To understand the role of different imaging modalities, including hybrid \nimaging, in diagnosing and staging neoplasms of the chest. \n \n \nE³ - European Diploma Prep Sessions \nE³ 523 \nMusculoskeletal \nE³ 523-1 \nA. Traumatic disorders of the musculoskeletal system \nAndrew J. Grainger; Cambridge/UK  \n \nLearning Objectives: \n1. To develop an understanding of the underlying mechanisms of injury in \nappendicular skeletal trauma and to correlate it with imaging findings. \n2. To gain an appreciation of typical fracture patterns and their accompanying \nsoft tissue injuries. \n3. To understand the benefits and disadvantages of different imaging \nmodalities in assessing trauma involving the skeleton and soft tissue in \ndiffering age groups. \n \nE³ 523-2 \nB. Bone tumours \nMarc-André Weber; Rostock/DE  \n(marc-andre.weber@med.uni-rostock.de) \n \nLearning Objectives: \n1. To learn about the typical imaging features of common bone tumours. \n2. To understand the typical imaging features of \"don't touch\" lesions. \n3. To become familiar with the imaging manifestations of haematological \ndisorders. \n \nE³ 523-3 \nC. Degenerative and inflammatory disorders of the spine \nMonique Reijnierse; Leiden/NL \n(m.reijnierse@lumc.nl) \n \nLearning Objectives: \n1. To learn about the imaging features and clinical features of degenerative \ndiseases of the spine.  \n2. To become familiar with the typical imaging manifestations of infection, \ninflammation, and metabolic diseases of the spine. \n3. To understand the application of different imaging modalities. \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 132  \n \nE³ - European Diploma Prep Sessions \nE³ 623 \nBreast \nE³ 623-1 \nA. Fundamentals of mammography \nJames Tanner; Cambridge/UK  \n \nLearning Objectives: \n1. To understand the anatomy, normal appearances, variants, and \nabnormalities of the female breast. \n2. To become familiar with the technical aspects of diagnostic mammography, \nespecially in regard to dose and image quality. \n3. To become familiar with the principles of current practice and risk/benefit \nanalysis in breast cancer screening. \n \nE³ 623-2 \nB. Breast cancer diagnosis and interventions \nTamar Sella; Jerusalem/IL  \n(tamarse@hadassah.org.il) \n \nLearning Objectives: \n1. To learn about the differentiation of benign and malignant breast disease. \n2. To understand the principles and basic application of standardised \ndiagnostic categorisation systems such as BI-RADS® (the ACR breast imaging \nreporting and data system).  \n3. To become familiar with indications, contraindications, and technical aspects \nof image-guided interventional breast procedures. \n \nE³ 623-3 \nC. Advanced imaging of the female breast \nEva M. Fallenberg; Munich/DE \n \nLearning Objectives: \n1. To understand the role of advanced imaging techniques in the evaluation of \nthe breast. \n2. To learn to use the added value of new techniques for lesion classification in \nmammography, ultrasound, and MRI. \n3. To recognise the major imaging challenges for common indications of breast \nimaging. \nAuthor Disclosures:  \nEva M. Fallenberg: Advisory Board: Bayer Siemens Guerbet; Board Member: \nEUSOBI DRG; Grant Recipient: DFG; Research Grant/Support: GE Guerbet; \nSpeaker: GE Siemens Bayer Guerbet \n \n \nSpecial Focus Session \nSF 3 \nThe prince that was promised: status of \nPET/MRI after the first 10 years \nSF 3-1 \nComplementary information: the key to success? \nLale Umutlu; Essen/DE  \n \nLearning Objectives: \n1. To appreciate the protocols that can be used for PET/MRI imaging to \nmaximise information gained in oncology imaging. \n2. To understand how the morphological and functional aspects of MRI and \nmolecular information from PET can be synergistic to give a better outcome for \noncology imaging. \n \nSF 3-2 \nImpact of PET/MRI on cancer patient management: the evidence \nOnofrio A. Catalano; Boston, MA/US  \n(onofriocatalano@yahoo.it) \n \n \n \nLearning Objectives: \n1. To understand the evidence that exists for the use of PET/MRI in oncologic \nimaging practice. \n2. To become familiar with some of the clinical indications of PET/MRI in \noncological practice. \n3. To appreciate potential advantages of combined PET/MRI in oncologic \nimaging. \n \nSF 3-3 \nProstate cancer imaging with PSMA-PET/MRI: the killer application? \nMarcus R. Makowski; Berlin/DE \n \nLearning Objectives: \n1. To become familiar with the protocols that can be used with PET/MRI in \nprostate cancer imaging. \n2. To learn about the current literature supporting the use of PET/MRI in \nprostate cancer. \n3. To appreciate the strengths and weaknesses of PET/MRI in prostate cancer \nimaging. \n \n \nSpecial Focus Session \nSF 4 \nCT-derived fractional flow reserve: hope or \nhype in cardiac imaging? \nSF 4-1 \nFractional flow reserve: an introduction \nRicardo P.J. Budde; Rotterdam/NL  \n(r.budde@erasmusmc.nl) \n \nLearning Objectives: \n1. To explain the basic concept of fractional flow reserve in coronary arteries. \n2. To review the available techniques for CT-derived fractional flow reserve. \n3. To discuss how CT-derived fractional flow reserve is done in clinical \npractice. \nAuthor Disclosures:  \nRicardo P.J. Budde: Research Grant/Support: Heartflow. Siemens \n \nSF 4-2 \nCT-derived fractional flow reserve: available techniques and current \nclinical evidence \nGianluca Pontone; Milan/IT  \n \nLearning Objectives: \n1. To learn about different solutions of FFRct. \n2. To learn how FFRct can improve diagnostic accuracy. \n3. To learn how the integration of FFRct in the diagnostic pathway is cost \neffective. \n \nSF 4-3 \nCT and MRI perfusion: how do they compare? \nFabian Bamberg; Freiburg/DE \n(fabian.bamberg@uniklinik-freiburg.de) \n \nLearning Objectives: \n1. To learn about the technical background of CT and MRI-based perfusion \nimaging. \n2. To understand the differences in imaging protocols between the two \napproaches. \n3. To become familiar with the current level of scientific evidence on the value \nof CT and MRI-based perfusion imaging. \nAuthor Disclosures:  \nFabian Bamberg: Grant Recipient: Bayer Healthcare, Siemens Healthineers; \nSpeaker: Bayer Healthcare, Siemens Healthineers \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 133  \n \nSpecial Focus Session \nSF 6 \nTumour profiling: established and novel \nMRI techniques \nSF 6-1 \nPerfusion: neovascularisation and aggressiveness \nVicky J. Goh; London/UK  \n(vicky.goh@kcl.ac.uk) \n \nLearning Objectives: \n1. To understand how DCE enables improved cancer detection by revealing \nmicrovasculature and perfusion. \n2. To become familiar with quantitative analysis of signal intensity-time curves \nafter intravenous contrast agent administration in order to reveal cancer \nspecific perfusion-related parameters. \n3. To appreciate the diagnostic potential of DCE to detect significant prostate \ncancer. \nAuthor Disclosures:  \nVicky J. Goh: Research Grant/Support: Siemens Healthcare \n \nSF 6-2 \nDWI: tissue architecture and cell viability \nRavikanth Balaji; Chennai/IN  \n(ravikanthbalaji@gmail.com) \n \nLearning Objectives: \n1. To understand how DWI enables improved cancer detection by revealing \nmicrostructural tissue features. \n2. To become familiar with quantitative analysis of signal intensity-curves \ndependent on b-values to reveal quantitative tissue parameters (i.e. IVIM, \nADC, and kurtosis). \n3. To appreciate the diagnostic potential of DWI to detect and characterise \ncancer. \n \nSF 6-3 \nCEST: protein content and cellular metabolism \nLinda Knutsson; Lund/SE \n(linda.knutsson@med.lu.se) \n \nLearning Objectives: \n1. To understand the basic physical principles of CEST MRI. \n2. To become familiar with the (patho-)biologic correlates of CEST contrast. \n3. To learn about clinical applications in oncology. \n \nSF 6-4 \nFingerprinting: the future of functional MR imaging \nSiegfried Trattnig; Vienna/AT \n(siegfried.trattnig@meduniwien.ac.at) \n \nLearning Objectives: \n1. To understand the rf pulse design of MR fingerprinting sequences (MRF). \n2. To appreciate how MRF enables the quantifying of tissue properties. \n3. To appreciate clinical applications in oncology. \n \n \nSpecial Focus Session \nSF 14 \nChest emergencies \nSF 14-1 \nDyspnoea: how to approach the diagnosis of diffuse lung abnormalities \non CT \nJuan José Arenas-Jiménez; Alicante/ES  \n(j.arenasjimenez@gmail.com) \n \n \n \n \nLearning Objectives: \n1. To become familiar with the characteristic radiologic patterns on CT of \ndiffuse lung abnormalities that can be diagnostic for a specific disease. \n2. To understand the importance of the clinical and laboratory background \nwhen interpreting CT with diffuse changes in patients with acute dyspnoea. \n3. To learn about how to use a proposed checklist combining clinical and \nradiological information to narrow the differential diagnosis in patients with \nacute dyspnoea and diffuse lung abnormalities on CT. \n \nSF 14-2 \nNon-cardiac chest pain: how to proceed? \nJohann Baptist Dormagen; Oslo/NO  \n(uxjorm@ous-hf.no) \n \nLearning Objectives: \n1. To become familiar with the clinical features and patient characteristics in \nacute and chronic non-cardiac chest pain (NCCP) and with common and less \ncommon causes of NCCP.  \n2. To understand the clues and pitfalls when imaging the chest for vascular \nemergencies, including dissection, pulmonary embolism, and less common \nnon-vascular conditions in patients presenting with NCCP. \n3. To appreciate the importance of different imaging modalities for differential \ndiagnoses of NCCP. \n \nSF 14-3 \nAcute haemoptysis: causes and radiological treatment \nMark O. Wielpütz; Heidelberg/DE \n(wielpuetz@uni-heidelberg.de) \n \nLearning Objectives: \n1. To appreciate that haemoptysis can be a life-threatening pulmonary \nemergency with high mortality, is symptomatic of an underlying severe \npulmonary disease, and requires immediate diagnosis and treatment. \n2. To learn about contrast-enhanced multi-detector computed tomography with \nCT angiography as a diagnostic modality in cases of acute haemoptysis to gain \ninformation on the underlying pulmonary disease, bleeding site, and vascular \nanatomy of the bronchial arteries. \n3. To understand that bronchial artery embolisation is a safe and potentially \nlifesaving therapy in severe haemoptysis. \n4. To become familiar with the fact that false embolisation in spinal branches of \nbronchial arteries is the most serious complication of bronchial artery \nembolisation. \nAuthor Disclosures:  \nMark O. Wielpütz: Research Grant/Support: Vertex, Boehringer Ingelheim \n \n \nSpecial Focus Session \nSF 16 \nRisk-adjusted screening for breast cancer \nSF 16-1 \nMethods to assess breast cancer risk \nMireille Broeders; Nijmegen/NL  \n(m.broeders@lrcb.nl) \n \nLearning Objectives: \n1. To become familiar with the current risk prediction models for breast cancer \nand their potential use in screening. \n2. To understand the most important measures used to determine how well a \nrisk model performs. \n3. To learn about the ongoing research to further improve models to assess \nbreast cancer risk. \nAuthor Disclosures:  \nMireille Broeders: Employee: Professor of Personalized Cancer Screening, \nRadboudumc, Nijmegen, the Netherlands; Scientific Supervisor, Dutch Expert \nCentre for Screening, Nijmegen, the Netherlands; Speaker: Agreements: \nHologic and Siemens \n \nSF 16-2 \nShort-term, image-based breast cancer risk prediction model \nPer Hall; Stockholm/SE  \n(per.hall@ki.se) \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 134  \nLearning Objectives: \n1. To argue why the same risk models should not be used for individualised \nprevention and early detection of breast cancer. \n2. To understand why early detection risk models must include mammographic \nfeatures and should not have a longer time span than the screening interval. \n3. To show why risk assessment should be repeated and performed each time \na woman performs screening mammography. \nAuthor Disclosures:  \nPer Hall: Advisory Board: Atossa Therapeutics; Patent Holder: Patent pending \n \nSF 16-3 \nRisk-based breast cancer screening programme: an example for the USA \nKarla Kerlikowske; San Francisco, CA/US \n(Karla.Kerlikowske@ucsf.edu) \n \nLearning Objectives: \n1. To appreciate the differences in risk prediction for overall breast cancer risk \nvs intermediary breast cancer outcomes. \n2. To understand how risk stratification impacts the balance of benefits and \nharms of screening. \n3. To become familiar with risk-based screening approaches in the US. \nAuthor Disclosures:  \nKarla Kerlikowske: Grant Recipient: NCI and PCORI \n \nSF 16-4 \nScreening with MRI in women with dense breasts \nCarla van Gils; Utrecht/NL \n \nLearning Objectives: \n1. To appreciate the importance of breast cancer masking in addition to breast \ncancer risk. \n2. To become familiar with the approaches of using breast density to \npersonalise breast cancer screening with MRI. \n3. To learn about the performance of MRI in women with dense breasts and \nincreased breast cancer risk. \nAuthor Disclosures:  \nCarla van Gils: Consultant: Bayer Pharma AG; Research Grant/Support: Bayer \nPharma AG, Volpara Solutions (in kind); Speaker: Bayer Pharma AG \n \n \nSpecial Focus Session \nOrganised by ESR eHealth and Informatics \nSubcommittee \nSF 18 \nDeep learning and image quality \nSF 18-1 \nAI-enhanced image processing: noise reduction \nJoel Greffier; Nimes/FR  \n(joel.greffier@chu-nimes.fr) \n \nLearning Objectives: \n1. To gain basic understanding of noise and how to measure it in radiologic \nimaging. \n2. To learn the principles of AI-enhanced noise reduction in medical imaging. \n3. To know the advantages and inconveniences of AI-enhanced noise \nreduction. \n \nSF 18-2 \nHow to use deep learning to improve image quality \nYuko Nakamura; Hiroshima/JP  \n \nLearning Objectives: \n1. To understand how image quality in radiology is traditionally improved. \n2. To learn how deep learning can be used to improve image quality. \n3. To explain the advantage of using deep learning to improve image quality. \n \nSF 18-3 \nAI helping to optimise dose and contrast agent application \nChristoph Hoeschen; Magdeburg/DE \n(christoph.hoeschen@ovgu.de) \n \n \n \nLearning Objectives: \n1. To learn about the relationship between radiation dose, contrast medium \napplication and image quality. \n2. To understand how AI can be used to optimise dose and contrast medium \napplication. \n \n \nSpecial Focus Session \nSF 23 \nOrgan transplantation \nSF 23-1 \nBrain death and donor evaluation \nFerdia Bolster; Dublin/IE  \n \nLearning Objectives: \n1. To obtain an overview of brain death and the clinical determination of brain \ndeath. \n2. To become aware of ancillary testing in brain death with a particular focus \non multimodality radiology imaging in the determination of brain death, \nincluding digital subtraction angiography, transcranial Doppler, nuclear \nmedicine scintigraphy, computed tomography (CT) and magnetic resonance \nimaging (MRI), CT and MR angiography, and CT and MR perfusion. \n3. To understand the role of the radiologist in the early recognition of brain \ndeath, to review some conditions that can mimic brain death/pitfalls, and to \nreview donor evaluation. \n \nSF 23-2 \nLiving donor evaluation: liver and kidney \nFederica Vernuccio; Palermo/IT  \n(federicavernuccio@gmail.com) \n \nLearning Objectives: \n1. To obtain an overview of the key surgical considerations and the role of \nimaging for the evaluation of living liver and kidney donors. \n2. To provide an outline of the optimal CT imaging protocol used in the \npreoperative evaluation of living liver and kidney donors. \n3. To discuss the main reportable findings for the diagnostic imaging work-up \nof living liver and kidney donors. \n \nSF 23-3 \nRecipient evaluation pre- and post-Tx: liver \nRossano Girometti; Udine/IT \n(rgirometti@sirm.org) \n \nLearning Objectives: \n1. To understand the role of preoperative imaging in selecting candidates for \nliver transplant. \n2. To understand the role of postoperative imaging in assessing transplant-\nrelated complications. \n3. To summarise the main imaging algorithms and findings in pre- and post-\noperative scenarios. \n \nSF 23-4 \nRecipient evaluation pre- and post-Tx: lung \nMarie-Pierre Debray; Paris/FR \n(marie-pierre.debray@aphp.fr) \n \nLearning Objectives: \n1. To learn about the imaging features evaluated in recipients before lung \ntransplantation and to understand those that may favour mono- or bi-\npulmonary transplantation and those that may lead to exclusion from the \nwaitlist. \n2. To learn to recognise the normal imaging appearance of the lung allograft in \nthe early phase after transplantation. \n3. To obtain an overview of the imaging features of the most common \ncomplications after lung transplantation. \nAuthor Disclosures: \nMarie-Pierre Debray: Speaker: Boehringer Ingelheim \n \nSF 23-5 \nContrast-enhanced ultrasound in the follow-up evaluation of kidney-Tx \nDirk André Clevert; Munich/DE \n(Dirk.Clevert@med.uni-muenchen.de) \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 135  \nLearning Objectives: \n1. To learn about actual indications and applications of CEUS in the follow-up \nafter transplantation of the kidney. \n2. To demonstrate better parameter settings for optimal technical results.  \n3. To illustrate the tips and tricks for technical and clinical successful \nexaminations. \n4. To become familiar with common transplantation pathologies of the kidney. \nAuthor Disclosures:  \nDirk André Clevert: Speaker: Bracco, Siemens, Philips, Esaote, Samsung \n \n \nSpecial Focus Session \nSF 24 \nOral and maxillofacial radiology \nSF 24-1 \nOverview of salivary gland imaging with an emphasis on sialo-CBCT \nChen Nadler; Jerusalem/IL  \n(nadler@hadassah.org.il) \n \nLearning Objectives: \n1. To learn about the sialography indications of salivary gland pathosis. \n2. To become familiar with sialography’s role in demonstrating the radiographic \nfeatures of salivary gland pathosis, computer-aided diagnosis, and creating a \nunique aid for patient assessment and treatment. \n3. To obtain an overview of ultrasound and sialaendoscopy for salivary gland \ndiagnosis and interventional treatment. \n \nSF 24-2 \nRole of imaging in the diagnosis of temporomandibular joint pathology \nTore A. Larheim; Oslo/NO  \n(t.a.larheim@odont.uio.no) \n \nLearning Objectives: \n1. To appreciate normal MRI variations. \n2. To become familiar with the most frequent MRI pathology (internal \nderangement, osteoarthritis, and inflammatory joint diseases). \n \nSF 24-3 \nOral and pharyngeal swallowing dysfunction among snorers, the elderly, \nand stroke and head and neck cancer patients \nEva K. Levring Jäghagen; Umea/SE \n(eva.levring.jaghagen@umu.se) \n \nLearning Objectives: \n1. To learn about the results from studies of oral and pharyngeal swallowing \ndysfunction, assessed with videofluoroscopy among snorers and patients after \nstroke and head and neck cancer treatment. \n2. To learn about neuromuscular injuries in the oropharyngeal area among \nsnorers. \n3. To learn about the results of neuromuscular training for the improvement of \nswallowing function in the elderly and patients after stroke. \n \n \nState of the Art Symposium \nSA 2 \nRadiological management of polytrauma \nSA 2-1 \nWhole-body CT in polytrauma: are we imaging properly? \nMonique Brink; Nijmegen/NL  \n(monique.brink@radboudumc.nl) \n \nLearning Objectives: \n1. To learn the importance of choosing the optimal CT imaging protocol for \ntrauma patients. \n2. To understand the differences in single and dual phase imaging. \n3. To appreciate the need to detect subtle but potentially fatal injuries in \npolytrauma patients. \n \nAuthor Disclosures:  \nMonique Brink: Grant Recipient: Canon Medical Systems Europe; Speaker: \nCanon Medical Systems Europe \n \nSA 2-2 \nContrast-enhanced ultrasound (CEUS) in the follow-up of trauma \npatients: does it have a role? \nAnnamaria Deganello; London/UK  \n(adeganello@nhs.net) \n \nLearning Objectives: \n1. To learn how to classify and grade solid organ injuries. \n2. To become familiar with incorporating CEUS in trauma patient follow ups as \nan alternative to repeated CT-studies. \n3. To appreciate patient selection and appropriate timing of follow up CEUSs. \n4. To understand the advantages and limitations of CEUS in solid organ \ntrauma. \nAuthor Disclosures:  \nAnnamaria Deganello: Speaker: Lecture fees Bracco \n \nSA 2-3 \nMRI in the follow-up of solid organ injury in trauma patients \nNupur Verma; Gainesville, FL/US \n \nLearning Objectives: \n1. To understand the feasibility and usefulness of MRI in solid organ injury \nfollow up imaging. \n2. To become familiar with the suitable candidates and timeline for MRI follow \nup with regard to severity of organ injury. \n3. To understand the limitations and challenges of interpreting traumatic \nlesions and assessing blood products in MRI. \n \nSA 2-4 \nInterventional management of abdominal vascular injuries \nLeena Lehti; Malmö/SE \n(leena.lehti.ll@gmail.com) \n \nLearning Objectives: \n1. To learn about the patient selection and interventional treatment options for \nsplenic, hepatic and renal injuries. \n2. To become familiar with the recommended treatment options for solid organ \nand abdominal vascular injury. \n3. To understand findings that indicate change of management from \nconservative to IR, from IR to surgical. \n4. To understand what the interventional radiologist/surgeon needs to know. \n \n \nProfessional Challenges Session \nPC 2 \nRadiology reporting in the age of \ncomputer-based interpretation \nPC 2-1 \nFrom automated measurements into meaningful reports \nAngel Alberich-Bayarri; Valencia/ES  \n(angel@quibim.com) \n \nLearning Objectives: \n1. To learn about the integration of reporting automation. \n2. To become familiar with novel reporting methodologies. \n3. To understand the role of man-machine interaction in reporting. \nAuthor Disclosures:  \nAngel Alberich-Bayarri: CEO: QUIBIM S.L. \n \nPC 2-2 \nCommon data elements in use: a critical component for improved \nreporting quality \nDaniel Pinto dos Santos; Cologne/DE  \n(daniel.pinto-dos-santos@uk-koeln.de) \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 136  \nLearning Objectives: \n1. To learn about the RSNA's and ACR's common data elements initiative. \n2. To understand the differences and similarities between template-based \nstructured reporting and the use of common data elements. \n3. To appreciate the potential benefits of common data elements for clinical \nroutine and scientific research. \n \nPC 2-3 \nHow to provide multi-media reports \nFlorian Jungmann; Mainz/DE \n \nLearning Objectives: \n1. To understand how radiological reports can be enriched with information that \nhelp the clinical referrers to better capture the key messages. \n2. To become familiar with the integration of schematic drawings, key images, \nand graphs and tables to illustrate responses in oncologic patients. \n3. To learn about the challenges of implementing multi-media reports and how \nthey can be solved. \n \nPC 2-4 \nThe value of structured information for research and quality management \nElmar Kotter; Freiburg/DE \n(elmar.kotter@uniklinik-freiburg.de) \n \nLearning Objectives: \n1. To learn about the use of structured information in research data \nrepositories. \n2. To understand how structured information can be used for the follow-up of \nfindings. \n3. To appreciate the potential of structured reporting for peer review and \ndouble-reading. \n \n \nProfessional Challenges Session \nOrganised by the ESR Ultrasound Subcommittee \nPC 3 \nThe future of ultrasound in radiology \nPC 3-1 \nAssessing point of care in ultrasound \nMaija Radzina; Riga/LV  \n(mradzina@gmail.com) \n \nLearning Objectives: \n1. To describe the current point of care concepts, guidelines, and technical \naspects. \n2. To provide an overview of pathologies and indications that can be covered \nby point of care ultrasound. \n3. To outline the difference of diagnostic and point of care ultrasound \napplications and training requirements. \nAuthor Disclosures:  \nMaija Radzina: Speaker: Canon, Bracco, Bayer \n \nPC 3-2 \nWho should be performing ultrasound? \nDirk André Clevert; Munich/DE  \n(Dirk.Clevert@med.uni-muenchen.de) \n \nLearning Objectives: \n1. To learn about who is performing ultrasound currently. \n2. To understand the new technical developments in ultrasound. \n3. To appreciate the advantages of ultrasound. \n4. To become familiar with the future developments. \nAuthor Disclosures:  \nDirk André Clevert: Speaker: Bracco, Siemens, Samsung, Esaote \n \nPC 3-3 \nWhat will the radiologists of the future be doing in their department? \nPaolo Ricci; Rome/IT \n(paolo.ricci@uniroma1.it) \n \n \n \n \nLearning Objectives: \n1. To describe the organisation of an ultrasound unit in the radiology \ndepartment. \n2. To define how to challenge with the new ultrasound tools and facilities. \n3. To identify a good method of cooperating with non-radiologists performing \nultrasound. \n \nPC 3-4 \nHow can radiology adapt to the change to handheld devices? \nVito Cantisani; Rome/IT \n(vito.cantisani@uniroma1.it) \n \nLearning Objectives: \n1. To update on technical developments. \n2. To define the role, limitations, and possibilities. \n3. To show the actual European and non-European status. \nAuthor Disclosures: \nVito Cantisani: Speaker: Bracco, Samsung, Canon \n \n \nCoffee & Talk (open forum) Session \nC 9 \nTracheobronchomalacia (TBM): optimising \nthe diagnostic approach to this \nincreasingly important childhood entity \nC 9-1 \nThe role of CT in tracheobronchomalacia \nEfthymia Alexopoulou; Athens/GR  \n(ealex64@hotmail.com) \n \nLearning Objectives: \n1. To learn about the indications for CT in TBM. \n2. To understand optimised CT protocols.  \n3. To discuss the CT findings in TBM. \n \nC 9-2 \nThe role of MRI in tracheobronchomalacia \nPierluigi Ciet; Rotterdam/NL  \n(p.ciet@erasmusmc.nl) \n \nLearning Objectives: \n1. To learn about the indications for MRI in TBM. \n2. To understand the MRI imaging protocols. \n3. To discuss the MRI findings in TBM. \nAuthor Disclosures: \nPierluigi Ciet: Consultant: Vertex Pharmaceutical; Grant Recipient: ZonMW \n \nC 9-3 \nBronchoscopy: is it the gold standard? \nKonstantinos Priftis; Athens/GR \n(kpriftis@otenet.gr) \n \nLearning Objectives: \n1. To acquire basic knowledge of bronchoscopic techniques. \n2. To learn about the indications and limitations for bronchoscopy of the large \nairways in children. \n3. To learn about typical bronchoscopic findings and therapeutic interventions \nin children. \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 137  \n \nRefresher Course: Abdominal Viscera \nRC 101 \nBenign and malignant lesions in \n\"forgotten organs\" \nRC 101-1 \nA. Imaging of the spleen \nCäcilia S. Reiner; Zurich/CH  \n \nLearning Objectives: \n1. To be aware of the most common benign and malignant lesions of the \nspleen. \n2. To know about imaging strategies and protocols involving ultrasound, CT, \nand MRI. \n3. To know about the management of splenic lesions. \n \nRC 101-2 \nB. Imaging of mesentery and omentum \nAntonella Filippone; Chieti/IT  \n \nLearning Objectives: \n1. To understand the anatomical landmarks of the mesentery and omentum. \n2. To be aware of the most common pathological findings. \n3. To learn how to avoid diagnostic misinterpretation of mesentery and \nomentum anomalies. \nAuthor Disclosures:  \nAntonella Filippone: Employee: Bracco Imaging \n \nRC 101-3 \nC. Imaging of the gallbladder \nBart J. Op de Beeck; Antwerp/BE \n(bart.op.de.beeck@uza.be) \n \nLearning Objectives: \n1. To become familiar with most common benign and malignant changes of the \ngallbladder. \n2. To be aware of the strengths and shortcomings of different imaging \ntechniques including ultrasound, CT, and MRI. \n3. To understand diagnostic pitfalls of gallbladder imaging. \n \n \nRefresher Course: Abdominal Viscera \nRC 201 \nCommon benign and malignant liver \nlesions: unusual radiological appearance \nRC 201-1 \nA. Features of benign liver lesions \nMaria Manuela França; Porto/PT  \n \nLearning Objectives: \n1. To be able to identify the most common benign liver lesions. \n2. To learn about unusual appearances of benign liver tumours. \n3. To develop an algorithm for correct identification of differentials. \n \nRC 201-2 \nB. Features of primary malignant liver lesions \nGiuseppe Brancatelli; Palermo/IT  \n(gbranca@yahoo.com) \n \nLearning Objectives: \n1. To learn about the typical features and prevalence of hepatocellular \ncarcinomas (HCCs) and cholangiocellular carcinomas (CCCs). \n2. To understand why HCCs and CCCs do not always show typical imaging \nfeatures. \n3. To establish a strategy for differentiating atypical HCCs and CCCs from \nother liver tumours. \n \nAuthor Disclosures:  \nGiuseppe Brancatelli: Consultant: Bayer; Speaker: Bayer, GE healthcare \n \nRC 201-3 \nC. Features of liver metastases \nAsunción Torregrosa Andrés; Valencia/ES \n(asunsuso@gmail.com) \n \nLearning Objectives: \n1. To review the most frequent tumours causing. \n2. To understand why liver metastases can have different imaging \ncharacteristics. \n3. To become familiar with post-therapeutic changes. \n \n \nRefresher Course: Abdominal Viscera \nRC 301 \nImaging of pancreatitis \nRC 301-1 \nA. Focal pancreatitis vs adenocarcinoma \nThomas Bollen; Nieuwegein/NL  \n(tlbollen@hotmail.com) \n \nLearning Objectives: \n1. To learn about the clinical markers of focal pancreatitis and \nadenocarcinoma. \n2. To understand the difficulties in differentiating these entities. \n3. To learn about follow-up strategies in non-conclusive cases. \n \nRC 301-2 \nB. IgG4 autoimmune pancreatitis \nAnkur Arora; Worthing/UK  \n \nLearning Objectives: \n1. To learn about the specific imaging characteristics of autoimmune \npancreatitis. \n2. To learn about the value of different imaging tool including US, CT, and MRI. \n3. To be aware of imaging markers indicating therapeutic success in patients \nwith autoimmune pancreatitis. \n \nRC 301-3 \nC. Imaging of chronic pancreatitis \nGiulia Zamboni; Verona/IT \n(gzamboni@hotmail.com) \n \nLearning Objectives: \n1. To understand the strengths and weaknesses of different imaging tools. \n2. To be aware of typical and atypical imaging findings in patients with chronic \npancreatitis. \n3. To learn about the pitfalls when evaluating patients with chronic pancreatitis. \n \nRC 301-4 \nD. Interventions in acute pancreatitis \nMichael M. Maher; Cork/IE \n(m.maher@ucc.ie) \n \nLearning Objectives: \n1. To recognise the techniques of interventions in acute pancreatitis. \n2. To understand the indications of transgastral vs percutaneous drainage. \n3. To learn how to avoid complications following pancreatic interventions. \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 138  \n \nRefresher Course: Abdominal Viscera \nRC 401 \nImaging of the biliary system \nRC 401-1 \nA. Magnetic resonance cholangiopancreatography (MRCP): state of the \nart \nCarlos Valls; Stockholm/SE  \n(carlos.valls-duran@karolinska.se) \n \nLearning Objectives: \n1. To learn about the different techniques of MRCP including their advantages \nand disadvantages. \n2. To discuss differences of MRCP at 1.5T and 3.0T. \n3. To understand how to deal with pitfalls in MRCP. \n \nRC 401-2 \nB. Primary sclerosing cholangitis (PSC) \nGiovanni Morana; Treviso/IT  \n(gmorana61@gmail.com) \n \nLearning Objectives: \n1. To be aware of the pathophysiological background of PSC. \n2. To learn about typical and atypical imaging features of PSC. \n3. To understand follow-up imaging strategies in patients with PSC. \nAuthor Disclosures:  \nGiovanni Morana: Speaker: BRACCO \n \nRC 401-3 \nC. Biliary drainage and stenting \nThomas K. Helmberger; Munich/DE \n(Thomas.Helmberger@klinikum-muenchen.de) \n \nLearning Objectives: \n1. To understand the access routes for biliary drainage and stenting. \n2. To be aware of pitfalls and complications during and after biliary \ninterventions. \n3. To learn how to evaluate therapeutic control on imaging. \n \n \nRefresher Course: Breast \nRC 202 \nThe radiologist and the oncoplastic \nsurgeon: the importance of interaction for \nsuccessful imaging evaluation \nRC 202-1 \nA. Oncoplastic surgical techniques: what the radiologist needs to know \nIsabel Rubio; Madrid/ES  \n(irubior@unav.es) \n \nLearning Objectives: \n1. To learn about the indications for oncoplastic surgery. \n2. To describe the most common oncoplastic techniques, their strengths, and \nlimitations. \n3. To learn about the expected outcome and common complications after \nsurgery. \nAuthor Disclosures:  \nIsabel Rubio: Advisory Board: Sirius Medical \n \nRC 202-2 \nB. The importance of imaging when planning oncoplastic surgery \nLaura Martincich; Candiolo/IT  \n \n \n \n \n \nLearning Objectives: \n1. To understand which imaging methods are most appropriate to use and \nwhen. \n2. To learn which anatomical landmarks are more relevant in preoperative \nimaging. \n3. To become updated on the latest imaging protocols. \n \nRC 202-3 \nC. Follow-up imaging of the oncoplastic breast: pearls and pitfalls \nSilvia Perez Rodrigo; Madrid/ES \n \nLearning Objectives: \n1. To understand which imaging methods and which intervals should be used \nfor follow-up. \n2. To learn about the most common false-positive and false-negative imaging \nfindings. \n3. To understand the role of imaging in follow-up and prognosis. \n \n \nRefresher Course: Breast \nRC 302 \nInterventional breast imaging: the \nincreasing role of the radiologist \nRC 302-1 \nA. Fine-needle aspiration cytology (FNAC), core-needle, or vacuum-\nassisted biopsy (VAB): what, when, and how? \nAndrew Evans; Dundee/UK  \n(a.z.evans@dundee.ac.uk) \n \nLearning Objectives: \n1. To get to know the different needle systems. \n2. To become familiar with the potential pitfalls. \n3. To be able to choose the right needle for the right indication. \n \nRC 302-2 \nB. Breast lesion localisation: going beyond wires \nMaja Marolt Music; Ljubljana/SI  \n(mmusic@onko-i.si) \n \nLearning Objectives: \n1. To appreciate the importance of image-guided preoperative wire localisation \nfor non-palpable lesions. \n2. To get to know alternative localisation techniques. \n3. To become familiar with the limitations of different techniques. \n \nRC 302-3 \nC. Percutaneous ablation of breast cancer: a step forward \nGiovanni Mauri; Milan/IT \n(vanni.mauri@gmail.com) \n \nLearning Objectives: \n1. To become familiar with the different techniques for tumour ablation. \n2. To acknowledge the value of each technique for the treatment of breast \nlesions. \n3. To identify the factors that affect success. \nAuthor Disclosures:  \nGiovanni Mauri: Advisory Board: Boston Scientific; Speaker: GE healtcare \n \n \nRefresher Course: Breast \nRC 402 \nUpdate on lesions with uncertain \nmalignant potential (B3) \nRC 402-1 \nA. A wrap-up of the newest literature on the most important B3 lesions \nZsuzsanna Varga; Zurich/CH  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 139  \nLearning Objectives: \n1. To learn about the biological behaviour of the most important B3 lesions. \n2. To understand the difference between B3a and B3b lesions. \n3. To recognise the most worrisome entities. \n \nRC 402-2 \nB. Imaging lesions of uncertain potential \nMagda Marcon; Zurich/CH  \n(magda.marcon@usz.ch) \n \nLearning Objectives: \n1. To become familiar with the most common imaging findings in B3 lesions. \n2. To identify the most appropriate imaging modality. \n3. To identify the factors that limit patient compliance to the management \nrecommendations of high-risk breast lesions. \n \nRC 402-3 \nC. How to handle them: update on B3 guidelines \nNisha Sharma; Leeds/UK \n(nisha.sharma2@nhs.net) \n \nLearning Objectives: \n1. To learn about the most recent international recommendations on the \nmanagement of B3 lesions. \n2. To differentiate between the results of a core-needle and a vacuum-assisted \nbiopsy (VAB). \n3. To be able to identify cases when VAB excision may pose a valid alternative \nto surgery. \n \n \nRefresher Course: Breast \nRC 502 \nState of the art and recent developments \nin breast ultrasound \nRC 502-1 \nA. Breast ultrasound: tell me the value of coloured images \nCorinne S. Balleyguier; Villejuif/FR  \n(Corinne.BALLEYGUIER@gustaveroussy.fr) \n \nLearning Objectives: \n1. To learn about the correct settings and interpretation of Doppler and \nelastography. \n2. To understand their respective added value in lesion assessment. \n3. To learn about their roll in follow-up and therapy monitoring. \nAuthor Disclosures:  \nCorinne S. Balleyguier: Speaker: Samsung, Siemens \n \nRC 502-2 \nB. Automated breast ultrasound (ABUS): the right add-on in screening \ndense breasts \nAthina Vourtsis; Athens/GR  \n(athinavourtsi@yahoo.gr) \n \nLearning Objectives: \n1. To learn how to perform, assess image quality, interpret, and recognise \nartefacts. \n2. To review the current literature of ABUS in women with dense breasts. \n3. To understand the value of 3D multiplanar images and ABUS workflow \nimplementation compared to handheld US (HHUS). \nAuthor Disclosures:  \nAthina Vourtsis: Advisory Board: Medical Advisory Board of Volpara Solutions; \nGrant Recipient: X; Investigator: GE Precision Healthcare LLC; Other: \nEuropean Liaison for DenseBreast-Info Europe \n \nRC 502-3 \nC. Can artificial intelligence (AI) be helpful in the US-screening setting? \nPanagiotis Kapetas; Vienna/AT \n(panagiotis.kapetas@meduniwien.ac.at) \n \n \n \n \n \nLearning Objectives: \n1. To understand the current status of the use of AI in US breasts screening. \n2. To realise the limitations in the implementation of AI in US examinations. \n3. To explore potential future applications. \n \n \nRefresher Course: Cardiac \nRC 103 \nImaging the complexity of pulmonary \nhypertension (PH) \"syndrome\" \nRC 103-1 \nA. Assessment of PH by CT \nElena Mershina; Moscow/RU  \n(elena_mershina@mail.ru) \n \nLearning Objectives: \n1. To review the spectrum of currently available techniques, from pulmonary \nangiography to CT perfusion, with spectral imaging. \n2. To list typical and subtle CT imaging parenchymal and vascular features in \nprimary and secondary diseases.  \n3. To review the current role of CT in the clinical guidelines for the diagnosis \nand treatment of pulmonary hypertension. \n \nRC 103-2 \nB. Uncoupling right ventricular physiology with cardiovascular magnetic \nresonance (CMR): from early adaptation to heart failure \nKarl-Friedrich Kreitner; Mainz/DE  \n(Karl-Friedrich.Kreitner@unimedizin-mainz.de) \n \nLearning Objectives: \n1. To review peculiarities of right heart physiology and ventricular \ninterdependence in pulmonary hypertension. \n2. To outline early and late morpho-functional changes associated with right \nventricular pressure overload.  \n3. To understand the primary role of CMR in the evaluation of different forms of \npulmonary hypertension. \n \nRC 103-3 \nC. Cardiac imaging to monitor therapeutic response and predict outcome \nMaria Nedevska; Sofia/BG \n(nedevska_maria@yahoo.com) \n \nLearning Objectives: \n1. To discuss the advances in treatment and importance of imaging to guide \ntherapy.  \n2. To understand the predictive role of CT and MRI. \n3. To analyse the importance and respective roles of CT and MRI to monitor \nresponse to therapy. \n \n \nRefresher Course: Cardiac \nRC 403 \nCardiac imaging in special patient \npopulations \nRC 403-1 \nA. Cardiovascular evaluation of the pregnant patient \nBirgitta K. Velthuis; Utrecht/NL  \n(b.k.velthuis@umcutrecht.nl) \n \nLearning Objectives: \n1. To learn about the normal physiological changes of the cardiovascular \nsystem during pregnancy. \n2. To understand the impact of pregnancy on existing and newly developed \ncardiomyopathies. \n3. To learn how to use CT/MRI for a pregnant patient with an acute \ncardiovascular problem. \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 140  \nAuthor Disclosures:  \nBirgitta K. Velthuis: Board Member: ESCR \n \nRC 403-2 \nB. Cardiotoxicity of recreational and therapeutic drugs \nElie Mousseaux; Paris/FR  \n(elie.mousseaux@egp.ap-hop-paris.fr) \n \nLearning Objectives: \n1. To understand the effects of recreational drugs on the cardiovascular \nsystem. \n2. To understand the cardiac consequences of different therapeutic agents \nused in oncology. \n3. To establish a comprehensive CT/MRI imaging protocol for the evaluation of \nacute and chronically ill patients. \n \nRC 403-3 \nC. Systemic infection/inflammation and the heart with special \nconsiderations for imaging during a pandemic \nMarco Francone; Rome/IT \n(marco.francone@uniroma1.it) \n \nLearning Objectives: \n1. To understand the aetiology and pathophysiology of different forms of \nmyocarditis. \n2. To learn about the cardiovascular implication for patients during the COVID-\n19 pandemic.  \n3. To become familiar with the different CT/MRI imaging characteristics of \ncardiac inflammation and its prognostic implications. \n \n \nRefresher Course: Chest \nRC 204 \nThoracic emergencies: part 2 \nRC 204-1 \nA. Emergencies in thoracic oncology \nCornelia M. Schaefer-Prokop; Amersfoort/NL  \n \nLearning Objectives: \n1. To learn about various causes of dyspnoea in thoracic oncology. \n2. To learn about cardiac complications of thoracic malignancies. \n3. To learn how to suggest an appropriate differential diagnosis. \n \nRC 204-2 \nB. Haemoptysis \nAntoine Khalil; Paris/FR  \n(antoine_khalil@yahoo.fr) \n \nLearning Objectives: \n1. To understand the role of multidetector CT angiography. \n2. To become familiar with the anatomy of bronchial arteries. \n3. To learn how to optimise the planning of endovascular interventions. \nAuthor Disclosures:  \nAntoine Khalil: Speaker: Guerbet Canon \n \nRC 204-3 \nC. Non-ischaemic cardiac emergencies \nChristian Loewe; Vienna/AT \n(christian.loewe@meduniwien.ac.at) \n \nLearning Objectives: \n1. To learn how to evaluate acute pericarditis. \n2. To learn how to explore patients with suspected myocarditis. \n3. To learn about takotsubo features on MRIs. \nAuthor Disclosures:  \nChristian Loewe: Author: BRACCO Springer; Speaker: Siemens Healthineers \n \nRC 204-4 \nD. Postoperative and iatrogenic complications \nJonathan D. Dodd; Dublin/IE \n \n \n \nLearning Objectives: \n1. To learn about the complications after thoracic surgery. \n2. To review the complications of percutaneous interventional radiology. \n3. To review illustrative cases. \n \n \nRefresher Course: Chest \nRC 504 \nPleural disease revisited \nRC 504-1 \nA. Pleural plaques and mimickers \nCatherine Beigelman; Lausanne/CH  \n \nLearning Objectives: \n1. To learn about the pathophysiology of pleural plaques. \n2. To recognise typical findings and differentials on radiographs. \n3. To recognise typical findings and differentials on CT. \n \nRC 504-2 \nB. Malignant mesothelioma \nIeneke Hartmann; Rotterdam/NL  \n(i.j.c.hartmann@gmail.com) \n \nLearning Objectives: \n1. To learn when to suspect mesothelioma on radiographs. \n2. To recognise imaging features highly suggestive of mesothelioma on CT. \n3. To learn the role of PET-CT and MRI in diagnosing mesothelioma. \n \nRC 504-3 \nC. Other pleural neoplasms \nTing Ting Zhang; Brighton/UK \n \nLearning Objectives: \n1. To learn how to differentiate pleural metastases from mesothelioma. \n2. To learn how to recognise benign pleural tumours. \n3. To learn about other rarer pleural malignancies. \n \n \nRefresher Course: Imaging Informatics \nRC 105 \nHow to manage data: moving patients' \ndata across hospitals, regions, and \ncountries \nRC 105-1 \nA. Transferring patients' data across hospitals, regions, and countries: \npros and cons \nElmar Kotter; Freiburg/DE  \n(elmar.kotter@uniklinik-freiburg.de) \n \nLearning Objectives: \n1. To learn the benefits and risks of patients' data sharing between centres. \n2. To discuss the use of novel technologies allowing data sharing. \n3. To understand the differences in data policy across hospitals and European \ncountries. \n \nRC 105-2 \nB. Anonymised vs pseudo-anonymised data \nTimo De Bondt; Antwerp/BE  \n(timo.debondt@gmail.com) \n \nLearning Objectives: \n1. To learn basic general data protection regulation (GDPR) law concepts. \n2. To appreciate the difference between anonymised and pseud-anonymised \ndata. \n3. To understand the relevance of anonymisation and pseudo-anonymisation \nfor clinical studies. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 141  \nAuthor Disclosures:  \nTimo De Bondt: Employee: Vinçotte - Controlatom \n \nRC 105-3 \nC. Management of data for research projects and clinical trials \nDaniele Regge; Turin/IT \n(daniele.regge@ircc.it) \n \nLearning Objectives: \n1. To learn how to design infrastructures for big projects and multi-centre trials. \n2. To appreciate the different researcher roles linked to data in clinical studies. \n3. To see practical examples of success stories in research projects. \nAuthor Disclosures:  \nDaniele Regge: Consultant: Kardo, Radmetrix \n \nRC 105-4 \nD. Federated learning: will artificial intelligence models travel to the \nimages? \nDaniel Rubin; Stanford, CA/US \n \nLearning Objectives: \n1. To learn about the federated learning concept. \n2. To discuss the benefits and risks of federated learning vs centralised \nrepositories. \n3. To observe the current technical implementations allowing for practical use \nof federated learning. \n \n \nRefresher Course: Hybrid, Molecular and \nTranslational Imaging \nOrganised by ESHIMT \nRC 106 \nAdvancing clinical hybrid imaging \nRC 106-1 \nA. Cost-effectiveness of hybrid imaging \nBarbara M. Fischer; London/UK  \n(Malene.fischer@kcl.ac.uk) \n \nLearning Objectives: \n1. To discuss why clinicians often consider hybrid imaging as the expensive \nchoice. \n2. To obtain knowledge of the basic concepts of health economy. \n3. To present and discuss examples of cost-effectiveness studies in the use of \nPET/CT in oncology. \n4. To evaluate how hybrid imaging may be incorporated as a cost-effective tool \ninto routine clinical practice. \n \nRC 106-2 \nB. PET/MRI in clinical routine \nVicky J. Goh; London/UK  \n(vicky.goh@kcl.ac.uk) \n \nLearning Objectives: \n1. To learn about the basic concepts underlying PET/MRI. \n2. To understand the potential clinical advantages of combining PET and MRI. \n3. To discuss how PET/MRI may find a role as a routine clinical test in the \nfuture. \nAuthor Disclosures:  \nVicky J. Goh: Research Grant/Support: Siemens Healthcare; Speaker: ESOR \n \nRC 106-3 \nC. PET/MRI in the context of radiation treatment \nJiri Ferda; Plzen/CZ \n(ferda@fnplzen.cz) \n \nLearning Objectives: \n1. To learn about the role of MRI and PET/MRI in radiation oncology. \n2. To understand how MRI and/or PET/MRI can be used to monitor \nradiotherapy response. \n3. To appreciate the role of hybrid imaging in targeting and modulating \nradiation therapy. \n \n \nRefresher Course: Genitourinary \nRC 107 \nImaging of benign female pelvis \nRC 107-1 \nA. Benign ovarian lesion characterisation \nRosemarie Forstner; Salzburg/AT  \n(r.forstner@salk.at) \n \nLearning Objectives: \n1. To understand the role of ultrasound and MRI in the characterisation of \nbenign ovarian lesions.  \n2. To learn the imaging findings that allow the radiologist to recognise a mass \nof ovarian origin.  \n3. To become familiar with the different benign ovarian entities and different \nhistological types of benign tumours. \n \nRC 107-2 \nB. Unusual appearances of uterine leiomyomas \nDeniz Akata; Ankara/TR  \n(dakata@hacettepe.edu.tr) \n \nLearning Objectives: \n1. To understand the role of ultrasound and MRI in the characterisation of \nleiomyomas, as distinct from adenomyosis.  \n2. To become familiar with the different histological subtypes of leiomyomas \nand forms of degeneration.  \n3. To understand the role of MRI in distinguishing unusual leiomyomas from \nmalignant entities. \n \nRC 107-3 \nC. Congenital malformations of the uterus \nCristina Maciel; Porto/PT \n(tina_maciel@yahoo.com) \n \nLearning Objectives: \n1. To understand how to optimise MRI protocols for the work-up of female \ngenital tract congenital anomalies.  \n2. To become familiar with the different classification of female genital tract \ncongenital anomalies.  \n3. To learn how to present a reporting MRI checklist according to the specific \nmalformation, complications and associated anomalies. \n \n \nRefresher Course: Genitourinary \nRC 207 \nImaging of recurrent gynaecological \ncancer \nRC 207-1 \nA. Cervical and vulvar carcinoma post-therapy \nLucia Manganaro; Rome/IT  \n \nLearning Objectives: \n1. To become familiar with MRI expected pelvic changes after cervical and \nvulvar carcinoma treatment.  \n2. To be aware of the possible complications associated with treatment.  \n3. To learn the MRI features of recurrent cervical and vulvar carcinoma in the \npelvis, in lymph nodes and of distant metastatic disease. \n \nRC 207-2 \nB. Accessing recurrent endometrial cancer \nMilagros Otero García; Vigo/ES  \n(milagros.otero.garcia@sergas.es) \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 142  \nLearning Objectives: \n1. To become familiar with MRI expected pelvic changes after endometrial \ncarcinoma treatment.  \n2. To be aware of the possible complications associated with endometrial \ncarcinoma treatment.  \n3. To learn the MRI features of recurrent endometrial carcinoma in the pelvis, \nin lymph nodes, and of distant metastatic disease. \n \nRC 207-3 \nC. Recurrent ovarian cancer \nAndrea G. Rockall; London/UK \n \nLearning Objectives: \n1. To learn the indications and techniques for follow-up imaging in ovarian \ncancer. \n2. To recognise the appearances and pitfalls of recurrent ovarian cancer on \nCT. \n3. To become familiar with the appearances of recurrent ovarian cancer on \nMRI. \n \n \nRefresher Course: Head and Neck \nRC 108 \nImaging of 'glands' in the head and neck \nRC 108-1 \nA. Lacrimal gland \nAta Siddiqui; London/UK  \n(ata.siddiqui@nhs.net) \n \nLearning Objectives: \n1. To review the anatomy of the lacrimal glands and their structure. \n2. To consider how best to image the lacrimal glands. \n3. To become acquainted with common lacrimal gland pathology and imaging \nfeatures. \n \nRC 108-2 \nB. Salivary gland \nRoberto Maroldi; Brescia/IT  \n(roberto.maroldi@unibs.it) \n \nLearning Objectives: \n1. To become familiar with salivary gland anatomy and structure. \n2. To learn how best to image these glands and indications for different \nmodalities. \n3. To review common salivary gland pathologies and their imaging features \n \nRC 108-3 \nC. Thyroid ultrasound: solving the pitfalls \nSteve Colley; Birmingham/UK \n(Steve.Colley@uhb.nhs.uk) \n \nLearning Objectives: \n1. To review the TI-RADS classification system. \n2. To learn about pitfalls and issues associated with it. \n3. To understand how to overcome these and develop logical imaging \nstrategies. \n \nRC 108-4 \nD. Parathyroid \nJenny Hoang; Baltimore, MD/US \n(jennykh@gmail.com) \n \nLearning Objectives: \n1. To review the anatomy and location of parathyroid glands. \n2. To become familiar with available imaging modalities and understand which \nto use and when. \n3. To learn about common pathologies and imaging features. \n \n \nRefresher Course: Head and Neck \nRC 308 \nImaging of head and neck trauma \nRC 308-1 \nA. Facial trauma \nElizabeth Loney; Halifax/UK  \n \nLearning Objectives: \n1. To consider a simplified approach to reporting facial trauma scans. \n2. To understand differing types of Le Fort fractures and key imaging review \nareas. \n3. To become acquainted with mandibular fractures, types, and complications. \n \nRC 308-2 \nB. Laryngeal trauma \nMinerva Becker; Geneva/CH  \n \nLearning Objectives: \n1. To become familiar with the causes of laryngeal trauma and classification \nsystems. \n2. To learn how best to image the larynx in such situations and the challenges \nthat can occur. \n3. To review the imaging features of laryngeal trauma and consider its \ncomplications. \n \nRC 308-3 \nC. Orbital trauma \nPim De Graaf; Amsterdam/NL \n \nLearning Objectives: \n1. To review the relevant orbital anatomy. \n2. To understand how best to image orbital trauma. \n3. To consider the relevant imaging findings in the acute and chronic setting. \n \nRC 308-4 \nD. Skull base trauma \nStephen Connor; London/UK \n \nLearning Objectives: \n1. To briefly review the relevant skull base anatomy. \n2. To understand the types and locations of traumatic injuries to the skull base. \n3. To consider how to image such patients and how to review the imaging \nfindings in acute trauma and of associated sequelae. \n \n \nRefresher Course: Head and Neck \nRC 408 \nGranulomatous disease and its mimics in \nthe head and neck \nRC 408-1 \nA. Infectious granulomatous disease \nSalman Qureshi; Doha/QA  \n \nLearning Objectives: \n1. To review the causes of infectious granulomatous disease. \n2. To reflect on the available imaging modalities and to describe the pros and \ncons of each. \n3. To become familiar with the imaging features of such conditions in the head \nand neck. \n \nRC 408-2 \nB. Non-infectious granulomatous disease \nSoraya Robinson; Vienna/AT  \n(s.robinson@dzu.at) \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 143  \nLearning Objectives: \n1. To become familiar with non-infectious granulomatous conditions in the \nhead and neck. \n2. To learn how best to image these conditions. \n3. To review the imaging features of such pathologies. \n \nRC 408-3 \nC. Granulomatous disease mimics \nBurce Ozgen Mocan; Chicago, IL/US \n \nLearning Objectives: \n1. To consider the spectrum of diseases which may mimic granulomatous \nconditions. \n2. To discuss the optimal imaging pathways. \n3. To review the imaging appearances of such pathology and how reflect on \nhow they might be differentiated from other conditions. \n \n \nRefresher Course: Musculoskeletal \nRC 210 \nMusculoskeletal imaging in rheumatology \nRC 210-1 \nA. Crystal arthropathies \nMonique Reijnierse; Leiden/NL  \n(m.reijnierse@lumc.nl) \n \nLearning Objectives: \n1. To describe the imaging findings of crystal arthropathies. \n2. To learn about differentials, choice of modalities, and possible clinical \nconsequences of crystal arthropathies. \n \nRC 210-2 \nB. MRI of inflammatory diseases of the spine and sacroiliac joints \nAnne Cotten; Lille/FR  \n(anne.cotten@chru-lille.fr) \n \nLearning Objectives: \n1. To describe the MRI findings of inflammatory diseases in the axial skeleton. \n2. To learn about differentials of inflammatory diseases of the axial skeleton. \n \nRC 210-3 \nC. Joint inflammation in children and adolescents \nNele Herregods; Ghent/BE \n \nLearning Objectives: \n1. To explain the imaging and diagnostic considerations in inflammatory \narthropathies in children and adolescents, including the choice of modalities. \n2. To list the imaging findings and differentials in inflammatory arthropathies in \nchildren and adolescents. \n \n \nRefresher Course: Musculoskeletal \nRC 310 \nThe unstable joint \nRC 310-1 \nA. Shoulder instability \nKlaus Wörtler; Munich/DE  \n(klaus.woertler@tum.de) \n \nLearning Objectives: \n1. To describe the morphological and epidemiological aspects of shoulder \ninstability. \n2. To explain new trends in the imaging of shoulder instability. \n \nRC 310-2 \nB. Elbow instability \nReto Sutter; Zurich/CH  \n \nLearning Objectives: \n1. To describe the imaging features of acute elbow dislocations. \n2. To explain the imaging hallmarks of chronic elbow instability. \nAuthor Disclosures:  \nReto Sutter: Author: Breitenseher Publisher; Other: Balgrist University Hospital \nhas an academic research collaboration with Siemens Healthineers and \nBalzano Informatik. \n \nRC 310-3 \nC. Joint instability of the lower extremities \nMaria Tzalonikou; Athens/GR \n(tzalonikou3@yahoo.gr) \n \nLearning Objectives: \n1. To explain the imaging findings of hip and knee dislocations. \n2. To describe the imaging findings of ankle instability. \n \n \nRefresher Course: Musculoskeletal \nRC 410 \nMy top three tips for musculoskeletal \nultrasound imaging \nRC 410-1 \nA. My top three tips for ultrasound of the shoulder \nMagdalena S. Posadzy; Poznan/PL  \n(magdalenaposadzy@gmail.com) \n \nLearning Objectives: \n1. To explain the utility of standardised views. \n2. To describe how to recognise common pathologies. \n3. To list pitfalls and explain how to avoid them. \n \nRC 410-2 \nB. My top three tips for ultrasound of the elbow \nHussain Al-Bulushi; Muscat/OM  \n(e_240@hotmail.com) \n \nLearning Objectives: \n1. To explain the utility of standardised views. \n2. To describe how to recognise common pathologies. \n3. To list pitfalls and explain how to avoid them. \n \nRC 410-3 \nC. My top three tips for ultrasound of the wrist and hand \nElena E. Drakonaki; Iraklion/GR \n(drakonaki@yahoo.gr) \n \nLearning Objectives: \n1. To explain the utility of standardised views. \n2. To describe how to recognise common pathologies. \n3. To list pitfalls and explain how to avoid them. \n \nRC 410-4 \nD. My top three tips for ultrasound of the hip \nEmma Rowbotham; Leeds/UK \n(emmarowbotham@doctors.org.uk) \n \nLearning Objectives: \n1. To explain the utility of standardised views. \n2. To describe how to recognise common pathologies. \n3. To list pitfalls and explain how to avoid them. \n \nRC 410-5 \nE. My top three tips for ultrasound of the knee \nAmanda Isaac; London/UK \n \nLearning Objectives: \n1. To explain the utility of standardised views. \n2. To describe how to recognise common pathologies. \n3. To list pitfalls and explain how to avoid them. \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 144  \nRC 410-6 \nF. My top three tips for ultrasound of the ankle and foot \nCarlo Martinoli; Genoa/IT \n(55904@unige.it) \n \nLearning Objectives: \n1. To explain the utility of standardised views. \n2. To describe how to recognise common pathologies. \n3. To list pitfalls and explain how to avoid them. \n \n \nRefresher Course: Musculoskeletal \nRC 510 \nMRI of the knee \nRC 510-1 \nA. ACL injury: associated soft tissue injuries \nPatrick Omoumi; Lausanne/CH  \n(patrick.omoumi@chuv.ch) \n \nLearning Objectives: \n1. To explain the mechanism of an ACL tear, focusing on the associated soft \ntissue injuries to the menisci, posteromedial, and posterolateral corners. \n2. To describe the MRI appearances of associated soft tissue injuries, their \nclinical importance, and potential pitfalls. \n \nRC 510-2 \nB. ACL repair: MRI of a normal graft and the complications \nChristian W.A. Pfirrmann; Zurich/CH  \n \nLearning Objectives: \n1. To describe the normal anatomy and MRI appearances of an ACL repair by \ngraft surgery. \n2. To explain the imaging appearances of normal maturation and pathological \nconditions involving ligament repair. \n3. To list the most valuable imaging findings that correlate with clinical \ncomplications. \n \nRC 510-3 \nC. Anterior knee pain \nP. Diana Afonso; Lisbon/PT \n(p.diana.a@gmail.com) \n \nLearning Objectives: \n1. To describe the normal anatomy and MRI appearances of the anterior knee \nstructures, including the extensor mechanism, fat pads, and synovial plicae. \n2. To explain the imaging appearances of pathological conditions that present \nwith anterior knee pain. \n \nRC 510-4 \nD. Image-guided interventions around the knee \nSilvia Mariani; L'Aquila/IT \n(mari.silvia@hotmail.it) \n \nLearning Objectives: \n1. To describe the different imaging modalities that can be used and their \nadvantages. \n2. To explain different conditions that benefit from image-guided interventions \naround and within the knee. \n3. To list which structures and mistakes to avoid. \n \n \nRefresher Course: Musculoskeletal \nRC 610 \nMusculoskeletal tumours \nRC 610-1 \nA. Bone tumours and tumour-like conditions \nPaul O'Donnell; Stanmore/UK  \n(paulodonnell@nhs.net) \nLearning Objectives: \n1. To learn about the imaging findings of bone tumours. \n2. To describe how to differentiate benign from malignant bone lesions. \n \nRC 610-2 \nB. Soft tissue tumours \nAlberto Bazzocchi; Bologna/IT  \n(abazzo@inwind.it) \n \nLearning Objectives: \n1. To explain the imaging findings of soft tissue tumours. \n2. To describe differential diagnostic considerations in imaging soft tissue \ntumours. \n \nRC 610-3 \nC. Tumours of the spinal column \nFilip M.H.M. Vanhoenacker; Antwerp/BE \n(filip.vanhoenacker@telenet.be) \n \nLearning Objectives: \n1. To explain the imaging findings of spinal tumours. \n2. To describe differential diagnostic considerations in imaging spinal tumours. \n \n \nRefresher Course: Musculoskeletal \nRC 710 \nMusculoskeletal infection \nRC 710-1 \nA. Imaging osteomyelitis: an update \nJan Fritz; Baltimore, MD/US  \n \nLearning Objectives: \n1. To describe the role of imaging in diagnosing osteomyelitis. \n2. To explain the role of intravenous contrast medium material in diagnosing \nosteomyelitis. \n3. To list the differential diagnostic considerations in imaging osteomyelitis. \nAuthor Disclosures:  \nJan Fritz: Advisory Board: Siemens, GE, Synthetic MR, ImageBiopsy Labs, \nMirata Pharma; Grant Recipient: Siemens AG, BTG International, Microsoft \nCorporation, Zimmer Biomed, DePuy Synthes, Synthetic MRI, QED; Patent \nHolder: Siemens, Johns Hopkins \n \nRC 710-2 \nB. Soft tissue infections \nSilvia Martin; Palma de Mallorca/ES  \n(silvia.m.martin@gmail.com) \n \nLearning Objectives: \n1. To describe the role of imaging in soft tissue infections. \n2. To explain the role of intravenous contrast medium material in diagnosing \nsoft tissue infections. \n3. To list the differential diagnostic considerations in imaging soft tissue \ninfections. \n \nRC 710-3 \nC. Septic arthritis \nRadhesh Lalam; Oswestry/UK \n(radhesh.lalam@rjah.nhs.uk) \n \nLearning Objectives: \n1. To describe the role of imaging in septic arthritis. \n2. To explain the role of intravenous contrast medium material in diagnosing \nseptic arthritis. \n3. To list the differential diagnostic considerations in imaging septic arthritis. \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 145  \n \nRefresher Course: Musculoskeletal \nRC 810 \nEssential measurements and \nclassifications in musculoskeletal joint \nimaging \nRC 810-1 \nA. Shoulder \nÜstün Aydingöz; Ankara/TR  \n(uaydingo@hacettepe.edu.tr) \n \nLearning Objectives: \n1. To describe essential measurements and classifications that need to be \nmade in shoulder imaging. \n2. To explain how these measurements/classifications relate to \npathophysiology and management-related decision making. \n \nRC 810-2 \nB. Elbow-wrist-hand \nMilko C. De Jonge; Utrecht/NL  \n(milkodejonge@gmail.com) \n \nLearning Objectives: \n1. To describe the essential measurements and classifications that need to be \nmade in elbow, wrist, and hand imaging. \n2. To explain how these measurements/classifications relate to \npathophysiology and management-related decision making. \n \nRC 810-3 \nC. Hip \nFlorian Schmaranzer; Berne/CH \n(florian.schmaranzer@insel.ch) \n \nLearning Objectives: \n1. To describe the essential measurements and classifications that need to be \nmade in hip imaging. \n2. To explain how these measurements/classifications relate to \npathophysiology and management-related decision making. \n \nRC 810-4 \nD. Knee \nChristoph Rehnitz; Heidelberg/DE \n(Christoph.Rehnitz@med.uni-heidelberg.de) \n \nLearning Objectives: \n1. To describe the essential measurements and classifications that need to be \nmade in knee imaging. \n2. To explain how these measurements/classifications relate to \npathophysiology and management-related decision making. \n \nRC 810-5 \nE. Ankle-foot \nRichard Fawcett; Leeds/UK \n \nLearning Objectives: \n1. To describe essential measurements and classifications that need to be \nmade in ankle and foot imaging. \n2. To explain how these measurements/classifications relate to \npathophysiology and management-related decision making. \n \n \n \n \n \n \n \n \n \n \n \n \nRefresher Course: Neuro \nRC 111 \nCraniocervical junction \nRC 111-1 \nA. Congenital abnormalities \nAndrea Rossi; Genoa/IT  \n(andrearossi@gaslini.org) \n \nLearning Objectives: \n1. To become familiar with the congenital bone anomalies and variants of the \ncraniocervical junction. \n2. To learn about associated cerebellar and spinal cord abnormalities. \n3. To illustrate craniocervical anomalies in syndromes. \n \nRC 111-2 \nB. Trauma \nGuillaume Bierry; Strasbourg/FR  \n \nLearning Objectives: \n1. To be able to categorise the spectrum of fractures. \n2. To develop an understanding of the biomechanics and management \noptions. \n3. To appreciate the imaging findings in ligamentous craniocervical injuries. \n \nRC 111-3 \nC. Systemic diseases and tumours \nKarl-Olof Løvblad; Geneva/CH \n(Karl-Olof.Lovblad@hcuge.ch) \n \nLearning Objectives: \n1. To recognise craniocervical injuries in rheumatoid arthritis. \n2. To differentiate systemic diseases from other pathology involving the \ncraniocervical junction. \n3. To become familiar with retro-odontoid pseudotumours without rheumatoid \narthritis. \n \n \nRefresher Course: Neuro \nRC 211 \nSellar and parasellar lesions \nRC 211-1 \nA. Anatomy, variants, and function of the pituitary gland \nSeamus Looby; Dublin/IE  \n \nLearning Objectives: \n1. To review the anatomy of the sellar and parasellar region. \n2. To recognise sellar variants. \n3. To be able to appropriately image the patient with diabetes insipidus. \n \nRC 211-2 \nB. Imaging of sellar and suprasellar lesions \nZoran Rumboldt; Rovinj-Rovigno/HR  \n(puz3@yahoo.com) \n \nLearning Objectives: \n1. To recognise pituitary and sellar neoplasms other than adenoma. \n2. To describe perisellar and suprasellar pathology. \n3. To provide an overview of sellar and suprasellar childhood lesions. \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 146  \nRC 211-3 \nC. Post-treatment findings and follow-up \nFabrice Bonneville; Toulouse/FR \n(bonneville.f@chu-toulouse.fr) \n \nLearning Objectives: \n1. To become familiar with the different types of pituitary adenoma. \n2. To define the most effective imaging strategy for pituitary adenoma. \n3. To learn about the role of MRI after surgical and/or medical treatment. \n \n \nRefresher Course: Neuro \nRC 311 \nNeuromuscular imaging \nRC 311-1 \nA. How to image patients with neuromuscular disease \nMarc-André Weber; Rostock/DE  \n(marc-andre.weber@med.uni-rostock.de) \n \nLearning Objectives: \n1. To become aware of the recent developments in muscle imaging. \n2. To understand the role of imaging in muscle atrophy. \n3. To become familiar with the expectations of the neurologist. \n \nRC 311-2 \nB. How to report congenital myopathies \nAnna Pichiecchio; Pavia/IT  \n(anna.pichiecchio@mondino.it) \n \nLearning Objectives: \n1. To appreciate muscle MRI findings in neuromuscular disorders. \n2. To learn about structured reporting in neuromuscular diseases. \n3. To understand the role of various imaging modalities in the workup of \ncongenital myopathies. \nAuthor Disclosures:  \nAnna Pichiecchio: Advisory Board: Sanofi G-enzyme; Consultant: Sanofi G-\nenzyme (Prex) \n \nRC 311-3 \nC. How to recognise adult neuromuscular disease \nSachit Shah; London/UK \n \nLearning Objectives: \n1. To learn how to apply the optimal imaging protocol. \n2. To appreciate the role of quantitative imaging in genetic and acquired \nmyopathies. \n3. To illustrate the role of brain imaging in neuromuscular disorders. \n \n \nRefresher Course: Neuro \nRC 411 \nAging brain imaging: essential clues for \ndiagnosis \nRC 411-1 \nA. Brain aging: what is normal? \nMeike Vernooij; Rotterdam/NL  \n(m.vernooij@erasmusmc.nl) \n \nLearning Objectives: \n1. To understand the importance for radiologists to have knowledge on the \nprocess of brain aging. \n2. To learn what is 'normal' and what is considered 'abnormal' aging in brain \nimaging. \n3. To illustrate how this knowledge can be incorporated into reading and \nreporting brain scans in clinical practice. \n \n \nRC 411-2 \nB. Imaging of abnormal cognitive deterioration: Alzheimer’s and beyond \nAlexandre Krainik; Grenoble/FR  \n \nLearning Objectives: \n1. To understand the relationships between imaging features and memory, \nexecutive, and speech impairments. \n2. To learn how to recognise abnormal brain imaging features and patterns \nuseful for clinical practice. \n3. To provide essential clues for reporting atrophy, grey, and white matter \nabnormalities. \n \nRC 411-3 \nC. Imaging of abnormal motor deterioration: Parkinson’s and beyond \nSven Haller; Geneva/CH \n \nLearning Objectives: \n1. To understand the pathophysiology of the main extrapyramidal syndromes \nand neurodegenerative diseases. \n2. To learn how to recognise related brain imaging abnormalities. \n3. To provide essential clues for reporting and discussing differential \ndiagnoses. \nAuthor Disclosures:  \nSven Haller: Advisory Board: EPAD; Consultant: WYSS, SPINEART; Speaker: \nGE \n \n \nRefresher Course: Neuro \nRC 611 \nCerebrospinal fluid (CSF) and glymphatic \nsystem imaging \nRC 611-1 \nA. How to identify Virchow-Robin spaces and glymphatic system \ndisorders \nNivedita Agarwal; Rovereto/IT  \n(niveditaaga@gmail.com) \n \nLearning Objectives: \n1. To understand the pathophysiological disorders of Virchow-Robin spaces. \n2. To learn how to optimise glymphatic system imaging. \n3. To be able to report enlarged perivascular spaces. \n \nRC 611-2 \nB. How to diagnose cerebrospinal fluid deficit \nHorst Urbach; Freiburg/DE  \n(horst.urbach@uniklinik-freiburg.de) \n \nLearning Objectives: \n1. To understand the pathophysiology of CSF production. \n2. To recognise malformations of cortical development. \n3. To learn how to report malformations of cortical development. \n \nRC 611-3 \nC. How to report cerebrospinal fluid excess \nJoanna Bladowska; Wroclaw/PL \n(joanna.bladowska@umed.wroc.pl) \n \nLearning Objectives: \n1. To understand the pathophysiology of CSF circulation. \n2. To be able to diagnose the different types of CSF excess. \n3. To understand the relationships between CSF excess and intracranial \nhypertension. \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 147  \n \nRefresher Course: Paediatric \nRC 112 \nLearning from common errors and \ndiscrepancies in paediatric radiology \nRC 112-1 \nA. Pitfalls to avoid in musculoskeletal imaging \nSusan Cheng Shelmerdine; London/UK  \n \nLearning Objectives: \n1. To understand how learning from mistakes improves clinical care. \n2. To review common pitfalls in musculoskeletal imaging. \n3. To learn how to avoid mistakes concerning bone marrow signal in children. \n \nRC 112-2 \nB. Pitfalls to avoid in chest imaging \nThomas Robert Semple; London/UK  \n(tsemple@doctors.org.uk) \n \nLearning Objectives: \n1. To understand how learning from mistakes improves clinical care. \n2. To review common pitfalls in chest imaging. \n3. To learn how to avoid mistakes concerning lines and tubes. \nAuthor Disclosures:  \nThomas Robert Semple: Consultant: Boehringer-Ingelheim and Calyx; \nResearch Grant/Support: Vertex and Chiesi pharmaceuticals; Speaker: Vertex \npharmaceuticals \n \nRC 112-3 \nC. Pitfalls to avoid in paediatric abdominal imaging \nMagdalena Wozniak; Lublin/PL \n(mwozniak@hoga.pl) \n \nLearning Objectives: \n1. To understand how learning from mistakes improves clinical care. \n2. To review common pitfalls in abdominal imaging. \n3. To learn how to avoid mistakes in patients with acute abdominal pain. \n \nRC 112-4 \nD. Pitfalls to avoid in neuroimaging \nAndrea Rossi; Genoa/IT \n(andrearossi@gaslini.org) \n \nLearning Objectives: \n1. To understand how learning from mistakes improves clinical care. \n2. To review common pitfalls in neuroimaging. \n3. To learn how to avoid mistakes concerning ventricles and subarachnoid \nspaces. \n \n \nRefresher Course: Paediatric \nRC 212 \nImaging the small ones: tips and tricks in \nneonatal imaging \nRC 212-1 \nA. Neuroimaging in the neonate \nElida Vázquez; Barcelona/ES  \n(evazquez@vhebron.net) \n \nLearning Objectives: \n1. To learn the most common neurological queries in neonatology. \n2. To understand the technical challenges of US and MRI in neonatal imaging. \n3. To discuss the key findings that may be useful for differential diagnosis. \n \nRC 212-2 \nB. Neonatal renal dilatation \nJim Carmichael; London/UK  \nLearning Objectives: \n1. To learn how to investigate antenatal renal dilatation. \n2. To understand congenital abnormalities leading to renal dilatation and how \nto investigate them. \n3. To present a protocol for investigation and follow-up of renal dilatation in the \nneonate. \n \nRC 212-3 \nC. Neonatal jaundice \nHelen Woodley; Leeds/UK \n(h.woodley@nhs.net) \n \nLearning Objectives: \n1. To understand the aetiologies of neonatal jaundice such as biliary atresia. \n2. To appreciate the key features for diagnosis. \n3. To discuss appropriate management. \n \nRC 212-4 \nD. Imaging the neonatal bowel \nAnne M.J.B. Smets; Amsterdam/NL \n(a.m.smets@amsterdamumc.nl) \n \nLearning Objectives: \n1. To recognise common bowel abnormalities in neonates on radiographs. \n2. To learn how to use ultrasound to investigate necrotising enterocolitis and \nbowel perforation. \n3. To discuss developmental bowel abnormalities. \n \nRC 212-5 \nE. Imaging lines and tubes in neonates \nOla Kvist; Stockholm/SE \n(ola.kvist@sll.se) \n \nLearning Objectives: \n1. To appreciate the normal course of lines and tubes in neonates on \nradiographs. \n2. To learn how to use ultrasound to assess line position. \n3. To discuss the complications of lines and tubes in neonates using \nradiographs and ultrasound. \n \n \nRefresher Course: Paediatric \nRC 412 \nImaging of key queries in children: an \nevidence-based approach \nRC 412-1 \nA. When a child is unusually short: work-up and the role of the paediatric \nradiologist \nAlistair D. Calder; London/UK  \n(Alistair.Calder@gosh.nhs.uk) \n \nLearning Objectives: \n1. To learn about possible causes of short stature. \n2. To understand the indications for imaging and the typical radiological \ninvestigations. \n3. To discuss a structured approach to diagnosis and how to seek help. \n \nRC 412-2 \nB. Respiratory tract infections \nPierluigi Ciet; Rotterdam/NL  \n(p.ciet@erasmusmc.nl) \n \nLearning Objectives: \n1. To learn about the role of imaging in childhood respiratory tract infections. \n2. To understand the indications and limitations of radiography, CT, and \nultrasound. \n3. To discuss the typical radiological findings and their clinical implications in a \nchild with a respiratory tract infection. \nAuthor Disclosures:  \nPierluigi Ciet: Consultant: Vertex Pharmaceutical; Grant Recipient: ZonMW \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 148  \nRC 412-3 \nC. Large and small heads: when and how to image \nÜmit Yaúar Ayaz; Mersin/TR \n(umityasarayaz@yahoo.com) \n \nLearning Objectives: \n1. To learn the indications for imaging in deviating head circumference. \n2. To understand examination techniques and imaging algorithms. \n3. To appreciate the most common pathologies and their clinical implications. \n \nRC 412-4 \nD. The limping child \nIgnasi Barber; Esplugues de Llobregat/ES \n(ibarber@hsjdbcn.org) \n \nLearning Objectives: \n1. To learn about the most important differential diagnosis in a limping child.  \n2. To understand the indications for imaging and choice of imaging modalities \nin a child with a limp. \n3. To appreciate the most important findings and 'red flag' features. \n \n \nRefresher Course: Paediatric \nRC 512 \nPolytrauma management \nRC 512-1 \nA. US, CT, and MRI in paediatric polytrauma: when and how to use? \nMaria Raissaki; Iraklion/GR  \n(mraissaki@yahoo.gr) \n \nLearning Objectives: \n1. To discuss the justification for imaging in paediatric polytrauma patients. \n2. To learn about the imaging protocols and current guidelines in paediatric \npolytrauma management. \n3. To discuss the potential applications and limitations of US, CT, and MRI in \npaediatric polytrauma patients. \n \nRC 512-2 \nB. Cerebral and spinal trauma in children: what the surgeon needs to \nknow \nStavros Stivaros; Manchester/UK  \n \nLearning Objectives: \n1. To learn about the imaging patterns of cerebral and spinal trauma in \nchildren. \n2. To discuss the indications for imaging in paediatric cerebral and spinal \ntrauma. \n3. To become familiar with basic and advanced imaging protocols. \n \nRC 512-3 \nC. Thoracic and abdominal trauma in children: what the surgeon needs to \nknow \nIlias Tsiflikas; Tübingen/DE \n(ilias.tsiflikas@med.uni-tuebingen.de) \n \nLearning Objectives: \n1. To learn about the imaging patterns of thoracic and abdominal trauma in \nchildren. \n2. To discuss the indications for imaging in paediatric thoracic and abdominal \ntrauma. \n3. To become familiar with basic and advanced imaging protocols. \n \n \n \n \n \n \n \n \n \n \n \n \nRefresher Course: Physics in Medical \nImaging \nRC 413 \nRadiation dose monitoring systems \n(RDMS): from commissioning to effective \nuse \nRC 413-1 \nA. Supply and commissioning of an RDMS to meet all your needs \nNiki Fitousi; Leuven/BE  \n(niki.fitousi@qaelum.com) \n \nLearning Objectives: \n1. To understand how to select the right system for each hospital. \n2. To learn how data should be validated after being collected. \n3. To understand how derived quantities are calculated. \nAuthor Disclosures:  \nNiki Fitousi: Employee: Qaelum NV \n \nRC 413-2 \nB. How to manage the data and extract the relevant information \nOsvaldo Rampado; Turin/IT  \n(orampado@cittadellasalute.to.it) \n \nLearning Objectives: \n1. To learn about the methods of data extraction. \n2. To be able to query the database with different filters. \n3. To understand how to use this data to guide optimisation actions. \nAuthor Disclosures: \nOsvaldo Rampado: Other: I'm a user of Physico (emme esse) radiation dose \nmonitoring system \n \nRC 413-3 \nC. Monitoring and analysis of patients with high cumulative risks \nJenia N. Vassileva; Vienna/AT \n(J.N.Vassileva@gmail.com) \n \nLearning Objectives: \n1. To learn the strategies of defining attention levels and possible intervention \nthresholds. \n2. To understand how to correlate cumulative dose indices with cumulative \nrisks. \n3. To evaluate which procedures and clinical pathways involve high cumulative \nrisks. \n \n \nRefresher Course: Physics in Medical \nImaging \nRC 513 \nQuantification of magnetic resonance \nimaging parameters in clinical practice \nRC 513-1 \nA. Parameter mapping in MRI: acquisition methodologies \nLars G. Hanson; Copenhagen/DK  \n \nLearning Objectives: \n1. To learn about available acquisition methodologies for the mapping of MRI \nparameters: T1, T2, T2*, and magnetic susceptibility. \n2. To understand the current limitations of different approaches in a clinical \nsetting. \n3. To be able to select suitable phantoms that assure reproducibility and \naccuracy when performing quantitative measures. \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 149  \nRC 513-2 \nB. Towards optimisation and standardisation of MRI techniques for \ndiffusion MRI of the body \nAlberto Torresin; Milan/IT  \n(alberto.torresin@unimi.it) \n \nLearning Objectives: \n1. To learn about diffusion MRI in body applications. \n2. To understand how to perform quantitative diffusion MRI in body \napplications. \n3. To evaluate the performance of different MRI techniques. \n \nRC 513-3 \nC. Quantitative, multi-parametric MRI as a useful biomarker in the clinic \nFerdia A. Gallagher; Cambridge/UK \n(fag1000@cam.ac.uk) \n \nLearning Objectives: \n1. To learn about the use of quantitative biomarkers in medical images. \n2. To understand how quantification improves decision making in a clinical \ncontext. \n3. To evaluate the open issues that need to be tackled to exploit such \ntechniques fully. \nAuthor Disclosures:  \nFerdia A. Gallagher: Consultant: AstraZeneca; Grant Recipient: GSK; \nResearch Grant/Support: GE Healthcare \n \n \nRefresher Course: Radiographers \nRC 214 \nImaging and advanced practice in \nradiotherapy \nRC 214-1 \nA. CT in radiotherapy \nRafaela Guisantes; Coimbra/PT  \n(rafaela_guis@hotmail.com) \n \nLearning Objectives: \n1. To explain the specific radiotherapy requirements of CT simulation. \n2. To understand the key principles of optimisation when performing CT \nsimulation. \n3. To be aware of the impact of patient preparation and positioning during CT \nsimulation in the treatment planning process. \n \nRC 214-2 \nB. MRI in radiotherapy \nVesna Mekis; Ljubljana/SI  \n \nLearning Objectives: \n1. To understand the importance of MRI simulation in the treatment planning \nprocess. \n2. To explain specific radiotherapy requirements of MRI simulation and to \nconsider the role of the MRI linear accelerator. \n3. To discuss future perspectives of MRI in radiotherapy. \n \nRC 214-3 \nC. Advanced practice in radiotherapy \nSue Mercieca; Msida/MT \n(susan.mercieca@um.edu.mt) \n \nLearning Objectives: \n1. To review the current advanced practice opportunities in radiotherapy. \n2. To explore the potential opportunities for radiographers in radiotherapy \npractice. \n3. To discuss the importance of education, training, and continuous \nprofessional development for radiographers specialising in radiotherapy. \n \n \nRefresher Course: Radiographers \nRC 314 \nDevelopments and practice in ultrasound \nRC 314-1 \nA. Advances in ultrasound transducer technology \nDamir Suhonjic; Vienna/AT  \n \nLearning Objectives: \n1. To become familiar with the latest technologies in ultrasound transducer \ntechnology. \n2. To explore the consequences of different transducer technologies in \nexamination protocols. \n3. To explore the use of the latest technologies in ultrasound in daily routine \npractice. \n \nRC 314-2 \nB. Technical quality management in ultrasound \nSaso Arnuga; Ljubljana/SI  \n(saso.arnuga@zf.uni-lj.si) \n \nLearning Objectives: \n1. To become familiar with technical quality management in ultrasound. \n2. To outline the benefits of technical quality management in ultrasound. \n3. To identify challenges and opportunities for radiographers/sonographers in \nimplementing technical quality management. \n \nRC 314-3 \nC. Perspectives of radiographers performing ultrasound \nGill Harrison; London/UK \n \nLearning Objectives: \n1. To provide an overview of the radiographer/sonographer role in ultrasound. \n2. To recognise the barriers to the successful implementation of radiographers \nperforming ultrasound. \n3. To explain the specific requirements of radiographers performing ultrasound. \nAuthor Disclosures:  \nGill Harrison: Investigator: Chair of an ultrasound survey working group for the \nEuropean Federation of Radiographer Societies \n \n \nRefresher Course: Radiographers \nRC 514 \nUpdates in forensic imaging \nRC 514-1 \nA. An overview of best practice for radiographers in forensic imaging \nJonathan McNulty; Dublin/IE  \n(jonathan.mcnulty@ucd.ie) \n \nLearning Objectives: \n1. To understand the key aspects of the radiographers' role in forensic imaging. \n2. To discuss the importance of the continuity of evidence and record keeping \nduring forensic examinations. \n3. To highlight other elements of current best-practice guidelines. \n \nRC 514-2 \nB. Paediatric forensic imaging \nNiamh Kirk; Belfast/UK  \n(niamh.kirk@belfasttrust.hscni.net) \n \nLearning Objectives: \n1. To appreciate the role of multi-modality imaging in paediatric forensic cases. \n2. To become familiar with the current guidelines on imaging in cases of \nsuspected physical abuse/non-accidental injuries. \n3. To recognise the potential challenges in obtaining cooperation from \nrelatives. \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 150  \nRC 514-3 \nC. Optimising post-mortem CT examinations and protocols \nJeroen Kroll; Maastricht/NL \n(j.kroll@mumc.nl) \n \nLearning Objectives: \n1. To explore the range of applications for CT in forensic imaging. \n2. To evaluate the approaches to the optimisation of workflow in post-mortem \nCT. \n3. To discuss tips and tricks to optimise your protocols for a range of forensic \napplications. \n \n \nRefresher Course: Vascular \nRC 115 \nVenous thrombotic disease \nRC 115-1 \nA. Acute deep vein thrombosis: diagnosis, interventional radiology (IR) \ntreatment, and outcomes \nGeert Maleux; Leuven/BE  \n(Geert.Maleux@uzleuven.be) \n \nLearning Objectives: \n1. To learn about the clinical symptoms and diagnosis of deep vein thrombosis \n(DVT). \n2. To become familiar with the different conservative and IR treatment options. \n3. To discuss the short-, mid-, and long-term outcomes. \nAuthor Disclosures:  \nGeert Maleux: Speaker: Terumo, Sirtex, Boston Scientific; Other: proctor \nTerumo &amp; Sirtex \n \nRC 115-2 \nB. Diagnosis and treatment of central venous occlusions \nSalah D. Qanadli; Lausanne/CH  \n \nLearning Objectives: \n1. To learn about clinical symptoms and the appropriate diagnostic tools. \n2. To become familiar with which patients IR treatment is indicated. \n3. To understand how to treat a central venous occlusion using IR methods. \n \nRC 115-3 \nC. Chronic deep vein thrombosis: diagnosis, IR treatment, and outcomes \nRomaric Loffroy; Dijon/FR \n(romaric.loffroy@chu-dijon.fr) \n \nLearning Objectives: \n1. To learn about the clinical symptoms and diagnosis of chronic DVT. \n2. To become familiar with preinterventional imaging and appropriate treatment \nplanning. \n3. To discuss different IR techniques and outcomes. \n \n \nRefresher Course: Oncologic Imaging \nRC 116 \nPeritoneal carcinomatosis: the role of \nimaging in detection and treatment \nplanning? \nRC 116-1 \nA. Detection and characterisation: tips and tricks \nLaure S. Fournier; Paris/FR  \n \nLearning Objectives: \n1. To become familiar with imaging strategies for the assessment of peritoneal \ncarcinomatosis. \n2. To discuss multimodal concepts for detection and characterisation. \n3. To learn about the limitations of non-invasive imaging approaches. \n \nAuthor Disclosures:  \nLaure S. Fournier: Research Grant/Support: Invectys, Novartis, Philips; \nSpeaker: Sanofi, Novartis, Jannssen, General Electric; Other: congress \nsponsorship Guerbet \n \nRC 116-2 \nB. Surgical view: cytoreductive surgery \nAnne-Sophie Bats; Paris/FR  \n(anne-sophie.bats@aphp.fr) \n \nLearning Objectives: \n1. To understand the surgeon's view on imaging strategies. \n2. To learn about surgical strategies for the treatment of peritoneal \ncarcinomatosis. \n3. To highlight the relevant information from imaging for decision making. \n \nRC 116-3 \nC. Imaging in treatment planning and follow-up \nGiulia Zamboni; Verona/IT \n(gzamboni@hotmail.com) \n \nLearning Objectives: \n1. To become familiar with the role of imaging for systemic and local treatment \nplanning. \n2. To discuss the value of imaging modalities. \n3. To understand the limitations and pitfalls of imaging. \n \n \nRefresher Course: Oncologic Imaging \nRC 316 \nRole of imaging in immunotherapy: \ntumour response assessment and \ncomplications \nRC 316-1 \nA. What is immunotherapy and (how) does it work? \nClarisse Dromain; Lausanne/CH  \n(Clarisse.Dromain@chuv.ch) \n \nLearning Objectives: \n1. To discuss the concept of immunotherapy treatment in cancer. \n2. To learn the different types of immunotherapies. \n3. To understand the challenges of assessing immunotherapy response. \nAuthor Disclosures:  \nClarisse Dromain: Advisory Board: IPSEN \n \nRC 316-2 \nB. Challenges in measuring immunotherapy response \nThorsten Persigehl; Cologne/DE  \n(thorsten.persigehl@uk-koeln.de) \n \nLearning Objectives: \n1. To understand the limitations of RECIST and to become aware of the \nimmune response criteria. \n2. To learn about the specifics of immune-related RECIST. \n3. To become familiar with pseudoprogression and hyperprogression. \nAuthor Disclosures:  \nThorsten Persigehl: Advisory Board: BMS; Author: Review; Speaker: MINT, \nPhilips, Siemens, BMS, BioNtech, Roche, Bayer \n \nRC 316-3 \nC. Functional and molecular imaging: FDG and beyond \nVicky J. Goh; London/UK \n(vicky.goh@kcl.ac.uk) \n \nLearning Objectives: \n1. To understand the current role of [18F]FDG-PET in immunotherapy \nresponse assessment. \n2. To become familiar with the concepts of Immuno-PET. \n3. To learn the applications of novel Immuno-PET tracers. \nAuthor Disclosures:  \nVicky J. Goh: Research Grant/Support: Siemens Healthcare \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 151  \nRC 316-4 \nD. Complications of immunotherapy \nOliver Lukas Sedlaczek; Heidelberg/DE \n \nLearning Objectives: \n1. To learn which immunotherapies frequently lead to complications. \n2. To become familiar with which life-threatening complicationscan be caused \nby immunotherapies. \n3. To learn when immunotherapy-related complications commonly occur. \n \n \nRefresher Course: Emergency Imaging \nRC 117 \nAcute neurological presentations \nRC 117-1 \nA. Acute central nervous system (CNS) infections \nMaureen Dumba; London/UK \n \nLearning Objectives: \n1. To learn about imaging preferences in the setting of acute CNS infections. \n2. To become familiar with the imaging features of the various CNS infections. \n3. To understand the role of emergency radiology in the diagnosis and follow-\nup of patients with acute CNS infections. \nAuthor Disclosures:  \nMaureen Dumba: Board Member: ESER and BSER; Employee: UCL, London \n \nRC 117-2 \nB. Usual and unusual imaging findings of stroke patient \nCem Calli; Izmir/TR  \n(cem.calli@gmail.com) \n \nLearning Objectives: \n1. To learn about the common imaging findings of ischaemic and haemorrhagic \nstroke. \n2. To understand the arterial and venous causative mechanisms and become \nfamiliar with unusual imaging findings to prevent missed stroke cases. \n3. To understand the 'time is brain approach' in the imaging evaluation of \npatients with stroke. \n \nRC 117-3 \nC. Neurological emergency imaging: which sequence and when? \nDanielle Byrne; Dublin/IE \n(dbyrne.radiology@gmail.com) \n \nLearning Objectives: \n1. To understand the terminology. \n2. To appreciate the rationale and value of the different imaging modalities and \nsequences available for acute neurology. \n3. To understand which imaging modality and sequence is most useful in each \nscenario. \n \n \nRefresher Course: Emergency Imaging \nRC 217 \nChest emergencies \nRC 217-1 \nA. Imaging of acute chest pain \nPaola Franchi; Teramo/IT  \n(paegiodi@hotmail.com) \n \nLearning Objectives: \n1. To learn how acute chest pain should be assessed in emergency imaging. \n2. To learn how to optimise the CT protocols. \n3. To understand the main pitfalls in the imaging assessment of acute chest \npain. \n \n \n \nRC 217-2 \nB. Infection in the lung: the role of the emergency radiologist in the \nmanagement of the patient \nMariano Scaglione; Castel Volturno/IT  \n \nLearning Objectives: \n1. To differentiate lung infection from other lung pathologies. \n2. To learn about specific imaging findings of different infectious processes in \nthe lung. \n3. To learn how to differentiate bacterial, viral, and fungal infections. \n \nRC 217-3 \nC. Acute aortic syndrome: from imaging to management \nFerco Henricus Berger; Toronto, ON/CA \n(fhberger@gmail.com) \n \nLearning Objectives: \n1. To understand the different forms of acute aortic syndrome, their prognosis, \nand potential treatments. \n2. To distinguish the high-risk features of acute aortic syndromes. \n3. To learn about proper imaging protocol selection. \n \n \nRefresher Course: Emergency Imaging \nRC 317 \nNew technologies in emergency imaging \nRC 317-1 \nA. New frontiers in emergency radiology: better imaging, less radiation - \nhow to optimise dose reduction \nMehmet Ruhi Onur; Ankara/TR  \n(ruhionur@yahoo.com) \n \nLearning Objectives: \n1. To describe radiation limiting strategies (including noise reducing image \nreconstruction algorithms, automatic tube modulation, optimum z-axis \ncoverage) and their impact on image quality in emergency CT. \n2. To explain the effect of CT scanning parameters on radiation dose and \nimage quality and to illustrate specific radiation dose output decreasing \nstrategies. \n3. To assess the importance of CT dose monitoring and workflow by dose \nmanagement systems and to be familiar with diagnostic reference levels (DRL) \nof CT examinations. \n4. To suggest consistent solutions to common problems in emergency CT that \nincrease radiation dose and decrease image quality. \n \nRC 317-2 \nB. Postprocessing CT programmes (ASPECT, cerebral blood flow \nimaging, cardiac function assessment programmes, lung analysis, and \ncinematic rendering) \nSteven P. Rowe; Baltimore, MD/US  \n(srowe8@jhmi.edu) \n \nLearning Objectives: \n1. To become familiar with the novel postprocessing CT imaging techniques \nand their contributions in the diagnosis of emergency settings, and their effect \non patient management. \n2. To understand the trade off between time taken for a post processing \ntechnique vs the clinical benefit in predicting the prognosis.  \n3. To be able to explain how techniques such as cinematic rendering can help \npatients and clinical staff to understand radiological findings more clearly. \nAuthor Disclosures:  \nSteven P. Rowe: Consultant: Progenics Pharmaceuticals; Founder: Precision \nMolecular, Inc., PlenaryAI, Inc.; Grant Recipient: Progenics Pharmaceuticals; \nPatent Holder: Precision Molecular, Inc., PlenaryAI, Inc.; Share holder: \nPrecision Molecular, Inc., PlenaryAI, Inc. \n \nRC 317-3 \nC. Role of dual-energy CT in bone injuries \nHatem Alkadhi; Zurich/CH \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 152  \nLearning Objectives: \n1. To review the basic technical principles of dual-energy CT for bone imaging. \n2. To understand the utility of dual-energy CT in bone injury evaluation in terms \nof management of the patients.  \n3. To learn the advantages and shortcomings of dual-energy CT in patients \nwith skeletal disease. \n \nRC 317-4 \nD. Utility of the clinical decision support system (CDS) in emergency \nradiology \nAlexander Goehler; Essen/DE \n(agoehler@post.harvard.edu) \n \nLearning Objectives: \n1. To learn what a CDS is and how it works. \n2. To understand how a CDS can help clinicians to eliminate inappropriate \ninvestigations or procedures and adhere to the latest practice guidelines. \n3. To recognise the concerns that a CDS may constrain clinical management \nand understand the benefits a good CDS can bring to the individual patient \npathway. \n \n \nResearch Presentation Session: \nAbdominal Viscera \nRPS 201a \nInfection and inflammation in the abdomen \nRPS 201a-1 \nRelationship between obesity and Covid-19: could an abdominal CT scan \npredict disease severity? \n*V. Rizzo*¹, F. Pediconi¹, S. Schiaffino², A. Cozzi², F. Galati¹, C. Catalano¹,  \nF. Sardanelli²; ¹Roma/IT, ²Milan/IT  \n(nican66@gmail.com) \n \nPurpose: The aim of our study is to investigate the relationship between \nCovid-19 and obesity, to document the role of different fat distribution in the \nseverity of lung disease and in the admission in intensive care units. \nMethods or Background: In a retrospective multicenter study, we examined \nclinical features, the need of mechanical ventilation and admission in ICU for \nSARS-CoV-2, the severity of lung disease analyzed by a chest CT and the \nevaluation of obesity estimating visceral and subcutaneous adipose tissue by \nan abdominal CT scan. Lung involvement was evaluated calculating the \npercentage of affected parenchyma. Obesity degree was classified by \nevaluation of visceral adipose tissue area (VAT area) and subcutaneous \nadipose tissue area (SAT area) at third lumbar vertebra (L3) lower margin. \nLung score with VAT and SAT were compared between patients with and \nwithout ICU admission using the Mann–Whitney U test, while multivariate \nbinary logistic regression was used to evaluate the association between VAT \narea, VAT score, and SAT areas, in predicting ICU admission. \nResults or Findings: Multivariate binary logistic regression identified VAT \nscore as best predictor of ICU admission (odds ratio 4.307, 95%CI 0.709–\n26.153) followed by sex (OR 2.783, 95%CI 0.378–20.517) and pulmonary \nscore (OR 1.253, 95%CI 0.982–1.598), with a resulting AUC of 0.821 \n(p<0.001). \nConclusion: Our work suggests that a high VAT increase the risk of ICU \nadmission for COVID-19, due to its action of promoting chronic inflammation \nand probably because the adipose tissue can be a viral reservoir. Obese \npatients infected by SARS-CoV-2 should be considered a high-risk class and \ncould be considered to extend chest CT scan to the L3 level, to perform a \nquantification of visceral adipose tissue to predict the risk of dangerous \ncomplications. \nLimitations: Not applicable \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nAndrea Cozzi: Nothing to disclose \nVeronica Rizzo: Nothing to disclose \nFrancesco Sardanelli: Nothing to disclose \nSimone Schiaffino: Nothing to disclose \nFrancesca Galati: Nothing to disclose \nFederica Pediconi: Nothing to disclose \nCarlo Catalano: Nothing to disclose \n \n \n \nRPS 201a-2 \n2D shear wave elastography (SWE) performance versus vibration-\ncontrolled transient elastography (VCTE/fibroscan) in the assessment of \nliver stiffness in chronic hepatitis \n*A. M. Osman*, A. El Shimy, M. M. Abd El Aziz; Cairo/EG  \n(Dr_osman80@yahoo.com) \n \nPurpose: Assessment of liver stiffness and fibrosis affects the management \nstrategy. Multiple non-invasive tools are now available to offer an adequate \nalternative to biopsy. \nMethods or Background: We compared the performance of 2D shear wave \nelastography (SWE) to the transient elastography/fibroscan as a non-invasive \ntool in the prediction of liver stiffness. This is a prospective study of 215 \npatients confirmed by serology to have positive virus C or B infection. 2D SWE \nwas done followed by vibration controlled transient elastography (VCTE) \nknown as fibroscan at the same session. Biopsy results were collected. \nResults or Findings: The mean age was 51.07 years ± 6.07 SD. 5 cases \nwere excluded due to insufficient data. Fibroscan failed in 30 cases out of 210 \ncases (failure rate of 14.3%) compared to only 12 patients (6.7% failure rate) \nwhile using SWE. Only 180 patients completed the study to the result analysis. \nSWE results showed significant agreement to the fibroscan results with 86.7% \nagreement with a tendency for overestimation of the degree of fibrosis (11.7%). \nThe efficacy of SWE was highest during the assessment of patients with F0 \n(98.9%), F1 (97.8%) and F4 (93.3%) respectively and relatively low in F2 \n(92.8%) and F3 (90.6%). \nConclusion: 2D SWE is a relatively recent non-invasive tool in the \nassessment of liver fibrosis which can be used as an alternative to the \nfibroscan with almost similar diagnostic performance when fibroscan is not \ncapable to obtain adequate results such as in obesity and ascites. \nLimitations: Absent control group due to the difficulty to get a biopsy from a \nhealthy person. US is operator dependent and we didn’t assess the inter-\noperator variability. \nEthics Committee Approval: Faculty of Medicine- Ain Shams University \nEthical Committee with informed written consents were taken from all patients. \nFunding for this study: Not available \nAuthor Disclosures: \nAhmed El Shimy: nothing to disclose \nMohamed M. Abd El Aziz: Nothing to disclose \nAhmed M. Osman: Nothing to disclose \n \nRPS 201a-3 \nQuantitative edge analysis of pancreatic margins in patients with chronic \npancreatitis: a correlation with exocrine function \n*A. Grecchi*, M. C. Ambrosetti, A. Ambrosetti, A. Amodio, G. Zamboni,  \nG. Mansueto; Verona/IT \n(annamaria.grecchi88@gmail.com) \n \nPurpose: To correlate the computer-aided analysis of pancreatic margins with \nexocrine function measured with fecal elastase values in patients with chronic \npancreatitis (CP). \nMethods or Background: The hospital registries were searched for patients \nwith confirmed diagnoses of CP with fecal elastase values and abdomen MRI \nperformed in our Institute in less than 1 year. We identified 123 Patients \ndivided into 3 groups of 41 patients each based on the fecal elastase value: \ngroup A with fecal elastase <100 ȝg/g; group B with fecal elastase between \n100 and 200 ȝg/g; group C with fecal elastase > 200 ȝg/g. An in-house \nsoftware was developed and computer-assisted quantitative edge-analysis was \nperformed on pancreatic margins in Fat Suppressed T1-Weighted images of \nthe pancreas with chronic inflammation changes, obtaining the root mean \nsquare deviation SD of the actual border from the average boundary line. \nBorder SD values were compared across groups using the Kruskal-Wallis test \nand correlation between border SD values and fecal elastase values were \ntested with the Spearman test. \nResults or Findings: A significant difference in SD values was observed \nbetween the three groups (p<0.0001). A significant correlation was observed \nbetween SD values and elastase values with ȡ =0.5945. \nConclusion: Quantitative edge-analysis with dedicated software may stratify \nPatients with chronic pancreatitis according to the degree of exocrine \ninsufficiency, potentially contributing to the morphological and functional \nstaging of this pathology. \nLimitations: Small number of cases \nEthics Committee Approval: Formal IRB approval not required for \nretrospective studies \nFunding for this study: None \nAuthor Disclosures: \nGiulia Zamboni: Nothing to disclose \nGiancarlo Mansueto: Nothing to disclose \nAntonio Amodio: Nothing to disclose \nAnnamaria Grecchi: Nothing to disclose \nMaria Chiara Ambrosetti: Nothing to disclose \nAmbrosetti Alberto Ambrosetti: Nothing to disclose \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 153  \nRPS 201a-4 \nTiming of CT scanning in acute pancreatitis: failure to follow guidelines \nsupported by evidence \n*C. Banziger*¹, M. Sharifpour², A. Ali¹, I. Zealley¹; ¹Dundee/UK, ²Leicester/UK \n(carina.banziger@nhs.scot) \n \nPurpose: Initial management of acute pancreatitis is supportive. Current \nguidelines recommend a delay of up to 6 days (and at least 3 days) before \nperforming CT in patients with a clinical/biochemical diagnosis of acute \npancreatitis (AP). In order to see if evidence leads to a change in practice we \nhave repeated a previous study performed at our institution (Dobbs, 2016) \nwhich provided evidence supporting these guidelines: CT scans performed at \n<6 days did not lead to any surgical or radiological interventions. \nMethods or Background: Single centre retrospective cohort study comparing \nintervention rates precipitated by early CT (<6 day of admission) and CT timing \nper current guidelines (•6 days of admission) in patients with a \nclinical/biochemical diagnosis of AP from October 2016 to April 2019. \nResults or Findings: 229 patients fulfilled the inclusion criteria, 179 patients \n(78%) were scanned at <6 days and 50 patients (22%) at •6 days. One \nintervention was performed on the basis of an ear-ly CT scan (<6 days). The \nannualised rate of ‘first’ CT scan has increased from 61 per year to 87 per \nyear. The proportion of ‘early’ CT scan has increased from 35% to 51%. The \nfrequency of intervention has reduced from 9% to 2%. \nConclusion: Only one intervention precipitated an early CT scan. Despite \nevidence from our previous study, our rate of early CT scans has increased \nfrom 35% to 51%. These changes suggest a reduced threshold for CT \nscanning with no corresponding increase in rate of therapeutic interventions. \nThe change in practice has not resulted in an increase in the rate of targeted \ntherapeutic interventions which improve outcomes in AP. \nLimitations: The timescale recommendations for initial CT in acute \npancreatitis vary (between guide-lines from 3-6 days). However this study has \nutilised the longest recommended delay and still found that patient \nmanagement was not altered by early CT scans. \nEthics Committee Approval: Approved by Caldicott Guardian \nFunding for this study: None \nAuthor Disclosures: \nAdnan Ali: Nothing to disclose \nMeedya Sharifpour: Nothing to disclose \nCarina Banziger: Nothing to disclose \nIan Zealley: Nothing to disclose \n \nRPS 201a-5 \nThe diagnostic value of dual-layer spectral detector CT in negative \ngallbladder stones \n*J. Bai*, Y. Qiao; Taiyuan/CN \n(bjq19834516901@163.com) \n \nPurpose: To investigate the diagnostic value of dual-layer spectral detector CT \nin negative gallbladder stones. \nMethods or Background: From June 2019 to July 2020, 63 patients with \nnegative gallbladder stones were collected from the First Hospital of Shanxi \nMedical University and were underwent enhanced upper abdominal CT \nscanning with dual-layer spectral detector CT. The TNC images, the effective \natomic number images, monochromatic energy images (40keV—200keV) and \nthe VNC images were gained in the post-processing workstation. The CT \nattenuation of negative stones and the adjacent bile in the monochromatic \nenergy images as well as the effective atomic number of images were \nmeasured, and the independent sample t-test was used for statistical analysis. \nThe contrast noise ratio (CNR) of bile and negative stones in TNC and VNC \nwere calculated. The paired sample t-test was used for statistical analysis. \nReceiver Operating Curve (ROC) was used to assess the accuracy of the \neffective atomic number in differentiating stones from bile. \nResults or Findings: The CT values of gallbladder negative stones are \ndifferent from that of bile in the monochromatic energy images (40keV and \n200keV). The effective atomic number of negative stones (6.74±0.41) was \nsignificantly lower than bile (7.22±0.18). The CNR of gallbladder negative \nstones and bile in the VNC and the TNC were 1.10±0.43 and 0.44±0.34 \nrespectively (P < 0.01). Taking 7.11 as the cut-off point of the effective atomic \nnumber, its specificity and sensitivity were 83.92% and 82.32% respectively, \nand the area-under-curve AUC was 0.90. \nConclusion: The monochromatic energy images (40keV, 200keV), effective \natomic number images and VNC obtained by dual-layer spectral detector CT \nhave high value in the diagnosis of negative stones, and improve the detection \nrate of negative gallbladder stones. \nLimitations: Not applicable \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nJingqi Bai: Nothing to disclose \nYing Qiao: Nothing to disclose \nRPS 201a-6 \nShear wave elastography of the liver in correlation with sustained \nvirological response in patients with chronic hepatitis C: a prospective \nfollow-up study \n*A. D. Rónaszéki*, B. K. Budai, B. Csongrády, V. Orban, A. Folhoffer,  \nF. Szalay, G. Györi, P. N. Kaposi-Novák; Budapest/HU \n(ronaszeki.aladar@gmail.com) \n \nPurpose: The purpose of our study was to observe that direct-acting antiviral \n(DAA) therapy has significant effect on serum biomarkers and liver stiffness \nvalues (LS). \nMethods or Background: 35 individuals with chronic hepatitis-C infection and \nattained sustained virological response (SVR) after antiviral therapy were \nenrolled. 32 patients received DAAs and three patients were treated with \ninterferon-based regimens. The LS was measured with shear-wave \nelastography (SWE) at the beginning of DAA treatment and at 48 weeks after \nthe end of treatment (EOT48). The fibrosis-4 (FIB-4) scores were calculated \nbased on laboratory tests. The METAVIR score and the varices needing \ntreatment (VNT) were determined based on the LS values. The clinical \nvariables between pre- and post-treatment groups were compared with \nFisher’s exact test and Student’s t-test. \nResults or Findings: There was a significant difference between the baseline \nLS (mean±standard deviation=2.59±0.89 m/s) and LS at EOT48 \n(1.90±0.50m/s; P<0.001). Compared to the baseline status, the METAVIR \nscore also showed significant improvement after successful antiviral therapy \n(F0/1=2, F2=1, F3=7, F4=25; P<0.028 vs. F0/1=9, F2=2, F3=10, F4=14). \nMoreover, the FIB4 score also indicated less fibrosis after therapy (2.04±1.12) \nthan at baseline (3.51±2.24; P<0.018). Meanwhile, there was a significant \ndecrease in the number of patients with high-risk of VNT at EOT48 vs. at \nbaseline (4 vs. 15; OR=0.17 95% confidence interval (CI)=0.05-0.59, P<0.007). \nConclusion: In conclusion, SWE indicates significant resolution of liver fibrosis \nwhen chronic hepatitis C patients are in SVR, which also coincides with lower \nrisk of VNT. \nLimitations: The limitation was the low members of patients. Longer post-\ntreatment follow-up is needed to fully understand the clinical impact of the \npresent findings. \nEthics Committee Approval: The study has been approved by the \ninstitutional ethics committee of our university (SE-TUKEB 163/2017). \nFunding for this study: The authors received no funding for this study. \nAuthor Disclosures: \nVince Orban: Nothing to disclose \nAnikó Folhoffer: Nothing to disclose \nPál N. Kaposi-Novák: Nothing to disclose \nBarbara Csongrády: Nothing to disclose \nAladár David Rónaszéki: Nothing to disclose \nGabriella Györi: Nothing to disclose \nBettina Katalin Budai: Nothing to disclose \nFerenc Szalay: Nothing to disclose \n \n \nResearch Presentation Session: \nAbdominal Viscera \nRPS 301a \nAbdominal diagnosis and imaging \nRPS 301a-1 \nIterative denoising and image enhancement in dynamic contrast-\nenhanced gradient echo Magnetic Resonance Imaging (MRI) of the \nabdomen: improvement of image quality and diagnostic confidence \n*S. Gassenmaier*¹, J. Herrmann¹, D. Nickel², S. Kannengiesser², S. Afat¹,  \nA. Othman¹; ¹Tübingen/DE, ²Erlangen/DE  \n \nPurpose: To investigate the impact of a novel iterative denoising and image \nenhancement technique in T1-weighted dynamic contrast-enhanced (DCE) \ngradient echo MRI of the abdomen on image quality, noise levels, diagnostic \nconfidence, and lesion detectability. \nMethods or Background: Fifty patients who underwent an MRI with DCE \nimaging of the abdomen between June and August 2020 were included. For \nDCE imaging a series of three volume interpolated breath-hold examinations \n(VIBE) was performed. The raw data of all DCE imaging studies was \nprocessed using standard reconstruction (DCES) and using an iterative \ndenoising and image enhancement approach (DCEDE). All imaging studies \nwere randomly reviewed by two radiologists independently regarding noise \nlevels, arterial contrast, sharpness of vessels, overall image quality, lesion \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 154  \ndetectability, and diagnostic confidence using a Likert-scale ranging from 1 – 4 \nwith four being the best. \nResults or Findings: Arterial contrast and sharpness of vessels were rated \nsuperior by both readers with a median of 4 in DCEDE versus a median of 3 in \nDCES (p<0.001). Furthermore, noise levels as well as overall image quality \nwere rated higher with a median of 4 in DCEDE compared to a median of 3 in \nDCES (p<0.001). Lesion detectability was evaluated to be superior in DCEDE \nwith a median of 4 versus DCES with a median of 3 (p<0.001). Consequently, \ndiagnostic confidence was also rated to be superior in DCEDE with a median \nof 4 versus DCES with a median of 3 (p<0.001). \nConclusion: Iterative denoising and image enhancement is feasible in DCE \nimaging of the abdomen providing superior arterial contrast, noise levels, and \noverall image quality. Furthermore, lesion detectability and diagnostic \nconfidence were significantly improved using this reconstruction method. \nLimitations: Retrospective study design. No quantitative SNR measurements \nwere possible. \nEthics Committee Approval: IRB approval obtained. \nFunding for this study: None. \nAuthor Disclosures: \nJudith Herrmann: Nothing to disclose \nStephan Kannengiesser: Employee: Siemens Healthcare GmbH \nSaif Afat: Nothing to disclose \nDominik Nickel: Employee: Siemens Healthcare Gmbh \nAhmed Othman: Nothing to disclose \nSebastian Gassenmaier: Nothing to disclose \n \nRPS 301a-2 \nAcoustic radiation force impulse (ARFI) elastography for the pancreatic \nallograft: looking for normal reference values \n*C. Bassaganyas Vancells*, A. Darnell, J. C. Soler Perromat, A. Soler,  \nP. Ventura-Aguiar, M. Cuatrecasas, M. T. Rodrigo, J. Ferrer, A. Garcia Criado; \nBarcelona/ES \n(bassaganyas@clinic.cat) \n \nPurpose: Acoustic radiation force impulse (ARFI) quantification is a non-\ninvasive ultrasonographic technique that allows quantification of the tissue \nelasticity. It has been studied in the native pancreas although no reports in \npancreatic allograft have been published. The purpose of this study is to \ndetermine normal reference ARFI values in pancreatic grafts and its variations \nover time. \nMethods or Background: Prospective study including all pancreas transplants \nperformed in our centre between October 2016 and January 2020. All \npancreatic allografts were evaluated by ARFI at 1 week, 3 weeks and 12 \nmonths after surgery. A protocol allograft biopsy was performed immediately \nafter ARFI evaluation at 3 weeks and 12 months post-transplantation. Besides, \nARFI quantification was also performed whenever a biopsy was done. Patients \nwith postoperative complications or rejection were excluded from the analysis. \nResults or Findings: During this period, 120 ARFI evaluations were \nperformed in 44 patients. Three patients had postoperative complications at \nthe time of the evaluation (5 evaluations) and 36 rejection episodes were \nregistered. Finally, 78 ARFI evaluations were measured in healthy pancreatic \ngrafts. ARFI values (mean±SD) were as follow: immediately postoperative time \n(0-11 days) 1.7±0.7 m/s, late postoperative time (12-53 days) 1.53 ±0.56 m/s \nand older than two months (>61 days) 1.08±0.3 m/s. Statistically significant \ndifferences were found between the immediately postoperative time and grafts \nolder than two months (p<0.05). \nConclusion: Pancreatic allograft stiffness varies over the post-transplantation \ntime, showing higher values during the immediate postoperative time, which \ntend to decrease over time. Two months after transplantation, ARFI values are \nsimilar to those previously reported in native pancreas. \nLimitations: Single-center study which limited the number of patients. \nEthics Committee Approval: Approved by Hospital Clínic de Barcelona ethics \ncommittee. \nFunding for this study: Supported by a grant of the Instituto de Salud Carlos \nIII (PI 16/00167). \nAuthor Disclosures: \nPedro Ventura-Aguiar: Nothing to disclose \nJoana Ferrer: Nothing to disclose \nMiriam Cuatrecasas: Nothing to disclose \nAlexandre Soler: Nothing to disclose \nJuan Carlos Soler Perromat: Nothing to disclose \nClara Bassaganyas Vancells: Nothing to disclose \nAnna Darnell: Nothing to disclose \nMaría Teresa Rodrigo: Nothing to disclose \nMª Angeles Garcia Criado: Nothing to disclose \n \nRPS 301a-3 \nAssociation of MRI-based adrenal gland volume and impaired glucose \nmetabolism in a population-based cohort study \n*E. A. Askani*; Freiburg im Breisgau/DE \nPurpose: Type 2 diabetes (T2DM) and prediabetes exert a stressful metabolic \ncondition, inducing chronic activation of the hypothalamic-pituitary-adrenal \n(HPA) axis. Chronic activation of HPA axis leads to hypercortisolism and \nadrenocortical growth. Thus, the aim of this study was to assess adrenal gland \nvolume (AGV) by MRI and to study its role as an indirect marker of HPA axis \nactivation in prediabetes and diabetes. \nMethods or Background: Subjects enrolled in a prospective case-control \nstudy underwent a 3T MRI, including T1w-VIBE-Dixon. For assessment of \nAGV, boundaries of each adrenal gland were delineated manually in axial \nreconstructions of T1w-VIBE-Dixon sequences and corrected on coronal and \nsagittal reconstructions. Univariate and multivariate associations were derived. \nResults or Findings: Among 375 subjects included in the study (58.4% male, \n56.1±9.1 years), 25.3% had prediabetes, 13.6% T2DM and average AGV was \n5.6 ± 2.1 ml.  \nFasting plasma glucose and glucose tolerance were significantly associated \nwith AGV (ȕ: 0.41, 95%-CI:[0.2, 0.6] and ȕ: 0.53, 95%-CI:[0.3, 0.7]; all \np<0.001). After adjustment for age, sex and BMI, only T2DM remained \nassociated with increased AGV compared to healthy subjects (OR:1.41, 95%-\nCI:[1.11, 1.78]) and showed a significantly increased AGV compared to \nprediabetes (OR:1.35, 95%-CI:[1.07, 1.69]). No significant difference was \nfound between prediabetes and healthy controls after adjustment for age, sex \nand BMI. \nConclusion: T2DM is significantly associated with increased AGV, \nindependent of age, sex and BMI, whereas the association of prediabetes and \nAGV is confounded by BMI. AGV may be used as a marker of impaired \nglucose metabolism and HPA axis dysfunction and may thus merit dedicated \nresearch. \nLimitations: No outcome data available. \nEthics Committee Approval: Yes. \nFunding for this study: German Research Foundation. \nAuthor Disclosures: \nEsther Adele Askani: Nothing to disclose \n \nRPS 301a-4 \nIodine concentration derived from dual energy CT: reference values and \nphysiological distribution \n*D. Zopfs*¹, J. Graffe¹, R. P. Reimer¹, S. Lennartz¹, S. Schäfer², J. Borggrefe³, \nD. Maintz¹, S. Haneder¹, N. Grosse Hokamp¹; ¹Cologne/DE, ²Heidelberg/DE, \n³Minden/DE \n \nPurpose: Quantitative iodine concentration (IC) derived from dual-energy-CT \nis increasingly used for detection and characterization of lesions. Information \non physiological distribution is an important prerequisite for any imaging \nbiomarker, however, data on reference values of IC is sparse. Aim of this study \nwas to define reference values for IC using a large cohort of healthy \nindividuals. \nMethods or Background: 571 spectral-detector-CT examinations of the chest \nand abdomen in portal-venous phase with a fixed amount of intravenous \ncontrast agent were retrospectively included. All examinations were screened \nfor absence of tumor burden, which was confirmed by follow-up imaging after \nat least three months. Absolute IC values were determined using ROI in \nparenchymatous organs (n=25), lymph nodes (n=6) and vessels (n=3). All \nabsolute IC values were normalized to the abdominal aorta to retrieve iodine \nperfusion ratios (IPR) and thus to adjust for the volume of contrast agent to \nbody weight. \nResults or Findings: IC values showed a varation with age, gender and BMI \nin lymph nodes, parenchymatous organs and vessels (range: 0.0±0.0mg/ml – \n6.6±1.3mg/ml). After normalization to the abdominal aorta, no relation between \nIPR and BMI persisted. Yet, significant variations with genders and age lasted, \nwith a tendency towards a decline in IPR with increasing age (e.g. liver – 18-\n44yrs/•64yrs: 0.50±0.11/0.43±0.10, p”0.05). \nConclusion: This study provides reference values obtained from a large-scale \ncohort for IC in abdominal organs, lymph nodes and large vessels. The \nvariation of IC with age and gender should be taken into account when \napplying absolute iodine thresholds. \nLimitations: - non-visible tumor burden may be present - results only account \nfor portal-venous phase examinations on a dual-layer spectral detector CT \nEthics Committee Approval: Written informed consent was waived \nFunding for this study: This work was partly funded through the Else Kröner-\nFresenius-Stiftung (2018_EKMS.34 to Nils Große Hokamp). \nAuthor Disclosures: \nSimon Lennartz: Research/Grant Support: Philips Healthcare \nJosefine Graffe: Nothing to disclose \nStefan Haneder: Nothing to disclose \nDavid Maintz: Speaker: Philips Healthcare \nDavid Zopfs: Nothing to disclose \nNils Grosse Hokamp: Research/Grant Support: Philips Healthcare \nSebastian Schäfer: Employee: Mint Medical GmbH \nJan Borggrefe: Speaker: Philips Healthcare \nRobert Peter Reimer: Nothing to disclose \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 155  \nRPS 301a-5 \nMultiparametric MR-analysis of the spleen with Gd-EOB-DTPA: can it be \nused for the assessment of portal hypertension in the daily clinical \nroutine? \n*D. Catucci*, V. C. Obmann, A. Berzigotti, C. Gräni, L. Ebner,  \nJ. T. Heverhagen, A. Christe, A. T. Huber; Bern/CH \n \nPurpose: To determine whether multiparametric T1 mapping of the spleen with \nGd-EOB-DTPA can be used to distinguish between patients with portal \nhypertension and patients without portal hypertension. \nMethods or Background: 251 consecutive abdominal MRI scans with T1 \nmapping of the spleen pre and post Gd-EOB-DTPA administration in \nequilibrium phase were analyzed between September 2018 and July 2019. \nThe patients were then divided into groups based on the absence or presence \nof portosystemic collaterals. Delta T1 (dT1) of the spleen was calculated as \n(native T1 spleen – post contrast T1 spleen) / native T1 spleen. Groups were \ncompared using Student’s t-test. \nResults or Findings: At 1.5T 52 patients had portosystemic collaterals (CL), \nwhile 82 patients had no collaterals (NCL). At 3T 48 patients had collaterals \n(CL), while 69 patients had no collaterals (NCL). At both 3T and 1.5T delta T1 \nof the spleen was significantly higher in patients with collaterals than in patients \nwithout collaterals (mean ± standard deviation 0.35 ± 0.08 vs. 0.31 ± 0.08 with \np= 0.0055 and mean ± standard deviation 0.35 ± 0.06 vs. 0.31 ± 0.07 with p= \n0.0129). \nConclusion: This study shows that dT1 of the spleen may be used to \ndiscriminate patients with and without portal hypertension using T1 mapping of \nthe spleen with Gd-EOB-DTPA. \nLimitations: We acknowledge limitations to our study, mainly the retrospective \nstudy design and the lack of the hepatic venous pressure gradient (HPVG) as \nanother classification criterion. \nEthics Committee Approval: Yes. \nFunding for this study: This project was funded by the Swiss National \nScience Foundation (SNF) grant # 320030_188591. \nAuthor Disclosures: \nJohannes T. Heverhagen: Nothing to disclose \nDamiano Catucci: Nothing to disclose \nVerena Obmann: Nothing to disclose \nChristoph Gräni: Nothing to disclose \nLukas Ebner: Nothing to disclose \nAndreas Christe: Nothing to disclose \nAdrian Thomas Huber: Nothing to disclose \nAnnalisa Berzigotti: Nothing to disclose \n \nRPS 301a-6 \nReproducibility of attenuation measurements in virtual unenhanced \nimages derived from three different DECT scanners \n*S. Lennartz*, A. Parakh, J. Cao, A. Kambadakone; Boston, MA/US \n(simon.lennartz@uk-koeln.de) \n \nPurpose: To investigate the longitudinal reproducibility of VUE attenuation \nmeasurements on three different dual-energy CT (DECT) scanner types. \nMethods or Background: 137 patients with repeated portal-venous, \nabdominal DECT either on a rapid kV switching (rsDECT; n=46), a dual-layer \ndetector (dlDECT; n=43) and a dual-source scanner (dsDECT; n=51) were \nincluded. ROI-based measurements of VUE attenuation and corresponding \ncontrast-enhanced attenuation in virtual monoenergetic images (VMI) were \nconducted in the liver, spleen, kidneys, aorta, portal vein and subcutaneous fat. \nReproducibility of VUE attenuation was analyzed by calculating the mean \nabsolute differences between the first and second scan. Measurements pairs \nwith differences ” 10 HU were considered reproducible. Influence of VMI on \nVUE reproducibility was analyzed using linear regression. \nResults or Findings: The scanner-specific cohorts showed similar age (p-\nrange:0.35-0.99), sex (p-range:0.68-1), body weight (p-range:0.26-0.87), body \ndiameter (p-range:0.34-0.76), and inter-scan time (p-range:0.52-0.83). 94.9% \nof VUE measurements were reproducible for rsDECT, 93.8% for dlDECT and \n90.6% for dsDECT. The scanner-specific cohorts showed similar mean \nabsolute inter-scan differences in VUE attenuation in the liver/portal vein/fat \n(rsDECT vs. dsDECT:p=0.27/0.16/0.81; rsDECT vs. dlDECT: \np=0.74/0.17/0.82; dlDECT vs. dsDECT: p=0.82/0.95/0.99). For the spleen, \nkidney and aorta, the inter-scan differences were significantly lower in rsDECT \n(spleen: 2.8±2.0 HU, kidney: 3.4±2.0 HU, aorta: 4.4±3.3 HU) and dlDECT \n(spleen:2.4±1.6 HU, kidney: 2.6±2.3 HU, aorta: 4.0±3.6 HU) compared to \ndsDECT (spleen: 5.0±3.6 HU, kidney: 5.6±3.7 HU, aorta: 6.4±4.3 HU; p<0.05 \nfor all). Inter-scan differences in VMI attenuation significantly influenced inter-\nscan differences in VUE attenuation (p<0.001, t-ratio:4.34). \nConclusion: There was high longitudinal reproducibility of VUE attenuation in \nall scanner types. The influence of contrast-enhanced attenuation on VUE \nreproducibility and higher inter-scan differences in dsDECT should be further \ninvestigated. \nLimitations: Retrospective study; limited sample size. \nEthics Committee Approval: IRB-approved \nFunding for this study: Deutsche Forschungsgemeinschaft (DFG, German \nResearch Foundation; 426969820 to Simon Lennartz) \nAuthor Disclosures: \nSimon Lennartz: Research/Grant Support: Koninklijke Philips N.V. \nAvinash Kambadakone: Research/Grant Support: GE Healthcare \nResearch/Grant Support: Koninklijke Philips N.V. \nJinjin Cao: Nothing to disclose \nAnushri Parakh: Nothing to disclose \n \n \nResearch Presentation Session: \nAbdominal Viscera \nRPS 401a \nAbdominal cancers and metastases \nRPS 401a-1 \nHepatic steatosis has no effect in diagnosis accuracy of LI-RADS v2018 \ncategorisation of hepatocellular carcinoma in MR imaging \n*S. Yao*, Y. Wei, Z. Ye, J. Chen, T. Duan, Z. Zhang, B. Song; Chengdu/CN  \n(shandy.yao@foxmail.com) \n \nPurpose: To determine whether hepatic steatosis (HS) affects the accuracy of \nthe diagnosis of hepatocellular carcinoma (HCC) using magnetic resonance \nimaging (MRI) based on the Liver Imaging Reporting and Data System (LI-\nRADS) v2018. \nMethods or Background: 130 patients with 184 pathologically proven HCCs \nwho underwent Gd-EOBDTPA-enhanced liver MRI were included and \nclassified as HS and non-HS groups according to quantitative MRI-proton \ndensity fat-fraction (PDFF). HS was defined as MRI-PDFF>5.6%. Two \nradiologists accessed HCC features and assigned LI-RADS categories in MRI \nindependently based on LI-RADS v2018. Frequencies of HCC major features \nand sensitivities for the LR assignment between the two groups as well as the \ninterobserver agreement between the two radiologists were assessed. \nResults or Findings: Major features including arterial hyperenhancement \n(APHE), enhancing “capsule” and nonperipheral \"washout\" observed between \nHS and non-HS groups were not significantly different (75.76% vs. 78.82%, \np=0.896; 54.55% vs. 52.98%, p=0.870; and 78.79% vs. 81.46%, p=0.807, \nrespectively), as well as the assessment of observation size (p=0.059). No \nsignificant difference in sensitivities of LR-5 assignment between the two \ngroups (63.64% vs. 72.85% for reader 1, p=0.296; 60.6% vs. 72.19% for \nreader 2, p=0.21). Interobserver agreement between the two radiologists \nshowed almost perfect in LR 5 assignment ( ț=0.895, P<0.05) and size \nobservation (ICC=0.999, P<0.05). \nConclusion: The diagnosis of HCC based on LI-RADS v2018 in MRI is of \ngreat comparable accuracy regardless of HS, in which there is no significant \ndifference in either the major imaging features or LR categorizations. \nLimitations: The comparison was between with and without HS groups, not \nanalyzing on the degree of HS severity. \nEthics Committee Approval: This retrospective study was approved by the \nInstitutional Review Board with written informed consent obtained. \nFunding for this study: Research Grant of National Nature Science \nFoundation of China and Science (Grant number 81971571 and 81771797). \nAuthor Disclosures: \nYi Wei: Nothing to disclose \nTing Duan: Nothing to disclose \nShan Yao: Nothing to disclose \nZhen Zhang: Nothing to disclose \nJie Chen: Nothing to disclose \nZheng Ye: Nothing to disclose \nBin Song: Nothing to disclose \n \nRPS 401a-2 \nQuantitative iodine concentration of dual layer spectral CT on differential \ndiagnosis of hyper-enhancing lesions in patients at high risk for \nhepatocellular carcinoma \n*W. Shi*¹, W. Zhang¹, W. Deng², W. Mao¹, J. Wang¹; ¹Guangzhou/CN, \n²Shanghai/CN  \n(wenkeyshi@163.com) \n \nPurpose: To evaluate the value of quantitative iodine concentration (IC) of \nDual Layer Spectral CT (DLSCT) on differential diagnosis of hyper-enhancing \nlesions in patients at high risk for Hepatocellular carcinoma (HCC) \nMethods or Background: Nineteen patients at high risk for HCC with 26 \nhyper-enhancing focal liver lesions including 14 HCCs and 12 non-HCC \nlesions with biopsy-proven and/or follow-up who underwent contrast \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 156  \nenhancement (370 mg/ml iodine) scanning by DLSCT were involved in this \nstudy. Parameters contained IC, normalized IC (NIC) from both arterial phase \n(AP) and portal venous phase (PVP), and arterial enhancement fraction (AEF). \nThe parameters were compared between HCC and non-HCC lesions using \nIndependent-Sample T test or Mann-Whitney test. The parameters with \nsignificant difference were also evaluated via receiver operating characteristic \n(ROC) curve \nResults or Findings: The values of IC and NIC of 14 HCCs in PVP were both \nsignificantly lower than those of 12 non-HCC lesions, which were 2.43±0.78 \nversus 3.68±1.10 (P=0.002), and 0.48±0.14 versus 0.58±0.08 (P=0.049), \nrespectively. While the values of IC and NIC between HCC and non-HCC \nlesions in AP were similar, which were 2.65±1.36 versus 2.41±1.43 (P=0.663), \n0.17±0.08 versus 0.18±0.09 (P=0.708), respectively. AEF value was higher in \nHCC lesions (1.19 ±0.68) than in non-HCC group (0.77±0.59), but with no \nsignificant difference (P=0.099). The ROC curve analysis of IC and NIC in PVP \nshowed that the area under curve was 0.845 and 0.705, with optimal sensitivity \nand specificity 71.43% and 83.33%, 57.14% and 83.33% respectively \nConclusion: IC and NIC in PVP derived from DLSCT may have the value to \ndifferentiate HCC from non-HCC lesions at high risk for HCC \nLimitations: This study performed at one institution with a small sample size, \nand did not contain some relatively rare lesions, including lymphoma, \nneuroendocrine tumor \nEthics Committee Approval: None \nFunding for this study: None \nAuthor Disclosures: \nWeibin Mao: Nothing to disclose \nWenqi Shi: Nothing to disclose \nJin Wang: Nothing to disclose \nWu Zhang: Nothing to disclose \nWeiwei Deng: Nothing to disclose \n \nRPS 401a-3 \nChemical and paradigm shift on the imaging of adrenal lesions \n*G. Freire*¹, E. Bandeira², V. A. G. Herédia³, A. P. Matos², M. Ramalho³; \n¹Loures/PT, ²Lisboa/PT, ³Almada/PT \n \nPurpose: Historically several small studies have reported high sensitivity and \nspecificity of Magnetic Resonance Chemical-shift Imaging (CSI) in diagnosing \nadrenal adenomas due to a superior sensitivity to detect smaller quantities of \nfat. Nevertheless, contrast-enhanced CT remains the method of choice for \ncharacterizing adrenal lesions. This study intended to assess the CSI's ultimate \ndiagnostic performance using the largest-ever consecutive cohort. \nMethods or Background: Our sample comprised 480 patients (mean age: \n64,3 ± 12,0; 249 females) with 560 consecutive adrenal lesions, including 450 \nadenomas and 110 non-adenomas (86 metastases, 14 pheochromocytomas, 8 \nadrenal cortical carcinomas, 1 lipid-poor myelolipoma, and 1 oncocytoma). CSI \nwas performed between Jan-08 and Dec-19. The adrenal signal intensity index \n(ASII) was calculated for all lesions. Statistical analyses were performed \n(Student's t-test and Receiver Operating Characteristic curve analysis). \nResults or Findings: Mean ASII of adrenal adenomas (58.31 ± 20.74) was \nsignificantly higher (p < 0.001) than that of the non-adenomas (2.05 ± 8.41). \nOnly 17 of the 450 adenomas (3.8%) were lipid-poor, and only 1 non-adenoma \n(liposarcoma metastasis) had an ASII higher than 16.5%. CSI showed a \nsensitivity and specificity of 95.6% and 98.2%, respectively (AUC = 0.980) for \ndifferentiating adenomas from nonadenomas (cut-off value of 13.784). \nConclusion: Lipid-poor adenomas represent less than 4% of all adenomas on \nMRI. An ASII >13.784% can be used to distinguish adenomas from non-\nadenomas. The high diagnostic performance of CSI should render it a different \nrole in the adrenal incidentaloma algorithm. \nLimitations: Most adenomas and metastases were not histologically proven \nand were diagnosed based on volumetric stability over 12 months. \nEthics Committee Approval: Institutional review board approval was obtained \nfor this retrospective single-center study. The need for informed consent was \nwaived. \nFunding for this study: No funding was requested. \nAuthor Disclosures: \nAntónio Pedro Matos: Nothing to disclose \nGonçalo Freire: Nothing to disclose \nMiguel Ramalho: nothing to disclose \nEduardo Bandeira: Nothing to disclose \nVasco Andresen Guimarães Herédia: Nothing to disclose \n \nRPS 401a-4 \nDifferentiating between peritoneal metastases and ectopic splenic tissue \nwith radiomics in spectral CT \n*F. C. Hasse*, E. Wehrse, L. T. Rotkopf, T. F. Weber, H-P. Schlemmer,  \nH-U. Kauczor, T. Mokry; Heidelberg/DE \nPurpose: Accessory spleens and splenosis can be challenging to differentiate \nfrom peritoneal metastases in initial or post-splenectomy imaging. Aim of this \nstudy was to assess quantifiable differences in spectral CT between ectopic \nsplenic tissue and peritoneal metastases in oncologic patients applying \nradiomics. \nMethods or Background: This is a retrospective study on 70 consecutive \npatients with histologically or clinically confirmed peritoneal metastases and/or \nectopic splenic tissue like accessory spleens or splenosis, who underwent \ncontrast-agent enhanced venous phase spectral CT of the abdomen. All \nectopic spleens (Group A) and peritoneal metastases without macroscopic \nnecrosis or calcifications (Group B) were 3D-segmented manually by two \nradiologists in consensus on monoenergetic 80 keV images. We performed a \nradiomics analysis using 107 features from the PyRadiomics library on the \nsegmentations. Two-tailed t-test was used for statistical analysis. \nResults or Findings: 27 men and 43 women were included (median age 54 \ny), among them 36 with peritoneal metastases (in total 146 segmented \nlesions), 25 with accessory spleens and 9 with splenosis (in total 36 \nsegmented ectopic spleens). 48 out of 107 features showed statistically \nsignificant differences between the two groups, among them 14 out of the 18 \nfirst order features. The first order features mean, 10th and 90th percentile \n(p<0.01) of CT values, were significantly higher in Group A. Group A also \nshowed higher sphericity (p<0.01) and higher Gray-level Co-occurrence Matrix \n(GLCM) contrast (p<0.001). Interestingly, apart from sphericity, surface-to-\nvolume-ratio and elongation there were no significant differences among the 14 \nfeatures of shape. \nConclusion: Differences between macroscopically homogenous peritoneal \nmetastases and ectopic splenic tissue can be shown in contrast enhanced \nvenous phase spectral CT using radiomics. \nLimitations: Small sample size in splenosis group. \nEthics Committee Approval: Approval granted by the Ethics Committee of \nthe Medical Faculty Heidelberg. \nFunding for this study: No funding received. \nAuthor Disclosures: \nTheresa Mokry: Nothing to disclose \nHans-Ulrich Kauczor: Nothing to disclose \nLukas Thomas Rotkopf: Nothing to disclose \nTim Frederik Weber: Nothing to disclose \nFelix Christian Hasse: Nothing to disclose \nHeinz-Peter Schlemmer: Nothing to disclose \nEckhard Wehrse: Nothing to disclose \n \nRPS 401a-5 \nLocal image variance based on diffusion-MRI may facilitate grading and \nprognosis in hepatocellular carcinoma: a retrospective study \n*H. Wu*, W. Zhang; Chongqing/CN \n(cefradine1005@gmail.com) \n \nPurpose: The preoperative study aimed to evaluate the potential for local \nimage variance (LIV) analysis based on diffusion-weighted imaging for \nhistological grading and prognosis of the hepatocellular carcinoma (HCC). \nMethods or Background: 66 patients with known grades were recruited. Also, \na follow-up survey was performed post the hospital discharge. Apparent \ndiffusion coefficient (ADC) parameter derived from DWI were used to manually \ndraw regions of interest of lesions, as well as ROIs of healthy tissues used for \nnormalization. In these ROIs, intratumoural hypointensities of ADC was \nquantified with LIV. The LIV analysis was conducted according to Steiner \ntranslation theorem. The discriminating potential of ADC-LIV method for HCC \ngrading prediction was evaluated using ROC curves. Also, KM survival \nanalysis were introduced for the prognosis predication. A log-rank test was \nused to determine the statistical significance of difference in observed \npopulation survival time. \nResults or Findings: ROC analysis revealed that the ADC-LIV at tumor mass \nhad great ability to discriminate HCC grading, with a sensitivity of 86.9% and a \nspecificity of 93.7% (AUC=.94). In addition, KM survival analysis yielded \nsignificant difference in survival time observed from the populations \ndichotomized by low (<0.632 ) and high (>0.632) LIV value ( log-rank test P < \n0.05) \nConclusion: The ADC-LIV method was proven to be capable for prediction of \nHCC grading and prognosis. \nLimitations: The main limitations is the validating accuracy of the ADC-LIV by \nbiopsy or pathologic sampling. Thus, the method should be used to analyze \nthe patient-derived tumor xenograft model and give a better solution to \ndemonstrate the clinical relevance. \nEthics Committee Approval: Our study was approved by the institutional \nreview board of the Army Medical Center of PLA and was conducted in \naccordance with Health Insurance Portability and Accountability Act \nregulations. \nFunding for this study: No funding. \nAuthor Disclosures: \nWeiguo Zhang: Nothing to disclose \nHao Wu: Nothing to disclose \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 157  \n \nResearch Presentation Session: \nAbdominal Viscera \nRPS 501a \nHepatic imaging \nRPS 501a-1 \nPostoperative single-Sequence (PoSSe) MRI: imaging work-up for \ndrainage indication of collections after hepatopancreaticobiliary surgery \n*U. Fehrenbach*¹, T. A. Auer¹, W. Schöning¹, M. Schmelzle¹, C. Jürgensen¹,  \nT. Malinka¹, M. Bahra¹, D. Geisel¹, T. Denecke²; ¹Berlin/DE, ²Leipzig/DE  \n(uli.fehrenbach@charite.de) \n \nPurpose: Fluid collections due to anastomotic leakage are a common \ncomplication after hepatopancreaticobiliary (HPB) surgery and are usually \ntreated with drainage. We conducted a study to evaluate imaging work-up with \na postoperative single-sequence (PoSSe) MRI for the detection of collections \nand indication of drainage. \nMethods or Background: Forty-six patients who developed signs of leakage \nafter HPB surgery were prospectively enrolled. Each patient was examined by \nabdominal sonography and our PoSSe MRI protocol (axial T2-weighted \nHASTE only). PoSSe MRI examination time (from entering to leaving the MR \nscanner room) was measured. Sonography and MRI were evaluated regarding \nthe detection and localization of fluid collections. Each examination was \nclassified for diagnostic sufficiency and an image-based recommendation if \ndrainage is necessary or not was proposed. Imaging work-up was evaluated \nand compared to actual performed drainage procedures and further clinical \ncourse. \nResults or Findings: Sonography, as first line modality, detected 21 focal fluid \ncollections and allowed to decide about the need for drainage in 41% of \npatients. The average time in the scanning room for PoSSe MRI was 9:23min \n[7:50-13:32min]. PoSSe MRI detected 46 focal collections and allowed \ntherapeutic decisions in all patients. Drainage was recommended in 25 \npatients (54%) and performed in 21 patients (100% sensitivity and 84% \nspecificity). No patient needed further imaging to optimize the treatment. \nConclusion: The PoSSe MRI approach is feasible in the early postoperative \nsetting after HPB surgery. Imaging work-up regarding drainage of collections \nwas successful in all patients and our proposed PoSSe MRI algorithm provides \nan alternative to the standard work-up. \nLimitations: Small patient cohort (explorative study) \nEthics Committee Approval: Approval was granted by the IRB of our \ninstitution (Internal reference: EA4/029/18). \nFunding for this study: This research did not receive any grant from funding \nagencies in the public, commercial, or not-for-profit sectors. \nAuthor Disclosures: \nChristian Jürgensen: Nothing to disclose \nTimm Denecke: Nothing to disclose \nWenzel Schöning: Nothing to disclose \nUli Fehrenbach: Nothing to disclose \nMarcus Bahra: Nothing to disclose \nDominik Geisel: Nothing to disclose \nTimo Alexander Auer: Nothing to disclose \nThomas Malinka: Nothing to disclose \nMoritz Schmelzle: Nothing to disclose \n \nRPS 501a-2 \nThin-section contrast-enhanced gradient echo T1-weighted MRI of the \nliver using CS-VIBE: its image quality and lesion detectability in \ncomparison with standard-section imaging using CAIPIRINHA-VIBE \n*J. Yoo*, J. M. Lee, J-H. Yoon, I. Joo, S. J. Park, H-J. Kang; Seoul/KR  \n \nPurpose: To investigate the practical value of thin-section volumetric \ninterpolated breath-hold (VIBE) sequence using compressed sensing (CS) of \ngadoxetic acid-enhanced liver MRI in comparison with standard-section \nControlled Aliasing in Parallel Imaging Results in a Higher Acceleration \n(CAIPIRINHA)-VIBE sequence regarding lesion conspicuity and detectability \nand image quality. \nMethods or Background: This retrospective study included 143 consecutive \npatients who underwent gadoxetic acid-enhanced MRI for the evaluation of \nfocal liver lesions. Portal venous phase (PVP) images were obtained twice \nusing thin-section) CS-VIBE technique (acceleration factor [AF], 6.5; slice \nthickness [ST], 1 mm) followed by standard-section CAIPIRINHA-VIBE \ntechnique (AF, 4; ST, 3 mm). Two board-certified radiologists independently \nreviewed the images and assessed lesion conspicuity and detectability and \nimage quality on a 5-point scale. Lesion detectability of two sequences was \ncompared by calculating jackknife alternative free-response receiver operating \ncharacteristics (JAFROC). \nResults or Findings: Thin-section CS-VIBE images showed superior lesion \nconspicuity (p<0.001 in reviewer 1; p=0.004 in reviewer 2), and better anatomic \ndetails ( p<0.001] in both reviewers) to standard-section CAIPIRINHA-VIBE \nimages. Thin-section CS-VIBE sequences demonstrated decreased motion \nartifact (p<0.001 in reviewer 1; p=0.046 in reviewer 2), but showed higher \nimage noise (p<0.001 in reviewer 1; p<0.001 in reviewer 2), and increased \nCS/PI-related artifacts ([p=0.012 in reviewer 1; p<0.001 in reviewer 2). \nConsequently, both image sets showed comparable overall image quality (4.08 \nvs. 3.86 [p=0.255] in reviewer 1; 4.13 vs. 4.03 [p=0.148] in reviewer 2). Lesion \ndetectability was not significantly different between two sequences (pooled \nfigures-of-merit estimated with JAFROC analysis; 0.715 vs. 0.716, p=0.956). \nConclusion: Thin-section CS-VIBE sequence in the PVP of gadoxetic acid-\nenhanced liver MRI provided higher lesion conspicuity and comparable lesion \ndetectability, compared with standard-section CAIPIRINHA-VIBE sequence. \nLimitations: Selection bias is inevitable owing to the retrospective nature \nEthics Committee Approval: Approved by Institutional Review Board \nFunding for this study: None \nAuthor Disclosures: \nIjin Joo: Nothing to disclose \nSae Jin Park: Nothing to disclose \nJeong Min Lee: Nothing to disclose \nHyo-Jin Kang: Nothing to disclose \nJeongin Yoo: Nothing to disclose \nJeong-Hee Yoon: Nothing to disclose \n \nRPS 501a-3 \nCombined ultrasound elastography vs computed tomography in patients \nwith non-alcoholic fatty liver disease \n*D. Y. Venidiktova*; Smolensk/RU \n(92darv@gmail.com) \n \nPurpose: To compare diagnostic effectiveness of combined ultrasound \nelastography (“Combi-elasto”) and computed tomography (MDCT) in \nquantitative liver evaluation in overweight patients. \nMethods or Background: In 2018–2020 298 patients of gastroenterological \ndepartment took part in prospective study at the base of Smolensk Clinical City \nHospital No. 1 (Russia). All the patients went through the multiple detector \ncomputed tomography of abdominal area (according to their main disease). \nThe inclusion criteria are the signs of liver steatosis according to MDCT (liver \nattenuation<40 HU), visceral obesity (cross-sectional area at L4-L5>131 cm2). \n184 patients (91 women (49,45%), 93 men (50,54%) were accepted, the \naverage age was 48,52 ± 6,45 years. All these patients went through “Combi-\nelasto” of liver with quantitatine evaluation of liver steatosis, inflammation, \nfibrosis. Liver biopsy with histological evaluation with SAF scale was used as a \nreference standard (n=57). Control group (n=104) - patients without obesity \nand liver steatosis. \nResults or Findings: All patients according to the “Combi-elasto” had \nenlarged liver sizes, increased echogenicity, and decreased sound \nconductivity. Patients according to the ultrasound attenutation in the liver \nparameter had minimal steatosis S1 (n = 85, 46,2%), moderate S2 (n = 46, \n25%), severe S3 (n = 53, 28,8%). Liver inflammation: minimal A1 (n = 44, \n23,9%), moderate A2 (n = 29, 15,8%), severe A3 (n = 48, 26%). Liver stiffness: \nclinically insignificant F1-F2 (n = 12, 6,5%), clinically significant F3 (n = 28, \n15,2%), cirrhosis F4 (n = 19, 10,3%). The sensitivity and specificity of “Combi-\nelasto” – 92,4% and 90,3%. \nConclusion: Combined ultrasound elastography is effective method for \nquantitative evaluation of liver steatosis, inflammation and fibrosis in \noverweight patients and can be used in detection and monitoring of non-\nalcoholic fatty liver disease. \nLimitations: Radiologist's experience in \"Combi-elasto\" is highly important. \nEthics Committee Approval: Yes \nFunding for this study: Personal \nAuthor Disclosures: \nDaria Yuryevna Venidiktova: Nothing to disclose \n \nRPS 501a-5 \nQuantitative ultrasound radiofrequency data analysis for the assessment \nof hepatic steatosis in nonalcoholic fatty liver disease \n*S. K. K. Jeon*, J. M. Lee, I. Joo, S. J. Park; Seoul/KR \n \nPurpose: To investigate diagnostic performance of quantitative ultrasound \n(QUS) parameters for assessment of hepatic steatosis in patients with \nnonalcoholic fatty liver disease (NAFLD) using magnetic resonance imaging \nproton density fat fraction (MRI-PDFF) as the reference standard. \nMethods or Background: In this prospective study, 120 patients with clinically \nsuspected NAFLD were enrolled. Participants underwent ultrasound (US) \nexamination for radiofrequency (RF) data acquisition and liver MRI for PDFF \nmeasurement. Using the RF data analysis, attenuation coefficient (AC) at \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 158  \ntissue attenuation imaging (TAI) and scatter-distribution coefficient (SC) at \ntissue scatter-distribution imaging (TSI) were measured. Correlation between \nQUS parameters (AC and SC) and MRI-PDFF was evaluated using Pearson \ncorrelation coefficients. Diagnostic performance of AC at TAI and SC at TSI for \ndetecting hepatic fat content •5% (MRI-PDFF •5%) and hepatic fat content \n•10% (MRI-PDFF •10%) were assessed by receiver operating characteristic \n(ROC) analysis. Significant clinical or imaging factors associated with AC and \nSC were analyzed using linear regression analysis \nResults or Findings: Participants were classified with MRI-PDFF <5% (n=38), \n5-10% (n=23), and •10% (n=59). AC and SC were significantly correlated with \nMRI-PDFF (r=0.659 and 0.727, P<0.001 for both). For detecting hepatic fat \ncontent •5% and hepatic fat content •10%, the area under the ROC curves \n(AUCs) of ACwere 0.861 and 0.835, and of SC were 0.964 and 0.935, \nrespectively. In multivariate linear regression analysis, MRI-PDFF was an \nindependent determinant of AC and SC. \nConclusion: AC at TAI and SC at TSI derived from quantitative US RF data \nanalysis yielded a good correlation with MRI-PDFF and provided good \nperformance for detecting hepatic steatosis and assessing its severity in \nNAFLD. \nLimitations: Validation is required \nEthics Committee Approval: Approved by IRB, and written informed consent \nwas obtained from all participants \nFunding for this study: Supported by a research grant from Samsung \nMedison \nAuthor Disclosures: \nIjin Joo: Nothing to disclose \nSae Jin Park: Nothing to disclose \nJeong Min Lee: Nothing to disclose \nSun Kyung Kyung Jeon: Nothing to disclose \n \nRPS 501a-6 \nRelationship between variant biliary and vascular anatomy in living liver \ndonors \n*L. Masood*, S. Sayeed, S. Aslam, B. Y. Faiz; Islamabad/PK \n(laibamasood66@gmail.com) \n \nPurpose: Purpose of this study was to investigate correlation of hepatic \nvascular variants in live liver donors with established biliary variant anatomy. \nMethods or Background: After IRB approval, two radiologists reviewed \npreoperative CT volumetry scans and MRCPs from 165 live liver donors having \nvariant biliary anatomy. Classification of conventional or variant hepatic artery, \nhepatic veins and portal veins was done based on CT volumetry scans while \nbiliary anatomy was characterized based on MRCP images. \nResults or Findings: Out of 165 subjects having variant biliary anatomy, \nconventional anatomy involving hepatic arteries were seen in 88(53.3%) and \nportal veins in 125(75.8%) subjects. Right inferior hepatic vein was found in \n7(4.2%) and 32(19.3%) having accessory hepatic venous drainage of segment \nVI or VII or both. 40(24%) liver donors had variant portal venous anatomy and \n77(46%) had hepatic artery variations. Significant association was seen \nbetween variant biliary drainage and hepatic arterial supply with p value = \n0.032. \nConclusion: Detailed preoperative evaluation of biliary and vascular anatomy \nof liver donors is essential with regards to surgical planning in selecting \nsuitable candidates, need for vascular or biliary reconstruction allowing \nsurgeon to prepare well in time and anticipate the possible complications which \nmay result in bile leak, bile duct stricture, vascular compromise and eventual \ngraft failure. \nLimitations: This is a single center study with a relatively limited sample \nvolume, multi centric collaborative studies are needed to consolidate our \nfindings. \nEthics Committee Approval: Study was performed after approval from \ninstitution review board and written consent was waived. \nFunding for this study: None \nAuthor Disclosures: \nBelqees Yawar Faiz: Nothing to disclose \nSamreen Aslam: Nothing to disclose \nSana Sayeed: Nothing to disclose \nLaiba Masood: Nothing to disclose \n \nRPS 501a-7 \nDynamic volumetric CT liver perfusion: a comparative analysis of liver \nperfusion results of donors and recipients after liver transplantation \nF. Nazyrov, A. Ikramov, N. Djuraeva, A. Devyatov, A. Amirkhamzaev,  \nU. R. Salimov, *N. Vakhidova*, X. Shamirzaev, K. Abdukhalimova; \nTashkent/UZ \n(sidikovan@yandex.ru) \n \nPurpose: To compare the perfusion MSCT parameters of the liver after \northotopic liver transplantation(LT) with a control group of donors. \nMethods or Background: Dynamic volume perfusion MSCT of the liver was \nperformed in 88 donors and 16 recipients. We performed a comparative \nanalysis of perfusion MSCT of the liver(arterial and portal perfusion, hepatic \nperfusion index) in the recipient before and after liver transplantation on the 7th \nday after surgery, and also 3 months after LT. \nResults or Findings: The volume of portal perfusion(PP) in recipients with \nliver cirrhosis(LC) was amounted to 150.2±4.0ml/100ml³/min versus \n180.5±2.4ml/100ml³/min(t=6.58;p<0.001) from donors. After LT PP increased \nto 185.6±4.7ml/100ml³/min. Arterial perfusion(AP) increased compensatory and \nif in healthy people this indicator was 20.8±0.7ml/100ml³/min, then with LC-\n34.1±1.1 ml/100ml³/min(t=10,56;p<0.001). After LT the AP decreased and \namounted to 21.8±0.6ml/100ml³/min. At the same time, the difference in \nindicators before and after LT ranged from -7.9-19.6 ml/100 ml³/ min with an \naverage value of-12.3±0.9ml/100 ml³/min(t=13.95;p<0.001). These values, as \nwell as in relation to portal perfusion, no longer had significant differences in \ncomparison with the data in donors(t=1.14;p>0.05). In turn, when comparing \nthe results after LT in recipients with the initial data in donors, a significant \ndifference in the hepatic perfusion index(HPI) was observed 12.3%(13.8±0.3% \nfor donors and 15.5±0.3% for recipients;t=4.10;p<0.001). \nConclusion: In relation to the indicators in donors in recipients before LT, the \nvalue of arterial perfusion was 64% higher, whereas after LT this indicator \ndiffered only by 4.8%, which was not significant.PP was initially 16.8% lower, \nand after LT increased to virtually normal values in relation to healthy people \nwith a difference of only 2.8%. The HPI was 81.8% higher than in donors. After \nLT this difference was only 12.3%. \nLimitations: within the Institution rules \nEthics Committee Approval: Approved by Institution \nFunding for this study: Institution \nAuthor Disclosures: \nAdham Ikramov: Nothing to disclose \nUmid Ravshanovich Salimov: Nothing to disclose \nXakim Shamirzaev: Nothing to disclose \nAndrey Devyatov: Nothing to disclose \nKhanum Abdukhalimova: Nothing to disclose \nAybek Amirkhamzaev: Nothing to disclose \nNigora Djuraeva: Nothing to disclose \nAcademician Feruz Nazyrov: Nothing to disclose \nNargiza Tulkinovna Vakhidova: Nothing to disclose \n \n \nResearch Presentation Session: GI Tract \nRPS 201b \nConditions in the GI tract \nRPS 201b-3 \nAssessment of lymph node status and tumour response after \nchemoradiation therapy in locally advanced rectal cancer: comparison of \nregion of interest methods of intravoxel incoherent motion parameters \n*Y. Yuan*, H. Pu, X-L. Chen, H. Li; Chengdu/CN  \n \nPurpose: To assess the diagnostic performance of region of interest (ROI) \nmethods of intravoxel incoherent motion diffusion-weighted imaging (IVIM-\nDWI) for determining lymph node metastases (LNM) and tumor response after \nchemoradiation therapy (CRT) in locally advanced rectal cancer (LARC). \nMethods or Background: 52 patients underwent preoperative IVIM-DWI \nbefore and after CRT. IVIM-DWI parameters apparent diffusion coefficient \n(ADC), slow diffusion coefficient (D), fast diffusion coefficient (D*), perfusion-\nrelated diffusion fraction (f) and their percentage changes [ ¨%]) were obtained \naccording to three ROI protocols: whole-volume, single-slice and small \nsamples. IVIM parameters were compared between LNM negative and positive \ngroups, between pathological complete response (pCR) and non-pCR groups, \nand between good and poor response groups. Areas under the receiver \noperating characteristic curves (AUCs) were calculated to evaluate diagnostic \nperformance. \nResults or Findings: Interobserver agreement were good for pre- and post-\nCRT whole-volume ROI and single-slice ROI (intraclass correlation coefficient \n[ICC], 0.775-0.953), and moderate for small samples ROI (ICC, 0.581-0.905). \nAs for LNM, AUCs for whole-volume ROI-derived post-f, post-D, and ¨%D \nwere higher than that of the other IVIM parameters (AUC,0.753-0.760 vs. \n0.658-0.733). As for pCR, AUCs for whole-volume ROI-derived ¨%D were \nhigher than that of the other IVIM parameters (AUC,0.878 vs. 0.727-0.759). As \nfor good response, AUCs for whole-volume ROI derived ¨%D were higher than \nthat of the other IVIM parameters (AUC,0.872 vs. 0. 640-0.822). \nConclusion: ¨%D was equally to post-D and post-f values derived from whole-\nvolume ROI in discriminating LNM after CRT. Whole-volume ROI-derived ¨%D \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 159  \nvalues provided high diagnostic performance for evaluating pCR and good \nresponse. \nLimitations: It was a retrospective study with a rather small sample size and \nlacked more lower b-values, especially b-values< 200 s/mm2. \nEthics Committee Approval: Approved by the institutional review board. \nFunding for this study: Sichuan Science and Technology Program (No. \n2019YFS0437) and (No.20GJHZ0105) \nAuthor Disclosures: \nYi Yuan: Nothing to disclose \nHong Pu: Nothing to disclose \nHang Li: Nothing to disclose \nXiao-Li Chen: Nothing to disclose \n \nRPS 201b-4 \nPreoperative measurement of the hiatal surface with MDCT: impact on \nsurgical planning \n*G. Trillò*¹, M. Rengo¹, S. Badia¹, D. M. Bellini¹, I. Carbone², S. Picchia¹,  \nS. Vicini¹, A. Capodanno¹, A. Laghi²; ¹Latina/IT, ²Rome/IT  \n \nPurpose: To evaluate the accuracy and reproducibility of Hiatal Surface Area \n(HSA) measured on dedicated Multidetector computed tomography (MDCT) \nacquisition, in patients previously subjected to laparoscopic sleeve \ngastrectomy (LSG) with hiatal hernia (HH), compared to surgical measurement. \nMethods or Background: Fifty-two candidates for laparoscopic antireflux \nsurgery were prospectively included in the study. The quantification of HSA \nwas performed on MDCT images acquired during the administration of \niodinated contrast media. Measurements were performed by nine readers with \ndifferent experiences. Results were compared with intraoperative \nmeasurements by means of linear regression. Reproducibility was evaluated \nwith intra and inter reader agreement by means of Intraclass correlation \ncoefficient (ICC) among nine readers with different experience. \nResults or Findings: A moderate correlation between HSA measured \nintraoperatively and on MDCT acquired during swallowing was observed (R2= \n0.59, p<0.0034). An excellent correlation between HSA measured \nintraoperatively and on MDCT acquired during strain was observed (R2=0.93, \np<0.0001) resulting in a good agreement between two methods ( ț =0.73). All \npatients were correctly classified by MDCT according to HSA cut off value as \ndetermined by surgery. An excellent correlation between HSA measurements \nobtained on MDCT, by expert and less experienced readers and \nintraoperatively was observed (R2= 0.94 and 0.83). Inter-reader agreement \nand intra-reader agreement were excellent (ICC= 0.95 and ț = 0.93). \nConclusion: HSA can be accurately measured on MDCT images. This method \nis reproducible and minimally influenced by reader experience. The \npreoperative measurement of HSA has potential advantages for surgeons in \nterm of correct approach to hiatal defects in obese patient. \nLimitations: We didn’t investigate the effect of surgery on symptoms or the \nrelapse of HH. Another limit is single center study design. \nEthics Committee Approval: The study was approved by the Institutional \nReview Board and informed consent was obtained. \nFunding for this study: None. \nAuthor Disclosures: \nGiovanni Trillò: Nothing to disclose \nIacopo Carbone: Nothing to disclose \nSimone Vicini: Nothing to disclose \nMarco Rengo: Nothing to disclose \nAndrea Laghi: Nothing to disclose \nAntonio Capodanno: Nothing to disclose \nDavide Maria Bellini: Nothing to disclose \nStefano Badia: Nothing to disclose \nSimona Picchia: Nothing to disclose \n \nRPS 201b-5 \nRadiomic's contribution to MR Imaging of patients with LARC (Locally \nAdvanced Rectal Cancer-stage IIa-IIIc AJCC) in the evaluation of long-\nterm outcome \nM. G. Belgrano¹, *I. Fiorese*¹, M. Costa², I. Gandin¹, C. Marrocchio¹, \nM. A. A. Cova¹; ¹Trieste/IT, ²Udine/IT \n \nPurpose: To perform a radiomic study on MR imaging to create a model able \nto predict the pathological response of patients with LARC on pre neoadjuvant \ntreatment images. \nMethods or Background: Between the 1st of January 2007 and the 31st of \nDecember 2017, pretreatment MR images of Patients with LARC who \nunderwent neoadjuvant therapy before surgical intervention and histologic \nevaluation of the TRG (Tumor Regression Grade) on the surgical specimen \nwere collected. Two radiologists identified the lesions and proceeded to their \nsegmentation. In addition, 1cm3 sphere was delineated in the most \nrepresentative area of the tumor. The radiomic features were extracted from \nthe volumes thus obtained and the statistical analysis was separately \nperformed for the entire lesion and for the single sphere. The clinical outcome \nwas the TRG grade. After a univariate analysis the features with a significance \nlevel < 0,05 were selected and then reduced to a singe variable (PC1) with the \nPrincipal Component Analysis. The PC1 and the T stage of the lesion were \nincluded in the model whose performance has been evaluated with the AUC-\nROC curve. \nResults or Findings: Thirty-nine patients (M:23, F:16, median age:70) were \nselected. For each patient 227 features were extracted. Ten features were \nselected from the entire lesion and 5 from the single sphere evaluation \n(p<0,05) and then reduced to the variable PC1. The models obtained \ndemonstrated a significant association between the PC1 and the clinical \noutcome with good performance both in the entire lesion (p-value = 0,0157, \nAUC-ROC = 0,731) and in the single sphere (p-value = 0,0229, AUC-ROC = \n0,743). \nConclusion: There is a correlation between radiomics features and \npathological response of patients with LARC. The sphere could significantly \nshorten and simplify radiomic studies'ecexution. \nLimitations: Number of Patients \nEthics Committee Approval: Approved \nFunding for this study: None \nAuthor Disclosures: \nMatilde Costa: Nothing to disclose \nManuel Gianvalerio Belgrano: Nothing to disclose \nCristina Marrocchio: Nothing to disclose \nIlaria Fiorese: Nothing to disclose \nMaria Assunta A. Cova: Nothing to disclose \nIlaria Gandin: Nothing to disclose \n \nRPS 201b-6 \nThe significance of preoperative computed tomography (CT) features in \nthe prediction of overall survival in gastric cancer: a retrospective \nanalysis \n*I. Kizildag Yirgin*, S. M. Ertürk, I. Dogan, S. Vatansever; Istanbul/TR \n(incikizil@hotmail.com) \n \nPurpose: The objective of this study was to evaluate the role of preoperative \ncomputed tomography (CT) findings in predicting overall survival (OS) in \npatients operated for gastric cancer. \nMethods or Background: The cases of 101 patients with gastric cancer (68 \nmen, 33 women; age range, 29-82 years; median, 61 years) who underwent \nCT before surgery were retrospectively evaluated. Two radiologists reviewed \nmultiplanar reconstruction images to measure invasion depth of the tumor (T \nstage), the number of pathological lymph nodes (N stage), the long diameter of \nthe lesion, the localization of the tumor and the attenuation values of tumor in \nthe arterial and venous phases (HUs). Post operative pathology findings, \nresection status (R0,R1), pathologic T stage, N stage, grade, histopathological \nsubtype were recorded. All CT-derived parameters and clinicopathological \nvariables associated with OS were analysed by univariate analysis, followed by \nmultivariate and receiver operator characteristics (ROC) analysis. \nResults or Findings: Multivariate cox regression analysis showed that non of \nthe preoperative CT findings correlated with the OS. The survival rate after \nresection was worse for the R1 group and high grade group than for the R0 \ngroup and low grade group (p:0.001,p:0.005 respectively). N stage and long \ndiameter of the lesion on CT imaging correctly predicted R1 resection ( \nAUC,0.697; sensitivity,63%; specificity, 88%, AUC,0.734; sensitivity,18%; \nspecificity, 76% respectively). \nConclusion: R1 resection is correlated with lower OS in operated gastric \ncancer. CT findings including the long diameter of the tumor and the number of \npathological lymph nodes, can predict R1 resection. \nLimitations: This is a retrospective study and number of participants were \nsmall. \nEthics Committee Approval: The study protocol was approved by our \ninstitutional ethics committee . \nFunding for this study: No \nAuthor Disclosures: \nInci Kızılda÷ Yırgın: Nothing to disclose \nIzzet Dogan: Nothing to disclose \nSezai Vatansever: Nothing to disclose \nSükrü Mehmet Ertürk: Nothing to disclose \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 160  \n \nResearch Presentation Session: GI Tract \nRPS 301b \nLiver and the pancreas \nRPS 301b-1 \nQuantification of liver steatosis with 3rd generation dual source dual \nenergy CT: a comparison with pathology after liver resection \n*A. Agostini*, M. Tufillaro, A. Borgheresi, L. Ottaviani, R. Rossi, F. Puccio, \nA. Mandolesi, M. Vivarelli, A. Giovagnoni; Ancona/IT  \n(dott.andrea.agostini@gmail.com) \n \nPurpose: To correlate the quantification of liver steatosis estimated on Dual \nSource Dual Energy CT (dsDECT) with pathological specimens after liver \nresection. \nMethods or Background: Inclusion criteria: patients >18 years old, underwent \nto liver surgery between January 2018 and January 2020, with an abdominal \ncontrast-enhanced dsDECT within 1 month before resection, were \nretrospectively included. Exclusion criteria: liver cirrhosis, absence of contrast-\nenhanced dsDECT or pathological data. dsDECT were performed with a 3rd \ngeneration Dual Source scanner (80-100/150Sn kV, modulated mA), with \ntriphasic contrast-enhanced study (370 mg[I]/ml, 1,3 ml/kg body weight). Liver \nsteatosis was quantified with three-material decomposition algorithm from \narterial and venous dsDECT datasets; liver attenuations on virtual non-contrast \n(VNC) images from both datasets were recorded. The pathological specimens \nwere reviewed by two liver pathologists in consensus. Steatosis from dsDECT \nand liver attenuation on VNC were compared to pathology with Receiver \nCharacteristic Curves (ROC) Analysis (endpoint: pathological steatosis •30%). \nResults or Findings: 48 patients (M/F=30/18, mean age: 65 years old) were \nretrospectively included; 20/48 were resected for colorectal metastases and \n15/48 for cholangiocarcinoma. dsDECT datasets showed significantly higher \nareas under the curve (AUC 0.872-0.891) than attenuation values on VNC \n(AUC 0.801-0.813) at ROC analysis, with comparable sensitivity (84%) and \nhigher specificity (86%-91% vs 65-75%). \nConclusion: Liver steatosis can be accurately quantified on dsDECT datasets, \nwith better performance of quantification with three-material decomposition \nthan VNC attenuation values. \nLimitations: Retrospective study, single center, small sample. \nEthics Committee Approval: The study was approved bay the local IRB and \nthe infromed consent wass waived. \nFunding for this study: None. \nAuthor Disclosures: \nMarianna Tufillaro: Nothing to disclose \nFrancesca Puccio: Nothing to disclose \nAndrea Agostini: Speaker: Siemens Healthineers \nAlessandra Mandolesi: Nothing to disclose \nRoberta Rossi: Nothing to disclose \nAlessandra Borgheresi: Nothing to disclose \nLetizia Ottaviani: Nothing to disclose \nAndrea Giovagnoni: Nothing to disclose \nMarco Vivarelli: Nothing to disclose \n \nRPS 301b-2 \nRadiomics signature of acute pancreatitis in CT \n*S. Bette*¹, J. Decker¹, P. Woznicki¹, S. Gölder¹, B. Geißler¹,  \nC. Scheurig-Münkler¹, T. J. Kroencke¹, B. Baessler², F. Schwarz¹; \n¹Augsburg/DE, ²Zürich/CH  \n \nPurpose: Acute pancreatitis (AP) remains a potentially life-threatening \ndisease. In early diagnostic workup, the role of CT is to establish the diagnosis, \nassess severity, and detect potential complications. The aim of our study was \nto develop and evaluate an automatic machine learning model for AP detection \nin CT images. \nMethods or Background: This retrospective analysis included 300 patients \nwho had undergone contrast-enhanced CT of the abdomen between 2015 and \n2020 with a clinical suspicion for AP (AP confirmed: n = 169; AP excluded: n = \n131). Automatic pancreas segmentation was performed using a pre-trained \ndeep learning model, based on 3D U-Net architecture. Subsequently, radiomic \nfeatures were extracted from the region of interest using pyradiomics. The 10 \nmost determinant and least correlated features were selected with the mRMR \nalgorithm and a Random Forest classifier was trained to perform classification \nusing the features. The model was evaluated using 5-fold cross-validation and \na temporally separated patient cohort. \nResults or Findings: The machine learning model achieved high predictive \nperformance with an AUC of 0.91 (95% CI: 0.85-0.94) for AP detection in the \ntest set. Accordingly, the method achieved a sensitivity of 88% (95% CI: 76%-\n97%) and a specificity of 79% (95% CI: 62%-93%) for the detection of the AP. \nConclusion: Radiomics-based machine learning model allows for the \ndetection of acute pancreatitis with high diagnostic accuracy and might \nfacilitate the correct diagnosis in clinical routine. We are planning to further \nextend the analysis with more clinical outcomes and evaluate the model in a \nfollow-up prospective study. \nLimitations: This is a single-center retrospective study. \nEthics Committee Approval: This retrospective study was approved by the \nlocal IRB. \nFunding for this study: PD Dr. Bette and PD Dr. Schwarz have received \nfunding from the university of Augsburg for this study. \nAuthor Disclosures: \nFrau Stefanie Bette: Nothing to disclose \nHerr Christian Scheurig-Münkler: Nothing to disclose \nHerr Stefan Gölder: Nothing to disclose \nFrau Bettina Baessler: Nothing to disclose \nPiotr Woznicki: Nothing to disclose \nThomas J. Kroencke: Nothing to disclose \nFlorian Schwarz: Nothing to disclose \nHerr Josua Decker: Nothing to disclose \nHerr Bernd Geißler: Nothing to disclose \n \nRPS 301b-3 \nImpact of meal intake on the liver stiffness assessed by MRE in healthy \nvolunteers \nM. Obrzut¹, *V. Atamaniuk*¹, J. Chen², R. Ehman², B. Obrzut¹, M. Cholewa¹,  \nK. Gutkowski¹; ¹Rzeszów/PL, ²Rochester, MN/US \n(vitaliyacera500@gmail.com) \n \nPurpose: Chronic liver diseases are a severe health problem worldwide. They \nlead to liver fibrosis and, if not treated, to liver cirrhosis. However, this dynamic \nprocess may be reversible when detected early. Magnetic Resonance \nElastography (MRE) is a non-invasive method for evaluating liver stiffness, \nwhich allows detecting liver fibrosis on its early stages. It has almost replaced \ninvasive liver biopsy, which has been a gold standard in the diagnosis of liver \nfibrosis for many years. To eliminate potential changes in the liver stiffness \ncaused by a postprandial increase in blood flow, current clinical protocols \nrecommend performing MRE examination at the earliest 4 hours after food \nintake. Nevertheless, this relationship has not been properly studied yet. \nMethods or Background: This study aimed to determine how the food intake \naffects liver stiffness and if it can be the reason of incorrect clinical diagnoses. \nA total of 100 healthy volunteers (36 men and 64 women; age range 20-32 \nyears, mean age 22.9 years) were enrolled in this study. A 1.5T GE Optima \nclinical MRI scanner was used to assess the liver stiffness. \nResults or Findings: The highest average liver stiffness value was recorded \n30 minutes after a meal. Then a gradual decrease was observed. Still, even at \n2h30m after meal, the liver stiffness was higher than that measured with empty \nstomach: 2.41 vs. 2.25 kPa. \nConclusion: Therefore, to avoid false positive results and the subsequent \nunnecessary diagnostics and/or treatment, we recommend performing MRE \nexams aimed to assess liver stiffness at least 3 hours after meal. \nLimitations: Narrow age range. \nEthics Committee Approval: The study was approved by the Ethics \nCommittee at the University of Rzeszów (No. 10/01/2019) and conformed to \nthe ethical guidelines of the 1975 Declaration of Helsinki (6th revision, 2008). \nFunding for this study: Not applicable. \nAuthor Disclosures: \nMarzanna Obrzut: Nothing to disclose \nMarian Cholewa: Nothing to disclose \nJun Chen: Other: Resoundant \nRichard Ehman: Other: Resoundant \nVitaliy Atamaniuk: Nothing to disclose \nKrzysztof Gutkowski: Nothing to disclose \nBogdan Obrzut: Nothing to disclose \n \nRPS 301b-5 \nMultiparametric-MRI of liver disease progression in preclinical animal \nmodels \n*F. Baskaya*, T. Nolte, S. Koletnik, A. Rix, V. Schulz, W. Lederle, F. Kiessling; \nAachen/DE \n(ferhanbaskaya@gmx.de) \n \nPurpose: Chronic liver diseases (CLD) are associated with inflammation and \nchanges in cell and tissue structure including fat content and activity of \nhepatocytes and macrophages. Thus, our goal was to investigate whether \nlongitudinal multiparametric MRI can sensitively assess these changes in two \nCLD animal models of different etiology. \nMethods or Background: In the NASH model, 32 mice received a high-fat \ndiet over 24 weeks. In the fibrosis model, 20 animals were injected twice \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 161  \nweekly intraperitoneally with CCl4 for 8 weeks. 37 healthy animals served as \ncontrols.  \nLongitudinal multiparametric imaging was performed at 7T MRI (Bruker \nBioSpec 70/20) using T1/T2-relaxometry, morphological T1w/T2w-imaging and \nfat-selective imaging. Furthermore, T1w and T2*w DCE/DSC-MRI were applied \nusing PrimovistR and VivoTraxTM, respectively. Imaging data were validated \nby serological and immunohistological analyses. \nResults or Findings: In the NASH-model, fatty liver degeneration was \nsemiquantitatively assessed by fat-selective MRI (wk0: 3.9±1.0a.u., wk16: \n33.7±13.1a.u., p=0.0043) and reflected by decreasing native T1-relaxation \ntimes (wk0: 1570±101ms, wk16: 816±214ms, p=<0.0001). While for CCl4 \nthese changes are absent, a prolongation of T2-relaxation times was found in \nboth models (NASH: wk4: 21.9±2.0ms, wk16: 28.6±4.6ms, p=0.0451; CCl4: \nwk0: 19.1±1.3ms, wk4: 21.2±0.6ms, p=0.0340) indicating inflammation-related \nedema. Furthermore, only in the NASH-model the uptake of PrimovistR and \nVivoTraxTM decreased suggesting either reduced delivery of the contrast \nagents to hepatocytes or macrophages, respectively, or disturbed cellular \ninternalization. ALT/AST levels were increased in diseased animals in both \nmodels. \nConclusion: Non-invasive MRI with commercially available contrast agents \ncan sensitively assess pathophysiological changes in the liver that can help to \nclassify CLD and to track its progression. In the future, these extended MRI \nexaminations may also be used to monitor treatments and to reduce the \nnumbers of liver biopsies. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: BMBF-LiSyM GrantNo.031L0041 \nDFG, SFB1382, project Q1, project-ID 403224013 \nAuthor Disclosures: \nFabian Kiessling: Nothing to disclose \nWiltrud Lederle: Nothing to disclose \nTeresa Nolte: Nothing to disclose \nFerhan Baskaya: Nothing to disclose \nVolkmar Schulz: Nothing to disclose \nAnne Rix: Nothing to disclose \nSusanne Koletnik: Nothing to disclose \n \nRPS 301b-6 \nInfluence of contrast medium on the CT textural parameters in hepatic \nmetastases and in normal liver: a radiomics analysis \n*F. Fiz*, G. Costa, N. Gennaro, L. La Bella, A. Boichuk, G. Torzilli, L. Balzarini, \nA. Chiti, L. Viganò; Milan/IT \n(francesco.fiz.nm@gmail.com) \n \nPurpose: Textural features (TF) of colorectal liver metastases (CLM) are \nusually extracted from portal venous phase of CT (PVP), but the impact of \ncontrast enhancement on their values is unclear. We investigated whether \nsignificant differences of CLM/liver TF values exist between PVP and basal \nphase (BP). \nMethods or Background: Patients undergoing CLM resection (2017-2020) \nwere considered. On the PVP, we drew the following VOI: CLM (up to 5 \nlesions, Tumor-VOI); a 5-mm rim of parenchyma around CLM (Margin-VOI); a \n2-ml sample of non-tumoral liver parenchyma distant from CLM (Liver-VOI). \nVOI were then copied onto the BP. Forty-five TF were extracted from each VOI \n(LIFEx®). \nResults or Findings: 409 CLM in 162 patients were analyzed. Most TF were \nsignificantly different between PVP and BP in Tumor-VOI (38/45, 85%) and \nMargin-VOI (41/45, 91%); less so in Liver-VOI (26/45, 58%, p<0.001). \nIn PVP, entropy increased and energy decreased in Tumor-VOI (log10-entropy \n0.93±0.10 vs 0.85±0.14 in BP; energy 0.14±0.03 vs 0.18±0.04; p<0.001) and in \nMargin-VOI (0.89±0.11 vs 0.85±0.12; 0.16±0.04 vs 0.18±0.04, p<0.001). These \nparameters remained stable in Liver-VOI. Remaining first-order TF were \nmodified by enhancement in all VOI. Modification of Tumor-VOI TF was \nindependent of tumor size. Comparing VOIs in BP, entropy and energy of \nTumor- and Margin-VOI were not significantly different, while Liver-VOI had \nlower entropy and higher energy (0.76/0.21, p<0.001). In PVP, an entropy and \nenergy gradient was observed (entropy: Tumor>Margin>Liver; energy: \nTumor<Margin<Liver, p<0,001). \nConclusion: Contrast enhancement on CT had a relevant effect on TF values \nof CLM, independently from size, while did not affect entropy and energy of \nliver parenchyma. TF of peritumoral tissue had modification similar to Tumor-\nVOI, despite its apparently normal radiological aspect. \nLimitations: Retrospective, monocentric. \nEthics Committee Approval: Obtained. \nFunding for this study: None. \nAuthor Disclosures: \nGuido Torzilli: Nothing to disclose \nAlexandra Boichuk: Nothing to disclose \nLudovico La Bella: Nothing to disclose \nFrancesco Fiz: Nothing to disclose \nArturo Chiti: Nothing to disclose \nNicolò Gennaro: Nothing to disclose \nGuido Costa: Nothing to disclose \nLuca Viganò: Nothing to disclose \nLuca Balzarini: Nothing to disclose \n \nRPS 301b-7 \nLiver volume parameters measured by Computed Tomographic (CT) \nportography may be used to predict the severity of esophageal varices in \ncirrhotic patients \n*S. Wan*¹, B. Song¹, X. Zhang²; ¹Chengdu/CN, ²Beijing/CN \n(604775856@qq.com) \n \nPurpose: To investigate whether liver lobe volume indices and the ratio of \ncaudate lobe volume(CV) to total liver volume(CV/TLV) on computed \ntomographic portography(CTP) could noninvasively predict the severity of \nesophageal varices(EV) in cirrhotic patients. \nMethods or Background: Sixty-one consecutive cirrhotic patients from \nJanuary 2020 to October 2020 were enrolled in this study. All participants \nunderwent CTP to measure liver volume indices, with endoscopy as reference \nstandard. According to endoscopic results, patients were divided into a non-\nconspicuous EV group(mild-to-moderate EV,n=29) and a conspicuous EV \ngroup(severe EV,n=32). Total liver volume(TLV), right liver lobe volume(RV), \nleft liver lobe volume(LV), caudate lobe volume(CV) were measured using \nMedical Image Processing software(Shanghai United Imaging Healthcare), and \nthe ratio of CV to TLV(CV/TLV) was calculated. Statistical analyses and the \nreceiver operating characteristic(ROC) curves were performed to determine \nwhether and how these parameters could predict the severity of EV. \nResults or Findings: The indices of CV and CV/TLV were statistically \nsignificant(P<0.05), CV/TLV could best distinguish mild-to-moderate EV from \nsevere EV, with an area under ROC curve(AUC) of 0.96, a sensitivity of 92.3% \nand a specificity of 100%, and the cutoff value was 5.2%. CV could also \ndistinguish mild-to-moderate EV from severe EV, with an AUC of 0.94, a \nsensitivity of 84.6% and a specificity of 92.0%, and the cutoff value was \n51.05cm³. \nConclusion: Liver morphological changes may correlate with the severity of \nEV, in which, liver volume parameters of CV and CV/TLV measured on CTP \nhave great potential to predict EV severity and be used as an alternative to \ninvasive endoscopy. \nLimitations: Some selection bias may introduce disagreement between \nobservers due to the subjective endoscopic grading system, and some interval \nprogression of disease cannot be ruled out. \nEthics Committee Approval: This study had approval from West China \nHospital. \nFunding for this study: Not applicable \nAuthor Disclosures: \nXin Zhang: nothing to disclose \nShang Wan: Nothing to disclose \nBin Song: Nothing to disclose \n \nRPS 301b-8 \nLiver iron concentration in healthy volunteers evaluated by MRI \nM. Obrzut¹, *V. Atamaniuk*¹, K. Glaser², J. Chen², R. Ehman², B. Obrzut¹,  \nM. Cholewa¹, K. Gutkowski¹; ¹Rzeszów/PL, ²Rochester, MN/US \n(vitaliyacera500@gmail.com) \n \nPurpose: Iron overload is a common clinical condition, which leads to \nprogressive liver fibrosis or even cirrhosis. It has numerous causes, including \nthalassemia, hereditary hemochromatosis, and myelodysplasia. Liver biopsy is \none of the reference tests used to quantify Liver Iron Concentration (LIC). Still, \nthis procedure has significant limitations and is associated with several \npotential risks. Magnetic Resonance Imaging (MRI) and assessment of the R2* \nrelaxation rate can become an alternative to liver biopsy, but it cannot be used \nas a diagnostic tool without accurate R2* data corresponding to standard LIC \nvalue. For this reason, this study aimed to evaluate the normative values of \nliver R2* in healthy volunteers. \nMethods or Background: A total of 100 healthy volunteers (36 men and 64 \nwomen; age range 20-32 years, mean age 22.9 years) were enrolled in this \nstudy. A 1.5T GE Optima clinical magnetic resonance scanner was used to \nassess the R2* rate. Images for measuring the LIC and liver fat concentration \nwere obtained using the IDEAL-IQ technique for liver imaging. \nResults or Findings: The Mean (SD) liver R2* was 28.34 (2.25) s−1 (95% CI, \n27.78– 28.90, range 23.67–33.00 s−1) in females, 29.57 (3.20) s−1 (95% CI, \n28.49–30.66, range 23.93–37.77 s−1) in males, and 28.72 (2.69) s−1 (range \n23.67–37.77 s−1) in the whole group. \nConclusion: R2* value in this particular population with a high proportion of \nyoung women did not exceed 38 s−1. In the absence of fibrosis or steatosis, \nliver stiffness and fat fraction did not show any relationship with R2*. \nLimitations: Narrow age range; high proportion of women. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 162  \nEthics Committee Approval: The study was approved by the Ethics \nCommittee at the University of Rzeszow (No. 10/01/2019) and conformed to \nthe ethical guidelines of the 1975 Declaration of Helsinki (6th revision, 2008). \nFunding for this study: Not applicable. \nAuthor Disclosures: \nMarzanna Obrzut: Nothing to disclose \nMarian Cholewa: Nothing to disclose \nJun Chen: Other: Resoundant \nRichard Ehman: Other: Resoundant \nKevin Glaser: Other: Resoundant \nVitaliy Atamaniuk: Nothing to disclose \nKrzysztof Gutkowski: Nothing to disclose \nBogdan Obrzut: Nothing to disclose \n \nRPS 301b-9 \nFree-breathing contrast-enhanced multiphase MRI of the liver in patients \nwith a high risk of breath-holding failure \nJ. S. Kim, *E. S. Choi*; Seoul/KR \n(eunnysunny11@gmail.com) \n \nPurpose: Purpose: To compare image quality of cartesian k-space sampling \nvolumetric interpolate examination with compressed sensing(XD-VIBE) and \nGolden-Angle radial sampling with denoising technique(GRASP) in patients \nwith a high risk of breath-holding failure. \nMethods or Background: Methods: A total of 67 patients with high risk of \nbreath-holding failure underwent XD-VIBE(n=33) or GRASP(n=34) with \noptimized protocol. Overall image quality, motion artifact, liver edge sharpness \nand on arterial phase and portal-venous phase were evaluated by two \nradiologists on a 4-point score. We also evaluated signal intensity ratio of liver \nat late arterial phase to aorta at peak enhancement and detection rate of \nhypervasular lesion. \nResults or Findings: Results: Overall image quality score, artifact score and \nliver edge sharpness of XD-VIBE and GRASP on arterial and portal phase was \nnot significantly different(p=0.070-0.397). Four(reviewer1, 12.1%) and seven \npatients (reviewer2, 21.2%) were received score 1 (nondiagnostic quality and \nreexamination needed) in XD-VIBE group whereas one patient (reviewer2, \n2.9%) was received score 1 in GRASP group. Ratio of aorta and liver of \nGRASP was significantly higher than that of XD-VIBE (0.32±0.10 vs \n0.47±0.13). The hypervascular lesion detection rate of XD-VIBE (86.7 %) was \nhigher than GRASP (57.1%) on arterial phase without statistical significant \ndifference(p=0.081). \nConclusion: Overall image quality, motion artifact and liver edge sharpness on \narterial and portal-venous phase of XD-VIBE and GRASP was not significantly \ndifferent, although XD-VIBE could be seen non-diagnostic quality image than \nGRASP. In the case of GRASP, the degree of enhancement of liver \nparenchyma on late arterial phase compared to aorta could be higher than XD-\nVIBE and this has the potential to reduce detection of hypervascular lesion on \narterial phase. \nLimitations: First, this was retrospective study. \nEthics Committee Approval: This retrospective study approved IRB. \nFunding for this study: None \nAuthor Disclosures: \nJin Sil Kim: nothing to disclose \nEwha Womans University Eun Sun Choi: nothing to disclose \n \n \nResearch Presentation Session: Breast \nRPS 302 \nBreast MRI \nRPS 302-1 \nIntra- and inter-reader agreement of diffusion ǦǦweighted magnetic \nresonance imaging for breast cancer detection: a multi-reader study \n*M. Montesano*, F. Pesapane, A. Rotili, S. Penco, L. Nicosia, V. Dominelli,  \nC. Trentin, G. M. Agazzi, E. Cassano; Milan/IT  \n(marta.mon@hotmail.it) \n \nPurpose: In order to utilize DWI as a reliable biomarker for detecting breast \ncancer through unenhanced MRI, we evaluated the inter-reader reproducibility \nand the inter-reader agreement between high-experience and low-experience \nreaders. \n \n \n \n \nMethods or Background: Consecutive breast MRI performed, in a single \ncentre, from February to September 2016, were retrospectively evaluated. \nExclusion criteria included: bilateral breast implants, absence of DWI \nsequences in the acquisition protocol, breast surgery performed in other \nhospitals and lack of regular follow-up. Four radiologists, divided in two groups \naccording to the different experience, independently evaluated only DWY and \nADC maps. Histopathology results or >1-year imaging follow-up was used as \nreference standard. Agreement was assessed through the calculation of intra-\nreader and inter-reader reproducibility using Cohen and Fleiss K statistics. \nResults or Findings: Out of 1,131 examinations, 378 women (49±11 years \nold) were included, 13% (51/1131) with unilateral mastectomy, totalling 705 \nbreasts. Intra-reader reproducibility was moderate to high in all readers \n(K=0.63–0.77) reflecting the overall proportion of lesions with concordant \nscoring. High-experience readers (R1, R2) showed specific agreement \noccurring in 90.7% (656/724) while low-experience readers (R3, R4) in 50.1% \n(368/724) of breasts. We reported higher intra-reader agreement for high-\nexperience readers (ț=0.72–0.78) compared to low-experience readers \n(ț=0.48–0.69). Inter-reader agreement for all readers was moderate ( ț=0.56) \nwhile it was substantial (ț=0.74) for high-experience readers and fair ( ț=0.37) \nfor low-experience readers. Pairwise agreement between low-experience \nreaders and high-experience readers was moderate ( ț=0.60) demonstrated \nsuperior scoring agreement between high-experience readers (p=0.003). \nConclusion: Breast MR based on DWI has a good reproducibility but may be \nassessed only by dedicated radiologists in referral/specialized centers. \nLimitations: The inherent retrospective and monocentric nature of the study \nand the lack of independence from individual variability of the results. \nEthics Committee Approval: IRB approved. \nFunding for this study: No funds. \nAuthor Disclosures: \nChiara Trentin: Nothing to disclose \nAnna Rotili: Nothing to disclose \nLuca Nicosia: Nothing to disclose \nSilvia Penco: Nothing to disclose \nValeria Dominelli: Nothing to disclose \nFilippo Pesapane: Nothing to disclose \nEnrico Cassano: Nothing to disclose \nGiorgio Maria Agazzi: Nothing to disclose \nMarta Montesano: Nothing to disclose \n \nRPS 302-2 \nDedicated axillary MRI-based radiomics analysis for the prediction of \naxillary lymph node metastasis in breast cancer \n*R. Granzier*¹, S. Samiei¹, A. Ibrahim¹, S. Primakov¹, M. B. I. Lobbes¹,  \nR. G. H. Beets-Tan², T. van Nijnatten¹, H. C. Woodruff¹, M. Smidt¹; \n¹Maastricht/NL, ²Amsterdam/NL  \n(r.granzier@maastrichtuniversity.nl) \n \nPurpose: To predict preoperative axillary lymph node metastasis in breast \ncancer patients using clinical models and radiomics models based on \nunenhanced T2-weighted (T2W) dedicated axillary MRI features with node-by-\nnode analysis \nMethods or Background: From August 2012 until October 2014, women who \nhad undergone a dedicated axillary T2W MRI(3.0T), followed by axillary \nsurgery, were retrospectively identified, and available clinical data were \ncollected. All axillary lymph nodes were manually delineated on the T2W MR \nimages, and quantitative radiomics features were extracted from the delineated \nregions. The data was partitioned patient-wise to train 100 models using \ndifferent splits for training and validation cohorts to account for multiple lymph \nnodes per patient and class imbalance. Features were selected in training \ncohorts using recursive feature elimination with repeated 5-fold cross-\nvalidation, followed by the development of random forest models. The \nperformance of the models was assessed using the area under the receiver \noperating characteristic curve (AUC). \nResults or Findings: 75 women with 511 axillary lymph nodes were included. \nOn final pathology, 36 of the lymph nodes had metastasis. A total of 105 \noriginal radiomics features were extracted from the T2W MR images. Each \ncohort split resulted in a different number of lymph nodes in the training cohorts \nand a different set of selected features. The performance of the 100 clinical \nand radiomics models showed a wide range of AUC values between 0.41-0.74 \nand 0.48-0.89 in the training cohorts, respectively, and between 0.30-0.98 and \n0.37-0.99 in the validation cohorts, respectively. With these results, it was not \npossible to obtain a final prediction model. \nConclusion: Clinical characteristics and dedicated axillary MRI-based \nradiomics with node-by-node analysis did not contribute to the prediction of \naxillary lymph node metastasis in breast cancer. \nLimitations: Skewed data, manual delineation \nEthics Committee Approval: Approved \nFunding for this study: Not applicable \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 163  \nAuthor Disclosures: \nMarjolein Smidt: Nothing to disclose \nMarc B I Lobbes: Nothing to disclose \nSanaz Samiei: Nothing to disclose \nHenry Christian Woodruff: Nothing to disclose \nAbdalla Ibrahim: Nothing to disclose \nRegina G. H. Beets-Tan: Nothing to disclose \nSergey Primakov: Nothing to disclose \nThiemo van Nijnatten: Nothing to disclose \nRenée Granzier: Nothing to disclose \n \nRPS 302-4 \nPotential of MR lymphography for lymph nodes (LN) staging in breast \ncancer \nA. Christenhusz, F. Simonis, N. de Vries, M. Hofman, A. Dassen, B. ten Haken, \n*L. Alic*; Enschede/NL \n(l.alic@utwente.nl) \n \nPurpose: Differentiation between healthy and malignant lymph nodes in breast \ncancer \nMethods or Background: Magnetic nanoparticles (MNs) enhanced MR \nlymphography is used for a minimally invasive preoperative detection of lymph \nnodes (LN). However, 80% of surgically dissected LNs are negative for \nmetastases. This study assesses the potential of MN-enhanced MR \nlymphography for preoperative LN staging. Sixteen invasive breast cancer \npatients (8 with and 8 without metastases) were included in this study. Prior to \nex vivo MRI, the patients received an intra-tumoral MN-injection containing 1.1-\n4.4 mg iron oxide. MRI settings include: T1-weighted (T1w,TR/TE = \n12.74/5.86ms) turbo field echo and T2-weighted (T2w, TR/TE = 2500/80ms) \nspin echo sequences. All SLNs were pathologically processed and H&E \nstained using a 5 level step-serial sectioning (200 ȝm intervals). Healthy and \nmalignant LNs were classified using signal intensities of ex vivo T1w and T2w \nscans quantified by four first order statistical (FOS) features (mean, median, \nskewness, entropy), five morphological features (volume, eccentricity, \ncurvature, circularity, spiculation), and four co-occurrence texture features \n(variance, correlation, angular moment, inverse moment). The significance was \nassessed using student’s t-test or Mann-Whitney U test. The four most \nsignificant features were used in a multiple discriminant analysis (MDA). \nResults or Findings: Statistical significance in classifying healthy and \nmetastatic LN was reached by texture feature (variance) based upon solely \nT1w-images, and by FOS features (median) and morphological (eccentricity) \nfeatures based upon solely T2w-images. MDA revealed a prediction sensitivity \nof 85.7% and specificity of 100%. \nConclusion: MN-enhanced MR lymphography provides sufficient classification \naccuracy to discriminate between healthy and metastatic LNs. \nLimitations: The limitations include the relatively low number of patients \nincluded, limited spatial resolution and the non- quantitative character of MRI \nsequences. \nEthics Committee Approval: Ethical committee approval (NL49285.044.14) \nregistered in the Dutch Trial Register (NTR4903). \nFunding for this study: InMediValue (under award number 122207) \nAuthor Disclosures: \nAnke Christenhusz: Nothing to disclose \nMarieke Hofman: Nothing to disclose \nLejla Alic: Nothing to disclose \nAnneriet Dassen: nothing to disclose \nBennie ten Haken: Nothing to disclose \nNynke de Vries: Nothing to disclose \nFrank Simonis: Nothing to disclose \n \nRPS 302-5 \nMRI-derived tumour-to-breast volume is associated with the extent of \nbreast surgery \n*A. Cozzi*, V. Magni, G. Della Pepa, S. Carriero, D. Spinelli, L. A. Carbonaro, \nS. Schiaffino, F. Sardanelli; Milan/IT \n(andrea.cozzi@gmail.com) \n \nPurpose: To assess the correlation between magnetic resonance imaging \n(MRI)-derived tumour-to-breast volume ratio (TBVR) and the performed \nsurgical strategy (breast-conserving surgery versus mastectomy). \nMethods or Background: All patients who had a biopsy-proven diagnosis of \nmalignancy and who underwent pre-operative breast MRI demonstrating a \nmass-like lesion between January 1st, 2013 and May 31st, 2019, were \nretrieved. TBVR was obtained using a fully manual method for segmenting the \ntumour volume (TV) and a growing region semiautomatic method for \nsegmenting the whole breast volume (WBV). Two specifically trained residents \n(R1 and R2), each of them with 2 years of breast MRI experience, \nindependently segmented T1-weighted images in 51 cancer cases in 51 \npatients (median age 57 years). Segmentation times and interobserver TBVR \nreproducibility was calculated. Mann-Whitney U test, Spearman correlation, \nand Bland-Altman statistics were used. \nResults or Findings: Breast conserving surgery was the surgical choice in \n31/51 (61%) patients, while 20/51 (39%) underwent mastectomy of the affected \nbreast. Strong correlations between TV and final pathology were found \n(Reader 1 ȡ=0.748, p<0.001; Reader 2 ȡ=0.778, p<0.001). Median TBVR was \n2.08‰ (interquartile range 0.70‰–9.13‰) for Reader 1, 2.28‰ (interquartile \nrange 0.71‰–9.61‰) for Reader 2, with an 84% inter-reader reproducibility. \nMedian segmentation times were 54 s for WBV and 141 s for TV. Significantly \nlower TBVR values were observed in the breast conserving surgery group \n(median 1.14‰, interquartile range 0.49‰–2.55‰) than in the mastectomy \ngroup (median 10.52‰, interquartile range 2.42‰–14.73‰) for both readers \n(p<0.001). \nConclusion: TBVR and its related metrics can be obtained from breast MRI \nwith good to high inter-reader reproducibility, also demonstrating a strong \ndirect relation between TBVR and subsequent surgical planning. \nLimitations: Single center, retrospective study, limited sample size, limited \nexperience of the two readers. \nEthics Committee Approval: Obtained (July 18th, 2019). \nFunding for this study: None. \nAuthor Disclosures: \nGianmarco Della Pepa: Nothing to disclose \nAndrea Cozzi: Nothing to disclose \nFrancesco Sardanelli: Grant Recipient: Bayer Healthcare Research/Grant \nSupport: General Electric Healthcare Speaker: Bracco Group \nSerena Carriero: Nothing to disclose \nDiana Spinelli: Nothing to disclose \nSimone Schiaffino: Speaker: General Electric Healthcare Other: Bracco \nImaging \nLuca Alessandro Alessandro Carbonaro: Nothing to disclose \nVeronica Magni: Nothing to disclose \n \nRPS 302-6 \nTowards contrast-free perfusion imaging in breast: feasibility of velocity-\nselective arterial spin labeling in breast cancer patients \n*S. L. Franklin*¹, H. Dankers¹, C. Bos², M. van Osch¹, N. Voormolen¹; \n¹Leiden/NL, ²Utrecht/NL \n(s.l.franklin@lumc.nl) \n \nPurpose: Breast MRI is a sensitive and specific tool in detection of breast \ncancer. Therefore, breast MRI is extremely valuable in breast cancer \nscreening, especially in women at increased risk. Dynamic contrast-enhanced \n(DCE-) MRI after administration of intravenous gadolinium-based contrast \nagents (GBCA) is an essential component of multi-parametric breast MR. \nHowever there are concerns related to repeated GBCA administration, e.g. \nretention, patient discomfort and cost. Velocity Selective Arterial Spin Labeling \n(VS-ASL) provides a measure of perfusion and vascularity without requiring \nGBCAs. VS-ASL is more suitable for the breast than traditional ASL-methods \nsince it can deal with slow blood flow and a complicated vascular bed by \nlabeling blood directly in the region of interest. \nMethods or Background: In this study ten patients (3 screening and 7 \nstaging) received a VS-ASL scan in addition to a regular MR-protocol including \nultrafast DCE-MRI and DWI. Scans were read by an experienced breast \nradiologist, and the relative VS-ASL signal increase at the tumor location was \ncalculated. \nResults or Findings: All five mass lesions showed a clear perfusion increase \non VS-ASL, anatomically concordant with perfusion on ultrafast DCE-MR within \n10 seconds after enhancement of the mammary artery. Two out of three non-\nmass lesions showed a moderate perfusion increase on VS-ASL,one did not. \nInterestingly, some scans showed a perfusion increase in a segmental pattern \nleading towards the tumor location in an adjacent slice, suggesting that VS-\nASL may provide additional information than is currently available. \nConclusion: Concluding, VS-ASL is a very promising technique for a GBCA-\nfree multi-parametric breast MRI protocol, adding specific vascular information. \nLimitations: Small group-size, the technique needs optimizations to deal with \ndense breast better. \nEthics Committee Approval: This study was approved by the local ethics \ncommittee and informed consent was obtained from all participants. \nFunding for this study: NWO ttw \nAuthor Disclosures: \nSuzanne Lisa Franklin: Nothing to disclose \nClemens Bos: Nothing to disclose \nMatthias van Osch: Nothing to disclose \nNora Voormolen: Nothing to disclose \nHenrike Dankers: Nothing to disclose \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 164  \nRPS 302-7 \nApparent diffusion coefficient mapping vs. the Kaiser score in the \nassessment of breast lesions: a multicentre comparison \n*M. Dietzel*¹, K. B. Krug², P. Clauser³, M. Hellmich², D. Maintz², M. Uder¹,  \nH. Bickel³, T. H. Helbich³, P. A. Baltzer³; ¹Erlangen/DE, ²Cologne/DE, \n³Vienna/AT \n \nPurpose: We compared the diagnostic-performance of apparent-diffusion-\ncoefficient (ADC) mapping with the Kaiser-score (KS) . \nMethods or Background: In this IRB approved multicentric study, consecutive \npatients from three different centers receiving standardized multiparametric \nbreast-MRI for standard nonscreening-indications were included. Experienced \nradiologists retrospectively interpreted the examinations in consensus and \napplied the KS to every histologically verified lesion. Corresponding mean-ADC \nwas measured (Wielema 4° region-of-interest). KS and ADC were combined, \nyielding the KS+ score as described previously. Diagnostic-accuracy was \nevaluated by the area-under-the-receiver-operating characteristics curve \n(ROC) and compared (KS vs. ADC vs. KS+; DeLong-test). Likewise the \npotential to avoid unnecessary biopsies was compared based on established \nhigh sensitivity thresholds (McNemar-test). \nResults or Findings: 450 lesions in 414 patients (mean-age: 51.5 years, \ninterquartile-range: 42–60.8 years) were included, with 219 lesions being \nmalignant [48.7%; 95%confidence-interval (CI): 44%–53.4%]. The KS (ROC: \n0.915, CI: 0.886–0.939) outperformed the ADC (ROC: 0.848; CI: 0.811–0.880; \nP<0.001). The use of the KS+ (ROC: 0.918; CI: 0.889–0.942) improved the \nperformance slightly, but without significant difference to a single KS or ADC \nreading (P=0.64). When applying high sensitivity thresholds for avoiding \nunnecessary biopsies, the KS and ADC achieved equal sensitivity (97.7% for \nboth; cutoff values: >4 for KS, ”1.4×10−3mm2/s for ADC). However, the rate of \npotentially avoidable biopsies was higher when using the KS (specificity: \n65.4% for KS vs. 32.9% for ADC; P < 0.0001). The KS was superior to the KS+ \nin avoiding unnecessary biopsies. \nConclusion: The KS outperformed the ADC in distinguishing benign from \nmalignant breast lesions. The KS may avoid twice as many unnecessary \nbiopsies. The combination of KS and ADC does not improve diagnostic-\nperformance. \nLimitations: Our data requires prospective validation, with special focus to \nclinical context (high risk? background-enhancement?) and technical \ndevelopments (new pulse-sequences? artificial intelligence?). \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nPascal A.T. Baltzer: Nothing to disclose \nHubert Bickel: Nothing to disclose \nDavid Maintz: Nothing to disclose \nThomas H. Helbich: Nothing to disclose \nMatthias Dietzel: Nothing to disclose \nMichael Uder: Nothing to disclose \nMartin Hellmich: nothing to disclose \nKathrin Barbara Krug: Nothing to disclose \nPaola Clauser: Nothing to disclose \n \nRPS 302-8 \nThe Kaiser score helps residents outperforming specialists in \ninterpreting breast MRI \n*N. Pötsch*, A. Korajac, P. D. Stelzer, P. Kapetas, R-I. Milos, T. H. Helbich,  \nP. Clauser, P. A. Baltzer; Vienna/AT \n \nPurpose: Due to its high sensitivity, DCE MRI of the breast (bMRI) is \nincreasingly used for both screening and assessment purposes. Differentiating \nbenign from malignant enhancements, even in the hands of experts, remains \nchallenging. The “Kaiser Score” (KS) was shown to facilitate characterization of \nenhancing breast lesion, potentially avoiding misdiagnosis and unnecessary \nbiopsies. The aim was to evaluate the diagnostic performance of residents \nusing the KS compared to expert radiologists in interpreting bMRI. \nMethods or Background: Three board certified radiologists, with more than \n15 years of experience, interpreted bMRI according to the five-point BI-RADS \nscale. The same studies were read by three radiology residents, without \nspecific training in breast imaging, using the KS. To ensure comparability, the \nresidents were aware of the location of the lesions rated by the experts. All \nreaders were blinded to clinical information. Histology was used as gold \nstandard. Ratings were dichotomized assigning (i) BI-RADS 1-3 corresponding \nto a KS 1-4 to benign and (ii) BI-RADS 4 and 5 related to a KS 5-12 to \nsuspicious. Statistical analysis was done by comparing the AUC of the ROC \ncurves. \nResults or Findings: A total of 80 women (mean 54.3 ± 11.2 years) with 93 \nlesions (32 benign, 61 malignant) were included. There was no significant \ndifference in the performance between the three expert readers (AUC 0.723-\n0.742, p>0.72) and a borderline significance in the performance in-between the \nthree residents (AUC 0.842-0.928, p=0.03 resp. p>0.08). The rating of each \nresident using the KS significantly outperformed the experts’ ratings using the \nBI-RADS scale (p <0.01 – 0.05). \nConclusion: Using the KS allowed untrained residents to achieve better \nresults in interpreting bMRI than expert readers using BI-RADS. \nLimitations: Retrospective analysis, cancer enriched database. \nEthics Committee Approval: Approved by local ethics committee. \nFunding for this study: None. \nAuthor Disclosures: \nPascal A.T. Baltzer: Nothing to disclose \nNina Pötsch: Nothing to disclose \nHerr Philipp Dominik Stelzer: Nothing to disclose \nAida Korajac: Nothing to disclose \nThomas H. Helbich: Nothing to disclose \nRuxandra-Iulia Milos: Nothing to disclose \nPanagiotis Kapetas: Nothing to disclose \nPaola Clauser: Nothing to disclose \n \nRPS 302-9 \nMultidimensional diffusion MRI of breast tumours: initial findings \n*I. Daimiel Naranjo*¹, A. Reymbaut², P. Brynolfsson², S. Thakur¹, R. Lo Gullo¹, \nD. Topgaard², E. A. Morris¹, K. Pinker-Domenig¹; ¹New York, NY/US, ²Lund/SE \n \nPurpose: To apply multidimensional diffusion (MDD) MRI to breast tumors, \nquantifying their composition through imaging biomarkers related to cell \ndensities, shapes, and orientations. \nMethods or Background: Sixteen patients with suspected breast tumors \nconsented to undergo a breast-MRI including MDD using a customized spin-\necho EPI sequence performed on a GE MR750 3T scanner with 16-channel \nbreast coils. Histopathology was used as gold standard yielding 1 invasive \nlobular carcinoma, 2 ductal carcinomas in situ, 8 invasive ductal carcinomas \n(IDC) and 5 IDCs with extensive in situ component. Per-case parameter maps \nwere generated featuring MDD-derived metrics such as “mean size” E[Diso] \n(comparable to conventional ADC), “mean shape” E[D¨2] (measuring \nmicroscopic anisotropy) and signal fractions from tissue-specific bins \nassociated with elongated cells (fbin1), isotropic cells (fbin2) and free water \n(fbin3). Tumor ROIs were also drawn in glandular tissue using b=700s/mm2 \nMDD images (Sb700). \nResults or Findings: Cancers were characterized by low E[Diso], and high \nSb700, E[D¨2], and fbin1. Tumor-ROI analysis yielded a 10th percentile of \nADC=1±0.46 x10-3mm2/s, in agreement with literature. It also gave \nE[D¨2]=0.47±0.15 and fbin1=0.53±0.27 significantly different than values in \nglandular tissue, E[D¨2]=0.27±0.11 and fbin1=0.17±0.14, respectively (Mann-\nWhitney U-test, p<0.001). Importantly, tumors were invisible in fractional \nanisotropy (FA) maps, because they lack orientational coherence (quantified \nby orientational order parameter OP). \nConclusion: MDD could distinguish breast cancer from glandular tissue within \nfeasible scan times, providing both conventional ADC consistent with literature \nand novel metrics reporting on specific microstructural tissue features. Further \nstudies evaluating correlation with histopathology/immunohistochemistry are \nguaranteed. \nLimitations: Small number of cases prevented detailed correlation of \nconventional and MDD-derived metrics with tumor grade/molecular profile. \nEthics Committee Approval: Memorial Sloan Kettering IRB-approved. \nFunding for this study: NIH/NCI Cancer Center Support \nGrant(P30CA008748), Breast Cancer Research Foundation, Swedish \nFoundation for Strategic Research (ITM17-0267), Swedish Research Council \n(2018-03697) and Foundation Alfonso Martin Escudero. \nAuthor Disclosures: \nKatja Pinker-Domenig: Nothing to disclose \nElizabeth A. Morris: Nothing to disclose \nPatrik Brynolfsson: Employee: RWI holds patents related to the described \nmethods \nRoberto Lo Gullo: Nothing to disclose \nSunitha Thakur: Nothing to disclose \nDaniel Topgaard: Shareholder: RWI \nIsaac Daimiel Naranjo: Nothing to disclose \nAlexis Reymbaut: Employee: RWI holds patents related to the described \nmethods \n \nRPS 302-10 \nPositive MRI findings in breast cancer patients with pathologic complete \nresponse after neoadjuvant chemotherapy \n*S. Erdemli*¹, F. Taúkin¹, ø. H. Erdo÷du², F. Tokat¹, K. Behzato÷lu¹, \nN. Meydan², L. Özer¹, A. Arıcan¹, C. Uras¹; ¹Istanbul/TR, ²Aydın/TR \n(srvterdemli@gmail.com) \n \nPurpose: To evaluate the MRI findings of breast cancer patients received \nneoadjuvant chemotherapy(NAC) with radiologic partial response(RPR) and \npathologic complete response(PCR) \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 165  \nMethods or Background: In this two-center, retrospective study, imaging and \nhistopathology records of breast cancer patients with RPR and PCR after NAC \nwere evaluated. MRI interpretation included lesion morphology at baseline, \nchanges in morphology, size, and contrast uptake kinetics. PCR was defined \nas the absence of invasive tumor cells in the resected breast specimen. \nResults or Findings: MRI examinations were performed in 108 women before \nand after NAC. RPR were found in 72 HER-2-positive (66.7%:39 hormone \nreceptor (HR) positive, 33 HR negative), 21 (19.4%) HR-positive/HER-2-\nnegative, and 15 (13.9%) triple-negative (TN) breast cancer patients. Findings \nof MRI after NAC were 53 (49%) non-mass enhancement (NME), 39 (36%) \nfoci, and 16 (%15) masses. Ductal carcinoma in situ (DCIS), lobular carcinoma \nin situ, sclerosing adenosis, and fibrosis were the most common lesions found \nin specimens. The most common MRI findings were foci in HER-2-positive \ndisease and NME in HR-positive and TN disease. \nConclusion: While interpreting MRI after NAC in breast cancer patients, the \npresence of contrast enhancement in the original tumor region is considered as \nRPR. In PCR cases, positive MRI findings can be related to the presence of \nDCIS or other benign proliferative conditions in the original tumor region. \nLimitations: The retrospective nature and the limited number of patients are \nthe major limitations of our study. \nEthics Committee Approval: We applied for institutional ethics committee \napproval. \nFunding for this study: No funding was received for this work. \nAuthor Disclosures: \nøbrahim Halil Erdo÷du: Nothing to disclose \nServet Erdemli: Nothing to disclose \nCihan Uras: Nothing to disclose \nKemal Behzato÷lu: Nothing to disclose \nFüsun Taúkin: Nothing to disclose \nLeyla Özer: Nothing to disclose \nAli Arıcan: Nothing to disclose \nNezih Meydan: Nothing to disclose \nFatma Tokat: Nothing to disclose \n \nRPS 302-11 \nFeasibility of computer-assisted triaging of MRI-guided biopsy in \npreoperative breast-cancer patients \n*H. Wang*, B. van der Velden, M. A. A. Ragusi, W. B. Veldhuis, M. Viergever, \nE. Verburg, K. Gilhuijs; Utrecht/NL \n \nPurpose: Additional breast lesions (i.e., incidental lesions in addition to the \nindex cancer) detected on MRI pose challenges in the preoperative workup of \npatients with early breast cancer. Our aim is to assess the sensitivity of \ncomputer-assisted triaging of patients with additional breast lesions on \npreoperative breast MRI to MRI-guided breast biopsy with high specificity. \nMethods or Background: We investigated 316 consecutive patients with early \nbreast cancer who received preoperative multiparametric breast MRI between \n2013 and 2016, 82 patients had 101 additional lesions (51 were benign and 50 \nwere malignant). We collected 4 clinical features, and 46 MRI radiomic features \nfrom T1-weighted dynamic contrast-enhanced (DCE) imaging, high-temporal-\nresolution DCE, T2-weighted, and diffusion-weighted imaging. A \nmultiparametric computer-aided diagnosis (CAD) model was constructed from \nthis training set using 10-fold cross validated ridge regression. The sensitivity \nwas calculated at operating point corresponding to 98% specificity. The model \ncalibration performance was evaluated by calibration-plot analysis and \ngoodness-of-fit tests. The model was tested in an independent cohort of 187 \nconsecutive patients from 2017 and 2018. In this testing cohort, 45 patients \nhad 55 additional lesions (23 were benign and 32 were malignant). \nResults or Findings: The multiparametric CAD identified 48% of the \nmalignant additional lesions with specificity of 98%. Calibration analysis \nindicated the model was well fitted. In the testing cohort, the specificity was \n96% and sensitivity 44% at the operating point of the training set. \nConclusion: Our multiparametric CAD demonstrated potential to triage \npatients to MRI-guided breast biopsy. Malignant additional lesions were \nidentified with near-perfect specificity in approximately half the population of \npreoperative patients originally indicated for a breast biopsy. In the remaining \nhalf, patients would still continue to MRI-guided biopsy to confirm absence of \nmalignancy. \nLimitations: No external validation \nEthics Committee Approval: Ethical review waived \nFunding for this study: None \nAuthor Disclosures: \nHui Wang: Nothing to disclose \nKenneth Gilhuijs: Nothing to disclose \nMax Viergever: Nothing to disclose \nBas van der Velden: Nothing to disclose \nWouter B. Veldhuis: Nothing to disclose \nErik Verburg: Nothing to disclose \nMax A A Ragusi: Nothing to disclose \n \nRPS 302-12 \nBreast MR biomarkers in benign and malignant tumours of the diseased \nand contralateral healthy breast \nR. E. Ochoa Albíztegui¹, J. V. M. Horvat¹, S. Thakur¹, I. Daimiel Naranjo¹, \nR. Lo Gullo¹, E. A. Morris¹, T. H. Helbich², *K. Pinker-Domenig*¹; ¹New York, \nNY/US, ²Vienna/AT \n(eochoa.albiztegui@gmail.com) \n \nPurpose: To assess if imaging biomarkers at dynamic contrast-enhanced \nmagnetic resonance imaging (DCE-MRI) are different for the contralateral \nhealthy breast than the diseased breast in patients with benign and malignant \ntumors. \nMethods or Background: One hundred consecutive patients who underwent \nDCE-MRI of the breast for the assessment of a BI-RADS 4-5 lesion on \nconventional image were included in this IRB approved study. Biomarkers for \nhealthy and diseased breast were evaluated by two independent readers and \nrecorded as BPE (background parenchymal enhancement) and fibroglandular \ntissue (FGT). Histopathology was used as standard of reference. Appropriate \nstatistics were used to assess the difference between biomarkers on patients \nwith benign and malignant lesions. \nResults or Findings: There were 33 benign and 67 malignant breast lesions. \nIn patients with malignant tumors, BPE was minimal in 42/51, mild in 16/33, \nmoderate 6/11, and marked 3/5. In patients with benign tumors, BPE was 9/51, \nmild in 17/33, moderate 5/11, and marked 2/5. BPE of contralateral healthy \nbreast (p=0.01) and BPE of diseased breast (p=<0.01) was statistically \nsignificantly different between benign and malignant tumors. FGT of \ncontralateral healthy breast (p=0.26) and diseased breast (p=0.19) showed no \ndifference between benign and malignant tumors. \nConclusion: BPE is decreased in patients with malignant tumors in the \ncontralateral healthy breast. There is no difference in FGT of contralateral \nhealthy breast in patients with benign and malignant tumors. BPE in both \nbreasts (disease and healthy breast) is significantly different in malignant and \nbenign lesions. \nLimitations: Patients were from a single center. \nEthics Committee Approval: Yes, Approved. \nFunding for this study: The Breast Cancer Research Foundation, and Susan \nG. Komen \nAuthor Disclosures: \nJoao Vicente Machado Horvat: nothing to disclose \nKatja Pinker-Domenig: nothing to disclose \nThomas H. Helbich: nothing to disclose \nElizabeth A. Morris: nothing to disclose \nRoberto Lo Gullo: nothing to disclose \nSunitha Thakur: nothing to disclose \nIsaac Daimiel Naranjo: nothing to disclose \nR. Elena Ochoa Albíztegui: nothing to disclose \n \nRPS 302-14 \nAdding b2500 diffusion-weighted imaging to BI-RADS improves \nspecificity of breast MRI \n*L. Saccenti*, Z. Jolibois, M. Scholer, C. De Bazelaire; Paris/FR \n \nPurpose: Evaluation of diagnostic performances of visual b2500 DWI \nassessment in addition to conventional breast MRI protocol \nMethods or Background: This single-institution retrospective study included \npatients who underwent a breast MRI examination on a 1.5T system from May \n2017 to February 2020. The examination was composed of a conventional \nprotocol (T1 and T2-weighted sequences, dynamic-contrast enhanced imaging \nand b0-b800 DWI) and of a b2500 DWI sequence. Lesions were classified \nbased on the conventional protocol using BI-RADS categories. 3 independent \nradiologists then assessed visually b2500 DW images. The diagnostic \nperformances of b2500 DWI assessment, BI-RADS categories, ADC value and \nof a model combining b2500 DWI assessment and BI-RADS categories, were \nevaluated by using ROC analysis. Specificity and sensitivity were computed. \nResults or Findings: 260 patients with 212 malignant and 100 benign lesions \nwere included. Interobserver agreement for b2500 DWI assessment was \nsubstantial (Fleiss Kappa = 0.77). Area under the curve (AUC) of ROC curve of \nthe model combining b2500 DWI and BI-RADS was 0.84 versus 0.81 for BI-\nRADS alone (P=0.34). Specificity of the combined model was higher than BI-\nRADS alone (73% versus 25%, P<0.001) but sensibility was lower (94% \nversus 100%, P<0.001). AUC of b2500 DWI was higher (0.81 than AUC of \nADC (0.71, P=0.14). Specificity of b2500 DWI was higher than ADC (69% \nversus 48%, P<0.001) but sensibility was lower (93% versus 94%, P=0.04). \nConclusion: Visual assessment of b2500 DWI has substantial interobserver \nagreement. Combining b2500 DWI assessment to BI-RADS categories \nsignificantly improves specificity of breast MRI compared to BI-RADS \ncategories alone. Visual assessment of B2500 DWI also presents higher \nspecificity than ADC values. \nLimitations: Only patients with histopathologic results were included \nSingle-institution study with over representation of high-risk patients \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 166  \nEthics Committee Approval: French Ethics Committee for Research in \nImaging (CRM-2005-090) \nFunding for this study: None \nAuthor Disclosures: \nMargaux Scholer: Nothing to disclose \nZoe Jolibois: Nothing to disclose \nLaetitia Saccenti: Nothing to disclose \nCedric De Bazelaire: Nothing to disclose \n \nRPS 302-15 \nEvaluation of high-risk (B3) breast lesions on MRI: the role of \nconventional and texture analysis features in predicting upgrade to \nmalignancy \n*T. Aybal*¹, O. Bu÷daycı¹, M. E. Aribal¹, H. Kaya¹, M. U. Ugurlu¹, C. Ilgin¹,  \nB. Ö. Demirci²; ¹Istanbul/TR, ²Siirt/TR \n(tahsinaybal89@gmail.com) \n \nPurpose: To investigate the potential of malignancy associated with high-risk \nbreast lesions using breast MRI characteristics, ADC measurements and \ntexture analysis parameters. \nMethods or Background: Our retrospective study included 40 patients with 41 \nlesions who were diagnosed with a high-risk lesion after needle biopsy. All \npatients underwent surgery. According to histopathological results of surgical \nexcision, patients were divided into two groups as those diagnosed with \nmalignancy and those who did not. MRI characteristics of the breast and the \nlesions (breast pattern, background parenchymal enhancement, lesion type \nand size, lesion kinetic pattern) were recorded. ADC values of the lesions were \nmeasured. Texture analysis of lesions was performed. \nResults or Findings: Fourteen lesions (34.1%) were upgraded to malignancy. \nThe median ADCmean values in the group with malignancy were 1.114 x 10-3 \nmm2/s vs 1.383 x 10-3 mm2/s in the non-malignant group which was \nstatistically significant (p <0.001). When the cut-off value for the mean ADC \nwas taken as 1.163 x 10-3 mm2/s, the sensitivity and specificity were % 71.4 \nand % 85.2, respectively. The AUC value of ADCmean was calculated as \n0.844 by ROC analysis. Among the texture analysis parameters, kurtosis \nvalues obtained from images on the ADC map and first subtracted dynamic \ncontrast-enhanced (DCE) series and contrast values obtained from images on \nthe second subtracted DCE series were found to be statistically significant (p = \n0.016 ; p = 0.019 and p= 0.045 respectively) between malignant and non-\nmalignant groups. \nConclusion: ADC measurements and texture analysis parameters provide \nuseful diagnostic information in determining which high-risk breast lesions will \nupgrade to malignancy. \nLimitations: Retrospective study and low number of samples \nEthics Committee Approval: The local Medical Ethical Committee permission \n(09.2019.255) was obtained. \nFunding for this study: No funding was received for this work. \nAuthor Disclosures: \nMustafa Erkin Aribal: Nothing to disclose \nHandan Kaya: Nothing to disclose \nMustafa Umit Ugurlu: Nothing to disclose \nCan Ilgin: Nothing to disclose \nOnur Bu÷daycı: Nothing to disclose \nBurcu Özdemir Demirci: Nothing to disclose \nTahsin Aybal: Nothing to disclose \n \nRPS 302-17 \nAssociations of non-contrast breast MRI biomarkers with benign and \nmalignant breast tumours \nR. E. Ochoa Albíztegui¹, J. V. M. Horvat¹, S. Thakur¹, I. Daimiel Naranjo¹, \nR. Lo Gullo¹, E. A. Morris¹, T. H. Helbich², *K. Pinker-Domenig*¹; ¹New York, \nNY/US, ²Vienna/AT \n(eochoa.albiztegui@gmail.com) \n \nPurpose: To investigate non-contrast MRI biomarkers and their association \nwith breast tumors. \nMethods or Background: Two readers independently evaluated 100 \nconsecutive patients who underwent multiparametric breast MRI at 3T with \nDCE and DWI for the assessment of a BI-RADS 4/5 lesion. Breast tumors were \nassessed for localization (in FGT, in fat or at the fat/FGT plane), T2 signal \nintensity, presence of tumoral edema and DWI signal intensity pattern \n(homogeneous, heterogeneous, rim). The amount of fibroglandular tissue \n(FGT) and background parenchymal enhancement (BPE) was recorded. \nAppropriate statistics to determine associations of un-enhanced MRI \nbiomarkers with malignancy were performed. \nResults or Findings: There were 33 benign and 67 malignant lesions. \nMalignant and benign tumors localization was significantly different p=<0.01. \nMalignant tumors were less likely localized as the FGT (n=2, 2.9%) and more \nlikely localized in fat (n=57, 85%) or at the fat/FAT plane (n=8, 11.9%). Odds \nRatio (OR) of malignant tumor localization in fat is 19.99 (p=<0.01) and fat/FG \nplane 13.57 (p=<0.01). Malignant tumors showed a rim pattern OR 14.7 (n=10, \n14.9%) and an heterogeneous DWI pattern OR 8.4 (n=40, 59%) rather than an \nhomogeneous DWI pattern (n=17, 25%). Peritumoral edema was skin in 30 \n(44.77%) of malignant tumors OR 12 (95%CI 2-56) p=<0.01 and in only 2 \n(6.25%) of benign tumors. Both benign (78%) and malignant (86%) tumors \npresented mostly with minimal/mild BPE (p=0.010). FGT was not different \nbetween benign and malignant tumors (p=0.186). \nConclusion: Malignant tumors are more likely to be located at the FGT/fat \nplane presenting with peritumoral edema and DWI heterogeneous or rim signal \nintensity pattern than benign tumors. \nLimitations: Single center study. \nEthics Committee Approval: Yes. \nFunding for this study: The Breast Cancer Research Foundation, and Susan \nG. Komen \nAuthor Disclosures: \nJoao Vicente Machado Horvat: Nothing to disclose \nKatja Pinker-Domenig: Nothing to disclose \nThomas H. Helbich: nothing to disclose \nElizabeth A. Morris: Nothing to disclose \nRoberto Lo Gullo: Nothing to disclose \nSunitha Thakur: Nothing to disclose \nIsaac Daimiel Naranjo: Nothing to disclose \nR. Elena Ochoa Albíztegui: Nothing to disclose \n \nRPS 302-18 \nFeasibility study of 2D MR fingerprinting (MRF) of breast cancer \n*E. Zanderigo*, T. Nolte, M. Broeckmann, D. Truhn, V. Schulz, C. K. Kuhl; \nAachen/DE \n(ezanderigo@ukaachen.de) \n \nPurpose: To establish and validate 2D blurring-corrected magnetic resonance \nfingerprinting (MRF) of breast cancer and normal fibroglandular tissue (FGT). \nMethods or Background: On a clinical 1.5T system, 14 women with breast \ncancer underwent a standardized multiparametric MRI protocol including a \ndynamic series before and 4 times after 0.1mmol/kg-BW Gadobutrol. Before \nand after the dynamic series, a single-slice 2D MRF sequence was performed \nover the area of the breast cancer. Three MRF trains with a length of 500 TR \nintervals, variable flip angles, constant TR=21 ms, and different but constant \nTE (TE1/TE2/TE3 = 4.6/6.9/9.2 ms) were acquired using undersampled spiral \nreadout. After 3-pt Dixon water-fat separation and spiral off-resonance blurring \ncorrection, fat signal was discarded and water T1 and T2 maps were \nreconstructed. For further quantitative analysis of MRF data, a ROI was drawn \nthat included the tumor on subtraction images and copied onto the MRF voxel \ngrid; for analysis of FGT, a ROI was placed into the contralateral, healthy \nbreast. The differences between mean T1 and T2 values of breast cancer vs. \nFGT and the respective difference after contrast injection were tested for \nsignificance by two tailed student t-test, setting alpha=5%. \nResults or Findings: In agreement with our expectation, pre-contrast T1 \nvalues of breast cancer were significantly longer than those of healthy FGT \n(mean, 1147±12 ms vs. 1052±95 ms) (p=0.007); the same was true for T2 \nvalues (83±14 ms vs 73±12 ms) (p=0.03). Post-contrast T1 values of healthy \ntissue were significantly longer than those of cancerous one (mean \n690.31±200.34 ms vs. 367.32±121.49 ms) (p=0.0005). Post contrast T2-values \nwere not significantly different. \nConclusion: Our quantitative T1 and T2 times of breast cancer and normal \nFGT before and after contrast injection are in agreement with expectations. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nEloisa Zanderigo: Nothing to disclose \nChristiane K. Kuhl: Nothing to disclose \nTeresa Nolte: Nothing to disclose \nVolkmar Schulz: Nothing to disclose \nDaniel Truhn: Nothing to disclose \nMirjam Broeckmann: Nothing to disclose \n \nRPS 302-19 \nBackground parenchymal enhancement on breast MRI in patients \nundergoing neoadjuvant chemotherapy: the association with tumour \nresponse and recurrence-free survival \n*C. Costanza*, M. Durando, G. Bartoli, G. Mariscotti, L. Bergamasco, P. Fonio; \nTurin/IT \n(dott.claudiacostanza@gmail.com) \n \nPurpose: To investigate whether background parenchymal enhancement \n(BPE) on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) \nis associated with patients’ outcomes following neoadjuvant chemotherapy \n(NCT) in locally advanced breast cancer \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 167  \nMethods or Background: We retrospectively included 93 consecutive women \n(mean age 51 years) with unilateral invasive breast cancer, who underwent \nNCT between March 2014 and December 2019. All patients underwent breast \nMRI examination before, during and post-NCT, before curative surgery. MRI \nfeatures (BPE of the contralateral breast, lesions’ characteristics) and \nclinicopathologic features (menopausal status, breast density, histological type, \nmolecular subtype, nuclear grade) were analyzed. Patients were grouped \naccording to BPE category (high[moderate or marked] or low[minimal or mild]). \nCox regression modeling was used to determine associations between MRI \nfeatures and recurrence-free survival(RFS) after controlling for \nclinicopathologic variables \nResults or Findings: The pathological tumor response after NCT was \ncomplete (pCR) in 36/93(38.7%) patients and non-complete(non-pCR) \nincluding partial and no-response in 57/93(61.3%). Considering pCR, we found \nstatistically significant association with HER2 positive cases. Other clinical-\npathological characteristics had no statistically significant association with \ntumor response. The mean follow-up period was 27 months. Twenty \nrecurrences occurred(11 loco-regional,9 distant). On multivariate analysis, high \nBPE on pre-NCT MRI was an independent variable associated with \nrecurrence. Patients with dense breast had a poorer RFS than patients with \nnon-dense breast, with statistically significant difference (p=0,01), as well as \npatients with triple negative cancer than patients with other molecular \nsubtypes(p=0,03), patients with high pre-NCT BPE than patients with low pre-\nNCT BPE (p=0,01) and patients with high nuclear grade cancer(p=0,02) \nConclusion: Our results suggest that BPE on pre-NCT DCE-MRI may have \npotential as a predictor of long-term outcomes in breast cancer patients who \nundergo NCT, representing a risk factor significantly associated with \nrecurrence \nLimitations: Single-institution retrospective study \nEthics Committee Approval: Not applicable \nFunding for this study: Nothing \nAuthor Disclosures: \nManuela Durando: Nothing to disclose \nGiovanna Mariscotti: Nothing to disclose \nPaolo Fonio: Nothing to disclose \nLaura Bergamasco: Nothing to disclose \nClaudia Costanza: Nothing to disclose \nGermana Bartoli: Nothing to disclose \n \nRPS 302-20 \nPreoperative staging in breast cancer: contrast-enhanced MRI vs digital \nbreast tomosynthesis (DBT) evaluated together with unenhanced MRI \n(UE-MRI) \n*V. Rizzo*, F. Galati, G. Moffa, E. Kripa, C. Caramanico, G. Panzironi, \nF. Pediconi; Rome/IT \n(nican66@gmail.com) \n \nPurpose: To evaluate the accuracy in tumor extent, size assessment and \ndetection of additional lesions of Digital Breast Tomosynthesis \n(DBT)+Unenhanced Magnetic Resonance Imaging (UE-MRI) compared to \nPostcontrast-MRI, in women with known breast cancer. Histology is considered \nthe gold standard. \nMethods or Background: A retrospective analysis was performed on 79 \npatients with histological diagnosis of breast cancer, who had performed DBT \nprojections and 3.0 T MRI over 2016-2017 in our Institution. Two breast \nradiologists, with 15 and 7 years of experience respectively, reviewed DBT and \nMRI (including DWI, T2-w and T1-w, before and after contrast agent \nadministration, sequences) in separate reading sections, unaware of the final \nhistological examination. MRI and DBT+UE-MRI sensitivity, PPV and accuracy \nwere calculated. Inter-reader agreement was evaluated using Cohen’s Kappa. \nSpearman correlation were used to evaluate post-contrast MRI vs Histology, \nDBT+UE-MRI vs Histology and post-contrast MRI vs DBT+UE-MRI lesions \ntumor size agreement to histological results. \nResults or Findings: Of a total of 79 patients, 104 lesions were confirmed on \nhistological examination. Post-contrast MRI showed 100% sensitivity, 96% \nPPV and 96% accuracy while DBT+UE-MRI achieved an average sensitivity of \n81%, PPV of 92% and accuracy of 77%. Regarding inter-reader agreement, k \nwas substantial for MRI (k=0,69) and DBT+UE-MRI (k=0,75) for detection rate. \nLesions size Spearman correlation coefficient was 0.97 for Post-Contrast MRI \nvs Histology, 0.92 for DBT+UE-MRI vs Histology, (p-value<0.0001). MRI vs \nDBT+UE-MRI regression coefficient was 0.83. \nConclusion: In preoperative study of breast cancer post-contrast MRI is the \nmost accurate imaging technique. However, DBT evaluated together with \nunenhanced sequences showed to be very accurate, with a good sensitivity \nand tumor size assessment and it could be a valid tool for preoperative staging \nwhen the use of contrast agents is contraindicated. \nLimitations: Not applicable \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \n \n \nAuthor Disclosures: \nGiuliana Moffa: Nothing to disclose \nVeronica Rizzo: Nothing to disclose \nClaudia Caramanico: Nothing to disclose \nGiovanna Panzironi: Nothing to disclose \nFrancesca Galati: Nothing to disclose \nEndi Kripa: Nothing to disclose \nFederica Pediconi: Nothing to disclose \n \nRPS 302-21 \nComparison of 3 abbreviated breast MRI protocols in a screening \npopulation: a reader study \n*I. Allajbeu*¹, R. Pintican², P. L. Moyle¹, V. Papalouka¹, G. C. Baxter¹,  \nF. J. Gilbert¹; ¹Cambridge/UK, ²Cluj/RO \n(ia359@cam.ac.uk) \n \nPurpose: To evaluate the diagnostic performance of abbreviated breast (ABB) \nMRI with a non contrast examination and with a subtracted first post contrast \nMIP only. \nMethods or Background: A retrospective reader study was conducted using \nbreast MRI examinations from 52 patients with 26 (50%) normal examinations, \nbiopsy proven benign pathology in 12 (23%) and breast cancer <15 mm in size \nin 14 (27%). The three MRI protocols (ABB-MRI - T1WI pre and post contrast, \nT2WI, DWI/ADC; T2WI + DWI/ADC; subtracted first post contrast MIP) were \nindependently evaluated by 3 radiologists (R - beginner with 2 years \nexperience and P & V - readers with > 10 years experience). BIRADS grading \nwas used to score each protocol into suspicious (BIRADS 4,5) or non-\nsuspicious (BIRADS 1,2,3). At least 4 week gap was left between protocols. \nResults or Findings: Diagnostic accuracy was 0.90 (experienced) and 0.86 \n(beginner) for MIP only protocol, 0.94 (experienced) and 0. 88 (beginner) for \nABB MRI protocol, and 0.86 for non contrast protocol, both experienced and \nbeginner. There was a good agreement between readers with the MIP series \nwith an intraclass correlation coefficient of 0.842 (95% CI 0.743 – 0.906), \np<0.001. Good agreement between readers was found with the ABB-MRI \nprotocol, intraclass correlation coefficient being 0.858 (95% CI 0.773 – 0.915), \np<0.001.The best agreement was found with the T2/DWI protocol, the \nintraclass correlation coefficient being 0.900 (95% CI 0.842 – 0.939), p<0.001. \nThe average reading time was shortest for MIP (12 sec), followed by T2+DWI \n(34 sec) and ABB-MRI protocol (41 sec). \nConclusion: Diagnostic accuracy was highest for the ABB MRI protocol. The \nnon-contrast protocol achieved similar results for all 3 readers but was \nconsistently poorer \nLimitations: One center Study  \nSmall number of patients \nEthics Committee Approval: Mixed case \nFunding for this study: Na \nAuthor Disclosures: \nPenelope Laura Moyle: Nothing to disclose \nFiona J. Gilbert: Research/Grant Support: GE funding for research Grant \nRecipient: GE Funding for Research Investigator: GE Funding for research \nIris Allajbeu: Nothing to disclose \nVasiliki Papalouka: Nothing to disclose \nRoxanna Pintican: Nothing to disclose \nGabrielle Carmen Baxter: Nothing to disclose \n \n \nResearch Presentation Session: Breast \nRPS 402 \nDiagnosing breast cancer \nRPS 402-1 \nDiagnostic performance of non-invasive imaging for assessment of \naxillary pathologic complete response after neoadjuvant systemic \ntherapy in clinically node-positive breast cancer: a meta-analysis \n*C. M. de Mooij*¹, S. Samiei¹, M. B. I. Lobbes², K. Keymeulen¹,  \nT. van Nijnatten¹, M. Smidt¹; ¹Maastricht/NL, ²Sittard-Geleen/NL  \n(c.demooij@maastrichtuniversity.nl) \n \nPurpose: Neoadjuvant systemic therapy (NST) can lead to downstaging of \naxillary lymph node disease. Imaging can potentially provide information about \nthe axillary response to NST and, consequently, tailor the surgical \nmanagement. The purpose of this study was to perform a systematic review \nand meta-analysis to determine the diagnostic performance of current \nnoninvasive imaging modalities for assessment of axillary response after NST \nin clinically node-positive breast cancer patients. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 168  \nMethods or Background: PubMed and Embase were searched for studies \nthat compared noninvasive imaging after NST with axillary surgery outcome to \nidentify axillary response in patients with initial pathologically proven axillary \nlymph node metastasis. Two reviewers independently screened the studies \nand extracted the data. A meta-analysis was performed by computing the \npooled sensitivity, specificity, positive predictive value (PPV), and negative \npredictive value (NPV). \nResults or Findings: Thirteen studies describing 2380 patients were included \nfor final analysis. Of these patients, 1322 had undergone axillary ultrasound, \n849 breast MRI, and 209 whole-body 18F-FDG PET-CT. The overall axillary \npathologic complete response (pCR) rate was 39.5% (941/2380). For axillary \nultrasound, the pooled sensitivity, specificity, PPV, and NPV were 65%, 69%, \n77%, 50%, respectively. For breast MRI, the pooled sensitivity, specificity, \nPPV, and NPV were 60%, 76%, 78%, 58%, respectively. For whole-body 18F-\nFDG PET-CT, the pooled sensitivity, specificity, PPV, and NPV were 38%, \n86%, 78%, 49%, respectively. \nConclusion: The diagnostic performance of current noninvasive imaging \nmodalities is limited to accurately assess axillary response after NST in \nclinically node-positive breast cancer patients. \nLimitations: The most important limitations of this meta-analysis are the \nheterogeneity between the included studies and the differences in NST \nregimens, type of axillary surgery, and definition of axillary pCR among the \nincluded studies. \nEthics Committee Approval: Not applicable. \nFunding for this study: No funding to disclose. \nAuthor Disclosures: \nMarjolein Smidt: Nothing to disclose \nKristien Keymeulen: Nothing to disclose \nCornelis Maarten de Mooij: Nothing to disclose \nMarc B I Lobbes: Nothing to disclose \nThiemo van Nijnatten: Nothing to disclose \nSanaz Samiei: Nothing to disclose \n \nRPS 402-2 \nAssessment on contrast-enhanced cone beam breast CT (CE-CBBCT): \ncharacteristics of breast cancers \n*Y. Ma*, A. Liu, Z. Ye; Tianjin/CN  \n(myue0205@163.com) \n \nPurpose: To assess the CE-CBBCT characteristics of breast cancers \ncompared with breast MRI and mammograms. \nMethods or Background: This retrospective study enrolled the patients who \nunderwent preoperative CE-CBBCT, breast MRI and mammography, and \nconfirmed pathologically as breast cancer between January 2017 to August \n2020. A set of characteristics of breast cancers were evaluated by consensus \ndouble reading using the BI-RADS atlas as guidance, including morphology \nfeatures, kinetic features and microcalcification characteristics. The CE-CBBCT \nimages, MRI images and mammograms were assessed separately. The \nagreements on characteristics assessment of breast cancers between CE-\nCBBCT and another two modalities were calculated by ICC and Kappa \ncoefficient, while the discrepancies were assessed by Chi-square test. \nResults or Findings: A total of 60 malignant lesions were enrolled. On CE-\nCBBCT images, the assessment of breast composition category indicated \nalmost perfect agreement degree with mammograms (Kappa=0.833), while the \nbackground parenchymal enhancement showed moderate degree with MRI \n(Kappa=0.563). CE-CBBCT images showed comparable multifocal lesions \ndetection with MRI, better than mammograms (92.86% and 100% vs. 42.86%, \nP<0.05). For morphology characteristics, CE-CBBCT images showed \nsubstantial agreement with MRI on both mass (Kappa=0.687-0.747) and non-\nmass (Kappa=0.714) lesions. The CE-CBBCT images showed moderate to \nsubstantial degree on enhancement pattern and degree (0.600-0.714) of \nlesions. For microcalcification, CBBCT images presented comparable detection \nrate and substantial agreement on characteristics assessment (Kappa=0.621-\n0.631) with mammograms. \nConclusion: CE-CBBCT images combined the morphology and part of \nhemodynamic features on MRI and microcalcification characteristics on \nmammograms, indicating that the corresponding BI-RADS lexicons could be \nused to describe CE-CBBCT characteristics associated with breast cancers. \nLimitations: This study was based on a relatively small data set. \nEthics Committee Approval: Institutional Review Board approval was \nobtained. \nFunding for this study: The National Key R&D Program of China (grant \n2017YFC0112600) and Tianjin Science and Technology Major Project (No. \n19ZXDBSY00080). \nAuthor Disclosures: \nYue Ma: Nothing to disclose \nZhaoxiang Ye: Nothing to disclose \nAidi Liu: Nothing to disclose \n \n \nRPS 402-3 \nDiagnostic performance of 18F-FDG PET/CT and DCE-MRI of the breast in \nassessment of early response to neoadjuvant chemotherapy (NAC) in \nlocally advanced braest cancer (LABC) patients \n*A. S. Abdelghani*, S. T. Hamed, E. Hussein, S. Lasheen, M. Hussein, \nY. G. Ebrahim; Cairo/EG \n(alaa.radio2013@gmail.com) \n \nPurpose: Evaluation the performance of DCE-MRI of breast &18 F-FDG \nPETCT regarding the assessment of early response to NAC in LABC patients \nand pCR prediction. \nMethods or Background: Forty patients with locally advanced breast cancer \nwho underwent NAC were screened, however twenty-five only were included in \nfinal analysis. Both PET/CT and DCE-MRI were performed before and during \nNAC. Different PET-CT parameters as well as size measurements and \nfunctional parameters by DCE-MRI were used. Patients were classified into \npathologic complete response (pCR) and pathologic non complete response \n(non-pCR). PET/CT and MRI findings were compared in correlation to post-\noperative pathology. \nResults or Findings: The sensitivity and specificity of MRI in assessment \nLABC response to NAC in correlation with pathological data were 100% \n(p<0.001) and 12.5% (p=0.18) respectively. The corresponding values for \nPET/CT were 94.1% (p<0.001) and 25% (p=0.18), however the estimated \noverall accuracy for both MRI and PETCT was the same measuring 72%. The \nsensitivity and specificity of MRI in assessment axillary lymph nodes(ALN) \nresponse to NAC in correlation with pathological data were 83% and 50% \nrespectively. The corresponding values for PET/CT were 47.4% and 68.4% \nrespectively, however estimated overall accuracy of PETCT was more than of \nMRI 64% and 56% respectively. Significant predictors factors for pCR were \nlongest diameter of lesion, ADC value and maximum enhancement in baseline \nMRI, SUVmax and SUV mean in baseline PETCT. \nConclusion: DCE-MRI had a higher sensitivity in predicting pCR in locally \nadvanced breast cancer after NAC in the primary breast mass and ALN. The \ndiagnostic accuracy of MRI and PETCT in detecting pCR of LABC patients to \nNAC was the same, however PETCT was more accurate in detecting \npathological response of ALN to NAC. \nLimitations: Small number \nEthics Committee Approval: Local scientific ethical committe approval \nFunding for this study: No fund \nAuthor Disclosures: \nSoha Talaat Hamed: nothing to disclose \nMai Hussein: Nothing to disclose \nElshaymaa Hussein: Nothing to disclose \nAlaa Sobhi Abdelghani: nothing to disclose \nYoustina Gerges Ebrahim: nothing to disclose \nShimaa Lasheen: Nothing to disclose \n \nRPS 402-5 \nCone-beam breast CT features associated with intrinsic subtypes of \nHER2-positive breast cancer according to hormone receptor status \n*Y. Zhu*, Y. Ma, Y. Zhang, Z. Ye; Tianjin/CN \n(zhuyueqiang1985@126.com) \n \nPurpose: To investigate the relationship between cone-beam breast CT \n(CBBCT) features and HER2-positive (HER2+) breast cancer subtypes \naccording to hormone receptor (HR) expression. \nMethods or Background: Preoperative CBBCT of patients were \nretrospectively evaluated in 124 surgically resected HER2+ breast cancer \nbetween January 2018 and December 2019. A set of CBBCT descriptors was \nsemiquantitatively assessed by consensus double reading. Multivariable \nlogistic regression analysis using backward elimination (BEA) with the Wald \ncriterion was performed to identify independent predictive factors of HR status \nin HER2+ breast cancer. Principle component analysis (PCA) was used to \ndetermine characteristics that might differentiate HER2+ subtypes. Receiver \noperating characteristic (ROC) curve analyses were conducted to determine \nthe predictive capability. \nResults or Findings: HR-HER2+ accounted for 46.8% (58/124) of patients. \nBased on BEA, pathologic grade (OR = 11.178; P = 0.015), Ki-67 index (OR = \n4.6; P = 0.011), concavity (OR = 0.012; P = 0.038), and with non-mass \nenhancement (NME) (OR = 5.913; P = 0.046) were confirmed as independent \nindicators. PCA showed that with NME and concavity were the most important \nfor differentiation. ROC curve analyses showed that CBBCT features combined \nwith clinicopathologic characteristics (AUC = 0.855) were superior to \nclinicopathologic characteristics alone (AUC = 0.729, P=0.015). \nConclusion: CBBCT features in combination with clinicopathologic \ncharacteristics can be used to prognosticate HER2+ subtypes better than use \nof clinicopathologic characteristics alone. It has the potential to be used for the \ndiagnosis and treatment decision in HER2+ breast cancer patients. \nLimitations: We limited our analyses to surgically resected and non-\npreoperative treated specimens. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 169  \nEthics Committee Approval: The institutional review board approved this \nstudy, and written informed consent was obtained from all patients. \nFunding for this study: National Key R&D Program of China (No. \n2017YFC0112600 and 2017YFC0112601), National Natural Science \nFoundation of China (No. 81571671) \nAuthor Disclosures: \nYue Ma: Nothing to disclose \nYueqiang Zhu: Nothing to disclose \nZhaoxiang Ye: Nothing to disclose \nYuwei Zhang: Nothing to disclose \n \nRPS 402-6 \nParameters of breast DTI (MD and FA) in high-grade and low-grade \ninvasive ductal carcinoma \n*M. Nadrljanski*, Z. Milosevic, V. Urban, I. Krusac; Belgrade/RS \n(dr.m.nadrljanski@gmail.com) \n \nPurpose: To assess potential diagnostic use of breast DTI parameters (MD – \nmean diffusivity; FA – fractional anisotropy) in patients with invasive ductal \ncarcinoma (IDC): a.) against the breast parenchyma and b.) between the \nsubgroups of high-grade (G3) vs. lower grade (G1-G2) tumours. \nMethods or Background: Prospective analysis of breast MRI (N=30) included \npatients with unilateral lesions: high-grade IDC (n1=15) and lower grade IDC \n(n2=15). All patients were examined with 1.5T MRI system with DTI, DWI (b50, \n850) and DCE-MRI. ADC, FA and MD were computed for all lesions and FA \nand MD were computed for the contralateral breast parenchyma. Mann \nWhitney U test was performed to assess the differences. \nResults or Findings: MD and FA were significantly different between IDC and \nparenchyma (1.00+/-0.05 vs. 1.62+/-0.02, p<0.00001; 0.31+/-0.02 vs. 0.32+/-\n0.02, p=0.001). No significant differences were obtained between n1 and n2 for \nMD and FA (0.99+/-0.06 vs. 1.01+/-0.05, p=0.215; 0.30+/-0.02 vs. 0.31+/-0.02, \np=0.153), while the differences in ADC were significant between the two \nsubgroups (1.00+/-0.07 vs. 1.08+/-0.06, p=0.006). Unlike FA, MD was \nsignificantly different between n1 and parenchyma and n2 and parenchyma \n(0.99+/-0.06 vs. 1.62+/-0.02, p<0.00001; 1.01+/-0.05 vs. 1.63+/-0.02, \np<0.00001). \nConclusion: DTI parameters MD and FA are significantly different between \nIDC and breast parenchyma. No significant differences are obtained between \nhigh-grade and low-grade IDC lesions in terms of MD and FA. \nLimitations: Retrospective, single-center study on a small number of patients. \nTechnical limitations may include1.5T field strength in DTI. \nEthics Committee Approval: Referent board approval obtained for \nretrospective analysis. \nFunding for this study: None. \nAuthor Disclosures: \nZorica Milosevic: Nothing to disclose \nVladimir Urban: Nothing to disclose \nIva Krusac: Nothing to disclose \nMirjan Nadrljanski: Nothing to disclose \n \n \nResearch Presentation Session: Breast \nRPS 502 \nBreast ultrasound \nRPS 502-1 \nPredicting breast cancer response to neoadjuvant chemotherapy with \nultrasound strain elastography and contrast-enhanced ultrasound: a \nnomogram integrating Ki-67 and ultrasound features \n*Q. Liu*, L. Tang, M. Chen; Shanghai/CN  \n(xiaoya1007@sjtu.edu.cn) \n \nPurpose: To explore whether conventional ultrasound, elastography and \ncontrast-enhanced ultrasound (CEUS) combined with histopathology can \nmonitor the efficacy of neoadjuvant chemotherapy (NAC) for breast cancer \n(BC), and develop a Nomogram prediction model monitoring response to NAC. \nMethods or Background: From February 2010 to November 2015, 91 BC \npatients who received NAC were recruited. The maximum diameter, stiffness, \nCEUS features before and after NAC were assessed. Core biopsy, surgical \npathology immunophenotype and Miller-Payne (MP) evaluation were \ndocumented. Univariate and multivariate analysis was performed using ROC \nanalysis and logistic regression analysis. \nResults or Findings: There were 37 cases showed pCR(MP=1,2,3) and 54 of \nnon-pCR(4,5). Interobserver agreement between sonographers shows good \nconsistency. The changes of maximal diameter were correlated with \nMP(P<0.05). The sensitivity (SEN), specificity (SPE), and area under the \nreceiver operating characteristic (ROC) curve (AUC) of baseline size predicting \npCR were 57.40%, 70.30%, and 0.64 (p=0.024). Baseline Ki-67 index of pCR \ngroup is significantly higher than that of non-pCR group (P=0.029), and the \nROC analysis of baseline Ki-67 indicate the SEN, SPE, and AUC of 51.70%, \n78.00%, and 0.638 (p=0.050). When combined with size, CEUS features, \nstiffness and Ki-67 of baseline, the ROC curve shows good performance with \nSEN, SPE, and AUC of 70.00%, 76.19%, 0.821 (p=0.004). Incorporate the \nchange of characteristics into multivariate regression analysis, the results \ndemonstrate excellent performance (SEN 100.00%, SPE 95.24%, AUC 0.986, \nP=0.000). \nConclusion: The change of the maximum size was correlated with MP score, \nwhich can provide reference to predict efficacy of NAC and evaluate residual \nlesions. When combining with elastography, CEUS and Ki-67, better \nperformance in predicting pathological response was showed. \nLimitations: Sample size and qualitative analysis. \nEthics Committee Approval: Institutional Review Board approval and written \ninformed consent was obtained. \nFunding for this study: Natural Science Foundation of Shanghai (No. \n18ZR1434800) \nAuthor Disclosures: \nLei Tang: Nothing to disclose \nQi Liu: Nothing to disclose \nMan Chen: Nothing to disclose \n \nRPS 502-2 \nInitial targeted ultrasound in women with focal breast complaints: what \nabout tomosynthesis? \n*L. Appelman*¹, S. Siebers¹, P. Appelman², S. Go³, P. Bult¹, M. Broeders¹, \nM. van Oirsouw຾, R. M. Mann¹; ¹Nijmegen/NL, ²Tienhoven/NL, ³Alkmaar/NL, \n຾Utrecht/NL  \n \nPurpose: To assess the potential of initial targeted ultrasound in the diagnostic \nwork-up of women with symptomatic localized breast disease, and the \nsupplemental value of tomosynthesis in this setting. \nMethods or Background: In this multicenter prospective study the standard \nbreast imaging protocol in women 30 years and older, presenting with focal \nbreast complaints in three different hospitals in the Netherlands, was reversed. \nInitially, ultrasound was performed and when required lesions were biopsied. \nSubsequently the tomosynthesis was evaluated. We assessed cancer \ndetection related to the focal complaint based upon initial ultrasound alone and \nthe combination. Furthermore, we evaluated the frequency of findings \nelsewhere in the breast by tomosynthesis. \nResults or Findings: Between September 2017 and June 2019 a total of 1961 \nwomen were enrolled (mean age 47.1 years). Based upon initial ultrasound \nalone, in 1588 women (81%) the complaints were due to normal fibroglandular \ntissue or benign findings (BI-RADS 1 or 2). In 2 of these women (0.1%), the \ntomosynthesis led to detection of a malignant lesion at the site of the complaint \n(sensitivity 99%). In 373 women (19%) initial ultrasound was judged as \nsuspicious and followed by biopsy, yielding benign results in 181 women \n(48.5%) and malignant results in 192 women (51.5%) (specificity 90%). In \nwomen without cancer at the site of the complaint tomosynthesis yielded \nfindings requiring additional investigations in 63 patients (3.2%), 8 of these \nwere malignant (0.4%, 3 DCIS, 5 invasive). \nConclusion: Initial targeted ultrasound is accurate and specific in the \nassessment of focal breast complaints. Tomosynthesis in this setting must be \nregarded as a screening examination with a low diagnostic yield. \nLimitations: No limitations \nEthics Committee Approval: Approved \nFunding for this study: ZonMw \nAuthor Disclosures: \nMireille Broeders: Nothing to disclose \nM van Oirsouw: Nothing to disclose \nS. Siebers: Nothing to disclose \nRitse Maarten Mann: Nothing to disclose \nPeter Appelman: Nothing to disclose \nLinda Appelman: Nothing to disclose \nS. Go: Nothing to disclose \nSir P Bult: Nothing to disclose \n \nRPS 502-3 \nComparison of ultrasound second-look and digital breast tomosynthesis \nsecond-look in the detection of additional lesions at presurgical CESM \n*C. Bellini*¹, G. Bicchierai¹, F. Amato², E. Savi¹, D. De Benedetto¹, F. Di Naro¹, \nV. Miele¹, J. Nori¹; ¹Florence/IT, ²Palermo/IT \n(1chiarabellini@gmail.com) \n \nPurpose: To compare Ultrasounds second-look (US-SL) and Digital Breast \nTomosynthesis second-look (DBT-SL) in the detection of additional lesions \n(ALs) at presurgical CESM. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 170  \nMethods or Background: We retrospectively included among patients who \nunderwent CESM for presurgical staging at our center, from September 2016 \nto December 2018, 121 women with 128 additional lesions (ALs). These ALs \nunderwent US-SL and DBT-SL, to evaluate the performance of each technique \nand of the combination of both. ALs in CESM images were evaluated \naccording to type of enhancement (focus, mass or non-mass), size (<10 mm or \n>10mm) and level of suspicion (BIRADS 3, 4 or 5). Our gold standard was \npost-bioptic histology and post-surgical specimen or >24-month negative \nfollow-up. McNemar test was used for statistical analysis. \nResults or Findings: Out of 128 ALs an imaging correlate was found for 71 \n(55.47 %,) at US, for 79(61.72%) at DBT, for 53 (41.41 %) at DBT and US, for \n97 (75.78%) at US and/or DBT. DBT-SL proved a higher detection rate vs. US-\nSL in non-mass enhancement (NME) pattern on CESM (p:0.0325) and in DCIS \nhistologic subtype (p:0.0081). Adding DBT-SL improved the performance of \nUS-SL alone in the overall sample (p:<0,0001) and in every subcategory \nidentified; adding US-SL to DBT-SL improved the dectectability of ALs in the \noverall sample and in every category except for NME (p:0.0833), foci \n(p:0.0833) and B3 lesions (p:0.3173). \nConclusion: Combined imaging second look (DBT-SL + US-SL) for CESM \nALs is superior to DBT-SL only and US-SL only. In B3 lesions, NME and foci \nthe analysis of a larger sample could determine if adding US-SL to DBT-SL is \nunnecessary. \nLimitations: Retrospective study; not blinded; readers knew site and histology \nof index lesion; limited sample. \nEthics Committee Approval: Our ethics committee approved this study. \nFunding for this study: Not needed. \nAuthor Disclosures: \nElena Savi: Nothing to disclose \nGiulia Bicchierai: Nothing to disclose \nFederica Di Naro: Nothing to disclose \nJacopo Nori: Nothing to disclose \nVittorio Miele: Nothing to disclose \nFrancesco Amato: Nothing to disclose \nChiara Bellini: Nothing to disclose \nDiego De Benedetto: Nothing to disclose \n \nRPS 502-4 \nBreast ultrasound radiomic features: potential for prediction of response \nto neoadjuvant chemotherapy at baseline \n*P. Kapetas*, C. Sodano, P. Clauser, T. H. Helbich, M. Bernathova, R-I. Milos, \nP. A. Baltzer; Vienna/AT \n(panagiotis.kapetas@meduniwien.ac.at) \n \nPurpose: Exploratory study to evaluate whether radiomics features acquired \nfrom pre-therapeutic, B-mode breast ultrasound (US) can predict response to \nneoadjuvant chemotherapy (NAC). \nMethods or Background: 97 patients with histologically confirmed invasive \nbreast cancer who underwent NAC were included in this retrospective \nmonocentric study. A representative B-mode US image of each tumor from the \nbaseline, pre-treatment examination was selected. The baseline examinations \nhad been performed with a variety of US devices. Tumors were segmented by \na dedicated breast radiologist and overall 851 radiomic features were \nextracted. Radiomic features included first-order statistics, textural and wavelet \nfeatures. LASSO regression was applied to reduce the number of features in \nthe prediction model. Multivariate logistic regression was used to identify \nindependent predictors of response to NAC. An exploratory area under the \nROC curve (AUC) was used for the evaluation of the diagnostic performance. \nPostoperative pathology served as the standard of reference. Pathological \ncomplete response (pCR) was defined as the lack of invasive tumor in the \nbreast or metastases in the axillary lymph-nodes. To rule-out interobserver \nsegmentation variability, 30 cases were independently segmented by a breast \nradiology fellow. \nResults or Findings: 44 patients (45.36%) achieved a pCR. After reduction of \nthe radiomic features, 14 features remained. Among these, 3 wavelet radiomic \nfeatures were shown by multivariate logistic regression to be independent \npredictors of response to NAC. The model demonstrated an AUC of 0.777 \n(95%CI: 0.681-0.855). At a predicted probability value of >18.2%, the presence \nof a residual tumor could be excluded with a sensitivity of 100%. \nSegmentations showed substantial reproducibility with an intraclass correlation \ncoefficient of 0.765. \nConclusion: Radiomic features acquired from baseline B-mode breast US \nexaminations have the potential to predict response to NAC. \nLimitations: Limited patient number. \nEthics Committee Approval: Yes. \nFunding for this study: None. \n \n \n \n \n \n \nAuthor Disclosures: \nPascal A.T. Baltzer: Nothing to disclose \nThomas H. Helbich: Nothing to disclose \nMaria Bernathova: Nothing to disclose \nRuxandra-Iulia Milos: Nothing to disclose \nPanagiotis Kapetas: Nothing to disclose \nClaudia Sodano: Nothing to disclose \nPaola Clauser: Nothing to disclose \n \nRPS 502-5 \nStrain elastography in breast ultrasound in addition to US-BI-RADS \nclassification \n*A. A. M. Orlando*¹, M. Di Marco¹, A. Cirino¹, R. Ienzi¹, M. Midiri¹, \nT. V. Bartolotta²; ¹Palermo/IT, ²Cefalù/IT \n(orlandoalessiamed@hotmail.it) \n \nPurpose: To assess the role of qualitative (Tsukuba score, TS) and/or semi-\nquantitative (Strain Ratio, SR) Strain Elastography (SE) assessment in adjunct \nto US-BI-RADS classification in the characterization of Focal Breast Lesions \n(FBLs) \nMethods or Background: 185 FBLs (3,5–45,2 mm) in 185 patients (mean \nage: 52,7 years) who underwent B-Mode breast-US, were evaluated with SE \nby an experienced breast radiologist. Two indipendent reviewers (both last \nyear radiology residents) retrospectively and in consensus assessed the same \n185 FBLs, assigning to each one a BI-RADS category and a Tsukuba Score. \nAs SOR, US-guided core-biopsy and follow-up at 24 months were considered \nrespectively for BI-RADS 4-5 and 2-3 FBLs. A cut-off for SR was calculated \nwith the Youden method. A comparison between TSs (chi-square test) and SR \n(T-Student) between benign and malignant FBLs was performed. Diagnostic \naccuracy, Sensitivity, Specificity, Negative and Positive Predictive Values (NPV \nand PPV) for each BI-RADS re-classification resulting from the adjunct of TS \n(BI-RADS+TS), SR (BI-RADS+SR), and of concordant TS and SR (BI-\nRADS+TS/SR) were calculated and differences were evaluated using the chi-\nsquare test. \nResults or Findings: 106/185 were benign and 79/185 were malignant FBLs. \nTS4-5 FBLs (72/185) were more frequently malignant (76.4%, p<0.0001) and \nTS1-2-3 (113/185) benign (78.8%, p<0.0001). Malignant FBLs showed higher \nSR mean value than benign ones (4.49 vs 2.73, p<0.0001). SR cut-off value \nwas 2.51. A significative improvement in specificity was revealed with BI-\nRADS+TS and BI-RADS+TS/SR re-classification (71.7% and 67.9% vs 56.6%; \np=0.002 and p=0.025), but with a significant decrease in sensitivity for BI-\nRADS+TS (83.5% vs 93.7%, p=0.0022). \nConclusion: BI-RADS reclassification, downgrading BI-RADS 4a FBLs to BI-\nRADS 3 when TS and SR values were concordant, could led to a significative \nimprovement in specificity without a significative decrease in sensitivity. \nLimitations: Monocentric retrospective study \nEthics Committee Approval: Obtained \nFunding for this study: None \nAuthor Disclosures: \nAlessia Angela Maria Orlando: Nothing to disclose \nMassimo Midiri: Nothing to disclose \nMariangela Di Marco: Nothing to disclose \nRaffaele Ienzi: Nothing to disclose \nAlessandra Cirino: Nothing to disclose \nTommaso Vincenzo Vincenzo Bartolotta: Nothing to disclose \n \nRPS 502-6 \nConcordance between breast core needle biopsy and postoperative \nhistopathology in B4 cases \n*V. Urban*, M. Nadrljanski, D. Pavlovic Stankovic, I. Petkovic, I. Krusac,  \nK. Obradovic, N. Adzic, Z. C. Milosevich; Belgrade/RS \n \nPurpose: To analyse concordances between B4 category after ultrasound-\nguided breast core needle biopsy and final histopathology. \nMethods or Background: A retrospective analysis of all ultrasound-guided \ncore needle biopsies at our institution between 2015. and 2020. was \nperformed. The eligibility criteria were B4 lesions that underwent surgical \ntreatment and received a final histopathology. T-test for independent samples \nand Fisher's test were used for calculating statistical significances. \nResults or Findings: Out of 52 patients with post-biopsy B4 category, 40 \n(76.92%) underwent surgical excision. Their post-biopsy histopathology \nsuggested 31 (77.5%) invasive cancers (IC), 3 (7.5%) DCIS, 4 (10%) papillary \ncarcinomas, and 2 (5%) lobular carcinomas. On final histopathology, 34 (85%) \ncases were malignant, and 6 (15%) cases were benign; 30 (75%) had IC, and \n4 (10%) had in situ cancer. Out of all IC, 16 (53.33%) were invasive ductal \ncarcinomas (IDC), 4 (13.33%) were invasive lobular carcinomas (ILC), 2 \n(6.67%) were mixed ductal/lobular carcinomas, 3 (10%) were invasive tubular \ncarcinomas, 1 (3.33%) was invasive tubulo-lobular carcinoma, 2 (6.67%) were \ninvasive papillary carcinomas, 1 (3.33%) was medullary carcinoma, and 1 \n(3.33%) was metaplastic carcinoma. Patients with benign outcomes were \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 171  \nsignificantly younger than patients with malignant outcomes (45.50±10.17 vs. \n58.47±13.42 respectively, p=0.03). All patients with BI-RADS 4c and 5 had a \nfinal malignant diagnosis. Statistical significances between post-biopsy and \npostoperative histopathologies were found for suspicious IC and final \nmalignancy (p=0.016), suspicious IC and final IC (p=0.002), suspicious DCIS \nand final DCIS (p=0.028), and for suspicious papillary carcinoma and final \nbenign histology (p=0.008). \nConclusion: All BI-RADS 4c and 5 lesions classified as B4 were malignant; \nassociations between post-biopsy suspicious IC and final malignancy/IC, and \npost-biopsy suspicious papillary carcinoma and final benign histology were \nhighly statistically significant, which could impact further management. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nKatarina Obradovic: Nothing to disclose \nDragana Pavlovic Stankovic: Nothing to disclose \nZorica C Milosevich: Nothing to disclose \nIvana Petkovic: Nothing to disclose \nIva Krusac: Nothing to disclose \nNina Adzic: Nothing to disclose \nMirjan Nadrljanski: Nothing to disclose \nVladimir Urban: Nothing to disclose \n \nRPS 502-7 \nAnalysis of functional imaging biomarkers in breast carcinoma \n*B. C R*, B. Raghavan, G. Sivaramalingam, S. Viswanathan; Chennai/IN \n(banupriyacr11@gmail.com) \n \nPurpose: •  To find the association of SUV and ADC values with the \npathological grading and molecular subtype of breast malignancy. \n• To evaluate the correlation of grade of malignancy with background \nparenchymal uptake (BPU), background parenchymal enhancement (BPE) & \nfibro glandular tissue (FGT) of the contralateral normal breast. \nMethods or Background: Patients with biopsy-proven breast carcinoma \nunderwent whole-body PET-CT and MRI at our institute. Imaging findings were \ncorrelated with the grade of malignancy, hormone receptors and molecular \nsubtypes. \nResults or Findings: 53 patients were included with mean age of 49.3 years. \nPositive correlation was found between tumor grade and Mean SUVmax (p-\nvalue - 0.003). Statistically significant variation in mean SUVmax was seen \namong ER/PR receptor status with low values in ER+ tumors (7.72+5.46, p-\nvalue – 0.043) and PR+ tumors (7.15±5.11, p-value – 0.001). Higher mean \nSUVmax was seen in TNBC (12.27±4.22) and significant correlation was seen \nbetween each molecular subtype (p-value – 0.02). No association was made \nbetween the ADC values and tumors with different grades of malignancy. \nHowever, there was significant variation in ADC values among different \nmolecular subtypes (p-value –0.09). Higher ADC values were seen in HER2 \nEnriched tumours (1.032±0.25) and low ADC values were seen in luminal A \nmolecular subtype (0.798±0.13). There was no statistically significant \ncorrelation between background SUV of the contralateral breast with grade of \nmalignancy, hormone receptor status or molecular subtypes. \nConclusion: PET CT and MRI can be used as a complementary imaging tool \nfor non-invasive assessment of the aggressiveness and biological \ncharacteristics of tumor such as grade, Hormone receptor status and to \ndifferentiate molecular subtypes. \nLimitations: Uneven distribution of histologic subtype and molecular subtypes \namong the patients. \nEthics Committee Approval: Acquired \nFunding for this study: Not required \nAuthor Disclosures: \nGeethapriya Sivaramalingam: Nothing to disclose \nSathyasree Viswanathan: Nothing to disclose \nBanupriya C R: Nothing to disclose \nBagyam Raghavan: Nothing to disclose \n \nRPS 502-8 \nCan shear-wave elastography (SWE) be used in predicting breast \nhistopathological gradings? \n*W. L. Ng*¹, N. N. B. Ab Mumin², N. B. Omar¹, K. Rahmat¹; ¹Kuala Lumpur/MY, \n²Sungai Buloh/MY \n(wei.lin@ummc.edu.my) \n \nPurpose: To evaluate the diagnostic performance of shearwave elastography \n(SWE) of breast lesions in predicting histopathological gradings. \nMethods or Background: Women with suspicious breast lesions underwent \nB-mode ultrasound and SWE of the breast prior to core needle biopsy and \nbreast surgery. Quantitative SWE parameters measured included Emax, \nEmean, Emin and Eratio (kPa). Diagnostic performance of the parameters \nwere assessed based on final surgical histopathology. Lesions were \ncategorized to their pathologic types including ductal carcinoma in situ (DCIS) \nand grade I to III invasive ductal carcinoma (IDC). Other pathologies were \nexcluded due to small number. Kruskal-Wallis test was used for correlation \nanalysis. ER, PR, HER2 status and axilla lymph node (ALN) metastasis were \nevaluated. \nResults or Findings: Total of 173 patients with 147 invasive carcinoma and \n26 ductal carcinoma in situ (DCIS) were analysed. Tumor grades included \nDCIS (n = 26), IDC grade I (n =30), IDC grade II (n = 69) and IDC grade III (n \n=48). Larger size of breast lesions showed increase in histological grade \n(p<0.05). There was no statistically significant difference between the \nquantitative SWE parameters, ER, PR and HER2 status with the histological \ngrade (p>0.05). However there is statistically significant association between \nthe histopathological grades of the breast lesion with ALN metastasis with p-\nvalue of <0.05. \nConclusion: This study did not show statistically significant results with SWE \nand histopathological gradings. However there is a positive correlation \nbetween size and ALN metastasis with histopathological gradings. \nLimitations: Small sample size. \nEthics Committee Approval: This study was approved by the Medical \nResearch Ethics Committee (MRED), University Malaya Medical Centre, \nMREC ID NO: 201879-6469 \nFunding for this study: Research Grant-Faculty Program, Project No: \nGPF06C-2018 \nAuthor Disclosures: \nNorlia Binti Omar: Nothing to disclose \nWei Lin Ng: Nothing to disclose \nKartini Rahmat: Nothing to disclose \nNazimah Ab Mumin: Nothing to disclose \n \nRPS 502-9 \nDetection of focal breast vascularisation with microvascular flow \ntechnique: a comparison with conventional colour and power doppler \n*A. A. M. Orlando*¹, M. I. Schillaci¹, L. Spatafora¹, M. Di Marco¹, A. Cirino¹,  \nR. Ienzi¹, M. Midiri¹, T. V. Bartolotta²; ¹Palermo/IT, ²Cefalù/IT \n(orlandoalessiamed@hotmail.it) \n \nPurpose: To compare MV-Flow technique with Color-Doppler and Power-\nDoppler in the detection of vascularization of Focal Breast Lesions (FBLs). \nMethods or Background: An experienced breast radiologist performed breast \nUS in 180 patients detecting 180 solid FBLs (3.5-45.2 mm) and saved separate \ncine-loops for B-mode, CD, PD and MV-Flow examination, which were \nevaluated off-line by two independent reviewers (R1 and R2). Reviewers \nassessed lesion vascularity as absent or present, classifying vascularity \npatterns into: a) internal, b) vessels in rim c) combined pattern. Differences in \nvascularization patterns rates among CD, PD and MV-Flow were calculated \nusing the chi-square test. K-scores with Fleiss method were calculated to \nassess intra- and inter-observer agreement. \nResults or Findings: 103/180 FBLs were benign and 77/180 were malignant. \nFor both readers, vascularity detection increased with MV-Flow (77.2% and \n77.8%) vs CD (52.2% and 56.7%) and PD (53.9% and 56.7%) (p<0.00001) \nwhen evaluating all 180 FBLS, and when assessing either benign FBLs or \nmalignant ones, even with statistical significance (p<0.05). With MV-Flow, for \nboth readers, benign FBLs showed more frequently absence of vascularity \n(p=0.0195 and p=0.0104), rim (p=0.0032 and p=0.0052) or combined pattern \n(p=0.0131 and p=0.0369), whereas malignant lesions showed higher \nprevalence of internal pattern (p<0.0001 for both). With MV-Flow penetrating \nvessels detection, more frequent in malignant FBLs than in benign ones \n(p<0.00001), increased significantly for both readers (p<05). Inter-reader \nagreement ranged from good to very good, with the lowest k-score of 0.8550 \nfor MV-Flow (vs 0.7882 and 0.7472 for CD and PD). Intra-observer agreement \ndemonstrated k-scores ranging from good to very good. \nConclusion: MV-Flow significantly increased the detection of vascularization \nin FBLs, regardless the experience of the readers or the nature of FBLs. \nLimitations: Only qualitative assessment No comparison with tumoral \nmicrovessel density \nEthics Committee Approval: Obtained \nFunding for this study: None \nAuthor Disclosures: \nAlessia Angela Maria Orlando: Nothing to disclose \nLuigi Spatafora: Nothing to disclose \nMassimo Midiri: Nothing to disclose \nMariangela Di Marco: Nothing to disclose \nMaria Ilenia Schillaci: Nothing to disclose \nRaffaele Ienzi: Nothing to disclose \nAlessandra Cirino: Nothing to disclose \nTommaso Vincenzo Vincenzo Bartolotta: Nothing to disclose \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 172  \n \nResearch Presentation Session: Breast \nRPS 602 \nMammography and breast cancer \nRPS 602-1 \nImpact of COVID-19 pandemic on breast imaging practice: results of a \nsurvey from an institutional department in north-western Italy \n*A. Timpani*, G. Bartoli, M. Durando, A. Frigerio, A. Luparia, V. Marra,  \nL. Milanesio, D. Tota, P. Fonio; Turin/IT  \n(alessandra.timpani@gmail.com) \n \nPurpose: The study’s purpose was to investigate working style changes \nadapting routine practice in Breast Imaging Services during the first COVID-19 \npandemic. \nMethods or Background: A web-based survey of 20 multiple-choice \nquestions was designed and distributed on April 2020 to healthcare staff of \nthree Breast Imaging Services(screening and diagnostic) of the same \nRadiology Department and returned in one week. The questionnaire collected \ninformation regarding organization adaptations, case volume changes, \npersonal protective equipment (PPE) use, personal exposure, staff resiliency to \nCOVID-19 and future challenges. All responses were collected and analysed \nanonymously. \nResults or Findings: We recorded complete responses from 61%Radiologists \n(Residents and Consultants),28%Radiographers and 11%Office Employers. \nDuring the first COVID-19 two months’ Italian lockdown, all participants \nreported a decline in mammography volume (89%), partly due to patients’ \nwithdrawal, no changes in MR examinations and 12% increase in \ninterventional pre-operative procedures. The interaction with other specialists \n(Oncologists and Surgeons) remained mainly unchanged (82%). 90% of the \nstaff advised that suspended activities had to be rebooked in the ordinary \nschedule or with additional sessions. More of 55% of the staff was exposed to \nCOVID-19 positive patients and then tested, with negative results. Nearly all \nresponders reported limited availability of PPE and that testing for COVID \nhealthcare staff had to be warranted. \nConclusion: First COVID-19 pandemic has drastically impacted the practice of \nbreast imaging,reducing mammography volumes both in screening and \ndiagnostic setting, otherwise maintaining pre-operative oncologic work-up and \nsymptomatic cases management. Breast Imaging Services faced significant \nrisks mainly from virus diffusion by asym ptomatic (not previously recognized) \nCOVID positive patients and from inadequate PPE availability and use. This \nsurvey was a local snapshot that would benefit from comparison studies with \nother regions and countries and with the second ongoing pandemic upsurge. \nLimitations: Small sample size \nMonocentric study \nEthics Committee Approval: Not applicable \nFunding for this study: No funding \nAuthor Disclosures: \nManuela Durando: Nothing to disclose \nDonatella Tota: Nothing to disclose \nPaolo Fonio: Nothing to disclose \nLuisella Milanesio: Nothing to disclose \nAlfonso Frigerio: Nothing to disclose \nAlessandra Timpani: Nothing to disclose \nAndrea Luparia: Nothing to disclose \nVincenzo Marra: Nothing to disclose \nGermana Bartoli: Nothing to disclose \n \nRPS 602-2 \nCEM-guided biopsy: an alternative to MRI-guided breast biopsy \n*R. Alcantara Souza*, E. N. Arenas Rivera, M. Pitarch Diago, B. Ejarque,  \nM. C. Posso Rivera; Barcelona/ES  \n(rodials@hotmail.com) \n \nPurpose: To describe the technical aspects and our initial experience with the \nuse of contrast enhanced mammography (CEM) for percutaneous breast \ninterventional procedures in a Teaching Hospital in Spain. \nMethods or Background: This is a retrospective evaluation of prospectively \ncollected data. Since October 2019, we have been selecting patients with \nenhancing lesions for a clinical validation study of an upright stereotactic breast \nbiopsy unit with dual-energy acquisition. Patients have been treated in our \nHospital, that serves a population of approximately 350,000 inhabitants. We \ndescribe here the management of enhancing only lesions, reporting our initial \nexperience with the CEM-guided biopsy. This study was approved by the \nEthics Committee of our institution in September 2019. \nResults or Findings: From October 2019 to October 2020, we have \nperformed 30 interventional procedures (in 28 patients) under CEM-guidance, \n27 biopsies, all of them using a 10G vacuum-assisted needle, and 3 wire \nlocalizations. We achieved 100% target visibility, although there were some \nchallenging findings. We used a horizontal approach with a lateral arm and a \nsitting position in almost 80% (24) of cases, and the procedure time ranged \nfrom 12 to 25 minutes. Regarding the histopathological results of the biopsies \nperformed (27), we found 37% (10) of neoplasms, 15% (4) atypia, and 48% \n(13) benign lesions. We did not observe major adverse effects. \nConclusion: From our experience, CEM-guided biopsy is a safe procedure, \nwith diagnostic results similar to those described in the literature for an MRI-\nguided biopsy. This novel approach has the potential to be a faster and more \naffordable alternative to MRI-guided biopsy, however larger prospective \nstudies are needed. \nLimitations: The relative small number of cases. \nEthics Committee Approval: Ethics committee approval Nº 2019-8890. \nFunding for this study: There was no direct funding for this clinical validation \nstudy. \nAuthor Disclosures: \nRodrigo Alcantara Souza: Speaker: GE Healthcare \nErika Natalia Arenas Rivera: Nothing to disclose \nBelen Ejarque Sanahuja: Nothing to disclose \nMargarita Cynthia Posso Rivera: Nothing to disclose \nMireia Pitarch Diago: Nothing to disclose \n \nRPS 602-3 \nThe results in patients diagnosed with high-risk breast lesions with \nimage-guided needle biopsy: a multicentre retrospective study \n*Ö. Aslan*¹, A. Oktay¹, F. Taúkin², N. Tunçbilek³, G. Esen², P. Balci¹,  \nM. E. Aribal², L. Çelik², S. Örgüç຾; ¹Izmir/TR, ²Istanbul/TR, ³Edirne/TR, \n຾Manisa/TR \n(dr.ozgeaslan@gmail.com) \n \nPurpose: In this multicenter study, the goal was to document the excisional \nbiopsy or follow-up results of high risk lesions diagnosed on image guided \nCNB/VAB, and evaluate the clinical, imaging and histologic features for \nassociated malignancy risk. \nMethods or Background: This is a retrospective multicentric study that \ninclude 1240 patients from 25 centers. The radiology records were searched \nfor all image guided biopsies and pathology reports were reviewed in a 12 year \nperiod, between 2008 and 2020. Patients who had a diagnosis of high risk \nbreast lesion on image guided core biopsy (tru-cut/vacuum biopsy) were \nreviewed. The patients who managed with an excisional biopsy or having at \nleast 1 year follow-up documentation following the diagnosis of borderline \nlesion were included in the study. Needle biopsy type and sampling method \nwere documented. The data were analysed using SPSS statistical program. \nResults or Findings: Pathological subtypes of 1240 high-risk lesions with \nbiopsy were 28% ADH, 45% intraductal papilloma without atypia, 9.4% \nintraductal papilloma with atypia, 9% flat epithelial atypia, 4.5% radial scar, \n4.3% Lobuler neoplasia, 0.1% pleomorphic LCIS. In all cases, the upgrade rate \nto malignancy was found to be 22%. According to pathological subtypes, the \nupgrade rates were 40.6% in ADH, 14.8% in LN, 100% in pleomorphic LCIS, \n45.7% in intraductal papilloma with atypia, 10% in intraductal papilloma without \natypia, 5.4% in radial scar, and 9.3% in FEA. \nConclusion: The appropriate management after the diagnosis of a high risk \nlesion on image guided biopsy is controversial and recommendations between \nsurgical excision and follow-up vary in different practices in these group of \nlesions. \nLimitations: The number of cases could not be increased more due to cases \nwhere follow-up results could not be achieved. \nEthics Committee Approval: The institutional review board approval was \nobtained. \nFunding for this study: None \nAuthor Disclosures: \nSebnem Örgüç: Nothing to disclose \nMustafa Erkin Aribal: Nothing to disclose \nAysenur Oktay: Nothing to disclose \nÖzge Aslan: Nothing to disclose \nNermin Tunçbilek: Nothing to disclose \nLevent Çelik: Nothing to disclose \nFüsun Taúkin: Nothing to disclose \nPinar Balci: Nothing to disclose \nGul Esen: Nothing to disclose \n \nRPS 602-4 \nThe prognostic potential of mammographic growth rate of invasive breast \ncancer in the Nijmegen breast cancer screening cohort \n*J. Peters*¹, J. van Dijck¹, S. Elias², J. Otten¹, M. Broeders¹, On behalf of the \nIMAGINE consortium¹; ¹Nijmegen/NL, ²Utrecht/NL \n(Jim.Peters@radboudumc.nl) \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 173  \nPurpose: Mammographic screening has led to increased detection of small \nbreast cancer tumours, but only those with unfavourable biological \ncharacteristics may be life-threatening. To distinguish aggressive from indolent \ncancers, tumour growth rate (GR) may provide valuable prognostic information. \nThis study addresses the association of mammographic GR with established \nprognostic factors and overall survival in a screened population. \nMethods or Background: In this historic cohort study, 293 women with \ninvasive ductal carcinoma were identified from all participants in the Nijmegen \nscreening programme between 2000-2007. Information on patient-related \nfactors and tumour characteristics was retrieved from patient files. Follow-up \non vital status was obtained through municipalities. On the diagnostic and two \nprior screening mammograms, tumour volumes were estimated, assuming a \nspheroid shape. After comparing the fit of five growth functions, GR was \ncalculated using a power-law growth function. Regression and survival \nanalyses, adjusted for age, volume, density and detection mode (screen-\ndetected or interval), were used to study associations between GR and \nprognostic factors as well as overall survival. \nResults or Findings: Each one-standard-deviation increase in GR was \nassociated with an increase in the Nottingham Prognostic Index by 0.23 \n[95%CI 0.10-0.35] and volume at diagnosis by 2.67 cm^3 [95%CI 0.65-470]. It \nwas further associated with increased odds to have a tumour of unfavourable \nsubtype (based on histologic grade and hormone receptors; OR 1.68 [95%CI \n1.07-2.64]). At the end of follow-up (median 12.4 years), 78 deaths occurred. \nGR was not associated with overall survival (HR=1.04 [95%CI 0.80-1.34]). \nConclusion: Mammographic GR may indicate differences in tumour \naggressiveness and shows the potential to be used as a prognostic marker if, \nlike in screening, serial mammograms are available. \nLimitations: A potential association of GR with cause-specific survival could \nnot be determined. \nEthics Committee Approval: Not applicable \nFunding for this study: Dutch Cancer Society (KWF11835) \nAuthor Disclosures: \nJim Peters: Nothing to disclose \nMireille Broeders: Nothing to disclose \nSjoerd Elias: Nothing to disclose \nJohannes Otten: Nothing to disclose \nOn behalf of the IMAGINE consortium: Nothing to disclose \nJos van Dijck: Nothing to disclose \n \nRPS 602-5 \nClinical performance of contrast-enhanced spectral mammography in \npre-surgical evaluation of breast malignant lesions in dense breasts: a \nsingle-centre study \nL. Nicosia, A. C. Bozzini, V. Dominelli, S. Penco, L. Meneghetti,  \n*M. Montesano*, A. Latronico, M. Pizzamiglio, E. Cassano; Milan/IT \n(marta.mon@hotmail.it) \n \nPurpose: To compare the efficacy of contrast-enhanced spectral \nmammography, with ultrasound, full field digital mammography and magnetic \nresonance imaging in detection and size estimation of histologically proven \nbreast tumors. \nMethods or Background: This study, included 160 dense breast women with \nat least one suspicious mammary lesion evaluated by ultrasound, full field \ndigital mammography and magnetic resonance imaging in whom a mammary \ntumor was histologically proven after surgery performed at the European \nInstitute of Oncology between January 2013 and December 2015. Following \nthe complete diagnostic procedure, the patients were investigated by contrast-\nenhanced spectral mammography prior to surgery. \nResults or Findings: Overall, the detection rate of malignant breast lesions (in \nsitu and invasive) was 93.8% (165/176) for contrast-enhanced spectral \nmammography, 94.4% (168/178) for ultrasound, 85.5 (147/172) for full field \ndigital mammography and 97.7% (173/177) for magnetic resonance imaging. \nRadiological measurements were concordant with the post-surgical \npathological measurements of the invasive tumor (i.e., within 5 mm) in: 64.6% \nfor contrast-enhanced spectral mammography, 62.0% for ultrasound, 45.2% \nfor full field digital mammography (p < 0.0001) and 69.9% for magnetic \nresonance imaging (p = 0.28); underestimated in: 17.4% for contrast-enhanced \nspectral mammography, 19.6% for ultrasound, 24.2% for full field digital \nmammography (p = 0.03) and 6.7% for magnetic resonance imaging (p = \n0.0005); and overestimated in: 16.2% for contrast-enhanced spectral \nmammography, 16.6% for ultrasound, 16.6% for full field digital mammography \nand 22.7% for magnetic resonance imaging (p = 0.02). \nConclusion: Our data suggest that contrast-enhanced spectral mammography \nimproves on full field digital mammography and is comparable to ultrasound \nand magnetic resonance imaging in terms of detection sensitivity and size \nestimation of malignant lesions in dense breasts \nLimitations: The study is monoinstitutional. \nEthics Committee Approval: The ethichs commitee approval was obtained. \nFunding for this study: The study did not receive any funds. \n \n \nAuthor Disclosures: \nLuca Nicosia: Nothing to disclose \nSilvia Penco: Nothing to disclose \nAntuono Latronico: Nothing to disclose \nValeria Dominelli: Nothing to disclose \nAnna Carla Bozzini: Nothing to disclose \nMaria Pizzamiglio: Nothing to disclose \nEnrico Cassano: Nothing to disclose \nLorenza Meneghetti: Nothing to disclose \nMarta Montesano: Nothing to disclose \n \nRPS 602-6 \nAccuracy of volume measurements of tumours seen in mammograms: a \nsimulation study \n*H. Tomic*¹, B. Barufaldi², K. Johnson¹, S. Zackrisson¹, M. Dustler¹,  \nA. Tingberg¹, P. Bakic²; ¹Malmö/SE, ²Philadelphia, PA/US \n(hanna.tomic@med.lu.se) \n \nPurpose: To analyze estimated tumour volumes in simulated mammograms. \nMethods or Background: Breast tumour volume is estimated to determine \ngrowth rate, which correlates with tumour aggressiveness and could, e.g., \nreduce unnecessary interventions. Clinically, the tumour size is commonly \nreported via its largest diameter. The reported size can assist volume \nestimation assuming spherical approximation. We simulated 42 mammograms \nwith tumours using an open-source simulation pipeline. Each tumour was \nsimulated as three overlapping ellipsoids. Individual tumours differed in shape \nby offsetting centers of ellipsoids for 0-5 mm relative to each other. The \nsimulation provided the ground true tumour volume. A radiologist analyzed \nsimulated mammograms, and measured the largest tumour size and the \nmaximum size orthogonal to it. We estimated tumour volumes using spherical \nand ellipsoidal approximations. The spherical volume estimations were \ncalculated using the largest size (method A) and the mean of the two \nmeasured sizes (method B). The ellipsoidal approximation (method C) used as \nsemi-axes the measured sizes, and in the z-direction their average value. The \nthree volume estimates were compared to the ground truth. The radiologist \nalso rated the resemblance of simulated tumours to clinical tumours. \nResults or Findings: The mean relative overestimation of tumour volume for \nmethod A, B, and C were 0.390, 0.331 and 0.324, respectively. Fifty-eight \npercent of simulated tumours resembled clinical tumours. Low clinical \nresemblance corresponded to large offsets in simulated tumour shape. \nConclusion: Our study suggests that ellipsoidal approximations (method C) \nimprove the volume estimation accuracy by 17% vs. the largest spherical \napproximation (method A). This observation is important when estimating \ntumour growth rate from clinical images. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: Supported by the Skåne University Hospital \nFoundation, Swedish Fund for Clinical Research (ALF), and Marie \nSkłodowska-Curie Fellowship #846540. \nAuthor Disclosures: \nKristin Johnson: Nothing to disclose \nAnders Tingberg: Research/Grant Support: Siemens \nHanna Tomic: Nothing to disclose \nBruno Barufaldi: Nothing to disclose \nPredrag Bakic: Research/Grant Support: Real Time Tomography \nMagnus Dustler: Nothing to disclose \nSophia Zackrisson: Research/Grant Support: Siemens Speaker: Siemens \n \nRPS 602-7 \nInitial experience of magnetic seed localisation in an Irish breast centre: \nof particular importance in the COVID era \n*L. Sweeney*, R. M. Heaney, A. O'Brien, F. Flanagan; Dublin/IE \n(laura.sweeney@live.ie) \n \nPurpose: Wire-guided localisation (WGL) has long been the mainstay of non-\npalpable breast lesion identification, however it has not been without its \ndrawbacks. WGL is performed the morning of surgery, which causes \nscheduling/co-ordination issues between admissions, radiology and theatre. \nMagnetic seed localisation (MSL) has become an excellent alternative which \novercomes these issues. MSL can be performed any time before surgery, \nresulting in greater patient-flow efficiency and reduced patient visits. \nMethods or Background: We examined our first year of MSL experience (July \n2019-July 2020), reviewing all cases in our screening/symptomatic centres \ncombined. Our primary outcome measure was accuracy of placement of the \nseed relative to target lesion/clip on post-seed mammogram, taking largest \ndistance on CC/lateral as index distance from target. We defined ‘acceptable \nplacement’ as <=10mm of target, with further breakdown of ‘at target’(0mm), \n‘very close’(<2mm), ‘close’(3-5mm) and ‘within range’(6-10mm). \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 174  \nResults or Findings: A total of 297 MSLs were performed July 2019-July \n2020, 243(82%) using US guidance and 54(18%) using tomographic guidance. \n285(96%) of cases were placed within acceptable range: 196(66%) at target, \n46(15%) within 2mm, 31(10%) within 3-5mm and 12(4%) within 6-10mm. \n12(4%) were outside of acceptable range of 10mm. 3(1%) required WGL the \nmorning of surgery for more accurate lesion identification. \nConclusion: MSL is an excellent alternative to WGL, with 96% of magnetic \nseeds placed within 10mm of target in our first year. MSL allows for more \nflexibility from a logistical patient-flow point of view, allowing lesion localisation \nin the outpatient setting any time/date prior to the surgical date. We have found \nthis a particularly beneficial factor in the era of COVID-19, whereby we reduced \nthe number of patient visits and contacts in the radiology department. \nLimitations: None \nEthics Committee Approval: Not required \nFunding for this study: None \nAuthor Disclosures: \nAngela O'Brien: Nothing to disclose \nLaura Sweeney: Nothing to disclose \nFidelma Flanagan: Nothing to disclose \nRoisin Mary Heaney: Nothing to disclose \n \nRPS 602-8 \nQuantitative analysis of enhancement parameters of breast cancer on \nContrast-Enhanced Spectral Mammography (CESM): correlation with \nDCE-MRI and prognostic significance \n*S. Akkaya*, S. Kul; Trabzon/TR \n(selcuk.akkaya85@gmail.com) \n \nPurpose: To determine the feasibility of quantitative analysis of enhancement \non contrast-enhanced spectral mammography (CESM) by comparing with \ndynamic contrast enhanced-MRI (DCE-MRI) and to correlate enhancement \nparameters with prognostic tumor markers in malignant lesions. \nMethods or Background: 99 malignant lesions imaged with CESM and DCE-\nMRI were retrospectively analyzed. Lesion enhancement on CESM images \nwas measured after manual segmentation of tumor and nearby background. \nContrast-to-noise ratio [CNR= (Lesion mean intensity-Background mean \nintensity)/Standard deviation measured in the background] derived from \nsequentially obtained CC and MLO views were used as a measure of early \n(CNR1) and delayed (CNR2) tumor enhancement, respectively. Kinetic curve \npattern was decided by comparing enhancement at early and delayed phases \nand grouped as persistent, stable and wash-out as in the case of DCE-MRI. To \ncalculate percent change in enhancement intensity SD=(CNR2-CNR1/CNR1) x \n100 formula was used. Early phase enhancement and kinetic pattern of the \nsame lesions were evaluated on DCE-MRI by manually segmenting the tumor \narea. CESM parameters were correlated with tumor size, histologic type, \ngrade, axillary status and immunohistochemical biomarkers. Cohen’s kappa, \nSpearman correlation, Mann Whitney U and Chi-square tests were used. \nResults or Findings: Early phase enhancements on CESM and MRI positively \ncorrelated (r=0.450, P=0.001). There was moderate agreement between \nCESM and DCE-MRI kinetic curve patterns (kappa=0.510, P<0.001). Early \nphase enhancement intensity on CESM positively correlated with tumor size, \ngrade and Ki67 index (P<0.040). Wash-out kinetic curve type on CESM was \nassociated with high histologic grade (P<0.048). \nConclusion: Quantitative analysis of enhancement on CESM images is \nfeasible and well-correlated with DCE-MRI. These enhancement parameters \nmight be helpful for prognostic significance of malignant tumors. \nLimitations: The study was carried out retrospectively. The sample size was \nrelatively limited. \nEthics Committee Approval: This study was approved by our ethics \ncommittee. \nFunding for this study: No funding. \nAuthor Disclosures: \nSelçuk Akkaya: Nothing to disclose \nSibel Kul: Nothing to disclose \n \nRPS 602-9 \nIdentifying potential improvement points in the breast cancer \nmultidisciplinary team meeting to facilitate development of a clinical \ndecision support system – an interview study \n*L. Koco*, R. Mann; Nijmegen/NL \n(lejla.koco@radboudumc.nl) \n \nPurpose: Determining areas in breast cancer multidisciplinary team meetings \n(MDTMs) where an AI based clinical decision support system (CDSS) can be \nof added value according to breast cancer care specialists, may lead to \ninclusion of their views in the development of the CDSS, and improve its \nusefulness in clinical practice. \nMethods or Background: From January 2019 to November 2020 core team \nmembers of the breast cancer MDT in three hospitals were interviewed. Semi-\nstructured interviews were performed based on an interview guide. All \ninterviews were recorded and transcribed verbatim. Deductive coding was \nperformed on the transcripts. The codes were organized in categories and \nthemes. \nResults or Findings: In total 27 clinicians; surgeons, medical oncologists, \nradiotherapists, pathologists, radiologists, and specialized nurses, were \ninterviewed. Improvement points most often mentioned were related to \nefficiency and missing data, during preparation and during the MDTM. Many \nactions are needed to find relevant patient information in the electronic medical \nrecords and redundant work is performed by the notetaker during the MDTM, \nwhich may be problematic as it was widely anticipated that the number of \npatients will increase. Foreseen benefits of using a CDSS would be; a clearer \noverview of all patient data, automatic generation of MDTM reports and clinical \ntrial suggestions. However, conditions for using the CDSS are that; it should be \nup to date at all times, it provides reliable and patient specific guideline \nsuggestions and it is editable and flexible. \nConclusion: Clinicians expect that using a CDSS could help to improve \nefficiency prior to, and during the MDTM, by affecting different aspects of the \nprocess. However, the CDSS should be up to date at all times and provide \nreliable, patient-specific suggestions. \nLimitations: For each hospital one clinician per discipline was interviewed. \nEthics Committee Approval: Not necessary \nFunding for this study: None \nAuthor Disclosures: \nRitse Maarten Mann: Nothing to disclose \nLejla Koco: Nothing to disclose \n \nRPS 602-10 \nContrast-Enhanced Spectral Mammography (CESM) guided biopsy - \ninitial clinical experience \n*A. Kornecki*, I. Ben-Nachum, M. Bhaduri, N. Khan, G. Muscedere,  \nO. Shmuilovich; London, ON/CA \n \nPurpose: Contrast Enhanced Spectral Mammography (CESM) is an emerging \nimaging technology with a cancer detection rate approaching that of MRI. For \nenhancing lesions detected by CESM and not by ultrasound or mammography, \nbiopsy is typically performed under breast MRI guidance. A new biopsy \ntechnique has been developed to allow radiologists to perform CESM guided \nbiopsy with the standard stereotactic- guided biopsy device. \nMethods or Background: As the first centre in North America to use CESM-\nguided biopsy, the purpose of this study to assess the feasibility of the use of \nCESM-guided biopsy in 50 patients. This abstract will describe our initial \nclinical experience in the patients that have been recruited so far. \nResults or Findings: Total of 199 enhancing lesions categorised as BI-RADS \n4/5 found in 283 CESM exams obtained between June 1-October 30, 2020. \n172 lesions were biopsied under US (131 malignant, 22 benign, 19 high risk \nlesions) and 15 were biopsied under routine stereotactic guidance (9 \nmalignant, 2 benign, 4 high risk lesions). CESM-guided biopsy was successful \nin 8/10 lesions (2 malignant, 5 benign, 1 high risk lesion). 3 were initially \ndetected by MRI and then by CESM. Two lesions did not enhance at the time \nof the biopsy; 1 was identified in a patient with brain metastases of unknown \norigin and died shortly after (PET CT was negative for breast primary) and 1 \nwas found in a patient who underwent subsequent mastectomy for 2 biopsy \nproven malignancies and found to have additional lesions. \nConclusion: Initial experience regarding the feasibility of CESM-guided biopsy \nwas encouraging. Lesions that were not seen were likely transient. \nLimitations: No limitations. \nEthics Committee Approval: The was approved by Health Canada and \nWestern University Research Ethic Board. \nFunding for this study: The study is funded by GE Healthcare. \nAuthor Disclosures: \nNasir Khan: Investigator: Study is funded by GE \nMousumi Bhaduri: Investigator: Study is funded by GE \nAnat Kornecki: Author: Study is funded by GE \nOlga Shmuilovich: Investigator: Study is funded by GE \nGiulio Muscedere: Investigator: Study is funded by GE \nIlanit Ben-Nachum: Investigator: Study is funded by GE \n \nRPS 602-11 \nComparison of background parenchymal enhancement on contrast-\nenhanced spectral mammography and breast MR images \n*E. D. Luczynska*¹, W. Rudnicki², T. Piegza², M. Pawlak², S. Heinze²; \n¹Rzeszow/PL, ²Krakow/PL \n(ela.luczynska@op.pl) \n \nPurpose: Contrast enhanced spectral mammography (CESM) and magnetic \nresonance imaging (MRI) are comparable methods regarding sensitivity. The \naim of this study is to check if analysis of background parenchymal \nenhancement (BPE) on CESM can improve its usefulness. \nMethods or Background: 79 patients with breast lesions found previously on \nultrasound or mammography underwent MRI and CESM. On MRI the \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 175  \nenhancement kinetics and visual BPE were evaluated. On CESM the \nenhancement of lesions was as well as a quantitative level of BPH were \nevaluated. The obtained data were analysed and compared. \nResults or Findings: A total of 83 lesions were identified both on MRI and \nCESM, including 16 (20.2%) benign and 67 (79.8%) malignant lesions. Among \nmalignant lesions 17 (21%) were assessed as intraductal and 50 (63.3%) as \ninfiltrating carcinomas. The study showed correlation between the level of \nenhancement on CESM and the type of kinetic curve on MRI and lesion \nenhancement on CESM as well as confirmed the fact that the BPE is important \nfactor in both methods of imaging. \nConclusion: Evaluation of BPE level on CESM can help reading radiologists \nto define a lesion as malignant with higher probability than based only on the \nqualitative lesion enhancement level. \nLimitations: Lack of data on the menstruation cycle day of the patients \nadmitted for CESM although we didn’t notice if it fluctuate during the cycle. \nAnother limitation is a small group of analysed patients. \nEthics Committee Approval: Ethics committee approval OIL/KBL/17/2018. \nFunding for this study: Nothing to declare. \nAuthor Disclosures: \nTomasz Piegza: Nothing to disclose \nSylwia Heinze: Nothing to disclose \nElzbieta Dorota Luczynska: Nothing to disclose \nMarta Pawlak: Nothing to disclose \nWojciech Rudnicki: Nothing to disclose \n \nRPS 602-12 \nIncidence of malignant disease associated with pregnancy and lactation: \na series of cases \n*F. J. Mercado Burgos*, M. E. Droguett; Santiago/CL \n(mercado.fdo@gmail.com) \n \nPurpose: Delaying motherhood is a growing trend in our society; this has \nincreased the incidence of malignant breast disease detected during \npregnancy and lactation. Breast ultrasound is the preferred method to study \npregnant patients since it does not involve ionizing radiation. Our purpose was \nto determine the incidence of malignant breast disease in pregnant/lactating \npatients studied with breast ultrasound in our institution. \nMethods or Background: We retrospectively reviewed all mammography and \nbreast ultrasound studies performed on this specific population for 3.5 years \n(January 2017 to September 2020). We collected the images and pathology \nreports available on our PACS, EMR, and analyzed them. \nResults or Findings: The sample included 1069 women, with an average age \nof 36 (SD 4.5 years), with a range of 25 and 53 years. 663 (62%) were 35 \nyears and older. All were studied with ultrasound, and on cases that the \nradiologist deemed necessary, a mammogram or other complementary \nprojections were requested. None of these additional studies detected new \nsuspicious lesions. In 98% of cases (1045/1069), benign or probably benign \n(BIRADS 2 or 3) findings were reported. In 25/1069 cases, the results were \nsuspicious of malignancy (BIRADS 4 and 5). 21 patients were biopsied with six \nmalignant lesions, 4/6 of them in patients older than 35 years. \nConclusion: Ultrasound proved to be a sensible method for detecting lesions \nconcerning for malignancy in this scenario. Mammography did not provide \nadditional information, and we observed an increased incidence in the group \nwith advanced maternal age. \nLimitations: It is not a prospective study. \nLow incidence of malignant disease. \nEthics Committee Approval: Not required \nFunding for this study: Not required \nAuthor Disclosures: \nFernando José Mercado Burgos: Nothing to disclose \nMaria Elisa Droguett: nothing to disclose \n \nRPS 602-13 \nThe diagnostic value of contrast-enhanced 2D mammography in clinical \npractice \n*L. Neeter*¹, H. Raat², S. Meens-Koreman², R. Van Stiphout²,  \nS. Timmermans², M. Smidt¹, J. E. Wildberger¹, P. Nelemans¹, M. B. I. Lobbes³; \n¹Maastricht/NL, ²Roermond/NL, ³Sittard-Geleen/NL \n(lidewij.neeter@mumc.nl) \n \nPurpose: Contrast-enhanced mammography (CEM) has shown to be \nconsistently superior to digital mammography. However, current results are \nmainly based on systems by a specific vendor (GE Healthcare). We aimed to \nevaluate the diagnostic performance of a CEM system by another vendor \n(Hologic) in clinical practice. \nMethods or Background: All patients in clinical practice who underwent CEM \nfor various indications in 2019 at Laurentius Hospital (Roermond, The \nNetherlands) were eligible for this study, except for those in whom CEM was \nused as response monitoring tool. CEM was performed on a dedicated system \n(Selenia Dimensions, HOLOGIC). Three experienced breast imaging readers \nfirst assessed and scored the low-energy images (LE) using BI-RADS \nclassification, before similarly assessing and scoring the CEM exams. \nHistopathology or one-year follow-up were the reference standard to assess \ntrue disease status. Diagnostic parameters, ROC curves, and AUCs were \ncalculated for LE and CEM and for all readers. \nResults or Findings: Breast cancer was diagnosed in 35 of the 152 included \npatients (23%). For all readers combined, sensitivity increased from 74.3% for \nLE to 87.6% for CEM (p=<0.0001) and specificity increased from 87.8% for LE \nto 94.6% for CEM (p=0.0146). The increase of the AUC from 0.872 for LE to \n0.957 for CEM (p=0.001) was also significant. These outcomes are \ncomparable to those from previous studies on other systems and meta-\nanalyses on CEM. \nConclusion: The tested CEM system provided superior diagnostic \nperformance over conventional mammography, which is in line with current \nknowledge. Results are comparable to published results for other clinical CEM \nsystems. \nLimitations: The sample size appears small and breast cancer prevalence \nwas relatively high. \nEthics Committee Approval: Necessity for written informed consent was \nwaived by our local IRB. \nFunding for this study: This research is supported by a ZonMw \nDoelmatigheidsOnderzoek grant. No funding by Hologic. \nAuthor Disclosures: \nSteffie Timmermans: Nothing to disclose \nMarjolein Smidt: Nothing to disclose \nLidewij Neeter: Nothing to disclose \nPatty Nelemans: Nothing to disclose \nMarc B I Lobbes: Research/Grant Support: GE Healthcare Speaker: GE \nHealthcare, Guerbet, and Bayer \nJoachim E. Wildberger: Other: Institiutional grants - AGFA, Bayer Healthcare, \nBard Medical, GE Healthcare, Optimed, Philips Healthcare, and Siemens \nHealthineers Speaker: Siemens Healthineers, Bayer Healthcare \nRogier Van Stiphout: Nothing to disclose \nStephanie Meens-Koreman: Nothing to disclose \nHenricus Raat: Nothing to disclose \n \nRPS 602-14 \nSensitivity for the assessment of breast lesions in contrast enhanced \nspectral mammography (CESM): can we exclude malignancy? \n*A. A. Marzogi*¹, P. Clauser², P. Kapetas², R-I. Milos², M. Bernathova²,  \nT. H. Helbich², P. A. Baltzer²; ¹Makkah/SA, ²Vienna/AT \n(alaamarzogi@live.com) \n \nPurpose: To measure the sensitivity and negative predictive value of breast \nlesions in CESM by correlating the enhancement intensity to the histology \nresult of breast biopsy \nMethods or Background: This is an IRB approved cross-sectional, \nretrospective study. Consecutive cases were collected from July 2018 until Oct \n2020. The reference standard was histology in all cases. CEM examinations \nwere performed with a standard technique and protocol. Two breast \nradiologists with 8 and 10 years of experience in breast imaging, blinded to \npatient data and histopathology result, qualitatively evaluated the breast \nlesions for enhancement intensity and a grade from (0) to (3) was given for \neach lesion; in which, (0)=no enhancement, (1)=subtle, (2)=moderate, \n(3)=distinct enhancement. ROC analysis was performed, and sensitivity and \nspecificity were calculated by dichotomizing Grade 0, 1 enhancement as \nnegative and grade 2, 3 enhancement as positive test result. \nResults or Findings: Among 200 patients, 139 lesions were included (84 \nmalignant (60%), 55 benign (40%)). For reader 1 (R1) the areas under the \ncurve (AUC) using the grade of enhancement were 0.842 (95% confidence \ninterval (CI), 0.771 - 0.898) and for reader 2 (R2) 0.879 (95% CI: 0.813 - \n0.928). Sensitivity for R1 and R2 were as follow 78.6% (95% CI: 68.3%-86.8%) \nand 88.1% (95% CI: 79.2%-94.1%). Negative predictive value was 71.9% \n(95% CI: 62.5%-86.8%), and 79.6% (95% CI: 68.03%-87.7%). Categorical \nassessment of CESM enhancement demonstrated moderate sensitivity and \nnegative predictive value. \nConclusion: Due to the moderate sensitivity and negative predictive value, our \nresults indicate that CESM cannot exclude malignancy. Consequently, invasive \nprocedures may be required for further workup of breast lesions independent \nfrom CESM results. \nLimitations: N/a \nEthics Committee Approval: This is an IRB approved \nFunding for this study: N/a \nAuthor Disclosures: \nPascal A.T. Baltzer: Nothing to disclose \nAlaa Abdulrahman Marzogi: Nothing to disclose \nThomas H. Helbich: Nothing to disclose \nMaria Bernathova: Nothing to disclose \nRuxandra-Iulia Milos: Nothing to disclose \nPanagiotis Kapetas: Nothing to disclose \nPaola Clauser: Other: Speaker for Siemens healthcare GmbH \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 176  \n \nResearch Presentation Session: Breast \nRPS 702 \nArtificial intelligence and machine learning \nin breast \nRPS 702-1 \nLeveraging ipsilateral dual-view information for mass detection in \nmammograms using deep learning \n*M. Jie*¹, X. Lin¹, R. Ouyang¹, M. Wu¹, Z. Yang², Z. Cao², Y. Zhang²,  \nP. Chang², M. Han²; ¹Shenzhen/CN, ²Palo Alto, CA/US  \n \nPurpose: To leverage the appearance and geometry relations of mass lesions \nin ipsilateral craniocaudal(CC) and mediolateral-oblique(MLO) views of one \nbreast to improve mass detection in mammograms. \nMethods or Background: The conventional deep learning framework typically \naccepts a single image input. However, the ipsilateral correlated information of \nCC and MLO views of one breast is well leveraged by radiologists in practice, \nbecause a mass lesion found in one CC/MLO view is highly possible to appear \nin the corresponding MLO/CC view. Moreover, the lesion-to-nipple distances of \none mass in both views are similar. We proposed a relation module integrated \nwith a dual-input Faster-RCNN framework to emphasize the appearance and \ngeometry similarities of a mass showing in the ipsilateral images. The \nappearance feature refers to an RoI's feature map after the RoI align stage and \nthe geometry feature is calculated based on the RoI-to-nipple distance. We \nalso upgraded the classification and regression losses with Focal loss(FL) and \nDistance-IoU loss(DIoU), respectively. A total of 3582 in-house cases including \nmalignant, benign, and normal cases, each of whom has four-view \nmammograms, were collected for our experiments. \nResults or Findings: We adopt the Free-Response-Operating-\nCharacteristic(FROC) metric to evaluate recall values at different False \nPositive per Image(FPI) points. Our recall values at 0.5,1.0,2.0 FPI are \n0.88,0.92,0.96, respectively. We also compare our proposed relation block with \na direct concatenation operation after the RoI align stage. The latter method \nreports the respective recall values of 0.80,0.86,0.91, worse than the \nperformance of our proposed methods. \nConclusion: Our proposed dual-input deep learning framework with the \nlearning of ipsilateral appearance and geometry relations in CC and MLO \nviews of one breast is demonstrated to improve mass lesion detection in \nmammograms. \nLimitations: The dataset size is relatively small. \nEthics Committee Approval: The IRB number is LL-XJS-2020011. \nFunding for this study: n/a \nAuthor Disclosures: \nZhicheng Yang: Nothing to disclose \nMa Jie: Nothing to disclose \nPeng Chang: Nothing to disclose \nMingxiang Wu: Nothing to disclose \nRushan Ouyang: Nothing to disclose \nMei Han: Nothing to disclose \nYanbo Zhang: Nothing to disclose \nZhenjie Cao: Nothing to disclose \nXiaohui Lin: Nothing to disclose \n \nRPS 702-2 \nArtificial intelligence-based breast density classifier improves \nmammography reporting reliability \n*A. Watanabe*¹, R. Mantey², C. Chim²; ¹Manhattan beach, CA/US,  \n²La Jolla, CA/US  \n(alyssa90266@gmail.com) \n \nPurpose: To demonstrate superior reliability of an AI-based tissue density \nclassifier for mammography using an innovative semi-supervised learning \n(SSL) method which addresses reader variability, poor consistency of \nquantitative classifiers, and the complex issues in machine training based on \nthe subjective assessment goals of BIRADS 5th-edition. The use of SSL \nremoves human bias from the training of software. \nMethods or Background: The AI-based density classifier (cmDensity(TM), \nCureMetrix.) is trained using SSL without explicit labeling, eliminating human \nbias. The classifier was compared to 7 MQSA qualified readers in 4-class (A-D) \nassessments using 792 mammograms from 3 institutions, 2 continents, and 3 \nvendors. Borderline exams between density classes were chosen to maximally \ntest performance. Kappa (k) statistics at 95% confidence interval (CI) including \nintraclass correlation coefficient (ICC) were used for measuring inter-reader \nagreement, intra-reader reliability, and comparison with cmDensity. \ncmDensity’s reliability was also tested using agreement across tomosynthesis \nimages. \nResults or Findings: The cmDensity agreement increased with degree of \nconsensus (4/7 to 7/7 readers) (k=0.65,0.82,0.94,0.97). In cases with 100% \nreader consensus, there was near perfect agreement with cmDensity. The \nintra-reader reliability ranged from ICC=0.70-0.82 vs near perfect cmDensity \nreliability (ICC=0.99). Dense cases were correctly scored by cmDensity, \ndespite variation in fibroglandular tissue (which is the downfall of non-AI based \nvolumetry software). The density classifier showed high agreement in the \ntomosynthesis evaluation. \nConclusion: cmDensity shows higher reliability compared to radiologists in \ntissue density categorization and addresses the BIRADS 5th-edition subjective \ngoal of reporting perceived masking effect of dense tissue. Benefits including \nreduced reporting variability, enhanced radiologist efficiency (including \npopulation of reports), and improved accuracy and consistency in \ncommunication of tissue density to clinicians and patients. \nLimitations: A larger sample size could be useful. \nEthics Committee Approval: As a retrospective study, an IRB waiver was \nobtained. \nFunding for this study: None. \nAuthor Disclosures: \nAlyssa Watanabe: Consultant: CureMetrix, Inc Shareholder: CureMetrix, Inc \nChiyung Chim: Employee: CureMetrix, Inc \nRichard Mantey: Employee: CureMetrix, Inc \n \nRPS 702-3 \nMRI-based radiomics for prediction to neoadjuvant chemotherapy in \nbreast cancer: a referral centre analysis \n*F. Pesapane*, A. Rotili, L. Bianchini, F. Botta, F. Ferrari, S. Raimondi,  \nD. A. Origgi, M. Cremonesi, E. Cassano; Milan/IT \n(filippopesapane@gmail.com) \n \nPurpose: We aimed to determine whether radiomic features extracted from \nbreast magnetic resonance imaging (MRI) could non-invasively predict the \nresponse to neoadjuvant chemotherapy (NACT) in patients with breast cancer. \nMethods or Background: 130 patients with breast cancer receiving NACT in \na single centre (01/2017-06/2019) and undergoing breast MRI, were \nretrospectively evaluated. For each included patient, radiomic features were \nextracted within the biopsy-proven tumour on T1-weighted contrast-enhanced \nMRI performed before NACT. The pathological complete response (pCR) of \nNACT was determined based on the final surgical specimen. The association \nof clinical/biological and radiomic features with response to NACT was \nevaluated by univariate and multivariable analysis by using Random Forest \nand logistic regression. The performance of all models was assessed using the \narea under the receiver operating characteristics curve (AUC) with 95% \nConfidence Intervals (CI). \nResults or Findings: 83 patients (mean [SD] age, 47.26 [8.6] years) were \nincluded. Patients with HER2+, basal-like molecular subtypes and Ki67 •20% \npresented more frequently a pCR to NACT; clinical/biological model AUC \n(95%CI) was 0.81 (0.71-0.90). Using 136 representative radiomics features \nselected through cluster analysis from the 1037 extracted features, a radiomic \nscore was calculated to predict the response to NACT, with AUC (95%CI): 0.64 \n(0.51-0.75). Combining clinical/biological- and radiomics-model, the AUC \n(95%CI) was 0.83 (0.73-0.92). \nConclusion: MRI-based radiomic features slightly improve the pre-treatment \nprediction of pCR to NACT in addiction to biological characteristics. If \nconfirmed on larger cohorts, it could be helpful to identify rightful patients for \navoiding unnecessary treatment. \nLimitations: First, the retrospective nature of the study and the limited number \nof patients; second, the assessment of interobserver agreement to ensure the \nreproducibility of the segmentation was not conducted. \nEthics Committee Approval: This retrospective-study was approved by the \ninstitutional review board (UID1926) \nFunding for this study: No funds. \nAuthor Disclosures: \nAnna Rotili: Nothing to disclose \nLinda Bianchini: Nothing to disclose \nFrancesca Botta: Nothing to disclose \nSara Raimondi: Nothing to disclose \nFilippo Pesapane: Nothing to disclose \nMarta Cremonesi: Nothing to disclose \nEnrico Cassano: Nothing to disclose \nFederica Ferrari: Nothing to disclose \nDaniela Anna Origgi: Nothing to disclose \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 177  \nRPS 702-4 \nMeasuring short and long-term breast cancer risk by combining \nmammographic texture models, an AI-based CAD system, and \nestablished risk factors \n*A. D. Lauritzen*¹, A. Rodriguez-Ruiz², M. C. von Euler-Chelpin¹, E. Lynge³,  \nI. Vejborg¹, M. Nielsen¹, N. Karssemeijer², M. Lillholm¹; ¹Copenhagen/DK, \n²Nijmegen/NL, ³Nykøbing Falster/DK \n(al@di.ku.dk) \n \nPurpose: To investigate the combined effect of mammographic texture and \nthe exam score of an AI-based CAD system in terms of quantifying short- and \nlong-term breast cancer risk. \nMethods or Background: This retrospective study comprised a cohort of \n52637 double-read screens of four FFDMs from the Danish Capital Region \nbreast cancer screening program, including 154 interval cancers (IC, \ndiagnosed 6-24 months after screening) and 808 long-term cancers (LTC, \ndiagnosed 2-5 years after screening). For each exam, three metrics were \ncomputed. Percent mammographic density (PMD) was measured using a \ndeep-learning-based tool. Mammographic texture-based risk (TBR) was \ncomputed using the deep-learning architecture, ResNet34, trained to detect \nimages of women with high probability of developing cancer in the future. An \nAI-CAD system, Transpara v1.6, analyzed all studies providing an exam score \nfrom 0 to 10, where a high score indicates a high probability of visible \nmalignancy. Using baseline screening mammograms, we examined risk \nsegregation performance of the models for IC (short-term) and LTC using area \nunder the ROC curve (AUC-ROC, 95% CI). Logistic regression was used to \ncombine co-variates and validated using 5-fold cross-validation. \nResults or Findings: TBR yielded an AUC-ROC of 0.69 (0.64-0.73) for ICs \nand 0.66 (0.64-0.68) for LTCs. The AI-CAD yielded an AUC-ROCs of 0.67 \n(0.62-0.71) for ICs and 0.64 (0.62-0.66) for LTCs. Combining TBR, AI-CAD, \nPMD, and age yielded an AUC-ROCs of 0.72 (0.68-0.76) for ICs and 0.68 \n(0.66-0.69) for LTCs. \nConclusion: Results indicate that combining texture-based risk, AI-CAD exam \nscore, PMD, and age improved risk segregation for both ICs and LTCs \ncompared to texture and AI-CAD alone suggesting that both systemic and \nlocalised findings can contribute to risk modelling. \nLimitations: The cross-validated performance should be validated \nindependently in future studies. \nEthics Committee Approval: n/a \nFunding for this study: Partially Eurostars project IBSCREEN ref. 9715 \nAuthor Disclosures: \nMy Catarina von Euler-Chelpin: Nothing to disclose \nAndreas David Lauritzen: Nothing to disclose \nAlejandro Rodriguez-Ruiz: Employee: ScreenPoint Medical \nMads Nielsen: Nothing to disclose \nMartin Lillholm: Nothing to disclose \nElsebeth Lynge: Nothing to disclose \nNico Karssemeijer: CEO: ScreenPoint Medical \nIlse Vejborg: Nothing to disclose \n \nRPS 702-5 \nEvaluation of 3T multiparametric MRI with radiomic analysis for \ndifferentiating benign and malignant breast lesions \n*A-C. Vamvakas*, D. Tsivaka, A. Logothetis, K. Vassiou, I. Tsougos; \nLarissa/GR \n(alek.vamv@gmail.com) \n \nPurpose: To investigate the contribution of 3Tesla multiparametric MRI in \nbenign and malignant breast lesions differentiation with radiomic analysis. \nMethods or Background: In this retrospective study 109 females with \nhistologically confirmed mass-like breast lesions (54 benign and 55 malignant), \nwho underwent a 3Tesla MRI scanning with T2-weighted, Dynamic Contrast \nEnhanced T1-weighted (DCE) and Diffusion Weighted Imaging (DWI), were \nincluded. 3-dimensional lesion contours were manually drawn in T2-w, 2nd \npost-contrast DCE frame and Apparent Diffusion Coefficient (ADC) images with \nLIFEx v5.1 software and 138 radiomic features (shape, histogram, texture) \nwere extracted. The Mann-Whitney U-test was used for initial elimination of \nnon-informative features and the remaining 100 features were imported into a \nbinary Logistic Regression classifier with Elastic-Net regularization. The \nevaluation of different feature subsets classification performance was based on \n10-fold cross-validation and Receiver Operating Characteristic analysis \nperformed in MATLAB R2019a. \nResults or Findings: The highest classification performance (AUC=0.94) was \nachieved by a subset combining features from the three MRI sequences. DCE \nhad a better performance (AUC=0.91) followed by ADC (AUC=0.86) and T2-w \n(AUC=0.83). We observed that histogram features were present in all feature \nsubsets, while only DCE, T2-w and mixed subsets included texture features. \nAlso, the number of texture features needed to maintain classification accuracy \nwas further increased when shape features were excluded from the analysis. \nConclusion: Multiparametric MRI radiomic analysis holds great potential for \nbreast cancer classification. \nLimitations: n/a \nEthics Committee Approval: Institutional ethics committee approval and \npatient informed consent were obtained. \nFunding for this study: This research is co-financed by Greece and the \nEuropean Union (European Social Fund-ESF) through the Operational \nProgramme «Human Resources Development, Education and Lifelong \nLearning 2014-2020» in the context of the project “Breast cancer assessment \nthrough advanced multiparametric imaging techniques and development of \ndifferential diagnosis software using artificial intelligence systems” \n(MIS5048948). \nAuthor Disclosures: \nAlexandros-Chrysovalantis Vamvakas: Nothing to disclose \nDimitra Tsivaka: Nothing to disclose \nAndreas Logothetis: Nothing to disclose \nKaterina Vassiou: Nothing to disclose \nIoannis Tsougos: Nothing to disclose \n \nRPS 702-6 \nDiagnostic performance of AI for cancers registered in a mammography \nscreening program: a retrospective analysis \nM. E. Seker, *Y. O. Köylüo÷lu*, M. E. Aribal; Istanbul/TR \n \nPurpose: The aim of this study is to evaluate the impact of AI based decision \nsupport system in radiologists’ detection rates in a screening setting. \nMethods or Background: MMG images of patients who were either \ndiagnosed with cancer or didn’t have an instance of cancer for 2 years \nbetween ages 40 and 69 were acquired from a single local screening center. A \ntotal of 110 cancer cases, of which 74 were screening detected, 27 were \ninterval/intermediate type and 9 were missed and a control group of another \n101 healthy women’s MMG images who were registered as free from cancer \nfor at least 2 years were evaluated with a web based AI algorithm which \nestimated a risk score between 0-100 for each breast. AI findings and \nradiologist decisions were analyzed separately for three subgroups; screen-\ndetected, interval/intermediate and missed. Results were analyzed with a ROC \ncurve to find a threshold with Youden’s index and patients were relabeled \naccordingly. Radiologists’ original findings were compared to a simulated \nradiologist/AI team up. \nResults or Findings: AI predicted cancers in the cancer cohort with an AUC of \n0.853 (95% CI = 0.801 – 0.905) and a sensitivity and specificity of 72.8% and \n88.3%, respectively, for a risk score of 34.5 as a cut off value. AI missed 7.8% \nof the radiologists’ true positive cases. However it has detected, an additional \n70.3% of interval/intermediate and 77.7 of missed cases. \nConclusion: AI is effective in detecting cancers and able to increase the \ndetection rate of interval and missed cancers. It may ameliorate the workflow of \nradiologists as a decision support system in a screening program by detecting \na high rate of interval and missed cancers. \nLimitations: 1.Single center study \n2.Absence of inter-observer reliability statistics \nEthics Committee Approval: Approved \nFunding for this study: n/a \nAuthor Disclosures: \nMustafa Erkin Aribal: Nothing to disclose \nMustafa Ege Seker: Nothing to disclose \nYılmaz Onat Köylüo÷lu: Nothing to disclose \n \nRPS 702-7 \nRadiomic machine learning for predicting prognostic biomarkers and \nmolecular subtypes of breast cancer based on the integration of tumour \nheterogeneity and angiogenesis properties at MRI \n*H. S. Park*¹, B. K. Seo¹, J. Y. Lee², K-S. Lee³, K. R. Cho³, O. Woo³,  \nE. K. Park¹, S. E. Song³; ¹Ansan/KR, ²Goyang/KR, ³Seoul/KR \n(phs9416@naver.com) \n \nPurpose: To investigate machine learning for radiomics-based prediction of \nprognostic biomarkers and molecular subtypes of breast cancer using \nquantification of heterogeneity and angiogenesis at MRI. \nMethods or Background: This prospective study examined 291 invasive \nbreast cancers in 288 patients who underwent breast MRI before treatment. \nFor quantification of heterogeneity and angiogenesis, texture analysis and \nperfusion analysis were performed using filtration-histogram technique and the \nTofts model, respectively. For each cancer, 144 heterogeneity and 16 \nangiogenesis parameters were extracted. Relationships between parameters \nand prognostic biomarkers were analyzed using six machine learning \nalgorithms. Each machine learning model was built using only texture features, \nonly perfusion features, or integrating both features. The model performance \nand importance of MRI parameters were derived. \nResults or Findings: Texture parameters were associated with status of \nlymph node, hormone receptors, HER2, Ki67, tumor size, grade, and molecular \nsubtypes (P<0.05). Among perfusion parameters, relative extracellular \nextravascular space parameter (Ve) was associated with status of hormone \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 178  \nreceptors and Ki67, tumor size, grade, and molecular subtypes (P<0.05). The \nrandom forest model integrating texture and perfusion parameters was the best \nfor prediction: 73% and 0.73 vs 70% and 0.71 (texture parameters only), and \n61% and 0.57 (perfusion parameters only) for average accuracy and area \nunder ROC curve, respectively. The most important parameters for prediction \nwere entropy (texture parameter) and Ve (perfusion parameter). \nConclusion: Radiomic machine learning, which integrates tumor heterogeneity \nand angiogenesis properties at MRI, can noninvasively predict prognostic \nbiomarkers and molecular subtypes of breast cancer. Entropy and Ve are the \nmost important parameters for this prediction. \nLimitations: External validation wasn’t performed. \nEthics Committee Approval: IRB approved. \nFunding for this study: Supported by National Research Foundation (NRF) of \nKorea grant funded by the Ministry of Science and ICT of Korea (No. NRF-\n2020R1F1A1073213) and the Korea University grant (No. K2008291). \nAuthor Disclosures: \nOkhee Woo: Nothing to disclose \nEun Kyung Park: Nothing to disclose \nBo Kyoung Seo: Nothing to disclose \nSung Eun Song: Nothing to disclose \nKwang-Sig Lee: Nothing to disclose \nJi Young Lee: Nothing to disclose \nHyun Soo Park: Nothing to disclose \nKyu Ran Cho: Nothing to disclose \n \nRPS 702-8 \nRadiomics analysis in breast MRI for non-invasive (in situ) breast cancer \ncharacterisation: initial results \n*G. Lavazza*¹, V. Giannini¹, L. Martincich², M. Durando¹, G. Bartoli¹,  \nA. Defeudis¹, D. Regge¹, P. Fonio¹; ¹Turin/IT, ²Asti/IT \n \nPurpose: To investigate the correlation between texture analysis and \nradiologic and histologic characteristics of breast cancer at preoperative breast \nMRI. To identify an imaging biomarker for therapeutic stratification. \nMethods or Background: Retrospective multicentric analysis including 74 \npatients with newly diagnosed in situ breast cancers, who preoperatively \nunderwent 1.5T breast MRI between October 2010 and April 2020. Histologic \nanalysis was obtained in all patients and histo-pathologic (including receptors \nexpression) characteristics were analyzed. Two dedicated breast radiologists \nin consensus reviewed MRI examination and breast lesions were manually \nsegmented on DWI and DCE sequences. Texture analysis was obtained with \nan “in-house” C++ software. The Mann-Whitney test was used for the statistical \nmonoparametric analysis. Moreover, stepwise logistic regression model used \nas significance levels: 0.20 for adding variables and 0.05 for removing \nvariables. Statistical significance was set at p<=0.05. \nResults or Findings: Evaluating lesion and patients’ characteristics, at DCE \nsequences 11 features reached statistical significance for the micropapillary in \nsitu subtype, 7 features for the high-grade nuclear lesions, 6 features for the \nnon-mass MRI lesions, 4 features for positive progesterone receptors lesions, \nand 4 features for patients candidate to mastectomy. At DWI sequence, 9 \nfeatures reached statistical significance for patients candidate to mastectomy. \nThe features considered were not able to statistically discriminate other breast \nlesions characteristics. The stepwise logistic regression models were are able \nto discriminate the previously reported lesions characteristics, with \nperformances measured by area under ROC curve ranging between 0.79 e \n0.93. \nConclusion: In accordance with literature, our results express the possible use \nof texture analysis as an imaging biomarker. The extraction of features from \nMR images could affect the decision-making process of the most suitable \ntherapeutic approach and bring advantages to oncologic practice. \nLimitations: The small sample size. \nEthics Committee Approval: Not applicable \nFunding for this study: None \nAuthor Disclosures: \nManuela Durando: Nothing to disclose \nDaniele Regge: Nothing to disclose \nPaolo Fonio: Nothing to disclose \nLaura Martincich: Nothing to disclose \nGiulia Lavazza: Nothing to disclose \nGermana Bartoli: Nothing to disclose \nArianna Defeudis: Nothing to disclose \nValentina Giannini: Nothing to disclose \n \n \n \n \n \n \n \n \nRPS 702-9 \nMachine learning approaches for optimization in MRI texture analysis of \nbreast cancer to predict prognostic biomarkers and molecular subtypes \n*H. S. Park*¹, B. K. Seo¹, E. K. Park¹, K-S. Lee², J. Y. Lee³, K. R. Cho²,  \nO. Woo², S. E. Song²; ¹Ansan/KR, ²Seoul/KR, ³Goyang/KR \n(phs9416@naver.com) \n \nPurpose: To investigate machine learning approaches for optimization in MRI \ntexture analysis of breast cancer to predict prognostic biomarkers and \nmolecular subtypes. Texture analysis is useful for non-invasive quantification of \ntumor heterogeneity. \nMethods or Background: A total of 291 invasive breast cancers in 288 \npatients who underwent dynamic breast MRI were enrolled. Texture analysis \nwas performed using filtration-histogram technique with spatial scale filters \n(SSF; 0-without filtration, 1-2 mm-fine scale, 3-4 mm-medium scale, 5 mm-\ncoarse scale). We measured 6 texture features (mean, standard deviation, \nmean of positive pixels, entropy, skewness, kurtosis) at T2-weighted(T2), pre-\ncontrast T1-weighted(PreT1), and post-contrast T1-weighted(PostT1) imaging. \n144 parameters were extracted and their relationship to pathological factors \nwas analyzed using logistic regression and 5 machine learning models. \nAccuracy and the AUC (area under the ROC curve) were used to evaluate \nmodel performance. \nResults or Findings: The random forest model was the best for predicting \nprognostic factors. As SSF approached 0, the superior performance of the \nrandom forest model became more apparent when compared to the logistic \nregression: in AUC, 0.79 vs. 0.71 for estrogen receptor status, 0.73 vs. 0.65 for \nKi67, 0.77 vs. 0.70 for tumor grade, and 0.83 vs. 0.74 for molecular subtype. \nAccording to variable importance from the random forest, the top 5 important \nparameters were PostT1 entropy, PostT1-PreT1 entropy, T2 entropy, T2 \nkurtosis, PreT1 standard deviation. \nConclusion: Based on machine learning analysis, entropy parameters and no \nor fine scale filtration are recommended for texture analysis at breast MRI in \npredicting prognostic biomarkers and molecular subtypes of breast cancer. \nLimitations: External validation wasn’t performed. \nEthics Committee Approval: IRB approved. \nFunding for this study: Supported by National Research Foundation (NRF) of \nKorea grant funded by the Ministry of Science and ICT of Korea (No. NRF-\n2020R1F1A1073213) and the Korea University grant (No. K2008291). \nAuthor Disclosures: \nOkhee Woo: Nothing to disclose \nEun Kyung Park: Nothing to disclose \nBo Kyoung Seo: Nothing to disclose \nSung Eun Song: Nothing to disclose \nKwang-Sig Lee: Nothing to disclose \nJi Young Lee: Nothing to disclose \nHyun Soo Park: Nothing to disclose \nKyu Ran Cho: Nothing to disclose \n \nRPS 702-10 \nDCE-MRI radiomics analysis for breast lesions characterisation \n*M. Di Marco*¹, A. A. M. Orlando¹, I. D'Angelo², C. Militello², L. Rundo³,  \nT. V. Bartolotta²; ¹Palermo/IT, ²Cefalu/IT, ³Cambridge/UK \n(maridimarco33@gmail.com) \n \nPurpose: To propose a radiomic signature, extracted from DCE-MRI datasets, \nable to predict focal breast lesions (FBLs) characterization. \nMethods or Background: 91 FBLs (mean size: 16.85 mm; size range: 5-60 \nmm), found with Breast DCE-MRI in 91 patients (mean age: 47.67 years; age \nrange: 24-72 years), underwent radiomic analysis by using a manual \nsegmentation method performed by an experienced breast radiologist. \nPyRadiomics software was used to extract 107 radiomics features. A feature \ncalibration and pre-processing step was performed to select only robust non-\nredundant features. An in-depth analysis was performed to build a predictive \nmodel: for this purpose, a Support Vector Machine (SVM) was trained in a \nnested 5-fold cross-validation scheme, by exploiting 5 different feature \nselection methods. \nResults or Findings: The 5 radiomic models built showed good and similar \npredictive performance in terms of AUC, specificity, sensitivity and accuracy, \nwith similar 'pattern of features' selected. Best results were given, in particular, \nby DGUFS feature selection method, obtaining: AUC = 0.72, sensitivity = 0.68, \nspecificity = 0.76, and accuracy = 0.72. The best predictive model obtained by \nmeans of DGUFS feature selection method, consists of a signature composed \nof 4 radiomic features: Flatness, Least Axis Length and Elongation (shape \nfeatures), and Dependence Non-Uniformity Normalized (Gray Level \nDependence Matrix feature). \nConclusion: We built a radiomic predictive model able to characterize breast \nlesions in DCE-Breast MRI, showing promising results in terms of accuracy \nand specificity. \nLimitations: Our study is a single-center study without large numbers. \nOnly manual annotation was considered and used, only regarding the \nintratumoral component. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 179  \nEthics Committee Approval: Ethics committee approval obtained \nFunding for this study: None \nAuthor Disclosures: \nAlessia Angela Maria Orlando: Nothing to disclose \nMariangela Di Marco: Nothing to disclose \nIldebrando D'Angelo: Nothing to disclose \nCarmelo Militello: Nothing to disclose \nLeonardo Rundo: Nothing to disclose \nTommaso Vincenzo Vincenzo Bartolotta: Nothing to disclose \n \nRPS 702-11 \nUsing AI to identify normal cases that may not need a second reader \nassessment in a French breast cancer screening program (BCSP): a \nretrospective evaluation \n*H. Jarraya*¹, Y. Damiens¹, C. Venel¹, M. Legros¹, C. Brochart¹, J. Rais¹, \nM. Medjahdi¹, T. Petit², A. Rodriguez Ruiz³; ¹Arras/FR, ²Amiens/FR, \n³Nijmegen/NL \n(hajer.jerraya@gmail.com) \n \nPurpose: To retrospectively investigate an AI system as aid to first reader to \nidentify which cases do not need double reading because very likely normal in \nBCSP with digital mammography (DM). \nMethods or Background: A cohort of 998 DM was collected and enriched \nwith additional 43 detected cancers (52 cancers in total). All DM (and their \nprior) were processed by an AI system (Transpara, version 1.6.0, ScreenPoint \nMedical), which categorizes them on a scale 1-10 representing the risk of \nabnormalities. Breast density was also recorded. Different cutoff points of AI \nwere investigated to define the largest group of screening exams with the \nlowest likelihood of cancer. Binomial method was used to compute 95% \nconfidence intervals (CI) of the distributions. \nResults or Findings: Detection wise, 49/52 detected cancers had an AI risk \nscore of 8 or higher. Using AI to identify likely normal exams, cases with risk \nscore 4 or lower included 0% (CI: 0-7.7) of cancers and 29% (CI: 26-32) of \ntotal screening volume. When taking breast density into account, cases with \nrisk scores 7 or lower and with low breast density (A or B) included 0% (CI: 0-\n7.7) of cancers and 47% (CI: 44-50) of total screening volume. \nWhen looking at prior exams 2 years earlier, 43% (CI: 20-70) of detected \ncancers already had the highest AI risk score of 10. \nConclusion: AI could be used in screening programs as aid to the first reader \nto identify 29% of very likely normal mammograms where double reading may \nnot be necessary. Combined with breast density, this volume could be \nincreased to 43%. \nLimitations: More mammograms and more diversity of data (different vendors) \nare needed to understand the generalisability of our results. \nEthics Committee Approval: Internal ethics commitee approval was obtained \nFunding for this study: None \nAuthor Disclosures: \nCédric Brochart: nothing to disclose \nYoann Damiens: Nothing to disclose \nAlejandro Rodriguez Ruiz: Employee: Screenpoint \nHajer Jarraya: nothing to disclose \nMylène Legros: nothing to disclose \nJamal Rais: Nothing to disclose \nColine Venel: Nothing to disclose \nMustapha Medjahdi: Nothing to disclose \nThomas Petit: nothing to disclose \n \nRPS 702-12 \nComparison of artificial intelligence/machine learning algorithm in \nreporting computed radiography (CR) and digital radiography (DR) \nmammography studies \n*R. Ananthasivan*¹, P. G. Patil¹, K. Garg², S. Bevoor Chowdaiah¹,  \nH. H. Prabhakaran², K. Ravindran², V. Raj¹; ¹Bangalore/IN, ²Chennai/IN \n(rupanth@yahoo.com) \n \nPurpose: Systems utilising Artificial Intelligence (AI)/Machine Learning(ML) \nhave shown to be highly accurate in reporting mammography studies. Digital \nradiography(DR) has become routine practice in most of the developed world \nand these AI/ML platforms have largely been trained in DR datasets. In many \ndeveloping nations, Computed Radiography(CR) mammography is still in \npractice. We compare the accuracy of an AI system in picking up abnormalities \nbetween a CR and a DR mammography study. \nMethods or Background: Mammography images from a tertiary referral \ncentre and a teleradiology unit, between Nov 2018 to Feb 2020 were collated. \nBoth CR (computed radiography) and DR (digital radiography) images were \navailable. Images were divided into training and testing groups randomly and \nthe training dataset was annotated by a team of senior radiologists. Cases \nfrom testing sets were reported by four radiologists and compared against the \nperformance of the AI/ML generated reports. \nResults or Findings: A total of 18908 examinations were available, of these \n7675 were CR (41%). Training set consisted of 9960 (70% of these were CR). \nA total of 3042 cases (from the testing set) were reported, of these 603 (20%) \nwere CR and 2439 were DR. Two radiologists reported 100 CR cases each. \nThe sensitivity of the AI/ML system in reporting CR and DR was 97% vs 98% \nrespectively. The specificity and accuracy of both CR and DR were similar at \n93 and 95% respectively. There was no significant difference in the \nperformance of the system in the CR dataset. \nConclusion: There is no significant difference in the interpretation of CR or DR \ndataset by the indigenously developed AI/ML system. High levels of accuracy \nwere seen in both types of films. \nLimitations: Larger adoption needs to be tested. \nEthics Committee Approval: Appropriate permission has been taken \nFunding for this study: None \nAuthor Disclosures: \nSanjana Bevoor Chowdaiah: Nothing to disclose \nVimal Raj: Advisory Board: CHS World \nHari Haran Prabhakaran: Founder: CHS World \nKrithika Ravindran: Board Member: CHS World \nKushagra Garg: Investigator: CHS World \nRupa Ananthasivan: Nothing to disclose \nPooja G Patil: Nothing to disclose \n \nRPS 702-13 \nMammographic breast density assessment via deeply aggregating \nbilateral context information \nX. Lin¹, *M. Jie*¹, Y. Ouyang¹, M. Wu¹, S. Wu¹, Q. Diao¹, L. Huang¹, J. Xiao¹,  \nY. Zhang²; ¹Shenzhen/CN, ²Palo Alto/US \n \nPurpose: To increase the performance and reproducibility of mammographic \nbreast density measurement, we develop an assessment network utilizing \ndeeply aggregating bilateral contextual information. \nMethods or Background: We collected 42154 cases of screening and \ndiagnosis mammograms of two manufacture facilities from in-house hospital. \nAll mammographic density categories were made sure by a senior radiologist \nand a junior one. In related works, density classification methods were based \non a single image. In practical verification, large lesions in image did disrupt \nthe density classifier. To tackle this problem, we proposed a novel density \nclassifier based on residual pyramid feature network, including two branches: a \nsingle inputting classification branch, and the other is a dual inputting which \naggregates bilateral contextual information to improve performance and reduce \nperturbation of lesions. Additionally, we only used a size 800 x 448 of Cranio-\nCaudal (CC) image duel to Medio-Lateral Oblique (MLO) consisting of pectoral \nmuscle and being of a phenomenon of glandular backlog. \nResults or Findings: To evaluate the classification performance, we had \ntested the model on an in-house mammogram dataset involving 1686 cases \nthat were re-annotated by a senior radiologist. Our two- and four-classification \nmodel achieved accuracies of 0.953 and 0.858, respectively. The \ncorresponding area under the receiver operating characteristic curve AUC and \nmac-AUC are 0.941 and 0.915, respectively. \nConclusion: As one of the most important breast cancer risk factors, breast \ndensity is usually measured on radiologist's daily work. In this retrospective \nstudy, the experimental results indicated well distinguished density categories. \nIt's able to contribute to decrease the inconsistency of mammographic density \njudgment between radiologists and improve density quantification, promoting \nanalysis of lesion nature and risk assessment of breast cancer. \nLimitations: The bias of race difference is not well considered. \nEthics Committee Approval: The IRB number is LL-XJS-2020011. \nFunding for this study: n/a \nAuthor Disclosures: \nMa Jie: Nothing to disclose \nYu Ouyang: Nothing to disclose \nQingchen Diao: Nothing to disclose \nShibin Wu: Nothing to disclose \nMingxiang Wu: Nothing to disclose \nJing Xiao: Nothing to disclose \nLingyun Huang: Nothing to disclose \nYanbo Zhang: nothing to disclose \nXiaohui Lin: Nothing to disclose \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 180  \n \nResearch Presentation Session: Cardiac \nRPS 303 \nIschaemia and infarction \nRPS 303-1 \nIdentify ischemic, infarcted, hibernant, and normal myocardium by stress \nand rest T1 mapping without the application of gadolinium contrast \nagents \n*B. Zhuang*, M. Lu; Beijing/CN  \n(zbyan10@163.com) \n \nPurpose: In chronic coronary artery disease, accurate detection of ischemic \nand hibernant myocardium is important because targeted revascularization \nimproves clinical outcomes.The aim of this study was to evaluate the potential \nof T1 mapping at rest and during adenosine triphosphate stress for the \ndetection of ischemic, hibernant and infarct myocardium in a swine model \nusing pathology as gold reference. \nMethods or Background: Twelve adult male Chinese miniature swine with the \ninduction of chronic coronary artery stenosis were enrolled in this study. The \nCMR imaging was performed at four time points: baseline, 1 week-, 2 weeks- \nand 4 weeks- after surgery. Pre- and post-contrast T1 mapping at rest and \nduring adenosine triphosphate stress, first-pass perfusion and stress perfusion \nas well as late gadolinium enhancement were performed at all imaging time \npoints. Myocardial perfusion reserve index(MPRI) were calculated. The native \nT1, extracelluar volume (ECV) and their percentage were also calculated. \nResults or Findings: The rest native T1 value of infarct, hibernant, ischemia \nand normal myocardium were 1586.4±159.0ms, 1350.7±165.5ms, \n1218.8±153.4ms, 1101.8±107.7ms, respectively. The rest ECV value of infarct, \nhibernant, ischemia and normal myocardium were 73.89±8.27, 40.25±7.77, \n34.09±3.00, 24.48±2.71, respectively. MPRI were associated with the change \nof native T1 (stress native T1 minus rest native T1, ᶭnative T1) (R=-0.45, \np=0.005) and native T1 percentage ( ᶭnative T1/ rest native T1) (R=-0.50, \np=0.034). Besides, there were correlation observed between MPRI and the \nchange of ECV (R=-0.41, p<0.001) and ECV percentage (R=-0.41, p=0.005). \nConclusion: We identified the native T1 and ECV values of four myocardium \ntypes in chronic ischemic cardiomyopathy. The rest/stress T1 mapping has the \npotential to detect ischemia and hibernation without the need for gadolinium \ncontrast. \nLimitations: There are some limitations \nEthics Committee Approval: This study is approved by Fuwai Hospital \nFunding for this study: There is no funding \nAuthor Disclosures: \nMinjie Lu: Nothing to disclose \nBaiyan Zhuang: Nothing to disclose \n \nRPS 303-2 \nCompressed SENSE for acceleration of multi-beath-hold short-axis cine \nin clinical routine \n*L. Pennig*¹, A-I. Iuga¹, C. Nelles¹, S. Lennartz¹, A. Bunck¹, D. Maintz¹,  \nK. Weiss², C. P. Naehle¹, J. Dörner¹; ¹Cologne/DE, ²Hamburg/DE  \n(lenhard.pennig@uk-koeln.de) \n \nPurpose: To compare image quality and diagnostic performance of \nCompressed SENSE (CS) accelerated multi-breath-hold short-axis (SAx) cine \nfor assessment of LV function, volumes, and mass to standard multi-breath-\nhold SAx cine using SENSE in clinical routine. \nMethods or Background: Retrospective, single-center study of 50 \nconsecutive patients (40.4 ± 18.1 years, 22 females; August–October 2019), \nwho received a CMR protocol in clinical routine at 1.5T including both, CS \n(factor 4.5) and SENSE (factor 2) accelerated multi-breath-hold SAx cine \nsequences with otherwise equal scanning parameters. Two radiologists, \nblinded to the type of sequence and clinical data, independently performed \nqualitative analysis of image quality (5-point scale, 1 non-diagnostic - 5 \nexcellent), quantitative analysis of LV volumetric and functional measurements, \nand visual analysis of LV wall-motion disorders (WMD). \nResults or Findings: CS allowed for a significant reduction of overall scan \ntime (CS: 04:31 ± 00:46 min, SENSE: 08:53 ± 01:26 min; P<.0001) with \ndecreased number (7 vs. 14) of breath-holds and increased number of \nacquired slices per breath-hold (2 vs. 1). Image quality was unchanged (CS: \nmedian 4 [min 2 - max 5], SENSE: 4 [1-5]; P=.337). For all quantitative LV \nmeasurements, no significant differences (P>.05) between CS and SENSE \naccelerated sequences were observed while interobserver agreement was \nexcellent for both techniques with ICCs ranging between 0.972 and 0.999. \nConsidering SENSE as reference standard, WMD were depicted on CS cine \nwith 100% sensitivity and specificity, respectively. \nConclusion: Compared to acceleration using SENSE, Compressed SENSE \n(factor 4.5) reduces scan time of multi-breath-hold SAx cine to 50% while \nmaintaining high image quality and unimpaired diagnostic performance. \nLimitations: Retrospective. \nEthics Committee Approval: Given. \nFunding for this study: N/a. \nAuthor Disclosures: \nSimon Lennartz: Research/Grant Support: Philips Healthcare \nLenhard Pennig: Research/Grant Support: Philips Healthcare \nChristian Nelles: Nothing to disclose \nDavid Maintz: Speaker: Philips Healthcare \nAndra-Iza Iuga: Nothing to disclose \nClaas Philip Naehle: Nothing to disclose \nKilian Weiss: Employee: Philips Healthcare \nAlexander Bunck: Nothing to disclose \nJonas Dörner: Nothing to disclose \n \nRPS 303-3 \nPrognostic value of dipyridamole stress CMR in patients with known or \nsuspected coronary artery disease: a long term follow-up study \nA. Meloni¹, C. Nugara², A. De Luca³, C. Cavallaro ຾, C. Cappelletto³, G. Novo², \nF. Grigioni຾, G. Sinagra³, *A. Pepe*¹; ¹Pisa/IT, ²Palermo/IT, ³Trieste/IT, \n຾Rome/IT \n(alessia.pepe@ftgm.it) \n \nPurpose: We determined the long-term prognostic value of dipyridamole \nstress-CMR in patients with known or suspected coronary artery disease \n(CAD). \nMethods or Background: 246 consecutive patients (61 females, 61.96±10.05 \nyears) were considered. Abnormal wall motion at rest and after dipyridamole, \nperfusion at stress and at rest, and late gadolinium enhancement (LGE) were \nanalysed.  \nEnd-points were \"major non-fatal cardiac events\" (ventricular arrhythmias, \ncoronary syndromes, heart failure hospitalization ) and cardiac death. \nResults or Findings: An abnormal stress CMR was found in 65(26.4%) \npatients: 39 patients had a reversible stress perfusion defect in >one \nmyocardial segment and 26 a reversible stress perfusion defect plus worsening \nof stress wall motion in comparison with rest. During a median follow up of \n60.59 months, 69(28.0%) patients experienced major nonfatal cardiac events. \nLGE, reversible perfusion deficit, age, diabetes and family history were \nunivariate prognosticators. In the multivariate analysis the independent \npredictive factors were reversible perfusion deficit (hazard ratio-HR=2.21, \nP=0.001) and diabetes (HR=2.21, P=0.003). Ten patients died during follow-up \nand reversible motion abnormality and LGE were univariate prognosticators. At \nmultivariate analysis, LGE remained a significant prognosticator (HR=10.83, \nP=0.026), after adjusting for age and diabetes. When the composite end-point \n(cardiac events+death) was considered, both myocardial fibrosis and reversible \nperfusion deficit resulted to be significant univariate prognosticators, in addition \nto age, diabetes and family history. At multivariate analysis the independent \npredictive factors were reversible perfusion deficit (HR=2.26, P<0.0001) and \ndiabetes (HR=2.59, P<0.0001). \nConclusion: Reversible perfusion deficit and diabetes identify patients at high \nrisk of fatal and non fatal cardiac events. LGE is a strong predictor for death in \npatients with known or suspected CAD. \nLimitations: Single-center study \nEthics Committee Approval: Local ethics committee \nFunding for this study: No funding received \nAuthor Disclosures: \nAlessia Pepe: Nothing to disclose \nGianfranco Sinagra: Nothing to disclose \nChiara Cappelletto: Nothing to disclose \nAntonio De Luca: Nothing to disclose \nGiuseppina Novo: Nothing to disclose \nFrancesco Grigioni: Nothing to disclose \nCinzia Nugara: Nothing to disclose \nAntonella Meloni: Nothing to disclose \nCamilla Cavallaro: Nothing to disclose \n \nRPS 303-5 \nDetection of myocardial fibrosis in chronic coronary heart disease by \ncardiac MRI \n*A. S. Abramenko*, M. Vishnyakova, M. Vishnyakova, D. Shumakov,  \nG. Shekhyan; Moscow/RU \n(a.s.abramenko@gmail.com) \n \nPurpose: Analyze magnetic resonance imaging capabilities in imaging of \ndiffuse and focal myocardial fibrosis in chronic coronary heart disease (CHD). \nMethods or Background: 50 patients were examined in 2019-2020 because \nof CHD. Cardiac MRI including delayed enhancement (MDE) was performed \non GE Optima MR450w GEM 1.5T with a surface cardiac coil. For assessment \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 181  \nof diffusion myocardial fibrosis 2D MOLLI (3-3-5) technique was used with \nfurther semi-automatic myocardial segmentation (software CVI42) and \ncalculation of Ɍ1 native and post contrast relaxation times, and extracellular \nvolume fraction (ECV). \nResults or Findings: The average Ɍ1 relaxation time in the entire study group \nwas 1127 ± 45 ms (signs of diffuse left ventricular myocardial fibrosis). All \npatients showed focal fibrosis: without aneurysm formation 16%, with \naneurysm formation 84%, of which 26% with thrombotic masses. In the group \nof patients who did not have aneurysm formation, the mean value of the native \nɌ1 value was 1080 ± 45 ms, while in patients with aneurysm formation 1125 ± \n47 ms (p = 0,041). After MDE, the estimated ECV in the group of patients who \ndid not show aneurysm formation was 41 ± 3.5% and in patients with aneurysm \nformation was 44 ± 2.5% (p = 0,044). Male patients showed a large myocardial \nmass of 164 ± 43 gr versus 126 ± 23 gr in women (p = 0.014). \nConclusion: ɋMR allows to identify and give a detailed characteristic of left \nventricular fibrous changes: MDE for qualitative assessment of focal fibrosis, \nautomatic segmental mode of analysis of left ventricular contractility, Ɍ1 \nmapping technique for determining diffuse myocardial fibrosis. Ɍ1 mapping \nshowed the presence of diffuse fibrosis in the entire cohort of patients. \nLimitations: Without limitations. \nEthics Committee Approval: Approved. \nFunding for this study: No funding was received for this study. \nAuthor Disclosures: \nMarina Vishnyakova: Nothing to disclose \nMaria Vishnyakova: Nothing to disclose \nDmitry Shumakov: Nothing to disclose \nGrant Shekhyan: Nothing to disclose \nAlexander S. Abramenko: Nothing to disclose \n \nRPS 303-6 \nAssessment of the accuracy of optimised IQ.SPECT and \nechocardiography in assessing left ventricle ejection fraction (LVEF) \nmeasurements: a comparison with cardiac MRI on a wide range of LVEF \nvalues \n*Y. Bouchareb*, H. Al Dhuhli, H. Sulaiman, N. Tag, A. Al Riyami, J. Zabah; \nMuscat/OM \n \nPurpose: To assess the accuracy of optimised IQ.SPECT, 2D and 3D \nechocardiography in patients suspected with cardiac abnormalities by \ncomparison to cardiac MR (cMR), as a reference standard, on a wide range of \nLVEF measurements. \nMethods or Background: This prospective study included twenty-three \npatients who underwent a Tc-99m sestamibi stress and rest SPECT/CT, 2D/3D \nechocardiography and cMR scans. All three scans were performed within 2 \nweeks. The cMR and 2D/3D echocardiography scans were processed using \ncardiac software packages available on the Symbia.net workstation and the \nEcho machine, respectively. To optimise the IQ.SPECT method, perfusion and \ngated raw data were reconstructed using the resolution recovery-based \nTurboFlash method by varying the number of iterations, number of subsets and \nfilter size. The optimised series was considered the one which provided the \nclosest LVEF values to cMR and improved visually perfusion images \n(assessed by 2 NM physicians). The IQ.SEPCT reconstructed series were \nprocessed using the Cedars-Sinai software. The LVEF measurements from \noptimised IQ.SPECT, routine IQ.SPECT, 2D/3D echocardiography were \ncompared to the ones obtained by cMR (LVEF range: 26 to 73) by means of \nthe mean percentage difference (MPD). \nResults or Findings: In terms of LVEF measurements, a MPD of 3%, 19%, \n12% and 14% was obtained between optimised IQ.SPECT (using “14-\niterations, 3-subsets, 8mm Gaussian-filter”), routine IQ.SPECT (using “12-\niterations, 1-subset, 10mm Gaussian-filter”), 2D- and 3D-echocardiography \nand cMR, respectively. The visual assessment of the optimised IQ.SPECT \nimages provided better image quality compared to routine IQ.SPECT images. \nA substantial inter-operator agreement (kappa=0.74) was obtained between \nthe 2 assessors. \nConclusion: The optimised IQ.SPECT method improves the accuracy of LVEF \nmeasurements compared to routine IQ.SPECT and 2D/3D echocardiography \nas well as provides better quality of perfusion images. \nLimitations: Not a large patient population. \nEthics Committee Approval: Yes. \nFunding for this study: Internal-Grant, Sultan Qaboos University. \nAuthor Disclosures: \nNaima Tag: Nothing to disclose \nYassine Bouchareb: Grant Recipient: Principal Investigator \nAdil Al Riyami: Nothing to disclose \nHajir Sulaiman: Investigator: Research Assistant at Sultan Qaboos University \npaid from the grant. \nJawa Zabah: Nothing to disclose \nHumoud Al Dhuhli: Other: Co-Principal Investigator \n \n \nRPS 303-7 \nIncidental cardiac uptake in bone scintigraphy: the increased importance \nand association with cardiac amyloidosis \n*F. Delaney*, M. J. O'Connell; Dublin/IE \n \nPurpose: Extraosseous radiotracer uptake during bone scintigraphy may \nsignify previously undiagnosed disorders. There has been renewed focus on \ncardiac uptake, commonly attributed to ischaemic heart diease, in recent years \ndue to developments in the management of cardiac amyloidosis. We review \nthe role of scintigraphy in cardiac amyloidosis and the importance of \nappropriate reporting of incidental cardiac uptake. \nMethods or Background: The recent literature on cardiac amyloidosis and \nbone scintigraphy is described and complemented by review of bone \nscintigraphy studies showing incidental cardiac uptake at our institution. \nResults or Findings: Cardiac uptake of bone avid radiotracers is highly \nsensitive and specific for the diagnosis of transthyretin (ATTR) amyloidosis, an \nunder-recognised cause of diastolic heart failure. Dedicated cardiac \nscintigraphy now plays a key role in the non-invasive diagnostic algorithm for \nATTR amyloidosis and may help in its early detection which is increasingly \nimportant as novel therapies emerge. Myocardial ischaemia/infarction can \ncause cardiac uptake but this is typically more focal and may not persist 7-10 \ndays beyond the ischaemic event. Cardiac uptake must be carefully assessed \nin conjunction with clinical information, therefore, to ensure it is not falsely \nattributed to coronary artery disease. Multiple large retrospective reviews of \nbone scans have consistently identified incidental cardiac uptake. While further \nstudy is required to fully define the appropriate approach to investigating this, it \nshould prompt clinical assessment and consideration of echocardiography. We \nillustrate this with cases of incidental cardiac uptake leading to diagnosis of \nATTR amyloidosis. \nConclusion: Cardiac uptake during bone scintigraphy must be carefully \ninterpreted as there is the potential to detect subclinical ATTR amyloidosis. \nCardiac scintigraphy plays a crucial and evolving role in the management of \ncardiac amyloidosis and an up-to-date knowledge is important for radiologists. \nLimitations: Not Applicable \nEthics Committee Approval: Not Applicable \nFunding for this study: None \nAuthor Disclosures: \nFrancis Delaney: Nothing to disclose \nMartin Joseph O'Connell: Nothing to disclose \n \nRPS 303-8 \nMyocardial mapping as a marker of subclinical myocardial injury in \npatients with active Coronavirus disease 19 \n*L. Marchitelli*, F. Catapano, G. Cundari, G. Pambianchi, N. Galea,  \nC. Catalano, M. Francone; Rome/IT \n(liviamarchitelli92@gmail.com) \n \nPurpose: Subclinical myocardial injury is not uncommon in COVID-19 and \nrecognizes a complex multifactorial pathogenesis. We hypothesized that CMR \nwith myocardial mapping techniques would allow non-invasive detection of \nmyocardial structural damage in patients with active infection. \nMethods or Background: We prospectively enrolled 22 consecutive patients \n(18 M and 4 F) with active SARS-CoV-2 infection (positive RT-PCR on \nnasopharyngeal swab). In all patients, routine blood tests, including and high \nsensitive troponin (HsTn), were available. A CMR multiparametric evaluation \nwas carried out including mapping sequences. CMR quantitative parameters \nwere matched with clinical and laboratory findings, including white blood cells \n(WBC), C-reactive Protein (PCR) and troponin levels. Both uni- and \nmultivariate analyses (Chi-squared, t-test, Pearson correlation coefficient and \nregression model) were performed to evaluate most significant predictors of \nmyocardial injury. \nResults or Findings: CMR T1 and T2 values were increased in 8/22 and \n12/22 patients, respectively, ranging from 994 to 1210 ms for T1 values and 47 \nand 66 ms for T2. Left ventricle ejection fraction was impaired in 10/22 \npatients, ranging from 41% to 60%. All patients were classified as “mild” \naccording to Chinese CDC clinical scoring for SARS-CoV-2 infection. A \nsignificant correlation was found between T1 map, T2map and ECVmap \nalterations and increase HsTn (p<0,05). The regression model analysis also \nshowed a significant relationship between WBC, PCR, HsTn and T2 value. \nConclusion: CMR mapping predicts subclinical myocardial damage in COVID-\n19 active disease and correlates with WBC, PCR and HsTn levels. Underlying \npathological substrate likely includes a combination of tissue edema and \nmyocarditis-like fibrosis/necrosis changes, suggesting a potential impact of \nCMR findings on prognosis and clinical decision-making. \nLimitations: Not applicable \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 182  \nAuthor Disclosures: \nGiacomo Pambianchi: Nothing to disclose \nGiulia Cundari: Nothing to disclose \nLivia Marchitelli: Nothing to disclose \nMarco Francone: Nothing to disclose \nFederica Catapano: Nothing to disclose \nNicola Galea: Nothing to disclose \nCarlo Catalano: Nothing to disclose \n \n \nResearch Presentation Session: Cardiac \nRPS 403 \nHaemodynamics and blood pressure \nRPS 403-1 \nComparison of CMR-based models for prediction of the mean pulmonary \narterial pressure \n*V. Nizhnikava*, U. Reiter, G. Kovacs, C. Reiter, C. Kräuter, H. Olschewski,  \nM. Fuchsjäger, G. Reiter; Graz/AT  \n(volha.nizhnikava@gmail.com) \n \nPurpose: Various published studies present promising models for non-\ninvasive estimation of the mean pulmonary arterial pressure (mPAP) based on \nparameters derived from cardiac magnetic resonance (CMR). The aim of the \npresent study was to compare proposed models for mPAP estimation using \nright heart catheterization (RHC) as reference. \nMethods or Background: 51 patients (female/male, 28/23; age, 67±9years) \nwho underwent comprehensive native 3T CMR and RHC within 2±3 days were \nrecruited in the prospective study. CMR protocol included cine short-axis \nimaging, 2- (2D), and 4-dimensional (4D) flow imaging of the pulmonary artery \n(PA). All functional and 2D flow measurements required for MR-based \nestimation of mPAP (MR-mPAP) in 14 out of 15 published models were \nevaluated using routine software (cvi42, Circle Cardiovascular Imaging). 4D \nflow-derived vortex duration along the main PA (VD) for estimation of MR-\nmPAP according to model MR-mPAP = 16+0.63*VD was evaluated with \nprototype software (4DFlow, Siemens Healthcare). Relationships between \nmPAP and MR-mPAPs were analyzed by correlation and Bland-Altman \nanalysis. \nResults or Findings: Out of 15 models 5 estimated MR-mPAPs revealed \nstrong correlations with mPAP. The strongest correlation among the models \nusing only cine-derived function parameters showed MR-mPAP=-4,6 + \n0.23*IVSA + 16.3*VMI (IVSA, intraventricular septal angle; VMI, ventricular \nmass index) with r=0.82; among the models involving cine function together \nwith 2D flow parameters it was MR-mPAP=-21.806 + 0.31*IVSA + 11.5*VMI + \n0.01*minPA+0.22*RAC (minPA, minimal PA cross-sectional area; RAC, PA \nrelative area change) with r=0.83. The strongest correlation (r=0.96) among all \n15 models was found for MR-mPAP evaluated from 4D-flow data. The \nstandard deviations of differences between MR-mPAP and mPAP for these \nthree models were 9mmHg, 9mmHg, and 4mmHg, respectively. \nConclusion: CMR-derived function and flow parameters allow non-invasive \nmPAP estimation with 4D-flow imaging providing the most accurate results. \nLimitations: Small number of subjects \nEthics Committee Approval: Obtained \nFunding for this study: OeNB-Anniversary-Fund No.17934, ESOR \nFellowship 2020 \nAuthor Disclosures: \nHorst Olschewski: Nothing to disclose \nUrsula Reiter: Nothing to disclose \nGert Reiter: Employee: Siemens Healthcare Diagnostics GmbH, Graz, Austria \nMichael Fuchsjäger: Nothing to disclose \nClemens Reiter: Nothing to disclose \nGabor Kovacs: Nothing to disclose \nVolha Nizhnikava: Nothing to disclose \nCorina Kräuter: Nothing to disclose \n \nRPS 403-2 \nAssessment of aortic and pulmonary flow volumes: acceleration by \ncompressed sensing \n*U. Reiter*¹, C. Reiter¹, C. Kräuter¹, V. Nizhnikava¹, D. Giese², M. Fuchsjäger¹, \nG. Reiter¹; ¹Graz/AT, ²Erlangen/DE  \n(ursula.reiter@medunigraz.at) \n \nPurpose: Cardiac magnetic resonance two-dimensional (2D) through-plane \nflow imaging during breath-holding, the well-established technique for the \nassessment of aortic and pulmonary flow volumes and volume ratios, could \nbenefit from scan time reduction. The purpose of the present study was to \ninvestigate if 2D flow measurements can be substantially accelerated by \ncompressed sensing (CS). \nMethods or Background: 20 prospectively recruited cardiac patients without \nknown or suspected shunts and with regular heart rhythm underwent \nretrospectively ECG-gated, breath-hold through-plane 2D flow imaging \nperpendicular to the aorta and the pulmonary artery at 3T (Magnetom Skyra, \nSiemens Healthcare). Both measurements were performed twice, once without \nCS and once employing a prototype sequence with a parameter-matched CS \nprotocol with a CS-acceleration-factor of 7.6. Baseline-corrected aortic (Qa) \nand pulmonary (Qp) net flow volumes were evaluated from data sets using \nroutine software (cvi42, Circle Cardiovascular Imaging). Relationships between \nresults derived with and without CS were analyzed by correlation analysis; \nmeans and variances were compared employing t- and Levene test, \nrespectively. \nResults or Findings: Employing CS, scan times were significantly reduced \n(4.8±1.2s vs. 9.4±2.2s, p<0.01). Flow volumes from CS flow measurements \n(Qa=74±26ml; Qp=75±27ml) had no significant bias compared to \nmeasurements without CS (Qa=74±27ml, p=0.62; Qp=76±30ml, p=0.55) and \ndemonstrated strong correlations (r=0.98 in both cases). Pulmonary-to-\nsystemic blood flow ratios (Qp/Qa=1.02±0.11 and Qp/Qa=1.02±0.08, with and \nwithout CS, respectively) did not differ significantly, either in means (p=0.96) or \nin variances (p=0.10). \nConclusion: Compressed sensing allows for substantial acceleration of 2D \nflow acquisition without significant impact on the precision of derived aortic and \npulmonary flow volumes. \nLimitations: Small sample size. \nEthics Committee Approval: Obtained. \nFunding for this study: OeNB-Anniversary-Fund No.17934, ESR Seed Grant \n2020, ESOR Fellowship 2020. \nAuthor Disclosures: \nDaniel Giese: Employee: Siemens Healthcare GmbH, Erlangen, Germany \nUrsula Reiter: Nothing to disclose \nGert Reiter: Employee: Siemens Healthcare Diagnostics GmbH, Graz, Austria \nMichael Fuchsjäger: Nothing to disclose \nClemens Reiter: Nothing to disclose \nVolha Nizhnikava: Nothing to disclose \nCorina Kräuter: Nothing to disclose \n \nRPS 403-3 \nEffects of regadenoson on the left ventricular ejection fraction in stress-\ncardiovascular magnetic resonance \n*A. C. Igual Rouilleault*, I. Soriano Aguadero, P. Malmierca Ordoqui,  \nA. Paternain Nuin, J. C. Pueyo Villoslada, G. Bastarrika Alemañ, \nA. Ezponda Casajus; Pamplona/ES \n(aigual@unav.es) \n \nPurpose: Regadenoson is recently used as a vasodilator drug to induce stress \nin cardiovascular magnetic resonance (CMR). The aims of our study are: - To \ndetermine the impact of regadenoson on the hemodynamic and volumetric \nparameters. - To compare the pre- and post- regadenoson stress values of the \nejection fraction (EF). \nMethods or Background: We studied prospectively a total of 45 patients \nundergoing a stress-CMR because of clinical ischemia suspicion. Exclusion \ncriteria included prior history of ventricular dysfunction or atrial fibrillation. \nShort-axis steady-state free-precession (SSFP) sequences with ECG \nsynchronization were performed before and after the intravenous \nadministration of regadenoson. All the images were transferred to Circle \nCardiovascular software (CMR42). Ventricular volumes and EF were \ncalculated before and immediately after the administration of the stressor. Two-\ntailed-p values were used for all statistical assessment and a p-value<0.05 was \nconsidered statistically significant. \nResults or Findings: We included 45 subjects (72.1 % men, mean age \n63±9.5years). 39.5% of the participants had a previous history of ischemic \ncardiopathy. During the stress, the average increase of heart rate was \n23.3ௗ±ௗ12.5 bpm and the mean decrease in systolic and diastolic blood \npressure (SBP and DBP) was 8.8 ± 21.3 mmHg and 4.9 ± 9.6 mmHg, \nrespectively. Differences were also seen analyzing ventricular volumes: after \nregadenoson administration, end-systolic volume decreases whereas EF and \nstroke volume increase. \nConclusion: Regadenoson entails a mild overestimation of EF and stroke \nvolume of both ventricles. In patients undergoing stress-CMR with \nregadenoson in whom biventricular volumes and EF are critical components for \nclinical decisions, short-axis SFFP sequences should be performed before the \nadministration of regadenoson. \nLimitations: -High number of patients with Killip class I (90%). \n-An overall quite young. \nEthics Committee Approval: Not applicable. \nFunding for this study: No. \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 183  \nAuthor Disclosures: \nIgnacio Soriano Aguadero: Nothing to disclose \nPatricia Malmierca Ordoqui: Nothing to disclose \nJesus Pueyo Villoslada: Nothing to disclose \nAlba Cristina Igual Rouilleault: Nothing to disclose \nAna Ezponda Casajus: Nothing to disclose \nGorka Bastarrika Alemañ: Speaker: SIEMENS Speaker: BAYER \nAlberto Paternain Nuin: Nothing to disclose \n \nRPS 403-4 \nThe additive prognostic value of end-systolic pressure-volume relation \nby stress CMR in patients with known or suspected coronary artery \ndisease \nA. Meloni¹, A. De Luca², C. Nugara³, C. Cappelletto², A. Barison¹, G. Todiere¹, \nG. Novo³, G. Sinagra², *A. Pepe*¹; ¹Pisa/IT, ²Trieste/IT, ³Palermo/IT \n(alessia.pepe@ftgm.it) \n \nPurpose: We assessed for the first time the prognostic value of delta rest-\nstress end-systolic pressure-volume relation ( ǻESPVR), an index of left \nventricular contractility, by dipyridamole stress-CMR in patients with known or \nsuspected coronary artery disease (CAD). \nMethods or Background: We considered 196 consecutive patients (49 \nfemales, 62.74±10.66 years). Abnormal wall motion and perfusion at rest and \nafter dipyridamole were analysed. Macroscopic myocardial fibrosis was \ndetected by the late gadolinium enhancement (LGE) technique. The ESPVR \nwas evaluated at rest and peak stress from raw measurement of systolic \narterial pressure by cuff sphygmomanometer and end-systolic volume by \nbiplane Simpson method. \nResults or Findings: An abnormal stress CMR was found in 52 (26.5%) \npatients: 36 with reversible stress perfusion defect in >one myocardial segment \nand 16 with reversible stress perfusion defect plus worsening of stress wall \nmotion in comparison with rest. LGE sequences were acquired in 170 (86.7%) \npatients and myocardial fibrosis was detected in 90 patients (52.9%). A \nǻESPVR index”0.02 mmHg/mL/m2 was found in 88 patients (44.9%). Mean \nfollow-up time was 53.17±28.21 months. Cardiac events were recorded in 50 \n(25.5%) patients: 5 cardiac deaths, 17 revascularizations for angina or \nmyocardial infarction, one myocardial infarction, 23 hospitalisations for heart \nfailure or unstable angina, and 4 ventricular arrhythmias. According to the Cox \nanalysis, diabetes, family history, LVEF, abnormal stress CMR, myocardial \nfibrosis, and reduced ǻESPVR were significant univariate prognosticators. In \nthe multivariate analysis the independent predictive factors were diabetes \n(hazard ratio-HR=2.33, 95%CI=1.21-4.51, P=0.012), a ǻESPVR index”0.02 \nmmHg/mL/m2 (HR=2.58, 95%CI=1.29-5.13, P=0.007), and myocardial fibrosis \n(HR=2.13, 95%CI=1.05-4.31, P=0.036). \nConclusion: ǻESPRV assessed by CMR provides a prognostic stratification in \npatients with known or suspected coronary artery disease, in addition to that \nsupplied by diabetes and myocardial fibrosis. \nLimitations: Single-center study \nEthics Committee Approval: Local ethics committee \nFunding for this study: No funding received \nAuthor Disclosures: \nAlessia Pepe: Nothing to disclose \nGianfranco Sinagra: Nothing to disclose \nChiara Cappelletto: Nothing to disclose \nAntonio De Luca: Nothing to disclose \nGiancarlo Todiere: Nothing to disclose \nGiuseppina Novo: Nothing to disclose \nCinzia Nugara: Nothing to disclose \nAntonella Meloni: Nothing to disclose \nAndrea Barison: Nothing to disclose \n \nRPS 403-5 \nRealtime flow imaging for assessment of aortic and pulmonary blood \nflow \n*G. Reiter*¹, C. Reiter¹, C. Kräuter¹, V. Nizhnikava¹, D. Giese², M. Fuchsjäger¹, \nU. Reiter¹; ¹Graz/AT, ²Erlangen/DE \n(gert.reiter@siemens-healthineers.com) \n \nPurpose: Combining compressed sensing (CS) and shared velocity encoding \n(SVE) enables magnetic resonance two-dimensional (2D) flow imaging \nacquisition in realtime. The purpose of the present study was to validate \nrealtime 2D flow imaging for the assessment of aortic and pulmonary flow \nvolumes and their ratio against the conventional segmented technique. \nMethods or Background: 21 prospectively recruited cardiac patients without \nknown or suspected shunts and with regular heart rhythm underwent breath-\nhold through-plane 2D flow imaging perpendicular to the aorta and the \npulmonary artery at 3T (Magnetom Skyra, Siemens Healthcare). Both \nmeasurements were performed once with a conventional retrospectively ECG-\ngated, segmented 2D flow sequence and once with a prototype realtime flow \nsequence employing CS and SVE acquired for 5 seconds. Baseline-corrected \naortic (Qa) and pulmonary (Qp) net flow volumes were evaluated using routine \nsoftware (cvi42, Circle Cardiovascular Imaging); realtime flow volumes were \nderived as averages of 3 heart beats. Relationships between flow volumes \nwere analyzed by correlation analysis; means and variances were compared \nemploying t- and Levene test, respectively. \nResults or Findings: Flow volumes from realtime measurements \n(Qa=71±26ml; Qp=72±26ml) showed no significant bias compared to \nconventional measurements (Qa=73±27ml, p=0.28; Qp=75±30ml, p=0.12) and \ndemonstrated strong correlations (r=0.95 for Qa, r=0.97 for Qp). Pulmonary-to-\nsystemic blood flow ratios derived from realtime measurements \n(Qp/Qa=1.03±0.12) and from conventional measurements (Qp/Qa=1.03±0.09) \ndid not differ significantly, either in means (p=0.91) or in variances (p=0.44). \nConclusion: Realtime 2D flow imaging allows accurate assessment of aortic \nand pulmonary flow volumes, suggesting the technique as fast alternative for \nassessment of the pulmonary-to-systemic blood flow ratio in clinical routine \npatients. \nLimitations: Small sample size. \nEthics Committee Approval: Obtained. \nFunding for this study: OeNB-Anniversary-Fund No.17934, ESR Seed Grant \n2020, ESOR Fellowship 2020. \nAuthor Disclosures: \nDaniel Giese: Employee: Siemens Healthcare GmbH, Erlangen, Germany \nUrsula Reiter: Nothing to disclose \nGert Reiter: Employee: Siemens Healthcare Diagnostics GmbH \nMichael Fuchsjäger: Nothing to disclose \nClemens Reiter: Nothing to disclose \nVolha Nizhnikava: Nothing to disclose \nCorina Kräuter: Nothing to disclose \n \nRPS 403-6 \nFunctional and structural abnormalities detected in patients with sickle \ncell disease using cardiac magnetic resonance imaging \n*L. Tantcheu*¹, V. Chevance², V. Tacher³, I. Sifaoui ຾, T. D'Humières຿,  \nP. Bartolucci຿, J-F. Deux຿; ¹Puteaux/FR, ²Velizy/FR, ³Paris/FR, ຾Angers/FR, \n຿Créteil/FR \n(taderlan@hotmail.com) \n \nPurpose: Cardiac involvement is a factor of poor prognosis in sickle cell \ndisease (SCD) patients. We aim to evaluate the aspect of cardiac involvement \nin SCD patients using cardiac magnetic resonance imaging (MRI) \nMethods or Background: Sixty sickle cell patients and 35 control patients \nwere included in this prospective study and explored with 1.5 T cardiac MRI. \nCine, T2 and T1 parametric (MOLLI) and LGE sequences were acquired in the \nshort axis and long axis planes. Left (L) and right (R) ventricular ejection \nfraction (VEF), ventricular volumes, atrial volumes, 3D components of the \nstrain, extracellular volume (ECV) and presence of focal area of myocardial \nenhancement on LGE sequences were noticed. Data are given as mean +/- \nSD. \nResults or Findings: SCD patients exhibited significant dilatation of both \nventricles, reduction of LVEF and RVEF and significant reduction of the 3 \ncomponents of the strain in comparison to control patients (data not shown). \nMyocardial T2 of SCD patients was significantly higher than control patients \n(53 +/-3 ms vs. 49+/-2 ms ; p<0.05) and significantly correlated with left \n(r2=0.50 ; p<0.001.) and right (r2=0.53 ; p<0.001.) diastolic ventricular \nvolumes. ECV of SCD patients was significantly higher than control patients \n(38+/-12% vs. 32+/-4% ; p<0.05), and significantly correlated with LFEF (r2=-\n0.35 ; p=0.03), LV diastolic volume (r2=0.41 ; p=0.06) and LV mass (r2=0.41 ; \np =0.005). One SCD patients exhibited area of focal enhancement on LGE \nsequences (none control). \nConclusion: SCD patients exhibited morphologic and functional cardiac \nabnormalities on cardiac MRI in comparison to control patients. We noticed a \nraise of ECV in SCD patients that suggest diffuse myocardial fibrosis, and an \nincrease of myocardial T2 suggesting myocardial edema. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: No funding was received for this work \nAuthor Disclosures: \nPablo Bartolucci: Nothing to disclose \nVania Tacher: Nothing to disclose \nThomas D'Humières: Nothing to disclose \nIslem Sifaoui: Nothing to disclose \nJean-François Deux: Nothing to disclose \nVirgile Chevance: Nothing to disclose \nLandry Tantcheu: Nothing to disclose \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 184  \nRPS 403-7 \nNormal values of the mitral valve vortex ring derived from MR 4D-flow \nimaging \n*C. Kräuter*¹, U. Reiter¹, C. Reiter¹, V. Nizhnikava¹, M. Masana², A. Schmidt¹, \nM. Fuchsjäger¹, R. Stollberger¹, G. Reiter¹; ¹Graz/AT, ²Barcelona/ES \n(corina.kraeuter@medunigraz.at) \n \nPurpose: The mitral valve (MV) vortex ring is an emerging blood flow structure \nfor studying diastolic function, however, normal values of MV vortex ring \nparameters are lacking. The aim of this study was to determine normal values \nof MV vortex ring vorticity and kinetic energy using cardiac magnetic \nresonance four-dimensional phase-contrast (4D-flow) imaging and to \ninvestigate dependencies of these vortex ring parameters on age and gender. \nMethods or Background: 46 subjects without symptoms of cardiopulmonary \ndiseases (male/female 14/32; age 61±8 years) underwent left heart 4D-flow \nimaging at 3T. Pre-processing of velocity data was performed by prototype \nsoftware (4DFlow, Siemens Healthcare), extraction and analysis of MV vortex \nrings was automatically performed by in-house software. Age dependencies of \nearly- and late-diastolic MV vortex ring peak average vorticity and peak \nabsolute kinetic energy as well as their ratios (curl_E, curl_A, Ekin_E, Ekin_A, \ncurl_E/curl_A, and Ekin_E/Ekin_A, respectively) were analyzed by correlation \nanalysis, differences between genders were analyzed by unpaired t-test or \nMann-Whitney test, in case of data non-normality. p<0.05 was considered \nstatistically significant. \nResults or Findings: Early- and late-diastolic MV vortex rings were detected \nin each subject. Normal values of the MV vortex ring parameters are \ncurl_E=81/s±12/s, curl_A=77/s±12/s, curl_E/curl_A=1.1±0.2, \nEkin_E=1.6±0.6mJ, Ekin_A=1.1±0.5mJ and Ekin_E/Ekin_A=1.7±0.9. While \nnone of the MV vortex ring parameters differed significantly between male and \nfemale, all of them correlated significantly with age, with the early-to-late-\ndiastolic parameter ratios showing the strongest correlations (r curl_E=-0.50, r \ncurl_A=0.38, r curl_E/curl_A=-0.65, r Ekin_E=-0.54, r Ekin_A=0.38, r \nEkin_E/Ekin_A=-0.62). \nConclusion: Whereas MV vortex ring parameters do not depend on gender, \ntheir age-dependency has to be taken into account when comparing with \ndiseased subjects. \nLimitations: Only middle-aged and elderly subjects were included. \nEthics Committee Approval: Medical University Graz (24-126ex11/12). \nFunding for this study: OeNB Anniversary Fund No.17934, ESR Seed Grant \n2020, ESOR Fellowship 2020. \nAuthor Disclosures: \nUrsula Reiter: Nothing to disclose \nMarc Masana: Nothing to disclose \nGert Reiter: Employee: Siemens Healthcare Diagnostics GmbH \nMichael Fuchsjäger: Nothing to disclose \nClemens Reiter: Nothing to disclose \nAlbrecht Schmidt: Nothing to disclose \nRudolf Stollberger: Nothing to disclose \nVolha Nizhnikava: Nothing to disclose \nCorina Kräuter: Nothing to disclose \n \nRPS 403-8 \nHighly accelerated compressed sensing 4D flow is feasible for intra-\ncardiac flow assessment \n*A. Varga-Szemes*¹, M. C. Halfmann², U. J. Schoepf¹, N. Jin³, D. Dargis¹,  \nF. Xiong³, M. Markl³, T. Emrich¹; ¹Charleston, SC/US, ²Mainz/DE,  \n³Chicago, IL/US \n(vargaasz@musc.edu) \n \nPurpose: Compressed sensing (CS) is a promising acceleration technique that \nprovides substantial reduction in image acquisition time. The aim of this study \nwas to compare intra-cardiac flow measurements between conventional and \nprototype CS-based highly accelerated 4D flow acquisitions. \nMethods or Background: Healthy volunteers (n=50) prospectively underwent \nwhole-heart 4D flow 3T MRI with conventional GRAPPA and CS accelerated \ntechniques with acceleration factors of 3 and 7.7, respectively. 4D flow data \nwere post-processed by applying a valve tracking algorithm that allowed for \nflow quantification over all four valves (aortic [AV], mitral [MV], pulmonary [PV], \nand tricuspid [TV]). Flow volumes and diastolic function (E/A and E/e’) were \nquantified. The agreement between the techniques was evaluated by Bland-\nAltman-analysis (BA) and intraclass correlation coefficient (ICC). \nResults or Findings: A significant improvement in acquisition time was \nobserved using CS compared to GRAPPA accelerated acquisition (6.7±1.3 vs. \n12.0±1.3 minutes; p<0.0001). Comparisons of net forward flow measurements \nfor all valves showed good correlation (r>0.81) and agreement (ICCs>0.89 and \nmean differences <9ml) between conventional and CS 4D flow with 3.3-8.3% \nunderestimation by the CS technique. Conventional vs CS net forward flow \nmeasurements were: AV 91.3±16.5ml vs 83.9±14.8ml, BA mean difference -\n7.3ml, ICC=0.96, r=0.92; MV 94.0±18.4ml vs 89.3±17.2ml, BA=-4.5ml, \nICC=0.91, r=0.84; PV 89.0±14.8ml vs 85.7±13.8ml, BA=-3.2ml, ICC=0.95, \nr=0.90; and TV 100.2±17.4ml vs 91.6±17.1ml, BA=-8.7ml, ICC=0.89, r=0.81. \nFurther evaluation of diastolic function using mitral inflow parameters showed \n3.2-17.6% error: E/A 2.2 [1.9-2.4] vs 2.3 [2.0-2.6], BA=0.08, ICC=0.82; and \nE/e’ 4.6 [3.9-5.4] vs 3.8 [3.4-4.3], BA=-0.9, ICC=0.89. \nConclusion: Analysis of intra-cardiac flow patterns and evaluation of diastolic \nfunction using a highly accelerated 4D flow sequence prototype is feasible and \nshows underestimation of flow measurements but within clinically acceptable \nlimits of <10%. \nLimitations: Only healthy volunteers studied \nEthics Committee Approval: Approved with informed consent \nFunding for this study: None \nAuthor Disclosures: \nNing Jin: Employee: Siemens \nDanielle Dargis: Nothing to disclose \nFei Xiong: Employee: Siemens \nUwe Joseph Schoepf: Consultant: Bayer, Bracco, Elucid Bioimaging, \nHeartFlow, Guerbet, Siemens Grant Recipient: Bayer, Bracco, Elucid \nBioimaging, HeartFlow, Guerbet, Siemens \nTilman Stephan Emrich: Speaker: Siemens \nMoritz Christian Halfmann: Nothing to disclose \nMichal Markl: Research/Grant Support: Siemens, Circle, Cryolife Consultant: \nCircle \nAkos Varga-Szemes: Consultant: Bayer, Elucid Bioimaging Grant Recipient: \nSiemens \n \nRPS 403-9 \nMultiparametric approach to detect chronic myocardial inflammation in \nheart failure with reduced ejection fraction \n*M. C. Halfmann*¹, G. Laux¹, S. Benz¹, S. Schwuchow¹, C. Düber¹, W. Philip¹, \nK-F. Kreitner¹, T. Emrich²; ¹Mainz/DE, ²Charleston, SC/US \n \nPurpose: In heart failure with reduced ejection fraction (HFrEF), presence of \nchronic inflammation leads to myocardial remodeling and ultimately fibrosis, \nthus affecting prognosis and outcome. As clinical detection of inflammation \nremains challenging, endomyocardial biopsy (EMB) with histological and \nimmune-histochemical quantification remains the current gold standard despite \nits invasive nature. In this study, a multiparametric cardiac magnetic resonance \n(CMR) approach was evaluated for its potential to detect chronic myocardial \ninflammation in HFrEF patients with EMB as a ground truth. \nMethods or Background: 35 HFrEF-patients who underwent both CMR at 3T \nand EMB were retrospectively identified. Volumetric measurements, feature-\ntracking (FT)-strains and septal T1/T2 values were acquired. Differentiation \nbetween patients with EMB-proven inflammation (I+) and those without (I-) was \nevaluated by means of receiver operating characteristic curves with their \nrespective areas under the curve (AUC). \nResults or Findings: Median time between EMB and CMR was 1±3 days. 17 \n(49%) of the patients were I+. Neither FT-strains nor left ventricular mass \n(LVM) or T1/T2-mapping alone were significantly different between I+ and I- \n(p>0.05). A multiparametric approach including global circumferential strain \n(GCS), LVM and T1/T2-mapping reached an AUC of 0.73 with a sensitivity of \n69% and specificity of 91%. This approach outperformed ejection fraction \n(0.60), enddiastolic volume (0.58) and LVM (0.59) as well as T1 (0.65) and T2 \n(0.59) mapping. \nConclusion: The multiparametric CMR approach was able to predict \ninflammation with a high specificity but suboptimal sensitivity. Currently, this \napproach may not replace EMB in detection of chronic myocardial \ninflammation. Further research is necessary to investigate additional methods, \nsuch as radiomics, to improve diagnostic accuracy of CMR in detecting \nmyocardial inflammation. \nLimitations: Single-center, retrospective study \nEthics Committee Approval: This study was approved with a waiver for \ninformed consent (837.196.13/837.477.14). \nFunding for this study: No outside funding was received for this study. \nAuthor Disclosures: \nWenzel Philip: Nothing to disclose \nGerald Laux: nothing to disclose \nSebastian Benz: Nothing to disclose \nSören Schwuchow: Nothing to disclose \nChristoph Düber: Nothing to disclose \nTilman Stephan Emrich: Speaker: Siemens Healthineers Other: Travel Support \nSiemens Healthineers \nMoritz Christian Halfmann: Nothing to disclose \nKarl-Friedrich Kreitner: Nothing to disclose \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 185  \n \nResearch Presentation Session: Cardiac \nRPS 503 \nArteriosclerosis \nRPS 503-4 \nThe effect of smoking status on coronary artery plaques in type 2 \ndiabetic patients: detected by CT angiography \n*Y. Jiang*, Y. ZhiGang; Chengdu/CN  \n(jiangyu_nsmc@163.com) \n \nPurpose: We aimed to explore characteristics of coronary artery plaques in \ntype 2 diabetes mellitus (DM) detected by CTA and relationship of plaques in \nDM between different smoking status. \nMethods or Background: Plaque types, luminal stenosis, segment \ninvolvement score (SIS) and segment stenosis scores (SSS) were evaluated \nand compared between groups. Multivariable analysis was performed to \nassess potential effect of smoking on performance of coronary artery plaques \nin DM patients. \nResults or Findings: 1063 DM patients were found to have coronary plaques \non CTA. Compared to never smoke, smoke group showed hgheri odds ratio \n[OR] of obstructive coronary artery disease, multi-segment disease, diseased \nvessel•3, SIS•4 and SSS•7 (OR of 1.569, 1.518, 1.427, 1.670 and 1.513; \n95%CI of 1.198-2.055, 1.010-2.283, 1.082-1.883, 1.263-2.209 and 1.149-\n1.992; respectively), smoking duration ( •40 years) was associated with an \nincreasing OR of obstructive disease, multi-vessel disease, multi-segment \ndisease, diseased vessel•3, SIS•4 and SSS•7 (OR of 1.811, 2.067, 2.992, \n1.635, 2.180 and 2.030; 95% CI of 1.195-2.742, 1.124-3.802, 1.449-6.186, \n1.070-2.499, 1.468-3.237 and 1.376-2.997; respectively), and quit smoking \nwas associated with a lower OR of SIS •4 (OR, 1.596; 95%CI, 1.144-2.227) \nand SSS•7 (OR, 1.432; 95%CI, 1.032-1.987) than current smoking group. \nConclusion: DM patients with smoking history and with longer pack-years are \nsignificantly associated with obstructive and more extensive coronary artery \nplaques, and quit smoking may reduce the risk of the obstructive or relatively \nmore extensive coronary artery disease. \nLimitations: There was a potential selection bias for the study was single-\ncentered and retrospective. Patients with coronary artery disease but without \nDM were not enrolled into study. \nEthics Committee Approval: Institutional Review Board of West China \nHospital, Sichuan University approved this study. Written informed consent \nwas waived. \nFunding for this study: 1·3·5 project for disciplines of excellence, West China \nHospital, Sichuan University (ZYGD18013) \nAuthor Disclosures: \nYu Jiang: Nothing to disclose \nYang ZhiGang: Nothing to disclose \n \nRPS 503-5 \nMyocardial native T1 mapping and correlations with clinical and CMR \nparameters in patients with systemic sclerosis \nA. Meloni¹, L. Gargani¹, C. Bruni², M. Gobbo³, G. D'Angelo¹, N. Martini¹,  \nG. Sinagra³, M. Matucci-Cerinic², *A. Pepe*¹; ¹Pisa/IT, ²Florence/IT, ³Trieste/IT  \n(alessia.pepe@ftgm.it) \n \nPurpose: We evaluated the prevalence of cardiac involvement by native T1 \nmapping and its correlation with clinical and CMR parameters in systemic \nsclerosis (SSc) patients. \nMethods or Background: Fifty-one SSc patients (51.8±13.7 years, 42 \nfemales) and 51 healthy subjects matched for age/sex were included. The \nCMR protocol included: cine, T1 mapping by MOLLI, T2 mapping by multi-echo \nfast-spin-echo sequence, LGE, and STIR T2-weighted sequences. Native T1 \nand T2 values were assessed in all 16 myocardial segments and the global \nvalue was the mean. \nResults or Findings: Global native T1 values were significantly higher in SSc \npatients than in healthy subjects. In patients native T1 values were significantly \nlower in males than in females and inversely correlated with age. Twenty-\nthree(45.1%) patients had an increased global heart T1 value (males:>1060; \nfemales:>1085 ms). Of them, 14(60.9 %) patients showed positive LGE. \nFrequency of cardiovascular risk factors, indices of disease activity/chronicity, \nbiochemical parameters, and cardio-active therapy were comparable between \npatients with normal and elevated T1. Patients with elevated T1 had \nsignificantly higher left ventricular (LV) end-diastolic volume index, stroke \nvolume index, cardiac output, and global heart T2 values. Replacement \nmyocardial fibrosis was detected in 24(47.1%) patients and they showed \nsignificantly higher global heart native T1 values. Positive T2-weighted images \nfor myocardial oedema were found in 5(9.8%) patients, all with increased \nglobal heart native T1 value. Patients with oedema had significantly higher \nnative global heart T1 values. \nConclusion: Elevated native T1 values are frequent in SSc patients and are \nassociated with inflammation, replacement fibrosis, and increased LV \ndimension. CMR T1 mapping seems to be a sensitive parameter to include in \nthe routine clinical assessment of SSc patients for detecting earlier pejorative \ncardiac involvement. \nLimitations: Single-center study \nEthics Committee Approval: Local ethics commitee \nFunding for this study: No funding received \nAuthor Disclosures: \nAlessia Pepe: Nothing to disclose \nGianfranco Sinagra: Nothing to disclose \nNicola Martini: Nothing to disclose \nLuna Gargani: Nothing to disclose \nAntonella Meloni: Nothing to disclose \nGennaro D'Angelo: Nothing to disclose \nCosimo Bruni: Nothing to disclose \nMarco Gobbo: Nothing to disclose \nMarco Matucci-Cerinic: Nothing to disclose \n \nRPS 503-6 \nPrognostic utility of coronary CT angiography-derived plaque information \non long-term outcome in patients with and without diabetes mellitus \n*V. Brandt*¹, C. Tesche², M. Bauer¹, M. Baquet³, F. Straube³, B. Brück³,  \nU. J. Schoepf¹, E. Hoffmann³, U. Ebersberger³; ¹Charleston, SC/US, \n²Dortmund/DE, ³Munich/DE \n(verena.brandt@gmx.net) \n \nPurpose: To investigate the long-term prognostic value of coronary CT \nangiography (cCTA)-derived plaque information on major adverse cardiac \nevents (MACE) in patients with and without diabetes mellitus. \nMethods or Background: 64 patients with diabetes (63.3±10.1 years, 66% \nmale) and suspected coronary artery disease (CAD) who underwent cCTA \nwere matched with 297 patients without diabetes according to age, sex, \ncardiovascular risk factors, statin and antithrombotic therapy. Major adverse \ncardiac events (MACE) were recorded. cCTA-derived risk scores and plaque \nmeasures were assessed. The discriminatory power to identify MACE were \nevaluated using multivariable regression analysis and the area under the \nreceiver-operating characteristics curve (AUC). \nResults or Findings: After a median follow-up of 5.4 years, MACE occurred in \n31 patients (8.6%). In patients with diabetes, cCTA risk scores and plaque \nmeasures were significantly higher compared to non-diabetic patients (all \np<0.05). The following plaque measures were predictors of MACE in diabetic \npatients (odds ratio [OR]): segment stenosis score (OR 1.31, p=0.002), low-\nattenuation plaque (OR 5.89, p=0.023), and >=2 high-risk features (OR 6.32, \np=0.017), and in non-diabetic patients: segment stenosis score (OR 2.08, \np=0.004), and >=2 high-risk features (OR 5.14, p=0.024). Discriminatory power \nof CT scores and plaque measures in diabetic patients were significantly better \nthan that of obstructive CAD and Framingham risk score (all p<0.05). \nConclusion: Diabetes is associated with a significantly higher degree of high-\nrisk plaque features, which have independent predictive value for MACE. \ncCTA-derived plaque information portends improved risk stratification in \ndiabetic patients beyond cCTA stenosis grading alone. \nLimitations: Single center study. \nSmall number of patients were included, which may incur selection bias. \nEthics Committee Approval: Approved by the institutional review board and \nthe need for written informed consent was waived due to the retrospective \nnature of this investigation. \nFunding for this study: No funding. \nAuthor Disclosures: \nVerena Brandt: Nothing to disclose \nEllen Hoffmann: Nothing to disclose \nChristian Tesche: Research/Grant Support: Tesche has received speaker’s \nfees from Siemens Healthineers \nUllrich Ebersberger: Nothing to disclose \nBenedikt Brück: Nothing to disclose \nUwe Joseph Schoepf: Research/Grant Support: Schoepf receives institutional \nresearch support from Astellas, Bayer, GE, and Siemens. \nFlorian Straube: Nothing to disclose \nMaximilian Bauer: Nothing to disclose \nMoritz Baquet: Nothing to disclose \n \nRPS 503-7 \n320-row MDCT: correlation of abdominal and epicardial adipose tissue \nwith CA as a predictor of acute coronary events \nA. Ikramov, *N. Djuraeva*, R. Ibadov, Z. Khaybullina, M. Maksudov,  \nK. Abdukhalimova, A. Sultanov; Tashkent/UZ \n(xanummuzik@yandex.ru) \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 186  \nPurpose: Determination of the correlation between the ratio of abdominal and \nepicardial fat to the amount of calcium in the coronary arteries (Ca-score) as a \npredictor of acute coronary events (ACE). \nMethods or Background: 260 patients(90 women and 170 men) at the age of \n55±12 years with a history of ACE inhibitors were examined. All patients \nunderwent scanning of the abdominal cavity at the level of the navel and at the \nlevel of the ventricles of the heart along the short axis using 320-rowMDCT \nwith determination of and Ca-score and the following indicators of abdominal \nand epicardial adipose tissue: TFA(total fat area), VFA(visceral fat area), EAT \n(epicardial accessory tissue), VFA/TFA, EAT/TFA. \nResults or Findings: The studies were based on the ratio of VFA / TFA of the \nabdominal region and EAT / TFA of the epicardial region to the Agatson \ncalcium index. Ca-score 0-50 was in 30% of all patients, 100-450-31%,> 450-\n39% (p <0.05). As the Ca-score increased, there was an increase in the VFA / \nTFA and EAT / TFA ratios in linear correlation (p<0.05). In the abdominal \ncavity, it was found that with a Ca-score of 0-50 VFA/TFA is 0.25±0.2 (p<0.05), \nwith 100-450 - 0.48 ± 0.25 (p<0, 05), for> 450-0.53±0.3 (p<0.05). When \nstudying the ratio of EAT/TFA of the epicardial region, it was determined that \nwith a Ca-score of 0-50 EFA/TFA is 0.1±0.025(p<0.05), with 100-450-\n0.13±0.03(p<0.05), for>450-0.22±0.2(p<0.05). These indicators are typical for \n80-85% of patients. In the rest of the patients, this dependence was not \ndetermined. \nConclusion: The ratio of VFA/TFA and EAT/TFA of the abdominal and \nepicardial regions respectively correlates with the degree of calcification of the \ncoronary arteries(p<0.05) and can be a reliable marker in predicting the \nseverity of acute coronary events. \nLimitations: within the Institution rules \nEthics Committee Approval: Approved by Institution \nFunding for this study: Institution \nAuthor Disclosures: \nAdham Ikramov: Nothing to disclose \nRavshan Ibadov: Nothing to disclose \nKhanum Abdukhalimova: Nothing to disclose \nAlisher Sultanov: Nothing to disclose \nMuzaffar Maksudov: Nothing to disclose \nNigora Djuraeva: Nothing to disclose \nZarina Khaybullina: Nothing to disclose \n \nRPS 503-8 \nMSCT structural analysis of atherosclerotic plaque and visceral fat \narea/total fat area in patients with functionally significant and \ninsignificant stenosis of coronary arteries \nA. Ikramov, *N. Djuraeva*, Z. Khaybullina, M. Maksudov, K. Abdukhalimova,  \nA. Sultanov; Tashkent/UZ \n(nika.kt@rambler.ru) \n \nPurpose: To study the differences in the composition and percentage of \natherosclerotic plaques(ASP)in individuals with functionally insignificant(FIS) \nand functionally significant stenosis(FSS)of coronary arteries(CA)according to \nvolume CT coronarography (CTCA)with the determination of the correlation \nwith the VFA/TFA(Visceral fat area/total fat area). \nMethods or Background: Volume CTCA were performed on 320-row MDCT \nto 144 patients. The degree of stenosis was determined using multisegment \nanalysis using the CAD-RADs system. The amount and percentage of \ncomponents of ASP: fatty, connective tissue and calcined were determined. \nThe indicators of plaque burden(PB)and the structure of the ASB were studied: \nthe volume(Vmm³)and the proportion(V%)of the components in the \ncomposition of the ASP, as well as the VF/TFA. \nResults or Findings: It was revealed that PB with FIS was 53.4±8.2, and with \nFSS was 62.6±5.3.Volume(mm³)of the fat component: with FIS56.86±8.3, with \nFSS72.66±5.5(p<0.05). The volume of the connective tissue component in \ncases FIS is 95.6±9.5, and for FSS is 125.3±25 (p<0.05). The volume of the \ncalcined component in patients with FIS is 51.7±1.4, and in patients with FSS \n52.6±1.5 (p<0.05). The % of the fat component in case of FIS is 30.4±3.3 and \nfor FSS is 29±5.5(p<0.05). The % of the connective tissue component in \npatients with FIS is 49.7±2.3, and for FSS is 50.5±2.5(p<0.05). The % of the \ncalcined component in cases of FIS is 20.6±3.5, and in cases of FSS is \n20.5±5.2. The ratio of VFA/TFA with FIS stenosis 0.3±0.025, with FSS stenosis \n0.52±0.065. \nConclusion: The plaque burden and the volume ratio(mm³)of the adipose \ntissue and connective tissue of ASP are significantly higher in FSS CA(CAD-\nRADs<3)and by determining the correlation with the ratio of the fat depot in the \nabdominal region of VFA/TFA(p<0.05). Whereas the volume ratio (mm3)Ca \nand the percentage of ASP components are equal(p<0.05)in the different \ngroups, which is confirmed by the data of PB,V (mm³),(%) and VF/TFA. \nLimitations: within the Institution rules \nEthics Committee Approval: Approved by Institution \nFunding for this study: Institution \n \n \n \nAuthor Disclosures: \nAdham Ikramov: Nothing to disclose \nKhanum Abdukhalimova: Nothing to disclose \nAlisher Sultanov: Nothing to disclose \nMuzaffar Maksudov: Nothing to disclose \nNigora Djuraeva: Nothing to disclose \nZarina Khaybullina: Nothing to disclose \n \n \nResearch Presentation Session: Cardiac \nRPS 603 \nArtificial intelligence and machine learning \nin cardiac imaging \nRPS 603-1 \nDevelopment and validation of a fully convolutional neural network for \nautomated left ventricular myocardium segmentation on cardiac ECG \n4DCT enhanced images \n*G. Gong*¹, T. Song², H. Yin², Y. Guo¹; ¹Jinan/CN, ²Beijing/CN  \n(gongguanzhong@163.com) \n \nPurpose: To develop and evaluate the performance of a convolutional neural \nnetwork for automatic segmentation of the left ventricular (LV) myocardium on \nECG 4DCT enhanced scan. \nMethods or Background: A total of 236 ECG 4DCT enhanced scans from 11 \npatients were retrospectively collected. The LV myocardium areas were \nmanually segmented as standard reference. The labeled images were further \ndivided into a training dataset (25444 images from 178 CT scans) and a \nvalidation dataset (6980 images from 58 CT scans). A modified U-Net model \nusing Xception network as backbone architecture was proposed for our \npurpose. The model performance was quantified by the Dice similarity \ncoefficient (DSC). Correlation coefficient and Bland-Altman analysis were used \nfor agreement evaluation between automated and reference values on per-\nslice and per-segment analyses. \nResults or Findings: The predicted LV volume (71.3 ± 12.8 cm3) showed \ngood consistency with manual segmentation result (69.1 ± 14.4 cm3), \nachieving average DSCs of 0.852 ± 0.152 and 0.869 ± 0.060 for the LV \nmyocardium per-slice and per-segment, respectively. The automated predicted \nmeasurements strongly correlated with reference values in per-slice (R = \n0.936, 95% CI: 0.933~0.939) and per-segment (R = 0.987, 95% CI: \n0.978~0.992) analyses. Bland-Altman analysis showed good agreement \nbetween the automatic and reference values in per-slice (-3.2% ± 7.6) and per-\nsegment (-1.5% ± 7.9) analyses. \nConclusion: We have developed a deep learning model for automated LV \nmyocardium segmentation with good performance. This method has the \npotential to replace time-consuming manual segmentations in large-scale \nstudies. \nLimitations: This model needs to be validated in prospective studies with a \nlarger sample size from multicenter to acquire high-level evidence for the \nclinical application usefulness. \nEthics Committee Approval: This study was approved by IRB, with a waiver \nof the written informed consent requirement. \nFunding for this study: Not applicable. \nAuthor Disclosures: \nYujie Guo: Nothing to disclose \nHongkun Yin: Nothing to disclose \nGuanzhong Gong: Nothing to disclose \nTian Song: nothing to disclose \n \nRPS 603-2 \nEvaluation of machine-learning algorithms to predict postoperative \noutcomes in asymptomatic patients with moderate-severe primary mitral \nregurgitation \n*E. Andrikopoulou*¹, Y-H. Fang¹, T. Denney², B. Pat¹, M. Ahmed¹, L. Dell'Italia¹; \n¹Birmingham, AL/US, ²Auburn, AL/US  \n(eandrikopoulou@uabmc.edu) \n \nPurpose: Despite adherence to guidelines, 20% of patients with primary mitral \nregurgitation (PMR) will experience postoperative left ventricular (LV) systolic \ndysfunction [LV ejection fraction less (LVEF) than 50%]. We hypothesize that a \nmachine learning (ML) model will allow for its prediction. \nMethods or Background: Clinical, demographic and imaging (cardiac \nmagnetic resonance, CMR) data from 46 symptomatic PMR patients \nundergoing mitral valve surgery and 43 asymptomatic PMR patients without \nintervention were included. The symptomatic subgroup underwent a follow-up \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 187  \nCMR 6 months postoperatively. Preoperative CMR data were used as input to \na two-level decision tree model. Resubstitution and leave-one-out were used to \nvalidate the model. Following an exhaustive search, the two optimal predictors \nfor postoperative LVEF <50% were determined. \nResults or Findings: 14.7% of men and 41.6% of women experienced a \nreduction in their postoperative LVEF. Given our sample size, the binary \nclassification tree method was used as the predictive model. We found that the \nbest decision tree used a LVEF threshold of 58% and LV sphericity index \nthreshold of 1.25. The resubstitution evaluation showed a 72.7% sensitivity, \n97% specificity and 91% accuracy; the leave-one-out validation yielded a \n54.6% sensitivity, 94% specificity and 85% accuracy. When applying this tree \nto the asymptomatic cohort, 12 out of the 43 subjects (28%) were predicted \nwith postoperative drop in LVEF. \nConclusion: The fraction (28%) of predicted poor outcome aligns with \nprevious reports in postoperative PMR and implies that some asymptomatic \npatients would benefit from early intervention. A ML-based decision model \ncould help guide management in moderate-severe asymptomatic PMR. \nLimitations: Lack of data to validate whether the prediction in the \nasymptomatic cohort is accurate. \nEthics Committee Approval: Not required \nFunding for this study: NIH grants R01HL60707 and R01HL54816 to LJD, \nand Specialized Center for Clinically Oriented Research in Cardiac Dysfunction \nP50HL077100. \nAuthor Disclosures: \nMustafa Ahmed: Nothing to disclose \nThomas Denney: Nothing to disclose \nBetty Pat: Nothing to disclose \nEfstathia Andrikopoulou: Nothing to disclose \nLouis Dell'Italia: Nothing to disclose \nYu-Hua Fang: Nothing to disclose \n \nRPS 603-3 \nEvaluation of the effect of type II diabetes mellitus on left ventricular \nfunction in patients with hypertension by 3.0 T magnetic resonance \nimaging \n*W-F. Yan*, Z-G. Yang, Y-K. Guo, X-M. Li, J. Li, J. Wang, K. Shi, Y. Gao; \nChengdu/CN \n(315847112@qq.com) \n \nPurpose: The purpose of this study was to explore the effect of type II \ndiabetes mellitus (T2DM) on the systolic and diastolic function of left ventricular \n(LV) in patients with essential hypertension (HTN) by the strain and volume-\ntime curve parameters from cardiac magnetic resonance. \nMethods or Background: One hundred and seventeen essential hypertension \npatients (46 with T2DM and 71 without T2DM) and forty-five normal individuals \nwere enrolled in this study. Volume-time curve parameters, including the peak \nejection rate (PER), peak ejection time (PET), peak filling rate (PFR), peak \nfilling time from end systolic (PFT), PER normalized to EDV (PER/EDV), PFR \nnormalized to EDV (PFR/EDV), and left ventricular stain parameters, including \nleft ventricular radial strain (GRPS), circumferential strain (GCPS) , longitudinal \npeak strain (GLPS) were measured and compared. Multivariate linear \nregression analyses were performed to determine the effects of T2DM on LV \ndiastolic dysfunction in patients with hypertension. \nResults or Findings: GLPࠊPFRࠊPFR/EDV deteriorated significantly from \ncontrols, through HTN(T2DMí\f\u000f\u0003WR\u0003+ 1\u000b\u0015'0\u000e\f\u0003URXS\u001e\u0003* 36\u0003L+ 1\u000b\u0015'0\u000e\f\u0003\ngroup was lower than those in both HTN(T2DM−) and control groups. PFT in \nHTN (T2DM-)group and HTN (T2DM+) group were longer than those in control \ngroup. Multiple regression analyses considering covariates of systolic blood \npressure, age, sex and BMI demonstrated that T2DM was independently \nassociated with PFR/EDV ( ȕ = 0.177, p = 0.01). \nConclusion: Type 2 diabetes exacerbates left ventricular systolic and diastolic \ndysfunction in hypertensive patients. The impairment of cardiac function is \nmore obviously reflected in the change of left ventricular volume during \ndiastole. \nLimitations: The present study was a single-center, retrospective study. \nEthics Committee Approval: This study was approved by the Clinical Trials \nand Biomedical Ethics Committee of West China Hospital of Sichuan \nUniversity. \nFunding for this study: The 1·3·5 project for disciplines of excellence, West \nChina Hospital, Sichuan University (ZYGD18013). \nAuthor Disclosures: \nJin Wang: Nothing to disclose \nYing-Kun Guo: nothing to disclose \nJiang Li: Nothing to disclose \nKe Shi: Nothing to disclose \nYue Gao: Nothing to disclose \nWei-Feng Yan: Nothing to disclose \nXue-Ming Li: Nothing to disclose \nZhi-Gang Yang: Nothing to disclose \n \n \nRPS 603-4 \nMachine learning can predict pulmonary hypertension in patients \nundergoing contrast-enhanced CT thorax \n*P. F. P. Charters*, W. Brown, J. Rossdale, O. Slegg, J. Willis, G. Robinson,  \nR. MacKenzie Ross, J. Suntharalingam, J. C. L. Rodrigues; Bath/UK \n(pia.charters@nhs.net) \n \nPurpose: CT pulmonary angiography (CTPA) is often used in suspected \npulmonary hypertension (PH). Right ventricular dilatation is a feature of PH. \nThe study purpose was to determine the diagnostic accuracy of a fully-\nautomated machine learning (ML) derived tool at detecting PH in patients with \nsuspected PH referred to a specialist centre relative to invasive right heart \ncatheterisation (RHC) as gold standard and to compare to contemporaneous \ntrans-thoracic echo (TTE). \nMethods or Background: Retrospective analysis of 162 consecutive patients \nover 25 months with suspected PH who underwent CTPA and TTE within 12 \nmonths of RHC. TTE were graded ‘low’, ‘intermediate’ or ‘high’ likelihood of PH \n(British Society of Echocardiography). CTPAs were uploaded to fully-\nautomated ML-derived image analysis software for ventricular segmentation \nand calculation of the RV/LV diameter ratio. RV/LV measurements were \ncompared with RHC pressure measurements. PH diagnosis was made using \nRHC gold standard. \nResults or Findings: RV/LV •1 was 86% sensitive and 40% specific for PH \nwhen scanned within 12 months of RHC, whilst ‘high’ likelihood TTE was 61% \nsensitive and 86% specific. In a subgroup analysis of 34 ‘intermediate’ \nlikelihood TTEs, 28 had PH at RHC and RV/LV >1 was present in 82% (23) of \nthese. Area under the receiver-operating-curve for RV/LV diameter for PH \ndiagnosis was 0.723 (95th CI 0.609-0.836), p = 0.001. RV/LV diameter >0.95 \nachieved 90% sensitivity and 30% specificity and RV/LV diameter >1.33 \nachieved 90% specificity and 39% sensitivity for diagnosis of PH. \nConclusion: In patients with suspected PH referred to a specialist centre, \nautomated RV/LV thresholds may help rule in and rule out PH and may have \ndiagnostic utility when TTE is ‘intermediate’ for PH. \nLimitations: ‘Low’ likelihood TTEs did not all have RHC. \nEthics Committee Approval: Approved by trust audit committee. \nFunding for this study: Nil \nAuthor Disclosures: \nJames Willis: Nothing to disclose \nGraham Robinson: Other: The Royal United Hospital is a Centre of Excellence \nfor Imbio and is not remunerated for use. \nOliver Slegg: Nothing to disclose \nPia Charters: Other: The Royal United Hospital is a Centre of Excellence for \nImbio and is not remunerated for use. \nJennifer Rossdale: Nothing to disclose \nRob MacKenzie Ross: Nothing to disclose \nWilliam Brown: Other: The Royal United Hospital is a Centre of Excellence for \nImbio and is not remunerated for use. \nJay Suntharalingam: Nothing to disclose \nJonathan Rodrigues: Other: The Royal United Hospital is a Centre of \nExcellence for Imbio and is not remunerated for use. \n \n \nResearch Presentation Session: Cardiac \nRPS 703 \nMyocardial deformations \nRPS 703-1 \nLeft ventricular strain can predict outcomes of pulmonary valve \nreplacement in patients with repaired tetralogy of Fallot \n*B. Zhuang*, M. Lu; Beijing/CN  \n(zbyan10@163.com) \n \nPurpose: Pulmonary valve replacement (PVR) is effective in reducing the right \nventricular volume and retaining right ventricular function in patients with repair \ntetralogy of Fallot (rTOF). However, prognostic outcomes after PVR surgery \nare still mixed. Key factors that determine outcomes after PVR in rTOF patients \nare largely unknown. Our study aims to analyze whether pre-PVR strain and \nstrain rate are associated with long-term outcomes after PVR in patients with \nrTOF. \nMethods or Background: This prospective study enrolled 41 asymptomatic \nrTOF patients who required PVR due to moderate or severe pulmonary \nregurgitation. The feature tracking parameters were measured pre-operatively \nbased on cine sequences. Adverse events including death due to any cause, \ncardiac transplantation, syncope caused by arrhythmias, redo PVR, \nsymptomatic heart failure and persistence ventricular tachycardia were \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 188  \ndocumented during follow-up. ROC analysis was performed and Kaplan-Meier \ncurves were drawn with log-rank statistics. \nResults or Findings: During 3.0±1.5 years of follow-up, 10 adverse events \nwere recorded. The 3-year event-free survival rate was 63% for patients with a \npre-operative radial strain (RS)>23.87% (p<0.001), 93% for patients with a pre-\noperative circumferential strain (CS)<-15.55% (p<0.001), 63% for patients with \na pre-operative longitudinal strain(LS)<-9.7% (p<0.001). As for strain rate, the \n3-year event-free survival rate was 68% for patients with a pre-operative \nsystolic radial strain rate (RSRs) >1.53s-1 (p=0.003), 68% for patients with a \npre-operative early diastolic radial strain rate (RSRe) <-1.73 s-1 (p<0.001) and \n59% for patients with a pre-operative early diastolic longitudinal strain rate \n(LSRe) >0.42 s-1 (p<0.001). \nConclusion: The RS, CS, LS, RSRs, RSRe, LSRe before PVR are important \nprognostic factors for adverse events. Identifying these factors can help \nrecognize patients at increased risk of adverse events. \nLimitations: There are some limitations \nEthics Committee Approval: This study is approved by Fuwai Hospital \nFunding for this study: There is no funding \nAuthor Disclosures: \nMinjie Lu: Nothing to disclose \nBaiyan Zhuang: Nothing to disclose \n \nRPS 703-2 \nRight left ventricular blood pool T2 ratio as an innovative screening tool \nfor the identification of left to right shunts in patients with dilated right \nventricle: results from a bi-centre study \n*V. Brandt*¹, V. Bordonaro², T. Emrich¹, A. Varga-Szemes¹, M. C. Halfmann³, \nT. Schoeler³, U. J. Schoepf¹, A. Secinaro²; ¹Charleston, SC/US, ²Rome/IT, \n³Mainz/DE  \n(verena.brandt@gmx.net) \n \nPurpose: Left-to-right shunts (L-R-Shunt) lead to volume overload of the right \nventricle(RV), resulting in adverse cardiac events. CMR is able to detect L-R-\nShunts by comparison of phase-contrast measurements of pulmonary and \naortic flow, which is not routinely performed in clinical examinations. Since T2 \nis sensitive to blood-oxygenation, we hypothesized that T2 mapping is able to \ndetect blood-oxygenation changes between the ventricles caused by L-R-\nShunts. The aim of this study was to evaluate T2 mapping for L-R-Shunt \ndetection in patients with dilated RV compared to healthy volunteers. \nMethods or Background: We analyzed the T2-ratio of the RV/LV blood-pool \nand Qp/Qs-ratio by phase-contrast-imaging from 21 patients with L-R-shunts. \nHealthy volunteers (HV,n=51) and patients with dilated right ventricles without \nL-R-Shunts (e.g.ARVC,n=21) were used as control groups. Qp/Qs-ratio was \ncalculated by dedicated measurements of pulmonary and aortic flow. T2 ratio \nof the LV/RV blood-pool was calculated from mid-ventricular T2-Maps. \nResults or Findings: The Qp/Qs-ratios in the L-R-Shunt vs the control groups \nwere 1.9±0.9 and 1.0±0.0, respectively (p<0.001). End-diastolic RV volume \nwas significant higher compared to HV (122.5±42.0ml and 94.4±16.2 \nml,p=0.004), but not in comparison to patients with RV dilatation (122.5±42.0ml \nand 127.8±34.6ml,p=0.247). T2 RV/LV-Ratio was significantly increased in \npatients with L-R-Shunts (0.90±0.08) compared to HV(0.74±0.10,p<0.001) and \npatients with dilated RV (0.73±0.12,p<0.001). A ratio over 0.76 showed 100% \nsensitivity and 56% specificity for detection of L-R-Shunts, resulting in a \nnegative predictive value of 100%. T2 RV/LV-ratio was strongly correlated with \nthe shunt-severity(r=0.863,p<0.001). \nConclusion: T2 RV/LV ratio has the potential to become a fast and reliable \nparameter to detect or rule-out L-R-Shunts with strong correlation to shunt-\nseverity, independent of RV volume. Such diagnostic tool enables to avoid \nunnecessary phase-contrast measurements in cases with RV dilatation of \nunknown etiology. \nLimitations: Bicenter, retrospective \nEthics Committee Approval: Approval-number: (837.196.13/837.477.14) \nFunding for this study: Not available \nAuthor Disclosures: \nVerena Brandt: Nothing to disclose \nAurelio Secinaro: Nothing to disclose \nTheresia Schoeler: Nothing to disclose \nUwe Joseph Schoepf: Consultant: Bayer, Guerbet, Elucid, Siemens \nHealthcare, Bracco, HeartFlow \nVeronica Bordonaro: Nothing to disclose \nTilman Stephan Emrich: Speaker: Siemens Healthineers \nMoritz Christian Halfmann: Nothing to disclose \nAkos Varga-Szemes: Consultant: Bayer Healthcare Research/Grant Support: \nSiemens Healthineers Consultant: Elucid Bioimaging \n \n \n \n \n \n \nRPS 703-3 \nImpact of short-term mapping parameter modification on left ventricle \nremodelling: Miami study \n*A. Palmisano*¹, D. Vignale¹, R. Faletti², M. Gatti², G. Peretto¹, N. Galea³,  \nM. Francone³, F. De Cobelli¹, A. Esposito¹; ¹Milan/IT, ²Turin/IT, ³Rome/IT \n(palmisano.anna@hsr.it) \n \nPurpose: Myocarditis is a multifaceted disease with variable outcome, ranging \nfrom complete recovery to end-stage dilated cardiomyopathy. Imaging \nprognosticators are widely unknown. Aim was to evaluate the value of \nmicrostructural alteration using mapping parameters in the prediction of \nunfavorable remodeling. \nMethods or Background: Eighty-eight patients with diagnosis of acute \nmyocarditis at multimodality approach (lab test, ECG, echocardiography and \nCMR) underwent 1.5 T CMR at baseline, 2-months after symptom onset and \nafter 12-months. CMR protocol included 2009 and 2018 Lake Louise criteria. \nForty-five healthy volunteers were used as control group. \nResults or Findings: Clinical presentation was infart-like in 69 patients, heart \nfailure in 14 and arrhythmic in 5 patients. T2 mapping showed best diagnostic \nperformances at baseline (0.97 vs 0.82 and 0.85 for native T1 and ECV), 2-\nmonths CMR (0.91 vs 0.66 and 0.78 for native T1 and ECV) and 12-months \nCMR (0.86 vs 0.48 and 0.69 for native T1 and ECV). Patients with infart-like \npresentation had more intense but more focal damage, with higher LGE \nburden (8% vs 3% and 2%, p=0.03) but lower number of myocardial segment \nwith mapping alteration (p=0.02 for T1; p=0.03 for T2, n.s for ECV). Moreover, \nmost of them (55/69) had a complete healing at 2-months CMR. Patients with \ndepressed ejection fraction (EF<55%) at 12-months had more than 10 \nmyocardial segments with altered native T1, T2 and ECV values at baseline \nand short-term CMR, and higher ECV at 12-months CMR (32% vs 27%). \nConclusion: Larger myocardial damage by mapping techniques is associated \nto higher risk of long-term myocardial dysfunction. \nLimitations: Endomyocardial biopsy was not performed in all patients. \nEthics Committee Approval: The study is approved by the Institutional review \nboard. \nFunding for this study: The study was granted by Young Research Award of \nthe Italian Ministry of Health (GR-2013). \nAuthor Disclosures: \nDavide Vignale: Nothing to disclose \nGiovanni Peretto: Nothing to disclose \nAntonio Esposito: Nothing to disclose \nFrancesco De Cobelli: Nothing to disclose \nRiccardo Faletti: Nothing to disclose \nAnna Palmisano: Nothing to disclose \nMarco Gatti: Nothing to disclose \nMarco Francone: Nothing to disclose \nNicola Galea: Nothing to disclose \n \nRPS 703-4 \nMyocardial remodelling in the first year after cardiac transplant \n*C. Obst*, M-E. Stelzmüller, A. Zuckermann, C. Loewe, D. Beitzke; Vienna/AT \n \nPurpose: Heart transplantation (HTX) is a lifesaving procedure for patients \nwith end stage-heart failure. Cardiac magnetic resonance imaging (CMR) is \nemerging as a promising imaging method to follow up myocardial remodelling \nafter HTX. The aim of this study is to investigate short term cardiac remodelling \nusing multiparametric CMR in the first year after HTX. \nMethods or Background: Thirty-one patients who underwent CMR on a 1.5 \nTesla system 3 and 12 months after HTX were included. Quantitative markers \nand left ventricular ejection fraction (LVEF) were derived from short axis \nsteady-state free precision (SSFP) sequences. Native T1 and T2 mapping was \nperformed at three short axis slices. \nResults or Findings: There was no statistically significant difference in T1 \n(p=0.931), T2 (p=0.386) and the left ventricular mass (p= 0.203) three and \ntwelve months after HTX. However both the LVEF (60.1% vs. 67.2%) and \nRVEF (51.7% vs. 59.3%) improved significantly (p=0.007 and 0.006) twelve \nmonths after transplantation. Endsystolic volume in both the left (51.1 vs. 34.5 \nml) and right (63.3 vs. 45.8 ml) ventricles decreased statistically significant \n(p<0.001 and p=0.048). A reduction of the enddiastolic volume of the left \nventricle (126.0 vs 103.6 ml) and the right ventricle (109.9 vs. 92.1 ml), with a \np-value of 0.002 vs 0.003 respectively, was observed. \nConclusion: In the first year after HTX significant improvements in cardiac \nfunction and a reduction in LV and RV size can be observed by CMR. However \nthis is not accompanied by a change in myocardial water content assed by T2 \nmapping or a relevant change in T1 mapping values potentially representing \nstructural remodelling. \nLimitations: Eventually low number of cases. \nEthics Committee Approval: Study was approved by the local ethics \ncommittee of the Medical University of Vienna. \nFunding for this study: There was no special funding. \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 189  \nAuthor Disclosures: \nChristian Obst: Nothing to disclose \nMarie-Elisabeth Stelzmüller: Nothing to disclose \nDietrich Beitzke: Nothing to disclose \nAndreas Zuckermann: Nothing to disclose \nChristian Loewe: Nothing to disclose \n \nRPS 703-5 \nLeft atrial functional analysis is superior to standard volumetric \nassessment in hypertensive heart disease patients with myocardial \nhypertrophy \nT. Emrich¹, S. Altmann², B. Yacoub¹, M. C. Halfmann², *C. Reichardt*²,  \nU. J. Schoepf¹, C. Düber², K-F. Kreitner², A. Varga-Szemes¹; ¹Charleston, \nSC/US, ²Mainz/DE \n(constantin.reichardt@gmx.de) \n \nPurpose: Chronic hypertension-related LV myocardial adaptation results in \nmyocardial fibrosis, leading to diastolic/systolic dysfunction. Besides standard \nvolumetric parameters, time-volume and strain analysis of the atria were used. \nThe purpose of this study was to compare diagnostic performance of \nvolumetric versus advanced functional atrial parameters to differentiate healthy \nvolunteers (HV) from patients with hypertensive heart disease (HHD) and \ncorrelate these parameters to the severity of LV hypertrophy. \nMethods or Background: 42 HHD patients and 50 HV who had previously \nundergone CMR (3T) were included in this retrospective study. Atrial time-\nvolume analyses based on long-axis cine acquisitions and atrial strain values \nwere acquired using a commercially available post-processing software. \nReservoir (TEF and reservoir strain), conduit (PEF and conduit strain) and \nbooster (AEF and booster strain) function of the LA were calculated. \nResults or Findings: HHD patients had significantly higher LV myocardial \nmass (78.1±17.7 g/m2 vs 54.6±9.8 g/m2,p<0.001)and lower EF (53.2±12.1% \nvs 62.3±5.3%,p<0.001)than HV.Maximal/Minimal atrial volumes, as well as \nAEF showed no significant differences between HHD and HV (p>0.05). The \nevaluation of reservoir and conduit function demonstrated significant \ndifferences in time-volume and strain parameters between the groups (all \np<0.001). Diagnostic performance to differentiate HHD from HV was \ncomparably high for all reservoir and conduit functional parameters of the LA \n(AUC:0.931-0.966;DeLong p>0.05).PEF and conduit strain demonstrated a \nsignificant negative correlation with myocardial mass (r=-0.562 and r=-0.674). \nConclusion: Functional parameters of atrial function by time-volume analysis \nand atrial strain imaging are superior to standard volumetric assessment of the \nLA to discriminate HHD patients from HV. Parameters from time-volume and \nstrain analysis can be used interchangeably. The correlation between LA \nfunction and LV myocardial mass can be used as a marker of diastolic \ndysfunction and is a potential parameter for treatment monitoring. \nLimitations: Single-center,retrospective study,lack of invasive/histological \nvalidation \nEthics Committee Approval: Approval-Number: 837.196.13/837.477.14 \nFunding for this study: None \nAuthor Disclosures: \nUwe Joseph Schoepf: Other: Elucid Bioimaging Other: Bayer Healthcare \nOther: HeartFlow Other: Guerbet Other: Siemens Healthcare (Travel support) \nOther: Bracco \nChristoph Düber: Nothing to disclose \nConstantin Reichardt: Nothing to disclose \nTilman Stephan Emrich: Speaker: Siemens Healthcare (Travel support) \nMoritz Christian Halfmann: Nothing to disclose \nBasel Yacoub: Nothing to disclose \nKarl-Friedrich Kreitner: Nothing to disclose \nAkos Varga-Szemes: Other: Siemens Healthcare (Travel support) Consultant: \nElucid Bioimaging Consultant: Bayer Healthcare \nSebastian Altmann: Nothing to disclose \n \nRPS 703-6 \nComparison of Cardiac Magnetic Resonance Imaging Findings between \nImmune Checkpoint Inhibitor-Induced Myocarditis and Presumed Viral \nMyocarditis \n*F. Cadour*, A. Varoquaux, P. Habert, A. Jacquier, J. Cautela, F. Thuny, \nU. Scemama; Marseille/FR \n(farah.cadour@hotmail.fr) \n \nPurpose: Immune checkpoint inhibitor-induced myocarditis (IIM) is one of the \nmost serious cancer therapy-related toxicities and represents a new diagnostic \nchallenge. Imaging findings of this rare condition have never been compared to \nthose of presumed viral myocarditis (PVM). This study sought to compare \ncardiac magnetic resonance imaging (CMR) findings between IIM and PVM. \nMethods or Background: This retrospective case-control study analyzed 46 \npatients with acute myocarditis (28 patients with PVM and 18 patients with IIM) \nconfirmed by CMR according to the updated Lake Louise criteria. Covariates of \ninterest were extracted from medical records, and CMR evaluation included \nlate gadolinium enhancement (LGE), T1 and T2 mapping, and extracellular \nvolume (ECV) values. \nResults or Findings: The subepicardial region was the most common site of \nLGE localization in both groups. However, the LGE distribution was \nsignificantly different between the two groups (p=0.005). In comparison to PVM \npatients, IIM patients more frequently had midwall LGE (3% vs. 39%, p=0.003) \nand LGE at the basal anteroseptal (3% vs. 44%, p=0.001), basal inferoseptal \n(14% vs. 44%, p=0.04), and midinferoseptal (14% vs. 27%, p=0.02) segments. \nThe global, maximum, and elevation values of T2, native T1, and ECV were \nnot significantly different between PVM and IIM patients. \nConclusion: PVM and IIM have different LGE patterns on CMR imaging. \nSeptal and midwall myocardial involvement was more frequently observed in \npatients with IIMs. \nLimitations: In addition to its retrospective nature, one of the main limitations \nof our study is the absence of systematic EMB. \nEthics Committee Approval: The study was approved by the local ethics \ncommittee (RGPD/APHM 2020-132), and informed consent was obtained from \nall patients. \nFunding for this study: This study was supported by Assistance Publique – \nHôpitaux de Marseille. \nAuthor Disclosures: \nPaul Habert: Nothing to disclose \nFarah Cadour: Nothing to disclose \nUgo Scemama: Nothing to disclose \nAlexis Jacquier: Nothing to disclose \nArthur Varoquaux: Nothing to disclose \nFranck Thuny: Nothing to disclose \nJennifer Cautela: Nothing to disclose \n \nRPS 703-7 \nFeature tracking vs speckle tracking in the assessment of myocardial \ndeformation in highly trained endurance athletes \n*B. Domenech Ximenos*¹, M. Sanz-de la Garza¹, Á. Sepulveda², D. Lorenzatti¹, \nF. Simard³, R. J. J. Perea Palazon¹, S. Prat-Gonzalez¹, M. Sitges¹; \n¹Barcelona/ES, ²Santiago/CL, ³Montreal, QC/CA \n(bl.domenech@gmail.com) \n \nPurpose: Assessment of myocardial deformation integrated with cardiac \ndimensions provides a comprehensive assessment of the ventricular \nremodeling patterns that might be induced by cumulative effects of intensive \nexercise. Although strain measurements using speckle tracking \nechocardiography (STE) have been widely reported, feature tracking (FT) \nmethodology assessed by cardiac magnetic resonance (CMR) has not been \nstandardized, and its accuracy is not yet fully validated. Our aim was to \ncompare FT accuracy and reproducibility to STE in highly-trained endurance \nathletes. \nMethods or Background: 93 athletes (>12hours training/week at least during \nthe last 5years) and 72 matched controls (52%male, mean age 35±5.1years) \nunderwent a resting CMR and an echocardiography to assess biventricular \nglobal longitudinal strain(GLS) by CMR-FT and STE. \nResults or Findings: Strain values(both CMR-FT and STE) proportionally \ndecreased with increasing ventricular volumes potentially depicting the \nincreased volume and functional biventricular reserve that characterize highly-\ntrained athletes’ heart. Strain values were lower when assessed by CMR-FT as \ncompared to STE(p<0.001), with good reproducibility for the LV \n(bias=3.94%,LOA=±4.27%) but wider variability for RV strains. \nConclusion: Both methods were comparable when measuring LV strain but \nnot RV strain. Strain values were significantly lower when assessed by FT as \ncompared to STE, which was expected due to the lower in-plane spatial and \ntemporal resolution of FTvsSTE, which is particularly relevant for the complex \nanatomy of the RV. \nLimitations: This study only assessed myocardial deformation analysis by FT \nand STE, and we did not include CMR tagging method. \nEthics Committee Approval: The Ethics Committee of our Institution \napproved the study. \nFunding for this study: This work was partially funded by grants from AGAUR \n(M. Sanz-de la Garza, MD, PhD), Plan Nacional I. D, Del Programa Estatal de \nFomento De La Investigaciyn Cienttfica y Tpcnica de Excelencia, \nSubprograma De Generaciyn Del Conocimiento, Ministerio de Econom ta y \nCompetitividad 2013 (grant number DEP2013–44923-P). \nAuthor Disclosures: \nRosario Jesús Perea Palazon: Nothing to disclose \nDaniel Lorenzatti: Nothing to disclose \nMaria Sanz-de la Garza: Nothing to disclose \nMarta Sitges: Nothing to disclose \nÁlvaro Sepulveda: Nothing to disclose \nFrançois Simard: Nothing to disclose \nBlanca Domenech Ximenos: Nothing to disclose \nSusanna Prat-Gonzalez: Nothing to disclose \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 190  \nRPS 703-8 \nCardiac Erdheim-Chester disease: disease localization and impact on \nmyocardial fibrosis \n*M. Gambardella*¹, A. Palmisano², D. Vignale², C. Campochiaro²,  \nA. Tomelleri², F. De Cobelli², L. Dagna², A. Esposito²; ¹Naples/IT, ²Milan/IT \n(mic.gambardella@libero.it) \n \nPurpose: To characterize with Cardiac Magnetic Resonance (CMR) the site \nand amount of ECD cardiac involvement and its impact on function and \nfibrosis. \nMethods or Background: Twenty-six biopsy-proven ECD patients (59 ± 13 \nyears, 77% males) were enrolled between 2009 and 2019. All patients \nunderwent CMR at 1.5 T using a standardized protocol to define cardiac ECD \nextension, Left Ventricle (LV) function and myocardial scar burden (+3SD). \nResults or Findings: Right atrio-ventricular (AV) groove involvement was the \nmost frequent (75% of cases; 31 ± 23 mL) followed by right atrial pseudo-mass \n(54%; 23.5 ± 19.1 mL), superior (38%; 16.5 ± 14.3 mL) and inferior (23%; 12.4 \n± 6.7 mL) cava vein infiltration. Left AV groove and anterior interventricular \ngroove involvement were less frequent (15%; 9.1 ± 5.8 mL and 15%; 7.8 ± 2.8 \nmL, respectively). Most of patients had pericardial effusion (54%; 138 ± 135.8 \nmL) with pericardial thickening in 25% cases. LGE was present in 19 patients \n(median 21% [IQR, 12-46%]) mostly involving basal and mid-ventricular infero-\nseptal (18/19) and inferior (8/19) walls. LGE presence was associate to right \nAV groove involvement (p < 0.001). Indexed LV End Diastolic Volume, Mass \nand Ejection Fraction values were normal. Coated aorta was present in 60% \ncases. \nConclusion: ECD mostly involved the right atrio-ventricular groove which is \nassociated to inferior LV fibrosis. \nLimitations: Relatively small sample size. \nEthics Committee Approval: Approved by Institutional Review Board and \nwaiver of consent for retrospective study. \nFunding for this study: No funding was recived. \nAuthor Disclosures: \nDavide Vignale: Nothing to disclose \nLorenzo Dagna: Nothing to disclose \nAntonio Esposito: Nothing to disclose \nAlessandro Tomelleri: Nothing to disclose \nAnna Palmisano: Nothing to disclose \nFrancesco De Cobelli: Nothing to disclose \nMichele Gambardella: Nothing to disclose \nCampochiaro Corrado Campochiaro: Nothing to disclose \n \nRPS 703-9 \nCardiac resynchronisation in treating the patients with left ventricular \nnon-compaction cardiomyopathy (LVNC): the role of CMR in the \nprognosis of outcome \n*E. Mershina*, R. Myasnikov, O. Kulikova, S. Koretskiy, O. Larina, M. Kharlap, \nP. Pilius, V. Sinitsyn, O. Drapkina; Moscow/RU \n(elena_mershina@mail.ru) \n \nPurpose: LVNC is a rare disease characterized by a structural abnormality of \nthe myocardium with uncertain etiology and pathogenesis. Patients with LVNC \nand heart failure with low ejection fraction (HFrEF) are treated with the same \ntherapy as the patients with other reasons of HFrEF. However, the cardiac \nresynchronization therapy (CRT) in treating the patients with LVNC, left bundle \nbranch block (LBBB) and HFrEF remains insufficiently studied. The aim of our \nstudy was to demonstrate the prognostic role of LGE CMR results before CRT-\nD application in patients with LVNC. \nMethods or Background: The diagnosis of LVNC was proven by Echo- (Chin, \nJenni, Stollberger) and CMR- (Petersen, Grothoff) criteria of non-compaction. \nLGE CMR was used to demonstrate intramyocardial fibrosis. EchoCG was \nused to monitor the response after CRT-D installation. The echo response \n(ER) was defined as a decrease in left ventricular end systolic volume \n(LVESV)•15%. \nResults or Findings: We studied the group of 19 patients (m/w–9/10, mean \nage 56 years[40;65]) with LVNC (6 pts with family history of LVNC), HFrEF – \nmean LVEF 28% [23;30]. All the patients had LBBB with median QRS 160 ms. \n9 of 19 pts were ER; 8 of 19 pts (42%) were super-responders, with the \ndecrease of LVESV •30%. The number of segments with intramyocardial \nfibrosis foci were significantly less in the ER group in comparison to non-\nresponders, 12 vs 76 (p<0.001). Ration of NC mass to the compacted \nmyocardium mass was higher in the group of non-responders: 26.4% vs 21.5% \n(p<0.1). \nConclusion: In the patients with LVNC the presence of intramyocardial fibrosis \ndefined with use of LGE CMR was an independent prognostic factor for worse \nclinical response after CRT-D installation. \nLimitations: Small group of patients; retrospective study \nEthics Committee Approval: Approved by the Moscow University Ethics \nCommittee. \nFunding for this study: No \n \nAuthor Disclosures: \nMaria Kharlap: Nothing to disclose \nPolina Pilius: Nothing to disclose \nOlga Larina: Nothing to disclose \nValentin Sinitsyn: Nothing to disclose \nOlga Kulikova: Nothing to disclose \nElena Mershina: Nothing to disclose \nOksana Drapkina: Nothing to disclose \nRoman Myasnikov: Nothing to disclose \nSergei Koretskiy: Nothing to disclose \n \n \nResearch Presentation Session: Cardiac \nRPS 803 \nAngiography \nRPS 803-1 \nPre and postcontrast pericoronary CT attenuation values with regards to \ncoronary stenosis \n*C. B. Monti*, D. Capra, C. Parietti, G. Florini, M. Zanardo, F. Sardanelli,  \nF. Secchi; Milan/IT  \n(caterinab.monti@gmail.com) \n \nPurpose: To assess pre- and post-contrast attenuation values of pericoronary \nadipose tissue (pCAT) with regards to coronary artery stenosis in patients \nundergoing cardiac CT (CCT) for suspected coronary artery disease (CAD). \nMethods or Background: All patients who underwent CCT between January \n2016 and June 2019 were retrospectively included. Patients who did not have \nboth pre- and post-contrast scans, or whose CCTs presented with relevant \nartifacts were excluded. A round region of interest with a 1 cm diameter was \nplaced in the post-contrast scan around each of the three main coronary \narteries on the slice that best depicted all. Such segmentations were then \nthresholded for fat (-190 to -30 Hounsfield units), and subsequently registered \non the basal scan. Data are presented as median and interquartile range \n(IQR). \nResults or Findings: A total of 480 patients were included. CAD patients were \nolder than those without (70 years, IQR 63−76 versus 62 years, 54−69, \np<0.001), and more often males (70% versus 56%, p=0.001). For all coronary \narteries both pre- and post-contrast pCAT attenuations were higher in CAD \npatients than in those without (p=0.001 both pre- and post-contrast in the right \ncoronary artery, p<0.001 both pre- and post-contrast in the interventricular \ndescending artery and the basal circumflex artery), except for the post-\ncontrast, pCAT around the circumflex artery where there was no significant \ndifference (p=0.131). \nConclusion: pCAT attenuation is higher in CAD patients, likely due to disease-\nrelated processes such as inflammation and adipose tissue beiging or fibrosis. \nLimitations: Retrospective, single-centre. \nEthics Committee Approval: The study was approved by the local Ethics \nCommittee. \nFunding for this study: The study was partially supported by BLINDED. \nAuthor Disclosures: \nGiorgia Florini: Nothing to disclose \nFrancesco Secchi: Nothing to disclose \nFrancesco Sardanelli: Speaker: Bayer, General Electric, Bracco Grant \nRecipient: Bayer, General Electric, Bracco Advisory Board: Bracco \nCaterina Beatrice Monti: Nothing to disclose \nMoreno Zanardo: Nothing to disclose \nCarlo Parietti: Nothing to disclose \nDavide Capra: Nothing to disclose \n \nRPS 803-2 \nA spectrum of extracardiac vascular anomalies on CT angiography in \npediatric patients of congenital heart disease and its correlation with \nintraoperative findings \nR. Anand, *M. Penuganchiprolu*, B. Aggarwal; Delhi/IN  \n(manasasmc@gmail.com) \n \nPurpose: To evaluate the spectrum of CT angiography (CTA) in various extra \ncardiac vascular anomalies in pediatric patients of congenital heart disease \nand its correlation with operative findings. \nMethods or Background: This is a retrospective study wherein two hundred \nfifty four consecutive patients with known congenital heart disease who were \nreferred for CTA as a part of their regular clinical work up from January 2017 to \nDecember 2019 were included. Operative findings were also recorded. \nResults or Findings: The vascular anomalies on CTA were found in 191 \npatients giving an incidence of 75.1% with MAPCAs showing the highest \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 191  \nincidence (34.61%) followed by left pulmonary artery origin stenosis (11.4%) \nand interrupted IVC (9.4%). Out of 254 patients 220 patients underwent \nsurgery. On operation vascular anomalies were found in 156 patients giving an \nincidence of 71.1%. Most common vascular anomaly detected was MAPCAs. \nThe most common congenital heart disease detected was TOF on both CTA \nand operation. \nConclusion: As patients of congenital heart diseases also present with a wide \nrange of associated extra cardiac vascular findings which range from non-\nsignificant to those affecting the clinical outcome of patients. Assessment of \nextra-cardiac vessels is mandatory at the time of performing these studies as \nthese findings are important for giving a complete diagnosis and for treatment \nplanning in some cases. \nLimitations: -As pediatric patients cannot hold their breath, image quality was \ncompromised in few cases. -Few vascular anomalies were missed due to \noverlapping of adjacent vascular structures. \nEthics Committee Approval: Appropriate consents were obtained during the \nprimary study and surgery. It is a retrospective study only the recorded data \nwas used for analysis. \nFunding for this study: No funding has been provided for this study. \nAuthor Disclosures: \nReena Anand: Nothing to disclose \nBharat Aggarwal: Nothing to disclose \nManasa Penuganchiprolu: Nothing to disclose \n \nRPS 803-3 \nCardiac event prediction by evaluating the variation of perivascular \nadipose tissue in serial coronary CT angiography \n*R. Gao*, Y. Gao, H. Han, K. Zhou, B. Lu; Beijing/CN \n(ruochen.gao@miracle.ict.ac.cn) \n \nPurpose: To evaluate the variation of perivascular adipose tissue (PVAT) for \ncardiac event prediction in patients with suspected coronary artery disease \n(CAD) who underwent serial coronary CT angiography (CCTA). \nMethods or Background: One hundred and eleven patients with suspected \nCAD underwent serial CCTA due to new or worsening symptoms were \nenrolled. Patients were followed-up for the incidence of cardiac events defined \nas cardiac death, coronary revascularization, nonfatal myocardial infarction \nand hospitalization due to unstable angina. Perivascular fat attenuation \nmapping was automatically done around the proximal right coronary artery \n(RCA), the left anterior descending artery (LAD), and the left circumflex artery \n(LCX) using our own developed algorithm. The variation of PVAT ( ¨PVAT) was \ndefined as the difference between PVAT2 and PVAT1. \nResults or Findings: 111 patients (mean age 59.9 years ± 10.1, male 65.8%) \nwere followed-up with 612.3 days ± 200.6, 6 patients were lost. Twenty-eight \npatients had cardiac events including 16 coronary revascularization, 5 \nmyocardial infarction and 7 hospitalization. ¨PVAT of LAD, LCX and RCA in \npatients without events were -2.72 (-7.93, 3.27), -2.94 (-7.00, 2.16), -2.57 (-\n8.65, 2.00), which were all significantly lower than those with events 㹙1.05, (-\n3.21, 4.81), 1.37 (-3.64, 5.07), 1.23 (-6.71, 4.61), respectively, all p < 0.05 㹛. In \npatients underwent events, PVAT of the three vessels were all increased / \ndecreased in the second CCTA in 10 (35.7%)/5 (17.9%) patients, which was \nsignificantly higher/lower than those without events (3 (3.9%), 26 (33.7%), both \np < 0.05). \nConclusion: The variation of PVAT is a novel indicator to predict cardiac \nevents. With the increase of PVAT in the major three coronary arteries, the risk \nof cardiac event also grows. \nLimitations: Our results require further prospective studies in large cohorts \nEthics Committee Approval: This retrospective study was approved by the \nEthics Committee. \nFunding for this study: None \nAuthor Disclosures: \nYang Gao: Nothing to disclose \nBin Lu: Nothing to disclose \nHu Han: Nothing to disclose \nRuochen Gao: Nothing to disclose \nKevin Zhou: Nothing to disclose \n \nRPS 803-4 \nThe orientation of the right superior pulmonary vein affects outcome after \npulmonary vein isolation \n*M. Vecsey-Nagy*, N. Szegedi, J. Simon, B. Szilveszter, S. Herczeg,  \nM. Kolossvary, P. Maurovich-Horvat, B. Merkely, L. Geller; Budapest/HU \n \nPurpose: No data is available on the impact of PV orientation on the long-term \nsuccess rates of point-by-point PVI. We sought to determine the impact of PV \nanatomy and orientation on atrial fibrillation (AF)-free survival in patients \nundergoing PVI using radiofrequency point-by-point technique. \n \n \n \nMethods or Background: We retrospectively included 448 patients who \nunderwent initial point-by-point radiofrequency ablation for AF at our \ndepartment. Left atrial CT-angiography (CTA) was performed before each \nprocedure. PV anatomical variations, ostial parameters (area, effective \ndiameter and eccentricity), orientation and their associations with 24-month \nAF-free survival were analyzed. \nResults or Findings: PV anatomical variations and ostial parameters were not \npredictive for AF-free survival (all p>0.05). Univariate analysis showed that \nfemale gender (p=0.025) was associated with higher rates of AF recurrence, \nventral-caudal (p=0.002), dorsal-cranial (p=0.034) and dorsal-caudal (p=0.042) \norientation of the right superior PV (RSPV), on the other hand, showed an \nassociation with lower rates of AF recurrence, as compared to the reference \nventral-cranial orientation. In multivariate analysis, both female gender [odds \nratio (OR) 1.83, 95% CI 1.15-2.93, p=0.011] and ventral-caudal RSPV \norientation, compared with ventral-cranial orientation, proved to be \nindependent predictors of 24-month recurrence (OR 0.37, 95% CI 0.19-0.71, \np=0.003). \nConclusion: Female gender and ventral-caudal RSPV orientation have an \nimpact on long-term arrhythmia-free survival. Assessment of PV orientation \nmay be a useful tool in predicting AF-free survival and may contribute to a \nmore personalized management of AF. \nLimitations: This is a single center, retrospective study with a limited number \nof patients. \nEthics Committee Approval: The requirement for informed consent was \nwaived due to the retrospective \nnature of the data. \nFunding for this study: This research did not receive any specific grant from \nfunding agencies. \nAuthor Disclosures: \nNándor Szegedi: Nothing to disclose \nMilán Vecsey-Nagy: Nothing to disclose \nBela Merkely: Nothing to disclose \nSzilvia Herczeg: Nothing to disclose \nMarton Kolossvary: Nothing to disclose \nJudit Simon: Nothing to disclose \nBálint Szilveszter: Nothing to disclose \nPál Maurovich-Horvat: Nothing to disclose \nLaszlo Geller: Nothing to disclose \n \nRPS 803-5 \nAdvanced myocardial tissue characterisation with cardiac CT in patients \npresenting with low-risk troponin positive chest pain \n*D. Vignale*¹, A. Palmisano¹, M. Gatti², R. Faletti², M. Tadic³, F. Moroni¹,  \nF. De Cobelli¹, A. Esposito¹; ¹Milan/IT, ²Turin/IT, ³Belgrade/RS \n(vignale.davide@hsr.it) \n \nPurpose: To evaluate the diagnostic yield of Late Iodine Enhancement (LIE) \nacquisition added to triple-rule-out CT (TRO-CT) performed in patients \npresenting with acute symptoms and troponin elevation without \nclinical/electrocardiographic criteria for acute myocardial infarction (AMI). \nMethods or Background: 80 consecutive patients with: 1)acute chest pain or \nequivalent; 2)troponin elevation; 3)no diagnostic criteria for AMI, underwent \nTRO-CT to rule-out obstructive coronary artery disease (CAD-RADS •4), \npulmonary embolism (PE), or acute aortic syndromes (AAS). Patients with \nnegative TRO-CT underwent LIE scan to: 1) evaluate presence/pattern of LIE; \n2) quantify the myocardial extracellular volume fraction (ECV). Invasive \ncoronary angiography and cardiac magnetic resonance were used as \nreference standard. \nResults or Findings: Forty two out of 80 patients (42/80) were male, median \nage=69 years [IQR=52-78]. Peak median troponinT was 49.0 ng/L [IQR=25-\n151]. Reported symptoms were chest pain (n=51[64%]), dyspnoea \n(n=17[21%]), syncope (n=9[11%]), sudden cardiac arrest (n=3[4%]). TRO-CT \nidentified: obstructive CAD 31(39%); AAS 1(1%); PE 6(8%). Additional non-\nvascular diagnosis were: cardiac metastasis 1(1%); pericarditis 2(3%). LIE \nacquisition was performed in TRO-negative patients (39/80). 17(21%) had non-\nischemic LIE suggestive for myocarditis; 2(3%) ischemic LIE with no-reflow \nsuggestive for MINOCA; 5(6%) dilated cardiomyopathy [1 ischemic LIE; 2 non-\nischemic LIE; 2 without LIE]; 3(4%) massively increased ECV suggestive for \namyloidosis, 4(5%) apical ballooning without scar suggestive of Takotsubo. \n8(10%) patients had both negative TRO and LIE; troponin dispersion was \nattributed to atrial fibrillation (5[6%]), kidney disease (2[3%]), and not found in \n1(1%). \nConclusion: LIE acquisition increases the diagnostic value of TRO-CT, finding \na diagnosis in 79% of TRO-negative patients. \nLimitations: Single-centre study. Relatively small sample size. \nEthics Committee Approval: Retrospective study approved by the \ninstitutional review board. \nFunding for this study: No funding received. \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 192  \nAuthor Disclosures: \nDavide Vignale: Nothing to disclose \nAntonio Esposito: Nothing to disclose \nFrancesco Moroni: Nothing to disclose \nRiccardo Faletti: Nothing to disclose \nAnna Palmisano: Nothing to disclose \nFrancesco De Cobelli: Nothing to disclose \nMarijana Tadic: Nothing to disclose \nMarco Gatti: Nothing to disclose \n \nRPS 803-6 \nCT based coronary artery access evaluation for a valve in valve TAVI \npatients using 3D modelling, 3D printing and mixed reality visualisation \n*A. A. Zlahoda-Huzior*¹, A. Khokhar², F. Ponticelli², K. Kotarba¹, A. Laricchia², \nF. Giannini², D. Dudek¹; ¹Krakow/PL, ²Cotignola/IT \n(adriana.zlahoda@medapp.pl) \n \nPurpose: Coronary access (CA) following valve-in-valve (ViV) transcatheter \naortic valve implementation (TAVI) may be extremely difficult due to the \npresence of two valvular prostheses. CA evaluation is usually performed using \nfluoroscopic images or computed tomography (CT) scans which often do not \nprovide a comprehensive three-dimensional (3D) estimation of the volume and \ngeometry of the structures. Accordingly, we propose the enhanced and specific \nvisualization of regions of interest using 3D modeling, printing and Mixed \nReality (MR). \nMethods or Background: CT scans of 20 patients after ViV-TAVI with the \nACURATE neo valve (Boston Scientific) were collected using Siemens \nSOMATOM Definition Flash scanner (512x512 pixels, spacing < 0.4 mm, slice \nthickness 0.3 mm). Semi-automatic data segmentation was performed using \nSlicer3D. Segmentation results were transformed into 3D mesh models \nconstituting the base of 3D graphics, printings and holograms. \nResults or Findings: 3D graphic models were presented on the flat screen \nwith the possibility of translation, rotation, zooming or changing the material \ntexture settings. Patient-specific, real-size 3D printings were performed in \nPolyJet technology using Stratasys J720 printer (CadXpert, Poland). Sufficient \nradiolucency of the tissue-like materials allowed to perform CA re-engagement \ntests under fluoroscopy. Holographic visualizations of 3D light-printed models \nwere presented in CarnaLife Holo system (MedApp, Poland) connected to \nMicrosoft HoloLens headset. \nConclusion: Enhanced visualization of ViV-TAVI data will likely become \ncrucial for pre-procedural planning offering faster, easier and more flexible data \nanalysis. Additionally, bench-side testin g on 3D printed models may facilitate \nthe selection of catheter and adjunctive materials prior to the procedure. \nLimitations: Further tests and clinical validation of proposed 3D visualization \ntechniques should be performed to confirm the usefulness of the method. \nEthics Committee Approval: NA for the study. \nFunding for this study: AGH UST Dean’s Grant, the subsidy from the \nMinister of Science and Higher Education,16.16.120.773, task 60 \nAuthor Disclosures: \nFrancesco Giannini: Nothing to disclose \nDariusz Dudek: Nothing to disclose \nAlessandra Laricchia: Nothing to disclose \nArif Khokhar: Nothing to disclose \nFrancesco Ponticelli: Nothing to disclose \nAdriana Anna Zlahoda-Huzior: Employee: MedApp S.A. \nKatarzyna Kotarba: Nothing to disclose \n \nRPS 803-8 \nEnvironmental tobacco smoke exposure estimated using the SHSES \nscale, and feature tracking computed tomography derived left ventricular \nglobal longitudinal strain in hypertensive patients \n*P. Gac*, M. Poreba, P. Macek, G. Mazur, R. Poreba; Wroclaw/PL \n(pawelgac@interia.pl) \n \nPurpose: Aim of the study was to assess the relationship between ETS and \nfeature tracking computed tomography-derived left ventricular global \nlongitudinal strain (LV GLS) in patients with hypertension. \nMethods or Background: 103 non-smokers with arterial hypertension were \nincluded in the study. The group consisted of 49 females and 54 males with the \nmean age of 67.73 ±8.84 years. Environmental tobacco smoke exposure was \nassessed with The Secondhand Smoke Exposure Scale (SHSES). LV GLS \nwas measured on dynamic multidetector computed tomography using feature \ntracking technology. In accordance to SHSES scale patients were divided into \nsubgroups: subgroup A– no ETS exposure (SHSES= 0 points, n=48), \nsubgroup B– low ETS exposure (SHSES= 1-3 points, n=16), subgroup C– \nmedium ETS exposure (SHSES= 4-7 points, n=21) and subgroup D– high ETS \nexposure (SHSES= 8-11 points, n=18). \nResults or Findings: Within the study group the mean peak of LV GLS was \n15.84 ±3.85% and the mean SHSES score was 3.37 ±3.96. Peak of LV GLS \nwas statistically significantly lower in subgroup D than in subgroup A (A: 17.35 \n±3.31%, D: 14.21 ±3.01%, p<0.05). There was a negative linear correlation \nbetween the exposure to ETS expressed by the SHSES scale and peak of LV \nGLS (r = -0.35, p<0.05). Regression analysis showed that higher SHSES \nscore, higher age, higher diastolic blood pressure and higher LDL cholesterol \nconcentration are independent risk factors for lower peak of LV GLS values. \nContrary, the use of ȕ-blockers appeared to be independent protecting factor \nagainst lower peak of LV GLS values. \nConclusion: There is an unfavourable relationship between ETS exposure \nestimated using the SHSES scale and LV GLS in hypertensive patients. \nLimitations: Small study group size. Lack of blood cotinine concentration test. \nEthics Committee Approval: Local Bioethic committee approval. \nFunding for this study: Wroclaw Medical University \nAuthor Disclosures: \nRafal Poreba: Nothing to disclose \nMalgorzata Poreba: Nothing to disclose \nPawel Gac: Nothing to disclose \nGrzegorz Mazur: Nothing to disclose \nPiotr Macek: Nothing to disclose \n \n \nResearch Presentation Session: Cardiac \nRPS 903 \nCardiac diagnosis and outcomes \nRPS 903-1 \nImpact of timing of hematocrit evaluation for calculation of ECV in \ncardiac magnetic resonance \n*C. Reiter*, G. Reiter, C. Kräuter, V. Nizhnikava, A. Schmidt, D. Scherr,  \nM. Fuchsjäger, U. Reiter; Graz/AT  \n(Clemens.Reiter@medunigraz.at) \n \nPurpose: Cardiac magnetic resonance (CMR) imaging assessment of \nmyocardial extracellular volume (ECV) requires the knowledge of blood \nhematocrit (HCT). In clinical routine, available HCT values are often non-\nrecent. Aim of this study was to compare ECV derived from HCT assessed \nimmediately before CMR and from routine laboratory data. \nMethods or Background: 27 subjects undergoing routine contrast-enhanced \n3T CMR (Magnetom Skyra, Siemens Healthcare) for whom blood laboratory \nincluding HCT (lab-HCT) within 90 days was available, were enrolled in this \nprospective study. Blood samples were drawn immediately before CMR \nimaging (onsite-HCT) using a point-of-care-meter system (StarTrip, Nova \nBiomedical). Global ECV was determined for both HCT values by segmenting \nthree native and post-contrast Modified Look-Locker inversion recovery \n(MOLLI) T1-maps in short-axis orientation using routine software (cvi42, Circle \nCardiovascular Imaging). Relationships between parameters based on lab-\nHCT and onsite-HCT were analyzed by Bland-Altman and correlation analysis. \np<0.05 was considered statistically significant. \nResults or Findings: Mean time between CMR and lab-HCT was 16±23 days. \nThere was no significant bias between onsite-HCT (40±5%) and lab-HCT \n(40±7%, p=0.32), standard deviation of differences was 3%, and HCT values \nshowed a strong correlation (r=0.89). Moreover, there was no significant \ncorrelation between the differences of HCT values and the time span between \nHCT assessments. ECV values showed no significant bias (onsite-HCT: ECV \n27.5±4.6%, lab-HCT: ECV 27.7±4.9%; p=0.35), standard deviation of \ndifferences was 1.3%, and their correlation was strong (r=0.95). \nConclusion: As neither a significant difference nor a large variability in ECV \nwas observed, the use of routine laboratory HCT values might be feasible for \nroutine ECV assessment. \nLimitations: Small sample size. No post-CMR HCT measurements were \nperformed. \nEthics Committee Approval: Obtained. \nFunding for this study: OeNB-Anniversary-Fund No.17934, ESOR \nFellowship 2020, MedUni Graz Foerderungsstipendien 2020. \nAuthor Disclosures: \nUrsula Reiter: Nothing to disclose \nGert Reiter: Employee: Gert Reiter is an employee of Siemens Healthcare \nDiagnostics GmbH, Austria. \nMichael Fuchsjäger: Nothing to disclose \nDaniel Scherr: Nothing to disclose \nClemens Reiter: Nothing to disclose \nAlbrecht Schmidt: Nothing to disclose \nVolha Nizhnikava: Nothing to disclose \nCorina Kräuter: Nothing to disclose \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 193  \nRPS 903-2 \nNovel virtual non-contrast reconstruction for coronary calcium scoring \nderived from coronary CT angiography using dual-layer dual-energy CT \n*M. C. Langenbach*¹, N. Grosse Hokamp¹, A. Bunck¹, J. Holz¹, E. Langzam², \nD. Maintz¹, L. Pennig¹; ¹Cologne/DE, ²Haifa/IL  \n(marcel.langenbach@me.com) \n \nPurpose: To investigate assessment of calcified coronary plaques by calcium \nscoring (CaSc) using a novel virtual non-contrast (VNC) reconstruction \nalgorism derived from contrast-enhanced coronary CT angiography (cCTA) \ncompared to true non-contrast (TNC) images. \nMethods or Background: Twenty consecutive patients (median age 55 years, \nrange 30-86, 6 female) receiving cCTA with suspicion of coronary artery \ndisease were included in this retrospective, single-center trial. All patients were \nscanned with the same dual-layer dual-energy CT using a standardized \nacquisition protocol in clinical routine including both, TNC scan for CaSc and \ncontrast-enhanced cCTA. In all patients, VNC-reconstructions were calculated \nfrom cCTA images using a novel post-processing algorism discriminating \ncalcified plaques in coronary arteries from contrast media and adjacent soft \ntissue. VNC images were calculated with identical imaging parameters as TNC \nscans. . Two radiologists independently analyzed VNC and TNC images \nregarding CaSc (by standard postprocessing software using the proprietary \nimage viewer) as well as image quality, plaque delineation and beam \nhardening artifacts using 5-point Likert scales (5=excellent). \nResults or Findings: In all patients, reconstruction of VNC-images was \nperformed successfully. For TNC and VNC images image quality (mean score \n4.1 vs. 4.2, p=0.832) and delineation of calcified plaques (mean score 4.1 vs. \n4.4, p=0.798) was excellent. Compared to TNC, beam hardening artifacts were \nsignificantly reduced in VNC-images allowing a clearer delineation of calcified \nplaques (mean score 3.2 vs. 4.3, p=0.02). Calculated Agatston-Score showed \nhigher values for TNC vs. VNC (172.9±247.0 vs. 76.4±107.7, p=0.385) with \nstrong correlation of respective values (rho=0.853, p<0.001). \nConclusion: VNC reconstructions of contrast-enhanced cCTA enable a \nreliable detection and evaluation of calcified coronary plaques without \nadditional acquisition of a native CT-scan. Reduction of beam-hardening \nartifacts in VNC-images potentially allows a more exact evaluation by \nAgatston-Score. \nLimitations: Retrospective \nEthics Committee Approval: Approved \nFunding for this study: Software support (Philips) \nAuthor Disclosures: \nJasmin Holz: Nothing to disclose \nLenhard Pennig: Nothing to disclose \nDavid Maintz: Nothing to disclose \nNils Grosse Hokamp: Nothing to disclose \nEran Langzam: Employee: Philips \nMarcel Christian Langenbach: Research/Grant Support: Guerbet GmbH \nAlexander Bunck: Nothing to disclose \n \nRPS 903-3 \nMyocardial native T1 mapping and cardiac outcomes in thalassemia \nmajor \nA. Meloni¹, N. Martini¹, A. De Luca², V. Positano¹, L. Pistoia¹, D. Visceglie³,  \nS. Gentili຾, G. Sinagra², *A. Pepe*¹; ¹Pisa/IT, ²Trieste/IT, ³Bari/IT, ຾Arezzo/IT \n(alessia.pepe@ftgm.it) \n \nPurpose: The T2* cardiovascular magnetic resonance (CMR) is the gold \nstandard for the non invasive detection of myocardial iron overload (MIO). The \nnative myocardial T1 mapping has been proposed as a complementary tool, \nthanks to its higher sensitivity to small amounts of iron. We explored the clinical \nimpact of T1 mapping for detecting cardiac complications in thalassemia major \n(TM). \nMethods or Background: We considered 146 patients (87 females, 38.7±11.1 \nyears) consecutively enrolled in the Extension-Myocardial Iron Overload in \nThalassemia Network. Three parallel short-axis slices of the left ventricle were \nacquired in end-diastole by a Modified Look-Locker Inversion recovery \nsequence with a 3(3s)3(3s)5 scheme. The native T1 values in all 16 \nmyocardial segments were obtained and the global value was the mean. \nResults or Findings: Twenty-one patients had an history of cardiac \ncomplications: 11 heart failure, 8 arrhythmias (7 supraventricular, 1 ventricular), \nand 2 pulmonary hyperthension. Patients with cardiac complications had \nsignificantly lower global heart T1 values (879.3±121.9 ms vs 963.2±98.5 ms; \nP<0.0001) but comparable T2* values (33.32±11.66 ms vs 37.17±9.15 ms; \nP=0.116). Cardiac complications were more frequent in the group of patients \nwith reduced global heart T1 value (males:<928 ms, females:<989 ms) \ncompared to the group with normal global heart T1 value (71.4% vs 39.5%; \nP=0.009). Odds ratio for cardiac complications was 3.8 (95%CI=1.3-10.9) for \npatients with reduced global heart T1 value versus patients with normal global \nheart T1 value. \n \nConclusion: We found out a significant association between decreased native \nglobal heart T1 values and a history of cardiac complications, suggesting that \nan early detection of myocardial iron burden by native T1 can support the \nclinicians in modifing chelation therapy earlier. \nLimitations: No prospective \nEthics Committee Approval: Local Ethics committee \nFunding for this study: No-profit support from Chiesi Farmaceutici S.p.A. and \nApoPharma Inc. \nAuthor Disclosures: \nAlessia Pepe: Research/Grant Support: Chiesi Farmaceutici S.p.A., \nApoPharma Inc. Speaker: Chiesi Farmaceutici S.p.A. \nGianfranco Sinagra: Nothing to disclose \nNicola Martini: Nothing to disclose \nAntonio De Luca: Nothing to disclose \nSara Gentili: Nothing to disclose \nAntonella Meloni: Speaker: Chiesi Farmaceutici S.p.A. \nLaura Pistoia: Speaker: Chiesi Farmaceutici S.p.A. \nDomenico Visceglie: Nothing to disclose \nVincenzo Positano: Nothing to disclose \n \nRPS 903-4 \nFunctional analysis of the left atrium provides high diagnostic accuracy \nto detect Fabry's disease and correlates with disease severity \n*S. Altmann*¹, M. C. Halfmann¹, C. Reichardt¹, K-F. Kreitner¹, C. Düber¹,  \nB. Yacoub², U. J. Schoepf², A. Varga-Szemes², T. Emrich²; ¹Mainz/DE, \n²Charleston, SC/US \n \nPurpose: Fabry’s disease (FD) is leading to increased myocardial mass and \nshortened myocardial T1, resulting in pathological alteration of myocardial \ngeometry and function. Data concerning correlation and diagnostic \nperformance comparing markers of disease severity, determined by myocardial \nmass, T1 and left atrial (LA) function, using cardiac MRI has not been \ndemonstrated. The aim of this study was to evaluate changes in LA strain in \ncorrelation to FD severity and demonstrate the improvement in diagnostic \nperformance by combining those parameters for myocardial involvement. \nMethods or Background: 3T CMR of fifty-seven FD patients (17 pre-\nhypertrophic stage,40 with cardiac involvement) and 50 healthy volunteers \nwere included in this retrospective study. Global longitudinal strain of LA was \ncalculated from 2-,3-,and 4-chamber cine acquisitions using feature-tracking \ntechnique. Group comparisons were performed using Mann-Whitney-U test \nand Pearson’s correlation coefficient. Receiver operating characteristic (ROC) \ncurve analysis was used to calculate area under the curve (AUC). DeLong \nmethod was used for pairwise to determine differences between AUCs. \nResults or Findings: There were significant differences between healthy \nvolunteers and FD patients in T1, myocardial mass, and LA reservoir strain (all \np<0.001). LA reservoir strain correlated with T1 (r=0.421,p=0.023) and \ninversely correlated with left ventricular myocardial mass (r=-0.489,p<0.001). \nCombining LA function parameters with myocardial mass and T1 improved \ndiagnostic performance to detect FD in every disease stage, providing \nexcellent diagnostic performance (AUC=0.93, sensitivity: 91.8%, specificity: \n86.1%), outperforming conventional parameters used to assess myocardial \ninvolvement. \nConclusion: LA strain parameters have potential to complement current \nmultiparametric approaches to diagnose myocardial involvement in FD, \nespecially in the pre-hypertrophic phase. Incorporating LA strain parameters \ninto FD diagnostic work-up would allow better evaluation of disease severity \nand progression, potentially improving initiation of ERT and monitoring of \ntreatment success. \nLimitations: Single-center, retrospective, no histological validation \nEthics Committee Approval: Approval-Number:837.196.13/837.477.14 \nFunding for this study: Funding not applicable \nAuthor Disclosures: \nUwe Joseph Schoepf: Other: Elucid Bioimaging (Other Activities) Other: \nHeartFlow (Other Activities) Other: Siemens Healthcare (Other Activities) \n(Travel support) Other: Bayer Healthcare (Other Activities) Other: Bracco \n(Other Activities) Other: Guerbet (Other Activities) \nChristoph Düber: Nothing to disclose \nConstantin Reichardt: Nothing to disclose \nTilman Stephan Emrich: Speaker: Siemens Healthcare (Travel Support) \nMoritz Christian Halfmann: Nothing to disclose \nBasel Yacoub: Nothing to disclose \nKarl-Friedrich Kreitner: Nothing to disclose \nAkos Varga-Szemes: Consultant: Bayer Healthcare Consultant: Elucid \nBioimaging Other: Siemens Healthcare (Other Activities) (Travel support) \nSebastian Altmann: Nothing to disclose \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 194  \nRPS 903-5 \nMyocardial tissue characterization by T2 mapping in thalassemia major \nA. Meloni¹, N. Martini¹, R. Borrello¹, V. Positano¹, L. Pistoia¹, M. Murgia²,  \nC. Paci³, R. Pedrinelli¹, *A. Pepe*¹; ¹Pisa/IT, ²Oristano/IT, ³Arezzo/IT \n \nPurpose: We compared myocardial T2 against T2* in patients with \nthalassemia major (TM) for myocardial iron characterization. \nMethods or Background: 133 TM patients (79 females, 38.4±11.3 years) \nenrolled in the Extension Myocardial Iron Overload in Thalassemia Network \nunderwent MRI. T2 and T2* images were acquired, respectively, with multi-\necho fast-spin-echo and gradient-echo sequences. Global heart T2 and T2* \nvalues were obtained by averaging the values in all 16 myocardial segments. \nData acquired on 80 healthy volunteers were used to establish the normal T2 \nrange (males:48-56 ms;females:50-57 ms) and the lower limit of normal for \nglobal heart T2* (32 ms). \nResults or Findings: A significant correlation was detected between global \nheart T2 and T2* values (R=0.577; P<0.0001). Out of the 113(84.9%) patients \nwith a normal global heart T2* value, none had a decreased global heart T2 \nvalue, while 58(51.3%) had an increased T2 value. Out of the 20 patents with a \ndecreased global heart T2* value, only 10(50%) had also a reduced T2 value. \nConversely, 9(45.0%) had a normal global heart T2 value and one(4.5) showed \nan increased T2 value. The 59 patients with increased global heart T2 value \nwere significantly older than the remaining patients (40.8±10.5 vs 36.4±11.6 \nyears; P=0.019) \nConclusion: All patients with decreased T2 value had also a decreased T2* \nvalue and in half of the patients iron load was undetected by T2, suggesting \nthat T2 mapping does not offer any advantage in terms of sensitivity for MIO \nassessment. However, more than half of TM patients had an increased T2 \nvalue, thus may be caused by the presence of myocardial inflammation and/or \nedema. So, T2 mapping could reveal subclinical myocardial involvement in TM \npatients. \nLimitations: Single-center study. \nEthics Committee Approval: Local Ethics Committee \nFunding for this study: No-profit support from Chiesi Farmaceutici and \nApopharma \nAuthor Disclosures: \nAlessia Pepe: Research/Grant Support: Chiesi Farmaceutici S.p.A., \nApoPharma Inc. Speaker: Chiesi Farmaceutici S.p.A. \nNicola Martini: Nothing to disclose \nRoberto Pedrinelli: Nothing to disclose \nAntonella Meloni: Speaker: Chiesi Farmaceutici S.p.A. \nRita Borrello: Nothing to disclose \nMauro Murgia: Nothing to disclose \nLaura Pistoia: Speaker: Chiesi Farmaceutici S.p.A. \nCristina Paci: Nothing to disclose \nVincenzo Positano: Nothing to disclose \n \nRPS 903-6 \nDiagnostic value of cardiothoracic ratio in the assessment of the heart in \npatients with non-ischemic cardiomyopathy: comparison with \ncardiovascular magnetic resonance \n*P. Simkus*¹, A. Banišauskaitơ², J. Noreikaite¹, M. Gutierrez¹, D. McCreavy¹,  \nD. Penha¹, M. Arzanauskaite¹; ¹Liverpool/UK, ²Kaunas/LT \n(pauliusimkus@gmail.com) \n \nPurpose: To determine reliability of the cardiothoracic ratio (CTR) as a simple \nmethod to assess the cardiac size and function in patients with non-ischemic \ncardiomyopathy (NICM). \nMethods or Background: Cardiovascular magnetic resonance (CMR) is the \ngold standard for cardiac volumetric and functional assessment. We used CMR \nto evaluate whether the long-standing and widely available CTR (with a cut-off \nvalue of 50% in a posteroanterior chest radiograph) can be a valuable method \nfor predicting heart size. CTR derived from chest radiographs (CXR) was \ncompared to CMR volumetric and functional parameters. The sample (n=91) \nconsisted of two groups: patients with NICM (n=66) and a control group with \nnormal CMR parameters (n=25). \nResults or Findings: The mean CTR in the NICM group was 50.74±5.49% \n(CTR was increased in 35 patients, 53%) and significantly higher compared to \nthe control group (45.28±4.74%). On CMR, LVEDVi, LV indexed mass, LA \nindexed volume, LA indexed area and RA indexed area were higher and LVEF \nand RVEF were lower in patients with non-ischemic cardiomyopathy (p<0.05). \nIn patients with non-ischemic cardiomyopathy, the greatest CTR relationship \nwas determined to LVEDVi, LA indexed volume and LA indexed area ( ȡ=0.405, \nȡ=0.478 and ȡ=0.467, respectively), however the strength of correlation was \nmoderate. \nConclusion: CTR was significantly higher in patients with NICM compared to \nthe control group. Nevertheless, an increased CTR is not specific for NICM. \nThe weak correlation noted between CTR and CMR parameter limits CTR \nreliability for reflecting the underlying cardiac volumetric and functional \ncharacteristics. \nLimitations: Heterogeneous sample (several types of NICM were included in \nthe study). \nEthics Committee Approval: IRB approval has been obtained. \nFunding for this study: Funded by the ESR Research Seed Grant. \nAuthor Disclosures: \nMonika Arzanauskaite: Nothing to disclose \nJurate Noreikaite: Nothing to disclose \nDiana Penha: Nothing to disclose \nAudra Banišauskaitơ: Nothing to disclose \nPaulius Simkus: Nothing to disclose \nManuel Gutierrez: Nothing to disclose \nDavid McCreavy: Nothing to disclose \n \nRPS 903-8 \nCardiothoracic ratio derived from cardiac MRI: how does it correlate with \nchest radiographs? \n*P. Simkus*, A. Banišauskaitơ, J. Noreikaite, M. Gutierrez Gimeno,  \nD. McCreavy, D. Penha, J. Holemans, M. Arzanauskaite; Liverpool/UK \n \nPurpose: To determine the association between cardiothoracic ratio (CTR) \nfrom posteroanterior chest radiography (CXR) and cardiovascular magnetic \nresonance (CMR) imaging \nMethods or Background: CTR is a well-known criterion to evaluate the heart \non CXR; CTR>50% is considered abnormal. CMR can provide a thorough \nassessment of the heart, and a simple CTR. Studies of 305 patients who had a \nCXR and a CMR within 1 month were retrospectively analysed. CTR was \nobtained on CMR axial sequences and compared to the CTR of CXR. The \ncalculation was the same in both techniques: the largest horizontal heart \ndiameter was divided by the largest horizontal internal thoracic cage diameter. \nResults or Findings: The mean CTR was lower on CXR than on CMR \n(49.47±5,07% and 55.36±5.47%, respectively, p<0.001). In 279 cases (91.5%) \nthe CTR measured on CMR was larger than the one measured on CXR. CTR \non CXR was 37% to 65%, vs. 41% to 72% on CMR. There was a strong \npositive correlation between CTR comparing the two modalities ( ȡ=0.665, \np<0.001). Using the standard cut-off value of 50%, the CXR-CTR was normal \nin 191 cases (62.6%) and increased in 114 cases (37.4%). CMR-CTR was \nnormal in 49 (16.1%) and increased in 256 cases (83.9%). Abnormal \nCTR>50% only weakly correlated on CXR and CTR (statistically significant), \nij=0.283, p<0.05. An additional cut-off value of CTR>55% on CMR showed a \nbetter, but still weak correlation ( ij=0.503, p<0.05). \nConclusion: Although CTR values were significantly higher on CMR \ncompared to CXR there was a strong correlation between the techniques. \nHowever, abnormal CXR-CTR correlated weakly with abnormal CMR-CTR. \nLimitations: A single centre study; CMR was acquired in supine position and \nin expiration; posteroanterior CXR in erect position and inspiration. \nEthics Committee Approval: IRB approval obtained \nFunding for this study: Funded by the ESR Research Seed Grant \nAuthor Disclosures: \nMonika Arzanauskaite: Nothing to disclose \nJurate Noreikaite: Nothing to disclose \nDiana Penha: Nothing to disclose \nManuel Gutierrez Gimeno: Nothing to disclose \nJohn Holemans: Nothing to disclose \nAudra Banišauskaitơ: Nothing to disclose \nPaulius Simkus: Nothing to disclose \nDavid McCreavy: Nothing to disclose \n \n \nResearch Presentation Session: Chest \nRPS 304 \nChest CT \nRPS 304-1 \nComputational fluid dynamics in predicting progressive aortic dilatation \nfollowing type A aortic surgical dissection \n*Y. Zhu*, X. Y. Xu, G. Asimakopoulos, A. Gambaro, R. Ulrich, J. Pepper,  \nS. Mirsadraee; London/UK  \n(yu.zhu14@ic.ac.uk) \n \nPurpose: This study aimed to examine the role of hemodynamic parameters, \nsuch as true/false lumen pressure difference and wall shear stress, in \nprogressive aortic dilatation following type A aortic dissection (TAAD) surgical \nrepair. \nMethods or Background: This retrospective study is based on the validated \ndatabase of patients with repaired TAAD at Royal Brompton and Harefield \nhospitals. All patients were initially treated by replacing the ascending aorta \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 195  \nalone. 40 patients underwent a minimum of 2 follow-up computed tomography \nangiography (CTA) following surgical repair were reviewed, whereas 23 were \ndeemed unsuitable for computational fluid dynamic (CFD) simulations due to \ninadequate CT image quality or coverage. A total of 17 patients were finally \nanalysed and divided into two groups: stable (N = 9), and unstable (N = 8). \nBased on post-surgery CTA scans, three-dimensional patient-specific models \nwere reconstructed for detailed CFD analysis. Geometric and hemodynamic \nparameters were evaluated and compared between the two groups using \nMann-Whitney U test. \nResults or Findings: Patients with progressive aortic dilatations were found to \nhave significantly higher luminal pressure difference, as expressed by the \nmaximum pressure differences (0.9 [0.5, 2.3] vs 6.7[4.6, 10.9] mmHg; \nP=0.001), as well as fewer number of re-entry tears (5[3.3, 7.5] vs 1.5[1, 2.8]; P \n= 0.02). \nConclusion: CFD is a promising technique based on standard care clinical \nimaging that may assist in predicting the risk of progressive aortic dilatation \nfollowing TAAD repair. Further large cohort studies are warranted to validate \nthese findings. \nLimitations: Small sample size and rigid wall assumption of CFD simulations. \nEthics Committee Approval: Ethic approval was obtained on 04/05/2020 \nfrom the Institutional Committee of Health Research Authority (HRA) and \nHealth and Care Research Wales (HCRW), with a REC reference of \n20/WM/0145. \nFunding for this study: n/a \nAuthor Disclosures: \nYu Zhu: Nothing to disclose \nXiao Yun Xu: Nothing to disclose \nSaeed Mirsadraee: Nothing to disclose \nAlessia Gambaro: Nothing to disclose \nJohn Pepper: Nothing to disclose \nRosendahl Ulrich: Nothing to disclose \nGeorge Asimakopoulos: Nothing to disclose \n \nRPS 304-2 \nDual energy computerised tomography pulmonary angiography \n(DECTPA) quantifies lobar iodine distribution in patients with severe \nemphysema \n*N. Jeyin*, S. P. Padley, S. R. Desai, K. Wechalekar, M. Polkey, N. Hopkinson, \nP. Shah, S. Kemp, C. A. Ridge; London/UK  \n(nidhishj98@gmail.com) \n \nPurpose: To compare DECTPA lobar enhancement in patients with severe \nemphysema to perfusion scintigraphy (PS). \nMethods or Background: Lung volume reduction (LVR) improves lung \nfunction in patients with severe emphysema. Patient selection is key to its \nsuccess and is dependent on accurate quantification of (1) disease distribution \nusing non contrast computed tomography (CT) and (2) lobar perfusion using \nthe gold standard, single photon emission CT perfusion scintigraphy (SPECT-\nPS). Dual energy CT pulmonary angiography (DECTPA) is hypothesised to \nprovide a surrogate marker for lobar perfusion, potentially streamlining the \nassessment paradigm. Between 2018-2020, 152 patients (89 male, 64.5 ௗ±ௗ8.6 \nyears) with emphysema underwent DECTPA. Perfused blood volume (PBV) \nsegmentation estimated lobar enhancement (eXamine, Siemens Healthineers). \nPearson correlation and Bland-Altman analysis provided inter-modality \ncomparison with lobar segmented SPECT-PS using Prism8, GraphPad. \nEffective dose, adverse reactions, and processing times were recorded. \nResults or Findings: There is very strong agreement between lobar perfusion \nusing DECTPA compared to SPECT-PS (r= 0.86, p<0.01). Individual lobar \ncomparison also showed strong correlation (r= 0.81, 0.79, 0.83, 0.81, 0.81 for \nthe right upper, middle, lower, left upper and lower lobes, respectively, p<0.01). \nMean bias was 0.044; LoA = -11.667, 11.75. 123 of 152 DECTPA(81%) did not \nrequire manual correction, taking 113±3 seconds to process. DECTPA manual \nsegmentation took 528±56 seconds in 18 patients with anatomic distortion. \nConclusion: Lobar segmentation of DECTPA data provides a novel \"one stop\" \nassessment of pulmonary lobar perfusion. \nLimitations: Manual segmentation considerably increases DECTPA \nprocessing time; a potential barrier to implementation into clinical practice. \nEthics Committee Approval: Institutional review board approval was obtained \nfor this retrospective study which waived the need for consent. \nFunding for this study: The authors are thankful to the Royal Brompton and \nHarefield Hospitals Charity for financial support in the purchase of dual energy \nadvanced processing software. \n \n \n \n \n \n \n \n \n \nAuthor Disclosures: \nNidhish Jeyin: Nothing to disclose \nCarole A Ridge: Nothing to disclose \nPallav Shah: Nothing to disclose \nMichael Polkey: Nothing to disclose \nKshama Wechalekar: Nothing to disclose \nSamuel Kemp: Nothing to disclose \nNicholas Hopkinson: Nothing to disclose \nSujal R. Desai: Nothing to disclose \nSimon Peter Padley: Nothing to disclose \n \nRPS 304-3 \nBiphasic split-bolus protocol for routine contrast-enhanced chest CT \nimaging: a comparison with a conventional early phase-single bolus \ntechnique \n*M. Kul*¹, D. Kuru Öz¹, A. Gürsoy Çoruh¹, F. Özalp Ate ú¹, B. Gülpınar¹,  \nÇ. Uzun¹, K. Ç. K. Atasoy²; ¹Ankara/TR, ²Istanbul/TR \n(melahatkul@yahoo.com) \n \nPurpose: To present our routine contrast-enhanced chest CT protocol with a \nsplit-bolus injection technique achieving combined early-and delayed phase \nimages with a single aquisition, and to compare this technique with a \nconventional early-phase single-bolus chest CT protocol we formerly used at \nour institution, in terms of attenuation of great thoracic vessels, pleura, \nincluded upper abdominal structures, contrast-related artifacts, and image \nquality. \nMethods or Background: A total of 210 patients, who underwent routine \ncontrast-enhanced chest CT examination aquired with either conventional \nearly-phase single-bolus technique (group A,n=102) or biphasic split-bolus \nprotocol (group B,n=108) were retrospectively included. Attenuation \nmeasurements were made by two radiologists independently on mediastinal \nwindow settings using a circular ROI at the following sites: main pulmonary \nartery(PA) at its bifurcation level, thoracal aorta(TA) at the level of MPA \nbifurcation, portal vein(PV) at porta hepatis, coeliac trunk, left and right hepatic \nlobe, and if present, thickened pleura (>2mm) at the level with the most intense \nenhancement. Contrast-related artifacts were graded by both reviewers \nindependently. Background noise was measured and CNRs of the liver and TA \nwere calculated. \nResults or Findings: While mean enhancement of thoracic vessels and \ncoeliac trunk did not differ significantly between both groups (p >0.05), mean \nenhancement of pleura, liver parenchyma and PV were significantly greater in \ngroup B for both observers (p<0.001). Perivenous artifacts limiting evaluation \nwere less frequent in group B than in A. No significant difference was detected \nin CNRTA, whereas CNRliver was higher in group B (p<0.05). \nConclusion: Split-bolus injection protocol facilitates simultaneous attenuation \nof early and delayed enhancing thoracal and upper abdominal structures in a \nsingle chest CT aquisition, and thus, might raise diagnostic confidency. \nLimitations: First, this is a retrospective study. Second, cardiac output-body \nweight of the patients, which can influence contrast enhancement, were not \nassessed. \nEthics Committee Approval: Approved. \nFunding for this study: None. \nAuthor Disclosures: \nMelahat Kul: Nothing to disclose \nBaúak Gülpınar: Nothing to disclose \nDi÷dem Kuru Öz: Nothing to disclose \nFunda Özalp Ateú: Nothing to disclose \nKayhan Çetin K. Atasoy: Nothing to disclose \nAyúegül Gürsoy Çoruh: Nothing to disclose \nÇa÷lar Uzun: Nothing to disclose \n \nRPS 304-4 \nContrast-enhanced MRI for lung nodule detection and characterization in \na high-risk population: a comparison with low-dose CT \n*L. Qian*, M. O. Wielpütz, B. Jobst, O. v. Stackelberg, H-U. Kauczor,  \nJ. Biederer; Heidelberg/DE \n(lipb37@163.com) \n \nPurpose: To investigate contrast enhanced MRI (CE-MRI) for the detection \nand characterization of lung nodules compared with low-dose CT (LDCT) in a \nhigh-risk population. \nMethods or Background: 177 patients with baseline LDCT scan from a large \nmulticenter COPD study (COSYCONET) who had at least 1 pulmonary nodule \nwere included. All subjects underwent CE-MRI and LDCT on the same day. \nNodule incidence, long and short axis, location and characteristics (solid, part-\nsolid or ground glass) and Lung-RADS category were assessed on CT and \nMRI separately and in a blinded fashion. MRI findings were correlated with \nLDCT as standard of reference. \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 196  \nResults or Findings: A total of 510 nodules were detected by LDCT, of which \nwere 479 solid, 10 part-solid and 21 purely GGO nodules. For solid nodules, \nMRI detected 152 of 292 nodules 3-5mm, 74 of 100 nodules 6-7mm, 52 of 60 \nnodules 8-14mm, and 24 of 27 solid nodules •15mm. For sub-solid nodules, \nMRI detected 5 of 10 part-solid nodules and 2 of 21 GGO nodules. Sensitivity \nand positive predictive value (PPV%) of MRI for solid nodules detection was \n52.1/75.2% for 3-5mm, 74.0/91.3% for 6-7mm, 86.7/89.7% for 8-14mm and \n88.9/100% for •15mm. Among sub-solid nodules, sensitivity and PPV% of MRI \ndetection was 50.0/83.3% for part-solid nodules and 9.5/100% for GGO \nrespectively. \nConclusion: CE-MRI performs moderately well for the detection of small \npulmonary nodules. Detection rate was acceptable for nodules 8 mm and \nlarger, which is the size to trigger further workup. \nLimitations: The benign and malignant classification of pulmonary nodules \nhas not been characterized by surgery/biopsy or follow-up. \nEthics Committee Approval: This study was approved by the ethics \ncommittee of the coordinating centre in Heidelberg (Institutional Review Board \nof the Medical Faculty of the University of Heidelberg, Germany, S-656/2012) \nFunding for this study: COSYCONET, Clinicaltrials.gov identifier \nNCT01245933 \nAuthor Disclosures: \nMark O. Wielpütz: Nothing to disclose \nJürgen Biederer: Nothing to disclose \nHans-Ulrich Kauczor: Nothing to disclose \nOyunbileg von Stackelberg: Nothing to disclose \nLi Qian: Nothing to disclose \nBertram Jobst: nothing to disclose \n \nRPS 304-5 \nVisual and quantitative CT airway assessment in phenotyping severe \nasthma for precision therapy \n*E. Robinson*¹, S. M. Mak², B. Kent², D. Jackson², A. Nair²; ¹Bristol/UK, \n²London/UK \n \nPurpose: To identify visual and quantitative (qCT) differences in severe \nasthmatics (SevA) eligible for standard optimised (ST) versus biologic (BT) \ntherapies Assess relationships between obstructive lung function and \nvisual/qCT airway remodelling. \nMethods or Background: 93 SevA CTs were retrospectively visually scored \nfor per lobe airway remodelling features, including wall thickening (vWT). qCT \nsoftware was used to measure wall thickness (WT), mean diameter (MD), wall \narea (WA), luminal area (LA) and total area (TA). Differences between groups, \nand correlations between physiologic parameters and CT metrics, were \nanalysed. \nResults or Findings: Proximal mucus impaction was lower in patients on ST \n(p=0.01). vWT and low attenuation areas were not significantly different \nbetween ST and BT. Conversely, of qCT metrics, MD (p=0.03) and TA \n(p=0.03) were significantly greater in BT, while WT, WA and LA were not. Both \nvWT (r=-0.27) and LAA (r=-0.34) were inversely correlated with FEV1, while \nvWT (r=0.41) inversely correlated with FEV1/FVC. No quantitative measures \ncorrelated with obstructive indices. \nConclusion: In SevA, visual CT evaluation of airway inflammation and small \nairways obstruction provides a proxy for severity of obstruction. qCT total \nairway dimensions potentially identify those with greater airway inflammation \nwho may require BT. \nLimitations: Sample size- limited population as the use of biological agents \nare uncommon, however our sample size is in line with others in the literature. \nSelection bias- those with abnormalities seen on other modalities e.g. X-ray or \nbloods more likely to have HRCT therefore more severe disease Cross-\nsectional- transient changes especially consolidations not captured and can \ngive no longitudinal data Subjective identification of abnormality on CT scan \naccording to previous definition \nEthics Committee Approval: HRA review of governance and legal \ncompliance (18/HRA/1611) \nFunding for this study: None \nAuthor Disclosures: \nArjun Nair: Nothing to disclose \nSze Mun Mak: Nothing to disclose \nElizabeth Robinson: Nothing to disclose \nBrian Kent: Nothing to disclose \nDavid Jackson: Nothing to disclose \n \n \n \n \n \n \n \n \n \nResearch Presentation Session: Chest \nRPS 404 \nTissue characterisation and image \nverification \nRPS 404-1 \nCT fluoroscopy for hook-wire localisation of pulmonary nodules before \nthoracoscopic surgery: retrospective analysis of efficacy and safety \n*C. Sicuso*, G. Vatteroni, E. Lanza, D. Poretti, F. Lutman,  \nF. D'Antuono; Rozzano/IT  \n(claudioesse@hotmail.it) \n \nPurpose: To evaluate the efficacy and safety of CT fluoroscopy-guided hook-\nwire localization before thoracoscopic surgery and to investigate the risk \nfactors associated with dislocation. \nMethods or Background: Between June 2016 and October 2019, 94 patients \n(56F, 38M) with small non-palpable lung nodules (mean diameter:11±5mm; \nrange: 5-33) underwent preoperative percutaneous localization by CT \nfluoroscopy-guided hook-wire system (MOON, Biopsybell), followed by \nthoracoscopic surgery. Clinical data, radiological characteristics, procedural \nand dosimetric (estimated as dose length product - DLP) features and \npathological findings were evaluated. Clinical and procedure-related variables \nwere investigated to determine the risk factors for dislocation. \nResults or Findings: Out of 94 nodules, 5 (5.3%) were pure ground-glass \n(GGOs), 23 (24.2%) partially solid GGOs, and 66 (69.5%) solid lesions. The \nmean length of the procedure was 6.5±2.5 min (range: 3-13), with a mean \ndistance from the pleural surface of 5.7±6.2 mm (range: 0-30). Median DLP \nincluding pre and post helical CT scan to identify the nodule and to check for \nthe hook-wire position was 565 mGy*cm (range: 212-2017) while median \nprocedural DLP was 40 mGy*cm (range: 8-1094). At the end of the procedure \n12 (12.7%) asymptomatic pneumothorax, 3 (3.2%) mild parenchymal \nhemorrhage and 2 (2%) early wire dislodgement were observed, while late \ndislodgement during surgery was found in 11 (12%) cases. Thoracoscopic \nsurgery was performed in 91 cases (97%), while in 3 cases conversion to a \nthoracotomy approach was required. Pathologic evaluation revealed 37 (39%) \nprimary lung cancers, 38 (40%) metastases, 18 (19%) benign lesions and 1 \n(1%) lung meningioma. \nConclusion: Hook-wire localization is a fast, low-dose procedure that enables \nlung nodule resection using thoracoscopic approach with a high percentage of \nsuccess and acceptable minor complication rate. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nFelice D'Antuono: Nothing to disclose \nFabio Lutman: Nothing to disclose \nEzio Lanza: Nothing to disclose \nGiulia Vatteroni: Nothing to disclose \nDario Poretti: Nothing to disclose \nClaudio Sicuso: Nothing to disclose \n \nRPS 404-3 \nHeterogeneity of structural changes in bronchiectasis patients assessed \nusing the bronchiectasis scoring technique for CT (BEST-CT) \nJ. Meerburg¹, M. De Bruijne¹, A. Garcia-Uceda Juarez¹, E-R. Andrinopoulou¹, \nM. Kemner van de Corput¹, S. Elborn², M. Tunney², J. Chalmers³, \n*H. A. W. M. Tiddens*¹; ¹Rotterdam/NL, ²Belfast/UK, ³Dundee/UK  \n(h.tiddens@erasmusmc.nl) \n \nPurpose: To develop a sensitive quantitative CT scoring method to phenotype \nand quantify structural lung changes in bronchiectasis (BE) patients \nMethods or Background: Recent CT-scans of BE patients with P.aeruginosa \nenrolled in the iBEST study were collected. Inclusion criteria: inspiratory \nvolumetric CT-scans and slice thickness ”3mm. Grid cells were annotated on \n10 axial slices per CT, scores expressed in % total lung volume. Scoring items \nin hierarchical order: consolidation/atelectasis (ATCON), BE with mucus \nplugging (BEMP), BE without MP (BE), airway wall thickening (AWT), mucus \nplugging (MP), ground-glass opacities (GGO), emphysema/bullae (EMBUL), \nhealthy airways (HA), and healthy parenchyma (HP). Composite scores: %TBE \n(%BEMP+%BE), airway disease (%AD) (%TBE+%MP+%AWT) and %DIS (all \nbut %HA and %HP) were calculated. ICCs were assessed. BEST-CT scores \nwere compared with the Hartmann-CT scores, intra-branch tapering, \nspirometry parameters, bronchiectasis severity index (BSI), quality of life \n(QoL), and exacerbations during the iBEST study. Results: median \n(interquartile range). \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 197  \nResults or Findings: 84 CTs were included. Age 66 [58-74] years, female \n64%, FEV1 59[46-70]%Pred, FVC 72[64-88]%Pred, BSI 10[7-13]. BEST-CT \nsubscores: %TBE 3.0[1.4-5.1], %AD 6.5[3.4-11.8], and %DIS 9.4[6.0-17.7]. \nIntra-airway tapering was assessed 262[178-326] airways/CT. Intra- and inter-\nICCs for %TBE, %AD and %DIS were excellent. Correlations between %TBE \nand Hartmann BE-score, (r=0.69, p<0.001) and FEV1 (r=-0.24, p=0.027). Less \ntapering correlated with higher %TBE score (r=-0.04, p=0.002), higher \nHartmann BE-score (r=-0.29, p=0.009), and lower FEV1 (r=-0.36, p<0.001). No \nsignificant correlations between %TBE, %TMP, %AD and %DIS and BSI, QoL \nscores (n=55), and exacerbations. \nConclusion: BEST-CT is a reproducible CT scoring method to quantify and \nphenotype BE patients. Considerable heterogeneity of structural changes was \nobserved. \nLimitations: Retrospective data collection, CT acquisition not standardised \nEthics Committee Approval: Yes \nFunding for this study: The Innovative Medicines Initiative (IMI) and EFPIA \ncompanies under the European Commission funded project, iABC (grant \n115721) \nAuthor Disclosures: \nStuart Elborn: Nothing to disclose \nJennifer Meerburg: Nothing to disclose \nAntonio Garcia-Uceda Juarez: Nothing to disclose \nEleni-Rosalina Andrinopoulou: Nothing to disclose \nMichael Tunney: Nothing to disclose \nJames Chalmers: Other: J.D. Chalmers reports research grants for CO and \npersonal fees from GlaxoSmithKline and Boehringer Ingelheim, research \ngrants for CO from AstraZeneca, research grants for CO and personal fees \nfrom Pfizer, research grants for bronchiectasis and personal fees from Bayer \nHealthcare and Grifols, consulting fees from Napp and the Aradigm \nCorporation, and grants and personal fees from Insmed, outside the submitted \nwork. \nMariëtte Kemner van de Corput: Nothing to disclose \nHarm A W M Tiddens: Research/Grant Support: Tiddens has received \nunconditional research grants from Gilead Sciences Inc, Chiesi \npharmaceuticals, Novartis, Vertex, and Vectura, and honoraria and travel \nexpenses for lectures and participation in expert panels from Novartis, Gilead, \nand Vertex Patent Holder: Tiddens owns a joint patent with Perth for \nPRAGMA-CF \nMarleen De Bruijne: Other: de Bruijne reports grants from Netherlands \nOrganisation for Scientific Research (NWO), during the conduct of the study; \ngrants and non-financial support from Quantib, grants and non-financial \nsupport from Cosmonio, outside the submitted work \n \nRPS 404-4 \nHystogram based analysis in progressive phenotype pattern: is early \nphenotype of progression dependent by HRCT quantification? \n*F. Tiralongo*, F. Galioto, S. Toscano, A. Vancheri, G. Sambataro,  \nL. A. Mauro, C. Vancheri, S. Palmucci, A. Basile; Catania/IT \n(tiralongofrancesco91@hotmail.it) \n \nPurpose: To investigate relationship between histogram-based HRCT indexes \nand Pulmonary Function Tests (PFTs) in Interstitial Lung Diseases (ILD) \npatients having progressive and non-progressive phenotype. \nMethods or Background: 28 patients having two HRCT (baseline and 1 year) \nand two PFTs were retrospectively investigated. Quantitative histogram-based \nHRCT indexes were calculated; strength of association between HRCT \nindexes and PFTs was investigated using Pearson correlation. Patients were \ndivided into two groups, based on the presence or absence of progressively \nfibrosing phenotype – which was assessed on the basis of: relative FVC \ndecline >10%, or relative 5-10% FVC decline and increased HRCT fibrosis. \nHRCT indexes were compared between the two groups using the U-test; within \neach group, Wilcoxon analysis was performed for comparison between \nbaseline and follow-up HRCT indexes. ROC analysis was performed for \npredicting the presence of the progressively fibrosing phenotype. \nResults or Findings: At baseline, moderate correlation was found – with \nr=0,55 for FVC and kurtosis and r=0,45 for DLco and kurtosis. Positive \nmoderate correlations were observed considering skewness and PFTs, \nwhereas negative moderate correlations were reported between HAA% and \nPFTs. We found more heterogenous results between quantitative indexes and \nPFTs collected at one-year follow-up, with r values ranging from 0.64 up to \n0.32; in progressive subgroup, r was 0.38 for DLCO and kurtosis, and 0.43 for \nFVC and kurtosis. HRCT indexes were not statistically different between the 2 \ngroups – with a p of 0.40 (baseline) and 0.48 (follow-up) for kurtosis; within \neach subgroup, Wilcoxon analysis did not report significant differences for \nquantitative indexes. ROC analysis reported a sensitivity of 54.5% and a \nspecificity of 75%. \nConclusion: Heterogeneity of correlation found at 1-years seems to suggest \nthat progression could be independent from quantitative HRCT assessment. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nFederica Galioto: Nothing to disclose \nLetizia Antonella Mauro: Nothing to disclose \nAntonio Basile: Nothing to disclose \nStefano Toscano: Nothing to disclose \nGianluca Sambataro: Nothing to disclose \nAda Vancheri: Nothing to disclose \nStefano Palmucci: Nothing to disclose \nFrancesco Tiralongo: Nothing to disclose \nCarlo Vancheri: Nothing to disclose \n \nRPS 404-5 \nEvaluation of radiological IPF distribution in males and females: a \npreliminary evaluation \nA. Vancheri, *F. Tiralongo*, M. Palermo, F. Galioto, G. Fazio, G. Vignigni,  \nG. Sambataro, S. Palmucci, A. Basile; Catania/IT \n(tiralongofrancesco91@hotmail.it) \n \nPurpose: To investigate differences of radiological pattern distribution in male \nand female IPF patients. \nMethods or Background: 102 IPF patients having HRCT scan were \ninvestigated: for their enrollment, Pulmonary Function Tests (PFTs) acquired \nnearest to the HRCT examinations, GAP and stage disease were achieved. \nQuantitative histogram-based analysis was performed providing HRCT indexes \n– which included kurtosis, skewness, High Attenuation Areas (HAA% -250, \nHAA% -600), Mean Lung Density (MLD) and volume. Indexes were obtained \nfor: whole lung, right lung, left lung, and for upper, middle and basal pulmonary \nregions. HRCT indexes were compared between males (n=56) and females \n(n=46) using the Mann-Whitney test; comparisons were also performed after \nadjustment for stage of disease. \nResults or Findings: In all stages – whole lung volume, left and right lung \nvolumes, and volumes of upper, middle and lower portion of each lung – were \nlower in female patients (median of 2.5 in females, 3.7 in males, p<0.0001); a \nstatistical difference was found considering MLD values of the left middle \nportion (p=0.05). No others differences were found. At stage I – the whole lung \nHAA% -250 values, the left and right lung HAA% -250 values, the left and right \nbasal, middle and upper portion HAA% -250 values were higher in females (p \nranging from 0.007 to 0.05); the left middle region MLD value in females was \nlower (p=0.04). In right basal region, female kurtosis was higher (1.1 vs 0.3, \np=0.02); also female skewness was higher (1.2 vs 1, p=0.06). At stage II-III, \nHRCT indexes didn’t show statistical differences. \nConclusion: In females, disease seems to be more homogeneously \ndistributed; at stage I, lower kurtosis values of right basal lung were found in \nmales, probably due to higher respiration movements. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nGiovanna Vignigni: Nothing to disclose \nFederica Galioto: Nothing to disclose \nMonica Palermo: Nothing to disclose \nAntonio Basile: Nothing to disclose \nGiulia Fazio: Nothing to disclose \nGianluca Sambataro: Nothing to disclose \nAda Vancheri: Nothing to disclose \nStefano Palmucci: Nothing to disclose \nFrancesco Tiralongo: Nothing to disclose \n \nRPS 404-6 \nBayesian network approach to diagnose subtypes of interstitial lung \ndisease \n*W. D. Lindsay*, J. Gee, W. T. Miller; Philadelphia, PA/US \n(lindsay@seas.upenn.edu) \n \nPurpose: Obtaining a specific, timely diagnosis of Interstitial Lung Disease \n(ILD) is a challenging clinical problem, with the majority of ILD patients being \nmisdiagnosed at least once. The purpose of our study was to train a machine \nlearning model to accurately diagnose subtypes of ILD using radiographic \nfeatures extracted by radiologists from High Resolution Computed \nTomography (HRCT) scans of the chest. \nMethods or Background: Data from 533 patients diagnosed with ILD at our \ninstitution were used to train four types of Bayesian network diagnosis models \nbased on 13 key imaging features extracted from HRCT scans of the chest. A \ntraining set of 70% of our total dataset was used during model development, \nreserving 30% of the data for testing. General and chest radiologists were \nasked to list their top three differential diagnoses for a subset of cases in the \ndataset. Machine learning models were compared against both groups of \nradiologists using top1 accuracy and top3 accuracy. \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 198  \n \nResults or Findings: The Naive Bayes diagnosis model performed best both \nin terms of top1 accuracy (60.2%) and top3 accuracy (90.1%), exceeding the \nperformance of both general radiologists (top1 accuracy of 30.5%, top3 \naccuracy of 48.1%) and chest radiologists (top1 accuracy of 43.2% and top3 of \n60.5%) when evaluated on the 30% test set. \nConclusion: In ILD, where specific diagnosis is challenging, our machine \nlearning based diagnosis engine combined with radiologist extracted features \noutperformed radiologists alone in terms of top1 and top3 diagnosis accuracy. \nWith further validation, we hope this model may help contribute to faster, more \naccurate diagnosis for patients suffering from ILD. \nLimitations: Single institution dataset, requires manual feature extraction, \nlimited sample size \nEthics Committee Approval: Approved by institutional review board, \nperformed in compliance with patient privacy laws \nFunding for this study: None \nAuthor Disclosures: \nWilliam David Lindsay: Nothing to disclose \nJames Gee: Nothing to disclose \nWallace Thomas Miller: Nothing to disclose \n \n \nResearch Presentation Session: Chest \nRPS 504 \nDiagnosing conditions of the chest \nRPS 504-1 \nPrenatal MRI evaluation of congenital diaphragmatic hernia \n*H. Morkovkina*, R. Tammo, T. Yalynska, O. Halchenko; Kiev/UA  \n(morkovkina@ukr.net) \n \nPurpose: Congenital diaphragmatic hernia (CDH) is one of the most common \nnon-cardiac fetal intrathoracic anomalies. Morbidity and mortality are high due \nto pulmonary hypoplasia with which it is associated. \nMethods or Background: This study included 68 fetal MRI scans of CDH \nwhich underwent at the Ukrainian Children Cardiac Center during the period 1 \nJanuary 2014 to November 2020. The fetuses were 19-38 weeks gestational \nage (mean 30,3 weeks). MRI was performed in a 1.5-Tesla magnet using \nsteady-state free precession, T2- and T1-weighted sequences. \nResults or Findings: MRI diagnosed left CDH (58), right (9), and bilateral \nCDH (1) and most of them were agreed with the postnatal diagnosis. Eight \nnewborns died a few hours after birth. The following MRI parameters were \nmeasured: total chest volume, mediastinal volume, expected lung volume, \npredicted lung volume, percentage of liver herniated into the fetal thorax (liver \nup/down; percentage of herniated liver volume). Between 8% and 45 % of the \npredicted lung volume were identified (mean 25%). MRI measured lung ratio \nhas a higher prognostic accuracy than with ultrasound. The fetal liver was \neasily demonstrated with MRI in all fetuses and was herniated into the chest in \n25 of the 68. \nConclusion: Fetal MR imaging has proved valuable for anatomic assessment, \ndetermining the position of the liver and visualizing lung tissue in fetuses who \nhave CDH, calculation of lung volume and liver herniation measurements. \nThese findings predict are important for prenatal counseling, estimating \nprognosis and perinatal planning, including the need for ECMO. \nLimitations: Contraindications for a pregnant woman: the presence in the \nbody of a metal, hearing aid, pacemaker or other electronic implants, epilepsy \nor claustrophobia, as well as the first trimester of pregnancy. \nEthics Committee Approval: Done \nFunding for this study: There was no funding from industry and/or a funding \nagency \nAuthor Disclosures: \nTetyana Yalynska: Nothing to disclose \nHanna Morkovkina: Nothing to disclose \nRaad Tammo: Nothing to disclose \nOleksanHalchenko: Nothing to disclose \n \nRPS 504-2 \nDiagnostic value of initial chest CT findings for the need of ICU \ntreatment/intubation in patients with COVID-19 \nL. Büttner, A. Aigner, F. N. Fleckenstein, C. M. Hamper, M. Jonczyk, B. Hamm, \nO. Scholz, *G. Böning*; Berlin/DE  \n \nPurpose: Computed tomography (CT) is used for diagnosing COVID-19 and \nthere is evidence that deep learning or volumetry can help detecting patients in \nneed of intensive care unit (ICU) or ventilation therapy. However, those tools \nare not available in all hospitals. The aim of this study was to investigate \nwhether a semi-quantitative method for measuring pulmonary involvement in \nCT scans could contribute to allow early identification of COVID-19 patients \nlikely to require ICU treatment and intubation. \nMethods or Background: The initial CT scans of 28 patients tested positive \nfor SARS-CoV-2 during the early phase of the pandemic at our level I center \nwere retrospectively analyzed. The extent of lung involvement on CT was \nclassified both subjectively and with a simple semi-quantitative method \nmeasuring the affected area at three standardized levels. Competing risks Cox \nregression was used to identify factors associated with the time to ICU \nadmission and intubation. Their potential diagnostic ability was assessed with \nROC/AUC analysis. \nResults or Findings: A 10% increase in the affected lung parenchyma area \nincreased the instantaneous risk of intubation (HR=2.00) and the \ninstantaneous risk of ICU admission (HR 1.73). The semi-quantitative \nmeasurement outperformed the subjective assessment diagnostic ability \n(AUC=85.6% for ICU treatment, 71.9% for intubation). \nConclusion: A simple measurement of the affected lung area in initial CT \nscans of COVID-19 patients may allow the early identification of patients likely \nto need ICU treatment/intubation and thus help make optimal use of limited \nresources in hospitals. \nLimitations: The study is limited by a small sample size, a short inclusion \nperiod and the exclusive use of initial CT scans. \nEthics Committee Approval: This retrospective study was approved by the \nLocal Ethics Committee of our hospital. \nFunding for this study: This research received no external funding. \nAuthor Disclosures: \nChristina Maria Hamper: Nothing to disclose \nBernd Hamm: Nothing to disclose \nAnnette Aigner: Nothing to disclose \nMartin Jonczyk: Nothing to disclose \nOriane Scholz: Nothing to disclose \nLaura Büttner: Nothing to disclose \nGeorg Böning: Nothing to disclose \nFlorian Nima Fleckenstein: Nothing to disclose \n \nRPS 504-3 \nDiagnostic value of dual-energy chest x-ray in immunocompromised \npatients to rule out pneumonia: initial results \n*F. Sanchez Tijmes*, S. Kandel, M. May, S. Ronghe, P. Rogalla;  \nToronto, ON/CA \n(fsancheztijmes@gmail.com) \n \nPurpose: To evaluate the diagnostic value of a novel single exposure portable \nmultilayer detector (KA-Imaging) for generating dual-energy X-rays of the chest \nfor the detection of pneumonia in immunocompromised patients. \nMethods or Background: With ethics board approval, immunocompromised \npatients (leukemia, HSCT) received both the standard-of-care (SOC) low-dose \nCT and a dual-energy X-ray (DEX) of the chest in two views (pa, lateral), back-\nto-back. The SOC served as the reference standard. Three images were \nreconstructed from the DEX data: conventional X-ray (CR), bone-only and soft-\ntissue image (DE). Two experienced chest radiologists reviewed the \nconventional X-rays first and were then provided with the two DE images. The \nreaders reported opacities, the size and location, pneumonia (yes, no, unsure), \nand the confidence level for the correct diagnosis (1=unsure, 5=confident). \nAfter unblinding the DE images, readers indicated the change in diagnosis (if \npresent) and their confidence level (same scale). The subjective DE image \nquality was rated as well (1=poor, 5=best). The radiation dose for DEX was \nrecorded. \nResults or Findings: The first 33 patients of an ongoing trial were included. \nFor reader1/2 and CR versus CR+DE, the sensitivity, specificity, accuracy, and \narea-under-the-curve (ROC analysis) were 57.9.5%/68.4% versus \n63.2%/73.7%, 78.6%/85.7% versus 85.7%/92.9%, 66.7%/75.8% versus \n72.7%/81.8%, 0.61/0.77 versus 0.72/0.76, respectively. The mean image \nquality was 3.7 and 3.4 for readers 1 and 2, respectively. The average DAP \n(mGy*cm) was 296 for pa and 555 for the lateral view. \nConclusion: The initial evaluation suggests that dual-energy X-ray provides \nadequate clinical image quality on conventional reconstructions; the additional \nbone and soft-tissue images improve the diagnostic accuracy; however, more \ndata are required to determine the robustness of this novel technology in \nclinical practice. \nLimitations: Sample size, DEX images reconstructed off-line. \nEthics Committee Approval: Ethics board approval. \nFunding for this study: Funded by Ontario Bioscience Innovation \nOrganization. \nAuthor Disclosures: \nFelipe Sanchez Tijmes: Nothing to disclose \nMary May: Nothing to disclose \nSonja Kandel: Nothing to disclose \nPatrik Rogalla: Nothing to disclose \nSandeep Ronghe: Nothing to disclose \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 199  \nRPS 504-4 \nDiagnosis and quantification of chronic thromboembolic pulmonary \nhypertension using gated spectral CT imaging - assessment of accuracy \nin 10 consecutive patients \n*P. A. Ball*; Belfast/UK \n(peterandrewball@me.com) \n \nPurpose: Assess the accuracy and reproducibility of a one stop imaging \nmodality for Chronic Thromboembolic Pulmonary Hypertension (CTEPH) using \na low dose ECG gated Spectral CT imaging \nMethods or Background: 10 consecutive patients referred for investigation of \nCTEPH were scanned using a modified dose modulated retrospective gated \nCTPA protocol. The images were reviewed both for perfusion using Iodine \nmapping and RV function using thick slice reconstructions from the lose dose \nmodulated studies. Lung findings and measurements of RVOT and PA ratios \nwere also reviewed. Findings were compared with complementary imaging \nincluding ECHO, V/Q and MR findings \nResults or Findings: There was a high level of agreement between the \nbetween the Iodine perfusion on CT and V/Q. The CT had the added \ninformation of vessel luminal assessment (filling defects, recanalisation etc) \nand vessel size quantification. There was also a high level of agreement \nbetween the ECHO measurements and the functional reconstructions on the \ngated CT of Ejection fraction, wall thickness and RV ejection fraction on Bland \nAltman scatter plot. The DLP for the gated study was higher than the normal \nungated CTPA however is similar when the normal CTPA exposure and V/Q \ndose are taken in combination \nConclusion: The pilot study suggests that a Spectral gated CTPA approach to \ninvestigation in CTEPH is a robust and potentially more accurate, cost effective \nmethod of investigation \nLimitations: Small study at present \nEthics Committee Approval: None \nFunding for this study: None \nAuthor Disclosures: \nPeter Andrew Ball: Speaker: Phillips Healthcare \n \nRPS 504-5 \nComputed tomography pulmonary angiography for the diagnosis of \npulmonary embolism: diagnostic accuracy of a reduced scan range \n*J. Schmid*, E. Nagy, J. Mandl, M. Janisch, A-K. Kaufmann-Bühler,  \nM. Eibisberger, E. Janek, C. Reiter, N. Softic, H. Guss, G. Adelsmayr; Graz/AT \n \nPurpose: Computed tomography pulmonary angiography (CT-PA) is \nfrequently applied in the diagnostic workup of pulmonary embolism (PE), even \nin highly radiosensitive patient populations, such as children or pregnant \nwomen. Based on the direct proportional relationship between radiation dose \nand scan length, narrowing the scan range is one well-known approach to \nreduce radiation dose. This study investigates the sensitivity of CT-PA with a \nreduced scan range for the detection of PE, compared to a standard scan \nrange covering the entire lung. \nMethods or Background: We retrospectively analysed 529 CT-PA scans with \nsuspected PE. A reduced scan range was defined based on the topogram, \nwhere the cranial slice was set at the upper edge of the aortic knob and the \ncaudal slice at the level of the lower diaphragm. Apparently reduced \nintravascular contrast, which was likely explained by artefacts, was not \nconsidered as PE. CT scans without definite PE or with significant artefacts \naffecting arterial branches proximal to a segmental level were excluded. \nResults or Findings: We included 454 CT-PA scans of 438 patients (mean \nage 63.4±17.4 years, 46.5% female) in our analysis. Median dose length \nproduct was 269.5[115.3-512.1]mGy*cm. Comparing the original and reduced \nscan range, mean scan length was significantly reduced by 48.1% (268±30 vs. \n139±26mm, p<0.001). Single emboli outside the reduced range in addition to \nemboli within were found in 11 scans (2.4%), while only one scan had emboli \nexclusively outside the reduced range. The resulting sensitivity of CT-PA with \nreduced scan range was 99.78% (95% confidence interval: 98.58-99.99) for \ndetecting any PE. \nConclusion: Reducing CT-PA scan range, as described above, is a simple \nand effective means to reduce radiation dose without a relevant loss of \nsensitivity for detecting PE. \nLimitations: Retrospective design. \nEthics Committee Approval: Obtained. \nFunding for this study: None. \n \n \n \n \n \n \n \n \n \n \nAuthor Disclosures: \nAnn-Katrin Kaufmann-Bühler: Nothing to disclose \nMartin Eibisberger: Nothing to disclose \nJakob Mandl: Nothing to disclose \nHelmuth Guss: Nothing to disclose \nClemens Reiter: Nothing to disclose \nMichael Janisch: Nothing to disclose \nElmar Janek: Nothing to disclose \nEszter Nagy: Nothing to disclose \nNina Softic: Nothing to disclose \nGabriel Adelsmayr: Nothing to disclose \nJohannes Schmid: Nothing to disclose \n \n \nResearch Presentation Session: Chest \nRPS 604 \nCancers in the chest \nRPS 604-1 \nCombining radiomics with domain-adversarial machine learning to \npredict EGFR mutation in non-small cell lung cancer patients on CT \nimages with and without contrast enhancement \n*X. Yang*, P. Yu, M. Liu, H. Dai, C. Wang; Beijing/CN \n(yxy18161659153@126.com) \n \nPurpose: To develop and validate the method that combines domain-\nadversarial machine learning with radiomics signature extracted from both the \nenhanced and non-enhanced CT images in order to identify EGFR mutations. \nMethods or Background: This study involved 393 patients with NSCLC who \nunderwent molecular testing. The validation set included 73 patients with both \nthe enhanced and non-enhanced CT scans. The remaining 320 patients were \nassigned to the training set (167 non-enhanced CTs and 153 enhanced CTs) 㸪\nRadiomics features were extracted through manual segmentation of the entire \ntumor. We combined such features with domain-adversarial method to build a \nmulti-task multi-layer perceptron (MT-MLP) model in order to eliminate feature \ndifferences between enhanced and non-enhanced CTs. The optimization of \nMT-MLP model was supervised by two tasks, namely EGFR mutation \nprediction and CT type prediction. To compare, we also constructed a standard \nMLP model that only predicted EGFR mutations. ROC curve analysis and \nDelong test were used to compare the predictive performances of different \nmodels. \nResults or Findings: A total of the 1015 radiomics features were selected. \nThe AUCs of the MLP model in the validation set based on enhanced and non-\nenhanced CT radiomics features were 0.702 (CI: 0.642-0.776) and 0.648 (CI: \n0.570-0.717). The corresponding results of the MT-MLP model were 0.764 (CI: \n0.706-0.829) and 0.756 (CI: 0.695-0.826). Comparing to the MLP model, the \nperformance of the MT-MLP model in predicting EGFR mutations was \nimproved in different CT types, especially on non-enhanced CTs (p = 0.042). \nConclusion: Domain-adversarial machine learning combining with radiomics \nsignature extracted from enhanced and non-enhanced CT images showed \nexcellent performance for predicting EGFR mutant, which may become a \nhelpful non-invasive biomarker to guide therapies. \nLimitations: We performed a single center. \nEthics Committee Approval: This study has been proved by ethnic \ncommunity \nFunding for this study: No funding \nAuthor Disclosures: \nPengxin Yu: Nothing to disclose \nChen Wang: Nothing to disclose \nMin Liu: Nothing to disclose \nHuaping Dai: Nothing to disclose \nXiaoyan Yang: Nothing to disclose \n \nRPS 604-2 \nQuantitative measurements with computed tomography and pulmonary \nfunction test as predictors of surgical resectability in patients affected by \npleural mesothelioma \n*A. Modugno*, A. Bellini, C. Giraudo, A. S. Fraia, R. Stramare, A. Dell'Amore, \nF. Rea; Padua/IT  \n(modugno.a@libero.it) \n \nPurpose: To evaluate if pulmonary volumes and tumor thickness, measured \nwith Computed Tomography (CT) and Total Lung Capacity (TLC%) can predict \nsurgical resectability in patients with pleural mesothelioma. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 200  \nMethods or Background: Patients affected by pleural mesothelioma referring \nto our tertiary center from 1994 to 2020, who underwent a pre-surgical CT with \na slice thickness <3mm were included in this retrospective study. One \nradiologist expert in thoracic imaging measured tumor thickness according to \nthe mRECIST criteria (i.e., up to six measurements of tumor thickness \nperpendicular to the chest wall/mediastinum) and computed pulmonary \nvolumes using a semi-automatic method (3D Slicer Open Source Software). \nTLC% was also recorded and patients were classified according to the residual \ntumor. To assess any difference, the Mann-Whitney and the exact Fisher’s test \nwere used respectively for continuous and categorical variables. Multivariate \nanalyses with odds ratio were applied to assess the predictive value of the \nexamined variables (p<0.05 applied level of significance for each analysis). \nResults or Findings: Fifty-eight patients with mesothelioma met the inclusion \ncriteria (43 R1, mean age 64 years, 25 males; 22 were R2, mean age 63 \nyears, 14 males). TLC% and tumor thicknes demonstrated to be independent \npredictors of surgical resectability (p=0.024; OR=0.917 and p=0.030; OR1.018) \nusing as cut-offs < 77.5% and > 120.5 mm, respectively. Tumor’s thicknesses \nshowed a statistically significant difference between R1 (mean 57 mm, range \n0-165; IQR 36-99) and R2 patients (mean 133 mm, range 34-241; IQR 70-181) \n(p=0.0012). No differences occurred comparing affected and healthy lung \nvolumes (p>0.05). \nConclusion: Tumor thickness, measured according to the mRECIST criteria, \nand TLC% can be considered as predictors of tumor resectability in patients \nwith pleural mesothelioma. \nLimitations: n/a \nEthics Committee Approval: Yes \nFunding for this study: n/a \nAuthor Disclosures: \nAnna Sara Fraia: Nothing to disclose \nAndrea Dell'Amore: Nothing to disclose \nAlice Bellini: Nothing to disclose \nRoberto Stramare: Nothing to disclose \nChiara Giraudo: Nothing to disclose \nAntonella Modugno: Nothing to disclose \nFederico Rea: Nothing to disclose \n \nRPS 604-3 \nRetrospective evaluation of CT findings of pulmonary toxicities in cancer \npatients treated with immunotherapy \n*C. Mazza*, F. Sandomenico, S. Cappabianca, I. Simonetti, P. A. Ascierto, \nM. Mattace Raso, R. Galdiero, A. Petrillo; Naples/IT \n(mazza.carmine89@gmail.com) \n \nPurpose: To analyze CT patterns of interstitial pneumonitis and sarcoid-like \nreactions as pulmonary immune-related adverse events, in patients treated \nwith immune checkpoint inhibitors. \nMethods or Background: A retrospective study was performed on 156 cancer \npatients (87 men and 69 women), treated with immune checkpoint inhibitors \n(anti-PD-1, anti-PD-L1, anti-LAG-3, anti-CTLA-4). Chest CT scans were \nreviewed from two radiologists to evaluate patterns and extension of \npneumonitis. Pattern CT were evaluated according to the classification of \ninterstitial pneumonitis of American Thoracic Society/European Respiratory \nSociety ATS/ERS: acute interstitial pneumonia (AIP), cryptogenic organizing \npneumonia (COP), hypersensitivity pneumonia (HP), non-specific interstitial \npneumonia (NSIP), acute respiratory distress syndrome (ARDS). \nResults or Findings: Among 156 patients treated with ICI, 20 patients \ndeveloped pneumonitis and 4 patients developed sarcoid-like reactions. CT \npatterns were AIP in 8, COP in 5, HP in 4, NSIP in 2, ARDS in 1 and sarcoid-\nlike reactions in 4 patients. The AIP pattern was most common in all tumors \nand treatment. This study also assessed the severity of pneumonitis and of \nsarcoidosis-like reactions and, among 24 patients were grade 1° in 16 patients, \ngrade 2° in 7 patients and grade 5° in 1 patient according to Common \nTerminology Criteria for Adverse Events (CTCAE v5.0). Treatment of immune-\nrelated pneumonitis includes discontinuation or not of immunotherapy and \nadministration of oral or intravenous corticosteroids, depending on the severity \nof CT findings of pneumonitis. \nConclusion: Radiologist must be aware of these possible adverse events and \ntheir CT patterns, in order to promptly communicate them to the oncologist for \nappropriate therapeutic options. \nLimitations: None \nEthics Committee Approval: Yes \nFunding for this study: None \nAuthor Disclosures: \nMauro Mattace Raso: Nothing to disclose \nIgino Simonetti: Nothing to disclose \nAntonella Petrillo: Nothing to disclose \nSalvatore Cappabianca: Nothing to disclose \nFabio Sandomenico: Nothing to disclose \nRoberta Galdiero: Nothing to disclose \nCarmine Mazza: Nothing to disclose \nPaolo Antonio Ascierto: Nothing to disclose \n \nResearch Presentation Session: Chest \nRPS 704 \nCOVID-19 findings \nRPS 704-1 \nA prognostic model for death in covid-19 patients presenting to the \nemergency room: the added value of computed tomography \n*G. Besutti*, L. Spaggiari, M. Ottone, E. Bonelli, R. Bonacini, S. Canovi,  \nT. Fasano, P. Giorgi Rossi, P. Pattacini; Reggio Emilia/IT  \n(giulia.besutti@libero.it) \n \nPurpose: To develop a prognostic model for death in COVID-19 patients using \nclinical and CT variables. \nMethods or Background: Consecutive patients who presented to the \nemergency room between February 27 and March 23, 2020 for suspected \nCOVID-19, underwent chest CT, and confirmed SARS-CoV-2 positive at RT-\nPCR were included in this retrospective study. CT disease extension was \nvisually graded as < 20%, 20-39%, 40-59%, or • 60%. The association \nbetween clinical and CT variables with death was estimated with multivariable \nCox proportional hazards models; model performance was assessed using k-\nfold cross-validation for the area under the ROC curve (CvAUC). \nResults or Findings: Of the 866 included patients (median age 59.8, women \n39.2%), 93 (10.74%) died. Clinical variables significantly associated with death \nin multivariable model were age, male sex, HDL cholesterol, dementia, heart \nfailure, vascular diseases, time from symptom onset, neutrophils, LDH, and \noxygen saturation level (SO2). CT disease extension was also independently \nassociated with death (HR=7.56, 95% CI=3.49; 16.38 for • 60% extension vs. \n<20%). CvAUCs were 0.927 (bootstrap bias corrected-95%CI=0.899-0.947) for \nthe clinical model and 0.936 (bootstrap bias corrected-95%CI=0.912-0.953) \nwhen adding CT extension. \nConclusion: A prognostic model based on clinical variables is highly accurate \nin predicting death in COVID-19 patients. Adding CT disease extension to the \nmodel scarcely improves its accuracy. \nLimitations: Lack of a validation cohort to test the generalizability of the \nmodel; lack of D-dimer values \nEthics Committee Approval: AVEN ethical committee (number: \n2020/0045199) \nFunding for this study: None \nAuthor Disclosures: \nLucia Spaggiari: Nothing to disclose \nTommaso Fasano: Nothing to disclose \nPierpaolo Pattacini: Nothing to disclose \nRiccardo Bonacini: Nothing to disclose \nSimone Canovi: Nothing to disclose \nEfrem Bonelli: Nothing to disclose \nPaolo Giorgi Rossi: Nothing to disclose \nGiulia Besutti: Nothing to disclose \nMarta Ottone: Nothing to disclose \n \nRPS 704-2 \nApplication of multiple radiological classifications to differentiate COVID-\n19 related pneumonia from the non-COVID-19 disease in a population \nwith a low prevalence of symptomatic COVID-19 patients \n*L. A. Carbonaro*¹, A. L. Nanni², P. Gemma¹, A. Cozzi¹, A. Vanzulli¹; ¹Milan/IT, \n²Pavia/IT  \n(luca.carbonaro@gmail.com) \n \nPurpose: We aimed to compare five chest CT categorization systems for the \ndifferential diagnosis between COVID-19 pneumonia and non-COVID-19 \ndisease in a population with low prevalence of COVID-19 pneumonia. \nMethods or Background: 98 chest CT examinations (83 with a non-COVID-\n19 pulmonary disease diagnosis and 15 with COVID-19 diagnosis) were \nindependently evaluated by two readers applying 5 classification systems \n(RSNA Statement, COVID-RADS, CO-RADS, Luo score, and Li score) then \ncompared with Cohen’s ț and ROC analysis. Sensitivity, specificity, positive \npredictive value (PPV), and negative predictive value (NPV) were calculated \nusing high or low thresholds of COVID-19 suspicion and compared with the \nMcNemar’s test. \nResults or Findings: Inter-reader agreement was good (Cohen’s ț = 0.721) \nfor RSNA Statement, and moderate to good (Cohen’s ț • 0.507) for CO-RADS, \nCOVID-RADS, Luo score, and Li score. No statistical difference was found \namong the AUCs of the ROC analysis of the five classifications for both \nreaders (P • 0.166). Applying a high threshold for COVID-19 suspicion, \nsensitivity among the five categorization systems ranged 40%–83%, specificity \n79%–98%, accuracy 79%–89%, PPV 42%–82%, and NPV 90%–96%. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 201  \nApplying a low threshold for COVID-19 suspicion, sensitivity among the five \nsystems ranged 80%–90%, specificity 18%–81%, accuracy 58%–81%, PPV \n17%–44%, and NPV 90%–97%. \nConclusion: In a cohort with low prevalence of COVID-19 pneumonia, all \nevaluated categorization systems showed similar diagnostic accuracy, the \nhighest specificity and PPV being achieved using the Li score categorization \nsystem with a high threshold for COVID-19 suspicion. \nLimitations: Retrospective design; relatively small sample size. \nEthics Committee Approval: Ethics committee approval was obtained in the \nframework of a local COVID-19 research project. Informed consent was waived \nfor all patients. \nFunding for this study: None. \nAuthor Disclosures: \nAndrea Cozzi: Nothing to disclose \nPietro Gemma: Nothing to disclose \nAnna Lisa Nanni: Nothing to disclose \nAngelo Vanzulli: Nothing to disclose \nLuca Alessandro Alessandro Carbonaro: Nothing to disclose \n \nRPS 704-3 \nCoronavirus disease 2019 (COVID-19): the optimisation of iterative \nreconstructions for pulmonary evaluation in low-dose, high-pitch, dual-\nsource acquisition with spectral shaping at 100 kV \nA. Agostini, *A. Borgheresi*, M. Carotti, L. Ottaviani, M. Badaloni, C. Floridi,  \nA. Giovagnoni; Ancona/IT \n \nPurpose: To optimize the use of iterative reconstructions (ADMIRE) in low-\ndose, high-pitch, dual-source chest CT acquisitions with tin filter at 100 kV in \npatients with COVID-19. \nMethods or Background: Patients with confirmed COVID-19 undergoing to \nunenhanced chest CT on a 3rd generation dual source scanner between \nMarch 12th and March 25th, 2020, were prospectively included. The CT \nprotocol included a Dual Energy (DECT, 90/150Sn kVp) and a dual source \n(LDCT) acquisition (100Sn kVp). The DECT was reconstructed with ADMIRE3; \nthe LDCT with ADMIRE=0,3,5. Two blinded radiologists evaluated in \nconsensus the DECT and the LDCT for image quality, motion artifacts, and \npulmonary elementary lesions on 5-point scales. A third radiologist calculated \nthe signal-to-noise ratio (SNR) of lung, trachea, muscle and fat. The effective \ndoses were calculated. Statistical analysis was performed with non-parametric \ntests (Friedman, Mann-Whitney). \nResults or Findings: 60 patients (45M/15F, median age 69 y.o.) were \nincluded. SNR was significantly higher in DECT than LDCT with any IR. The \nsubjective quality and elementary findings had significantly higher scores in \nDECT (•4/5); among LDCT, the IR=3 had the highest score ( •3/5) in all cases. \nIn LDCT, the motion artifacts and effective doses (0.35 mSv vs 4.44 mSv) were \nsignificantly lower than DECT (p<0.0001). \nConclusion: The low dose CT protocol at medium IR strength (ADMIRE3) \nachieved acceptable image quality with significant reduction of radiation dose \nand motion artifacts in patients with COVID-19. \nLimitations: Single center, small cohort. \nEthics Committee Approval: The study was approved by the local IRB, and \nthe informed consent was acquired. \nFunding for this study: None \nAuthor Disclosures: \nChiara Floridi: Nothing to disclose \nAndrea Agostini: Nothing to disclose \nMyriam Badaloni: Nothing to disclose \nMarina Carotti: Nothing to disclose \nAlessandra Borgheresi: Nothing to disclose \nLetizia Ottaviani: Nothing to disclose \nAndrea Giovagnoni: Nothing to disclose \n \nRPS 704-4 \nPulmonary arterial thrombosis 3 months after a SARS-CoV2 infection: \nFrequency on dual-energy ct (dect) angiographic examinations in 55 \npatients \n*M. Remy-Jardin*, L. Duthoit, S. Fry, T. Perez, N. Bautin, J-B. Faivre, J. Remy, \nA. Scherpereel, A. Duhamel; Lille/FR \n(martine.remy@chru-lille.fr) \n \nPurpose: To evaluate pulmonary vascular abnormalities 3 months after a \nSARS-Cov2 infection. \nMethods or Background: Among the 320 patients with confirmed COVID-19 \nhospitalized between March and April 2020 who participated in a systematic \nfollow-up at 3 months, 67 patients with residual respiratory symptoms were \nreferred for specialized follow-up. Fifty-five of them (30 males; 25 females; \nmean age: 60.4 yr) underwent a DECT angiographic examination on a 3rd-\ngeneration dual-source CT system (Force, Siemens Healthineers) with \nreconstruction of perfusion images (Lung PBV). \nResults or Findings: All patients had partial (n=40; 72.7%) or complete (n=15; \n27.3%) resolution of COVID-19 lung infiltration. CT angiographic images were \nnormal in 52 patients (52/55; 94.6%) and showed non-obstructive thrombi in 3 \npatients (3/55; 5.4%) at the level of (a) one (n=1) and two (n=1) segmental \narteries of a single lobe; and (b) central and peripheral arteries of both lungs \n(n=1); none showed features of lung infarction. Lung perfusion was rated as \nnon-interpretable in 2 patients (3.6%; shoulder prosthesis/morbid obesity), \nnormal in 17 patients (30.9%) and abnormal in 36 patients (65.5%), the latter \ngroup comprising 32 patients with residual COVID-19 opacities (32/55; 58%) \nand 4 patients with normal lung parenchyma (4/55; 7%). Perfusion \nabnormalities consisted of (a) patchy perfusion defects in both lungs (30/36; \n83%), (b) PE-type perfusion defects (6/36; 16.6%) in presence (n=1) or \nabsence of proximal thrombosis (n=5); and (c) focal areas of hypoperfusion \n(2/36; 5.5%). \nConclusion: DECT depicted non-obstructive proximal thrombosis in 5.4% of \npatients and perfusion abnormalities suggestive of widespread \nmicroangiopathy in 65.5% of patients. Lung microcirculation was abnormal in \n7% of patients with a normal lung parenchyma. \nLimitations: No correlation was possible between CT and PFTs. \nEthics Committee Approval: Waiver of patient informed consent \nFunding for this study: None \nAuthor Disclosures: \nJean-Baptiste Faivre: Nothing to disclose \nStéphanie Fry: Nothing to disclose \nM. Thierry Perez: Nothing to disclose \nMartine Rémy-Jardin: Research/Grant Support: Siemens \nNathalie Bautin: Nothing to disclose \nLouise Duthoit: Nothing to disclose \nJacques Remy: Research/Grant Support: Siemens \nM. Alain Duhamel: Nothing to disclose \nM. Arnaud Scherpereel: Nothing to disclose \n \nRPS 704-5 \nDeveloping a chest low-dose CT protocol for COVID-19: a phantom study \n*I. Blokhin*, V. Chernina, T. Korb, A. P. Gonchar, O. O. Aleshina, A. Nikolaev, \nS. Morozov, V. Gombolevskiy; Moscow/RU \n \nPurpose: To determine a threshold value of automatic tube current modulation \nnoise index below which there is a chance to miss an onset of ground-glass \nopacities (GGO) in COVID-19, thus reduci ng patient dose without affecting the \ndiagnostic outcome. \nMethods or Background: First, 25 CT studies of an anthropometric phantom \nwith BMI=29 were performed using different automatic tube current modulation \n(SureExp.3D). Then we retrospectively evaluated chest CT (N=22) and \ncalculated the density difference between the GGO and unaffected tissue. \nFinally, the clinical image evaluation results were matched to the phantom \nstudy results to determine the minimum noise index threshold value. \nResults or Findings: The minimum difference in density between the GGO \nand normal lung tissue at the onset of COVID-19 was 252 HU with 95% CI \n(252 - 349), p=0.00001. This corresponds to the SureExp.3D noise index of 36 \nas measured at Th11-12 levels. \nConclusion: We established a SureExp.3D noise index for Canon scanner \nwithout iterative reconstructions, allowing for reduction of radiation dose by \n80%. Further dose reduction is not recommended for patients with BMI=29 \nsuspected of having COVID-19, as this might compromise image quality and \nCOVID-19 detection. \nLimitations: Although the LungMan Phantom N1 anthropometric phantom is \nsimilar to the human body in many features, there is no way to adjust the \ninspiration depth affecting healthy lung tissue density. Second, we used the \nadapter plates to simulate a patient with BMI=29. The proposed threshold will \nentail a lower radiation dose in lower BMI, but not for those with BMI>29. \nEthics Committee Approval: The IEC approval was not required. \nFunding for this study: No funding was received for this work. \nAuthor Disclosures: \nAnna P. Gonchar: Nothing to disclose \nSergey Morozov: CEO: CEO of Research and Practical Clinical Center for \nDiagnostics and Telemedicine Technologies of the Moscow Health Care \nDepartment \nTatiana Korb: Nothing to disclose \nValeria Chernina: Nothing to disclose \nOlga Olegovna Aleshina: Nothing to disclose \nAlexander Nikolaev: Nothing to disclose \nIvan Blokhin: Nothing to disclose \nVictor Gombolevskiy: Nothing to disclose \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 202  \nRPS 704-6 \nIncidental multi-detector computed tomography (MDCT) findings in \npatients with COVID-19 pneumonia \n*A. El-Badrawy*; Mansoura/EG \n(adelelbadrawy@hotmail.com) \n \nPurpose: To investigate the frequency and significance of incidental MDCT \nfindings in patients with COVID-19 pneumonia. \nMethods or Background: Medical records of 2,364 COVID-19 patients who \nunderwent chest MDCT scanning were reviewed. All patients proved to be \ninfected with COVID-19 by RT-PCR. Incidental findings were determined from \nimaging reports. Radiologist coded such findings as benign or clinically \nsignificant require further evaluation. These findings are either pulmonary or \nextra-pulmonary. We analyzed the spectrum of incidental findings and \nidentified potentially significant. \nResults or Findings: Incidental findings were noted in 257/2364 (10.87%) \npatients. Follow-up imaging was recommended in 196 patients (8.29%). The \nprevalence of potentially significant abnormalities was highest for hepato-biliary \nfindings 76/2364 (3.2%), followed by cardiovascular findings 44/2364 (1.86), \nand breast 38/2364 (1.6%). The prevalence of cancers among screened \nparticipants was 48/2364 (2%). The most common malignancy was hepato-\ncellular carcinoma (20/2364), followed by breast (11/2364), bony thoracic cage \n(8/2364), bronchogenic carcinoma (7/2364) and lymphoma (2/2364). \nConclusion: Incidental findings are commonly identified on MDCT in patients \nwith COVID-19 pneumonia. These findings have a significant impact on \ntreatment and follow up imaging. Further evaluations are needed to avoid the \nrisk of missing malignancy. \nLimitations: Limitation of our study includes retrospective of our analysis \nEthics Committee Approval: The study was approved by the institutional \nresearch ethics review committee (Mansoura University/Faculty of Medicine/ \nEgypt). IRB reference number is “R.20.11.1057 \". \nFunding for this study: This manuscript is made by the author’s own work \nwithout receiving any funding. \nAuthor Disclosures: \nAdel El-Badrawy: nothing to disclose \n \nRPS 704-7 \nEvaluation of the diagnostic performance and interobserver agreement of \nCO-RADS classification in COVID-19 pneumonia \n*M. Koúar Tunç*, N. Kıú, O. Ince, H. Kurtul Yildiz, H. Önder; Istanbul/TR \n(meliskosar@hotmail.com) \n \nPurpose: To evaluate the diagnostic accuracy of Coronavirus Disease 2019 \n(COVID-19) Reporting and Data System (CO-RADS) classification in patients \nsuspected of having COVID-19 and to determine the interobserver agreement \nbetween radiologists with different years of experience. \nMethods or Background: Between March and May 2020, 209 chest CT scans \nof patients with clinically suspected COVID-19 who underwent both chest CT \nand RT-PCR tests were included in our retrospective study. The images were \nseparately evaluated in consensus by two groups of radiologists with blinding \nto RT-PCR results. Group 1 consisted of two residents; group 2 consisted of \ntwo specialists with at least 15 years of experience. Sensitivity, specificity, and \narea under the receiver operating characteristic curve (AUC) were calculated. \nInterobserver agreement was calculated using Kappa statistic by comparing \ntwo groups of radiologists. \nResults or Findings: In 149 of the 209 patients, RT-PCR results were \npositive. In 302 of 418 (72.2%) observations, there was absolute agreement in \nthe assignment CO-RADS category. A discrepancy of one CO-RADS category \nwas seen in 38 (18.2%) of 418, of two CO-RADS categories in 8 (3.9%) of 418, \nof three categories in 9 (4.3%) of 418 observations. Interobserver agreement in \nCO-RADS grading was moderate (k = 0.55). CO-RADS was able to distinguish \npatients with positive PCR results from those with negative PCR results with an \naverage AUC of 0.75 in group 1 and an average AUC of 0.81 in group 2 (Cut-\noff value > CO-RADS 3). There was a significant difference in both groups \n(p<0.001). \nConclusion: The diagnostic performance of CO-RADS classification for \npredicting the pulmonary involvement of COVID-19 was very good with \nsignificant interobserver agreement. \nLimitations: Our patient population was small. \nIt is known that despite negative RT-PCR test results COVID-19 can be \ndiagnosed. \nEthics Committee Approval: Yes \nFunding for this study: None \nAuthor Disclosures: \nMelis Koúar Tunç: nothing to disclose \nNaciye Kıú: nothing to disclose \nHakan Önder: nothing to disclose \nHülya Kurtul Yildiz: nothing to disclose \nOkan Ince: nothing to disclose \n \nRPS 704-8 \nPulmonary embolism and coronavirus disease 2019 pneumonia: \nevidence from the first Italian epicentre \n*E. Mercanzin*, P. A. Bonaffini, P. N. Franco, A. Bonanomi, C. Valle, S. Sironi; \nMilan/IT \n(e.mercanzin@campus.unimib.it) \n \nPurpose: Our aims were to assess pulmonary embolism (PE) features on \nchest computed tomography angiography (CTA) in Coronavirus disease 2019 \n(COVID-19) pneumonia patients and to evaluate its correlations with \ncomorbidities, relevant laboratories tests, pulmonary stages and outcomes. \nMethods or Background: We retrospectively evaluated 114 COVID-19 \npatients with pneumonia (mean age 61 years; 26.3% females) who underwent \nCTA examinations for suspicious PE. PE features (distribution in one or \nmultiple pulmonary lobes; involvement of the pulmonary trunk and/or main \npulmonary arteries), pulmonary stages (early; progressive; peak; absorption), \ncomorbidities, D-dimer levels (DD), coagulation tests and outcomes \n(hospitalized; discharged; died) were investigated. Their corresponding \ncorrelations were tested. \nResults or Findings: PE was diagnosed in 65/114 patients (57%); in 16.9% of \ncases, pulmonary trunk and/or main arteries were involved. Progressive \n(24.6%) and peak (67.7%) pulmonary stages were the most frequent. Over a \nshort-term follow-up (60 days) 25 patients (21.9%) were still hospitalized, 72 \n(63.2%) have been discharged and 17 patients (14.9%) were dead. At least \none comorbidity affected 88/114 patients (77.2%). DD showed a significant \ncorrelation with PE: in particular, if the main arteries were involved, DD \nincreased (p = 0.003). A significant relationship between pulmonary stages and \nDD was also noted. \nConclusion: PE represents a major concern in COVID-19 patients. CTA \naccurately describes PE features and provides information about concurrent \npulmonary stages in COVID-19 pneumonia, according with DD. Therefore, \nimaging has a crucial role in the overall assessment and management of \npatients. \nLimitations: A retrospective study with selection bias as only patients with \nsevere pneumonia were included. \nEthics Committee Approval: This study was approved by our institutional \nethics committee. \nFunding for this study: No funding was received for this work. \nAuthor Disclosures: \nElisa Mercanzin: Nothing to disclose \nAlice Bonanomi: Nothing to disclose \nClarissa Valle: Nothing to disclose \nPietro Andrea Bonaffini: Nothing to disclose \nPaolo Niccolò Franco: Nothing to disclose \nSandro Sironi: Nothing to disclose \n \nRPS 704-9 \nIncidental discovered COVID-19 pneumonia in asymptomatic cancer \npatients undergoing follow-up multi-detector CT \n*A. El-Badrawy*; Mansoura/EG \n(adelelbadrawy@hotmail.com) \n \nPurpose: To investigate the frequency and imaging findings of incidental \ndiscovered COVID-19 pneumonia in asymptomatic cancer patients undergoing \nfollow up MDCT. \nMethods or Background: This retrospective study was conducted for 1122 \ncancer patients who underwent follow up MDCT scanning without suspicious of \nCOVID-19 infection. Thoracic CT examinations were reviewed. CT images \nwere analyzed to confirm the presence of findings consistent with COVID-19 \npneumonia and qualify disease extent. The severity of lung affection was \nevaluated according to Bernheim et al. (2020) guidelines. Patient with \nsuspicious findings underwent RT-PCR. Clinical and laboratory data re-\nevaluated. \nResults or Findings: Among 1122 cancer patients underwent follow up MDCT \nscanning, 46/1122 (4.1%) patients (28 women and 18 men: median age, 60 \nyears) revealed images highly suggestive of COVID-19 pneumonia. All 46 \ncases were confirmed by RT-PCR. All had increase CRP and lymphopenia. \nDisease extent on CT was minimal in 5/46 patients, mild in 31/46 patients, \nmoderate in 7/46 patients and severe in 3/46 patients. \nConclusion: Incidental diagnosis of COVID-19 pneumonia on follow up cancer \npatient about 4.1%. This finding has a significant impact on treatment. Proper \nevaluation of chest CT images in cancer patient, are needed to avoid the risk \nof missing incidental discovered COVID-19. \nLimitations: Limitation of our study includes small numbers of our patients. \nEthics Committee Approval: The study was approved by the institutional \nresearch ethics review committee (Mansoura University/Faculty of Medicine/ \nEgypt). IRB reference number is “R.20.11.1056 \". \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 203  \nFunding for this study: This manuscript is made by the author’s own work \nwithout receiving any funding. \nAuthor Disclosures: \nAdel El-Badrawy: Nothing to disclose \n \nRPS 704-10 \nA spectrum of atypical HRCT chest imaging features in COVID 19  \npatients – a revelation \n*R. Arora*; Delhi/IN \n(arorarohit0810@gmail.com) \n \nPurpose: To identify and categorize the additional Atypical imaging features \ndetected in COVID 19 patients from eastern India. \nMethods or Background: HRCT images of 1300 COVID-19 patients without \nany known co-morbid conditions and showing positive HRCT findings were \nanalyzed and evaluated for prevalence of atypical imaging features. HRCT \nimages were categorized into typical, atypical and indeterminate. Further the \nadditional atypical features were evaluated. \nResults or Findings: Out of 1300 patients, 320 (24.6%) patients showed \natypical imaging features, 860 patients (64.6%) were in the Typical and 140 \n(10.7%) were in the indeterminate category. Amongst patient with atypical \nimaging features we found that isolated lobar or segmental consolidation \nwithout associated GGO’s prevalent in 5.6% patients, discrete pulmonary \nnodules which includes both centrilobular and tree-in bud nodular patterns in \n42%, mediastinal / hilar lymphadenopathy in 9.3%. About 11% patients had \npleural effusion and 1.2% demonstrated pneumothorax and \npneumomediastinum. Linear or sub segmental atelectasis was noted in 66% \npatients. \nConclusion: Significantly higher additional atypical features like atelectatic \nbands & subpleural curvilinear atelectasis (66%), followed by discrete nodules \n(42%) were associated with COVID 19 diagnosis in absence any known co-\nmorbid conditions. We propose that additional imaging features which have not \nbeen categorized under any of the existing four groups, be incorporated in \neither a mixed category or added to any of the existing groups, in the current \nimaging based classification for COVID 19. \nLimitations: No long duration follow-up scans were done in our study \npopulation. \nEthics Committee Approval: Approved \nFunding for this study: Not Applicable \nAuthor Disclosures: \nGirendra Shankar: Nothing to disclose \nKamal Sen: Nothing to disclose \nRohit Arora: Nothing to disclose \nSunny Swaraj: Nothing to disclose \nJagadeesh Kuniyil: Nothing to disclose \nDwarampudi Sindhu Reddy: Nothing to disclose \nSangram Panda: Nothing to disclose \n \nRPS 704-11 \nA composite index considering CT disease extension and days from \nsymptom onset at emergency room presentation predicts hospital \nreadmission after emergency room discharge in COVID-19 patients \n*G. Besutti*, M. Ottone, F. Luppi, O. Duric, M. Galli, V. Curcio, A. Nitrosi,  \nP. Giorgi Rossi, P. Pattacini; Reggio Emilia/IT \n(giulia.besutti@libero.it) \n \nPurpose: To find baseline predictive factors for emergency room (ER) \nreadmission with hospitalization in COVID-19 patients who were initially \ndischarged from ER. \nMethods or Background: All consecutive COVID-19 patients admitted to the \nER between March 2 and March 31,2020, and discharged for home treatment, \nwere included. Age, sex, comorbidities (alone and combined in Charlson \nindex), days from symptom onset, signs and symptoms, laboratory \nexaminations, CT findings (including CT disease extension as visual \npercentage) at the moment of first ER admission were collected and tested as \npredictive factors for ER readmission with hospitalization within 45 days, by \nmeans of univariate and multivariate models reporting incidence rate ratio \n(IRR) with 95%CI. A disease progression rapidity index dividing CT extension \nby the days from symptom onset plus three days lag was also considered. \nResults or Findings: We included 454 patients (median age 54 years, 47% \nfemales), 82 (18.1%) were readmitted to the ER and among them 56 (12.3%) \nwere hospitalized. Only age (IRR=1.03,95%CI=1.01-1.05), Charlson index 3 vs \n0 (IRR=4.79,95%CI=1.58-14.52) days from symptom onset (IRR for one day \nincrease=0.86,95%CI=0.78-0.94), and CT extension (IRR for 1% \nincrease=1.03,95%CI=1.01-1.06) were associated in multivariate model with \nreadmission with hospitalization. When replacing the latter two with the \ncomposite index (IRR for unit increase =1.28,95%CI=1.12-1.46), the variance \nexplained by the model slightly decreased (R2 from 0.12 to 0.10). \nConclusion: A disease progression rapidity index combining CT extension and \ndays from symptom onset at first ER presentation may predict disease \nworsening, i.e. a patient with 20% CT parenchymal involvement 1 day after \nsymptom onset has the same risk of a person with 50% after 7 days. \nLimitations: Findings depend on the criteria for home discharge applied to our \ncohort, studies on other populations are needed. \nEthics Committee Approval: AVEN (number:2020/0045199) \nFunding for this study: None \nAuthor Disclosures: \nMariagiulia Galli: Nothing to disclose \nPierpaolo Pattacini: Nothing to disclose \nOlivera Duric: Nothing to disclose \nAndrea Nitrosi: Nothing to disclose \nVittoria Curcio: Nothing to disclose \nFrancesco Luppi: Nothing to disclose \nPaolo Giorgi Rossi: Nothing to disclose \nGiulia Besutti: Nothing to disclose \nMarta Ottone: Nothing to disclose \n \nRPS 704-12 \nCOVID-19 disease beyond pulmonary manifestation: a radiological \noverview \n*R. I. E. Yasin*¹, W. A. Gouda¹, E. A. G. Ibrahim²; ¹Menofia/EG, ²Cairo/EG \n(rabab_yasin@outlook.com) \n \nPurpose: Our study focuses on the incidence of different extrapulmonary \nimaging findings in patients with COVID-19 pneumonia. \nMethods or Background: COVID-19 disease was primarily described as a \npandemic of respiratory illness, however with the disease progression variable \ncases with extrapulmonary manifestations have been reported all over the \nworld. SARS-CoV-2 infection can affect different body systems with the \nneurologic, abdominal, thromboembolic, cardiac, mediastinal and \nhematological manifestations had been reported in many literatures. The \nunderstanding of these multisystemic involvement are being better understood \nas the pandemic progresses. \nResults or Findings: 3500 proved COVID-19 patients were enrolled in our \nstudy 2670 (76.3%) males and 830 (23.7 %) females with mean age was 48.11 \n± 10.18 years old, ranging from 20-82 years. COVID-19 associated \nextrapulmonary imaging findings were reported in 159 patients (4.5%) with the \nneurological findings were the most frequent extrapulmonary manifestations \nand detected in 98 cases (61.6%), followed by 46 cases (29%) with abdominal \nfindings and 15 (9.4 %) cases with limb ischemia. \nConclusion: COVID-19 infection showed wide spectrum of multisystemic \ninvolvement and imaging modality have a great role in the assessment of \ndisease dissemination to avoid any untreated causes of morbidity/ mortality. \nLimitations: Not applicable \nEthics Committee Approval: The study protocol was approved by the local \nEthics Committee \nFunding for this study: Not applicable \nAuthor Disclosures: \nWalaa Abdullah Gouda: Nothing to disclose \nRabab Ibrahim Elsayed Yasin: Nothing to disclose \nEnas Abdel Ghany Ibrahim: Nothing to disclose \n \nRPS 704-13 \nCoronary and total thoracic calcium: strong predictors of COVID-19 \npatients outcome \n*V. Nicoletti*¹, A. Palmisano¹, D. Vignale¹, R. Leone¹, C. Gnasso¹, M. Toselli², \nA. Cereda², F. Giannini², A. Esposito¹; ¹Milan/IT, ²Cotignola/IT \n(nicoletti.valeria@hsr.it) \n \nPurpose: The study aim was to evaluate the role of coronary and total thoracic \ncalcium on in-hospital mortality in COVID-19 patients. \nMethods or Background: Since December 2019, an acute respiratory \ndisease, the coronavirus disease 2019 (COVID-19), has spread worldwide \nbecoming a global public health emergency. Early identification of high-risk \npatients could permit a tailored approach and improve disease management. \nCoronary, thoracic aorta and aortic valve calcium are validated long-term \npredictors of cardiovascular events and all-cause mortality and can be easily \nmeasured from a non-gated chest computer tomography (CT). However, their \nprognostic role in the context of an acute and systemic inflammatory disease, \nsuch as COVID-19, has not been previously investigated. We retrospectively \nenrolled 1093 consecutive patients hospitalized for COVID-19 in 17 Italian \nhospitals, all with an admission chest CT performed to evaluate pneumonia \nseverity. Coronary, thoracic aorta, aortic valve and total thoracic calcium were \nqualitatively and quantitatively assessed (Agatston calcium scoring and \ncalcium volume methodology). \nResults or Findings: Compared to survivors, non-survivors had higher \ncoronary artery [Volume (487.79±565.34 vs 207.77±406.81, p<0.001); \nAgatston (467.76±570.92 vs 206.80±424.13 mm2, p<0.001)], aortic valve \n[Volume (322.45±390.90 vs 98.27±250.74 mm2, p<0.001; Agatston \n337.38±414.97 vs 111.70±282.15, p<0.001)] and thoracic aorta [Volume \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 204  \n(3786.71±4225.57 vs 1487.63±2973.19 mm2, p<0.001); Agatston \n(4688.82±5363.72 vs 1834.90±3761.25, p<0.001)] calcium scores. Coronary \nartery calcium (HR 1.308; 95% CI, 1.046-1.637, p=0.019) and total thoracic \ncalcium (HR 1.975; 95% CI, 1.200-3.251, p=0.007) resulted to be independent \npredictors of in-hospital mortality. \nConclusion: Calcium assessment of coronary, aortic valve and thoracic aorta \non non-gated chest CT is an easy and useful tool to predict the in-hospital \nmortality risk of COVID-19 patients. \nLimitations: This a retrospective study and includes only patients who \nunderwent CT for lung assessment, being potentially not reflective of all \nCOVID-19 patients. \nEthics Committee Approval: Approved \nFunding for this study: None \nAuthor Disclosures: \nFrancesco Giannini: Nothing to disclose \nValeria Nicoletti: Nothing to disclose \nDavide Vignale: Nothing to disclose \nAntonio Esposito: Nothing to disclose \nAnna Palmisano: Nothing to disclose \nMarco Toselli: Nothing to disclose \nAlberto Cereda: Nothing to disclose \nRiccardo Leone: Nothing to disclose \nChiara Gnasso: Nothing to disclose \n \nRPS 704-14 \nCT chest in novel COVID-19 pandemic: how can it help diagnose and \npredict patient’s ICU needs? \n*A. M. M. Abdrabou*, A. M. Osman, A. Yassin, R. Hashim; Cairo/EG \n(arabou2000@hotmail.com) \n \nPurpose: COVID-19 infection is a worldwide pandemic since December 2019. \nThis study aimed to assesses the CT accuracy in the detection of COVID-19 \ncases, evaluate the CT manifestations, and try to find a relation between the \nCT severity and the management \nMethods or Background: A retrospective study was conducted on 600 \npatients, presented with symptoms suspicious for COVID-19 infection from \nMarch till the end of June 2020. 466 patients were included, 340 patients were \nconfirmed COVID-19 infection by PCR. We followed the RSNA \nrecommendations in CT reporting to be correlated with the PCR. The different \nCT findings were analyzed. Finally, the CT severity score was correlated with \nthe patient’s management \nResults or Findings: CT sensitivity was 92.6% while the PCR is the \nreference. We found an increase in specificity with the increase in the level of \nCT probability. The CT high probability findings showed 97.6% specificity. \nGGO was the commonest CT findings 85.9% with a high incidence of bilateral, \nperipheral, and multilobar involvement (88%, 92.8%, and 92.8% respectively). \nConsolidation was found in 81.5% between ICU patients being predominant in \n66.7% of the ICU cases. CT severity score was significantly higher in ICU \npatients with score • 14 \nConclusion: CT can be used as a rapid and sensitive investigation to detect \nCOVID-19 infection. COVID-19 infection is typically presented as bilateral \nperipheral ground-glass opacities. CT severity score and consolidation can be \nused as parameters for ICU need \nLimitations: It was difficult to collect detailed clinical and laboratory data about \nthe patients due to pandemic status. So, we used the decision taken for the \npatient’s management as a reflection of their clinical condition \nEthics Committee Approval: Faculty of medicine - Ain Shams University \nethical committee approval \nFunding for this study: No fund \nAuthor Disclosures: \nReham Hashim: Nothing to disclose \nAhmed Mohammed Mahmoud Abdrabou: Nothing to disclose \nAya Yassin: Nothing to disclose \nAhmed M. Osman: Nothing to disclose \n \nRPS 704-15 \nQuantitative chest CT and radiography substantially improve prognostic \nprediction of severe COVID-19 in multiparametric statistical models, \nwhen compared to clinical variables \n*E. J. M. Barbosa Jr.*¹, H-M. Jung¹, R. Yang¹, W. Gefter¹, F. Ghesu², S. Liu²,  \nA. Mansoor², S. Grbic², S. Vogt³; ¹Philadelphia, PA/US, ²Princeton, NJ/US, \n³Malvern, PA/US \n(eduardo.mortani@gmail.com) \n \nPurpose: To evaluate whether severe COVID-19 can be predicted by \nstatistical models leveraging clinical, quantitative chest CT (qCT) and \nquantitative chest radiograph (qCXR) airspace disease (AD) variables, \nobtained at initial diagnosis. \n \nMethods or Background: We retrospectively selected 86 COVID-19 patients \n(SARS-CoV2 positive, March-July 2020) at a tertiary hospital in the USA, who \nunderwent chest CT and CXR within 48 hrs. Clinical variables (CVs) included \nage, BMI, PaO2, C-reactive protein; imaging variables included qCT volumetric \npercentage AD (POv) and qCXR area-based percentage AD (POa), assessed \nby 2 expert thoracic radiologists and a deep convolutional neural network \n(CNN). Our prognostic outcome was the need for ICU admission. We \ndeveloped 3 pairs of Random Forest (RF) and Logistic Regression (LR) \nmodels: using CVs known to be associated with worse prognosis (Model I); \nusing only age and imaging variables (Model II); and using a dimension-\nreduced set of best predictor variables (Model III). RF and LR results were \nsummarized respectively as out-of-bag error rate (OOB) and ROC AUC. \nResults or Findings: 42/86 patients did not require ICU admission, whereas \n44/86 did. Model I had the worst performance (AUC=0.739 [0.634-0.844]; \nOOB=42%), with only age as a statistically significant predictor. Model II \ndemonstrated substantially improved performance (AUC=0.833 [0.748-0.918]; \nOOB=25%). Model III was the best overall (AUC=0.858 [0.782-0.943]; \nOOB=25%). Model II and III results did not change significantly when POv was \nreplaced by POa. \nConclusion: Severe COVID-19 can be accurately predicted with only age and \nquantitative AD imaging metrics at presentation. Quantitative imaging \ncontributes to prognostication to a greater extent than the set of CVs, and \nqCXR metrics can replace qCT without loss of prognostic performance. Our \nresults could assist with resource allocation to foster better outcomes for \nCOVID-19 patients. \nLimitations: Retrospective study \nEthics Committee Approval: IRB approved \nFunding for this study: None \nAuthor Disclosures: \nHae-Min Jung: Nothing to disclose \nFlorin Ghesu: Employee: Siemens \nSebastian Vogt: Employee: Siemens \nEduardo Jose Mortani Barbosa Jr.: Research/Grant Support: Siemens \nResearch Grants \nAwais Mansoor: Employee: Siemens \nSasa Grbic: Employee: Siemens \nRochelle Yang: Nothing to disclose \nWarren Gefter: Research/Grant Support: Siemens Research Grants \nSiqi Liu: Employee: Siemens \n \nRPS 704-16 \nImpact of COVID-19 on the lung cancer diagnostic pathway in Liverpool: \nan audit \n*D. Duvva*, M. Khan, M. Arzanauskaite, M. Ledson; Liverpool/UK \n(dileepduvva@doctors.org.uk) \n \nPurpose: The first nationwide lockdown introduced in the UK has led to \ndeferment of routine diagnostic work with most hospitals and primary services \nprioritising only urgent and symptomatic cases for diagnostic pathways \nresulting in concerns of diagnostic delay and subsequent higher cancer related \ndeaths. In this study, we aimed to review the functioning of diagnostic \npathways of Liverpool Lung Cancer Unit (LLCU) during the lockdown \ncomparing to its performance in 2019. \nMethods or Background: Liverpool Lung Cancer Unit (LLCU), one of the \nlargest Lung cancer units in the UK provides for investigations, diagnosis and \ntreatment and inpatient services at both Royal Liverpool University hospital and \nLiverpool Heart and Chest Hospital (LHCH) and importantly outpatient services \nthrough the virtually operated Rapid Access Lung Service (RALS). It has \nextended its diagnostic and outpatient services to Aintree hospital, another \nmajor tertiary centre in Liverpool city from 27th of March till the 9th of June. \nData was collected from PACS, CRIS and the Somerset Cancer Registry to \nidentify and cross reference all the entries in the diagnostic pathways. \nResults or Findings: The total number of coded images for suspected lung \ncancer, referrals from GPs and outpatient services have increased by 85%, \n19% and 78% whilst the referrals from the emergency units surged by a 141%. \nHowever, the total number of patients seen by RALS has seen a decline of \n18% during the same period. \nConclusion: The LLCU \"straight to CT model\" was operating efficiently during \nthe spring 2020 UK lockdown. Whilst it successfully managed patients from its \nown catchment, it also was able to extend its virtual platform based RAL \nservices another tertiary hospital catering for the needs of a population of the \nwhole of Liverpool City. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: None \nAuthor Disclosures: \nMonika Arzanauskaite: Nothing to disclose \nDileep Duvva: nothing to disclose \nMuhammad Khan: Nothing to disclose \nMartin Ledson: Nothing to disclose \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 205  \nRPS 704-17 \nCOVID-19-related acute respiratory distress syndrome: HRCT findings \nwithin two months after resolution of the infection \n*E. Baratella*, N. Starvaggi, C. Marrocchio, S. Tollot, F. Giudici, M. A. A. Cova; \nTrieste/IT \n(elisa.baratella@gmail.com) \n \nPurpose: To evaluate the imaging findings on high-resolution CT of patients \nwith COVID-19-related ARDS. \nMethods or Background: Between March and September 2020, patients with \na previous diagnosis of COVID-19-related ARDS who had performed a CT \nscan within 8 weeks since a negative RT-PCR on nasopharyngeal swabs were \nretrospectively identified. The following CT findings were evaluated and \ndescribed according to their segmental distribution: ground glass opacities \n(GGO), consolidations, reticulations, bronchiectasis/bronchiolectasis, linear \nbands, loss of pulmonary volume and pleural effusion. Radiological findings \nwere correlated with age, sex, positive swab days, hospitalization days and \nspirometry results. The t-student or Mann-Whitney tests were used for \ncontinuous variables, while categorical variables were compared by the Chi-\nSquare independence test or Fischer's exact test. To evaluate the linear \ncorrelation between age and number of CT findings per patient, the Spearman \ncorrelation coefficient was calculated. Statistical tests were two-tailed and the \nsignificance level was considered for p-value<0.05. \nResults or Findings: Forty-four patients (M:32, F:12, median age:64) were \nincluded. Alterations of the pulmonary parenchyma were observed in 97,7% of \npatients. Linear bands were the most common findings (84%), followed by \nGGO (75%), reticulations (34%), bronchiolectasis (32%), consolidations (30%), \nbronchiectasis (30%) and volume loss (25%). Imaging findings had a \nsymmetric distribution and both lower lobes were the most affected ones. \nConclusion: Our study describes the short-term HRCT findings of COVID-19-\nrelated ARDS after resolution of the infection. Reticulations can be an early \nsign of post-ARDS fibrosis, as described in previous coronavirus outbreaks. \nLimitations: Retrospective nature of the study \nEthics Committee Approval: Ethical approval was obtained \nFunding for this study: This study has not received funding \nAuthor Disclosures: \nElisa Baratella: Nothing to disclose \nFabiola Giudici: Nothing to disclose \nCristina Marrocchio: Nothing to disclose \nSaverio Tollot: Nothing to disclose \nMaria Assunta A. Cova: Nothing to disclose \nNatalia Starvaggi: Nothing to disclose \n \nRPS 704-18 \nChest CT texture-based radiomics analysis in differentiating COVID-19 \nfrom other interstitial pneumonia \n*C. Rucci*, M. Zerunian, T. Polidori, G. Guido, E. Lucertini, B. Bracci, M. Polici, \nA. Laghi; Rome/IT \n(carlottarucci@gmail.com) \n \nPurpose: To evaluate the ability of Texture Analysis in differentiating COVID-\n19 pneumonia from pneumonia of other etiology on Chest-CT. \nMethods or Background: One hundred and twenty patients admitted to \nEmergency Department, from March 8, 2020 to April 25, 2020, with suspicious \nof COVID-19 that underwent Chest-CT, were retrospectively analyzed. All \npatients presented CT findings indicative for interstitial pneumonia. Sixty \npatients with positive COVID-19 real-time reverse transcription polymerase \nchain reaction (RT-PCR) and sixty patients with negative COVID-19 RT-PCR \nwere enrolled. CT Texture analysis (CTTA) was manually performed using \ndedicated software by two Radiologists in consensus and textural features on \nfiltered and unfiltered images were extracted as follows: mean intensity, \nstandard deviation (SD), entropy, mean of positive pixels (MPP), skewness, \nkurtosis. Non-parametric Mann Whitney test assessed CTTA ability to \ndifferentiate positive from negative COVID-19 patients. Diagnostic criteria was \nobtained from ROC curves. \nResults or Findings: Unfiltered CTTA showed lower values of mean density, \nMPP and kurtosis in COVID-19 positive patients compared to negative patients \n(p=0,041; 0,004 and 0,002 respectively). On filtered images, fine and medium \ntexture scales were significant differentiators; fine texture scale being most \nsignificant where COVID-19 positive patients had lower SD (p= 0.004) and \nMPP (p=0.004) compared to COVID-19 negative patients. A combination of the \nsignificant texture features could identify the patients with positive COVID-19 \nfrom negative COVID-19 with a sensitivity of 60% and specificity of 80% \n(p=0.001). \nConclusion: Preliminary evaluation suggests potential role of CTTA in \ndistinguishing COVID-19 pneumonia from other interstitial pneumonia on \nChest-CT. \nLimitations: Retrospective nature, single-center design and small sample size. \nEthics Committee Approval: This study was approved by our local \ninstitutional review board and written informed consent was obtained from all \nstudy participants. \nFunding for this study: No. \nAuthor Disclosures: \nCarlotta Rucci: Nothing to disclose \nMarta Zerunian: Nothing to disclose \nBenedetta Bracci: Nothing to disclose \nTiziano Polidori: Nothing to disclose \nAndrea Laghi: Nothing to disclose \nMichela Polici: Nothing to disclose \nGisella Guido: Nothing to disclose \nElena Lucertini: Nothing to disclose \n \n \nResearch Presentation Session: Artificial \nIntelligence & Machine Learning \nRPS 305 \nAI in the diagnosis and treatment of COVID \nRPS 305-1 \nPrognostic modelling of COVID-19 patients risk stratification using chest \nCT radiomic features and machine learning \n*I. Shiri*¹, M. Pakbin², Y. Salimi¹, A. Sanaat¹, A. Akhavanalaf¹,  \nS. Sandoughdaran³, K. R. Kalantari³, H. Arabi¹, H. Zaidi¹; ¹Geneva/CH, \n²Qom/IR, ³Tehran/IR  \n(isaac.sh92@gmil.com) \n \nPurpose: A wide range of radiological examinations, including chest CT, are \ncurrently used for clinical diagnosis and prognosis of COVID-19 patients. In \ncurrent work, we developed a risk strati fication model for COVID-19 patients \nusing radiomics features extracted from chest CT images and machine \nlearning \nMethods or Background: We enrolled 2525 volumetric CT images of COVID-\n19 patients, including 1992 alive and 533 deceased patients. Eighty percent of \nthe patients were used for training whereas 20% were kept for external \nvalidation. 3D volumes of whole lung and COVID-19 lesions were segmented \nusing a deep learning-based algorithm. Radiomic features were extracted from \nthe segmented lung and infectious lesions from CT images. Maximum \nrelevance minimum redundancy (MRMR) and XGBoost were used for feature \nselection and risk stratification. The metrics adopted for model performance \nassessment include the area under the receiver operating characteristic curves \n(AUC), accuracy, sensitivity and specificity. \nResults or Findings: Our results indicated that the combined model (Lung + \nLesion) had the highest prognostic capability with AUC = 0.94 ± 0.021, 0.91 ± \n0.03 accuracy, 0.90 ± 0.072 sensitivity and 0.90 ± 0.02 specificity. \nConclusion: We developed a radiomics and machine learning-based risk \nstratification model for COVID-19 patients. The results demonstrated high \nprognostic performance in terms of discrimination between alive and deceased \nCOVID-19 patients. The proposed model has significant potential for improved \nmanagement of COVID-19 patients. \nLimitations: Not applicable \nEthics Committee Approval: This retrospective study was conducted with \ninstitutional review board approval. Formal written consent was waived owing \nto the nature of the study. \nFunding for this study: Swiss National Science Foundation under grant \nSNRF 320030_176052 \nAuthor Disclosures: \nSaleh Sandoughdaran: Nothing to disclose \nAmirhossein Sanaat: Nothing to disclose \nHossein Arabi: Nothing to disclose \nHabib Zaidi: Nothing to disclose \nAzadeh Akhavanalaf: Nothing to disclose \nMasoumeh Pakbin: Nothing to disclose \nYazdan Salimi: Nothing to disclose \nIsaac Shiri: Nothing to disclose \nKiara Rezaei Kalantari: Nothing to disclose \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 206  \nRPS 305-2 \nDeep learning-based diagnostic model for COVID-19 pneumonia \ndetection from chest CT images \n*I. Shiri*¹, M. Pakbin², Y. Salimi¹, A. Sanaat¹, A. Akhavanalaf¹,  \nS. Sandoughdaran³, K. R. Kalantari³, H. Arabi¹, H. Zaidi¹; ¹Geneva/CH, \n²Qom/IR, ³Tehran/IR  \n(isaac.sh92@gmil.com) \n \nPurpose: Chest CT imaging has emerged as a useful tool for early diagnosis \nand longitudinal follow up of COVID-19 patients. In this work, we developed a \ndeep learning-based diagnostic model of COVID-19 disease. \nMethods or Background: We used 2332 3D CT images of COVID-19 \npatients, including 1010 PCR-positive COVID-19 pneumonia and 1322 non-\nCOVID-19 pneumonia (bacterial and viral) patients. Eighty percent of the \nsubjects were used for training whereas 20% were kept for external validation. \nAll images were cropped and resized according to outcome of lung \nsegmentation and the intensity values clipped and normalized. A 3D deep \nresidual convolutional neural network (RCNN) built in PyTorch was employed \nfor classification. The metrics adopted for model performance assessment \nincluded the area under the receiver operating characteristic curves (AUC) and \naccuracy. \nResults or Findings: A mean AUC and accuracy of 0.88±0.05 and 0.87±0.02 \nwere achieved for distinguishing PCR-positive COVID-19 and non-COVID-19 \npneumonia when using the 3D-RCNN. \nConclusion: We developed a deep learning-based classification model of \nCOVID-19 patients using a deep learning algorithm. The results in terms of \ndiscriminating PCR-positive COVID-19 and non-COVID-19 pneumonia patients \nare promising. \nLimitations: Not applicable \nEthics Committee Approval: This retrospective study was conducted with \ninstitutional review board approval. Formal written consent was waived owing \nto the nature of the study. \nFunding for this study: Swiss National Science Foundation under grant \nSNRF 320030_176052 \nAuthor Disclosures: \nSaleh Sandoughdaran: nothing to disclose \nAmirhossein Sanaat: Nothing to disclose \nHossein Arabi: Nothing to disclose \nHabib Zaidi: Nothing to disclose \nAzadeh Akhavanalaf: Nothing to disclose \nMasoumeh Pakbin: Nothing to disclose \nYazdan Salimi: Nothing to disclose \nIsaac Shiri: Nothing to disclose \nKiara Rezaei Kalantari: Nothing to disclose \n \nRPS 305-3 \nFrom no data to big data: development of a management system for \nimaging and data analysis of chest X-Rays in patients diagnosed COVID-\n19 in Mexico \nE. Hernandez Rangel, A. Negreros, *B. A. Gonzalez Vazquez*, M. Francisco, \nG. Elizondo Riojas; Monterrey/MX \n(bagzzvzz@gmail.com) \n \nPurpose: To develop an open-access chest X-Ray´s and data storage \nplatform in patients diagnosed with COVID-19, for deep neural networks and \nmachine learning tools creation in Mexico. To collaborate with different \nhospitals, medical centers, and universities in the construction a national \nimaging database with COVID-19 in Mexico. \nMethods or Background: In most Latin America Countries, there is a poor \nrepresentations in image datasets, because of the lack of IT resources. We \ndeveloped a graphical user interface for image and data storage, patient de-\nidentification, image curation and annotation, formatting annotation output, for \nchest X-rays of patients diagnosed with COVID-19. Certified radiologist from all \nthe country were in charge to upload, curate, annotate and segment ROI with \nCOVID-19 pneumonia most common findings. \nResults or Findings: We received a total of 688 x-ray images from different \nmedical centers. We developed 15 convolutional neural network (CNN) \nmodels, which were tested against expert radiologists to find the best model, \nand we are in the validation process of the most accurate CNN´s. \nConclusion: Developing countries lack the access to robust IT and state of the \nart technologies. Having access to user friendly platforms to create image \ndatasets will bring more representation of these countries. \nLimitations: Among our most important limitations is that we couldn't include \nsome hospitals specially in rural areas because they lack EHR or PAC´s \nsystems \nEthics Committee Approval: IRB approval \nFunding for this study: None \n \n \n \nAuthor Disclosures: \nGuillermo Elizondo Riojas: Nothing to disclose \nManuel Francisco: Nothing to disclose \nEduardo Hernandez Rangel: Nothing to disclose \nBarbara Aimee Gonzalez Vazquez: Nothing to disclose \nAdrian Negreros: Nothing to disclose \n \nRPS 305-5 \nUsefulness of the Botkin.AI platform for screening non-calcified \npulmonary nodules in patients with chest CT scans performed during the \nCOVID-19 pandemic \n*P. Pilius*, I. Drokin; Saint Petersburg/RU \n(polishka1903@gmail.com) \n \nPurpose: During the coronavirus disease pandemic, the number of chest CT \nscans performed for assessment of the lung changes increased dramatically. \nOur aim was a retrospective analysis of chest CT studies on the Botkin.AI \nplatform, which is trained to search for features of malignant neoplasms in the \nlungs using artificial intelligence. \nMethods or Background: Chest CT scans that we use for analysis were \nperformed in patients undergoing hospital treatment for laboratory-confirmed \ncoronavirus infection. Since the sensitivity of nodules detection is reduced \nagainst the background of pronounced lungs opacities, the first stage of all \nstudies was processed on the Botkin.AI platform, which is trained to recognize \nand quantify such syndromes as ground glass opacities and consolidation. \nStudies in which the total percentage of both lung affection was more than 5% \nand less than 25% were used for further analysis by the platform for the \npresence of pulmonary nodules. \nResults or Findings: In 170 chest CT studies in patients with coronavirus \ninfection, the platform found non-calcified solid nodules, 19 of which were \nlarger than 6 mm in diameter and required additional dynamic monitoring. The \nsensitivity of artificial intelligence in detecting nodules was higher than that of a \nradiologist (respectively 88.4% and 81%, p<0.005). The false-positive rate for \nthe AI results was 12%. \nConclusion: The Botkin.AI Platform can be used for additional screening of \npulmonary nodules in patients who have performed Chest CT scans in order to \nassessment of viral pneumonia affection during the coronavirus pandemic. The \nsensitivity of detecting nodules using artificial intelligence is higher than that of \na radiologist. \nLimitations: For better evaluation of benefit of clinical use of the platform it’s \nrequired to follow-up patients with suspicious pulmonary nodules and check \nwhether some of them will grow. \nEthics Committee Approval: Approved \nFunding for this study: Botkin.AI \nAuthor Disclosures: \nIvan Drokin: Nothing to disclose \nPolina Pilius: Nothing to disclose \n \nRPS 305-6 \nMulti-modal trained artificial intelligence solution to triage chest x-ray for \nCOVID-19 \n*T. Tan*¹, B. Das², R. Soni³, M. Fejes ຾, S. R. Ranjan², P. Tegzes຾, L. Ferenczi຾, \nR. Mullick², G. Avinash³; ¹Eindhoven/NL, ²Bangalore/IN, ³San Ramon, CA/US, \n຾Budapest/HU \n(tao.tan@ge.com) \n \nPurpose: Artificial intelligence (AI) assisted X-ray (XR) based applications for \ntriaging and monitoring COVID patients efficiently is seen as a promising \nsolution. We demonstrate a functional AI model to triage by inferencing using a \nsingle x-ray image, while the deep-learning model is trained on labeled paired \nand unpaired X-ray and CT data. \nMethods or Background: Our experiment leverages multi-center paired \n(48hr.) and unpaired CT and XR data. To avoid domain shift in evaluation, we \nonly use in-house data for testing. Three-class data includes COVID-19 (974 \ntrain images/113 validation images/268 testing images), pneumonia \n(10175/531/119) and negative (17068/3731/34). From unpaired and paired CT \ndata, we created synthetic X-ray (SXR) to significantly augment training image \npool. With projection and registration, we transferred the CT annotations to \npaired XR with manual fine-tuning. The transferred annotations were used for \ntraining. Our deep-learning model takes frontal X-ray as input and outputs \nlocation of the disease regions and classification. \nResults or Findings: Compared to X-ray only training, the multi-modal training \nimproves area under receiver operating characteristic curve (AUC) from 0.89 to \n0.93 and segmentation DICE from 0.59 to 0.62. \nConclusion: Multi-modal training learns from CT and benefits the model \ninferencing on X-rays for COVID-19 diagnosis and segmentation. \nLimitations: Polymerase chain reaction (PCR) tests are used as ground-truth \nbut PCR is not 100% reliable. \nEthics Committee Approval: IRB oversight waived. \nFunding for this study: Not applicable. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 207  \nAuthor Disclosures: \nGopal Avinash: Employee: GE healthcare \nTao Tan: Employee: GE healthcare \nMate Fejes: Employee: GE healthcare \nLehel Ferenczi: Employee: GE healthcare \nBipul Das: Employee: GE healthcare \nPál Tegzes: Employee: GE healthcare \nSohan R. Ranjan: Employee: GE healthcare \nRavi Soni: Employee: GE healthcare \nRakesh Mullick: Employee: GE healthcare \n \nRPS 305-7 \nAI for COVID: an Italian multicentre study for the prediction of clinical \noutcomes in COVID-19 patients by applying artificial intelligence to chest \nx-ray examinations \nN. C. D'Amico¹, G. Valbusa², D. Sona³, M. Cellina ຾, E. Stellato຾, S. Panella຾,  \nC. Biasibetti຿, D. Cozzi๤, *M. Alì*຾; ¹Rome/IT, ²Colleretto Giacosa/IT, \n³Genova/IT, ຾Milan/IT, ຿Pavia/IT, ๤Florence/IT \n(marco.ali90@gmail.com) \n \nPurpose: The second wave of SARS-CoV-2 has arrived. Although major \nimprovements have been made in therapies, there are no ways to predict the \nclinical evolution of patients. We propose a machine learning (ML) and \nradiomics tools for predicting the clinical evolution of COVID patients from \nchest x-ray (CXR), integrating in the analysis blood and other clinical data \nincluding comorbidities obtained at admission. These tools aim to support: i) \nhigh risk patients management, and ii) hospital resources management (e.g. \nIntensive Care Unit (ICU) beds). \nMethods or Background: CXR images and clinical data of 823 COVID19-\npatients were collected from a network of Italian hospitals. According to their \nrequired treament and outcome, patients were divided into two groups: mild \n(no ventilatory support) and severe (non-invasive ventilation support or ICU, or \ndead). Images and clinical data were analyzed using 3 ML methods and \nradiomics: support vector machine (SVM), logistic regression (LR) and decision \ntrees (DT). Model were validated with 10-fold and centre-wise cross-validation. \nResults or Findings: Females (32%) were significantly older than males: 70 \n(57–80) vs 64 (53–74) years. 87% of patients had at least one comorbidity. \nSignificant differences between severe and mild groups were: Age (years): 70 \n(60–79) vs 60 (49–72), LDH (U/L): 405 (310-527) vs 271 (214-323), O2 (%): 92 \n(87-96) vs 96 (94-98), D-dimer: 820 (438-2056) vs 549 (262-909) and others. \nDistributions were reported as median and interquartile range. The 3 predictive \nmodels based on SVM, LR and DT showed 74%, 75%, 65% and 73%, 75%, \n60% accuracy with 10-fold and center-wise crossvalidation respectively. \nConclusion: ML applied to CXR images and clinical data showed robust \nresults in predicting COVID-19 patients outcome. Raw data will be made open-\naccess to the scientific community. \nLimitations: Retrospective design \nEthics Committee Approval: Approval was obtained on 7.APR.2020 \nFunding for this study: None \nAuthor Disclosures: \nDiego Sona: Nothing to disclose \nGiovanni Valbusa: Nothing to disclose \nMarco Alì: Nothing to disclose \nElvira Stellato: Nothing to disclose \nSilvia Panella: Nothing to disclose \nMichaela Cellina: Nothing to disclose \nNatascha Claudia D'Amico: Nothing to disclose \nDiletta Cozzi: Nothing to disclose \nCarla Biasibetti: Nothing to disclose \n \n \nResearch Presentation Session: Artificial \nIntelligence & Machine Learning \nRPS 405 \nAI in neuroradiology \nRPS 405-1 \nTowards a comprehensible convolutional neural network for the \ndetection of Alzheimer’s disease in magnetic resonance images \n*D. Cantré*, M. Dyrba, M. Hanzig, M-A. Weber, S. Teipel; Rostock/DE  \n(daniel.cantre@med.uni-rostock.de) \n \nPurpose: Convolutional neural networks (CNN) achieve high diagnostic \naccuracy for detecting Alzheimer’s disease (AD) dementia based on MRI \nscans. However, they are not yet applied in clinical routine, one reason being \nlack of suitable methods for model comprehensibility. Recently developed \nmethods for deriving CNN relevance maps may facilitate model \ncomprehensibility through visualization with high spatial resolution. \nMethods or Background: We trained a CNN for the detection of AD in N=663 \nT1-weighted MPRAGE MRI scans of patients with AD or mild cognitive \nimpairment (MCI) and evaluated the accuracy of the models via cross-\nvalidation, and in three further independent samples, including in total N=1655 \ncases. For intuitive model inspection, we implemented a web-interface with \ninteractive visualization of 3D CNN relevance maps. Finally, we evaluated the \nassociation of relevance scores and hippocampus volume to validate the \nclinical utility of this approach. \nResults or Findings: We reached excellent group separation for AD vs. \ncontrols with an AUC•0.92 and lower results for MCI vs. controls with an \nAUC§0.75 across three independent datasets. Relevance maps indicated that \nhippocampal atrophy was considered the most informative region for AD \ndetection by the CNN, with additional contributions from atrophy in other \ncortical and subcortical regions. Relevance scores within the hippocampus \nwere highly correlated with hippocampal volume, with a Pearson correlation of \nr§-0.81. \nConclusion: The strong correlation of hippocampus relevance scores and \nhippocampus volume, as well as the performance achieved in independent \nsamples, indicate a high validity of the CNN models. The relevance maps \nindicating discriminative brain regions, as visualized by our dedicated interface, \nhighlighted atrophy in regions we expected a-priori. Given that the CNN \nmodels were learnt purely data-driven, based on the MRI scans and diagnosis \nlabels, this strengthens the comprehensibility of the models. \nLimitations: N.a. \nEthics Committee Approval: Positive \nFunding for this study: N.a. \nAuthor Disclosures: \nMartin Dyrba: Nothing to disclose \nStefan Teipel: Nothing to disclose \nMoritz Hanzig: Nothing to disclose \nMarc-André Weber: Nothing to disclose \nDaniel Cantré: Nothing to disclose \n \nRPS 405-4 \nDetection of ischaemic stroke presence and classification of territorial \ntype in diffusion-weighted MRI by deep learning \n*I. Ö. Koska*, Y. K. K. Çetino÷lu, M. E. Uluç, M. A. Selver, M. F. Gelal; \nIzmir/TR  \n(ozgurkoska@icloud.com) \n \nPurpose: Experimenting with ischemic stroke detection and territorial \nclassification task using our own institutional data by using deep learning \nMethods or Background: A total of 421 diffusion magnetic resonance images \nof 271 patients with acute stroke and 150 normal cases obtained between \nJanuary 2017 and April 2020 were included in the study. A stroke diagnosis \ndataset was created with 900 slices with stroke and 900 normal slices. In the \nclassification of stroke according to vascular territories, 1717 positive slices are \nobtained and divided into three classes as middle cerebral artery (MCA) \ninfarction, posterior circulation (PC) infarction, and border zone (BZ) infarction. \nMobileNetV2 and EfficientNet-B0 CNN architectures were selected for the \ntraining of datasets. \nResults or Findings: In the diagnosis of ischemic stroke, an accuracy of 96% \nwas achieved with MobileNetV2 and 93% with EfficientNet-B0 . In the \nclassification of stroke as MCA, PC or BZi, 93% accuracy was achieved with \nthe MobileNetV2 and 87% with the EfficientNet-B0 . Sensitivity, specificity and \nPPV of MobileNetV2 were 98%, 93.5%, and 88.29% for MCA infarction group, \n92%, 98.5%, and 96.84% for PC infarction group, 89%, 97,5%, and 94,68% for \nBZ infarction group, respectively. Sensitivity, specificity and PPV of \nEfficientNet-B0 were 98%, 93.5%, and 88.29% for MCA infarction, 92%, \n98.5%, and 96.84% for PC infarction, 89%, 97,5%, and 94,68% for BZ \ninfarction, respectively. \nConclusion: This study showed that CNN models are successful methods that \ncan be used both in the detection of acute stroke and stroke classification \naccording to vascular territories. \nLimitations: All the datasets were obtained from single institution, this may \nintroduce some selection bias. Annotation of the data is a labor intensive \nprocess. In the limited time settings we could not obtain ACA infarcts \nsegmentation maps. \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nMustafa Alper Selver: Nothing to disclose \nYusuf Kenan KENAN Çetino÷lu: Nothing to disclose \nIlker Özgür Koska: Nothing to disclose \nMustafa Fazil Gelal: Nothing to disclose \nMuhsin Engin Uluç: Nothing to disclose \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 208  \nRPS 405-5 \nMultivariable diagnostic prediction model to detect hydrocephaly from \nT2-weighted MRI radiomics and conventional features with artificial \nneural networks in colloid cysts \nB. Hoúgören Atalay, *M. B. Do÷an*, M. B. Eser; Istanbul/TR \n(mbilaldogan@hotmail.com) \n \nPurpose: We aim to train neural networks to detect hydrocephaly in patients \nwith colloid cyst based on T2 weighted MRI radiomics. \nMethods or Background: This retrospective model development study \nincluded a cohort of 40 patients with colloid cysts in one tertiary university \nhospital. The mean patient age was 54.08±16.57 years, and 25/40 (62.5%) \nwere women. We segmented cysts on axial T2 weighted MRI, and evaluated \nconventional features based on the colloid cyst risk score (i.e., patient age, \nheadache, FLAIR hyperintensity, dimensions, location of the cyst). Predictors \nwere identified as radiomics features (n = 851) and conventional features (n = \n10). Feature selection was based on coefficient variance (CoV), variance \ninflation factor (VIF), and LASSO regression analysis. The outcome was \nidentified as hydrocephaly (11/40, 27.5%). Models were developed with \nartificial neural networks (ANN) with three diagnostic prediction models. The \nfirst model included radiomics features, the second model included \nconventional features, and the third model included all of the features. Internal \nvalidation was performed using bootstrapping and cross-validation. \nResults or Findings: The 779 of 851 features were eliminated with CoV \nanalysis (> 0.15). Another 23 features were eliminated by VIF analysis due to \ncollinearity. Most of the radiomics features were found to be unstable (n = 802, \n94%). Conventional features detected hydrocephaly with AUC = 0.87, p < \n0.001, sensitivity: 82%, specificity: 93%. Radiomics predicts hydrocephaly with \nAUC = 0.88, p < 0.001, sensitivity: 92%, specificity: 97%. Third model’s AUC \nwas 0.99, p <0.001, sensitivity: 91%, specificity: 100%. \nConclusion: This study was successful in training neural networks that can \ndetect hydrocephaly on patients with colloid cysts. \nLimitations: The small sample size is the limitation of this study. Studies \ninvolving a larger population are required to confirm these results fully. \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nBaúak Hoúgören Atalay: Nothing to disclose \nMehmet Bilgin Eser: Nothing to disclose \nMahmut Bilal Do÷an: Nothing to disclose \n \nRPS 405-6 \nThe predictive power of MRI VASARI features for identifying the mutation \nstatus of multiple genes in glioblastoma using machine learning \nalgorithms \n*A. Haddadi Avval*¹, G. Hajianfar², S. Mostafaei³, M. Oveisi ຾, I. Shiri຿, H. Zaidi຿; \n¹Mashhad/IR, ²Tehran/IR, ³Kermanshah/IR, ຾Vancouver, BC/CA, ຿Geneva/CH \n(atlas.ha78@gmail.com) \n \nPurpose: Several gene mutations have been shown to be associated with the \nprognosis of patients with glioblastoma multiforme (GBM). We aimed to \nevaluate the predictive power of MRI-based features, named Visually \nAccessible Rembrandt Images (VASARI) in the mutational status of the tumor \ngenes using machine learning (ML). \nMethods or Background: MR images of 188 patients along with their \ndemographic and clinical data (e.g. tumor biopsy results and mutation status of \nfive genes) were obtained. The data were randomly split into 80% and 20% as \ntraining and testing datasets, respectively. We defined a set of 54 features \nutilizing VASARI features. the selected features with the most important values \nand highest rankings were depicted using principal component analysis (PCA), \nRandom Forest, support vector machine (SVM), and the Chi-square test. Our \nmultivariate analysis involved 16 different ML algorithms applied to the whole \nfeature set to extract the area under the ROC curve (AUC), sensitivity, and \nspecificity for assessing models’ performance. \nResults or Findings: The enhancement quality, proportion enhancing, and \nlesion size feature appeared as the most frequent among our ranking lists \ngenerated through feature selection methods in the mutation prediction of each \nfive genes. Among ML classifiers, SVM (AUC: 0.68), QDA (AUC: 0.60), \nAdaBoost (AUC: 0.70), MLP (AUC: 0.68), and Decision Tree (AUC: 0.66) \nclassifiers obtained the highest AUC for the prediction of the mutation status in \nATRX, CIC, EGFR, TP53 and 1p19q deletion status, respectively. \nConclusion: Our study demonstrated that machine learning helps in the \ndetection of mutant genes in GBM tumors. Understanding tumor genomics \nenables better management and prognostication of patients with glioblastoma. \nLimitations: Our limitations include a small sample size and a lack of external \nvalidaiton. \nEthics Committee Approval: Not applicable \nFunding for this study: Swiss National Science Foundation under grant \nSNRF 320030_176052 \n \n \nAuthor Disclosures: \nShayan Mostafaei: Nothing to disclose \nAtlas Haddadi Avval: Nothing to disclose \nGhasem Hajianfar: Nothing to disclose \nHabib Zaidi: Nothing to disclose \nMehrdad Oveisi: Nothing to disclose \nIsaac Shiri: Nothing to disclose \n \nRPS 405-7 \nApplication of deep learning for a reliable MRI-based diagnosis for \nprogressive supranuclear palsy (PSP) \nJ-E. Meissner¹, P. Mann¹, H. J. Michaely², *J. R. Opalka*¹, A. Lemke¹; \n¹Berlin/DE, ²Karlsuhe/DE \n(j.opalka@mediaire.de) \n \nPurpose: To quantify the performance of a new Deep Learning (DL)-based \nalgorithm in differentiating Progressive Supranuclear Palsy (PSP) patients from \nhealthy individuals and patients with Parkinson’s disease (PD). \nMethods or Background: Quantitative brain volumetry was carried out with \nour new DL-based algorithm. It was tested on 248 patients that consist of 221 \nhealthy patients (age 61.3y±10.1y, source: Parkinson’s Progression Markers \nInitiative, PPMI), 46 patients with confirmed PD (age 64.2y±8.7y, source: \nPPMI) and 11 patients with confirmed PSP (age 68.8y±8.4y, source: internal). \nImages were acquired on 1.5T/3.0T MR-scanner using 3D-T1w images. Brain \nvolumetry and quantitative comparison against a normal model was performed \nfor: whole brain, grey&white matter, frontal, parietal, occipital, temporal lobe, \nhippocampus, mesencephalon, pons and all ventricles. Furthermore, the \nmidbrain-to-pons-ratio (MtPR) was calculated in 3D. Performance was tested \nwith respect to the algorithm's ability to correctly identify (i) PSP against \nhealthy patients and (ii) PSP against those with confirmed PD based on \npercentiles. For that, ROC was used to calculate the corresponding AUC and \nsensitivity/specificity on the best performing regions. \nResults or Findings: In the case of (i), calculations yielded highest AUC for: \nmesencephalon (0.944+/-0.049) and 3D MtPR (0.896+/-0.129) while for (ii), \ncalculations yielded highest AUC for: mesencephalon (0.915+/-0.084) and the \noccipital lobe (0.893+/-0.085). Resulting sensitivity/specificity calculations on \nthe best performing region yielded values of 0.91/0.89 for (i) and of 0.91/0.87 \nfor (ii). \nConclusion: We successfully applied a DL approach to correctly identify PSP \npatients against healthy and PD patients. Our algorithm is comparable to the \nconventional 2D segmentation where both a reduced mesencephalon and \nMtPR are signs for PSP (NEUROLOGY_2005;64:2050–2055). In combination \nwith a fast evaluation (<4mins) our algorithm is a promising tool to aid in the \ndiagnosis of PSP in clinical routine. \nLimitations: No \nEthics Committee Approval: No \nFunding for this study: No \nAuthor Disclosures: \nJan-Eric Meissner: Employee: mediaire GmbH \nPhilipp Mann: Employee: mediaire GmbH \nJens Ruediger Opalka: Employee: mediaire GmbH \nAndreas Lemke: CEO: mediaire GmbH \nHenrik J Michaely: Shareholder: mediaire GmbH \n \nRPS 405-8 \nAneurysmal subarachnoid haemorrhage: deep learning assessment vs \nradiologist in aneurysm size and volume \n*L. Pennig*, U. C. I. Hoyer, C. E. S. Zaeske, R. Shahzad, M. Perkuhn,  \nM. Schlamann, C. Kabbasch, J. Borggrefe, L. Goertz; Cologne/DE \n(lenhard.pennig@uk-koeln.de) \n \nPurpose: To investigate the potential clinical performance of deep learning \nenabled fully automatic segmentation of aneurysms in aneurysmal \nsubarachnoid hemorrhage (aSAH) on computed tomography angiography \ncompared to radiologists. \nMethods or Background: In this retrospective single-center study, 3 deep \nlearning models (DLMs) were trained on 68 patients with 79 aneurysms treated \nfor aSAH (2016-2017) with their outputs being combined using ensemble \nlearning (DLM-Ens). Further, the DLM-Ens was evaluated on an independent \ntest set of 104 patients treated for aSAH between 2013 and 2015 on which it \nperformed 3D voxel-wise segmentations of aneurysms. Two radiologists with \nfour (R1) and two years (R2) of experience in diagnostic neuroradiology \nmanually measured the largest diameter of aneurysms in the test set in three \ndimensions. Correlations between manual measurements and deep learning \ngenerated segmentations were calculated using Pearson’s correlation \ncoefficient (r). \nResults or Findings: In the test set, the DLM-Ens segmented 105 of 126 \naneurysms (detection sensitivity of 83%) accurately. Considering the \nsegmented aneurysms, there was a strong correlation for maximum diameter \nof aneurysms between the DLM (mean 6.2 ± 5.4 mm) and manual \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 209  \nmeasurements (R1: 6.4 ± 2.6 mm, r=0.739; R2: 6.6 ± 2.5 mm, r=0.751), which \nwas slightly lower than correlation between readers (r=0.868). Aneurysm \nvolume correlated even stronger between deep learning generated \nsegmentations (mean 124.6 ± 182.9 mm3) and volumes calculated based on \nmanual measurements (R1: 132.1 ± 185.9 mm3, r=0.898; R2: 134.7 mm3, \nr=0.911), which was comparable to interreader correlation (r=0.934). \nConclusion: Compared to human measurements, deep learning provides \nstrong correlation of maximum diameter and volume of aneurysms. Hence, it \nmay be of valuable assistance to the treating physician in patients with aSAH, \nfor which accurate 3D geometrical characterization of aneurysms is required \nfor treatment planning. \nLimitations: Retrospective. \nEthics Committee Approval: Approved. \nFunding for this study: N/a. \nAuthor Disclosures: \nRahil Shahzad: Employee: Philips Healthcare \nChristoph Kabbasch: Nothing to disclose \nLenhard Pennig: Research/Grant Support: Philips Healthcare \nCharlotte Elisabeth Sigrid Zaeske: Nothing to disclose \nJan Borggrefe: Speaker: Philips Healthcare \nUlrike Cornelia Isabel Hoyer: Nothing to disclose \nLukas Goertz: Nothing to disclose \nMarc Schlamann: Nothing to disclose \nMichael Perkuhn: Research/Grant Support: Philips Healthcare \n \nRPS 405-9 \nClinical performance of a deep learning model for detection of aneurysms \nin subarachnoid haemorrhage compared to human readers \n*L. Pennig*¹, U. C. I. Hoyer¹, A. Krauskopf², R. Shahzad¹, M. Perkuhn¹,  \nM. Schlamann¹, C. Kabbasch¹, J. Borggrefe¹, L. Goertz¹; ¹Cologne/DE, \n²Düsseldorf/DE \n \nPurpose: To investigate the potential clinical use of a deep learning model \n(DLM) for fully automatic detection of aneurysms in patients with aneurysmal \nsubarachnoid hemorrhage (aSAH) on computed tomography angiography by \ncomparing and merging its diagnostic performance with human readers. \nMethods or Background: In this retrospective single-center study, three \ndifferent DLMs based on DeepMedic were trained on 68 patients with 79 \naneurysms treated for aSAH (2016-2017) with their outputs being combined \napplying ensemble learning (DLM-Ens). The DLM-Ens was evaluated on an \nindependent test set consisting of consecutive patients treated for aSAH \nbetween 2013 and 2015. Ground truth (GT) of the test set without annotations \nwas presented to three blinded radiologists (reader 1: 13, reader 2: 4, and \nreader 3: 3 years of experience in diagnostic neuroradiology). \nResults or Findings: One-hundred-and-twenty-six aneurysms (mean \ndiameter: 6.1±5.4 mm) of 104 patients (mean age: 55.4±14.3 years, 66 \nfemales) comprised the GT of the test set. With a sensitivity of 83.3%, the \nDLM-Ens achieved to human readers (reader 1: 91.2%, reader 2: 86.5%, and \nreader 3: 86.5%; P=.313) comparable sensitivity, which showed a moderate \ninterrater agreement (Fleiss ț of 0.502). When combining the findings of \nhuman readers with deep learning generated detections, sensitivity increased \nto nearly 100% (reader 1: 97.6%, reader 2: 97.6%, and reader 3: 96.0%; \nP=.024) resulting in an almost perfect interrater agreement (Fleiss ț of 0.878). \nConclusion: In aSAH, DLM-Ens detects aneurysms with to human readers \ncomparable sensitivity and significantly increases their detection rate to almost \n100% while leading to an almost perfect interrater agreement. Hence, it \nprovides a valuable adjunct to physicians’ performance in emergency imaging \nrequiring fast and accurate diagnosis to optimize patient treatment. \nLimitations: Retrospective. \nEthics Committee Approval: Approved. \nFunding for this study: N/a. \nAuthor Disclosures: \nRahil Shahzad: Employee: Philips Healthcare \nChristoph Kabbasch: Nothing to disclose \nLenhard Pennig: Research/Grant Support: Philips Healthcare \nJan Borggrefe: Speaker: Philips Healthcare \nAlexandra Krauskopf: Nothing to disclose \nUlrike Cornelia Isabel Hoyer: Nothing to disclose \nLukas Goertz: Nothing to disclose \nMarc Schlamann: Nothing to disclose \nMichael Perkuhn: Employee: Philips Healthcare \n \n \n \n \n \n \n \n \n \nRPS 405-11 \nK-space based deep learning reconstruction empowers 50% acceleration \nof MR spine imaging: a prospective multicentre multireader trial \n*L. N. Tanenbaum*¹, S. Bash², M. Thomas³, M. Fung³, M. Lebel³; ¹New York, \nNY/US, ²Woodland Hills, CA/US, ³Waukesha, WI/US \n(nuromri@gmail.com) \n \nPurpose: This prospective, multicenter, multireader study evaluates the impact \non perceived image quality of 50% scan-time reduced spine MRI reconstructed \nwith deep learning (DL). \nMethods or Background: With IRB approval and patient consent, 50 \nconsecutive patients underwent standard-of-care (SOC) and accelerated \n(FAST) spine MRI exams acquired from a GE 3T Architect scanner. DL \nprocessing of the FAST scan data set (FAST-DL) was performed using an \nFDA-cleared CNN based, DL image enhancement product - Air Recon DLTM. \nThe k-space based tool offers powerful denoising, sharpness enhancement \nand elimination of some artifacts such as truncation ringing. Two \nneuroradiologists were presented with the different image series as paired \nside-by-side datasets. Datasets were blinded and randomized in sequence and \nleft-right display order. Image features were preference rated on a 5-point \nLikert scale. \nResults or Findings: FAST-DL was qualitatively better than SOC for \nperceived signal-to-noise ratio (SNR), sharpness and artifacts. FAST-DL and \nSOC were better than FAST for all assessed features. No anatomic aberration \nor data loss was observed on the DL processed images. \nConclusion: DL enables 50% spine MRI scan time reduction as well as what \nradiologists perceive as enhanced image quality with benefits in SNR, image \nsharpness, and artifact reduction over SOC and FAST images without DL \nprocessing, providing gains in efficiency and portending practice utility for \nroutine use. \nLimitations: Small sample size. Limited numbers of cervical and thoracic \nexams. \nEthics Committee Approval: IRB approved. \nFunding for this study: None \nAuthor Disclosures: \nMarc Lebel: Employee: GE Heathcare \nMary Thomas: Employee: GE Heathcare \nSuzie Bash: Nothing to disclose \nLawrence N Tanenbaum: Speaker: GE Heathcare \nMaggie Fung: Employee: GE Heathcare \n \nRPS 405-12 \nDeep learning enables 60% accelerated volumetric brain MRI while \npreserving quantitative performance: a prospective multicentre \nmultireader trial \n*S. Bash*¹, C. Airriess², L. Wang³, G. Zaharchuk ຾, E. Gong³, T. Zhang³,  \nS. Dupont³, A. Shankaranarayanan³, L. N. Tanenbaum¹; ¹Woodland Hills, \nCA/US, ²San Diego, CA/US, ³Menlo Park, CA/US, ຾Stanford, CA/US \n(suzie.bash@radnet.com) \n \nPurpose: Evaluating the impact on both image quality and quantitative \nconsistency (NeuroQuant™) of 60% accelerated volumetric MRI scans \nprocessed with a DICOM-based deep learning (DL) tool (SubtleMR™) \ncompared to standard of care (SOC). \nMethods or Background: 40 subjects underwent brain MRI on 6 scanners (5 \ninstitutions). SOC and accelerated (FAST) datasets were acquired for each \nsubject. FAST scans were enhanced with DL processing (FAST-DL). Both \nSOC and FAST-DL were subjected to quantitative analysis with NeuroQuant™ \nand classification by a neuroradiologist into disease categories. Quantitative \nbiomarker concordance of SOC and FAST-DL was assessed. For subjective \nassessment, randomized, side-by-side, multiplanar datasets (360 series) were \npresented blinded to 2 neuroradiologists. Images were preference rated on a \n5-point Likert scale for apparent signal-to-noise ratio, image sharpness, \nartifacts, lesion conspicuity, image contrast, and gray-white differentiation. \nResults or Findings: FAST-DL was superior to SOC for quality across all \nfeatures despite 60% scan time reduction (p<0.05). Both FAST-DL and SOC \nwere superior to FAST for all quality features. There was high inter-reader \nagreement of quality ratings. Paired T-test analysis demonstrated excellent \nagreement of quantitative data between the SOC and FAST-DL datasets. \nLinear Regression and Bland-Altman analysis demonstrated strong \nconcordance in quantitative values across conditions (normal, MCI, \nAlzheimer's). There was 100% agreement in disease classification for the SOC \nand FAST-DL datasets (n=29 normal/MCI and n=11 dementia). \nConclusion: DL reconstruction allows 60% scan time reduction while \nmaintaining high volumetric quantification accuracy, consistent clinical \nclassification, and superior image quality compared with SOC. This trial \nsupports the reliability, efficiency, and utility of DL based enhancement for \nquantitative imaging. Shorter scan times may boost utilization of volumetric \nquantitative MRI in routine clinical settings. \nLimitations: Evaluation of only one quantitative imaging product. Small \nsample size. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 210  \nEthics Committee Approval: IRB approved \nFunding for this study: Subtle Medical and Cortechs \nAuthor Disclosures: \nTao Zhang: Employee: Subtle Medical \nGreg Zaharchuk: Founder: Subtle Medical \nEnhao Gong: Founder: Subtle Medical \nSuzie Bash: Advisory Board: Subtle Medical and Coretechs \nLong Wang: Employee: Subtle Medical \nChris Airriess: CEO: Coretechs \nLawrence N Tanenbaum: Advisory Board: Subtle Medical \nSara Dupont: Employee: Subtle Medical \nAjit Shankaranarayanan: Employee: Subtle Medical \n \nRPS 405-13 \nAutomated segmentation and reconstruction of the optic nerves and \nchiasm in MR images using deep learning \n*Y. Zhang*, C. Chen, J. Xu; Chengdu/CN \n \nPurpose: To develop and evaluate a novel automatic algorithm for the \nsegmentation and reconstruction of the optic nerves and chiasm from MR \nimages. \nMethods or Background: In this retrospective study, a convolutional neural \nnetwork based on the 3D U-Net architecture was trained in a data cohort of \n4800 three-dimensional T2-weighted images and was validated in 800 MR \nimages. Optic nerves and chiasm were manually segmented by experienced \nradiologists for comparison. Performance of the automatic segmentation was \nevaluated with Dice coefficient. Volume rendering was employed to \nautomatically reconstruct the optic nerves and chiasm. \nResults or Findings: Compared with the manual segmentation, the 3D U-Net \nmodel represented feasible performances with Dice coefficients of 0.75 in the \nvalidation set. Moreover, the volume rendering model reconstructed the optic \nnerves and chiasm with the sophisticated surface and clearly defined \nstructures. \nConclusion: A novel and accurate method based on deep learning technology \nhas been proposed for the automatic segmentation and reconstruction of the \noptic nerves and chiasm in MR images. \nLimitations: There are several limitations in the present study. First, the study \ncohort was relatively small. This study is currently being continued with larger \nMR images datasets, and it is expected to generate more accurate and robust \nmodels. Second, the MR images included were all collected from a single \ninstitution, and our results need to be validated in external datasets in the \nfuture. \nEthics Committee Approval: This retrospective study was approved by Ethics \nCommittee of Sichuan University. \nFunding for this study: This work was supported by 1.3.5 project for \ndisciplines of excellence, West China Hospital, Sichuan University \n(ZYJC18007); Key research and development project of science and \ntechnology department of Sichuan Province (2019YFS0392). \nAuthor Disclosures: \nYang Zhang: Nothing to disclose \nChaoyue Chen Chaoyue Chen: Nothing to disclose \nJianguo Xu: Nothing to disclose \n \nRPS 405-14 \nMultiparametric deep learning model segmentation for glioblastoma on \nmulti-institutional clinical trial data sets: feasibility, opportunities and \nchallenges \n*M. V. Knopp*¹, R. Shahzad², C. Nealer¹, R. Jacko¹, P. Robson¹, J. Gorski¹,  \nM. M. Knopp³, M. Ahrens຾, M. Perkuhn²; ¹Columbus, OH/US, ²Cologne/DE, \n³Munich/DE, ຾Aachen/DE \n(knopp.16@osu.edu) \n \nPurpose: To assess the feasibility of deep-learning model based automated \nglioblastoma tumor segmentation algorithms on large multi-institutional \naggregated clinical trial data sets. To demonstrate both opportunities as well as \nchallenges for the assessment in multi-site clinical trials. \nMethods or Background: We serve as the imaging core service (IROC) for \nthe NCI NCTN to collect, curate imaging studies and support utilization of \nanalytical tools. Within this secure framework, coded brain MRI imaging studies \nacquired in several neuro-oncologic clinical trials of patients diagnosed with \nglioblastoma (GB) were aggregated and 3423 imaging timepoints included. \nUsing a scalable environment orchestrated via a portal system several deep \nlearning models (DLM) utilizing T1w, T2w, FLAIR, and CE T1w images with co-\nregistration, brain mask segmentation, normalization and resampling, \nsegmented the GB tumor compartments. \nResults or Findings: Inconsistencies and variability in MR acquisition and \nlabeling were extensive. All trained DLM tools were successfully applied. A \nmulti reader review assessed the segmentation performance using a likert \nscale and feature descriptors. Performance of the tools were consistently lower \nthan reported by the developers. Evaluating DLM tools on diverse multi-center \nbased dataset appears essential to confirm technical feasibility and \nperformance. \nConclusion: The use of DLM model for segmentation of glioblastoma tumor \nfeatures is feasible even in highly diverse large-scale data sets of multi-\ninstitutional trials. More consistent MRI acquisitions and labeling is essential \nand can be ensured by appropriate QC approaches. The ability to upscale \nDLM tools for glioblastoma segmentation to a national clinical trial environment \nwas demonstrated. \nLimitations: DLM based segmentation dependent on the quality of the original \nannotations and data sets. This highlights that input QC as well as data \ndiversity for development is essential and should be disclosed. \nEthics Committee Approval: Approved 2017H0429, 2013H0304 \nNCT03490656 \nFunding for this study: ODSA TECH 13-060 Award, NCI 5U24CA180803 \nAuthor Disclosures: \nRahil Shahzad: Employee: Philips \nConner Nealer: Nothing to disclose \nRichard Jacko: Nothing to disclose \nMarcel M Knopp: Nothing to disclose \nJustin Gorski: Nothing to disclose \nParker Robson: Nothing to disclose \nMichael Vinzenz Knopp: Nothing to disclose \nMartin Ahrens: Employee: Philips \nMichael Perkuhn: Employee: Philips \n \nRPS 405-2 \nVolumetric analysis of tumour compartments on longitudinal MRI of \nglioblastoma patients using deep learning \n*M. Perkuhn*, R. Shahzad, F. Thiele, M. Schlamann, C. Kabbasch,  \nJ. Borggrefe; Cologne/DE \n(michael.perkuhn@uk-koeln.de) \n \nPurpose: In patients with glioblastoma (GB), MRI is essential for diagnosis, \ntreatment planning and treatment monitoring. Volumetric assessment of tumor \nburden is expected to improve patient management. However, manual \nsegmentation is time-consuming and suffers from high interrater-variability. \nThis study aimed to evaluate deep learning models (DLM’s) for fully-automatic \nGB segmentation over the course of treatment. \nMethods or Background: 332 studies from 41 subjects were included, each \nsubject had a pre-operative, a post-operative, and multiple follow-up studies. \nAll studies comprised T1, T2, FLAIR, and contrast-enhanced (CE) T1 \nsequences. Edema (ED), contrast-enhancing tumor (CET), necrosis (NC) and \ntumor-cavity (TC) were manually delineated by experts using consensus \nreading. Multi-parametric, multi-label, 3D CNN DLM’s were trained and \nevaluated according to treatment stage and CET volumes. \nResults or Findings: On pre-operative studies the average CET volume was \n27.3±18.2ml. The DLM detected CET with accuracy=100% and \ndice=0.78±0.15; ED with accuracy=100%, dice=0.86±0.1 and NC \naccuracy=85%, dice=0.56±0.31. Volume correlation (r) was 0.90(CET), \n0.96(ED) and 0.84(NC). On post-operative studies 28 subjects had confirmed \nCE residual tumor (CE-RT) with a volume of 0.86±1.93ml. DLM detected CE-\nRT >0.5ml(n=16) with accuracy=82%; >1ml(n=12) accuracy=94%; >2ml(n=6) \naccuracy=96%, dice=0.43±0.25(CE-RT>2ml). ED with accuracy=100%, \ndice=0.75±0.16(ED) and TC accuracy=96%, dice=0.64±0.22(TC). Volume \ncorrelations (r) was 0.71(CE-RT), 0.97(ED) and 0.84(TC). On follow-up, 242 \nstudies had confirmed CE recurrent tumors with a volume of 6.1±13.8ml. DLM \ndetected CET >0.5ml(n=207) with accuracy=78%; >1ml(n=168), \naccuracy=76%; >2ml(n=113) accuracy=91%, dice=0.53±0.22(CET>2ml). ED \nwith accuracy=100%, dice= 0.66±0.19 and TC/NC accuracy=91%, \ndice=0.48±0.27. Volume correlations (R) were 0.80(CET), 0.91(ED), \n0.76(TC/NC). \nConclusion: Fully-automatic assessment of GB tumor compartments on \nroutine clinical data is possible with high correlation to manually traced \nvolumes. This approach could overcome the limitations of two-dimensional \ntracking and improve the radiologist’s workflow in GB assessment. \nLimitations: n/a \nEthics Committee Approval: The local ethics committee approved this \nretrospective study \nFunding for this study: n/a \nAuthor Disclosures: \nRahil Shahzad: Employee: Philips Healthcare \nChristoph Kabbasch: Nothing to disclose \nJan Borggrefe: Nothing to disclose \nFrank Thiele: Employee: Philips Healthcare \nMarc Schlamann: Nothing to disclose \nMichael Perkuhn: Employee: Philips Healthcare \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 211  \n \nResearch Presentation Session: Artificial \nIntelligence & Machine Learning \nRPS 505 \nAI in oncology \nRPS 505-2 \nSpatio temporal risk prediction of focal bone lesion evolution in multiple \nmyeloma \n*R. Licandro*¹, J. Hofmanninger¹, M. Perkonigg¹, S. Röhrich¹, M-A. Weber²,  \nM. Wennmann³, L. Kintzelé³, B. Menze¹, G. Langs¹; ¹Vienna/AT, ²Rostock/DE, \n³Heidelberg/DE  \n(roxane.licandro@meduniwien.ac.at) \n \nPurpose: The earliest possible detection of focal bone lesions is key to \nfacilitate timely treatment decisions in patients with Multiple Myeloma (MM). \nHere we propose a machine-learning based routine to assess the risk of MM \nprecursor bone regions to evolve towards focal lesions within a definable \ntimeframe in the future. \nMethods or Background: Longitudinal T1 weighted whole body MRI (wbMRI) \nof 63 patients were acquired with overall 170 annotated locations, which \nevolved to either diffuse or focal lesions. Here, we propose a methodology, \nwhich first automatically segments bones in wbMRI and subsequently predicts \nfuture focal lesion progression within the detected bone. The proposed network \narchitecture “Asymmetric Conditioned Cascade U-Net” identifies early \nsignatures of emerging lesions in dependence of the prediction time and \nvisualizes risk locations as full body risk score maps. \nResults or Findings: We evaluated the segmentation and predictive \nperformance in the thoracic (1) and pelvic/femoral (2) skeletal system. The \nbone segmentation performance reported a mean Dice Score of 0.67 (1) and \n0.78 (2). Baseline scans predicted new lesions in the follow up scan with a \nmean AUC of 0.82 (1) and 0.96 (2) and progressive lesions with a mean AUC \nof 0.94 (1) and 0.96 (2), respectively. \nConclusion: We propose an evolution risk predictor for both new and \nprogressive lesions based on a baseline scan and visualize associated high-\nrisk locations accordingly. Our findings indicate hidden imaging markers \nbeyond lesion size, currently used for categorization and risk stratification in \nMM, and that evolution trajectories of lesion progression can be encoded using \nthe proposed network. \nLimitations: We observed that partial volume artifacts and anomalous bone \nregions (without future lesion progression) are the main triggers for false \npositive predictions. \nEthics Committee Approval: Heidelberg EK \nFunding for this study: DFG (WE 2709/3-1 and ME 3511/3-1) and FWF \n(I2714-B31) \nAuthor Disclosures: \nGeorg Langs: Research/Grant Support: Novartis Pharmaceuticals Corporation \nShareholder: contextflow GmbH Research/Grant Support: Siemens \nHealthineers \nBjoern Menze: Nothing to disclose \nSebastian Röhrich: Consultant: contextflow GmbH \nJohannes Hofmanninger: Research/Grant Support: Siemens Healthineers \nMatthias Perkonigg: Research/Grant Support: Novartis Pharmaceuticals \nCorporation \nMarc-André Weber: Nothing to disclose \nMarkus Wennmann: Nothing to disclose \nLaurent Kintzelé: Nothing to disclose \nRoxane Licandro: Nothing to disclose \n \nRPS 505-3 \nA multi-institutional comparative effectiveness analysis of AI-assisted vs. \ncurrent practice methods for advanced cancer imaging evaluation \n*A. D. Smith*¹, B. Allen², A. Abou Elkassem¹, R. Mresh¹, S. Lirette³, A. Farag¹, \nM. Anderson¹, A. M. Khalaf¹; ¹Birmingham/US, ²Durham, NC/US,  \n³Jackson, MS/US  \n(andrewdennissmith@uabmc.edu) \n \nPurpose: To compare the effectiveness of artificial-intelligence (AI)-assisted \nvs. current practice methods for advanced cancer longitudinal imaging \nresponse evaluation. \nMethods or Background: For this multi-institutional retrospective study, 24 \nradiologists collectively interpreted body CT images in triplicate from 120 \nconsecutive patients with serial imaging of advanced cancer treated by \nsystemic therapy. Current-practice included manual tumor measurements and \ndictated text-based reports. For the AI-assisted method, custom software \nutilized AI for tumor measurement, anatomic labelling, and localization at follow \nup and automatically categorized tumor response per RECIST 1.1 and \ndisplayed longitudinal data in a graph, table, and key images. Oncologists \n(N=20) collectively reviewed 120 final reports in quadruplicate and categorized \nresponse. Comparative effectiveness metrics included: accuracy (agreement \nbetween oncologist and radiologist final response category), major errors, \nefficiency, and inter-observer agreement. A post-study survey of opinions was \nconducted. \nResults or Findings: The accuracy of the report impression was 77% for \ncurrent-practice and 100% for AI-assisted (p<0.001). Average percent of major \nerrors per time point was 27.5% (99/360) for current-practice and 0.3% (1/360) \nfor AI-assisted (p<0.001), corresponding to a 99% reduction. Average \nradiologist read times were 18.7 min for current-practice and 9.8 min for AI-\nassisted (p<0.001), with AI-assisted nearly twice as fast. Radiologist total \nagreement on final report response category was 52% (62/120) for current-\npractice and 75% (90/120) for AI-assisted (p<0.001), corresponding to a 45% \nrelative increase in inter-reader agreement. 96% of radiologists and 100% of \noncologists preferred the AI-assisted method and reporting. \nConclusion: AI-assisted imaging evaluation and reporting of advanced cancer \nlongitudinal response is more effective than current-practice methods with \nmanual measurements and text-based reports. \nLimitations: Source of CT images was from a single institution. \nEthics Committee Approval: IRB-approved study \nFunding for this study: Funded by the University of Alabama at Birmingham \nAuthor Disclosures: \nRafah Mresh: Nothing to disclose \nAhmed M Khalaf: Nothing to disclose \nAsser Abou Elkassem: Nothing to disclose \nMichael Anderson: Nothing to disclose \nAhmed Farag: Nothing to disclose \nAndrew Dennis Smith: Owner: Radiostics LLC Speaker: Canon Medical \nSpeaker: GE Grant Recipient: General Electric Owner: AI Metrics LLC \nSeth Lirette: Nothing to disclose \nBrian Allen: Shareholder: AI Metrics LLC \n \nRPS 505-4 \nMachine learning models applied to whole-body MRI in the staging of \ncancer: the MALIBO study \n*A. Fagan*¹, X. Li¹, S. A. Taylor¹, G. J. Wengert², E. Aboagye¹,  \nM. Investigators¹, A. Rockall¹; ¹London/UK, ²Vienna/AT \n(faganai@tcd.ie) \n \nPurpose: Whole-body MRI (WB-MRI) has been shown to have similar \naccuracy to standard staging for lung and colon cancer, but is more efficient \nand cost effective. It is, however, not widely performed, and can be time \nconsuming to report. The MALIBO study concerns the development of a \nmachine learning (ML) model in order to aid detection of primary cancer and \nmetastases on WB-MRI. \nMethods or Background: The model chosen was a convolutional neural \nnetwork (CNN), trained on 226 cases from the NIHR Streamline study. Expert \nand non-expert readers were provided with all available MRI sequences, and \nthe cases were read in a random order, both with and without ML output. \nResults or Findings: Clinical validation used 188 evaluable WB-MRI studies \n(including lung and colon cancer), 50 of which had metastatic disease. For \nexperienced readers, per-patient specificity and sensitivity for detection was \n86.2% and 66.0% with ML support, and 87.7% and 70% without support. For \ninexperienced readers, per-patient sensitivity with ML support was 73.3% and \n60% without. None of these results were statistically significant. ML assistance \nreduced WB-MRI read time by 1.95 minutes (95%CI:-3.05,-0.85;p=0.001). \nConclusion: In this first large study on the use of WB-MRI with machine \nlearning in the diagnosis and staging of colorectal and lung cancers, we have \nfound a reduction in reading time with ML assistance. Interestingly, there was \nno difference in diagnostic test accuracy. This work represents a significant first \nstep in the development of a complex machine learning algorithm for \ninterpretation of WB-MRI in oncological imaging. \nLimitations: The data set was heterogeneous (from 16 different centres). \nThere was also a relatively low number of metastatic lesions, which limited the \ntraining data. \nEthics Committee Approval: ICREC reference: 15IC2647. \nFunding for this study: Funding was from the NIHR (EME stream), funder \nreference number: 13/122/01 \nAuthor Disclosures: \nStuart Andrew Taylor: Nothing to disclose \nXingfeng Li: Nothing to disclose \nAisling Fagan: Nothing to disclose \nGeorg J Wengert: Nothing to disclose \nMalibo Investigators: Nothing to disclose \nEric Aboagye: Nothing to disclose \nAndrea Grace Rockall: Nothing to disclose \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 212  \nRPS 505-5 \nMagnetic resonance imaging (MRI) radiomic features to predict tumour \naggressiveness and outcomes in patients with endometrial cancer (EC) \n*J. Russell*, X. Li, D. Marcus, N. Soneji, S. Ghaem-Maghami, I. Lavdas,  \nE. Aboagye, N. Bharwani, A. Rockall; London/UK \n \nPurpose: The purpose of this study is to determine whether MRI radiomic \nfeatures can predict tumour aggressiveness and outcomes in patients with EC, \nthus determining treatment selection in a clinical setting. \nMethods or Background: In this ethically approved retrospective cohort \nstudy, a total of 445 patient scans were evaluated and divided into training and \nvalidation sets (80:20). Tumour volumes were manually segmented from T2-\nweighted sagittal MR images using the image segmentation tool ITK-SNAP. \nRadiomic features were extracted and delineated to predict (i) type, grade and \nstage of tumour, and (ii) overall survival and recurrence of EC. Twenty machine \nlearning algorithms were used to classify the features. Stratified five-fold cross \nvalidation was used to calculate accuracy and determine the best model. \nResults or Findings: In total, 969 radiomic features were extracted. Prediction \nof high-risk EC was 0.73 using a K(=5)nearest neighbours classifier (KNN) \nmodel. Prediction of EC type, grade (high versus low) and LVSI were 0.80, \n0.81 and 0.77 respectively. Five-year survival was predicted with almost 80% \naccuracy. 139 features (16 following least absolute shrinkage and selection \noperator (LASSO) regression) were significantly associated with progression-\nfree survival. \nConclusion: Results demonstrate that radiomic features derived from \npreoperative MRI studies are significantly associated with high-risk disease \nand reduced survival in EC. Prospective validation of this model will be \nrequired with larger datasets. It is hoped that prediction of high-risk histological \nfeatures, overall survival and recurrence in EC patients will translate into better \ntreatment selection. \nLimitations: Several limitations of the study include a lack of standardisation \nof MR scan parameters as well as intra- and inter-observer variability \nassociated with manual image segmentation. Five-year survival is also \ninfluenced by multiple patient and treatment factors that cannot be accounted \nfor by radiomic feature analysis. \nEthics Committee Approval: Granted \nFunding for this study: None \nAuthor Disclosures: \nIonnis Lavdas: Nothing to disclose \nNeil Dev Raju Soneji: Nothing to disclose \nXingfeng Li: Nothing to disclose \nJames Russell: Nothing to disclose \nSadaf Ghaem-Maghami: Nothing to disclose \nDiana Marcus: Nothing to disclose \nEric Aboagye: Nothing to disclose \nAndrea Grace Rockall: Nothing to disclose \nNishat Bharwani: Nothing to disclose \n \nRPS 505-6 \nDifferentiating between invasive and non-invasive breast carcinomas in \ndigital breast tomosynthesis using deep convolutional neural networks \n*D. Shimokawa*¹, K. Shibuya¹, K. Takahashi¹, T. Usuzaki¹, M. Kadowaki¹,  \nT. Fukuda², K. Oba², E. Takaya², T. Ueda¹; ¹Sendai/JP, ²Tokyo/JP \n(lucklmn7@icloud.com) \n \nPurpose: To develop a deep convolutional neural network to differentiate \ninvasive and non-invasive breast carcinoma from digital breast tomosynthesis \n(DBT). \nMethods or Background: Four hundred eighty-nine patients who were \nsuggested breast carcinoma on screening mammography, admitted and \nperformed DBT at St. Luke’s International Hospital from 2019/03/01-2019/8/31 \nwere enrolled. From 489 enrolled patients, 187 patients who were proved \npresence of breast carcinoma by needle biopsy and were performed surgery \nwere included in this study. Pathological results revealed 25% and 75% of the \npatients showed non-invasive and invasive breast carcinoma, respectively. \nXception (F. Chollet et al. IEEE Conference on Computer Vision and Pattern \nRecognition, 2017, pp. 1800-1807) was used for the AI model to differentiate \nnon-invasive and invasive breast carcinoma from DBT images. To assess \nperformance of the model, we used 5-fold cross-validation where 80% and \n20% data was applied for training and validation, respectively. In cross-\nvalidation assessment, the dataset was randomly shuffled in each training \nprocess. Each training process of cross-validation was repeated 5 times and \nthe average validation accuracy was calculated. \nResults or Findings: Average of the validation accuracy showed 0.902 (max: \n0.948, min: 0.850). \nConclusion: Our research suggested AI model can differentiate non-invasive \nand invasive breast carcinoma from DBT images, which is significantly \nassociated with outcome of breast carcinoma patients. \nLimitations: This study only enrolled limited number of patients. \nEthics Committee Approval: The institutional review board of Tohoku \nUniversity approved this study and waived the requirement for informed \nconsent. \nFunding for this study: This work was supported by JST CREST Grant \nNumber 17-171024528, Japan. \nAuthor Disclosures: \nKen Oba: Nothing to disclose \nEichi Takaya: Nothing to disclose \nDaiki Shimokawa: Nothing to disclose \nTakuya Ueda: Nothing to disclose \nToshinori Fukuda: Nothing to disclose \nMizuki Kadowaki: Nothing to disclose \nKiichi Shibuya: Nothing to disclose \nTakuma Usuzaki: Nothing to disclose \nKengo Takahashi: Nothing to disclose \n \nRPS 505-7 \nDifferentiation of solid renal masses based on radiomic features from \ncontrast-enhanced CT scan: a retrospective study \nC. Mosquera, *M. Aineseder*, F. N. Diaz, R. Lopez Grove, A. Beresnak,  \nS. Benitez, A. Jurado, P. Garcia Marchiñena, J. A. Ocantos; Buenos Aires/AR \n(martina.aineseder@hospitalitaliano.org.ar) \n \nPurpose: To develop and evaluate the performance of radiomic features \nprocessed with ML model for oncocytoma (ONC) and renal carcinoma (RCC) \ndifferentiation. \nMethods or Background: We included histologically proven cases of RCC \nand ONC from Jan/2015 to Dec/2017, from patients who underwent surgical \nresection and had a preoperative contrast-enhanced computed tomography \nscan acquired with standard protocol in unenhanced, corticomedullary, \nnephrographic, and excretory phases. For every mass we obtained a \nsegmentation mask in each contrast-phase and extracted 70 radiomic features \nfrom each mask, obtaining a total of 280 features per mass. Patients were split \ninto two independent sets: training(85%) and test(15%). The training set was \nused to adjust four Random Forest classification models corresponding to the \nfour contrast phases. We selected the best model by a hyperparameter grid \nsearch with 5-folds cross-validation on the training set. We calculated \ndiagnostic metrics on the test set, using the histological tumor type as a \nreference standard to assess performance. \nResults or Findings: Final dataset:104 RCC and 58 ONC, from 159 patients. \nWe observed that the median and the skewness of gray-level distribution \nacross the renal mass have a high influence on the model prediction. We \nevaluated the mean prediction score on 23 test samples, calculated as the \naverage over model outputs from the available contrast-phases on each \nsample. It showed an area under the curve of 0.96, with a sensitivity 1.00 and \nspecificity 0.83 for RCC diagnosis. \nConclusion: The differentiation between ONC/RCC is a challenging clinical \ntask that carries the risk of delivering unnecessary surgical procedures. The \ntechnique presented in this study could become a reliable non-invasive method \nto characterize renal lesions that would have relevant clinical value. \nLimitations: Retrospective study \nEthics Committee Approval: Ethics committee approved. \nFunding for this study: This study had no funding from any resource. \nAuthor Disclosures: \nFacundo Nahuel Diaz: Nothing to disclose \nAlberto Jurado: Nothing to disclose \nJorge Alberto Ocantos: Nothing to disclose \nSonia Benitez: Nothing to disclose \nRoy Lopez Grove: Nothing to disclose \nMartina Aineseder: Nothing to disclose \nAlejandro Beresnak: Nothing to disclose \nPatricio Garcia Marchiñena: Nothing to disclose \nCandelaria Mosquera: Nothing to disclose \n \nRPS 505-8 \nAdvanced deep learning approach to automatically segment malignant \ntumours and ablation zone in liver with contrast-enhanced CT \nX. Liu¹, K. He¹, *R. Shahzad*², R. P. Reimer², F. Thiele², J. Niehoff², A. Bunck², \nH. Zhang¹, M. Perkuhn²; ¹Changchun/CN, ²Cologne/DE \n(rahil.shahzad@uk-koeln.de) \n \nPurpose: To develop an automatic deep learning based method for \n(1)segmentation of liver tumors in arterial and venous phase for pre-treatment \nCT images, and (2)segmentation of liver and ablation zones in arterial and \nvenous phase for CT images after ablation treatment. Automatic and robust \nsegmentation of liver tumors and ablation zones would enable the evaluation of \ntreatment success \nMethods or Background: 252 CT images from 63 patients undergoing liver \ntumor ablation were included, four CT images for each patient (pre-treatment \nand post-treatment arterial/venous-phase). Ground truth segmentations for the \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 213  \nliver, tumors and ablation zone were manually performed by an experienced \nradiologist. Data was split into a training-set (48 patients) and test-set (15 \npatients). A 2D residual-attention Unet (RA-Unet) was trained to segment the \nliver. Then, a multi-scale patch-based 3D RA-Unet was trained for \nsegmentation of tumor and ablation zone. Image augmentations were used to \nincrease the amount of training samples. Transfer learning approach was \napplied to models pre-trained on 131 CT images from the MICCAI2017(LiTS). \nResults or Findings: On the independent test-set, the proposed method \nachieved an average dice of 0.96 and 0.92 for liver segmentation on arterial \nand venous phase, respectively . For tumor segmentation, the average dice \nwas 0.69. For tumors >0.5cm3, sensitivity=79%, FP’s/scan=0.4, dice=0.65 in \narterial phase; sensitivity=86%, FP’s/scan=0.6, dice=0.72 in venous phase. \nAverage volume of FP's was 1.63cm3, average volume of FN's was 1.10 cm3. \nFor ablation zone segmentation, sensitivity=90%, dice=0.83 in arterial phase, \nsensitivity=90%, dice=0.89 in venous phase. \nConclusion: The proposed deeplearning approach can provide automated \nsegmentation of liver tumors and ablation zones on multi-phase (arterial and \nvenous) and multi-time-point (before and after treatment) CT images, enabling \nquantitative evaluation of treatment success. \nLimitations: n/a \nEthics Committee Approval: The local ethics committee approved this \nretrospective study \nFunding for this study: n/a \nAuthor Disclosures: \nRahil Shahzad: Employee: Philips Healthcare \nXiaoming Liu: Nothing to disclose \nFrank Thiele: Employee: Philips Healthcare \nAlexander Bunck: Nothing to disclose \nMichael Perkuhn: Employee: Philips Healthcare \nHuimao Zhang: Nothing to disclose \nJulius Niehoff: Nothing to disclose \nRobert Peter Reimer: Nothing to disclose \nKan He: Nothing to disclose \n \nRPS 505-9 \nIncorporation of polymorphisms of SULF1 into a pre-treatment CT based \nmachine-learning radiomic model to predict the risk of platinum \nresistance in ovarian cancer \n*X. Yi*, Y. Liu, F. Zeng; Changsha/CN \n(yixiaoping@csu.edu.cn) \n \nPurpose: To develop a machine learning model incorporating Single-\nNucleotide Polymorphisms (SNPs) of Human Sulfatase 1 (SULF1) with a pre-\ntreatment CT radiomic model, to predict platinum resistance for ovarian cancer \n(OC) treatment. \nMethods or Background: A research cohort that consisted of 102 patients \nwith clinicopathologically confirmed OC was recruited during the time period \nfrom January 2006 to February 2018. All OC patients underwent maximal cyto-\nreductive surgery followed by platinum based chemotherapy (treatment \nresponse: platinum-resistant or platinum-sensitive disease), were divided into \ntwo cohorts [training, n=71; validation, n=31]. We genotyped 12 SNPs of \nserous SULF1 for all OC patients using Mass array method before treatment. \nRadiomic features, SNPs data and clinicopathological data of patients were \nused to build differentiation models. Feature selection and predictive modeling \nwere performed using least absolute shrinkage and selection operator \n(LASSO), Random Forest Classifier and Support Vector Machine methods. \nModel performance for predicting platinum resistance was assessed with \nrespect to its calibration, discrimination, and clinical application. \nResults or Findings: For prediction of platinum resistance, the approach \ncombining the radiomics, clinicopathological data and SNP data demonstrated \nhigher classification efficiency, with an AUC value of 0.993 (95% CI: 0.83 to \n0.98) in the training cohort and 0.967 (95% CI: 0.83 to 0.98) in validation \ncohort, than the performance with only the SNPs of SULF1 model (AUC: \ntraining, 0.843 [95%CI: 0.738-0.948]; validation, 0.815 [0.601-1.000]), or with \nonly the radiomic model (AUC: training, 0.874 [95%CI: 0.789-0.960]; validation, \n0.832 [95%CI: 0.687-0.976]). This integrated approach also showed good \ncalibration and favorable clinical utility. \nConclusion: A predictive model combining pretreatment CT radiomics with \ngenomic data such as SNPs of SULF1 could potentially help to predict \nplatinum resistance in ovarian cancer treatment. \nLimitations: Retrospective nature of this study. \nEthics Committee Approval: ChiCTR-TNC-15007604 \nFunding for this study: Natural Science Foundation of Hunan Province \n(2018JJ2641) \nAuthor Disclosures: \nFeiyue Zeng: Nothing to disclose \nYingzi Liu: Nothing to disclose \nXiaoping Yi: Nothing to disclose \n \n \nRPS 505-10 \nAn MRI radiomics signature to distinguish benign from malignant orbital \nlesions \n*L. Duron*, A. Heraud, F. Charbonneau, M. Zmuda, J. Savatovsky, L. Fournier, \nA. Lecler; Paris/FR \n \nPurpose: To differentiate benign from malignant orbital lesions using \nradiomics on 3T MRI examinations. \nMethods or Background: This prospective single-center study enrolled \nconsecutive patients presenting with an orbital lesion undergoing a 3T MRI \nprior to surgery from 2015 to 2019. Radiomics features were extracted from six \nMRI sequences. Features were selected based on their reproducibility, non-\nredundancy, and with a step forward feature selection method. Selected \nfeatures were used to train and optimize a Random Forest algorithm on the \ntraining set (75%) with 5-fold cross-validation. Performance metrics were \ncomputed on the test set (25%) with 95% confidence intervals (95%CI). Five \nresidents, four general radiologists and three expert neuroradiologists were \nasked to visually distinguish benign from malignant lesions on the test set. \nPerformance comparisons between reader groups and the model were \nperformed. The impact of clinical and categorizable imaging data on algorithm \nperformance was assessed. \nResults or Findings: Two hundred patients (116/200[58%] women and \n84/200[42%] men, mean age 53.0+/-17.9 years) with 126/200[63%] benign and \n74/200[37%] malignant orbital lesions were included in the study. A total of 606 \nradiomics features were extracted. The best model on the training set \ncombined 8 features including ADC Mean Value, Maximum Diameter on T1-WI \nand texture features. Area Under the ROC curve, accuracy, sensitivity and \nspecificity on the test set were respectively 0.869 (95%CI [0.834-0.898]), 0.840 \n(95%CI [0.806-0.874]), 0.684 (95%CI [0.615-0.751]), and 0.935 (95%CI [0.905-\n0.961]). The radiomics model outperformed all reader groups, including expert \nneuroradiologists (p<0.01). Adding clinical and categorizable imaging data \ndidn’t impact the performance (p=0.49). \nConclusion: An MRI radiomics signature is helpful to differentiate benign from \nmalignant orbital lesions and may outperform expert radiologists. \nLimitations: Single-center study, without Perfusion-WI. Retrospective readers' \ntask with its cognitive biases compared to real-life clinical decisions. \nEthics Committee Approval: Yes: IRB2015-A00364-45 \nFunding for this study: None \nAuthor Disclosures: \nFrédérique Charbonneau: Nothing to disclose \nLoïc Duron: Nothing to disclose \nLaure Fournier: Nothing to disclose \nMathieu Zmuda: Nothing to disclose \nAlexandre Heraud: Nothing to disclose \nJulien Savatovsky: Nothing to disclose \nAugustin Lecler: Nothing to disclose \n \n \nResearch Presentation Session: Artificial \nIntelligence & Machine Learning \nRPS 605 \nAI in breast imaging \nRPS 605-1 \nA deep-learning classification model for mammogram screening \n*M. Jie*¹, X. Lin¹, R. Ouyang¹, M. Wu¹, Z. Cao², Y. Zhang², Z. Yang², Y. Tang², \nP. Chang²; ¹Shenzhen/CN, ²Palo Alto, CA/US  \n \nPurpose: Mammogram screening is dominated by a massive amount of \nhealthy patients, whose mammograms have no suspicious lesion findings. We \naim to build a deep learning classification model to screen out some \nconfidently healthy patients and to reduce the workload for radiologists in the \nscenario of physical examination. \nMethods or Background: Indicated by radiologists, 16,556 patients who have \nat least one mammogram having suspicious lesions, and 22,625 patients \nwhose both breasts are BI-RADS1, are collected. The train/val/test sets have \n70%,10%,20% of the data split at the patient level. All patients’ data are \ncollected from three hospitals in Shenzhen, China. The model has a Siamese \nstructure to take bilateral mammograms from the same patient, such as LCC \nand RCC, at one time. One of these bilateral mammograms is the main \nmammogram, on which the model will output the result. With a selected \nthreshold, the model predicts the main mammogram to be healthy or \nsuspicious. During testing, only if all mammograms of a patient are claimed \nhealthy, will we claim her healthy. Otherwise, we mark her as a suspicious \npatient. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 214  \nResults or Findings: We define a patient as false negative when, indicated by \nradiologists, at least one of her mammograms has suspicious findings, but the \nmodel predicts her to be healthy. Applying a threshold to keep a false-negative \nrate as 0, the model achieves a true-negative rate of 0.231 on the test set. This \nmeans that the model correctly screens out 23.1% healthy patients while \nremaining 100% sensitive to suspicious patients. \nConclusion: Applying this artificial intelligence-based screening system can \npotentially reduce the workload for radiologists by screening out some healthy \nmammograms. \nLimitations: The bias caused by race difference is not well considered. \nEthics Committee Approval: The IRB number is LL-XJS-2020011. \nFunding for this study: n/a \nAuthor Disclosures: \nZhicheng Yang: Nothing to disclose \nMa Jie: Nothing to disclose \nPeng Chang: Nothing to disclose \nMingxiang Wu: Nothing to disclose \nYuxing Tang: Nothing to disclose \nRushan Ouyang: Nothing to disclose \nYanbo Zhang: Nothing to disclose \nZhenjie Cao: Nothing to disclose \nXiaohui Lin: Nothing to disclose \n \nRPS 605-2 \nAutomated classification of breast calcification malignancy in \nmammograms with deep-learning \nR. Ouyang¹, *M. Jie*¹, X. Lin¹, M. Wu¹, Y. Zhang², Y. Tang², Z. Cao², Z. Yang², \nM. Han²; ¹Shenzhen/CN, ²Palo Alto, CA/US  \n \nPurpose: To investigate the capability of breast calcification malignancy \nclassification for each individual calcification region with a deep learning-based \nclassification approach. \nMethods or Background: We develop an attention-based deep learning \nmodel for benign and malignant calcification classification in mammograms. \nWe apply a 400*400 pixel sliding window moves in mammogram images to \nextract patches, and patches with calcifications are preserved and its \ncorresponding calcification binary mask is used as attention map. A widely \nused ResNet 18 is used as classification architecture, a patch embedded with \nattention map is assumed as the input, and biopsy malignancy label of \ncalcifications in the patch is the training target. Two junior radiologists \nannotated calcification regions in mammograms, and then specified each \ncalcification region a “benign/malignant” label with the guidance of pathology \nreport. All the annotations were finally checked by an experienced radiologist. \nIn total, 1776 mammogram images with both calcifications and pathology \nreports, collected between 2011 and 2018, were annotated. These images \nwere classified with the ratio of 3:1:1, and then image patches, the \ncorresponding attention maps and malignancy labels were generated as \ntraining, validation, test dataset. \nResults or Findings: The calcification malignancy classification model was \ntrained and validated over 32484 patches, and evaluated over 12730 patches. \nThe developed method achieves an AUC of 0.956±0.02 (a sensitivity of \n94.5±0.4% and a specificity of 80.1±0.5%) for malignant versus benign \ncalcification classification. \nConclusion: This study showed that the designed calcification classification \nmethod was capable of discriminated about 94.5% of malignant calcifications \nfrom radiologists' annotated calcifications. \nLimitations: In this study, all the mammograms were collected from only one \nhospital. More data sources are desired to enhance diversity. \nEthics Committee Approval: The IRB number is LL-XJS-2020011. \nFunding for this study: n/a \nAuthor Disclosures: \nZhicheng Yang: Nothing to disclose \nMa Jie: Nothing to disclose \nMingxiang Wu: Nothing to disclose \nYuxing Tang: Nothing to disclose \nRushan Ouyang: Nothing to disclose \nMei Han: Nothing to disclose \nYanbo Zhang: Nothing to disclose \nZhenjie Cao: Nothing to disclose \nXiaohui Lin: Nothing to disclose \n \nRPS 605-3 \nUse of an artificial intelligence software to identify low-likelihood of \ncancer exams collected across four commercial digital tomosynthesis \nscreening systems \n*E. F. Conant*¹, A. Y. Toledano², S. Periaswamy³, J. W. Hoffmeister³,  \nR. M. Nishikawa຾; ¹Philadelphia, PA/US, ²Kensington, MD/US,  \n³Nashua, NH/US, ຾Pittsburgh, PA/US \n(emily.conant@pennmedicine.upenn.edu) \n \nPurpose: To evaluate using a deep convolutional neural network artificial \nintelligence (AI) system to identify low-likelihood of cancer digital breast \ntomosynthesis (DBT) screening exams to triage workload. The impact of \nincorporating age and/or breast density in the algorithm is also evaluated. \nMethods or Background: This retrospective study used consecutive cases \nfrom 18 U.S. and 3 French sites. The dataset comprised 506 cancer and 1,293 \nnon-cancer cases with at least 320 days of negative follow-up. Analysis used \n2,999 bootstrap samples randomly selected to match a screening population \nwithin subsets of cancer and non-cancer cases and a cancer detection rate of \n6.0 per 1000 screened. Endpoints included assessment of an AI-derived case-\nscore threshold such that the false negative rate (FNR) was 0%, overall and \nadjusting for age (30-49, 50-64, >64) and/or breast density (dense, non-\ndense). Reduction in workload was measured as percentage of all cases below \nthreshold. Trend in triage rate by AI score decile also was estimated. Medians \nand confidence intervals (CIs) are reported. \nResults or Findings: With an AI-derived case-score threshold for 0% FNR, \n33.4% (95% CI: 30.7-36.3%) of exams could be triaged as low-likelihood of \ncancer. Triaging the 40% and 50% lowest AI scores, FNR was 1.3% (95% CI: \n0.4-2.4%) and 2.8% (95% CI: 1.5-4.3%), respectively. Adjusting case-score \nthreshold for age and breast density increased potential workload reduction by \n26.5% (95% CI: 23.8%-29.2%) without increasing FNR. The incremental \nbenefit of adding breast density to age adjustment is 7.1% (97.5% CI: 5.2-\n9.3%); adding age to breast density, incremental benefit is 15.9% (97.5% CI: \n13.3-18.6%). \nConclusion: An AI system can identify 33.4% of screening DBT exams to \ntriage with 0% FNR. Combining AI case-score with age and breast density, \ntriage could potentially increase to 58.6%. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: iCAD, Inc. \nAuthor Disclosures: \nSenthil Periaswamy: Shareholder: iCAD, Inc. Employee: iCAD, Inc. \nJeffrey W Hoffmeister: Shareholder: iCAD, Inc. Employee: iCAD, Inc. \nRobert M Nishikawa: Research/Grant Support: GE Heathcare Advisory Board: \niCAD, Inc. Research/Grant Support: Koios Medical Other: Hologic, Inc. \nResearch/Grant Support: Hologic, Inc. Advisory Board: maiData Corp. \nAlicia Y Toledano: Consultant: iCAD, Inc. \nEmily F. Conant: Advisory Board: iCAD, Inc. Grant Recipient: iCAD, Inc. \nAdvisory Board: Hologic, Inc. Grant Recipient: Hologic, Inc. \n \nRPS 605-4 \nPerformance of indigenously build artificial-intelligence/machine-learning \nalgorithm in reporting mammography: experience from a developing \ncountry \n*R. Ananthasivan*¹, K. Garg², P. G. Patil¹, S. Bevoor Chowdaiah¹,  \nH. H. Prabhakaran², K. Ravindran², V. Raj¹; ¹Bangalore/IN, ²Chennai/IN \n(rupanth@yahoo.com) \n \nPurpose: Healthcare systems in developing countries are heterogeneous in \ntheir capabilities and delivery structure. Artificial Intelligence (AI)/Machine \nLearning (ML) systems from developed countries are often very expensive and \nnot adaptable to local practices. Breast cancer screening programs are not well \nestablished in developed countries. We assessed the performance of an \nindigenously built AI/ML application in reporting mammography in a developing \ncountry. \nMethods or Background: Mammography images from one hospital and a \nteleradiology setup were collated between Nov 2018 to Feb 2020. A team of \nsenior radiologists annotated training datasets, on which AI/ML system was \ntrained. Cases from the testing dataset were reported by four radiologists and \nassessed against the AI/ML generated report. Any discrepancy between the \nradiologist and AI report was reviewed by a panel of senior radiologists and \nconsensus opinion was generated. \nResults or Findings: A total of 18908 examinations were included, the \ntraining set consisted of 9960 studies (53%). Of the testing set, randomly \nselected 3042 (23% were CR) cases were reported by 4 radiologists. The \naccuracy of the AI/ML system was 95% in differentiating normal from the \nabnormal study. The sensitivity was 98% and specificity 94%. Commonest \nfalse-positive findings were axillary lymph nodes (58). The commonest false-\nnegative findings were of microcalcification (33%) followed by focal asymmetry \nand masses obscured by dense tissue. AI/ML failed to detect subtle \narchitectural distortion and diffuse changes like skin and parenchymal \nthickening. \nConclusion: The indigenously built AI/ML algorithm has promising results with \nhigh sensitivity and specificity in a large dataset. \nLimitations: Wider use in different clinical set-ups need to be tested to \nunderstand universal adoption. \nEthics Committee Approval: Approved by local body. \nFunding for this study: None \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 215  \nAuthor Disclosures: \nSanjana Bevoor Chowdaiah: Nothing to disclose \nVimal Raj: Advisory Board: CHS World \nHari Haran Prabhakaran: Founder: CHS World \nKrithika Ravindran: Board Member: CHS World \nKushagra Garg: Investigator: CHS World \nRupa Ananthasivan: Nothing to disclose \nPooja G Patil: Nothing to disclose \n \nRPS 605-5 \nAutomated classification of benign and malignant breast mass in digital \nmammograms with deep multi-task learning \nX. Lin¹, *M. Jie*¹, R. Ouyang¹, M. Wu¹, Y. Tang², Y. Zhang², Z. Cao², Z. Yang², \nM. Han²; ¹Shenzhen/CN, ²Palo Alto, CA/US \n \nPurpose: To investigate whether the BI-RADS scores reported by radiologists \ncould improve the automated classification performance of benign and \nmalignant breast mass on mammography. \nMethods or Background: We propose an end-to-end architecture for benign \nand malignant mass classification on mammograms using multi-task learning, \nby training with both binary biopsy labels from pathology reports and BI-RADS \nscores from radiologists. The proposed architecture aims to improve learning \nefficiency and prediction accuracy by learning two separate objectives from a \nshared representation. Namely, a 121-layer densely connected convolutional \nnetwork is shared for feature learning, with a classification branch and a \nregression branch padded for benign/malignant classification and malignancy \nprediction, respectively. During training, the BI-RADS scores range from 1 to 6 \n(4A, 4B, and 4C are separate classes) are normalized into the range [0, 1] \naccording to a pre-defined distance map. We design a novel multi-task loss \ncombining classification and regression to simultaneously learn these two \ntasks in a unified architecture. \nResults or Findings: The proposed method is trained and cross-validated on \n5865 mammographic images. A hold-out set containing 390 images (no patient \noverlap) is used to evaluate the performance of the proposed method. Our \nmethod achieves an AUC of 0.915±0.03 (a sensitivity of 90.10±0.54% and a \nspecificity of 70.05±0.37%) for benign versus malignant mass classification, \ncompared to 0.886±0.03 using only binary labels in training (p<0.05). \nConclusion: In addition to the objective biopsy labels, subjective BI-RADS \nscores can provide auxiliary information in training deep neural networks for \nbenign/malignant mass classification and malignancy prediction in a multi-task \nsetting. \nLimitations: BI-RADS scores are subjective and might vary across \nradiologists. A more thorough analysis of this variance is desired. \nEthics Committee Approval: The IRB number is LL-XJS-2020011. \nFunding for this study: No \nAuthor Disclosures: \nZhicheng Yang: Nothing to disclose \nMa Jie: Nothing to disclose \nMingxiang Wu: Nothing to disclose \nYuxing Tang: Nothing to disclose \nRushan Ouyang: Nothing to disclose \nMei Han: Nothing to disclose \nYanbo Zhang: Nothing to disclose \nZhenjie Cao: Nothing to disclose \nXiaohui Lin: Nothing to disclose \n \nRPS 605-6 \nBreast lesions identification employing radial basis function on \nmammowave clinical data \n*S. P. Rana*¹, M. Dey¹, R. Loretoni², M. Duranti³, L. Sani³, A. Vispa³,  \nM. Ghavami¹, S. Dudley¹, G. Tiberi³; ¹London/UK, ²Foligno/IT, ³Perugia/IT \n(ranas11@lsbu.ac.uk) \n \nPurpose: Recently, a novel microwave apparatus for breast lesion detection \n(MammoWave), uniquely able to function in air with 2 antennas rotating in the \nazimuth plane and operating within the band 1-9 GHz has been developed. \nMachine learning (ML) can help to understand phenomena from the frequency \nspectrum collected through MammoWave in response to the stimulus, \nsegregating breasts with and without lesions. The performance is quantified \nstatistically for the ML augmented apparatus. \nMethods or Background: The study comprises 61 breasts (from 34 patients), \neach one with the correspondent output of the radiologist’s conclusion (i.e. gold \nstandard) obtained from echography and/or mammography and/or MRI. The \nMammoWave examinations are performed, recording complex S21 in multi-\nbistatic fashion where the magnitudes show substantial discrepancy and reveal \ndissimilar behaviours when reflected from healthy tissues or tissues with \nlesions. Principal component analysis (PCA) is implemented to extract the \nunique quantitative responses from the frequency response for automated \nbreast lesion identification, engaging support vector machine (SVM) with radial \nbasis function (RBF) kernel. \nResults or Findings: According to the radiologist conclusions, 25 breasts \nwithout lesions and 36 breasts with lesions underwent MammoWave \nexamination. The proposed SVM model achieved the optimal accuracy, \nsensitivity, and specificity of 92.50%, 85.40%, and 97.40% respectively, \noutperforming comparable gold standards. \nConclusion: The proposed ML augmented MammoWave can identify the \nbreast lesions early with high accuracy for woman of any ages and any breast \ndensity. \nLimitations: We did not consider patients pre-menstrual information. \nEthics Committee Approval: Ethical Committee of Umbria, Italy (N. \n6845/15/AV/DM of 14/10/2015, N. 10352/17/NCAV of 16/03/2017, N \n13203/18/NCAV of 17/04/2018). \nFunding for this study: This project has received funding from the European \nUnion’s Horizon 2020 research and innovation program under grants \nagreements No: 830265, 793449, 872752. \nAuthor Disclosures: \nLorenzo Sani: Employee: UBT - Umbria Bioengineering Technologies, \nPerugia/IT \nSandra Dudley: Nothing to disclose \nMaitreyee Dey: Nothing to disclose \nMichele Duranti: Nothing to disclose \nMohammad Ghavami: Nothing to disclose \nAlessandro Vispa: Employee: UBT - Umbria Bioengineering Technologies, \nPerugia/IT \nSoumya Prakash Rana: Nothing to disclose \nGianluigi Tiberi: Shareholder: UBT - Umbria Bioengineering Technologies, \nPerugia/IT \nRiccardo Loretoni: Nothing to disclose \n \nRPS 605-7 \nBiDualNet: mammographic bilateral-view mass segmentation network \nX. Lin¹, *M. Jie*¹, R. Ouyang¹, M. Wu¹, Z. Cao², Y. Zhang², Z. Yang²,  \nP. Chang², M. Han²; ¹Shenzhen/CN, ²Palo Alto, CA/US \n \nPurpose: To incorporate this diagnostic prior information and facilitate the \nlearning of the symmetry constraint, we develop a Bilateral Dual-view Network \nfor mass segmentation. \nMethods or Background: The proposed BiDualNet model is derived from a \nDeepLab v3+ structure, including a Siamese input module, a non-local(NL) \nmodule and the pixel-wise focal loss(PWFL) function. For a given \nmammogram, the other breast image of the same view is registered as an \nauxiliary input of the model. The Siamese input module consists of two NL \natrous convolution modules, which share the same weights to extract features \nfrom the bilateral images in the same manner. The auxiliary feature map is \nthen assumed as a reference and concatenated with the main feature map, \nand in turn the feature difference at the same location can highlight the \nabnormality. Finally, DeepLab v3+ decoder generates a segmentation result for \nthe main image. We train and test the proposed model using the public Digital \nDatabase for Screening Mammography(DDSM) and our private mammogram \ndataset. DDSM has 2,620 patient cases collected from U.S. hospitals, and the \nprivate dataset contains 2,749 cases of Asian patients. Each case has four \nviews of mammograms. Both datasets have normal, cancer, and benign cases, \nclose to the practical distribution. These two datasets are randomly divided into \nthe train/val/test sets by approximately 8:1:1, respectively. \nResults or Findings: The proposed BiDualNet respectively achieves recall \nscores of 0.78,0.84,0.89 on DDSM when false positive per image(FPI) rates \nare 0.5,1.0,2.0. For the same FPI settings, the recall scores respectively reach \n0.87,0.93,0.95 on the private dataset. \nConclusion: The BiDualNet considers the symmetry information for both \nbreasts at the same view, which in turn enhances mass segmentation \ncapability for mammograms. \nLimitations: The dataset sizes are relatively small. \nEthics Committee Approval: The IRB number is LL-XJS-2020011. \nFunding for this study: n/a \nAuthor Disclosures: \nZhicheng Yang: Nothing to disclose \nMa Jie: Nothing to disclose \nPeng Chang: Nothing to disclose \nMingxiang Wu: Nothing to disclose \nRushan Ouyang: Nothing to disclose \nMei Han: Nothing to disclose \nYanbo Zhang: Nothing to disclose \nZhenjie Cao: Nothing to disclose \nXiaohui Lin: Nothing to disclose \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 216  \nRPS 605-10 \nText mining in Russian radiology reports \nD. Kokina, *Y. Meshalkin*, V. Gombolevskiy, A. Vladzymyrskyy,  \nA. E. Andreychenko, S. Morozov; Moscow/RU \n \nPurpose: The research was aimed to explore the possibilities of NLP, ML \nmethods for classification of Russian free-text radiology reports in order to form \nlarge scale medical datasets and to perform a prospective agreement study \nbetween physicians and AI in radiology. \nMethods or Background: Three use cases were studied that included: chest \nCT radiology reports with COVID-19 signs (28173 total reports, 21752 reports \npositive for COVID-19 signs) and lung nodules suspected of cancer (894 total \nreports, 411 reports positive for lung nodules suspected of cancer) and MMG \nradiology reports (1120 total reports, 289 BiRADS 0 or >3) created between \n01|2019 and 08|2020. The following NLP and machine learning techniques \nwere investigated: k-nearest neighbours model (selection of optimal \nhyperparameters using cross-validation technique, k=3) and keyword models. \nFor every use case, best performing techniques were chosen based on their \naccuracy metrics values for the test datasets. \nResults or Findings: The best results were achieved in classification for signs \nof breast cancer according to MMG radiology report data (accuracy 0.996) with \nkeyword-based model and Covid-19-pneumonia according to CT reports \n(accuracy 0.993) with k-nearest neighbour model. These results are \ncomparable to the accuracy of analogous studies in free text English, Chinese \nand Spanish radiology reports classification. The classification of CT radiology \nreports for lung nodules suspected of cancer (that were much less structured \nthan MMG and COVID-CT reports) achieved 0.972 accuracy with the keyword-\nbased model. \nConclusion: The results indicate that the Russian radiology reports can be \nsuccessfully classified with the help of text mining methods (machine learning, \nNLP). Similar to other languages (semi-)structured reporting benefits the \nmachine-based classification accuracy. \nLimitations: Class imbalance per subset could bias the results \nEthics Committee Approval: Based on the results of the registered study \n(https://clinicaltrials.gov/ct2/show/NCT04489992). \nFunding for this study: Internal \nAuthor Disclosures: \nYuri Meshalkin: Author: algorithm realization \nSergey Morozov: Consultant: concept formation \nAnna Evgenevna Andreychenko: Author: concept formation \nAnton Vladzymyrskyy: Consultant: consultation \nVictor Gombolevskiy: Consultant: data preparation \nDaria Kokina: Author: data preparation \n \nRPS 605-11 \nOn the ability of an AI system to detect breast cancer earlier \nS. Pacilè¹, P. Fillard², *J. Lopez*³; ¹Nice/FR, ²Paris/FR,  \n³Newport Beach, CA/US \n(January.Lopez@hoag.org) \n \nPurpose: To investigate about the ability of an AI-system to detect breast \ncancer at earlier stages. \nMethods or Background: A dataset of 2D Full-Field Digital Mammograms \nwas retrospectively collected including in the study 16004 women. For each \npatient 3 consecutive screening exams were collected (delayed by one \nscreening interval ǻT). The most recent exam for each patient was referred to \nas T0, and it was considered as malignant (n=408) if a biopsy proved the \npresence of cancer within ǻT+3 months or negative/benign (n=15596) if the \nsubsequent screening exam was negative or triggered a negative follow-up. \nThe inferred status was propagated back and attributed to the prior exams \ncollected at T-1 and T-2. At T0, T-1 and T-2 the predictions of the AI system \n(MammoScreen v1.0.2, Therapixel) were computed and compared to the \noriginal decision (patient recalled or not) made by the radiologist. \nResults or Findings: The sensitivity of the AI system and the radiologist at T0 \nwas 58% and 65%, respectively. The AI system was able to predict 110 \ncancers at T-1 (18.57 months – 95% CI: 16.55 - 20.58) with a sensitivity of \n27%, and 84 cancers at T-2 (36.93 months – 95% CI: 33.60 - 40.25) with a \nsensitivity of 21%. Inclusion of AI positive cases resulted in an incremental \nincrease in recall rate of 12.6% at T-1 and 11% at T-2. \nConclusion: The addition of AI positive assessments to radiologist \ninterpretations of screening mammograms has the potential to detect breast \ncancers 1 or 2 screening cycles earlier than without AI, with a modest increase \nin recall rates to approximately 11% overall. \nLimitations: Retrospective character of the study. \nEthics Committee Approval: The investigation protocol was approved by an \nIRB. \nFunding for this study: The study was sponsored by Therapixel. \nAuthor Disclosures: \nJanuary Lopez: Nothing to disclose \nPierre Fillard: Employee: Therapixel Founder: Therapixel \nSerena Pacilè: Employee: Therapixel \nRPS 605-12 \nValue of technical stratification of medical datasets for AI services \n*N. Pavlov*, Y. S. Kirpichev, A. Revazyan, V. Klyashtorny, A. Vladzymyrskyy, \nA. E. Andreychenko, S. Morozov; Moscow/RU \n(nickvolvap@gmail.com) \n \nPurpose: Fast and reliable evaluation of AI service before its clinical \nimplementation is needed to obtain threshold values that differentiate normal \nstudies from pathologic ones (known as calibration). Here, we explore whether \nthresholds should be calculated independently for different vendor diagnostic \ndevices. \nMethods or Background: Two AI services were included in the study: one for \nmammographic BI-RADS evaluation (MG), and one for COVID-19 findings on \nchest computed tomography (CT). Initially, the thresholds for MG and CT were \ndetermined during calibration on retrospective data (balanced dataset \nconsisted of 50 studies with findings related to target pathology and 50 \nwithout). Then, the optimal thresholds were evaluated for every subset of \nprospective data determined by scanner manufacturer, of which 6 vendors \nwere for MG (MG1–MG6), and 5 for CT (CT1–CT5) based on an agreement \nstudy of AI and radiologists. The number of prospectively analysed studies \n(radiologists) in each subset: MG1: 33248 (115); MG2: 8478 (46); MG3: 336 \n(5); MG4: 354 (2); MG5: 136 (1); MG6: 45 (2); CT1: 74630 (580); CT2: 10032 \n(92); CT3: 2422 (67); CT4: 4326 (70); CT5: 651 (25). \nResults or Findings: For CT, when compared in pairs between each subset \nby scanner manufacturer, the statistical difference in optimal thresholds has \nbeen significant for all (p”0.001) but one pair of CT2–CT3 (p=0.941). For MG, \nthe difference was significant as well for MG1–MG2 (p<0.001), MG1–MG4 \n(p=0.025) and MG2–MG4 (p=0.002). These findings could be explained by \nvariation in technical features of image acquisition process such as matrix size \nwhich in a way impact AI performance. \nConclusion: Accuracy of AI service could be improved by defining individual \nthresholds for each vendor during the calibration process. \nLimitations: Differences in total number of cases per subset could potentially \nbias the results. \nEthics Committee Approval: https://clinicaltrials.gov/ct2/show/NCT04489992. \nFunding for this study: No funding. \nAuthor Disclosures: \nSergey Morozov: Nothing to disclose \nAnna Evgenevna Andreychenko: Nothing to disclose \nAnton Vladzymyrskyy: Nothing to disclose \nNikolay Pavlov: Nothing to disclose \nVladislav Klyashtorny: Nothing to disclose \nAnush Revazyan: Nothing to disclose \nYury S Kirpichev: Nothing to disclose \n \nRPS 605-13 \nAn image annotation software for mammography \nR. Ouyang¹, *M. Jie*¹, X. Lin¹, M. Wu¹, Y. Zhang², S. Wu¹, L. Huang¹,  \nP. Chang², Y. Xin¹; ¹Shenzhen/CN, ²Palo Alto, CA/US \n \nPurpose: To efficiently and effectively annotate mammogram images, we \ndevelop specific annotation software. \nMethods or Background: Deep learning has achieved great success in \nvarious medical image analysis scenarios. While its performance highly \ndepends on the quality and quantity of annotated data. However, general-\npurpose annotation tools are usually difficult to efficiently provide high-quality \nannotations for a specific medical image modality. \nResults or Findings: This software enables clinically-oriented users to \nefficiently annotate mammograms for deep learning models. It consists of five \nmajor modules. (1) Each patient's breast images and corresponding diagnosis \ninformation can be loaded and displayed in the software. (2) It enables users to \nmanually draw boundary curves for lesions including mass, calcification, \nstructural distortion and asymmetry. Alternatively, there is an \"AI Analysis\" \noption in this software. This embedded pre-trained AI model automatically \ngenerates lesion contours, accelerating the annotation remarkably. (3) For \neach lesion and image, users can specify various clinical information, including \nlesion types, malignancy, BI-RADS classes, density classes, etc. (4) The \nannotated information is automatically written into corresponding \".json\" format \nfiles. (5) The software works in label/review modes, which allows a senior \nradiologist to review and correct the annotation. This function ensures the high \nquality of the obtained annotations. Three junior and one senior radiologists \nhave labeled and reviewed more than 2000 patients' dataset. This dataset \nallows AI scientists to conduct various research or pre-clinical work, such as \nlesion segmentation, image classification, cancer-risk estimation, etc. Based \non this well-annotated dataset, our trained mass and calcifications detection \nmodels have achieved state-of-the-art performance. \nConclusion: The developed software can efficiently annotate mammography \nimages, providing a large number of annotated data for training deep learning-\nbased lesion detection and classification models. \nLimitations: This tool is currently used in a single-center study. \nEthics Committee Approval: The IRB number is LL-XJS-2020011. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 217  \nFunding for this study: n/a \nAuthor Disclosures: \nMa Jie: Nothing to disclose \nPeng Chang: Nothing to disclose \nShibin Wu: Nothing to disclose \nMingxiang Wu: Nothing to disclose \nRushan Ouyang: Nothing to disclose \nLingyun Huang: Nothing to disclose \nYi Xin: Nothing to disclose \nYanbo Zhang: Nothing to disclose \nXiaohui Lin: Nothing to disclose \n \n \nResearch Presentation Session: Artificial \nIntelligence & Machine Learning \nRPS 705 \nAI in abdominal imaging \nRPS 705-2 \nPET-CT co-registration and classification model for oesophagal cancer \nW. Cao, C. S. G. Lui, J. van Lunenburg, K. O. Lam, P. L. H. Yu, \n*W. H. K. Chiu*; Hong Kong/HK  \n(kwhchiu@hku.hk) \n \nPurpose: Positron-Emission Tomography-Computed Tomography (PET-CT) is \nan essential imaging modality for managing patients with esophageal cancer. \nThe objective of this study was to combine PET and CT to predict complete \npathological response (pCR) after neoadjuvant chemoradiotherapy (nCRT) in \npatients with Esophageal squamous cell carcinoma (ESCC). \nMethods or Background: 86 patients with locally advanced ESCC who had \nundergone staging PET-CT, received nCRT followed by surgery were split into \ntraining and testing sets (65:21) stratified by outcome. We first developed a \nmodel to co-registration PET and CT images allowing alignment of both sets of \nvolumes that have different dimensions. We then conducted data \naugmentation to increase the number of cases in the training set eight times by \nrotation, flipping and re-scaling. Using the augmented dataset, we trained a \nnetwork-based classification model, composing of 8 convolutional layers and 2 \nfully-connected layers. \nResults or Findings: In total, 85% of subjects were male, median age 65 (22-\n82) and 15% female with median age 68 (40-79). pCR of primary tumour was \nachieved in 34 patients (40.0%). The model achieved an accuracy of 0.810, \n0.846 sensitivity, 0.750 specificity, 0.846 positive predictive value (PPV), 0.750 \nnegative predictive value (NPV) and an area under the receiver operator curve \n(AUROC) of 0.798 for predicting pCR based on the fused PET and CT. Using \nCT alone, the model only achieved the accuracy of 0.7619, 0.846 sensitivity, \n0.625 specificity, 0.786 PPV, 0.714 NPV and a significantly lower AUROC of \n0.736 (p=0.008). \nConclusion: These results indicate that integrating PET and CT images using \ndeep learning allows performance improvement in predicting pCR compared \nwith a single modality approach of using CT alone. \nLimitations: Single centre study with no external validation. \nEthics Committee Approval: The study was approved by the HKU/HA HKW \nIRB. \nFunding for this study: None \nAuthor Disclosures: \nWenming Cao: nothing to disclose \nChiu Sing Gilbert Lui: Nothing to disclose \nJurgen van Lunenburg: Nothing to disclose \nKa On Lam: Nothing to disclose \nWan Hang Keith Chiu: Nothing to disclose \nPhilip Leung Ho Yu: Nothing to disclose \n \nRPS 705-3 \nRadiomics analysis for the differentiation of autoimmune pancreatitis and \npancreatic carcinoma in MRI \n*A. Mahnken*, L. Campisi, M. Diehl, D. Heider, A. König, T. Thormälen; \nMarburg/DE  \n \nPurpose: Focal autoimmune pancreatitis (AIP) and pancreatic cancer (PC) \nhave many similar clinical symptoms and similar imaging features impeding \naccurate, noninvasive differentiation of these entities. The aim of this study \nwas to explore whether the use of radiomics techniques on magnetic \nresonance imaging (MRI) data could help to differentiate between AIP, PC and \nnormal pancreas. \nMethods or Background: This retrospective study included data of 58 \npatients (17 with AIP, 21 with PC, 20 with normal pancreas). All patients \nobtained a pretreatment MRI with unenhanced fat-suppressed, axial T1, and \naxial T2 weighted scans. After labeling manually the pancreas in each scan, \n120 radiomics features were extracted. Different radiomics models were tested \nto achieve the best differentiation between AIP, PC and healthy individuals. \nFinally, the random forest model showed the best results. The performance of \nradiomics model was evaluated by AUC. \nResults or Findings: The AUCs of the optimal radiomics model were 92% for \nAIP, 81% for PC and 87% for the control group. All results were highly \nsignificant (p < 0,0001). \nConclusion: The combination of MRI findings and radiomics techniques might \nbe helpful to differentiate between AIP, PC and healthy individuals in clinical \npractice. \nLimitations: This study suffers some limitations. Firstly, it only comprises a \nsmall dataset with 17 AIP patients due to its rare entity. Secondly, the classes \ndiffer in age and gender. This is due the fact that AIP patients are on average \nyounger than patients with PC. Finally, the model was trained with a cross-\nvalidation approach using the whole dataset without subsequent independent \ntesting of the model. \nEthics Committee Approval: No research ethics approval was necessary for \nthis research. \nFunding for this study: This study was supported by the European Regional \nDevelopment Fund, EFRE-Program, European Territorial Cooperation (ETZ) \n2014-2020, Interreg V A, Project 191. \nAuthor Disclosures: \nMarie Diehl: Nothing to disclose \nDominik Heider: Nothing to disclose \nLuana Campisi: Nothing to disclose \nAlexander König: Nothing to disclose \nThorsten Thormälen: Nothing to disclose \nAndreas Mahnken: Nothing to disclose \n \nRPS 705-4 \n3d MRI-based radiomics features in the prediction of placenta adhesion \nspectrum disorders in patients with placenta previa: a machine learning \npreliminary study \n*F. Verde*, M. Di Stasi, R. Cuocolo, A. Stanzione, V. Romeo, L. Sarno,  \nM. Guida, M. D'Armiento, S. Maurea; Naples/IT \n(francescoverde87@gmail.com) \n \nPurpose: To assess the reliability of a 3D segmentation method of placenta \nMR images for the prediction of Placenta Adhesion Spectrum (PAS) disorders \nin patients with placenta previa (PP) using a Machine Learning Radiomics \nanalysis. \nMethods or Background: 63 patients (n=44 without PAS and n= 19 with PAS) \nwith PP who underwent MRI examination for suspicion of PAS were \nretrospectively selected. Whole placental tissue was manually segmented \nslice-per-slice on sagittal placental T2-weighted images, by a first radiologist, \nobtaining a volume of interest (VOI) from each patient. For feature stability \ntesting, the same procedure was then repeated on 30 randomly selected \nplacental MRI examinations by two additional radiologists, working \nindependently and blinded to the original segmentations. Radiomic features \nwere extracted from all available VOIs. ML analysis was subsequently run to \nidentify the best performing method to correctly classify instances. \nResults or Findings: A number of 1106 radiomics features were extracted \nfrom whole-placental tissue VOIs. Of these, 420 showed intraclass correlation \ncoefficient values lower to 0.75.and were therefore discarded. After the \ntrain/test split (75/25%), the model training set was composed of 47 cases \nwhile the test one included 16 cases. In the training test, 10 features were \nfinally selected due to high Pearson’s Correlation Coefficient. Using these \nfeatures with a Bayesian Network analysis, the final model obtained a \nprecision, recall, F1 score and AUROC of respectively 0.925, 0.813, 0.841 and \n0.893. \nConclusion: A predictive ML model, based on 3D placental MRI radiomics \nfeatures, is highly accurate in identifying PAS in patients with placenta previa. \nLimitations: A retrospective study at a single institution and the relatively small \npatient population. \nEthics Committee Approval: Approval by the local Institutional Review Board. \nInformed consent waived. \nFunding for this study: No funding source \nAuthor Disclosures: \nValeria Romeo: Nothing to disclose \nLaura Sarno: Nothing to disclose \nMartina Di Stasi: Nothing to disclose \nFrancesco Verde: Nothing to disclose \nArnaldo Stanzione: Nothing to disclose \nMaurizio Guida: Nothing to disclose \nRenato Cuocolo: Nothing to disclose \nMaria D'Armiento: Nothing to disclose \nSimone Maurea: Nothing to disclose \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 218  \nRPS 705-5 \nLiver fibrosis staging by deep learning: a visual-based explanation of \ndiagnostic decisions of the model \n*Y. Yin*¹, D. Yakar¹, R. Dierckx¹, K. Mouridsen², T. Kwee¹, R. de Haas¹; \n¹Groningen/NL, ²Aarhus/DK \n(y.yin@umcg.nl) \n \nPurpose: Deep learning has been proven to be able to stage liver fibrosis \nbased on contrast-enhanced CT images. However, until now the algorithm is \nused as a black box and lacks transparency. This study aimed to provide a \nvisual-based explanation of the diagnostic decisions made by deep learning. \nMethods or Background: The liver fibrosis staging network (LFS network) \nwas developed at contrast-enhanced CT images in the portal venous phase in \n252 patients with histologically proven fibrosis stage. To give a visual \nexplanation of the diagnostic decisions made by the LFS network, Gradient-\nweighted Class Activation Mapping (Grad-cam) was used to produce location \nmaps indicating where the LFS network focuses on when predicting liver \nfibrosis stage. \nResults or Findings: The LFS network had areas under the receiver operating \ncharacteristic curve of 0.92, 0.89, and 0.88 for staging significant fibrosis (F2-\nF4), advanced fibrosis (F3-F4), and cirrhosis (F4), respectively, on the test set. \nThe location maps indicated that the LFS network had more focus on the liver \nsurface in patients without liver fibrosis (F0), while it focused more on the \nparenchyma of the liver and spleen in case of cirrhosis (F4). \nConclusion: Deep learning methods are able to exploit CT-based information \nfrom the liver surface, liver parenchyma and extrahepatic information to predict \nliver fibrosis stage. Therefore, we suggest to use the entire upper abdomen on \nCT images when developing deep learning-based liver fibrosis staging \nalgorithms. \nLimitations: The training dataset in our study was relatively small. Because \ndeep learning methods are data-driven, diagnostic accuracy and stability of \nlocation maps highly depend on the variety and volume of the dataset. \nTherefore, our results should be confirmed in larger (multicenter) studies. \nEthics Committee Approval: IRB statement: the study was approved by the \ninstitutional review board (IRB number: 2018/139) \nFunding for this study: None \nAuthor Disclosures: \nKim Mouridsen: Nothing to disclose \nRobbert de Haas: Nothing to disclose \nThomas Kwee: Nothing to disclose \nYunchao Yin: Nothing to disclose \nDerya Yakar: Nothing to disclose \nRudi Dierckx: Nothing to disclose \n \nRPS 705-6 \nTexture analysis for diagnosis of steatohepatitis and chemotherapy-\nassociated liver injuries: performances of a combined radiomic and \nclinical model \n*F. Fiz*, L. Cavinato, C. Masci, G. Costa, F. Leva, G. Torzilli, A. Chiti,  \nL. Balzarini, L. Viganò; Milan/IT \n(francesco.fiz.nm@gmail.com) \n \nPurpose: Patients undergoing liver resection for colorectal metastases after \noxaliplatin- and/or irinotecan-based chemotherapy-associated liver injuries \n(CALI) have a major clinical impact, but their non-invasive diagnosis is still an \nunmet need. To elucidate the contribution of radiomic analyses to diagnosis of \nsinusoidal dilatation, nodular regenerative hyperplasia (NRH) and non-\nalcoholic steatohepatitis (NASH). \nMethods or Background: Patients undergoing liver resection for colorectal \nmetastases after oxaliplatin- and/or irinotecan-based chemotherapy between \nJanuary 2018 and February 2020 were retrospectively analyzed. Radiomic \nfeatures were extracted from a standardized volume of non-tumoral liver \nparenchyma outlined in the portal phase of preoperative post-chemotherapy \ncomputed tomography (CT). A multivariate logistic-regression model was \nperformed to identify predictors of CALI. Internal validation was applied. \nResults or Findings: Overall, 78 patients were included. Of these, 25 (32%) \nhad grade 2-3 sinusoidal dilatation, 27 (35%) NRH, and 14 (18%) NASH. \nThree fingerprints derived from radiomic features were independent predictors \nof grade 2-3 sinusoidal dilatation: GLRLM_f3 (OR=12.25), NGLDM_f1 \n(OR=7.77), and GLZLM_f2 (OR=0.53). The combined clinical/radiomic \npredictive model had 82% accuracy, 64% sensitivity, and 91% specificity \n(AUC=0.87 vs. AUC=0.77 of the model without radiomics). Three radiomic \nparameters were independent predictors of NRH: conventional_HUQ2 \n(OR=0.76), GLZLM_f2 (OR=0.05), and GLZLM_f3 (OR=7.97). The combined \nclinical/radiomic model had 85% accuracy, 81% sensitivity, and 86% specificity \n(AUC=0.91 vs. AUC=0.85 without radiomic features). One radiomic feature \nwas associated with NASH: conventional_HUQ2 (OR=0.79). Steatohepatitis \nwas predicted with 91% accuracy, 86% sensitivity, and 92% specificity \n(AUC=0.93 vs. AUC=0.83 without radiomic features). In the validation setting, \naccuracy was 72%, 71%, and 91% for sinusoidal dilatation, NRH, and NASH, \nrespectively. \nConclusion: Radiomic analysis of liver parenchyma provides a signature that, \nin combination with clinical and laboratory data, improves diagnosis of CALI. \nLimitations: Retrospective, monocentric. \nEthics Committee Approval: IRB-approved, need for specific consent was \nwaived. \nFunding for this study: None. \nAuthor Disclosures: \nFrancesca Leva: Nothing to disclose \nGuido Torzilli: Nothing to disclose \nFrancesco Fiz: Nothing to disclose \nArturo Chiti: Nothing to disclose \nChiara Masci: Nothing to disclose \nLara Cavinato: Nothing to disclose \nGuido Costa: Nothing to disclose \nLuca Viganò: Nothing to disclose \nLuca Balzarini: Nothing to disclose \n \nRPS 705-8 \nUsing variable flip angle evolution to implement deep learning \naccelerated abdominal HASTE sequence in a single breath-hold at 3 T \n*J. Herrmann*; Tuebingen/DE \n(judith.herrmann@med.uni-tuebingen.de) \n \nPurpose: Due to numerous refocusing pulses, HASTE sequences have SAR-\nrelated speed limitations at 3T. Our purpose was to create a protocol with a \ndeep learning (DL) accelerated single-breath-hold half-Fourier single-shot \nturbo spin echo (HASTE_DL) sequence for T2-weighted MRI of the abdomen \nat 3T. We first defined a suitable flip angle (FA) evolution with low cardiac-\nmotion related signal loss and low specific absorption rate (SAR) in a volunteer \nstudy and implemented this FA evolution in clinical routine. Its clinical \nfeasibility, image quality (IQ) and diagnostic accuracy compared to standard \nT2-weighted sequences were assessed. \nMethods or Background: 11 volunteers were included to evaluate the \ntechnical feasibility and diagnostic performance of 9 different FA evolutions of \na HASTE_DL to identify the most suitable FA evolution with reasonable SAR, \nand low cardiac-motion related signal loss. Suitable FA was determined and \nimplemented in clinical routine. 51 patients who underwent clinically indicated \nliver/pancreas MRI at 3T were included. Two radiologists assessed HASTE_DL \nand standard sequence regarding IQ, noise, contrast, sharpness, artifacts, \ncardiac-motions related signal loss, diagnostic confidence, lesion detectability, \nand characterization using a Likert-Scale ranging from 1-4 with 4 being best. \nResults or Findings: Suitable FA was defined as 130°-100°-120°-140° \n(HASTE_DL_100) and implemented with one lower FA (130°-90°-110°-130°; \nHASTE_DL_90) in clinical routine. All HASTE_DL were successfully acquired \nat 3 T and showed comparable IQ to standard sequences. \nConclusion: We successfully created and implemented a novel, single breath-\nhold HASTE_DL with variable FA evolutions at 3T in clinical routine. IQ and \ndiagnostic confidence of HASTE_DL is comparable to standard T2w images \nand can highly accelerate TA, while staying within SAR limitations. \nLimitations: Limitation is the relatively small sample size and single-center \nstudy design. \nEthics Committee Approval: The institutional review board approved this \nmonocentric study with waiver of informed consent. \nFunding for this study: None. \nAuthor Disclosures: \nJudith Herrmann: Author: Using variable flip angle evolution to implement deep \nlearning accelerated abdominal HASTE sequence in a single breath-hold at 3T \nSpeaker: Using variable flip angle evolution to implement deep learning \naccelerated abdominal HASTE sequence in a single breath-hold at 3T \n \nRPS 705-9 \nSlice-propagated 3D gastric tumour segmentation from a single 2D \nannotation \n*Z-F. Chen*, l. Jiazheng, Y-T. Liu, J. Zhao, L. Zhang, L. Tang, B. Dong; \nBeijing/CN \n(czifan@pku.edu.cn) \n \nPurpose: To develop a deep learning model on 3D CT images to generate the \nvolumetric segmentation of a gastric tumor from the annotation of its largest \ncross-section. \nMethods or Background: In this work, 232 CT volumes of different phases \nare obtained from 128 gastric cancer patients, of which 98 (173 CT scans) are \nrandomly chosen as the training set and the remaining 30 (59 CT scans) as the \ntest set. A two-stage convolutional model is established to generate the \ncomplete 3D tumor segmentation from the annotation of its largest cross-\nsection. In the first stage, our model iteratively segments the adjacent slices \nfrom the annotated 2D slice to eventually obtain a coarse-grained \nsegmentation of the entire tumor. In the second stage, the model focuses on \noptimizing difficult pixels. Our method is established under a one-shot learning \nframework. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 219  \nResults or Findings: The Dice (Kappa) coefficients between the segmentation \nresults and the manual annotations of the two radiologists are 0.7805 (0.7799), \np=0.3634, and 0.7772 (0.7766), p=0.3618, respectively, which is comparable \nto the inter-observer variability of 0.7971 (0.7966) between the radiologists. \nOur method takes about 1.1 seconds to process a CT volume on a standard \nGPU (the time of annotating the largest cross-section is about 40 seconds), \nwhile manual annotation takes about 7 minutes. \nConclusion: The proposed method can greatly enhance the efficiency of 3D \ngastric tumor segmentation without accuracy loss, facilitating the quantitative \nanalysis of gastric cancer. \nLimitations: We believe that a third doctor can be introduced to make \ndecisions for the ambiguity between two doctors' annotations. \nEthics Committee Approval: Our method is consistent with the Declaration of \nHelsinki. \nFunding for this study: Beijing Natural Science Foundation (Z180001). \nAuthor Disclosures: \nLei Tang: Nothing to disclose \nZi-Fan Chen: Nothing to disclose \nJie Zhao: Nothing to disclose \nYi-Ting Liu: Nothing to disclose \nBin Dong: Nothing to disclose \nli Jiazheng: Nothing to disclose \nLi Zhang: Nothing to disclose \n \nRPS 705-11 \nQuantitative edge analysis for the diagnosis of pancreatic carcinoma \n*M. Bariani*¹, A. Ambrosetti², M. C. Ambrosetti¹, G. Zamboni¹, G. Malleo¹,  \nG. Mansueto¹; ¹Verona/IT, ²Padua/IT \n(matildebariani@gmail.com) \n \nPurpose: Provide a possible starting point for machine-learning recognition of \npancreatic lesions based on lower-dimensional feature space. \nMethods or Background: Quantitative techniques are increasingly acclaimed \nas an effective support for Multi-detector computed tomography (MDCT) \nimage-analysis and computer-assisted diagnostics. From all Patients who \nunderwent Multi-detector Computed Tomography (MDCT) for staging of \npancreatic adenocarcinoma from January 2018 to January 2020 we selected \n50 Patients (36 Males, 14 Females; mean age 63.7 years) with \nadenocarcinoma of the body-tail of the pancreas. Computer-assisted \nquantitative edge-analysis was performed on border fragments in MDCT \nimages of neoplastic and healthy glandular parenchyma, obtaining the mean \nsquare deviation SD of the actual border from the average boundary line. SD \nvalues relative to healthy and neoplastic borders were compared by paired t-\ntest. \nResults or Findings: Tumoral border portions were systematically \ncharacterized by significantly lower SD values than healthy fragments (0.50 vs \n1.27; p<0.001). In our series, using a threshold value of SD > 0,6855 pix \nshowed 96% sensitivity and 96 % specificity in differentiating cancerous from \nhealthy pancreatic edge segments. \nConclusion: We introduce a quantitative measure of boundary irregularity \nwhich correlates with the presence/absence of pancreatic adenocarcinoma. \nQuantitative edge-analysis can be promptly performed on select border \nfragments in MDCT images, thereby providing a useful supporting tool for \ndiagnostics and a possible starting point for machine-learning recognition \nbased on lower-dimensional feature space. \nLimitations: We only analyzed a small number of patients with pancreatic \nadenocarcinoma (preliminary study). The technique could be less useful in \nsmall lesions embedded within the parenchyma. We calculated SD values \nrelated to a virtual measure (pixels) and not to a physical measure \n(millimeters). \nEthics Committee Approval: Informed consent for utilization of clinical and \nradiologic data was provided by all patients (PAD-R registry, n1101CESC). \nFunding for this study: None \nAuthor Disclosures: \nGiulia Zamboni: Nothing to disclose \nMatilde Bariani: Nothing to disclose \nGiancarlo Mansueto: Nothing to disclose \nMalleo Giuseppe Malleo: Nothing to disclose \nMaria Chiara Ambrosetti: Nothing to disclose \nAmbrosetti Alberto Ambrosetti: Nothing to disclose \n \nRPS 705-13 \nAccurate assessment of the minimal ablative margin and unablated \nregion volume after liver tumor ablation on pre- and post-procedural \ncontrast-enhanced CT: Using deep learning and image registration \nK. He¹, R. P. Reimer², X. Liu¹, *R. Shahzad*², F. Thiele², J. Niehoff², H. Zhang¹, \nA. Bunck², M. Perkuhn²; ¹Changchun/CN, ²Cologne/DE \n(rahil.shahzad@uk-koeln.de) \n \nPurpose: Currently, liver tumor ablation(LTA) has emerged as a first-line \ntreatment approach for patients with small malignant liver tumors, especially in \nhepatocellular carcinoma(HCC) and colorectal liver metastasis. The ideal \nablation zone should encompass the tumor by at least 5mm. To evaluate \nimmediate treatment response after LTA, the minimal ablative margin(MAM) \nbetween the tumor and ablative margin is estimated using side-by-side \ncomparison of CT images, which is time-consuming and suffers from high \ninterrater-variability. To overcome these limitations in clinical routine, we \npropose an automatic method to assess MAM and the unabated region \nvolume(URV). \nMethods or Background: 55 patients with 64 malignant liver tumors(40 HCC, \n24 metastasis) who underwent LTA were retrospectively included. Pre-trained \ndeep learning models(DLM) that localize and segment the liver, tumors and \nablation zone in 3D on multi-phase CT scans were used. A non-rigid \nregistration method for the liver between pre- and post-procedural CT scans \nwas developed. After successful segmentation and registration, MAM and URV \nwere computed and compared between cases with and without local tumor \nprogression(LTP) using Wilcoxon test. \nResults or Findings: The mean tumor volume was 4.2cm3. The mean \nablation zone volume was 66.2cm3. Median MAM was 3.9(0-10.5)mm and \nmedian URV 0.044(0-2.16)cm3. A total of 48(75%) lesions had an URV of \n<0.3cm3, 12(19%) between 0.3 and 1cm3 and 4(6%)>1cm3. Overall LTP rate \nwas 7 of 64(10.9%) per ablated malignant liver tumor. URV significantly \ndiffered between ablated tumors with and without LTP (0.7 [0.4-2.2] vs. 0.0 [0-\n1.5]cm3; p<0.05), whereas MAM showed no significant difference (p>0.05). \nConclusion: The proposed 3D approach based on deeplearning and image \nregistration allows for the assessment of MAM and URV, and can facilitate the \nevaluation of immediate treatment response after LTA. \nLimitations: n/a \nEthics Committee Approval: The local ethics committee approved this \nretrospective study \nFunding for this study: n/a \nAuthor Disclosures: \nRahil Shahzad: Employee: Philips Healthcare \nXiaoming Liu: Nothing to disclose \nFrank Thiele: Employee: Philips Healthcare \nAlexander Bunck: Nothing to disclose \nMichael Perkuhn: Employee: Philips Healthcare \nHuimao Zhang: Nothing to disclose \nJulius Niehoff: Nothing to disclose \nRobert Peter Reimer: Nothing to disclose \nKan He: Nothing to disclose \n \nRPS 705-14 \nLocally advanced rectal cancer: T2w-MRI based radiomics may detect \nresponder patients undergoing neoadjuvant chemoradiotherapy \nA. Bevilacqua, F. Coppola, *M. Mottola*, S. Lo Monaco, A. Cattabriga,  \nA. Cocozza, D. Cuicchi, L. Ricciardiello, R. Golfieri; Bologna/IT \n(margherita.mottola@unibo.it) \n \nPurpose: To investigate whether in locally advanced rectal cancer (LARC) \ntreated with neo-adjuvant chemoradiotherapy (nCRT), radiomics on T2 \nweighted (T2w) MRI sequences can discriminate responder (R) and non-\nresponder (NR) patients based on the Tumour Regression Grade (TRG) \nassigned after surgical resection \nMethods or Background: This study retrospectively enrols 40 patients \nundergoing pre-therapy 1.5T-MRI. Regions of Interest (ROIs) are manually \noutlined in all slices of the tumour’s site on T2w sequences in the oblique-axial \nplane, acquired with 3 mm slice thickness. Based on TRG, R patients have \ncomplete and partial nCRT response (TRG=[0,1], n°15) while NR patients have \na minimal and poor nCRT response (TRG=[2,3], n°25). Eighty-four local first-\norder radiomic features (RFs) are extracted from tumour ROIs. To prevent \noverfitting, only single RFs are investigated to discriminate Rs and NRs. The \nmost performing feature is selected through a univariate analysis guided by \none-tail Wilcoxon rank-sum test (p=0.05 significance level). To assess the \nfeature discrimination capability, ROC curve analysis is performed, through \nAUC computation, Youden Index (YI) for sensitivity and specificity. \nResults or Findings: One RF measuring the local heterogeneity of T2w \nvalues within tumour ROIs discriminates Rs and NRs with p~10-5, AUC=0.90 \n(95%CI, 0.73-0.96), with YI=0.68 corresponding to sensitivity=80% and \nspecificity=88%. The separation achieved highlights 3 false positives and 3 \nfalse negatives. \nConclusion: Pre-therapy baseline tumour heterogeneity measured from T2w-\nMR images has a very promising role in predicting the TRG histological \nclassification. Patients with lower tumour heterogeneity at pre-therapy show a \nbetter response to nCRT. \nLimitations: This study involves a small number of patients. However, one-\nonly feature is considered and such a strong discrimination stresses the future \nrole of the feature in a classification study. \nEthics Committee Approval: n° 842/2020/Oss/AOUBo \nFunding for this study: Not applicable \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 220  \nAuthor Disclosures: \nSilvia Lo Monaco: Nothing to disclose \nRita Golfieri: Nothing to disclose \nArrigo Cattabriga: Nothing to disclose \nAdriana Cocozza: Nothing to disclose \nMargherita Mottola: Nothing to disclose \nDajana Cuicchi: Nothing to disclose \nLuigi Ricciardiello: Nothing to disclose \nFrancesca Coppola: Nothing to disclose \nAlessandro Bevilacqua: Nothing to disclose \n \nRPS 705-15 \nDeep learning for differentiation of liver cirrhosis aetiology from clinical \nMRI \n*S. Nowak*, A. Faron, N. Mesropyan, M. Reuter, W. Block, D. Kütting,  \nU. I. Attenberger, J. A. Luetkens, A. M. Sprinkart; Bonn/DE \n \nPurpose: To investigate whether a Deep Learning approach allows \ndifferentiation of alcohol-related vs. non-alcohol-related liver cirrhosis based on \nclinical T2-weighted MRI. \nMethods or Background: Clinical MRI examinations of 465 patients with \nconfirmed diagnosis of liver cirrhosis from 2017 to 2019 formed the data set for \nthis retrospective monocentric study. Patients were classified according to the \netiology of liver cirrhosis into (a) alcohol-related (n=221) and (b) non-alcohol-\nrelated (n=244) diseases. T2-weighted single slice images at the height of the \ncaudate lobe were used for the analysis. The cohort was randomly divided into \ntraining (85%) and test data (15%) and the training data set was split for 5-fold \ncross-validation. For classification of alcohol-related and non-alcohol-related \ncirrhosis, two different ImageNet pre-trained Convolutional Neural Network \n(CNN) architectures (ResNet50, DenseNet121) were employed after upstream \nliver segmentation. \nResults or Findings: The mean accuracy and mean area under the receiver \noperating curve (AUC) for 5-fold cross-validation were 0.74 and 0.83 for \nResNet50 and 0.71 and 0.82 for DenseNet121. The highest classification \nperformance on test data was observed for the ensemble of cross-validated \nResNet50 with an accuracy of 0.75 (95% confidence interval: 0.64 - 0.85) and \nan AUC of 0.82 (0.72 - 0.92). \nConclusion: The application of a CNN supports the differentiation of alcohol-\nrelated vs. non-alcohol-related liver cirrhosis based on clinical T2-weighted \nMRI. This proof-of-principle study demonstrates that Deep Learning classifiers \ncan aid in uncovering the underlying cause of liver cirrhosis, which may also \nguide the decision for an appropriate treatment. \nLimitations: Although of clinical interest, the different types of etiologies of \nnon-alcohol-related cirrhosis were not addressed due to limited number of \ncases per subgroup. \nEthics Committee Approval: The study was approved by the local \ninstitutional review board with waiver for written informed consent. \nFunding for this study: Study was supported by BONFOR (2020-2A-04). \nAuthor Disclosures: \nJulian Alexander Luetkens: Nothing to disclose \nAnton Faron: Nothing to disclose \nAlois Martin Sprinkart: Nothing to disclose \nWolfgang Block: Nothing to disclose \nSebastian Nowak: Nothing to disclose \nUlrike I. Attenberger: Nothing to disclose \nDaniel Kütting: Nothing to disclose \nMartin Reuter: Nothing to disclose \nNarine Mesropyan: Nothing to disclose \n \nRPS 705-16 \nRadiomic features disclose the presence of microvascular invasion in \nhepatocellular carcinoma \nA. Bevilacqua, F. Coppola, *M. Mottola*, M. Renzulli, G. Vara, A. Rustici,  \nL. V. Pastore, L. Strigari, R. Golfieri; Bologna/IT \n(margherita.mottola@unibo.it) \n \nPurpose: To investigate whether a radiomic analysis performed on \nhepatocellular carcinoma can reveal the presence of microvascular invasion \n(MVI). \nMethods or Background: The dataset includes seventy-one early-stage HCC \nnodules (Milan criteria, nodule”3 cm, without macrovascular invasion and \nextrahepatic spread), where forty-two are MVI positive (MVI+) and twenty-nine \nare MVI negative (MVI-), at histopathological report obtained after surgery. \nRadiomic analysis is performed on contrast-enhanced CT imaging during the \narterial phase. HCC nodules were manually segmented and eighty-four local \nfirst-order radiomic features (RFs) are computed from HCC Region of Interest \n(ROIs). To avoid overfitting, only one couple of RFs is selected for \ndiscriminating MVI+ and MVI- into three steps: (i) a subset of RFs is first \nselected through LASSO; (ii) linearly correlated couples are discarded; (iii) \nafter computing the ROC curve, the most discriminating couple is selected as \nthat one yielding the highest AUC. The discrimination between MVI+ and MVI- \nis assessed through specificity and sensitivity computed at the Youden Index \n(YI). \nResults or Findings: The selected couple combines a measure of local \nheterogeneity to mean CT image values in HCC ROIs and allows achieving an \nAUC=0.86, with specificity=81% and sensitivity=83% at the YI=0.64. \nConclusion: The radiomic analysis allows unravelling different inner properties \nof HCC MVI+ nodules, which show a more heterogeneous tumour pattern with \nrespect to MVI-. \nLimitations: This radiomic analysis was performed exclusively on arterial-\nphase contrast enhanced images, although it is reasonable arguing that the \nnext inclusion of venous phase images must only improve the outcomes. \nEthics Committee Approval: No 197/2020/Oss/AOUBo \nFunding for this study: Not applicable \nAuthor Disclosures: \nRita Golfieri: Nothing to disclose \nLuigi Vincenzo Pastore: Nothing to disclose \nGiulio Vara: Nothing to disclose \nArianna Rustici: Nothing to disclose \nMargherita Mottola: Nothing to disclose \nMatteo Renzulli: Nothing to disclose \nLidia Strigari: Nothing to disclose \nFrancesca Coppola: Nothing to disclose \nAlessandro Bevilacqua: Nothing to disclose \n \nRPS 705-18 \nInfluence of different adaptive statistical iterative reconstruction (ASIR-V) \nlevels on computed tomography (CT) radiomic features \n*F. Pucciarelli*, M. Zerunian, T. Polidori, G. Guido, E. Lucertini, B. Bracci,  \nC. Rucci, A. Laghi; Rome/IT \n(pucciarelli.fra@gmail.com) \n \nPurpose: To evaluate the influence of different levels of ASIR-V on CT \nRadiomic Features. \nMethods or Background: One-hundred and twenty patients who underwent \nunenhanced abdominal CT scans with the same scanner (Revolution Evo, GE \nHealthcare, USA) were analyzed. Subsequently, raw data of filtered-back \nprojection (FBP) were reconstructed with 10 levels of ASIR-V (from 10 to \n100%). Two radiologists extracted texture features of liver and kidney tissues \nusing two different regions of interest (ROIs) that were cloned for all eleven \ndifferent iteration levels datasets. Data were extracted with TexRad Medical \nImaging Software. Six different radiomic features (Mean, Standard Deviation \n(SD), Entropy, Mean of Positive Pixel (MPP), Skewness, Kurtosis) were \nextrapolated and compared between FBP and all ASIR-V levels. \nResults or Findings: Texture analysis of the liver revealed significant \ndifferences between FBP and all ASIR-V reconstructions for mean (all \np<0.002), SD (all p<0.0001), Entropy (all p<0.0001) and MPP (all p<0.0001), \nwhile no significant differences was observed for Skewness and Kurtosis \nbetween FBP and all ASIR-V reconstructions (all p>0.45 and all p>0.58, \nrespectively). Similar results were obtained for kidney analysis with no \ndifferences for Skewness and Kurtosis (all p>0.053 and all p>0.176, \nrespectively) and significant changes for Mean (all p<0.0001), SD (all \np<0.0001), Entropy (all p<0.0036) and MPP (all p<0.0001). \nConclusion: No influence of iterative reconstructions algorithm was reported \nfor skewness and kurtosis compared to FBP in liver and kidney analysis \nwhereas Mean, SD, Entropy and MPP were significantly affected by ASIR-V. \nSkewness and Kurtosis may be reliable quantitative parameters. \nLimitations: Analysis performed on image acquired without contras medium, \nonly on healthy parenchyma and a single vendor. \nEthics Committee Approval: This study was approved by our local \ninstitutional review board and written informed consent was obtained from all \nstudy participants. \nFunding for this study: No. \nAuthor Disclosures: \nFrancesco Pucciarelli: Nothing to disclose \nCarlotta Rucci: Nothing to disclose \nMarta Zerunian: Nothing to disclose \nBenedetta Bracci: Nothing to disclose \nTiziano Polidori: Nothing to disclose \nAndrea Laghi: Nothing to disclose \nGisella Guido: Nothing to disclose \nElena Lucertini: Nothing to disclose \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 221  \nRPS 705-19 \nRevealing the most suitable CT radiomics features for retrospective \nstudies with heterogeneous datasets \n*O. Jimenez-del-Toro*¹, C. Aberle², M. Bach², R. Schaer¹, M. M. Obmann²,  \nE. Konukoglu³, B. Stieltjes², H. Müller¹, A. Depeursinge ຾; ¹Sierre/CH, \n²Basel/CH, ³Zurich/CH, ຾Lausanne/CH \n(oscar.jimenez@hevs.ch) \n \nPurpose: There is a strong variability of CT images when using regular clinical \nimaging protocols, as it is often the case in retrospective studies. Their \ninfluence on the usability of radiomics features is still unclear. This study aims \nto assess the stability and discriminative power of radiomics features in 240 CT \nseries of different reconstruction parameter variations using an \nanthropomorphic abdominal phantom. \nMethods or Background: A novel anthropomorphic 3D-printed radiopaque CT \nphantom was created based on a CT of a cancer patient. Regions-Of-Interests \n(ROIs) were manually annotated in normal liver tissue and 3 lesion types: \ncysts, hemangioma and metastasis. 86 radiomics features were extracted from \nthe ROIs in 30 repeated phantom acquisitions for 8 groups of CT parameter \nsettings with varying reconstruction algorithms, reconstruction kernels, slice \nthicknesses and slice spacings. Univariate pairwise Wilcoxon signed-rank tests \nassessed the statistical significance of the feature variations among the 8 \ngroups and 4 tissue classes. \nResults or Findings: The variations of CT parameter settings produced \nstatistically significant differences in pairwise comparisons, with more than 70% \nof the 86 radiomics features showing significant differences in their value \ndistributions. All radiomics features were able to differentiate between the 4 \nclasses of liver tissue in more than 40% of the performed tests. In a principal \ncomponent analysis, the inter-class variation from the 4 classes was larger \nthan the intra-class variations caused by CT reconstruction parameter \nvariations in the 8 groups. \nConclusion: While the tested radiomics features are influenced by CT \nreconstruction parameters, the features have sufficient stability and \ndiscriminative power to differentiate tissue types. The presented approach \nusing a 3D-printed phantom could systematically analyse different scanner \ntypes in the future. \nLimitations: Not applicable \nEthics Committee Approval: Not applicable \nFunding for this study: Swiss Personalized Health Network (SPHN) QA4IQI \nproject DMS2445, SNSF grant 205320\\_179069 \nAuthor Disclosures: \nBram Stieltjes: Nothing to disclose \nMarkus Obmann: Nothing to disclose \nEnder Konukoglu: Nothing to disclose \nMichael Bach: Nothing to disclose \nAdrien Depeursinge: Nothing to disclose \nChristoph Aberle: Nothing to disclose \nHenning Müller: Nothing to disclose \nOscar Jimenez-del-Toro: Nothing to disclose \nRoger Schaer: Nothing to disclose \n \nRPS 705-20 \nDeep learning-based algorithm yields high accuracy for the detection of \nsmall renal cell carcinoma on contrast-enhanced CT \n*N. Toda*¹, M. Hashimoto¹, H. Haque¹, Y. Arita¹, H. Akita¹, T. Akashi¹,  \nH. Gobara², A. Nishie³, M. Jinzaki¹; ¹Tokyo/JP, ²Okayama/JP, ³Fukuoka/JP \n(ntohda@rad.med.keio.ac.jp) \n \nPurpose: Small (<=4 cm) renal cell carcinoma (RCC) is often found \nincidentally on imaging and to our knowledge, its automatic detection has not \nbeen widely investigated. We aimed to develop a deep learning-based \nalgorithm for the detection of small RCC on CT. \nMethods or Background: Our dataset consisted of 510 nephrogenic and \ndelayed phase CT images with histologically confirmed solid single RCC \nbetween January 2005 and March 2020 from Japan Medical Image Database. \nThese images were split into training and test samples (80% and 20%). We \ndeveloped algorithms using a combination of RCC segmentation and binary \nclassification. We also adopted kidney segmentation for extracting kidneys to \nimprove RCC segmentation result. First, both kidneys were extracted from \nimages by using 3D U-Net kidney segmentation model. Then, RCC-suspected \nslice was extracted from each kidney by using different 3D U-Net called RCC \nsegmentation model. Finally, RCC-suspected lesion was classified as RCC-\npositive or RCC-negative with 2D ResNet-34. All models were independently \ntrained from the scratch. We evaluated the performance of the model pipeline \nwith test dataset and compared with the algorithm without kidney extraction \nstep. \n \n \n \nResults or Findings: Mean diameter of RCC in balanced test dataset was 2.8 \ncm. Our algorithm with kidney extraction step achieved sensitivity, specificity of \n83.3%, 92.2% respectively. AUC of this algorithm was 0.907 and significantly \nhigher than that of the algorithm without kidney extraction step. \nConclusion: The proposed deep learning-based algorithm was feasible with \nhigh performance for detection of small RCC on multicenter contrast-enhanced \nCT images. It can contribute to early detection and treatment of small RCC. \nLimitations: Small sample size of RCC except clear cell subtype. Patients with \nsolid benign tumor were not included as RCC-negative in this study. \nEthics Committee Approval: Institutional Review Board approval was \nobtained. \nFunding for this study: AMED JP19lk1010025. \nAuthor Disclosures: \nMasahiro Jinzaki: Research/Grant Support: Radiologist \nToshiaki Akashi: Nothing to disclose \nMasahiro Hashimoto: Research/Grant Support: Radiologist \nHasnine Haque: Employee: GE Healthcare \nAkihiro Nishie: Nothing to disclose \nHideo Gobara: Nothing to disclose \nNaoki Toda: Research/Grant Support: Ph.D student \nYuki Arita: Research/Grant Support: Radiologist \nHirotaka Akita: Nothing to disclose \n \n \nResearch Presentation Session: Artificial \nIntelligence & Machine Learning \nRPS 805 \nAI in thoraxial imaging \nRPS 805-1 \nDeep learning for improved lung cancer detection on chest radiographs: \nresults of a multi-reader study in national lung cancer screening dataset \n*Y. Hyunsuk*¹, S. S. Lee¹, C. D. Arru², R. Singh², S. R. Digumarthy²,  \nM. K. Kalra²; ¹Seoul/KR, ²Boston, MA/US  \n(hyunsuky@lunit.io) \n \nPurpose: To assess whether AI improves the reader performance for lung \ncancer detection using CXRs selected from participants from NLST \nMethods or Background: This reader study included 519 CXRs selected from \nthe NLST data set. 75 CXRs from 68 patients with visible lung cancers and 444 \nCXRs belonging to 226 patients were selected. Six readers, including three \nradiology residents, and three board-certified radiologists, participated in the \nobserver performance test. Performance of the readers without and with AI in \nterms of visible lung cancer detection and chest CT recommendation was \nanalyzed. \nResults or Findings: With AI, the average sensitivity of readers for the \ndetection of visible lung cancer increased for residents, but was similar for \nradiologists compared to that without AI (0.61 [95%CI,0.55-0.67] vs. 0.72 \n[95%CI,0.66-0.77], p<0.001 for residents, and 0.78 [95%CI,0.73-0.84] vs. 0.78 \n[95%CI,0.73-0.84, p=1.00 for radiologists), while false-positive findings per \nimage (FPPI) was similar for residents, but decreased for radiologists (0.15 \n[95%CI,0.11-0.18] vs. 0.14 [95%CI,0.11-0.17], p=0.60 for residents, and 0.36 \n[95%CI,0.31-0.41] vs. 0.25 [95%CI,0.21-0.30], p<0.001 for radiologists). With \nAI, the average rate of chest CT recommendation for visible cancer increased \nfor residents, but was similar for radiologists (54.7% [95%CI,48.2%-61.2%] vs. \n70.2% [95%CI,64.2%-76.2%], p<0.001 for residents and 72.0% [95%CI,66.1%-\n77.9%] vs. 74.7% [95%CI,69.0%-80.3%], p=0.11 for radiologists), while that for \nnonvisible cancer was similar for both groups. On CXRs of seven patients with \nmissed lung cancer, average residents detected more lung cancer with AI \n(39% [2.7 of 7] vs. 71% [5.0 of 7], p<0.001). \nConclusion: An AI algorithm increased sensitivity and decreased false-\npositives for lung cancer detection for residents and radiologists, respectively. \nAI can enhance the value of CXRs for lung cancer screening. \nLimitations: The prevalence of lung cancer was low, and only 98 lung cancer \npatients were included. \nEthics Committee Approval: Approved \nFunding for this study: None \nAuthor Disclosures: \nSanghyup Simon Lee: Employee: Lunit \nMannudeep K Kalra: Nothing to disclose \nChiara Daniela Arru: Nothing to disclose \nYoo Hyunsuk: Employee: Lunit Inc \nRamandeep Singh: Nothing to disclose \nSubba Rao Digumarthy: Nothing to disclose \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 222  \nRPS 805-2 \nComputer-aided analysis of airway dimensions for objective diagnosis \nand monitoring of bronchiectasis and airway wall thickening \n*Q. Lv*¹, L. Gallardo Estrella², E-R. Andrinopoulou¹, J-P. Charbonnier²,  \nM. Kemner van de Corput¹, E. Van Rikxoort², M. De Bruijne¹, P. Ciet¹,  \nH. A. W. M. Tiddens¹; ¹Rotterdam/NL, ²Nijmegen/NL  \n(l.qianting@erasmusmc.nl) \n \nPurpose: Develop and validate an automated method for assessment of \nairway artery (AA) - dimensions on chest-Computer Tomography (CT) of Cystic \nFibrosis (CF) - patients for detection and monitoring of airway wall thickening \n(AWT) and bronchiectasis. \nMethods or Background: Lung diseases such as CF are characterized by \nAWT and bronchiectasis. Manual measurement of AA pairs on chest-CTs is a \nsensitive but time-consuming method to detect and monitor airways disease. \nLung quantification software (LungQ, Thirona, Nijmegen) was used to identify \nAA-pairs and airway generations (G) to automatically quantify for each AA-pair: \nouter airway diameter(Aout), inner airway diameter(Ain), artery diameter(A), \nairway wall thickness (Awt), and the Aout-A, Ain-A, Awt-A ratios. Results \npresented starting at the first segmental bronchi(G1). 40 out of 70 CT scans \nfrom the Erasmus-MC CF-cohort were added to the internal training dataset to \nmake the algorithm robust against CF abnormalities. For validation, LungQ AA-\nanalysis was compared against a manual AA-method of chest-CTs of 11 CF-\npatients (median 11, [7-16] years) and of 12 age matched control chest-CTs. \nAA-dimensions, AA-ratios, and the area under the curve (AUC) of CF and \ncontrols for segmental generation (G1-G7) were compared between the two \nmethods. \nResults or Findings: The LungQ AA-analysis detected 4693 AA-pairs, against \n4814 AA-pairs by manual method. For Aout/A ratio, and Awt/A ratio outcomes \nthere was no significant difference between the AUC of the LungQ AA-analysis \nand the manual method from G4 to G7. AUC of Aout/A ratio (from G5 to G7) \nand Awt/A ratio(from G3 to G7) were above 0.8 for the LungQ AA-analysis, \nreflecting excellent discrimination. \nConclusion: The automatic AA-method showed a high accuracy to detect \nAWT and bronchiectasis comparable to the manual method. \nLimitations: Further validation is currently ongoing. \nEthics Committee Approval: Mixed case \nFunding for this study: Dutch CF foundation (PPP grant) \nAuthor Disclosures: \nJean-Paul Charbonnier: Shareholder: shareholder at Thirona \nEleni-Rosalina Andrinopoulou: Nothing to disclose \nPierluigi Ciet: Nothing to disclose \nQianting Lv: Nothing to disclose \nMariëtte Kemner van de Corput: Nothing to disclose \nLeticia Gallardo Estrella: Employee: scientists working at Thirona \nEva Van Rikxoort: Shareholder: Co-founder and shareholder Thirona \nHarm A W M Tiddens: Consultant: Director ErasmusMC Lunganalysis, \nConsultant for Novartis, Insmed, Thirona, Translate Bio \nMarleen De Bruijne: Nothing to disclose \n \nRPS 805-6 \nPushing the boundaries of deep learning-based image translation: \ncreating PET images from CT images of the lung \nV. K. Venugopal, *V. Mahajan*, H. Mahajan , R. Takhar; Delhi/IN \n(vidur@mahajanimaging.com) \n \nPurpose: To create Positron Emission Tomography (PET) images from \nComputed Tomography (CT) images using Deep Learning based methods with \na focus on the thorax. \nMethods or Background: 3,878 PET-CT scans were pulled from PACS and \nanonymised. From these, ~670,000 paired images of contrast enhanced CT \nand PET of the lung were extracted. CECT images were used since contrast \nflow can provide a potential surrogate for perfusion, and thereby function, in \nthe tissue. A pre-processing pipeline consisting of linear scaling, SUV \nnormalization (for PET), HU conversion (for CT), and re-windowing to lung \nwindow was created. To train the deep learning model an incremental learning \napproach was utilised comprising a Cycle-GAN (Pix2Pix) to create a baseline \nPET image which is then passed through a conditional GAN (cascaded UNET \nwith 2 UNETs). A held out test set of 49 PET-CT scans was used for clinical \nassessment of the model and Peak Signal to Noise Ratio (PSNR) and \nStructural Similarity Index (SSIM) were used for quantitative assessment of the \nalgorithm. \nResults or Findings: Training of the deep learning algorithm took 72 hours on \ntwo 1080ti GPUs (Nvidia, USA). On the held-out test set, the average PSNR \nwas 16.8638 with standard deviation of 3.34 and median of 16.14 and average \nSSIM was 0.50 with standard deviation of 0.076 and median of 0.4919. Cases \nwith the least SSIM were analyzed by a clinician and most such cases \nconsisted of images of the abdomen or distorted anatomy. Further deep dive is \nrequired to establish correlations between such errors. \nConclusion: Our work provides emerging evidence of the fact that it might \nindeed be possible to extract functional information (PET images) from \nanatomic scans (CT scans) using deep neural networks. \nLimitations: Small validation set \nEthics Committee Approval: IRB approval obtained \nFunding for this study: None \nAuthor Disclosures: \nRohit Takhar: Nothing to disclose \nHarsh Mahajan : Other: Director, Mahajan Imaging Pvt Ltd \nVasantha Kumar Venugopal: Other: Research collaboration, Aikenist Other: \nResearch collaboration, General Electric Company Other: Research \ncollaboration, Lunit Inc. Other: Research collaboration, Predible Health Other: \nResearch collaboration, Koninklijke Philips NV Other: Research collaboration, \nQure.ai Other: Research collaboration, Oxipit \nVidur Mahajan: Other: Head of Research at CARING \n \nRPS 805-7 \nImpact of a deep learning AI pneumothorax detection algorithm: \ncomparison of radiologist and bedside clinician performances \nJ. M. Sabol¹, T. Zhang², *A. Baenen*², G. Rao², Z. Herczeg², B. Heckel²,  \nP. Tegzes²; ¹Sussex, NJ/US, ²Waukesha, WI/US \n(alec.baenen@ge.com) \n \nPurpose: On-device AI applications assist both radiologists and bedside \nclinicians. This study compares the impact of a deep-learning-based AI \nalgorithm on detection of pneumothorax (PTX) by radiologists and bedside \nclinicians. \nMethods or Background: The AI system evaluated uses frontal chest x-ray \nclassifier and PTX classification algorithms developed from over 32k and 12.5k \nindependent images, respectively. This study used a challenging, independent, \ndataset of 174 cases with a range of co-morbidities from 3 international clinical \nsites which was curated by 3 independent radiologists. 48% were positive for \nPTX, 64% were small. Readers represented clinicians reading chest x-rays \nincluding thoracic radiologist and resident, ER physician and resident, Internal \nMedicine resident, and two nurse practitioners. All readers read each case \ntwice, with and without the aid of AI with minimum of 4-weeks between. PTX \ndetection was assessed with a Multiple-Reader Multiple-Case ROC analysis \nand sensitivity/specificity analyzed from separate binary responses on the \npresence/absence of PTX. \nResults or Findings: ROC AUC of radiologists increased by 0.015 (p<0.703) \nwith aid of AI. However, for the other clinicians, the AUC increase of 0.100 was \nsignificant (p<0.035). Similarly, with the aid of AI, radiologists showed a 1.2% \nincrease in sensitivity and 0.6% increase in specificity whereas for the other \nclinicians the sensitivity and specificity increased by 6.9% and 12.5% \nrespectively. The significant improvement of non-radiologist clinicians was \nmostly attributed to improved performance on small PTX with AUC increase of \n0.129 (p<0.012). \nConclusion: Although AI improved performance of all readers, increases were \nmost significant for non-radiologist clinicians. This study supports deployment \nof AI tools to bedside practitioners who experience the greatest benefit. \nLimitations: Research with more readers of each category is required to \nthoroughly define the impact of AI on bedside radiography. \nEthics Committee Approval: IRB oversight waived. \nFunding for this study: Not applicable \nAuthor Disclosures: \nBeth Heckel: Employee: GE Healthcare \nPál Tegzes: Employee: GE Healthcare \nGireesha Rao: Employee: GE Healthcare \nAlec Baenen: Employee: GE Healthcare \nJohn M Sabol: Nothing to disclose \nTianhao Zhang: Employee: GE Healthcare \nZita Herczeg: Employee: GE Healthcare \n \nRPS 805-8 \nPediatric age estimation from thoracic and abdominal CT scout views \nusing deep learning \n*A. Demircioglu*, L. Umutlu, K. Nassenstein; Essen/DE \n(aydin.demircioglu@uk-essen.de) \n \nPurpose: Age assessment is regularly used in clinical routine by pediatric \nendocrinologists to determine the physical development or maturity of children \nand adolescents. In this study, a deep neural network is developed to \nautomatically estimate chronological age from thoracic and abdominal CT \nscout views in pediatric patients. \nMethods or Background: In this retrospective study, 1,903 CT scout views \nfrom pediatric patients (acquired between January 2013 and December 2018) \ncorresponding to thoracic and abdominal CT scans were collected to train a \nwide & deep neural network. The network was trained to predict chronological \nage from the CT scout views and was evaluated on an independent validation \nset of 494 CT scout views (acquired between January 2019 and July 2020). A \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 223  \nt-test was used to test whether the mean average error was smaller than 2.0 \nyears. \nResults or Findings: The trained model showed a mean absolute error of \n1.30 +/- 1.25 years on the validation data set. The one-sided t-test was \nstatistically highly significant (p < 0.001), i.e. the difference between the \npredicted and actual chronological age was less than 2.0 years The correlation \ncoefficient was very high (R = 0.95). \nConclusion: The chronological age of pediatric patients can be assessed with \nhigh accuracy from thoracic and abdominal CT scout views using a deep \nneural network. \nLimitations: This study was conducted at a single site using CT scanners from \na single vendor. To ensure that the results are valid in other populations, \nexternal validation using data acquired with scanners from different vendors is \nrequired. \nEthics Committee Approval: Ethical approval for this retrospective study was \ngranted by the local ethics committee. Written and informed consent was \nwaived because of the retrospective nature. \nFunding for this study: None \nAuthor Disclosures: \nKai Nassenstein: Nothing to disclose \nLale Umutlu: Nothing to disclose \nAydin Demircioglu: Nothing to disclose \n \nRPS 805-9 \nDetermining age, body height and weight from thoracic and abdominal \nCT scout view \n*A. Demircioglu*, M. S. Kim, K. Nassenstein, L. Umutlu; Essen/DE \n(aydin.demircioglu@uk-essen.de) \n \nPurpose: To automatically determine the age, body height and weight of \npatients from thoracic and abdominal CT scout views using deep learning \nmethods. \nMethods or Background: For this retrospective study, 5000 thoracic and \nabdominal CT scout views (acquired between January 2016 and December \n2018) were collected. A wide & deep network was trained to predict the age, \nbody height and width from the CT scout views. Evaluation was performed on \nan independent validation set of 2000 CT scout views (acquired between \nJanuary 2019 and July 2020) by computing the mean average error between \nthe predictions and the true outcomes. \nResults or Findings: For prediction of age, the model showed an accuracy of \n6.8 ± 5.7 years, for body height of 4.5 ± 3.5 cm and for body weight of 4.7 ± 6.8 \nkg. A one-sided t-test indicated that the difference between the predicted and \nreal outcomes to be statistically significantly in all cases, i.e. the difference is \nless than 10 years, 10 cm and 10 kg resp. A high correlation coefficient could \nbe seen for all three outcomes (R = 0.80, 0.81 and 0.91 resp.). \nConclusion: Automated estimation of age, body height and weight from \nthoracic and abdominal CT scout views can be performed with good accuracy \nusing a deep neural network. \nLimitations: Some limitations apply to our study: While the CT scout views \nwere acquired from several different scanner models, they all were from a \nsingle vendor. An external validation set is necessary to ensure that the trained \nmodel generalizes to data acquired from scanners from different vendors and \nhospital sites. \nEthics Committee Approval: Ethical approval for this retrospective study was \ngranted by the local ethics committee. Written and informed consent was \nwaived because of the retrospective nature. \nFunding for this study: None \nAuthor Disclosures: \nMoon Sung Kim: Nothing to disclose \nKai Nassenstein: Nothing to disclose \nLale Umutlu: Nothing to disclose \nAydin Demircioglu: Nothing to disclose \n \nRPS 805-12 \nImpact of destructive and bronchiectasis changes on the quality of \nautomatic lung emphysema quantification \n*N. Griva*, P. Gavrilov; St. Petersburg/RU \n(grivamd@gmail.com) \n \nPurpose: The aim of the study is to assess the impact of infectious destructive \nchanges (lung cavities) and bronchiectases on the quality of automatic lung \nemphysema quantification. \nMethods or Background: Retrospective analysis of chest CT of 50 patients \nwith pulmonary emphysema combined with lung cavities and bronchiectases \nwas performed. All studies were performed on the same computed tomograph \nusing a standard program. Initially, all CT scans was estimated in a standard \n\"lung window\" (-1200/-600HU) by two independent radiologists. For deeper \nanalysis three different software programs were used. \nResults or Findings: The minimum percentage of detected changes for \nprograms A and C was 0.2%, for program B - 0.3%. Differences in program \ncalculations in one patient ranged from 0 to 17.6%. Bronchiectases were \ndetermined in 49 patients and included in the final emphysema volume in \n100% of cases by all three programs. Lung cavities were found in 19 out of the \n50 patients. In most cases, this changes were considered by programs as \nemphysema, nevertheless program B gives a slightly better result (9 out of 19), \ncompared to programs A (11 out of 19) and C (13 out 19). We found a \nsignificant overstatement of the results of the estimated emphysema \npercentage by program B, while the difference in the results of programs A and \nC was within the confidence interval. \nConclusion: The presence of lung cavities and bronchiectases in patients with \nemphysema significantly affects the final result of volumetric analysis. When \ncomparing all three software products, there was a significant overestimation \nby program B and a good correlation between programs A and C. \nLimitations: The CT scan did not include spirometric triggering, so we could \nnot completely ensure that imaging studies were obtained during maximum \ninspiration. \nEthics Committee Approval: Approved \nFunding for this study: None \nAuthor Disclosures: \nPavel Gavrilov: Nothing to disclose \nNadezda Griva: Nothing to disclose \n \nRPS 805-13 \nAutomated calculation of the right ventricle to left ventricle ratio on CT \nfor the risk stratification of patients with acute pulmonary embolism \n*R. W. Foley*, S. Glenn-Cox, G. Mynott, T. A. Burnett, W. Brown,  \nJ. Suntharalingam, B. J. Hudson, G. Robinson, J. C. L. Rodrigues; Bath/UK \n \nPurpose: To assess the feasibility of the use of artificial intelligence post-\nprocessing to calculate the right ventricle to left ventricle (RV:LV) ratio on \ncomputed tomography pulmonary angiography (CTPA) and to investigate its \nprognostic value in patients with acute pulmonary embolism (PE). \nMethods or Background: Single centre, retrospective study of 101 \nconsecutive patients with CTPA-proven acute PE. Ventricular volumes were \nsegmented on 1mm contrast-enhanced axial slices and maximal ventricular \ndiameters were derived for RV:LV ratio using automated post-processing \nsoftware (IMBIO LLC, USA) and compared to manual analysis in two \nobservers, via intraclass coefficient correlation analysis. Each CTPA report was \nanalysed for mention of the RV:LV ratio and compared to the automated \nRV:LV ratio. 30-day all-cause mortality was recorded. \nResults or Findings: Automated RV:LV analysis was feasible in 87% (n=88). \nRV:LV ratios ranged from 0.67-2.43, with 64% (n=65) >1.0. There was very \nstrong agreement between manual and automated RV:LV ratios (ICC = 0.83, \n0.77-0.88). The use of automated analysis led to a change in risk stratification \nin 45% of patients (n=40). The AUC of the automated measurement for the \nprediction of all-cause 30-day mortality was 0.77 (95% CI: 0.62 – 0.99). \nConclusion: The automated RV:LV ratio on CTPA can be reliably measured in \nthe majority of patients, with perfect reproducibility. The routine use of this \nautomated analysis in clinical practice would add important prognostic \ninformation in patients with acute PE. \nLimitations: This study is limited by its retrospective design. The initial results \nof this automated analysis are promising. However, before its implementation \nin clinical practice, it is essential that this technique undergo robust external \nvalidation via a multicentre study with larger patient numbers. \nEthics Committee Approval: This study was approved by our institution’s \nTrust Audit Committee. \nFunding for this study: No specific funding was obtained for this study. \nAuthor Disclosures: \nSophie Glenn-Cox: Nothing to disclose \nGraham Robinson: Nothing to disclose \nTim Alexander Burnett: Nothing to disclose \nGeorgina Mynott: Nothing to disclose \nWilliam Brown: Nothing to disclose \nBenjamin James Hudson: Nothing to disclose \nJay Suntharalingam: Nothing to disclose \nRobert Foley: Nothing to disclose \nJonathan Rodrigues: Nothing to disclose \n \nRPS 805-15 \nRadiomics based analysis of spectral detector CT derived pulmonary \nperfusion maps for the diagnosis and classification of pulmonary \nhypertension \n*R. J. Gertz*, L. Caldeira, R. Shahzad, J-R. Kroeger, F. Gerhardt,  \nS. Rosenkranz, M. Perkuhn, D. Maintz, A. Bunck; Cologne/DE \n(roman.gertz@uk-koeln.de) \n \nPurpose: To investigate if radiomics-based analysis of normal and \nmalperfused lung regions as derived from spectral-detector CT (SDCT) can be \nused to identify patients suffering from pulmonary hypertension (PH) and to \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 224  \ndifferentiate between chronic thromboembolic hypertension (CTEPH) and PH \ndue to different etiologies. \nMethods or Background: 66 consecutive patients with right heart catheter \nproven PH (62±16 years; male/female ratio, 21/45; CTEPH/noCTEPH 26/41) \nand 37 controls (62±17 years; m/f ratio, 26/11) who underwent CT pulmonary \nangiography on a SDCT were included. Lungs were automatically segmented \ninto normal perfused and malperfused areas based on iodine density \nthreshold. 222 Radiomics features were computed, 111 from each region. Two \nclassification tasks were performed: 1)PH vs. controls; 2)CTEPH vs. PH due to \ndifferent etiologies. The dataset was divided into training (~75%, 50 PH, 29 \ncontrols) and test-set (~25%, 16 PH, 8 controls). Mutual information was used \nfor feature pre-selection, recursive feature elimination was performed and a \nrandom forest classifier trained using 5-fold-cross-validation(CV). \nResults or Findings: In the first task, PH vs. controls, 5 features derived from \nthe normal perfused region were opted for classification, resulting in a CV \naccuracy (ACC) of 0.82±0.05. In the testing dataset, an ACC of 0.79 was \nattained. Differentiation between CTEPH and PH due to different etiologies, \nhowever, appealed more challenging. Selecting 13 features, 10 from the \nnormal perfused and 3 from the malperfused regions lead to a CV ACC of \n0.60±0.12, while in the testing dataset, an ACC of 0.68 could be achieved. \nConclusion: Radiomics features derived from SDCT pulmonary perfusion \nmaps can identify patients suffering from PH with high accuracy and show \npromising results differentiating between CTEPH and PH due to other \netiologies. \nLimitations: n/a \nEthics Committee Approval: The local ethics committee approved this \nretrospective study \nFunding for this study: n/a \nAuthor Disclosures: \nRahil Shahzad: Employee: Philips Research \nFelix Gerhardt: Nothing to disclose \nStephan Rosenkranz: Nothing to disclose \nLiliana Caldeira: Nothing to disclose \nDavid Maintz: Nothing to disclose \nJan-Robert Kroeger: Nothing to disclose \nRoman Johannes Gertz: Nothing to disclose \nAlexander Bunck: Nothing to disclose \nMichael Perkuhn: Employee: Philips Healthcare \n \nRPS 805-17 \nDeep learning for classification and selection of cine CMR images to \nachieve fully automated quality controlled CMR analysis \n*V. Vergani*, A. King, R. Razavi, E. Puyol-Antòn, B. Ruijsink; London/UK \n(vergani.vittoria@gmail.com) \n \nPurpose: In cardiac magnetic resonance (CMR), image-quality and planning \nsignificantly affect cardiac function analysis. In this study, we developed a deep \nlearning pipeline for automated identification and quality control (QC) of cine \nimages from routine clinical cardiovascular magnetic resonance (CMR) exams. \nMethods or Background: This is a multicenter, multivendor study of 3,448 \nsubjects (114,145 CMR images). The first step of our pipeline identifies \npotential cine images with a set of heuristic rules (time and number of frames). \nThe second step consisted of a convolutional neural network (CNN)-1 to \nclassify images into conventional cine classes (4Ch, 3Ch, 2Ch, short-axis), or a \nclass of ‘other’. This was followed by another CNN for each long-axis class \n(2ChCNN-2, 3ChCNN-2, 4ChCNN-2) to classify images according to quality. \nThis was then used as a QC to select the best sequence of each class per \npatient. Accuracy was computed to determine performance of each CNN using \na test-set (10% and 20% of the total images for CNN-1 and CNN-2). To \nvalidate the pipeline, we subsequently used it to process 50 full clinical CMR \nstudies, not used for training, and computed Cohen’s coefficient to assess \nagreement with manual processing. \nResults or Findings: Accuracy of the CNN-1 was 1.00. Accuracy of 2ChCNN-\n2, 3ChCNN-2, 4ChCNN-2 were 0.88, 0.87, 0.87 respectively. There was \nsubstantial agreement between manual and automated processing (K=0.74). \nConclusion: We developed a robust and generalisable algorithm to classify \nand QC-select CMR images prior to further automated analysis. To the best of \nour knowledge, this is the first work with this aim in the field of CMR. \nLimitations: This is a proof of concept study. The pipeline will need to be \nvalidated on a larger cohort before widespread use for automated CMR \nanalysis. \nEthics Committee Approval: N.a. \nFunding for this study: N.a. \nAuthor Disclosures: \nReza Razavi: Nothing to disclose \nBram Ruijsink: Nothing to disclose \nEsther Puyol-Antòn: Nothing to disclose \nVittoria Vergani: Nothing to disclose \nAndrew King: Nothing to disclose \n \nRPS 805-18 \nDetecting the pulmonary trunk in CT scout views using deep learning \nA. Demircioglu, M. C. Stein, *M. S. Kim*, L. Umutlu, K. Nassenstein; Essen/DE \n \nPurpose: CT pulmonary angiography is an important examination to diagnose \nor exclude pulmonary embolism. As an initial step towards automating \npulmonary angiography in clinical routine, a deep neural network is trained to \npredict and mark the location of pulmonary trunk in the CT scout view, which is \na necessary step for bolus triggering in CT. \nMethods or Background: For training, 750 patients who have received a \nthoracic CT scan between March 2003 and February 2020 were randomly \nchosen and anonymized. In addition, a validation set of 239 CT scout views \nfrom patients between March 2020 and May 2020 was collected. The \ncraniocaudal limits of the pulmonary trunk were identified in the 5 mm axial \nslices by a board-certified radiologist and carried over to the CT scout view. A \nconditional generative adversarial network was trained on the CT scout views \nto predict the area of the pulmonary trunk and slice position for bolus-triggering \nthe CT-scan. \nResults or Findings: Overall, the predictions of the neural network showed \nhigh precision (Dice score 0.82). On 6 out of 239 images the slice by the neural \nnetwork was outside the region of the pulmonary trunk, yielding an accuracy of \n97.5%. The mean distance to the slice where the pulmonary trunk was best \nvisible was 4.7 +/- 4.0mm. \nConclusion: Deep learning can be used to train an automated detection of \nregions in CT scout views corresponding to the pulmonary trunk with high \nprecision. Thus, it is a promising initial approach for automating the scan-\nprocedure of CT pulmonary angiography. \nLimitations: This study was conducted on a single site, an external validation \ncohort is needed to confirm the results. \nEthics Committee Approval: Ethical approval for this retrospective study was \ngranted by the local ethics committee, informed consent was waived. \nFunding for this study: None \nAuthor Disclosures: \nKai Nassenstein: Nothing to disclose \nLale Umutlu: Nothing to disclose \nMoon Sung Kim: Nothing to disclose \nAydin Demircioglu: Nothing to disclose \nMagdalena Charis Stein: Nothing to disclose \n \n \nResearch Presentation Session: Artificial \nIntelligence & Machine Learning \nRPS 905 \nAI in musculoskeletal imaging \nRPS 905-1 \nCT radiomics-based machine-learning classification of atypical \ncartilaginous tumours and appendicular chondrosarcomas \n*S. Gitto*¹, R. Cuocolo², M. Acquasanta ¹, A. Cincotta¹, V. Chianca¹,  \nD. Albano¹, C. Messina¹, A. Annovazzi³, L. M. Sconfienza¹; ¹Milan/IT, \n²Naples/IT, ³Rome/IT  \n(sal.gitto@gmail.com) \n \nPurpose: To investigate the diagnostic performance of computed tomography \n(CT) radiomics-based machine learning for classification of atypical \ncartilaginous tumors and higher-grade chondrosarcomas of long bones. \nMethods or Background: One-hundred-twenty patients with surgically treated \nand histology-proven cartilaginous bone tumors were retrospectively included \nat two tertiary tumor centers. The training cohort consisted of 84 CT scans from \ncenter 1 (n=55 G1 or atypical cartilaginous tumors; n=29 G2-G4 \nchondrosarcomas). The external test cohort consisted of the CT component of \n36 positron emission tomography-CT scans from center 2 (n=16 G1 or atypical \ncartilaginous tumors; n=20 G2-G4 chondrosarcomas). All tumors were \nmanually segmented on preoperative CT using the axial image showing the \nmaximum lesion extension. First-order, shape-based and matrix features were \nextracted. After dimensionality reduction, a machine-learning classifier \n(LogitBoost) was tuned on the training cohort using 10-fold cross validation and \ntested on the external cohort. In patients from center 2, the classifier’s \nperformance was compared with preoperative biopsy using McNemar’s test. \nResults or Findings: The classifier had 81% (AUC=0.89) and 75% \n(AUC=0.78) accuracy in identifying the cartilaginous tumors in the training and \nexternal test cohorts, respectively. Specifically, its accuracy in classifying \natypical cartilaginous tumors and higher-grade chondrosarcomas was 84% and \n78% in the training cohort, and 81% and 70% in the external test cohort, \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 225  \nrespectively. Preoperative biopsy had 64% (AUC=0.66) accuracy in center 2 \n(p=0.289). \nConclusion: Machine learning showed good accuracy in classifying atypical \ncartilaginous tumors and higher-grade chondrosarcomas of long bones based \non CT radiomic features and could prove a valuable aid in preoperative \nassessment. \nLimitations: Retrospective; lack of contrast-enhanced scans. \nEthics Committee Approval: Local Ethics Committee approved this \nretrospective study and waived the need for informed consent. \nFunding for this study: ESSR Young Researchers Grant (first author) \nAuthor Disclosures: \nMarzia Acquasanta: Nothing to disclose \nVito Chianca: Nothing to disclose \nCarmelo Messina: Nothing to disclose \nSalvatore Gitto: Nothing to disclose \nLuca Maria Sconfienza: Nothing to disclose \nAntonino Cincotta: Nothing to disclose \nRenato Cuocolo: Nothing to disclose \nDomenico Albano: Nothing to disclose \nAlessio Annovazzi: Nothing to disclose \n \nRPS 905-3 \nAutomated bone age assessment in a retrospective cohort of German \nchildren from the clinical routine: agreement between AI and expert \nreaders \nD. Gräfe¹, A. B. Päts¹, R. Pfäffle¹, *M. DiFranco*²; ¹Leipzig/DE, ²Vienna/AT  \n(m.difranco@imagebiopsy.com) \n \nPurpose: The radiological determination of BA from a left-hand x-ray \ncontinues to be the reference standard for skeletal maturity assessment related \nto short or long stature, premature or delayed puberty, and underlying \nconditions. Artificial intelligence (AI) algorithms are becoming more prevalent \ndue to the subjectivity and time-consuming nature of BA assessment. In this \nstudy we evaluate the agreement between AI and expert readers for bone age \n(BA) assessment according to the Greulich & Pyle method. \nMethods or Background: Radiographs of 259 patients were analyzed \nretrospectively (133 males aged 2 to 17 years, 126 females aged 2 to 16 \nyears). Two pediatric radiologists and one pediatric endocrinologist made blind \nreads of BA using the Greulich & Pyle (GP) method independently, and an AI-\nsoftware was subsequently used to estimate BA from the same images. \nAgreement of AI with readers was assessed based on mean absolute deviation \n(MAD) and root mean squared deviation (RMSD), as well as via comparison of \nBland-Altman limits of agreement (LOA). \nResults or Findings: MAD and RMSD of AI vs. reader average (0.51 and 0.66 \nyears) was less than that for mean of three reader pairs (0.66 and 0.86 years, \np<0.05 for each reader pair). Bland-Altman LOA between AI and reader \naverage was (-1.22, 1.35 years), well within the mean LOAs of the three reader \npairings (-1.62, 1.75 years). \nConclusion: A fully automated AI software shows agreement with expert \nreaders in BA assessment on a cohort of German children and adolescents, \nsuggesting AI integration into the radiology workflow is possible and could lead \nto more efficient bone age reading. \nLimitations: n/a \nEthics Committee Approval: This retrospective study was approved by the \ninstitutional review board and informed consent was waived. \nFunding for this study: n/a \nAuthor Disclosures: \nDaniel Gräfe: Nothing to disclose \nAnne Bettina Päts: Nothing to disclose \nRoland Pfäffle: Nothing to disclose \nMatthew DiFranco: Employee: ImageBiopsy Lab \n \nRPS 905-4 \nIncreasing the detection of Vertebral Fractures (VFs) using AI on CT \nperformed for all clinical indications \n*R. Gordon*¹, B. Gordon², K. White², H. Lebel¹, E. Spitz¹, E. Blumenfeld¹,  \nE. Elnekave¹; ¹Shfayim/IL, ²Salt Lake City, UT/US \n(Ronen@zebra-med.com) \n \nPurpose: We report on the diagnostic accuracy and potential for clinical \nimpact of software which detects VFs. \nMethods or Background: A neural network based VF detection tool was \ngenerated utilizing a training set of 1,832 CT scans including compression \nfractures indexed according to the Genant method. Ground truth was \nestablished by three expert radiologists. Validation was performed on a novel \ndataset of 611 CT scans of the chest and abdomen. To assess for clinical \nimpact, the software was applied to 76,069 anonymized CTs acquired from a \nU.S. based integrated health delivery system comprising 24 hospitals. The \nthreshold for a positive result was set at the presence of at least one moderate \nVF. Each corresponding CT report was evaluated by a combination of human \nand natural language processing. 290 studies were reviewed by two expert \nradiologists to verify consistent algorithmic accuracy. \nResults or Findings: The software achieved an overall AUC of 0.95 with \nsensitivity 90.6% and specificity of 86.6% for the detection of VFs. VFs were \nnoted in 4,996 (6.6%) of 76,069 radiology reports; of these, 3,167 were also \ndetected algorithmically. VFs were detected by the software in a total of 11,890 \n(15.6%) CT examinations (Fig 1). Of the 290 CTs analyzed for consistent \naccuracy, results achieved a negative predictive value of 90.7% and positive \npredictive value of 58.2%. Of the 94 false positive cases, 72 (76.6%) \ncomprised studies with mild compression fractures. \nConclusion: An automatic VF detection tool with high diagnostic accuracy \ndemonstrates potential to substantially improve the current reporting gap for \nvertebral compression fractures, increasing the detected moderate-severe VFs \nby 138%. \nLimitations: The study was limited by its retrospective nature. \nEthics Committee Approval: Approved by IRB \nFunding for this study: This study was supported by research funds of \nIntermountain Healthcare and Zebra `medical Vision. \nAuthor Disclosures: \nKeith White: Nothing to disclose \nRonen Gordon: Employee: Zebra Medical Vision \nEinav Blumenfeld: Employee: Zebra Medical Vision \nEldad Elnekave: Employee: Zebra Medical Vision \nEyal Spitz: Employee: Zebra Medical Vision \nHila Lebel: Employee: Zebra Medical Vision \nBen Gordon: Nothing to disclose \n \nRPS 905-5 \nHow much does non-blinded assessment shift the goalpost for AI \nalgorithms? Exploring the hidden role of bias in AI evaluation using knee \nosteoarthritis grading as an example \nV. Desai¹, J. Belair¹, G. Nanda², *V. K. Venugopal*², R. Takhar², V. Mahajan², \nH. Mahajan ²; ¹Philadelphia, PA/US, ²New Delhi/IN \n(vasanthdrv@gmail.com) \n \nPurpose: To study the change in the performance of AI results when tested on \nground truth established by blinded and non-blinded assessments. \nMethods or Background: Anteroposterior views of 271 knee x-rays (542 \njoints) were randomly extracted from PACS and anonymized. These x-rays \nwere analyzed using DeepKnee, an open-source algorithm based on the Deep \nSiamese CNN architecture that automatically predicts the presence of \nosteoarthritis on Knee X Rays on a 5 scale Kellgren and Lawrence system \n(KL). The algorithm also provides an attention map that explains the decision \nmade by the network. These x-rays were independently read by three \nsubspecialist MSK radiologists on the CARPL AI research platform (CARING \nResearch, India). The KL grade for each x-ray was recorded by the \nradiologists, following which the AI algorithm grade was shown, and \nradiologists given the option to change their result. The pre-AI result and post-\nAI results were both recorded. Ground Truth (GT) KL grade was considered to \nbe the one with a consensus between at least two readers. In cases with a \ndisagreement between all three readers, the median was considered. The \nperformance of AI was assessed using misclassification rate and change in \nmisclassification rates for AI as well as the individual readers were compared \nfor both phases. \nResults or Findings: The misclassification rate of the AI algorithm reduced \nfrom 0.43 in the blinded phase to 0.37 during the non-blinded phase. The \nmisclassification rates for the readers changed from 0.25, 0.18, and 0.22 to \n0.2, 0.14 and 0.23 respectively. Krippendorff’s alpha among the readers \nimproved from 0.84 & 0.87 between the phases. \nConclusion: We demonstrate that the perceived performance of an algorithm \ncan show spurious improvement when tested by radiologists in a non-blinded \nfashion. \nLimitations: Small sample set \nEthics Committee Approval: Not required \nFunding for this study: None \nAuthor Disclosures: \nVishal Desai: Nothing to disclose \nJeffrey Belair: Nothing to disclose \nGeetanjali Nanda: Nothing to disclose \nRohit Takhar: Nothing to disclose \nHarsh Mahajan : Other: Research collaboration, Oxipit Other: Research \ncollaboration, General Electric Company Other: Research collaboration, Lunit \nInc. Other: Research collaboration, Aikenist Other: Research collaboration, \nKoninklijke Philips NV Other: Research collaboration, Qure.ai Other: Director, \nMahajan Imaging Pvt Ltd Other: Research collaboration, Predible \nVasantha Kumar Venugopal: Other: Research collaboration, Lunit INC Other: \nResearch collaboration, Predible Health Other: Research collaboration, \nKoninklijke Philips NV Other: Research collaboration, Oxipit Other: Research \ncollaboration, General Electric Company Other: Research collaboration, \nGeneral Electric Company Other: Research collaboration, Qure.ai \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 226  \nVidur Mahajan: Other: Research collaboration, Qure.ai Other: Research \ncollaboration, Predible Other: Research collaboration, General Electric \nCompany Other: Research collaboration, Lunit Inc. Other: Research \ncollaboration, Koninklijke Philips NV Other: Research collaboration, Aikenist \nOther: Head of Research at CARING Other: Research collaboration, Oxipit \n \nRPS 905-6 \nEffects of interobserver variability on 2D and 3D CT- and MRI-based \ntexture feature reproducibility of cartilaginous bone tumors \n*S. Gitto*¹, R. Cuocolo², I. Emili¹, L. Tofanelli¹, V. Chianca¹, D. Albano¹,  \nC. Messina¹, M. Imbriaco², L. M. Sconfienza¹; ¹Milan/IT, ²Naples/IT \n(sal.gitto@gmail.com) \n \nPurpose: To investigate the influence of interobserver manual segmentation \nvariability on the reproducibility of 2D and 3D unenhanced computed \ntomography (CT)- and magnetic resonance imaging (MRI)-based texture \nanalysis. \nMethods or Background: This retrospective study included 30 patients with \ncartilaginous bone tumors (10 enchondromas, 10 atypical cartilaginous tumors, \n10 chondrosarcomas). Three radiologists independently performed manual \ncontour-focused segmentation on unenhanced CT, T1-weighted and T2-\nweighted MRI by drawing both a 2D region of interest (ROI) on the slice \nshowing the largest tumor area and a 3D ROI including the whole tumor \nvolume. Additionally, a marginal erosion was applied to both 2D and 3D \nsegmentations to evaluate the influence of segmentation margins. A total of \n783 and 1132 features were extracted from original and filtered 2D and 3D \nimages, respectively. Intraclass correlation coefficient •0.75 defined feature \nstability. \nResults or Findings: In 2D vs. 3D contour-focused segmentation, the rates of \nstable features were 74.71% vs. 86.57% (p<0.001), 77.14% vs. 80.04% \n(p=0.142) and 95.66% vs. 94.97% (p=0.554) for CT, T1-weighted and T2-\nweighted images, respectively. Margin shrinkage did not improve 2D (p=0.343) \nand performed worse than 3D (p<0.001) contour-focused segmentation in \nterms of feature stability. In 2D vs. 3D contour-focused segmentation, matching \nstable features derived from CT and MRI were 65.8% vs. 68.7% (p=0.191), \nand those derived from T1-weighted and T2-weighted images were 76.0% vs. \n78.2% (p=0.285). \nConclusion: 2D and 3D radiomic features of cartilaginous bone tumors \nextracted from unenhanced CT and MRI are reproducible, although some \ndegree of interobserver segmentation variability highlights the need for \nreliability analysis in future studies. \nLimitations: Single institution; retrospective; lack of contrast-enhanced scans. \nEthics Committee Approval: Local Ethics Committee approved this \nretrospective study and waived the need for informed consent. \nFunding for this study: None \nAuthor Disclosures: \nIlaria Emili: Nothing to disclose \nVito Chianca: Nothing to disclose \nLaura Tofanelli: Nothing to disclose \nCarmelo Messina: Nothing to disclose \nSalvatore Gitto: Nothing to disclose \nLuca Maria Sconfienza: Nothing to disclose \nMassimo Imbriaco: Nothing to disclose \nRenato Cuocolo: Nothing to disclose \nDomenico Albano: Nothing to disclose \n \nRPS 905-7 \nWhole-body Bone Age Assessment (BAA) based on deep-learning \n*R. Louiset*¹, A. Ducarouge²; ¹Saclay/FR, ²Paris/FR \n(robin76lt@gmail.com) \n \nPurpose: Development of an AI algorithm to assess bone age from X-rays of \nany part of the body. \nMethods or Background: Many scientific papers already address the Deep \nLearning bone age assessment problem and compare their results with the \nGreulich and Pyle atlas performance. We managed to reproduce these results \nwith hand radiographs and extended the scope of our model to whole body \nradiographs with a wider age range. Our approach enabled us to compare \neach bodypart bone age assessment relevance. Furthermore, we also \nproduced heat maps to enforce our algorithm explainability. \nResults or Findings: The Mean Average Error (MAE) of the Deep Learning \nmodel on representative hand test set of 3 409 images was 11.37 months \n(std=0.2 months), compared with 11.1 months for a comparable litterature \nmethod having a different clean testing set (214 images) of developmentally \nnormal pediatric hand radiographs. Our algorithm yields a MAE of 13.68 \n(std=0.45) months on growth retardation suspicious pediatric hand test set, \ncompared with 13.53 (std=0.44) months for a cohort of random radiologists. \nWe observed comparable metrics on other body part radiographs such as \nPelvis (MAE=10.68+/-0.50), Foot (MAE=11.70+/-0.20), Leg (MAE=13.06+/-\n0.30). \nConclusion: We emphasized the relevance of using chronological age to \nupdate and improve old and biased skeletal maturity assessment atlas. We \ndemonstrated bone age state-of-the-art litterature comparable performances \non hand, broadening it upon whole body parts radiographs. Finally, we \nproduced a method in order to highlight the zones our model relies on for \nexplainability purposes. \nLimitations: The MAE metric between predicted bone age and patient \nchronological age suffers from a natural bias and standard deviation, further \nstudies should propose metrics to mitigate these limitations. \nEthics Committee Approval: None, already fully anonymized retrospective \ndata. \nFunding for this study: Research internship funded by Gleamer, a French AI-\nbased medical imaging company. \nAuthor Disclosures: \nRobin Louiset: Other: Gleamer \nM. Alexis Ducarouge: Founder: Gleamer \n \nRPS 905-8 \nVisual, structured report of spinal trauma: evaluation of a diagnostic and \ndecisional reasoning assistant \n*F. Lafourcade*¹, J-N. Ravey², N. Sans¹, M. Faruch-Bilfeld¹; ¹Toulouse/FR, \n²Grenoble/FR \n(fphlaf@orange.fr) \n \nPurpose: To evaluate a visual structured report produced by a computerized \nreasoning assistant (Keydiag), compared to a traditional radiology report, in the \ncontext of spinal trauma. \nMethods or Background: A model of spinal trauma was developed with \nKeydiag support. Its goal is to generate structured reports. Consecutive \npolytrauma whole-body CT were analyzed. Patients with complex traumatic \nspinal injuries were selected. Their traditionnal radiology reports were grouped \ntogether. Structured reports were produced for these patients. Completeness, \nsurgeons' assessment of reports quality, and Keydiag reproducibility were \nevaluated. \nResults or Findings: 1001 bodyscanners were performed over 1 year. Among \nthem, 808 vertebral stages of 288 rachis were injured, 124 in a complex \nmanner. 6 of them were not accessible for technical reasons. 118 structured \nreports were produced and compared with traditionnal reports. Completeness \nwas significantly higher in the structured group (+20.7% information). The \nevaluation of their average overall quality was better in structured group (76%) \nthan in the traditional group (67%). The reproducibility of the Keydiag model for \nAOSpine was very high (ț=0.80). \nConclusion: Spinal trauma structured report provides an innovative and useful \naid to the radiologist, more complete and qualitative, for the benefit of his \ncorrespondents and the patient. \nLimitations: Monocentric study. \nKeydiag software was a beta version. \nEthics Committee Approval: Not concerned. \nFunding for this study: None. \nAuthor Disclosures: \nNicolas Sans: Nothing to disclose \nJean-Noël Ravey: Nothing to disclose \nFrançois Lafourcade: Nothing to disclose \nMarie Faruch-Bilfeld: Nothing to disclose \n \n \nResearch Presentation Session: Artificial \nIntelligence & Machine Learning \nRPS 1005 \nAdvances in AI \nRPS 1005-1 \nA novel thick-to-thin-cut generation model for CT imaging \n*W. H. K. Chiu*, W. Cao, C. S. G. Lui, Y. Fang, A. Yap, W. K. W. Seto,  \nP. L. H. Yu; Hong Kong/HK  \n(wmingcao@hku.hk) \n \nPurpose: Constraints for Picture Archiving and Communication System mean \nthat although Computed Tomography (CT) images are acquired in thin slices, \nthey had to be stored as thick slices to reduce storage. This results in \nsignificant data loss that affects analyses. \nMethods or Background: We developed a synthetic model based on \ngenerative adversarial networks (GAN): the generator turns thick-cut into thin-\ncut images to fool the discriminator while the discriminator tries to distinguish \nbetween generated and real data. New cost functions related to content and \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 227  \ndepth estimation are introduced to further improve the image quality. Mean \nsquared error (MSE) and structural similarity (SSIM) were used to quantify the \nquality of synthetic thin-cut CT images. Dice coefficient (DC) was used to \ncompare performances of liver lesion segmentation on real and synthetic thin-\ncut CT images. \nResults or Findings: 1390 contrast-enhanced abdominal CT scans with thin \n(1 mm) and corresponding thick (5 mm) slices were retrieved from our institute. \nCT images were normalized to the range [0, 255] and split into training, \nvalidation and testing with a 6:1:3 ratio. Our algorithm achieved a MSE of \n57.10, indicating the mean pixel-wise error is 7.56, and SSIM of 0.934 when \nthick-cut images are from maximizing pixel-wise intensity. Additionally, the \nsegmentation performance of liver lesion on real and synthetic thin-cut CT \nimages were 0.836 and 0.829 quantified by DC, respectively. \nConclusion: Our results highlight the feasibility of generating high-quality thin-\ncut CT images from thick-slice with no compensation in image quality. In the \nera of big-data mining in medical imaging, our technique can be used to \nretrieve historical data and applied to enhance imaging quantitative analyses. \nLimitations: Feasibility study with no external validation \nEthics Committee Approval: Approved by the HKU/HA HKW IRB \nFunding for this study: Innovation and Technology Fund and United Ally \nResearch limited \nAuthor Disclosures: \nWenming Cao: Nothing to disclose \nYanwen Fang: Nothing to disclose \nChiu Sing Gilbert Lui: Nothing to disclose \nAlistair Yap: Nothing to disclose \nWan Hang Keith Chiu: Nothing to disclose \nWai Kay Walter Seto: Nothing to disclose \nPhilip Leung Ho Yu: Nothing to disclose \n \nRPS 1005-2 \nAutomated TICI scoring from 2D DSA images \n*R. Su*¹, S. A.P. Cornelissen¹, M. van der Sluijs¹, A. van Es², W. Van Zwam³, \nP. J. van Doormaal¹, W. J. Niessen¹, A. Van Der Lugt¹, T. van Walsum¹; \n¹Rotterdam/NL, ²Leiden/NL, ³Maastricht/NL  \n(ruisheng.su@hotmail.com) \n \nPurpose: The Thrombolysis in Cerebral Infarction (TICI) score is a common \ntechnical outcome assessment for endovascular treatment (EVT) in acute \nischemic stroke. Existing TICI scores are defined in coarse ordinal grades \nbased on visual inspection, leading to inter- and intra-observer variation. In this \nwork, we investigate whether such scores can be computed automatically. \nMethods or Background: The automated scoring method consists of three \nstages. First, each digital subtraction angiography sequence is separated into \nfour phases (non-contrast, arterial, parenchymal and venous phase) using a \nconvolutional neural network. Next, a minimum intensity map is computed \nusing the motion corrected arterial and parenchymal frames, on which the \nvessel, perfusion and background pixels are segmented. Finally, the autoTICI \nscore is computed as the ratio of reperfused pixels after EVT. \nResults or Findings: The algorithm pipeline was evaluated on a subset of 141 \nMR CLEAN registry subjects. The automated TICI scoring method showed \ngood correlation with the extended TICI (eTICI) reference with an average area \nunder the curve score of 0.81. The AUC score was 0.90 with respect to the \ndichotomized eTICI. In addition, autoTICI exhibited overall comparable \ncapability to eTICI with respect to outcome prediction. \nConclusion: TICI scores can be quantified in an automated way. \nLimitations: Not applicable \nEthics Committee Approval: The ethics committee of the Erasmus Medical \nCenter Rotterdam evaluated the MR CLEAN Registry protocol and approved \nthe study. All subjects gave written informed consent in accordance with the \nDeclaration of Helsinki. \nFunding for this study: The MR CLEAN Registry was partly funded by \nunrestricted grants from TWIN Foundation, Erasmus MC University Medical \nCenter, Maastricht University Medical Center, and Amsterdam University \nMedical Centers. The current work was financially supported by Health-Holland \n(TKI Life Sciences and Health), Q-Maestro project (grant number: \nEMCLSH19006) and Philips Healthcare (Best, The Netherlands). \nAuthor Disclosures: \nTheo van Walsum: Grant Recipient: Erasmus MC \nRuisheng Su: Nothing to disclose \nAad Van Der Lugt: Grant Recipient: Erasmus MC \nPieter Jan van Doormaal: Nothing to disclose \nSandra A.P. Cornelissen: Nothing to disclose \nMatthijs van der Sluijs: Nothing to disclose \nAdriaan van Es: Nothing to disclose \nWillem Van Zwam: Nothing to disclose \nWiro J. Niessen: Nothing to disclose \n \n \n \nRPS 1005-3 \nEnabling privacy-preserving training of deep learning models for \nradiological applications using federated learning \n*K. S. Younis*; Waukesha, WI/US \n(kh.younis@gmail.com) \n \nPurpose: Covid19 Pandemic highlighted the need to collaborate and quickly \naccess whatever data is available worldwide in order to develop AI models to \naid in early diagnosis. Mastering the art of collaboration is a necessity to \nsucceed in our highly complex and networked world. Federated Learning (FL) \nis a privacy-preserving collaborative framework for model development that \nsolves many problems related to quick sharing of data. The purpose of this \nproof of concept is to establish the infrastructure and environment utilizing an \nFL framework solving a real-world problem of chest X-Ray disease \nclassification. \nMethods or Background: The Stanford University CheXpert dataset (224 \nthousand images) was divided into five parts. Each image can have zero or \nmore label “multi-label” out of 15 different labels. CheXpert challenge website \nreports the Area Under the average ROC curve (AUC) performance for five \ndiseases (a) Atelectasis, (b) Cardiomegaly, (c) Consolidation, (d) Edema, and \n(e) Pleural Effusion. Nvidia Clara Train SDK that supports FL was installed on \nthe server at Vanderbilt University and in the five client sites. The \nDenseNet121 model architecture along with the hyper-parameters were \nincluded. Each client site created the self-signed certificates and exchanged \nthem with the server host. Connectivity and proper port selection were tested, \nand training was completed. \nResults or Findings: The FL global model when tested from sites depicts \noverall high performance of AUC of 0.8031- 0.8034. Model Averaging works \nwell for identically distributed data. \nConclusion: Federated learning is a viable tool for training deep learning \nmodels while preserving the data privacy. A DenseNet121 model for disease \npattern detection in chest x-rays was able to train securely and efficiently on \ngeographically distributed data with excellent performance. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nBrad Genereaux: Employee: NVIDIA \nLiangqiong Qu: Nothing to disclose \nBennett A. Landman: Nothing to disclose \nAnas Abidin: Nothing to disclose \nAmilcare Gentili: Nothing to disclose \nParas Lakhani: Nothing to disclose \nKhaled Salem Younis: Employee: Philips \nNishank Singla: Employee: Sr. Software Engineer at GE Healthcare \nNathaniel Swinburne: Nothing to disclose \nDaniel Rubin: Nothing to disclose \nVishwesh Nath: Employee: Nvidia (Applied Research Scientist) \n \nRPS 1005-4 \nDeep scatter estimation (DSE) and correction for dual-source dual-energy \nCT \n*J. F. J. Erath*¹, T. Vöth², J. Maier², E. Fournié¹, M. Petersilka¹, K. Stierstorfer¹, \nM. Kachelrieß²; ¹Forchheim/DE, ²Heidelberg/DE \n(julien.erath@dkfz.de) \n \nPurpose: To correct for forward and cross scattered radiation in dual source \ndual energy CT. \nMethods or Background: Dual source dual energy CT operates the two x-ray \ntubes at different tube voltages. Forward and cross-scattered radiation can \nlead to strong artifacts. To remove the scatter from the measured projections \nwe developed two deep convolutional neural networks (CNN). The forward \nDSE network is estimating the forward scatter based on the actual projection. \nTo estimate cross-scatter we use cross DSE, a CNN that uses as input the \nactual projection and a cross-scatter approximation. The latter is calculated \nthrough a raytracing operation. The scatter contributions are obtained through \nour in-house Monte Carlo simulation, simulating a dual source CT system. The \nCNNs are trained in dual energy mode (80 kV, 140 kV). As a quantitative \nevaluation we determine the lung density and the mean lung CT number for \nthree patients and compared them to the values obtained without scatter \ncorrection and with a measurement-based scatter correction (based on \nadditional detector rows). \nResults or Findings: DSE is able to remove the scatter artifacts and improves \nthe accuracy of the CT values. The mean error in the lungs without scatter \ncorrection is about 14 HU. With DSE this error is reduced to 2.5 HU. The \nmeasurement-based scatter correction reduces the error to 1.5 HU. \nConclusion: DSE improves the accuracy of CT numbers for quantitative CT \nimaging. The accuracy of the corrected CT values is similar to a measurement-\nbased correction technique but does not need additional detector sensors. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 228  \nLimitations: Prior to predicting the actual cross-scatter intensity, the second \ninput to xDSE needs a low resolution reconstruction to perform the raytracing \noperation. \nEthics Committee Approval: Approved \nFunding for this study: Siemens Healthcare \nAuthor Disclosures: \nEric Fournié: Employee: Siemens Healthcare \nTim Vöth: Nothing to disclose \nJulien Frank Josef Erath: Employee: Siemens Healthcare \nMartin Petersilka: Employee: Siemens Healthcare \nKarl Stierstorfer: Employee: Siemens Healthcare \nMarc Kachelrieß: Nothing to disclose \nJoscha Maier: Nothing to disclose \n \nRPS 1005-5 \nClinical use of artificial intelligence (AI) in radiology departments in the \nNetherlands: a survey \n*K. G. van Leeuwen*¹, M. Rutten², S. Schalekamp¹, M. De Rooij¹,  \nB. Van Ginneken¹; ¹Nijmegen/NL, ²'s-Hertogenbosch/NL \n(kicky.vanleeuwen@radboudumc.nl) \n \nPurpose: There are over 150 artificial intelligence (AI) products for radiology \noffered, but little is known about their current clinical use. We investigated \nactual clinical use of AI software in radiology departments in the Netherlands. \nMethods or Background: We consulted the radiology department of each \nhospital organization in the Netherlands (n=70) about their current AI \nimplementations and plans from February-March 2020. A representative of the \ndepartment was asked to fill in a questionnaire about their knowledge, \nexperience, research and/or clinical use of commercially available CE-certified \nAI products for radiology (n=93). \nResults or Findings: The response rate of the consulted hospitals was 43/70: \n38/62 for general hospitals, 5/7 for academic medical centers, and 0/1 for \nchildren’s hospitals. Of the respondents 30 (70%) were radiologists, 5 (12%) \napplication or information managers, and 8 (19%), among others, clinical \nphysicists and managers. A third (14) of the participating organizations had \none to three AI applications in clinical use, with a total of 19 implementations. \nThese implementations involved eight different vendors of which four were \nfrom the Netherlands. Most commonly used was software for bone age \nprediction and stroke detection. Respondents were most familiar with products \naimed at neurology and cardiology. MR, CT and mammography were the most \nfamiliar modalities for AI. Most interest for clinical implementation was shown in \nsoftware to triage exams. Eleven organizations (26%) had a dedicated budget \nfor AI, either from the hospital or the department. \nConclusion: Even though the supply of AI software is extensive, clinical use \nremains limited showing that we are still in the initial stages of integrating AI in \nclinical practice in the Netherlands. \nLimitations: As not all hospitals responded to our request, bias may be \npresent. \nEthics Committee Approval: N.a. \nFunding for this study: This work has not received any funding. \nAuthor Disclosures: \nMatthieu Rutten: Nothing to disclose \nBram Van Ginneken: Founder: Thirona Other: Mevis Medical Solutions Other: \nDelft Imaging Shareholder: Thirona \nKicky Gerhilde van Leeuwen: Nothing to disclose \nSteven Schalekamp: Nothing to disclose \nMaarten De Rooij: Nothing to disclose \n \nRPS 1005-6 \nQualitative and quantitative comparison of image quality of upresolved \nsimulated fast MR acquisitions and standard of care images \nV. Batra, J. S. Chatha, *V. K. Venugopal*, R. Takhar, V. Mahajan, H. Mahajan ; \nNew Delhi/IN \n(vasanthdrv@gmail.com) \n \nPurpose: To make qualitative and quantitative comparisons of the images \ngenerated by a super-resolving algorithm from simulated undersampled MR \nbrain and standard of care images. \nMethods or Background: The retrospective study was conducted on 50 MRI \npathological scans acquired on Siemens Magnetom 1.5T. Two types of \nundersampling were done, undersampling by 3 and undersampling by 4 in the \nK space which simulated fast MR acquisition. These images were then \nconverted to resemble undersampled images. Undersampling by 3 and 4 will \nbe equivalent to acquiring an MRI signal by 1/3rd and 1/4th of the time \nrespectively. The up-resolution is done on this simulated undersampled data \nby a customized CNN network based on encoder-decoder CNN with 14.8 \nmillion parameters by Aikenist. The three sets of images were randomized, and \npresented to two neuroradiologists for evaluation of their overall quality on a \nfive-point Likert scale (1- nondiagnostic,2 -poor quality,3- diagnostic,4-good,5-\nexcellent). The parameters for evaluation were grey-white matter differentiation \n(for CNR), delineation of pathologies, delineation of normal deep grey matter \nanatomy, and artifacts. The overall image quality score was then estimated for \neach set of images and compared. The Peak SNR and SSIM values were also \ncalculated for each set of images with respect to the SOC images. \nResults or Findings: The average SSIM for both the 1/3rd undersampled and \n1/4th undersampled images was 0.95 & 0.97. The PSNR for the 1/3rd \nundersampled and 1/4th undersampled images were 36.03 dB and 33.90 dB. \nThe average qualitative scores for the SOC, 1/3rd undersampled, and 1/4th \nundersampled images were 11.16, 11.11 & 10.98 out of 20. \nConclusion: We demonstrate that the super-resolved undersampled images \nare comparable to the routine SOC images both in quantitative and qualitative \ncomparisons. \nLimitations: Small study sample \nEthics Committee Approval: Not required \nFunding for this study: None \nAuthor Disclosures: \nJagneet Singh Chatha: Nothing to disclose \nRohit Takhar: Nothing to disclose \nHarsh Mahajan: Other: Research collaboration, Koninklijke Philips NV Other: \nResearch collaboration, Lunit INC Other: Research collaboration, General \nElectric Company Other: Director, Mahajan Imaging Pvt Ltd Other: Research \ncollaboration, Predible Health Other: Research collaboration, Qure.ai \nVasantha Kumar Venugopal: Other: Research collaboration, Lunit Inc. Other: \nResearch collaboration, Aikenist Other: Research collaboration, Koninklijke \nPhilips NV Other: Research collaboration, Qure.ai Other: Research \ncollaboration, General Electric Company Other: Research collaboration, \nPredible Health \nVikas Batra: Nothing to disclose \nVidur Mahajan: Other: Research collaboration, Qure.ai Other: Research \ncollaboration, Koninklijke Philips NV Other: Research collaboration, General \nElectric Company Other: Head of Research at CARING Other: Research \ncollaboration, Predible Health Other: Research collaboration, Lunit Inc. Other: \nResearch collaboration, Aikenist \n \nRPS 1005-7 \nHow to select and fine-tune an artificial intelligence (AI) service for \npractical application in radiology \n*A. E. Andreychenko*, V. Gombolevskiy, A. Vladzymyrskyy, S. Morozov; \nMoscow/RU \n(a.andreychenko@npcmr.ru) \n \nPurpose: There are multiple AI solutions in radiology that are positioned as \nready for practical clinical use by their creators. However, a wide application of \nAI in radiology departments at non-academic sites is yet to be proven feasible \nand justified. Here we propose a universal framework for selection and \nadjusting an AI service performance for practical use on a megalopolis scale. \nMethods or Background: Methodologies of software testing by end-users; \nquality assurance for medical diagnostic equipment and diagnostic tools’ \naccuracy assessment were used. Three routine use cases were chosen: chest \nXray, mammography and chest CTs. The following AI functionality was tested: \nworklist's triage, pathological findings indications on the images as an \nadditional series and report template. Prospective applications of the \npreselected and fine-tuned AI solutions were being assessed within the unified \nMoscow RIS that connects > thousand diagnostics devices and > 1400 \nradiologists. \nResults or Findings: The framework resulted in 5 steps: (1) is a so-called \n“self-test” with a representative dataset of the dicom files of the RIS devices; \n(2) is a functional test by means of a small dataset to check whether all AI \nfeatures work properly within the RIS; (3) is a calibration test to fine-tune an AI \nmodel diagnostic accuracy on the balanced dataset that represents population \nand mimics settings for prospective application; (4) is a QA test for each \nradiology device; (5) is a periodical monitoring. \nConclusion: The framework showed ability to predict well real-world \nperformance of AI solutions in radiology, to maximize its’ stability and minimize \nrisks of failures during the prospective applications. \nLimitations: The framework was tested on limited amount of use cases for AI \nin radiology. \nEthics Committee Approval: The work was approved by the local ethical \ncommittee. \nFunding for this study: No funding was received for this work. \nAuthor Disclosures: \nSergey Morozov: Nothing to disclose \nAnna Evgenevna Andreychenko: Nothing to disclose \nAnton Vladzymyrskyy: Nothing to disclose \nVictor Gombolevskiy: Nothing to disclose \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 229  \nRPS 1005-8 \nEvaluation of artificial intelligence (AI)-based intelligent reader of medical \narticles (IRMA) in radiology \n*G. Bartal*¹, V. Guryanova², O. Leshchinskaya², M. Ayal¹, L. Kokov², \nV. Sinitsyn²; ¹Tel Aviv-Yafo/IL, ²Moscow/RU \n(gbartal@gmail.com) \n \nPurpose: Reading scientific papers for non-native English speakers’ is time \nconsuming and deterring. We evaluated AI based Intelligent Reader of Medical \narticles (IRMA) that reduces the word count by ~70% maintaining article \ncontents. Our aim was evaluation of IRMA by non-native English speakers \nutilizing validated Linkert scale questionnaires. \nMethods or Background: IRMA is based on advanced text processing \ntechniques comprising neural network-based language models, extraction of \ntopics from texts and graph-based text representation. A proprietary data set \nwas used for configuration of the resulting solution. PDFs of 3 articles from \nleading medical journals and their summarization by IRMA have been firstly \nevaluated by 25 4-6th year medical students and by 15 radiologists, using \nvalidated questionnaires. Mean time of cloud-based article analysis by IRMA is \nabout 2.5 minutes. \nResults or Findings: Based on the analysis of questionnaires on 3 articles by \n2 groups we observed several differences in using the tool. (1) As 96% of the \nstudents noted that IRMA meets well their needs, only 67% of the radiologists \nshared that view (p<0.01). (2) 72% of the students plan to read more than 11 \narticles/month using this tool, whereas only 46% intend to follow that number \namongst the radiologists (p<0.05). (3) Although 93% of radiologists found that \nAI based summarization is accurate and does not contain plethoric information, \n72% of the students conceived that impression (p<0.01). Of note is an \nagreement as to the complete representation of the article's main content \n(p<0.01). \nConclusion: Medical students, and radiologists alike, were significantly \nsatisfied with IRMA, declaring that they will use it for their research and \npractice. However, radiologists were more selective and decisive in stating that \nthe IRMA service is accurate and useful. \nLimitations: Small groups of participants. \nEthics Committee Approval: Not required \nFunding for this study: Algomost LLC \nAuthor Disclosures: \nValeria Guryanova: Employee: Algomost \nValentin Sinitsyn: Nothing to disclose \nOlga Valerievna Leshchinskaya: Nothing to disclose \nLeonid Kokov: Nothing to disclose \nMoshe Ayal: Consultant: Algomost \nGabriel Bartal: Consultant: Algomost \n \nRPS 1005-9 \nEffective integration of artificial intelligence (AI) services into PACS: \nradiologist requirements \n*K. M. Arzamasov*, N. Ledikhova, E. Turavilova, V. Gombolevskiy, \nA. Vladzymyrskyy, A. E. Andreychenko, S. Morozov; Moscow/RU \n(k.arzamasov@npcmr.ru) \n \nPurpose: Aim of our study was to determine key requirements for an effective \npractical integration into PACS of radiological services based on artificial \nintelligence (AI) and computer vision. \nMethods or Background: Summarizing the experience of using AI services, \nwe had identified the necessity to standardize the requirements for the \noperation of AI services. \nResults or Findings: A radiologist, opening an examination in PACS, faces: 1) \noriginal (native) series; 2) series from AI (may include: generalizing image; \ntabular view of results; a series (copy of the original) with marks from the AI); 3) \ntextual description in DICOM SR; 4) AI-feedback module. Each additional AI-\nformed series should contain: the name of the AI service, probability of \npathology and contrast marking of pathological findings. Additional information \nis optional. If the AI service didn’t detect pathological changes, additional \nseries should contain an image with a corresponding message. The number of \nslices in the additional series isn’t less than in the original series in case of a \npathology according to AI. The textual description should contain a short user \nmanual containing information about the pathology detected by the service and \na conclusion. The conclusion should be presented in an understandable form, \nif possible, it should contain a clinical classification of the findings. Additional \ndetails on the AI findings are of interest, but in routine work it isn’t essential. \nAny additional information is superfluous. \nConclusion: The introduced practice is aimed to create possibilities for a \nradiologist for a comfortable operation within PACS both with and without AI \nresults, seamlessly weaving the results of AI into the workflow. \nLimitations: No limitation. \nEthics Committee Approval: This study is based upon the results of the \nregistered study \n(https://clinicaltrials.gov/ct2/show/NCT04489992). \nFunding for this study: Internal. \nAuthor Disclosures: \nSergey Morozov: Nothing to disclose \nAnna Evgenevna Andreychenko: Nothing to disclose \nNatalia Ledikhova: Nothing to disclose \nAnton Vladzymyrskyy: Nothing to disclose \nElena Turavilova: Nothing to disclose \nKirill Mihajlovich Arzamasov: Nothing to disclose \nVictor Gombolevskiy: Nothing to disclose \n \nRPS 1005-10 \nOptimal timing for collateral assessment using CTP data \n*J. Su*, L. Wolff, P. J. van Doormaal, D. Dippel, W. J. Niessen, \nA. Van Der Lugt, T. van Walsum; Rotterdam/NL \n(sujiahang@gmail.com) \n \nPurpose: To investigate whether there are optimal time points in CTP for \ncollateral status assessment. \nMethods or Background: Patients with ischemic stroke due to large vessel \nocclusion underwent baseline non-contrast CT, multiphase CT angiography \nand CT perfusion. Baseline clinical variables were National Institutes of Health \nStroke Scale (NIHSS) and Alberta Stoke Program Early CT Score (ASPECTS). \nFor each time point in a CTP image sequence, the vessel volume of the \noccluded side and its contralateral side and the arterial and venous Hounsfield \nUnits (annotated in a spherical ROI of ICA top and confluence sinuses) were \nobtained, yielding five curves over time. The Collateral Score(CS) was \ncomputed at the peak amplitude of each of the curves and the first acquisition \nof the multiphase CTA(mCTA) images. Its association with baseline NIHSS \nand ASPECTS was assessed with regression analysis. \nResults or Findings: In total 58 subjects (median age, 74 years, interquartile \nrange, 61-83 years; 33 male) were included. CS at peak arterial enhancement \nwas associated with NIHSS and had moderate correlation with ASPECTS \n(NIHSS: beta =-0.586, CI, [-0.946, -0.225]; ASPECT: beta =0.452, CI, [0.079, \n0.825]). The other candidate collateral measurements were less associated \nwith NIHSS and ASPECTS. The association of the CS at the peak arterial time \nenhancement were comparable the CS in the first acquisition of the mCTA. \nConclusion: CS at peak of arterial enhancement curve has a better \nassociation with NIHSS baseline and ASPECTS compared to the other \ncandidate collateral measurements, and has a similar association as the mCTA \ncollateral score. This suggests that the optimal time point for collateral \nassessment is at the peak of arterial enhancement. \nLimitations: The single center image data and relatively small data size. \nEthics Committee Approval: n/a \nFunding for this study: No funding was received for this work. \nAuthor Disclosures: \nTheo van Walsum: Nothing to disclose \nAad Van Der Lugt: Nothing to disclose \nPieter Jan van Doormaal: Nothing to disclose \nDiederik Dippel: Nothing to disclose \nJiahang Su: Nothing to disclose \nWiro J. Niessen: Nothing to disclose \nLennard Wolff: Nothing to disclose \n \n \nResearch Presentation Session: Hybrid, \nMolecular and Translational Imaging \nRPS 206 \nHybrid, molecular, and translational \nimaging developments \nRPS 206-1 \nAI-enhanced breast cancer molecular subtyping using simultaneous 18F-\nFDG PET/MRI \n*V. Romeo*¹, P. Kapetas², P. Clauser², P. A. Baltzer², S. Rasul², P. Gibbs³,  \nR. A. Woitek຾, K. Pinker-Domenig³, T. H. Helbich²; ¹Naples/IT, ²Vienna/AT, \n³New York, NY/US, ຾Cambridge/UK  \n(valeria.romeo@unina.it) \n \nPurpose: To investigate whether an AI-based radiomics model applied to 18F-\nFDG PET/MRI is effective in molecular subtyping of breast cancer (BC) and \nspecifically in discriminating triple negative (TN) from other molecular subtypes \nof BC. \nMethods or Background: In this IRB-approved, prospective, single-institution \nstudy, 86 patients with 98 BC lesions (Luminal A=10, Luminal B=51, \nHER2+=12, TN=25) were included and underwent simultaneous 18F-FDG \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 230  \nPET/MRI of the breast. 3D segmentation of BC lesion was performed on T2w, \nDCE, DWI and PET images. Quantitative diffusion (tumor ADCmean and \ncontralateral breast parenchyma), perfusion (tumor Mean Transit Time, Plasma \nFlow, Volume Distribution) and metabolic (tumor SUVmax, min, mean, \nSUVmean of ipsi and contralateral breast parenchyma) parameters were \ncalculated and radiomics features (first, second, higher order) extracted. \nQuantitative parameters and radiomics features were selected using the \nLASSO regression and used by a fine gaussian support vector machine (SVM) \nclassifier with a 5-fold cross validation for identification of TNBC lesions. \nDifferent radiomics models were built based on different combinations of \nquantitative parameters and/or radiomic features to obtain the highest \naccuracy. \nResults or Findings: Eight radiomics models were built. The best \nperformance (AUROC 0.887, accuracy 82.8%, sensitivity 79.7%, specificity \n86%, PPV 85.3%, NPV 80.8%) was found for the model combining first order, \nneighbourhood gray level dependence matrix and size zone matrix-based \nradiomics features extracted from ADC and PET images. \nConclusion: An AI-based radiomics model applied to 18F-FDG PET/MRI is \nable to non-invasively discriminate TNBC lesions from other BC molecular \nsubtypes with high accuracy. In a future perspective, a “virtual biopsy” might be \nperformed using radiomics signatures. \nLimitations: Small sample size \nLack of external validation \nEthics Committee Approval: IRB-Approved \nFunding for this study: EU Grant \nAuthor Disclosures: \nPascal A.T. Baltzer: Nothing to disclose \nKatja Pinker-Domenig: Nothing to disclose \nValeria Romeo: Research/Grant Support: Supported by the ESOR \"Bracco \nFellowship\" \nThomas H. Helbich: Grant Recipient: EU Grant \nRamona Anna Woitek: Nothing to disclose \nSazan Rasul: Nothing to disclose \nPanagiotis Kapetas: Nothing to disclose \nPeter Gibbs: Nothing to disclose \nPaola Clauser: Speaker: Siemens \n \nRPS 206-2 \nPotential role of deep learning for detection and localization of \nhyperfunctioning parathyroid glands in primary hyperparathyroidism on \n[18F]fluorocholine PET/CT \n*L. Jarabek*, J. Jamsek, A. Cuderman, S. Rep, M. Ho þevar, T. Kocjan, \nK. Zaletel, M. Jensterle Sever, L. Ležaiü; Ljubljana/SI  \n(leon.jarabek@gmail.com) \n \nPurpose: [18F]fluorocholine PET/CT (FCH-PET) has excellent diagnostic \nperformance in primary hyperparathyroidism, with experienced human readers \nachieving high sensitivity (91.7%) and specificity (99.7%). Interpretation of \nFCH-PET using deep learning in the setting of primary hyperparathyroidism \nhas not yet been investigated. The study aimed to train and test a baseline and \nnovel deep learning classification model for detection (CPr) and localization \n(CLoc) of hyperfunctioning parathyroid tissue from FCH-PET and to compare it \nto human diagnostic performance. \nMethods or Background: Ninety-eight FCH-PET studies of seventy-nine \npatients with primary hyperparathyroidism and nineteen control patients were \nobtained from our clinical trial (NCT03203668). We evaluated two deep \nlearning models: a baseline ResNet10 classifier and a novel mPETResnet10 \narchitecture. mPETResnet10 used UNet to mask physiologically high PET \nsignal in order to improve the performance of Resnet10. The performance of \nboth models was evaluated with 95% CI and compared to human performance \nfrom NCT03203668 using McNemar’s test. \nResults or Findings: Both models showed comparable performance for CPr \n(p > 0.05), with mPETResnet10 achieving 0.90[0.82–0.95] sensitivity and \n0.62[0.38–0.82] specificity. mPETResnet10 performed statistically better (p < \n0.05) for CLoc, with sensitivity of 0.81[0.72–0.89] and specificity of 0.80[0.75–\n0.85] whereas Resnet10 achieved 0.74[0.64–0.82] sensitivity and 0.76[0.70–\n0.80] specificity. Based on qualitative observations, mPETResnet10 masked \nthe physiologic signal of salivary glands. Human performance for both tasks \nwas significantly higher (p < 0.001). \nConclusion: We proved that deep learning could be used to identify \nhyperfunctioning parathyroid tissue on FCH-PET. Our improved \nmPETResnet10 classifier performed better than the standard Resnet10 \nclassifier. However, performance of experienced human readers was still better \nthan our deep learning models. \nLimitations: Given our small dataset, the results are promising and diagnostic \nperformance might be improved by including more cases. \nEthics Committee Approval: ClinicalTrials.org: NCT03203668 \nkme-nmec.si/: 77/11/12 \nFunding for this study: No funding was received for this study. \n \n \nAuthor Disclosures: \nMojca Jensterle Sever: Nothing to disclose \nLeon Jarabek: Nothing to disclose \nTomaž Kocjan: Nothing to disclose \nLuka Ležaiü: Nothing to disclose \nMarko Hoþevar: Nothing to disclose \nKatja Zaletel: Nothing to disclose \nAnka Cuderman: Nothing to disclose \nJan Jamsek: Nothing to disclose \nSebastijan Rep: Nothing to disclose \n \nRPS 206-3 \nComparison of three different dietary modifications on myocardial 18F-\nFDG suppression in PET/CT evaluation of patients for cardiac \nsarcoidosis \n*C. Ozutemiz*, Y. K. Köksel, N. Rubin, J. Froelich, D. Steinberger; Minneapolis, \nMN/US \n \nPurpose: To compare three different dietary preparations in achievement of \nthe best myocardial suppression (MS) for diagnosis of cardiac sarcoidosis (CS) \nwith 18F-FDG-PET/CT. \nMethods or Background: All 18F-FDG-PET/CT exams for CS were \nretrospectively reviewed. Three different diets were applied from 03/2014-\n12/2019. Diet-A)24h ketogenic diet with overnight fasting (n=94); Diet-B)18h-\nfasting (n=44); Diet-C)72h ketogenic diet with 3day/12h overnight fasting \n(n=98). The results of initial reports were recorded, and a separate radiologist \nretrospectively re-evaluated each case regarding CS (Negative, Positive, \nIndeterminant) and MS (Complete, Failed, Partial). Interobserver agreement \nwas studied. MaxSUV was measured from blood-pool, liver, the most \nsuppressed normal myocardium. Three dietary groups were compared. \nResults or Findings: Significantly lower myocardial FDG uptake, higher \nblood-pool/myocardium and liver/myocardium ratios were found with Diet-C, \nindicating better MS (P<0.001). The observer found statistically superior MS \nwith Diet-C; complete-MS:96.9% (Diet-A/Diet-B:68.1%/52.3%), failed-MS:0% \n(Diet-A/Diet-B:23.4%/25%), partial-MS: 3.1% (Diet-A/Diet-B:8.5%/22.7%) \n(P<0.001). Borderline statistical difference was found regarding MS per the \nradiology report (P=0.052). Regarding MS, mild to moderate agreement was \nfound between the report and the observer ( ț=0.41). Diet-C has significantly \nmore “negative”, less “positive” and less “indeterminant” active CS diagnoses \ncompared with other diets. The rates of negatives/indeterminants/positives \naccording to the report and observer in Diet-A, Diet-B, and Diet-C are as \nfollows respectively; Report A: 52.1%/4.3%/43.6%, B:34.1%/13.6%/52.3%, \nC:83.7%/1.0%/15.3%. Observer A: 52.1%/24.5%/23.4%, B: \n27.3%/40.9%/31.8%, C: 82.7%/2.0%/15.3%. High agreement was present with \nthe observer and the report (ț=0.88) \nConclusion: 72h ketogenic diet with overnight fasting is superior to other \ndiets, providing excellent MS and allowing decreased number of indeterminant \nand potentially “false positive” results. \nLimitations: Retrospective \nno standard calculated diet was given \nno confirmation by gold standard, because there is no gold standard. \nEthics Committee Approval: This retrospective study was approved by the \ninstitutional review board (STUDY00005814). \nFunding for this study: Departmental funding for statistical analysis \nAuthor Disclosures: \nNathan Rubin: Nothing to disclose \nCan Ozutemiz: Nothing to disclose \nYasemin Kocabas Köksel: Nothing to disclose \nDaniel Steinberger: Nothing to disclose \nJerry Walter Froelich: Grant Recipient: No activities related to the present \narticle. Author receives scientific grant support from Siemens Healthineers for a \nproject unrelated to this study. \n \nRPS 206-4 \nLongitudinal MRI-analysis of body composition in melanoma: from \nmouse model to immune checkpoint inhibitor-treated metastatic patients \n*W. Thaiss*¹, S. Gatidis², J. Machann², K. Nikolaou², B. Pichler², M. Kneilling²; \n¹Ulm/DE, ²Tübingen/DE \n \nPurpose: Cancer cachexia (CC) is associated with cancer progression, thus \nearly identification would be clinically beneficial. The aim was to establish an \nautomated MRI-based segmentation workflow defining visceral and \nsubcutaneous adipose tissue (VAT, SCAT) and lean tissue water (LTW) in \nmice and human melanoma patients for therapy assessment. \nMethods or Background: For in vivo monitoring of CC B16-melanoma \nbearing and healthy mice underwent longitudinal three-point DIXON MRI (days \n3, 12, 17 after subcutaneous tumor inoculation). In a prospective clinical study, \n18 metastatic melanoma patients underwent MRI before, 2 and 12 weeks after \nonset of checkpoint inhibitor therapy (CIT; n=16). We employed an in-house \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 231  \nMATLAB script for automated whole-body segmentation for detection of VAT, \nSCAT and LTW. \nResults or Findings: B16 mice developed a reduced VAT volume compared \nto baseline (B16 -249.8 μl, -25%; controls +85.3 μl, +10%, p=0.003) and to \nhealthy controls. LTW was increased in controls compared to melanoma mice. \nFive melanoma patients responded to CIT, 7 progressed, and 6 displayed a \nmixed response. Responding patients exhibited a very limited variability in VAT \nand SCAT in contrast to others. LTW was decreased in CIT responding \npatients (í\u0016\u0011\u0013\u0015\b“\u0015\u0011\u0019\u001a\b\u001e\u0003S \u0013\u0011\u0013\u0013\u0016\u0017\f\u0003EXW\u0003L UH HG\u0003L\u0003S WLH WZLWK\u0003SUR UH LYH\u0003\ndisease (+1.97%±2.19%) and mixed response (+4.59%±3.71%). \nConclusion: MRI-based segmentation of fat and water contents adds \nadditional information for monitoring the development of cancer cachexia in \nmice and metastatic melanoma patients under treatment. \nLimitations: Larger cohort studies are needed to take individual patient \nparameters into account. \nEthics Committee Approval: Animal experiments were performed according \nto the German Animal Protection Law with permission from the local \nauthorities. The prospective human study was approved by the local ethics \ncommittee. \nFunding for this study: Deutsche Forschungsgemeinschaft (DFG, German \nResearch Foundation), Werner Siemens-Foundation (Zug, Switzerland), \nintramural funding (Medical Faculty of the Eberhard Karls Universität \nTübingen). \nAuthor Disclosures: \nKonstantin Nikolaou: Nothing to disclose \nManfred Kneilling: Nothing to disclose \nJürgen Machann: Nothing to disclose \nSergios Gatidis: nothing to disclose \nBernd Pichler: Nothing to disclose \nWolfgang Thaiss: Nothing to disclose \n \nRPS 206-5 \nProspective comparison of CT and 18F-FDG PET/MRI in N and M staging \nof primary breast cancer patients: initial results \n*N-M. Bruckmann*; Düsseldorf/DE \n \nPurpose: To compare the diagnostic accuracy of contrast enhanced (ce) \nthoraco-abdominal computed tomography (CT) and whole-body 18F-FDG \nPET/MRI in N and M staging in newly diagnosed, histopathological proven \nbreast cancer. \nMethods or Background: A total of 80 consecutive women with newly \ndiagnosed and histopathologically confirmed breast cancer were enrolled in \nthis prospective study. All patients underwent a thoraco-abdominal ceCT and a \nwhole-body 18F-FDG PET/MRI. All datasets were evaluated separately by two \nradiologists blinded to clinical/follow-up data regarding suspect lesion count, \nlocalization, categorization and diagnostic confidence. Histopathological results \nas well as follow-up imaging served as reference standard in all patients. \nDifferences in staging accuracy were assessed using Mc Nemar´s chi² test. \nResults or Findings: CT rated the N stage correctly in 64 of 80 (80%, 95 % \nCI:70.0-87.3) patients with a sensitivity of 61.5%, a specificity of 97.6%, a PPV \nof 96%, and a NPV of 72.7%. Compared to this, 18F-FDG PET/MRI \ndetermined the N stage correctly in 71 of 80 (88.75%, CI:80.0-94.0) patients \nwith a sensitivity of 82.1%, a specificity of 95.1%, a PPV of 94.1%, and a NPV \nof 84.8%. Differences in sensitivities were statistically significant (20.6%, CI:-\n0.02-40.9; p=0.008). Distant metastases were present in 7/80 patients (8.75%). \n18F-FDG PET/MRI detected all of the histopathological proven metastases \nwithout any false-positive findings, while 3 patients with bone metastases were \nmissed in CT (sensitivity 57.1%, specificity 95.9%). Additionally, CT presented \nfalse-positive findings in 3 patients. \nConclusion: 18F-FDG PET/MRI has a high diagnostic potential and \noutperforms CT in assessing the N and M stage in patients with primary breast \ncancer. \nLimitations: Application of a modified reference standard, based on follow-up \nimaging for lesions without a histological sampling. \nEthics Committee Approval: This study is approved by the local ethics \ncommittee. \nFunding for this study: Funded by Deutsche Forschungsgemeinschaft \n(DFG). \nAuthor Disclosures: \nNils-Martin Bruckmann: Nothing to disclose \n \n \n \n \n \n \n \n \n \n \nRPS 206-7 \nIs there a benefit of a late-phase PET as part of 68Ga-PSMA-11 PET/CT in \npatients with biochemical recurrence of prostate cancer? \n*C. C. Loberg*, J. Kirchner, N-M. Bruckmann, E. Mamlins, C. Arsov,  \nJ. Morawitz, L. Schimmöller, G. Antoch, L. M. Sawicki; Düsseldorf/DE \n(christina.loberg@med.uni-duesseldorf.de) \n \nPurpose: To assess the diagnostic value of late-phase PET scan as part of \n68Ga-PSMA-11 PET/CT in patients with biochemical recurrence of prostate \ncancer. \nMethods or Background: This was a retrospective trial including 33 patients \n(mean age 74 ± 8 y) with newly documented biochemical recurrence of \nprostate cancer following radical prostatectomy (PSA 6.9±12.5 ng/ml; 0.27–\n50.0 ng/ml). Patients underwent early-phase PET PET/CT and a late-phase \nPET scan performed 54+/- 12.7 min after injection of 68Ga-PSMA-11. Late-\nphase PET-scan was conducted after emptying urinary bladder. Images were \nindependently evaluated by two radiologists and two nuclear medicine \nspecialists, regarding lesion count, localization, and SUVmax followed by a \nconsensus reading. Reference standard for lesion nature was based on \nhistopathology and follow-up imaging. \nResults or Findings: Whole-body early-phase PSMA PET/CT detected 93 \ncancer lesions in 33 patients. There were 57 nodal, 28 bone, and three lung \nmetastases as well as seven local recurrences. Late phase PET/ CT scans \ndetected two additional lesions in two patients, according to local recurrence. \nBetween early- and late-phase PET, corresponding lymph node metastases \nshowed a significant increase of SUVmax from 14.47±11.63 to 21.5±17.6 \n(p=0.00007). Benign lymph nodes measured in the respective regions showed \na significantly lower increase of SUVmax of 1.43±0.5 to 1.65±0.47 (p=0.0014). \nOn late phase PET/CT local recurrence and bone metastases had a SUVmax \n3.83 and 1.1 times higher in early phase PET/CT. \nConclusion: Late-phase PETin addition to early-phase 68Ga-PSMA-11 \nPET/CT is useful to detect local recurrences of prostate cancer and to \ndistinguish between malignant and benign nodes. Bone metastases and local \nrecurrences also demonstrate a strong metabolic increase over time. \nLimitations: It was a monocentric study with a limited amount of patients. \nEthics Committee Approval: The study was approved by local ethic comittee \n(2020-871) \nFunding for this study: There was no funding recquired \nAuthor Disclosures: \nChristina Christina Loberg: Nothing to disclose \nChristian Arsov: Nothing to disclose \nLino M Sawicki: Nothing to disclose \nEduard Mamlins: Nothing to disclose \nLars Schimmöller: Nothing to disclose \nJulian Kirchner: Nothing to disclose \nGerald Antoch: Nothing to disclose \nJanna Morawitz: Nothing to disclose \nNils-Martin Bruckmann: Nothing to disclose \n \nRPS 206-8 \nFree-breathing 3D Stack of Stars GRE (StarVIBE) sequence for detecting \npulmonary nodules in 18F-FDG PET/MRI \n*N-M. Bruckmann*; Düsseldorf/DE \n \nPurpose: The free-breathing T1-weighted 3D Stack of Stars GRE (StarVIBE) \nMR sequence potentially reduces artifacts in chest MRI. The purpose of this \nstudy was to evaluate StarVIBE for the detection of pulmonary nodules in 18F-\nFDG PET/MRI. \nMethods or Background: In this prospective study, 88 consecutive women \nwith newly diagnosed breast cancer underwent both contrast-enhanced whole-\nbody 18F-FDG PET/MRI and computed tomography. Patients’ chests were \nexamined on CT as well as on StarVIBE and conventional T1-weighted VIBE \nand T2-weighted HASTE MR sequences, with CT serving as the reference \nstandard. Presence, size, and location of all detectable lung nodules were \nassessed. A Wilcoxon test was applied and Pearson’s correlation coefficients \nwere calculated. \nResults or Findings: Out of 65 lung nodules detected in 36 patients with CT, \nthe StarVIBE sequence was able to detect 31 (47.7%), the VIBE sequence 26 \n(40%) and the HASTE sequence 11 (16.8%), respectively. Overall, CT showed \na significantly higher detectability than all MRI sequences combined (65 vs. 36, \ndifference 44.6%, p<0.001). The VIBE sequence showed a significantly better \ndetection rate than the HASTE (23.1%, p=0.001). Detection rates between \nStarVIBE and VIBE did not significantly differ (7.7%, p=0.27), but the StarVIBE \nshowed a significant advantage detecting centrally located nodules (66.7% vs. \n16.7%, p=0.031). There was a strong correlation in nodule size between CT \nand MRI sequences (HASTE: r=0.80; VIBE: r=0.77; StarVIBE: r=0.78, p<0.01). \nConclusion: Detectability of centrally located nodules is slightly better with \nStarVIBE than with VIBE. Nevertheless, all MRI analyses demonstrated \nconsiderably lower detection rates for small lung nodules, when compared to \nCT. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 232  \nLimitations: Women with newly diagnosed breast cancer are generally \nyounger and physically better constituted than most other people suffering from \ncancer. \nEthics Committee Approval: This study was approved by the local ethics \ncommittee. \nFunding for this study: Funded by Deutsche Forschungsgemeinschaft \n(DFG). \nAuthor Disclosures: \nNils-Martin Bruckmann: Nothing to disclose \n \n \nResearch Presentation Session: \nGenitourinary \nRPS 307 \nGenitourinary cancers \nRPS 307-1 \nQuantitative diffusion-weighted MR imaging in preoperative evaluation of \nendometrial cancer: the correlation between apparent diffusion \ncoefficient (ADC) and definitive histological grade \n*E. Scibilia*, P. V. Foti, F. Costa, R. Farina, S. Palmucci, R. Caltabiano,  \nG. Broggi, A. Cianci, A. Basile; Catania/IT  \n(edoardoscibilia@gmail.com) \n \nPurpose: According to the European Society for Medical Oncology guidelines, \nlymphadenectomy in endometrial cancer (EC) is performed on the basis of \ntumor stage and grade. Magnetic resonance imaging (MRI) can preoperatively \nassess the depth of myometrial invasion (tumor stage). Preoperative \nendometrial sampling is used to obtain the histopathological tumor grade, \nnevertheless a discrepancy between preoperative and definitive \nhistopathological diagnosis occurs in up to 29% of cases. The aim of our study \nwas to retrospectively investigate the value of quantitative diffusion weighted \n(DW) MRI with apparent diffusion coefficient (ADC) in predicting tumour grade \nof EC. \nMethods or Background: 40 patients with EC were enrolled in the study. All \npatients underwent preoperative MRI with conventional and DWI sequences. \nAll patients underwent surgery. For quantitative analysis, the ADC values of \nEC were measured and compared with definitive (surgical) histopathological \ndiagnosis considered as the reference standard. The diagnostic performance \nof ADC for discriminating grade 3 from grade 1-2 tumours was analysed using \na receiver-operating characteristic (ROC) curve. \nResults or Findings: Mean ADC values of EC were significantly different \namong grade 1, grade 2 and grade 3 groups (Grade 1: 909.4±135.7 x 10-6 \nmm2 /s; Grade 2: 806.7±89.7 x 10-6 mm2 /s; Grade 3: 657.7±124.2 x 10-6 \nmm2 /s; p<0.001). When an ADC <753 x 10-6 mm2 /s was used as the cut-off \nvalue for distinguishing between the grade 3 and grade 1-2 groups [area under \nthe ROC curve, 0.86], a sensitivity of 92.9% and a specificity of 83.3% were \nobtained. \nConclusion: DWI-ADC value was feasible for discriminating grade 3 from \ngrade 1-2 tumours in EC and may be useful to guide lymphadenectomy, thus \navoiding overtreatment in low-risk patients. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nRenato Farina: Nothing to disclose \nAntonio Cianci: Nothing to disclose \nPietro Valerio Foti: Nothing to disclose \nRosario Caltabiano: Nothing to disclose \nFederico Costa: Nothing to disclose \nAntonio Basile: Nothing to disclose \nEdoardo Scibilia: Nothing to disclose \nGiuseppe Broggi: Nothing to disclose \nStefano Palmucci: Nothing to disclose \n \nRPS 307-3 \nSynthetic MRI for quantitative measurements of endometrial cancer and \ncorrelation with depth of myometrial invasion \n*Y. Wang*, P. Cao, E. Y. P. Lee; Hong Kong/CN \n \nPurpose: The depth of myometrial invasion (MI) has prognostic value in \nendometrial cancer (EC). Synthetic MRI is an emerging technique that enables \naccurate quantitative measurements of T1/T2 maps with fast speed. The \nrelationships between T1/T2 values and the depth of MI in EC have not been \nexplored. The aim of this study was to measure the T1/T2 values of EC, and \ntheir relationships with MI. \nMethods or Background: Synthetic MRI of 49 patients with EC were acquired \non 1.5 T MRI scanner (Signa Explorer, GE Healthcare, Waukesha, USA). A \nregion of interest (ROI) was delineated on the axial slice that EC appeared \nlargest using the MAGiC software to derive the mean T1/T2 values of EC. \nPatients were dichotomized into Group 1 (no MI, 8/49), Group 2 (MI<50%, \n28/49) and Group 3 (MI•50%, 13/49). Kruskal Wallis test was used to test for \ndifferences among groups with subsequent pairwise Mann Whitney U (MWU) \ntest to compare the differences in T1/T2 values between groups. \nResults or Findings: The measured T1/T2 values of EC were 1347.0±275.8 \nmsec and 108.1±14.7 msec, respectively. The T1/T2 values were different \namong the 3 groups (p = 0.037 for T1 and p = 0.030 for T2). Decreasing \ntendencies in T1/T2 values were observed from Group 1 to Group 3. However, \npairwise MWU comparisons did not reveal significant differences between \ngroups, except for T2 values between Group 2 and 3 (p = 0.008) with T2 value \nin Group 2 larger than Group 3. \nConclusion: The T2 value derived from synthetic MRI of EC with less than \n50% MI was significantly larger than EC with more than 50% MI. \nLimitations: Small sample size. \nEthics Committee Approval: Yes. \nFunding for this study: No. \nAuthor Disclosures: \nElaine Yuen Phin Lee: Nothing to disclose \nPemg Cao: Nothing to disclose \nYiang Wang: Nothing to disclose \n \nRPS 307-4 \nComparison of abdominal attenuation values on virtual unenhanced \nimage obtained with renal mass to hematuria dual-energy computed \ntomography protocol \n*J. Cao*, S. Lennartz, A. Parakh, N. Pisuchpen, A. Kambadakone; Boston, \nMA/US \n(JCAO11@MGH.HARVARD.EDU) \n \nPurpose: To compare virtual unenhanced (VUE) attenuation between patients \nwho underwent dual-energy CT with renal mass protocol(DECTRM) and \npatients with hematuria who received split-bolus nephrographic phase \nurography(DECTHT). \nMethods or Background: A total of 105 consecutive patients who underwent \nDECT were included: 55 patients received DECTRM for suspected renal mass \nand 50 patients received DECTHT for assessing hematuria on a dual-layer \ndetector DECT. Study inclusion period was July 2018 to November 2019. All \nscans were biphasic examinations comprising an unenhanced nephrographic \nphase acquisition. DECTRM was performed with single bolus and DECTHT \nwith a split-bolus technique. VUE and iodine-overlay images were \nreconstructed from 120-kVp contrast-enhanced(CE) acquisitions of the \nnephrographic phase. A radiologist quantified attenuation of liver parenchyma, \nmain portal vein, aorta, spleen, renal cortex, and pelvis on TUE, VUE, CE, and \nIodine no water images. Agreement between TUE and VUE images was \ndetermined for both protocols and each anatomical region. \nResults or Findings: The attenuation of renal cortex and pelvis were \nsignificantly different between the two protocols. VUE attenuation of the renal \ncortex was significantly higher in the renal mass protocol compared to the \nhematuria protocol (left renal cortex 61.05 vs 44.14 HU, right renal cortex \n60.33 vs 44.94 HU; both p<0.05). Conversely, VUE attenuation of the renal \npelvis was significantly higher in the hematuria protocol compared to the renal \nmass protocol (left renal pelvis 78.42 vs 29.89 HU, right renal pelvis 79.29 vs \n29.10 HU; both p<0.001). \nConclusion: There was significant variability between the renal mass protocol \nand hematuria protocol regarding renal VUE attenuation, which impacts the \napplication of established attenuation thresholds for lesion characterization. \nLimitations: Retrospective study with a limited sample size. \nEthics Committee Approval: HIPAA-compliant, IRB approved. \nFunding for this study: Research Grant, Philips \nAuthor Disclosures: \nSimon Lennartz: Nothing to disclose \nAvinash Kambadakone: Nothing to disclose \nJinjin Cao: Nothing to disclose \nNisanard Pisuchpen: Nothing to disclose \nAnushri Parakh: Nothing to disclose \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 233  \nRPS 307-6 \nDiagnostic accuracy of the ADNEX MRI scoring system based on a \nsimplified MRI protocol: preliminary results of a single tertiary center \nretrospective study \n*S. Aslan*, S. Alanya Tosun; Giresun/TR \n(serdaraslan28@hotmail.com) \n \nPurpose: To evaluate the ADNEX MR scoring system efficacy based on a \nsimplified MRI protocol in adnexal masses. \nMethods or Background: In this retrospective study, 179 masses belonging \nto 116 cases who underwent Pelvic MRI with the diagnosis of adnexal mass \nbetween November 2019 and November 2020 were evaluated. An \nexperienced radiologist with board certification calculated the ADNEX MR \nscores of adnexal masses using an MRI protocol with a simplified dynamic \nstudy. The masses were scored from 1 to 5. Sensitivity, specificity, PPV, NPV, \naccuracy and the area under the receiver operating characteristic (ROC) curve \nwere calculated (cutoff for malignancy, score • 4). The reference standard was \nhistopathologic diagnosis or imaging findings during >12 months of follow-up. \nResults or Findings: Of 179 lesions, 32 (17.8%) were malignant. The \nmalignancy rates of masses with scores of 2, 3, 4 and 5 were 0% (0/81), \n12.5% (5/40), 37.5% (18/48) and 90% (9/10) respectively. The ADNEX MR \nscoring system, using a simplified MRI protocol, showed 87,5% (95% CI, \n61,6% - 98,4%) sensitivity, 96,2% (95% CI, 89,4% - 99,2%) specificity, 82,3% \n(95% CI, 60,2% - 93,5%) PPV, 97,4% (95% CI, 91,3% - 99,3%) NPV, and \n94,8% (95% CI, 88,2% - 98,2%) accuracy in the malignancy prediction. The \narea under the ROC curves for the differentiation of benign and malignant \nmasses were 0,969. \nConclusion: The ADNEX MR scoring system, even based on a simplified MRI \nprotocol, performed well in the prediction of malignant adnexal masses. This \nscoring system may enable the standardization of MRI reporting on adnexal \nmasses, thereby improving communication between radiologists and \ngynecologists. \nLimitations: A retrospective, single-center study and low number of malignant \nlesions. \nEthics Committee Approval: This retrospective study was approved by our \ninstitutional ethics committee. \nFunding for this study: No funding was received for this study. \nAuthor Disclosures: \nSerdar Aslan: nothing to disclose \nSebnem Alanya Tosun: Nothing to disclose \n \nRPS 307-7 \nContrast-enhanced ultrasound (CEUS) imaging for active surveillance of \nsmall renal masses \n*I. Baldi*, N. Morelli, S. Agostini, R. Campi, S. Serni, E. Bertelli, V. Miele; \nFlorence/IT \n(irene.baldi@gmail.com) \n \nPurpose: To assess the safety and efficacy of contrast-enhanced ultrasound \n(CEUS) imaging for monitoring small (<4 cm) renal masses (SRMs) in patients \nundergoing active surveillance (AS) at a high-volume kidney cancer Centre. \nMethods or Background: We selected all consecutive patients with SRMs \nwho underwent AS for at least 6 months at our Institution between January \n2014 and December 2018. CEUS was performed by two experienced genito-\nurinary radiologists at established time points. We identified four enhancement \npatterns (EP) of solid SRMs and defined as “growing SRMs” those whose size \ngrowth was > 5 mm over the AS period. \nResults or Findings: Of 1049 patients with SRMs treated during the study \nperiod, 158 (15.1%) underwent AS. The median follow-up was 25 months (IQR \n13-39). No patient died due to renal cell carcinoma (RCC) during the follow-up. \nOf patients undergoing AS, 43 (27.2%) underwent delayed intervention (DI) \nafter a median follow-up of 10 months (IQR 8-19). Overall, there was a large \nvariability in the pattern of growth of SRMs. The median SRMs size did not \nsignificantly change over the AS period. Yet, there was a significantly different \nEP between growing vs not growing SRMs in both patient cohorts. Notably, \nCEUS provided a reliable assessment of SRMs beyond their size: in particular, \nEP calculated during the real time CEUS examination was associated with the \n“growing potential” of SRMs. In addition, CEUS was especially appreciated by \npatients and reduced the inter-observer variability. \nConclusion: CEUS is a safe, reliable and cost-effective strategy for strict \nmonitoring of SRMs undergoing AS. Furthermore the EP could help clinicians \nin the management of SRMs. \nLimitations: Retrospective study. We could not evaluate the specific triggers \nfor DI. Relatively small sample size and mid-term follow-up. \nEthics Committee Approval: Approved by Ethical Committee \nFunding for this study: Not applicable \n \n \n \n \n \nAuthor Disclosures: \nNoemi Morelli: Nothing to disclose \nVittorio Miele: Nothing to disclose \nRiccardo Campi: Nothing to disclose \nElena Bertelli: Nothing to disclose \nSimone Agostini: Nothing to disclose \nIrene Baldi: Nothing to disclose \nSergio Serni: Nothing to disclose \n \nRPS 307-8 \nEx vivo 1H high resolution magic angle spinning (HRMAS) NMR \nspectroscopy for early prostate cancer detection \n*A. Steiner*¹, S. A. Schmidt¹, C-S. Fellmann¹, M. J. Beer¹, L. L. Cheng²; \n¹Ulm/DE, ²Boston, MA/US \n(annabelsteiner@gmx.de) \n \nPurpose: to evaluate the diagnostic value of ex vivo 1H HRMAS NMR \nspectroscopy for early prostate cancer detection with focus on the predictive \npotential of metabolomic alterations in biopsy samples for a cancer diagnosis \nin the following years. \nMethods or Background: 351 prostate biopsy patients were prospectively \nincluded in a primary study (04/2006-10/2018). Samples from each patient \nwere analyzed with NMR spectroscopy (Bruker 14.1 Tesla, Billerica, MA, USA) \nand histopathologically evaluated. With regard to our research question we \nperformed a subgroup analysis of all 351 patients and built three homogenous \ngroups à 16 patients which we compared in our subproject: Group 1 and 2 \nrepresented patients whose NMR scanned biopsy sample was histobenign, but \npatients of group 1 were diagnosed with cancer in the following years, while \npatients of group 2 stayed histobenign until the end of the study period. Group \n3 included cancer patients. \nResults or Findings: Metabolite concentrations (e.g. polyamines, p=0.0052) \nand metabolomic profiles could separate histobenign and malignant prostate \ntissue. Metabolite signals (e.g. glycerophosphoethanolamine, p=0.0027) could \nalso differentiate between histobenign samples of patients diagnosed with \ncancer in the following years and of those who stayed histobenign. Metabolite \nconcentrations correlated with volume percentage of benign epithelia (e.g. \ncitrate, p=0.0008, r2=0.2181) and PSA density (Valin in group 3, p=0.0047, \nr2=0.4465). Metabolite concentrations could also differentiate between \nGleason Score 3+3=6 and 3+4=7 (e.g. polyunsaturated fatty acids n-6, \np=0.0206). \nConclusion: Metabolomic information seems to hold a high potential in early \nprostate cancer detection. Moreover, the predictive power of metabolomic \nprofiles could improve active surveillance strategies on the basis of single \npatients, thus paving the way to a high level of personalized medicine for \nprostate cancer. \nLimitations: n/a \nEthics Committee Approval: An independent ethics committee reviewed and \napproved the study. \nFunding for this study: n/a \nAuthor Disclosures: \nCara-Sophie Fellmann: Nothing to disclose \nAnnabel Steiner: Nothing to disclose \nStefan Andreas Schmidt: Nothing to disclose \nLeo L. Cheng: Nothing to disclose \nMeinrad Johannes Beer: Nothing to disclose \n \nRPS 307-9 \nNon-prostate cancer tumours: incidence on 18F DCFPyL PSMA PET/CT \nand uptake characteristics \n*E. Perry*¹, S. Sharma², T. Sutherland²; ¹Christchurch/NZ, ²Melbourne/AU \n(elisa.perry@pacificradiology.com) \n \nPurpose: 18F DCFPyL PSMA PET/CT has been widely adopted in \nmanagement algorithms for patients with prostate cancer (PCa). Although \ninitially thought to be specific for PCa, multiple cases reports exist describing \navidity in a variety of other malignancies. To detect the incidence and types of \nnon-prostate cancer tumours detected on 18F DCFPyL PSMA PET/CT and \ndescribe the SUV and imaging uptake characteristics of these. Determine the \ninfluence of imaging indication on the incidence of these malignancies, with \nevaluation of three main cohorts referred for PSMA PET/CT; primary staging; \nbiochemical progression; and primary diagnosis. \nMethods or Background: The 18F DCFPyL databases of our institutions were \naccessed to identify patients referred for 18F DCFPyL PET/CT to investigate \nknown or suspected prostate cancer. All reports were reviewed to identify \npatients with suspected incidental non-prostate cancer related tumours. These \nstudies were then reviewed to describe the imaging features, SUV, and \nproportion/volume of avid tumour. Histology was obtained from medical \nrecords and pathologic databases. \nResults or Findings: Over 1,300 studies were reviewed, with potential non-\nPCa tumours present in around 10%. Lung nodules comprised approximately \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 234  \nhalf of these. Other tumours include renal cell carcinoma, primary \nbronchogenic carcinoma, recurrent breast cancer, recurrent laryngeal cancer, \nlymphoma, grade 4 glioma, transitional cell carcinoma and gastrointestinal \nstromal tumour. Branch duct IPMN was a common benign tumour. \nConclusion: Incidental non-PCa tumours are common with around 50% of \npotential tumours comprising non-avid small lung nodules. Visceral malignancy \nand recurrent tumours in a diverse range of organs are also frequently \nencountered. \nLimitations: Retrospective review is dependent upon report quality for case \nidentification. \nEthics Committee Approval: New Zealand national QA ethics. St Vincent's \nQA department. \nFunding for this study: We do not require any funding for this study. \nAuthor Disclosures: \nSanjana Sharma: Nothing to disclose \nTom Sutherland: Nothing to disclose \nElisa Perry: Nothing to disclose \n \nRPS 307-10 \n68Ga-PSMA PET/CT in prostate cancer patients with biochemical \nrecurrence after primary treatment: diagnostic performance and impact \non management strategy \n*R. Wang*, R. Tian; Chengdu/CN \n(wangrangscu@qq.com) \n \nPurpose: We aimed to evaluate the diagnostic performance of 68Ga PSMA \nPET/CT in detecting relapse or metastasis in patients with biochemical \nrecurrence (BCR), and to further assess the impact of 68Ga PSMA PET/CT on \nthe management strategy. \nMethods or Background: The PubMed, EMBASE, Cochrane Library and Web \nof Science databases were searched. Studies regarding the diagnostic \nperformance of 68Ga-PSMA PET/CT in patients with BCR were included. The \ndetection rate was pooled using a random-effects model. Studies reporting the \nimpact of 68Ga PSMA PET/CT on the management of patients with BCR were \nalso included. The proportion of management changes was calculated using a \nrandom-effects model. Subgroup and meta-regression analyses were \nperformed to explore heterogeneity. \nResults or Findings: Fifty-two studies were included. In patients with BCR, \nthe pooled detection rate was 77%. For the prostate-specific antigen (PSA) \ncategories of 0-0.19 ng/ml, 0.2-0.49 ng/ml, 0.5-2.0 ng/ml, 2.0-1.9 ng/ml and \nabove 2 ng/ml, the pooled detection rates were 26%, 45%, 62%, 84% and \n94%, respectively. The impact of 68Ga PSMA PET/CT on management was \nalso studied, and the pooled proportion of management changes was 55%. \nAmong these, increasing proportions were seen for treatments including \nradiotherapy, multimodal treatment, focal treatment and surgery, whereas the \nproportions of systemic treatment and no treatment decreased due to positive \n68Ga PSMA PET/CT scans. \nConclusion: 68Ga PSMA PET/CT had high diagnostic accuracy in \nbiochemically recurrent PCa, and the detection rate was positively correlated \nwith PSA levels. Furthermore, 68Ga PSMA PET/CT had a significant impact on \npatient management, particularly patients being considered for systematic \ntreatment. \nLimitations: None. \nEthics Committee Approval: None. \nFunding for this study: The National Natural Science Foundation of China \n(grant 81971653). \nAuthor Disclosures: \nRong Tian: Nothing to disclose \nRang Wang: Nothing to disclose \n \nRPS 307-11 \nMaking an art into a science: a mathematical “Likert tool” can change PI-\nRADS (v2) scores into Likert scores when reporting mpMRI for prostate \ncancer \n*W. M. Stevens*¹, C. Parchment-Smith², P. Melling², J. T. Smith²; \n¹Huddersfield/UK, ²Leeds/UK \n \nPurpose: To create a tool which can objectively convert PI-RADS (v2) to Likert \nscores, based on features shown to be predictors of clinically significant \nprostate cancer (CSPC). \nMethods or Background: 791 patients referred with query prostate cancer \nbetween 2017 and 2019 were prospectively allocated a Likert score by an \nexperienced reporter based on their PI-RADS scores, clinical and radiological \nfeatures. Histology results were used to compare the predictive accuracy of \nboth PI-RADS and Likert scoring systems. A logistic regression was run based \non criteria found to predict CSPC in a (n=411) cohort of 2018-19 patients. This \nwas used to create a “Likert tool” which, when applied to a PI-RADS score \nwould produce a Likert score. The tool’s performance was tested against the \nsame patients and against an earlier (n=380) 2017-18 cohort of patients. \nResults or Findings: Assuming a policy whereby patients with a PI-\nRADS/Likert score of 3 or above are biopsied, the Likert score allocated by the \nreporter to the cohort of 411 patients (sensitivity 0.92, specificity 0.77) would \nhave resulted in 107 fewer biopsies and 20.3% higher cancer yields than the \nPI-RADS score (sensitivity 0.99, specificity 0.43). Four criteria found to predict \nCSPC: PI-RADS (v2) score; Prostate Specific Antigen Density (PSAD); age \nand contrast enhancement pattern (CEP). These were used to create the \n“Likert tool”. Similar outcomes (111 fewer biopsies, 22.3% increase in cancer \nyield) could be seen when the “Likert tool” was applied to the same patient \ncohort (sensitivity 0.93, specificity 0.79) and to the earlier cohort. \nConclusion: A “Likert tool” could reduce inter-reporter variability and, if linked \nto an agreed biopsy policy, increase CSPC yield whilst decreasing the number \nof patients unnecessarily biopsied. \nLimitations: Only a single reporter was used in this study \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nWilliam Mark Stevens: Nothing to disclose \nPhilip Melling: Nothing to disclose \nJonathan Smith: Nothing to disclose \nCatherine Parchment-Smith: Nothing to disclose \n \nRPS 307-12 \nFollow-up for women after treatment for cervical cancer: a study about \n418 patients \n*R. Taoussi*, E. Assia, D. Anouar, S. Jelloul, A. Jadib, M. Sabiri, S. Lezar,  \nF. Essodegui; Casablanca/MA \n(taoussi.md@gmail.com) \n \nPurpose: MRI now occupies a prominent place in the post-treatment \nevaluation of cervical cancer and in the detection of its complications. It is \ntherefore useful to know the normal post-treatment MRI aspects of cervical \ncancer and to know how to differentiate a post-treatment change from a tumor \nresidue. \nMethods or Background: Descriptive retrospective study on MRI scans of \n418 patients received at the Central Radiology Department of the Ibn Rushd \nUniversity Hospital of Casablanca, Morocco, between January 2014 and \nJanuary 2020 for post-therapeutic assessment of cervical cancer \nResults or Findings: We identified 418 cases, the average patient age was \n56.6 years [23 years - 87 years]. They were distributed as follows: 185 patients \nhad an ad integrum restitution of the zonal anatomy, there were 31 patients \nwith a tumor recurrence, 12 with a tumor residue, 36 patients with obvious \nparametrial involvement without involvement of the pelvic wall,, 28 a post-\nradiation proctitis, 30 ureterohydronephrosis. \nConclusion: MRI is an important step in the assessment, lesion \ncharacterization and loco-regional extension of cervical cancers, providing vital \ninformation in lesion staging and therapeutic planning. \nLimitations: No limitations were found \nEthics Committee Approval: Yes \nFunding for this study: No fundings were needed \nAuthor Disclosures: \nDaki Anouar: Nothing to disclose \nFatiha Essodegui: Nothing to disclose \nAbdelhamid Jadib: Nothing to disclose \nReda Taoussi: Nothing to disclose \nMouna Sabiri: Nothing to disclose \nElberhoumi Assia: nothing to disclose \nSamira Lezar: Nothing to disclose \nSarah Jelloul: Nothing to disclose \n \nRPS 307-13 \nRole of radiomics in the evaluation of PI-RADS 3 lesions \n*D. Nicoletta*¹, P. N. Franco², P. A. Bonaffini³, E. De Bernardi², A. Corsi²,  \nR. Simonini², S. Sironi²; ¹Merate/IT, ²Milan/IT, ³Bergamo/IT \n(dario.nicoletta1988@gmail.com) \n \nPurpose: To evaluate the role of radiomics, combined with routine clinical \nparameters, in identifying clinically significant tumor in PI-RADS 3 lesions in \nprostate MRI studies. \nMethods or Background: Sixty-eight patients with at least one PI-RADS 3 \nlesion (according to PI-RADS v2.1), detected on prostate MRI on a 3T MRI \nscanner were retrospectively included. Final pathological analysis by means of \nMRI-targeted biopsy was used as a reference standard. Lesions were \nmanually contoured in ITK-SNAP on T2 sequences and ADC maps after \nnormalization and magnetic field inhomogeneity correction, radiomics analysis \nwas performed in Pyradiomics with 64-bins quantization. A total of 586 \nradiomics features per patient were computed. Clinical features included: age, \nPSA, PSA density and mean ADC value in a circular 2D ROI. Clinical and \nradiomics features best correlated with histologic results and less correlated to \neach other were selected. Multivariate predictive models based on clinical \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 235  \nfeatures only and on both clinical and radiomics features were assessed with \n17-fold cross-validation. \nResults or Findings: At pathological analysis 25 lesions were identified as \nclinical significant tumors (Gleason 3+4). PSA density, mean ADC in 2D ROI \nand 4 radiomic features (1 from T2, 3 from ADC maps) were selected. The best \nclinical radiomics model (KNN model based on PSA density, T2 glcm-\nAutocorrelation, ADC wavelet-LLL-firstorder-Median; AUC: 0.86, ı: 1 e-02) \nturned out to be more predictive than the best clinical-only model (cubic SVM \nmodel based on PSA density, mean ADC value in 2D ROI; AUC: 0.81; ı: \n0.02), with P-value of 2 e-03. \nConclusion: T2 and ADC radiomic features, combined with routine clinical \nparameters, might help improving the identification of clinically significant \nprostate tumor in PI-RADS 3 lesions. \nLimitations: The retrospective nature of the study and the paucity of patients. \nEthics Committee Approval: Not required. \nFunding for this study: Not required. \nAuthor Disclosures: \nDario Nicoletta: Nothing to disclose \nPietro Andrea Bonaffini: Nothing to disclose \nElisabetta De Bernardi: Nothing to disclose \nRoberto Simonini: Nothing to disclose \nPaolo Niccolò Franco: Nothing to disclose \nAndrea Corsi: Nothing to disclose \nSandro Sironi: Nothing to disclose \n \nRPS 307-14 \nRisk stratification of PIRADS 3 nodules using clinical/radiological \ncharacteristics in comparison to histopathological gold standard \n*F. Monelli*¹, F. Fiocchi², L. Venerandi³, M. C. Sighinolfi², B. M. C. Rocco²,  \nG. Ligabue², P. Torricelli²; ¹Reggio Emilia/IT, ²Modena/IT, ³Riccione/IT \n(mofilippo@hotmail.it) \n \nPurpose: PIRADS3 represents 19-36% of prostate lesion at MRI but only 6-\n31% are clinically significative lesions (CSL) defined by a Gleason Score •7. \nOur aim was to evaluate clinical/radiological features which may help to identify \nPIRAD3 nodules at a higher risk of being CSL. \nMethods or Background: We included every patient who received a 3T-MRI \nwith detection of a PIRADS3 nodule, availability of PSA value within 1 month \nand histopathological characterization of the lesion within 6 months from MRI. \nImages have been evaluated prospectively by two radiologists who registered \nvolume, ADC, ADC-ratio (fraction between lesion ADC and ADC of \ncontralateral healthy gland) and PSA-density. The database was randomly \nsubdivided into two equal cohorts. Presence of statistical differences in \nclinical/radiological variables between CSL and non CSL lesions were \nanalysed in cohort-1 (n=40, CSL=3). Selected variables were used to build an \nalgorithm to distinguish high risk from low risk nodules. This algorithm was \ntested on cohort-2. \nResults or Findings: 81 nodules were included, 7 were CSL (8.64%). PSA-\ndensity and ADC-ratio had a statistical correlated with CSL (p<0.05). Optimal \ncut-offs in cohort-1 (cohort-1=40) to differentiate CSL from non CSL nodules \nwere: PSA-density 0.13 and ADC-ratio 0.708 for PZ and 0.800 for TZ. The \nalgorithm was designed to assign a high risk of CSL to nodules with both \nparameters positive and a low risk to nodules with both negative. Applying the \nalgorithm to cohort-2 (n=41, CSL=4) every CSL was placed in high risk \ncategory and 13/37 non CSL were reclassified to low risk. Considering only \nreclassified lesions accuracy was high: Sensitivity=100% (IC 39.8%-100%), \nspecificity=81.25% (IC 54.4%-96.0%). \nConclusion: PSA-density and ADC-ratio are useful to stratify the risk of CSL in \nPIRADS3 nodules at 3T-MRI. \nLimitations: Low number of patients and CSL. \nEthics Committee Approval: AreaVastaEmiliaNord ethical committee. \nFunding for this study: None. \nAuthor Disclosures: \nMaria Chiara Sighinolfi: Nothing to disclose \nPietro Torricelli: Nothing to disclose \nFederica Fiocchi: Nothing to disclose \nLaura Venerandi: Nothing to disclose \nFilippo Monelli: Nothing to disclose \nGuido Ligabue: Nothing to disclose \nBernardo Maria Cesare Rocco: Nothing to disclose \n \nRPS 307-15 \n18F choline PET/MR to assess clinically significant disease in prostate \ncancer: correlation with maximum and total cancer core length obtained \nvia template mapping biopsies \n*L. M. Davis*, A. Haroon, A. Freeman, A. Afaq, H. U. Ahmed, M. Emberton,  \nJ. Bomanji; London/UK \n(lauramaydavis@nhs.net) \n \nPurpose: To compare diagnostic accuracy of 18F Choline PET/MR against \nreference standard Template Mapping biopsies. \nMethods or Background: 26 prostate lobes in 13 patients (age range 56-79; \nmedian 66 years) who had no evidence of metastatic disease on 18F Choline \nPET/MR and underwent TPM for evaluation of disease burden in the prostate \ngland and presence or absence of metastatic disease. \nResults or Findings: Mean age was 66 years (median 66; range 56-79 \nyears), mean PSA level 5.17 ng/mL, mean SUVmax was 3.18 (median 2.3; \nrange ranges 0.6-12.3), mean MCCL was 1.5 mm (range 1-9 mm). Prostate \ncancer was identified in 9 lobes with a Gleason of 6 in 3 lobes, Gleason score \nof 7 in 6 lobes. In 17 lobes there was no evidence of cancer, clinically \nsignificant disease was seen in 4 lobes, and clinically insignificant disease in 5 \nlobes. 18F Choline PET/MR detected cancer in all 9 lobes containing either \nclinically significant or insignificant cancer. The 12 lobes, which were positive \non PET, had cancer in 7 lobes (True positive) while in 5 lobes there was no \nevidence of malignancy on histology. Of the 14 lobes reported as normal, 2 \nhad cancer on histology while in 12 lobes (True negative) there was \nconcordance between histology and 18F Choline PET/MR. \nConclusion: 18F Choline PET/MR can detect clinically significant and clinically \ninsignificant disease. In patients who have undergone HIFU treatment 18F \nCholine PET/MR has higher accuracy compared to PET/CT due to better \nanatomical delineation of post-HIFU changes. False negative cases of 18F \nCholine PET/MR had very small volume disease (=/<2mm MCCL and TCCL). \nLimitations: Small sample size \nRetrospective study design \nEthics Committee Approval: Retrospecitve analysis hence Ethics committee \napproval was not obtained. \nFunding for this study: NIHR  \nBiomedical Research Centre \nAuthor Disclosures: \nLaura May Davis: Nothing to disclose \nAsim Afaq: Nothing to disclose \nAlex Freeman: Nothing to disclose \nJamshed Bomanji: Nothing to disclose \nAthar Haroon: Nothing to disclose \nHashim U Ahmed: Nothing to disclose \nMark Emberton: Nothing to disclose \n \n \nResearch Presentation Session: \nGenitourinary \nRPS 407 \nThe prostate and other glands \nRPS 407-1 \nIncidence of thyroid dysfunction after iodine-based contrast medium \nadministration and identification of risk factors \n*J. Carlqvist*¹, H. Filipsson Nyström¹, U. Nyman², M. Hellström¹; ¹Göteborg/SE, \n²Lund/SE  \n \nPurpose: To prospectively study contrast medium (CM) effects on thyroid \nfunction. \nMethods or Background: Reported frequencies of contrast-induced thyroid \ndysfunction vary greatly and are often observational and retrospective. Our aim \nwas to prospectively study CM effects on thyroid function in a randomly \nselected cohort. Six hundred participants in SCAPIS (Swedish \nCArdioPulmonary bioImage Study), aged 50–65 years, randomly selected from \nthe Swedish population registry, and scheduled for Coronary Computed \nTomography Angiography (CCTA) with intravenous iohexol were included. \nBlood samples (s-TSH, s-fT4, s-fT3) were obtained immediately before and 6–\n8 weeks after the CCTA. Individuals with abnormal hormone levels were \ncontacted for additional follow-up. Possible risk factors, such as thyroid \nperoxidase (TPO) antibodies were analyzed pre-CCTA, and thyroid ultrasound \nwas performed to detect thyroid nodules. \nResults or Findings: Follow-up blood samples were obtained in 448 of the \n600 individuals, in 408 cases (184 men, 224 women) within 4–10 weeks after \nCCTA. There were no cases of overt hyperthyroidism/thyrotoxicosis or overt \nhypothyroidism before or after CM exposure. There was a small, yet \nstatistically significant, mean increase of s-TSH (1.81 to 1.95 mIU/L, p<0.01) \nand s-fT4 (15.33 to 15.54 pmol/L, p<0.01) for the whole cohort. Eight \nindividuals developed subclinical hypothyroidism post-CCTA. We found no \ncorrelation between presence of thyroid nodules and CM-induced thyroid \ndysfunction. Elevated TPO antibodies was associated with greater risk of \nthyroid dysfunction post-CCTA (p<0.001). \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 236  \nConclusion: Preliminary results showed slight increase in s-TSH and s-T4 \nafter CM exposure but no overt hyper- or hypothyroidism in this randomly \nselected cohort aged 50–65 years. In-depth analysis of data remains. \nLimitations: Age span limited to 50–65 years. \nEthics Committee Approval: Approved by the Regional Research Ethics \nCommittee, Gothenburg (ref nr 277-17, addendum T1036-17). \nFunding for this study: Grants from the Swedish state (ALF agreement), \nVästra Götaland Region and Sahlgrenska University Hospital. \nAuthor Disclosures: \nUlf Nyman: Nothing to disclose \nJeanette Carlqvist: Nothing to disclose \nHelena Filipsson Nyström: Nothing to disclose \nMikael Hellström: Nothing to disclose \n \nRPS 407-2 \nInterobserver reproducibility of the PI-QUAL scoring system for prostate \nMRI quality: a pilot study from the NeuroSAFE PROOF trial \n*F. Giganti*, E. Dinneen, V. Kasivisvanathan, A. Haider, A. Freeman,  \nM. Emberton, G. Shaw, C. M. Moore, C. M. Allen; London/UK  \n \nPurpose: To evaluate the interobserver reproducibility of the PI-QUAL score \nfor assessing the quality of multiparametric magnetic resonance imaging \n(mpMRI) in patients with prostate cancer enrolled in the multicentre \nNeuroSAFE PROOF trial, in which patients receive mpMRI before being \nrandomised to robot-assisted laparoscopic prostatectomy using either \nNeuroSAFE or standard procedure. \nMethods or Background: PI-QUAL is a 1-to-5 scale, where a score ” 2 \nmeans that the diagnostic quality is inadequate while a score • 3 implies that \nthe scan is of sufficient diagnostic quality. A PI-QUAL score • 4 means that the \nmpMRI quality is high, and all significant lesions can be ruled in and out. Two \nradiologists independently used the published PI-QUAL scoring sheet in 20 \ndifferent scans. Cohen’s ț coefficients and percent agreement were computed. \nResults or Findings: Sixteen out of 20 scans were conducted on a 1.5T and \n4/20 on a 3T system. Seven patients were examined on a Philips, 4/20 on a \nGE and 9/20 on a Siemens scanner. \nReader 1 scored 6 scans as PI-QUAL 2, 9 as PI-QUAL 3 and 5 as PI-QUAL 4. \nReader 2 scored 6 scans as PI-QUAL 2, 7 as PI-QUAL 3 and 7 as PI-QUAL 4. \nAgreement was substantial (weighted ț = 0.766 and percent agreement = \n80%), especially for T2-WI, followed by DCE and DWI. \nConclusion: We observed substantial reproducibility in the assessment of PI-\nQUAL between two experts, particularly for the presence of artefacts and in the \nevaluation of the quality of the ADC map. \nLimitations: For the time being, PI-QUAL offers clinicians the only available \nscoring system for evaluating and reporting the quality of their prostate mpMRI \nscans but the composition of the scoring system will need to undergo further \nrefinements. \nEthics Committee Approval: Yes: 17/LO/1978 \nFunding for this study: Trial number: NCT03317990 \nAuthor Disclosures: \nClare Mary Allen: Nothing to disclose \nEoinn Dinneen: Nothing to disclose \nGreg Shaw: Nothing to disclose \nCaroline M Moore: Nothing to disclose \nAlex Freeman: Nothing to disclose \nAiman Haider: Nothing to disclose \nMark Emberton: Nothing to disclose \nVeeru Kasivisvanathan: Nothing to disclose \nFrancesco Giganti: Nothing to disclose \n \nRPS 407-3 \nEvaluation of the diagnostic performance of biparametric MRI, with and \nwithout quantitative analysis of ADC values vs multiparametric MRI of the \nprostate \n*G. Carnicelli*, M. Pecoraro, E. Messina, M. del Monte, C. Catalano,  \nV. Panebianco; Rome/IT \n \nPurpose: To compare biparametric MRI, with and without quantitative analysis \nof ADC values, and multiparametric MRI of the prostate in the diagnosis of \nprostate cancer in naïve patients, evaluating the role of contrast sequences. \nMethods or Background: 460 patients were retrospectively enrolled: they \nunderwent MRI according to the acquisition protocol defined by PI-RADS v2.1 \n(T2-weighted morphological sequences, diffusion functional sequences-DWI \n,and contrast sequences-DCE). The exams were evaluated by two radiologists, \none senior (with more than ten years of experience in prostate MRI imaging) \nand one junior (with five years of experience). The cases were evaluated \ninitially omitting the contrast sequences, without (method I) and with (method \nII) quantitative analysis of ADC values; after at least 6 weeks, the cases were \nre-evaluated by the same readers, with the addition of contrast sequences \n(method III). The results were stratified according to the pathological categories \ndefined by the International Society of Urological Pathology (ISUP). \nResults or Findings: For the senior radiologist, no statistically significant \ndifferences were demonstrated between the three methods, for all ISUP \ncategories, in the detection of lesions classified as PI-RADS > 3. For the junior \nradiologist, statistically significant differences were found between the three \nmethods for ISUP category 1 (non-clinically significant carcinoma); for ISUP \ncategories > 1, statistically significant differences were identified between \nmethods I vs II and I vs III, but not between II vs III. The highest inter-reader \nagreement was demonstrated for method III (k = 0.863). \nConclusion: The use of contrast media and the quantitative analysis of \ndiffusion parameters should be performed in patients with PCa suspicion, \nunless the MRI examination is evaluated by an expert radiologist. \nLimitations: Single center retrospective study. \nEthics Committee Approval: EC approved \nFunding for this study: Not applicable \nAuthor Disclosures: \nEmanuele Messina: Nothing to disclose \nValeria Panebianco: Nothing to disclose \nGiorgia Carnicelli: Nothing to disclose \nMartina Pecoraro: Nothing to disclose \nMaurizio del Monte: Nothing to disclose \nCarlo Catalano: Nothing to disclose \n \nRPS 407-5 \nAssessing the role of radiomic features from high b-value DWI sequences \nin the early detection of clinically significant prostate cancer (PCa) \n*M. Mottola*¹, A. Bevilacqua², F. Ferroni², G. Gavelli², D. Barone²; ¹Bologna/IT, \n²Meldola/IT \n(margherita.mottola@unibo.it) \n \nPurpose: To assess the role of radiomic features from high b-value DWI \nsequences in the early detection of clinically significant prostate cancer (PCa). \nMethods or Background: 76 patients are retrospectively enrolled, who \nundergo multiparametric MRI (mpMRI) and biopsy examination, where they \nreceived a Gleason Score (GS)=3+3 representing non-clinically significant PCa \n(ncsPCa, n=26) or GS•3+4 meaning clinically significant PCa (csPCa, n=50). \nPCa Regions of Interest (ROIs) are outlined on DWI at b=2000s/mm2 and \neighty-four local first-order radiomic features are extracted. First, the LASSO-\nbased method selects a subset of relevant features, discarding linearly \ncorrelated couples. Then, to prevent overfitting, only the couple with the lowest \np-value at Wilcoxon rank-sum test is selected. A Support Vector Machine \n(SVM) is trained on 48 patients, validated through 3-fold Cross Validation and \ntested on 28 patients. ROC curve and AUC are used to assess the SVM \nperformance, together with specificity, sensitivity, and Positive Predictive Value \n(PPV). \nResults or Findings: The AUC of the ROC curve on the training set is 0.86, \nwith specificity and sensitivity equal to 94% and 77%, respectively, whilst the \nAUC on the test set is 0.84 with specificity and of 75% and 90%, respectively, \nand PPV=90%. ncsPCa and csPCa are separated with p=0.007. \nConclusion: The classifier shows a very low probability of overtreatment of \nncsPCa while a high PPV strongly improves the performances of clinical \nmpMRI used in triage pre-biopsy setting. \nLimitations: This study has been carried out on a 3T machine. \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nDomenico Barone: Nothing to disclose \nFabio Ferroni: Nothing to disclose \nMargherita Mottola: Nothing to disclose \nGiampaolo Gavelli: Nothing to disclose \nAlessandro Bevilacqua: Nothing to disclose \n \nRPS 407-6 \nPharmacokinetic analysis of benign and malignant diseases of the \nprostate gland in MpMRI \nG. Yücel¹, *R. E. Büyüktoka*², Z. H. Adibelli², H. Mollamehmeto ÷lu², E. Sefik², \nE. Vardar², B. Günlüsoy², H. ø. Bozkurt²; ¹Manisa/TR, ²Izmir/TR \n(rasiterenbuyuktoka@hotmail.com) \n \nPurpose: To evaluate the contribution of pharmacokinetic analysis to \ndifferentiate prostate cancer from benign lesions,to correlate ISUP scores with \nquantitative and semi-quantitative parameters. \nMethods or Background: Total of 106 lesions who underwent MpMRI, then \nTRUS-guided cognitive fusion biopsy were included in this study. The MpMRI \nimages were evaluated by a radiologist, based on PI-RADSv2.1 before the \nbiopsy. Patients' age, PSA, PSA density (PSAd), prostate volume, location of \nlesions, PI-RADSv2.1 scores, pharmacokinetic analysis of normal PZ and \nlesions were recorded. \nResults or Findings: The mean age, PSA, prostate volume and PSAd in this \nstudy was; 63.5±7.5, 11.68±17.34ng/ml, 62.4±38.08cc and 0.23±0.39 \nrespectively.43 of 106 lesions were malignant. 65.1% of malignant lesions \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 237  \nwere located in the PZ and 20.9% had uncertain boundaries. There was \npositive correlation in between PI-RADSv2.1 scores and ISUP scores(p \n<0,001). Of the PI-RADS 3 lesions 22,2% were diagnosed as prostate \ncancer(ISUP1). Pharmacokinetic analysis proved that Ktrans and Kep mean \nvalues were the lowest in the normal PZ and the highest in the cancer group(p: \n<0,001).Chi2 value was the highest in the cancer group and was measured \nquite close to each other in the other groups. Ktrans, Kep and Chi 2 values \nwere significantly higher in cancer patients when the prostate cancer group \nand the non-cancer group were compared. There was no significant difference \nbetween the mean of the other parameters.No statistically significant difference \nwas found between ISUP groups and between ISUP 1 and ISUP>1 in terms of \nmeans of these parameters. \nConclusion: MpMRI shows the lesions to be biopsied, can predict tumor \naggressiveness.PI-RADS is expected to evolve in the future versions, with \nsetting up the international standards for pharmacokinetic analysis in DCE. \nLimitations: Limited number of patients is observed. \nEthics Committee Approval: For this prospective study, the approval of the \nEthics Committee was obtained from the local ethics committee. \nFunding for this study: n/a \nAuthor Disclosures: \nEnver Vardar: Nothing to disclose \nGülúen Yücel O÷uzdo÷an: Nothing to disclose \nHalil øbrahim Bozkurt: Nothing to disclose \nHülya Mollamehmeto÷lu: Nothing to disclose \nRaúit Eren Büyüktoka: Nothing to disclose \nErtugrul Sefik: Nothing to disclose \nBülent Günlüsoy: Nothing to disclose \nZehra Hilal Adibelli: nothing to disclose \n \nRPS 407-7 \nCan prostate biopsy sepsis be eliminated? A radiology departments \nexperience with 215 outpatient transperineal prostate biopsies \n*J. W. Power*, C. G. Cronin, B. Hutchinson, K. O'Malley, D. T. Murphy,  \nM. Hannan, J. Murray; Dublin/IE \n(jackwpower1@gmail.com) \n \nPurpose: To audit post-procedure sepsis after a COVID-mandated transition \nfrom transrectal ultrasound-guided biopsy (TRUS) to outpatient transperineal \nprostate (TP) biopsy. \nMethods or Background: Outpatient prostate biopsy continues to be \nperformed primarily using TRUS, despite rising antibiotic resistance and post \nprocedural sepsis. The COVID-19 international guidance has been to avoid \nTRUS biopsy where possible given the increased risk of sepsis associated with \nthe procedure. With some expertise in TP biopsy under GA, we took this \nopportunity to transition completely from TRUS to TP biopsy under local \nanaesthetic. We audited sepsis rates in 215 sequential TP prostate biopsies \nperformed from March-October 2020 and compared them with sepsis rates in \n590 TRUS biopsies performed in 2019. \nResults or Findings: In 590 TRUS biopsies, there were 15 cases of clinical \nsepsis (2.5%; clinical symptoms of sepsis without blood culture growth) and 8 \ncases of blood stream infection (1.4%). There were 0 cases of post procedural \nsepsis in 215 patients who underwent TP biopsy (chi-squared test P = 0.007). \nThere was 1 case of haematuria and 1 case of urinary retention requiring \nhospitalisation in the TRUS group, with no cases seen in the TP group (chi-\nsquared test P = 0.7). In all, there were no adverse event requiring \nhospitalisation in the TP group. \nConclusion: The COVID pandemic recommendation to avoid TRUS prompted \nour transition to outpatient TP biopsy. This resulted in elimination of post-\nprocedure sepsis. In the COVID era, it is more important than ever to reduce \niatrogenic sepsis, both for patient safety  and to avoid hospital admissions. Our \nexperience shows that it is possible to move from outpatient radiology-\ndelivered TRUS to an outpatient TP. \nLimitations: None identified \nEthics Committee Approval: NA - no Identifiable patient material included. \nFunding for this study: None \nAuthor Disclosures: \nDarra Thomas Murphy: Nothing to disclose \nJohn Murray: Nothing to disclose \nCarmel Geraldine Cronin: Nothing to disclose \nJack W. Power: Nothing to disclose \nKiaran O'Malley: Nothing to disclose \nMargaret Hannan: Nothing to disclose \nBarry Hutchinson: Nothing to disclose \n \n \nResearch Presentation Session: \nGenitourinary \nRPS 507 \nReproduction in GI \nRPS 507-1 \nNon-contrast MRI visualisation of penile vessels anatomy \n*I. Pyatnitskiy*, R. Ovchinnikov, S. Ivanov, B. Aleksandrov; Moscow/RU  \n(i.a.pyatnitskiy@gmail.com) \n \nPurpose: 1) Examine the anatomy of the penile vessels using non-contrast \nMRI; 2) Evaluate various techniques to visualize the penile vessels. \nMethods or Background: We examined two groups of patients: Group A: 20 \nhealthy volunteers underwent non-contrast MRI in the flaccid state and PPDU \n(Alprostadil 10 mcg); Group B: 15 healthy volunteers underwent non-contrast \nMRI in the flaccid and erection states (Alprostadil) and PPDU, also five of them \n- contrast-enhanced MRA and CT angiography (CTA). MRI scanner: Siemens \nAera 48, 1,5T, 32-Channel Body Coil. MRI protocol: T2_TSE, dynamic T2_TSE \n(during the erection process), 3D-T2 SPACE FS. \nResults or Findings: We obtained high-quality MRI images with clear \nvisualization of penile vessels: cavernous (CA), dorsal (DA), urethral arteries, \ndeep and superficial dorsal veins. We have found the anastomoses between \nDA and CA in 32 volunteers (91%). The average diameters of CA and DA’s \nbranch before anastomosis in the inner part of corpus cavernosum (CC) were: \n1,15±0,07 (SD) and 1,3±0,2 mm (flaccid state), 1,2±0,1 and 1,5±0,2 mm (blood \nfilling), 1,15±0,1 and 1,4±0,15 mm (erection), respectively. \nConclusion: Our study provides a primary understanding of the DA \nanastomoses anatomy and role in the erection process. The DA branches \nwere bigger than CA with a more substantial increase during CC blood filling, \nwhich indicates the equivalent or even more significant contribution to the \nblood filling of the outer part during the erection process. MRI T2_TSE and \nSPACE sequences provide a clear visualization of the most penile structures \nand vessels with high reproducibility of the PPDU, CTA, and contrast-\nenhanced MRA results and measurements. Probably MRI SPACE sequence \nmay be useful for the study of arterial stenosis. \nLimitations: The study did not include patients with erectile dysfunction. \nEthics Committee Approval: Approved by Ochapovsky Regional Clinical \nhospital ʋ1 \nFunding for this study: Rostagroexport Ltd. \nAuthor Disclosures: \nRoman Ovchinnikov: Nothing to disclose \nSergey Ivanov: Nothing to disclose \nBoris Aleksandrov: Nothing to disclose \nIlya Pyatnitskiy: Nothing to disclose \n \nRPS 507-2 \nThe role of magnetic resonance imaging in the evaluation of placenta \naccreta spectrum disorders in patients with placenta previa \n*E. Güler*, A. Öz, G. Serin, T. Köse, M. Harman, N. Elmas; Izmir/TR  \n(gulerezgi@yahoo.com) \n \nPurpose: To evaluate the use of magnetic resonance imaging (MRI) in the \ndiagnosis of placenta accreta spectrum (PAS) disorders in patients with \nplacenta previa. \nMethods or Background: MRI scans of patients with suspected placenta \nprevia that were obtained between January 2016 and January 2020 were \nretrospectively reviewed to identify cases with PAS disorders. The diagnosis of \nPAS disorders was confirmed by histopathology. Two radiologists \nindependently searched for MRI findings including intraplacental dark T2 \nbands, uterine/placental bulge, loss of low T2 retroplacental line, myometrial \nthinning, bladder wall interruption, focal exophytic placental mass, and \nabnormal vascularization of placental bed, that were recommended for \ndiagnosing PAS disorders by the joint consensus statement of Society of \nAbdominal Radiology and European Society of Urogenital Radiology. The \ninterobserver reliability was assessed using kappa statistic. \nResults or Findings: One hundred two patients with placenta previa (median \nage: 32, range: 20-45 years) were identified. Thirty-one patients (30.4%) had \nhistopathologically confirmed PAS disorders. For the diagnosis of PAS \ndisorders, MRI had a sensitivity of 93.5% and specificity of 85.9%. The positive \nand negative predictive values were 74.3% and 96.8%, respectively. \nSubstantial agreement was noted among the diagnosis of PAS disorders \nbased on MRI and histopathology (k=0.741). Interobserver agreement was \nalmost perfect for all MRI findings of PAS disorders except for the detection of \nbladder wall interruption, for which substantial agreement was found (k=0.790). \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 238  \nConclusion: MRI can be a useful tool for the diagnosis of PAS disorders in \npatients with placenta previa. High reliability was observed for the identification \nof MRI findings of PAS disorders. \nLimitations: The retrospective design of the study and lack of ultrasound \nevaluation for PAS disorders are the major limitations. \nEthics Committee Approval: It was approved by institutional review board. \nFunding for this study: None. \nAuthor Disclosures: \nAyúegül Öz Özcan: Nothing to disclose \nNevra Elmas: Nothing to disclose \nGürdeniz Serin: Nothing to disclose \nEzgi Güler: Nothing to disclose \nTimur Köse: Nothing to disclose \nMustafa Harman: Nothing to disclose \n \nRPS 507-3 \nComplex investigation of the penile erectile using dynamic MRI and \nPPDU \n*I. Pyatnitskiy*, R. Ovchinnikov, S. Ivanov, B. Aleksandrov; Moscow/RU \n(i.a.pyatnitskiy@gmail.com) \n \nPurpose: Complex investigation of the penile erectile process using dynamic \nMRI and Pharmaco-penile Doppler Ultrasonography(PPDU). \nMethods or Background: Twelve healthy volunteers underwent MRI 1,5T \nduring the erection process (Alprostadil,10 mcg) and PPDU twice (first – \ncontinuous exam of the cavernous artery(CA) blood flow during erection, \nsecond - deep dorsal vein (DDV)). MRI protocol: dynamic T2 TSE (each 2 min. \nduring 15-20 min till full erection), or T2 Trufi cine (each 1-3 sec). Changes in \nall parts of the penis were analyzed and compared with PPDU data. Corpus \ncavernosum(CC) was divided into three parts: crura, middle and outer parts. \nResults or Findings: During the erection process, CC’s outer part is growing \nthe most (from 9,4 to 74,6 ml, or + 690±95%). In the first 5-10 minutes, it \nactively expands to a plateau. The maximal CA blood flow (inflow, 6,2±1,1 \nml/min) and maximal DDV blood flow (outflow, 18,4±3,3 ml/min) corresponds to \nthe point of 50-60% of the max CC’s outer part volume. At this moment, CC’s \ncrura and middle parts and corpus spongiosum gain the maximum of their \nvolume. Further blood inflow and outflow fall sharply. But the excess of inflow \nover outflow persists, therefore CC continues to grow actively until the point of \ndisappearance of diastolic blood flow. After equaling intracavernosal pressure \nand diastolic arterial pressure, CC reaches the plateau. \nConclusion: According to our data, this is the first report about MRI and PPDU \ninvestigation of the erection process. Dynamic MRI represents the full picture \nof changes as outer as inner penile parts with precise measurement data. \nUsing data from different diagnostic methods allows achieving a more in-depth \nunderstanding of the complex physiological process, like a penile erection. \nLimitations: Small sample size \nEthics Committee Approval: Approved by Ochapovsky Regional Clinical \nhospital ʋ1 \nFunding for this study: Rostagroexport Ltd. \nAuthor Disclosures: \nRoman Ovchinnikov: Nothing to disclose \nSergey Ivanov: Nothing to disclose \nBoris Aleksandrov: Nothing to disclose \nIlya Pyatnitskiy: Nothing to disclose \n \nRPS 507-5 \nRole of sonosalpinogography in female subfertility – diagnostic or \ntherapeutic tool? \n*N. Neha*, R. Rastogi, R. Najam, R. Agarwal, V. Pratap; Moradabad/IN \n(neha11aug@gmail.com) \n \nPurpose: Sonosalpingography (SSG) has long been in radiology as a less \ncommonly used tool for assessing the patency of fallopian tubes in subfertile \nfemales. It's significance is undermined by laparoscopic evaluation (LE) of \ntubal patency as latter also allows simultaneous therapeutic procedures to \nrestore its patency, if the obstruction exists. But LE is invasive and expensive. \nHence, we evaluated the role of SSG not only in diagnosis of tubal obstruction \nbut also its role in diagnosing the cause and if possible relieving the \nobstruction. \nMethods or Background: Fifty subfertile females with normal appearing \nuterus and ovaries on transvaginal ultrasonography were included in our study. \nSSG was performed to evaluate tubal patency by recording free peritoneal \nspill. If peritoneal spill was absent bilaterally then the patient underwent \nlaparoscopic evaluation. However, if unilateral or bilateral peritoneal spill was \nnoted, then patient was recruited for assisted reproductive techniques (ART) \nand the results were correlated with pregnancy. \nResults or Findings: Out of 50 patients, SSG was able to demonstrate free \nperitoneal spill at least unilaterally in 46 patients who conceived with ART. In \nrest of the four patients, with lack of bilateral spill on SSG, two revealed \nunilateral partial block while other two revealed bilateral tubal block. In all \npatients SSG correctly depicted the site of obstruction. In nine, patient it \nrevealed PID (tubercular) by demonstrating flimsy peritubal adhesions and in \n14 patients, higher pressure exerted during SSG restored the patency with \nsharp abdominal pain. \nConclusion: Our study reveals that SSG is not only a diagnostic Golden Old \nTool but a New Therapeutic Platinum tool as well. Hence, SSG should be used \nmore often and can be used to segregate patients who prudently need \nlaparoscopic evaluation. \nLimitations: None \nEthics Committee Approval: Approved \nFunding for this study: None \nAuthor Disclosures: \nRehana Najam: Nothing to disclose \nRajul Rastogi: Nothing to disclose \nRitika Agarwal: Nothing to disclose \nNeha Neha: Nothing to disclose \nVijai Pratap: Nothing to disclose \n \nRPS 507-6 \nEvaluating the role of MRU in anterior male urethral strictures \n*R. Rastogi*, N. Jain, P. Joon, V. Pratap; Moradabad/IN \n(rajulrst@yahoo.co.in) \n \nPurpose: Magnetic Resonance Urethrography (MRU) has recently gained \nacceptance over Retrograde Urethrography for evaluation of anterior urethral \nstrictures as it has the additional advantage of evaluating periurethral region \nwhich may affect further management besides obviating radiation exposure. In \nfact, MRU has been described as a gold standard and one-stop shop for \nevaluating anterior urethral strictures due to its excellent soft tissue contrast & \nlack of operator dependence. This prospective study aimed to: \n•Compare accuracy of MRU in evaluation of anterior male urethral strictures. \n•Role of MRU in predicting management of anterior male urethral strictures. \nMethods or Background: Twenty male patients with suspected anterior \nurethral strictures were referred to our department for MRU that was performed \non 1.5T scanner following distension of the urethra by instillation of optimal \namounts of sterile gel per urethram & application of soft-plastic, penile-tip \nclamp. High-resolution, T2 weighted images were obtained in all planes. Data \nrelated to site & length of stricture, presence or absence of spongiofibrosis with \nits extent and any other associated abnormality was recorded in MRU. The \nfindings were compared to that of the intraoperative findings. \nResults or Findings: Out of 20 patients, three patients were excluded from \nour study due to suboptimal MRI scan quality. Long-segment stricture in \nanterior urethra was detected in 14 out of 17 (82.4%) patients. In rest three \ncases, though the stricture was diagnosed as short-segment but revealed \nspongiofibrosis affecting the patient management. Thus, MRI had an overall \naccuracy of 100% when correlated with final management. \nConclusion: MRU can be used with high accuracy in anterior urethral \nstrictures to predict the correct mode of management in anterior male urethral \nstrictures thus preventing related morbidity due to recurrence. \nLimitations: None \nEthics Committee Approval: Approved \nFunding for this study: None \nAuthor Disclosures: \nNeha Jain: Nothing to disclose \nRajul Rastogi: Nothing to disclose \nPawan Joon: Nothing to disclose \nVijai Pratap: Nothing to disclose \n \nRPS 507-7 \nPenile veins non-contrast MRI visualisation \n*I. Pyatnitskiy*, R. Ovchinnikov, S. Ivanov, B. Aleksandrov; Moscow/RU \n(i.a.pyatnitskiy@gmail.com) \n \nPurpose: Evaluate the potential use of non-contrast MRI as a diagnostic tool \nfor penile veins examination. \nMethods or Background: Fifteen healthy volunteers underwent MRI in the \nflaccid and erect states (Alprostadil 10 mcg) and PPDU. MRI scanner: Siemens \nAera 48, 1,5T, 32-Channel Body Coil. MRI protocol: T2_TSE, dynamic T2_TSE \n(during penile erection process), 3D-T2 SPACE FS, T2 Trufi cine. T2_trufi_cine \nwas performed during voluntary pelvic floor muscles (PFM) contraction to \nassess their potential influence on the veins. \nResults or Findings: We obtained high-quality MRI images with clear \nvisualization of penile vessels. Deep dorsal vein (DDV) had a single-branch \ntype, but it was divided into two branches at the proximal part of the corpus \ncavernosum (CC) in three volunteers (20%). In all the volunteers, we have \nfound a severe narrowing of DDV between CC and the pubic bone (PB). \nBefore this narrowing, DDV showed significant dilation. We have compared the \nPPDU (in proximal outer part) and MRI (dilation and narrowing parts) DDV \ndiameters: 2,1±0,2 (SD) mm, 3,2±0,4 mm, 1,1±0,1 mm (flaccid state), 2,8±0,2 \nmm, 4,8±0,4 mm, 0,8±0,1 mm (erection), respectively. The DDV diameters \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 239  \ndifference in dilation and narrowing parts was 2,9 and 6 times in flaccid and \nerect states, respectively. Besides, we have discovered the compression of \nDDV during PFM contraction. \nConclusion: Non-contrast MRI can be effectively used for penile veins \nanatomy study and potentially for the leakage assessment. We have found the \nsevere narrowing of DDV between CC and PB. In this place, the DDV diameter \ndeclines during erection, and DDV is fully compressed during PFM contraction, \nwhich can be an essential factor in the veno-occlusive mechanism. \nLimitations: The study did not include patients with erectile dysfunction. \nEthics Committee Approval: Approved by Ochapovsky Regional Clinical \nhospital ʋ1 \nFunding for this study: Rostagroexport Ltd. \nAuthor Disclosures: \nRoman Ovchinnikov: Nothing to disclose \nSergey Ivanov: Nothing to disclose \nBoris Aleksandrov: Nothing to disclose \nIlya Pyatnitskiy: Nothing to disclose \n \nRPS 507-8 \nRole of uterine artery doppler in subfertile patients \n*N. Neha*, R. Rastogi, V. Pratap; Moradabad/IN \n(neha11aug@gmail.com) \n \nPurpose: Ultrasound (Mostly transvaginal) is the first-line investigation and can \nbe coupled with color Doppler and 3D/4D scans. It is readily available, \ninexpensive, noninvasive, radiation-free, relatively less time consuming, and \neasily repeatable. Limitations include subjective errors, limited field of view, \ninterference by obesity or by gaseous bowel loops, suboptimal visualization of \nfallopian tubes and broad ligament, failure to delineate small ovaries, and \ninability to obtain images in the surgical plane. Hence, this study aimed to \ndetermine the role of uterine artery doppler in subfertile females by determining \nthe relevant RI, PI and SD ratio values. \nMethods or Background: Thirty patients who are of reproductive age group \nand have been clinically labelled subfertile were evaluated by Doppler Imaging. \nWomen of reproductive age group were divided in primary & secondary \nsubfertility group. Transvaginal colour D oppler ultrasonography in the ovulatory \nphase was performed 48hours prior and after the expected date of ovulation in \nall patients. Pulsatility index (PI), resistive index (RI) and systolic/diastolic ratio \n(S/D) were recorded and noted in each case with subsequent calculation of \ntheir incidences. \nResults or Findings: The majority of subfertile females (with both primary & \nsecondary subfertility) had high RI, PI and SD ratio values with reversal \ndiastolic component in spectral waveform. \nConclusion: Uterine artery doppler is an important imaging tool to evaluate \nuterine receptivity in subfertile patients and should be performed before \nresorting to assisted reproductive techniques. Uterine artery doppler indices \ncan be used to objectively to assess the effects of different clinical methods \naimed to improve the uterine perfusion. It can also help in selecting the \npatients for early institution of various therapies and different types of ART at \nan early stage. \nLimitations: None \nEthics Committee Approval: None \nFunding for this study: None \nAuthor Disclosures: \nRajul Rastogi: Nothing to disclose \nNeha Neha: Nothing to disclose \nVijai Pratap: Nothing to disclose \n \n \nResearch Presentation Session: \nGenitourinary \nRPS 607 \nImaging of the kidney \nRPS 607-2 \nCost-effectiveness analysis of multimodal imaging in diagnosis and \nfollow-up of intermediate complex cystic renal lesions \n*P. Spiesecke*, T. Reinhold, Y. Wehrenberg, S. Werner, A. Maxeiner,  \nJ. Busch, T. Fischer, B. Hamm, M. H. Lerchbaumer; Berlin/DE  \n(Paul.spiesecke@charite.de) \n \nPurpose: Cystic renal lesions are frequent incidental findings. Due to a certain \nrisk of malignancy, many such lesions require a follow-up diagnostic test. The \npresent study evaluates costs and outcomes of patients with Bosniak IIF and III \nrenal cysts detected and followed up by either contrast-enhanced computed \ntomography (ceCT), contrast-enhanced magnetic resonance imaging (ceMRI), \nor contrast-enhanced ultrasound (CEUS). \nMethods or Background: A simulation using Markov models was \nimplemented and performed with 10 cycles of one year each. Proportionate \ncohorts were allocated to Markov models by a decision tree processing specific \nincidences of malignancy and levels of diagnostic performance. Costs of \nimaging and surgical treatment were investigated using internal data of a \nEuropean university hospital. Multivariate probabilistic sensitivity analysis was \nperformed to confirm results considering input value uncertainties.Patient \noutcomes were measured in quality-adjusted life years (QALY), and costs as \naverages per patient including costs of imaging and surgical treatment. \nResults or Findings: Compared to the gold standard of ceCT, ceMRI was \nmore effective but also more expensive, with a resulting ICER being larger \nthan 70,000€ per QALY gained. CEUS was dominant compared to ceCT in \nboth Bosniak IIF and III renal cysts in term of QALYs and costs. Probabilisitic \nsensitivity analysis confirmed these results in the majority of iterations. \nConclusion: Both ceMRI and CEUS are more effective than ceCT in the \ndiagnosis and follow-up of intermediately complex cystic renal lesions, while \nCEUS was clearly cost-effective. \nLimitations: The economic results apply to a large university hospital and \nmust be adapted for smaller hospitals. \nEthics Committee Approval: This study was approved by the local \ninstitutional ethics committee. \nFunding for this study: n/a \nAuthor Disclosures: \nBernd Hamm: Consultant: Canon Medical Imaging \nPaul Spiesecke: Nothing to disclose \nThomas Reinhold: Nothing to disclose \nJonas Busch: Nothing to disclose \nMarkus Herbert Lerchbaumer: Consultant: Siemens Healthineers \nAndreas Maxeiner: Speaker: Hitachi-Medical-Systems, Canon Medical \nSystems, Stryker and Janssen-Cilag \nThomas Fischer: Consultant: Bracco and Canon Medical Imaging \nYano Wehrenberg: Nothing to disclose \nSven Werner: Nothing to disclose \n \nRPS 607-3 \nMRI texture analysis of transplanted kidney for the prediction of \ninterstitial fibrosis and tubular atrophy at renal biopsy: an observational \nretrospective study \n*F. Monelli*¹, G. Besutti¹, F. Fontana², V. Trojani¹, M. Bertolini¹, G. Ligabue²,  \nP. Torricelli², P. Giorgi Rossi¹, P. Pattacini¹; ¹Reggio Emilia/IT, ²Modena/IT  \n(mofilippo@hotmail.it) \n \nPurpose: To evaluate the accuracy of MRI texture features in predicting \nInterstitial Fibrosis and Tubular Atrophy (IFTA) at renal biopsy (RB), the \nreference standard. \nMethods or Background: All consecutive patients in follow-up after kidney \ntransplant who received MRI and RB within 6 months were included. RB was \nclassified following Banff guidelines. Radiomic analysis was performed on axial \nT2 pre-contrast and T1 fat-suppressed post-contrast sequences. The whole \nrenal parenchyma (PAR) was segmented and labelled on T2 and T1, renal \ncortex (COR) only on T2. After imaging preprocessing, PyRadiomics was used \nto extract radiomic features. After removal of shape features, 93 features were \nincluded and reduced using LASSO regression to produce radiomic signatures. \nThese were introduced in Machine Learning (ML) models to test the \nassociation with IFTA (25% and 50% thresholds) and with specific \nhistopathologic outcomes: Sclerosis, Inflammation, Glomerulitis and \nPeritubular Capillaritis (GCPT) (presence/absence). 5-fold cross-validation was \nused. \nResults or Findings: Sixty patients were included; some patients performed \nmultiple MRI and biopsy: 67 pairs of MRI/biopsy met inclusion criteria. Among \nML models, three showed a good performance; results are reported as AUC \nand a value of sensitivity and specificity which optimizes the test accuracy. T2 \nCOR “firstorder_minimum/firstorder_range/glrlm_run_entropy” for IFTA•50% \n(AUC=0.77, sensitivity=73%, specificity=71%), T1 PAR “firstorder_energy” for \nIFTA•25% (AUC=0.71, sensitivity=74%, specificity=51%), T1 PAR \n“firstorder_energy/gldm_small_dependence_low_gray_level_emphasis” for \nGCPT (AUC=0.74, sensitivity= 78%, specificity=68%). \nConclusion: We propose a method to extract renal MRI imaging radiomic \nfeatures, which may have the potential to produce biomarkers for the prediction \nof graft diseases. \nLimitations: Retrospective design and small sample. Further analyses are \nnecessary to explore radiomic signature potential in the prediction of clinical \nrather than histopathological outcomes. \nEthics Committee Approval: AVEN, Number: AOU 0010167/20 \nFunding for this study: None. \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 240  \nAuthor Disclosures: \nPietro Torricelli: Nothing to disclose \nMarco Bertolini: Nothing to disclose \nPierpaolo Pattacini: Nothing to disclose \nFilippo Monelli: Nothing to disclose \nGuido Ligabue: Nothing to disclose \nFrancesco Fontana: Nothing to disclose \nPaolo Giorgi Rossi: Nothing to disclose \nValeria Trojani: Nothing to disclose \nGiulia Besutti: Nothing to disclose \n \nRPS 607-4 \nOral hydration compared to intravenous hydration in the prevention of \npost-contrast acute kidney injury in patients with chronic kidney disease \nstage IIIb: a phase III non-inferiority study \n*A. Páez Carpio*, M. D. C. Sebastia Cerqueda, E. Guillen, B. Paño, E. Poch,  \nL. Oleaga, C. Nicolau; Barcelona/ES \n(alfredopaezcarpio@gmail.com) \n \nPurpose: To evaluate the non-inferiority of oral hydration compared to \nintravenous (IV) hydration in the prevention of post-contrast acute kidney injury \n(PC-AKI) in patients with stage IIIb CKD referred for an elective CE-CT. \nMethods or Background: This is a prospective, randomized, phase 3, \nparallel-group, open-label, non-inferiority trial. Patients were randomly \nassigned 1:1 to receive prophylaxis against PC-AKI either with oral hydration: \n500 mL of water two hours before and 2000 mL during the 24 hours after \nperforming CE-CT or IV hydration: sodium bicarbonate (166mmol/L) 3 mL/kg/h \nstarting one hour before and sodium bicarbonate (166mmol/L) 1 mL/kg/h \nduring the first hour after CE-CT. The primary outcome was the proportion of \nPC-AKI in the first 48 to 72 hours after CE-CT. Secondary outcomes were \npersistent PC-AKI, the need for hemodialysis, and the occurrence of adverse \nevents. \nResults or Findings: Of 264 patients randomized between January 2018 and \nJanuary 2019, 114 received oral hydration, and 114 received IV hydration and \nwere evaluable. No significant differences were found between arms in clinical \ncharacteristics or risk factors (p=0.13->0.95). PC-AKI rate was 4.4% (95%CI: \n1.4-9.9%) in the oral hydration arm and 5.3% (95%CI: 2.0-11.1%) in the IV \nhydration arm. IV hydration arm's 90% upper bound was 10.2%. Persistent PC-\nAKI rate was 1.8% (95%CI: 0.2-6.2%) in both arms. No patient required \ndialysis during the first month after CE-CT or had adverse effects related to the \nhydration regime. \nConclusion: Oral hydration is non-inferior compared to IV hydration in the \nprevention of PC-AKI in patients with stage IIIb CKD referred for an elective \nCE-TC. \nLimitations: Unbalanced groups due to non-stratified randomization. PC-AKI \nrates were lower than predicted when designing the trial. \nEthics Committee Approval: This study was approved by our institution's \nethics committee. \nFunding for this study: This study was not supported by any funding. \nAuthor Disclosures: \nElena Guillen: Nothing to disclose \nCarlos Nicolau: Nothing to disclose \nBlanca Paño: Nothing to disclose \nMaria Del Carmen Sebastia Cerqueda: Nothing to disclose \nLaura Oleaga: Nothing to disclose \nAlfredo Páez Carpio: Nothing to disclose \nEsteban Poch: Nothing to disclose \n \nRPS 607-5 \nPerfusion computed tomography in the assessment of functional \noutcomes after nephron-sparing surgery \n*E. Kryaneva*¹, N. Rubtsova¹, A. B. Golbitc¹, A. V. Leont’ev¹, A. D. Kaprin²; \n¹Moscow/RU, ²Obninsk/RU \n \nPurpose: To investigate the relationship between changes of perfusion \nparameters of affected kidney and renal function in patients with renal cell \ncarcinoma undergoing laparoscopic partial nephrectomy (PN). \nMethods or Background: 68 patients with primary renal tumors were included \nin our study. In the first group (n=31) PN was performed without any vascular \nclamping. Patients included in the 2nd and 3rd groups had renal artery \nclamping: warm ischemia time (WIT) in the 2nd group (n=15) was 8-25 \nminutes, in the 3rd group (n=12) WIT was 26-45 minutes. Overall renal function \nwas assessed by glomerular filtration rate (GFR). Split renal function measured \nusing nuclear medicine renal scintigraphy (NMS) with 99mTc diethylene \ntriamine penta-acetic acid . Effective renal plasma flow (ERPF) was evaluated. \nThe following perfusion parameters of cortex and medulla of affected kidney, \nand ischemia zone were measured: blood volume (BV), blood flow (BF), mean \ntransit time (MTT) and permeability surface area product (PS). ERPF, \nperfusion parameters and GFR were assessed at baseline pre-operative and \nat 4 days and 3 months post-operatively. The changes of the parameters were \nevaluated: early and late postoperative changes and recovery of renal function. \nResults or Findings: The study obtained significant (p<0.05) correlation \nbetween changes of following perfusion parameters: BV, BF and MTT of \naffected kidney cortex with alterations of function of the affected kidney in a 3-\nday and 4-month period. There were no significant correlation (p>0.05) \nbetween perfusion parameters and overall renal function in a 3-day period, but \nthey were identified in the 4-month interval. \nConclusion: Alterations of perfusion parameters were significantly correlated \nwith NMS data, which allows using perfusion CT data as an independent \nobjective method for evaluating function of the affected kidney after acute \nischemic injury. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: None \nAuthor Disclosures: \nElena Kryaneva: Nothing to disclose \nAleksandra Borisovna Golbitc: Nothing to disclose \nAndrey Dmitrievich Kaprin: Nothing to disclose \nAleksey Victorovich Leont’ev: Nothing to disclose \nNatalia Rubtsova: Nothing to disclose \n \nRPS 607-6 \nDiagnostic value of combined magnetic resonance urography and \napparent diffusion coefficient calculation in pediatric obstructive \nuropathy \nN. Adel Zeed¹, *E. H. A. Emara*², A. Sakr¹, S. Khalil¹, A. Abdel Azim¹,  \nA. Amer¹, A. Al Gayar¹; ¹Zagazig/EG, ²Kafr El Sheikh/EG \n(emademara85@yahoo.com) \n \nPurpose: to assess combined role of magnetic resonance urography and ADC \nvalue measured by DWI in evaluation of renal morphology and function in \npediatric obstructive uropathy and to find correlation between ADC value \nmeasured by DWI and split glomerular filtration rate(GFR) in children with \nobstructive uropathy. \nMethods or Background: 40 pediatric patients with urinary tract obstruction \nwere included. Diagnostic work up included ultrasound, voiding cytogram, MRI, \nStatic MRU, DWI and Renal scintigraphy. The patients were divided according \nto the degree of renal insufficiency into group A of 26 renal units (mild renal \nimpairment), group B of 24 renal units (moderate renal impairment) and group \nC of 13 renal units (severe renal impairment) \nResults or Findings: Conventional MRI & MRU provided accurate information \nregarding the cause and level of obstruction as well as associated congenital \nanomalies. The most common cause of obstruction was pelvi-ureteric junction \nobstruction (12 patients) followed by megaureter (7 patients) then obstructed \nduplex (6 patients) and inadequate pyeloplasty (4patients). The mean ADC \nvalue of hydronepherotic kidney was (1.56+ 0.21 X10-3) which was lower than \nADC value of contra-lateral non hydronepherotic kidney (2.22+ 0.15 X10-3) \nwith high statistical significance difference (P 0.0001). mean ADC values of the \n3 groups were 1.82+0.08 X10-3 for group with e GFR >50 ml /min, 1.52+0.09 \nX10-3 for group with e GFR (25-50 ml /min) and 1.32+0.07 X10-3 for group \nwith e GFR <25 ml /min. There was positive correlation between renal ADC \nvalue of obstructed hyrdonephrotic kidney and renal split GRF (p 0.001) . \nConclusion: the combination of MRU and ADC calculation provided valuable \nmorphological and functional information in obstructive uropathy and ADC can \nreflect the filtration function of obstructed hydronephrotic kidney \nLimitations: Motion artifact \nEthics Committee Approval: Yes \nFunding for this study: No funding \nAuthor Disclosures: \nNesma Adel Zeed: Nothing to disclose \nAhmed Sakr: Nothing to disclose \nAlaa Al Gayar: Nothing to disclose \nAhmed Abdel Azim: Nothing to disclose \nAyman Amer: Nothing to disclose \nEmad Hassan Ali Emara: Nothing to disclose \nSalem Khalil: Nothing to disclose \n \nRPS 607-7 \nDECT parameters as predictors of laser energy used in lithotripsy \n*H. Fruchtman-Brot*¹, Z. Romman², I. Leichter¹, M. Duvdevani¹, J. Sosna¹; \n¹Jerusalem/IL, ²Haifa/IL \n(hilafru@gmail.com) \n \nPurpose: Stones chemical composition may affect the level of energy required \nduring lithotripsy. We aimed to assess the correlation between urinary stone \nvalues of electron density (ED) and effective atomic number (Zeff) measured \non Dual-Energy Computed Tomography (DECT) with the level of energy \nrequired during lithotripsy. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 241  \nMethods or Background: We performed a retrospective study of 30 patients \n(26 M, 4 F, average age 50.4 years) scanned on a single source DECT (IQON, \nPhilips, Eindhoven-Netherlands), in which a stone was identified and treated by \nlithotripsy later. Hounsfield unit (HU), Zeff and ED values were measured and \nstandard deviation (SD) was calculated. Data regarding the energy used during \nlithotripsy was obtained. Spearman's ȡ, Mann Whitney test and F test were \nused. \nResults or Findings: Stone volume was on average 444 mm3 (range 11-\n2162). Energy/volume used was on average 11.75 Joule/mm3 (range 0.4-\n30.5). Six stones had a Zeff value ”10 compared to 24 stones with Zeff >10. \nMean SD of Zeff among stones of Zeff>10 was higher compared to stones of \nZeff”10 (P 0.019). The variance of energy/stone volume was different between \nvalues of both groups (P 0.014), with Zeff ”10 showing small variance of energy \nlevel compared to Zeff>10. No significant correlation was found between the \nactual value of Zeff or ED and the level of energy during lithotripsy. \nConclusion: Stones of Zeff”10 are more homogenous and require a rather \nuniform level of energy which is easier to predict comparing to stones of \nZeff>10 which are more heterogeneous and require varying energy levels. \nDECT provides information regarding urinary tract stones homogeneity and \ncan predict the level of energy in lithotripsy. \nLimitations: Retrospective study, with 30 patients only \nEthics Committee Approval: Yes \nFunding for this study: None \nAuthor Disclosures: \nMordechai Duvdevani: Nothing to disclose \nIsaac Leichter: Nothing to disclose \nHila Fruchtman-Brot: Nothing to disclose \nJacob Sosna: Nothing to disclose \nZimam Romman: Employee: Philips Healthcare Haifa Israel \n \n \nResearch Presentation Session: \nGenitourinary \nRPS 707 \nGenitourinary ultrasound \nRPS 707-1 \nFirst-trimester assessment of placental quotient and vasculature on \nthree-dimensional ultrasound for the prediction of foetal growth \nrestriction \n*S. Jain*, V. Bhardwaj, R. C. Shukla, M. Jain, T. B. Singh; Varanasi/IN  \n(shivijain1103@gmail.com) \n \nPurpose: To evaluate the role of placental quotient and vascular indices on \nthree-dimensional ultrasound (3D-USG) for prediction of foetal growth \nrestriction (FGR) in first trimester. \nMethods or Background: 362 pregnant women with singleton foetus at \ngestation age (GA) of 6-9 weeks, confirmed through transvaginal ultrasound, \nwere enrolled. At 11-14 weeks, transabdominal 3D-USG assessment of \nplacental volume (PV), placental quotient (PQ), vascularization index (VI), flow \nindex (FI), vascularization flow index (VFI) was done. In 340 women, follow-up \nwas done till delivery. Diagnosis of FGR was confirmed when birth weight (BW) \nwas <10th percentile for that GA with malnutrition clinically. Receiver operator \ncharacteristic (ROC) curves were plotted; correlation coefficients of PV, PQ, VI, \nFI, VFI with birth weight were calculated. \nResults or Findings: 24.1% (82/340) pregnancies showed FGR. The mean \nvalues of PV, PQ, VI, FI & VFI were significantly lower (p<0.001) in FGR than \nnormal (PV: 51.53 ± 8.70 vs 58.11 ± 9.98, PQ: 0.88 ± 0.03 vs 0.91 ± 0.02, VI: \n4.00 ± 2.82 vs 6.12 ± 1.09, FI: 18.89 ± 5.46 vs 23.61 ± 2.7, VFI: 2.26 ± 1.64 vs \n3.69 ± 0.63, respectively) with their area under ROC curve being 0.685, 0.757, \n0.698, 0.756 & 0.769, respectively. Sensitivity and specificity of cut-off values \nfor prediction of FGR for PV (63.5 ml), PQ (0.92), VI (6.5%), FI (26.0), VFI \n(3.98) were 90.2% and 31.8%, 91.5% and 33.7%, 90.2% and 24.0%, 90.2% \nand 20.9%, 90.2% and 23.3% respectively. The maximum correlation with BW \nwas noted for VFI followed by FI and VI (r=0.492, 0.422, 0.395, respectively). \nConclusion: 3D-USG assessment of placental quotient and vascular indices \ncan help in prediction of FGR in first trimester. \nLimitations: It was tertiary hospital-based study; results cannot be generalized \nat community level. \nEthics Committee Approval: Taken \nFunding for this study: None \n \n \n \n \nAuthor Disclosures: \nShivi Jain: Nothing to disclose \nRam Chandra Shukla: Nothing to disclose \nMadhu Jain: Nothing to disclose \nVritika Bhardwaj: Nothing to disclose \nTej Bali Singh: Nothing to disclose \n \nRPS 707-2 \nUltrasound evaluation of scar thickness for predicting the risk of uterine \nrupture in term women with previous cesarean sections \n*S. A. Saeed*, I. Masroor, A. Majeed; Karachi/PK  \n(shaista.afzal@aku.edu) \n \nPurpose: The sonographic evaluation of lower uterine scar near term can help \nto assess the risk of uterine dehiscence and thus increase safety for those \nundergoing a trial of labor. The objective of the study was to determine the \naccuracy of lower uterine scar thickness measurement on ultrasound in \npredicting the intraoperative outcome of the uterine scar. \nMethods or Background: This retrospective cross-sectional study conducted \nin the Radiology Department, Aga Khan University from January 2017 to \nDecember 2019 after exemption from the institutional ethics review committee. \nAll patients referred for scar thickness measurements in the third trimester \nwere included. Patients who did not undergo C-section were excluded. The \ndemographic data, comorbidities, clinical presentation, number of prior C-\nsections, and interpregnancy interval was recorded in the proforma. Data were \nanalyzed to evaluate the sensitivity, specificity, positive predictive, and \nnegative predictive value of scar thickness measurements in predicting the \nprobability of uterine dehiscence. \nResults or Findings: A total of 126 patients were included. The number of \nprevious C sections was 1 to 5 and the interpregnancy interval ranged from 1 \nto 11 years. In the present study at a cut-off value of 2 mm for scar thickness, \nthe sensitivity, specificity, positive predictive value, and negative predictive \nvalue of ultrasound in predicting uterine dehiscence was 83%, 36%, 93%, and \n85% respectively. \nConclusion: The ultrasound evaluation of lower uterine segment scar \nthickness showed a high sensitivity in predicting the intraoperative appearance \nof the lower uterine segment. The scar thickness measurement can be used as \na screening test to predict the integrity of the scar. \nLimitations: Non-availability of prior operative records, non-provision of \nintraoperative lower uterine segment scar measurement, and ultrasound is \noperator dependent \nEthics Committee Approval: approved  \nETHICS REVIEW COMMITTEE \n2020-3616-11439 \nFunding for this study: No funding received  \nNo financial disclosure \nAuthor Disclosures: \nAiman Majeed: Nothing to disclose \nShaista Afzal Saeed: nothing to disclose \nImrana Masroor: Nothing to disclose \n \nRPS 707-3 \nClinical study of transvaginal ultrasonography combined with clinical \nintegration model in menopausal endometrial lesions \n*Y. M. Zhu*, M. Chen, J. Yang; Shanghai/CN \n(10344891@qq.com) \n \nPurpose: To analyze transvaginal ultrasound and clinical data, and to build a \nclinical integrated model to provide diagnostic basis for the evaluation of \nendometrial lesions of menopausal. \nMethods or Background: A retrospective analysis was performed on 156 \npatients with menopausal endometrial lesions, who were divided into benign \nlesions group and malignant lesions group. Statistical analysis was performed \nto establish an integrated ultrasound clinical model. \nResults or Findings: A total of 156 cases of patients were divided into \nmalignant group (28 cases) and benign group (128 cases). According to \nunivariate Logistic regression analysis, age, abnormal vaginal bleeding, \nendometrial thickness, endometrial echo uniformity, and endometrial blood flow \nsignal in ultrasonic indicators were screened out for variables with clinical \nhistory with statistical significance. Multivariate stepwise logistic regression \nanalysis was conducted to establish corresponding regression equation. \nMultivariate logistic regression analysis showed that age, endometrial \nthickness and abnormal vaginal bleeding had statistical significance (P<0.05). \nThe diagnostic efficiency of the regression equation for endometrial benign and \nmalignant lesions, the sensitivity, specificity and AUC of the regression model \nfor the diagnosis of endometrial malignant lesions were 75.0%, 81.3% and \n0.85, respectively. \nConclusion: The regression model suggested that ultrasound indicators and \nclinical history had a good diagnostic effect on endometrial lesions in \nmenopause. Among them, endometrial thickness, age and abnormal vaginal \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 242  \nbleeding had better diagnostic efficacy and can provide an important basis for \nthe personalized diagnosis and treatment of patients. \nLimitations: The endometrial malignant lesions studied in this project are few, \nwith bias. The sample size will be increased for further study and observation \nin the future. \nEthics Committee Approval: The study protocol was approved by the clinical \nmedical research ethics committee of our hospital. \nFunding for this study: None \nAuthor Disclosures: \nJun Yang: Nothing to disclose \nYa Mei Zhu: Nothing to disclose \nMan Chen: Nothing to disclose \n \nRPS 707-4 \nComparative role of retrograde urethrography (RGU) and \nsonourethrography (SUG) in anterior urethral strictures \n*N. Neha*, R. Rastogi, V. Pratap; Moradabad/IN \n(neha11aug@gmail.com) \n \nPurpose: Retrograde urethrography (RGU) has been the mainstay of \nevaluating the anterior urethra in male patients for clinicians for a long time. \nHowever, its invasive nature and radiation exposure has paved a way for \nintroduction of sonourethrography (SUG) that has recently started gaining \nacceptance. Urethral management primarily depends upon site & length of \nstricture (>1.5cm length of stricture requires urethroplasty), presence or \nabsence of spongiofibrosis (presence requires urethroplasty), etc. Hence, this \nprospective pilot study aims for determining: • Comparative role of RGU & SUG \nin evaluation of anterior urethral strictures • Comparative role of RGU & SUG in \npredicting management of anterior urethral strictures \nMethods or Background: Thirty patients with suspected anterior urethral \nstrictures referred to our department were evaluated by RGU followed by SUG \nwith a high-resolution, linear-array, transducer Data related to site & length of \nstricture; presence or absence of spongiofibrosis with its extent and any other \nassociated abnormality was recorded in both RGU & SUG. \nResults or Findings: Long-segment stricture in anterior urethra was detected \nin 20 out of 30 (66.7%) patients by RGU while SUG detected it in 24 out of 30 \n(80.0%) patients meaning thereby that 4 patients were falsely diagnosed as \nshort-segment stricture by RGU which were in bulbar urethra. More \nsignificantly, SUG detected spongiofibrosis in addition to the accurate length of \nstricture required for management in 10 patients out of thirty affecting the mode \nof management. \nConclusion: SUG is an accurate imaging tool in anterior urethral stricture that \nnot only complements RGU but also affects the mode of management thus \naffecting the prognosis of the patient, hence should be a routine procedure in \nall patients with positive findings on RGU \nLimitations: None \nEthics Committee Approval: None \nFunding for this study: None \nAuthor Disclosures: \nRajul Rastogi: Nothing to disclose \nNeha Neha: Nothing to disclose \nVijai Pratap: Nothing to disclose \n \nRPS 707-5 \nNormal and asymptomatic pathological urachal remnants in adults \n*F. Loddo*, L. Anfigeno, G. Valenti, J. P. Zawaideh, L. E. Derchi; Genova/IT \n(federico.loddo@fastwebnet.it) \n \nPurpose: The urachus is an embryonic tubular structure between allantois and \ncloaca which obliterates after birth becoming a fibrous midline cord running \nfrom umbilicus to apex of the bladder (the median umbilical ligament). \nAnomalous remnants result from incomplete involution of this embryonic \nstructure and from these inflammatory or neoplastic complications can follow. \nVisibility of this structure, how it appears and prevalence of asymptomatic \nanomalies is poorly understood in adults. The aim of our study is to establish \nhow often and with which shape the median umbilical ligament is visible in \nadults and to evaluate the prevalence of urachal regression anomalies. \nMethods or Background: We reviewed the images of 300 randomly selected \npatients (201 males, 99 females; age range: 14 – 96 years) referred to imaging \nexaminations with unrelated indications between August 2019 and January \n2020 (100 US, 100 CT, 100 MRI). Visibility of median umbilical ligament and of \nurachal regression anomalies was recorded. \nResults or Findings: The median umbilical ligament was identified in 51% of \npatients studied with US, in 67% of patients studied by CT and in 71% of \npatients by MRI. It starts with a triangular shape originating from the anterior \nwall of the bladder and becomes a tubular structure cephalad. Median length \nwas 62,55 mm. Asymptomatic anomalies were found in 8 cases (2.67%): 4 \npatients had urachal cyst and 4 vesico-urachal diverticula. \nConclusion: Our study demonstrates that normal urachal remnants are \nfrequently visible during imaging studies in adults. Asymptomatic regression \nanomalies such as cysts or diverticula are relatively rare but probably more \nfrequent than expected. \nLimitations: Future studies will include a better division between males and \nfemales and into age groups. \nEthics Committee Approval: Images and data were acquired, anonymously, \nwith the consent of the patients. \nFunding for this study: No funding received. \nAuthor Disclosures: \nFederico Loddo: Nothing to disclose \nLorenzo E. Derchi: Nothing to disclose \nLorenzo Anfigeno: Nothing to disclose \nJeries Paolo Zawaideh: Nothing to disclose \nGiacomo Valenti: Nothing to disclose \n \nRPS 707-6 \nRole of intraplacental villous artery (IPVA) doppler in normal pregnancies \nand pregnancies with intrauterine growth restriction (IUGR) \n*N. S. Mehta*, C. Mehta; Vadodara/IN \n(nsjmrad@gmail.com) \n \nPurpose: To evaluate the intraplacental villous artery Doppler indices in \nnormally grown foetuses and growth restricted foetuses. To evaluate the role of \nintraplacental villous artery Doppler in early detection of IUGR \nMethods or Background: A quantitative prospective study of pregnant \nfemales coming for antenatal ultrasound was conducted using low frequency (3 \nto 5 MHz) curvilinear transducer of Philips Affinitti 50G at the Radiology \nDepartment. Singleton uncomplicated pregnancies were included. A total of \n116 pregnant females were included and were scanned for 3 times between 16 \nto 20 weeks, 25 to 28 weeks and 32 to 36 weeks. The data was analysed with \nstandard statistical tests. \nResults or Findings: Out of 116 females included, 94 females had normal \npregnancy outcome and 22 females developed intrauterine fetal growth \nrestriction. There was a significant decrease in PI, RI and S/D values of IPVA \nand umbilical artery Doppler with advancing gestational age in normal \nuncomplicated pregnancies (p < .05) . Intraplacental Villous Artery PI, RI and \nS/D values were significantly higher in IUGR foetuses as compared to normal \nfoetuses (p <0.05) at all three consecutive scans. Umbilical artery PI, RI and \nS/D values were significantly higher in IUGR foetuses as compared to normal \nfoetuses (p <0.05) at last two scans. There was no statistically significant \ndifference between umbilical artery PI, RI and S/D values between the two \ngroups as early as 16 to 20 weeks. \nConclusion: IPVA resistance indices decrease as gestational age increases in \nnormal uncomplicated pregnancies. Lack of decrease in IPVA resistance \nindices or increase in their values with advancing gestational age may be early \npredictor of IUGR. \nLimitations: A tertiary hospital based study in a small sample size, results can \nnot be generalized to community level. \nEthics Committee Approval: Ethics Committee approval obtained. \nFunding for this study: n/a \nAuthor Disclosures: \nNirali Satish Mehta: Nothing to disclose \nChetan Mehta: Nothing to disclose \n \n \nResearch Presentation Session: Head and \nNeck \nRPS 308 \nEar, nose, and throat \nRPS 308-2 \nThe pneumatization of the sphenoid sinus, its variations and relations \nwith surrounding neurovascular anatomic structures: a computerized \ntomography study \nE. Fatiho÷lu, *S. Aydın*, E. Karavaú, A. Kantarci; Erzincan/TR  \n(sonaydin89@hotmail.com) \n \nPurpose: The wide range of variability of sphenoid sinus (SS) pneumatization \nand relation with surrounding structures can result in serious complications; \nseeing that, the assessment of regional anatomy is essential for both surgeons \nand radiologists. We mainly aim to reveal the possible correlation between the \nSS pneumatization types and protrusion/dehiscence of the adjacent \nneurovascular structures in a larger population by using Computerized \nTomography (CT) images. \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 243  \nMethods or Background: The type of SS pneumatization (I-IV), \npneumatization of anterior clinoid process (ACP), greater wing of sphenoid \n(GWS), and pterygoid process (PP) was evaluated. Protrusion and dehiscence \nof internal carotid artery (ICA), optic nerve (ON), maxillary nerve (MN), and \nvidian nerve (VN) was noted. \nResults or Findings: 1003 patients were included into the study. ICA, ON, \nand MN protrusions were not seen in patients with the type I or II SS on both \nsides. These protrusions were most frequently seen along with the type IV SS \non both sides (p<0.05). ICA, ON, MN, and VN dehiscence was not found in any \npatients with the type I SS. The rate of ICA protrusion increased with presence \nof GWS and PP; ICA dehiscence was found to be positively correlated with \nACP, GWS, and PP pneumatization. \nConclusion: Variations, either amount or the extent, of the pneumatization of \nthe SS are related with the presence of protrusion/dehiscence of ICA, ON, MN \nand VN. Knowing and reporting these relations can decrease the rate of \ncomplications during skull base surgery. \nLimitations: Larger patient numbers can still change the results. The study \nwas performed in a single center. The data was acquired from CT studies only. \nEthics Committee Approval: The present retrospective study was approved \nby the institutional review board. Informed consent was waived because of \nretrospective nature. \nFunding for this study: None \nAuthor Disclosures: \nErdal Karavaú: Nothing to disclose \nSonay Aydın: Nothing to disclose \nErdem Fatiho÷lu: Nothing to disclose \nAbdulmecit Kantarci: Nothing to disclose \n \nRPS 308-3 \nSound therapy can modulate the functional connectivity of the auditory \nnetwork \n*H. Lv*, Z. Wang; Beijing/CN  \n(chrislvhan@126.com) \n \nPurpose: The functional connectivity of the auditory network is considered to \nbe important in the development of tinnitus. We hypothesized that sound \ntherapy, as a commonly used effective treatment for tinnitus, can modulate the \nfunctional connectivity of the auditory network. \nMethods or Background: In this prospective observational study, we recruited \n27 tinnitus patients who had undergone 12 weeks of sound therapy and 27 \nmatched healthy controls. For the two groups of subjects, resting-state \nfunctional magnetic resonance imaging was acquired both at baseline and at \nthe 12th week. We utilized independent component analysis and seed-based \nfunctional connectivity analysis to characterize the connectivity features within \nthe auditory network and between the auditory network and other brain \nregions, respectively. \nResults or Findings: Interaction effects between the two groups and the two \nscans within the auditory network were observed at the left primary auditory \ncortex (PAC) and secondary auditory cortex (SAC). The interaction effects \nwere driven by increased functional connectivity in the PAC and decreased \nvalues in the SAC in tinnitus patients after treatment. Increased connections \nbetween the auditory network and limbic network and decreased values with \nthe bilateral thalami were identified. The effects were mainly driven by the \nactivity of the SAC rather than the activity of the PAC. Significant positive \ncorrelations between the percent improvement in the THI score and the \npercent change in functional connectivity were observed in the SAC-bilateral \nthalami. \nConclusion: Our study provided evidence to support the theory of a gain \nadaptation mechanism and that quantifies the recovered gating function of the \nthalamus in tinnitus patients. \nLimitations: Patients with sham treatments are recommended to be enrolled. \nEthics Committee Approval: Beijing Friendship Hospital, Capital Medical \nUniversity \nFunding for this study: Grant No.61801311, 61931013 from the National \nNatural Science Foundation of China \nAuthor Disclosures: \nZhenchang Wang: Nothing to disclose \nHan Lv: Nothing to disclose \n \nRPS 308-4 \nThe risk of complications during endoscopic sinus surgery in cystic \nfibrosis patients: an anatomical and endoscopic study \n*M. Pietragalla*, L. G. Locatello, C. Nardi, S. Colagrande, L. Bonasera,  \nA. L. Perrone, C. De Amicis, G. Taccetti, G. Maggiore; Florence/IT \n(michelepietragalla2@gmail.com) \n \nPurpose: CFTR mutations profoundly alter both sinonasal development and \nsurgical anatomy. As an increasing proportion of adult cystic fibrosis (CF) \npatients are referred to endoscopic sinus surgery (ESS) to relieve the \nsymptoms of chronic rhinosinusitis (CRS), the relationship between their \npeculiar anatomy and the risk of postoperative complications is unclear. \nMethods or Background: Paranasal sinuses CT scans of 103 CF adult \npatients with CRS were compared to 100 non-CF adult patients to explore their \nanatomical differences. From the two groups, patients who received ESS were \nextracted to assess their preoperative CT scan in terms of surgically relevant \nvariants, according to the CLOSE checklist. Clinical-surgical outcomes were \ncompared between groups. \nResults or Findings: CF group presented more frequently with smaller and \nless pneumatized paranasal sinuses and a higher Lund-Mckay score \ncompared with controls. No anatomical differences emerged in terms of \ngenotype stratification. Non-CF patients undergoing ESS showed a \nsignificantly deeper olfactory fossa and a more frequent supraorbital \npneumatization compared to CF patients (p<0.001 and p=0.032). CF patients \nunderwent more often aggressive surgical procedures (p<0.001), yet no \ndifference in terms of postoperative adverse events was found (p=0.645). \nConclusion: Despite receiving more often aggressive ESS procedures, adult \nCF patients do not show an increased risk of postoperative complication. \nLimitations: The definition of the complications remains subjective. \nSingle-center experience. \nOnly primary ESS in adult CF subjects was included. \nEthics Committee Approval: All procedures performed in studies involving \nhuman participants were in accordance with the ethical standards of the \ninstitutional and/or national research committee and with the 1964 Helsinki \ndeclaration and its later amendments or comparable ethical standards. \nInformed consent was obtained from all individual participants included in the \nstudy. \nFunding for this study: No funding \nAuthor Disclosures: \nGiovanni Taccetti: Nothing to disclose \nMichele Pietragalla: Nothing to disclose \nAnna Lara Perrone: Nothing to disclose \nLuca Giovanni Locatello: Nothing to disclose \nCosimo Nardi: Nothing to disclose \nLuigi Bonasera: Nothing to disclose \nStefano Colagrande: Nothing to disclose \nGiandomenico Maggiore: Nothing to disclose \nCristian De Amicis: Nothing to disclose \n \nRPS 308-5 \nCT and MRI-based imaging features to predict response to olfactory \ntraining in post-traumatic olfactory dysfunction \nA. Altundag¹, O. Saatci¹, *S. G. Kandemirli*², D. Tekcan Sanli¹, D. Yildirim¹; \n¹Istanbul/TR, ²Iowa City, IA/US \n(sedat-kandemirli@uiowa.edu) \n \nPurpose: Prognosis of posttraumatic olfactory dysfunction is poor, with \nmedical treatment options showing limited success rates. Olfactory training \n(OT) has been introduced as a potential therapeutic option in olfactory \ndysfunction. We aimed to identify the imaging features that would predict a \nbetter response to olfactory training and create an imaging-based prognostic \nscale. \nMethods or Background: We retrospectively reviewed 52 patients that \nunderwent olfactory training at our center for posttraumatic olfactory \ndysfunction. Olfactory function at the time of initial presentation and at \ncompletion of olfactory training were ev aluated using Sniffin’ Sticks test and \nTDI scores were calculated. Patients were divided into responders (ROT \ngroup: 16 cases) and non-responders (n-ROT group: 36 cases) to OT based \non TDI score change (cut-off 5.5 point). Morphological measurements of \nolfactory fossa, olfactory bulb volume and signal abnormalities, olfactory nerve \nfilia integrity, siderosis, encephalomalacic changes in olfactory cortex and other \ncortical regions were reviewed. \nResults or Findings: There was no significant difference between the two \ngroups in terms of age, gender distribution, olfactory dysfunction duration, \nhead-trauma severity and initial TDI scores. A model incorporating 5 variables: \ncribriform plate fracture, olfactory fossa depth (cut-off:4.9 mm), olfactory bulb \nencephalomalacia, olfactory bulb volume (cut-off:27.1 cm3) and siderosis was \ndeveloped. This model had an AUC of 0.950, with a cut-off of 1 showing \nsensitivity of 76.5% and specificity of 97.1% to predict no response to olfactory \ntraining. \nConclusion: We developed an imaging-based scoring system with good \nspecificity that can be used as an adjunctive tool for patient counseling, and \noptimal selection of management options. \nLimitations: Limited patient number and retrospective nature of the study with \nits inherent limitations, selection bias with overall results of the study reflecting \na worst-case scenario. \nEthics Committee Approval: Acibadem hospital \nFunding for this study: Not available. \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 244  \nAuthor Disclosures: \nDüzgün Yildirim: Nothing to disclose \nSedat Giray Kandemirli : \nAytug Altundag: Nothing to disclose \nDeniz Tekcan Sanli: Nothing to disclose \nOzlem Saatci: Nothing to disclose \n \nRPS 308-6 \nIdiopathic vocal cord palsy: consider tortuosity of the extracranial \ninternal carotid artery \n*J. F. Maier*, L. Abdulhady, H. Glad; Koege/DK \n \nPurpose: The cause of vocal cord palsy (VCP) is often unexplained. Clinical \npractice made us suspect that vocal cord palsy (VCP) can be associated with \nextracranial internal carotid artery (ICA) tortuosity. The study was conducted in \norder to find evidence for a causative relation between ICA tortuosity and VCP. \nMethods or Background: This single-center, retrospective study comprised \n66 patients with VCP (39 females, 27 males, mean age 63,9y). A total of 45 \npatients without VCP (16 females, 29 males, mean age 60,0y) served as \ncontrol group. Patient charts were reviewed for etiology and side of VCP. CT \nscans were reviewed independently by two radiologists for imprint in the \njugular vein (JV) caused by a tortuous ICA, considered an indirect sign of \npotential vagus nerve affection. \nResults or Findings: A total of 33 patients had idiopathic VCP. ICA tortuosity \ncausing a JV imprint with >10% JV lumen reduction was found more frequently \non the paretic sides of patients with idiopathic VCP (15–24%) than in controls \n(3–9%), with p<.05 for observer 2 and p=.07 for observer 1. In patients with \nidiopathic VCP and JV imprint with >10% JV lumen reduction on one or both \nsides (n=9), both observers found JV imprint with >10% JV lumen reduction \nmore frequently on the side of VCP (p<.05). The interobserver agreement for \ngrading of JV imprints was kappa= 0.52, i.e. moderate agreement. \nConclusion: ICA tortuosity causing a JV imprint may be the cause of VCP in \nsome of the cases of VCP currently regarded as idiopathic. \nLimitations: Small single center study. \nEthics Committee Approval: Danish patient safety authority (Journal no. 3-\n3013-1713/1) \nDanish data protection agency (Journal no. 2016-41-4761) \nFunding for this study: This study did not receive funding. \nAuthor Disclosures: \nLuka Abdulhady: Nothing to disclose \nJens Friedrich Maier: Nothing to disclose \nHenrik Glad: Nothing to disclose \n \nRPS 308-7 \nEvaluation of temporal bone cholesteatoma with high resolution \ncomputed tomography (HRCT) \n*R. Rastogi*, N. Jain, V. Pratap; Moradabad/IN \n(rajulrst@yahoo.co.in) \n \nPurpose: Background: Cholesteatoma is a potentially dangerous condition \naffecting middle ear cavity. As high-resolution computed tomography (HRCT) \nof temporal bone clearly depicts the inner anatomy, it can serve as an \nimportant imaging tool in evaluating cholesteatoma for preoperative planning. \nHence, this study evaluates the efficacy of pre-operative HRCT in the \nevaluation of patients with middle ear cholesteatoma. \nMethods or Background: This was a prospective pilot study of 40 patients \nwith chronic suppurative otitis media and unsafe type cholesteatoma. Each \npatient was subjected to full clinical evaluation, and HRCT examination prior to \noperative intervention. Preoperative radiological data were correlated with data \nrelated to surgical findings. \nResults or Findings: The study showed that a high incidence of \ncholesteatoma in the 2nd to 4th decade of life. The scutum and lateral attic wall \nwere the most common bony erosions in the middle ear bony wall in nearly \ntwo-third patients. The malleus was the most eroded ossicle in the middle ear \nin nearly 80% cases. Facial canal erosion was found in nearly one-fifth \npatients. Temporal bone complications were commoner than intracranial \ncomplications. When compared with operative features, HRCT findings had an \naccuracy of more than 90% in detecting, localizing and determining the extent \nof cholesteatoma and nearly 100% accuracy in demonstrating ossicular chain \nerosion, labyrinthine fistula and intracranial complications \nConclusion: HRCT scan is an excellent preoperative imaging modality for the \notologist to predict ossicular status and determining patient prognosis. \nLimitations: None \nEthics Committee Approval: None \nFunding for this study: None \nAuthor Disclosures: \nNeha Jain: Nothing to disclose \nRajul Rastogi: Nothing to disclose \nVijai Pratap: Nothing to disclose \n \nRPS 308-8 \nOlfactory bulb MRI findings in persistent COVID-19 anosmia \n*S. G. Kandemirli*¹, A. Altundag², D. Yildirim², D. E. Tekcan Sanli², O. Saatci²; \n¹Iowa City, IA/US, ²Istanbul/TR \n(sedat-kandemirli@uiowa.edu) \n \nPurpose: There is limited literature consisting of case reports or series on \nolfactory bulb imaging in COVID-19 olfactory dysfunction. A systematic imaging \nstudy with objective clinical correlation is needed in COVID-19 anosmia to \nbetter understand underlying pathogenesis. \nMethods or Background: We evaluated 23 patients with persistent COVID-19 \nolfactory dysfunction. Patients included in this study had minimum 1-month \nduration between onset of olfactory dysfunction and evaluation. Olfactory \nfunctions were evaluated with Sniffin’ Sticks Test. Paranasal sinus CTs and \nMRI dedicated to olfactory nerves were acquired. On MRI, quantitative \nmeasurements of olfactory bulb volumes and olfactory sulcus depth and \nqualitative assessment of olfactory bulb morphology, signal intensity and \nolfactory nerve filia architecture were performed. \nResults or Findings: All patients were anosmic at time of imaging based on \nolfactory test results. Olfactory cleft opacification was seen in 73.9% of cases \nwith a mid and posterior segment dominance. 43.5% of cases had below \nnormal olfactory bulb volumes and 60.9% of cases had shallow olfactory sulci. \n54.2% of cases had changes in normal inverted J shape of the bulb. 91.3% of \ncases had abnormality in olfactory bulb signal intensity in the forms of diffuse \nincreased signal intensity, scattered hyperintense foci and microhemorrhages. \nClumping of olfactory filia was seen in 34.8% of cases and thinning with \nscarcity of filia in 17.4%. Primary olfactory cortical signal abnormality was seen \nin 21.7% of cases. \nConclusion: Our findings support the observations of olfactory cleft \ninflammation in COVID-19 anosmia. Additionally, relatively high percentage of \nolfactory bulb degeneration suggests that direct/indirect injury to olfactory \nneuronal pathways may also take place. \nLimitations: Relatively low number of patients and selection bias. \nEthics Committee Approval: Acibadem Hospital \nFunding for this study: None \nAuthor Disclosures: \nDüzgün Yildirim: Nothing to disclose \nSedat Giray Kandemirli : \nAytug Altundag: Nothing to disclose \nDeniz Esin Tekcan Sanli: Nothing to disclose \nOzlem Saatci: Nothing to disclose \n \n \nResearch Presentation Session: Head and \nNeck \nRPS 408 \nDisorders of the head and neck \nRPS 408-1 \nThe “jugular vein footprint sign”: a strong CT imaging predictor of \ncervical lymph node metastasis in patients with head and neck \nsquamous cell carcinoma \n*G. C. T. E. Garcia*, L. Lebouvier, S. Ammari, C. S. Balleyguier, F. Bidault; \nVillejuif/FR  \n(gabriel.garcia@gustaveroussy.fr) \n \nPurpose: Radiological assessment of lymph node metastasis (LNM) is \nchallenging in patients treated for head and neck squamous cell carcinomas \n(HNSCC). We present a new CT-scan sign: the “Jugular vein footprint sign” \n(JVFS), its definition, its frequency and its diagnostic performances to predict \ncervical LNM. \nMethods or Background: This is a monocentric retrospective cohort study \nincluding consecutive patients newly diagnosed for HNSCC between 2005 and \n2018 presenting only one histopathologically proven lymphadenopathy with no \nprevious treatment for HNSCC who underwent surgery with lymph node \ndissection and histopathological analysis. Pre-treatment neck CT-scans were \nanalyzed by two radiologists blinded to histopathological data. They \ndetermined whether or not a LNM was radiologically detectable, in contact with \nthe internal jugular vein (IJV), and if a notch was imprinted on the wall of the \nIJV (defining JVFS). Same analysis was performed on non-metastatic lymph \nnodes. Among all lymph nodes in contact with the IJV sensitivity, specificity, \npositive predictive value and negative predictive value of the JVFS to predict \nhistopathological LNM were computed. Inter-reader reliability was assessed \nusing the Cohen’s kappa technique. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 245  \nResults or Findings: 208 patients were screened, 110 with a radiological \nLNM. Among them 43 LNM (40.6%) were in contact with the IJV as well as 39 \nnon-metastatic lymph nodes. Specificity, sensitivity, positive predictive value \nand negative predictive value of the JVFS to predict nodal metastatic invasion \nwere respectively 97.4%, 74%, 97.4% and 74.5% with a Cohen’s Kappa value \nof 75% (p<0.001). \nConclusion: JVFS is a strong imaging predictor of lymph node metastasis in \npatients with HNSCC. \nLimitations: Retrospective study \nEthics Committee Approval: Approved by our institutional review board at \nGustave Roussy Cancer Center \nFunding for this study: None \nAuthor Disclosures: \nGabriel Cristobal Théophile Eudoxe Garcia: Nothing to disclose \nFrançois Bidault: Nothing to disclose \nSamy Ammari: Nothing to disclose \nCorinne S. Balleyguier: Nothing to disclose \nLea Lebouvier: Nothing to disclose \n \nRPS 408-2 \nDifferentiation of orbital malignant and benign tumours with dual-energy \ncomputed tomography \n*S. Luo*, Y. Sha; Shanghai/CN  \n(724972064@qq.com) \n \nPurpose: To investigate the diagnostic accuracy of dual-energy computed \ntomography (DECT)-derived iodine concentration (IC), the slope (k) value of \nspectral attenuation curve, and effective atomic number (Zeff) in differentiating \norbital malignant and benign tumors. \nMethods or Background: Data from 29 patients with orbital malignant or \nbenign tumors were retrospectively analyzed. Each patient underwent DECT \nexamination, using a 128-slice dual-source CT scanner. Dual-energy \ninformation (IC, normalized iodine concentration (NIC), Zeff), and spectral \ninformation ( k values, calculated from virtual monoenergetic images (VMIs), \nreconstructed from 40 to 180 keV) were determined. Two experienced \nradiologists, blinded to clinical, independently analyzed conventional grayscale \nand virtual monoenergetic DECT series for evaluation. Quantitative analysis \nwas performed by a third radiologist. \nResults or Findings: A total of 29 patients (age, 48.1±14.4) with pathologically \nproven orbital malignant and benign tumors (malignant, n=7; benign, n=22) \nwere evaluated. IC, NIC, Zeff and k values of malignant orbital tumors were \nsignificantly higher than the benign tumors(p < 0.05). The qualitative image \nscore was superior in 40 to 100 keV VMI images to conventional images. The \nCT attenuation was significantly higher in 80 keV reconstructed VMI images in \nmalignant than benign tumors (56.23±9.28 HU vs 73.37±10.91 HU, P < 0.05, \nAUC, 0.91). Multivariate logistic regression analysis showed the combination of \nparameters (IC, NIC, Zeff, k value, VMI series at 80 keV) had overall high \ndiagnostic performance for differentiation (AUC, 0.97; sensitivity, 95.5%; \nspecificity, 85.7%). \nConclusion: Quantitative DECT analysis can be a useful technique which \nyields superior diagnostic accuracy when compared to conventional \nmeasurements for differentiation of orbital malignant and benign tumors. \nLimitations: This study was performed in a single center with a relatively small \nsample size. \nEthics Committee Approval: This retrospective study was approved by the \ninstitutional review board of our hospital. \nFunding for this study: None \nAuthor Disclosures: \nYan Sha: Nothing to disclose \nSiqi Luo: Nothing to disclose \n \nRPS 408-3 \nAssessment of microcirculatory changes in normal-appearing white \nmatter of the brain in patients with multiple sclerosis by perfusion MRI \n*Y. Stankevich*, L. Vasilkiv, O. Bogomyakova, A. Tulupov; Novosibirsk/RU \n(stankevich@tomo.nsc.ru) \n \nPurpose: To evaluate perfusion changes in normal-appearing white matter \n(NAWM) of the brain with demyelinating lesions of the central nervous system \nusing the method of dynamic susceptibility contrast (DSC). \nMethods or Background: The MR study was carried out on a MR-scanner \n\"Ingenia\" (\"Philips\") 3 Tesla using the method of DSC. The study included 30 \nhealthy volunteers and 80 patients with demyelinating disease of the central \nnervous system (9 patients with CIS, 66 patients with RRMS and 5 patients \nwith SPMS) over the age of 18 up to 48 years (average age was 34.6 ± 8.02 \nyears). \nResults or Findings: In all groups in NAWM, a significant decrease in CBF \nand CBV was observed in all lobes of the brain, and the severity of these \nchanges increases with the progression of the disease: in patients with CIS \nCBF is reduced to 13.7% and CBV to 7.3%; the most pronounced decrease in \nperfusion was observed in patients with SPMS: CBF by 40% and CBV by \n24.8% (p <0.001); with a moderate increase in TTR and MTT by 15%. \nConclusion: Perfusion data complements routine MRI and provides a \ncomprehensive assessment of changes in brain matter. \nLimitations: All patients received immunomodulating therapy, but not a single \npatient received systemic corticosteroids during the study or 3 months before \nthe study. \nEthics Committee Approval: The study was overseen by the local ethics \ncommittee ITC SB RAS, in compliance with the ethical principles of medical \nresearch with human participation in accordance with the Declaration of \nHelsinki of the World Medical Association. \nFunding for this study: We thank Ministry of Science and Higher Education of \nthe RF for access to MRI equipment ( ȺȺȺȺ-Ⱥ16-116121510090-5). The work \nwas supported by Russian Science Foundation (the project #19-75-00052). \nAuthor Disclosures: \nLiubov Vasilkiv: Employee: Researcher \nOlga Bogomyakova: Employee: Researcher \nYuliya Stankevich: Employee: Researcher \nAndrew Tulupov: Employee: Researcher \n \nRPS 408-4 \nDiagnostic accuracy of 4DCT for preoperative localisation of parathyroid \nadenoma \n*A. Gupta*, M. Garg, V. Aggarwal; New Delhi/IN \n(arushigupta1215@gmail.com) \n \nPurpose: Assess the diagnostic accuracy of 4DCT for localising pathologically \nproven parathyroid adenomas found at surgery. \nMethods or Background: • It was a single institution retrospective study done \nfrom February 2019 to August 2020. • Inclusion criteria was availability of \npathological specimen. No cases were excluded. • Each scan included a scout \nscanogram, a noncontrast acquisition followed by multiphasic imaging. • \nDiagnostic accuracy was measured by comparing CT findings to the gold \nstandard of surgical specimen. \nResults or Findings: A total of 35 pathologically proven cases were collected \nout of which 30 were found positive on 4DCT including 3 cases of \nmultiglandular disease. For lateralization of single-gland disease, 4D-CT \ndemonstrated an accuracy of 93%. 4D-CT revealed a suboptimal 44% \nsensitivity, but 100% specificity, for multigland disease. \nConclusion: 4DCT demonstrated high diagnostic accuracy for single and \nmultiglandular disease. Potential difficulties include high radiation dose and \nnecessity of iodinated contrast media. \nLimitations: This was a retrospective study and was not designed to make a \ndirect prospective comparison of the accuracy of sonography, sestamibi, and \n4D-CT imaging for the detection of parathyroid pathology. Selection bias for \ncases of ectopic and multigland disease because these are more difficult to \ndiagnose on traditional imaging modalities and thus more likely to progress to \n4D-CT imaging. Although the technique of 4D-CT at our institution has been \nperformed with high accuracy, variability in diagnostic accuracy may occur \nacross institutions, secondary to interpreter experience and study technique. \nEthics Committee Approval: Yes \nFunding for this study: No \nAuthor Disclosures: \nMonika Garg: Nothing to disclose \nArushi Gupta: Nothing to disclose \nVivek Aggarwal: Nothing to disclose \n \nRPS 408-6 \nHigh frequency ultrasound in the assessment of thyroid nodules: a \nprospective trial \n*N. C. Mcaddy*¹, H. K. Yang², A. Rattansingh³, A. Kielar³, J. Schwock³,  \nL. Rotstein³, J. Pasternak³, K. Khalili³; ¹London/UK, ²Seoul/KR, ³Toronto/CA \n \nPurpose: Compare high frequency ultrasound (HFU) to standard ultrasound \n(SFU) in categorizing thyroid nodules. \nMethods or Background: Prospective SFUௗ(14MHz) and HFUௗ(24MHz)ௗ were \nperformed onௗ44 patients (34:10 F:M, mean age ௗ53.9 (range 30-76))ௗwith 47 \nnodules. Additionally, microflow Doppler (SMI™), punctate echogenic foci \n(PEF) quantification (using Micropure™) and elastography were performed. \nOne radiologist conducted blinded reviews of ௗrandomised raw cine images and \nclassified nodules according to ௗACRௗTIRADs. Internal vascularity with SMI™ \nwas quantified using a 6-point scale. Two readers independently quantified \nPEF with SFU, HFU and Micropure™. FNA ௗwas performed for 29/47 (62%) \nnodules andௗthyroidectomy for 18 (38%). FNAs were independently assessed \nby two dedicated cytopathologists, surgical specimens by an endocrine \npathologist. \nResults or Findings: Final diagnosis was benign/likely benign (AUS/FLUS) in \n37/47 (78%) and malignant in 10 (21%, all by surgery). TIRADs category \ndistribution from TR1 to 5 were 6,6,6,18,11 by SFU and 10,5,0,13,19 by HFU \n(p=0.003). Compared to SFU, HFU significantly changed echogenicity \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 246  \n(p=0.0006) and margins (p=0.002) but not composition, calcification or shape \nTIRADS assessment categories. In detection of nodules requiring biopsy at \nany size (TR5), the sensitivity/specificity of SFU & HFU were not significant. In \ndetection of benign lesions not requiring biopsy (TR1-2) the SEN/SPE of SFU \n& HFU were 32%/100% and 38%/90% (NS). The AUC ROC for quantitative \ndetection of malignant calcification by two independent readers for 14 Mhz, \n24Mhz and MicroPure™ were 0.49-0.52, 0.46-0.49, and 0.35-0.41. \nSemiquantitative internal vessel count using microflow Doppler were not a \npredictor of malignancy. \nConclusion: HFU shows promise, improving categorization of nodules into \nhighly suspicious and benign categories. Its use may negate need for biopsy in \na higher proportion of benign lesions and facilitate earlier FNA of malignant \nlesions. \nLimitations: Study size \nEthics Committee Approval: Yes \nFunding for this study: None \nAuthor Disclosures: \nAnand Rattansingh: Nothing to disclose \nJoerg Schwock: Nothing to disclose \nNaami Charlotte Mcaddy: Nothing to disclose \nJesse Pasternak: Nothing to disclose \nHyun Kyung Yang: Nothing to disclose \nLorne Rotstein: Nothing to disclose \nAnia Kielar: Nothing to disclose \nKorosh Khalili: Nothing to disclose \n \n \nResearch Presentation Session: \nInterventional Radiology \nRPS 309 \nAdvances in vascular interventional \nradiology \nRPS 309-1 \nPortal vein embolization with N-Butyl cyanoacrylate is superior to other \nmaterials: a systematic review and meta-analysis \n*A. Ali*¹, M. Ahle², B. Björnsson², P. Sandström²; ¹Lancaster/UK, ²Linköping/SE  \n(adnan.ali.lancs@gmail.com) \n \nPurpose: It remains uncertain which embolization material is best for portal \nvein embolization (PVE). We investigated the various materials for \neffectiveness in inducing future liver remnant (FLR) hypertrophy, technical and \ngrowth success rates, complications and resection rates. \nMethods or Background: A systematic review from 1998 to 2019 on materials \nfor PVE was performed on Pubmed, Embase and Cochrane. FLR growth \nbetween the two most commonly used materials was compared in a random-\neffects meta-analysis. In a separate analysis using local data (n=52), n-butyl \ncyanoacrylate (NBCA) was compared with microparticles regarding costs, \nradiation-dose, and procedure time. \nResults or Findings: From 51 papers, 2896 patients, 61.0 ± 4.0 years of age \nand 65% male were included in the analysis. In 61% of the patients either \nNBCA or microparticles was used for embolization. The remaining were treated \nwith ethanol, gelfoam or sclerosing agents. The FLR growth with NBCA was \n49.1% ± 29.7 compared to 42.2% ± 40 with microparticles (P = .037). The \ngrowth success rate with NBCA vs microparticles was 95.3%, vs 90.7% \nrespectively, (P < .001). There were no differences in major complications \nbetween NBCA and microparticles. In the local analysis, NBCA (n=41) entailed \nshorter procedure time and reduced fluoroscopy time (P < .001), lower \nradiation exposure (P < .01) and lower material costs (P < .0001) than \nmicroparticles (n=11). \nConclusion: PVE with NBCA seems to be the best choice when combining \ngrowth of the FLR, procedure time, radiation exposure and costs. \nLimitations: 1. No randomised controlled trials were available. 2. Minor \ncomplications were not reported explicitly, hence minor complications reported \nin our study is an underestimate. 3. Local data between NBCA and \nmicroparticles was small, but the differences were significantly in favour for \nNBCA. \nEthics Committee Approval: Not applicable. \nFunding for this study: None. \nAuthor Disclosures: \nAdnan Ali: Nothing to disclose \nPer Sandström: Nothing to disclose \nBergthor Björnsson: Nothing to disclose \nMargareta Ahle: Nothing to disclose \nRPS 309-3 \nEmbolization procedures performed outside the neurological area using \nPhil® System: our experience \nP. Lucatelli, *L. Teodoli*, B. Rocco, S. Cipollari, P. G. Nardis, A. Cannavale,  \nM. Bezzi, C. Catalano, M. Corona; Rome/IT  \n(lteodoli@gmail.com) \n \nPurpose: To evaluate the efficacy of Phil® System liquid embolic agent during \nembolization procedures performed outside the neurological area. \nMethods or Background: Forty patients with a mean age of 64.8 years \nunderwent percutaneous embolization using the Phil® System for: splancnic \npseudoaneurysms (n=11), abdominal aortic type II endoleaks (N=8), iliac \naneurysm endoleak (n=2), AVM (n=2), gastric varices associated with a \nspleno-renal shunt (n=2), paraumbilical vein varices (n=1), intrapancreatic \nbleedings (n=2) and arterial bleedings in soft tissue (n=12). Phil® System \nconsists of a co-polymer dissolved in dimethyl sulfoxide (DMSO), with different \nviscosities. The monomer hydroxyethylmethacrylate is used to make the \npolymer (PHEMA). Procedures were performed with injection of Phil 25% or \nPhil®30% at a rate of 0.16 ml/sec, under fluoroscopic guidance to avoid \nocclusion or embolization of non-target vessels. In case of high flow conditions, \nPhil® can also be injected in combination with coils avoiding misplacement of \nthe Phil® solution during injection. \nResults or Findings: Technical success was achieved in all patients. In all \ncases Phil® embolic device was correctly inserted into the selected branches \nand no embolization of collateral vessels was recorded. All soft-tissue and \nintrapancreatic bleedings have been arrested; all endoleaks disappeared \nduring follow-up. Phil® provided durable AVM embolization with exclusion of \nthe nidus and durable embolization of splancinc pseudoaneurysms. After a \nmean follow-up of 12 months, ranging from 3 to 24 months, no late \nrevascularization occurred. No complications and no embolization of collaterals \nvessels were also recorded. \nConclusion: Phil® System is a valid alternative embolic material for the \ntreatment of different peripheral pathologies. However, there are some \ndisadvantages to consider, especially the high costs. \nLimitations: Single center study and a small number of Patients enrolled. \nEthics Committee Approval: Study was approved by our institutional ethics \ncommittee. \nFunding for this study: No funding has been received. \nAuthor Disclosures: \nBianca Rocco: Nothing to disclose \nStefano Cipollari: Nothing to disclose \nMario Bezzi: Nothing to disclose \nMario Corona: Nothing to disclose \nPier Giorgio Nardis: Nothing to disclose \nAlessandro Cannavale: Nothing to disclose \nLeonardo Teodoli: Nothing to disclose \nPierleone Lucatelli: Nothing to disclose \nCarlo Catalano: Nothing to disclose \n \nRPS 309-4 \nRole of transcatheter endovascular embolization in non-operative \nmanagement of high-grade blunt hepatic trauma and incidence of post-\ntraumatic complications \n*A. Borzelli*, F. Pane, F. Amodio, F. Giurazza, F. Corvino, M. Silvestre,  \nG. Cangiano, G. de Magistris, R. Niola; Naples/IT \n(antonio.borzelli@libero.it) \n \nPurpose: Evaluate feasibility, safety and clinical efficacy of selective hepatic \nartery endovascular embolization in hemodynamically stable patients with high \ngrade liver blunt trauma(AAST>III) \nMethods or Background: Between June 2017 and June 2020 we \nretrospectively considered 38 patients(24 M 14 F; medium age 38) with blunt \ntrauma of abdomen and liver injury, all of them hemodynamically stable. All \ninjuries have been studied by CT of the abdomen and classified considering \nAAST grades:(22)III,(11)IV,(5)V. We considered of each patient the percentage \nof hemoglobin value lowering, the presence of vascular lesions such as \npseudoaneurysm and/or arterio-venous fistula, the entity of hemoperitoneum \nand the evidence of contrast blush on CT. All patients underwent selective \nendovascular embolization of hepatic artery and embolic agents used were \ncoils, PVA and Gelfoam. We considered as success of procedures the \nabsence of active bleeding at post-embolization angiogram and at follow-up CT \nof abdomen, with significant improvement of serum hemoglobin values, and as \ncomplications related to procedures the rebleeding rate, the incidence of \nhepatobiliary complications related to hepatic trauma during follow-up and the \nrate of eventual subsequent liver resections \nResults or Findings: In 34 patients(90%) selective hepatic artery embolization \nwas successful, with no evidence of rebleeding at follow-up and significant \nimprovement of serum hemoglobin values, while 4 patients(10%)died during \nfollow-up:2 of them for hemorrhagic shock after the embolization and the other \n2 because of trauma complications of multiple systems.Among the 34 surviving \npatients,4 of them(12%)developed hepatobiliary complications:hepatic abscess \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 247  \nin 2 patients, biloma in 1 and perihepatic fluid effusion in 1.All the hepatobiliary \ncomplications were successfully managed by image-guided percutaneous \ndrainage; none of the patients underwent hepatic resection \nConclusion: Transcatheter endovascular embolization is a feasible, safe and \nclinical effective procedure in high grade blunt liver injuries, not only to stop \nbleedings, but also to reduce the rate of hepatic resections and hepatobiliary \ncomplications related to hepatic trauma \nLimitations: Retrospective single center study \nEthics Committee Approval: Yes \nFunding for this study: None \nAuthor Disclosures: \nAntonio Borzelli: Nothing to disclose \nFrancesco Amodio: Nothing to disclose \nFabio Corvino: Nothing to disclose \nFrancesco Pane: Nothing to disclose \nFrancesco Giurazza: Nothing to disclose \nMattia Silvestre: Nothing to disclose \nRaffaella Niola: Nothing to disclose \nGiuseppe de Magistris: Nothing to disclose \nGianluca Cangiano: Nothing to disclose \n \nRPS 309-6 \nTransjugular intrahepatic portosystemic shunt placement with \ntranssplenic balloon-puncture-technique in patients with portal vein \nthrombosis \n*T. C. Meine*, B. Maasoumy, E. Jaeckel, T. Werncke, S. K. Maschke,  \nL. S. Becker, F. Wacker, B. C. Meyer, J. B. Hinrichs; Hannover/DE \n \nPurpose: To evaluate the feasibility, safety and procedural characteristics of \ntransjugular intrahepatic portosystemic shunt (TIPS) placement with \ntranssplenic balloon-puncture-technique in patients with portal vein thrombosis \n(PVT). \nMethods or Background: Eleven patients (7m,47yr) with PVT were referred \nfor TIPS placement from the department of hepatology (8/17-4/20). TIPS \nplacements were performed with an ultrasound-guided transsplenic access. \nThen, a balloon catheter was advanced via the splenic vein and dilated in an \nintrahepatic portal vein branch. The TIPS needle was inserted in the right \nhepatic vein via a transjugular access. When the balloon-puncture was \nperformed, a guidewire was introduced through the TIPS needle and \nintercalated with the balloon cover. The balloon catheter was removed and the \nintercalated guide wire was captured at the transsplenic access site. After tract \ndilatation the TIPS stentgraft was placed. Transjugular access site was \nmanually compressed. Transsplenic access site was closed with gelfoam. \nDemographics, technical success, clinical significant complications, \ntranssplenic access time (TAT), procedure time (PT) and Dose-Area-Product \n(DAP) were recorded. Values were median(min-max). \nResults or Findings: Patients with PVT had ethyltoxic cirrhosis (3), \nautoimmune hepatitis (2), essential thrombocythemia (1), congenital fibrosis \n(1), hepatitis B (1), primary (1) and secondary sclerosing cholangitis (1) and \ncryptogenic PVT (1). TIPS placement was impossible once, because no \nintrahepatic portal vein branch could be identified. Technical success was \nachieved in all other patients without clinically significant complications. TAT \nwas 18min (11-90min), PT was 157min (98-268min) and DAP was 175Gy*m2 \n(6-436Gy*m2). \nConclusion: TIPS placement in patients with PVT via transsplenic access and \nballoon-puncture is time-intense, but feasible and safe. \nLimitations: It is a retrospective study with a small number of patients and no \ncontrol cohort (snare-puncture-technique). \nEthics Committee Approval: The institutional ethic’s committee approved our \nstudy and a waiver for informed consent was given. \nFunding for this study: None. \nAuthor Disclosures: \nTimo C. Meine: Nothing to disclose \nBernhard C Meyer: Nothing to disclose \nElmar Jaeckel: Nothing to disclose \nSabine Katharina Maschke: Nothing to disclose \nLena Sophie Becker: Nothing to disclose \nThomas Werncke: Nothing to disclose \nFrank Wacker: Nothing to disclose \nBenjamin Maasoumy: Nothing to disclose \nJan B Hinrichs: Nothing to disclose \n \n \n \n \n \n \n \n \n \nRPS 309-7 \nLong-term results of intrasaccular flow-disrupting (WEB) devices in the \ntreatment of intracranial wide-necked bifurcation aneurysms \n*T. Y. Kuzan*, F. Baltacioۜlu; Istanbul/TR \n(tykuzan@gmail.com) \n \nPurpose: This unicentric study aims to evaluate the efficacy, safety, long-term \nresults, and the effect of the aneurysm axis on the treatment response in \npatients treated with a Woven EndoBridge (WEB) device for intracranial wide-\nneck bifurcation aneurysm. \nMethods or Background: Clinical, demographic, and digital subtraction \nangiography parameters of the patients treated with WEB device in our unit \nbetween January 2014 and February 2018 were evaluated retrospectively. The \ntreatment response to the WEB device was assessed at different time points. \nThe relationship between the aneurysm axis and parent artery was examined \nin predicting the WEB device treatment response. \nResults or Findings: Twenty-five aneurysms of 22 patients were included in \nthe study. Procedural peri-operative complications were observed in three of \n25 aneurysms treated with the WEB device. No mortality was seen because of \nthe aneurysm during the procedure and at two years of follow-up. Acute \naneurysm occlusion was observed in five (20.0%) of 25 aneurysms in the peri-\noperative period. In the follow-up, an acceptable level of aneurysm occlusion \nwas observed in 16 (66.7%) of 24 aneurysms at the sixth month, 17 (73.9%) of \nthe 23 aneurysms at the 12th month, and 20 (87.0%) of the 23 aneurysms at \nthe 24th month. No statistically significant relationship between the aneurysm \naxis and parent arteries in determining the treatment response was \ndetermined. \nConclusion: WEB devices have technical difficulties and rare complications. \nHowever, WEB devices provide effective and reliable endovascular treatment \nmethod with low complication and mortality rates for treating wide-necked \nbifurcation aneurysms that are complex and difficult to treat and have a high \naneurysm occlusion rate. \nLimitations: The sample size is relatively small. \nEthics Committee Approval: Approved by institutional IRB. \nFunding for this study: No funding was received for this work. 7 aneurysms \nwere treated within WEB-IT study. \nAuthor Disclosures: \nTaha Yusuf Yusuf Kuzan: Nothing to disclose \nFeyyaz Baltacioۜlu: Nothing to disclose \n \nRPS 309-8 \nDepiction of mosaic perfusion in patients with chronic thromboembolic \npulmonary hypertension (CTEPH) on C-arm computed tomography \n(CACT) compared to computed pulmonary angiogram (CTPA) \n*S. K. Maschke*, T. Werncke, C. Dewald, L. S. Becker, K. Olsson, M. Hoeper, \nF. Wacker, B. C. Meyer, J. B. Hinrichs; Hannover/DE \n \nPurpose: To detect and distinguish different patterns of mosaic perfusion in \npatients with chronic thromboembolic pulmonary hypertension (CTEPH) on C-\nArm computed tomography (CACT) compared to computed tomography \npulmonary angiography (CTPA). \nMethods or Background: We included 41 patients with confirmed CTEPH, \nundergoing CACT and CTPA within a maximum of 21 days. All datasets were \nindependently evaluated by two readers (R1, R2) regarding mosaic perfusion \npatterns, presence of vascular lesions typical for CTEPH and the ratio of \npulmonary arterial segments affected. Inter-observer agreement was \ncalculated for both modalities using the intraclass-correlation-coefficient (ICC). \nA consensus reading was conducted afterwards and, again using the ICC, \ninter-modality agreement was calculated between both modalities (CACTcons \nvs. CTPAcons). \nResults or Findings: On CACT and CTPA, inter-observer agreement was \nexcellent for the perceptibility of mosaic perfusion (ICC=1), vascular lesions \n(ICC>0.8), the ratio of affected segments (ICC>0.7) and good for the attribution \nof the pattern of mosaic perfusion (ICC>0.5). Inter-modality agreement was \ncalculated for CACTcons and CTPAcons. Inter-modality agreement was \nexcellent for the perceptibility of mosaic perfusion (ICC=1), the present \nperfusion pattern (ICC=1) and vascular lesions (ICC=1). With a greater \nproportion of identified affected segments on CACTcons, inter-modality \nagreement for the ratio of affected segments was fair (ICC=0.50). \nConclusion: For detection and distinction of different mosaic perfusion \npatterns in patients with CTEPH, CACT and CTPA demonstrate high \nagreement. \nLimitations: CACT and CTPA have not been acquired at the same day.  \nCTPA has been acquired on different scanners and with slightly different \nprotocols. \nEthics Committee Approval: Our local ethics committee approved this \nretrospective study. \nFunding for this study: The study was funded in parts by personal grants \nfrom the “Junge Akademie”. \nNo grant or grant support. \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 248  \nAuthor Disclosures: \nKaren Olsson: Nothing to disclose \nMarius Hoeper: Nothing to disclose \nBernhard C Meyer: Nothing to disclose \nCornelia Dewald: Nothing to disclose \nSabine Katharina Maschke: Nothing to disclose \nLena Sophie Becker: Nothing to disclose \nThomas Werncke: Nothing to disclose \nFrank Wacker: Nothing to disclose \nJan B Hinrichs: Nothing to disclose \n \nRPS 309-9 \nMechanical thrombectomy for acute ischemic stroke in the posterior \ncirculation: assessment of efficacy and outcome and identification of \nprognostic factors \n*M. Szmygin*, M. Sojka, K. K. Pyra, P. Tarkowski, P. Luchowski,  \nA. Drelich-Zbroja, T. Jargiełło; Lublin/PL \n(mszmygin@gmail.com) \n \nPurpose: Mechanical thrombectomy (MT) is well-established in the treatment \nof acute ischemic anterior circulation stroke. However, there is no evidence \nfrom randomized trials or meta-analyses that MT is safe and effective in the \ntreatment of patients with acute ischemic posterior circulation stroke (PCS). \nThe aim of this study was to evaluate the clinical and procedural factors \nassociated with recanalization and outcome of patients with PCS treated with \nMT. \nMethods or Background: 43 patients with PCS treated with MT were \nincluded. Data including demographics, baseline stroke severity, radiological \nimaging, procedure and post-procedure complications were documented. \nClinical outcome was evaluated using the modified Rankin Scale (mRS). \nResults or Findings: Median baseline National Institute of Health Stroke \nScale (NIHSS) was 17. Successful recanalization was observed in 88.4% of \npatients. After 90 days, favorable outcome (defined as mRS 0–2) was \nachieved in 26 patients; six patients had an unfavorable outcome (mRs >2). \nFinal mortality rate was 25.5%. Baseline NIHSS, onset to reperfusion time, \nprocedure duration, and successful recanalization had a statistically significant \nassociation with outcome. Failed recanalization and occurrence of intracranial \nhemorrhage were found to be associated with a higher mortality rate. \nConclusion: MT is feasible and effective method in treatment of PCS. \nBaseline NIHSS and onset to reperfusion time were found to be independent \npredictive factors of clinical outcome. \nLimitations: The present study has some limitations:  small sample size; \nretrospective study design; and single-center study. There was also no unified \nscoring of brainstem infarction and penumbra area conducted from diagnostic \nimaging (e.g. posterior circulation Acute Stroke Prognosis Early CT Score \n[pcASPECTS]). \nEthics Committee Approval: This study was approved by Institutional Review \nBoard (IRB) \nFunding for this study: None \nAuthor Disclosures: \nMaciej Szmygin: Nothing to disclose \nTomasz Jargiełło: Nothing to disclose \nMichał Sojka: Nothing to disclose \nPiotr Tarkowski: Nothing to disclose \nPiotr Luchowski: Nothing to disclose \nAnna Drelich-Zbroja: Nothing to disclose \nKrzysztof K. Pyra: Nothing to disclose \n \nRPS 309-10 \nSAFARI technique for limb rescue in diabetic patients with CLI: a single \ncenter experience \nF. Pane¹, *A. Borzelli*¹, G. Cangiano¹, M. Silvestre¹, M. Coppola¹, A. Paladini², \nF. Corvino¹, F. Giurazza¹, R. Niola¹; ¹Naples/IT, ²Novara/IT \n(antonio.borzelli@libero.it) \n \nPurpose: Evaluate the clinical and technical efficacy of retrograde arterial \naccess for endovascular revascularization of chronic occlusions not passable \nby antegrade access in patients with critical limb ischemia \nMethods or Background: We retrospectively considered between January \n2017 and April 2020 32 patients (medium age 70,4 years-old, 20 M 12 F)with \ncritical limb ischemia and trophic lesions of lower limb. All patients underwent \ndiagnostic angiography which showed, together with the localization of the \ntrophic lesions, according to angiosomic distribution map, the target vessels. \nRetrograde access was performed employing micropuncture kit under \ncombined ultrasonographic and fluoroscopic guidance and corroboration. After \narterial retrograde access was realized, the target vessel was recanalized \nemploying .014” guidewires and angioplasty performed; if necessary, stenting \nof target vessels was performed too. Technical success was considered as \nsuccessful recanalization of target vessels at final angiographic control while \nclinical success as major amputation avoided at 6 months follow-up \nResults or Findings: Target vessels for retrograde arterial access were:12 \npedidia(38%),6 anterior tibial(18%),6 popliteal(18%),4 posterior tibial(12%),2 \ntibio-peroneal trunk(7%),2 peroneal(7%).In 8 patients stenting of superficial \nfemoral artery/popliteal was performed.Technical success was reached in 28 \npatients(87%),clinical success in 26 patients(81%).At 6 months follow-up 1 \nmajor amputation and 5 minor amputations (3 trans-metatarsal and 2 toes) \nwere performed;1 patient died for other comorbidities \nConclusion: Retrograde arterial endovascular access proved to be \nsafe,feasible and clinical effective in diabetic patients with critical limb \nischemia, as it allows significant lowering of major amputations rates with low \nmajor complications rates associated to the procedure \nLimitations: Retrospective single center study \nEthics Committee Approval: Yes \nFunding for this study: None \nAuthor Disclosures: \nAntonio Borzelli: Nothing to disclose \nFabio Corvino: Nothing to disclose \nFrancesco Pane: Nothing to disclose \nMilena Coppola: Nothing to disclose \nAndrea Paladini: Nothing to disclose \nFrancesco Giurazza: Nothing to disclose \nMattia Silvestre: Nothing to disclose \nRaffaella Niola: Nothing to disclose \nGianluca Cangiano: Nothing to disclose \n \nRPS 309-11 \nMaternal and neonatal outcome in patients with placenta previa \nundergoing prophylactic internal iliac arteries balloons placement prior \nto cesarean section \nK. K. Pyra, *M. Szmygin*, W. Dymara-Konopka, G. Pietras, M. Sojka,  \nT. Jargiełło, B. LeszczyĔska-Gorzelak; Lublin/PL \n(mszmygin@gmail.com) \n \nPurpose: Placenta previa (PP) describes an implantation abnormality with \nplacenta implanted in the lower segment of the uterus rather than in the \nfundus. The aim of this study was to summarize our experience with patients \ndiagnosed with PP and treated with prophylactic internal iliac balloon \nimplantation prior to cesarean section and to assess maternal and fetal \noutcomes. \nMethods or Background: In this retrospective, single-center study we \ninvestigated the medical records of patients with PP who underwent \nprophylactic internal iliac balloon implantation prior to cesarean section. \nClinical information including age, history of deliveries/cesarean sections and \nrisk factors was collected. \nResults or Findings: A total of 30 patients were included in the study. \nHysterectomy was performed in 10 cases. Median estimated blood loss (EBL) \nwas 1.18 L. A total of 30 live infants were delivered. Mean birth weight was \n2435 g. In 2 cases (7%) technical complications occurred. In 1 case (3%) \nbilateral common iliac thrombosis requiring urgent surgical intervention \noccurred. Control angiography disclosed minor post-cesarean contrast \nextravasation in 3 cases (10%). In all 3 patients successful embolization of \nuterine arteries was performed with gelatine sponge powder \nConclusion: Prophylactic placement of internal iliac balloons in patients with \nplacenta previa prior to cesarean section is an effective and minimally invasive \nprocedure that results in lowering the blood loss. Moreover, it is safe for both \nmother and the neonate. \nLimitations: Our study has several limitations - its retrospective and single-\ncenter nature, limited number of participants and no control arm (patients with \nPP without prophylactic balloon placement) are the most important ones. \nEthics Committee Approval: This study was approved by IRB. \nFunding for this study: None. \nAuthor Disclosures: \nWeronika Dymara-Konopka: Nothing to disclose \nMaciej Szmygin: Nothing to disclose \nTomasz Jargiełło: Nothing to disclose \nMichał Sojka: Nothing to disclose \nBoĪena LeszczyĔska-Gorzelak: Nothing to disclose \nGrzegorz Pietras: Nothing to disclose \nKrzysztof K. Pyra: Nothing to disclose \n \nRPS 309-13 \nAnalysis of traumatic carotid artery injuries: clinical predictors of \nmanagement and outcomes \n*R. T. Tomihama*, H. Boggs, D. Turay, K. Mukherjee, S. Kiang;  \nLoma Linda, CA/US \n(rtomihama@llu.edu) \n \nPurpose: Optimal management of traumatic carotid artery injury (CAI) to \npreserve neurologic function remains undefined. We sought to evaluate the \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 249  \nfactors that influence management, stroke and brain death outcomes of \ntraumatic CAI. \nMethods or Background: A search of the PROOVIT Trauma Registry of \npatients >18 years of age with a diagnosis of CAI was performed at a Level 1 \nTrauma Center from 2013-2019. Patient demographics, injuries, the timing of \npresentation, Biffl Cerebral Injury Grade, Injury Severity Score (ISS), \nAbbreviated Injury Scale (AIS) were documented. Medical management, \nprocedures, and brain-related outcomes were recorded. \nResults or Findings: Carotid artery injuries were identified in 30 patients. \nThere were 25 (83.3%) blunt and 5 (16.7%) penetrating carotid injuries. While \na higher Biffl grade was predictive of vascular intervention over medical \nmanagement (3.6 vs. 2.4; p = 0.03, respectively), the ISS and AIS scores were \nnot. A higher ISS score was a predictor of stroke (33.33 vs. 22.86; p = 0.012) \nwhile Biffle grade and AIS scores were not. All stroke patients declared their \nneurological change on average within 11.7 hours (SD±12.7) of the \npresentation. In addition, a higher ISS score was predictive of brain death (38.6 \nvs 23.6; p = 0.004) but Biffl grade and AIS scores were not. There was a trend \nof eventual brain death seen in blunt trauma over penetrating trauma (36% vs \n0%, p = 0.11). \nConclusion: Analysis of carotid artery injuries revealed certain predictors of \nmanagement and clinical outcomes. A higher Biffl grade can help predict \nvascular intervention while a higher ISS score can help predict stroke and brain \ndeath. \nLimitations: Given the rarer disease process, study numbers are small. \nLong term clinical follow up is limited \nEthics Committee Approval: IRB approval was waived due registry study \ndata analysis \nFunding for this study: None \nAuthor Disclosures: \nHans Boggs: Nothing to disclose \nSharon Kiang: Nothing to disclose \nRoger Takeshi Tomihama: Nothing to disclose \nKaushik Mukherjee: Nothing to disclose \nDavid Turay: Nothing to disclose \n \nRPS 309-14 \nProstatic artery embolisation in benign prostatic hyperplasia: a single-\ncentre retrospective study \n*T. J. Vogl*, A. Zinn, E. Elhawash, L. S. Alizadeh, N-E. A. N-E. Mohammed,  \nN. N. N. Naguib; Frankfurt/DE \n(t.vogl@em.uni-frankfurt.de) \n \nPurpose: To evaluate the advantages of MR angiography (MRA)-planned \nprostatic artery embolization (PAE) in benign prostatic hyperplasia (BPH). \nMethods or Background: In this retrospective study MRAs of 56 patients \n(range: 47-82 years; mean: 67.23 ± 7.73 years) with a PAE were evaluated \nbetween 2017 and 2018. For inclusion, full information on procedure time and \nradiation values was necessary. In every patient 3-dimensional MRA \nreconstruction with maximum intensity projection was conducted in order to \nidentify prostatic artery (PA) origin. 33 patients completed clinical and imaging \nfollow up and were included in the clinical evaluation. \nResults or Findings: In total there were 131 PAs with a second PA in 19 \npelvic sides. PA origin was correctly identified in 108 of 131 PAs (82.44%) via \nMRA. In patients in which MRA allowed a PA analysis, a significant reduction \nof the fluoroscopy time (-26.96%, p=0.028) and of the dose area product (-\n38.04%, p=0.003) were detected versus those with no PA analysis prior to \nPAE. Intervention time was reduced by 13.15%, (p=0.249). Mean fluoroscopy \ntime was 30.14 minutes, mean dose area product 27,748.76 μGym2 and mean \nentrance dose 1,553.48 mGy. Technical success was achieved in all 56 \npatients (100.0%); all patients were embolized on both pelvic sides. The \nevaluated data documented a significant reduction in IPSS (p<0.0001; mean \n9.67 points). \nConclusion: MRA prior to PAE successfully identified PAs in 82.44% of the \ncases. MRA-planned PAE is an effective treatment for patients with BPH. \nLimitations: - small sample size - retrospective nature of the study.  \n- only the origin of PA was analyzed and no precise analysis of the \nintraprostatic distribution pattern was documented \nEthics Committee Approval: This retrospective single-center study was \napproved by the ethical committee \nFunding for this study: No funding \nAuthor Disclosures: \nAnnette Zinn: Nothing to disclose \nNagy Naguib Naeem Naguib: Nothing to disclose \nThomas J. Vogl: Nothing to disclose \nNour-Eldin Abdelrehim Nour-Eldin Mohammed: Nothing to disclose \nElsayed Elhawash: Nothing to disclose \nLeona Soraja Alizadeh: Nothing to disclose \n \n \n \n \nRPS 309-15 \nPredictors of outcome after mechanical thrombectomy for acute \nischaemic stroke in patients aged •90 years \nM. Sojka, *M. Szmygin*, K. K. Pyra, P. Tarkowski, J. Wojczal,  \nA. Drelich-Zbroja, T. Jargiełło; Lublin/PL \n(mszmygin@gmail.com) \n \nPurpose: Mechanical thrombectomy (MT) has established its role as a first-line \ntreatment of acute ischemic stroke due to large vessel occlusions (LVO). \nHowever, patients older than 85 or even 80 are commonly excluded from large \nrandomized controlled studies as this group was found to be associated with \nsignificantly poorer clinical outcome and increased mortality compared to \nyounger patients. The aim of this study was to evaluate clinical and procedural \nfactors associated with clinical outcome and mortality among nonagenarians \nwith acute ischemic stroke treated with MT. \nMethods or Background: This retrospective, single-center study was \nconducted on 38 patients with LVO treated with MT. Clinical features including \nbaseline results, radiological imaging, procedural details and outcome results \nwere documented and evaluated. Recanalization was assessed according to \nthe TICI score. The clinical condition was evaluated on admission (NIHSS) and \nafter 3 months (mRS). \nResults or Findings: The rate of successful recanalization (TICI •2b) was \n84.2% (32/38). Symptomatic intracranial hemorrhage was observed in 3 (7.9%) \npatients. After 90 days, the mortality rate was 47.4%. Favorable clinical \noutcome (mRs 0-2) was regained in 28.9% of the patients (11/38). Poor clinical \noutcome (mRsޓ2) was observed in 9 patients (23.7%). \nConclusion: Very elderly patients with LVO should not be excluded from MT \neven if prognosis for good clinical outcome in this age group remains low and \nthe procedure is more challenging. Long-term outcome is predicted by stroke \nseverity (baseline NIHSS and occluded vessel) and hospital arrival time. \nLimitations: Firstly, retrospective design and relatively small number of \nnonagenarians that limits the validity of the data. Secondly, initial ASPECTS \nand final infarct volume were not calculated. Finally, lack of control arm \nconsisting of patients treated with intravenous thrombolysis for direct \ncomparison. \nEthics Committee Approval: Study was approved by institutional review \nboard. \nFunding for this study: None \nAuthor Disclosures: \nMaciej Szmygin: Nothing to disclose \nTomasz Jargiełło: Nothing to disclose \nMichał Sojka: Nothing to disclose \nJoanna Wojczal: Nothing to disclose \nPiotr Tarkowski: Nothing to disclose \nAnna Drelich-Zbroja: Nothing to disclose \nKrzysztof K. Pyra: Nothing to disclose \n \nRPS 309-16 \nImpact of the laboratory results on cerebral vasospasm and delayed \ncerebral ischaemia in aneurysmal subarachnoid haemorrhage \n*V. Opancina*, R. Vojinovic, S. Jankovic; Kragujevac/RS \n(valentina.opancina@gmail.com) \n \nPurpose: The main objective of this study was to examine the laboratory \nvalues associated with an increased or decreased risk of cerebral vasospasm \nand delayed cerebral ischemia, which develop after aneurysmal subarachnoid \nhemorrhage. \nMethods or Background: The study was designed as a cross-sectional study. \nThe study included all patients, 18 or more years of age, who were diagnosed \nfor the first time with aneurysmal subarachnoid hemorrhage detected on CT \nscans and who were treated with endovascular embolization of the aneurysm, \nat our institution, from January 2014 until January 2019. The following \nvariables were examined: age, gender, Glasgow Coma Scale score and \nlaboratory analysis (maximum recorded values and nadir values): blood count, \ncoagulation tests and biochemistry analysis. The impact of these variables on \nthe main outcomes (cerebral vasospasm, delayed cerebral ischemia) was \ninvestigated by univariate and multivariate logistic regression. \nResults or Findings: In total, 66 patients were enrolled. The multivariate \nanalysis showed that the maximum recorded INR values, in patients not \nreceiving anticoagulant therapy and the maximum recorded white blood cells, \nwere strongly associated with cerebrovascular spasm, increasing its chances \nby 4.4 and 8.4 times. In addition, maximum recorded values of the white blood \ncells were associated with delayed cerebral ischemia, increasing its chances \nby 1.4 times. \nConclusion: It was determined that aneurysmal subarachnoid hemorrhage \ncreates an endocranial inflammatory condition, whose intensity is probably \ndirectly related to the formation of vasospasm and delayed ischemia. These \nresults might have value in potential pharmacological interference for \nneuroinflammation as a useful strategy for the prevention of vasospasm and \ndelayed cerebral ischemia. \nLimitations: Not applicable \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 250  \nEthics Committee Approval: The study was approved by the Ethics \nCommittee of the Clinical Center Kragujevac before any of the study \nprocedures was initiated. \nFunding for this study: Not applicable \nAuthor Disclosures: \nValentina Opancina: Nothing to disclose \nSlobodan Jankovic: Nothing to disclose \nRadisa Vojinovic: Nothing to disclose \n \nRPS 309-18 \nIntravascular embolisation in four cases of intralobar pulmonary \nsequestration: a new treatment perspective? \nA. Paladini¹, *A. Borzelli*², S. Tricca¹, D. Zagaria¹, S. Bor¹, F. Pane¹,  \nA. Carriero¹; ¹Novara/IT, ²Naples/IT \n(antonio.borzelli@libero.it) \n \nPurpose: To evaluate endovascular embolic treatment as an alternative \ntherapeutic option to surgery in patients suffering from intralobar pulmonary \nsequestration. \nMethods or Background: Four symptomatic patients (two with hemoptysis \nand two with recurrent inflammatory events) with intralobar pulmonary \nsequestration were treated and a systematic review of the literature on this \ncongenital anomaly was performed. The embolization of the aberrant arteries \noccurred in two cases by means of metal spirals and in two cases by a liquid \nembolizing agent (Easyx). \nResults or Findings: The procedure was shown to be effective in selectively \nreducing arterial inflow to pathological lung tissue, causing necrosis and \nprogressive involutionary fibrosis. The intra and periprocedural complications \nwere analyzed, as well as the long-term results obtained with clinical and \nradiological evaluation (TC at 1 and 6 months later). The only complication \nfound was reported by patients treated with embolic fluid, such as a pleuritic-\nlike pain that is limited over time. Embolization is therefore a less invasive and \nsafer therapeutic alternative than surgical resection where morbidity and \ncomplications are greater. \nConclusion: Endovascular treatment has been shown to be a valid and \neffective therapy in patients suffering from intralobar pulmonary seizure, a \nresult that is in line with the current literature \nLimitations: Poor cohort of Patients \nEthics Committee Approval: Not requested \nFunding for this study: None \nAuthor Disclosures: \nAntonio Borzelli: Nothing to disclose \nFrancesco Pane: Nothing to disclose \nSimone Bor: Nothing to disclose \nAndrea Paladini: Nothing to disclose \nAlessandro Carriero: Nothing to disclose \nStefano Tricca: Nothing to disclose \nDomenico Zagaria: Nothing to disclose \n \nRPS 309-19 \nSuccessful endovascular embolisation of active lumbar arteries \nbleedings in patients with blunt trauma and huge retroperitoneal \nhaematoma \n*A. Borzelli*¹, F. Pane¹, F. Amodio¹, M. Silvestre¹, M. Coppola¹, F. Giurazza¹, \nA. Paladini², F. Corvino¹, R. Niola¹; ¹Naples/IT, ²Novara/IT \n(antonio.borzelli@libero.it) \n \nPurpose: Evaluate efficacy and safety of transcatheter endovascular \nembolization in lumbar arteries active bleedings \nMethods or Background: Between January 2015 and January 2020 we \nretrospectively considered 62 patients(37 M 25 F; medium age 43 anni) \naffected by huge retroperitoneal hematoma due to active arterial bleedings for \nblunt trauma and with clinical and laboratoristic evidence of serum hemoglobin \nvalue lowering. All patients undergone preliminar CT study evaluation followed \nby angiographic study and endovascular transcatheter embolization. In all \ncases we employed 5 Fr catheters for angiographic initial evaluation of gluteal \narterial district and 2,7 Ft microcatheters for selective and super-selective distal \nbranches of lumbar arteries catheterization. We employed as embolizing \nagents: metallic coils, PVA, cyanoacrylate and Spongostan, alone or in \nassociation \nResults or Findings: In all cases the endovascular embolization was \nsuccessful with a complete stop of bleedings; 9 cases required a second \nprocedure due to recidivant bleedings. In none of the cases we observed major \ncomplications related to the procedures. \nConclusion: The elevated rate of technical and clinical success reported and \nthe absence of major complications suggest that endovascular transcatheter \nembolization is a safe and effective minimally invasive treatment for lumbar \narteries active bleedings as an alternative to surgery, expecially in very old \npatients, affected by many other comorbidities. It is fundamental, however,an \nadequate pre-treatment non-invasive imaging by CT-angiography, to correctly \nidentify all the sources of bleedings, even the minimal, but potentially fatal, \nones, to perform a more precise and faster embolization. \nLimitations: Restrospective and monocentric study \nEthics Committee Approval: Yes \nFunding for this study: None \nAuthor Disclosures: \nAntonio Borzelli: Nothing to disclose \nFrancesco Amodio: Nothing to disclose \nFabio Corvino: Nothing to disclose \nFrancesco Pane: Nothing to disclose \nMilena Coppola: Nothing to disclose \nAndrea Paladini: Nothing to disclose \nFrancesco Giurazza: Nothing to disclose \nMattia Silvestre: Nothing to disclose \nRaffaella Niola: Nothing to disclose \n \nRPS 309-20 \nThe prelude-BTK study: novel serration angioplasty balloon for below-\nthe-knee arteries \n*C. Wissgott*; Rendsburg/DE \n(cwissgott@gmx.de) \n \nPurpose: PRELUDE-BTK assessed safety and efficacy of the Serranator® \nPTA Serration Balloon Catheter in subjects with atherosclerotic disease of the \nBTK arteries. \nMethods or Background: PRELUDE-BTK is a single arm, prospective, multi-\ncenter feasibility study to assess Serranator in subjects with lesions in BTK \narteries. Acute angiographic data captured pre-Serranator® inflation vs. post \ninflation effects with 30 day and 6 month follow up. Subjects had CLTI or \nsevere claudication, de novo stenoses or non-stented restenotic or CTOs with \nlengths <12cm and RVD of 2.5 - 3.5mm. Safety was a composite of MALE and \nPOD, assessed at 30 days. Efficacy was rate of device success with final \ndiameter stenosis <50% by visual assessment using only the Serranator. A \nsecondary objective assessed OCT or IVUS pre- and post-treatment in up to \n10 subjects to evaluate lesion characteristics and presence of serrations. \nResults or Findings: Forty-nine subjects enrolled treating 55 lesions, 53 \nanalyzable. Mean pre-treatment diameter stenosis was 81.3% +/- 17.2% \nversus post treatment of 21.8% +/- 12.7%, with 28.3% CTOs (n=15/53). \nTwenty six percent (n=14/53) had moderate/severe calcification. One flow \nlimiting dissection resulted in a 1.9% (1/53) bailout stent rate. All OCT/IVUS \nimaged lesions showed serration effects (n=10). There were no CD TLRs at \n30-days. Thirty day and 6-month data to be presented. \nConclusion: Acute study endpoints were achieved. PRELUDE-BTK showed \nexceptional lumen gain in challenging infrapopliteal lesions while minimizing \narterial injury. Serranator’s mechanism of action was demonstrated by OCT \nand IVUS showing serrations without significant dissection, allowing for an \nincrease in lumen area. \nLimitations: Only short-term results yet available. \nEthics Committee Approval: Yes. \nFunding for this study: Sponsored by Cagent Vascular. \nAuthor Disclosures: \nChristian Wissgott: Research/Grant Support: Cagent Vascular. Investigator: na \n \nRPS 309-21 \nFocal dissection repair after DCB angioplasty: 12- and 24-month results \nof Tack-Optimised Balloon Angioplasty (TOBA) III \n*C. Wissgott*; Rendsburg/DE \n(cwissgott@gmx.de) \n \nPurpose: TOBA III evaluated a novel dissection repair device for treating post-\nPTA dissection in the superficial femoral (SFA) and/or proximal popliteal (PPA) \narteries. \nMethods or Background: The prospective clinical study enrolled 201 patients: \n169 patients with lesions ”150mm and a subset of 32 patients with lesions \n>150-250mm. Eligibility included Rutherford classification 2-4 with de novo or \nnon-stented restenotic target SFA/PPA lesion(s) undergoing drug-coated \nballoon (DCB) angioplasty. After DCB angioplasty, lesions with <30% residual \nstenosis and presence of •1 dissection were enrolled and treated. The system \nconsists of six self-expanding nitinol implants on a 6F catheter. Each implant is \n6mm in length, self-sizes to vessels 2.5-6.0mm in diameter. The 12-month \nendpoint were primary patency—freedom from binary restenosis and clinically-\ndriven target lesion revascularization (CD-TLR). All imaging was adjudicated by \ncore laboratories. \nResults or Findings: In ”150mm lesions, the mean lesion length was \n68±42mm. The safety endpoint was met with zero major adverse events at 30 \ndays (P<0.0001). The 12-month efficacy endpoint was also met (P<0.0001). \n12-month K-M primary patency and freedom from CD-TLR were 95.0% and \n97.5% respectively, with 97.7% of dissections resolved. Bailout stent in 1 \n(0.6%) case. In the longer lesion subset, mean lesion length was 154±56mm. \nIn this group, 12-month K-M primary patency and freedom from CD-TLR were \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 251  \n89.3% and 96.8% respectively, with 98.8% of all dissections resolved. In both \ngroups, K-M freedom from CD-TLR was sustained to 24 months at 92.3% and \n82.6% for lesions ”150mm and lesions >150-250mm respectively. \nConclusion: The TOBA III study met its primary endpoints in a 100% \ndissected vessel population and demonstrated primary patency of 95.0% at 12 \nmonths for lesions up to 15cm and 89.3% for lesions 15-25cm with sustained \nfreedom from CD-TLR. \nLimitations: Non-randomized trial. \nEthics Committee Approval: Yes. \nFunding for this study: Sponsored by Intact Vascular. \nAuthor Disclosures: \nChristian Wissgott: Investigator: Intact Vascular \n \nRPS 309-22 \nCOVID-19 pandemic prompts a paradigm shift to remote training of \nresidents via cloud-based e-simulation platform \n*G. Bartal*, S. Fargun, T. Avziz, A. Ben-Moshe, E. Yechezkel, A. Shacharit;  \nTel Aviv/IL \n(gbartal@gmail.com) \n \nPurpose: WHO declaration of COVID-19 Pandemic lead to the “social \ndistancing” and prevents in-person residency academic activities. Currently, \nclinical education and hands-on training can be achieved only remotely and \nvirtually. Residency programs seek an alternative way to carry out training, to \nachieve goals of curriculum and to complete their training program. Our aim \nwas to develop and evaluate performance of an interactive cloud-based e-\nsimulation platform for remote simulation and training of endovascular \ninterventions. \nMethods or Background: E-simulation, interactive cloud-based platform was \ndeveloped allowing remote simulation for learning and practicing steps of \nvarious endovascular procedures. The desktop software was converted to a \ncloud service and enables trainee to remotely connect with the simulation \nsession using personal computer. The platform allows step-by-step practice of \ncomplete endovascular procedure using standard keyboard and mouse. The \nvirtual reality simulation includes the fluoroscopic screen, vital signs monitor, \nselection of endovascular tools (wire, catheters, balloons, stent/grafts) and \ncontrast injection thus creating an entire procedure flow in a variety of \nendovascular techniques and patient anatomies. \nResults or Findings: The cloud-based software comprises entire simulation \npackage besides the physical tool manipulation and deployment, all replaced \nby PC controls. The system provides cognitive training of every procedure step \nand prepares to future hands-on simulator training during which the trainee can \nalso practice manipulating real tools. Furthermore, e-simulation can be used \nfor remote demonstration and training on new devices. The simulation can be \npracticed under real-time remote supervision which allows evaluation of \nperformance. \nConclusion: Remote resident training via cloud-based e-simulation platform is \ntimely and feasible. It allows the physician to practice different patient \nscenarios and simulate a full procedure experience based on the patient file. \nEvaluation by physicians using validated questionnaires is underway. \nLimitations: Laboratory evaluation \nEthics Committee Approval: Not required \nFunding for this study: Not required \nAuthor Disclosures: \nElad Yechezkel: Employee: Simbionix 3DSysteHealthcare \nShani Fargun: Employee: Simbionix 3DSysteHealthcare \nAriel Ben-Moshe: Employee: Simbionix 3DSysteHealthcare \nAlex Shacharit: Employee: Simbionix 3DSysteHealthcare \nGabriel Bartal: Consultant: Simbionix 3DSystems \nTal Avziz: Employee: Simbionix 3DSysteHealthcare \n \nRPS 309-23 \nSaving the uterus: our experience in uterine artery embolisation for \nacquired uterine vascular abnormalities \n*L. Masood*, A. Rana, M. S. Ahmed, S. Haider, Z. A. Khan; Islamabad/PK \n(laibamasood66@gmail.com) \n \nPurpose: The aim of this study was to describe our experience with the \ndiagnosis and management of acquired uterine vascular abnormalities with \nuterine preservation. \nMethods or Background: 5 patients were enrolled from the hospital database \nwho presented to our Interventional Radiology department for uterine artery \nembolization (UAE) with a history of iatrogenic/acquired uterine vascular \nabnormalities confirmed on imaging (doppler ultrasound, CT, or MRI). These \nincluded 1 patient with uterine artery pseudoaneurysm and arteriovenous \nfistula (AVF), 2 having uterine arteriovenous malformations (AVMs), and 2 \npatients with uterine AVFs. Embolization agents used were histoacryl glue \nmixed with lipodol, PVA particles, and gelfoam slurry. Medical records, imaging \nstudies, and telephonic contact with patients were assessed for patient \npresentation, intraprocedural details, and follow up to record treatment \nsuccess. Statistical analysis was performed using descriptive statistics. \nResults or Findings: A total of 5 bilateral UAE were performed in 5 patients \nranging between 28 to 33 years of age. Three of the patients presented with \nlife-threatening bleed requiring 2 – 3 transfusions. Clinical as well as \nangiographic success was achieved in all patients with immediate control of \nhemorrhage. No complications were identified during follow-up. Restoration of \nnormal menstrual cycle was observed in all patients after 2- 3 months. Two of \nthe patients were able to conceive normally within one year. \nConclusion: Acquired/iatrogenic uterine vascular abnormalities are a rare but \nimportant cause of life-threatening hemorrhage which can be expertly \nmanaged and successfully treated using UAE, which is rapid, safe, and \nminimally invasive with the added advantage of fertility preservation. \nLimitations: This is a single-center study having a limited number of patients \nand a lack of follow-up on imaging. \nEthics Committee Approval: Study was performed after approval from \nhospital institution review board. \nFunding for this study: No funding. \nAuthor Disclosures: \nMuhammed Shozab Ahmed: Nothing to disclose \nSyed Haider: Nothing to disclose \nLaiba Masood: Nothing to disclose \nAtif Rana: Nothing to disclose \nZahid A Khan: Nothing to disclose \n \n \nResearch Presentation Session: \nInterventional Radiology \nRPS 409 \nAdvances in non-vascular interventional \nradiology \nRPS 409-1 \nNational dose reference levels in computed tomography–guided \ninterventional procedures: a proposal \n*J. Greffier*, D. Dabli, J-P. Beregi, J. Frandon; Nimes/FR  \n(joel.greffier@chu-nimes.fr) \n \nPurpose: To establish national reference levels (RLs) in interventional \nprocedures under CT guidance as required by the 2013/59/Euratom European \nDirective. \nMethods or Background: Seventeen categories of interventional procedures \nin thoracic, abdominopelvic, and osteoarticular specialties (percutaneous \ninfiltration, vertebroplasty, biopsy, drainage, tumor destruction) were analyzed. \nTotal dose length product (DLP), number of helical acquisitions (NH), and total \nDLP for helical, sequential, or fluoroscopic acquisitions were recorded for 10 to \n20 patients per procedure at each center. RLs were calculated as the 3rd \nquartiles of the distributions and target values for optimization process (TVOs) \nas the median. RLs and TVOs were compared with previously published \nstudies. \nResults or Findings: Results on 5001 procedures from 49 centers confirmed \nthe great variability in patient dose for the same category of procedures. RLs \nwere proposed for the DLPs and NHs in the seventeen categories. RLs in \nterms of DLP and NH were 375 mGy.cm and 2 NH for spinal or peri-spinal \ninfiltration, 1630 mGy.cm and 3 NH for vertebroplasty, 845 mGy.cm and 4 NH \nfor biopsy, 1950 mGy.cm and 8 NH for destruction of tumors, and 1090 \nmGy.cm and 5 NH for drainage. DLP and NH increased with the complexity of \nprocedures. \nConclusion: This study was the first nationwide multicentric survey to propose \nRLs for interventional procedures under CT guidance. Heterogeneity of \npractice in centers were found with different levels of patient doses for the \nsame procedure. The proposed RLs will allow imaging departments to \nbenchmark their practice with others and optimize their protocols. \nLimitations: The main limitation of our study is the non-consideration of the \nbody habitus. \nEthics Committee Approval: Institutional Review Board approval was \nobtained. \nFunding for this study: No \nAuthor Disclosures: \nJean-Paul Beregi: Nothing to disclose \nJulien Frandon: Nothing to disclose \nJoel Greffier: Nothing to disclose \nDjamel Dabli: Nothing to disclose \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 252  \nRPS 409-2 \nSafety and efficacy of a new percutaneous interspinous spacer: a \nmulticentre retrospective study \nC. Zini¹, M. Bellini², E. Piras³, L. Manfré ຾, A. E. De Vivo຾, *S. Marcia*³; \n¹Firenze/IT, ²Siena/IT, ³Cagliari/IT, ຾Catania/IT  \n(stemarcia@gmail.com) \n \nPurpose: To evaluate safety and efficacy of a new percutaneous interspinous \nprocess device (IPD) Lobster® (Techlamed, Firenze, Italy) in 147 patients with \ndegenerative lumbar spinal stenosis(DLSS) from 3 different centers. \nMethods or Background: From November 2016 and March 2020, 147 \npatients (67 male, age 72 ± 9.7 years old, range 45-91) with neurogenic \nintermittent claudication because of DLSS related to mono/bi-segmental \nlumbar central canal and/or foraminal stenosis were enrolled in the present \nstudy. Clinical outcomes were evaluated using Visual Analog Scale(VAS) and \nZurich Claudication Questionnaire (ZCQ) before and after the procedure. \nTechnical success was defined as correct placement of the IPD demonstrated \nwith computer tomography (CT), performed immediately after treatment; \nspinoplasty was accomplished in patients with BMD T-score<- 2.5. \nResults or Findings: In 178 levels (L2-L3=7; L3-L4=61; L4-L5=102; L5-S1=8) \na total of 177 IPDs (8mm= 60;10 mm=90;12 mm=26;14 mm=1) were \nimplanted; in 22 patients more than 1 level have been treated in the same \nsession; spinoplasty was accomplished in 66 patients. We registered 99,4% of \ntechnical success: in 1 case, because of spinous process rupture during \nspinoplasty, the device was not implanted. In 2 cases we observed \ndisplacement of the IPD subsequently removed under fluoroscopy and \nreplaced. No major complications were registered. 5 point of VAS reduction \nwas registered after the procedure(mean VAS pre-procedure=7.74±0.69; mean \nVAS post-procedure=3.36±1.3)(p<0.001); mean pre-procedural ZCQ was \n50.6±10.67 and post-procedural ZCQ was 30±1.3(p<0.001). \nConclusion: The Lobster®IPD is safe and effective totally percutaneous \nminimally-invasive decompression procedure in DLSS. \nLimitations: Number of patients \n3 National Centres \nEthics Committee Approval: The present study has been approved by ATS \nSardegna Ethical Committee (231/2020/CE) \nFunding for this study: No profit observational study \nAuthor Disclosures: \nEmanuele Piras: Nothing to disclose \nMatteo Bellini: Nothing to disclose \nStefano Marcia: Nothing to disclose \nChiara Zini: Nothing to disclose \nAldo Eros De Vivo: Nothing to disclose \nLuigi Manfré: Nothing to disclose \n \nRPS 409-3 \nPercutaneous management of benign biliary strictures (BBS) after liver \ntransplantation (LT) in paediatric patients: a singlecentre experience \n*L. Dulcetta*¹, P. Marra², F. S. Carbone¹, C. Sallemi², P. A. Bonaffini²,  \nS. Sironi¹; ¹Monza/IT, ²Bergamo/IT \n(l.dulcetta@campus.unimib.it) \n \nPurpose: To assess the role of percutaneous transhepatic cholangiography \n(PTC) for diagnosis confirmation and treatment of BBS after LT in pediatric \npatients. To evaluate technical success and short-term clinical outcome. \nMethods or Background: Clinical, laboratory, imaging and procedural data of \n52 pediatric patients (mean age 22.1 months; range 1-128), who underwent \nPTC after LT between 2009 and 2020 in a single center, were retrospectively \nreviewed. Indication to PTC was clinical suspicious of BBS based on laboratory \nand liver biopsy data, regardless bile ducts dilation at pre-procedural imaging. \nResults or Findings: 122 PTCs were performed, with 2.3 procedures for each \npatient on average (range 1-8). Technical success of intrahepatic biliary \ncatheterization was 99.2%; one failed catheterization was repeated \nsuccessfully after 7 days. In 108/121 cases (89.2%) ductal or biliodigestive \nanastomosis stenosis was found at PTC. In 95/108 cases (87.9%) stenosis \nwas treated with transluminal bilioplasty and insertion of an internal-external \nbiliary drainage (IEBD). In 10/108 the stenosis was managed in a second \nattempt. The remaining 3 cases failed all attempts of bilioplasty and underwent \nsurgery. In 13/121 cases without evident stenosis at PTC only an IEBD was \nplaced. Procedure-related complications were: 35 cholangitis (within 72 hours \nof procedure), 4 bilomas, 3 sepsis and 1 septic shock. Liver function tests \n(compared before, 7 days and 1 month after PTC) were available for 58 \nprocedures. Reduction in cholestasis was indicated by significantly improving \nin serum levels of Ȗ-glutamyl transpeptidase (p < .001), total bilirubin (p < \n.005), direct bilirubin (p < .05) and alkaline phosphatase (p < .05). \nConclusion: PTC with bilioplasty and IEBD is feasible, has low morbidity and \nimproves cholestasis in children who developed BBS after LT. \nLimitations: More cases are needed to confirm the accuracy of results. \nEthics Committee Approval: n/a \nFunding for this study: n/a \n \nAuthor Disclosures: \nPaolo Marra: Nothing to disclose \nPietro Andrea Bonaffini: Nothing to disclose \nClaudio Sallemi: Nothing to disclose \nFrancesco Saverio Carbone: Nothing to disclose \nSandro Sironi: Nothing to disclose \nLudovico Dulcetta: Nothing to disclose \n \nRPS 409-4 \nThe role of dacryocystography in cases of epiphora \n*A. Posa*¹, V. Vingiani²; ¹Rome/IT, ²Sorrento/IT \n(alessandro.posa@gmail.com) \n \nPurpose: To retrospectively evaluate imaging findings of patients with \nepiphora undergoing dacryocystography and to describe the most common \nfindings. \nMethods or Background: From October 2011 to March 2020, consecutive \ndacryocystographies performed at our Interventional Radiology service were \nreviewed. During this procedure, a 24-G plastic cannula is inserted through the \nlacrimal canal, and 2 mL or less of a radio-opaque iodinated contrast medium \nis slowly injected. Patients suffering from epiphora underwent this procedure to \ndynamically evaluate the patency of lacrimal canals, lacrimal sacs, and \nnasolacrimal ducts and to identify any pathological finding. \nResults or Findings: 723 dacryocystographies were reviewed. Abnormal \nfindings were observed in 468 exams. Lacrimal sac dilation was the most \ncommon finding (20.7% of cases) due to Beraud-Krause’s valve occlusion. The \nlacrimal points were epithelized in 3.8% of cases, whereas the opacification of \nlacrimal canals alone, due to Rosenmuller’s valve obstruction, was evident in \n11.5% of cases. Beaded appearance of the nasolacrimal duct was seen in \n16.3% of cases. Seven patients had previous lacrimal duct, turbinate, or nasal \nsurgery. \nConclusion: Dacryocystography plays an essential role in the diagnostic \nassessment and treatment decision in patients with epiphora. Other than being \ndiagnostic, it proves to be therapeutic in cases where obstruction is related to \nmucous clogs. Knowledge of pathological findings of dacryocystography is \nmandatory for the correct management of these patients. \nLimitations: The retrospective nature of this study represents its main \nlimitation. \nEthics Committee Approval: Ethics committee approved this study. \nFunding for this study: No funding. \nAuthor Disclosures: \nAlessandro Posa: nothing to disclose \nVincenzo Vingiani: Nothing to disclose \n \nRPS 409-5 \nRole of contrast-enhanced ultrasonography (CEUS) in percutaneous \ndrainages of abdominal abscesses and inflammatory fluid collections not \ndetectable at B-mode US \n*A. Borzelli*¹, F. Pane¹, F. Amodio¹, M. Coppola¹, F. Giurazza¹, F. Corvino¹,  \nM. Silvestre¹, A. Paladini², R. Niola¹; ¹Naples/IT, ²Novara/IT \n(antonio.borzelli@libero.it) \n \nPurpose: Evaluate the role of contrast-enhanced ultrasound(CEUS)as a \npowerful tool and aid to better identify and define abdominal abscesses and \ninflammatory fluid collections, otherwise not detactable by Duplex B-mode US, \nto allow a more precise and safer percutaneous drainage \nMethods or Background: We retrospectively considered, from January 2019 \nto June 2020, 14 patients (medium age 53,8M-6F), with CT diagnosis of \nabscesses and inflammatory fluid collections in paracolic-perisigmoid seat(6), \nin precoccygeal-presacral site (3) and perirenal-retroperitoneal site (5). In all \ncases, the identification of the target abscess/fluid collection by Duplex B-mode \nUS was not possible due to intestinal bloating and gas bubbles into the \nabscesses, and CE-US (Sonovue, sulfur hexafluoride) was employed to better \nidentify and delineate them, to finalise the placement of a percutaneous \ndrainage. We considered a portal-venous and late-venous phase(60-180 sec) \nto identify them. All procedures were performed in angiographic suite, \nemploying Convex probes, followed by fluoroscopic guide and corroboration. \nWe employed CHIBA coaxial 18G needles, stiff .035” guidewires and 8-10Fr \ncatheters for the drainage. \nResults or Findings: Technical success was achieved in 93% (13/14) \npatients: in 1 patient with abscess in precoccygeal-presacral site, the \nplacement of a drainage was not possible due to unfavourable anatomical \nconditions, with overlay of non-passable bone structures. In all cases, the \ntarget abscess/fluid collection was identified with more accuracy, and in 13/14 \npatients the placement of a percutaneous drainage was allowed with more \nprecision and safety: for each of them, 2 samples of fluid material was \ncollected for laboratory tests. In none of the cases major complications such as \nbleeding or haemorrhage due to injury to abdominal/pelvic parenchymas or \ngreat vessels occurred. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 253  \nConclusion: The elevated rate of technical success reported,the absence of \nmajor complications and faster performance,suggest the added value of CEUS \nas an advantageous tool to better identify and delineate abdominal abscesses \nand inflammatory fluid collections,not detactable by Duplex US,to allow a safer \nand more precise placement of a percutaneous drainage \nLimitations: Restrospective Monocentric study \nEthics Committee Approval: Yes \nFunding for this study: None \nAuthor Disclosures: \nAntonio Borzelli: Nothing to disclose \nFrancesco Amodio: Nothing to disclose \nFabio Corvino: Nothing to disclose \nFrancesco Pane: Nothing to disclose \nMilena Coppola: Nothing to disclose \nAndrea Paladini: Nothing to disclose \nFrancesco Giurazza: Nothing to disclose \nMattia Silvestre: Nothing to disclose \nRaffaella Niola: Nothing to disclose \n \nRPS 409-6 \nComparison of perfused volume segmentation based on cone-beam CT \nvs 99mTc-MAA SPECT/CT for treatment dosimetry before selective \ninternal radiation therapy using 90Y-glass microspheres \n*I. Hutuca*¹, M. Martin¹, A. Hocquelet², F. Debordeaux¹, L. Bordenave¹,  \nP. Papadopoulos¹, B. Lapuyade¹, H. Trillaud¹, J-B. Pinaquy¹; ¹Bordeaux/FR, \n²Lausanne/CH \n(ioana.hutuca@gmail.com) \n \nPurpose: Comparing the accuracy and reliability of the pre-treatment \ndosimetry predictions by cone-beam Computed Tomography (CBCT) versus \n99mTc-labeled macroaggregated albumin (MAA) SPECT/CT in selective \ninternal radiation therapy (SIRT) of hepatocellular carcinoma using 90Y-glass \nmicrospheres. \nMethods or Background: We have made a retrospective study of 15 patients \n(7 women and 8 men) with non-resectable hepatocellular carcinoma who \nunderwent a total of 17 SIRT procedures using 90Y-glass microspheres from \nDecember 2014 to June 2019. Pre-treatment dosimetry data were calculated \nfrom 99mTc-MAA SPECT/CT using either CBCT or 99mTc-MAA SPECT/CT to \nsegment the perfused volume, while post-treatment dosimetry data were \ncalculated using 90Y imaging (SPECT/CT or PET/CT). Intra-and interobserver \nreliabilities were evaluated by calculating Lin’s concordant correlation \ncoefficients (ȡc values). The biases between pre- and post-treatment dosimetry \ndata were investigated using the modified Bland–Altman method, and the \nsystematic bias was evaluated using Passing–Bablok regression. \nResults or Findings: Both methods showed good-to-excellent ( ȡc 0.80-0.99) \ninterobserver reliabilities. By comparing with 90Y imaging, the median \ndifferences were 5.8 Gy (IQR: í\u0014\u0015\u0011\u001a\u001e\u0003\u0014\u0019\u0011\u0014\f\u0003IRU\u0003'3/-CBCT and 5.6 Gy (IQR: \ní\u0014\u0016\u0011\u0019\u001e\u0003\u0014\u0013\u0011\u0015\f\u0003IRU\u0003'3/\u0003\u001c\u001cP -MAA SPECT/CT. The median differences were \n1.6 Gy (IQR: í\u0015\u001c\u001e\u0003\u001a\u0011\u0018\u0016\f\u0003IRU\u0003' \u0003- CBCT and 9.8 Gy (IQR: í\u0015\u001b\u0011\u0017\u001e\u0003\u0014\u001c\u0011\u001c\f\u0003IRU\u0003' - \n99mTc-MAA SPECT/CT. Passing–Bablok regression analysis showed that \nboth CBCT and 99mTc-MAA SPECT/CT had proportional biases and thus \ntendencies to overestimate DT and DPL at higher post-treatment doses. \nConclusion: CBCT is a reliable segmentation method, but it does not \nsignificantly increase the accuracy of dose prediction compared with that of \n99mTc-MAA SPECT/CT. Both methods tend to overestimate the doses to \ntumors and perfused livers at higher doses. \nLimitations: Retrospective, single-center study with a small number of \npatients. \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nPanteleimon Papadopoulos: Nothing to disclose \nIoana Hutuca: Nothing to disclose \nManuel Martin: Nothing to disclose \nHervé Trillaud: Nothing to disclose \nBruno Lapuyade: Nothing to disclose \nLaurence Bordenave: Nothing to disclose \nJean-Baptiste Pinaquy: Nothing to disclose \nArnaud Hocquelet: Nothing to disclose \nFrederic Debordeaux: Nothing to disclose \n \n \n \n \n \n \n \n \n \n \nRPS 409-8 \nPercutaneous renal cryoablation (PCA): association between tumour \ncomplexity scoring systems and outcomes \n*R. Ciabattoni*, S. Cernic, C. Marrocchio, G. Visalli, M. Rizzo, A. Piasentin,  \nF. Giudici, M. Bertolotto, M. A. A. Cova; Trieste/IT \n(ciabattoni.riccardo@gmail.com) \n \nPurpose: To evaluate the association between renal tumor complexity, \naccording to PADUA, RENAL and ABLATE score, and outcomes in a cohort of \npatients that underwent percutaneous cryoablation (PCA) \nMethods or Background: All patients who underwent PCA between 2012 and \n2020 for one or more clinically localized renal masses were included, \nregardless of the histology. PCA was performed by two radiologists with \nrespectively 13 and 30 years of experience in interventional radiology. Pre-\noperative imaging was evaluated by 2 radiologists to determine PADUA, \nRENAL and ABLATE score for each lesion, based on which the lesions were \nclassified as low-, moderate- or high-risk. The association between scores and \ntechnical success was evaluated for all lesions. Oncologic outcomes were \nevaluated assessing the rate of persistence or recurrence of malignant and \nuncharacterized lesions. Accuracy of scores was calculated using ROC \nanalysis. \nResults or Findings: The cohort included 174 treated lesions in 139 patients \n(M:98, F:41, mean age: 73 years) and a median follow up of 24,6 months. \nAccording to Padua score, 52 lesions were low risk (6-7), 64 moderate (8-9) \nand 58 high (>9); according to RENAL score, 69 were low risk (3-6), 93 \nmoderate (7-9) and 12 high (>9). Mean Ablate score was 3,8. Technical \nsuccess was achieved in 171/174 lesions, and only the RENAL score \napproached statistical significance (p=0,09) 23 patients had persistent or \nrecurrent disease. No statistically significant difference was observed in the \ntotal scores of each scoring system between lesions that persisted/recurred \nand lesions that did not recur. \nConclusion: None of the validated score is accurate to predict the risk of \nrecurrence. Therefore, it's necessary to develop a new score dedicated to \nablation procedures to predict successfully patients’ outcome. \nLimitations: Retrospective study \nEthics Committee Approval: Ethical approval was obtained \nFunding for this study: None \nAuthor Disclosures: \nStefano Cernic: Nothing to disclose \nMichele Bertolotto: Nothing to disclose \nMichele Rizzo: Nothing to disclose \nGianluca Visalli: Nothing to disclose \nFabiola Giudici: Nothing to disclose \nCristina Marrocchio: Nothing to disclose \nAndrea Piasentin: Nothing to disclose \nMaria Assunta A. Cova: Nothing to disclose \nRiccardo Ciabattoni: Nothing to disclose \n \nRPS 409-9 \nPercutaneous cryoablation of thoraco-abdominal soft tissue lesions: \nefficacy, safety and technical aspects \n*G. Castiello*, E. Faiella, G. Pacella, C. Altomare, B. B. Beomonte Zobel,  \nR. F. Grasso; Rome/IT \n(ge.castiello@gmail.com) \n \nPurpose: To evaluate efficacy, safety and local control of cryoablation \nprocedures for the treatment of recurrent or metastatic tumors in thoraco-\nabdominal soft tissues, analyzing the technical aspects. \nMethods or Background: 12 percutaneous cryoablation procedures in 10 \npatients, performed under ultrasound and/or CT-guidance for the treatment of \nthoraco-abdominal soft tissue lesions were retrospectively reviewed. Lesions \nincluded metastases from colorectal adenocarcinoma (n=3), lung squamous-\ncell carcinoma (n=1), lung small-cell carcinoma (n=1) and pancreatic \nadenocarcinoma (n=2), locally recurrent renal cell carcinoma (n=4) and \nseeding site of hepatocellular carcinoma (n=1). Efficacy of the treatment, \ncomplications rate and local control in terms of Disease-Free Survival (DFS) \nwere analyzed. \nResults or Findings: Mean age of patients was 68.7 years (range 58-81) and \nmean tumor size was 28.2 mm (range 9-53). Mean time of procedures was 65 \nminutes (range 30–110) with an average number of probes of 2.8 (range 1–5). \nHydro-dissection was performed during 6 of the 12 procedures (50%) to \nprotect surrounding anatomical structures. Mean ice-ball dimension, measured \non CT images at the end of procedures, was 48.2 mm (range 30-90). No major \ncomplications were observed except for one case of persistent pain in the \nablation site. Treatment was effective in 91.7% of the cases. Mean follow-up \nperiod was 7.9 months (range 1-12 months) with an average DFS of 6 months. \nConclusion: Although collection of further data is necessary, our experience \nsuggests that cryoablation procedure is a safe and efficacious option in \nselected cases of recurrent or metastatic tumors of thoraco-abdominal soft \ntissues. \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 254  \nLimitations: n/a \nEthics Committee Approval: All methods and procedures were carried out \nfollowing the ethical standards of the institutional research committee and \ncomplied with the 1964 Helsinki declaration. \nFunding for this study: None \nAuthor Disclosures: \nGennaro Castiello: Nothing to disclose \nBruno Beomonte Beomonte Zobel: Nothing to disclose \nRosario Francesco Grasso: Nothing to disclose \nEliodoro Faiella: Nothing to disclose \nGiuseppina Pacella: Nothing to disclose \nCarlo Altomare: Nothing to disclose \n \n \nResearch Presentation Session: \nInterventional Radiology \nRPS 509 \nInterventional radiology in cancer \ntreatment \nRPS 509-1 \nSurgical resection versus CT-guided percutaneous thermal ablation \nsurvival outcomes for stage I Non-Small Cell Lung Cancer (NSCLC):  \na systematic review and meta-analysis \n*R. Huo*, M. V. Chan, C. Cao, L. Ridley; Sydney/AU \n \nPurpose: Multiple cohort studies have compared surgical resection with CT-\nguided percutaneous thermal ablation for patients with Stage 1 non-small cell \nlung cancer (NSCLC), however the results have been heterogeneous. This \nsystematic review and meta-analysis aims  to compare the survival and disease \nfree survival (DFS) of surgery and percutaneous ablation for Stage 1 NSCLC. \nMethods or Background: A search of five databases was performed from \ninception to July 2020. Studies were included if survival outcomes were \ncompared between patients treated with CT-guided thermal ablation versus \nsurgical resection for Stage 1 NSCLC. \nResults or Findings: A total of eight studies were included, involving a total of \n708 patients. There were no significant differences in 1- to 5-year survival \nbetween surgery versus ablation. There was significantly better 1- and 2-year \nDFS for surgery over ablation, but not 3- to 5-year DFS. Subgroup analysis in \nStage 1A demonstrated no significant differences in 1- to 3-year survival or \nDFS between surgery versus ablation. There was no significant survival \ndifference between lobectomy and microwave ablation (MWA), but there was \nsignificantly better 1- and 2-year survival with limited resection versus \nradiofrequency ablation (RFA). \nConclusion: Surgical resection of Stage 1 NSCLC remains the optimal choice. \nHowever, for non-surgical patients with Stage 1A, CT-guided thermal ablation \nmay be an alternative which offers promising disease-free survival and overall \nsurvival. Future prospective randomised controlled trials are warranted. \nLimitations: Firstly, most studies were retrospective in nature, which contain \ninherent biases such as differences in the baseline patient and tumour \ncharacteristics between the two treatment groups. To minimise the risk of bias, \nmatched data was used when available. Secondly, there are only two studies \nthat specifically assessed MWA outcomes. \nEthics Committee Approval: Not required as systematic review \nFunding for this study: Not funding \nAuthor Disclosures: \nRuth Huo: Nothing to disclose \nMichael Vinchill Chan: Nothing to disclose \nChristopher Cao: Nothing to disclose \nLloyd Ridley: Nothing to disclose \n \nRPS 509-2 \nCT-Guided High-Dose-Rate Brachytherapy (CT-HDRBT) & combined \ntransarterial chemoembolisation with irinotecan-loaded microspheres vs. \nCT-HDRBT in patients with unresectable colorectal liver metastases \n*F. Busch*, S. A. Friedrich, M. Jonczyk, G. Wieners, G. Böning, A. Meddeb,  \nF. Collettini, B. Gebauer; Berlin/DE  \n(felix.busch@charite.de) \n \nPurpose: To compare outcome and toxicity profiles of mono-CT-HDRBT with a \ncombination therapy of irinotecan-TACE and CT-HDRBT in patients with \nirresectable colorectal liver metastases (CRLM). \nMethods or Background: This retrospective matched-pair-analysis included \n44 patients in 2 cohorts with irresectable CRLM, treated either with mono-CT-\nHDRBT or with a combination of irinotecan-TACE and CT-HDRBT in equal \nparts. Matching addressed clinical target volume (CTV), number of lesions, \ntarget dose, coverage and number of catheters per CT-HDRBT, age and sex. \nTime of local tumour control (LTC) and progression-free survival (PFS) were \nestimated using Kaplan-Meier-Method. Treatment toxicities were documented \nper National Cancer Institute Common Terminology Criteria for Adverse Events \n4.0. Catheter-related adverse events were documented per Society of \nInterventional Radiology classification. Statistical analysis included the \nShapiro-Wilk, the paired sample T- and the Wilcoxon test. p-values <0.05 were \nconsidered significant. \nResults or Findings: Combination therapy resulted in longer PFS (5/2 \nmonths; p=0.004) and higher LTC rates after 12 months (68%/23%; p=0.002) \ncompared to mono-CT-HDRBT. There are tendencies for longer LTC (17/9 \nmonths; p=0.052) and lower systemic progress rates after 12 months \n(64%/91% of patients; p=0.058) in patients undergoing combination therapy. \nNo catheter-associated major or minor complications occurred. AST, ALT and \ntheir toxicity levels showed significant higher increases after combination \ntherapy post-interventionally. Patients with monotherapy presented with a \nsignificantly higher increase in haemoglobin and total bilirubin toxicity levels. \nConclusion: The combination of irinotecan-TACE and CT-HDRBT shows \nlonger LTC and PFS compared to mono-CT-HDRBT in patients with non-\nresectable CRLM. Irinotecan-TACE combined with CT-HDRBT shows a \nsatisfying safety profile. \nLimitations: - retrospective cohort allocation of the group with mono-CT-\nHDRBT; monocentric treatment at Charité - University Medicine Berlin; limited \nnumber of 22 patients per cohort \nEthics Committee Approval: Ethics committee of Charité – University \nMedicine Berlin (EA1/043/15) \nFunding for this study: Charité – University Medicine Berlin \nAuthor Disclosures: \nGero Wieners: Nothing to disclose \nMartin Jonczyk: Nothing to disclose \nBernhard Gebauer: Nothing to disclose \nAymen Meddeb: Nothing to disclose \nStefanie Andrea Friedrich: Nothing to disclose \nFelix Busch: Nothing to disclose \nFederico Collettini: Nothing to disclose \nGeorg Böning: Nothing to disclose \n \nRPS 509-3 \nEfficacy and safety of PD1 inhibitor combined with TACE in the treatment \nof huge primary live cancer \n*S. Fang*, L. Zheng, F. Wu, W. Chen, Z. Zhao, J. Ji; Lishui/CN \n(fsj1216@163.com) \n \nPurpose: To investigate the efficacy and safety of PD1 inhibitor combined with \nTACE in the treatment of huge primary live cancer \nMethods or Background: From June 2016 to December 2019, the clinical \ndata of 31 patients with huge primary live cancer were collected and analyzed. \nThe patients were divided into the control group (n=18 cases) and the \ncombined group (n=13 cases). The patients were followed up and the adverse \nevents were observed. The DCR were compared. The median OS and PFS \nwere calculated. The expression of GPC3 was detected. \nResults or Findings: The DCR in combined group (53.8%) was higher than \nthat in control group (22.2%). The difference was statistically significant (Z= 㸫\n2.13, P=0.04). The median PFS in combined group was significantly longer \nthan that in control group (5.0 months vs. 3.0 months ,X2=4.39, P=0.04). The \nmedian OS in combined group was significantly longer than that in control \ngroup (15 months vs. 9 months,,X2=5.51, P=0.02). The median PFS of GPC3 \nnegative patients in combined group was higher than that in the control group \n(7 months vs. 5 months, X2=4.38, P=0.03). The incidence rate of rash in \ncombine group was higher than that in control group (23.1% vs. 0.0%, \n(P=0.01). \nConclusion: The combine PD1 inhibitors with TACE is an efficacy and safety \ntherapy for huge primary live cancer and the outcome of patients with GPC3 \nnegative is better than those with positive patients. \nLimitations: the defects inherent to type of retrospective study design. In \naddition, the limitation of the sample size of patients and the length of follow-up \nalso had a significant impact on the outcome. \nEthics Committee Approval: approved by the ethics committee of Lisui \nHospital, Zhejiang University, China \nFunding for this study: National Natural Science Foundation of China \n(81803778); Zhejiang Natural Science Foundation/exploration project Q \n(LQ20H160055) \nAuthor Disclosures: \nFazong Wu: Author: conducted all experiments, analyzed the data and wrote \nthe manuscript. \nShiji Fang: Speaker: conducted all experiments, analyzed the data and wrote \nthe manuscript, and designed the study and revise this manuscript. \nJiansong Ji: Author: designed the study and revise this manuscript. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 255  \nLiyun Zheng: Author: conducted all experiments, analyzed the data and wrote \nthe manuscript. \nWeiqian Chen: Author: conducted all experiments, analyzed the data and \nwrote the manuscript. \nZhongwei Zhao: Author: conducted all experiments, analyzed the data and \nwrote the manuscript. \n \nRPS 509-4 \nB-TARE in local advanced HCC patients: safety and feasibility \nP. Lucatelli, *C. Trobiani*, F. Cappelli, S. Ungania, G. E. E. Vallati; Rome/IT \n(Claudio.trobiani@gmail.com) \n \nPurpose: To evaluate safety and feasibility of balloon-occluded trans-arterial \nradioembolization (B-TARE) treatment in local advanced, unresectable, \nhepatocellular carcinoma (HCC) patients. \nMethods or Background: We treated 10 Child A patients with unresectable \nHCC (BCLC B) using balloon-occluded trans-arterial radioembolization. \nEvery patient underwent clinical and laboratory (Bilirubine, ALT, AST, GGT, \nINR, Platelets) monitoring to assess presence of intra- or periprocedural \ncomplications. Impact of balloon micro-catheter trans-arterial loco-regional \ntreatment was analyzed using 2D and 3D dosimetry in post-procedural \nSPECT. Early local efficacy was evaluated on 1- and 3-month follow-up \nmultiphasic computed tomography (CT) on the basis of m-RECIST criteria. \nResults or Findings: Technical success was obtained for all procedures and \nno major complications were observed. In 2D evaluation, the activity intensity \npeak was 987.5 (±393.8), that shows that a high amount of Y90-microspheres \nwas delivered to the lesion. Regarding 3D dose analysis (expression of \nAbsorbed Dose in Gy), the mean dose <D> administered to the treated lesions \nwas 151.6 (±53.2) with a low mean dose delivered to the normal liver (29.4 ± \n5.7). Complete response (CR) was obtained at 3-months follow up in 7 out of \n10 patients, with 2 Partial Response (PR) e 1 Stable Disease (SD). \nConclusion: In our preliminary experience B-TARE seems to be a safe and \neffective local therapeutic option for unresectable HCC lesions, showing a high \nrate of local response. \nLimitations: Small number of patients. \nEthics Committee Approval: Study was approved by our institutional ethics \ncommittees. \nFunding for this study: No funding was received for this work. \nAuthor Disclosures: \nPierleone Lucatelli: Nothing to disclose \nGiulio Eugenio Eugenio Vallati: Nothing to disclose \nClaudio Trobiani: Nothing to disclose \nSara Ungania: Nothing to disclose \nFederico Cappelli: Nothing to disclose \n \nRPS 509-8 \nHepatic hilar and celiac plexus nerve block as analgesia for doxorubicin-\neluting beads embolisation procedures for hepatocellular carcinoma \n*A. A. A. Bessar*; Zagazig/EG \n(ahmedawadbessar@gmail.com) \n \nPurpose: The aim of the present study was to assess hepatic hilar and celiac \nplexus nerve block as analgesia for doxorubicin-eluting beads embolization \nprocedures for hepatocellular carcinoma. \nMethods or Background: A total of 92 patients underwent their first \ntransarterial chemoembolization procedures with doxorubicin-eluting beads. \nPatients were grouped in two groups A and B. Patients in group A underwent \nhepatic hilar and celiac block procedures (HHCB group) and the control group \nB were referred as (sham group). All patients were diagnosed by CT or MRI \nand laboratory investigations. The study required a post-TACE follow-up for \nthree weeks. \nResults or Findings: Pain was significantly lower in group A than group B for \nfirst day and week. Regarding the doses for intra-arterial lidocaine injection, \ngroup B was significantly higher than group A. The oral morphine equivalent \nopioid dose in HHCB group was nearly the double dose in sham group. \nPatients in group A were satisfied more than group B patients. \nConclusion: Pre-procedural nerve block for hepatic hilar nerves and celiac \nplexus can result in lower intra-procedural and post-procedural pain in patients \nunderwent DEB-TACE procedures also result in lower opioid consumption and \nopioid related complications in the next few weeks following TACE. \nLimitations: 1- No data regarding the size of masses embolized to assess \nvolume of necrosis and it could be impossible to compare between degree of \npain and volume of necrosis in the tumor tissue. 2- We didn’t measure the \neffect of pre-operative preventive opioid treatment for our patients in improving \nthe severity of pain during and after TACE. \nEthics Committee Approval: This prospective, randomized, double-blind \nclinical trial was approved by the Committee of Institutional Review Board in \nZagazig University (IRB#: 6524-6-1-2019) \n \nFunding for this study: The study was funded by the national health \ninsurance system in Egypt. \nAuthor Disclosures: \nAhmed Awad Abdelaziz Bessar: Nothing to disclose \n \nRPS 509-10 \nChemosaturation with Percutaneous Hepatic Perfusion (CS-PHP) in \npatients with liver-dominant metastatic uveal melanoma: outcome and \nsafety analysis \n*C. Dewald*¹, L. S. Becker¹, S. K. Maschke¹, T. C. Meine¹, J. B. Hinrichs¹,  \nM. Kirstein², A. Vogel¹, B. C. Meyer¹, F. Wacker¹; ¹Hannover/DE, ²Lübeck/DE \n(dewald.cornelia@mh-hannover.de) \n \nPurpose: Chemosaturation percutaneous hepatic perfusion (CS-PHP) is a \npalliative treatment approach, which allows selective intrahepatic delivery of \nhigh dose melphalan while minimizing syst emic toxicity via filtration of the \nhepatic venous blood. Aim of this study was to assess safety, response and \nsurvival of CS-PHP in patients with liver-dominant metastatic uveal melanoma \n(UM). \nMethods or Background: Adverse events (AEs) were classified using \nCommon Terminology Criteria for Adverse Events (CTCAE) v5. Overall \nresponse rate (ORR) and disease control rate (DCR) were evaluated according \nto RECIST 1.1. Median overall survival (mOS), median progression-free \nsurvival (mPFS) and hepatic mPFS (mhPFS) were assessed using Kaplan-\nMeier estimation. \nResults or Findings: Overall, 70 CS-PHP were performed in 30 patients with \nmetastasized UM in a salvage setting (10/2014-01/2019). ORR and DCR were \n42.3% and 80.8%, respectively. Overall, mOS was 12 months (95% confidence \ninterval (CI) 7-15), mPFS was 6 months (95% CI 4-10) and mhPFS was 6 \nmonths (95% CI 4-13). AEs most frequently included significant hematologic \ntoxicities (87% of grade 3/4 thrombocytopenia), which were transient. Less \nfrequent AEs were hepatic injury extending to liver failure (3%) and \ncardiovascular events including one case of ischemic stroke (3%). \nConclusion: CS-PHP is an effective treatment in selected patients with liver-\ndominant metastasized UM. The interventional procedure is safe. Severe \nhepatic and cardiovascular AEs, albeit rare, demand careful patient selection. \nLimitations: Main limitation are the retrospective study design and the mono-\ncentric nature of the study. Complications might be underestimated, if they \noccurred after discharge. \nEthics Committee Approval: This retrospective was approved by the local \nethics committee. \nFunding for this study: Our institute received a grant from the developer of \nthe CS-PHP-specific catheter Delcath Systems Inc. Design, evaluation and \nresults of the study were not influenced by Delcath Systems Inc. \nAuthor Disclosures: \nTimo C. Meine: Nothing to disclose \nBernhard C Meyer: Nothing to disclose \nMartha Kirstein: Nothing to disclose \nArndt Vogel: Nothing to disclose \nCornelia Dewald: Nothing to disclose \nSabine Katharina Maschke: Nothing to disclose \nLena Sophie Becker: Nothing to disclose \nFrank Wacker: Nothing to disclose \nJan B Hinrichs: Nothing to disclose \n \nRPS 509-11 \nPercutaneous microwave ablation (MWA) of hepatocellular carcinoma \n(HCC): local tumour progression, survival and complication rate \n*T. J. Vogl*, H. Adwan, B. Panahi, T. Gruber-Rouh,  \nN-E. A. N-E. Mohammed; Frankfurt/DE \n(t.vogl@em.uni-frankfurt.de) \n \nPurpose: To retrospectively evaluate the efficacy of microwave ablation \n(MWA) in the therapy of hepatocellular carcinoma (HCC) using local tumor \nprogression, survival and complication rate. \nMethods or Background: In this study 235 patients (54 females, 181 males; \nmean: 66 years; range: 56-76 years) with 418 HCC lesions were treated using \nCT-guided MWA. They were evaluated according to location, diameter and \nvolume of HCC lesions, post ablation necrosis volume, used power, duration of \nablation, survival time, local tumor progression and complications. For \nevaluation of response to MWA treatment MRI was performed post ablation. \nResults or Findings: Pre ablation mean diameter of HCC lesions was 2.11 cm \nand mean volume was 4.75³. Mean post ablation necrosis volume was 31.51 \ncm³. Rate of local tumor progession was 5.1% (12/235). The 1-, 3- and 5-year \nsurvival rates were 93.4%, 72.5%, and 46.3%. Complication rate was 4.2% \n(10/235). Median survival time was 4.5 years. \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 256  \nConclusion: Percutaneous MWA is an effective and safe treatment method for \npatients with HCC with a long overall survival time, low local tumor progression \nand low complication rate. \nLimitations: Retrospective study design \nEthics Committee Approval: Approval of the ethical committee obtained \nFunding for this study: No funding \nAuthor Disclosures: \nBita Panahi: Nothing to disclose \nTatjana Gruber-Rouh: Nothing to disclose \nThomas J. Vogl: Nothing to disclose \nNour-Eldin Abdelrehim Nour-Eldin Mohammed: Nothing to disclose \nHamzah Adwan: Nothing to disclose \n \nRPS 509-12 \nLocal ablation therapy of pulmonary tumours: a retrospective analysis of \nfactors affecting the outcome \n*E. H. A. Emara*¹, E. Elhawash², B. Panahi³, N. N. N. Naguib³,  \nN-E. A. N-E. Mohammed³, T. J. Vogl³; ¹Kafr El Sheikh/EG, ²Alexandria/EG, \n³Frankfurt a. Main/DE \n(emademara85@yahoo.com) \n \nPurpose: To evaluate retrospectively the factors affecting the treatment \noutcome of microwave ablation of lung tumors (MWA). \nMethods or Background: 124 patients (average age 61.8 +/- 4.6 years, 59 \nman & 65 women) with 168 inoperable pulmonary lesions (41 primary, 127 \nmetastatic); tumor board decision was to perform CT-guided MWA. Initial CT \nassessment of lesions size, volume, outli nes, location in relation to hilum, \nvascular and bronchial structures followed by CT-guided MWA. Post-ablation \nfollow-up contrast enhanced CT was performed at 24 hours 3,6,9 12 months \nthen every 6 months to determine response to treatment. Certain parameters \nincluding the pre-ablation size and volume, lesion location in relation to lung \nhilum, pulmonary vessels or bronchial tree, pathological type and outlines of \nthe lesions are precisely evaluated and correlated with the follow up images \nand long-term treatment response. \nResults or Findings: 129 lesions (76.8%) showed complete response with no \nresidual activity while the rest (23.2%) showed incomplete response on follow \nup. Certain factors have been found and suggested as early predictors for the \nresponse including the maximum diameter of the lesion as well as its volume \nand location in relation to hilum with scientifically better response seen with \nperipherally located lesions less than 3 cm in diameter (p=0.019,0.026,0.037 \nrespectively). The pathological type and location of the lesion as well as its \nrelation the significant vessel or bronchus and outlines of lesions in the current \nstudy didn’t seem to affect the overall response (p=0.41,0.34,0.47,0.18 \nrespectively). \nConclusion: Pulmonary microwave ablation therapy is a safe effective \nminimally invasive therapeutic tool with the preablation tumor size, volume and \nlocation in relation to lung hilum are the main determinant of the treatment \nefficacy \nLimitations: Retrospective study- small number of patients \nEthics Committee Approval: Yes \nFunding for this study: No fund \nAuthor Disclosures: \nBita Panahi: Nothing to disclose \nNagy Naguib Naeem Naguib: Nothing to disclose \nThomas J. Vogl: Nothing to disclose \nNour-Eldin Abdelrehim Nour-Eldin Mohammed: Nothing to disclose \nElsayed Elhawash: Nothing to disclose \nEmad Hassan Ali Emara: Nothing to disclose \n \nRPS 509-13 \nConstruction of a novel radiomics nomogram for the prediction of \naggressive intra-segmental recurrence of HCC after radiofrequency \nablation \n*J. Ji*, X. Lv, M. Chen, G. Shu, C. Kong, S. Cheng, L. Zheng, S. Fang,  \nC. Chen; Lishui/CN \n(lschrjjs@163.com) \n \nPurpose: Construction of a Novel Radiomics Nomogram for the Prediction of \nAggressive Intra-segmental Recurrence of HCC after Radiofrequency Ablation \nMethods or Background: There were 22 patients with AIR and 36 patients \nwithout AIR enrolled in our study. MRI scans were performed before RFA and \nfollowed up for more than 6 months. The laboratory indicators and MRI \nfeatures were compared and assessed. Preoperative CE-T1WI were used for \nradiomics analysis. The selected clinical indicators and texture features were \nscreened out to generate the novel prediction nomogram. \nResults or Findings: Tumor shape, ADC Value, SI of DWI and ǻSI were \nselected as the independent factors of AIR. Meanwhile, two radiomics features \nwere selected&nbsp; by LASSO (p<0.05), which were further integrated with \nthe Rad-score to construct the predictive model, and AUCs were 0.941 (95% \nCI: 0.876-1.000) and 0.818 (95% CI: 0.576-1.000) in the training and validation \ncohorts, respectively. The AIR predictive model was further converted into a \nnovel radiomics nomogram, and decision curve analysis showed good \nagreement. \nConclusion: The predictive nomogram integrated with clinical factors and CE-\nT1WI -based radiomics signature could accurately predict the occurrence of \nAIR after RFA. \nLimitations: 1. The number of patients enrolled in this study was small. 2.The \ncurrent study was a single-center, retrospective study. \nEthics Committee Approval: The study was approved by the institutional \nreview board, human ethics committee of Lishui Hospital of Zhejiang \nUniversity, and the requirement for informed consent was waived. \nFunding for this study: The National Key Research and Development \nprojects intergovernmental cooperation in science and technology of China \n(No. 2018YFE0126900) Key projects jointly built by provincial and ministry of \nthe National Health Commission (No. WKJ-ZJ-1932) the Public Welfare \nTechnology Research Projects of Zhejiang Province (Nos. LGD19H160002 \nand LGF19H180009) the Research and Development projects of Lishui City \n(Nos. 2019ZDYF17 and 2019ZDYF09) \nAuthor Disclosures: \nMinjiang Chen: Nothing to disclose \nChunli Kong: Nothing to disclose \nShiji Fang: Nothing to disclose \nJiansong Ji: Nothing to disclose \nShimiao Cheng: Nothing to disclose \nLiyun Zheng: Nothing to disclose \nGaofeng Shu: Nothing to disclose \nXiuling Lv: Nothing to disclose \nChunmiao Chen: Nothing to disclose \n \nRPS 509-14 \nPrediction of tumour response via pretreatment MRI radiomics-based \nnomogram in hepatocellular carcinoma treated with transcatheter arterial \nchemoembolisation \n*C. Kong*; Lishui/CN \n \nPurpose: To develop and validate a pre-transcatheter arterial \nchemoembolization (TACE) MRI-based radiomics model for predicting tumor \nresponse in advanced hepatocellular carcinoma (HCC) patients. \nMethods or Background: 99 advanced HCC patients (69 for training cohort \nand 30 for validation cohort) with TACE treatment were enrolled. MRI \nexamination were performed before TACE, and the imageological examination \nwere performed 3 months after TACE to evaluate the efficacy according to the \nmRECIST criterion. A total of 396 radiomics features were extracted from T2-\nweighted images of pre-TACE, and least absolute shrinkage and selection \noperator (LASSO) regression was applied to feature selection and model \nconstruction. The performance of the model was evaluated by receiver \noperating characteristic curve (ROC), calibration curve, and decision curve. \nResults or Findings: The AFP value, Child-Pugh score and BCLC stage \nshowed statistical differences between the TACE response (TR) and non-\nTACE response (nTR) patients. Six radiomics features were selected by \nLASSO, which were further applied to calculate the Rad-score. The AUC of the \nROC based on Rad-score were 0.812 and 0.866 in the training and validation \ncohorts, respectively. To improve the diagnostic efficiency, the Rad-score was \nfurther integrated with the above clinical indicators to form a novel predictive \nnomogram. Results suggested that the AUC increased to 0.861 and 0.884 in \nthe training and validation cohorts. Decision curve analysis showed that the \nradiomics nomogram was clinically useful. \nConclusion: The radiomics and clinical indicators-based predictive nomogram \ncan well predict TR in advanced HCC, which can further be applied for \nauxiliary diagnosis of clinical prognosis. \nLimitations: The selection bias was inevitable because the study was a \nsingle-center, retrospective study. \nEthics Committee Approval: The institutional review board and human ethics \ncommittee of Lishui Hospital of Zhejiang University approved the study, and \nthe requirement for informed consent was waived. \nFunding for this study: None \nAuthor Disclosures: \nChunli Kong: Nothing to disclose \n \nRPS 509-15 \nRole of microwave ablation in the treatment of lung tumours \n*E. H. A. Emara*¹, H. M. Abdel-Rahman², S. S. Hegab², M. Abo Elez²,  \nT. J. Vogl³; ¹Kafr El Sheikh/EG, ²Zagazig/EG, ³Frankfurt/DE \n(emademara85@yahoo.com) \n \nPurpose: To evaluate prospectively the efficacy and safety of CT-guided \nmicrowave ablation in treatment of lung tumours with studying the effect pre-\nablation lesions characteristics on the treatment outcome. \nMethods or Background: This prospective study included 40 patients with 52 \nmalignant lung lesions, underwent CT-guided microwave ablation. All patients \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 257  \nwere subjected to complete clinical examination, pre-procedural laboratory \ninvestigations & imaging evaluation. Post ablation follow up by chest CT was \ndone after 24 hours, three, six, nine months, one year and every 6 months \nonwards to determine treatment response. Patients were either adequately \nablated (no residual tumor activity) or had local progression (residual tumor \nactivity). \nResults or Findings: 44 lesions (84.6%) showed complete response to \ntreatment and 8 lesions (15.4%) had local progression (residual activity). The \nmedian time to local tumor progression was 8.3 months. The median survival \nwas 32 months for patient underwent MWA according to the Kaplan-Meier test. \nThe overall survival rate at 1, 2, and 3 years was 97.5%, 90%, and 82.5%, \nrespectively. Successful tumor ablation was significantly more frequent for \nlesions with a maximal axial diameter of 3 cm or smaller (P =.0001). There \nwere no deaths during the procedure and the mortality rate within 6 months \nafter ablation was 0%. Early postablation complications included \npneumothorax (13.5%), pulmonary hemorrhage (9.6%) and postablation \nsyndrome (3.85%), Pleural Effusion (3.85%), Hemoptysis (3.85%). Manual \nevacuation was done in 3 cases out of 7 sessions complicated by \npneumothorax. No significant long-term complications were detected. \nConclusion: Percutaneous CT-guided microwave ablation therapy for \nmanagement of pulmonary tumors is safe and effective minimally invasive \noption and can improve local tumor control and survival rate in patients who \nare not candidate for surgical resection. \nLimitations: Small number of patients- heterogenicity of lung tumors \nEthics Committee Approval: Yes \nFunding for this study: No funding \nAuthor Disclosures: \nMona Abo Elez: Nothing to disclose \nHossam Mansour Abdel-Rahman: nothing to disclose \nThomas J. Vogl: Nothing to disclose \nSameh Saber Hegab: Nothing to disclose \nEmad Hassan Ali Emara: Nothing to disclose \n \nRPS 509-16 \nsABLATE: a simplified ABLATE score for the prediction of complications \nand outcome in percutaneous thermal ablation of renal lesions \n*P. Biondetti*, M. Papa, R. Colombo, A. M. Ierardi, G. Cardone, G. Carrafiello; \nMilan/IT \n \nPurpose: To evaluate the performance of a simplified-ABLATE score \n(sABLATE) in predicting complications and outcome in percutaneous thermal \nablation of renal lesions, when compared to RENAL, mRENAL and ABLATE \nscores. \nMethods or Background: This retrospective study included 136 renal lesions \nin 113 patients (M:F ratio=2.5; mean age 70.8 years). 98 tumors underwent \nablation at San Raffaele hospital between 01/2015 and 03/2020, 37 at San \nPaolo or Policlinico hospitals between 07/2016 and 03/2020. RENAL, \nmRENAL, ABLATE and sABLATE scores were calculated for each lesion using \npreprocedural imaging. Data regarding complications and follow-up were \nregistered. Mann-Whitney U test, ROC analyses, and logistic regression \nanalyses were used for complications. Cox-regression analyses were \nperformed for outcome \nResults or Findings: Mean diameter of renal tumors was 23.2mm. Mean and \nmedian RENAL, mRENAL, ABLATE and sABLATE scores were 6.8 and 7, 6.9 \nand 7, 5.3 and 5, and 3.5 and 3, respectively. During a mean follow-up of 21.9 \nmonths (range 1-73) we registered 7 complications, 3 cases of residual \ndisease and 10 of local tumor progression. Mann-Whitney U test p-values for \ncomplications for RENAL, mRENAL, ABLATE and sABLATE were 0.51, 0.49, \n0.66 and 0.05, respectively. ROC analyses for complications showed an AUC \nfor RENAL, mRENAL, ABLATE and sABLATE of 0.57, 0.57, 0.55 and 0.71 \nrespectively. Logistic regression failed to demonstrate significant associations \nbetween scores and complications. HR and p-values of Cox-regression \nanalyses were 1.30 and 0.36 for RENAL, 1.33 and 0.35 for mRENAL, 2.16 and \n0.01 for ABLATE, 2.29 and 0.004 for sABLATE. \nConclusion: sABLATE seems to perform better than the other scores in \npredicting complications, without reaching 5% significance. Both ABLATE and \nsABLATE were significantly associated with outcome, with sABLATE \ndemonstrating the best performance. \nLimitations: Retrospective nature \nEthics Committee Approval: IRB-approved with waiver of informed consent \nFunding for this study: None \nAuthor Disclosures: \nMaurizio Papa: Nothing to disclose \nAnna Maria Ierardi: Nothing to disclose \nPierpaolo Biondetti: Nothing to disclose \nRoberta Colombo: Nothing to disclose \nGianpiero Cardone: Nothing to disclose \nGianpaolo Carrafiello: Nothing to disclose \n \n \nRPS 509-17 \nNeutrophil to lymphocyte ratio predicts local tumour progression-free \nsurvival after microwave ablation of hepatocellular carcinoma \n*A. Della Corte*, F. Ratti, D. Grippaldi , S. Gusmini, F. Cipriani, L. Aldrighetti,  \nF. De Cobelli; Milan/IT \n(dellacorte.angelo@hsr.it) \n \nPurpose: To evaluate the short- and long-term oncological outcome of \nMicrowave Ablation (MWA) of HCC. Technique-, nodule- and disease-related \nfeatures, as well as inflammatory markers were analyzed. \nMethods or Background: From November 2014 to September 2020, 106 \npatients (155 tumors) underwent MWA with a 2450Hz/100W generator \n(Emprint, Medtronic) with percutaneous or intraoperative approaches. Data \nwere collected regarding amount of delivered energy, technical approach, \ntumor size and location, Child-Pugh class, hepatitis etiology, multifocality, \nprevious treatments for HCC. Inflammatory markers (neutrophil/lymphocyte \nratio [NLR]) were collected pre-, post-operatively, upon patient discharge and \non first follow-up visit. Endpoints were local tumor progression-free survival \n(LTPFS) and intrahepatic progression-free survival (IHPFS). \nResults or Findings: 94 patients (121 nodules) satisfied inclusion criteria for \nanalysis (technique efficacy, follow-up •6 months), with median follow-up of 19 \nmonths (range 6-55 months). LTP occurred in 26 tumors (21.5%). At univariate \nanalysis, risk factors for LTP included NLR1stFU (HR=1.24, p=0.004), \nǻNLRPREOP-1stFU (HR=1.23 p=0.001), percutaneous approach (HR=3.3 \n,p=0.05), previous TACE (HR=2.24, p=0.046) Child-Pugh B (HR=3.08, \np=0.025). Upon multivariate analysis, independent predictive factors of LTP \nwere ǻNLRPREOP-1stFU (HR=1.63 ,p=0.04) and Child-Pugh B (HR=7.56, \np=0.002). IHP occurred in 51 patients (54.3%). At univariate analysis, risk \nfactors for IHP were subcapsular location (HR=1.82, p=0.036) and multifocality \n(HR=1.96, p=0.021). \nConclusion: Disease characteristics and inflammatory status seem to \ninfluence local recurrence more than technique- and nodule-related features. \nOur data support the role of inflammation in development of LTP after MWA, \nas NLR change in response to ablation was an independent predictive factor. \nInflammatory markers do not seem to play a role on distant hepatic recurrence. \nLimitations: More data are required to define the exact mechanisms of action \nof post-ablation immune response. \nEthics Committee Approval: Retrospective study approved by Institutional \nBoard. \nFunding for this study: No funding was received for this study. \nAuthor Disclosures: \nAngelo Della Corte: Nothing to disclose \nLuca Aldrighetti: Nothing to disclose \nSimone Gusmini: Nothing to disclose \nFederica Cipriani: Nothing to disclose \nFrancesco De Cobelli: Nothing to disclose \nDaniele Grippaldi: Nothing to disclose \nFrancesca Ratti: Nothing to disclose \n \n \nResearch Presentation Session: \nMusculoskeletal \nRPS 310 \nTrauma in MSK \nRPS 310-1 \nPrimary arthrodesis versus open reduction and internal fixation based on \nclinical outcome and 2D and 3D geometrical analyses obtained from \nweight-bearing cone-beam CT images \n*R. Wellenberg*, N. Baboeram, F. Sanders, I. Dobbe, G. Streekstra,  \nT. Schepers, M. Maas; Amsterdam/NL  \n(r.h.wellenberg@amsterdamumc.nl) \n \nPurpose: The purpose of the study was to compare primary arthrodesis versus \nopen reduction and internal fixation (ORIF) based on clinical outcome and 2D \nand 3D geometrical analyses obtained from weight-bearing (WB) cone-beam \nCT images. \nMethods or Background: In this prospective study, 40 patients with surgically \ntreated calcaneal fractures were included, consisting of 20 primary arthrodesis \nand 20 ORIF patients. WB cone-beam CT-images of the left and right hindfoot \nand forefoot were acquired on a Planmed Verity cone-beam CT-scanner with a \nminimum of one-year follow-up. Hindfoot and forefoot images were fused using \nstitching software. Automated 2D and 3D geometric analyses, i.e. calcaneal \npitch and Meary’s angle were obtained for injured and healthy feet. Clinical \noutcomes were measured using the EQ5D and FFI questionnaires. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 258  \nResults or Findings: Baseline criteria of patients undergoing arthrodesis or \nORIF did not differ, apart from age (p<0.005). Calcaneal pitch and Meary’s \nangle were not statistically different between healthy feet of arthrodesis and \nORIF patients in both 2D and 3D. In 2D, calcaneal pitch of the injured foot was \nlower in arthrodesis patients (10.9° ± 4.5) compared to ORIF patients (13.8° ± \n5.6) (p<0.001). Meary’s angle in 2D was lower in the injured foot in arthrodesis \npatients (7.0° ± 5.8) compared to ORIF patients (15.5° ± 5.9) (p=0.046). In 3D, \nno statistical differences were found between both groups for both \nmeasurements. Clinical outcomes were not statistically different between both \ngroups. \nConclusion: Three-dimensional WB CT imaging enables functional 2D and 3D \nanalyses under natural load in patients with complex calcaneal fractures. \nBased on clinical outcome and geometrical analyses both primary arthrodesis \nand ORIF appear viable treatment options. \nLimitations: Manual bone segmentation, limited follow-up period. \nEthics Committee Approval: Medical ethical approval was obtained \n(METC2019_038). \nFunding for this study: Funding was received from Amsterdam Movement \nSciences. \nAuthor Disclosures: \nFay Sanders: Nothing to disclose \nTim Schepers: Nothing to disclose \nMario Maas: Nothing to disclose \nRuud Wellenberg: Nothing to disclose \nIwan Dobbe: Nothing to disclose \nGeert Streekstra: Nothing to disclose \nNigel Baboeram: Nothing to disclose \n \nRPS 310-2 \nPosterior extraarticular ischiofemoral impingement can be caused by the \nlesser and the greater trochanter in patients with increased femoral \nversion \n*T. D. Lerch*¹, F. Schmaranzer¹, I. Todorski¹, S. Steppacher¹, K. Siebenrock¹, \nM. Tannast²; ¹Bern/CH, ²Fribourg/CH  \n(till.lerch@insel.ch) \n \nPurpose: Posterior extraarticular hip impingement has been described for hips \nwith increased femoral version (FV). These patients can present clinically with \nlack of external rotation (ER) and extension and with a positive posterior \nimpingement test. We evaluated patient-specific 3D-CT and asked whether \nrange of motion (ROM) and location of osseous posterior intra-and \nextraarticular impingement differ between hips with increased FV and a control \ngroup using patient-specific 3D-CT. \nMethods or Background: Osseous 3D-models based on 3D-CT scans were \nreconstructed of 52 hips(38 symptomatic patients) with positive posterior \nimpingement test and increased FV(>35°). They were mainly female patients \n(96%) with a mean age ranging from 23 to 38 years. These included 26 hips \nwith an increased McKibbin instability index>70, while 21 hips had isolated \nincreased FV(>35°). The control group consisted of 20 hips with normal FV, \nnormal AV and no valgus(CCD-angle<139°). Segmentation of the hip joint was \nperformed using segmentation software AMIRA. Validated 3D-CT based \ncollision-detection software for impingement-simulation was used to calculate \nimpingement-free ROM and location of hip impingement. \nResults or Findings: Hips with increased FV had significantly(p<0.001) \ndecreased extension and ER in 90° of flexion compared to the control group. \nPosterior impingement was located(92%) extraarticular in hips with increased \nFV. Posterior hip impingement occurred between the ischium and the lesser \ntrochanter in 20° of extension and 20° ER. Impingement was located between \nthe ischium and the greater trochanter or intertrochanteric area in 20° of flexion \nand 40° ER \nConclusion: 3D CT enables patient-specific diagnosis of posterior \nextraarticular hip impingement. Posterior hip impingement can be caused by \nthe lesser and the greater trochanter or the intertrochanteric region. 3D-CT can \nhelp for surgical planning such as femoral derotation osteotomy and/or hip \narthroscopy. \nLimitations: Only osseous impingement \nEthics Committee Approval: Yes \nFunding for this study: None \nAuthor Disclosures: \nTill Dominic Lerch: Nothing to disclose \nInga Todorski: Nothing to disclose \nFlorian Schmaranzer: Nothing to disclose \nSimon Steppacher: Nothing to disclose \nMoritz Tannast: Nothing to disclose \nKlaus Siebenrock: Nothing to disclose \n \n \n \n \n \nRPS 310-3 \nUSG and MRI imaging of rotator cuff tears with surgical correlation \n*V. Rustagi *; Mumbai/IN \n(drvikashrustagi@gmail.com) \n \nPurpose: To compare the diagnostic efficacy of ultrasound and MRI in the \ndetection of rotator cuff tears with surgical findings (arthroscopy or open \nsurgery) as a gold standard. To describe the distribution of rotator cuff tears in \nterms of age, gender, symptomatology, and associated abnormalities among \nthe study population. \nMethods or Background: Prior ultrasound screening was done for every \npatient who came for MRI shoulder1.5T with clinical suspicion of rotator cuff \ntear. Of 75 patients who were diagnosed with a rotator cuff tear, only those 56 \nwere included in the study group in whom arthroscopy/open surgery \nconfirmation was available. \nResults or Findings: STATISTICAL ANALYSIS: Univariate analysis \nprocessed by Windostat Version 9.2 was used to correlate ultrasound and MRI \nfindings of rotator cuff tears with surgical (arthroscopy/open surgery) findings \nby using the Chi-Square and t-test. Sensitivity, specificity, positive, and \nnegative predictive values were calculated. Sensitivity, specificity, positive and \nnegative predictive values of USG is 0.8919, 0.8947, 0.9429, 0.8095 and of \nMRI is 0.9459, 1.0000, 1.0000, 0.9048 respectively \nConclusion: Among the cases, dominant arm, increasing age, male gender, \nand history of trauma were commonly associated with rotator cuff tears. Also, \nglenohumeral joint effusion, bursal effusion, degenerative changes were \ncommonly seen associated with rotator cuff tears. Among young individuals, \ntrauma was the common causative factor, and in elderly degenerative \nchanges. From the present prospective study of 56 patients following \ninferences were drawn MRI (sensitivity-0.9459, specificity-1.00) is more \nsensitive and specific than USG (sensitivity-0.8919, specificity 0.8947) for \ndetecting rotator cuff tears. \nLimitations: There were a few limitations. \nEthics Committee Approval: Yes \nFunding for this study: by Insititute \nAuthor Disclosures: \nVikash Rustagi : Speaker: TNMC and BYL Nair Charitable Hospital, Mumbai \n \nRPS 310-4 \nFast field echo resembling a CT using restricted echo-spacing \n(FRACTURE): a novel MRI technique with superior bone contrast \n*H. Alizai*, B. Johnson, M. Dempsey; Dallas, TX/US \n \nPurpose: Objective. Computerized tomography (CT) is the modality of choice \nfor imaging bone, however, it utilizes ionizing radiation and suffers from poor \nsoft-tissue contrast. Unlike CT, magnetic resonance imaging (MRI) provides \nexcellent soft-tissue contrast but is limited in its ability to image bone. The \nobjective of this study is to describe a new technical innovation that provides \nsuperior cortical and trabecular bone contrast on MRI. \nMethods or Background: FRACTURE (FFE Resembling A CT Using \nRestricted Echo-spacing), a 3D gradient echo pulse sequence with restricted \necho-spacing combined with an automated post-processing is described. \nResults or Findings: Cases demonstrating the application and utility of this \ntechnique in diagnostic MRI performed for traumatic, inflammatory, neoplastic, \nand developmental conditions in pediatric patients are presented. \nConclusion: The cortical and trabecular bone contrast generated by \nFRACTURE yields clinically relevant information for diagnosis and \nmanagement of a subset of patients in whom it may potentially obviate the \nneed for a pre-operative CT scan. \nLimitations: This is a technical report with a small number of cases presented. \nEthics Committee Approval: Local IRB approval was obtained. \nFunding for this study: Not applicable. \nAuthor Disclosures: \nHamza Alizai: Nothing to disclose \nBrian Johnson: Employee: Philips Healthcare \nMolly Dempsey: Nothing to disclose \n \nRPS 310-5 \nIs MRI or CT more accurate in diagnosing Chopart joint injuries? \n*R. Janssen*, S-R. Yang, S. Manneck, S. Eiden, F. Amsler, J. E. Gehweiler,  \nA. Hirschmann; Basel/CH \n(ru1jans2@gmail.com) \n \nPurpose: Is MRI or CT more accurate in diagnosing Chopart joint injuries? \nMethods or Background: Twenty-two patients (mean age 43.7±14 years) \nwere included after an acute Chopart joint injury. MRI and CT were \nretrospectively assessed by three radiologists. On CT avulsion fractures of the \nChopart joint ligament insertions were evaluated. On MRI ligament integrity \nwas assessed as follows: spring, plantar, bifurcate, dorsal calcaneocuboid and \ndorsal talonavicular ligaments . The McNemar-test was used to assess \nstatistical differences (p<0.05). Kappa ( ୁ) statistics were used to evaluate \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 259  \ninterrater agreement including 44 control patients without a history of recent \nChopart-joint trauma. \nResults or Findings: There was no difference in the detection of avulsion and \nfull thickness tear between CT and MRI (p=0.125-1.000). On MRI full-thickness \ntears were seen in 45% (10/22) at the dorsal calcaneocuboid ligament and \ndorsal talonavicular ligament, and in 50% (11/22) at the bifurcate ligament. \nAlthough the spring ligament was affected in 45% there was only one full \nthickness tear of the medioplantar oblique component. No complete tear of the \nplantar ligaments were seen. On CT avulsions of the ligaments were detected \nin 45% (10/22) at the dorsal calcaneocuboid and the bifurcate, in 27% (6/22) at \nthe dorsal talonavicular and in 9% (2/22) at the plantar ligaments. With \nexception of the plantar ligaments (CT ୁ, -0.038-0.482; MR ୁ, 0.313-0.579), \ninterrater agreement was marginally higher on CT ( ୁ, 0.616-1.00) than MRI \n(0.295-0.776). \nConclusion: No significant difference in the detection of Chopart-joint injuries \non CT or MRI could be found. MRI may be useful in detecting associated \ninjuries of the spring ligament complex. \nLimitations: Time interval between injury, CT and MRI varied and already \nhealed lesions may have been evident. \nEthics Committee Approval: Institutional review board approval was waived \nfor this retrospective study. \nFunding for this study: Unfunded. \nAuthor Disclosures: \nSchu-Ren Yang: Nothing to disclose \nJulian Emanuel Gehweiler: Nothing to disclose \nSebastian Manneck: Nothing to disclose \nAnna Hirschmann: Nothing to disclose \nRuben Janssen: Nothing to disclose \nFelix Amsler: Nothing to disclose \nSebastian Eiden: Nothing to disclose \n \nRPS 310-6 \nHigh-resolution ultrasound of the anterior talofibular ligament \ncomponents: normal anatomy and pathologic findings in sprained ankles \n*S. Sanguinetti*¹, F. Zaottini¹, R. Picasso¹, F. Pistoia¹, M. Pansecchi¹, L. Tovt¹, \nM. Miguel-Pérez², C. Martinoli¹; ¹Genova/IT, ²Barcelona/ES \n \nPurpose: The anterior talofibular ligament (ATFL) consists of two distinct \ncomponents: a thicker superior band that lies underneath the capsule, a \nthinned inferior band, extraarticular and connected to the calcaneofibular \nligament. The aim of this study was to evaluate the US appearance of the \nabove fascicles and to describe their abnormalities in sprained ankles. \nMethods or Background: Latex injection of the two ATFL components from \nn=10 fresh-frozen unembalmed cadaveric specimens was performed under US \nguidance to determine whether US is accurate to localize the two components. \nThe number and thickness of the ATFL bands were then recorded by three \nreaders in a series of n=20 healthy volunteers. Lastly, n=20 consecutive \npatients (age range, 25-54yrs) who underwent an ATFL inversion injury were \nevaluated. US was performed with matrix 24-8MHz US technology. Micro- and \novert lateral ankle instability was measured blindly by an orthopedic surgeon. \nResults or Findings: Cadaveric correlation showed the ATFL as single-\nbanded (n=1), double-banded (n=8) or triple-banded (n=1). In double-banded \nATFL, the superior band was twice wider and thicker than the inferior band. In \nhealthy volunteers, the ATFL components were visualized with substantial \nagreement among readers (k=0,78). In the patients' group, the most common \ninjury patterns affected the two components (65%) or the superior fascicle \n(35%). A higher degree of lateral ankle instability was observed in double \nbanded tears. \nConclusion: High-resolution US is accurate to depict the ATFL components in \nnormal and pathologic states. \nLimitations: None \nEthics Committee Approval: The study was conducted in accordance with \nthe declaration of Helsinki. \nFunding for this study: None \nAuthor Disclosures: \nFederico Zaottini: Nothing to disclose \nCarlo Martinoli: Nothing to disclose \nLuca Tovt: Nothing to disclose \nMaribel Miguel-Pérez: Nothing to disclose \nMichelle Pansecchi: Nothing to disclose \nSara Sanguinetti: Nothing to disclose \nRiccardo Picasso: Nothing to disclose \nFederico Pistoia: Nothing to disclose \n \n \n \n \n \n \n \nRPS 310-7 \nRole of diffusion tensor imaging in anterior cruciate ligament injury: a \ncase control study \n*A. M. R. Khalil*, R. S. Aboukhadra; Tanta/EG \n(lolo20-12-1986@hotmail.com) \n \nPurpose: The purpose of this study was to evaluate quantitively the role of DTI \nto delineate ACL fibres by using a 1.5T MRI unit for grading of ACL injury. \nMethods or Background: DTI of the knee was done (bௗ=ௗ0, 400, and 800 \ns/mm2, 10 diffusion directions, repeated 16 times for a total of 336 diffusion Ǧ\nweighted volumes) was performed at 1.5Tesla MRI unit for 30 patients and 20 \npersons (control group). Fractional anisotropy (FA), mean diffusivity (MD), axial \ndiffusivity (AD), and radial diffusivity (RD) were calculated within the ACL \nfibres. After image acquisition, tractography was performed by two \nindependent trainee radiologists (of 15 years and 10 years’ experience in \nMusculoskeletal imaging respectively) \nResults or Findings: Out of 30 patients in cases group; 13 patients (43.3%) \nhad low grade tear of ACL fibres and 17 patients (65.6%) had high grade tear \nof ACL fibres. Another control group (n=20) was included in the study for \ncomparison. FA (r = −0.87, P < 0.05) and apparent diffusion coefficient (ADC) \n(r = 0.82, P < 0.05) were significantly correlated with the severity of ACL \ninjuries. The area under the curve values for differentiation between low and \nhigh-grade ACL injuries with FA and ADC were 0.972 and 0.961, respectively. \nNo significant differences in FA and ADC between grades I and II ACL injuries \nor in ADC between grades III and IV, but there were significant differences in \nFA and ADC between two grades and between control group and different ACL \ninjury grades.(P < 0.05). \nConclusion: DTI had important role in quantitative assessment and grading of \nACL injuries. \nLimitations: No limitations for this study \nEthics Committee Approval: The study was approved by the research ethical \ncommittee of Tanta University (23451/3/10) \nFunding for this study: No funding for the study \nAuthor Disclosures: \nAlaa Mohammed Reda Khalil: Nothing to disclose \nRania Sobhi Aboukhadra: Nothing to disclose \n \n \nResearch Presentation Session: \nMusculoskeletal \nRPS 410 \nBone and muscle tumours \nRPS 410-1 \nRole of dynamic contrast enhanced magnetic resonance imaging in \ndifferentiating benign bone tumours and tumour like conditions from \nmalignant bone tumours \n*V. Jirankali*¹, P. Aggarwal², S. K. Garg², R. Kundu²; ¹Ballari/IN, \n²Chandigarh/IN  \n(vivekjirankali@gmail.com) \n \nPurpose: To evaluate the usefulness of Dynamic Contrast Enhanced Magnetic \nResonance Imaging in differentiating benign bone tumours and tumour like \nconditions from malignant bone tumours. \nMethods or Background: Patients referred from Orthopaedic OPD to the \ndepartment of Radiodiagnosis for MRI of the lesion in bone on x-ray, \nsuspicious of a tumour/tumour like condition were taken into study. Sample \nsize is 100. Dynamic Contrast Enhanced Magnetic Resonance Imaging (DCE-\nMRI) was done. Pattern of enhancement of curves (Time intensity curves) were \nassessed which were classified into five types. \nResults or Findings: 18/42 (43%) benign bone tumours showed type 2 curve, \n14/42 (33%) benign bone tumours showed type 4 curve and 10/42 (24%) \nbenign tumours showed type 3 curve. 52/58 (90 %) malignant bone tumours \nshowed type 3 curve, 4/58 (7 %) malignant tumours showed type 4 curve and \n2/58 (3 %) malignant tumour showed type 2 curve. Association is statistically \nsignificant (p value < 0.001). Twenty-six malignant tumours revealed rapid \nearly enhancement followed by a plateau phase (type 3 curve). A sensitivity of \n89.7 % and specificity of 76.2 % was noted when this parameter was used to \ndifferentiate benign bone tumours and tumour like conditions from malignant \nbone tumours. Positive predictive value, Negative predictive value and total \npredictive values are 83.9 %, 84.2 % and 84 % respectively. \nConclusion: DCE-MRI is highly sensitive and specific with good overall \naccuracy in differentiating benign tumours and tumour like conditions from \nmalignant bone tumours. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 260  \nLimitations: The quantitative parameters of DCE-MRI were not evaluated in \nour study and only qualitative study was done - assessing the pattern of \nenhancement (type of curve). \nEthics Committee Approval: Institutional ethics committee approval was \nobtained. \nFunding for this study: n/a \nAuthor Disclosures: \nSudhir Kumar Garg: Nothing to disclose \nReetu Kundu: Nothing to disclose \nPurnima Aggarwal: Nothing to disclose \nVivek Jirankali: nothing to disclose \n \nRPS 410-2 \nLong-term diagnostic value of MRI in detecting recurrent aggressive \nfibromatosis at two multidisciplinary sarcoma centres \n*S. Sedaghat*¹, M. Both¹, O. Jansen¹, B. Reichardt²; ¹Kiel/DE, ²Essen/DE  \n(samsedaghat1@gmail.com) \n \nPurpose: To assess the diagnostic accuracy of MRI in detecting recurrent \naggressive fibromatosis (AF) during long-term follow-up at two multidisciplinary \nsarcoma centers. \nMethods or Background: Seventy-nine patients from two sarcoma centers \nwere included in this IRB-approved study and were examined postoperatively \nusing 1.5-T MRI. MRI follow-up scans were reviewed for true-positive/-negative \nand false-positive/-negative results. Available pathological reports and MRI \nfollow-ups were set as reference. \nResults or Findings: The median age of the patients was 38.1±15.3 years. Of \nthe patients 26.6% showed recurrent AF lesions. The most common \nlocalizations of AF were the axilla/shoulder (n=15) and the thigh (n=11). From \n498 postoperative MRI follow-ups, 24 true-positive, 16 false-positive, 6 false-\nnegative, and 452 true-negative MRI follow-ups were identified. The overall \nsensitivity and specificity for detecting recurrent AF was 80% and 97%, \nrespectively. There was no significant difference in the diagnostic accuracy at \nthe two sarcoma centers. All false-negative results were found in small lesions. \nFalse-positive results mostly mimicked streaky (n=9) and small ovoid/nodular \n(n=5) lesions. The configuration of recurrent AF was significantly most often \nfascicular (50%; p=0.001-0.005). \nConclusion: MRI shows a high long-term diagnostic value in detecting AF \nrecurrences. Nevertheless, radiologists should pay close attention when \nlesions are small, as they may remain undetected. Although the configuration \nof recurrent AF is most often fascicular, recurrences may also appear in \ndifferent shapes. \nLimitations: The main limitation of our study is the retrospective design.  \nIn many patients in whom biopsy was not performed, MRI follow-ups were set \nas reference. \nEthics Committee Approval: The study was approved by the local \ninstitutional review board (IRB). \nFunding for this study: None. \nAuthor Disclosures: \nSam Sedaghat: Nothing to disclose \nMarcus Both: Nothing to disclose \nBenjamin Reichardt: Nothing to disclose \nOlav Jansen: Nothing to disclose \n \nRPS 410-4 \nAccuracy of clinical diagnosis, imaging and biopsy in hand tumours and \npseudotumours \n*F. Ruiz Santiago*, A. Martinez Martinez, J. Garcia Espinosa,  \nA. J. Lainez Ramos-Bossini; Granada/ES \n(ferusan12@gmail.com) \n \nPurpose: To present the experience in our institution in the management of \ntumors and pseudo-tumors of the hand and to review the utility of different \nimaging methods in their diagnosis. \nMethods or Background: 150 patients with pathological or microbiological \ndiagnosis by surgery (n = 100) and/or core needle biopsy (n = 48), or puncture-\ndrainage (25) were included. Of these 150 cases, 18 proved to be infectious, \nmetabolic or inflammatory processes, and 132 were diagnosed as tumours or \npseudo-tumours of the hand (85 from soft tissues and 47 from the bone). The \naccuracy of clinical and imaging diagnosis was evaluated, considering a \n\"correct diagnosis\" if the final pathological/microbiological diagnosis had been \nincluded among the differential diagnoses of the radiology or clinical report, \nrespectively. \nResults or Findings: The overall accuracy for each approach was: 25.3 % \nclinical, 71.9 % US, 81.8 % MRI, 87% CT, and 47.9% radiography. For soft \ntissue masses, the overall accuracy was: 35.3% clinical, 72.4 % US, 78.1 % \nMRI, 63.6% CT, and 25.0% radiography. For bone tumours: 4.2% clinical, \n66.7% US, 89.2% MRI, 94.3 % CT, 83.0% radiography. A core needle biopsy \nwas performed in 48 cases (39 US-guided and 9 CT-guided), with 32 true \npositives, 2 false negatives and 14 true negatives for tumour conditions. The \noverall diagnostic accuracy of biopsies was 95.8 %, 94.1% in soft tissue \nmasses and 100% in bone tumours. \nConclusion: Imaging outperforms clinical diagnosis in terms of accuracy and \nshould be mandatory before any interventional procedure. Imaging-guided \nbiopsy is an efficient complementary technique when doubts persist about the \nnature or malignancy of the tumor. \nLimitations: This is a retrospective study but intended to reflect real-world \nclinical practice. \nEthics Committee Approval: This study was approved by the local ethics \ncommittee (code TFG-EITM-2020). \nFunding for this study: No funding \nAuthor Disclosures: \nFernando Ruiz Santiago: Nothing to disclose \nJade Garcia Espinosa: Nothing to disclose \nAlberto Martinez Martinez: Nothing to disclose \nAntonio Jesus Lainez Ramos-Bossini: Nothing to disclose \n \nRPS 410-5 \nSystematic analysis of post-treatment soft-tissue oedema and seroma on \nMRI in 177 sarcoma patients \n*S. Sedaghat*, O. Jansen, M. Both; Kiel/DE \n(samsedaghat1@gmail.com) \n \nPurpose: To assess post-treatment subcutaneous edema, muscle edema, and \nseroma in MRI after soft-tissue sarcoma (STS) resection with regard to muscle \ninvolvement of STS and therapy. \nMethods or Background: 177 patients were included and received 1.5-T MRI \nfollow-up after treatment. Posttreatment changes were classified according to \ntype of therapy (therapy 1-surgery; therapy 2-surgery with radiation therapy) \nand primary tumor localization in soft tissue (localization 1, subcutaneous \ntissue; localization 2, muscle involvement). Subcutaneous and muscle edema \nwere divided into three grades: grade 0, no edema; grade 1, low-to moderate \nedema; and grade 2, high-grade edema. \nResults or Findings: After therapy 1 of a sarcoma in localization 1, patients \nsignificantly more often showed low-grade subcutaneous tissue edema and an \nabsence of muscle edema (p < 0.001) than high-grade edema. The risk for \ngrade 2 subcutaneous tissue and muscle edema significantly increased with a \ntumor in localization 2 (RR = 2.58, p = 0.016 and RR = 15, p = 0.0065/RR = \n2.05 , p = 0.021, respectively) and after therapy 2 (RR = 15, p = 0.0087 and \nRR = 2.05, p < 0.0001, respectively). Of the patients with sarcoma in \nlocalization 2, 88% developed grade 2 muscle edema after therapy 2; 40% of \nthe patients developed post-treatment seroma. The risk for seroma is \nsignificantly higher after surgery and radiation therapy than after surgery alone \n(p < 0.001). \nConclusion: High-grade postoperative subcutaneous and muscle edema are \nsignificantly associated with muscle involvement of primary STS both in \npatients with and without radiation therapy. The risk for seroma is significantly \nhigher after surgery with additional radiation therapy than after surgery alone. \nLimitations: The retrospective design is the main limitation of the current \nstudy. \nEthics Committee Approval: The study was approved by the responsible \nEthics Committee. \nFunding for this study: None. \nAuthor Disclosures: \nSam Sedaghat: Nothing to disclose \nMarcus Both: Nothing to disclose \nOlav Jansen: Nothing to disclose \n \nRPS 410-6 \nMagnetic resonance and ultrasound imaging findings of soft tissue \nlesions referred to a tertiary sarcoma centre: a pictorial review \n*A. Mermekli*, R. Chowdhury, R. Mansour; Oxford/UK \n \nPurpose: The aim of this presentation is to demonstrate the variety of soft \ntissue lesions, which are referred to a tertiary sarcoma centre and to correlate \ntheir Magnetic Resonance Imaging (MRI) and Ultrasound (US) characteristics. \nMethods or Background: All US guided soft tissue biopsies, which were \nperformed during 12 months , via the dedicated sarcoma clinic pathway, were \nanalysed. The respective MRI and US images were reviewed, as well as their \nhistopathology reports. \nResults or Findings: 146 US guided soft tissue biopsies were performed in \none year via the dedicated sarcoma clinic service. The biopsied lesions \nincluded malignant and benign causes, such as high grade sarcoma (15.7%), \nmetastases (7.5%), vascular malformations (6.2%), infection/inflammation \n(5.5%), fibrous/fibrofatty tissue (5.5.%), low grade myxoid tumours (5.5%), \nlipomata (3.4%), schwannomas (3.4%), endometriosis (2.7%), epidermoid \ncysts (2%) and several more. \nConclusion: We review the imaging characteristics of the biopsied lesions, \nwith a view to increasing the diagnostic accuracy and reducing the number of \npotentially unnecessary biopsies for benign causes. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 261  \nLimitations: Review of a larger sample may provide us with a greater variety \nof lesions and be more representative of our diagnostic yield. \nEthics Committee Approval: Not applicable. \nFunding for this study: Not applicable. \nAuthor Disclosures: \nRamy Mansour: Nothing to disclose \nRajat Chowdhury: Nothing to disclose \nAsimenia Mermekli: Nothing to disclose \n \nRPS 410-7 \nDiffusion-weighted MRI radiomics classification of spinal bone tumours \n*F. Serpi*, S. Gitto, M. Bologna, I. Emili, D. Albano, C. Messina, V. Corino,  \nL. Mainardi, L. M. Sconfienza; Milan/IT \n(francesca.serpi@unimi.it) \n \nPurpose: The objective of this study was to classify spine bone tumors using \ndiffusion \nMethods or Background: This local ethics committee-approved retrospective \nstudy included 101 patients with histology-proven bone tumor of the spine (22 \nbenign; 38 primary malignant; 41 metastatic). All tumor volumes were manually \nsegmented by a radiology resident experienced in musculoskeletal and \noncologic imaging on morphologic T2-weighted sequences. The same region \nof interest (ROI) was used to perform radiomic analysis on apparent diffusion \ncoefficient (ADC) map. A total of 1702 radiomic features was considered. \nFeature stability was assessed through small geometrical transformations of \nthe ROIs mimicking multiple manual delineations. Intraclass correlation \ncoefficient (ICC) quantified feature stability. Feature selection consisted of \nstability-based (ICC>0.75) and significance-based selections (ranking features \nby decreasing Mann-Whitney p-value). Class balancing was performed to \noversample the minority (i.e. benign) class. Selected features were finally used \nto train and test a support vector machine (SVM) to discriminate benign from \nmalignant spine tumors using 10-fold cross validation. \nResults or Findings: A total of 76.4% radiomic features were stable. The \nquality metrics for the SVM were evaluated as a function of the number of \nselected features. The radiomic model with the best performance and the \nlowest number of features for classifying tumor types included 8 features. The \nmetrics were 78% sensitivity, 68% specificity, 76% accuracy, and AUC 0.78. \nConclusion: SVM classifiers based on radiomic features extracted from T2- \nand diffusion-weighted imaging with ADC map are promising for classification \nof spine bone tumors. Radiomic features of spine bone tumors show good \nreproducibility rates. \nLimitations: Sample size. \nEthics Committee Approval: Due to the retrospective nature of this study, \nspecific informed consent was waived. \nFunding for this study: This research received no external funding. \nAuthor Disclosures: \nValentina Corino: Nothing to disclose \nLuca Mainardi: Nothing to disclose \nIlaria Emili: Nothing to disclose \nCarmelo Messina: Nothing to disclose \nSalvatore Gitto: Nothing to disclose \nLuca Maria Sconfienza: Nothing to disclose \nMarco Bologna: Nothing to disclose \nFrancesca Serpi: Nothing to disclose \nDomenico Albano: Nothing to disclose \n \n \nResearch Presentation Session: \nMusculoskeletal \nRPS 510 \nBone density and muscle mass \nRPS 510-1 \nDecreased muscle mass can predict worse outcome in COVID-19 \npatients: a retrospective multicentre study \n*S. Schiaffino*¹, D. Albano¹, A. Cozzi¹, C. Messina¹, C. Bnà², A. Carriero³,  \nA. Vanzulli¹, F. Sardanelli¹, L. M. Sconfienza¹; ¹Milan/IT, ²Brescia/IT, ³Novara/IT  \n(schiaffino.simone@gmail.com) \n \nPurpose: To investigate the potential association between muscle mass status \nretrieved from chest CTs and clinical outcomes (i.e. intensive care unit [ICU] \nadmission and death) in COVID-19 patients. \nMethods or Background: Clinical data, CT findings and clinical outcomes \nwere retrospectively retrieved for COVID-19 patients who underwent chest CT \non admission in four hospitals in Northern Italy from February 21 to April 30, \n2020. Pulmonary involvement, mediastinal lymphadenopathy, pleural effusion, \nattenuation and cross-sectional areas of paravertebral muscles on axial CT \nimages at T5 and T12 vertebral level were assessed. Associations between \nvariables in predicting ICU admission or death were investigated through \nmultivariate linear regression. Binary logistic regression was used to obtain a \npredictive model, including odds ratio (OR) calculation. Performance of these \nmodels in predicting outcomes was assessed by applying them to both a \ntraining and test set, using receiver operating characteristic curve (ROC) \nanalysis. \nResults or Findings: We included 552 patients (364 men; median age 65 \nyears, IQR 54–75). Muscle area at T5 level (OR=4.50; P<.001), pleural \neffusion (OR=3.00; P=.040), and lung involvement extent (OR=2.12; P<.001) \nwere the best predictors of ICU admission (AUC 0.79 in training and 0.75 in \ntest set). Muscle area at T5 level (OR=2.26; P=.005), male sex (OR=2.24; \nP=.012), and lung involvement extent (OR=1.61; P=.001) were the best \npredictors of death (AUC was 0.82 in training and 0.82 in test set). \nConclusion: Decreased muscle mass assessed through CT exams performed \nat emergency department admission is an independent predictor of ICU \nadmission and death in COVID-19 patients. \nLimitations: Retrospective study; high disease prevalence and disease \nseverity during the study period; incomplete data for part of the patients. \nEthics Committee Approval: Approval from the Ethics Committee of each \ninstitution was obtained. \nFunding for this study: Partially supported by the Italian Ministry of Health. \nAuthor Disclosures: \nAndrea Cozzi: Nothing to disclose \nClaudio Bnà: Nothing to disclose \nFrancesco Sardanelli: Advisory Board: Bracco Advisory Board: Bayer Advisory \nBoard: GE Healthcare \nSimone Schiaffino: Speaker: GE Healthcare \nAngelo Vanzulli: Nothing to disclose \nCarmelo Messina: Nothing to disclose \nLuca Maria Sconfienza: Nothing to disclose \nAlessandro Carriero: Nothing to disclose \nDomenico Albano: Nothing to disclose \n \nRPS 510-2 \nShort-term precision error of bone strain index, a new DXA-based finite \nelement analysis software for hip strength assessment \n*S. Tortora*, M. Acquasanta , E. Carlicchi, D. Albano, L. M. Sconfienza,  \nC. Messina; Milan/IT  \n \nPurpose: Bone Strain Index (BSI) is a new finite element analysis (FEA) tool \napplied to hip dual energy X-ray absorptiometry (DXA) scans. Aim of this study \nis to assess the short-term precision error of BSI on the proximal femur, both \non a phantom and patients. \nMethods or Background: We followed the International Society for Clinical \nDensitometry guidelines followed for short-term precision error assessment. \nWe performed DXA measurements on an anthropomorphic femur phantom \nthat was scanned twice for 30 times, for a total of 60 scans. For patients' study, \n30 subjects were scanned twice. BSI precision error was compared to that of \nbone mineral density (BMD). \nResults or Findings: BSI reproducibility was lower compared to that of BMD \nboth for the in-vivo and phantom study, as the precision error of BSI resulted \nthree times higher compared to that of BMD. For the in-vivo study, the highest \nprecision was found at total femur (TF) BMD (CoV = 1.36%, reproducibility = \n96.22%), while the lowest value of precision was found for femoral neck (FN) \nBSI (CoV = 4.17%, reproducibility = 88.46%). For phantom measurements, the \nhighest precision value was that of TF BMD (CoV = 0.63%, reproducibility = \n98.24%), while the lowest precision was that of FN BSI (CoV = 3.08%, \nreproducibility = 91.48%). Reproducibility at TF was always better compared to \nthat of the FN. \nConclusion: BSI precision error was about three times higher compared to \nBMD, confirming previous results of lumbar spine BSI. The main source of \nvariability of this new software is supposed to be related to patient positioning. \nLimitations: Heterogeneous patient group in terms of age, BMD and T-score \nvalues. \nEthics Committee Approval: Not needed. For patients' study all scans were \nperformed during the periodic institutional precision error calculation. \nFunding for this study: None \nAuthor Disclosures: \nMarzia Acquasanta: Nothing to disclose \nEleonora Carlicchi: Nothing to disclose \nCarmelo Messina: Nothing to disclose \nLuca Maria Sconfienza: Nothing to disclose \nSilvia Tortora: Nothing to disclose \nDomenico Albano: Nothing to disclose \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 262  \nRPS 510-3 \nUse of the fragility score measured at the femoral neck for the prediction \nof fragility incident fractures \n*F. A. Lombardi*, P. Pisani, D. Ciardo, M. Di Paola, F. Conversano,  \nS. Casciaro; Lecce/IT \n(fiorella@ifc.cnr.it) \n \nPurpose: The Fragility Score (FS), calculated by Radiofrequency Echographic \nMulti Spectrometry (REMS) technology, estimates skeletal fragility regardless \nof bone mineral density (BMD). It is a dimensionless parameter from 0 to 100, \nproportional to the degree of fragility (Measurement 2017;101:243–249). This \nstudy evaluates the effectiveness of FS in identifying patients at risk for \nincident osteoporotic femoral fracture (OP-FF), and compares the FS \nperformance with T-score ones. \nMethods or Background: REMS and DXA scans of the femoral neck were \nperformed in women aged between 30 and 90 years. The incidence of fragility \nfemoral fractures was assessed during a 5-year follow-up. The ability of the FS \nto identify patients with incident OP-FF was evaluated and compared with the \nperformance of T-scores obtained with DXA and REMS. \nResults or Findings: 414 women completed the follow-up (median 40 months, \ninterquartile range (IQR): 36-57 months). Of these, 22 patients had an incident \nOP-FF during follow-up. The median FS for patients with and without an \nincident OP-FF were 25.3 (IQR: 21.0-33.0) and 42.8 (IQR: 30.4-54.7), \nrespectively, and the difference was statistically significant (p<0.001). Also \nREMS T-score were lower in patients with incident OP-FF (median value -2.5, \nIQR: -2.8 to -1.8) than in patients without incident OP-FF (median value -1.8 \nIQR: -2.4 to -1.2), with p-value=0.013, and similarly for DXA T-score values (-\n2.1 (IQR: -3.0 to -1.5) versus -1.7 (IQR: -2.4 to -1.2), respectively, p-\nvalue=0.033). At ROC curve analysis, the area under the curve (AUC) for FS \nwas 0.80, statistically significantly higher than the REMS T-score AUC (0.65) \nand DXA T-score AUC (0.63). \nConclusion: The FS obtained from REMS femoral scans is an effective tool \nfor identifying the risk of femoral fracture, with performance superior than the T-\nscore’ ones. \nLimitations: None. \nEthics Committee Approval: Approved. \nFunding for this study: None. \nAuthor Disclosures: \nFrancesco Conversano: Nothing to disclose \nSergio Casciaro: Nothing to disclose \nDelia Ciardo: Nothing to disclose \nFiorella Anna Lombardi: Nothing to disclose \nMarco Di Paola: Nothing to disclose \nPaola Pisani: Nothing to disclose \n \nRPS 510-4 \nMuscle involvement in a familiar form of tubular aggregates myopathy: \ncomparison between radiologic and radiomic analysis \nA. Lupi, *A. Favero*, S. M. Tripodi, C. Giraudo, E. Pegoraro, R. Stramare; \nPadua/IT \n(alessandrofavero6@gmail.com) \n \nPurpose: Congenital myopathies are a heterogeneous group of diseases \naffecting the skeletal muscles and characterized by high clinical, genetic and \nhistological variability. In this scenario, magnetic resonance (MR) is becoming \nincreasingly important, leading to the identification of the pathognomonic \npatterns and to the assessment of disease progression at follow-up. The aim of \nthis study is to evaluate the MR pattern of a mutation responsible for tubular \naggregates myopathy (TAM) and to determine if radiomics may identify \nprogression of disease. \nMethods or Background: A family affected by TAM with the histologically \nproven autosomal dominant mutation of the STIM1 gene, was examined. All \npatients underwent two pelvic girdle and lower limbs MR assessment (i.e. A \nand B, the latter after 5 years): twenty-two muscles were evaluated for \nmuscular fatty replacement applying the modified Mercuri scale on the T1w \nimages, and for edema with a four-points score (absent=0,low=1,moderate=2, \nsevere=3) on the STIR images, to determine muscle involvement and disease \nprogression. All dataset was extracted by two raters and inter-rater reliability \nwas calculated. Moreover, 58 radiomic features were collected (i.e. using \n3DSlicer) and t-test was performed to analyze differences between A and B \nMR (p<0.05). \nResults or Findings: Six patients with TAM STIM1-mutation were included \n(three males and three females). Coehn's k showed substantial agreement \nbetween the two raters. In the T1w sequences, all patients showed widespread \ninvolvement (median value of the Mercuri score=2) and progression, while \nmuscle oedema mainly affected the muscles of the legs and it was of low \ngrade (median value of the score=1) and stable at follow-up. Two radiomic \nfeatures showed statistically significant differences between A and B MR \nassessments. \nConclusion: Muscle MR and radiomics are valid tools to map muscle \ninvolvement and disease progression in STIM1 patients. \nLimitations: Further analysis are needed to confirm these results. \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nAmalia Lupi: Nothing to disclose \nSilvia Maria Tripodi: Nothing to disclose \nRoberto Stramare: Nothing to disclose \nAlessandro Favero: Nothing to disclose \nChiara Giraudo: Nothing to disclose \nElena Pegoraro: Nothing to disclose \n \nRPS 510-5 \nMyosteatosis is a potential indicator to predict the risk of transition to \nsevere disease in COVID-19 patients \n*X. Yi*, W. Liao; Changsha/CN \n(yixiaoping@csu.edu.cn) \n \nPurpose: To evaluate whether myosteatosis can serve as an indicator for \npredicting the risk of transition to severe disease before admission among \npatients with COVID-19. \nMethods or Background: A total of 234 laboratory-confirmed COVID-19 \npatients with initial common subtype disease at admission, with 31 of which \ndeveloped to severe status during hospitalization, were retrospectively \nrecruited between January 21th 2020 and February 19th 2020 from six \ndesigned hospitals (H1-6) in Hunan province, China. Myosteatosis features \nwas evaluated based on initial routine chest CT at the level of twelfth thoracic \nvertebra. The myosteatosis nomogram was constructed by multivariable \nlogistic regression. The performance of the nomogram was evaluated by \ndiscrimination, calibration curve, and decision curve. \nResults or Findings: The myosteatosis features, including SM-RA and \nPSMFI_score fitted by PSMFI, age and gender, were significantly associated \nwith transition risk (P<0.01 for both training and validation cohorts). The \ncombination nomogram based on SM-RA, PSMFI_score and clinical model \n(CRP, SPO2 and CKP), showed better discrimination with an AUC of 0.85 \n[95% CI, 0.75~0.95] (and 0.84 [95% CI, 0.71 to 0.97]in validation cohort, when \ncomparing to clinical model (0.75 in training vs. 0.74 in validation cohort). \nFavorable clinical utility was observed using decision curve analysis. \nConclusion: The myosteatosis nomogram developed in the present study \nprovided an individualized prediction of transition risk to severe disease and \nhelped decision making and guidance of intensive treatment for COVID-19 \npatients. \nLimitations: Retrospective nature of the study \nEthics Committee Approval: Xiangya hospital, central south university. IRB#: \n202002019 \nFunding for this study: None \nAuthor Disclosures: \nWeihua Liao: Nothing to disclose \nXiaoping Yi: Nothing to disclose \n \nRPS 510-6 \nMR-based Proton-Density Fat Fraction (PDFF) differentiates between \npatients with and without osteoporotic vertebral fractures \n*F. T. Gassert*, F. G. Gassert, Y. N. Leonhardt, S. Kronthaler, B. J. Schwaiger, \nJ. S. Kirschke, T. Baum, D. C. Karampinos, A. Gersing; Munich/DE \n \nPurpose: To evaluate the diagnostic value of bone marrow Proton-Density Fat \nFraction (PDFF) in patients with and without osteoporotic vertebral fractures \nand to assess whether PDFF values are a useful tool to differentiate between \nosteoporotic and traumatic vertebral fractures. \nMethods or Background: Overall, 52 patients were included in this study \n(mean age 67.5±12.9 years, 34 women) of which 32 patients presented with \none or multiple vertebral fractures of the lumbar spine (66.4±14.4y, 20 women). \nThese patients were frequency-matched for age and sex to patients without \nvertebral fractures (n=20, 69.3±10.1 years, 14 women). Bone mineral density \n(BMD) values were derived from quantitative CT. Patients were categorized \ninto a normal BMD group (BMD>120g/cm3) and an osteopenic/osteoporotic \ngroup (BMD<120g/cm3). A six-echo 3D spoiled gradient-echo sequence was \nacquired at 3T. Chemical shift encoding-based water-fat separation was \nperformed considering a single T2* decay and PDFF maps were calculated. \nFractured vertebrae were excluded. Associations between fracture status and \nPDFF values were assessed using multivariate linear regression models \nadjusting for age, sex and BMD. \nResults or Findings: Over all patients, there was a significant correlation \nbetween the mean PDFF and BMD (r=-0.664, P<0.001), suggesting high PDFF \nin patients with low BMD. In the osteopenic/osteoporotic group, those patients \nwith osteoporotic fractures had a significantly higher PDFF than those without \nosteoporotic fractures (adjusted mean difference [95% confidence interval] \nbetween groups: 0.20 [0.13, 0.27]; P<0.001). In patients with vertebral \nfractures, those with traumatic fractures had a significantly lower mean PDFF \nthan those with osteoporotic vertebral fractures (P<0.001). \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 263  \nConclusion: MR-based PDFF values may serve as a biomarker for \nosteoporosis. PDFF enables a differentiation between patients with and without \nosteoporotic vertebral fractures and may be useful for the differentiation \nbetween osteoporotic and traumatic vertebral fractures. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nBenedikt Jakob Schwaiger: Nothing to disclose \nFlorian Tilman Gassert: Nothing to disclose \nAlexandra Gersing: Nothing to disclose \nJan S Kirschke: Nothing to disclose \nFelix Gerhard Gassert: Nothing to disclose \nThomas Baum: Nothing to disclose \nSophia Kronthaler: Nothing to disclose \nDimitrios C. Karampinos: Nothing to disclose \nYannik Niklas Leonhardt: Nothing to disclose \n \nRPS 510-7 \nSarcopenia as a predictor of semi- and intensive care unit hospitalisation \nin COVID-19 patients \nC. Giraudo, *G. Fichera*, G. Librizzi, E.  Balestro, A. Cattelan, P. Navalesi,  \nA. Vianello, R. Stramare; Padua/IT \n(gfichera90@gmail.com) \n \nPurpose: To evaluate if sarcopenia, assessed with Computed Tomography, is \na predictor of semi- (SICU) and intensive care unit (ICU) hospitalization in \nCOVID-19 patients. \nMethods or Background: We retrospectively evaluated patients with COVID-\n19 treated in our tertiary center from March to August 2020 who underwent an \nunenhanced chest CT scan during the first three weeks of hospitalization. We \ncollected the mean Hounsfield Unit (Hu) value of the right paravertebral muscle \nat the level of the 12th thoracic vertebra using a 2 cm region of interest. \nInformation regarding the unit of hospitalization considering SICU/ICU and \ncovid-19 wards were separately recorded. We used the odds/ratio (OR) to \nassess if sarcopenia, defined as Hu values <30, is a predictor of SICU/ICU \nadmission. The Fisher’s exact and the student’s tests were respectively applied \nto evaluate if any difference regarding gender and age occurred between \npatients with and without sarcopenia (p<0.05). \nResults or Findings: Seventy-six patients were examined (28 females; mean \nage±SD 61.5±14 years old); 56 treated in covid-19 wards and 17 in SICU/ICU. \nEight out of twenty-four patients with sarcopenia were hospitalized in \nSICU/ICU. Patients with sarcopenia showed a higher risk of SICU/ICU \nadmission (OR= 2.389, CI 0.786 – 7.263). Patients with muscle loss were \nsignificantly older (71.5±10 vs 56.9±13.5 years old, p=0.00) whereas there was \nno statistically significant difference for gender between patients with and \nwithout sarcopenia (p=1.00). \nConclusion: According to our preliminary results, sarcopenia can be \nconsidered a predictor of SICU/ICU hospitalization in patients with COVID-19. \nFurther analyses including a larger sample are expected to fully assess this \nevidence and evaluate if sarcopenia may even contribute to the distinction of \nthe level of required intensive care (i.e., SICU or ICU). \nLimitations: n/a \nEthics Committee Approval: Yes \nFunding for this study: n/a \nAuthor Disclosures: \nGiulia Fichera: Nothing to disclose \nAndrea Vianello: Nothing to disclose \nRoberto Stramare: Nothing to disclose \nElisabetta Balestro: Nothing to disclose \nChiara Giraudo: Nothing to disclose \nPaolo Navalesi: Nothing to disclose \nAnnamaria Cattelan: Nothing to disclose \nGiovanni Librizzi: Nothing to disclose \n \nRPS 510-8 \nPrecision and repeatability of lumbar spine and proximal femur bone \nmineral density evaluated using ultrasound REMS technology \n*C. Messina*, S. Gitto, S. Rapisarda, A. Corazza, D. Albano, L. M. Sconfienza; \nMilan/IT \n(carmelomessina.md@gmail.com) \n \nPurpose: Several quantitative ultrasound methods for a non-ionizing diagnosis \nof osteoporosis have been developed. Radiofrequency Echographic Multi \nSpectrometry (REMS) is a recent ultrasound technology that allows for the \nevaluation of bone density on both lumbar spine (LS) and proximal femur \n(FEM). REMS technology assesses a new parameter, the ultrasound-BMD \n(US-BMD), which is expressed as grams/cm2. Our aim is to determine the \nshort-term intra-operator precision of US-BMD and its short-term inter-operator \nrepeatability. \nMethods or Background: US-BMD was evaluated on LS (L1-L4) and FEM by \nusing a dedicated ultrasound device (EchoStation, Echolight Spa, Lecce, Italy), \nequipped with a 3.5 MHz convex transducer. Lumbar scans were performed \nusing longitudinal scans with the probe positioned under the sternum (scanning \ntime 80 seconds); femur scans were performed with longitudinal scans \nshowing the head and neck of the hip (40 seconds). Short-term intra-operator \nprecision and inter-operator repeatability were calculated root-mean-square \ncoefficient of variation (RMS-CV) and least significant change (LSC) for a 95% \nconfidence level, according to the International Society for Clinical \nDensitometry (ISCD) official positions. Inclusion criteria were: caucasian \nethnicity, age 30–90 y, BMI < 35 kg/m2. \nResults or Findings: A total of 36 postmenopausal women were included in \nthis study. Intra-operator precision expressed as RMS-CV was 0.48% for \nlumbar spine and 0.31% for femoral neck (LSC values of 1.33% and 0.87%, \nrespectively). Inter-operator repeatability (RMS-CV) was 0.55% for lumbar \nspine and 0.53% for femoral neck (LSC values of 1.52% and 1.47% \nrespectively). \nConclusion: US-BMD assessed with REMS can be used to precisely monitor \nBMD. Ongoing studies will focus on the evaluation of US-BMD accuracy \ncompared to that of dual energy x-ray absorptiometry, still the gold standard for \nosteoporosis assessment. \nLimitations: Single-center-study \nEthics Committee Approval: Approved by local Ethics Committee; informed \nconsent obtained by all subjects. \nFunding for this study: Echolight-Spa \nAuthor Disclosures: \nAngelo Corazza: Nothing to disclose \nCarmelo Messina: Nothing to disclose \nSalvatore Gitto: Nothing to disclose \nLuca Maria Sconfienza: Equipment Support Recipient: Echolight Spa \nSanti Rapisarda: Nothing to disclose \nDomenico Albano: Nothing to disclose \n \nRPS 510-11 \nThe clinical importance of bone marrow adipose tissue ratio on sacroiliac \nMRI: a comprehensive study with bone mineral density \nN. Hürsoy, *E. B. Çetin*; Rize/TR \n \nPurpose: Osteoporosis imaging has critical importance in determining risks for \nfractures and monitoring response to treatment. Studies have focused on bone \nquality and showed that bone marrow adiposity linkage with bone health by \nusing conventional and advanced MR imaging techniques such as MR \nspectroscopy and perfusion. However, for routine clinical practice, these \nmethods are not useful. Hence, we aimed to evaluate bone mineral density's \nassociation with bone marrow adipose tissue with a qualitative technique. \nMethods or Background: The patients who had both sacroiliac magnetic \nresonance imaging and the dual-energy X-ray absorptiometry (DEXA) scan \nfrom 2016 to 2020 were listed retrospectively. DEXA results were recorded as \nnormal, osteopenia, and osteoporosis. A specialized musculoskeletal \nradiologist detected the T1-Weighted axial MR slices on S1 -2 level without the \nknowledge of the DEXA measurements. The images were evaluated to \nwhether the fat deposits cover more than fifty percent of the bone area \nsubjectively. \nResults or Findings: 121 patients with six men (%5) and 115 women (%95) \nwith a mean age of 54.4±10.7 years were included. There was a statistically \nsignificant difference in the sacrum's bone marrow adipose tissue deposition \namong bone marrow density measurements (p = 0.011). Patients with \nosteopenia and osteoporosis had higher bone marrow adipose tissue rates \nthan those whose T-scores were normal. \nConclusion: Radiologists should examine sacroiliac joint MR images in terms \nof bone marrow changes and indicate osteoporosis risk in their reports. The \nmethod that we have proposed allows radiologists and clinicians to know about \nbone mineral density in routine practice and contributes to preventing and \nreducing osteoporosis-related complications. \nLimitations: The number of patients and lack of clinical data \nEthics Committee Approval: This study was carried out in accordance with \nthe World Medical Association Declaration of Helsinki. \nFunding for this study: 0 \nAuthor Disclosures: \nEda Beykoz Beykoz Çetin: Author: Observer \nNur Hürsoy: Author: Observer \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 264  \n \nResearch Presentation Session: \nMusculoskeletal \nRPS 610 \nImaging of the joints \nRPS 610-1 \nPelvic venous congestion on sacroiliac MRI: its prevalence and \nassociation with sacroiliitis \n*Ü. Aydingöz*, A. E. Yıldız, G. Aghayeva, D. ømre, F. B. Ergen; Ankara/TR  \n(ustunaydingoz@yahoo.com) \n \nPurpose: Pelvic venous congestion (PVC) can cause chronic pelvic pain, \nwhich might mimic inflammatory back pain from sacroiliitis. We aimed to \ndetermine the prevalence of PVC on sacroiliac MRI and its association with \nsacroiliitis. \nMethods or Background: This retrospective cross-sectional observational \nstudy covered sacroiliac MRI examinations performed for chronic inflammatory \ntype back back pain at our institution of all females •15 and <45 years of age \nduring a 48-month period. Images were reviewed for active and/or chronic \nsacroiliitis (according to ASAS [Assessment of SpondyloArthritis international \nSociety] criteria) and the presence of PVC. PVC criterion was •4 ipsilateral \ntortuous dilated parauterine veins, at least one of which measuring •6 mm in \ndiameter. Exclusion criteria included studies suboptimal for diameter \nmeasurement and featuring pregnancy, hysterectomy and malignant pelvic \nmass(es). \nResults or Findings: A total of 794 females (mean age, 32.1 years) were \nincluded. PVC was identified in 64 patients (prevalence, 8.1%; mean age, 33.3 \nyears; age range, 20௅44). Sacroiliitis was detected in 253 patients (prevalence, \n31.9%; mean age, 32.2 years; age range, 15 ௅44). Active and/or chronic \nsacroiliitis was present in 21 (32.8%) of patients with PVC, and 232 patients \n(31.8%) without PVC (P=0.889). In patients with PVC, mean parauterine vein \ndiameters were 7.1 mm and 7.4 mm (range, 6 ௅12 mm, and 6௅11 mm) in \nsubgroups without and with sacroiliitis, respectively (P=0.385). \nConclusion: Found in 8.1% of fertile-aged females, PVC on sacroiliac MRI is \nindependent of the presence of active and/or chronic sacroiliitis. PVC needs to \nbe mentioned in the sacroiliac MRI report as a differential or additional \ndiagnostic possibility in female patients at fertile age. \nLimitations: Retrospective study; therefore menopause status, parity \ninformation and exact duration of chronic back pain symptoms were not \navailable in all patients. \nEthics Committee Approval: Yes \nFunding for this study: None \nAuthor Disclosures: \nFatma Bilge Ergen: Nothing to disclose \nDuygu ømre: Nothing to disclose \nAdalet Elçin Yıldız: Nothing to disclose \nGülnar Aghayeva: Nothing to disclose \nÜstün Aydingöz: Nothing to disclose \n \nRPS 610-2 \nAutologous Matrix-Induced Chondrogenesis (AMIC) treatment for patellar \ncartilage defects: MRI imaging correlation to clinical outcome \n*A. Antón Jiménez*, R. D. O. D. Dominguez Oronoz,  \nM. De Albert De Delas-Vigo, A. Gimeno, M. Veintemillas, L. Casas,  \nC. Torrents, I. Portas, N. Joshi Jubert; Barcelona/ES  \n(alba.antonj@gmail.com) \n \nPurpose: The aim of this study is to demonstrate correlation between MRI \nimaging and short-term clinical benefit in patients with isolated patellar \ncartilage defects treated with AMIC surgical technique in our center. \nMethods or Background: Retrospective study included 15 consecutive \npatellar cartilage defects (grade 3-4 based on ICRS) treated with AMIC \ntechnique (collagen matrix and fibrin glue) in our hospital by a single surgeon. \nBaseline and follow-up MRI after 1 and 2 years of treatment were blinded \nevaluated by 2 radiologists. The cartilage target lesion was scored based on a \nmodified MODIC scale using 9 MRI features (defect filing, surface and signal \nintensity of the deficit cover, bone and cartilage integration, presence of \nchondral osteophyte, bone marrow edema, subchondral bone state and \neffusion). Therapeutic efficacy was evaluated by KOOS, Kujala and VAS \nscores for pain pre and post treatment. Analysis of Variance (ANOVA) was \nimplemented as feature selector and a logistic regression model was \ngenerated. \nResults or Findings: The study included 15 knees (8 right and 7 left) in 12 \npatients (7 female; mean age 40,2 years; mean BWI 26,6) who underwent \nAMIC surgery at our Institution. None of the patients had additional surgical \nprocedures. All lesions were non-traumatic. Main location was lateral facet \n(66,7%) and mean surface volume was of 0,6 cm3. After follow-up (24 months) \nthere was a significant improvement based on clinical scores in most of the \npatients. From 9 MRI imaging features; 2 (defect filling and signal intensity) \ncorrelated with clinical response. Patients with higher modified MODIC score \nshowed better clinical outcome (p<0.05). \nConclusion: Change of MRI features from baseline to follow-up after \ntreatment (2 years) correlate with patient's clinical outcome after AMIC surgical \ntechnique. \nLimitations: None. \nEthics Committee Approval: Approved. \nFunding for this study: None. \nAuthor Disclosures: \nAlba Antón Jiménez: Nothing to disclose \nLourdes Casas: Nothing to disclose \nNayana Joshi Jubert: Nothing to disclose \nMatias De Albert De Delas-Vigo: Nothing to disclose \nRosa Dominguez Oronoz Dominguez Dominguez Oronoz: Nothing to disclose \nIrene Portas: Nothing to disclose \nAlfredo Gimeno: Nothing to disclose \nMaite Veintemillas: Nothing to disclose \nCarme Torrents: Nothing to disclose \n \nRPS 610-3 \nChoosing the right imaging: differential diagnosis at the sacroiliac joint \n*T. Diekhoff*¹, F. Radny¹, K. Ziegeler¹, D. Poddubnyy¹, F. N. Proft¹, J. Greese¹, \nR. Biesen¹, K-G. Hermann¹, I. A. Eshed²; ¹Berlin/DE, ²Ramat Gan/IL \n \nPurpose: To analyse the diagnostic accuracy of radiography (XR), computed \ntomography (CT) and magnetic resonance imaging (MR) for the differential \ndiagnosis of axial spondyloarthritis (axSpA) and mechanical disease at the \nsacroiliac joints (SIJ). \nMethods or Background: 166 patients underwent XR, CT and MR of the SIJ \nand were scored by three musculoskeletal experts for their diagnosis in the \ncategories axSpA, mechanical disease and normal findings. The images were \nseparately anonymised: XR, CT and MR only, MR with XR and MR with CT. \nThus, every patient was evaluated five times. The readers were blinded to \nidentifying information and clinical and laboratory findings. The final diagnosis \nof the rheumatology expert served as standard of reference. Interrater \nreliability was assessed with Fleiss’ kappa. \nResults or Findings: Ninety-one patients were diagnosed by the \nrheumatologist with axSpA, 57 with mechanical disease such as osteitis \ncondensans or osteoarthritis and 18 as SIJ unrelated disease. XR showed \nrather low diagnostic accuracy (65.6% sensitivity/67.6% specificity) and was \noutperformed by CT (76.7%/97.3%) and MR (81.3%/86.7%). Adding XR to MRI \nreduced the sensitivity (77.8%) with only a minor increase in specificity \n(88.6%). However, while adding CT to MRI reduced the sensitivity (75.6%) it \nsubstantially increased the specificity (97.3%). The interrater agreement was \nmoderate for XR (0.5), almost perfect for CT (0.88), and substantial for MR \n(0.67), XR+MR (0.66) and CT+MR (0.74). \nConclusion: Radiography is neither sensitive nor specific for the differential \ndiagnosis in patients with suspected axSpA. MR and CT performed equally \nwell, while MR showed higher sensitivity (81% vs 77%) but CT higher \nspecificity (97% vs 87%) and reliability. Adding XR to MR showed no \nsubstantial effect while adding CT improved specificity at the expense of \nsensitivity. \nLimitations: SOR was influenced by imaging. \nEthics Committee Approval: IRB approved. \nFunding for this study: Not applicable \nAuthor Disclosures: \nRobert Biesen: Nothing to disclose \nDenis Poddubnyy: Nothing to disclose \nTorsten Diekhoff: Nothing to disclose \nKatharina Ziegeler: Nothing to disclose \nFabian N. Proft: Nothing to disclose \nKay-Geert G. Hermann: Nothing to disclose \nJuliane Greese: Nothing to disclose \nIris Ariel Eshed: Nothing to disclose \nFelix Radny: Nothing to disclose \n \nRPS 610-4 \nShear-wave elastography assessment of the coracohumeral ligament \nfollowing rotator interval injection in patients with adhesive capsulitis - a \ncohort study \n*A. Mermekli*¹, R. Te Water Naudé², B. McElroy³, J. Baxter¹, A. Pendse¹,  \nJ. Papanikitas¹, J. Teh², R. Hughes¹, D. McKean¹; ¹Aylesbury/UK, ²Oxford/UK, \n³Great Missenden/UK \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 265  \nPurpose: The aim of this study is to evaluate the changes in elasticity of the \ncoracohumeral ligament (CHL) in patients with adhesive capsulitis of the \nshoulder (ACS) treated with ultrasound guided rotator interval injections. \nMethods or Background: Shear-wave elastography (SWE) was used to \nevaluate the elasticity of the CHL in symptomatic and asymptomatic shoulders \nboth in neutral position and 30° external rotation. 22 shoulders were assessed. \nUltrasound-guided steroid injection via the rotator interval was administered in \nthe symptomatic shoulders, with subsequent shoulder manipulation under local \nanaesthetic block. The elasticity of the CHL was re-assessed, in 14 shoulders, \nat 10 weeks post injection. \nResults or Findings: In all patients, the CHL elastic modulus was larger at 30° \nexternal rotation than the neutral position. In patients with ACS, the CHL \nthickness and elastic modulus was significantly greater in the symptomatic \nshoulder in both positions. Treated patients had an excellent response, which \nwas assessed with the Oxford Shoulder Score (OSS) and Visual Analogue \nScale (VAS) pain scores. This was also associated with a trend to \nnormalisation of the elastic modulus of the CHL in the treated shoulder. \nConclusion: In patients with ACS, elastography demonstrated that the CHL is \nstiffer in the symptomatic shoulder than the unaffected shoulder. Treatment \nwith ultrasound guided injection via the rotator interval is associated with \nimprovement in OSS, VAS pain scores and reduced stiffness in the CHL. \nLimitations: This is a relatively small cohort study and a larger, age and sex \nmatched, study would provide additional information. One consistent CHL area \nwas analysed for this study, however different locations along the CHL for \nSWE measurement may result in higher CHL elasticity measurements. \nThe rotator cuff tendons’ elasticity was not measured. \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nJoseph Papanikitas: Nothing to disclose \nAnniruddha Pendse: Nothing to disclose \nJonathan Baxter: Nothing to disclose \nJames Teh: Nothing to disclose \nBernard McElroy: Nothing to disclose \nAsimenia Mermekli: Nothing to disclose \nRebecca Te Water Naudé: Nothing to disclose \nDavid McKean: Nothing to disclose \nRichard Hughes: Nothing to disclose \n \nRPS 610-5 \nDiagnostic value of MRI symptoms in patients with diabetic arthropathy \nand osteomyelitis: a clinical follow-up analysis \n*A. Ageev*, J. Babushkina, E. Burleva; Ekaterinburg/RU \n(ageev.artem@gmail.com) \n \nPurpose: The purpose of the study was to evaluate diagnostic value of MRI \nfindings usually used in diagnosis of osteomyelitis complicating diabetic \nosteoarthropathy in patients with diabetes mellitus. \nMethods or Background: 44 adult outpatients with diabetes mellitus were \nincluded in this study: 28 men and 16 women underwent differentiated \ntreatment including operative treatment in 14 cases. Patients with clinically \nproven osteomyelitis were included in the positive group while patients \nuncomplicated osteoarthropathy were included in the negative group. \nFollowing MRI findings were analyzed: 1. Bone marrow edema: subchondral \nand diffuse edema counted separately; 2. Bone marrow edema in weight \nbearing zones, including displaced cuboid and talus bones; 3. Diffusion \nrestriction in bone marrow; 4. Diffusion restriction in soft tissue; 5. Visible with \nMRI skin ulceration and traveling to weight bearing zone fistula. Analyzed \nfindings were compared to complex clinical data including post-operative \nhistological data. ROC-analysis were applied to evaluate diagnostic value \nthese findings. \nResults or Findings: Area under curve as the criterion of diagnostic accuracy \nis decreasing in following sequence: Fistula (AUC=0,760), bone marrow DWI \nrestriction (AUC=0,698), weight bearing bone marrow edema (AUC=0,682), \nsoft tissue fluid collections DWI restriction (AUC=0,661), diffuse bone marrow \nedema (AUC=0,605), soft tissue edema (AUC=0,563) \nConclusion: The best MRI diagnostic finding was MRI presentation of fistula \nbut AUC of 0,760 demonstrates insufficient diagnostic value, and this finding \nalso can be easily detected without MRI. Therefore, no one MRI finding is \nrecommended to be taken as sole criterion for deciding on the presence of \nosteomyelitis, complicating the diabetic osteoarthropathy. \nLimitations: This research was limited by one radiologist, opinion, cross-\nchecking multi-specialist opinion will be applied in further research \nEthics Committee Approval: The study assumes only data analysis and does \nnot affect the diagnosis and treatment of patients \nFunding for this study: No funding for this study was applied \nAuthor Disclosures: \nElena Burleva: Nothing to disclose \nArtem Nikiforovich Ageev: Nothing to disclose \nJulia Babushkina: Nothing to disclose \n \nRPS 610-6 \nMagnetic Resonance Imaging (MRI) and High-Resolution \nUltrasonography (HRSG) to evaluate patients with carpal tunnel \nsyndrome: which is better? \n*K. Singh*, R. Malik, R. Sarawagi; Bhopal/IN \n(drkjsrandhawa@gmail.com) \n \nPurpose: The study was conducted to evaluate the extent of agreement \nbetween MRI and HRSG in clinically or nerve conduction test (NCT) diagnosed \ncases of Carpal Tunnel Syndrome (CTS) and to evaluate the better modality \nbetween the two. \nMethods or Background: The patients presenting with clinical signs & \nsymptoms of CTS were included in the study. Total of 95 wrists of 51 patients \nwith NCT positive/clinically positive cases of CTS were evaluated. 50 controls \nwere taken for comparison. The same technical methodology & parameters \nwere used to evaluate all the patients both sonographically and by MRI i.e \ncross sectional area (CSA) at various levels and few other parameters. \nStatistical analysis was done for sensitivity & specificity of various parameters. \nResults or Findings: Kohen's Kappa Analysis, Bland Altmann Plot & Paired T \ntest were used to determine degree of agreement between HRSG and MRI for \ncommon parameters. Analysis revealed that CSAp & CSAi were comparatively \nmore in agreement when measured by either HRSG or MRI than CSAo & \nCSAd. By analyzing ROC, maximum area under the curve for HRSG was that \nof CSAi (0.9), subsequent cut-off was 0.095cm2(sensitivity & specificity of \n88.3% and 79.7%). For the MRI parameters, most statistically significant was \nCSAo (0.923) and cut off for CSAo was 0.095cm2 (sensitivity and specificity of \n84.1% and 91.3%). \nConclusion: High resolution sonography revealed increased CSAp as having \nmost positive predictive value for the patients having clinical symptoms & \npositive NCT results while for MRI it was CSAd. However, analyzing cost-\nbenefit ratio and easy availability of HRSG, MRI does not offer any significant \nadvantages over HRSG for radiological diagnosis of Carpal Tunnel Syndrome. \nLimitations: Limitations of this study include the relatively small sample size. \nEthics Committee Approval: Institutional Ethics Committee approved the \nstudy via letter IHEC-LOP/2018/MD006. \nFunding for this study: Funded by the Department of Radiodiagnosis & \nImaging, AIIMS, Bhopal \nAuthor Disclosures: \nKamaljeet Singh: Nothing to disclose \nRadha Sarawagi: Nothing to disclose \nRajesh Malik: Nothing to disclose \n \nRPS 610-7 \nMagnetic resonance imaging evaluation of osteochondral allografts in the \nknee using the OCAMRISS score \n*B. Tintaya*, C. Sitges, J. Oliva, E. Ramirez, P. Gelber, J. Llauguer; \nBarcelona/ES \n \nPurpose: To correlate Osteochondral Allograft MRI Scoring System \n(OCAMRISS) in patients undergoing osteochondral allograft transplantation in \nthe knee with clinical outcomes. \nMethods or Background: A retrospective observational study was performed \nin our center of a cohort of 37 patients that underwent osteochondral allograft \ntransplantation in the knee from August 2017 to November 2019. All patients \nreceived an MR examination nine months after surgery. Clinical outcomes \nwere evaluated using the following scores: International Knee Documentation \nCommittee (IKDC), Kujala, Western Ontario Meniscal Evaluation (WOMET) \nand Tegner. Correlation between the OCAMRISS and clinical outcomes was \ncalculated using Spearman’s correlation coefficients. \nResults or Findings: A correlation was observed between IKDC total score \nand OCAMRISS cartilage score ( ȡ = 0.396, P = 0,015), and OCAMRISS total \nscore (ȡ = 0.476, P = 0,003). A correlation was observed between Kujala score \nand OCAMRISS cartilage score ( ȡ = 0.339, P = 0,04), and OCAMRISS total \nscore (ȡ = 0.467, P = 0,004). A correlation was observed between WOMET \nscore and OCAMRISS ancillary score ( ȡ = 0.403, P = 0,013). No correlation \nwas observed between WOMET score and OCAMRISS total score. No \ncorrelation was observed between Tegner activity score and OCAMRISS total \nscore. \nConclusion: The MRI scoring system (OCAMRISS) is a useful, objective and \nnoninvasive monitoring tool for postoperative assessment after osteochondral \nallograft transplantation surgery. \nLimitations: Not applicable \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nEduard Ramirez: Nothing to disclose \nPablo Gelber: Nothing to disclose \nBenjamin Tintaya: Nothing to disclose \nJavier Oliva: Nothing to disclose \nCarla Sitges: Nothing to disclose \nJaume Llauguer: Nothing to disclose \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 266  \nRPS 610-8 \nIntermetatarsal bursitis: a novel feature of juxta-articular inflammation in \nearly rheumatoid arthritis - results from a longitudinal MRI-study \n*B. van Dijk*, Y. J. Dakkak, X. Matthijssen, E. Niemantsverdriet, M. Reijnierse, \nA. van der Helm-van Mil; Leiden/NL \n(B.T.van_Dijk@lumc.nl) \n \nPurpose: Intermetatarsal bursae in the forefeet possess a synovial lining, \nsimilarly to joints and tendon-sheaths. Inflammation of these bursae \n(intermetatarsal bursitis; IMB) was recently identified as specific for early \nrheumatoid arthritis (RA). We hypothesised that if IMB is indeed an RA-feature, \nthen 1) its presence associates with other measures of local inflammation \n(synovitis/tenosynovitis/osteitis) at diagnosis and 2) it responds to DMARD-\ntherapy similarly as other local inflammatory measures. \nMethods or Background: 157 consecutive early RA-patients underwent \nunilateral contrast-enhanced 1.5T forefoot-MRI at diagnosis. MRIs were \nevaluated for IMB-presence, and for synovitis/tenosynovitis/osteitis in line with \nthe RA MRI scoring-system (summed as RAMRIS-inflammation). MRIs at \n4/12/24 months were evaluated for IMB-presence and -size in patients who \nhad IMB at baseline and received early DMARD-therapy. Logistic regression \nand generalised estimating equations were used for analyses at patient- and \nbursa-level. ACPA-stratification was performed. \nResults or Findings: 69% of RA-patients had •1 IMB. In multivariable \nanalysis on bursa-level, presence of IMB was independently associated with \nlocal presence of synovitis and tenosynovitis (OR 1.69(95%CI 1.12-2.57) and \n2.83(1.80-4.44), respectively), but not osteitis. On patient-level, IMB-presence \nwas most strongly associated with tenosynovitis (OR 2.92(1.62-5.24)). During \ntreatment, IMB-size decreased. This decrease was associated with decrease \nin RAMRIS-inflammation scores; and most strongly with a decrease in synovitis \nbut not in osteitis. Within ACPA-positive and ACPA-negative RA similar results \nwere obtained. \nConclusion: IMB particularly accompanies inflammation of the synovial lining \nof joints and tendon-sheaths, both regarding simultaneous occurrence at \ndiagnosis and simultaneous treatment-response. These findings suggest that \nIMB represents juxta-articular synovial inflammation and is a hallmark of early \nRA. \nLimitations: Novel consensus-based scoring-method; relatively limited \nsample-size in the longitudinal part; unavailability of weight-bearing \nradiographs. \nEthics Committee Approval: Obtained (Leiden University Medical Centre \nethics committee) \nFunding for this study: European Research Council (H2020, starting grant, \nagreement 714312) Dutch Arthritis Society \nAuthor Disclosures: \nMonique Reijnierse: Nothing to disclose \nEllis Niemantsverdriet: Nothing to disclose \nBastiaan van Dijk: Nothing to disclose \nYousra J. Dakkak: Nothing to disclose \nAnnette van der Helm-van Mil: Nothing to disclose \nXanthe Matthijssen: Nothing to disclose \n \nRPS 610-9 \nTest-retest repeatability and reproducibility of 3D joint space mapping at \nthe ankle using weight-bearing computed tomography \n*T. Turmezei*¹, J. W. MacKay¹, K. Malhotra², A. Gee³, G. Treece³, K. Poole³, \nM. Welck²; ¹Norwich/UK, ²Stanmore/UK, ³Cambridge/UK \n(tom@turmezei.com) \n \nPurpose: Joint space mapping (JSM) is a semi-automated image analysis tool \nfor measuring joint space width in 3D that here we apply for the first time at the \nankle. \nMethods or Background: 23 individuals with repeat weight-bearing cone \nbeam CT examinations of both ankles within 4 months between 2013 and 2017 \nwere selected (13 left, 10 right) to provide a mix of pathology: 11 no metalwork; \n6 metalwork fusions ipsilateral foot, 6 contralateral foot. Mean±SD interval \nbetween imaging visits was 74.0±29.6 days. JSM mapping was performed at \nmedial talocrural (MTC), lateral talocrural (LTC), talonavicular (TN), and \nposterior subtalar (PST) surfaces at both visits by a single blinded operator. A \nsecond operator trained on 6 opposite ankles then repeated JSM in baseline \ncases. Bland-Altman analysis demonstrated test-retest repeatability and \ninterobserver reproducibility, with results shown as global statistics as well as \n3D maps. \nResults or Findings: Surfacewise bias was 0.00 mm across all joints for test-\nretest repeatability and reproducibility. Repeatability limits of agreement at \nindividual surfaces were: TN=±0.26 mm, MTC=±0.28 mm, ST=±0.34 mm, and \nLTC=±0.40 mm. Optimum test-retest sensitivity was less than ±0.2 mm at each \ncentral articular surface. Reproducibility limits of agreement at individual \nsurfaces were: TN=±0.27 mm, MTC=±0.24 mm, ST=±0.31 mm, and \nLTC=±0.37 mm. 3D maps show mean thickness at each joint surface as well \nas the 3D surface distribution of repeatability and reproducibility metrics. \nConclusion: JSM at the ankle is repeatable and reproducible with weight-\nbearing cone beam CT and is feasible at these joints that feature metalwork \nand complex regional anatomy. \nLimitations: 2 from the original selection of 25 failed JSM because of too \nmuch metal-induced artefact. \nEthics Committee Approval: Consent waiver for retrospective analysis of \nanonymised data and subsequent data sharing was approved by institution 2. \nFunding for this study: None \nAuthor Disclosures: \nKaran Malhotra: Nothing to disclose \nAndrew Gee: Nothing to disclose \nGraham Treece: Patent Holder: U.S. patent US8938109B2, “Image data \nprocessing systefor estimating the thickness of human/animal tissue \nstructures” \nJames William MacKay: Nothing to disclose \nMatthew Welck: Shareholder: Standing CT Company \nKenneth Poole: Patent Holder: U.S. patent US8938109B2, “Image data \nprocessing systefor estimating the thickness of human/animal tissue \nstructures” \nTom Turmezei: Advisory Board: International Society of Osteoarthritis Imaging \n \n \nResearch Presentation Session: \nMusculoskeletal \nRPS 710 \nNerves and the spine \nRPS 710-1 \nVisualizing patterns of intervertebral disc destruction: diagnostic \naccuracy of dual-energy computed tomography in an ex vivo spine \n(bio)phantom \n*J. Pohlan*, C. Stelbrink, M. Pumberger, A. D. Gruber, T. Diekhoff; Berlin/DE  \n \nPurpose: To analyse the diagnostic accuracy of dual-energy computed \ntomography (DECT) in visualizing differential patterns of intervertebral disc \ndestruction. \nMethods or Background: A lumbar spine from a great dane dog was used as \nan ex-vivo biophantom. DECT was performed in sequential volume acquisition \nwith 80 and 135kVp tube voltage with ascending order of tube current. \nIntervertebral discs were imaged before, and after injection of sodium chloride \nsolution and after ventral discectomy. Oblique axial reformations were used for \nfurther analysis. Standardized regions of interest (ROI) were placed in \nintervertebral disc (IVD) structures. Three blinded readers scored all images \nseparately, i.e. intact disc, nucleus and annulus lesion. \nResults or Findings: The analysis of the inter-rater reliability yielded an \nalmost perfect agreement with Fleiss kappa at 0.833 (95% CI 0.831-0.835). \nThe analysis of the combined detection accuracy of IVD damage using DECT \nyielded a sensitivity 91.0% (95% CI 83.6-95.8) and a specificity of 92.0% (95% \nCI 80.8-97.8). The positive Likelyhood Ratio was 11.4. \nConclusion: This work indicates a high accuracy in diagnosing differential \npatterns of IVD damage using DECT. These data stress the potential of DECT \ncMaps in imaging spine pathologies with involvement of the IVD. \nLimitations: First, our exvivo biophantom is a spine from a great dane with \ndifferent size of the IVD as compared with human IVD. Still, the similarities in \nmorphology suggest that the dog spine provides an adequate model of the \nhuman spine. Second, the lesions in this experimental setup are only partially \nreflecting IVD damage in human pathology. The injection of sodium chloride \nsolution into the IVD does not reflect enzymatic destruction of the connective \ntissue network of the IVD as in patients with spondylodiscitis. \nEthics Committee Approval: Waived \nFunding for this study: Research grant by Canon medical services for the \nDept. of radiology \nAuthor Disclosures: \nAchim D. Gruber: Nothing to disclose \nTorsten Diekhoff: Nothing to disclose \nCarsten Stelbrink: Nothing to disclose \nJulian Pohlan: Nothing to disclose \nMatthias Pumberger: Nothing to disclose \n \nRPS 710-2 \nCombination of quantitative MRI fat fraction and texture analysis to \nevaluate spastic muscles of children with cerebral palsy \n*T. Akıncı D'Antonoli*¹, F. Santini¹, X. Deligianni¹, M. Garcia Alzamora²,  \nE. Rutz³, O. Bieri¹, R. Brunner¹, C. Weidensteiner¹; ¹Basel/CH, ²Barcelona/ES, \n³Parkville/AU  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 267  \nPurpose: Cerebral palsy (CP) is the most common cause of physical disability \nin childhood. Muscle pathologies occur due to spasticity and contractures; \ntherefore, imaging of muscles to detect pathologies is often required. Fat \nfraction(FF) measurement can quantify muscle fat and is often a part of \nstandard imaging in neuromuscular dystrophies. To date, FF has been used to \nassess muscle fat and function in CP. In this study, we aimed to utilize a \nradiomics analysis of MR images along with FF analysis to differentiate \naffected muscles from healthy ones and to compare our radiomics model(RM) \nwith FF model(FFM). \nMethods or Background: A total of 9 CP patients (8-15y) and 12 healthy \ncontrols (9-16y) were prospectively enrolled(2018-2020). Multi-echo Dixon \nacquisition was used for FF calculation and the second echo (TE=2.87msec) \nwas used for feature extraction. Least absolute shrinkage and selection \noperator(LASSO) regression was employed for feature selection. Synthetic \nMinority Over-sampling Technique(SMOTE) was used to overcome class \nimbalance. RM, FFM and combined model(CM) were built for each calf muscle \nin datasets with and without SMOTE. The receiver operating characteristic \narea under the curve(AUC) values were used to evaluate model performance. \nResults or Findings: In total 42 legs (12 sick,30 healthy) were analyzed. The \nperformance of RM for soleus, gastrocnemius medialis and gastrocnemius \nlateralis(AUC 0.94,0.91,0.88,respectively) was always better than the \nFFM(AUC 0.86, 0.69, 0.75,respectively). Combination of both models either \nhad a better performance than RM or a comparable performance(AUC \n0.95,0.91,0.88). SMOTE application substantially improved the performance of \nall models in all muscles(AUC>0.90). \nConclusion: In conclusion, the combination of MRI quantitative fat fraction \nanalysis and texture analysis of muscles in CP patients is a promising tool to \nevaluate muscle involvement of CP in a noninvasive manner. \nLimitations: Sample size. \nEthics Committee Approval: Approved by EC. \nFunding for this study: Funded by SNSF. \nAuthor Disclosures: \nFrancesco Santini: Nothing to disclose \nMeritxell Garcia Alzamora: Nothing to disclose \nXeni Deligianni: Nothing to disclose \nTu÷ba Akıncı D'Antonoli: Nothing to disclose \nClaudia Weidensteiner: Nothing to disclose \nOliver Bieri: Nothing to disclose \nErich Rutz: Nothing to disclose \nReinald Brunner: Nothing to disclose \n \nRPS 710-3 \nUltrasound-guided infiltration of the greater occipital nerve: a radiological \napproach to pain management in occipital neuralgia \n*N. A. Ochoa Sambrizzi*, A. Gimeno, M. De Albert De Delas-Vigo,  \nM. Veintemillas, L. Casas, C. Torrents, L. Cuni, R. Dominguez; Barcelona/ES \n(n.ochoa.sambrizzi@gmail.com) \n \nPurpose: We present a controlled before and after study of patients diagnosed \nwith Arnold’s neuralgia in our center that received ultrasound (US) guided \ninfiltration of the Greater Occipital nerve (GON) in the last year. \nWith the aim of showing the efficacy of US infiltration of the GON in the \ntreatment of Occipital Neuralgia. \nMethods or Background: 12 patients received a total of 20 infiltrations of \nbotulinum toxin or a mixture of corticosteroid and local anesthetic. The follow-\nup was at least 4 months after the infiltrations. We compared visual analogue \nscale (VSA) and “Neck Disability Index” (NDI) before and after the procedure. \nConsidering the main outcome a statistical significant reduction of the VSA, as \nwell as an improvement of the NDI. Statistical analysis was through t-test for \npaired samples. \nResults or Findings: All 12 patients completed at least 4 months follow up \nafter the procedure. Statistical analysis showed a significant reduction of the \nVSA score after infiltration as well as a reduction of the NDI scale. There was a \nsignificant difference in the average of the VSA scores before and 7 days after \nthe procedure ((p < 0.001)) with an average reduction of 4.9 points (95% CI \n[3.7, 6.1]), the mean duration of the effect was 3.4 months. There was also an \nimportant difference between the averages of NDI before and after the \ninfiltrations (p < 0.001), with an average reduction of 24.5% after the procedure \n(95% CI [17.4, 31.5]). \nConclusion: US guided infiltrations of the GON are an effective way to \nmanage cervical pain in patients with occipital neuralgia and should be \nconsidered among the therapeutic options when treating these patients. \nLimitations: Retrospective study with absence of control group \nEthics Committee Approval: Approved by ethics committee \nFunding for this study: No funding was received \n \n \n \n \n \n \nAuthor Disclosures: \nLourdes Casas: Nothing to disclose \nMatias De Albert De Delas-Vigo: Nothing to disclose \nAlfredo Gimeno: Nothing to disclose \nLaura Cuni: Nothing to disclose \nMaite Veintemillas: Nothing to disclose \nCarme Torrents: Nothing to disclose \nRosa Dominguez: Nothing to disclose \nNicolás Andrés Ochoa Sambrizzi: Nothing to disclose \n \nRPS 710-4 \nHigh-resolution ultrasound of the marginal mandibular branch of the \nfacial nerve: normal appearance and pathological findings in a case \nseries of postsurgical nerve damage \n*R. Picasso*¹, F. Zaottini¹, F. Pistoia¹, M. Miguel-Pérez², C. Martinoli¹; \n¹Genova/IT, ²Barcelona/IT \n(riccardo.picasso@gmail.com) \n \nPurpose: The aim of this observational cross-sectional study was to validate \nhigh-resolution ultrasound (US) as an imaging modality able to map the normal \nmarginal mandibular nerve (MMN) and recognize its abnormalities in the \npostoperative setting. \nMethods or Background: A cadaveric study was performed on n=3 fresh \nfrozen face specimens to verify the correspondence between the anatomical \nand US localization of the MMN. N=20 healthy volunteers (mean age= 29 \nyears) were examined with a 22-8MHz hockey stick probe and the following \nparameters were collected: I)MMN caliber around the facial artery; II) length of \nthe tract of the MMN amenable to US; III) distance between the gonion and the \npoint where the MMN steps over the mandible body. Finally, n=3 patients with \nclinically confirmed MMN iatrogenic injury were evaluated with US. \nResults or Findings: In the cadaveric study, US-guided latex injection \nprovided identification of the MMN. In healthy volunteers, mean MMN caliber \nresulted 0.69±0.07mm. US was able to recognize the MMN for 3.4±1.2 cm. \nThe nerve was visualized stepping over the mandible body 3.3±0.6 cm from \nthe gonion. Pathologic abnormalities of the MMN were detected and \ncharacterized in three patients. \nConclusion: High-resolution US is a valuable diagnostic tool to identify the \nMMN and detect its pathologic changes. This is the first evidence that US is \nable to image the MMN around the mandible body in normal and pathologic \nstates. \nLimitations: Only a small series of patients was evaluated \nEthics Committee Approval: The study was conducted in accordance the \ndeclaration of Helsinki \nFunding for this study: None \nAuthor Disclosures: \nFederico Zaottini: Nothing to disclose \nCarlo Martinoli: Nothing to disclose \nMaribel Miguel-Pérez: Nothing to disclose \nRiccardo Picasso: Nothing to disclose \nFederico Pistoia: Nothing to disclose \n \nRPS 710-5 \nDiagnostics of infrapatellar saphenous neuralgia: a reversible cause of \nchronic anteromedial pain following knee surgery \n*S-R. Yang*, A. Schiffmann, B. K. Kovacs, F. Amsler, M. Hirschmann,  \nA. Hirschmann; Basel/CH \n \nPurpose: To evaluate the impact of diagnostic nerve block and ultrasound \nfindings on therapeutic choices and predict the outcome after concomitant \nsurgery in patients with suspected neuropathy of the infrapatellar branch of the \nsaphenous nerve (IPBSN). \nMethods or Background: A total of 55 patients (mean age 57 years ± 13.1 \nyears) following knee surgery with intractable knee pain were retrospectively \nincluded. Ultrasound reports including ultrasound-guided anesthetic injection of \nthe IPBSN were assessed for neuroma and postsurgical scarring. Pain severity \nwas graded on visual analog scale (VAS 1-10) before and 40 min following the \nprocedure. Clinical success was defined as a minimum of 50% decrease of the \nVAS score or an absolute VAS reduction to 1. Electronic medical records were \nassessed for the type of procedure (neurectomy; other than nerve associated \ntherapy) and pain score at initial follow up consultation. Factors associated with \na relevant VAS score were assessed by uni- and multivariate logistic \nregression and chi-square for quantitative and qualitative variables. \nResults or Findings: Positive diagnostic nerve block yielded a sensitivity of \n96.9% and a specificity of 53.3%. Strongest association was between pain \nrelief by nerve block, positive Tinel sign (p = 0.002, odds ratio 8.75) and \nabsence of any case of prosthetic instability (p = 0.029, odds ratio 0.17). \nConclusion: Selective denervation for neuromatous knee pain is beneficial in \nselected patients with significant VAS reduction after diagnostic nerve block. \nPatients without VAS reduction and sonography evidence of IPBSN \npathologies need to be evaluated for other causes. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 268  \nLimitations: Verification bias as patients were selected to undergo surgery \nbased on the positive diagnostic nerve block result, more likely received \nsurgery than those tested negative. \nEthics Committee Approval: Institutional review board approval was waived \nfor this retrospective study by the local ethics committee. \nFunding for this study: Unfunded. \nAuthor Disclosures: \nSchu-Ren Yang: Nothing to disclose \nBalazs Krisztian Kovacs: Nothing to disclose \nMichael Hirschmann: Nothing to disclose \nAnna Hirschmann: Nothing to disclose \nFelix Amsler: Nothing to disclose \nAlain Schiffmann: Nothing to disclose \n \nRPS 710-6 \nPlantar forefoot pain: ultrasound findings before and after treatment with \ncustom-made foot orthoses \n*D. Albano*, C. Bonifacini, S. Zannoni, S. Bernareggi, C. Messina,  \nL. M. Sconfienza; Milan/IT \n(albanodomenico@me.com) \n \nPurpose: Currently, ultrasound has not a role to assess the response to \nconservative treatment of metatarsalgia. No previous studies investigated how \nultrasound features might change over time in these patients. We aimed to \ndescribe ultrasound findings of patients with plantar forefoot pain treated with \ncustom-made foot orthoses. \nMethods or Background: Twenty patients (15 females; mean age: \n62.6±11years) affected by metatarsalgia in 27/40 feet underwent clinical \nevaluation before, three and six months after conservative treatment with \ncustom-made full foot insole with a support proximal and an excavation below \nthe painful metatarsals. Ultrasound was performed before and three months \nafter the use of orthoses to examine the presence of intermetatarsal / \nsubmetatarsal bursitis, metatarsophalangeal joints effusion, anterior plantar fat \npad edema, flexor tendinitis/tenosynovitis, and Morton’s neuroma. Clinical \nresponse with Foot Function Index (FFI)/Visual Analogue Scale (VAS) and \nultrasound features changes were evaluated with McNemar and paired \nStudent t tests. \nResults or Findings: Median VAS and FFI before treatment were 8[5-8.5] and \n45.85[32.4-59.4], respectively. After 3 and 6 months of insoles use, both \nmedian VAS (2.5 [0-5] and 0 [0-2.75], respectively) and median FFI (7.9 [3.95-\n20] and 0 [0-3.95], respectively) showed a significant reduction in pain and \ndisability (p<.001). Before treatment, ultrasound revealed 22 intermetatarsal \nbursitis, 16 submetatarsal bursitis, 10 joint effusions, 20 fat pad edema, 3flexor \ntendinitis/tenosynovitis and 3 Morton’s neuromas. After 3 months of treatment, \na significant decrease of intermetatarsal bursitis (7, p<.001) was observed. No \nsignificant changes were observed regarding the remaining ultrasound \nparameters. \nConclusion: Ultrasound might be able to detect some imaging features \nassociated with the response of forefoot pain to custom-made foot orthoses, \nespecially identifying sonographic changes of intermetatarsal bursitis. \nLimitations: Small sample size, short follow-up, no healthy subjects as \ncontrols and no randomization in treatment arms. \nEthics Committee Approval: Obtained \nFunding for this study: None \nAuthor Disclosures: \nCarlo Bonifacini: Nothing to disclose \nSusan Bernareggi: Nothing to disclose \nCarmelo Messina: Nothing to disclose \nLuca Maria Sconfienza: Nothing to disclose \nStefania Zannoni: Nothing to disclose \nDomenico Albano: Nothing to disclose \n \nRPS 710-7 \nPatients with episodic migraine show increased T2 values of the \ntrapezius muscles: an investigation by quantitative high-resolution \nmagnetic resonance imaging \n*N. Sollmann*, P. Schandelmaier, D. Weidlich, C. Zimmer, D. C. Karampinos, \nF. Heinen, M. Landgraf, M. Bonfert; Munich/DE \n(nico.sollmann@tum.de) \n \nPurpose: Neck pain and dysfunction is frequent in patients with migraine. \nLikewise, evidence for inflammatory processes in the trapezius muscles is \naccumulating. However, non-invasive and objectively assessable correlates \nare missing in vivo. \nMethods or Background: Twenty-one subjects with episodic migraine (mean \nage: 24.6±3.2 years, 18 females) and 22 controls (mean age: 23.0±2.2 years, \n17 females) without any history of headache prospectively underwent physical \nexamination and quantitative 3-Tesla MRI of the trapezius muscles. A T2 Ǧ\nprepared turbo spin-echo (TSE) sequence was acquired for manual \nsegmentation of the trapezius muscles and extraction of mean T2 values. \nResults or Findings: There were no statistically significant differences \nregarding age, sex, body mass index, or number of myofascial trigger points \n(mTrPs) between groups. All patients with migraine presented with mTrPs in \nthe trapezius muscles. T2 of the entire trapezius muscles was significantly \nhigher in the migraine group when compared to controls (31.0±1.2 ms versus \n30.1±1.0 ms; p=0.022). \nConclusion: Elevated T2 values of the trapezius muscles may indicate subtle \ninflammatory processes within musculature among patients with migraine \nbecause T2 increase is likely to stem from edematous changes. Future work \nmay validate this finding in larger cohorts, but muscle T2 might have potential \nto develop into a viable in-vivo biomarker for muscular affection in migraine. \nLimitations: The cohort demographics with a small age range and constitution \nof predominantly females represent this study’s limitations. \nEthics Committee Approval: This prospective study was approved by the \nlocal Institutional Review Board. \nFunding for this study: Not applicable. \nAuthor Disclosures: \nMichaela Bonfert: Nothing to disclose \nFlorian Heinen: Nothing to disclose \nMirjam Landgraf: Nothing to disclose \nClaus Zimmer: Nothing to disclose \nPaul Schandelmaier: nothing to disclose \nNico Sollmann: Nothing to disclose \nDominik Weidlich: Nothing to disclose \nDimitrios C. Karampinos: Nothing to disclose \n \nRPS 710-8 \nDifferentiation of benign and malignant vertebral compression fractures \nusing qualitative and quantitative analysis of a single fast spin echo T2-\nweighted Dixon sequence \n*P. Omoumi*, S. Bacher, S. D. Hajdu, Y. Maeder, V. Dunet, T. Hilbert; \nLausanne/CH \n(patrick.omoumi@chuv.ch) \n \nPurpose: To determine and compare the qualitative and quantitative \ndiagnostic performance of a single sagittal fast spin echo (FSE) T2-weighted \nDixon sequence in differentiating benign and malignant VCFs, using multiple \nreaders and different quantitative methods. \nMethods or Background: From July 2014 to October 2019, 90 consecutive \npatients with spine MRI performed prior to cementoplasty for acute VCFs were \nretrospectively included. VCFs were categorized as benign (n=61, mean \nage=76±13years) or malignant (n=29, mean age=63±13years) based on the \nreference standard, biopsy and/or •9months clinical and imaging follow-up. \nQualitative analysis was independently performed by four radiologists by \ncategorizing each VCF as either benign or malignant using only the image sets \nprovided by FSE T2-weighted Dixon sequences. Quantitative analysis was \nperformed using two different regions of interest (ROI1-2), and three methods \n(signal drop, fat fraction (FF) from ROIs, FF from maps). Diagnostic \nperformance was compared using ROC curves analyses. Interobserver \nagreement was assessed using kappa statistics and intraclass correlation \ncoefficients (ICC). \nResults or Findings: The qualitative diagnostic performance ranged from area \nunder the curve (AUC)=0.97 (95%CI:0.92-1.00) to AUC=0.99 (95%CI:0.98-\n1.0). The quantitative diagnostic performance ranged from AUC=0.82 \n(95%CI:0.72-0.92) to AUC=0.96 (95%CI:0.92-0.99). Pairwise comparisons \nshowed no statistical difference in diagnostic performance (all p •0.002, \nBonferroni corrected p<0.0011). All five cases with discordance among the \nreaders, were correctly diagnosed at quantitative analysis using ROI2. \nInterobserver agreement was excellent for both qualitative and quantitative \nanalysis. \nConclusion: A single FSE T2-weighted Dixon sequence can be used to \ndifferentiate benign and malignant vertebral compression fractures with high \ndiagnostic performance using both qualitative and quantitative analysis, which \ncan provide complementary information. \nLimitations: No correction for potential confounding effect of previous \ntreatment. \nRetrospective design. \nEthics Committee Approval: Regional Ethical committee approval \n(Commission d'éthique de la recherche sur l'être humain, Vaud). \nFunding for this study: None. \nAuthor Disclosures: \nVincent Dunet: Author: co-author \nSebastien Bacher: Author: First author \nYaël Maeder: Author: co-author \nTom Hilbert: Author: co-author \nPatrick Omoumi: Author: Guarantor \nSteven David Hajdu: Author: co-author \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 269  \n \nResearch Presentation Session: Neuro \nRPS 311 \nCancer in neuroradiology \nRPS 311-2 \nNoninvasive differentiation of molecular subtypes of non-enhancing \nglioma using MRI perfusion and diffusion parameters \n*I. J. Pruis*¹, S. Koene¹, S. van der Voort¹, F. Incekara¹, A. Vincent¹, \nM. van den Bent¹, G. Lycklama à Nijeholt², S. Veldhuijzen van Zanten¹,  \nM. Smits¹; ¹Rotterdam/NL, ²The Hague/NL  \n(i.pruis@erasmusmc.nl) \n \nPurpose: Approximately 14-45% of non-enhancing glioma have a highly \naggressive course due to glioblastoma genetic status requiring rapid \nintervention and treatment. The aim of this retrospective study is to distinguish \nthe molecular profiles of non-enhancing glioma using physiological MRI. \nMethods or Background: Ninety-five patients with non-enhancing glioma \nwere included in whom pre-operative MRI was available including at least \nT2w/FLAIR, dynamic contrast susceptibility perfusion and diffusion imaging, \nand molecular status including 1p/19q co-deletion status and IDH mutation. \nTumours were segmented semi-automatically using ITK-SNAP to derive whole \ntumour histograms of relative Cerebral Blood Volume (rCBV) and Apparent \nDiffusion Coefficient (ADC). Tumours were divided into three clinically relevant \nmolecular subgroups; IDH mutation (IDHmt) with (n=39) or without 1p/19q co-\ndeletion (n=38), and IDH-wildtype (IDHwt) (n=18). ANOVA and Kruskall-Wallis \ntests were performed using SPSS. \nResults or Findings: rCBV (mean, median, 75th and 85th percentile) and \nADC (mean, median, 15th and 25th percentile) showed significance across \nmolecular profiles (p<0.01), post-hocs revealed 1p/19q intact IDHmt tumours \nhave significantly lower rCBV compared to 1p/19q co-deleted IDHmt and \nIDHwt tumours (mean rCBV 1.06 (0.37-1.83) versus 1.36 (0.84-2.76) and 1.37 \n(0.55-2.31), p<0.05). Also, 1p/19q intact IDHmt tumours had significantly \nhigher ADC compared to the two other profiles (mean ADC 1.46 (1.12-2.09) \nversus 1.27 (1.05-1.74) and 1.16 (0.56-1.56), p<0.001). No significant \ndifferences were found in ADC and rCBV parameters between 1p/19q co-\ndeleted IDHmt and IDHwt tumours. \nConclusion: 1p/19q intact IDHmt tumours had significantly lower rCBV and \nhigher ADC compared to 1p/19q co-deleted IDHmt and IDHwt tumours, \nindicating that MRI perfusion and diffusion parameters could be useful to \ndetermine the molecular profile of non-enhancing glioma. \nLimitations: n/a \nEthics Committee Approval: Obtained from the Erasmus MC Medical Ethics \nCommittee. \nFunding for this study: n/a \nAuthor Disclosures: \nStephan Koene: Nothing to disclose \nSebastian van der Voort: Nothing to disclose \nFatih Incekara: Nothing to disclose \nSophie Veldhuijzen van Zanten: Nothing to disclose \nArnaud Vincent: Nothing to disclose \nIlanah Johanna Pruis: Nothing to disclose \nMartin van den Bent: Nothing to disclose \nMarion Smits: Nothing to disclose \nGeert Lycklama à Nijeholt: Nothing to disclose \n \nRPS 311-3 \nImaging-based classification of glioma, it’s validation with survival \nanalysis and integration with new WHO genetic glioma classification \n*A. N. Kamble*¹, N. K. Agrawal², S. Koundal¹, S. Bhargava¹, A. N. Kamble³,  \nD. A. Joyner຾, T. Kalelioglu຾, S. Patel຾, R. Jain຿; ¹New Delhi/IN, ²Mohali/IN, \n³Mumbai/IN, ຾Charlottesville, VA/US, ຿New York, NY/US  \n(akshaykumar.kamble92@gmail.com) \n \nPurpose: Imaging-based classification of glioma independent of histological or \ngenetic markers predicting survival of patients is an unmet need. We propose a \nclassification which can predict survival and integrates with the new WHO \ngenetic classification. \nMethods or Background: Multicentric study with TCGA-LGG (199 patients), \nREMBRANDT (130 patients) and TCGA-GBM (262 patients) dataset of glioma \nwere analyzed as training dataset. Based on MRI images, gliomas were \nclassified into four types. Survival analysis was done using Kaplan Meier and \nCox regression. UVA dataset with (202 patients) was analyzed to validate the \nclassification as testing dataset. Evaluation the sensitivity and specificity of \nradiological types with existing histological and genetic markers was done. \nResults or Findings: Imaging-based classification predicted survival \nindependent of genetic or histological information in both testing and training \ndatabases. Type I glioma have good specificity in identifying 1p 19q co-deleted \nIDH mutated, oligodendrogliomas and grade II gliomas. Type II gliomas have \ngood specificity identifying IDH mutant 1p 19q non co-deleted and Grade II \ngliomas. Type III and Type IV have good specificity in identifying Grade IV and \nIDH wild gliomas (p value < 0.05). There is a substantial interobserver \nagreement for new radiological classification in both training and testing \ndatabases (Ƹ > 0.6). \nConclusion: Proposed ‘Imaging-based radiological glioma classification’ does \npredict the survival of patients independent of histological or genetic testing. \nThis can especially useful in resource strained or remote healthcare facilities \nwhere this novel classification can provide the preliminary insight into \nprognosis and genotype of gliomas using non-invasive routine MRI scan. \nLimitations: Limitations of our study includes retrospective design. \nEthics Committee Approval: TCIA achieve being open access has ethics \ncommittee approval stated on the website from the respective institutes. UVA \nteam obtained the ethic committee approval for UVA the testing database. \nFunding for this study: None \nAuthor Disclosures: \nDavid A. Joyner: Nothing to disclose \nSohil Patel: Nothing to disclose \nNidhi Kishore Agrawal: Nothing to disclose \nRajan Jain: Nothing to disclose \nAbhaykumar Nana Kamble: Nothing to disclose \nSurabhi Koundal: Nothing to disclose \nAkshaykumar Nana Kamble: Nothing to disclose \nSalil Bhargava: Nothing to disclose \nTuba Kalelioglu: Nothing to disclose \n \nRPS 311-4 \nDiagnostic accuracy of ASL in comparison with DSC perfusion in the \nsurveillance of different types of brain tumours \n*A. Lavrova*¹, W. Teunissen², E. Warnert², M. van den Bent², V. Cheremisin¹, \nM. Smits²; ¹St. Petersburg/RU, ²Rotterdam/NL \n(lavrova.anya@gmail.com) \n \nPurpose: Dynamic susceptibility contrast-enhanced (DSC) perfusion is an \nestablished standard in the assessment of brain tumor perfusion. This study \naims to assess the feasibility of using non-contrast arterial spin-labeling (ASL) \ninstead of DSC. \nMethods or Background: We included 122 (78 males, mean age 54±13) \npatients in this retrospective study, who underwent both ASL and DSC \nperfusion in the same MRI-scanning session at 3T (GE) during 2019. ASL-\nderived Cerebral Blood Flow (CBF) maps were created with Ready View (AW \nServer, GE); DSC-derived relative Cerebral Blood Volume (rCBV) maps, \nuncorrected for leakage, were created with Intellispace Portal (Philips). Lesions \nwere identified as T2 and T2-FLAIR hyperintensity with or without contrast \nenhancement (CE). Measurements were done in Radiant DICOM Viewer by \nplacing a region of interest of approximately 70 mm2 on the rCBV map and \ncopying it to the contralateral normal-appearing white matter (NAWM) and to \nthe CBF map. Pearson’s correlation coefficient testing was done on the CBF \nand rCBV ratios of tumor versus NAWM. \nResults or Findings: We identified 183 lesions, 120 with and 63 without CE. \nCorrelation coefficients were as follows: glioma with (80 lesions, r=0.648, \np<0.001), and without CE (56 lesions, r=0.551, p<0.001), lymphoma with (10 \nlesions, r=-0.233, p=0.464) and without CE (7 lesions, r=0.02, p=0.952), \nmetastases with CE (30 lesions, r=0.33, p=0.081). \nConclusion: We found a strong correlation in glioma, while there was no \nsignificant correlation in lymphoma and metastases. Our findings suggest that \nASL can be used instead of DSC to measure perfusion in glioma at 3T. For \nlymphoma and metastases, this should be further investigated in a larger \ngroup. \nLimitations: Cases with motion (1), signal loss at the site of the tumor (2) were \nexcluded. \nEthics Committee Approval: Approved by the Erasmus MC Ethics \nCommittee. \nFunding for this study: None. \nAuthor Disclosures: \nVladimir Cheremisin: Nothing to disclose \nEsther Warnert: Nothing to disclose \nAnna Lavrova: Nothing to disclose \nWouter Teunissen: Nothing to disclose \nMartin van den Bent: Nothing to disclose \nMarion Smits: Nothing to disclose \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 270  \nRPS 311-5 \nCombination of magnetic resonance relaxometry and ASL perfusion in \nassessment of high-grade glioma subregions and surrounding brain \ntissue \n*I. Chekhonin*, A. Batalov, A. Tyurina, E. Pogosbekian, P. Nikitin, A. Bykanov, \nN. Zakharova, D. Pitskhelauri, I. N. Pronin; Moscow/RU \n(Ivan-Chekhonin@yandex.ru) \n \nPurpose: To assess the capability of MR relaxomery and ASL perfusion to \ndifferentiate between regions of malignant gliomas and areas of surrounding \nbrain tissue. \nMethods or Background: 27 patients older than 18 years with newly \ndiagnosed contrast-enhancing supratentorial glial tumors were enrolled. The \nMRI protocol (1.5 T) contained conventional stuctural MRI (including contrast-\nenhanced images), pseudocontinuous ASL perfusion and magnetic resonance \nimage compilation (MAGiC). Before tumor resection, the following ROIs on \nrelaxometric and ASL maps were chosen: - area of maximal perfusion within \ncontrast-enhancing tumor part (1); - perifocal infiltrative edema (non-enhancing \nT2 FLAIR hyperintensive) zone (2) - normal-appearing tumor-adjacent white (3) \nand gray (6) matter along the operative approach - normal-appearing white (4) \nand gray (5) matter remote from the tumor zone Statistics included Kruskal-\nWallis and Bonferroni-corrected Mann-Whitney tests, ROC analysis and \nSpearman correlation. \nResults or Findings: There were 18 patients with glioblastoma, 5 patients with \nanaplastic oligodendroglioma, 4 patients with anaplastic astrocytoma. Cerebral \nblood flow (CBF) allowed to differentiate between zones 1 and 2 with higher \nvalues in zone 1. T1, T2 and proton density values could differentiate between \nzones 2 and 3 with higher values in zone 2. T2 values could also afford to \ndiscriminate between zones 3 and 4 with lower values in zone 3. No difference \nwas shown between relaxomertic or perfusion properties of zones 5 and 6. \nSignificant inverse correlation was found between T2 and CBF in zone 1. \nConclusion: ASL perfusion and MR relaxometry possess complementary \npower for differentiation of glioma subregions and adjacent brain matter and \nthus represent a rationale for combined application. \nLimitations: Sample size. \nPossible anatomical differences in relaxometric values between brain regions \nindependent of tumor presence. \nEthics Committee Approval: Approval granted. \nFunding for this study: Russian Foundation for Basic Research grant ʋ18-\n29-01018. \nAuthor Disclosures: \nDipl.Phys. Eduard Pogosbekian: Nothing to disclose \nPavel Nikitin: Nothing to disclose \nAndrey Bykanov: Nothing to disclose \nDavid Pitskhelauri: Nothing to disclose \nArtem Batalov: Nothing to disclose \nAnastasia Tyurina: Nothing to disclose \nIvan Chekhonin: Nothing to disclose \nIgor Nikolaevich Pronin: Nothing to disclose \nNatalia Zakharova: Nothing to disclose \n \nRPS 311-6 \nAssessment of subcortical brain volume changes in breast cancer \npatients undergoing treatment: a pilot study \n*A. S. C. Verde*, B. Sousa, A. Oliveira-Maia, F. Cardoso, C. Matos,  \nN. Papanikolaou; Lisboa/PT \n \nPurpose: Prior studies have focused on the investigation of chemotherapy-\nrelated cognitive impairment (CRCI) in breast cancer patients, as supported by \nneuroimaging findings. In this study, we aim at investigating whether \nchemotherapy treatment induces subcortical volumetric changes. \nMethods or Background: Brain images of 29 breast cancer patients – 19 \nendocrine-treated and ten chemotherapy-treated– were prospectively acquired \non a 3T MRI at two-time points, namely, before and six months after treatment. \nAdditionally, 27 gender- and age-matched healthy controls, provided by the \nOpen Access Series of Imaging Studies (OASIS) Cross-Sectional dataset, \nwere included in the analysis. Firstly, T1-weighted images were segmented \ninto 15 subcortical structures using FIRST from FSL (FMRIB software library). \nSecondly, its respective volumes were quantified using FSLstats and \nnormalized using the V-scaling factor from SIENAX. A two-way repeated-\nmeasures ANOVA was performed, using age and total brain volume as study \ncovariates. Post-hoc Tukey tests were employed and p-values obtained were \nadjusted for multiple comparisons using FDR. \nResults or Findings: After controlling for age and total brain volume, a \nsignificant main effect of the participants’ group in the volumes of the bilateral \nthalamus, putamen, nucleus accumbens, and right pallidum was found. \nParticularly, Tukey test results corrected for multiple comparisons showed that \nat six months there were statistically significant volume reductions in the \nbilateral thalamus (left: p=0.011, right: p=0.006) of the chemotherapy-treated \npatients compared with the healthy controls, while for the endocrine-treated \ngroup similar comparisons to healthy controls were non-significant (left: \np=1.000, right: p=0.750). \nConclusion: There is evidence of thalamic volume reduction in chemotherapy-\ntreated breast cancer patients, which may reflect attention and emotion \ndysregulations in these patients. \nLimitations: Reduced number of chemotherapy-treated patients. \nEthics Committee Approval: MR acquisitions approved by the local EC. \nFunding for this study: BOUNCE project funded by the EU Horizon 2020 \nresearch and innovation program. \nAuthor Disclosures: \nAlbino Oliveira-Maia: Nothing to disclose \nFátima Cardoso: Nothing to disclose \nCelso Matos: Nothing to disclose \nBerta Sousa: Nothing to disclose \nNickolas Papanikolaou: Advisory Board: Advantis Medical SysteFounder: \nMRIcons \nAna Sofia Castro Verde: Nothing to disclose \n \nRPS 311-7 \nImproved imaging of therapy-naive high-grade glioma by turbo spin-echo \nblack blood sequences \n*N. Sollmann*, J. Gempt, C. Zimmer, J. S. Kirschke, T. Finck; Munich/DE \n(nico.sollmann@tum.de) \n \nPurpose: To investigate the value of contrast-enhanced (CE) turbo spin echo \nblack blood (BB) sequences for imaging of therapy-naive high-grade gliomas \n(HGGs). \nMethods or Background: Patients with WHO grade III or IV gliomas and no \noncological treatment were retrospectively included (March 2019 to January \n2020). 3-Tesla MRI comprised CE BB and CE turbo field echo (TFE) \nsequences. The lack/presence of tumor-related contrast enhancement and \nsatellite lesions were evaluated by two readers. Sharper delineation of tumor \nboundaries (1, bad; 2, intermediate; 3, good delineation) and vaster expansion \nof HGGs into the adjacent brain parenchyma on CE BB imaging were the \nendpoints. Furthermore, contrast-to-noise ratios (CNRs) were calculated. \nResults or Findings: Fifty-four patients were included (mean age: 61.2±15.9 \nyears, 64% male). The vast majority of HGGs (51/54) showed contrast \nenhancement in both sequences, while two HGGs as well as one of six \ndetected satellite lesions were depicted in CE BB imaging only. Tumor \nboundaries were significantly sharper (R1: 2.43±0.71 vs. 2.73±0.62, p<0.001; \nR2: 2.44±0.74 vs. 2.77±0.60, p=0.001), while the spread of HGGs into the \nadjacent parenchyma was larger when considering CE BB sequences \naccording to both readers (larger spread in CE BB sequences: R1: 23 patients; \nR2: 20 patients). The CNR for CE BB sequences significantly exceeded that of \nCE TFE sequences (43.4±27.1 vs. 32.5±25.0, p=0.0028). \nConclusion: Our findings suggest that BB imaging may considerably improve \ndelineation of therapy-naive HGGs when compared with established TFE \nimaging. \nLimitations: The retrospective character of the study and the evaluation of \ntumor boundaries and size only in qualitative manner represent this study's \nlimitations. \nEthics Committee Approval: This study was approved by the local \nInstitutional Review Board (registration number: 340/16 S). \nFunding for this study: Not applicable. \nAuthor Disclosures: \nJan S Kirschke: Nothing to disclose \nClaus Zimmer: Nothing to disclose \nJens Gempt: Nothing to disclose \nNico Sollmann: Nothing to disclose \nTom Finck: Nothing to disclose \n \nRPS 311-8 \nRecurrence assessment in glioblastoma: 11C-methionine PET vs \nperfusion magnetic resonance imaging (MRI) \n*A. C. Igual Rouilleault*, I. Soriano Aguadero, J. F. Bastidas,  \nP. Malmierca Ordoqui, A. Paternain Nuin, R. Garcia de Eulate,  \nM. Calvo Imirizaldu, J. Arbizu, P. Dominguez Echavarri; Pamplona/ES \n(aigual@unav.es) \n \nPurpose: To compare dynamic susceptibility contrast perfusion MRI (DSC-\nMRI) and 11C -MET PET (MET-PET) accuracy in differentiating radiation \nnecrosis from tumor recurrence in patients with treated glioblastoma. \nMethods or Background: We studied 19 patients with treated glioblastoma \nundergoing DSC-MRI and MET-PET in the follow-up evaluation due to new \ncontrast enhancement in T1-weighted images, including a total of 25 \nexaminations. In DSC-MRI, regions of interest (ROI) with maximum relative \ncerebral blood volume (rCBV) in the area with contrast enhancement was \ncompared to the average value of a reference ROI in the contralateral white \nmatter to obtain the relative rCBV ratio. For MET-PET, we calculated the \ntarget-to-background ratio (TBR) in the areas with increased uptake. We \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 271  \nstudied the diagnostic accuracy of both imaging modalities (ROC-AUC), \nexplored their concordance (Kappa index) and compared rCBV and TBR \nvalues between radiation necrosis and tumor recurrence diagnosis (U-Mann-\nWhitney test). A subanalysis was conducted after excluding patients under \nantiangiogenic treatment. \nResults or Findings: DSC-MRI analysis showed a sensitivity and specificity of \n81% and 100%, respectively, and positive predictive value and negative \npredictive value of 100% and 75% (AUC: 0.83). As for the MET-PET, statistics \nrevealed a sensitivity and specificity of 100% and 78%, respectively, and \npositive predictive value and negative predictive value of 89% and 100%(AUC: \n0.84), with a moderate concordance between both examinations(kappa:0.6). \nAfter excluding patients with antiangiogenic therapies, DSC-MRI sensitivity \nincreased by 9%, not detecting changes in MET-PET results(kappa:0.7). The \nrCBV and TBR were higher in the recurrence group than in the necrosis \ngroup(p=0.007 and p=0.006). \nConclusion: Both techniques seem excellent in the recurrence assessment of \ntreated glioblastoma patients. In patients treated with antiangiogenic therapies, \nMET-PET should be preferred. \nLimitations: Small sample size  \nLack of histological final diagnosis in most patients. \nEthics Committee Approval: Not applicable. \nFunding for this study: No. \nAuthor Disclosures: \nPablo Dominguez Echavarri: Nothing to disclose \nIgnacio Soriano Aguadero: Nothing to disclose \nPatricia Malmierca Ordoqui: Nothing to disclose \nJuan Fernando Bastidas: Nothing to disclose \nJavier Arbizu: Nothing to disclose \nAlba Cristina Igual Rouilleault: Nothing to disclose \nMarta Calvo Imirizaldu: Nothing to disclose \nReyes Garcia de Eulate: Nothing to disclose \nAlberto Paternain Nuin: Nothing to disclose \n \nRPS 311-9 \nASL for brain tumours: do we really need CBF maps? \n*W. Teunissen*¹, A. Lavrova², E. Warnert¹, V. Cheremisin², M. van den Bent¹, \nM. Smits¹; ¹Rotterdam/NL, ²St. Petersburg/RU \n(whtteunissen@gmail.com) \n \nPurpose: Cerebral blood flow (CBF) in intra-axial tumours can be measured \nwith arterial spin labelling (ASL), an advanced MRI technique in which \nperfusion-weighted images (PWI) are acquired and quantified based on a \nkinetic model. The aim of this study was to compare non-quantitative PWI with \nquantitative CBF maps to assess whether quantification could be omitted. \nMethods or Background: We identified a retrospective consecutive cohort \nwho underwent ASL in addition to routinely performed DSC perfusion MRI at \n3T in 2019 for surveillance of intra-axial brain tumours. ASL derived CBF maps \nwere computed with AWServer. PWI consisted of the averaged subtractions of \nthe unlabelled minus the labelled acquisitions as provided directly by the \nscanner without additional post-processing. After visual quality assessment, \nROIs of approximately 70mm2 were drawn manually within a representative \npart of the tumour and copied to the contralateral normal appearing white \nmatter (nawm) to calculate ratios. Pearson’s correlation coefficients of CBF and \nPWI ratios were calculated. Subset analyses were done separating \nprimary/secondary tumours and enhancing/non-enhancing lesions. \nResults or Findings: We measured 183 lesions within 122 patients. Mean age \nwas 54y(±13), 77 were male. We found a high correlation of PWI and CBF \nratios (r=0.969,p<0.001), also in a subset of enhancing glioma \n(n=80,r=0.956,p<0.001), non-enhancing glioma (n=56,r=0.997,p<0.001), \nenhancing metastasis (n=30,r=0.943,p<0.001) and non-enhancing lymphoma \n(n=7,r=0.944,p=0.0013). Correlation in enhancing lymphoma was lower \n(n=10,r=0.833,p=0.0027). \nConclusion: The results show an excellent correlation of the ratios of non-\nquantitative PWI and quantitative CBF ratios. Such high correlation can be \nexpected when there is no violation of the underlying assumptions for \nquantification of CBF from PWI. However, these results suggest that for \nlymphoma with high PWI these assumption are not valid. \nLimitations: Lack of follow-up data for definitive diagnosis: part of future \nresearch. \nEthics Committee Approval: Approved (ErasmusMC ethics committee). \nFunding for this study: None. \nAuthor Disclosures: \nVladimir Cheremisin: Nothing to disclose \nEsther Warnert: Nothing to disclose \nAnna Lavrova: Nothing to disclose \nWouter Teunissen: Nothing to disclose \nMartin van den Bent: Nothing to disclose \nMarion Smits: Nothing to disclose \n \n \n \nRPS 311-10 \nComparison of capability for molecular-based assessment in various \nbrain tumour patients between 3D gradient echo-based CEST imaging \nand 2D spin echo-based CEST imaging \n*K. Murayama*¹, Y. Ohno¹, M. Yui², K. Yamamoto², M. Ikedo², S. Hanamatsu¹, \nA. Iwase¹, T. Fukuba¹, H. Toyama¹; ¹Toyoake, Aichi/JP, ²Ohtawara/JP \n \nPurpose: To compare the capability for molecular-based assessment using 2D \nand 3D chemical exchange saturation transfer imaging at 3.5 ppm (APT-\nweighted image) in various brain tumor patients. \nMethods or Background: 46 consecutive patients with brain tumors were \nexamined with APT-weighted image by using 2D spin echo and 3D gradient \necho sequences at a 3T MR system. Then, all patients were divided into \nbenign and malignant intra-axial tumor and extra-axial tumor. In each lesion, \nmagnetization transfer ratio asymmetry (MTRasym) was assessed by ROI \nmeasurements. To determine the relationship between two methods \nmeasurement of MTRasym, Spearman’s rank correlation was performed. \nStudent’s t-test was performed to determine the difference between malignant \nand benign tumors. Finally, diagnostic accuracy to differentiate glioblastoma \nwas compared between two methods by McNemar test. \nResults or Findings: 3D APT-weighted image had significant and excellent \ncorrelation with 2D APT-weighted image (r=0.71, p<0.0001). The limits of \nagreement between 2D and 3D APT-weighted image was enough small. \nMTRasym had significant difference between low-grade and high-grade \ngliomas (2D: p=0.002, 3D: p<0.001). Diagnostic performance to differentiate \nglioblastoma from high-grade gliomas of 3D APT-weighted image was superior \nto that of 2D APT-weighted image. \nConclusion: 3D APT-weighted image appears to be as useful as 2D APT-\nweighted image for molecular-based assessment and can be considered at \nleast as valuable as 2D APT-weighted image in various brain tumor patients. \nLimitations: Limited study population is one of the limitations in this study. \nEthics Committee Approval: This study was retrospective study and written \ninformed consent from each subject was waved. This study was approved by \nthe institutional review board of Fujita Health University Hospital. \nFunding for this study: This study was technically supported by Canon \nMedical Systems Corporation. Ohno, Murayama, Toyama: Research grants/ \nCanon Medical Systems Corporation. Yui, Yamamoto, Ikedo: Employee/ \nCanon Medical Systems Corporation \nAuthor Disclosures: \nMasato Ikedo: Employee: Canon Medical SysteCorporation \nKazuhiro Murayama: Grant Recipient: Canon Medical SysteCorporation \nSatomu Hanamatsu: Nothing to disclose \nKaori Yamamoto: Employee: Canon Medical SysteCorporation \nHiroshi Toyama: Nothing to disclose \nMasao Yui: Employee: Canon Medical SysteCorporation \nYoshiharu Ohno: Grant Recipient: Canon Medical SysteCorporation \nAkiyoshi Iwase: Nothing to disclose \nTakashi Fukuba: Nothing to disclose \n \nRPS 311-12 \nImage subtraction maps for longitudinal FLAIR imaging in patients with \nglioma may facilitate early detection of tumour progression \n*N. Sollmann*, M. Gutbrod-Fernandez, E. Burian, J. Gempt, C. Zimmer,  \nJ. S. Kirschke; Munich/DE \n(nico.sollmann@tum.de) \n \nPurpose: Progression of glioma is frequently characterized by increases or \nenhanced spread of a hyperintensity in fluid attenuated inversion recovery \n(FLAIR) sequences. However, changes in FLAIR signal over time can be \nsubtle, and conventional (CONV) visual reading is time-consuming. The \npurpose of this study was to compare CONV reading to reading of subtraction \nmaps (SMs). \nMethods or Background: FLAIR datasets of 3-Tesla MRI acquired at two \ndifferent time points (mean inter-scan interval: 5.4±1.9 months) were \nconsidered per patient, derived from a consecutive series of 100 patients \n(mean age: 49.0±13.7 years) diagnosed with glioma (81 glioma WHO grade \nIII&IV). Two readers performed CONV and SM reading assessing alterations in \ntumor-associated FLAIR signal over time (stable/unchanged or progressive), \ndiagnostic confidence (1-very high to 5-very low diagnostic confidence), and \ntime needed for reading. Gold-standard (GS) reading including all available \nclinical and imaging information revealed progressive FLAIR signal in 61 \npatients. \nResults or Findings: SM reading revealed FLAIR signal increases in a larger \nproportion of patients according to evaluations of both readers (R1: 61 patients \n/ R2: 60 patients identified with FLAIR signal increase vs. R1: 45 patients / R2: \n44 patients for CONV reading) with significantly higher diagnostic confidence \n(R1: 1.29±0.48, R2: 1.26±0.44 vs. R1: 1.73±0.80, R2: 1.82±0.85; p<0.0001). \nThis resulted in increased sensitivity (99.9% vs. 73.3%) with maintained high \nspecificity (98.1% vs. 98.8%) for SM reading when compared to CONV \nreading. The time needed for SM reading was significantly lower compared to \nCONV assessment (p<0.0001). \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 272  \nConclusion: SM reading may improve diagnostic accuracy and sensitivity \nwhile reducing reading time, thus potentially enabling earlier detection of \ndisease progression. \nLimitations: The retrospective character and qualitative analysis approach \nreflect this study’s limitations. \nEthics Committee Approval: This retrospective study was approved by the \nlocal Institutional Review Board. \nFunding for this study: Not applicable. \nAuthor Disclosures: \nJan S Kirschke: Nothing to disclose \nClaus Zimmer: Nothing to disclose \nJens Gempt: Nothing to disclose \nMagaly Gutbrod-Fernandez: Nothing to disclose \nNico Sollmann: Nothing to disclose \nEgon Burian: Nothing to disclose \n \nRPS 311-13 \nDiffusion tensor imaging (DTI): a better understanding of spinal cord \ntumours \n*A. Ignatius*, P. S. Babu, R. Ravi; Chennai/IN \n(dr.amalanignatius@gmail.com) \n \nPurpose: The primary diagnosis of spinal intramedullary tumour suspected \nlesions is difficult and often it requires diagnostic spinal biopsy with the risk of \nneurological deficits. The DTI helps in identifying the type of tumour. The aim \nof the study is to assess the integrity of the spinal cord tracts in spinal tumours, \nanalyse the DTI parameters and correlate them with HPE, prognosticate the \ntumour, plan surgery and predict post-operative damage \nMethods or Background: The prospective study was conducted in the \nBarnard Institute of Radiology, MMC & RGGGH. The consecutive subjects \nundergoing Spinal MR for spinal cord tumours were invited to participate in this \nstudy. RESOLVE DTI was performed using a 1.5-T scanner (Avanto, \nSiemens). The tractography, FA, ADC (MD), E1 (AD), E2, E3 & RD values \nwere analysed with HPE and compared with age/sex-matched normal controls. \nResults or Findings: Ependymoma (n=2) caused the dispersion of fibres \nwhile astrocytoma (n=3) and ganglioglioma (n=2) caused the disruption of \nfibres. Tuberculoma (n=3) caused mild dispersion of fibres. The extramedullary \ntumours(n=4) caused compression of fibres while intramedullary tumours \n(n=10) caused dispersion and disruption of fibres. Mean FA values were \ndecreased in ganglioglioma (0.223), ependymoma (0.451), astrocytoma \n(0.351), spinal intramedullary metastasis (0.380),tuberculoma (0.430) and \nextramedullary tumours (0.498). ADC values were increased in all tumours \n(n=14) except in tuberculoma (n=3) where it is decreased (0.916). \nConclusion: The mean-FA values were decreased in all tumours (n=14) while \nmean-ADC values were significantly increased except in tuberculoma where \nthe mean-ADC values were decreased. The high-grade tumours caused the \ndisruption of fibres while low-grade tumours caused the dispersion of fibres. \nDTI avoids paralytic biopsies, predicts the prognosis and avoids postoperative \ncomplication. \nLimitations: Further studies with larger cohorts are needed to infer a definite \nconclusion. \nEthics Committee Approval: Institutional-Ethical committee approval. \nFunding for this study: Nil. \nAuthor Disclosures: \nR Ravi: Nothing to disclose \nPeter S. Babu: Nothing to disclose \nAmalan Ignatius: Nothing to disclose \n \nRPS 311-14 \nComparative analysis of arterial spin labeling and dynamic contrast \nperfusion imaging for quantitative perfusion measurements of brain \ntumours \n*S. Ahmed*, S. Tiwari, T. Yadav, P. K. Garg, P. S. Khera,  \nB. Sureka; Jodhpur/IN \n(ahmedsabha03@gmail.com) \n \nPurpose: This is a prospective comparative study between perfusion metrics \nobtained from arterial spin labeling (ASL) technique and dynamic susceptibility \ncontrast perfusion (DSC) in glial neoplasms. To assess the utility of rCBF \n(cerebral blood flow) maps derived from Arterial spin labeling in pre-operative \nassessment of primary neoplasms of brain and study its correlation with the \nrCBF derived from DSC perfusion. \nMethods or Background: Forty two cases of newly diagnosed intra-axial \nhistologically proven primary brain tumors assessed on a GE DISCOVERY 3T \nMR system were included in our study. The ASL derived CBF and DSC derived \nrelative CBF of 42 glioma patients were normalized (ASL-nCBF and DSC-\nnrCBF) for data analysis. A comparison between the two technique derived \nperfusion values was drawn using paired t test and correlated using Pearson \ncorrelation coefficient. \nResults or Findings: Out of 42 patients ,  24 were high grade neoplasms \n(15 glioblastoma multiforme, 1 anaplastic ependymoma, 1 anaplastic \noligodendroglioma, 4 lymphomas and 3 medulloblastoma)  18 were low \ngrade neoplasms ( 3 pilocytic astrocytoma,1 pilomyxoid astrocytoma,3 grade II \ngliomas, 2 grade II astrocytoma, 6 grade II oligodendroglioma, 2 grade II \nependymoma and 1 hemangioblastoma).  {27 males and 15 females- mean \nage 29.78 }. A significant correlation was demonstrated between ASL \nnormalised TBF and DSC normalised TBF using contralateral grey matter (R- \n0.836) and white matter (R- 0.864). \nConclusion: A significant correlation was demonstrated between the ASL and \nDSC derived normalised perfusion parameters in brain tumors using \nmultiparametric MRI. Our study establishes the ground for claims of ASL to be \na viable alternative tool for DSC perfusion. \nLimitations: Small sample size Pseudocontinous ASL was used perfusion \nassessment. A multi-delay ASL may serve as a better technique for correlation \nwith T2* perfusion. \nEthics Committee Approval: Approved \nFunding for this study: None \nAuthor Disclosures: \nSarbesh Tiwari: Author: nothing to disclose \nSabha Ahmed: Nothing to disclose \nPawan Kumar Garg: Nothing to disclose \nPushpinder Singh Khera: Nothing to disclose \nBinit Sureka: Nothing to disclose \nTaruna Yadav: Nothing to disclose \n \nRPS 311-15 \nIntracranial cystic lesions: wherever there is fluid \n*F-E. Badi*, M. Sabiri, S. Lezar, F. Essodegui; Casablanca/MA \n(badi.fatima.ezzahrae@gmail.com) \n \nPurpose: Analyze the different characteristics of intracranial cystic lesions on \nCT and MRI. Discuss the imaging features that’s allow differentiation between \nthe various intracranial cystic lesions. Propose a simplified algorithm allowing \nto make differential diagnosis of intracranial cystic lesions. \nMethods or Background: Intracranial cystic lesions are very common findings \nin neuro-imagery. These lesions can be asymptomatic. At present, there’s no \nestablished classification for brain cysts. But some features can help to \ndifferentiate these lesions, such as the location, the appearance of the wall of \nthe cyst and his thickness, enhancement, the components of the cyst. \nResults or Findings: The differential diagnosis of intracranial cystic lesions \nincludes a broad spectrum of conditions: normal variants (cavum of the septum \npellucidum, Rathke’s cyst.), developmental cystic lesions (arachnoid cysts, \nepidermoid and dermoid cysts.), vascular cystlike structures (choroid plexus \ncyst.), infectious cysts (hydatid cysts, abscess.) and neoplasic cysts \n(Glioblastoma, metastasis.). MRI is the method of choice to establish the \ndiagnosis of these cystic lesions by providing information about the anatomic \nlocation, size, shape and signal of the lesions as well as their enhancement \nand their mass effect on adjacent structures. \nConclusion: Understanding the spectrum of appearances of the various \nintracranial cystic lesions improves the diagnostic yield, enables one to \nunderstand their pathogenesis, and facilitates patient care. \nLimitations: None \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nFatiha Essodegui: Nothing to disclose \nFatima-Ezzahare Badi: Nothing to disclose \nMouna Sabiri: Nothing to disclose \nSamira Lezar: Nothing to disclose \n \n \nResearch Presentation Session: Neuro \nRPS 411 \nNeurological trauma \nRPS 411-1 \nDiscriminating cognitive motor dissociation from disorders of \nconsciousness through structural MRI \n*P. Pozeg*, J. Jöhr, R. A. Meuli, K. Diserens, V. Dunet; Lausanne/CH  \n(polona.pozeg@chuv.ch) \n \nPurpose: Detection of awareness in patients with disorders of consciousness \nis crucial for diagnosis, treatment, and end-of-life decisions. However, the \nstandard neurobehavioral bedside assessments often overlook subtle signs of \nconsciousness due to fluctuating arousal and other comorbidities hindering the \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 273  \npatient’s interaction. This retrospective study aimed to develop an MRI-based \nscore for brain lesion assessment to distinguish between patients with and \nwithout covert awareness as defined by a novel Motor Behavior Tool. \nMethods or Background: Retrospective data of 128 patients with severe \nbrain injury were split into a development and validation set. We assessed their \nbrain MRIs for lesions in 18 brain regions. Using logistic regression and \nsupport vector machine, we first identified a combination of damaged brain \nstructures with a high relevance to discriminate between the patients with and \nwithout awareness. For each classifier we constructed an MRI-based score for \nlesion assessment and estimated its optimal diagnostic cut-off point. We \nevaluated the performance of the two classifiers on the validation dataset. \nResults or Findings: The brain regions identified as relevant predictors of the \nnegative outcome were highly overlapping between two classifiers. They \nincluded the left mesencephalon, right basal ganglia, right thalamus, right \nparietal cortex, and left frontal cortex. When tested on the validation dataset, \nsupport vector machine showed higher specificity (0.97, 95% CI: 0.85, 1) than \nlogistic regression (0.90, 95% CI: 0.75, 0.97), whereas sensitivity level was at \n0.67 for both classifiers (95% CI: 0.24, 0.94 and 0.22, 0.96, respectively). \nConclusion: The MRI-based score assessing brain lesions in patients with \ndisorders of consciousness accurately detected patients with residual \nawareness. It can valuably complement behavioral evaluation as it is time-\nefficient and requires only a conventional MRI. \nLimitations: n/a \nEthics Committee Approval: The local ethics committee (CER-VD-142/09) \napproved the study. \nFunding for this study: Swiss National Science Foundation \nAuthor Disclosures: \nJane Jöhr: Nothing to disclose \nVincent Dunet: Nothing to disclose \nPolona Pozeg: Nothing to disclose \nReto Antoine Meuli: Nothing to disclose \nKarin Diserens: Nothing to disclose \n \nRPS 411-2 \nReduced rate of brain waste clearance for TBI patients: glymphatic \nfunction assessed via MRI within a short time \n*J. Bao*, X. Wang, Y. Zhang, J. Cheng; Zhengzhou/CN  \n(baoguojianfeng@gmail.com) \n \nPurpose: Dementia is commonly observed in traumatic brain injury (TBI), \nhowever, there is no consensus on the mechanism of how TBI promotes \nsusceptibility to the development of dementia. Recent studies have shown that \nTBI significantly affects the glymphatic function on the rate of clearance of \nfluorescence tracer in mice. Herein, the TBI glymphatic function was assessed \nvia MRI within a short time (1 hour) by measuring the rate of brain waste \nclearance. \nMethods or Background: This study includes 16 TBI patients and 7 relative \nhealthy controls with no history of TBI. T1W brain images were obtained three \ntimes with 20 min intervals after 4 hours lumbar intrathecal injections of \ngadolinium. Along the pathway of CSF propagation, 4 regions in each \nhemisphere were predefined. And the signal intensity of CSF nearby above \nregions was extracted for analyses. The rate of T1 signal change of two time \npoints was simply calculated using the following equations R_2=((S_2-\nS_1))»6B\u0014\u0003 G\u00035B\u0016 \u000b\u000b6B\u0016-S_1))»6 1, where R is the rate and S is the signal \nintensity of corresponding time point. \nResults or Findings: Significantly higher signal change rates were observed \nin 7 predefined CSF ROIs in TBI patients compared to controls within 1 hour \nscan after 4 hour injection gadolinium. The TBI patients show relatively slow \nclearance ability of gadolinium tracer for almost all predefined CSF regions. \nConclusion: Besides previously reported the delayed enhancement after 24 \nhours injection of tracer, this work proved the glymphatic dysfunction can be \nassessed by signal intensity dynamic change rate within 20 min after 4 hour \ninjection of the tracer as well. The deduced rate of tracer clearance in TBI \npatients may reflect damage of brain glymphatic system. \nLimitations: The number of subjects. \nEthics Committee Approval: Ethics Committee of the Zhengzhou University \nFunding for this study: NNSF (No.81601470) \nAuthor Disclosures: \nJingliang Cheng: Nothing to disclose \nJianfeng Bao: Nothing to disclose \nXiao Wang: Nothing to disclose \nYong Zhang: Nothing to disclose \n \n \n \n \n \n \n \n \nRPS 411-4 \nDiagnostic accuracy of dual-layer spectral CT for detecting post-\ntraumatic prevertebral haematoma of the cervical spine \n*S. Sedaghat*, M. Both, O. Jansen; Kiel/DE \n(samsedaghat1@gmail.com) \n \nPurpose: To investigate the diagnostic value of dual-layer spectral detector \ncomputed tomography (SDCT) in detecting posttraumatic prevertebral \nhematoma of the cervical spine \nMethods or Background: Thirty-eight patients with posttraumatic imaging of \nthe cervical spine were included in this study and received both SDCT and MRI \nexaminations. MRI was set as reference and electron density (ED) images \nwere compared to conventional CT (CCT) images alone. \nResults or Findings: 18 prevertebral hematomas were identified. CCT \nshowed a sensitivity of 33-50% and a specificity of 75-80%, while for ED \nreconstructed images sensitivity was 77-83% and specificity 85-90%. Accuracy \nincreased from 55-66% to 84% by using ED images. The sizes of prevertebral \nhematoma on CCT or ED images were not significantly under- or \noverestimated compared to the MRI reference. There was a significant \ndifference between the two readers for measuring hematoma sizes on CCT \n(p=0.04). Readers showed an excellent inter-rater reliability (kappa = 0.82) for \nC + ED images and a moderative inter-rater reliability (kappa = 0.44) for CCT. \nConclusion: Diagnostic accuracy for detecting post-traumatic prevertebral \nhematoma is improved on SDCT by using combined electron density \nreconstructions compared to conventional images alone. \nLimitations: The main limitation is the small number of patients. \nEthics Committee Approval: The study was approved by the responsible \nInstitutional Review Board (IRB). \nFunding for this study: None. \nAuthor Disclosures: \nSam Sedaghat: Nothing to disclose \nMarcus Both: Nothing to disclose \nOlav Jansen: Nothing to disclose \n \nRPS 411-6 \nBrain glymphatic system is impaired in TBI found with MRI: the first \nhuman study \n*X. Wang*, J. Bao, Y. Zhang, J. Cheng; Zhengzhou/CN \n(daisywangxiao@outlook.com) \n \nPurpose: The pathology of neurodegeneration following the traumatic brain \ninjury (TBI) is still unknown. Recently, a new brain waste clearance system, \n‘glymphatic system’, was proved to be damaged in TBI rodent. Herein, the \nfunctionality of human brain glymphatic system of TBI patients and related \nhealthy controls was evaluated using MRI. \nMethods or Background: The glymphatic function was assessed by T1W MRI \nwith intrathecal gadolinium injection as tracer. Images were obtained from TBI \n(n = 16) and relatively healthy controls (n = 7) at 4 time points. Along the \ncerebrospinal fluid (CSF) drawing pathway, Fig.1 predefined 4 regions of \ninterest (ROIs), were automatically generated using standard brain atlas. Each \nROI was subsequently split into sub-ROIs including CSF and gray matter (GM) \nseparately for analyzing the signal enhancement characteristics. The \npercentage changes of signal were used for group comparisons. \nResults or Findings: After 24-hour injection, the percentage changes of T1 \nsignal intensity were significantly higher in TBI patients than controls for CSF \nand GM, but not for WM in all ROIs (not show here). The CSF enhancement \nseems more pronounced than GM enhancement. The higher T1 signal in TBI \npatient at 24 h can be attributed to the reduced efficiency of the contrast agent \nclearance. \nConclusion: The significantly delayed enhancements in CSF and GM in TBI \ngroup indicates that the brain glymphatic system is impaired in TBI. Glymphatic \ndysfunction may provide a new clue to understand its pathogenesis of the \ncognitive impairments along with TBI in later life. What’s more, this study \nreconfirmed the MRI scan with gadolinium intrathecal administration may hold \na potential to explore the glymphatic function in human. \nLimitations: None \nEthics Committee Approval: This study was approved by Ethics Committee \nof the Zhengzhou University. \nFunding for this study: NNSF (No. 81601470) \nAuthor Disclosures: \nJingliang Cheng: Nothing to disclose \nJianfeng Bao: Nothing to disclose \nXiao Wang: Nothing to disclose \nYong Zhang: Nothing to disclose \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 274  \n \nResearch Presentation Session: Neuro \nRPS 511 \nFoetal and paediatric neurological imaging \nRPS 511-1 \nMagnetic resonance spectroscopy of the paediatric cerebellum: what is \nthe range of normal metabolite ratios? \n*V. J. Balian*, D. Connolly, S. Mordekar, N. Hoggard; Sheffield/UK  \n(balianvartan@gmail.com) \n \nPurpose: Proton magnetic resonance spectroscopy (1H-MR spectroscopy) is \na valuable tool in brain MR imaging used to identify metabolic changes in \nneurological disorders. Its diagnostic role is well established in adults, \nparticularly for cerebellar pathology. In children this has not occurred due to \ndifficulty in obtaining normal control data. We aim to define a range of normal \ncerebellar metabolite ratios in children, and identify when normal adult levels \nare reached. \nMethods or Background: Healthy children between the ages of 0 and 16 \nwere prospectively included over the study period from November 2018 to \nNovember 2020. Metabolite concentrations of n-acetylaspartate (NAA), \ncreatine (Cr) and choline (Ch) and NAA/Cr, NAA/Cr (height), Cho/Cr, and \nNAA/Ch ratios were acquired in the superior vermis and right cerebellar \nhemisphere in each participant using 1H-MR single voxel point-resolved \nspectroscopy (PRESS) at 3 T with echo time (TE) 144 ms, and repetition time \n(TR) 2000ms. \nResults or Findings: In the 80 children who met the inclusion criteria, we \nshowed that metabolite ratios increase steadily under the age of 3, but \nthereafter follow a stable pattern. From the age of 3 onwards, mean ± standard \ndeviation metabolite ratios in the superior vermis were 0.99 ± 0.07 (NAA/Cr), \n0.94 ± 0.06 (NAA/Cr (h)), 0.90 ± 0.08 (Ch/Cr), and 1.10 ± 0.08 (NAA/Ch); and \nratios in the right cerebellar hemisphere were 1.07 ± 0.16 (NAA/Cr), 0.96 ± \n0.10 (NAA/Cr (h)), 0.92 ± 0.08 (Ch/Cr), and 1.17 ± 0.15 (NAA/Ch). \nConclusion: We have shown for the first time that the paediatric range of \nnormal cerebellar metabolite ratios acquired by long TE 1H-MR spectroscopy \nreach adult levels by the age of 3 onwards. \nLimitations: Relatively small sample size (although largest in current \nliterature); and some data were collected retrospectively. \nEthics Committee Approval: Yes. \nFunding for this study: No funding. \nAuthor Disclosures: \nVartan Jacques Balian: Nothing to disclose \nNigel Hoggard: Nothing to disclose \nSantosh Mordekar: Nothing to disclose \nDaniel Connolly: Nothing to disclose \n \nRPS 511-2 \nFoetal brainstem visualisation using super-resolution and postmortem \nMRI – a first step towards AI-based prognostication in foetal \nneuroimaging \n*G. O. Dovjak*¹, G. Gruber², P. Brugger¹, M. Weber¹, E. Schwartz¹, D. Prayer¹, \nG. Kasprian¹; ¹Vienna/AT, ²Krems/AT  \n(gregor.dovjak@meduniwien.ac.at) \n \nPurpose: The fetal posterior fossa is a complex anatomic compartment that \nconsists of different functional systems. This study aimed to quantitatively \nassess prenatal brainstem pathologies with reconstructed “super-resolution” \nfetal MRI and postmortem data using biometry. The resulting insights aim to \nincrease diagnostic accuracy and characterization of disorders in hindbrain \nsegmentation. \nMethods or Background: Fetuses with brainstem malformations and an \navailable fetal MRI, postmortem MRI and a confirmatory autopsy were \nincluded. Three orthogonal T2-weighted prenatal brain sequences were \nalgorithmically reconstructed into a three-dimensional “super-resolution” \nisovoxel dataset. Based on this data, as well as on high resolution isovoxel T2-\nweighted postmortem sequences, the volumes of the midbrain, pons, medulla \noblongata and cerebellum were segmented using ITK-SNAP. Further, the area \nand diameters of these structures were quantified. \nResults or Findings: 29 fetuses with a mean gestational age of 26.9±5.3, \nranging from 18+3 to 37+5 gestational weeks were included. The brainstem \nfindings included aqueductal stenosis, z-shaped brainstem, pontocerebellar \nhypoplasia, elongated and thin brainstem, brainstem disconnection, and \ndysplastic tectum. The associated cerebellar pathologies consisted of \ncerebellar hypoplasia, rhombencephalosynapsis, and dysplastic/hypoplastic \nvermis. All substructures of the fetal brainstem and cerebellum could be \nconsistently measured in both modalities. The super-resolution brainstem \nvolumetry allowed for a more detailed assessment of the brainstem disorders \ncompared to standard two-dimensional evaluation. \nConclusion: A detailed prenatal three-dimensional analysis of posterior fossa \nstructures is valid and possible using novel super-resolution reconstruction. \nCorrelating prenatal super-resolution MRI data with postnatal \nneurodevelopmental long-term outcomes using computerized imaging based \nlearning methods will optimize prenatal counseling of posterior fossa \nmalformations. This will help to reduce anxiety of parents with ambiguous \nresults during fetal organ screening examinations and improve parental \ncounseling. \nLimitations: Retrospective, small case amount \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nErnst Schwartz: Nothing to disclose \nGregor Oliver Dovjak: Nothing to disclose \nPeter Brugger: Nothing to disclose \nGerlinde Gruber: Nothing to disclose \nDaniela Prayer: Nothing to disclose \nGregor Kasprian: Nothing to disclose \nMichael Weber: Nothing to disclose \n \nRPS 511-3 \nThe prenatal origins of human brain asymmetry: lessons learned from a \ncohort of foetuses with body lateralisation defects \n*P. Kienast*¹, E. Schwartz¹, M. C. Diogo¹, G. Gruber², P. Brugger¹,  \nL. Bartha-Doering¹, M. Weber¹, D. Prayer¹, G. Kasprian¹; ¹Vienna/AT, \n²Krems/AT \n(pat.kienast@gmail.com) \n \nPurpose: This study investigated whether body lateralization defects or \nciliopathies have a morphological effect on physiological asymmetry patterns in \nfetal brains. \nMethods or Background: Structural brain asymmetries are linked to \nasymmetries in the functional representation of cognitive functions and \nabilities. Knowledge about structural brain asymmetries of human fetuses with \nbody lateralization defects—congenital diseases in which visceral organs are \npartially or completely incorrectly positioned—can improve our understanding \nof the developmental origins of hemispheric brain asymmetry. This study \ninvestigated structural brain asymmetry in 21 fetuses, who were diagnosed \nwith different types of lateralization defects (situs inversus totalis, situs inversus \nabdominalis, situs ambiguus and isolated dextrocardias), five fetuses with \nciliopathies; and 26 age-matched healthy control cases, between 22 and 34 \ngestational weeks (GW) of age. A database of 4,007 1.5 Tesla fetal MRIs was \naccessed and searched for the corresponding diagnoses. Specific temporal \nlobe brain asymmetry indices were quantified using in vivo, super-resolution \nprocessed MR brain imaging data. \nResults or Findings: Results revealed that perisylvian fetal structural brain \nlateralization patterns and asymmetry indices did not differ between cases with \nlateralization defects, ciliopathies, and normal controls. \nConclusion: Molecular mechanisms involved in the definition of the right/left \nbody axis—including cilium-dependent lateralization processes—appear to \noccur independently from those involved in the early establishment of structural \nhuman brain asymmetries. Atypically inverted early structural brain \nasymmetries are similarly rare in individuals with lateralization defects and may \nhave a complex, multifactorial, neurodevelopmental background with currently \nunknown postnatal functional consequences. \nLimitations: The main limiting factor of the study was the small number of \nMRIs with sufficiently well represented brains of fetuses who suffered from \nlateralization defects. \nEthics Committee Approval: Approval-number 1900/2016, MUV. \nFunding for this study: No author has received payment specifically for the \ndevelopment of this study. \nAuthor Disclosures: \nLisa Bartha-Doering: Nothing to disclose \nErnst Schwartz: Nothing to disclose \nMariana Cardoso Diogo: Nothing to disclose \nPatric Kienast: Nothing to disclose \nPeter Brugger: Nothing to disclose \nGerlinde Gruber: Nothing to disclose \nDaniela Prayer: Nothing to disclose \nGregor Kasprian: Nothing to disclose \nMichael Weber: Nothing to disclose \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 275  \nRPS 511-4 \n“SyMRI”-based quantitative mapping of the human foetal brain \n*V. Schmidbauer*, G. O. Dovjak, M. S. Yildirim, B. Ulm, D. Prayer, G. Kasprian; \nVienna/AT \n(schmidbauervictor@gmail.com) \n \nPurpose: Based on a single multi-dynamic multi-echo (MDME) sequence, the \nMR data post-processing software “SyMRI” generates a variety of MR \ncontrasts characterizing tissue-specific properties. The aim of this study is to \nassess the feasibility of “SyMRI” in the early prenatal characterization of brain \nmaturation. \nMethods or Background: 47 fetuses were examined using a standardized \nfetal MRI protocol (1.5 Tesla). MDME sequence (acquisition time: 3 min. 20 \nsec.)-based post-processing was performed using “SyMRI” (Synthetic MR AB, \nLinköping, Sweden; Version 11.1.5). T1-relaxation time (T1R), T2-relaxation \ntime (T2R) (ms), and proton density (PD) (%) of the germinal matrix were \ndetermined. \nResults or Findings: Fetal motion limited the use of “SyMRI” in 39/47 \n(82.98%). Non-motion degraded images of diagnostic quality were available in \n8/47 (17.02%) [gestational age (GA): 23+6; 24+6; 25+4; 25+4; 25+5; 26+6; \n32+4; 34+0]. T1R, T2R, and PD of the germinal matrix were determined in six \nfetuses: range GA: 23+6 – 26+6 (T1R: 1195 – 1399/T2: 137 – 150/PD: 75.4 – \n82.7). \nConclusion: “SyMRI” for MDME-based MR post-processing is feasible to \nprovide MR contrasts of diagnostic image quality, although limited by fetal \nmotion. Maturational changes of transient brain structures such as the germinal \nmatrix can be quantified in utero and in vivo. In a small sample of non-motion \ndistorted MDME acquisitions, higher GA is consistently associated with higher \nT1R of the germinal matrix. \nLimitations: Small sample size \nEthics Committee Approval: All procedures were carried out in accordance \nwith the Declaration of Helsinki. \nFunding for this study: None \nAuthor Disclosures: \nVictor Schmidbauer: Nothing to disclose \nMehmet Salih Yildirim: Nothing to disclose \nBarbara Ulm: Nothing to disclose \nGregor Oliver Dovjak: Nothing to disclose \nDaniela Prayer: Nothing to disclose \nGregor Kasprian: Nothing to disclose \n \nRPS 511-5 \nNeuraxial deformation stress in “Complex” chiari malformation \nM. D. Papachristou¹, *R. Ward*², V. Agarwal²; ¹Warrendale, PA/US, \n²Pittsburgh, PA/US \n(Wardr2@upmc.edu) \n \nPurpose: 1. To review the radiographic features of “Complex” Chiari 2. To \nlearn metrics of neuraxial deformation stress and integrate them into clinical \nreports 3. To gain awareness of algorithms used by neurosurgeons to plan \nappropriate surgical strategy. \nMethods or Background: Chiari I Malformation (CMI) is a relatively common \nabnormality familiar to most radiologists. Cerebellar tonsillar herniation \naccompanied by additional abnormalities is often referred to as “Complex” \nChiari (CC). Both CMI and CC patients present generally with cervicomedullary \nsyndrome (CMS), although some authors maintain distinct clinical \npresentations for these disease processes. Relevant abnormalities may be \ngrouped into deformities of the CVJ (e.g. Basilar invagination, retroflexed dens) \nand central nervous system (e.g. cervicomedullary kink) components. Because \nthese abnormalities contribute to the overall disease process, such patients \noften require different surgical procedures to achieve symptom relief. \nMorphologic features of Complex Chiari may be described in terms of \nreference lines such as those defined by McRae and Chamberlain. More \nrecently, the neurosurgical community has increasingly recognized the \nimportance of neuraxial deformation stress (NDS) in the pathogenesis of CMS. \nNDS is a general term encompassing forces acting to deform the long-axis of \nthe CNS, which, for this subject, concerns the normal cranio-caudal axis of the \nbrainstem and upper cervical spinal cord. Mechanisms of NDS may be \nsubdivided into ventral brainstem compression (VBSC) and stretch-induced \nmyelopathy (SIM). The risk of ventral brainstem compression and stretch-\ninduced myelopathy associated with skull base/CVJ variants is subsumed into \ncertain radiographic metrics: clivo-axial angle (CXA) and Grabb’s line (pB-C2). \nFamiliarity with the imaging findings and relevant metrics of Complex Chiari \ncan improve radiologists’ relevance to our neurosurgical colleagues and the \npatients we both serve. \n \n \n \n \n \n \nResults or Findings: N/a \nConclusion: N/a \nLimitations: N/a \nEthics Committee Approval: N/a \nFunding for this study: No disclosures. \nAuthor Disclosures: \nMarios D Papachristou: Nothing to disclose \nRebecca Elizabeth Ward: Nothing to disclose \nVikas Agarwal: Nothing to disclose \n \nRPS 511-6 \nSex-related differences in extremely preterm neonates – a quantitative \nMR data analysis of infra- and supratentorial regions \n*V. Schmidbauer*, G. O. Dovjak, M. C. Diogo, M. S. Yildirim, K. Goeral,  \nD. Prayer, G. Kasprian; Vienna/AT \n(schmidbauervictor@gmail.com) \n \nPurpose: DTI parameters [fractional anisotropy (FA)/apparent diffusion \ncoefficient (ADC)] and tissue-specific properties [T1-relaxation time (T1R)/T2-\nrelaxation time (T2R)] allow for a quantitative MRI assessment. The aim of this \nstudy is to investigate sex-related maturity differences of infra- and \nsupratentorial regions in extremely preterm infants by means of a quantitative \nMR approach. \nMethods or Background: 35 extremely preterm neonates [born <28 weeks \ngestational age (GA)] (female: n=17/male: n=18) were examined at term-\nequivalent age using a standardized neonatal MRI protocol (1.5 Tesla). \nQuantitative analysis was applied in the midbrain and the left/right posterior \nlimb of the internal capsule (PLIC). DTI data post-processing was performed \n[IntelliSpace Portal (Philips Healthcare Systems; Version 10)] to determine FA-\n/ADC-values. T1R/T2R was determined based on multi-dynamic multi-echo \nsequence post-processing using “SyMRI” (Synthetic MR AB, Linköping, \nSweden; Version 11.1.5). A Pearson’s correlation analysis was performed to \nassess correlations between T1R/T2R and FA-/ADC-values. ANCOVA \n(covariate: GA at MRI) was used for group comparison. A paired t-test was \nused to compare the left and right PLIC in both female and male neonates. \nResults or Findings: No consistent correlations were observed between \nT1R/T2R and FA-/ADC-values. T1R of the midbrain was significantly \ndecreased in female compared to male infants (p=0.015). ADC-values/T1R \n(decreased)/FA-values (increased) differed significantly between the left and \nright PLIC in both female (ADC: p=0.002/T1R/FA: p<0.001) and male \n(ADC/T1R/FA: p<0.001) neonates. \nConclusion: DTI parameters and tissue-specific properties respond to \ndifferent aspects of brain maturation. T1R metrics reveal sex-related maturity \ndifferences that indicate a more advanced state of brain maturation in female \ncompared to male neonates. A consistently more advanced state of maturity of \nthe left compared to the right PLIC was found using both mapping approaches. \nLimitations: Small sample size \nEthics Committee Approval: All procedures were performed in accordance \nwith the Declaration of Helsinki. \nFunding for this study: None \nAuthor Disclosures: \nVictor Schmidbauer: Nothing to disclose \nMehmet Salih Yildirim: Nothing to disclose \nMariana Cardoso Diogo: Nothing to disclose \nGregor Oliver Dovjak: Nothing to disclose \nDaniela Prayer: Nothing to disclose \nKatharina Goeral: Nothing to disclose \nGregor Kasprian: Nothing to disclose \n \n \nResearch Presentation Session: Neuro \nRPS 611 \nIchaemia and infarction in the brain \nRPS 611-1 \nMyosteatosis is correlated with poor clinical outcome in patients who \nundergo mechanical thrombectomy for acute ischaemic stroke \n*M. Bonatti*¹, A. Comai¹, R. Valletta¹, F. Lombardo², F. Ferro¹; ¹Bolzano/IT, \n²Negrar/IT  \n(matteobonatti@hotmail.com) \n \nPurpose: To assess the impact of sarcopenia and myosteatosis on clinical \noutcome in patients successfully reperfused after acute ischemic stroke. \nMethods or Background: In this IRB-approved retrospective cohort study, we \nincluded 166 patients (84F/82M, 70±13years) who underwent technically \nsuccessful mechanical thrombectomy for acute ischemic stroke in our \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 276  \nInstitution between Jan2016 and Dec2019. 90days mRS was retrieved from \nInstitutional database. ASPECTS and collateral score were assessed on pre-\noperative CT/triphasic CT-angiography(CTA). Skeletal muscle area (SMA) and \nmean muscle attenuation at the level of C5 were calculated using free software \n(ImageJ v1.52). ASPECTS, collateral score, SMA and muscle attenuation were \ncompared to clinical outcome (90days mRS 0-2=good outcome; 3-6=poor \noutcome). \nResults or Findings: ASPECTS was significantly higher in patients with good \nclinical outcome than in those with poor clinical outcome (8.7±1.4 vs. 7.6±2.1, \np=0.0006, Mann-Whitney test). The presence of good/intermediate collaterals \nwas significantly associated with good clinical outcome (p=0.0013, Fisher’s \nexact test). SMA was not significantly different between patients with good and \npoor clinical outcome (41.97±10.29mm2 vs. 41.66±10.59 mm2, p=n.s., Mann-\nWhitney test). Mean muscle attenuation was significantly higher in patients with \ngood clinical outcome than in those with poor clinical outcome (47.15±9HU vs. \n43.5±8HU, p=0.0202, Mann-Whitney test). \nConclusion: Beyond other well-known predictors, myosteatosis represents a \nrisk factor for poor clinical outcome in patients who underwent mechanical \nthrombectomy for acute ischemic stroke. On the other hand, low neck muscle \nmass didn't correlate with poor outcome. \nLimitations: Retrospective study. Mechanical thrombectomy performed by \nfour different interventional radiologists. \nEthics Committee Approval: IRB-approved retrospective cohort study \nFunding for this study: None \nAuthor Disclosures: \nMatteo Bonatti: Nothing to disclose \nRiccardo Valletta: Nothing to disclose \nFabio Lombardo: Nothing to disclose \nAlessio Comai: Nothing to disclose \nFederica Ferro: Nothing to disclose \n \nRPS 611-2 \nEndovascular treatment of intracranial aneurysms in small peripheral \nvessel segments – efficacy and intermediate follow-up results of flow \ndiversion with the silk vista baby low-profile flow diverter \n*M-S. Schüngel*, K-T. Hoffmann, U. Quäschling, S. Schob; Leipzig/DE  \n(Marie-Sophie.Schuengel@medizin.uni-leipzig.de) \n \nPurpose: Low-profile flow diverter stents (FDS) quite recently amended \nperipheral segments as targets for hemodynamic aneurysm treatment, \nhowever, reports on outcomes, especially later than 3months, are scarce. This \nstudy therefore reports our experience with the novel silk vista baby (SVB) FDS \nand respective outcomes after eight and eleven months with special respect to \nspecific adverse events. \nMethods or Background: 44patients harbouring 47aneurysms treated with \nthe SVB between June 2018 and December 2019 were included. Clinical, \nprocedural and angiographic data were collected. Follow-ups were performed \non average after three, eight and eleven months, respectively. Treatment effect \nwas assessed using the O´Kelly Marotta (OKM) grading system. \nResults or Findings: Overall, angiographic follow-ups were available for \n41patients/ 45aneurysms. Occlusion or significant reduction in aneurysmal \nperfusion (OKM:D1, B1-B3 and A2-3) was observed in 98% of all aneurysms \nafter eight months. Only 2% of the treated aneurysms remained \nmorphologically unaltered and without an apparent change in perfusion \n(OKMA1). Adverse events in the early post-interventional course occurred in \nseven patients: Permanent and transient stent occlusion, acute infarction and \nprogressive inflammatory mass effect were observed in one patient, \nrespectively. Two patients suffered hemodynamically relevant device-induced \nvasospasm. Excepting two patients, however, all patients recovered \ncompletely within 90days after endovascular treatment. One death occurred in \ncontext of a major SAH due to an acutely ruptured, multi-segmental dissecting \nvertebra-basilar aneurysm. \nConclusion: The SVB achieves sufficient occlusion rates of intracranial \naneurysms originating from peripheral segments, which are comparable to \nprior established conventional FDS with acceptably low complication rates. \nHowever, alteration of a hemodynamic equilibrium in distal localizations \nrequires special attention to prevent ischemic events. \nLimitations: Limitations are a small patient collective and missing long-term \nangiographic follow-up data of our cohort. \nEthics Committee Approval: Approval was given by the institutional ethics \ncommittee. \nFunding for this study: None \nAuthor Disclosures: \nKarl Titus Hoffmann: Nothing to disclose \nMarie-Sophie Schüngel: Nothing to disclose \nStefan Schob: Nothing to disclose \nUlf Quäschling: Nothing to disclose \n \n \n \nRPS 611-3 \nArtificial intelligence in acute stroke: an early health technology \nassessment of vessel-occlusion detection on computed tomography \n*K. G. van Leeuwen*¹, F. J. A. Meijer¹, S. Schalekamp¹, M. Rutten²,  \nE. van Dijk¹, T. Govers¹, M. De Rooij¹, B. Van Ginneken¹; ¹Nijmegen/NL, \n²'s-Hertogenbosch/NL \n(kicky.vanleeuwen@radboudumc.nl) \n \nPurpose: To demonstrate the cost-effectiveness of artificial intelligence (AI) \nsoftware to aid in the detection of intracranial vessel occlusions in stroke \ncompared to standard care by performing early health technology assessment. \nMethods or Background: We used a Markov based model from a societal \nperspective in a UK setting to demonstrate the potential value of an AI tool \nreported in expected incremental costs (IC) and effects (IE) in quality adjusted \nlife years (QALYs). Initial population existed of patients suspected of stroke \nbased on symptoms and exclusion of other causes as demonstrated by non-\ncontrast cerebrum CT. Input parameters for the model were predominantly \nbased on stroke registry data from the UK and complemented with pooled \noutcome data from large randomized trials. Parameters were varied to \ndemonstrate model robustness. \nResults or Findings: The AI strategy with its base-case parameters (6% \nmissed diagnoses of intra-arterial therapy eligible patients by clinicians, $40 \nper AI analysis, 50% reduction of missed vessel occlusions by AI) resulted in \nmodest cost-savings and incremental QALYs over the projected lifetime (IC: - \n$156, -0.23%; IE: +0.01 QALYs, +0.07%) per ischaemic stroke patient. Within \na ninety-day window after treatment no financial (IC: +$60) and negligible \nQALY (IE: +0.0001) gain was observed. For each yearly cohort of patients in \nthe UK this translates to a total cost saving of $11 million. \nConclusion: We showed that computer aided thrombus detection in \nemergency care has the potential to increase health and save costs. Results \nmay contribute to the debate on the investments, financial accountability and \nreimbursement for the clinical use of AI technology. \nLimitations: Parameter values of the model were based on results from \nprevious studies. \nEthics Committee Approval: N.a. \nFunding for this study: This work has not received any funding. \nAuthor Disclosures: \nEwoud van Dijk: Nothing to disclose \nFrederick Jan Anton Meijer: Nothing to disclose \nMatthieu Rutten: Nothing to disclose \nBram Van Ginneken: Founder: Thirona Shareholder: Thirona Other: Delft \nImaging Other: Mevis Medical Solutions \nKicky Gerhilde van Leeuwen: Nothing to disclose \nTim Govers: Nothing to disclose \nSteven Schalekamp: Nothing to disclose \nMaarten De Rooij: Nothing to disclose \n \nRPS 611-4 \nPrognostic evaluation of cerebral venous thrombosis using clinical, \nstructural imaging characteristics and clot burden \n*J. S C*, S. Nandikoor, S. Kumar, V. Kamath; Bangalore/IN \n(jayashreesc@gmail.com) \n \nPurpose: Cerebral venous thrombosis (CVT) is an uncommon cause of stroke \nwith varied presentations and outcomes. The study aims to perform prognostic \nevaluation of CVT using clinical, imaging characteristics and extent of clot \nMethods or Background: Prospective observational study conducted in a \ntertiary care center (April 2018 to May 2019) including patients with \nsymptomatic CVT. Demographic data, clinical presentation and Modified \nRankin Scale (mRS) (at admission, discharge and follow up (1 and 3 month)) \nwere documented. MRI brain was evaluated for extent of parenchymal \ninvolvement and venogram for extent of dural sinuses and cerebral venous \nthrombosis. Clot burden score (CBS) was computed as the sum of the \nthrombosis degree (1-partial or 2-complete) in dural sinuses / cerebral veins. \nThe parenchymal changes and CBS was correlated with mRS score. \nResults or Findings: 61 (M:37; F:24) patients were included (age: 9 to \n77years). Poor mRS (at discharge and/or followup) was seen in patients \npresenting with focal neurological deficit, altered sensorium, large area of \nparenchymal involvement, cytotoxic edema and haemorrhage (p < 0.05). \nCerebral vein CBS had moderate correlation with mRS score in patients who \nhad no parenchymal involvement at presentation and follow up (p< 0.05). Deep \ncerebral venous system CBS in patients with small area of parenchymal \ninvolvement (p< 0.05) and superficial cerebral venous system CBS in patients \nwith hemorrhagic infarct showed moderate correlation with mRS on follow up \n(p< 0.05). Total CBS and cerebral sinus CBS in patients with hemorrhagic \ninfarct at presentation (p< 0.05) had moderate correlation with mRS. \nConclusion: Clinical and structural imaging characteristics can be of help in \npredicting the clinical outcome. Quantitative clot burden measurement convey \nadditional prediction on outcomes of CVT. \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 277  \nLimitations: chronic CVT - not included in study \nEthics Committee Approval: Has been approved \nFunding for this study: No funding sources \nAuthor Disclosures: \nShrivalli Nandikoor: Nothing to disclose \nSavith Kumar: Nothing to disclose \nVikram Kamath: Nothing to disclose \nJayashree S C: Nothing to disclose \n \nRPS 611-5 \nHigh-resolution MRI demonstrates signal abnormalities of the 3rd cranial \nnerve in giant-cell arteritis patients with 3rd cranial nerve impairment \n*S. Mournet*; Paris/FR \n(sandy.mournet@gmail.com) \n \nPurpose: To determine the sensitivity and specificity of high resolution (HR) \nMRI for detecting signal abnormalities of cranial nerves (CN) in giant cell \narteritis (GCA) patients presenting with diplopia. \nMethods or Background: This IRB-approved retrospective single-center \nstudy included GCA patients who underwent 3T HR MRI from December 2014 \nto January 2020. Two radiologists, blinded to all data, individually assessed for \nthe presence of enhancement of the 3rd, 4th and/or 6th CN on post-contrast \nHR imaging and high-signal intensity on HR T2-WI, for signal abnormalities of \nextraocular muscles and the brainstem, and for inflammatory changes of the \nophthalmic and extracranial arteries. A Fisher’s Exact test was used to \ncompare patients with or without diplopia. \nResults or Findings: 64 patients (42/64 (66%) women and 22/64 (34%) men, \nmean age 76.3 +/- 8 years) were included. 14/64 (21.9%) presented with \ndiplopia. 3rd CN enhancement was detected in 7/8 (87.5%) patients with 3rd \nCN impairment, as compared to no patients with 4th or 6th CN impairment or to \npatients without diplopia, p<0.001. 3rd CN abnormal high-signal intensity on \nHR T2-WI was detected in 4/5 (80%) patients with 3rd CN impairment versus \nnone of other patients, p<0.001. Sensitivity, specificity, predictive positive value \nand negative predictive value for detecting 3rd CN signal abnormalities were of \n0.88, 1, 1 and 0.99 and 0.8, 1, 1 and 0.98 for post-contrast HR imaging and HR \nT2-WI, respectively. \nConclusion: HR MRI had excellent diagnostic sensitivity and specificity when \ndetecting signal abnormalities of the 3rd CN in GCA patients presenting with \n3rd CN impairment. \nLimitations: However, one should remain cautious given the lack of a control \ngroup consisting of non-GCA patients. \nEthics Committee Approval: Approbation by an Institutional Review Board. \nFunding for this study: No financial support to disclose \nAuthor Disclosures: \nSandy Mournet: nothing to disclose \n \nRPS 611-6 \nSubarachnoid haemorrhage, CT head and lumbar puncture - can our \nwords influence clinicians actions? \n*M. Spurr*, R. Hunt; Bristol/UK \n(matthew.spurr1@nhs.net) \n \nPurpose: Subarachnoid haemorrhage (SAH) guidelines advise a non-contrast \ncomputed tomography (CT) head followed by lumbar puncture (LP) if the scan \nis negative. This project aimed to assess if LPs are performed appropriately \nand establish whether report wording impacts LP rate. \nMethods or Background: CT head studies were analysed at a tertiary \nNeurosurgical centre over 2 months and examinations performed for SAH \nidentified. LP rate was assessed following a negative CT examination. \nLanguage within reports was evaluated to assess if it affected LP rate. All CT \nhead reports could be categorised according to how the report concluded. \nThere were 4 styles: 1. No advice provided 2. CT cannot exclude SAH 3. No \ncontraindication to LP 4. LP recommended. \nResults or Findings: 2433 CTs were analysed; 88 were performed for SAH. \nOverall 48% of patients with a negative scan underwent LP. If no advice was \ngiven LP rate was 23%. CT cannot exclude SAH, 44%; no LP contraindication, \n67% and LP recommended, 79%. \nConclusion: CT report wording impacted LP rate. The most effective way for a \nRadiologist to influence clinical practice is to make a recommendation. \nLimitations: Study size \nEthics Committee Approval: None required \nFunding for this study: None \nAuthor Disclosures: \nRebecca Hunt: Nothing to disclose \nMatthew Spurr: Nothing to disclose \n \n \n \n \n \nRPS 611-7 \nRisk assessment of haemorrhagic transformation of middle cerebral \nartery occlusion acute ischaemic stroke using multimodal imaging: a \ncase-control study \n*C. Li*; Shanghai/CN \n(11111220032@fudan.edu.cn) \n \nPurpose: To identify the multimodal image parameters most predictive of \nhaemorrhagic transformation (HT) in acute ischaemic stroke (AIS) with middle \ncerebral artery occlusion (MCAO). \nMethods or Background: MCAO AIS patients who underwent baseline (CT \nperfusion) CTP/ (CT angiography) CTA + MRI/ (susceptibility-weighted \nimaging) SWI within 12 hours of symptom onset and follow-up SWI/MR \nangiography within 3 weeks were included from January 2016 to December \n2019. Baseline CTP data were postprocessed to generate maps of different \nperfusion parameters. Collateral flow was assessed on the baseline CTA. The \ninfarct volume, imaging markers of cerebral small vessel disease and MCAO \nrecanalization were assessed on the baseline MRI/ baseline SWI/ follow-up \nMR angiography. Outcome event, HT was defined according to European \nCooperative Acute Stroke Study II criteria on follow-up SWI imaging. \nMultivariate logistic regression analysis identified independent predictors of HT \nand the receiver operating characteristic curve selected an optimal threshold. \nResults or Findings: 33 (52%) developed HT of 63 consecutive MCAO AIS \npatients who met inclusion criteria from 181 ones. Multivariate logistic analysis \nrevealed poor collateral flow (odds ratio, 8.003; 95% confidence interval, \n6.912-8.949; P=0.021) and relative permeability surface (PS) (odds ratio, \n13.254; 95% confidence interval, 10.611-19.926; P<0.001) were independent \npredictors of HT. The poor collateral flow predicted HT with 36% sensitivity and \n93% specificity. The optimal relative PS threshold for predicting HT was 2.3 \n(area under the curve, 0.853; 95% confidence interval, 0.811-0.889), with 94% \nsensitivity and 60% specificity. \nConclusion: For AIS patients with MCAO, the strongest predictors of HT on \nthe multimodal image protocol were poor collateral flow on CTA and increased \nrelative PS on CTP. \nLimitations: Not applicable. \nEthics Committee Approval: The Ethics Committee of Huashan Hospital, \nFudan University (2020-939). \nFunding for this study: The National Natural Science Foundation of China \n(81771788). \nAuthor Disclosures: \nChanchan Li: Nothing to disclose \n \n \nResearch Presentation Session: Neuro \nRPS 711 \nImaging the brain \nRPS 711-1 \nThe onset of schizophrenia prior to the end of brain maturation alters \ngrey matter volume loss \n*R. Antulov*¹, A. Ruzic Barsic², D. Mileti ü³, G. Rubesa³; ¹Esbjerg/DK, \n²Opatija/HR, ³Rijeka/HR  \n(ronald.antulov@outlook.com) \n \nPurpose: Brain maturation (BM) is considered completed around the age of \n25, when prefrontal cortex maturation has been achieved. Previous studies \nshowed that early onset schizophrenia, prior to the age of 18, causes a more \nsevere clinical presentation. The aim of our study was to investigate grey \nmatter volume (GMV) alterations between schizophrenia patients (SP) with \ndisease onset (DO) before completed BM and after completed BM. \nMethods or Background: The study included 100 SP which were divided into \ntwo groups of similar size according to DO – before the age of 25 (BABM) and \nafter the age of 26 (AABM). The control group (CP) consisted of 50 healthy \nindividuals. Brain magnetic resonance imaging was acquired on a 1.5 T \nscanner. Variance and co-variance analysis for GMV in correlation with the age \nof DO (BABM and AABM), as well as in correlation with the number of \npsychotic episodes (PE), including interactions and co-variables for total brain \nvolume and age were calculated. Voxel-based morphometry (VBM) analyses \nwere performed between groups. \nResults or Findings: A greater number of PE resulted in GMV reduction in \nboth groups, but more in BABM. GMV reduction caused by multiple PE is \nmuch less pronounced in AABM. VBM analyses detected GMV reduction in the \nfrontal cortex and the cerebellum when BABM was compared to AABM and CP \nrespectively. \nConclusion: Early DO of schizophrenia, prior to full BM, results in GMV \nreduction in comparison with healthy subjects and SP with later DO after \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 278  \ncompleted BM. A more prominent effect of schizophrenia on the developing \nbrain compared to the effect on a fully developed brain is suggested. \nLimitations: The study groups should include more subjects. \nEthics Committee Approval: Study approved by Ethical Committee of the \nClinical Hospital Center Rijeka, Croatia. \nFunding for this study: None. \nAuthor Disclosures: \nAntonija Ruzic Barsic: Nothing to disclose \nGordana Rubesa: Nothing to disclose \nRonald Antulov: nothing to disclose \nDamir Miletiü: Nothing to disclose \n \nRPS 711-2 \nAberrant dynamic functional network connectivity in cirrhotic patients \nwithout overt hepatic encephalopathy \n*J-Y. Shi*, H-J. Chen; Fuzhou/CN  \n(sjy0311926@163.com) \n \nPurpose: This study aimed to explore dynamic functional network connectivity \n(FNC) differences and to elucidate their association with neurocognitive \nchanges in cirrhotic patients. \nMethods or Background: 54 cirrhotic patients and 42 controls underwent \nresting-state functional magnetic resonance imaging. Psychometric hepatic \nencephalopathy score(PHES)was used to assess neurocognitive function. \nIndependent component analysis was performed to identify the components of \nseven intrinsic brain networks, including sensorimotor (SMN), auditory, visual, \ncognitive control (CCN), default mode (DMN), subcortical (SC), and cerebellar \nnetworks. Sliding window correlation approach was employed to calculate \ndynamic FNC. FNC states were determined by k-means clustering method, \nand then functional state analysis was conducted to measure dynamic indices. \nResults or Findings: The patients showed decreased FNC in State 2, \ninvolving the connectivity between posterior subsystem of DMN and CCN \n(represented by bilateral insular cortex), and in State 3, involving the \nconnectivity between SMN (represented by bilateral precentral gyrus) and \nSC(represented by bilateral putamen and caudate). The patients spent \nsignificantly longer time in State 4 that was with weakest FNC across all \nnetworks. We observed a significant correlation between PHES and fraction \ntime/mean dwell time in State 4. \nConclusion: Aberrant dynamic FNC may be the underlying mechanism of \nneurocognitive impairments in cirrhosis. Dynamic FNC analysis may potentially \nbe utilized in investigating cirrhosis-related neuropathological processes. \nLimitations: The cross-sectional design. \nEthics Committee Approval: The Research Ethics Committee of Fujian \nMedical University Union Hospital. All subjects provided their written informed \nconsent. \nFunding for this study: The National Natural Science Foundation of China \n(No. 81501450 and 82071900) and Academic Exchange Fund for \nPostgraduates of Fujian Medical University \nAuthor Disclosures: \nJia-Yan Shi: Nothing to disclose \nHua-Jun Chen: Nothing to disclose \n \nRPS 711-5 \nPrognostic value of brain atrophy in patients with essential tremor \ntreated with MRgFUS thalamotomy: a VBM study \n*E. Tommasino*, F. Bruno, M. Varrassi, A. Catalucci, A. Gagliardi,  \nM. R. Antenucci, L. Pertici, V. Pagliei, A. Splendiani; L'Aquila/IT \n(emanuele.tommasino@gmail.com) \n \nPurpose: Essential Tremor is one of the most common movement disorders \nand since the FDA approval, MRgFUS Vim thalamotomy is rapidly becoming \nan effective minimally invasive therapeutic option for the treatment of tremor. \nSkull density ration (SDR) was proposed as an indication for MRgFUS \neligibility. Nevertheless, the role of brain tissue interposed between the target \nand the ultrasound transducers has never been explored. Therefore, the \npurpose of our study was to analyse data from our experience to evaluate the \ncorrelation between periprocedural technical findings (Accumulated Thermal \nDose and Area), instrumental MRI findings, clinical outcome scores, \nSupratentorial Grey Matter (ST – GM), White Matter (ST – WM), Cerebral \nSpinal Fluid (ST – CSF) and their possible predictive value. \nMethods or Background: Forty patients were addressed to the MRgFUS \nThalamotomy. Pre-treatment T1-Weighted Sequences automatically \nsegmented in WM, GM and Cerebral Spinal Fluid (CSF) using SPM 12. For \neach subject, ST- GM, WM, CSF and Total Intracranial Volume (ICV) were \ncomputed with The PeekAtlas software toolbox. \nResults or Findings: In the pre-treatment and procedural settings, ST-GM \nwas significantly positively correlated with the Accumulated Thermal Dose \n(p<0,001) whereas the ATD temperature negatively correlated with ST-CSF \nand ST-TIV (p<0,001). Interestingly, the Accumulated Thermal dose Area \nnegatively correlated with ST-WM and ST-TIV (p<0,001). \nConclusion: Ultrasound propagation speed is lower in fluids than brain \ntissues. In addition, WM has an attenuation rate of 1.5 higher than the GM. The \ndifference in the Accumulated Thermal Dose may therefore be explained by \nthe different acoustic properties of normal brain tissues interposed between the \ntransducers and the VIM. \nLimitations: We did not evaluate the density of the brain tissues but just the \nvolume. \nEthics Committee Approval: Local ethical committee approval was obtained. \nFunding for this study: n/a \nAuthor Disclosures: \nAlessio Gagliardi: Nothing to disclose \nEmanuele Tommasino: Nothing to disclose \nAlessandra Splendiani: Nothing to disclose \nMarco Varrassi: Nothing to disclose \nMaria Rosaria Antenucci: Nothing to disclose \nLeonardo Pertici: Nothing to disclose \nAlessia Catalucci: Nothing to disclose \nFederico Bruno: Nothing to disclose \nValeria Pagliei: Nothing to disclose \n \nRPS 711-6 \nThe cerebral perfusion and microstructure integrity pattern in advanced \nParkinson's disease \n*Z. Liu*, Y. Zhang, H. Wang, D. Xu, H. You, F. Feng; Beijing/CN \n(m18246157638_1@163.com) \n \nPurpose: To explore the features of cerebral perfusion and microstructural \nintegrity of the whole brain in advanced PD patients and to further investigate \nthe possibility of a relationship between these features and cognition in \nadvanced PD patients \nMethods or Background: Forty-two subjects (21 PD patients and 21 healthy \ncontrols㸦HC) were recruited with the performance of arterial spin labeling \n(ASL), diffusion tensor imaging (DTI ) and 3D T1 weighted imaging (3D-T1WI) \non a 3T MR scanner. The cerebral blood flow (CBF) of the whole brain, the \nfractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), mean \ndiffusivity (MD) and grey matter (GM) volume of subcortical and cerebellar \nregions were measured. Mann-Whitney U-test was used to compare these \nparameters between PD and HC groups. Spearman’s correlations were used \nto test correlations between Montreal Cognitive Assessment (MoCA) /Mini-\nMental State Examination (MMSE) and CBF/DTI measurements. \nResults or Findings: The cerebellum CBF, the AD, RD and MD in left_crusII \nand vermis_VIIIa , FA in the left subthalamic nucleus, right substantia nigra \nwere negatively correlated with MoCA and MMSE in PD. The CBF in bilateral \nthalamus, right red nucleus, right substantia nigra, most cerebellum regions, \nbilateral hippocampus and parahippocampus was significantly higher in PD \ncompared to HC. Right thalamus, left_crusI, left_crusII, left_VIIb and right_VIIIb \nin PD showed significantly higher AD, RD and MD than HC. PD had a \nsignificant decrease in GM volume in bilateral thalamus and right \nglobuspallidusexterna. \nConclusion: Although hypoperfusion was found in some cortical areas, \nhyperperfusion and microstructure impairments were detected in most \nsubcortical and cerebellum regions, which may influence cognition, can also be \ndetected. Importantly, right thalamus, left_crusI, left_crusII, left_VIIb and \nright_VIIIb may be the most crucial regions in the patholgy of PD. \nLimitations: The sample size is relatively small. \nEthics Committee Approval: Ethics Committee of Peking Union Medical \nCollege Hospital \nFunding for this study: None \nAuthor Disclosures: \nFeng Feng: Nothing to disclose \nHui You: Nothing to disclose \nYiwei Zhang: Nothing to disclose \nDan Xu: Nothing to disclose \nZhaoxi Liu: Nothing to disclose \nHan Wang: Nothing to disclose \n \nRPS 711-7 \nDorsal and ventral pathways interaction for cognitive load evaluation in \nfMRI lie detection \nI. Dykan, L. Myroniak, K. Lisovyi, D. Gryshchak, O. Zakomornyi, I. Kobzar,  \nM. Makarchuk, *O. Omelchenko*; Kiev/UA \n \nPurpose: Cognitive load evaluation is necessary for development of fMRI lie \ndetection method. We propose a unique pattern of the ventral pathway with \nmesolimbic system activation and ventral pathway with default mode network \ndeactivation for cognitive load evaluation. \nMethods or Background: Group of 10 healthy volunteers (5F, 5M, aged 21-\n48) was studied using Philips Ingenia 3.0T. Blocked design fMRI was used. \nPersonally false characteristics were used for stimulation. Stimulation was \nmade vocally. Volunteers were instructed to agree with false characteristics. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 279  \nFor fMRI we used EPI pulse sequence: TR/TE=3000/30ms. Activation and \ndeactivation were modelled with GLM as opposite contrasts. Connectivity was \nevaluated with ICA. Analysis was made with FSL (Oxford, GB). \nResults or Findings: Activation medial occipital lobes, medial and inferior \ntemporal lobes bilaterally, left inferior lateral parietal cortex, left medial \nprefrontal, superior frontal and premotor cortex, left caudate nucleus and \nnucleus accumbens were shown. Deactivation of lateral occipital cortex, pre-\n/postecentral gyri, posterior inferior frontal gyri, superior parietal lobuli, \nprecuneus and posterior cingulate cortex bilaterally were shown. Thus, \nactivation of ventral pathway with mesolimbic system, and deactivation of \ndorsal pathway with default mode network were shown. Extensive pattern of \nactivation and deactivation might indicate the high cognitive load. Dorsal \npathway and default mode network regions deactivation might indicate the \negocentric frame of reference and short memory suppression. Ventral pathway \nand mesolimbic regions activation might indicate the allocentric frame of \nreference, long term memory, emotional and reward-related response \nactivation. \nConclusion: Unique pattern of ventral pathway with mesolimbic system \nactivation and dorsal pathway with default mode network deactivation might be \nused for cognitive load evaluation and fMRI lie detection method development. \nLimitations: This is experimental study for fMRI lie detection method \ndevelopment. \nEthics Committee Approval: Approved by local ethics committee. \nFunding for this study: No additional funds were used. \nAuthor Disclosures: \nMykola Makarchuk: Nothing to disclose \nOleksanZakomornyi: Nothing to disclose \nIryna Dykan: Nothing to disclose \nLiudmyla Myroniak: Nothing to disclose \nDmytro Gryshchak: Nothing to disclose \nKostiantyn Lisovyi: Nothing to disclose \nOleksii Omelchenko: Consultant: Institute of Nuclear Medicine and Radiology \nIhor Kobzar: Nothing to disclose \n \nRPS 711-8 \nThe radio-clinical spectrum of Dyke-Davidoff-Masson syndrome \nB. Baysal, A. Orhan Varo÷lu, *M. B. Do÷an*; Istanbul/TR \n(mbilaldogan@hotmail.com) \n \nPurpose: Dyke-Davidoff-Masson syndrome (DDMS) is a rare condition \npresenting with cerebral hemiatrophy, which can be congenital or may develop \nin early childhood. The diagnosis of the disease is based on clinical and \nimaging findings and is important in terms of approach and treatment. \nMethods or Background: In this study, clinical and radiological examinations \nof eleven patients with a diagnosis of DDMS are discussed. Epidemiological \ncharacteristics of the patients, etiological risk factors, presenting symptoms, \nlateralization of hemiatrophy, and other CT and/or MRI results were evaluated. \nDescriptive statistics were used to describe the characteristics of the disease. \nResults or Findings: Eleven patients (4 female, 7 male) were included in our \nstudy. The mean age of the patients was 40 years. Six patients had \nhemiatrophy in the unilateral hemisphere and associated falcin displacement. \nAtrophy of the basal ganglia was detected in 6 patients and Wallerian \ndegeneration was seen in 6 patients, also. Parenchymal sequel (10/11, 90.9%) \nand Ipsilateral lateral ventricle (9/11, 81.8%) are the most common imaging \nfindings. Thickening of the skull vault was observed in 6 patients. Elevation of \nthe left petrous ridge (6/11, 54,5%) and mastoid air-cells enlargement (3/11, \n27.2%) are other findings. Enlargement of frontal sinus was seen in 4 patients. \nIn addition to parenchymal and skull changes, vascular pathologies such as \ncapillary malformation are observed in 6 patients. \nConclusion: In Dyke-Davidoff-Masson syndrome, MRI is the preferred \nimaging method for evaluating cerebral hemiatrophy and structural bone \nchanges. It is important to diagnose the condition at the earliest, treatment, and \noptimum control of seizures. \nLimitations: The main limitation of our study is its retrospective nature and, \ntherefore, insufficient detailed clinical evaluation. \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nBegumhan Baysal: Nothing to disclose \nAsuman Orhan Varo÷lu: Nothing to disclose \nMahmut Bilal Do÷an: Nothing to disclose \n \nRPS 711-9 \nFLAIR Hyperintensity in the subarachnoid space: differentials \n*J. Miranda Bautista*¹, J. A. Guzmán de Villoria Lebiedziejewski¹,  \nI. Herrera Herrera¹, I. Garrido Morro¹, P. Fernández García¹,  \nP. Menéndez Fernández-Miranda², G. Moreno Zamarro¹, J. Amorim Sortino¹, \nP. Elvira Ruiz¹; ¹Madrid/ES, ²Cantabria/ES \n(mirandabautistajuan@gmail.com) \n \nPurpose: The main objectives of this review are to illustrate the most frequent \ncauses of CSF hyperintensity in the subarachnoid space in FLAIR sequence, \nto describe the different mechanisms by which they are produced, and to \nreview the relevance of the rest of the imaging findings to guide the radiologist \namong the differential diagnoses. \nMethods or Background: The FLAIR sequence allows suppression of the \nCSF signal, which increases the detection of pathology that affects the CSF of \nthe subarachnoid space. The hyperintensity of the CSF in this sequence has \nbeen described in numerous diseases of various etiologies: tumor \n(leptomeningeal carcinomatosis, lymphomatosis, glioneuronal tumors and \ngliomatosis), inflammatory (meningitis), vascular (vascular malformations and \nMoya-moya disease), CSF hypercellularity (HaNDL headache), or blood \n(SAH). However, this finding has also been a source of diagnostic errors; for \nexample, in patients treated with supplemental oxygen or other non-\npathological processes. \nResults or Findings: In this educational exhibit, we expose a pictorial review \nof the main differential diagnosis of FLAIR subarachnoid space hyperintensity \nbased on several patients diagnosed in our institution. \nConclusion: FLAIR Hyperintensity of the CSF in the subarachnoid space can \nbe found in diverse entities, including pathological and non-pathological \nprocesses, that the radiologist should be aware of. The clinical context, CSF \nanalysis, and other coexisting imaging findings are essential to establish the \ndifferential diagnosis. \nLimitations: There were no limitations to this exhibit. \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nPablo Menéndez Fernández-Miranda: Nothing to disclose \nJoaquim Amorim Sortino: Nothing to disclose \nIsabel Herrera Herrera: Nothing to disclose \nJuan Adan Guzmán de Villoria Lebiedziejewski: Nothing to disclose \nJuan Miranda Bautista: Nothing to disclose \nIrene Garrido Morro: Nothing to disclose \nPilar Fernandez Garcia: Nothing to disclose \nGonzalo Moreno Zamarro: Nothing to disclose \nPascual Elvira Ruiz: Nothing to disclose \n \nRPS 711-10 \nManagement of carotid cave aneurysms \nM. Güdük, *A. Arslan*, A. Dinçer; Istanbul/TR \n(arslanaydan@gmail.com) \n \nPurpose: To analyze the follow-up of incidentally diagnosed carotid cave \naneurysms, and figure out if extrapolating results from other intracranial \naneurysms is reasonable for them. \nMethods or Background: Saccular intracranial aneurysms can cause severe \nmorbidity and mortality, and with the advent of imaging techniques, incidental \ndiagnosis of them is more common. Even when they are diagnosed \nincidentally, a treatment is chased either surgical or endovascular. Carotid \ncave aneurysms are a rare group, and they seem to have a more benign \ncourse compared to other intracranial aneurysms, probably related with \nphysical enveloping effect of the surrounding structures. Yet, their surgery is a \nserious challenge technically for the neurosurgeon, and with its severe \nmorbidity and mortality for the patient. Endovascular techniques also have its \nown risks, too. The age, and gender of patients, the size, laterality, and MR-\nangiographic follow-up of aneurysms were reported. Their clinical results were \nnoted. \nResults or Findings: Fifty-six patients who had incidentally diagnosed 59 \ncarotid cave aneurysms were followed-up. No patient was operated, but 15 \npatients had endovascular treatment for 15 aneurysms.None of the patients \nhad carotid cave aneurysms related SAH during follow-up, and none of the \naneurysms had shown growth. Two patients who had endovascular treatment, \nhad ischemic complications with minor neurologic deficits. \nConclusion: Follow-up can be a reasonable option for the incidental \naneurysms that are located and confined to the carotid cave. \nLimitations: Our research had some limitations. First of all, it had a limited \nnumber of patients (55 cases) with a single center. It was correlated with DSA \nin only 15 cases due to its invasiveness. The intradural-extradural distinction \nwith the CISS sequence in aneurysm was demonstrated only in a limited \nnumber of patients. \nEthics Committee Approval: Yes \nFunding for this study: Non \nAuthor Disclosures: \nMustafa Güdük: nothing to disclose \nAydan Arslan: Nothing to disclose \nAlp Dinçer: nothing to disclose \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 280  \nRPS 711-11 \nThe BACH (Brain Aging in Congenital Heart Disease) study: the burden of \nsmall vessel disease \n*L. Melazzini*¹, P. Vitali¹, F. Savoldi¹, M. Codari², A. Giamberti¹, F. Secchi¹,  \nM. Chessa¹, E. Callus¹, F. Sardanelli¹; ¹Milan/IT, ²Stanford, CA/US \n \nPurpose: Adults with congenital heart disease have recently outnumbered \nchildren with heart defects. This large population is at increased risk of \ndeveloping cerebrovascular disease across the lifespan. The BACH (Brain \nAging in Congenital Heart Disease) prospective cohort study aims at assessing \nthe clinical impact of MRI signs of cerebral small vessel disease in adults with \nconotruncal anomalies. \nMethods or Background: 23 adult patients with surgically-repaired tetralogy \nof Fallot and 23 age- and sex-matched healthy controls were recruited at our \ncardiovascular referral centre. Both groups underwent 3D-T1-weighted, 3D-\nFLAIR and 2D-T2*-weighted brain MRI scans. White matter hyperintensities \n(WMHs) masks were obtained using a machine-learning approach. An \nautomated method was applied for sub-classifying WMHs into periventricular \nand deep. Cerebral microbleeds were manually counted. Patients were also \nadministered a thorough neuropsychological examination. \nResults or Findings: Total, deep and periventricular WMH volumes did not \ndiffer between the study groups (p=0.468). However, a statistically significant \nassociation was found between deep WMH volume and patients' performance \nat the frontal assessment battery (r=-0.650, p=0.012). Cerebral microbleeds \nwere higher in patients than in controls (p<0.001) but were not significantly \nassociated with cognitive performance. \nConclusion: Sub-classifying WMHs revealed useful for detecting a specific \nlink to worse cognitive performance. Moreover, we found more cerebral \nmicrobleeds in the patients' group. Small vessel disease in patients could \nderive from a synergistic effect of cyanosis prior to surgical correction, \nsurgically induced brain damage and patients’ susceptibility to developing \ncardiovascular diseases. If confirmed on larger samples, our findings may warn \nphysicians to adopt preventive strategies and promptly act on risk factors of \ncognitive deterioration in congenital heart disease. \nLimitations: Preliminary results. Cross-sectional study. \nEthics Committee Approval: Yes. \nFunding for this study: This study was partially supported by Ricerca \nCorrente funding from the Italian Ministry of Health to IRCCS Policlinico San \nDonato. \nAuthor Disclosures: \nPaolo Vitali: Nothing to disclose \nFrancesco Secchi: Nothing to disclose \nFrancesco Sardanelli: Nothing to disclose \nEdward Callus: Nothing to disclose \nMarina Codari: Nothing to disclose \nLuca Melazzini: Nothing to disclose \nAlessandro Giamberti: Nothing to disclose \nMassimo Chessa: Nothing to disclose \nFilippo Savoldi: Nothing to disclose \n \nRPS 711-12 \nSex differences in imaging of patients with multiple sclerosis \n*N. Fileva*, D. Zlatareva, V. Hadjidekov; Sofia/BG \n(nevena.fileva@yahoo.com) \n \nPurpose: Multiple sclerosis is a chronic inflammatory disease affecting young \nadults with the predominance of the female sex. Many studies show that the \ndisease has a different progression pattern between males and females. \nMethods or Background: We performed a 3 Tesla MRI exam using a \nstandard head and spine coil in 210 patients diagnosed with MS – 64 males \nand 146 females (mean age - 41,08, SD = 11.277). We had clinical information \nincluding age of initial symptoms, disease duration, EDSS score, and some \nclinical symptoms for each of them. Using the MRI findings we divided them \ninto groups according to the atrophy stage, the lesion count, and location. \nResults or Findings: We reached a statistically significant difference in the \nrate of global atrophy in male patients (U = 3357.0, p=0.001, r=0.23). Our \nresults showed no sex predominance in lesion count. Depending on the \nspecific location the lesions, affecting corpus callosum were found more often \nin males, rather than in females. The disease disability, measured by the \nEDSS score, showed higher linear progression again in male patients. \nConclusion: There were significant differences in the rate of atrophy and \ndisease progression in males in comparison to females. \nLimitations: We have no information of the form of the disease in each \npatients. \nEthics Committee Approval: Not applicable \nFunding for this study: No fundings \nAuthor Disclosures: \nDora Zlatareva: Nothing to disclose \nNevena Fileva: Nothing to disclose \nVassil Hadjidekov: Nothing to disclose \nRPS 711-13 \nDisentangling cortical function and its spatial topography reveals the \nsubstantial genetic influence of connectivity acting through topography \nin a cohort of healthy young adults \n*B. Burger*¹, K-H. Nenning¹, E. Schwartz¹, D. Margulies², A. Goulas³, H. Liu ຾,  \nJ. Dauwels຿, D. Prayer¹, G. Langs¹; ¹Vienna/AT, ²Paris/FR, ³Hamburg/DE, \n຾Charlestown, MA/US, ຿Singapore/SG \n(bianca.burger@meduniwien.ac.at) \n \nPurpose: We used functional magnetic resonance imaging (fMRI) to study \ngenetic influence on disentangled variability of human functional connectivity \nstrength and its spatial cortical topography in a cohort of young healthy \nsubjects. We evaluated the distribution of genetic influence on these two \naspects. \nMethods or Background: To investigate genetic influence we used the data \nof 231 participants labeled either as monozygotic or dizygotic twins from the \nHCP S1200 ICA-FIX denoised dataset. Only twins with 4 resting state fMRI \nruns available were chosen. Two runs were used for discovery analysis and \nthe remaining for replication. To examine disentangled connectivity strength \nand topography, we first aligned functional units of each subject to the \ncorresponding units of a reference. This functional alignment allowed us to \nobserve variability in topography and functional connectivity strength of \ncorresponding functional regions independently. Genetic influence was \nestimated using separate twin models for both features and each unit, after sex \nand motion were regressed out. We also analysed genetic influence for \nentangled functional connectivity and compared it to influence on disentangled \nconnectivity strength using a paired t-test. \nResults or Findings: After disentangling variability of connectivity strength \nand spatial topography, genetic influence on connectivity strength decreased \nsignificantly on average (left hem: corrected p-value < 0.0001; right hem: \ncorrected p-value < 0.0001) and is more homogeneous throughout the cortex \nranging from 2.92% to 42%, compared to genetic influence on spatial \ntopography ranging from and 0% to 67%. A replication experiment yielded \nconsistent results. \nConclusion: Results suggest that a substantial fraction of genetic influence on \nfunctional connectivity architecture shapes variability of its spatial topography. \nLimitations: Applied twin models estimate only additive effects, not \ninteractions. \nEthics Committee Approval: Consent was provided following Wu-Minn HCP \nConsortium guidelines. \nFunding for this study: This project was supported by Medical University of \nVienna. \nAuthor Disclosures: \nKarl-Heinz Nenning: Nothing to disclose \nGeorg Langs: Nothing to disclose \nErnst Schwartz: Nothing to disclose \nHesheng Liu: Nothing to disclose \nJustin Dauwels: Nothing to disclose \nDaniela Prayer: Nothing to disclose \nDaniel Margulies: Nothing to disclose \nAlexandros Goulas: Nothing to disclose \nBianca Burger: Nothing to disclose \n \nRPS 711-14 \nCorrelation of hippocampal and parietal lobe volumes with visual rating \nscales in mild cognitive impairment patients \n*I. Soriano Aguadero*¹, A. C. Igual Rouilleault¹, R. Garcia de Eulate¹,  \nP. Dominguez Echavarri¹, M. Vidorreta Díaz de Cerio²,  \nO. Fernández González², M. Riverol Fernández¹, B. Echeveste¹,  \nM. Calvo Imirizaldu¹; ¹Pamplona/ES, ²Madrid/ES \n(isoriano@unav.es) \n \nPurpose: To evaluate the correlation between visual rating scales and \nvolumetry with MRI in patients with mild cognitive impairment (MCI). \nMethods or Background: Ninety-five (95) patients who underwent MRI due to \nMCI were retrospectively analysed. Two independent radiologists rated atrophy \nin medial temporal lobe (MTA) and posterior (PA) bilaterally, according to \nScheltens’ and Koeman’s scales, respectively. Afterwards they made a \nconsensus rank for both scales. The hippocampal and parietal lobe volumes \nwere collected with a morphometry function (Syngovia Brain Morphometry, \nSiemens Healthineers, Erlangen, Germany). A Spearman’s rank correlation \ncoefficient was used to compare volume against scales. \nResults or Findings: Mean volume of right and left hippocampus decreased \nfrom 3.15 and 3.25 ml in grade 0 of the Scheltens’ scale to 2.89 and 2.85 ml in \ngrade 3, respectively. In parietal lobe, volume changed from 104.77 and \n107.81 ml in grade 0 of the Koeman’s scale to 88.84 and 97.89 ml in grade 3, \nfor right and left sides. Analysing MTA, correlation was statistically significant in \nboth right (-0.209, p=0.042) and left (-0.230, p=0.025) hippocampal volumes \ncompared to visual assessment (Scheltens’ scale). Statistical differences in \nSpearman’s rank correlation were also found when comparing right (-0.220, \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 281  \np=0.032) and left (-0.221, p=0.031) parietal lobe volumes with visual posterior \natrophy scale (Koeman’s scale). \nConclusion: Increasing values in Scheltens’ and Koeman’s scales have a \nstatistically significant correlation with decreasing hippocampal and parietal \nlobe volumes. Ongoing long-term follow up in these patients will allow to \nanalyse if either of this techniques can better predict transformation from MCI \nto Alzheimer´s disease. \nLimitations: Small sample size. \nEthics Committee Approval: Yes. \nFunding for this study: Not applicable. \nAuthor Disclosures: \nPablo Dominguez Echavarri: Nothing to disclose \nBeatriz Echeveste: Nothing to disclose \nMarta Vidorreta Díaz de Cerio: Employee: Siemens Healthinners \nMario Riverol Fernández: Nothing to disclose \nIgnacio Soriano Aguadero: Nothing to disclose \nAlba Cristina Igual Rouilleault: Nothing to disclose \nMarta Calvo Imirizaldu: Nothing to disclose \nReyes Garcia de Eulate: Nothing to disclose \nOscar Fernández González: Employee: Siemens Healthineers \n \nRPS 711-15 \nDifferentiating opportunistic CNS infection from disease infiltration in \nhaematological malignancy \n*J. K. Ruffle*, E. Lim, R. Gnanadurai, H. H-C. H. Lee, R. Miller, H. Hyare; \nLondon/UK \n \nPurpose: Haematological malignancies are a heterogeneous group of \nconditions wherein individuals are both at risk of intracranial dissemination and \nopportunistic infection secondary to treatment-induced immunosuppression. \nDifferentiating CNS infection and disease infiltration in these patients is \nvaluable, yet often difficult as the imaging appearances can be strikingly \nsimilar. We sought to characterise the similarity – and evaluate dissimilarity – \nbetween these processes. \nMethods or Background: MR brain studies for all adult patients with \nhaematological malignancy at University College London Hospitals between \n2007-17 were retrieved and deep phenotyped for imaging abnormality across \nnumerous anatomical distributions, in addition to the presence of pathological \nenhancement, diffusion restriction and haemorrhage. Clinical and laboratory \nwere also retrieved. \nResults or Findings: 109 patients met inclusion criteria (56 male; cohort mean \nage 48 years). Lymphoma and leukaemia formed the majority of \nhaematological diagnoses, wherein 28 had proven intracranial infection and 15 \nintracranial metastatic spread. Across infection and disease, the commonest \nanatomical distributions of abnormality were multifocal parenchymal (34.9%), \nfocal parenchymal (29.4%) and leptomeningeal (11.9%). Pathological \nenhancement was the most frequently observed abnormality (46.8%), followed \nby haemorrhage (22.9%) and restricted diffusion (19.3%). Logistic regression \ncould differentiate CNS infection from disease infiltration with an AUC of 0.85 \nwhere, with OR >1 favouring infection, and <1 favouring CNS disease \ninfiltration, significantly predictive imaging features were haemorrhage (OR \n24.61, p=0.02), enhancement (OR 0.17, p=0.04) and an extra-dural location \n(OR 0.06, p=0.05). \nConclusion: Both CNS infection and disease infiltration have variable \nappearances and can be difficult to distinguish. We provide preliminary models \nof key radiological findings that may help in differentiating them. \nLimitations: Future studies should further develop these preliminary models \nboth across multiple hospital sites and with a larger sample. \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nRobert Miller: Nothing to disclose \nHeather Hoi-Ching Lee: Nothing to disclose \nHarpreet Hyare: Nothing to disclose \nRoshina Gnanadurai: Nothing to disclose \nEmma Lim: Nothing to disclose \nJames K. Ruffle: Nothing to disclose \n \n \n \n \n \n \n \n \n \n \n \n \n \nResearch Presentation Session: Neuro \nRPS 811 \nDevelopments in neuroradiology \nRPS 811-2 \nExploring the epidemiology of motion artefacts using natural language \nprocessing of clinical MRI reports \n*S. Demir*, A. Lio Goncalves Filho, S. Cauley, M. Gee, P. Schaefer,  \nO. Rapalino, S. Yi Huang, J. Conklin; Boston, MA/US  \n(sdemir@mgh.harvard.edu) \n \nPurpose: Determine the frequency, distribution and risk factors for motion \nartifacts in brain MRI based on clinical radiologists’ reports. \nMethods or Background: All brain MRI scans performed in 2019 at a single \ninstitution (n=26,173). Presence of motion artifacts in clinical reports were \ndetermined using regular expression matching and graded with a pre-defined \nseverity scoring system(mild/moderate/severe/non-diagnostic). Clinically \nsignificant motion was defined as “severe” or “non-diagnostic”. Two radiologists \nalso visually scored the presence of motion artifacts for a random sample of \n100 MRI scans using a validated visual rating system. Logistic regression \nanalysis was used to determine the clinical factors associated with motion \n(age, study indication, patient location, and MRI protocol). \nResults or Findings: Prevalence of motion artifacts described in clinical MRI \nreports was 10.7% (n=2807). Motion was described as severe in 2.9% (n=771) \nof brain MRI reports, and 0.6% (n=153) described the study as non-diagnostic, \nthus total clinically significant motion was 3.9%. The report grading showed a \nstrong positive correlation with mean and maximum radiologist visual scores \n(Spearman's rho = 0.69 and 0.74, respectively). Logistic regression analysis \nrevealed that patient location (ED or inpatient), indication (altered mental \nstatus, stroke, seizure, and hydrocephalus), and age (pediatric and elderly \npatients) were associated with clinically significant motion artifacts. \nConclusion: Clinically significant motion artifact is relatively common, with an \nestimated prevalence of 3.9% based on retrospective review of 26,173 brain \nMRI reports. Motion is more common in ED/Inpatients as well as pediatric and \ngeriatric patients, therefore future artifact mitigation strategies may benefit from \nfocusing on these patient groups. \nLimitations: Natural language processing of radiologist reports provides a \nmethod for estimating the prevalence of motion artifacts, but likely \nunderestimates mild artifacts not mentioned by the reporting radiologist. \nEthics Committee Approval: IRB approved and HIPAA compliant. \nFunding for this study: No external funding. \nAuthor Disclosures: \nStephen Cauley: Nothing to disclose \nPamela Schaefer: Nothing to disclose \nOtto Rapalino: Nothing to disclose \nSusie Yi Huang: Nothing to disclose \nJohn Conklin: Nothing to disclose \nSerdest Demir: Nothing to disclose \nAugusto Lio Goncalves Filho: Nothing to disclose \nMichael Gee: Nothing to disclose \n \nRPS 811-3 \nThe usefulness of subtraction images for accurate diagnosis of pituitary \nmicroadenomas in dynamic contrast-enhanced magnetic resonance \nimaging \n*Z. Ghomi*, M. Sanei Taheri, S. Sabouri; Tehran/IR  \n(zgh1881@gmail.com) \n \nPurpose: Dynamic contrast-enhanced Magnetic resonance imaging (MRI) is \nthe modality of choice for the diagnosis of pituitary microadenomas; however, it \nmay be associated with a relatively false-negative rate especially in small \nlesions. We aim to evaluate the usefulness of subtraction for enhancing visual \ndetection of pituitary microadenomas. \nMethods or Background: This was a retrospective cross-sectional study. We \nevaluated patients with clinically established diagnosis prolactinoma, growth \nhormone (GH) producing adenoma with acromegaly and Cushing’s disease. \nRoutine dynamic MRI of the pituitary gland and obtained subtraction MRI \nimages were scrutinized separately on different sessions by two radiologists \nblinded to study design and patient data. The investigator’s opinion on the \npresence or absence of a lesion and lesion size were collected. \nResults or Findings: Fifty patients including 40 (80%) female and 10 male \n(20%) with a mean age of 34.88± 10.95 years were enrolled. Dynamic MRI \nimages were reported positive in 39 patients (78%) and negative in 11 patients \n(22%). Subtraction images were described as positive in all patients (100%); \nincluding all patients with negative dynamic MRI and the difference was \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 282  \nstatistically significant (p-value: 0.002). Undetected lesions on dynamic MRI \nhad a mean size of 2.95±1.61 mm and a significant inverse correlation was \nnoted between lesion size and negative report of dynamic MRI (p-value: \n0.007). \nConclusion: Our results confirmed that subtraction images can successfully \nidentify all lesions detectable with conventional dynamic MRI as well as \nimproving visualization of lesions undetected on conventional dynamic MRI; \nespecially in small lesions. \nLimitations: Due to the rare nature of GH- or ACTH-producing \nmicroadenomas, our study population included very few numbers of these \nlesions. \nEthics Committee Approval: The study was approved by the Ethical \nCommittee of Shahid Beheshti University of Medical Science, Tehran, Iran \nFunding for this study: No funding to declare. \nAuthor Disclosures: \nMorteza Sanei Taheri: Nothing to disclose \nSofia Sabouri: Nothing to disclose \nZahra Ghomi: Nothing to disclose \n \nRPS 811-4 \nRadiological cervical foraminal grading systems: a systematic review \n*J. Meacock*, M. Schramm, S. Selvanathan, S. Currie, D. Stocken, D. Jayne, \nS. Thomson; Leeds/UK \n(James.Meacock@nhs.net) \n \nPurpose: A systematic review to evaluate the existing radiological grading \nsystems that are used to assess cervical foraminal stenosis. \nMethods or Background: The importance of imaging the cervical spine using \nCT or MRI in evaluating cervical foraminal stenosis is widely accepted however \nthere is no consensus for standardised methodology to assess the \ncompression of the cervical nerve roots. In collaboration with the University of \nLeeds a search strategy was developed and performed for reports published \nbefore 01.02.2020. \nResults or Findings: 6952 articles were identified with 59 articles satisfying \nthe inclusion criteria. Most reports involved multiple imaging modalities; MRI \n(69%), CT (50%) and plain X-rays (14%). Standard axial and sagittal imaging \nwere used most with 53% including oblique views. This systematic review \nshowed that the most mature grading for cervical foraminal stenosis is in the \nform of systems described by Kim et al. 2015 and Park et al. 2013. Area \nanalysis was performed in 48% and global degenerative analysis with a focus \non the neuroforamina was included in 41% of reports. \nConclusion: Imaging of the cervical nerve root canals is mostly performed \nusing MRI and is reported using subjective terminology. The Park and Kim \nsystems for classifying the degree of stenosis of the nerve root canal have \nbeen described. Oblique fine cut images derived from three dimensional MRI \ndatasets may yield more consistency, better clinical correlation, enhanced \nsurgical decision making and outcomes. \nLimitations: Clinical application of these scoring systems is limited by their \nreliance on non-standard imaging (Park), limited validation against clinical \nsymptoms and surgical outcome data. \nEthics Committee Approval: Local ethical approval was obtained \nFunding for this study: This study was partly funded by the LGI Neurosurgery \nResearch Fund. Dr. Meacock is supported by a RCS Research Fellowship and \nan NIHR grant. \nAuthor Disclosures: \nJames Meacock: Nothing to disclose \nMoritz Schramm: Nothing to disclose \nSenthil Selvanathan: Nothing to disclose \nDavid Jayne: Nothing to disclose \nDeborah Stocken: Nothing to disclose \nStuart Currie: Nothing to disclose \nSimon Thomson: Nothing to disclose \n \nRPS 811-5 \nThe correlation between DIR, FLAIR and T2W imaging sequences with \nEDSS and determine the diagnostic accuracy of three sequences in the \ndetection of MS lesions at different anatomical regions \n*A. D. Almutairi*, R. Mahmud, S. Suppiah; Selangor/MY \n(alrha123@hotmail.com) \n \nPurpose: The purpose of our study was to evaluate the dependability of the \ncorrelation between the lesion load measurement of double inversion recovery \n(DIR), fluid-attenuated inversion recovery (FLAIR) and T2 weighted imaging \n(T2WI) sequences with the expanded disability status scale (EDSS) to \ndetermine the role of DIR technique as a practical test for clinical disability. \nMethods or Background: 97 patients were included in our study, imaging \nperformed on a 3T Siemens Skyra MRI scanner using DIR, FLAIR, and \nT2W_TSE sequences. EDSS was used to investigate the physical disability. \nThe diagnostic accuracy of DIR, FLAIR, and T2WI sequences evaluated in \ndifferent anatomical regions. Sensitivity and specificity were tested by the \nreceiver operating characteristics (ROC) curve. Spearman correlations were \nperformed to identify the significant relationships between the load \nmeasurement and EDSS scores at different regions with the sequences. \nResults or Findings: Our results demonstrated that the highest correlation \ncoefficients between the number of lesions and EDSS were in the infratentorial \nregion (r= 0.584, p<0.001) for the DIR sequence. It was found that the number \nof lesions in infratentorial is the best predictor for EDSS. The highest sensitivity \n(84.6%) and specificity of 81% were observed for the lesions in infratentorial at \nthe cut-off point of 3.5. \nConclusion: DIR can describe physical and cognitive dysfunction. Because of \nthe higher potential of the DIR sequence to identify MS lesions and overcome \nthe technical defect of conventional MRI sequences for the diagnosis of cortical \nlesions, we recommend adding DIR sequence routinely in patients with MS \nLimitations: None \nEthics Committee Approval: The study was approved by the research ethics \ncommittee of the Faculty of Medicine and Health Sciences, Universiti Putra \nMalaysia on 30th January 2018, with a reference approval number \nUPM/TNCPI/RMC/KEUPM/1.4.18.2 (JKEUPM) \nFunding for this study: No funding was obtained for this study \nAuthor Disclosures: \nOthman Alomair: Nothing to disclose \nHasyma Abu Hassan: Nothing to disclose \nSubapriya Suppiah: nothing to disclose \nRozi Mahmud: Consultant: non \nAbdullah Dhaifallah Almutairi: Speaker: non \n \nRPS 811-6 \nLesion load assessment among multiple sclerosis patients using DIR, \nFLAIR and T2WI sequences \n*A. D. Almutairi*¹, R. Mahmud¹, S. Suppiah¹, H. Abu Hassan¹, O. Alomair²; \n¹Selangor/MY, ²Riyadh/SA \n(alrha123@hotmail.com) \n \nPurpose: Magnetic resonance imaging (MRI) is a diagnostic imaging \ntechnique that is widely used to diagnose lesions in neurological disorders \nsuch as multiple sclerosis (MS). The aim of our study was to investigate MS \nlesion load at different anatomical regions in the brain using double inversion \nrecovery (DIR), fluid-attenuated inversion recovery (FLAIR), and T2- weighted \nimaging (T2WI) sequences \nMethods or Background: A total of 97 MS patients were included in our \nretrospective study. All images were obtained using 3T Scanner (Siemens \nSkyra). The images from the DIR, FLAIR, and T2WI sequences were \ncompared on axial planes with identical anatomic positions and the number of \nlesions was assigned to their anatomical region. The contrast ratios were \ncalculated from the mean values of the signal intensity among lesion/normal \nappearing white matter, lesions/CSF and lesion/ normal appearing grey matter \nResults or Findings: DIR displayed a significantly higher number of MS \nlesions in all anatomical regions comparing to FLAIR and T2W_TSE (p < 0.05). \nOur results indicated that in DIR, the number of lesions in the cortical region \nwas significantly higher than FLAIR and T2WI techniques. The highest contrast \nratio observed for DIR in all regions except for lesion/CSF which FLAIR \nshowed the highest ratio \nConclusion: DIR is a valuable technique for better delineation, greater \ncontrast measurements, and the increasing total number of MS lesions, as well \nas more intracortical lesions in MS patients, compared to FLAIR and T2WI. It is \nstrongly recommended to add DIR sequence in daily routine imaging \nsequences \nLimitations: Non \nEthics Committee Approval: The study was approved by the research ethics \ncommittee of the Faculty of Medicine and Health Sciences, Universiti Putra \nMalaysia on 30th January 2018, with a reference approval number \nUPM/TNCPI/RMC/KEUPM/1.4.18.2 \nFunding for this study: No funding was obtained for this study \nAuthor Disclosures: \nOthman Alomair: Nothing to disclose \nHasyma Abu Hassan: Nothing to disclose \nSubapriya Suppiah: Nothing to disclose \nRozi Mahmud: Consultant: non \nAbdullah Dhaifallah Almutairi: Author: non \n \nRPS 811-7 \nInfluence of ageing and gadolinium exposure on T1, T2 and T2*-\nrelaxation in healthy women with and without prior exposure to \ngadoterate meglumine at 3.0-T brain MR imaging \n*K. B. Krug*¹, C. Burke¹, K. Weiss², P. A. Baltzer³, K. Rhiem¹, D. Maintz¹,  \nM. Schlamann¹, M. Hellmich¹; ¹Cologne/DE, ²Hamburg/DE, ³Vienna/AT \n(Barbara.krug@uk-koeln.de) \n \nPurpose: The effects of aging and intravenous application of gadolinium \nbased contrast agents (GBCA) on MRI-measures in Deep brain nuclei remain \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 283  \npoorly understood. We aimed to assess the effects of aging and GBCA-\nexposure on MRI-measurements in deep brain nuclei. \nMethods or Background: This prospective, single-center study enrolled 100 \nhealthy participants of our high-risk screening center for hereditary breast \ncancer, who had received at least six doses of macrocyclic GBCA or were \nnewly entering the program. All participants underwent unenhanced 3.0-T brain \nMRI including quantitative T1, T2 and R2*-mapping. The relaxation times were \nderived from ROI measurements in the brain nuclei performed by a radiologist \nand a neuroradiologist. Statistical analysis was based on descriptive \nevaluations and multivariate analyses. \nResults or Findings: The participants (exposed group: 49, controls: 51) were \naged 42±9 years. In a multivariable model, age had a comparatively strong \nimpact on R2* (p<0.001-0.01), T2 (p=0.005-0.048) and T1-relaxation times \n(p<0.001-0.037) for the majority of brain nuclei, mostly affecting the substantia \nnigra, globus pallidus (GP), nucleus ruber, thalamus and dentate nucleus (DN). \nThe effect of prior GBCA-administration on T1-relaxation times was \ncomparatively less pronounced, yielding statistically significant results in the \nDN, GP and pons (p=0.019-0.033). \nConclusion: The effects of aging and gadolinium-exposure on MRI-\nmeasurements of deep brain nuclei was observed in a homogeneous group of \nmiddle-aged healthy females. Aging had a pronounced effect on T2 and R2*-\nrelaxation more than any effect of former GBCA-applications on measured T1-\nrelaxation times. \nLimitations: The main limitation of the presented study lies in the \ninterindividual comparison of healthy young women of the same age group. \nThe lack of an intraindividual approach will be addressed in an ongoing study \nincluding attenders of the screening program. \nEthics Committee Approval: Approval of the institutional ethics review board \n(file reference 17-240). \nFunding for this study: None \nAuthor Disclosures: \nPascal A.T. Baltzer: Nothing to disclose \nKerstin Rhiem: Nothing to disclose \nDavid Maintz: Nothing to disclose \nChristina Burke: Nothing to disclose \nMartin Hellmich: nothing to disclose \nKilian Weiss: Nothing to disclose \nKathrin Barbara Krug: Nothing to disclose \nMarc Schlamann: Nothing to disclose \n \nRPS 811-8 \nMR prevalence of incidental findings on brain MR: a retrospective \nanalysis of 36,808 MRI scans \n*V. K. Venugopal*, V. Mahajan, H. Mahajan ; Delhi/IN \n(vasanthdrv@gmail.com) \n \nPurpose: To analyze the frequency of benign incidental findings on Brain MR \nin a multicenter MRI report database on a python based web platform using \nkeyword and substring match. \nMethods or Background: The study was conducted on retrospective reports \nof MR scans from six imaging centers between June 2016 to January 2020. \nThese reports were loaded on a python based search platform CARPL data \nminer. The platform is enabled by MongoDB for handling the huge amount of \nunstructured data(modality, report, department etc). The platform keeps the \nrecent search results stored in a Redis database, an in-memory database, \nthus, making the search faster for similar queries. Searches were performed for \nthe frequency of the following incidental findings: Basal ganglia calcifications, \nempty sella/ partial empty sella, sinusitis, mastoid cell effusion, arachnoid cyst, \ncalcified granuloma, mega cisterna magna, cavum septum pellucidum (CSP), \nhyperostosis frontalis interna, developmental venous anomaly (DVA), cavum \nvergae and pineal cyst. \nResults or Findings: From a total of 128,397 MRI reports done across these \nsix centers, there were 36, 808 MRI Brain studies. The frequency of basal \nganglia calcifications, empty sella/ partial empty sella, sinusitis, mastoid cell \neffusion, arachnoid cyst, calcified granuloma, mega cisterna magna, CSP, \nhyperostosis frontalis interna, DVA, cavum vergae, pineal cyst were: 28111 (22 \n%), 2527 (2 %), 1727 (1 %), 1197 (1 %), 857 (1%), 596 (0.5%), 368 (0.3%), \n310 (0.2%), 189 (0.1%), 172 (0.1%), 161 (0.1%), 96 (0.1%). \nConclusion: We report MR prevalence of incidental findings on brain MR. \nPython-based web data-miner is helpful in identifying these incidental findings \nin large retrospective report datasets. \nLimitations: None \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nHarsh Mahajan : Other: Research collaboration, Predible Health Other: \nResearch collaboration, Lunit INC Other: Research collaboration, Qure.ai \nOther: Research collaboration, General Electric Company Other: Research \ncollaboration, Lunit Inc. Other: Director, Mahajan Imaging Pvt Ltd Other: \nResearch collaboration, Koninklijke Philips NV \nVasantha Kumar Venugopal: Other: Research collaboration, Koninklijke Philips \nNV Other: Research collaboration, General Electric Company Other: Research \ncollaboration, Predible Health Other: Research collaboration, Qure.ai Other: \nResearch collaboration, Lunit Inc. \nVidur Mahajan: Other: Head of Research at CARING \n \nRPS 811-9 \nMagnetic resonance neurography in the evaluation of peripheral \nneuropathy and plexopathy \n*P. Lenin*, M. Z. Mohammad Zakir, A. Kale, Y. J. Kirubha, K. Sudhakar,  \nN. Chidambaranathan; Chennai/IN \n(pradhaplenin@gmail.com) \n \nPurpose: To evaluate the role of MR Neurography (MRN) in plexopathy, \nperipheral neuropathy and to localize the abnormality with its extent and to \ncharacterize the aetiology. In addition to evaluate the role of MRN in grading \nthe nerve injuries into Neuropraxia, Axonotmesis and Neurotmesis. \nMethods or Background: 125 patients with different clinical suspicions \nreferred to our department for MRN. The study included both traumatic and \nnon-traumatic cases. The study was done on 3 Tesla MRI machine with the \nstandard departmental protocol using T1W, T2W, PDW-SPAIR, STIR, DWIBS, \n3D-Nerve view sequences, and post-contrast T1W sequence if required. The \ncalibre, signal intensity, course, fascicular pattern, and enhancement pattern of \nthe nerve analysed. Then the data was collected, processed, analysed and \nresults were tabulated. We correlated the results of clinical examination, nerve \nconduction study, histopathology (in case of nerve sheath tumours) and intra-\noperative findings (in case of nerve injuries) with MRN diagnosis. \nResults or Findings: Of the 125 patients, 40 had neurogenic tumour, 2 had \nmedian nerve fibrolipomatous hamartoma, 5 had acute brachial neuritis, 8 had \nradiation plexitis, 21 had post-traumatic brachial plexopathy, 25 had post-\ntraumatic neuropathic changes in peripheral nerves, 3 patient had infective \nneuritis, 10 patients had malignant brachial plexopathy, 2 patients had CIDP as \nevidenced by imaging findings of MR Neurography. 6 patients had no \nabnormality in MRN. Follow up histopathology report correlated well with MRN \nfindings \nConclusion: MRN is a non-invasive, reliable, and novel imaging technique \ngiving detailed anatomical information to diagnose plexopathy and peripheral \nneuropathy. Nerve injuries are graded with higher reliability in MRN which \nhelps the surgeon in planning the course of treatment effectively. \nLimitations: The presence of haemorrhage and excess oedema limits the \ngrading the nerve injury. \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nAlok Kale: Nothing to disclose \nNatesan Chidambaranathan: Nothing to disclose \nYvette Kirubha Jayakar David Livingstone: Nothing to disclose \nK Sudhakar: Nothing to disclose \nMohammad Zuber Mohammad Zakir: Nothing to disclose \nPradhap Lenin: Nothing to disclose \n \nRPS 811-10 \nEvaluation of brain morphometry DTI and perfusion MRI in patients with \nmild cognitive impairment \nE. Wong Pak Yew, *K. Rahmat*, N. F. Muhammad, T. Li Kuo, N. Ramli,  \nT. Maw Pin; Kuala Lumpur/MY \n(kartini@ummc.edu.my) \n \nPurpose: To determine the differences in brain morphometry, cerebral white \nmatter lesion, diffusion tensor imaging (DTI) indices and arterial spin labelled \n(ASL) perfusion between subjects with mild cognitive impairment (MCI) and \ncognitively normal control (CNC). \nMethods or Background: A total of 28 subjects underwent MRI \nneurodegenerative protocol. Brain morphometry was processed using \nFreesurfer to obtain surface area, subcortical brain volume and cortical \nthickness. A template-based ROI was used to obtain fractional anisotropy (FA), \nmean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) values. \nPulsed Arterial spin labelling (PASL) was evaluated using FSL software suite. \nWhite matter lesion burdens were evaluated visually by Fazekas score and \nquantitatively by automated lesion segmentation tool method. \nResults or Findings: MCI group showed significant volume loss in both \nhippocampi, both amygdala and corpus callosum (p<0.05) compared to CNC. \nReduced cortical thickness in both parahippocampal, both entorhinal, right \nposterior cingulate and right temporal lobe in MCI group. MCI group had \nsignificantly lower FA, higher MD, AD and RD values in white matter tracts \npredominantly in the hippocampus and cingulate gyrus when compared to \nCNC (p<0.05). DTI parameters particularly FA, MD and RD were significantly \ncorrelated with MoCA and VCAT scores. White matter lesion volume via \nquantitative assessment were significantly higher in MCI group. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 284  \nConclusion: Morphometric analysis, DTI and white matter lesion assessment \nare useful for evaluation of MCI patients and aid in their early diagnosis. \nLimitations: Data collection and analysis in progress. \nEthics Committee Approval: Medical ethics was approved by the UMMC \nMedical Research Ethics Committee in July 2018 (MREC ID NO 201832-\n6071). \nFunding for this study: The funding of the study was provided by the \nUniversity of Malaya Research Grant (Grant Code: RP052B-17HTM) \nAuthor Disclosures: \nTan Maw Pin: Nothing to disclose \nNorlisah Ramli: Nothing to disclose \nTan Li Kuo: Nothing to disclose \nKartini Rahmat: Nothing to disclose \nEustace Wong Pak Yew: Nothing to disclose \nNadia Fareeda Muhammad: Nothing to disclose \n \nRPS 811-12 \nQuantitative DTI measurements in non-compressive and compressive \ncervicodorsal myelopathy with the degree of compression correlation \n*H. G. E. Hassan*, R. Ali Maarouf, N. Ramzy Mohamady,  \nM. A. Farouk Abo-Elela; Cairo/EG \n(doctor_hendgalal@yahoo.com) \n \nPurpose: DTI is a specific and sensitive method in evaluation of spinal cord \ntrauma abnormalities in regions that appeared normal on conventional MRI, \nassessment of the functional integrity of the axons of the compressed spinal \ncord can improve prognostic prediction. \nMethods or Background: thirty patients (15 female and 15 male patients their \nages ranged from 16 to 65 years) presented with clinical symptoms of spinal \ncord compression (unilateral or bilateral numbness of upper limbs or back \npain). Diffusion tensor sequence was added to conventional MRI study. FA and \nADC were measured in all cases in three sites (at, above, and below the site of \nlesion); the last two measures are considered as control \nResults or Findings: Statistically significant difference of (FA) and (ADC) \nbetween compressive and non-compressive lesions and control with p value < \n0.05, resultant cut-off value of FA = 0.385 with sensitivity 71%, specificity \n100%, and cutoff value of ADC = 1.35 with sensitivity 61.3 %, specificity \n88.3%. There is positive correlation between degrees of cord compression and \nFA value which have clinical impact on specification of clinical symptoms. \nConclusion: The more increase of FA and decrease of ADC values implies a \nbetter prognosis in acute lesions and clinical recovery.There is positive \ncorrelation between degrees of cord compression and FA value which have \nclinical impact on specification of clinical symptoms. \nLimitations: further study is advised with specific pathological category with \nadditional post-operative clinical data and follow-up of the DTI results \ncorrelation could add relevant value. \nEthics Committee Approval: This study was approved by the Research \nEthics Committee of the Faculty of Medicine at Ain Shams University in Egypt \nin 2018 and extended to 2020; Reference Number of approval: MD 76/2018. \nFunding for this study: This study had no funding from any resource. \nAuthor Disclosures: \nHend Galal Eldeen Hassan: Nothing to disclose \nMohamed AFarouk Abo-Elela: Nothing to disclose \nRania Ali Maarouf: Nothing to disclose \nNorhan Ramzy Mohamady: Nothing to disclose \n \nRPS 811-13 \nA 6-year review of imaging studies used to investigate patients with \npapilloedema \n*A. A. Ahmmed*¹, J. Olson²; ¹Bristol/UK, ²Aberdeen/UK \n(afsara.a.ahmmed@gmail.com) \n \nPurpose: To examine what imaging studies patients with suspected \npapilloedema that presented to a tertiary emergency eye service received and \nif this complies with national consensus guidelines. \nMethods or Background: The Association of British Neurologists consensus \nguidelines in 2018 for the diagnosis and management of idiopathic intracranial \nhypertension state all patients found to have papilloedema should have \nCT/MRI head and venography to rule out a space occupying lesion and venous \nsinus thrombosis. A database of clinical records from all attendances to the \nemergency eye service was searched to identify all episodes where \npapilloedema was the listed diagnosis from February 2013 to June 2019. \nElectronic patient records were used to determine what imaging they had and \nwhat it showed retrospectively. Those with no report from their imaging studies \nwere excluded. If a patient was seen multiple times, the imaging relating to \ntheir first visit with a diagnosis of papilloedema was noted. \nResults or Findings: There were 179 entries with papilloedema as the \ndiagnosis. Imaging reports were not available for 29 entries and there were 19 \nduplicate entries, giving 131 cases. Ninety-six patients had a CT or MRI head \n(73%) and 64 patients (49%) had a CT or MR venogram. \nConclusion: Imaging was not performed as per national guidelines. \nConcordance with the guideline could be improved through teaching sessions \nto referring clinicians as well as educational posters within the radiology \ndepartment. A reaudit could take place in six months. \nLimitations: The study was conducted retrospectively, which resulted in 29 \ncases being excluded due to inaccessible imaging reports. All cases of \nsuspected papilloedema may have not been identified using the filtering \nmethod used. \nEthics Committee Approval: This study was a service improvement project, \nhence no ethics committee approval was required. \nFunding for this study: Nil \nAuthor Disclosures: \nAfsara Anisa Ahmmed: Nothing to disclose \nJohn Olson: Nothing to disclose \n \nRPS 811-14 \nUltrasound-guided motor unit scanning EMG (UltraMUSE) \n*S. Maitland*, J. Hall, R. Whittaker; Newcastle/UK \n(stu.maitland@newcastle.ac.uk) \n \nPurpose: Needle EMG is a neurophysiological procedure performed ‘blind’ \nwith no sense of the position of the needle within the motor unit. As a result, no \ninformation on motor unit dimensions or internal structure is available. We have \ndeveloped a simple to use technique combining EMG and ultrasound to \nperform targeted motor unit transects in human muscles. \nMethods or Background: Ultrasound guidance was achieved using a Philips \nEPIQ with eL18-4 linear transducer, frequency 2-20MHz. The ultrasound \nrecordings were captured using a video capture card and synchronised to \nEMG recording using the audio-in channel. We stimulated the peroneal nerve \nuntil alternation was visible in a single motor unit in the tibialis anterior muscle, \nand targeted this with a 28g concentric needle electrode. By placing the needle \nthrough to the far side of the twitch and withdrawing in small increments by \nhand, around 20 motor unit potentials were recorded at each position. Needle \nposition was determined post-hoc to allow a 2D motor unit scan to be \nreconstituted. \nResults or Findings: Here, we present the first recordings of this new \ntechnique. We demonstrate that the movement resolution of the human \noperator is around 1-2mm, which is sufficient to allow a transect of a motor \nunit. We establish the motor unit potential at each location, and how this \nevolves as the needle position moves. The corridor length of each motor unit \ntransect is around 6mm. \nConclusion: This quick and easy technique holds the potential to allow \nrigorous sampling of motor unit activity, reducing the inter-operator variability of \nneedle EMG and improving the sensitivity to conditions including Motor \nNeurone Disease. \nLimitations: Further work is ongoing modelling the diagnostic accuracy of this \ntechnique. \nEthics Committee Approval: Newcastle Medical School Ethics Committee \napproval received. \nFunding for this study: NIHR Newcastle BRC \nAuthor Disclosures: \nStuart Maitland: Nothing to disclose \nJulie Hall: Nothing to disclose \nRoger Whittaker: Nothing to disclose \n \nRPS 811-15 \nLooking outside the box: a review of incidental findings outside lumbar \nspinal canal causing back pain on routinely performed MRI lumbar spine \n*R. Kanwal*, M. Rauf, B. Y. Faiz, S. Gul, A. Rana; Islamabad/PK \n(raanakanwal@hotmail.com) \n \nPurpose: 1. To document the prevalence of findings additional to lumbar \nspinal canal pathologies on routinely performed MRI lumbar spine. 2. To \neducate radiologists to search for causes of back pain other than discogenic \ndisease by reviewing all the visible structures acquired in MRI lumbar spine. \nMethods or Background: Lower backache is one of the well-recognized \nindications for acquiring MRI lumbar spine with reported prevalence to be 60-\n70 percent. Apart from expected spinal pathologies, radiological imaging helps \nto recognize the incidental findings which are unexpected yet can explain \npatient's symptoms. We reviewed these pathologies on MRI spine and \ndetermined their prevalence which can have an impact on clinical \nmanagement. \nResults or Findings: We reviewed 350 MRI lumbar spine of patients with \nlower backache performed from January till June 2020. Among recognized \nincidental findings classification was made into vascular, oncological, \ninfectious, congenital and others. Among the included patients 117 were \nfemales; while 233 were males. Out of total 350 patients 80 had extra-spinal \nincidental findings with most commonly seen finding being renal cyst seen in \n33 (41.2%) patients. Others had simple ovarian cyst 13 (16.2%), complex \novarian cyst 5 (6.2%), ovarian mass 2 (2.5%), vertebral metastasis 9 (11.2%), \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 285  \nprostatic carcinoma 2 (2.5%), cervical carcinoma 1 (1.2 %), rectal carcinoma 1 \n(1.2%), vertebral body fracture 2 (2.5%), retroperitoneal fibromatosis 1 (1.2%), \npara-aortic lymphadenopathy 3 (3.7%), cholelithiasis 1 (1.2%), congenital \nanomaly 3 (3.7%) and hydronephroureter due to urolithiasis 4 (5%). \nConclusion: Our study points out uncommonly reported incidental findings \nthat can explain patient’s symptoms. It provides a road map towards spinal and \nnon-spinal structures assessment in MRI lumbar spine. \nLimitations: No \nEthics Committee Approval: Approved \nFunding for this study: Not needed. \nAuthor Disclosures: \nBelqees Yawar Faiz: Nothing to disclose \nAtif Rana: Nothing to disclose \nRaana Kanwal: Nothing to disclose \nSalma Gul: Nothing to disclose \nMaria Rauf: Nothing to disclose \n \n \nResearch Presentation Session: Paediatric \nRPS 312 \nCT and MRI in paediatrics \nRPS 312-2 \nHaematopoietic stem cell transplantation (HSCT) in children: the basics \nand how to identify the main abdominal complications \n*C. Ponich Clementino*, L. Suzuki, D. Otto, M. Lebouche, R. Correia, \nM. Rocha; São Paulo/BR \n(caponich@gmail.com) \n \nPurpose: To review the most common indications for HSCT in the pediatric \npopulation, as well as revise briefly the central principles and different types of \ntransplantation. To discuss the most common abdominal complications, clinical \nmanifestations, imaging findings, and relation to the three posttransplantation \nphases. To propose a simple diagram that aids radiologists to suggest the \nmost accurate diagnosis in this scenario. \nMethods or Background: HSCT is currently an option of treatment for many \nbenign and malignant hematologic disorders, as well as some solid tumours. In \nchildren, some of the main indications include leukemia, lymphoma, \nneuroblastoma, and Wilms tumour. It consists of extracting stem cells from \nanother individual (allogeneic transplantation) or from the patient himself \n(autologous transplantation) and injecting them into the host. Previously, the \npatient has to undergo a conditioning therapy, in which virtually all of the \npatient’s hematopoietic cells will be cleared from the organism. The patient \nbecomes more susceptible to contract various bacterial, viral and fungal \ninfections, as well as other conditions that affect the liver, gastrointestinal tract, \nurinary tract and the lymphatic system. \nResults or Findings: Complications following HSCT include acute and chronic \ngraft-versus-host disease (GVHD), infectious enterocolitis, neutropenic colitis, \nthrombotic microangiopathy, benign pneumatosis, sinusoidal obstruction \nsyndrome, hemorrhagic cystitis, and posttransplant lymphoproliferative \ndisorder (PTLD). Imaging findings in ultrasound and computed tomography, \nsuch as bowel wall thickening and mesenteric fat stranding, are common in \nmany of these conditions and often mislead to an equivocal diagnosis. \nConclusion: Abdominal complications following HSCT may present a \ndiagnostic challenge for radiologists due to overlapping clinical symptoms and \nimaging findings. It is important for radiologists to know what clinical data and \nkey imaging findings will help them narrow down the diagnosis and allow an \nadequate treatment. \nLimitations: No limitations \nEthics Committee Approval: Not required \nFunding for this study: Non \nAuthor Disclosures: \nCarolina Ponich Clementino: Nothing to disclose \nMelody Lebouche: Nothing to disclose \nRaphael Correia: Nothing to disclose \nDeborah Otto: Nothing to disclose \nMarina Rocha: Nothing to disclose \nLisa Suzuki: Nothing to disclose \n \n \n \n \n \n \n \nRPS 312-3 \nNormal pancreatic thickness values in healthy children: MRI values \nE. Fatiho÷lu, *S. Aydın*, E. Karavaú; Erzincan/TR  \n(sonaydin89@hotmail.com) \n \nPurpose: Normal pancreatic thickness values on ultrasound (US) have been \ndefined in literature. However, there is insufficient information about normal \npancreatic measurements acquired from computed tomography (CT) or \nmagnetic resonance imaging (MRI). We aim to define normal pancreatic \nthickness measurements acquired from different localizations. \nMethods or Background: A retrospective evaluation was made of the \nabdominal MRI examinations of 105 pediatric patients. Patients with any \npancreatic disease, or chronic gastrointestinal inflammatory disease were \nexcluded from the study. Measurements were taken from T2-weighted images \nResults or Findings: The study population comprised 51 (48.6%) males and \n54 (51.4%) females with a median age of 11 years. The median normal \npancreatic thickness of head, neck, body and tail portions were measured as \n18 mm, 10 mm, 14 mm, and 14 mm, respectively. N. A positive correlation was \ndetermined between age, height, weight, body mass index (BMI) and \npancreatic thickness in all the anatomic localizations measured. \nConclusion: The defined normal ranges were found to be mostly consistent \nwith previously determined US and CT-based values. Pancreatic thickness \nwas determined to be positively correlated with age, height, weight, and BMI \nfor all four localizations. Knowledge of the normal pancreatic thickness values \nwill increase the diagnostic accuracy of radiologists for pancreatic diseases. \nLimitations: A larger population would enable more definitive normal ranges. \nPatients younger than 4 years of age were not included in this study. The \ninclusion of more centers in the study would have increased the reproducibility \nand reliability of the data. Moreover, the interobserver variability data were of \nonly two researchers. Data were collected using only T2-weighted images. \nEthics Committee Approval: Approval for this retrospective study was \ngranted by the Institutional Review Board. Informed consent was waived \nbecause of the retrospective nature. \nFunding for this study: None \nAuthor Disclosures: \nErdal Karavaú: Nothing to disclose \nSonay Aydın: Nothing to disclose \nErdem Fatiho÷lu: Nothing to disclose \n \nRPS 312-4 \nPower injector usage for paediatric CT angiography: a single centre \nexperience \n*M. Pop*, C. Patricia Carmen, D. C. Cucoranu, I. P. Simu; Tirgu Mures/RO \n(pop.marian@gmail.com) \n \nPurpose: To evaluate the safety of power injector usage for pediatric CT \nangiography when using central versus peripheral access, by assessing the \nincidence of adverse events. \nMethods or Background: We retrospectively evaluated data of 399 pediatric \nCT angiography examinations performed 2015-2020 in a tertiary \ncardiovascular center. All examinations were done using a pressure-limited \npower injector (300 psi) and room-temperature contrast medium. Recorded \ndata included patient age and weight, cannulation type, site of venous access, \ntype and volume of contrast agents, flow rate and adverse events (e.g. \nextravasation, allergic reactions). \nResults or Findings: The median patients age was 349 days, with a male: \nfemale ratio of 1.27. The most frequently site for peripheral cannulation was \nthe left antecubital fossa (159 cases, 39.8%) and the most frequently used \ncanula size was 24 gauge(143 cases). A central line was used in 74(18.5%) \ncases. The average flowrate was significantly higher (2.03 vs 0.99 ml/s) when \nusing a peripheral canula. Using peripheral access we have encountered three \ncases of extravasation (0.75 %), 8 minor allergic reactions and one \nanaphylactic shock. All cases resolved favorably. Using a central line was not \nassociated with incidents due to contrast medium injection; however, in two \ncases we found the central line to be placed in an artery. \nConclusion: The usage of power injectors in CT angiography is generally safe \nwhen using either peripheral or central venous access. Even with a rigorous \nsystematic approach and a properly trained team the presence of incidents is \nnot zero. \nLimitations: Small sample size and single center experience. Lack of data \nregarding the central line type (single/multi lumen, diameter, length). 45.7% of \npatients were infants, unable to express complaints. \nEthics Committee Approval: IUBCvT 4920/2020 \nFunding for this study: n/a \nAuthor Disclosures: \nChiscariu Patricia Carmen: Nothing to disclose \nIunius Paul Simu: Nothing to disclose \nDragos Constantin Cucoranu: Nothing to disclose \nMarian Pop: Nothing to disclose \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 286  \nRPS 312-5 \nSilent anatomic deformities of the paediatric chest: more often than we \nthink \n*D. Bako*¹, O. Yapici Ugurlar²; ¹Van/TR, ²Istanbul/TR \n(deryabakokeskin@gmail.com) \n \nPurpose: To evaluate the frequency of silent anatomic malformations and \nvariations of the pediatric chest, which were not even recognized by the \nphysicians. \nMethods or Background: Thorax CT scans of 592 children were \nretrospectively reviewed. 82 children who had undergone chest wall surgery or \nsuspected of having chest wall deformity, chest wall mass, scoliosis, chest wall \nor clavicular fracture were excluded. The frequency of silent chest wall \ndeformities evaluated and compared with age subgroups and sex. \nResults or Findings: 118 of 510 patients had silent anatomic deformity \n(malformation or variation) of chest wall (23.1%). These deformities or \nvariations were depicted in 50 of 204 girls and 68 of 306 boys. The most \ncommon deformity was the prominent convexity of the costal cartilage (n=36, \n30.5%). While there was no statistically significant difference between sex and \nthe frequency of deformities; significant difference (p <0.001) existed in \nfrequency between age subgroups. \nConclusion: We detected that the frequency of silent anatomic variation / \nmalformations in child population is about 23%. It means that approximately \nevery fourth child has some silent deformity of the chest wall. A high rate \ndepicts that asymptomatic asymmetries-lesions of the chest wall are mostly \nbenign and there is no need for further imaging. The other important finding is \nan increase in the frequency of malformation / variations with age, which \nsupports the hypothesis that these subtle malformations/variations are mostly \ndevelopmental, not congenital and becoming more prominent with age and \npuberty. The other conclusion and next hypothesis might be that these silent \nmalformations/variations are expected to be even more frequent in adult \npopulation. \nLimitations: It was based on data from a single center and sample size is \nrelative small. \nEthics Committee Approval: Available (Van Regional Training and Research \nHospital) \nFunding for this study: Van Regional Training and Research Hospital \nAuthor Disclosures: \nOzge Yapici Ugurlar: Nothing to disclose \nDerya Bako: Nothing to disclose \n \nRPS 312-7 \nLet’s play: using games to perform fMRI in 3-5 year-old children \n*M. T. Podgórski*, M. Podgórska, J. Błasiak, N. Smiech, K. B. Biernacka,  \nT. Puzio, P. Grzelak; Lodz/PL \n(podgorskimt@gmail.com) \n \nPurpose: The main aim of the study was to prepare the interactive application \nthan can be used as a motor paradigm in fMRI study. Secondary goal was to \ndecrease the age of paediatric patients than can undergo the fMRI study when \ncompared with the standard fMRI protocol. \nMethods or Background: The application was prepared according to authors' \nscenario. Child has to squeeze the rubber figure powering up the car waiting at \nthe start of the track. The figure is connected through the silicon tube with the \nreceiver and the pace of squeezing corresponds with energy accumulated in \ncar (active block lasting 30 sec.). During next 30 sec. child observes how the \ncar moves through the track (passive block). The schema with different tracks \nof increasing difficulty is repeated 5 times. Thirty children aged 3-5 years were \nexamined according to the standard and interactive motor paradigms (5 girls \nand 5 boys in each year of life). \nResults or Findings: None of ten of the 3-years old children were able to fulfill \nthe examination. In 4-years old one out of ten was able to undergo the \nstandard paradigm, while fife the interactive one. In a group of 5-years old \nchildren three undergo the standard paradigm and seven the interactive one. \nOn the visual inspection examination with the interactive paradigm resulted \nwith less artifacts. \nConclusion: Application of a game as a motor paradigm can decrease the age \nof children able to undergo the fMRI study and improve examination quality. \nLimitations: Only healthy children were examined. Children with neurological \nproblems will be tested next to confirm usefulness of the application. \nEthics Committee Approval: Local bio-ethical committee agreement no. \n109/2015 \nFunding for this study: The study was funded by Narodowe Centrum Nauki \nas a scientific grant SONATA (gran no: 2016/21/D/NZ4/03721) \n \n \n \n \n \n \n \nAuthor Disclosures: \nNina Smiech: Nothing to disclose \nTomasz Puzio: Nothing to disclose \nMichał Tomasz Podgórski: Nothing to disclose \nMonika Podgórska: Nothing to disclose \nPiotr Grzelak: Nothing to disclose \nJoanna Błasiak: Nothing to disclose \nKatarzyna Barbara Biernacka: Nothing to disclose \n \n \nResearch Presentation Session: Paediatric \nRPS 412 \nUltrasound in paediatrics \nRPS 412-1 \nAccordance of histopathology with imaging diagnosis of congenital \npulmonary lesions using prenatal ultrasound, prenatal MRI and postnatal \nCT: a single centre experience \n*D. Kifjak*, F. Prayer, H. Prosch, M. Weber, G. Gruber, A. Scharrer, A. Hojreh, \nD. Prayer, G. Kasprian; Vienna/AT  \n(daria.kifjak@meduniwien.ac.at) \n \nPurpose: Evaluation of diagnostic accuracy of prenatal ultrasound, prenatal \nMRI and postnatal CT in congenital pulmonary malformations. Histopathology \nafter lung lesion resection served as gold standard. \nMethods or Background: In this retrospective, single-center study, 32 fetuses \nwith histopathologically verified congenital pulmonary lesions evaluated by \nprenatal ultrasound, prenatal MRI and postnatal CT during the first year of life \nwere included. Prenatal ultrasound and prenatal MRI were performed at an \naverage gestational age of 22+3 gestations weeks (GW) (range 12+16 to 32+5 \nGW) and 27+2 GW (21+5 to 38+3 GW), respectively. Routine fetal MRI was \nperformed according to ISUOG guidelines. Afterwards, diagnosis based on \nprenatal ultrasound, prenatal MRI and postnatal CT was compared to \nhistopathological findings. \nResults or Findings: Histologically proven congenital lung lesions included 14 \ncases of congenital pulmonary airway malformation (CPAM), seven cases of \nhybrid lesions, six cases of bronchopulmonary sequestration, three cases of \nbronchial atresia and two cases of bronchogenic cysts. Prenatal sonography \nfindings agreed with histopathological results in twelve of 32 (38%) cases. In \n23 of 32 (72%) cases fetal MRI diagnosis was consistent with the \nhistopathological results. Histopathological diagnosis confirmed CT findings in \n26 of 32 (81%) cases. \nConclusion: In our study we succeeded showing that fetal MRI is an excellent \ntool for the diagnosis of congenital pulmonary lung lesions, thereby \ncomplimenting prenatal ultrasound screening. Moreover, fetal MRI facilitates \npersonalized perinatal management of cases with congenital pulmonary lung \nlesions. \nLimitations: Different gestational age (gestational weeks) during prenatal MRI \nand prenatal ultrasound. \nEthics Committee Approval: Approved by local ethics committee (EK# \n1343/2020). \nFunding for this study: No funding. \nAuthor Disclosures: \nHelmut Prosch: Nothing to disclose \nFlorian Prayer: Nothing to disclose \nAnke Scharrer: Nothing to disclose \nDaria Kifjak: Nothing to disclose \nAzadeh Hojreh: Nothing to disclose \nGerlinde Gruber: Nothing to disclose \nDaniela Prayer: Nothing to disclose \nGregor Kasprian: Nothing to disclose \nMichael Weber: Nothing to disclose \n \nRPS 412-4 \nPseudo-testicular sign: a new ultrasonographic feature of the ovaries in \nfemale neonates with ambiguous genitalia due to congenital adrenal \nhyperplasia \n*S. Dehghani Dashtabi*, S. A. Alamdaran, A. Vahabi, S. Hashemian,  \nY. Nikooiyan; Mashhad/IR  \n(soroosh.dehghani@gmail.com) \n \nPurpose: A common cause of ambiguous genitalia is congenital adrenal \nhyperplasia (CAH). The imaging features of the uterus and ovaries in infants \nwith CAH have not been thoroughly investigated. We aimed to investigate the \ngynecologic findings in ultrasound exams of these patients. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 287  \nMethods or Background: This case series study was performed in the \nradiology and endocrine departments of Akbar Children’s Hospital, Mashhad, \nIran, during 2016-2018. The diagnosis of CAH was confirmed using medical \nhistory, physical examination, laboratory tests, and ultrasound exams \n(indicated by the enlarged cerebriform adrenal gland in ultrasound imaging). \nUltrasound variables including uterus size, uterus-to-cervix ratio, echogenicity \nand size of the ovary, and presence of follicles and/or cysts in the ovaries were \ncollected for all patients. After a two-month course of treatment, a second \nultrasound was performed to evaluate the response to treatment. Data were \nanalyzed in SPSS version 22 for Windows. \nResults or Findings: Overall, 18 female patients with a mean age of \n16.83±5.44 days were studied. The adrenal enlargement and cerebriform \nappearance were reported in all patients. We studied the ovarian follicular \nappearance and found that 14 patients (78%) had no follicles in either of the \novaries, showing the pseudo-testicular sign. In the second ultrasound, all \npatients had bilateral multi-follicular ovaries, and cerebriform adrenal \nenlargements were resolved in all patients except one (8%). \nConclusion: The pseudo-testicular appearance of ovaries is an auxiliary sign \nin female infants with CAH, obviating the need for other laboratory tests and \nkaryotyping and preventing misdiagnosis and loss of time. \nLimitations: The small number of our cases was our main limitation. \nEthics Committee Approval: The study was approved by the Ethics \nCommittee, Mashhad University of Medical Sciences (MUMS) (approval code: \nIR.MUMS.MEDICAL.REC.1398.803). \nFunding for this study: This study was funded by the Vice-Chancellor for \nResearch, MUMS (grant number 981056). \nAuthor Disclosures: \nSomayeh Somayeh Hashemian: Nothing to disclose \nYasaman Nikooiyan: Nothing to disclose \nArmin Vahabi: Nothing to disclose \nSoroosh Dehghani Dashtabi: Nothing to disclose \nAli Seyed Ali Alamdaran: Nothing to disclose \n \nRPS 412-5 \nShearwave elastography of healthy paediatric testicular tissue and \ncorrelation with age \n*I. Sarı Karaba÷*, M. Ceyhan Bilgici; Samsun/TR \n(iremsari@yahoo.com) \n \nPurpose: Ultrasound elastography is a newly developed technique that is used \nfor assessment of tissue elasticity in a fast and noninvasive way. Recently, \nnumerous studies proved its capability in differentiating between normal and \ndiseased tissue. The aim of this study is to determine the testicular stiffness \nchange throughout childhood. Besides, correlation with age, we wanted to \nmanifest baseline standard values for pediatric testicular elasticity. \nMethods or Background: A total of 91 pediatric patients (mean age; \n7,49±5,06 years, range; 1 month- 17 years) with no known systemic or \ntesticular disease were enrolled in the study. First, B mode ultrasound had \nbeen done and testicular parenchyma was evaluated. During B mode \nultrasound, patients with incidental testicular parenchymal lesions were \ndiscarded from the study. Then, testicular volume calculations were done for \nhealthy testicular tissue. Lastly, testicular elasticity was measured for each \npatient with Siemens Acuson S2000 (Mountain View, CA, USA). \nResults or Findings: Statistically, there was a strict correlation of testicular \nvolume with age p<0,001). There was no significant correlation of tissue \nelasticity within different age groups. The mean shear-wave velocities in ”5, 6-\n10, 11-15 and > 16 years were 0,728 ± 0,063, 0,714 ± 0,048, 0,723 ± 0,067, \n0,702 ± 0,036 m/s, respectively. \nConclusion: Shear wave elastography demonstrated pediatric testicular \nelasticity doesn't have correlation with age. However, with the basal pediatric \ntesticular elasticity values, this study will be beneficial for future pediatric \ntesticular elasticity researches including focal scrotal masses and diffuse \ntesticular diseases. \nLimitations: No limitations. \nEthics Committee Approval: Approved \nFunding for this study: No fund has been received. \nAuthor Disclosures: \nMeltem Ceyhan Bilgici: Nothing to disclose \nIrem Sarı Karaba÷: Nothing to disclose \n \n \n \n \n \n \n \n \n \n \n \n \nResearch Presentation Session: Physics \nin Medical Imaging \nRPS 313 \nPhysics in medical imaging developments \nRPS 313-1 \nRobustness and reproducibility of radiomics in virtual monoenergetic \nimages of dual-energy CT \n*A. Euler*, D. Cester, M. Eberhard, T. D. J. Sartoretti, N. Lohaus, H. Alkadhi,  \nB. Baessler; Zurich/CH  \n \nPurpose: To evaluate the robustness and reproducibility of radiomic features \nfrom Virtual Monoenergetic Images (VMIs) of different energy levels and to \nassess their impact on machine-learning-based classification as a function of \nradiation dose and dual-energy CT (DECT) approach for dual-source (DS-DE) \nand split-filter DECT (SF-DE). \nMethods or Background: Our phantom consisted of 4 kiwi fruits, 4 onions, 4 \napples, and 4 oranges, chosen to reflect different HU, shapes, and tissue \ntextures. It was imaged in dual-energy mode on a DS-DE and SF-DE at two \nradiation doses of 5 and 15mGy. To assess test-re-test robustness, all scan \nsetups were repeated after repositioning the phantom. For each setup, VMIs at \n40,50,75,120,190keV were reconstructed. Datasets were pre-processed and a \ntotal of 1218 radiomic features were extracted (pyRadiomics; 3D-Slicer). The \nrobustness of each feature was tested by calculating the concordance-\ncorrelation-coefficients (CCCs). A Random Forest classifier was repeatedly \ntrained with different data splitting and feature subsets, to assess a) the impact \nof the setup parameters and b) the relative importance of the features and its \nstability. \nResults or Findings: Test re-test robustness was relatively homogeneous \nacross the settings with 80% robust features. SF-DE showed a larger variation \nof the number of robust features compared to DS-DE. Reproducibility of \nfeatures differed substantially among VMI levels (as low as 32.8%) and \ndepended on DECT. In regards to the classification task, a subset of 20 \nfeatures achieved high performance for every parameter combination \n(accuracy and F-Score higher than 0.99). \nConclusion: Robustness of radiomic features was high within each VMI while \ncomparisons among different VMI levels and DECT scanners decreased \nrobustness. Machine-learning-based classification was, however, unaffected \nand achieved high performance independent of parameter combination. \nLimitations: Phantom study. \nEthics Committee Approval: Not needed because of design as phantom \nstudy \nFunding for this study: No funding \nAuthor Disclosures: \nMatthias Eberhard: Nothing to disclose \nDavide Cester: Nothing to disclose \nBettina Baessler: Nothing to disclose \nThomas Daniel Jean Sartoretti: Nothing to disclose \nNiklas Lohaus: Nothing to disclose \nAndre Euler: Nothing to disclose \nHatem Alkadhi: Nothing to disclose \n \nRPS 313-2 \nMicro-beam vs broad-beam radiation-driven effects on lungs studied by \nx-ray phase contrast 3D virtual histology \n*M. Romano*¹, A. Bravin², J. A. Laissue³, M. Wright ຾, V. Djonov³, P. Coan¹; \n¹Munich/DE, ²Grenoble/FR, ³Berne/CH, ຾Roseville, CA/US  \n(mariele.romano@lmu.de) \n \nPurpose: The aim of this study is to visualize and characterize the effects of \nboth standard and novel spatially-fractionated radiotherapy (RT) methods \nusing a label-free, three-dimensional (3D), full organ coverage, ex-vivo X-ray \nphase contrast imaging (XPCI)-based approach for virtual 3D histology \ntechnique. We focussed on the effects of different X-ray beam configurations \non healthy rat lungs. \nMethods or Background: Consisting of air sacs separated by thin tissue \nlayers, lungs are ideally suited to XPCI, allowing small airways visualization \nwith high contrast. Thirty-three healthy rat lungs were irradiated at the \nEuropean Synchrotron (ESRF) with X-ray micrometre-wide and standard \nseamless broad beams delivering different doses. Rats were sacrificed 12 \nmonths after irradiation, lungs removed, fixed and embedded in paraplast \nblocks which were imaged by XPCI micro-computed tomography using a 20 \nkeV monochromatic beam and voxel sizes of 1.63^3 and 0.65^3 μm3. \nResults or Findings: The 3D nature of XPCI datasets was exploited to \ninvestigate the radio-induced pulmonary lesions. The effects of irradiation were \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 288  \nstrongly dependent both on the delivered dose and on the beam geometry. \nFibrotic tissues were segmented and quantified. Conventional broad beam \nirradiations produced the largest amount of fibrotic tissue while spatially-\nfractionated RTs caused isolated scars with small iron accumulations and \ncalcium deposits in damaged blood vessels. \nConclusion: The proposed method is well suited for 3D virtual histology of \nlung tissue and allows visualization, discrimination and detailed quantification \nof radio-altered tissues in the entire lung of healthy rats. \nLimitations: n/a \nEthics Committee Approval: Animal care procedures conformed to the \nguidelines of the French government and were approved by the ESRF Internal \nEvaluation Committee for Animal Welfare and Rights. \nFunding for this study: This study was supported by the German Research \nFoundation within the Research Training Group GRK2274. \nAuthor Disclosures: \nAlberto Bravin: Nothing to disclose \nValentin Djonov: Nothing to disclose \nMichael Wright: Nothing to disclose \nMariele Romano: Nothing to disclose \nJean Albert Laissue: Nothing to disclose \nPaola Coan: Nothing to disclose \n \nRPS 313-3 \nA phantom study to investigate the reproducibility of radiomics variables \nwith different magnetic resonance imaging (MRI) parameters \n*R. N. Mitchell-Hay*, T. Ahearn, A. Murray; Aberdeen/UK \n \nPurpose: A phantom study to investigate the reproducibility of Radiomics \nvariables with different Magnetic Resonance Imaging (MRI) parameters. \nMethods or Background: MRI has multiple different alterable parameters. \nThis is particularly relevant in Radiomics which produces quantitative variables \nthrough high throughput analysis of the medical imaging. One of the limitations \nof Radiomics is reproducibility. This phantom study aims to investigate the \nrepeatability of Radiomic variables across a range of different TR and TE \nvalues. The T1 Mapping and ECV Standardization Program phantom (Captur \net al., 2016) (T1MES) was scanned under a range of different parameters, 10 \ntimes under the same conditions on a Philips 3T Achieva dStream using a \nbody coil over a period of 4 months. The TE time ranged from 80 to 110ms \nwhile the TR ranged from 3000 to 5000ms. Radiomics analysis was performed \non the same segmented section of the phantom across all acquired \nsequences. Intraclass Correlation Coefficient (ICC) was calculated across the \ndifferent TE and TR ranges to investigate the reproducibility of Radiomics \nvariables. \nResults or Findings: Of 1596 variables calculated, 187 variables had \nexcellent reproducibility (ICC >0.9) across the range of TE, while 82 variables \nhad an excellent reproducibility across a range of TR values. 664 had good \nreproducibility (ICC >0.75) across the range of TEs, with 541 across the range \nof TR values. \nConclusion: Reproducibility of Radiomics variables in MRI is dependent on \nthe imaging parameters and careful consideration of this, in combination with \nvariable selection, is required when applying Radiomics within MRI. \nLimitations: Small sample size and performed on a single site. \nEthics Committee Approval: Not applicable as a phantom study. \nFunding for this study: RSAT funded Dr Rosalind Mitchell-Hay salary. Kind \npermission for use of T1MES phantom was given (Captur et al., 2016). \nAuthor Disclosures: \nRosalind Nina Mitchell-Hay: Nothing to disclose \nAlison Murray: Nothing to disclose \nTrevor Ahearn: Nothing to disclose \n \nRPS 313-4 \nX-ray dark-field computed tomography allows for the detection of \nradiation-induced lung damage in early stages \n*F. T. Gassert*, R. Burkhardt, D. Pfeiffer, A. Fingerle, A. Sauter, J. Wilkens,  \nF. Pfeiffer; Munich/DE \n \nPurpose: To show the benefit of dark-field computed tomography imaging for \nthe detection of radiation-induced lung damage in early stages compared to \nattenuation based imaging. \nMethods or Background: We compared attenuation based CT imaging to \ndark-field (DF) CT imaging in a murine model of radiation-induced lung \ndamage in the right lung (n=6) and a control group (n=6). Animals were \nscanned before irradiation and 12, 16, 20 and 24 weeks thereafter. Three \nradiologists assessed the images twice for the presence of lung damage and \nrated their confidence on a scale from 1 to 5. The inter-rater- and intra-rater-\nreliability was determined and rated with Cohen’s ߢrespectively Fleiss’ ߢFor \nthe quantitative analysis the ratio of the mean pixel value of the right and left \nlung (ۦRۧwas calculated. Results of the irradiated group were compared with \nthe respective control group by using a t-test. \nResults or Findings: The sensitivity of DF CT for radiation-induced lung \ndamage in the reader study was significantly higher at 12 weeks (Att: 36.7%, \nDF: 53.3%, p=0.023) and at 16 weeks (Att: 50.0%, DF: 91.7%, p<0.001). The \noverall confidence of the readers was significantly higher when reading DF \nimages (Att: 3.48, DF: 4.77, p<0.001). Both the average Intra-Rater-Reliability \n(Att: ߢ0.82, DF: ߢ0.91) and the Inter-Rater-Reliability (Att: ߢ0.66, DF: \nߢ0.75) were higher for DF imaging. For attenuation based imaging the \ndifference of the ratio ۦRۧbetween the control group and the irradiated group \nbecame significant after 20 weeks (p=0.011), while for DF imaging it was \nalready highly significant after 16 weeks (p=0.003). \nConclusion: This small animal study demonstrates that dark-field CT imaging \nallows for the detection of radiation-induced lung damage in early stages and, \nin that respect, is superior to conventional CT. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nAndreas Sauter: Nothing to disclose \nFlorian Tilman Gassert: Nothing to disclose \nRico Burkhardt: Nothing to disclose \nJan Wilkens: Nothing to disclose \nAlexander Fingerle: Nothing to disclose \nFranz Pfeiffer: Nothing to disclose \nDaniela Pfeiffer: Nothing to disclose \n \nRPS 313-5 \nInfluence of spectrum and patient size on dose conversion factors for \nchest radiography \n*A. S. L. Dedulle*¹, N. Fitousi², H. Bosmans²; ¹Heverlee/BE, ²Leuven/BE \n(an.dedulle@qaelum.com) \n \nPurpose: Chest posterior-anterior radiography is a commonly performed \nexamination. The need for size-specific dosimetry was highlighted in earlier \nstudies. In this study, the influence of patient size and spectrum on the dose \nconversion factors is investigated to evaluate how specific the conversion \nfactors should be. \nMethods or Background: A Monte Carlo (MC) framework dedicated to \nprojection radiography was used with a set of 44 voxel phantoms. A standard \nchest PA geometry was simulated for 6 spectra (half value layer 3.8–8.8mmAl). \nThe derived Monte Carlo patient-specific effective dose and organ dose \nconversion factors (lung, breast, skin, thyroid) were correlated with the body \nmass index (BMI) of the phantoms. \nResults or Findings: All the derived MC conversion factors, besides the \nthyroid, were found to decrease with increasing BMI due to the shielding \nfunction of adipose tissue. The correlation was not significant (p>0.05) for the \nthyroid, because the increase in adipose tissue is less pronounced in the neck \nregion. All MC conversion factors, but the ones for skin, were found to increase \nwith increasing beam energy; for skin, this relationship was inverse. Increasing \nthe beam energy might have a dose saving effect for the skin, but could \nincrease the dose to other organs. Therefore, for similar entrance air kerma, \nthe organ doses may vary a lot depending on the used spectrum. For example, \npatient-specific effective dose changed by 75% between the lowest and \nhighest beam energy. \nConclusion: Dose conversion factors in chest radiography are influenced by \nboth patient size and spectrum. As estimation of patient size and input of beam \nquality in projection radiography are not always straightforward, it is important \nto have the right tools when moving towards personalized dosimetry. \nLimitations: Not applicable. \nEthics Committee Approval: Not applicable. \nFunding for this study: PhD grant VLAIO [HBC.2016.0233]. \nAuthor Disclosures: \nAn Saskia Luc Dedulle: Research/Grant Support: grant VLAIO \n[HBC.2016.0233] Employee: Qaelum NV \nHilde Bosmans: Board Member: Qaelum NV Founder: Qaelum NV \nNiki Fitousi: Employee: Qaelum NV \n \nRPS 313-7 \nValidation of a statistical method for low-contrast detectability as a \nsimple tool for QC in tomosynthesis \n*N. Paruccini*¹, R. Villa¹, N. Oberhofer², P. Caricato¹, V. Faccenda¹,  \nE. De Ponti¹; ¹Monza/IT, ²Bolzano/IT \n(n.paruccini@asst-monza.it) \n \nPurpose: The aim of this work was to validate an innovative and simplified \nmethod for threshold contrast evaluation in tomosynthesis based on a single \nacquisition of a homemade test tool. \nMethods or Background: A homogeneous region was used to calculate \nthreshold contrast for details of varying size with a statistical approach. A \ncircular insert of aluminium was used to evaluate Spatial Modulation effect. An \nincluded aluminium step wedge permitted to express the threshold contrast \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 289  \nalso as an absolute quantity in terms of mmAl. Validation of the statistical \nmethod was carried out comparing contrast detail curves calculated with the \nCDMAM image analysis method. Cause Both CDMAM and statistical method \n(SM) suffer the presence of scatter radiation, acquisitions were performed in \nscattering free geometry, using 2 mm of aluminium block close to the \ncollimator. Furthermore, SDNR was calculated for each aluminium step of the \nSM Phantom, from 0.2 to 1 mm thickness. \nResults or Findings: In scatter free condition, the [c-d] curve calculated with \nSM doesn't depend on the ROI size. CDMAM and SM of projection images \nhave been analysed. Contrast detail curves calculated with the proposed SM \nfor threshold resulted in good accordance with the curves obtained with the \nreference CDMAM method, within 20% for all the detail sizes. \nConclusion: The statistical approach for threshold contrast evaluation, based \non a single acquisition of a simple test object, has been proven to be a reliable \nmeans for relative and absolute image quality evaluation in tomosynthesis. \nThis method might be an alternative to large_area SNDR and DQE \nassessment, too \nLimitations: Tomosynthesis images are usually acquired without the presence \nof the grid, introducing a significant non-uniformity caused by scattering \nradiation. Scattering free condition was used to overcome this critical issue. \nEthics Committee Approval: Not required \nFunding for this study: Nothing \nAuthor Disclosures: \nNadia Oberhofer: Nothing to disclose \nRaffaele Villa: Nothing to disclose \nNicoletta Paruccini: Nothing to disclose \nElena De Ponti: Nothing to disclose \nPaolo Caricato: Nothing to disclose \nValeria Faccenda: Nothing to disclose \n \nRPS 313-8 \nA patient-specific model for the estimation of the well-aerated lung \nvolume from CT images: application to COVID-19 patients \nL. Berta, C. De Mattia, F. Rizzetto, D. Lizio, S. Carrazza, A. Vanzulli,  \n*A. Torresin*; Milan/IT \n \nPurpose: to propose a patient-independent model for the well-aerated volume \nestimation (WAVE) using CT images of the lung \nMethods or Background: The model was applied to the histograms of lungs \nsegmented in CT images of the chest. Two cohorts of 20 patients each with \nhealthy lungs (cohort1, from emergency department of our hospital) and with \n4DCT acquisitions (cohort2, from a public database) were used to test the \nindependence of our model from reconstruction parameters and respiratory \ncycle. Data points around the first peak, corresponding to the healthy \nparenchymal tissue, were fitted with a Gaussian function and WAVE.f was \ndefined by integrating the fitted curve between the histogram range. WAVE.f \nwas compared to another equivalent metric based on histogram thresholds \n(WAVE.th). Finally, WAVE.f and first order radiomic features were calculated \nfor a third cohort of 20 COVID-19 patients and results were compared with \nthose relative to cohort1. \nResults or Findings: Average values of (84±2)% and (75±4)% were found for \nWAVE.f and WAVE.th for healthy subjects. Differences of 1%, 2% and up to \n14% were found comparing WAVE.f values on images of patients from cohort1 \nreconstructed with a moderate iterative strength and FBP algorithm, 1 and 3 \nmm of slice thickness and different reconstruction kernels. Results from \ncohort2 showed independence of WAVE.f and WAVE.th from the respiratory \nmotion in 80% and 20% of the cases, respectively. Patients from cohort1 were \nsignificantly different from COVID-19 patients for all the calculated metrics. \nConclusion: Unlike other metrics derived from CT histogram for the \nquantification of healthy lung parenchyma based on fixed thresholds, the \nproposed model is able to consider the inter- and intra-subject variability. \nLimitations: Absolute values of WAVE metric is not yet validated clinically \nusing functional data \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nFrancesco Rizzetto: Nothing to disclose \nLuca Berta: Nothing to disclose \nDomenico Lizio: Nothing to disclose \nAngelo Vanzulli: Nothing to disclose \nAlberto Torresin: Nothing to disclose \nCristina De Mattia: Nothing to disclose \nStefano Carrazza: Nothing to disclose \n \n \n \n \n \n \n \nRPS 313-9 \nComparison of attenuation measurements in unenhanced CT images and \nvirtual non-contrast images calculated from Twin Beam Dual Energy CT \nscans \n*D. Rieger*, S. C. Krämer, H. Seifarth; Esslingen/DE \n \nPurpose: Twin Beam Dual Energy offers dual-Energy features on a single \ndetector CT-scanner. The purpose of this study was to assess the reliability of \nattenuation values measured in virtual non-contrast images in various regions \nof the body using this technique compared to true unenhanced images. \nMethods or Background: 100 patients after endovascular aortic repair \n(EVAR) were included in the study. For each patient, a triphasic scan was \nperformed consisting of a single energy unenhanced scan followed by a dual-\nenergy arterial and venous phase scan. Virtual non-contrast images were \ncreated. Two independent readers measured attenuation values in the \nthrombus outside the aortic stent, the psoas muscle, the subcutaneous fat and \nthe liver. The measurements of both readers were averaged. A Wilcoxon \nsigned rank test was used to assess differences between the density values for \neach region. \nResults or Findings: Correlation between measurements from the two \nreaders was good in all regions and for all scan series. There were no \nsignificant differences between attenuation values from true unenhanced and \nvirtual non-contrast images in the aortic thrombus (mean 41,3 ± 9,5 HU; 41,2± \n13,8 and 40,1 ± 13,3HU; p>0.05). For the other regions attenuation values \ndiffered significantly. Mean values were -106,7 ±15,3; -101,4±9,1 and -100,2 \n±9,5; p<0.01 for subcutaneous fat; 43,1±56,7; 56,6 ± 6.7 and 58,0 ±7,4 for the \npsoas muscle and 43,9 ±10,1; 45,3 ± 9,4 and 53,4 ±9,7 for the liver (p<0.05 for \nall measurements). \nConclusion: Using Twin Beam Dual Energy CT technique, attenuation values \nmeasured in virtual non-contrast images differ significantly from values \nobtained from true unenhanced images in perfused tissues. Attenuation \nmeasurements in thrombus did not differ between virtual non-contrast and true \nunenhanced images. \nLimitations: Only four types of tissue were analyzed \nEthics Committee Approval: Approval for retrospective data analysis \nFunding for this study: Klinikum Esslingen \nAuthor Disclosures: \nHarald Seifarth: Nothing to disclose \nStefan C. Krämer: Nothing to disclose \nDavid Rieger: Nothing to disclose \n \nRPS 313-10 \nTesting CT image reconstruction methods using a 3D printed \nanthropomorphic thorax vessel phantom: deep learning vs iterative and \nfiltered-back projection \n*I. Hernandez-Giron*¹, G. Streekstra², J. den Harder², O. V. V. Ivashchenko¹, \nW. Veldkamp¹; ¹Leiden/NL, ²Amsterdam/NL \n(irene.debroglie@gmail.com) \n \nPurpose: To evaluate quantitatively commercial deep learning (DL) CT \nreconstruction image quality performance, versus filtered back-projection (FBP) \nand iterative reconstruction (IR), using an anthropomorphic phantom with \nuniform and textured background sections. \nMethods or Background: An in-house anthropomorphic-thorax PMMA \nphantom, mimicking a thin patient section (300x200x29mm3), containing two \n3D-printed elliptical lung vessels inserts (material_VisijetEX200) and spine \n(material_Teflon), was scanned (Canon Aquilion Prism-CT, clinical thorax \nprotocol, varying mA, [CTDIvol=4.0-(2.1-clinical dose)-1.0-0.5-0.2mGy], x4 \nrepetitions). Images were reconstructed with FBP, AIDR3De (IR) (FC08-kernel \nboth) and AiCE-lung (DL). The phantom materials attenuation (HU) and SNR in \nPMMA-thorax parts were analyzed. Noise properties (inter-acquisitions \nstandard deviation maps) were compared across backgrounds \n[uniform_(PMMA-thorax); textured-lung_vessels], dose and reconstruction. \nResults or Findings: The highest averaged attenuation differences \n(AIDR3De_baseline, (material,Average_HU_Diff,[HU_range]) were found for \nthe lowest dose and high attenuation materials; AIDR3De_vs_FBP: (PMMA-\nthorax, (Average_HU_Diff=10HU), [-30,-1HU]); (Teflon-spine, \n(Average_HU_Diff=-54HU), [-62,-47HU]); (VisijetEX200-vessels, \n(Average_HU_Diff=-21HU), [-60,1HU]; (air,(Average_HU_Diff=13HU), [-\n5,31HU]). For AIDR3De_vs_AiCE: (PMMA-thorax, (Average_HU_Diff=-0.5HU), \n[-3,3HU]); (Teflon-spine, (Average_HU_Diff=-27HU), [-32,-25HU]); \n(VisijetEX200-vessels, (Average_HU_Diff=-19HU), [-40,-3HU]; (air, \n(Average_HU_Diff=8HU), [6,12HU]). Average PMMA_SNR increased with \ndose at different rates per reconstruction. From lowest to highest dose, values \nwere [FBP_SNR=(1.1-2.3-3.4-4.8-6.4)]; [AIDR3De_SNR=(4.2-4.9-6.0-7.6-\n10.0)]; [AiCE-Lung_SNR=(3.9-3.8-4.5-5.1-6.0)]. Noise maps were \nhomogeneous at all dose-reconstructions combinations for uniform \nbackgrounds (PMMA-thorax,Teflon-spine). They were non-homogeneous and \nenhanced in vessel edges for textured backgrounds (vessel_inserts) for \nAIDR3De and AiCE. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 290  \nConclusion: Attenuation and noise properties differences were found in an \nanthropomorphic textured lung vessel phantom between deep learning, \niterative (current clinical standard) and FBP reconstruction. Stronger noise \nreduction was observed in the uniform phantom parts. Noise was enhanced in \nvessel edges for IR and DL-based reconstruction compared to FBP. \nOur result suggest that anthropomorphic textured background phantoms better \nrepresent complex patient anatomy and are better suited for evaluation of IR \nand DL-based reconstructions. \nLimitations: The phantom represents a simplified small-sized patient, \ncontaining textured lung vessels’s complexity, except parenchyma. Alternative \ntissue-equivalent materials can be investigated. \nEthics Committee Approval: Phantom-study-N/A \nFunding for this study: NWO-Talent-Programma_Personal_Veni_grant \n(17378-Through_the_eyes_of_AI) \nNWO-OTP_grant-CLUES-project_13592:Phantom creation \nAuthor Disclosures: \nOleksandra V. V Ivashchenko: Nothing to disclose \nWouter Veldkamp: Nothing to disclose \nJ.M. den Harder: Nothing to disclose \nIrene Hernandez-Giron: Research/Grant Support: The phantom was created \nunder NWO-OTP grant (CLUES-project: 13592) Research/Grant Support: \nIrene Hernandez received a NWO-Talent Programma personnal Veni grant \n(project 17378-Through the eyes of AI) \nGeert Streekstra: Nothing to disclose \n \n \nResearch Presentation Session: \nRadiographers \nRPS 314 \nInvestigations in radiography \nRPS 314-1 \nPerception of breast screening clients towards male radiographers \nworking in breast screening \n*M. Iles*, F. Zarb, D. Mizzi; Msida/MT  \n(m.iles@student.maastrichtuniversity.nl) \n \nPurpose: To evaluate the perception of breast cancer screening clients \ntowards male radiographers performing mammography screening in Malta. \nMethods or Background: The research consisted of a quantitative, \nprospective, non-experimental, and descriptive study design. Questionnaires \nwere distributed to all women, aged 50-69 years, who were invited and \nattended either prevalent or incident breast screening mammography at a local \nbreast screening unit. A total of 204 questionnaires were collected between \nFebruary and March 2020. \nResults or Findings: Thirty-five percent of participants were aged 50-54 \nyears; 50.5% completed their highest level of education at secondary level and \n81.4% of participants were invited for an incident screening round. The \nparticipants were mostly (87.7%) Maltese. Twenty-nine percent stated they \nwould agree to have a male radiographer performing their mammogram, but \nthey would feel more comfortable having a female radiographer. Also, 31.4% of \nparticipants stated that a male radiographer would not affect their future \nattendance to breast cancer screening appointments. \nConclusion: Even though several women would accept a male radiographer \nperforming their mammogram, further evidence based research is required on \nthe perception of women towards male radiographers performing screening \nmammography before implementing in the local scenario. Further studies are \nneeded to also include symptomatic women. \nLimitations: Due to the COVID-19 pandemic and subsequent closure of the \nlocal breast screening unit, only a small sample was obtained. This resulted in \na limited distribution of demographics limiting comparison to literature findings. \nEthics Committee Approval: Approval was obtained from the University of \nMalta Research Ethics Committee (2657_30082019). \nFunding for this study: No specific grant from any funding agency in the \npublic, commercial or non-profit sectors was received. \nAuthor Disclosures: \nDeborah Mizzi: Nothing to disclose \nMaria Iles: Nothing to disclose \nFrancis Zarb: Nothing to disclose \n \n \n \n \n \n \nRPS 314-2 \nProfile-based kV and NI selection to evaluate auto prescription \n*N. Sogge*¹, K. Jensen¹, H. K. Andersen¹, F. Rupcich², J. Glittum¹,  \nM. Svanteson¹; ¹Oslo/NO, ²Wauwatosa, WI/US  \n(nicsog@ous-hf.no) \n \nPurpose: Auto Prescription can be applied to optimize radiation dose and \nimage quality across patient sizes by automatically adjusting kV and Noise \nIndex (NI) as a function of patient size and clinical task. Size Adjusted Noise \nIndex (SANI) may also be enabled to further tune the noise and dose level. \nMethods or Background: Image quality of chest CT and abdominal/pelvic CT \nwere compared using the hospital’s original protocol and a protocol based on \nparameters suggested by the Auto Prescription algorithm. Each patient was \nexamined with both protocols on the same scanner. We tested which kV and \nNI Auto Prescription would give for different patient sizes and adjusted this to \nthe hospital’s requirements. Four radiologists compared the two \nabdominal/pelvic exams in a random order. 16 patients with AP+Lat diameters \nbetween 46-57cm were evaluated for liver contrast, sharpness psoas muscle, \nperirenal fascia and overall impression. The following scale was used: \nconsiderably/slightly worse, no difference, slightly/considerably better. Ordinal \nlogistic regression analysis was performed on the radiologists’ score. Chest \nimages will be evaluated with the criteria: pulmonary vessels, segmental \nbronchi, lung parenchyma, border pleura - thoracic wall and overall impression. \nResults or Findings: The score percentage (better – no difference) for the \nnew abdominal/pelvic protocol compared to the original protocol were on liver \ncontrast: 62,5%-18,8%, sharpness of psoas muscle: 45,3%-37,5%, perirenal \nfascia: 32,8%-50,0%, and overall impression: 50,0%-25,0%. Regression \nanalysis showed the differences were significant. With one exception, CTDI \nwas either lower with the new protocol or within 10% of the original CTDI. 12 of \nthe 16 cases had lower CTDIs. The chest examination is work in progress. \nConclusion: Auto Prescription proved useful for optimizing image quality or \ndose with patient size. \nLimitations: n/a \nEthics Committee Approval: Institutional approval. \nFunding for this study: n/a \nAuthor Disclosures: \nNicolas Sogge: Other: The Oslo University Hospital has a collaboration with \nGE Healthcare. \nJan Glittum: Author: The Oslo University Hospital has a collaboration with GE \nHealthcare. \nKristin Jensen: Other: The Oslo University  Hospital has a collaboration with GE \nHealthcare. \nMona Svanteson: Other: The Oslo University Hospital has a collaboration with \nGE Healthcare. \nFranco Rupcich: Employee: Employee at GE Healthcare. \nHilde Kjernlie Andersen: Other: The Oslo University Hospital has a \ncollaboration with GE Healthcare. \n \nRPS 314-3 \nThe impact of ASiR-V and kVp variations on CT image quality and \nradiation dose \n*S. D. Moerup*¹, J. G. Stowe², H. Precht¹, S. J. Foley²; ¹Odense/DK, ²Dublin/IE \n(sdmo@ucl.dk) \n \nPurpose: To investigate how ASiR-V and kVp changes in Computed \ntomography (CT) affects radiation dose and image quality, when using \nautomatic tube current modulation (ATCM) for different sized phantoms. \nMethods or Background: A Liver-Phantom with two different liver inserts \n(QRM, Moehrendorf, Germany) was repeatedly scanned on a 16cm detector \nCT scanner (GE Healthcare, Milwaukee, WI, USA). Extension rings, \nrepresenting fat, were additionally applied to the phantom to simulate patients \nof different sizes (small: 30cm diameter, medium: 35cm and large: 40cm). \nScans were performed with consistent pitch (0.992), rotation time (0.5s), slice \nthickness (0.625) and collimation (80mm), while other parameters were varied \n(kVp: 80/100/120/140; Noise Index: 13/22; mA interval 80-720, ASiR-V: \n30/60/100%). CTDI and DLP was recorded for each scan and image quality \nwas assessed using objective metrics in predefined anatomic areas (HU, SD \nand CNR). Radiation dose and image quality was evaluated using ANOVA. \nResults or Findings: A total of 216 scans were performed, resulting in 432 \nmeasurements of image quality. Radiation dose reductions (1-85%) were \nnoted for all phantom sizes and kVp settings when more ASiR-V is applied. \nRegarding image quality, no significant differences in HU was found between \nASIR-V levels (p=0.064). For a majority of the scans the lowest SD and highest \nCNR was obtained at 60% ASiR-V, with SD increasing at 100% ASiR-V \nbecause of the large reduction in tube current applied (80 mA). Notably, image \nquality in the low contrast area of the liver insert was impaired when the large \nphantom was scanned with 100% ASiR-V and either 80/100kVp (NI 22). \nConclusion: Substantial radiation dose reductions are possible with increasing \nASiR-V levels. However, image quality deteriorates when 100% ASiR-V is \napplied due to low applied tube current. \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 291  \nLimitations: Not applicable \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nHelle Precht: Nothing to disclose \nJohn Gerard Stowe: Nothing to disclose \nSvea Deppe Moerup: Nothing to disclose \nShane J Foley: Nothing to disclose \n \nRPS 314-4 \nPredictors of image quality at human foetal post-mortem micro CT \n*I. C. Simcock*, S. C. Shelmerdine, D. Langan, N. Sebire, O. J. Arthurs; \nLondon/UK \n(ian.simcock@gosh.nhs.uk) \n \nPurpose: To determine the main factors determining diagnostic image quality \nfor human foetal whole body post-mortem micro-CT. \nMethods or Background: Post-mortem micro-CT is a non-invasive, high \nresolution (up to 5 μm) imaging method which can provide high diagnostic \naccuracy particularly for fetuses below 20 weeks gestation, however the main \npredictors of image quality are yet to be determined. In this prospective, single \ncentre study, we imaged all fetuses referred for micro-CT over a 3 year period \non a Nikon Micro-CT scanner. Axial images of the head and chest were \nretrospectively assessed by 2 paediatric radiologists for maceration and image \nquality. Simple and multivariable linear regression models were fitted for \noutcome variables, with demographics, maceration score and tissue \npreparation considered as predictor variables. \nResults or Findings: 258 foetal micro-CT scans were evaluated with mean \nfoetal weight 64.8g (range 2.6 - 300) and mean gestational age of 16 weeks \n(range 11 – 24). Diagnostic image quality was recorded in 497/516 (95.9%) \nhead or chest images. Maceration score was the strongest positive indicator \nfor poor image quality (p<0.001), with gestational weight being a weak negative \npredictor of image quality (p<0.001). \nConclusion: Low weight, non-macerated fetuses yielded the highest \ndiagnostic image quality scores with micro-CT, emphasising its usage as an \nexcellent clinical tool for early pregnancy loss. \nLimitations: Although maceration and gestational weight were identified as \npredictors of image quality, it is believed that other factors will also play a role \nin image quality and will require investigation. \nEthics Committee Approval: Ethical approval was granted for this study \n(13/LO/1994 and 17/WS/0089). \nFunding for this study: Supported by the National Institute for Health \nResearch (NIHR), Medical Research Council, Royal College of Radiologists, \nGreat Ormond Street Hospital Children’s Charity and NIHR GOSH/ICH \nBiomedical Research Centre. \nAuthor Disclosures: \nIan C. Simcock: Nothing to disclose \nDean Langan: Nothing to disclose \nNeil Sebire: Nothing to disclose \nSusan Cheng Shelmerdine: Nothing to disclose \nOwen Arthurs: Nothing to disclose \n \nRPS 314-5 \nAutomated artifact detection in uniform mammography images: transfer \nlearning approach \n*E. Alukiü*, N. Mekis, J. Žibert; Ljubljana/SI \n(erna.alukic@zf.uni-lj.si) \n \nPurpose: The aim was to build a system for the automatic detection of artifacts \nin mammographic images that can be used in practice as an analysis tool for \nthe daily quality control of flat-field homogenous images in mammography \nsystems. \nMethods or Background: A deep learning system was designed for \nrecognition of the most frequent artifacts in mammography (contrast non-\nuniformity, ghosting, lines, dead pixels and acquisition errors). Total of 542 \nmammographic images were acquired from 7 different mammography units. A \ndeep learning approach was performed with the convolutional neural network \nVGG19 (CNN), which was trained to detect the given artifacts by transfer \nlearning approach. For each artifact a separate CNN was trained and \nevaluated by measuring the AUCs in the ROC analysis. \nResults or Findings: The evaluation results were measured by AUC scores \nfor each individual artifact with sensitivity and specificity at Youden cutoff \npoints. The AUCs results were: contrast non-uniformity 0.995, ghosting 0.986, \nlines0.954, dead pixels and acquisition errors 0.997 respectively. The overall \ndetection results were better in a comparison with the results achieved by \nconventional machine learning approaches. At the same time the transfer \nlearning approach, that was used in our modelling, proved to be efficient even \nin the case of small amount of training material (images of artifacts), which are \nusually needed in huge amounts for deep learning approaches. \nConclusion: The developed system was proven to be efficient in case of \nselected artifacts detection on the flat-field homogenous mammography \nimages. The lowest score was observed at line detection, but even though the \nsuccess rate was 95.4%. \nLimitations: No limitations. \nEthics Committee Approval: It was not necessary. \nFunding for this study: No funding. \nAuthor Disclosures: \nNejc Mekis: Nothing to disclose \nJanez Žibert: Nothing to disclose \nErna Alukiü: Nothing to disclose \n \nRPS 314-6 \nIntra/inter-observer repeatability in liver computed tomography volumetry \nin patients undergoing radioembolisation simulation \n*A. Masperi*, L. Bombelli, V. Cubadda; Milan/IT \n(andrea.masperi1992@gmail.com) \n \nPurpose: Recently, angiography can be associated using MDCT at the same \ntime (Angio-CT suite), which may provide useful precise information, regarding \nthe volumes of future treated liver area in pre-treatment for Trans-Arterial \nRadio Embolization (TARE). The careful evaluation of MDCT is an essential \nstep for the treatment planning, because it may provide unique volumetric data \n(CTVs), which are information useful for an effective and safe TARE. \nMethods or Background: We select 17 consecutive patients, who underwent \npre-treatment work-up for TARE, in our Institution, between May 2019 and \nFebruary 2020. For each patient, four specific parameters are evaluated from \nMDCT achieved during treatment simulation: healthy liver volume (HLV), the \nwhole hepatic parenchyma (THV=healthy liver and TTV= tumor) involved by \nTARE, and whole liver volume (WLV). Four independent observers: R1 (expert \nInterventional Radiologist), T1, T2 and T3 (Radiographers, with different \nexperience in the field of Interventional Radiology) are involved in the imaging \nanalysed. The intraclass correlation coefficient (ICC) is used to quantify intra-\ninter observer repeatability and accuracy. \nResults or Findings: All the four observers detect the same number of hepatic \nlesion(s) per patient. Regarding the three radiographers, the intra-observer \nreliability for CTVs is very high (0.997 to 1.000). Also Inter-observer \nreproducibility between radiographers is excellent regarding CTVs, (0.965 to \n0.999). The accuracy of radiographers evaluation is very high (0.964 to 0.999). \nConclusion: The high intra-inter observer reproducibility shows that a properly \ntrained radiographers might have the same accuracy as interventional \nradiologists, in assessing liver CTVs data for planning TARE. \nLimitations: The limited number of patients undergoing pre-therapeutical \nimaging so far leads to a limitation to this study, although promising in the first \nanalysis. \nEthics Committee Approval: The ethics committee of our institute approves \nthe study (trial ID:2234 - protocol: hepatic volumetry). \nFunding for this study: None \nAuthor Disclosures: \nLuca Bombelli: Nothing to disclose \nValerio Cubadda: Nothing to disclose \nAndrea Masperi: Nothing to disclose \n \n \nResearch Presentation Session: \nRadiographers \nRPS 414 \nProfessional issues in radiography \nRPS 414-1 \nA critical appraisal of the quality of guidelines for radiation protection in \ninterventional radiology using the AGREE II tool: a EuroAIM initiative \n*M. Zanardo*¹, R. Gerasia², L. Giovannelli³, G. Scurto², P. Cornacchione ຾,  \nA. Cozzi¹, D. Catania¹, S. Durante ຿; ¹Milan/IT, ²Palermo/IT, ³Trento/IT, \n຾Rome/IT, ຿Bologna/IT  \n \nPurpose: The growing interest in radiation protection and the importance of \nawareness in radiation safety resulted in the production of several clinical \npractice guidelines, with an unavoidable variability in terms of overall quality. \nThe aim of this review was to assess the methodological quality of guidelines \nfor patient safety in interventional radiology department and to compare their \nrecommendations. \nMethods or Background: In September 2020, a systematic search was \nperformed using MEDLINE, EMBASE, National Guideline Clearinghouse, and \nNational Institute for Health and Clinical Excellence, to find guidelines \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 292  \nregarding radiation protection in interventional radiology departments. The \nevaluation of guidelines quality was performed independently by three authors \nusing the AGREE II tool. We excluded those guidelines that were not primarily \nfocused on radiation protection or not mainly focused on interventional \nradiology. \nResults or Findings: Our literature search identified 106 citations, and after \napplying exclusion criteria, 11 guidelines were eventually included. Guidelines \nwere published between 2009 and 2018 and the overall quality of included \nguidelines was acceptable (median 72%, IQR 64%–83%), with only one \nconsidered low-quality (<60%). “Scope and Purpose”, “Clarity of \nPresentations”, and “Editorial Independence” had the best domain results \n(87%, 76%, and 75% respectively), while “Applicability”, “Rigor of \nDevelopment”, and “Stakeholder Involvement” the worst (46%, 49%, and 52% \nrespectively). Most of the authors were interventional radiologists (168/224, \n75%). \nConclusion: The overall quality of all guidelines was acceptable, with one-third \nof them reaching a “high-quality” score. The domain “Applicability” showed the \nlowest median result suggesting that possible strategies for implementing \nguideline recommendations in clinical practice should be researched. \nLimitations: AGREE II tool does not assess the consistency of guidelines. \nEthics Committee Approval: Not applicable. \nFunding for this study: Not applicable. \nAuthor Disclosures: \nAndrea Cozzi: Nothing to disclose \nDiego Catania: Nothing to disclose \nPatrizia Cornacchione: Nothing to disclose \nStefano Durante: Nothing to disclose \nGiuseppe Scurto: Nothing to disclose \nMoreno Zanardo: Nothing to disclose \nLorenzo Giovannelli: Nothing to disclose \nRoberta Gerasia: Nothing to disclose \n \nRPS 414-2 \nA systematic review of reasonable and feasible adjustments to facilitate \npatients with autism spectrum disorders undergoing MRI examinations \n*N. Stogiannos*¹, S. Carlier², J. Harvey-Lloyd³, A. Brammer ຾, K. Cleaver຿,  \nJ. McNulty๤, C. S. d. Reis², C. Malamateniou¹; ¹London/UK, ²Lausanne/CH, \n³Suffolk/UK, ຾Manchester/UK, ຿Greenwich/UK, ๤Dublin/IE  \n(nstogiannos@yahoo.com) \n \nPurpose: To summarise all evidence-based interventions used within \nradiography practice when scanning patients with autism spectrum disorders \n(ASD) in the MR environment. \nMethods or Background: A systematic review of the literature was conducted \nfrom July to October 2020. The methodology of this study was in line with the \nPreferred Reporting Items for Systematic Reviews and Meta-Analyses \n(PRISMA) guidelines. An electronic search was performed across nine \ndatabases. Specific keywords were used for this search, with Boolean \noperators. Filters included: English language, studies published after 2010, \nonly full-text, and peer-reviewed studies. The included studies were critically \nevaluated using the Critical Appraisal Skills Programme (CASP) tools. Two \nreviewers conducted searches and the final eligible studies were determined \nby consensus between two independent researchers. \nResults or Findings: Twenty-three studies were eligible for inclusion. This \nreview indicates that current methods to facilitate MRI examinations for ASD \npatients were based on the following core themes: 1) image acquisition and \noptimisation techniques, 2) image post-processing software to improve image \nquality, 3) technology-assisted distraction techniques, 4) simulation \napproaches, 5) psychological interventions, while a core component of the \nmajority of the interventions was 6) effective communication with patient and \ncarers. \nConclusion: MRI can present challenges for neurotypical patients. Given the \ncommunication difficulties, sensory sensitivities, and increased anxiety of ASD \nindividuals it is vital to employ customised interventions to improve the \nexperience of ASD patients when undergoing MRI examinations to allow truly \npatient-centred care. These might be person-centred and technology-enabled, \nand a standardisation of these protocols should occur for the benefit of the \npatients. \nLimitations: Not applicable \nEthics Committee Approval: Not applicable \nFunding for this study: The Society and College of Radiographers CORIPS \ngrant scheme \n \n \n \n \n \n \n \n \n \nAuthor Disclosures: \nSarah Carlier: Nothing to disclose \nClaudia Sa dos Reis: Nothing to disclose \nKaren Cleaver: Nothing to disclose \nJonathan McNulty: Nothing to disclose \nNikolaos Stogiannos: Nothing to disclose \nAndrea Brammer: Nothing to disclose \nJane Harvey-Lloyd: Nothing to disclose \nChristina Malamateniou: Nothing to disclose \nRPS 414-4 \nAnxiety and claustrophobia evaluation in patients undergoing magnetic \nresonance imaging \nB. Lopes, *K. B. Azevedo*, A. Abrantes, S. I. Rodrigues, L. Ribeiro, B. Vicente, \nR. P. P. Almeida; Faro/PT \n \nPurpose: The purpose of this research was to evaluate the anxiety and \nclaustrophobia levels in patients undergoing Magnetic Resonance Imaging of \nthe Head, Extremities or Breast. \nMethods or Background: This is a quantitative and descriptive-correlational \nresearch. Data collection was done in the Magnetic Resonance area from the \nImaging Department. All the patients undergoing head, extremities or breast \nscans were invited to fulfill the sociodemographic, anxiety (State-Trait Anxiety \nInventory) and claustrophobia (Questionnaire of Claustrophobia for Patients \nUndergoing Magnetic Resonance Imaging) before the procedure. Data were \nanalysed using SPSS version 26. \nResults or Findings: The internal consistency of the anxiety and \nclaustrophobia scales was above 0,9. The mean age of participants was 46 \nyears. Most of the patients were moderately anxious and the majority of the \npatients related low concern related to claustrophobic environment of the \nMagnetic Resonance equipment. Anxiety is correlated with claustrophobia \n(r=0,47 p=0,000) and both variables are correlated with female genre (anxiety \nhas a r=0,379 and p=001 / claustrophobia has a r=0,429 and p=0,000). \nConclusion: Anxiety is positively correlated with anxiety, which means that \nhigher the anxiety, higher the claustrophobia that patients feel. Also, the female \ngenre is associated with higher levels of both anxiety and claustrophobia, \nwhich requires closer attention. \nLimitations: Data was collected in only one institution, composed by 3 \nhospitals, which may difficult generalizations to other regions of the country. \nData collection from patients is a difficult process, which limited the sample \nsize. Results would be more robust if there is a larger sample. The fulfillment of \nthe survey was onsite, which may influence the answers provided. \nEthics Committee Approval: Authorization (Refª 87-2018) from the \nAdministration Board, after the agreement from the Ethics Commission. \nFunding for this study: No funding \nAuthor Disclosures: \nAntónio Abrantes: Nothing to disclose \nKevin Barros Azevedo: Nothing to disclose \nRui Pedro Pereira Almeida: Nothing to disclose \nBianca Vicente: Nothing to disclose \nSónia Isabel Rodrigues: Nothing to disclose \nBruno Lopes: Nothing to disclose \n \nRPS 414-3 \nThe design and prototype testing of a novel device to protect the use of \nDR detectors in radiography practice \n*E. Conroy*, A. S. Karam, E. O'Cearbhaill, A. Toohey, L. A. Rainford; Dublin/IE \n(emily.conroy@ucdconnect.ie) \n \nPurpose: Digital radiography (DR) detectors are removed from their normal X-\nray housing when imaging patients who require modified examinations e.g. \nimaging patients in wheelchairs or trauma situations, with a subsequent \nincreased risk of damage to the DR detector. A flexible supporting prototype \nwas to be developed with the aim of stabilizing the DR detector outside of its \nroutine housing for: antero-posterior (AP) chest x-ray, horizontal beam lateral \nand “skyline” knee projections. \nMethods or Background: Prototype components needed to remain outside \nthe area of investigation and be fully supportive of the DR detector for use in \nportrait and landscape positions. The prototype needed to be lightweight, easy \nto transport and facilitate efficient positioning by the radiographer. The device \nwas required to be chemically resistant to allow for repeated cleaning with \nActichlor and Cliniwipes and facilitate cleaning between consecutive patients. \nResults or Findings: A prototype was developed, using an off-the-shelf \nmonitor arm and a 3D printable hook component. The monitor arm could hold a \nmaximum weight of 10kg: the Carestream detector (3.63kg) and the detector \nholder (3kg) had a a combined weight of 6.63kg. A range of motion was \npossible at the 3 joints (180, 360 and 360 degrees), allowing for a sufficient \ndegree of flexibility. The hook component was 3D printed and attached to the \noff-the-shelf monitor arm. \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 293  \nConclusion: The device was tested and demonstrated particular potential for \nAP chest imaging for patients in wheelchairs. Further research is warranted to \nimprove the prototype design for X-ray table use and radiographer feedback \nwas collated to inform further development. \nLimitations: Not applicable \nEthics Committee Approval: Institutional waiver from full ethics application \nconfirmed \nFunding for this study: None \nAuthor Disclosures: \nAliaa Sherif Karam: Nothing to disclose \nAndrea Toohey: Nothing to disclose \nEoin O'Cearbhaill: Nothing to disclose \nLouise A. Rainford: Nothing to disclose \nEmily Conroy: Nothing to disclose \n \n \nResearch Presentation Session: \nRadiographers \nRPS 514 \nSafety in radiography \nRPS 514-1 \nDosimetric comparison of two radiotherapy techniques in irradiation of \nbreast cancer \n*B. S. M. Vaz*¹, A. F. L. Abrantes², S. I. Rodrigues², L. P. V. Ribeiro²,  \nM. Ramos², F. Serra², B. Vicente², R. P. P. Almeida²; ¹Vila Nova de Cacela/PT, \n²Faro/PT  \n(brunav7@hotmail.com) \n \nPurpose: To compare and analyze the dosimetric aspects of three-\ndimensional conformational radiation therapy (3DCRT) and Volumetric \nModulated Arc Therapy (VMAT) techniques in irradiation of breast cancer. \nMethods or Background: A quantitative and descriptive-correlational study \nwas carried out and a total of 47 patients were included, of which 24 underwent \n3DCRT and 19 were treated with VMAT. In dosimetric analysis we obtained \ndose-volume histograms (HDV) evaluation. Besides that, parameters such as \nconformity index, homogeneity index and body dose values were calculated in \norder to compare both techniques. The dose prescribed was 50 Gy in 25 \nfractions with conventional fractionation to the whole breast. The dose \nprescribed was 50 Gy in 25 fractions with 2 Gy per fraction, 1 fraction per day \nfor 5 days per week to the whole breast. \nResults or Findings: Dosimetric analysis showed that VMAT presents a \ngreater coverage of the planning target volume (PTV) according to definition \nproposed by ICRU Report 83. Conformity and Homogeneity indexes are also \nhigher in patients who underwent irradiation with VMAT technique (between \n0.11 to 0.16). However, 3DCRT presents, on average, a greater protection of \nthe organs at risk. Data showed that VMAT may have an effect of “low dose \nexposure bath” on adjacent healthy organs, mainly on the contralateral breast. \nConclusion: In conclusion, VMAT presents advantages comparing to 3DCRT \nin cases where the cervical and axillary ganglionar nodes are involved to do \nthe treatment. However, in selected cases based in stage and patient anatomy \n3 DCRT can be a preferred technique because it achieves better protection of \nthe organs at risk. \nLimitations: Sample size. \nEthics Committee Approval: Ethics committee approved the study \nFunding for this study: No funding \nAuthor Disclosures: \nMagda Ramos: Nothing to disclose \nRui Pedro Pereira Almeida: Nothing to disclose \nSónia Isabel Rodrigues: Nothing to disclose \nFábio Serra: Nothing to disclose \nAntonio Fernando Lagem Abrantes: Nothing to disclose \nBianca Vicente: Nothing to disclose \nBruna Sofia Mangas Vaz: Nothing to disclose \nLuís Pedro Vieira Ribeiro: Nothing to disclose \n \nRPS 514-2 \nDeep-learning reconstruction in CT \n*S. D. Moerup*¹, J. G. Stowe², H. Precht¹, S. J. Foley²; ¹Odense/DK, ²Dublin/IE  \n(sdmo@ucl.dk) \n \nPurpose: To investigate the influence of the new deep-learning image \nreconstruction TrueFidelity on image quality for cardiac computed tomography \nangiography scanning in different size phantoms. \nMethods or Background: Four sizes of cardiac phantom (small: 30cm, \nmedium: 35cm, large: 40cm, XL: 60cm) (QRM, Moehrendorf, Germany) were \nscanned on the Revolution Apex CT scanner (GE Healthcare, USA) using \ncombinations of ASiR-V (50/70%), kV assist with a standard cardiac protocol. \nRadiation dose was recorded by CTDI and DLP and each scan reconstructed \nwith three levels of TrueFidelity (low (TF-L) medium (TF-M) and high (TF-H)). \nImage quality was assessed using objective metrics in predefined areas (SD \nand CNR) and subjectively by evaluating the nine calcifications in the phantom. \nDescriptive statistics was performed. \nResults or Findings: By increasing ASIR-V from 50-70%, radiation dose \nreduced by 42%, 81% and 101% for the small, medium and large phantoms \nrespectively, with a slight (1%) increase for the XL phantom. When using ASiR-\nV50%, increasing TrueFidelity strength lead to image noise reductions (17-\n56%) for the small, medium and large phantom. For ASiR-V70%, image noise \nis reduced (0-45%) for both small and medium phantom. For the large and XL \nphantom noise increases 11% for TF-L, but reduces (4-37%) for TF-M and TF-\nH. CNR improves (4-105%) for all levels of TrueFidelity when using ASiR-\nV50%. For ASiR-V70% the CNR decreased (4-15%) for TF-L for all phantoms \nand increased (4-64%), for TF-M and TF-H. For the small, medium and large \nphantom 7/8 calcifications were visible with TrueFidelity, the XL phantom 5/6 \ncalcifications. \nConclusion: TrueFidelity reduces image noise and improves the CNR, the \nlargest noise reduction (56%) is obtained with ASiR-V50%. For the XL \nphantom the change in noise and CNR was significantly lower. \nLimitations: Not applicable \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nHelle Precht: Nothing to disclose \nJohn Gerard Stowe: Nothing to disclose \nSvea Deppe Moerup: Nothing to disclose \nShane J Foley: Nothing to disclose \n \nRPS 514-3 \nEvaluation of residual activity in a nuclear medicine department \n*A. D. S. Queirós*, S. I. Rodrigues, L. P. V. Ribeiro, A. F. L. Abrantes,  \nJ. Rosas, R. P. P. Almeida, J. Pinheiro; Faro/PT \n(andredsqueiros@gmail.com) \n \nPurpose: The exposure to ionizing radiation by radiographer in Nuclear \nMedicine departments is inevitable, as this area has the highest rates of \nresidual activity. The main objective of this study was to ascertain to which \ndoses are the staff exposed in the Radiopharmacy and the Injection Room \n(IR). \nMethods or Background: Activity measurements were performed at different \npoints of the department and at different distances (0m, 0.5m and 1m) of the \nradioactivity waste. These measurements were taken for 63 days, with a \nsurvey-meter Geiger-Müller. \nResults or Findings: In Radiopharmacy, the mean dose rate values obtained \nwere 77.16, 1.14, 0.57 and 0.52 ȝSv/h at distances of 0m, 0.5m, 1m and 1.5m \nrespectively, and in the Injection Room, mean dose rate values of 1.75, 0.31 \nand 0.19 ȝSv/h were observed at distances of 0m, 0.5m and 1m. At 1.5m, \nbeing a general point in this area, a value of 0.361 mSv/year was obtained, \nand in the IR at a distance of 1m, the value of 0,132 mSv/year was obtained for \neach radiographer. \nConclusion: We conclude that the effective dose values are lower than the \ndose limits legally established (20 mSv per year) and that management of \nradioactive waste is greatly optimized. \nLimitations: Not applicable \nEthics Committee Approval: Ethics committee approved the study \nFunding for this study: No funding was received for this work. \nAuthor Disclosures: \nJoao Pinheiro: Nothing to disclose \nRui Pedro Pereira Almeida: Nothing to disclose \nSónia Isabel Rodrigues: Nothing to disclose \nAndré Daniel Santos Queirós: Nothing to disclose \nJoana Rosas: Nothing to disclose \nAntonio Fernando Lagem Abrantes: Nothing to disclose \nLuís Pedro Vieira Ribeiro: Nothing to disclose \n \nRPS 514-4 \nEstablishment of local diagnostic reference levels and trigger values \nanalysis in a cath-lab department \nA. Cortez¹, *J. Santos*¹, J. Costa², G. Paulo¹; ¹Coimbra/PT, ²Braga/PT \n(joanasantos@estescoimbra.pt) \n \nPurpose: This study aims to assess the examination dose values in \ninterventional cardiology procedures to establish diagnostic reference levels \nand analyse number of procedures that exceed trigger values. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 294  \nMethods or Background: Data about the procedure type, operator \nidentification, procedure access, patient characteristics (gender, age and \nweight), fluoroscopy time (min), Kerma Area Product - PKA (Gy.cm2), was \nretrospectively collected, for a period of 12 months. Patients were categorised \nin three weight groups: low (<65kg), standard (65kg to 75kg) and high (>75kg). \nResults or Findings: The majority of the 2540 examinations were diagnostic \nprocedures (65%) and the more common access was via the right radial artery \n(92%). Significant differences (p<0,05) in fluoroscopy time and PKA values, \nbetween procedure access, patient weight group and type of procedure were \nfound. The trigger level of PKA (>300Gy.cm2) value was exceeded in 0,5% of \nthe procedures, lower than the incidence found in the literature. The local DRL \nvalues for diagnostic and therapeutical procedures were respectively 39 and \n111Gy.cm2, in line with values published in the literature. \nConclusion: The dose distribution is in line with the ones found in the \nliterature. The percentage of patients that exceed one of trigger levels is lower \nwhen compared with the literature, however a patient follow-up plan should be \nestablished. \nLimitations: It was not possible to obtain Air Kerma at reference point \nretrospectively in order to analyse that trigger value. \nEthics Committee Approval: This study was approved by the institutional \nethical committee. \nFunding for this study: This study was performed without funding. \nAuthor Disclosures: \nGraciano Paulo: Nothing to disclose \nAngela Cortez: Nothing to disclose \nJoana Santos: Nothing to disclose \nJoão Costa: Nothing to disclose \n \n \nResearch Presentation Session: \nRadiographers \nRPS 614 \nEducation and training in radiography \nRPS 614-1 \nInformation seeking preferences among patients undergoing \nradiotherapy in Malta \n*C. Borg*, G. v. Dijk, K. Borg Grima; Msida/MT  \n(clarissa.borg.16@um.edu.mt) \n \nPurpose: Adequate information is necessary to help cancer patients cope with \ntheir disease and treatment. The aim of this study was to investigate whether \nradical cancer patients undergoing radiotherapy, seek information regarding \ntheir pathology. The objectives of this study were to identify any correlation \nbetween the sources of information used by cancer patients and the \ninformation-seeking tendencies of these patients. Moreover, the topics \nsearched by the patients, and during which time frame patients mostly sought \ninformation, were all investigated factors. \nMethods or Background: This study used a quantitative cross-sectional \nresearch design, in which an already established questionnaire was distributed \nby intermediaries to consenting patients. \nResults or Findings: In this research, 42 patients undergoing radical \nradiotherapy consented to participate. The results demonstrated that the \ninformation seeking tendencies were affected by the patient’s educational \nlevel. Moreover, the most frequently searched topics included ‘diagnosis’, ‘tests \nof investigations’, ‘radiotherapy’ and ‘side effects.’ In this study, participants \ntended to search for information at the time of diagnosis and prior to \nradiotherapy. The preferred sources of information were ‘Nurses’ (66.7%), \n‘Websites’ (54.8%), ‘Written Materials’ (50%), ‘General Practitioners’ (50%), \n‘Radiographers’ (47.6%) and ‘Friends/Family’ (47.6%). The participants who \nused internet as an information source searched for treatment options (54.8%), \ncancer diagnosis (52.4%) and possible treatment side effects (50.0%). \nHowever, 28% of the participants admitted that the information found online \nwas difficult to understand. \nConclusion: This study indicated that cancer patients tend to search for more \ninformation than that provided initially. \nLimitations: The amount of information sought throughout the treatment \njourney might have varied and patients could have found it difficult to recall the \namount of information they sought and all the sources used. \nEthics Committee Approval: Ethical approval was obtained from the \nuniversity research ethics committee, University of Malta. \n \n \n \n \nFunding for this study: None \nAuthor Disclosures: \nKaren Borg Grima: Nothing to disclose \nGerbert van Dijk: Nothing to disclose \nClarissa Borg: Nothing to disclose \n \nRPS 614-2 \nManagement of patients with autism spectrum disorders in Swiss \nmedical imaging departments \n*S. Carlier*¹, C. S. d. Reis¹, C. Malamateniou²; ¹Lausanne/CH, ²London/UK  \n \nPurpose: To understand and explore the strategies currently in use to imaging \npatients with autism spectrum disorder (ASD) by radiographers in Swiss \nmedical imaging departments. To develop recommendations for imaging ASD \npatients. \nMethods or Background: An online questionnaire on REDCap platform to \ncollect information on demographics, the strategies used, barriers and \nfacilitating factors during the management of ASD patients was developed, \npiloted and disseminated via the Swiss Professional Body/(ASTRM). \nDescriptive statistics and thematic analysis were used according to the nature \nof the questions to analyse data. \nResults or Findings: A hundred radiographers participated in the study but \nonly 60 reported having managed an ASD patient. Nineteen out of 121(15.7%) \nradiographers declared that the condition of the patient was not communicated \nbefore the examination. The main strategy used to manage the patient was to \nuse the help from carers who accompanied the patient (50/111; 45%). The \nmain difficulties identified by the participants were: lack of training (35/92, \n38.04%), lack of guidelines (24/92; 26.08%) and poor communication (15/92; \n16.3%). \nConclusion: The lack of knowledge/training and the lack of local guidelines \nabout autism seem to impact in the management of ASD patients. The \ncaregivers were identified as playing an important role during the examination. \nImprovement in communication routes in clinical settings is vital for better \nmanagements and clinical services for these patients. Education about autism \nand local guidelines are recommended to help radiographer to manage ASD \npatients. \nLimitations: The spread of the questionnaire was realised during summer \nholidays, which could contribute to a lower participation. The different parts of \nASTRM complicated the dissemination of the questionnaire. Switzerland has \nthree main languages however the questionnaire was developed only in \nFrench. \nEthics Committee Approval: Ethics approval was obtained for this study from \nSwiss Ethics Vaud. \nFunding for this study: No funding. \nAuthor Disclosures: \nSarah Carlier: nothing to disclose \nClaudia Sa dos Reis: Nothing to disclose \nChristina Malamateniou: nothing to disclose \n \nRPS 614-4 \nPractice and safety guidelines in interventional radiology: what the \nradiographer should know \n*R. Gerasia*¹, A. Roletto², N. Giannotti³, G. S. Gallo¹, C. Tafaro¹, A. Cozzi²,  \nM. Zanardo², S. Durante຾, D. Catania²; ¹Palermo/IT, ²Milan/IT, ³Sydney/AU, \n຾Bologna/IT \n(roberta.gerasia@gmail.com) \n \nPurpose: The aim of this narrative review was to integrate major evidence \nabout the multi-layered role of radiographers in the practice of interventional \nradiology (IR), summarising relevant recommendations for safe handling of X-\nray equipment, radiation protection, procedural assistance, quality assurance, \nimage and data management. We also outlined learning strategies and \ncontinuing education goals for both radiographers in training and practicing \nradiographers, in order to foster an ever-better integration in the IR workflow. \nMethods or Background: No ethics committee approval was needed for this \nnarrative review. In September 2020, an in-depth literature search \n(Medline/EMBASE) targeting practice guidelines for IR was performed. \nRecommendations were divided: before procedure; during procedure; after \nprocedure; considerations about education. \nResults or Findings: Nine guidelines were considered eligible. Widely \nrecommended pre-procedural checks include the verification of patient identity \nand procedure site, management of relevant clinical data, and assistance to \nprocedure planning. During the procedure, the radiographer must be aware of \nhow the exposure settings should be tailored according to each patient’s \nclinical and anatomical features to ensure appropriate image quality while \ndelivering the lowest level of dose achievable. Radiation dose must be \ncontinuously monitored and patient-specific radiation dose data must be \nrecorded in the patient’s medical folder at the end of the IR procedure. \nConclusion: Radiographers have clearly defined and paramount roles in all \nsteps of IR procedures, particularly providing correct management of x-ray \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 295  \nequipment, procedural assistance, and radiation protection planning. A strong \nlearning attitude from direct experience in the IR suite should be developed in \naddition to constant in-house training and advanced IR courses offered by \nacademic institutions. A working culture that protects patient safety should be \nattained by multilateral integration with radiologists, medical physicists and \nnurses. \nLimitations: Review not systematically conducted. \nEthics Committee Approval: Not applicable. \nFunding for this study: None. \nAuthor Disclosures: \nAndrea Cozzi: Nothing to disclose \nDiego Catania: Nothing to disclose \nNicola Giannotti: Nothing to disclose \nGiuseppe Salvatore Gallo: Nothing to disclose \nStefano Durante: Nothing to disclose \nAndrea Roletto: Nothing to disclose \nMoreno Zanardo: Nothing to disclose \nRoberta Gerasia: Nothing to disclose \nCorrado Tafaro: Nothing to disclose \n \n \nResearch Presentation Session: \nRadiographers \nRPS 714 \nQuality assurance in radiography \nRPS 714-1 \nDiagnostic reference levels in computed tomography examinations by \nclinical indication \nR. Marques¹, S. I. Rodrigues², A. F. L. Abrantes², L. P. V. Ribeiro²,  \nK. B. Azevedo², R. P. P. Almeida², *B. Vicente*²; ¹Portimao/PT, ²Faro/PT  \n(biancaicvicente@gmail.com) \n \nPurpose: The present work intends to define the Diagnostic Reference Levels \n(DRL) in computed tomography examinations by clinical indications, as \nliterature suggest that these are lower than the Diagnostic Reference Levels by \nanatomical regions, inducing a reduced exposure in the patients submitted to \nthis procedures. \nMethods or Background: By registering dosimetric parameters related to CT \nscans of the skull, chest, spine, abdomen, pelvis, angio and uro-CT through \nthe examination of the file dose protocol grouped into 12 different clinical \nindications and using a sample of 20 patients per each clinical indication. A \nfinal total of 240 examinations were considered. \nResults or Findings: The Diagnostic Reference Levels established for the CT-\nBrain examination with clinical indication of trauma, stroke and vascular \npathology was 884mGy.cm; 884 mGy.cm; 1772.50 mGy.cm, respectively. For \nthe CT-Face examination (trauma) the DRL obtained was 410 mGy.cm, for the \nCT-Cervical, Dorsal and Lumbar Spine examination (trauma) it was 410 \nmGy.cm, 677 mGy.cm, 577.3 mGy.cm, respectively, for the chest examination \n(Pulmonary Thrombo Embolism) 383.0 mGy.cm, for the abdomen-pelvic \nexamination (pathology of the urinary system and colon pathology) it was \n1305.5 mGy.cm, 782.3 mGy.cm, respectively. \nConclusion: It was concluded that there was a great variation in the results \nobtained within the same exam, which leads to the conclusion that the DRLs \nshould be suitable for the clinical indication and not just for an anatomical \nregion. The obtained values were below comparing to the DRL’s by anatomical \nregions in the following cases: CT-Brain exams (trauma and stroke), Face-CT \n(trauma), Cervical, Dorsal and Lumbar Spine (trauma), CT-Chest (Thrombo \nEmbolism). \nLimitations: Sample size. \nEthics Committee Approval: Ethics committee approved the study and \nwritten informed consent was delivered to the participants. \nFunding for this study: No funding was received for this work. \nAuthor Disclosures: \nKevin Barros Azevedo: Nothing to disclose \nRui Pedro Pereira Almeida: Nothing to disclose \nSónia Isabel Rodrigues: Nothing to disclose \nRaquel Marques: Nothing to disclose \nAntonio Fernando Lagem Abrantes: Nothing to disclose \nBianca Vicente: Nothing to disclose \nLuís Pedro Vieira Ribeiro: Nothing to disclose \n \n \n \n \nRPS 714-2 \nLongterm ultrasound follow-up in patients with small gallbladder polyps \nS. R. Rafaelsen, P. O. Otto, *M. R. V. Pedersen*; Vejle/DK  \n(Malene.Roland.Vils.Pedersen@rsyd.dk) \n \nPurpose: The aim of the study was to examine long-term follow-up growth in \ngallbladder polyps <6 mm and explore the risk of developing gallbladder \ncancer. \nMethods or Background: Abdominal ultrasonography reports from 2007 to \n2009 were reviewed in order to include patients diagnosed with gallbladder \npolyps < 6 mm. The patients were invited to a final follow-up ultrasonography \nof the gallbladder from October 2019 to February 2020. A total of 154 patents \nwere included ( 100 woman and 53 men). \nResults or Findings: Gallbladder polyps were confirmed in 101 patients \n(65.6%) and not visible in 53 patients (34.4). A total of 49 patients had a single \npolyp (31.8%), and 52 (33.8%) had multiple polyps. A total of 15 patients \nexperienced a growth of the polyps of 2 mm or more. The median gallbladder \npolyp size was 4.0 mm (range 2.0-5.9 mm) at baseline and median size was \n4.0 mm (range 1.7-15.0 mm) during follow up. None had developed gallbladder \ncancer. \nConclusion: Gallbladder polyps <6 mm has a low probability of growth. None \nof the patients with small gallbladder polyps developed gallbladder cancer. The \nneed for follow-up in patients with small gallbladder polyps is questionable. \nLimitations: One limitation of this study is the small study size. \nEthics Committee Approval: The study was approved by the Institutional \nReview Board of the University Hospital of Southern Denmark and the local \nDanish data protection agency. Patients consent was mandatory. \nFunding for this study: None \nAuthor Disclosures: \nMalene Roland Vils Pedersen: Nothing to disclose \nPeter O. Otto: Nothing to disclose \nSören R. Rafaelsen: nothing to disclose \n \nRPS 714-3 \nDesign and development of a 3D printable holder for digital radiography \ndetector safety \n*A. S. Karam*, E. Conroy, L. A. Rainford, E. O'Cearbhaill; Dublin/IE \n(aliaa.karam@ucdconnect.ie) \n \nPurpose: In digital radiography (DR), electronic detectors transform X-rays into \ndigital images. These expensive detectors are highly vulnerable outside of their \nroutine housing under the X-ray table. If damaged while in use, may require \nreplacement at significant cost. To overcome this problem, there is a need to \ndevelop a holder to stabilize and secure the detector in a range of adjustable \npositions within a clinical setting. This study aims to design a novel inexpensive \n3D printable based holder to fully support DR detectors when imaging using \nmodified techniques either on the X-ray table or in a wheelchair. \nMethods or Background: The holder was mechanically designed, modeled, \nand assembled using the Autodesk Inventor software. The Stress Analysis \nfeature was employed to simulate the holder’s performance with movement \nconstraints and applied forces. \nResults or Findings: The designed holder consists of seven parts connected \nwith joints allowing movements in different planes. The holder’s free end \nincludes a hook and latch creating a safe grasp for the detector. Using \npolylactic acid (PLA), the most readily available 3D printable material, the \nmaximum Von Mises stress, displacement, and the safety factor on the holder \nwere 0.551 MPa, 0.147 mm, and 15, respectively. \nConclusion: The yield stress of PLA is greater than maximum stress \ngenerated on the holder. Maximum displacement was minor, and the safety \nfactor was greater than one. Thus, the designed holder should be capable of \nfully supporting the detector without material failure, under the static loading \nconditions analyzed. These results provide a potential solution to reduce the \nrisk of DR detector damage in clinical practice. \nLimitations: Not Applicable \nEthics Committee Approval: Not Applicable \nFunding for this study: The authors would like to acknowledge funding from \nthe Health Research Board, Dublin, Ireland. \nAuthor Disclosures: \nAliaa Sherif Karam: Nothing to disclose \nEoin O'Cearbhaill: Nothing to disclose \nLouise A. Rainford: Nothing to disclose \nEmily Conroy: Nothing to disclose \n \nRPS 714-4 \nDifferences in display size of sequential posteroanterior chest \nradiographs on PACS: a potential source of interpretative error \n*A. Stirling*, A. Murray, A. N. Murphy, M. Brennan, J. Murray; Dublin/IE \n \nPurpose: Sequential digital radiography unit acquired (DR) posteroanterior \nchest radiographs (CXRs) are routinely displayed at different sizes on PACS \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 296  \nmonitors. The purpose of this study was to determine the cause of these \ndifferences, the percentage of radiographs affected, the relative change in \nmagnification seen and if radiologists were aware of this display difference. \nMethods or Background: Differences in routine radiographer collimation pre-\nacquisition and image cropping (shuttering) post acquisition were noted. From \n3 different centres, 300 posteroanterior (PA) erect CXRs with prior comparative \nstudies were viewed side-by-side on a standard landscape display monitor. \nVariation in display size (i.e. the extent of magnification) was calculated using \nthe number of detector elements (Dels) in the autofitted axis of the radiograph, \nwhen compared with the prior study. Correlation between age, sex and extent \nof magnification between images was recorded. Following this, a national \nsurvey was circulated to see if radiologists were aware of this phenomenon. \nResults or Findings: Large variations in display size were noted. The mean \nextent of magnification between sequential PA chest radiographs was ±6.8% \n(range 0 – 21.6%) when viewed side-by-side. 98% of CXRs had some degree \nof variability in display size. There was no significant difference in the extent of \nvariation in magnification based on age or gender. 86% of the radiologists who \nresponded to the survey (n=132) were unaware of any display size variability. \nConclusion: Sequential DR acquired chest radiographs are routinely \ndisplayed with varying degrees of magnification on PACS monitors due to \ndifferences in radiographer practice and auto-fit display settings. Most \nradiologists are unaware of these differences which could lead to perceptive \nerror. \nLimitations: Possible response bias in survey \nEthics Committee Approval: Yes \nFunding for this study: None to declare \nAuthor Disclosures: \nMichael Brennan: Nothing to disclose \nJohn Murray: Nothing to disclose \nAoife Murray: Nothing to disclose \nAaron Stirling: Nothing to disclose \nAlexandra N Murphy: Nothing to disclose \n \nRPS 714-6 \nQuality of life and quality of work-life among radiographers: a \ncomparative study between Portugal and England \n*I. Pinto*¹, L. P. V. Ribeiro², S. I. Rodrigues², B. Vicente², A. F. L. Abrantes²,  \nR. P. P. Almeida²; ¹Loulé/PT, ²Faro/PT \n(inespinto54@gmail.com) \n \nPurpose: Nowadays, Quality of Life (QL),as well as Quality of Work Life \n(QWL), represent an important factor in any human being. Physical and \npsychological well-being, environmental factors, personal relationships and \ncareer factors influence a person’s life and, when positives, provide a greater \npersonal achievement. The purpose of this study is to analyze QL and QWL \namong radiographers and to compare the results between these professionals \nin two different countries. \nMethods or Background: A total of 83 radiographers participated, of which 51 \nworked in Portugal and 32 in England. For the accomplishment of this study \ntwo online questionnaires were applied, one to assess QL and another \nconcerning QWL. Both combined allowed the assessment of individuals \ngeneral QL. \nResults or Findings: Despite the sample's homogeneity, some differences \nwere observed between radiographers of the two countries.The differences \nfound are mostly work-related questions, in which radiographers from England \npresented more satisfactory response averages than Portuguese \nradiographers concerning, respectively, the ability for innovation (3,78 vs \n3,08),staff equality (3,53 vs 3,04),professional fulfilment (3,72 vs \n3,37),satisfaction in QWL (3,25 vs 3,78),among others. In addition,significant \ndifferences were found between radiographers from both countries concerning \npersonal relationships dimension (p=0,001).It was found positive correlations \nbetween QL and QWL, mostly in environmental (r=0,439;p=0,000), physical \n(r=0,266;p=0,017) and psychological (r=0,255;p=0,023) factors. \nConclusion: It was possible to verify that radiographers from Portugal present \na greater QL unlike England, which presents a better QWL of its professionals. \nThis study may lead to an awareness and to an effort to improve \nradiographer’s QL and QWL in order to achieve a greater personal satisfaction \nand, consequently,a better performance of their professional practice. \nLimitations: Sample size \nEthics Committee Approval: Ethics committee approved the study and \nwritten informed consent was delivered to the participants. \nFunding for this study: No funding was received for this work. \nAuthor Disclosures: \nRui Pedro Pereira Almeida: Nothing to disclose \nBianca Vicente: Nothing to disclose \nSónia Isabel Rodrigues: Nothing to disclose \nAntonio Fernando Lagem Abrantes: Nothing to disclose \nInês Pinto: Nothing to disclose \nLuís Pedro Vieira Ribeiro: Nothing to disclose \n \n \nResearch Presentation Session: Vascular \nRPS 315 \nVascular ultrasound and MR \nRPS 315-1 \nUltrasonography for the diagnosis of extra-cranial carotid occlusion: \ndiagnostic test accuracy meta-analysis \n*D. M. Rojoa*¹, A. Lodhi¹, F. J. Raheman², N. Kontopodis³, C. Ioannou³,  \nN. Labropoulos຾, G. Antoniou¹; ¹Manchester/UK, ²Leicester/UK, ³Heraklion/GR, \n຾New York, NY/US  \n(Djamila.rojoa@doctors.org.uk) \n \nPurpose: The correct diagnosis of internal carotid artery (ICA) occlusion is \ncrucial as it limits unnecessary intervention, whereas correct identification of \npatients with severe ICA stenosis is paramount in decision making and \nselecting patients who would benefit from intervention. We aimed to evaluate \nthe accuracy of ultrasonography (US) in the diagnosis of ICA occlusion. \nMethods or Background: We conducted a systematic review in compliance \nwith the Preferred Reporting Items for a Systematic Review and Meta-analysis \n(PRISMA) of diagnostic test accuracy studies. We interrogated electronic \nbibliographic sources using a combination of terms to identify studies \nassessing the diagnostic accuracy of US in ICA occlusion. We used a mixed-\neffects logistic regression bivariate model to estimate summary sensitivity and \nspecificity and developed hierarchical summary receiver operating \ncharacteristic (HSROC) curves. \nResults or Findings: We identified 23 studies reporting a total of 5,675 \narteries of which 722 were proven to be occluded. The reference standard was \ndigital subtraction or cerebral angiography in all but two studies, which used \nsurgery to ascertain a carotid occlusion. The pooled estimates for sensitivity \nand specificity were 0.97 (95% confidence interval (CI) 0.94 to 0.99) and 0.99 \n(95% CI 0.98 to 1.00), respectively. The diagnostic odds ratio was 3,846.15 \n(95% CI 1,375.74 to 10,752.65). The positive and negative likelihood ratio were \n114.71 (95% CI 58.84 to 223.63) and 0.03 (95% CI 0.01 to 0.06), respectively. \nConclusion: US is a reliable and accurate method in diagnosing ICA \nocclusion. US can be used as a screening tool with cross-sectional imaging \nbeing reserved for ambiguous cases. \nLimitations: The fact that there have been multiple advances in technology \nsince some of the old papers were written means that the diagnostic errors due \nto technological limitations are now significantly reduced. \nEthics Committee Approval: None \nFunding for this study: None \nAuthor Disclosures: \nAhmad Lodhi: Nothing to disclose \nGeorge Antoniou: Nothing to disclose \nNicos Labropoulos: Nothing to disclose \nDjamila Mubashchira Rojoa: Nothing to disclose \nChristos Ioannou: Nothing to disclose \nFiras J Raheman: Nothing to disclose \nNikos Kontopodis: Nothing to disclose \n \nRPS 315-2 \nExistence of helical flow of superior vena cava in healthy young males: a \n4D flow MRI study \n*H. Pu*; Chengdu/CN  \n(phxia0409@126.com) \n \nPurpose: Helical flow is considered to be of positive significance to human \nblood circulation, but its existence in superior vena cava (SVC) has not been \nwell confirmed in vivo. This study aimed to investigate whether helical flow \nexists in SVC of healthy young males, and to describe the development and \ncharacteristics of this flow pattern with 4D flow magnetic resonance imaging \n(MRI). \nMethods or Background: 4D flow MRI data with full coverage of SVC and \nbrachiocephalic veins (BVs) were acquired with a 3-Testa MRI in 8 young male \nvolunteers. Hemodynamic parameters in SVC including velocity, velocity \nvector, pathline, streamline and flow waveforms were obtained with a \nspecialized commercial post-processing software based on the 4D flow MRI \ndata. \nResults or Findings: This study found that: 1) the helical flow appeared in \ndiastole of cardiac cycle and mainly located at the upper and middle segments \nof SVC; 2) with the decrease of blood velocity, the helical flow area had the \ntendency of gradual extension; 3)the flow pathline of left and right BVs formed \nhelical flows respectively, and there were two development types: twining and \nuntwining; 4)the flow waveform of the SVC presented as a double peak shape, \nsome cases have a centrifugal blood flow during diastole. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 297  \nConclusion: Helical flow does exist in SVC in healthy young males. It seems \nto have the physiological function of ensuring the venous return rate and \npreventing venous thrombus. This finding might help to explain the occurrence \nand development of potential SVC disease, such as thrombosis. \nLimitations: Single-center research and small sample may cause sampling \nerror. \nEthics Committee Approval: The Ethical Review Committee of the West \nChina Hospital of Sichuan University (Chengdu, Sichuan, China) approved this \nresearch. \nFunding for this study: the National Natural Science Foundation of China \n[grant number 81601462], et al. \nAuthor Disclosures: \nMA Huaxia Pu: Nothing to disclose \n \nRPS 315-3 \nTwo dimensional vessel wall diffusion anisotropy detects age related \nalterations of diffusivity in human carotids \n*S. L. Leber*, E. M. Hassler, F. Gunzer, G. Silbernagel, T. Metzner,  \nH. Deutschmann, G. Reishofer; Graz/AT \n(stefan.leber@medunigraz.at) \n \nPurpose: The application of magnetic resonance (MR) diffusion tensor \nimaging on carotid arteries is a relatively new, non-invasive method to monitor \narterial health and disease progression. High resolution diffusion weighted \nimaging (DWI) in combination with a two-dimensional (2D) diffusion gradient \nsampling scheme has recently been demonstrated as feasible for evaluating \nfractional anisotropy (FA) in the vessel wall of human carotids. The aim of our \nstudy was to detect age related alterations of diffusivity in human carotids in a \nclinical context. \nMethods or Background: We used DWI in combination with a 2D gradient at \n3T to evaluate FA of carotid vessel walls in older patients (mean age 65.2 \nyears) and compare them to a healthy control group of younger patients (mean \nage 47.6 years). DWI was carried out using a read-out segmented EPI (rs-EPI) \nsequence. \nResults or Findings: Our group comparison revealed significantly decreased \nfractal anisotropy values in carotids of older patients compared to healthy \ncontrols (p< 0.05). \nConclusion: Our work demonstrates that FA in human carotid vessel walls \nchanges with age and support the hypothesis that 2D vessel wall diffusion \nanisotropy is feasible for detecting age related architectural changes in blood \nvessels and monitor arterial health. Furthermore we show the applicability of \n2D vessel wall diffusion anisotropy in a clinical context. \nLimitations: Since group size was limited in our study, our findings need to be \nvalidated on a larger independent cohort. \nEthics Committee Approval: The study was approved by the ethics \ncommittee of the Medical University of Graz. \nFunding for this study: No funding was received. \nAuthor Disclosures: \nEva Maria Hassler: Nothing to disclose \nHannes Deutschmann: Nothing to disclose \nStefan L. Leber: Nothing to disclose \nGünther Silbernagel: Nothing to disclose \nFelix Gunzer: Nothing to disclose \nGernot Reishofer: Nothing to disclose \nThomas Metzner: Nothing to disclose \n \nRPS 315-4 \nTransferring catheter interventions into the MR environment \n*C. M. Reich*¹, S. Schauer², M. Schmid², K. Höger³, A. Hegel³, F. Cranz ຾,  \nM. Azhar຿, M. Steinmetz຿, A. Melzer¹; ¹Leipzig/DE, ²Dettingen an der Erms/DE, \n³Pforzheim/DE, ຾Wessling/DE, ຿Göttingen/DE \n(ChristophMartin.Reich@medizin.uni-leipzig.de) \n \nPurpose: Over the last years, researchers and clinicians have successfully \nshown the advantage of MRI-guidance for multiple procedures. Our research \ngroup takes part in joint research and development projects focussing on \ncatheter-based interventions using MRI-guidance instead of the currently used \nx-ray fluoroscopy. \nMethods or Background: The development process to realize MRI-guided \nvascular interventions starts with MRI compatible instruments. The paradigm \nshift from MRI as a diagnostic to a therapeutic imaging modality makes \ntechnological adaptions necessary. Taken the aforementioned issues together, \na need is generated for a workflow for MRI-guided interventions. \nResults or Findings: Novel instrument designs and MRI marker technology \nare developed and first prototypes are being tested. Besides passive and semi-\nactive markers, we aim for semi-active instruments. A technical setup is \ndeveloped to support interventionalists during the procedure in a way they are \naccustomed to from the catheter laboratory. Our approach is to use everyday \ntechnology to establish an interventional MRI suite that can be operated by \nminimally trained staff. A clinical workflow was compiled, taking into \nconsideration MR Safety aspects, effective handling of the MRI scanner and \npredefined sequences for the desired use case. Among other aspects, this is \nsupposed to provide guidance for the clinical personnel. \nConclusion: The three milestones: MRI compatible instrument, clinical \nworkflow, and technical setup were accomplished in a preliminary project. The \napplicability and usability of each aspect need to be proven and evaluated in \nin-vitro/ex-vivo trials. Afterwards, necessary adaptations can be made before \nanimal studies will be carried out. \nLimitations: To assure MR Safety, further investigations in conformity with \nstandards have to be carried out. \nEthics Committee Approval: No approval required \nFunding for this study: German Federal Ministry of Education and Research, \n„KMU-innovativ: Medizintechnik\", contract numbers 13GW0242B, \n13GW0288D; \"Bildgeführte Diagnostik und Therapie – Neue Wege in der \nIntervention\", 13GW0365C \nAuthor Disclosures: \nFelix Cranz: Employee: Bavaria Medizin Technologie GmbH \nSenta Schauer: Employee: EPflex Feinwerktechnik GmbH \nAndreas Melzer: Nothing to disclose \nMichael Steinmetz: Other: DZHK (German Center for Cardiovascular \nResearch), partnersite Goettingen \nAlexander Hegel: Employee: ADMEDES GmbH \nMueed Azhar: Other: DZHK (German Center for Cardiovascular Research), \npartnersite Goettingen \nC. Martin Reich: Nothing to disclose \nMichael Schmid: Employee: EPflex Feinwerktechnik GmbH \nKim Höger: Employee: ADMEDES GmbH \n \nRPS 315-5 \nOne stop giant cell arteritis: the Oxford experience of GCA sonographer \ndevelopment during the COVID-19 pandemic crisis \n*G. Sallemi*, S. Dubey, M. Adamson, J. Thorne, J. P. E. White, K. Partington, \nR. A. Luqmani; Oxford/UK \n(germana.sallemi@ouh.nhs.uk) \n \nPurpose: Demonstrate the presence of the “halo” sign in ultrasound patients \nwith suspected Giant Cell Arteritis (GCA), confirming diagnosis due to a daily \npandemic clinic. \nMethods or Background: Prior pandemic, our GCA ultrasound performed \ntwice week clinic/scanning assessing 15 patients/session, including newly \nsuspected and follow-up patients. Patients required 20 minute-slot, resulting in \nlate clinics and delays in establishing new patient’s timely diagnosis. The risks \nof high dose steroid during the pandemic and early diagnosis was imperative \ndue to diagnostic uncertainty if partially pre-treated. We reviewed records from \npatients between November 2019 to July 2020, including 17 weeks seen ‘pre-\nCOVID’ and 17 weeks of 5 days per week service, termed ‘intra-COVID’. All \npatients underwent clinical evaluation and ultrasound in longitudinal and \ntransverse plane: axillary, common, parietal and frontal arteries evaluated as \nour institutional protocol. Those hypoechoic, non-compressible peri-luminal \narterial wall-thickening (or halo sign) were considered ultrasound ‘positive’; \nincreasingly used as diagnostic standard. \nResults or Findings: 139 patients with suspected GCA, 63 pre-COVID period \nvs 76 intra-COVID were reviewed. Diagnosis of GCA made in 33.3% pre-\nCOVID and 42% intra-COVID (p=0.289). Ultrasound sensitivity improved from \n38.1% to 68.6% (p<0.0001). Proportion of patients diagnosed within 7days of \nreferral improved 61.6% (p<0.0001), from 31.7% to 93.3%. Median number of \ndays from referral to assessment fell over four-fold, from 12.5 to 3. Median \nnumber of days steroid exposure fell over seven-fold from 15 days to 2 days. \nConclusion: The pandemic led to the development of a sonographer daily \nultrasound/clinic one-stop service for patients with suspected GCA or with a \nflare of symptoms, achieving an efficient system with regards to patient \npathway, diagnosis and earlier treatment. \nThis model is used as our institution’s gold standard of care planning emerging \nfrom the pandemic. \nLimitations: None \nEthics Committee Approval: None \nFunding for this study: None \nAuthor Disclosures: \nMatthew Adamson: Nothing to disclose \nRaashid A Luqmani: Nothing to disclose \nJonathan P E White: Nothing to disclose \nJessica Thorne: Nothing to disclose \nGermana Sallemi: Nothing to disclose \nShirish Dubey: Nothing to disclose \nKaren Partington: Nothing to disclose \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 298  \n \nResearch Presentation Session: Vascular \nRPS 415 \nVascular CT and angiography \nRPS 415-1 \nFeasibility of ultra-low dose contrast media in pancreatic arteries \ndepiction using the combination of advanced virtual monoenergetic \nimaging and high-concentration contrast medium \n*J. Li*¹, X. Chen², H. Xue¹, J. Zhengyu¹; ¹Beijing/CN, ²Chengdu/CN  \n(mzy_lyy@163.com) \n \nPurpose: To evaluate the feasibility of ultra-low dose (224mgI/kg) contrast \nmedia (CM) in the depiction of pancreatic arteries, by using the combination of \nadvanced virtual monoenergetic imaging (VMI+) and high-concentration \n(400mgI/ml) CM. \nMethods or Background: From April 2019 to May 2020, 41 patients (26 men, \n15 women; mean age, 56.0 years), who underwent both normal dose CM (ND-\nCM, 320mgI/kg) and low dose CM (LD-CM, 224mgI/kg) thoracoabdominal \nenhanced CT (with or without pelvic CT) for tumor follow-up, were \nprospectively included. The VMI+ at the energy level of 40-kev for the LD-CM \nimages was reconstructed. The CT attenuation, signal-to-noise ratios (SNRs) \nand contrast-to-noise ratios (CNRs) of abdominal artery, celiac artery and \nsuperior mesenteric artery (SMA) as well as the depiction of pancreatic arteries \nwere recorded and compared between the ND-CM images and LD-CM images, \nthe ND-CM images and VMI+ of the LD-CM images respectively. Paired t-test, \nWilcoxon-signed rank test and McNemar’s test were used for analysis. \nResults or Findings: Comparing to the ND-CM images, SNRs of aorta and \nceliac artery in VMI+ LD-CM images were significantly lower (all p < 0.05), but \nthe mean CT value and CNRs in VMI+ LD-CM images is significantly higher \n(all p < 0.001). There was no significant difference of SNR of SMA between \nND-CM images and VMI+ LD-CM images (p=0.223). There were no significant \ndifferences of qualitative scores of all pancreatic arteries between the ND-CM \nimages and VMI+ LD-CM images in the (all p> 0.05). \nConclusion: Ultra-low dose CM (224mgI/kg) could be used in the depiction of \npancreatic arteries, by using the combination of VMI+ and high-concentration \n(400mgI/ml) CM. \nLimitations: Firstly, the duration between two examinations is long; Secondly, \nwe didn't use constant injection duration; Finally, we didn’t further group by \nBMI. \nEthics Committee Approval: Yes \nFunding for this study: Na \nAuthor Disclosures: \nJin Zhengyu: Nothing to disclose \nJuan Li: Nothing to disclose \nXinyue Chen: Nothing to disclose \nHuadan Xue: Nothing to disclose \n \nRPS 415-2 \nImpact of false lumen outflow variability on adverse event risk \nstratification in patient with uncomplicated type B aortic dissection \n*M. Codari*, M. J. Willemink, D. Mastrodicasa, M. Madani, G. Mistelbauer,  \nV. Turner, V. Hinostroza, M. Fischbein, D. Fleischmann; Stanford, CA/US  \n(mcodari@stanford.edu) \n \nPurpose: False lumen outflow (FLO) has emerged as an independent imaging \npredictor for late adverse events (LAE) in patients with initially uncomplicated \nStanford type B aortic dissection (uTBAD). Before it can be clinically used, \nreproducibility and subsequent effects on risk stratification should be \nevaluated. We investigated the impact of inter-observer variability of visually \nassessed aortic branches drainage patterns and derived FLO values on LAE \nrisk stratification. \nMethods or Background: We selected 40 patients who underwent CTA for \nacute uTBAD. Left subclavian, visceral, renal, and iliac arteries were visually \nclassified as arising from the true lumen, false lumen, or both (defining their \ndrainage pattern). Then, we derived FLO values and resulting 1-year, 2-years, \nand 5-years LAE probabilities. Assessments were done twice by independent \nobservers. Agreement was assessed using Cohen’s kappa and Bland-Altman \nanalysis. Wilcoxon tests were used to compare paired samples. Finally, we \nclassified patients according to derived risk scores and evaluated number of \nreclassifications. \nResults or Findings: Agreement varied across aortic branches with a median \nkappa (interquartile range) of 0.54 (0.23–0.61). FLO differed significantly \namong observers: 638.8 (434.4–837.5) vs. 828.8 (633.1–1268.8) mL/min, \np<0.001. Resulting LAE probabilities varied significantly: 1-year probability \n7.4% (5.1–15.0%) vs. 5.6% (3.6–15.0%), p<0.001; 2-years probability 13.6% \n(9.5–26.6%) vs. 10.5% (6.6–26.6%), p=0.001; 5-years probability 28.1% (20.2–\n50.2%) vs. 22.0% (14.4–50.2%), p=0.001, respectively. Bland-Altman analyses \nshowed suboptimal agreement. As the results of different FLO assessments, \n8/40 (20%) patients were reclassified to a different risk class. \nConclusion: Inter-observer variability of FLO significantly impacts risk \nstratification in uTBAD patients. Computer-aided solutions may allow to \nimprove its reproducibility. \nLimitations: Single center, retrospective. \nEthics Committee Approval: This study was approved by our institutional \nethical research board (IRB-51630). Patient informed consent was waived due \nto the retrospective design of the study. \nFunding for this study: AHA grant (18POST34030192), NIBIB grant \n(5T32EB009035). \nAuthor Disclosures: \nDominik Fleischmann: Nothing to disclose \nVirginia Hinostroza: Nothing to disclose \nMichael Fischbein: Nothing to disclose \nMarina Codari: Nothing to disclose \nGabriel Mistelbauer: Nothing to disclose \nValery Turner: Nothing to disclose \nMartin J. Willemink: Founder: Segmed, Inc. Grant Recipient: American Heart \nAssociation \nMohammad Madani: Nothing to disclose \nDomenico Mastrodicasa: Grant Recipient: National Institute of Biomedical \nImaging and Bioengineering \n \nRPS 415-3 \nExtracorporeal membrane oxygenation (ECMO) ‘return’ cannulae: now \nyou see them, now you don’t! \n*J. K. Ruffle*, K. Pinto, J. Doyle, C. Russell, C. Bleakley, S. Ledot, S. R. Desai; \nLondon/UK \n \nPurpose: Extracorporeal membrane oxygenation (ECMO) is a proven \ntechnique for supporting patients with severe acute respiratory failure (SARF). \nHowever, iatrogenic complications are recognised and may be problematic. \nAmong recognised adverse effects is the mal-positioning of ECMO cannulae \nand confirming satisfactory positioning — in particular, of the radiolucent tip of \nthe return cannula (RC) — with computed tomography (CT) is important. We \ninvestigated the utility of CT in accurately identifying ECMO RC positioning. \nMethods or Background: Retrospective review of CT scans in consecutive \nECMO patients treated between January 2019 and September 2020. On \nreconstructed contrast-enhanced coronal CT images, where visible, two \nobservers independently recorded i) the distance from the tip of RC to the \ncavo-atrial junction (CAJ) and, where appropriate, ii) the proximity of the RC to \nthe inter-atrial septum (IAS). In those without a visible RC tip, a 4 cm length \nfrom the radio-opaque end was assumed. \nResults or Findings: The tip of the RC was visible in 32/50 (64%) patients; \nmeasurement agreement for RC positioning was excellent (r=0.93, p<0.0001). \nThe median distance of the RC from the CAJ was -0.90cm (interquartile range \n(IQR), -2.05cm — +0.94cm). In 17/50 (34%) patients, the cannula tip was a \nmedian distance 1.4 cm (IQR 1.01-2.40cm) beyond the CAJ. Of these, 13/17 \n(76%) RC - sited in the right atrium - were adjacent to the IAS, whereas 4/17 \n(23%) were in the SVC. \nConclusion: The radiolucent tip of the ECMO RC was not visible on CT in \nnearly one-third and, importantly, of those in the right atrium, the majority were \nadjacent to the IAS. This has important practical implications for radiologists \nand intensivists managing patients with SARF. \nLimitations: Future study should relate these findings to complementary \nimaging modalities. \nEthics Committee Approval: Not applicable. \nFunding for this study: Not applicable. \nAuthor Disclosures: \nCaroline Bleakley: Nothing to disclose \nStephane Ledot: Nothing to disclose \nClare Russell: Nothing to disclose \nJames K. Ruffle: Nothing to disclose \nJames Doyle: Nothing to disclose \nKaren Pinto: Nothing to disclose \nSujal R. Desai: Nothing to disclose \n \nRPS 415-4 \nIs the undetermined stroke genesis really unknown? - a retrospective \nstudy \n*M. V. M. Micelli*, U. Russo, E. G. Puglielli, N. Caputo; Teramo/IT \n(micelli.mvm@gmail.com) \n \nPurpose: Carotid web (CW) is a rare entity characterized by a \nnonatherosclerotic fibrous band of the internal carotid artery (ICA). The overall \nprevalence of CW is 1%, with an uncertain clinical effect. The aim of the study \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 299  \nis to evaluated the correlation between CWs incidence and large vessel \nocclusion ischemic strokes (LVOIS). \nMethods or Background: All consecutive LVOIS-patients treated by \nendovascular trombectomy performed at our Interventional Radiology Division, \nwere enrolled in the study. Site of occlusion, risk factors, CTA of the neck were \nretrospectively evaluated per each patient. Moreover, strokes were classified in \n5 subtypes using the TOAST classification ( Trial of Org 10172 in Acute Stroke \nTreatment classification). Exclusion criteria were posterior-strokes, known \ncauses of ischemic stroke, absence of neck-imaging. \nResults or Findings: During the last 3 years, 85 LVOIS-patients were eligible \nfor endovascular trombectomy procedures. 11 of 85 cases didn’t performed \nimaging of neck and were excluded from the study. 63 of 74 (85.1%) patients \npresented an anterior-LVOIS and 13 of them (20.6%) were classified as \nundetermined strokes using TOAST classification. CWs were retrospectively \nobserved in 6 of 63 cases. 5 of 6 CWs were ipsilateral to the anterior-LVOIS \nand they occurred in 2 men and 3 women (mean age of 66 ± 7years), with no \nsmoking history, a BMI<32, no other arteriopathies at the imaging, no apparent \nrisk factors. \nConclusion: CWs prevalence in our anterior-LVOIS population and in our \nundetermined anterior-LVOIS patients were respectively 9.5% and 38.4%. \nCWs diagnosis were easily dismissed but it could be an underappreciated risk \nfactor for ischemic strokes. \nLimitations: Our data is referring to a quite small sample but we are enrolling \nmore patients. \nEthics Committee Approval: No necessary for this retrospective study. \nFunding for this study: No funding to declare. \nAuthor Disclosures: \nUmberto Russo: Nothing to disclose \nMaria Valeria Marcella Micelli: nothing to disclose \nNevia Caputo: Nothing to disclose \nEdoardo Gaetano Puglielli: Nothing to disclose \n \nRPS 415-5 \nInter-observer analysis of morphologic risk predictors in aortic \ndissection \nM. J. Willemink, *D. Mastrodicasa*, M. Madani, G. Mistelbauer, A. M. H. Sailer, \nV. Turner, V. Hinostroza, M. Codari, D. Fleischmann; Stanford, CA/US \n(domenico.mastrodicasa@gmail.com) \n \nPurpose: Morphologic features such as (i)maximum aortic diameter, (ii)relative \nfalse-lumen circumference, (iii)false-lumen drainage, and (iv)number of \nidentifiable intercostal arteries, have recently emerged as independent \npredictors of late complications in patients with uncomplicated type-B aortic \ndissection (uTBAD). We sought to determine the inter-observer variability of \nthese manually extracted features (i-iv), which is a prerequisite for \nincorporation into a clinical risk prediction model. \nMethods or Background: Forty-seven patients who underwent CTA for acute \nuTBAD were included. Each CT-scan was evaluated twice by different \nobservers. (i)Maximum aortic diameter(mm) was measured orthogonal to the \naortic centerline; (ii)relative false-lumen circumference (angular degrees) was \nmeasured in the same plane; (iii)false-lumen drainage (mL/min) was measured \nas the sum of estimated branch vessel blood flow arising off the false-lumen, \nand (iv)intercostals (n) at the dissection level were counted. Differences \nbetween measurements were compared with paired t-tests. Reliability was \nevaluated with intraclass correlation coefficients (ICCs) and agreement with \nBland-Altman plots. \nResults or Findings: Repeated measurements of maximum aortic diameter \n37.1±5.6 mm vs. 35.8±5.0 mm (3.5%,p=0.047) were significant but small, while \nother imaging features differed more substantially: relative circumference of \nfalse lumen 242.2±29.1° vs. 256.3±30.2° (5.8%,p=0.004), false lumen drainage \n904.9±459.6 mL/min vs. 714.6±372.1 mL/min (21.0%,p<0.001), and intercostal \narteries n=15.4±3.5 vs. n=12.9±3.6 (16.2%,p<0.001). Inter-observer reliability \nwas poor to moderate with ICCs of 0.69(0.51-0.82) for maximum aortic \ndiameter, 0.43(0.16-0.64) for relative false-lumen circumference, 0.71(0.52-\n0.84) for false-lumen drainage, and 0.52(0.27-0.70) for number of intercostals. \nBland-Altman analyses indicated suboptimal agreement with a non-zero bias \nfor all four features and relatively wide 95%-confidence intervals. \nConclusion: With the exception of maximum aortic diameter, the \nreproducibility of emerging imaging features is limited. New tools supporting \nmanual feature-extraction or the development of new, reproducible automated \nmethods are needed. \nLimitations: Retrospective study \nEthics Committee Approval: IRB-approved \nFunding for this study: American Heart Association \n \n \n \n \n \n \n \nAuthor Disclosures: \nDominik Fleischmann: Research/Grant Support: Siemens Healthineers \nVirginia Hinostroza: Nothing to disclose \nMarina Codari: Nothing to disclose \nGabriel Mistelbauer: Research/Grant Support: cool IT GmbH \nValery Turner: Shareholder: Segmed, Inc \nAnna M. H. Sailer: Nothing to disclose \nMartin J. Willemink: Grant Recipient: Philips Healthcare Consultant: Arterys, \nInc Shareholder: Segmed, Inc \nMohammad Madani: Nothing to disclose \nDomenico Mastrodicasa: Nothing to disclose \n \nRPS 415-6 \nAutomatic assessment of morphologic risk predictors in aortic \ndissection: a reliability study \n*J. Hop*, G. Mistelbauer, L. Hahn, M. Codari, D. Mastrodicasa, M. Madani,  \nD. Fleischmann, M. J. Willemink; Stanford, CA/US \n(j.f.hop@umcg.nl) \n \nPurpose: Recent studies have shown that morphologic features such as \nmaximum aortic diameter and false-lumen arc length are independently \nassociated with late adverse-events in uncomplicated type-B aortic dissection \n(uTBAD) patients. We developed an automatic method to assess these \nmorphologic features on CTA-images. Our aim was to evaluate the reliability of \nthese automatically-derived measurements. \nMethods or Background: Baseline CT-scans of 36 uTBAD-patients were \nretrospectively evaluated. We developed a method to identify the centerline \nand create multiplanar-reformations. For the current study, the centerline was \ndetermined based on ground-truth segmentations. We automatically assessed \nthe orthogonal plane with the maximum aortic diameter. In this plane, we \nestimated the maximum aortic diameter by fitting an ellipse to the aortic \nboundary and false-lumen arc length by describing the arc’s contour using a \nFreeman chain-code. To validate this approach, an observer manually \nmeasured the maximum aortic diameter and false-lumen arc length using \niNtuition-software. Automatic and manual measurements were compared using \npaired t-tests. Reliability was evaluated with intraclass correlation-coefficients \n(ICCs) and agreement with Bland-Altman plots. \nResults or Findings: The automatically-derived mean maximum aortic \ndiameter (39.4±5.5mm) was slightly larger than the manual diameter \n(37.9±6.6mm,p=0.001). The automatically derived mean false-lumen arc length \n(80.8±18.3mm) was similar to the manual measurement (79.0±18.2 \nmm,p=0.374). Inter-method reliability was good to excellent with ICCs of \n0.91(0.82-0.95) for maximum aortic diameter and 0.79(0.62-0.89) for false-\nlumen arc length. Bland-Altman analyses indicated a small mean difference of \n1.5±2.6mm (4.8±6.8%) and a 95%-confidence interval of -3.6–6.7mm for \nmaximum aortic diameter. Similarly, we found a small mean difference of \n1.8±11.9mm (3.3±16.6%) and 95%-confidence interval of -21.6–25.1mm for \nfalse-lumen arc length. \nConclusion: Our fully automatic method allowed for reliable measurements of \nthe maximum aortic diameter and false-lumen arc length on CT-images of \nuTBAD-patients. \nLimitations: Retrospective study \nEthics Committee Approval: IRB-approved \nFunding for this study: American Heart Association \nAuthor Disclosures: \nDominik Fleischmann: Research/Grant Support: Siemens Healthineers \nLewis Hahn: Consultant: Arterys, Inc \nMarina Codari: Nothing to disclose \nGabriel Mistelbauer: Research/Grant Support: cool IT GmbH \nMartin J. Willemink: Consultant: Arterys, Inc Grant Recipient: Philips \nHealthcare Shareholder: Segmed, Inc \nMohammad Madani: Nothing to disclose \nDomenico Mastrodicasa: Nothing to disclose \nJoost Frederik Hop: Nothing to disclose \n \nRPS 415-7 \nEvaluation of hybrid technique (three-phase scintigraphy with CT \nangiography) for prediction of treatment outcomes in patients with acute \nand chronic critical lower limb ischaemia \n*O. Leshchinskaya*, N. Kudryashova, I. Mikhailov, O. Lbova, B. Kozlovskiy,  \nA. Panyukova, L. Kokov; Moscow/RU \n(o.leshchinskay@icloud.com) \n \nPurpose: Main predictors of limb salvage with open or endovascular \ninterventions are level of arterial occlusion, degree of ischemia and severity of \nmicrocirculatory disturbance. Our aim was to predict the outcomes in before \nand following intervention using hybrid technique. \nMethods or Background: Between 2018-2020 113 patients with lower limb \nischemia 106/113 acute (ALI) and 7/113 chronic (CCLI) have been examined \nusing Hybrid technique. We used GE, Discovery 670 NM/CT scanner. For \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 300  \nScintigraphy we used 99mɌɫ-pyrɨphosphate (500MBq, 2.85mSv) or 99m Ɍɫ-\nMIBI (500MBq, 4.5mSv). 31/113 (27%) were referred to surgery and follow-up \nHybrid examinations performed in 17/31 (55%) of patients a week after \nintervention due to undetermined clinical symptoms. \nResults or Findings: In 12/17 (71%) of patients at follow-up studies CTA \ndemonstrated restoration of the blood flow and scintigraphy shown increase of \ntissue blood-flow in the zones of hypoperfusion, regression of infiltrative-\nnecrotic changes and positive dynamics of calculated indices. 5/17 (29%) had \nno evidence of revascularization or aggravation of ischemia. 3/5 patients had \nnecrosis and reperfusion syndrome with signs of nonviable tissue on \nscintigraphy, which led to amputations. Other 2/5 patients had persistent \nischemia without positive dynamics on scintigraphy and medical treatment was \ninitiated. 99mɌɫ-pyrɨphosphate studies had an advantage due to the ability to \nidentify foci of aseptic necrosis. \nConclusion: Our initial results indicate the reliability of the hybrid technique in \ndiagnosis of the severity of ischemic changes in ALI and CCLI thus predicting \nthe outcomes prior to and following the intervention. Hybrid technique \ncharacterizes both tissue viability and the state of the arterial vessels to choose \nthe method of revascularization, along with predicting probability of limb \nsalvage and/or reducing a level of amputation. \nLimitations: Relatively small number of patients \nEthics Committee Approval: Yes \nFunding for this study: Non \nAuthor Disclosures: \nOlga Valerievna Leshchinskaya: Nothing to disclose \nAlexandra Panyukova: Nothing to disclose \nIgor Mikhailov: Nothing to disclose \nNatalia Kudryashova: Nothing to disclose \nLeonid Kokov: Nothing to disclose \nBoris Kozlovskiy: Nothing to disclose \nOlga Lbova: Nothing to disclose \n \nRPS 415-8 \nStenting of the left renal vein \n*O. B. Zhukov*; Moscow/RU \n(ob.zhukov@yandex.ru) \n \nPurpose: We are presents the results left renal vein stenting in 35 patients \nwith proven hemodynamically significant compression of the vein in \"aorto-\nmesenteric tweezers\". \nMethods or Background: Men - 7 aged 39 - 54 years (average 44.3 years), \nwomen - 28 aged 31 - 64 years (average 34.7 years). All patients were \nexamined according to the accepted algorithm: USS, CT and MRA. MRI. All \nwere examined by a urologist and/or a gynecologist. Direct contrast \nphlebography (PCF) in the overwhelming majority of cases (33–94%) preceded \nthe decision to perform stenting of the LPV. In two cases (6%), direct renal \npdebography ended with LPV stenting. The first stenting of the left renal vein \nwas performed on February 24, 2003. \nResults or Findings: In the overwhelming majority of cases (4 men and 26 \nwomen), patients underwent simultaneous operations, including stenting of the \nleft renal vein and spiral embolization or sclerotherapy (often in combination) of \ntesticular, ovarian veins. In 4 cases, in women, at different times (from 6 \nmonths to 1 year) prior to stenting of LPV, endovascular interventions were \nperformed for May-Turner syndrome. The stenting of the left common iliac vein \nwas performed. In 5 cases (3 men, 2 women), only stenting of the left renal \nvein was performed. In all cases, technical success was achieved \nConclusion: LPV stenting is an effective and safe method of treatment of \ncompression syndrome accompanying venous hypervolemia, which has many \nclinical manifestations. Currently, pelvialgia, relapse of varicocele or ovariko-\nvarix, hematuria, progressive pelvic varicose veins in the form of pathological \nvenous drainage of the cavernous bodies of the penis, progression of external \nor internal hemorrhoids are indications for in-depth follow-up of these patients \nand possible subsequent stenting of LPV. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nOleg B. Zhukov: Nothing to disclose \n \nRPS 415-9 \nPreoperative aortic geometry in predicting perioperative peri-stent false \nlumen patency for type B aortic dissection after thoracic endovascular \nrepair \n*H. Pu*; Chengdu/CN \n(phxia0409@126.com) \n \nPurpose: The study aimed to investigate whether pre-operative three-\ndimensional aortic geometric parameters can predict the perioperative peri-\nstent false lumen patency (FLP) in patients with Type B aortic dissection \n(TBAD) after thoracic endovascular aortic repair (TEVAR). \nMethods or Background: We retrospectively collected the pre- and post-\noperative imaging data of patients with TBAD who underwent TEVAR. \nAccording to the false lumen (FL) status confirmed by follow-up computed \ntomography angiography (CTA) at 1 week after TEVAR, 51 patients with peri-\nstent FLP were enrolled as group-FLP, while 43 patients with peri-stent FL \nobliteration (FLO) were enrolled as control (group-FLO). Pre-operative aortic \ngeometry parameters, including diameters, area and volume of true lumen (TL) \nand FL, intimal tear number, branch involvement, aortic arch angulation, et al. \nLogistic regression was employed to evaluate parameters which can predict \nthe risk of perioperative peri-stent FLP in post-TEVAR TBAD patients. \nResults or Findings: Maximum area of the upper segment of FL and aortic \narch angulation were independent risk factors for perioperative peri-stent FLP \nafter TEVAR. ROC curve showed that maximum area of the upper segment of \nFL had higher predictive efficiency [AUC = 0.924; cut-off value: 2.69 cm²] for \nperioperative peri-stent FLP after TEVAR compared with aortic arch angulation \n[AUC = 0.766; cut-off value: 48°]. \nConclusion: Pre-operative maximum area of the upper segment of FL might \nbe a good predictor for perioperative peri-stent FLP after TEVAR. The greater \nthe maximum area of the upper segment of FL, the less likely it was for the \nobliteration of FL. \nLimitations: Retrospective design, single-center research and relatively small \nsample may cause sampling error. \nEthics Committee Approval: The Ethical Review Committee of the West \nChina Hospital of Sichuan University (Chengdu, Sichuan, China) approved this \nresearch. \nFunding for this study: the National Natural Science Foundation of China \n[grant number 81601462]. \nAuthor Disclosures: \nMA Huaxia Pu: Nothing to disclose \n \n \nResearch Presentation Session: Vascular \nRPS 515 \nAneurysms and arteriosclerosis \nRPS 515-1 \nRetrograde use of the outback re-entry catheter in complex infrainguinal \narterial recanalisations \n*L. Patrone*¹, D. Akhtar¹, Z. Ahmed¹, P. Kalia¹, B. Dharmarajah¹, E. Blessing²; \n¹London/UK, ²Karlsbad/DE  \n(Lorenzo.patrone@nhs.net) \n \nPurpose: We present our experience with retrograde, infrainguinal \nrecanalizations using the Outback re-entry catheter in challenging chronic total \nocclusions. \nMethods or Background: We report data from a retrospective multi-centre \nregistry of high-volume centres. Procedural outcomes included technical \nsuccess (defined as successful wire passage and delivery of adjunctive \ntherapy with <30% residual stenosis), as well as safety (peri-procedural \ncomplications) \nResults or Findings: 45 consecutive patients underwent retrograde, \ninfrainguinal recanalization attempts with the Outback re-entry catheter \nbetween February 2015 and August 2020. Thirty (66.7 %) patients had history \nof open vascular surgery in the index limb. In 4 patients (8.9 %), \nrecanalizations were even more challenging due to previous surgical removal \nand/or ligation of the proximal superficial artery. Retrograde access site of the \nOutback catheter was the femoropopliteal segment in 31 (68.9 %) patients and \ncrural vessels in 14 (31.1 %) patients. The re-entry target sites were as follows: \ncommon femoral artery in 31 (68.9 %) patients, superficial femoral artery in 9 \n(20.0%) patients, popliteal artery in 1 (2.2 %) and below-the-knee arteries in 2 \n(4.4 %) patients. In 4 patients (8.9 %), the needle of the re-entry device was \ntargeted to an inflated balloon, inserted via the antegrade route. The Outback \nre-entry catheter was placed via a 6-French sheath in 19 (42.2 %) cases and \nsheathless in 26 (57.8 %) cases. Technical success was achieved in 41 (91.1 \n%) patients, 30-day amputation free survival was at 100%. There were 2 (4.4 \n%) instances of distal embolizations and 3 (6.7 %) minor bleeding episodes. \nConclusion: Retrograde use of the Outback re-entry catheter in infra-inguinal \nchronic total occlusions provides an effective and safe endovascular adjunct, \nwhen conventional antegrade and retrograde recanalization attempts have \nfailed. \nLimitations: Retrospective study \nEthics Committee Approval: Not needed \nFunding for this study: None \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 301  \nAuthor Disclosures: \nErwin Blessing: Consultant: Abbott, Shockwave, Cardinal Health \nZain Ahmed: Nothing to disclose \nBrahman Dharmarajah: Nothing to disclose \nParul Kalia: Nothing to disclose \nLorenzo Patrone: Consultant: Abbott, Terumo, Pathfinder Medical, Shockwave \nDaoud Akhtar: Nothing to disclose \n \nRPS 515-2 \nPledget reinforcement and tractional compression as adjunctive \ntechniques for suture mediated closure in percutaneous endovascular \naneurysm repair (pEVAR): a retrospective observational cohort study \n*L. Patrone*¹, M. Najem², M. Malina¹, D. Akhtar¹, Z. Ahmed¹,  \nN. S. Theivacumar¹; ¹London/UK, ²Bedford/UK  \n(Lorenzo.patrone@nhs.net) \n \nPurpose: Percutaneous endovascular aneurysm repair (pEVAR) are \ncommonly utilised and require the use of suture-mediated closure (SMC) \ndevices to ensure adequate femoral artery haemostasis. Despite the use of \nsuch devices, puncture related complications remain relatively common. We \nintroduced two new adjuncts (pledget reinforcement and tractional \ncompression) along with SMC to reduce such puncture related complications. \nThe aim of the study was to assess the efficacy and safety of the new adjunct \ntechniques compared to the previous year data prior to this new introduction of \nadjunct techniques. \nMethods or Background: The two adjuncts described were introduced in our \ndepartment in June 2018. 61 (in 32 patients) percutaneous common femoral \nartery punctures as part of routine pEVAR utilising adjunct techniques (Adjunct \nGroup) were retrospectively compared to 89 punctures (in 46 patients) in the \npreceding year who had standard percutaneous closure with SMC (Standard \nGroup). All patients had a CT Angiogram at one month and puncture \ncomplications (failure to achieve haemostasis requiring surgical cut \ndown/forming hematoma, occlusion of puncture vessel requiring a surgical \nrepair, pseudo aneurysm formation, wound infection, chronic pain) were \nobjectively recorded at time of procedure. \nResults or Findings: 61 percutaneous femoral punctures (in 31 patients) \nutilising adjunct techniques for closure (Adjunct Group) were retrospectively \ncompared to 89 punctures (in 46 patients) closed with standard SMC technique \n(Standard Group). The use of adjunctive techniques led to a significant \nreduction in overall puncture related complications (3/61 (4.9%) vs. 20/89 \n(22.5%), p=0.0106), and the need for emergent surgical repair following failed \nhaemostasis (2/61 (3.3%) vs. 13/89 (14.6%), p=0.037). \nConclusion: The pledget reinforcement and tractional compression of SMC for \npEVAR reduces puncture related complications and increase the confidence to \noffer percutaneous techniques for more patients. \nLimitations: Retrospective \nEthics Committee Approval: Obtained \nFunding for this study: None \nAuthor Disclosures: \nMojahid Najem: Nothing to disclose \nZain Ahmed: Nothing to disclose \nMartin Malina: Nothing to disclose \nLorenzo Patrone: Nothing to disclose \nDaoud Akhtar: Nothing to disclose \nNada Selva Theivacumar: Nothing to disclose \n \nRPS 515-3 \nThe ipsilateral retrograde approach to the treatment of femoropopliteal \nlesions: a systematic review \n*L. Patrone*, D. Akhtar, Z. Ahmed, P. Kalia, A. Antonietti, M. Covani,  \nM. Malina; London/UK \n(Lorenzo.patrone@nhs.net) \n \nPurpose: The endovascular treatment of femoropopliteal lesions is an integral \npart of managing patients with peripheral arterial disease. The antegrade \napproach is the most widely used technique with good evidence for its safety \nand efficacy. Retrograde approach is nowadays increasingly used to maximise \nthe chances of procedural success. The objective of this systematic review is \ntherefore to assess the safety and effectiveness of the ipsilateral retrograde \napproach to femoropopliteal lesions. \nMethods or Background: A systematic review conforming to the PRISMA \nstandards was undertaken. MEDLINE, EMBASE and The Cochrane Register \nwere searched between 1st January 1988 and 1st January 2020. Full-text, \nEnglish language peer-reviewed articles pertaining to peripheral arterial \ndisease, endovascular intervention and access site were included. \nResults or Findings: A total of 8,599 papers were screened, of which 38, \ninvolving 1,940 patients undergoing 2,184 retrograde procedures, were \nincluded. The mean number of patients per study was 51.1, with three studies \nincluding <10 and four >100. A retrograde approach was used as the primary \naccess route in 45.1% (648/1,438) of procedures with relevant data. Primary \ntechnical success was achieved in 87.9% (1,920/2,184, 63.5%-100%) with a \nreported complication rate of 11.1% (235/2,117, 0% - 27.1%). \nConclusion: The ipsilateral retrograde approach to femoropopliteal lesions \nhas good primary technical success and a low rate of complications, and has a \npromising role as a bailout, or even a primary access technique in complex \nlesions. Patient positioning, puncture site and technique, lesion anatomy and \nthe size of catheters and devices used are important considerations to achieve \nthe best outcomes. \nLimitations: Overall, the quality of evidence was poor, with just 7 papers \ndeemed to be of high quality with a low risk of bias. \nEthics Committee Approval: Not required \nFunding for this study: No funds \nAuthor Disclosures: \nZain Ahmed: Nothing to disclose \nAlberto Antonietti: Nothing to disclose \nMarco Covani: Nothing to disclose \nMartin Malina: Nothing to disclose \nParul Kalia: Nothing to disclose \nLorenzo Patrone: Consultant: Abbott, Terumo, Pathfinder Medical, Shockwave \nDaoud Akhtar: Nothing to disclose \n \nRPS 515-5 \nComparative diagnostic role of CTA vs NC-MRA in CVA patients \n*R. Rastogi*, S. Parashar, N. Jain, V. Pratap; Moradabad/IN \n(rajulrst@yahoo.co.in) \n \nPurpose: Cerebrovascular accidents (CVA) are a major cause of mortality and \nmorbidity in middle and elderly age groups. It can be ischemic or hemorrhagic \nand thrombotic or embolic. Digital subtraction angiography (DSA) is a gold \nstandard investigation for evaluating patients with CVA. Due to the invasive \nnature of DSA, computed tomography angiography (CTA) has long been used \nas a primary noninvasive imaging tool to evaluated patients with CVA. \nAngiography can also be performed with magnetic resonance imaging, both \nwith & without contrast. Introduction: CTA serves as a primary noninvasive \nimaging tool in evaluation of patients with CVA as nearly half of these patients \ndo not have treatable underlying cause. Due to increasing awareness \nregarding the radiation exposure, contrast-induced nephrotoxicity and iodine \nsensitivity, magnetic resonance angiography (MRA) is gaining more and more \nattention. Noncontrast MRA (NC-MRA) can be performed utilizing 3D-time of \nflight sequence which provides results comparable to that of CTA. Hence, we \nperformed a study to evaluate comparable role of NC-MRA and CTA . \nMethods or Background: Fifty patients with cerebrovascular accidents were \nevaluated with CTA & NC-MRA in tandem on the same day. The results \nobtained were statistically evaluated and conclusions were drawn. \nResults or Findings: Detection of aneurysm in intracranial and stenoses in \nintracranial as well as extracranial vessels can be detected with good accuracy \nby NC-MRA. The results of NC-MRA was comparable to that obtained by CTA \nexcept in very small aneurysm (<3mm) and early stenosis (20-30%) which \nrarely affect immediate patient management. \nConclusion: MRA is comparable in accuracy to CTA in detection of clinically-\nsignificant ICA stenosis as well as in detecting occlusive disease of intracranial \narteries. Hence, NC-MRA can be a good substitute to CTA. \nLimitations: 1.5T MR scanner \nSmall sample volume \nEthics Committee Approval: Approved \nFunding for this study: None \nAuthor Disclosures: \nNeha Jain: Nothing to disclose \nRajul Rastogi: Nothing to disclose \nSagar Parashar: Nothing to disclose \nVijai Pratap: Nothing to disclose \n \nRPS 515-6 \nAssociation between PET functional imaging and CT/MR morphological \nfindings at CT/MR imaging at baseline and during follow-up in patients \naffected by large vessel vasculitis \n*M. Ferrari*, F. Monelli, G. Besutti, L. Spaggiari, F. Muratore, C. Salvarani,  \nP. Mancuso, P. Giorgi Rossi, P. Pattacini; Reggio Emilia/IT \n(m21011990@gmail.com) \n \nPurpose: To evaluate the association between baseline PET uptake and \nMR/CT contrast-enhanced angiography findings (aneurysmal dilatations, \nstenosis and arterial wall thickening) present at baseline or appeared after at \nleast 6 months follow-up, in patients with giant cell (GCA) or Takayasu arteritis \n(TA). The association between baseline thickening and appearance of \nstenosis/dilatations was also evaluated. \nMethods or Background: All consecutive GCA or TA patients who \nsimultaneously performed PET and CT or MR (<6 months distance) were \nincluded. Images were retrospectively reviewed to assess, for each of 12 \nvascular segments, stenosis (<50%/50-74%/>75%), dilatations \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 302  \n(absence/presence), thickening (3mm/4mm/>4mm), and PET uptake (0-3, with \ngrade>2 indicating active disease). Follow-up CT/MR examinations performed \n6 to 30 months after baseline PET were also reviewed. \nResults or Findings: Ninety-eight patients were included (age 57±18,8 years, \n81% females, 55 TA and 43 GCA), for a total of 1176 arterial segments. For 31 \npatients, a follow-up CT/MR was available. Baseline PET uptake showed weak \nor no association with baseline stenosis (p=0.19) and dilatations alone \n(p=0.37), when considering stenosis and/or dilatations a borderline significant \nassociation was observed (stenosis/dilatation in 9% PET inactive vs 15% in \nPET active segments, p=0.08); while it was highly associated with baseline \nthickening (thickening in 15% PET inactive vs 32% in PET active segments, \np<0.001). Baseline PET uptake was associated with appearance at follow-up \nof stenosis and/or dilatations (1,5% vs 11% stenosis/dilatations in PET inactive \nvs active segments, p=0.003). Baseline thickening was not associated with \nfollow-up appearance of stenosis and/or dilatations (p=0.78). \nConclusion: PET uptake is highly associated with CT/MR arterial wall \nthickening at baseline. Baseline PET uptake, but not thickening, may predict \nmorphological vascular changes during follow-up. \nLimitations: Further analyses are necessary to evaluate the association of \nimaging findings with clinical outcomes. \nEthics Committee Approval: AVEN number:724/2020 \nFunding for this study: None. \nAuthor Disclosures: \nFrancesco Muratore: Nothing to disclose \nLucia Spaggiari: Nothing to disclose \nPierpaolo Pattacini: Nothing to disclose \nFilippo Monelli: Nothing to disclose \nMarco Ferrari: Nothing to disclose \nCarlo Salvarani: Nothing to disclose \nPamela Mancuso: Nothing to disclose \nPaolo Giorgi Rossi: Nothing to disclose \nGiulia Besutti: Nothing to disclose \n \n \nResearch Presentation Session: Oncologic \nImaging \nRPS 316 \nGastrointestinal oncology \nRPS 316-1 \nAnalysis of main preoperative prognostic factors in locally advanced \nrectal cancer: an essential role of the EMVI \n*B. Desana*, A. Balbo-Mussetto, G. Gallo, E. Soncin, D. Molinar, A. Macera,  \nA. Fornari, M. Petracchini, S. Cirillo; Turin/IT  \n(benedetta.desana@me.com) \n \nPurpose: Treatment of locally advanced rectal cancer foresees neoadjuvant \nchemo-radiotherapy, followed by radical surgery. Based on outcome of \nhistological examination, patients are then subjected to adjuvant \nchemotherapy. With this approach there is little control over the development \nof metachronous metastases. Clinical and Magnetic Resonance (MR) data \nhave been analyzed in order to identify the most important presurgical \nprognostic factor. \nMethods or Background: Data of fifty-nine consecutive patients who \nperformed a staging MR for rectal cancer have been retrospectively evaluated. \nAfter neoadjuvant therapy, all of them underwent surgery with curative intent \nand were monitored for at least two years through clinical-instrumental follow-\nup. Univariate and multivariate analyses using COX model were performed in \norder to identifying the main risk factors for the development of metachronous \nmetastases. Kaplan-Meier analysis was made to evaluate the cumulative \nincidence of metastases between different groups. A ROC (Relative Operating \nCharacteristics) curve was executed to compare the most relevant parameters \nof MR and Pathological Anatomy (PA). \nResults or Findings: Metachronous metastases appeared in 17/59 patients. \nUnivariate analyses demonstrated the statistically significant relevance of \nparameters like extra-mural vascular invasion in MR (mrEMVI; HR=4.06, \np=0.009) and in PA (pEMVI; HR=5.74; p=0.003), positivity of lymphnodes \n(HR=10.16, p<0.001) and radial margins infiltration (HR=13.42, p<0.001) at \nhistological examination. Multivariate analysis of MRI parameters showed an \nincreased risk of significant metastasis only in mrEMVI positive patients \n(HR=3.195, p 0.045). The difference between EMVI-related ROC curves in \nMRI and AP was not statistically significant (p=0.2904). \nConclusion: EMVI currently appears to be early prognostic factor that best \npredicts the risk of metachronous metastasis. In anticipation of new presurgical \npersonalized therapies it could be used as a benchmark for choosing the most \nappropriate approach. \nLimitations: Low sample quantity. \nEthics Committee Approval: Ethical committee approval was obtained. \nFunding for this study: No founding. \nAuthor Disclosures: \nBenedetta Desana: Nothing to disclose \nDaniela Molinar: Nothing to disclose \nEnrico Soncin: Nothing to disclose \nMassimo Petracchini: Nothing to disclose \nAnnalisa Balbo-Mussetto: Nothing to disclose \nStefano Cirillo: Nothing to disclose \nAlberto Fornari: Nothing to disclose \nGiulia Gallo: Nothing to disclose \nDear Annalisa Macera: Nothing to disclose \n \nRPS 316-2 \nRadiomic analysis performed on 68Ga-DOTANOC PET/CT allows \ndiscriminating primary pancreatic neuroendocrine tumour grading \nA. Bevilacqua, D. Calabrò, *S. Malavasi*, C. Ricci, R. Casadei, D. Campana, \nS. Fanti, V. Ambrosini; Bologna/IT  \n(s.malavasi@unibo.it) \n \nPurpose: To evaluate the effectiveness of radiomic features (RFs) computed \non 68Ga-DOTANOC PET/CT to discriminate grade 1 (G1) and grade 2 (G2) \npancreatic neuroendocrine tumours (panNET). \nMethods or Background: Twenty-eight patients with primary panNET \n(M:F=13:15; mean age: 56 years old [17-78]; G1=13, G2=15) whose grading \nwas assessed after surgical excision were enrolled in this study. First and \nsecond-order RFs were computed on the standardized uptake value (SUV) \nmaps pertaining to the whole lesion. 1770 coupled texture RFs initially were \nconsidered, but those with a high correlation were subsequently discarded. \nThe linear discriminant analysis was used on the remaining couples to build as \nmany discriminative radiomic models (RMs), and their discrimination capability \nwas assessed using two-tail Wilcoxon rank-sum test on the RF space and the \nBonferroni correction (p-value=0.001). The Area under the curve (AUC) of the \nreceiver operating characteristic (ROC) was used to assess RM performances, \ntogether with sensitivity, specificity and accuracy. The best RM was selected \nas that showing the lowest p-value and the highest AUC. \nResults or Findings: The RF couple made of first-order skewness and \nsecond-order sum entropy shows the highest significant performance (p-\nvalue=0.0003) with sensitivity=93%, specificity=85%, accuracy=89%, achieved \nwith 2 false positive and 1 false negative. \nConclusion: The radiomic model identified shows a high statistical \nsignificance in discriminating G2 from G1 primary panNET and it is promising \nfor the validation step. This preliminary study suggests that the texture-based \nRFs computed on 68Ga-DOTANOC PET/CT could represent a valid tool for \ntumour grade assessment, potentially useful in panNET not amenable to \nbiopsy before surgery. \nLimitations: The limited number of sample size. \nEthics Committee Approval: 164/2017/O/Oss \nFunding for this study: Not applicable \nAuthor Disclosures: \nDiletta Calabrò: Nothing to disclose \nDavide Campana: Nothing to disclose \nSilvia Malavasi: Nothing to disclose \nRiccardo Casadei: Nothing to disclose \nValentina Ambrosini: Nothing to disclose \nStefano Fanti: Nothing to disclose \nClaudio Ricci: Nothing to disclose \nAlessandro Bevilacqua: Nothing to disclose \n \nRPS 316-3 \nIdentifying high-risk colon cancer on CT: can a radiomics signature \nimprove radiologist’s performance for T staging? \n*E. K. Hong*¹, Z. Elkarghali¹, F. Landolfi¹, N. Bogveradze¹, P. Bos¹, S. J. Park², \nJ. M. Lee², R. G. H. Beets-Tan¹; ¹Amsterdam/NL, ²Seoul/KR \n(amyh0803@gmail.com) \n \nPurpose: To assess the role of radiomics in detection of high-risk (pT3-4) \ncolon cancer and develop a combined model that combines both radiomics \nand CT staging of colon cancer. \nMethods or Background: We included 292 colon cancer patients who \nunderwent pre-operative CT and primary surgical resection within two months. \nThree-dimensional segmentations and CT staging of primary colon tumours \nwere done. From each 3D segmentation of colon tumour, radiomic features \nwere automatically extracted. Logistic regression analysis was performed to \nidentify associations between radiomic features and high-risk (pT3-4) colon \ntumours. A combined model that integrated both radiomics and CT staging was \ndeveloped and their diagnostic performance was compared with that of \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 303  \nconventional CT staging. 10-fold cross-validation was used to validate the \nperformance of the model and CT staging. \nResults or Findings: The model that combined radiomic features and CT \nstaging demonstrated a significantly better performance in detection of high-\nrisk colon tumours in training set (AUC = 0.799, 95% CI: 0.720 – 0.839 for \ncombined model and AUC = 0.697, 95% CI = 0.538 – 0.756 for CT staging \nonly, p < 0.001 for difference). Cross-validation results also demonstrated \nsignificantly better detection performance of combined model (AUC = 0.727, \n95% Confidence Interval (CI): 0.621 – 0.777 for combined model and AUC = \n0.628, 95% CI = 0.558 – 0.689 for CT staging only, Boot CI = 0.099). \nConclusion: CT radiomic features of primary colon cancer, combined with CT \nstaging, can improve the detection of high-risk colon cancer patients. \nLimitations: Tumour segmentations were manually done by 3 radiologists. \nEthics Committee Approval: This is a retrospective study and local \ninstitutional boards from two tertiary centers approved and waived the \nrequirement for informed consent. \nFunding for this study: None \nAuthor Disclosures: \nZuhir Elkarghali: Nothing to disclose \nSae Jin Park: Nothing to disclose \nJeong Min Lee: Nothing to disclose \nEun Kyoung Hong: Nothing to disclose \nRegina G. H. Beets-Tan: Nothing to disclose \nFederica Landolfi: Nothing to disclose \nNino Bogveradze: Nothing to disclose \nPaula Bos: Nothing to disclose \n \nRPS 316-4 \nRadiomic analysis could allow detecting misassigned bioptic grading \nwhen discriminating G1 and G2 primary pancreatic neuroendocrine \ntumours imaged with 68Ga-DOTANOC PET/CT \n*S. Malavasi*, D. Calabrò, A. Bevilacqua, C. Ricci, R. Casadei, D. Campana, \nS. Fanti, V. Ambrosini; Bologna/IT \n(s.malavasi@unibo.it) \n \nPurpose: Evaluating whether radiomic analysis applied to 68Ga-DOTANOC \nPET/CT examinations could allow detecting misassigned bioptic grading, when \ndiscriminating grade 1 (G1) and grade 2 (G2) pancreatic neuroendocrine \ntumours (panNET). \nMethods or Background: Thirty-three patients with low grade primary \npanNET assessed through pathological bioptic samples underwent 68Ga-\nDOTANOC PET/CT. Seven lesions with volume lower than 1cm3 were \nexcluded from the study and standardized uptake value (SUV) maps were \nextracted for the remaining twenty-six patients (M:F=11:15; mean age:64 y.o. \n[48-85]; G1:G2=18:8). 60- first and second-order radiomic features (RFs) were \ncomputed on SUV maps of the whole tumour volume, discarding those \nshowing high linear correlation. A discriminative radiomic model (RM) was \ngenerated for each of the surviving RFs. The area under the curve (AUC) were \ncomputed on the receiver operating characteristic curve. To evaluate models’ \ndiscrimination capability, the two-tail Wilcoxon rank-sum test was applied (p-\nvalue”0.05) on the features space and the RF with the lowest p-values and the \nhighest AUC were selected. \nResults or Findings: The best performing RM is based on second-order \ncorrelation which provides a significant (p-value=0.028) separation between G2 \nand G1 panNET, with AUC=0.78, sensitivity=88%, specificity=78%, \naccuracy=81%. More importantly, the only FN is a lesion with borderline ki67=3 \nindex, detected as FN in all the other RMs, this leading to questioning if it was \ncorrectly discriminated by the bioptical sample examination. \nConclusion: This preliminary study showed that this single RF well \ndiscriminates low grade panNET. Considering that tumour grade based on \nbioptical samples is not representative of the entire lesion, RFs may be used \nas tool to overcome this limitation, assigning a correct grade in all patients, \nespecially in cases with borderline ki67. \nLimitations: Reduced patients’ sample size and lack of grading assessment \non tumour surgically excided. \nEthics Committee Approval: 164/2017/O/Oss \nFunding for this study: Not applicable \nAuthor Disclosures: \nDiletta Calabrò: nothing to disclose \nDavide Campana: Nothing to disclose \nSilvia Malavasi: Nothing to disclose \nRiccardo Casadei: Nothing to disclose \nValentina Ambrosini: Nothing to disclose \nStefano Fanti: Nothing to disclose \nClaudio Ricci: Nothing to disclose \nAlessandro Bevilacqua: Nothing to disclose \n \n \n \n \nRPS 316-5 \nPET/MRI for the preoperative diagnosis and staging of peritoneal \ncarcinomatosis: a prospective multireader study \n*N. Vietti Violi*¹, S. Gavane², P. Argiriadi², A. Law², S. Heiba², E. Bekhor²,  \nJ. S. Babb², D. Labow², B. Taouli²; ¹Lausanne, VD/CH, ²New York, NY/US \n(nviettivioli@gmail.com) \n \nPurpose: To assess the diagnostic performance of FDG-PET/MRI for \ndiagnosis and staging of peritoneal carcinomatosis (PC) using surgical \nSugarbaker’s PCI (PC index) as the reference. \nMethods or Background: 14 adult patients (mean age:57±12y) with PC were \nprospectively included in 2016-2018 in a single center. They underwent \nPET/MRI prior to surgery (14d, range:1-63d) that were reviewed independently \nby 2radiologists and 2nuclear medicine physicians. According to surgical PCI, \nthe abdomen was divided in 13regions, scored 0-3 according to tumor burden. \nEach region score was summed to reach PCI (0-39). Radiologists read 2sets \nseparated by 6w: 1)T2wi+DWI, and 2)T2wi+contrast-enhanced sequences. \nNuclear medicine physicians read images based on PET images+T2wi. Hybrid \nPET/MRI PCI was created by combining the data. Inter-reader agreement was \nmeasured using weighted-kappa. For each set, radiological PCI was compared \nto the surgical PCI on a per-patient and per-region basis using generalized \nestimating equations based on logistic regression. \nResults or Findings: Mean surgical PCI was 10±8 [range 0-24,PCI \n0(n=2),PCI 1-10(n=8),PCI 11-19(n=1),PCI 20-24(n=3)]. Interreader agreement \nwas almost perfect for all sets for PCI (Kappa:0.81-0.98). Per-patient pooled \nsensitivity, specificity, accuracy were 75%(18/24), 50%(2/4), 71.4%(20/28) for \nMRI; 66.7%(16/24), 50%(2/4), 64.3%(18/28) for PET and 91.7%(22/24), \n50%(2/4), 85.7%(24/28) for PET/MRI, without statistical difference. MRI and \nPET/MRI achieved 100% sensitivity and specificity for cutoff PCI of 20. Per-\nregion sensitivity, specificity, accuracy were 37%(54/146), 78.4%(171/218), \n61.8%(225/364) for MRI, 17.8%(26/146), 95%(207/218), 64.3%(234/364) for \nPET and 52.7%(77/146), 66.5%(145/218), 60.4%(220/364) for PET/MRI, with \nstatistical difference between sets for sensitivity (p:0.001–0.035) and specificity \n(p<0.001). \nConclusion: PET/MRI improves sensitivity and accuracy for PC detection on \nper-patient basis, and has high diagnostic performance in patients with high \ntumor burden. The performance of PET/MRI is lower per-region. \nLimitations: This study is limited by its small sample size. \nEthics Committee Approval: Local ethics committee approved the study. \nFunding for this study: No funding. \nAuthor Disclosures: \nAmy Law: Nothing to disclose \nJames S Babb: Nothing to disclose \nSherif Heiba: Nothing to disclose \nNaik Vietti Violi: Nothing to disclose \nBachir Taouli: Nothing to disclose \nEliahu Bekhor: Nothing to disclose \nPamela Argiriadi: Nothing to disclose \nDaniel Labow: Nothing to disclose \nSomali Gavane: Nothing to disclose \n \nRPS 316-6 \nPET/MRI for M-staging of rectal cancer: a primary economic evaluation \n*F. G. Gassert*¹, J. Rübenthaler¹, F. T. Gassert¹, M. R. Makowski¹,  \nS. O. Schönberg², M. F. Froelich²; ¹Munich/DE, ²Mannheim/DE \n \nPurpose: Correct identification of the TNM state in primary staging of rectal \ncancer has critical implications on patients’ management. Initial evaluations \nrevealed a high sensitivity and specificity for whole body (wb) PET/MRI in \ndetection of metastasis allowing the application of local ablative techniques. \nNevertheless, cost-effectiveness compared to standard procedure using pelvic \nMRI + chest and abdominopelvic CT (SCI) is yet to be investigated and \ntherefore was aim of this study. \nMethods or Background: A decision model including the diagnostic \nmodalities wbPET/MRI and SCI was created based on Markov simulations \nestimating lifetime costs and quality-adjusted life years (QALYs). Deterministic \nsensitivity of diagnostic parameters and costs was determined and probabilistic \nsensitivity analysis using Monte-Carlo Modelling was applied. \nResults or Findings: In the base-case scenario, the strategy wbPET/MRI \nresulted in total costs of $ 52,186 whereas total costs of SCI were at $ 51,672. \nWbPET/MRI resulted in an expected effectiveness of 3.542 QALYs versus \n3.535 QALYs for SCI.&nbsp;This resulted in an incremental cost-effectiveness \nratio of $ 70,291 per QALY for PET/MRI. Therefore, from an economic point of \nview wbPET/MRI was identified as an adequate diagnostic alternative to SCI. \nConclusion: Based on the results of the analysis use of wbPET/MRI was \nidentified as a feasible diagnostic strategy for initial staging of rectal cancer \nfrom a cost-effectiveness perspective. \nLimitations: Regarding limitations, our Markov-model does not differ between \nlocal tumor-states as this would outrange the scope of this study. Additionally, \nwe assumed biopsy to be performed in approximately two third of unclear \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 304  \ncases in SCI. Although this number may vary in clinical practice, sensitivity \nanalysis showed high robustness of results to variation of input parameters. \nEthics Committee Approval: Not applicable. \nFunding for this study: No funding was received. \nAuthor Disclosures: \nFlorian Tilman Gassert: Nothing to disclose \nStefan Oswald Schönberg: Nothing to disclose \nMatthias Frank Froelich: Nothing to disclose \nMarcus R. Makowski: Nothing to disclose \nFelix Gerhard Gassert: Nothing to disclose \n Johannes Rübenthaler: Nothing to disclose \n \nRPS 316-7 \nCT for lymph node staging of colon cancer: not only size but also \nlocation and number of lymph node count \n*E. K. Hong*¹, F. Landolfi¹, F. Castagnoli¹, S. J. Park², J. M. Lee²,  \nR. G. H. Beets-Tan¹; ¹Amsterdam/NL, ²Seoul/KR \n(amyh0803@gmail.com) \n \nPurpose: To evaluate the diagnostic accuracy of imaging features to predict \nlymph node status of colon cancer using CT. \nMethods or Background: 317 Colon cancer patients who underwent primary \nsurgical treatment were included. The number of lymph nodes according to the \nanatomical location, size, cluster, degree of attenuation, shape, presence of \ninternal heterogeneity and irregular outer border of the lymph node were \nassessed and compared according to histological lymph node status. \nResults or Findings: The largest short diameter of lymph node and presence \nof internal heterogeneity of lymph node showed significant association with \nmalignant lymph node status (P<0.001 and P=0.041, respectively). The ROC \ncurve analysis revealed AUC of 0.703 for the largest short diameter of lymph \nnode (P<0.001), and AUC of the presence of internal heterogeneity was 0.630 \n(P<0.001). In addition, our study showed that a total number of lymph nodes, \nregardless of size, (P=0.022) and number of lymph nodes in the peritumoral \narea (P<0.001) and along the mesenteric vessels (P<0.001) on CT \ndemonstrated significant association with malignant status of lymph nodes in \ncolon cancer. \nConclusion: There were significant associations between lymph node status \nand imaging features of lymph nodes on CT in colon cancer patients. The \nlargest short diameter of lymph node and presence of internal heterogeneity \ncan be effectively used to predict the malignant status of lymph node in colon \ncancer patients. Also, the number of lymph nodes near the colonic tumor \nshould be considered in the assessment of colon cancer lymph node \ninvolvement on CT. \nLimitations: This study was limited by a lack of lesion based assessment of \nradiologic-pathologic data. \nEthics Committee Approval: This was a retrospective study. Institutional IRB \napproved the study and waived informed consent. \nFunding for this study: None \nAuthor Disclosures: \nFrancesca Castagnoli: Nothing to disclose \nSae Jin Park: Nothing to disclose \nJeong Min Lee: Nothing to disclose \nEun Kyoung Hong: Nothing to disclose \nRegina G. H. Beets-Tan: Nothing to disclose \nFederica Landolfi: Nothing to disclose \n \nRPS 316-8 \nComparing PET-derived semiquantitative parameters and radiomic \nfeatures in discriminating G1 and G2 primary pancreatic neuroendocrine \ntumours in 68Ga-DOTANOC PET/CT \n*S. Malavasi*, D. Calabrò, A. Bevilacqua, C. Ricci, R. Casadei, D. Campana, \nS. Fanti, V. Ambrosini; Bologna/IT \n(s.malavasi@unibo.it) \n \nPurpose: To assess whether PET-derived semiquantitative parameters \n(PDSPs) extracted from 68Ga-DOTANOC PET/CT and single radiomic \nfeatures (RFs) can differentiate low grade pancreatic neuroendocrine tumour \n(panNET). \nMethods or Background: 13 patients with G1 and 15 with G2 primary \npanNET demonstrated by pre-surgical 68Ga-DOTANOC PET/CT were \nincluded in this study (M:F=13:15; mean age: 56 years old [17-78]). Tumour \ngrading was assessed after surgical excision evaluation. Total lesion \nreceptorial expression (TLRE), Receptorial tumour volume (RTV), and \nSUVmax were analysed together with 60 first and second-order RFs computed \non standardized uptake value (SUV) maps of the primary lesion whole volume. \nTo prevent overfitting, only single RF were considered to generate \ndiscriminative radiomic models, where linearly correlated RFs were removed. \nDiscrimination capability was assessed through the two-tail Wilcoxon rank-sum \ntest with Bonferroni correction (p-value<0.0031). Receiver operating \ncharacteristic and area under the curve (AUC) were computed. Features with \nthe lowest p-values and highest AUC were selected. \nResults or Findings: RTV is the only PDSP yielding a significant separation \n(p-value=0.03) between G2 and G1 panNET patients (Sensitivity=67%, \nSpecificity=92%, Accuracy=79%). Indeed, SUVmax (Sensitivity=93%, \nSpecificity=38%, Accuracy=68%, p-value=0.71) and TLRE (Sensitivity=87%, \nSpecificity=54%, Accuracy=71%, p-value=0.20) were not significant and led to \nworse performance, accordingly. On the contrary, the first-order kurtosis \nprovided the best performance (p-value=0.0009) at all, with Sensitivity=93%, \nSpecificity=77%, Accuracy=86%. \nConclusion: Despite PDSPs are more easily accessible by clinicians, RFs \nproved to be more accurate in discriminating tumour grading in well-\ndifferentiated panNETs. The use of this radiomic model, if validated on a larger \npopulation, could represent a novel non-invasive approach to avoid biopsy \nbefore surgery, especially in selected patients not amenable to biopsy or with \npoor health conditions. \nLimitations: Reduced patients’ sample size. \nEthics Committee Approval: 164/2017/O/Oss \nFunding for this study: Not applicable \nAuthor Disclosures: \nDiletta Calabrò: Nothing to disclose \nDavide Campana: Nothing to disclose \nSilvia Malavasi: nothing to disclose \nRiccardo Casadei: nothing to disclose \nValentina Ambrosini: Nothing to disclose \nStefano Fanti: Nothing to disclose \nClaudio Ricci: Nothing to disclose \nAlessandro Bevilacqua: Nothing to disclose \n \nRPS 316-9 \nThe use of Lipiodol in hepatocellular carcinoma: multipotent applicability \nor common contrast media? \n*M. C. Langenbach*¹, T. J. Vogl², J-E. Scholtz², L. Basten², R. Hammerstingl², \nT. Gruber-Rouh²; ¹Cologne/DE, ²Frankfurt a. Main/DE \n(marcel.langenbach@me.com) \n \nPurpose: To evaluate the potentials of Lipiodol in diagnosis, therapy and \noutcome-to-therapy prediction of hepatocellular carcinoma (HCC) beyond the \nestablished application as a lesion-visualizer, drug carrier and micro-embolic \nagent. \nMethods or Background: In total, 250 patients with HCC were evaluated \nregarding the potentials of Lipiodol. First, 60 patients with hepatic LI-RADS 3 \nand 4 lesions in MRI received a Lipiodol angiography directly followed by an \nunenhanced CT to identify enhancement patterns allowing a differentiation of \nbenign vs. malign lesions. Second, 204 patients with HCC suspicious liver \nlesions underwent a CT-guided biopsy, 67 unenhanced, 26 with i.v. contrast, \nand 96 with prior Lipiodol marking of the suspected lesion. Third, 30 patients \nwith secured HCC received a Lipiodol-based cTACE. Enhancement patterns in \nangiography and CT were analyzed regarding the outcome prediction. \nResults or Findings: Lipiodol shows potential benefits for all steps in tumor \ndiagnosis and treatment. Clearly detectable lesions in Lipiodol-based \nangiography with a homogeneous or lacunar enhancement in post-\nangiographic CT allow for differentiation of LI-RADS 3 and 4 lesions as malign \n(sensitivity 86.1%, specificity 100%). The lesion hitting rate was significantly \nbetter for lesions prior marked with Lipiodol compared to i.v. contrast or \nunenhanced lesions (78.6% vs. 73.2% vs. 65.2%, overall 72.2%, p=0.038), this \nbenefit is increased in small lesions and cirrhotic liver. Therapy monitoring \nduring cTACE is possible, strong enhancing, hypervascularized lesions show a \nsignificant better response (p=0.008; rho=0.475) allowing an early adaption of \nthe therapy protocol. \nConclusion: Use of Lipiodol beyond the role for TACE might be beneficial in \nseveral steps of diagnosis and treatment of HCC for selected patients: in \ndifferentiation of LI-RADS 3/4 lesions in benign vs. malign, in CT-guided \nbiopsies, and in therapy outcome prediction of cTACE during treatment. \nLimitations: Retrospective \nEthics Committee Approval: Approved \nFunding for this study: Research grant (Guerbet) \nAuthor Disclosures: \nLajos Basten: Nothing to disclose \nJan-Erik Scholtz: Nothing to disclose \nRenate Hammerstingl: Nothing to disclose \nTatjana Gruber-Rouh: Nothing to disclose \nThomas J. Vogl: Nothing to disclose \nMarcel Christian Langenbach: Research/Grant Support: Guerbet GmbH \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 305  \n \nResearch Presentation Session: Oncologic \nImaging \nRPS 416 \nGenitourinary oncology \nRPS 416-2 \nThe value of radiomic features extracted from preoperative contrast-\nenhanced computed tomography (CECT) in predicting tumor mutation \nburden (TMB) of bladder cancer patients \n*X. Tang*, W-F. Yan, Y-l. Gong, Z-G. Yang; Chengdu/CN  \n \nPurpose: Tumor mutation burden (TMB) is an emerging biomarker for \npredicting the response of immunotherapy in bladder cancer (BLCA). We aim \nat investigating the value of radiomic features in predicting the TMB status of \nBLCA patients. \nMethods or Background: Totally, 75 patients with BLCA were enrolled. \nRadiomic features extracted from volume of interest of preoperative contrast-\nenhanced computed tomography (CECT) were obtained in each case. \nUnsupervised hierarchical clustering analysis was performed based on the \nradiomic profile. Logistic regression and least absolute shrinkage and selection \noperator (LASSO) regression analysis were used to test each feature’s power \nin TMB-prediction. Finally, a TMB-predicting model was established using \nradiomic features. \nResults or Findings: The hierarchical clustering analysis divided the total \ncohort into group A (32.0%, 24/75) and group B (68.0%, 51/75) with high \nradiomic similarity within each group while distinct radiomic profile between \ngroups. Patients in group A had significantly higher proportion of high TMB \nagainst those in group B (66.7% [16/24] vs. 41.2% [21/51], p=0.039). TMB \nregarded as a continuous factor was also higher in group A than group B \n(median TMB: 8.32 vs. 4.97 mut/Mb, p=0.049). Based on five radiomic features \nselected by logistic and LASSO regression, a TMB-predicting model was built \nand evaluated using different approaches which revealed the good \nperformance of the model. \nConclusion: We firstly explored the connection between radiomics and TMB in \nBLCA and found that radiomic features from preoperative CECT can \nsatisfactorily predict TMB status. Our findings will facilitate doctors in decision-\nmaking of TMB test in BLCA patients. \nLimitations: This is a retrospective study with small sample size. \nEthics Committee Approval: No ethical approval or informed consent was \nneeded for this study because all patients’ data from TCIA and TCGA \ndatabases were publicly and freely available. \nFunding for this study: Not applicable \nAuthor Disclosures: \nXin Tang: Nothing to disclose \nYou-ling Gong: Nothing to disclose \nWei-Feng Yan: Nothing to disclose \nZhi-Gang Yang: Nothing to disclose \n \nRPS 416-3 \nDiagnostic imaging approach to retroperitoneal lesions \n*S. Nagarajan*, D. Jagannathan, G. Kathirvelu, K. Geetha; Chennai/IN  \n(cbesuriya@gmail.com) \n \nPurpose: To illustrate and classify the different types of retroperitoneal masses \nand their imaging features. To give a systematic approach to identifying and \nclassifying primary retroperitoneal masses. Identify the imaging findings and its \ncorrelate with the HPE findings. \nMethods or Background: Retroperitoneum is a compartmentalized space \nbounded anteriorly by posterior parietal peritoneum and posteriorly by \ntransversalis fascia extending from diaphragm superiorly to pelvic brim \ninferiorly. The abdominal retroperitoneum is divided by fascial planes into the \nanterior and posterior pararenal spaces and perirenal space. \nResults or Findings: IMAGING APPROACH CT and MR imaging can \ndemonstrate important characteristics of retroperitoneal tumors. Step 1: Intra or \nRetroperitoneal - Beak sign, Embedded organ sign, Displacement of bowel \nloops. Step 2: Classification of retroperitoneal masses into primary and \nsecondary masses. Step 3: Assessment of the tumor - Tumor \ncomposition(fat,cyst,solid,calcification), Vascularity(hypervascular/moderately \nvascular/hypovascular), Location. Step 4: Extent of the tumor for biopsy and \nsurgical planning. SAMPLE CASES 1. Castlemans Disease 2. Paraganglioma \n3. Primitive Neuroectodermal Tumor 4. Retroperitoneal Lymphoma 5. \nRetroperitoneal Necrotic Lymphadenopathy 6. Retroperitoneal \nLeiomyosarcoma 7. Retroperitoneal Lipomatosis 8. Undifferentiated \nPleomorphic Sarcoma 9. Aggressive Fibromatosis 10. Liposarcoma 11. Mature \nTeratoma 12. Ganglioneuroma 13. Retroperitoneal Metastasis From Serous \nPapillary Carcinoma Of Ovary 14. Erdheim Chester Disease 15. Myxoid \nLiposarcoma \nConclusion: CT and MRI can contribute to tumor diagnosis, though \nhistological confirmation is often required because of the considerable overlap \nof imaging features. Attention to diagnostic clues is essential in making an \naccurate radiologic diagnosis or narrowing the differential diagnosis and in \nobtaining clinically significant information. Cross-sectional imaging is key to the \npre-operative staging and planning of retroperitoneal masses. Imaging also \nhelps to select and guide the site to biopsy from these usually large and \nheterogeneous neoplasms. \nLimitations: Not Applicable \nEthics Committee Approval: Not Applicable \nFunding for this study: Not Applicable \nAuthor Disclosures: \nSuriyaprakash Nagarajan : \nK Geetha: nothing to disclose \nGopinathan Kathirvelu: Nothing to disclose \nDevimeenal Jagannathan: Nothing to disclose \n \nRPS 416-4 \nAdded value of MRI for extraperitoneal findings in potential CRS-HIPEC \ncandidates: seeing the whole picture \n*I. Van'T Sant-Jansen*, E. Nerad, C. Rijsemus, M. P. Engbersen,  \nD. M. J. Lambregts, R. G. H. Beets-Tan, A. Aalbers, N. Kok, M. J. Lahaye; \nAmsterdam/NL \n \nPurpose: In colorectal cancer patients the selection of suitable cytoreductive \nsurgery and hyperthermic peritoneal chemotherapy (CRS-HIPEC) candidates \nis based on the location and extent of peritoneal metastases (PM) and the \npresence of extraperitoneal metastases. MRI is increasingly being used to \nassess the extent of PM, however, the significance of extraperitoneal findings \nin these scans has never been evaluated before. \nMethods or Background: Colorectal cancer patients who had undergone an \nadditional MRI scan after standard diagnostic work-up with CT for preoperative \nstaging between January 2016-January 2020 were selected. CT and MRI \nreports were reviewed for new extra-peritoneal findings (EPF) on MRI and the \nMRI findings concerning lesions previously indicated as equivocal (uncertain \nbenign/malignant) on CT. Reference standard were surgical results or follow-\nup imaging. \nResults or Findings: In 163 included patients 60 findings (58/163 patients) \nwere noted on MRI: twenty-seven (45%) were new findings and thirty-three \n(55%) were on CT equivocal findings. Of the 33 equivocal findings 25 were \n‘rejected as malignant’, 4 ‘confirmed malignant’, 3 ‘more likely malignant’, and \n1 as ‘less likely malignant’ based on MRI. In 30 patients (18%) a new finding or \nan equivocal finding scored as ‘more likely malignant’ or ‘confirmed malignant’ \non MRI could have contributed to a more complete CRS-HIPEC. CRS-HIPEC \nwas cancelled in three patients (2%) because of EPF on MRI. Six EPF were \nmissed on imaging altogether. \nConclusion: MRI had an added value in more than a third of the patients due \nto extraperitoneal findings that were undetected or indeterminate on CT and \nhad a clinical impact in 20% of the patients. Therefore, MRI seems a logical \naddition to the diagnostic workup of potential CRS-HIPEC candidates. \nLimitations: The retrospective nature of the study. \nEthics Committee Approval: Yes. \nFunding for this study: None. \nAuthor Disclosures: \nMax Lahaye: Nothing to disclose \nElias Nerad: Nothing to disclose \nMaurits Peter Engbersen: Nothing to disclose \nDoenja Marina Johanna Lambregts: Nothing to disclose \nCharlotte Rijsemus: Nothing to disclose \nNiels Kok: Nothing to disclose \nRegina G. H. Beets-Tan: Nothing to disclose \nIris Van'T Sant-Jansen: Nothing to disclose \nArend Aalbers: Nothing to disclose \n \nRPS 416-5 \nFeasibility of ultra-fast dynamic perfusion 18F-NaF PET in prostate \ncancer as enabled by digital photon counting PET/CT \n*K. Binzel*, C. L. Wright, E. Folefac, D. A. Diaz Pardo, D. G. Stover, Y-l. Hsieh, \nM. V. Knopp; Columbus, OH/US \n \nPurpose: To assess the feasibility of ultra-fast frame rate dynamic perfusion of \n18F-NaF PET/CT for patients with advanced prostate cancer. \nMethods or Background: Twenty patients with suspicion of recurrent prostate \ncancer were imaged as part of this initial feasibility and methodology \ndevelopment study. Patients were imaged on a digital photon counting system \n(Philips Vereos) for 15 minutes over a single bed position, beginning at the \ntime of injection of 185MBq 18F-NaF, followed by whole body imaging at 75 \nminutes post-injection. Listmode data from the dynamic acquisition was \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 306  \nreconstructed with time frames of 1, 9, and 15 seconds, in addition to the \nstandard 1 minute per frame. Regions of interest were placed over any \nsuspected bone tumors as well as regions of degenerative changes, blood \npool, and a region of healthy bone. \nResults or Findings: Using the 1 min/frame images for reference, regions of \ninterest were placed in a reliable manner. The ultra-short 1 and 9 sec/frame \ndynamic curves gave exceptionally detailed uptake intensity curves of the \nperfusion in both bone lesions and areas of degenerative changes. The 15 sec \nframe rate can be used to visualize post perfusion phase uptake characteristics \nof each region. \nConclusion: One second per frame image reconstruction of dynamic perfusion \n18F-NaF PET/CT data is consistently achievable even at a low dose of \n185MBq. Quantification of tumor features such as vascularity, perfusion and \nuptake kinetics appear to be robustly and accurately assessable. \nLimitations: Evaluation and further optimization of the count sparse \nreconstruction parameters will improve the quantitative readouts from such \nshort frame time image sets. \nEthics Committee Approval: Performed with approval of University \nInstitutional Review Board \nFunding for this study: ODSA TECH 13-060 (IPP), R01 CA-195513, NCI \n5U24CA180803 grants \nAuthor Disclosures: \nChadwick Lewis Wright: Nothing to disclose \nDayssy A. Diaz Pardo: Nothing to disclose \nKatherine Binzel: Nothing to disclose \nEdmund Folefac: Nothing to disclose \nMichael Vinzenz Knopp: Nothing to disclose \nYu-lung Hsieh: Nothing to disclose \nDaniel G. Stover: Nothing to disclose \n \nRPS 416-6 \nThe prognostic value of radiomics features extracted from computed \ntomography (CT) in patients with localised clear cell renal cell carcinoma \n(ccRCC) after nephrectomy \n*X. Tang*, T. Pang, W-F. Yan, W. Qian, Y-l. Gong, Z-G. Yang; Chengdu/CN \n \nPurpose: Radiomics is an emerging field of quantitative imaging. The \nprognostic value of radiomics analysis in patients with localized clear cell renal \ncell carcinoma (ccRCC) after nephrectomy remains unknown. \nMethods or Background: Computed tomography images of 167 eligible \ncases were obtained from the Cancer Imaging Archive database. Radiomics \nfeatures were extracted from the region of interest contoured manually for each \npatient. Hierarchical clustering was performed to divide patients into distinct \ngroups. Prognostic assessments were performed by Kaplan-Meier curves, \nCOX regression and least absolute shrinkage and selection operator COX \nregression. Besides, transcriptome mRNA data were also included in the \nprognostic analyses. Endpoints were overall survival (OS) and disease-free \nsurvival (DFS). \nResults or Findings: Hierarchical clustering groups from nephrographic \nfeatures and mRNA can divide patients into different prognostic groups while \nclustering groups from corticomedullary or unenhanced phase couldn’t \ndistinguish patients’ prognosis. In multivariate analyses, 7 OS-predicting and 6 \nDFS-predicting features were identified in nephrographic phase. Similarly, 7 \nOS-predictors and 7 DFS-predictors were confirmed in mRNA data. In contrast, \nlimited prognostic features were found in corticomedullary (1 OS-predictor and \n2 DFS-predictors) and unenhanced phase (2 OS-predictors and 2 DFS-\npredictors). Prognostics models combining both nephrographic features and \nmRNA showed improved C-index than any model alone (C-index: 0.943 and \n0.881 for OS- and DFS-predicting, respectively). \nConclusion: We firstly investigated the prognostic significance of preoperative \nradiomics signatures in ccRCC patients. Radiomics features obtained from \nnephrographic phase had stronger predictive ability than features from \ncorticomedullary or unenhanced phase. Multi-omics models combing radiomics \nand transcriptome data could further increase the predictive accuracy. \nLimitations: This is a retrospective study and require further external \nvalidation from other centers. \nEthics Committee Approval: No ethical approval or informed consent was \nneeded because all patients’ data from TCIA and TCGA databases were \npublic. \nFunding for this study: Not applicable. \nAuthor Disclosures: \nWenlei Qian: nothing to disclose \nXin Tang: Nothing to disclose \nYou-ling Gong: Nothing to disclose \nTong Pang: Nothing to disclose \nWei-Feng Yan: Nothing to disclose \nZhi-Gang Yang: Nothing to disclose \n \n \nResearch Presentation Session: Oncologic \nImaging \nRPS 516 \nCT in oncology \nRPS 516-1 \nIncidence, risk factors and CT characteristics of radiation recall \npneumonitis induced by immune checkpoint inhibitor in lung cancer \n*F. Cousin*; Liège/BE  \n \nPurpose: Radiation recall pneumonitis (RRP) is a delayed radiation-induced \nlung toxicity triggered by systemic agents, typically anticancer drugs. Immune \ncheckpoint inhibitors (ICIs) have recently been identified as potential causal \nagents of RRP but its real incidence and potential risk factors remain unknown. \nMethods or Background: Medical records and CTs of patients treated with \nprogrammed death 1 (PD-1) or programmed death ligand 1(PD-L1) inhibitors \nfor advanced lung cancer between 2014 and 2019 at our tertiary center, and \nwho had a previous history of lung irradiation were retrospectively analyzed. \nWe identified RRP as lung CT modifications occurring in the irradiation field > 6 \nmonths after conventionally fractionated radiotherapy completion and >1 year \nafter stereotactic body radiation therapy. Clinical and dosimetric data were \nanalyzed to identify potential risk factors for RRP. \nResults or Findings: Among 348 patients treated with ICIs, data from 80 \neligible patients were analyzed (mean age, 69 years [standard deviation, 8.3]; \n45 men). Fifteen patients (18.8%) presented with RRP. Median time between \nend of radiotherapy and RRP was 450 days (range, 231 – 1859). No risk factor \nwas significantly associated with RRP. ICI-related pneumonitis was associated \nwith RRP in 33.3% of cases (p=0.0021), developing either concomitantly or \nafter RRP. Incidence of grade • 3 pneumonitis in the RRP population was 13.3 \n%. \nConclusion: We demonstrated a high incidence of RRP (18.8%) in our \npopulation of previously irradiated patients treated with ICIs for lung cancer. \nWe identified no risk factors for RRP, but an association was noted between \nRRP and ICI-related pneumonitis. \nLimitations: Retrospective single institution analysis, additional prospective \nstudies with larger sample sizes are required to confirm our observations. RPP \nhas no clear definition in the literature. \nEthics Committee Approval: This study received approval from our \ninstitutional review board. \nFunding for this study: No \nAuthor Disclosures: \nFrancois Cousin: Nothing to disclose \n \nRPS 516-2 \nMultiparametric functional imaging in lung cancer: the importance of \ntumour radiomic heterogeneity beyond FDG PET/CT and lung biopsy \n*T. Polidori*, D. Caruso, G. Guido, E. Lucertini, M. Zerunian, B. Bracci,  \nM. Polici, M. Rossi, A. Laghi; Rome/IT  \n(tiziano.polidori13@gmail.com) \n \nPurpose: [18F]-Fluorodeoxyglucose Positron Emission Tomography-\nComputed Tomography (FDG PET/CT) has a central role in the lung nodules’ \ncharacterization even if, with SUV<2.5, percutaneous CT-guided Lung Biopsy \n(CTLB) is needed to assess nodule nature. In that scenario, CT Texture \nAnalysis (CTTA) could be a non-invasive imaging biomarker. The aim of the \nstudy is to test CTTA ability in differentiating malignant from benign lung \nnodules. \nMethods or Background: Patients that underwent FDG PET/CT followed by \nCTLB between January 2013 and December 2018 were retrospectively \nenrolled. Were included patients with lung nodule SUV<2.5 and histological \ndiagnosis. Exclusion criteria: nodules with SUV>2.5, patients who refused \nCTLB or received oncological treatment before CTLB, indeterminate pathology \nreport, motion artifacts on chest CT. Two radiologists in consensus performed \nCTTA on preliminary CT performed for CTLB with a dedicated software. \nStatistics included a comparison between malignant and benign neoplasms \ndistribution (2-tailed T-test or Mann-Whitney test according to normal/non-\nnormal data distribution), P-values<0.05 were considered significant. CTTA \naccuracy was test with Receiver operating characteristics (ROC) curve. \nResults or Findings: From an initial population of 1178, 46 patients \nencountered inclusion criteria. Pathologist reported 27/46 (59%) with malignant \nand 19/46 (41%) with benign nodules. CTTA showed lower values of Kurtosis \nand higher values of Skewness in malignant lesions (all P ”0.0013 and all \nfiltered TA P<0.024 respectively). ROC curve showed significant AUC for \nKurtosis (P<0.001; AUC 0.654) and Skewness (P<0.001; AUC 0.642) at \nmedium filtration. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 307  \nConclusion: CTTA is a promising radiological tool which may allow the \ncharacterization of benign and malignant lung nodules even in those cases \nwithout an altered glucose metabolism. \nLimitations: Small population sample; only first order texture parameters. \nEthics Committee Approval: This study was approved by our local \ninstitutional review board and written informed consent was obtained from all \nstudy participants. \nFunding for this study: No. \nAuthor Disclosures: \nDamiano Caruso: Nothing to disclose \nMichele Rossi: Nothing to disclose \nMarta Zerunian: Nothing to disclose \nBenedetta Bracci: Nothing to disclose \nTiziano Polidori: Nothing to disclose \nAndrea Laghi: Nothing to disclose \nMichela Polici: Nothing to disclose \nGisella Guido: Nothing to disclose \nElena Lucertini: Nothing to disclose \n \nRPS 516-3 \nSkeletal muscle mass and skeletal muscle radiodensity: two sides of the \nsame medal or two different medals? \n*L. Weerink*¹, B. van Leeuwen², T. Kwee², G. de Bock²; ¹Almelo/NL, \n²Groningen/NL \n \nPurpose: Muscle wasting is associated with inferior outcome following surgical \ntreatment of solid malignancies. Radiological measurement of sarcopenia is a \nwidespread method to detect muscle wasting. Measurement of myosteatosis \nmight present an alternative strategy. Aim of this study was to evaluate if the \npresence of myosteatosis is related to the presence of sarcopenia and if \nmyosteatosis can be used to predict the presence of sarcopenia. \nMethods or Background: For this analysis, data were used from the PICNIC \ncohort including patients undergoing surgical cancer treatment. The total psoas \nindex (TPI) for detection of sarcopenia and psoas radiodensity (PRD) for \ndetection of myosteatosis on the L3 level were estimated on CT images. Age \nand Body Mass Index (BMI) were registered, BMI ”25 was considered normal. \nGender-specific 25-percentile cut-off values were applied to determine low TPI \nand PRD. Spearman’s correlations coefficient was calculated. To determine if \na low PRD relates to a low TPI logistic regression analyses were performed. \nResults or Findings: A total of 372 patients were included. 79 patients \n(24.2%) had a low TPI and 85 patients (26%) had a low PRD. 29 (8.9%) \npatients had both a low TPI and low PRD. BMI was normal in 35.5%. The \ncorrelation between TPI and PRD was 0.011 (P:0.84). A low PRD related to \nthe presence of a low TPI (OR adjusted for BMI and age:2.02, 95-CI:1.12-3.64, \nP:0.019. \nConclusion: This study showed that in patients undergoing surgical cancer \ntreatment the presence of myosteatosis combined with a normal BMI relates to \nthe presence of sarcopenia. Therefore, even though the correlation between \nsarcopenia and myosteatosis in general is low, presence of myosteatosis in \npatients with a normal BMI can function as a warning for the presence of \nsarcopenia. \nLimitations: Not applicable. \nEthics Committee Approval: Not applicable. \nFunding for this study: None. \nAuthor Disclosures: \nGeertruida de Bock: Nothing to disclose \nLinda Weerink: Nothing to disclose \nThomas Kwee: Nothing to disclose \nBarbara van Leeuwen: Nothing to disclose \n \nRPS 516-4 \nThe prognostic significance of radiomic features from chest CT in \nadvanced non-small cell lung cancer (NSCLC) patients with EGFR-T790M \nmutation receiving second-line osimertinib treatment \n*X. Tang*, Y. Li, Y-l. Gong, Z-G. Yang; Chengdu/CN \n \nPurpose: Osimertinib is approved for treating advanced non-small cell lung \ncancer (NSCLC) patients with EGFR-T790M mutation after progression on \nfirst-line EGFR-TKIs. We aim at investigating the prognostic value of radiomic \nfeatures in advanced NSCLC patients receiving second-line osimertinib \ntherapy. \nMethods or Background: Chest CT images before osimertinib treatment were \ncollected from 140 metastatic NSCLC patients with EGFR-T790M mutation. \nRadiomics features were extracted from the volume of interest. Hierarchical \nclustering was used to identify patients with different radiomic patterns. \nRadiomics’ ability in predicting progression-free survival (PFS) was analyzed \nby COX and LASSO COX regression. \nResults or Findings: The predictive ability of CT morphological features was \nlimited. The PFS-predicting ability was only achieved in 1/11 CT morphological \nfeatures, i.e. lobulation (HR, 95%CI: 1.94, 1.14-3.32). Hierarchical clustering \ngroups from contrast-enhanced phase can divide patients into two groups of \ndiscrepant prognosis (mPFS: 17.0-Mo vs. 11.8-Mo, P=0.007), while clustering \ngroups from unenhanced CT phase shared similar prognosis (mPFS: 12.3-Mo \nvs. 13.9-Mo, P=0.972). In univariate analyses, sixty-six and eight features from \ncontrast-enhanced and unenhanced CT were predictors of PFS, respectively, \nindicating great potential of contrast-enhanced CT features in prognostic \nprediction. We then performed LASSO COX and backward COX regression \nusing contrast-enhanced CT features, and an 8-feature-based radiomic model \nwas developed (C-index: 0.701). Adding the radiomic model to the clinical \nmodel can substantially increase its C-index from 0.725 to 0.787 and \nstrengthen its performance in decision curve analysis. \nConclusion: We firstly explored the prognostic value of radiomics in advanced \nNSCLC patients receiving second-line osimertinib therapy. Our study will help \ndoctors in dicision-making process. \nLimitations: It's a retrospective study. \nEthics Committee Approval: This study was approved by West China \nHospital Research Ethics Board. \nFunding for this study: This study was supported by 1·3·5 project for \ndisciplines of excellence, West China Hospital, Sichuan University \n(ZYGD18013). \nAuthor Disclosures: \nYuan Li: Nothing to disclose \nXin Tang: Nothing to disclose \nYou-ling Gong: Nothing to disclose \nZhi-Gang Yang: Nothing to disclose \n \nRPS 516-5 \nOrbital metastases: common pathologies and imaging pearls \n*J. O'Mahony*, A. Nasoodi, C. Johnston; Dublin/IE \n(omathuns@tcd.ie) \n \nPurpose: Orbital metastases present a diagnostic challenge for the busy \nradiologist as the imaging features are often subtle, and can be easily \noverlooked on cross-sectional imaging of the brain or head and neck using \nroutine oncological protocols. Although accounting for only 4% of all adult \norbital tumours, orbital metastases must be considered in patients with a \nhistory of malignancy. This is particularly relevant in the presence of known \nmetastases, progressive disease, or symptoms of visual impairment, pain on \neye movements or proptosis at presentation. \nMethods or Background: The most common primary malignancies \nassociated with orbital metastases are carcinoma of the breast, prostate, \nmelanoma and lung. We share our experience as one of the major oncology \ncentres in Ireland through a series of illustrative cases from our institution that \ndemonstrate the common imaging appearances of orbital metastases. We also \nillustrate diagnostic pearls which enable diagnosticians to identify and \ncharacterise such lesions more efficiently. \nResults or Findings: Metastatic lesions may be found within any compartment \nof the orbit and careful attention must be paid to identify any abnormalities as \nlesion detection may be difficult on axial imaging alone, particularly in the \nsetting of a routine brain protocol. To this end, adopting a more structured \napproach with utilisation of multi-planar reconstruction of the images cannot be \nover-emphasised. \nConclusion: Orbital Metastases must be considered in the context of patient \nwith known metastatic disease and may be easily overlooked on routine axial \noncological imaging. Careful attention to the orbits with multi-planar \nreconstruction of images is essential to identification of subtle orbital pathology. \nLimitations: Primary orbital malignancy not assessed \nEthics Committee Approval: Not required \nFunding for this study: None \nAuthor Disclosures: \nAfshin Abdollahzadeh Nasoodi: Nothing to disclose \nJohnny O'Mahony: Nothing to disclose \nCiaran Johnston: Nothing to disclose \n \nRPS 516-6 \nDosimetry and biokinetic modelling of thyroid cancer patients treated \nwith radioiodine as part of an international multi-centre study within \nMEDIRAD \n*J. Taprogge*¹, F. Leek¹, M. Bardiès², F. Courbon², U. Eberlein³,  \nM. Lassmann³, M. Luster຾, D. Vallot², G. Flux¹; ¹Sutton/UK, ²Toulouse/FR, \n³Würzburg/DE, ຾Marburg/DE \n \nPurpose: MEDIRAD investigates the effects of low-dose radiation exposure in \nthe medical field. Work package 3 aims to recruit 100 thyroid cancer patients \nfor a multi-national multi-centre observational clinical study to determine \nbiokinetics of radioiodine in thyroid cancer patients and to measure the range \nof absorbed doses to healthy tissues and thyroid remnants. \nMethods or Background: Four European centres were set-up and five \nSPECT and SPECT/CT systems were calibrated to allow for quantitative \nimaging of high-activity I-131. Flexible image acquisition protocols were \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 308  \ndeveloped based on local requirements and availability of equipment. A \nmodified biokinetic model based on the ICRP-128 I-131 model was \nimplemented in Monolix2019R1. Feasibility of the modelling was assessed \nusing retrospective data of 23 patients for whom biokinetic data was available \nfor thyroid remnant, blood, protein-bound-iodine and whole body. \nResults or Findings: Five SPECT or SPECT/CT systems were set up for \nquantitative imaging with system volume sensitivities ranging from 62 to 92 \ncps/MBq. 87 patients have been recruited for the study to date. The modified \nICRP-128 model was able to accurately reproduce the activity retention of the \nretrospective data. The modified model has slower transfer rate constants from \nblood to thyroid (0.12 day-1) compared to ICRP-128 (7.26 day-1). Thyroid to \nblood transfer in both models was found to be comparable (30 day-1 and 36 \nday-1). \nConclusion: A network of centres able to perform quantitative I-131 imaging \nwas set-up to support a series of clinical studies and recruitment is ongoing. \nInitial results have shown that iodine bio-kinetics change after thyroidectomy. \nThe model will be further adapted using data acquired as part of the multi-\ncentre multi-national prospective study. \nLimitations: n/a \nEthics Committee Approval: Obtained. \nFunding for this study: The MEDIRAD project received funding from the \nEuratom research and training programme 2014-2018 under grant agreement \nNo 755523. \nAuthor Disclosures: \nDelphine Vallot: Nothing to disclose \nManuel Bardiès: Consultant: Theragnostics Consultant: IPSEN Consultant: \nMEDPACE \nMichael Lassmann: Research/Grant Support: IPSEN \nFrederic Courbon: Nothing to disclose \nGlenn Flux: Nothing to disclose \nJan Taprogge: Nothing to disclose \nFrancesca Leek: Nothing to disclose \nMarkus Luster: Nothing to disclose \nUta Eberlein: Nothing to disclose \n \nRPS 516-7 \nCT based radiomic approach on first line Pembrolizumab in lung cancer \n*E. Lucertini*, M. Zerunian, G. Guido, T. Polidori, D. Caruso, C. Rucci,  \nF. Pucciarelli, M. Polici, A. Laghi; Rome/IT \n \nPurpose: To assess whether CT-derived texture parameters extrapolated from \nbaseline examinations can predict overall survival (OS) and progression-free \nsurvival (PFS) in patients with advanced non-small-cell lung cancer (NSCLC) \ntreated with Pembrolizumab as a first line. \nMethods or Background: Twenty-one patients with NSCLC were \nprospectively enrolled; all participants underwent contrast enhanced CT \n(CECT) at baseline and during Pembrolizumab treatment. Response to therapy \nwas assessed both with clinical assessment and iRECIST criteria. Two \nradiologists in consensus drew a volume of interest of the tumor at baseline \nCECT on portal-venous phase, extracting the following first level histogram \nbased texture parameters: mean, standard deviation, entropy, kurtosis, \nskewness and mean value of positive pixels (MPP). ROC curves, a univariate \nKaplan-Meyer analysis and Simple Cox proportional hazard regression \nanalysis were performed to evaluate the prognostic value of texture analysis. \nResults or Findings: Twelve (57%) patients showed partial response to \ntherapy while nine (43%) had confirmed progressive disease. Among texture \nparameters MPP at fine and medium filter showed an AUC of 72% and 74% \nrespectively (P<0.001). Kaplan-Meyer analysis showed that MPP under 56.2 \nwere significantly associated with lower OS and PFS in patients with advanced \nNSCLC treated with Pembrolizumab (P <0.0035). Further, Cox proportional \nanalysis showed a significant correlation between MPP4 and OS (P=0.0038; \nHR=0.89 [CI 95%:0.83,0.96]). \nConclusion: MPP could be used as predictive imaging biomarker of OS and \nPFS in patients with NSCLC with first line immune treatment. \nLimitations: The study has a small population sample. No test validation and \nno multivariate analysis have been performed. \nEthics Committee Approval: After the approval of the institutional ethics \ncommittee, all patients have accepted and signed the written informed consent. \nFunding for this study: No sources of funding have been used for this study. \nAuthor Disclosures: \nDamiano Caruso: Nothing to disclose \nFrancesco Pucciarelli: Nothing to disclose \nCarlotta Rucci: Nothing to disclose \nMarta Zerunian: Nothing to disclose \nTiziano Polidori: Nothing to disclose \nAndrea Laghi: Nothing to disclose \nMichela Polici: Nothing to disclose \nGisella Guido: Nothing to disclose \nElena Lucertini: Nothing to disclose \n \nRPS 516-8 \nDual-energy CT assessment of skeletal bone marrow involvement in \nmultiple myeloma \n*R. Gu*¹, A. Amlani¹, O. A. Westerland¹, A. Green¹, U. Haberland², M. Streetly¹, \nM. Antonelli¹, I. Dregely¹, V. Goh¹; ¹London/UK, ²Frimley Camberley/UK \n(renyang.gu@kcl.ac.uk) \n \nPurpose: In multiple myeloma, accurate and objective assessment of skeletal \nbone marrow involvement would enable more precise monitoring of disease \nburden. We aimed to develop a quantitative dual-energy CT approach for \nassessing whole skeletal disease burden and to correlate CT with clinical \nmetrics. \nMethods or Background: Consecutive patients with suspected or confirmed \nmyeloma underwent CT from vertex to below knees on a third-generation dual-\nsource scanner, generating 120 kVp-equivalent images and corresponding \nthree-material decomposition calcium-subtracted attenuation maps. The \nskeleton was segmented on the 120 kVp-equivalent images using Hounsfield \nunit (HU) thresholding and application of a Chan-Vese morphological \noperation. Skeletal marrow attenuation values were generated from the \ncorresponding calcium-subtracted maps using the segmented marrow mask \noverlay. Associations of whole skeleton calcium-subtracted attenuation with \nbone marrow biopsy infiltration percentage, haemoglobin level and age were \nassessed with Spearman’s rank correlation; significance was at 5%. \nResults or Findings: 20 patients (11 females; median 68 years; 12 relapsed, \n8 new myeloma) were evaluated; 14 patients had subsequent bone marrow \nbiopsy. Median (IQR) of mean skeletal attenuation was -56.0 HU (-65.6, -\n44.9HU). There was a strong positive correlation with bone marrow plasma cell \ninfiltration percentage (Spearman’s rho: + 0.91, p < 0.001); a negative \ncorrelation with haemoglobin level (Spearman’s rho: -0.77, p < 0.001) but no \ncorrelation with age (Spearman’s rho: -0.19, p = 0.4). \nConclusion: Whole skeletal assessment is feasible and associated with the \ndegree of bone marrow plasma cell infiltration. This may provide an additional \nobjective measure of marrow disease burden to the current assessment of \nfocal lytic bone lesions. \nLimitations: It was an exploratory study with a small number of patients. \nEthics Committee Approval: REC number 13/EM/0409. \nFunding for this study: No funding. \nAuthor Disclosures: \nAdrian Green: Nothing to disclose \nMatthew Streetly: Nothing to disclose \nVicky Goh: Research/Grant Support: Siemens Healthcare \nUlrike Haberland: Employee: Siemens Healthcare \nRenyang Gu: Nothing to disclose \nOlwen Amy Westerland: Nothing to disclose \nAshik Amlani: Nothing to disclose \nIsabel Dregely: Nothing to disclose \nMichela Antonelli: Nothing to disclose \n \nRPS 516-9 \nDevelopment of perfusion CT and its importance for evaluating \npancreatic diseases: a quantitative meta-analysis \n*N. Vats*, H-U. Kauczor, W. Stiller, S. Skornitzke; Heidelberg/DE \n(neha.vats@med.uni-heidelberg.de) \n \nPurpose: This meta-analysis evaluated changes in perfusion computed \ntomography (pCT) acquisition protocols over ~40 years, assessing its potential \nto differentiate pancreatic diseases. \nMethods or Background: 491 pCT studies from 1982-2020 gathered from \nPubMed using key terms (pancreas/pancreatic, dynamic/perfusion, and \ncomputed tomography/CT) were included. 50 studies met inclusion criteria: \noriginal data, human study, at least 5 datasets. Sample size, CT acquisition \nparameters, and quantitative perfusion parameters (Blood flow (BF), Blood \nvolume (BV) and permeability) were extracted. Year-wise mean acquisition \nparameters were calculated and linear regression plots computed over the \nyears. Perfusion measurements were grouped into 4 categories of pathology: \nnormal pancreas (control), pancreatitis, carcinoma, and non-carcinoma. \nWeighted-ANOVA followed by Student’s t-test was performed for comparing \nquantitative measurements for different pathologies. \nResults or Findings: Over the years, pCT acquisition parameters varied \nconsiderably, with the number of studies and sample size increasing after \n2010. Mean tube potential and current-time product have slightly decreasing \n(2010-2014:92±13.0kVp, 2015-2019:88.8±5.0kVp) and increasing (2010-\n2014:101.4±51.4mAs, 2015-2019:150.9±68.7mAs) trends respectively, with \ntissue coverage also increasing, but without a significant trend in effective \ndose. Lowest averaged perfusion measurements were found in carcinoma (BF: \n29.3±10.9ml/100ml/min, BV: 9.5±8.9ml/100ml, permeability: \n23.7±10.8ml/100ml/min) compared to non-carcinoma (BF: \n109.6±39.9ml/100ml/min, BV: 14.4±7.7ml/100ml, permeability: \n30.2±16.5ml/100ml/min), pancreatitis (BF: 64.0±22.4ml/100ml/min, BV: \n3.1±5.0ml/100ml, permeability: 33.7±15.6ml/100ml/min), and control (BF: \n100.9±30.9ml/100ml/min, BV: 20.0±6.0ml/100ml, permeability: \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 309  \n36.9±13.4ml/100ml/min). Weighted-ANOVA shows BF (p<0.0001) and BV \n(p<0.0001) differ significantly between pancreatic pathologies but permeability \ndoes not (p=0.1131). Student’s t-test shows significant differences between \ncontrol/pancreatitis, control/carcinoma, and carcinoma/non-carcinoma for BF \nand BV, and between pancreatitis/carcinoma, and pancreatitis/non-carcinoma \nfor BF. \nConclusion: Results illustrate the need for standardization of pCT. \nQuantitative perfusion parameters (BF and BV) can differentiate between \npancreatic pathologies. Thus, pCT could qualify as a biomarker for diagnosing \npancreatic diseases. \nLimitations: Limited number of pancreatic pCT studies reporting perfusion \nparameters \nEthics Committee Approval: Not applicable \nFunding for this study: BMBF-grant 031L0163 \nAuthor Disclosures: \nNeha Vats: Nothing to disclose \nWolfram Stiller: Nothing to disclose \nHans-Ulrich Kauczor: Nothing to disclose \nStephan Skornitzke: Nothing to disclose \n \n \nResearch Presentation Session: \nEmergency Imaging \nRPS 317 \nDevelopments in emergency imaging \nRPS 317-1 \nPseudo-pneumatosis of the gastrointestinal tract: its incidence and the \naccuracy of a checklist developed by artificial intelligence (AI) techniques \nto reduce the misinterpretation of pneumatosis \n*A. A. Esposito*¹, L. Castoldi¹, S. Zannoni¹, E. Casiraghi¹, C. Giannitto¹,  \nE. Avola¹, O. Catalano², G. Carrafiello¹; ¹Milan/IT, ²Boston, MA/US  \n(andrea.esposito@policlinico.mi.it) \n \nPurpose: To assess the incidence of pseudo-pneumatosis in patients who \nunderwent an emergency abdominal CT and to verify the performance of \nimaging features, selected by artificial intelligent techniques, to reduce this \nmisinterpretation. \nMethods or Background: We searched for patients who underwent an \nemergency abdominal CT between 2012 and 2019 and whose radiological \nreports contained the word pneumatosis, retrieving 71 patients. Surgical \nfindings, clinical outcomes and reevaluation of the CT scans, were used as \nreference standard. Five imaging signs were considered useful for \ndifferentiating pneumatosis versus pseudo-pneumatosis: gas location, \ndissecting gas in the bowel wall edge, a circumferential gas pattern, intramural \ngas beyond a gas-fluid/faecal level, the presence of alterations associated with \nbowel ischemia. An unbiased performance evaluation on individual features \nwas obtained by training and testing decision trees through a Leave One Out \n(LOO) strategy. Most accurate variables (accuracy >75%) were selected, and \nused to train and test boosted Random Forest classifiers through LOO. \nResults or Findings: Of the 71 patients, 27 resulted as pseudo-pneumatosis \n(38% of error). The most significant features to diagnose pneumatosis were: \nthe presence of dissecting gas (96% of accuracy), the presence of intramural \ngas beyond a gas-fluid/faecal level (86% of accuracy), the presence of at least \none alteration associated with bowel ischemia (86% of accuracy), a \ncircumferential gas pattern (78% of accuracy). When pooled the selected \nvariables obtained 96% of accuracy. \nConclusion: In patients who undergo an emergency abdominal CT, the \nincidence of pseudo-pneumatosis can be high. The use of a checklist including \nfour imaging signs, can be useful to reduce this overestimation. \nLimitations: The low number of patients. \nIt is a retrospective monocentric study \nEthics Committee Approval: The study was approved by the Ethics \nCommittee, and patient’s informed consent was waived for its retrospective \nnature. \nFunding for this study: No. \nAuthor Disclosures: \nOnofrio Catalano: Nothing to disclose \nCaterina Giannitto: Nothing to disclose \nLaura Castoldi: Nothing to disclose \nAndrea Alessandro Esposito: Nothing to disclose \nStefania Zannoni: Nothing to disclose \nElena Casiraghi: Nothing to disclose \nEmanuele Avola: Nothing to disclose \nGianpaolo Carrafiello: Nothing to disclose \nRPS 317-2 \nSoft tissue assessment on multidetector computed tomography (MDCT) \ncan improve imaging classification of incomplete pelvic ring injuries: a \ncohort study \n*L. Gudauskas*, R. Karthikeyan, S. Choudhary, R. Rajakulasingam,  \nS. Balamoody; Birmingham/UK  \n \nPurpose: Pelvic soft tissue assessment, in addition to fracture patterns on \ncomputed tomography (CT) can improve identification and classification of \npelvic ring injuries in patients with polytrauma. \nMethods or Background: A cohort of consecutive patients with incomplete \npelvic ring injuries who underwent examination under anaesthesia were \nidentified from the operative database of an adult major trauma centre over 10 \nyears. Pelvic CT scans were retrospectively reviewed for signs of pelvic \nligament injury. The findings assessed were - obscured retropubic fat plane, \nthickening of symphyseal ligaments, symphysis pubis width, ischial spine and \nsacral avulsion fractures, thickening of sacrospinous and sacrotuberous \nligaments, obscured anterior and posterior sacroiliac fat plane and sacroiliac \njoint width. Pelvic ring injury was classified according to Young- Burgess \nclassification and compared with operative findings. \nResults or Findings: Obscured retropubic fat plane and symphysial ligament \nthickening identified pubic symphysial injury at CT, irrespective of the presence \nof a pelvic binder and degree of diastasis (APC type 1, n=15). Assessment of \nposterior pelvic ligaments and pre-defined fat planes allowed classification of \nAPC type 2 (n=13) and type 3 (n=3) injuries at imaging, which were confirmed \nwith operative findings. Sacral bony avulsion was the commonest pattern of \nsacrospinous and sacrotuberous ligament injury. \nConclusion: Soft tissue assessment can identify pelvic ring injury on CT \nscans, when diastasis may not be readily apparent with a pelvic binder. Pelvic \nring ligaments should be assessed in addition to fractures when interpreting CT \nscans in polytrauma patients, to improve identification and classification of \npelvic ring injuries. \nLimitations: Retrospective study design. Patients with pelvic trauma not \nincluded if they did not have examination under anaesthesia or operative \nintervention. \nEthics Committee Approval: Approved by Clinical Governance Board, formal \nEthics Committee review not required. \nFunding for this study: None. \nAuthor Disclosures: \nSharon Balamoody: Nothing to disclose \nSurabhi Choudhary: Nothing to disclose \nRavichandran Karthikeyan: Nothing to disclose \nLinas Gudauskas: Nothing to disclose \nRamanan Rajakulasingam: Nothing to disclose \n \nRPS 317-3 \nEffects of the COVID-19 lockdown on the radiological examination \noutcomes \n*V. Vingiani*¹, A. Posa², A. F. Abadia³, G. Belmonte ຾, C. R. Rutigliano຿,  \nL. Pasqualetto¹, A. Presidente¹, M. Catalano², G. B. Berte²; ¹Sorrento/IT, \n²Rome/IT, ³Denver, CO/US, ຾Potenza/IT, ຿Andria/IT \n(vincenzovingiani@gmail.com) \n \nPurpose: The aim of this multicentric study is to illustrate how the COVID-19 \npandemic lockdown affected the workload and outcomes of radiological \nexaminations in emergency radiology. \nMethods or Background: The exams performed in the radiology departments \nof four Italian hospitals during three weeks of the Italian lockdown were \nretrospectively reviewed and compared to the exams conducted during the \nsame time-period in 2019. Only exams coming from the emergency \ndepartment (ED) were included. Two radiologists from each hospital defined \nthe cases as positive or negative findings, based on independent blind \nreadings of the imaging studies and correlation with the clinical indication. In \ncase of differences in the evaluation, consensus was reached amongst them \nvia discussion. Continuous measurements are presented as median and \ninterquartile range, while categorical measurements are presented as \nfrequency and percentages; p-values were calculated using T-test, Mann-\nWhitney test and the Chi-squared test. \nResults or Findings: There were 745 patients [53% male; 62 years (44-78)] \nwho underwent radiological examinations in 2020 vs. 2623 [52% male; 56 \nyears (35-76)] in 2019 (p<.001). Furthermore, the total number of ED exams \ndropped from 3206 (2019) to 939 (2020), with a relative increase of CT \nexaminations from 23% to 33% (p<.001). The percentage of patients with a \npositive finding was significantly higher in 2020 (355, 48%) compared to 2019 \n(684, 26%) (p<.001). \nConclusion: Our findings showed that despite the reduction of emergency \nradiological examinations there was a relative increase of positive cases. \nThese significant findings are crucial to ensure better organization of radiology \ndepartment and patient management in similar health emergencies in the \nfuture. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 310  \nLimitations: Study results might change according to the level of lockdown \napplied. \nEthics Committee Approval: Institutional review boards approved this \nretrospective multi-center study. \nFunding for this study: Not applicable. \nAuthor Disclosures: \nGiovanna Berte Bertè: nothing to disclose \nGianfranco Belmonte: Nothing to disclose \nClaudia Rutigliano Rutigliano: nothing to disclose \nAlfonso Presidente: Nothing to disclose \nAlessandro Posa: nothing to disclose \nAndres Felipe Abadia: nothing to disclose \nLuigi Pasqualetto: nothing to disclose \nMarialavinia Catalano: nothing to disclose \nVincenzo Vingiani: nothing to disclose \n \nRPS 317-4 \nBleeding haematomas in COVID-19 patients related to fibrinogen levels \nand anticoagulation \n*V. Picasso*, L. Ball, F. Rapetti, A. Pezzino, G. Bovio, P. Pelosi, L. E. Derchi; \nGenoa/IT \n(virgi.picasso@gmail.com) \n \nPurpose: Bleeding/non bleeding hematomas in Covid 19 patients, correlated \nto the degree of anticoagulation and fibrinogen levels. \nMethods or Background: Major arterial or venous thromboembolism occurs \nfrequently in patients with severe Covid-19 disease, especially in the ICU \nsetting. Anticoagulant therapy is given to these patients, with Its inherent risks. \nWe reviewed the contrast enhanced CT studies of 100 patients admitted to the \nICU and emergency room between February 29th and May 30th, 2020 for \nCOVID disease to identify presence of active bleeding and/or hematomas. \nResults or Findings: At the time of CT scan, most patients were treated with \nanticoagulant therapy (low molecular weight heparin – LMWH – every 24h: 33; \nLMWH every 12h: 30; sodium heparin in continuous infusion: 33, no therapy: \n4). Ninety-one (91%) studies had been requested for pulmonary assessment or \nfor suspected pulmonary arteries thrombosis, 9 (9%) for suspected bleeding. \nWe observed 24 (24%) cases of hematoma in thoracoabdominal regions, of \nwhich 13 were located in the deep abdominal muscles in the retroperitoneal \narea, 10 were actively bleeding and required treatment. \nConclusion: Patients with versus those without hematomas had comparable \nD-Dimer levels (1167 vs. 1576 mcg/L, p=0.107) and anticoagulation regimens \n(p=0.276). Mortality was similar in patients with and without bleeding at the CT \nscan (37.5% vs. 42.1%, p=0.891). \nLimitations: None \nEthics Committee Approval: N/a \nFunding for this study: N/a \nAuthor Disclosures: \nVirginia Picasso: Nothing to disclose \nFrancesca Rapetti: Nothing to disclose \nGiulio Bovio: Nothing to disclose \nPaolo Pelosi: Nothing to disclose \nLorenzo E. Derchi: Nothing to disclose \nLorenzo Ball: Nothing to disclose \nAngelo Pezzino: Nothing to disclose \n \nRPS 317-5 \nPrognostic value of the initial chest radiography in patients admitted with \nSARS-CoV-2 pneumonia \n*J. M. Plasencia Martinez*, I. Herves Escobedo, M. Martín-Cascón,  \nA. Blanco Barrio, J. M. Gómez-Verdú, S. Alemán-Belando, C. Jiménez Pulido, \nA. Moreno Pastor, I. M. González Moreno; Murcia/ES \n(plasen79@gmail.com) \n \nPurpose: To determine the chest X-ray (CXR) ability to predict the outcome in \nCOVID-19 hospitalized patients. \nMethods or Background: Brixia-Score (BS) and bilateral pneumonia (BN) in \nthe initial CXR, inflammatory laboratory biomarkers, SaO2/FiO2 ratio, ARDS, \ndeath, non-invasive mechanical ventilation (NIMV) and intensive care unit \n(ICU) admissions were assessed in hospitalized patients with SARS-CoV-2 \npneumonia in the first pandemic wave by intraclass correlation coefficient \n(ICC), Chi2, Student t and Spearman tests. \nResults or Findings: 117 patients (62 men-53%-), age 57.03±15.47 years, \nwere admitted between March-13 and April-27, 2020. 38/117 (32.5%) patients \nsuffered from ARDS, 12/117 (10.3%) needed NIMV and 18/117 (15.4%) were \nadmitted to ICU or died. The BS-ICC was 0.833 (95CI%0.752-0.887). BS was \ngreater in males (6.03±3.42 vs 4.78±3.04, P=0.04) and older patients \n(61.47±13.91 -BS>5- vs 53.18±15.58 -BS”5- years; P=0.003). BS>5 patients \nhad higher ferritin (862±744 vs 562±648; P=0.04), lactate-dehydrogenase \n(658±250 vs 512±210, P<0.001) and C-reactive protein (CRP; 11±10 vs 7±7; \nP=0.006) and lower lymphocyte (0.78±0.48 vs 1.1±0.67x103; P<0.001) levels. \nCRP (10.4±9 vs 6.38±7.3; P=0.027) and lymphocyte (0.85±0.55x103 vs \n1.2±0.71x103; P<0.001) levels worsened for BN. BS and SaO2/FiO2 ratio \ncorrelated moderately (R=-0.435; P<0.001). BS>5 (23/38-60%- vs 28/78-\n35.9%-; OR 2.7-95CI%1.2-6.1-, P=0.012) and BN (32/38-84%- vs 48/74-\n69.5%-; OR 2.88-95CI%1.07-7.81-, P=0.032) were more frequent in ARDS. \nBS>5 (vs”5) led to earlier hospital (symptoms-onset-to-hospital-admission \ndays: 7.82±3.9 vs 9.75±6.86; P=0.06) and ICU (hospitalization-to-ICU days : \n2±1.4 vs 4.2±1.9; P=0.04) admissions, and longer hospital stay (9.1±6.5 vs \n6.0±4.9 days; P=0.004), but BN (8.8±5.0 vs 9.4±7.4; P=0.644; 3±2.1 vs \n3.0±0.0; P=1; and 8.2±5.9 vs 6.0±5.4; P=0.083, respectively) did not. \nConclusion: CXR for SARS-CoV-2 pneumonia diagnosis can be an early, \ninexpensive, and reproducible biomarker of the later systemic inflammatory \nresponse, hospital stay, prompt hospitalization and ICU admission need, \nproviding a timely advantage. \nLimitations: Small sample \nEthics Committee Approval: Yes \nFunding for this study: No \nAuthor Disclosures: \nSergio Alemán-Belando: Nothing to disclose \nJuana María Plasencia Martinez: Nothing to disclose \nIsabel María González Moreno: Nothing to disclose \nIgnacio Herves Escobedo: Nothing to disclose \nAna Moreno Pastor: Nothing to disclose \nMiguel Martín-Cascón: Nothing to disclose \nJosé Miguel Gómez-Verdú: Nothing to disclose \nAna Blanco Barrio: Nothing to disclose \nCristina Jiménez Pulido: Nothing to disclose \n \nRPS 317-6 \nImproved diagnostic accuracy of computer-aided peripheral embolism \ndetection by CTPA on virtual monochromatic images compared to \nconventional polychromatic images \n*E. Langius*¹, I. M. Nijholt¹, E. De Boer¹, J. Nijboer-Oosterveld¹, S. Walen¹,  \nJ. W. van den Berg¹, P. A. de Jong², M. F. Boomsma¹; ¹Zwolle/NL, ²Utrecht/NL \n(elinelangius@gmail.com) \n \nPurpose: Pulmonary embolism (PE) is a potentially life threatening condition \nand therefore requires quick diagnosis and treatment. In this study, the \ndiagnostic accuracy of computer-aided PE detection by computed tomography \npulmonary angiography (CTPA) on conventional polychromatic images (CPI) \nwas compared with virtual monochromatic images (VMI) retrospectively \nobtained with a detector-based spectral CT scanner (SDCT). \nMethods or Background: Paired CPI and 60 keV VMI of 113 consecutive \npatients suspected of PE were independently evaluated by two radiologists \nusing computer aided PE detection software (CAD). Sensitivity and specificity \nof the radiologists on VMI and CPI were compared using the McNemar test. In \naddition, the odds of false positive (FP) PE CAD markers were determined on \nVMI and CPI. The image quality of VMI and CPI was compared by determining \nsignal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). \nResults or Findings: The number of FP CAD markers per scan on VMI was \nsignificantly reduced compared to the number per scan on CPI (p < 0.001). \nThe odds of FP PE markers also decreased significantly on VMI (OR 0.51, p \n<0.001). Improved image quality of VMI compared to CPI was found to largely \nexplain the lower odds of false positive PE markers on VMI. All diagnostic \nmeasures of radiologists using CAD to detect PE improved on VMI vs. CPI, \nalbeit not always statistically significant. \nConclusion: Diagnostic accuracy of computer aided PE detection on CTPA \nimproved on VMI compared to routinely used CPI. This can largely be \nattributed to improved image quality on VMI. \nLimitations: Reference standard not an absolute standard of truth. \nRadiologists blinded to clinical information, not image type. The mportance of \ndetecting peripheral emboli is unclear. \nEthics Committee Approval: Approved by the local Institutional Review \nBoard of Isala (no. 190209). \nFunding for this study: Funded by Isala and UMCU. \nAuthor Disclosures: \nMartijn F. Boomsma: Nothing to disclose \nErwin De Boer: Nothing to disclose \nJacqueline Nijboer-Oosterveld: Nothing to disclose \nStefan Walen: Nothing to disclose \nJan Willem van den Berg: Nothing to disclose \nEline Langius: Nothing to disclose \nPim A. De Jong: Nothing to disclose \nIngrid M. Nijholt: Nothing to disclose \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 311  \n \nResearch Presentation Session: Radiation \nProtection / EuroSafe Imaging \nRPS 200 \nProfessional issues: radioprotection \nRPS 200-1 \nEuropean Diagnostic Reference Levels (DRLs) for Computed \nTomography (CT) applications in nuclear medicine: results from the \nMEDIRAD project \n*G. Verfaillie*, Y. D'Asseler, K. Bacher; Ghent/BE  \n(Gwenny.Verfaillie@UGent.be) \n \nPurpose: Unlike in diagnostic radiology, published national Diagnostic \nReference Levels (DRLs) in Europe for CT acquisitions used in hybrid imaging \nare limited. This study aims to propose the first European DRLs for specific \napplications of CT in hybrid SPECT/CT and PET/CT. \nMethods or Background: As part of the EU Horizon 2020 MEDIRAD project, \na CT dosimetry survey was conducted from October 2018 until February 2020. \nParticipating nuclear medicine departments were asked to provide patient-\nspecific information (gender, age, length and weight) and CT dose indicators \n(CTDIvol, DLP) from the most frequently performed diagnostic SPECT/CT and \nPET/CT examinations. Per scan type, data from 30 adult patients (weight of 70 \n± 10 kg) were collected. European DRLs were defined as the 75th percentile \nvalue from the distribution of the median CTDIvol and DLP values. \nResults or Findings: Data were received from 50 nuclear medicine \ndepartments in 20 European countries. As expected, CT doses were lower for \nattenuation correction than for localisation or diagnostic hybrid CT scans. \nSuggested European DRLs for CTDIvol (and DLP) of 18F-FDG half body \nPET/CT examinations are 2.5 mGy (230 mGy.cm) and 6.3 mGy (580 mGy.cm) \nfor attenuation correction only and localisation CT scans, respectively. A value \nof 6.4 mGy (160 mGy.cm) is proposed for attenuation correction only 18F-FDG \nbrain PET/CT studies. For 99mTc-bone (trunk) and parathyroid SPECT/CT \nexaminations, a DRL of 4.4 mGy (160 mGy.cm) for attenuation correction and \nlocalisation CT scans is suggested. Finally, the proposed European DRL for \nattenuation correction CT scans of 99mTc-cardiac SPECT/CT studies is 3.1 \nmGy (60 mGy.cm). \nConclusion: European DRLs for typical CT applications in nuclear medicine \nwere derived. The large variations in observed CT doses highlights the need \nfor optimisation. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: H2020 Euratom Grant ID 755523 \nAuthor Disclosures: \nGwenny Verfaillie: Nothing to disclose \nKlaus Bacher: Nothing to disclose \nYves D'Asseler: Nothing to disclose \n \nRPS 200-2 \nA comparison of Computed Tomography (CT) justification practices \nbetween core hours and on-call hours in Irish CT centres \n*A. Dowley*, S. J. Foley, J. Potoþnik, T. Thiel, M-L. Ryan; Dublin/IE  \n(anna.dowley@ucdconnect.ie) \n \nPurpose: Radiation dose from CT scans are among the highest in diagnostic \nimaging. In Ireland, CT scans account for 5.7% of examinations but contribute \nto 55% of the collective dose. There is a legislative requirement to justify CT \nexaminations. Also, health service resources are stretched and appropriate \nuse of CT is crucial to maximise efficiency. The purpose of this study was to \naudit justification of CT examinations in Irish CT departments, during standard \nworking and on-call hours. \nMethods or Background: CT referrals (six common exam types) were \nrandomly sampled from a three-month period in 2019 from five public Irish \nhospitals. Two experienced radiographers independently assessed referrals for \nadequate completion and justification in accordance with UK iRefer guidelines \n(2), with any disagreements being addressed by a third radiographer. Each \nreferral was further assessed by a consultant radiologist (20+ years \nexperience) for justification in an on-call setting. \nResults or Findings: 1158 CTs were reviewed, of which 488 of which were \nperformed on-call. 11% of exams were not justified- 12% during working hours \nand 9% during on-call times. Justification per anatomical region varied widely- \n28% of CT pulmonary angiogram scans were unjustified, compared to 3% of \nKidney, Ureter and Bladder CTs. Similarly, justification between hospitals \nvaried widely, from 8% of scans being unjustified up to 21%. 37% of scans \nwere deemed inappropriate for completion during on-call hours. 43.8% of \njustified exams had a clinical finding related to the reason the scan was \ncompleted, compared with 20.0% findings for unjustified exams. \nConclusion: Notable differences exist in CT justification between working and \non-call hours, among different examination types and between hospitals. \nContinued efforts in justification can save both resources and unnecessary \nradiation dose. \nLimitations: Limit in examination numbers. \nEthics Committee Approval: Approved by institutional ethics review. \nFunding for this study: None. \nAuthor Disclosures: \nThomas Thiel: Nothing to disclose \nJaka Potoþnik: Nothing to disclose \nMarie-Louise Ryan: Nothing to disclose \nShane J Foley: Nothing to disclose \nAnna Dowley: Nothing to disclose \n \nRPS 200-3 \nPerformance evaluation of Computed Tomography (CT) examinations at \nhighest radiation doses \n*I. Fitton*, E. Charpentier, C. Van Ngoc Ty, O. Clement; Paris/FR \n(isabelle.fitton@aphp.fr) \n \nPurpose: Dose data and image scoring were chosen to be representative and \nappropriate as indicators of CT exams performance to evaluate professional \npractices in CT. \nMethods or Background: The highest radiation dose levels (HRDL) were \ndetermined and set on two CT scanners (Siemens SOMATOM® Definition \nEdge and Siemens SOMATOM® Force) dedicated to emergency and \nconventional examinations. HRDL values were fixed by calculating the 99.5th \npercentile of DLP distributions for all CT exams acquired during 4 months on \neach CT equipment. CT examinations exceeding HRDL were collected over 15 \nmonths. Clinical practices checking were based first, on the interaction with the \nCT console by the team by studying the dose reduction difference between \nactual and projected total DLP for three thresholds at 5 %, 10 %, and 15 %. \nSecond, image quality and diagnostic performance were visually assessed by \none reader on a 5-point-Likert scale. \nResults or Findings: Over 30038 exams, 153 exams were superior to HRDL. \nWe observed that 33 % of these patients had a dose reduction higher than 5 \n%. Mean image score was 3.7 ± 1.1. 3.26% of CT exams higher than HDRL \nwere not interpretable. \nConclusion: Analyzing CT examinations of patients exposed to the highest \nradiation doses is an adequate approach for evaluating professional practices \nin radiology. \nLimitations: Some patient morphology data or examination indication, for \nexample, overweight or patient suffering from polytrauma, had an impact on \nthe HRDL triggering without possibilities to interact with the CT console for \nimproving image quality or dose. \nEthics Committee Approval: Retrospective study. Submitted to the ethic \ncommittee of our institution. \nFunding for this study: This work was awarded by The French Society of \nRadiology and SHAM. \nAuthor Disclosures: \nEtienne Charpentier: Nothing to disclose \nIsabelle Fitton: Nothing to disclose \nOlivier Clement: Nothing to disclose \nClaire Van Ngoc Ty: Nothing to disclose \n \nRPS 200-4 \nOut-of-field patient shielding in medical imaging: current legislative \ndocuments and recommendations reviewed by EURADOS WG12 \nO. Ciraj Bjelac¹, *H. de las Heras Gala*², C. Candela-Juan³, J. Dabin ຾, D. Faj຿, \nA. Gallagher๤, F. de Monteເ, G. Simantirakisແ, M. Sans Merce๥; ¹Belgrade/RS, \n²Oberschleissheim/DE, ³Valencia/ES, ຾Mol/BE, ຿Osijek/HR, ๤Limerick/IE, \nເPadova/IT, ແAthens/GR, ๥Geneva/CH \n \nPurpose: The objective of this work is to extensively review current national \nlegislation and recommendations on the use of out-of-field shielding in x-ray \nimaging, including those from national authorities and professional bodies as \nwell as international organizations. \nMethods or Background: The review was performed within the activities of \nEURADOS Working Group 12 covering available recommendations for adult, \npregnant and paediatric patients in radiography, fluoroscopy, computed \ntomography, mammography and dental radiology. It included a comprehensive \nsearch of 80 legislative documents and recommendations from 34 countries \nand 6 international organizations. \nResults or Findings: Some national legislation does not explicitly mention \npatient shielding, or do not state in which cases it should be used. Other \nnational documents (such as guidelines and publications of professional \nbodies) explicitly consider the use of patient shielding as a means of good \npractice or require its availability without further specification of its use. When \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 312  \npatient shielding is recommended, it is only suggested if it does not \ncompromise the diagnostic task (e.g. it does not interfere with the primary \nbeam or influences the automatic exposure control system), or if it serves to \nreassure the patients and comforters. In addition, the documents often mention \nthat shielding should only be considered if organs at risk are within 5 cm from \nthe field edge. Among those documents explicitly considering this subject, \nbetween 29 % (in computed tomography) and 43 % (in dental radiology) \ndiscourage the use of patient shielding for that modality or in general. \nConclusion: Very large discrepancies exist between recommendations, even \nfrom organizations of the same country. A common position seems advisable \nfor the efficient information of the public and the proper education of \nprofessionals. \nLimitations: The review mainly includes European countries. \nEthics Committee Approval: Not required \nFunding for this study: EURADOS Working Group 12 \nAuthor Disclosures: \nJeremie Dabin: Nothing to disclose \nOlivera Ciraj Bjelac: Nothing to disclose \nDario Faj: Nothing to disclose \nHugo de las Heras Gala: Nothing to disclose \nGeorgios Simantirakis: Nothing to disclose \nChrysoula Theodorakou: Nothing to disclose \nCristian Candela-Juan: Nothing to disclose \nFrancoise Louise Malchair: Nothing to disclose \nFrancesca de Monte: Nothing to disclose \nAoife Gallagher: Nothing to disclose \nMarta Sans Merce: Nothing to disclose \n \nRPS 200-5 \nComparison of peak skin dose assessment between RDIM software and \nradiochromic film measurements in interventional procedures: impact of \nthe patient's BMI \n*P. E. Colombo*¹, M. M. J. Felisi¹, S. Riga¹, D. Curto¹, C. Dillion², S. Massey², \nF. Barbosa¹, A. Rampoldi¹, A. Torresin¹; ¹Milan/IT, ²Scottsdale, AZ/US \n(paolae.colombo@ospedaleniguarda.it) \n \nPurpose: To evaluate the accuracy of the algorithm that calculates the skin \ndose distribution in interventional radiology procedures, provided by the \nradiation dose index monitoring software NEXO[DOSE]® (Bracco Injeneering \nSA, Lausanne). \nMethods or Background: To calculate the skin dose, the software uses \nexposure parameters taken from the Radiation Dose Structured Report, \nangiographic system information and other factors, such as backscatter factor. \nThe software had been previously validated on phantoms. GafChromic® XR-\nRV3 films were positioned under the patient’s back. 22 interventional \nprocedures (including prostatic artery embolization, uterine fibroid \nembolization, transjugular intrahepatic portosystemic shunt, endovascular \naneurysm repair, transcatheter aortic valve implantation and transarterial \nchemoembolization) were performed in three angiographic rooms with two \nPhilips Integris Allura FD20 and a Siemens Artis Zeego. The Body Mass Index \n(BMI) was evaluated for each patient. Student’s t-test was used to compare \npeak skin dose (PSD) differences for patients with different BMI. \nResults or Findings: The PSD values range from 0.18 Gy to 9.90 Gy. The \nmean deviation between estimated and measured PSD is -4%±14%. For \npatients with BMI>25 kg/m2 the mean of the absolute PSD differences is \n0.44±0.12 Gy, while for patients with BMI<25 kg/m2 it is 0.11±0.01 Gy. \nConclusion: We observed a good correlation (r=0.980, p<0.0001) between \nfilm measurements and software estimates even if a significant dependence on \nthe patient’s BMI was observed (p<0.05). This study suggests that \nNEXO[DOSE]® software can be considered as a valuable dose calculation tool \nto optimize existing practices and to monitor the follow-up required for patients \nwho have received high doses. A significant improvement can come from using \npersonalized phantoms that consider the increase of scatter radiation in the \ncase of higher BMI values. \nLimitations: Limited number of cases. \nEthics Committee Approval: Approved by the Institutional Review Board \n(596-13102020). \nFunding for this study: No funding. \nAuthor Disclosures: \nSteve Massey: Employee: PACSHealt, LLC \nColby Dillion: Employee: PACSHealt, LLC \nFabiane Barbosa: Nothing to disclose \nDenise Curto: Nothing to disclose \nAlberto Torresin: Nothing to disclose \nMarco Maria Jacopo Felisi: Nothing to disclose \nPaola E. Colombo: Nothing to disclose \nAntonio Rampoldi: Nothing to disclose \nStefano Riga: Nothing to disclose \n \n \nRPS 200-7 \nDose reduction potential using patient-specific prefilters in single-energy \nComputed Tomography (CT) within the performance limits of current \ndiagnostic CT systems \n*J. Steidel*, L. Klein, J. Maier, S. Sawall, M. Kachelrieß; Heidelberg/DE \n(joerg.steidel@dkfz.de) \n \nPurpose: To assess the dose reduction potential of patient-specific prefilters \nwithin the limitations of current diagnostic single energy CT systems. \nMethods or Background: CT scans of child, adult and obese abdomen \nphantoms were simulated with tube voltages between 35 and 150 kV with tin (0 \nto 2 mm) and copper (0 to 5 mm) prefilters in 0.1 mm steps. Tube current \nmodulation was on for all scans. CTDI was used as a measure of dose and \ndetermined with Monte Carlo simulations of a 32 cm CTDI phantom and \nvalidated with measurements. Soft tissue and iodine contrast performance was \nquantified using the contrast-to-noise-ratio at unit dose (CNRD) and compared \nto the standard protocols to obtain dose reduction values. Current CTs were \nassumed to operate from 70 to 150 kV in 10 kV steps, and up to 1000 mAs. \nResults or Findings: Using patient-specific prefilters achieved 17%, 32% and \n29% dose reduction for child, adult and obese phantoms for soft tissue \ncontrast, and 3%, 44% and 28% for iodine contrast. Here, no significant \ndifference between tin and copper prefilters was observed. Optimal prefilter \nthickness depends on patient size and contrast modality. Therefore, fine filter \nthickness gradations are needed. Dose reduction for iodine contrast is mostly \nachieved due to the decrease of tube voltage. Reducing tube voltage to 50 kV \nincreases dose reduction of the child to 39% with tin and 57% with copper \nprefilters. \nConclusion: Patient-specific prefilters provide significant dose reductions for \nsoft tissue contrast with current CT systems. Dose reduction for iodine contrast \nrequires tube voltage reduction in combination with copper prefilters. \nLimitations: Our results are based on simulations. Measurements are not \npossible because today’s CT systems do not have such a variety of prefilter \nthicknesses. \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nLaura Klein: Nothing to disclose \nJörg Steidel: Nothing to disclose \nMarc Kachelrieß: Nothing to disclose \nStefan Sawall: Nothing to disclose \nJoscha Maier: Nothing to disclose \n \nRPS 200-8 \nComparison of Size-Specific Dose Estimates (SSDE) and CTDIvol values \nin patients undergoing CT examinations of abdomen and pelvis \n*S. Joshi*; Lalitpur/NP \n(swetajoshi95@gmail.com) \n \nPurpose: To compare CTDIvol and SSDE values in patients undergoing CT \nscans of the abdomen and pelvis and to determine their relationship with \npatient size (patient weight and BMI). \nMethods or Background: Background: Computed Tomography Dose Index \nvolume (CTDIvol) underestimates the radiation dose being given to small \nchildren and smaller adults and overestimates the dose to larger patients. The \nuse of Size Specific Dose Index (SSDE) helps convert CTDIvol into more \npatient size specific radiation dose and is a better measure of estimated patient \ndose. Method: Purposive sampling was used for data collection and 96 adults \nwere included. Effective diameters were calculated from the AP and Lateral \ndiameters at the mid-liver region. These were used to determine the \nconversion factors which were then used to convert the CTDIvol values to \nSSDE. \nResults or Findings: The average CTDIvol was found to be 9.42 ± 3.26 mGy \nand the average SSDE was found to be 13.48 ± 3.53 mGy. Moderate positive \ncorrelation(r=+0.52) was found between CTDIvol and patient weight and low \npositive correlation(r=+0.17) was found between SSDE and patient weight. \nSimilarly, moderate positive correlation(r=+0.5) was found between CTDIvol \nand patient BMI and low positive correlation(r=+0.14) was fond between SSDE \nand patient BMI. \nConclusion: In comparison with SSDE, CTDIvol seemed to underestimate the \npatient dose estimate by 30.11%. CTDIvol values showed dependency with \npatient weight and BMI, this dependency was significantly reduced when those \nvalues were converted into SSDE. Thus, providing more concrete evidence to \nthe fact that SSDE values are a more reliable patient dose estimate since it \naddresses the patient’s size. \nLimitations: Neither risk nor organ doses were determined in this work. SSDE \nvalues were calculated using the effective diameter and not the water \nequivalent diameter. \nEthics Committee Approval: Yes \nFunding for this study: No \nAuthor Disclosures: \nSweta Joshi: Nothing to disclose \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 313  \nRPS 200-9 \nEstimation of radiation exposure and assessment of local diagnostic \nreference levels in the endovascular therapy of subarachnoid \nhaemorrhage related vasospasm \n*M. Opitz*, A. Wetter, S. Zensen, D. Bos, M. Forsting, C. Deuschl,  \nN. Guberina; Essen/DE \n \nPurpose: This study aims to determine local diagnostic reference levels \n(LDRLs) of endovascular therapy in patients with cerebral vasospasm (CVS) \ndue to spontaneous subarachnoid hemorrhage (sSAH). \nMethods or Background: In a retrospective study design, LDRLs and \nachievable dose (AD) were assessed for all consecutive patients undergoing \nselective intra-arterial vasodilator administration or additional mechanical \nangioplasty for CVS treatment. All procedures were performed at the flat-panel \nangiography-systems Allura Xper (Philips Healthcare). Interventional \nprocedures were differentiated according to the type of procedure and the \nnumber of probed vessels. \nResults or Findings: Altogether 494 consecutive neurointerventional \nprocedures of 121 patients with CVS due to sSAH could be included. The \nfollowing diagnostic reference values, AD and mean values could be \ndetermined: (I) (ICA bilateral+VA) DRL 80.29Gy*cm², AD 67.77Gy*cm², mean \n70.12Gy*cm²; (II) (ICA bilateral) DRL 59.15Gy*cm², AD 49.88Gy*cm², mean \n50.25Gy*cm²; (III) (ICA unilateral) DRL 34.70Gy*cm², AD 27.12Gy*cm², mean \n33.19Gy*cm²; (IV) (VA unilateral) AD 32.57Gy*cm², mean 34.25Gy*cm², (V) \n(Nimodipine+TBA) DRL 130.17Gy*cm², AD 108.56Gy*cm², mean \n106.09Gy*cm² and (VI) (Nimodipine+stent) DRL 107.60Gy*cm², AD \n81.13Gy*cm², mean 86.53Gy*cm². Kruskal-Wallis-test confirmed significant \ndose difference considering the number of probed vessels (p<0.001). Mann-\nWhitney-U-test revealed significant differences of DAP and fluoroscopy time \nbetween chemical-only and additional mechanical angioplasty (p<0.001). \nConclusion: The LDRLs of intra-arterial chemical angioplasty are substantially \nlower compared with diagnostic reference levels (DRLs) proposed for other \ntherapeutic interventions. The total dose may be reduced efficiently by probing \nonly the target vessels during repeated applications. \nLimitations: The DAP allows to contrast radiation exposure during the course \nof time, for different procedures of the same anatomic area, at different devices \nand centers. To estimate stochastic risks of radiation exposure the effective \ndose is a more straightforward value. \nEthics Committee Approval: Ethical approval was approved by the ethical \ncommittee of our institution (20-9604-BO). \nFunding for this study: No funding. \nAuthor Disclosures: \nMichael Forsting: Nothing to disclose \nNika Guberina: Nothing to disclose \nDenise Bos: Nothing to disclose \nCornelius Deuschl: Nothing to disclose \nSebastian Zensen: Nothing to disclose \nAxel Wetter: Nothing to disclose \nMarcel Opitz: Nothing to disclose \n \nRPS 200-10 \nThe Image Gently mission: one voice through many languages \n*D. P. Frush*¹, R. Yurchuck¹, F. Fahey², S. T. Treves², D. Gress³,  \nD. d. C. T. Bustelo຾, K. E. Applegate຿; ¹Durham, NC/US, ²Boston, MA/US, \n³Reston, VA/US, ຾Curitiba - Paraná/BR, ຿Zionsville, IN/US \n(dfrush@stanford.edu) \n \nPurpose: The Image Gently (IG) Alliance mission, to improve safe and \neffective imaging care of children worldwide has advanced through campaigns \nwith eight campaign posters adhering to simple, resonant messaging. An early \nsuccessful partnership with the Brazilian Society of Nuclear Medicine resulted \nin Portuguese translations of the two nuclear medicine posters and a call for \nadditional translations. \nMethods or Background: A committee that met regularly with strong \ninternational and intersocietal relationships formalized the process: (1) initially \ntargeting common languages, (2) identifying project lead(s), (3) providing \naccess to the publisher adobe acrobat through DropBox and Google Drive for \ntemplates and PDFs of all English versions, (4) leveraging networks for \ntranslators including IAEA (as a convener), ESPR, and the World Federation of \nPediatric Imaging, (5) attributing the translating society and a statement that \nthe translation accuracy is the responsibility of the translator, (6) placing \nposters on both IG and translating society websites. \nResults or Findings: Completed translations: Farsi, German, Portuguese, \nRomanian, Russian, and Spanish; ongoing Albanian, Bulgarian, Chinese, \nEstonian, Finnish, French, Latvian, Lithuanian, Macedonian, Norwegian, \nSerbo-Croatian, and Swedish. Several corrections in the English versions also \nresulted. \nConclusion: Based on a successful model for informed radiation use in \nchildren, poster translations can result in potentially more influential message \npenetration into regions. Image Gently’s translation initiative has served as a \nmodel and inspiration for Image Wisely to pursue similar international \ncollaboration(s), such as translated publications. \nLimitations: Challenges included occasional difficulties navigating the adobe \nacrobat software, accuracy of translations especially with English catchphrases \n(implied meanings such as “Back to Basics” may not translate well), reliance on \nvolunteer efforts, and inability, without follow up survey, in determining \nimpact/value. \nEthics Committee Approval: Not applicable \nFunding for this study: None \nAuthor Disclosures: \nDustin Gress: Nothing to disclose \nKimberly E Applegate: Nothing to disclose \nRobin Yurchuck: Nothing to disclose \nFrederic Fahey: Nothing to disclose \nDolores del Carmen Tanus Bustelo: Nothing to disclose \nS. Ted Treves: Nothing to disclose \nDonald P. Frush: Nothing to disclose \n \nRPS 200-11 \nNovel application of a comparison metric between software simulation \nand radiochromic film skin dose maps in high dose interventional \nangiographic procedures \n*M. M. J. Felisi*¹, S. Riga¹, P. E. Colombo¹, M. M. Vincenzi¹, C. Dillion²,  \nS. Massey², A. Torresin¹; ¹Milan/IT, ²Scottsdale, AZ/US \n(marco.felisi@unimi.it) \n \nPurpose: Feasibility study of a comparison metric to evaluate the skin dose \nmaps accuracy in interventional radiology procedures, provided by the \nalgorithm implemented in the Radiation Dose Index Monitoring (RDIM) \nsoftware NEXO[DOSE]® (Bracco Injeneering SA, Lausanne). \nMethods or Background: The RDIM software uses the Radiation Dose \nStructured Report information for skin dose maps estimation. The algorithm \nhad been previously validated on geometrical phantom in terms of Peak Skin \nDose (PSD) and dose profiles, using the gold standard GafChromic® XR-RV3 \nfilms, positioned under the phantom. Although in the simplest cases the \ninformation relating to the PSD is sufficient, in more complex ones, as occurs in \nclinical routine, it is necessary to have information relating to the entire dose \nmap and not only in the most exposed area. To address this need, the gamma \nanalysis method, usually used in radiotherapy to verify treatment plans, was \nadapted to this issue. This metric was tuned by comparing dose maps obtained \nwith the software and GafChromic® XR-RV3 for 8 tests performed on phantom \nwith angiography systems of two different vendors. Gamma analysis was \nperformed using FilmQA Pro software (Ashland, Inc, Covington, KY, USA). \nResults or Findings: Dose difference and distance to agreement acceptance \ncriteria were established, using the simple cases performed on phantom. \nGamma criteria of 12%/10mm has been found to be appropriate as a tolerance \nlevel with a passing rate of 90%. The obtained tolerance values will be used to \nassess the accuracy also in complex clinical cases. \nConclusion: The proposed metric appears to be promising for evaluating dose \ndistributions in diagnostic procedures, allowing a full 2D skin dose maps \nvalidation. \nLimitations: Results obtained in preliminary studies on phantom tests. \nEthics Committee Approval: Not Available \nFunding for this study: No Funding \nAuthor Disclosures: \nMonica Maria Vincenzi: Nothing to disclose \nSteve Massey: Employee: PACSHealt, LCC, Scottsdale, AZ, USA \nColby Dillion: Employee: PACSHealt, LCC, Scottsdale, AZ, USA \nAlberto Torresin: Nothing to disclose \nMarco Maria Jacopo Felisi: Nothing to disclose \nPaola Enrica Colombo: Nothing to disclose \nStefano Riga: Nothing to disclose \n \nRPS 200-12 \nEffective dose conversion factors from air-kerma area product in three \nhigh dose abdominal interventional angiographic procedures \n*S. Riga*, M. M. J. Felisi, D. Curto, P. E. Colombo, A. Torresin; Milan/IT \n(stefano.riga@unimi.it) \n \nPurpose: Establishment of conversion factors to evaluate effective dose (E) \nfrom air-kerma area product (KAP) in three interventional angiographic \nprocedures: trans-arterial chemoembolization (TACE) endovascular aneurysm \nrepair (EVAR), transjugular intrahepatic portosystemic shunt (TIPS) \nprocedures. These procedures involve high-doses and the patient exposure \nestimation is strongly recommended in the European Directive \n2013/59/EURATOM. \nMethods or Background: Radiation Dose Index Monitoring software \nNEXO[DOSE]® (Bracco Injeneering SA, Lausanne) was used to extract 60 \nprocedures with more than 6000 irradiation events. For each irradiation event, \nthe software collects information from the Radiation Dose Structured Report \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 314  \n(RDSR) about kV, primary/secondary angles, source-to-isocenter distance, \nadditional filtration, air-kerma at the interventional radiological point and KAP. \nEffective dose was calculated using the rotation module for PCXMC 2.0 \n(STUK, Helsinki, Finland) based on a Monte Carlo simulations and on the \nmathematical ORNL phantoms model. The PCXMC software processed the \ndosimetric and geometrical data obtained from the RDSR. \nResults or Findings: In addition to the inherent filtration of 3 mm of Al, \nadditional Cu and Al filtrations are taken into account for high (0.1mm/1mm), \nnormal (0.4mm/1mm) and low fluoroscopy (0.9mm/1mm) mode, and no \nfiltration for cine-fluorography. The X-ray beam quality may lead to a relevant \nimpact to the effective dose calculation. The achieved E/KAP conversion \nfactors for TACE, EVAR and TIPS procedures are estimated in 0.28±0.03 \nmSv/mGy·cm2, 0.19±0.02 mSv/mGy·cm2 and 0.34±0.04 mSv/mGy·cm2 \nrespectively. The differences obtained reflect the different position and beam \nquality of the considered procedures. \nConclusion: Effective dose conversion factors from KAP were assessed using \nICRP 103 tissue weighting factors and considering the different filtration. These \nfactors can be integrated in the RDIM system to estimate population doses \nfrom KAP and to compare different procedures. \nLimitations: Limited number of exams analyzed. \nEthics Committee Approval: Not applicable. \nFunding for this study: No funding. \nAuthor Disclosures: \nDenise Curto: Nothing to disclose \nAlberto Torresin: Nothing to disclose \nMarco Maria Jacopo Felisi: Nothing to disclose \nPaola Enrica Colombo: Nothing to disclose \nStefano Riga: Nothing to disclose \n \nRPS 200-13 \nRadiation exposure of CT-guided percutaneous manual and power drill \nbone biopsy \n*S. Zensen*, S. Selvaretnam, M. Opitz, D. Bos, J. Haubold, J. Theysohn,  \nM. Forsting, N. Guberina, A. Wetter; Essen/DE \n \nPurpose: Apart from the commonly applied manual needle biopsy, CT-guided \npercutaneous biopsies of bone lesions can be performed with battery-powered \ndrill biopsy systems. Due to assumably different radiation doses and \nprocedural duration, the aim of this study is to examine radiation exposure and \nestablish local diagnostic reference levels (DRLs) of CT-guided bone biopsies \nof different anatomical regions. \nMethods or Background: In this retrospective study, dose data of 187 \npatients who underwent CT-guided bone biopsy with a manual or powered drill \nbiopsy system performed at one of three different multi-slice CT were \nanalyzed. Between January 2012 and November 2019, a total of 27 femur (A), \n74 ilium (B), 27 sacrum (C), 28 thoracic vertebrae (D) and 31 lumbar vertebrae \n(E) biopsies were included. Radiation exposure was reported for volume-\nweighted CT dose index (CTDIvol), dose-length product (DLP) and effective \ndose. \nResults or Findings: CTDIvol and DLP of manual versus powered drill biopsy \nwere (median,IQR): A: 56.9(41.4-128.5)/66.7(37.6-76.2)mGy, 410(203-\n683)/303(128-403)mGy·cm, B: 83.5(62.1-128.5)/59.4(46.2-79.8)mGy, 489(322-\n472)/400(329-695)mGy·cm, C: 97.5(71.6-149.2)/63.1(49.1-83.7)mGy, \n627(496-740)/404(316-515)mGy·cm, D: 67.0(40.3-86.6)/39.7(29.9-89.0)mGy, \n392(267-596)/207(166-402)mGy·cm, E: 100.1(66.5-162.6)/62.5(48.0-\n90.0)mGy, 521(385-619)/315(240-452)mGy·cm. Radiation exposure with \npowered drill was significantly lower for ilium and sacrum, while procedural \nduration was not increased for any anatomical location. Local DRLs could be \ndepicted as follows (CTDIvol/DLP): A: 90.9mGy/522mGy·cm, B: \n90.3mGy/530mGy·cm, C: 115.5mGy/740mGy·cm, D: 86.6mGy/578mGy·cm, E: \n115.0mGy/546mGy·cm. \nConclusion: Use of powered drill bone biopsy systems for CT-guided \npercutaneous bone biopsies can significantly reduce the radiation burden \ncompared to manual biopsy for specific anatomical locations such as ilium and \nsacrum and does not increase radiation dose or procedural duration for any of \nthe investigated locations. \nLimitations: Limitations are the retrospective design and that there were no \nequivalent numbers of manual and powered drill biopsies. Possibly operator \ndependent variability affected radiation dose. \nEthics Committee Approval: This study has obtained IRB approval. \nFunding for this study: n/a \nAuthor Disclosures: \nMichael Forsting: Nothing to disclose \nJens Theysohn: Nothing to disclose \nNika Guberina: Nothing to disclose \nDenise Bos: Research/Grant Support: Research grant within the University \nMedicine Essen Academy (UMEA) program, funded by the German Research \nFoundation (DFG; grant FU356/12-1) and the Faculty of Medicine, University of \nDuisburg-Essen \nJohannes Haubold: Research/Grant Support: Research grant within the \nUniversity Medicine Essen Academy (UMEA) program, funded by the German \nResearch Foundation (DFG; grant FU356/12-1) and the Faculty of Medicine, \nUniversity of Duisburg-Essen \nSebastian Zensen: Nothing to disclose \nAxel Wetter: Nothing to disclose \nMarcel Opitz: Nothing to disclose \nSumitha Selvaretnam: Nothing to disclose \n \nRPS 200-14 \nInstitutional Diagnostic Reference Levels (iDRLs) for fluoroscopic \ndiagnostic and interventional procedures \n*J. Tristram*¹, A. Steuwe¹, F. Kröpil¹, C. Thomas², G. Antoch¹, J. Boos³; \n¹Düsseldorf/DE, ²Krefeld/DE, ³Münster/DE \n(juliana.tristram@hhu.de) \n \nPurpose: To follow the call for action by the European Society of Radiology \nEurosafe imaging campaign and implement institutional diagnostic reference \nlevels (iDRLs) for fluoroscopic diagnostic and interventional procedures. \nMethods or Background: 3812 fluoroscopic procedures performed on a \nmonoplanar angiography system (device 1), a biplane angiography system \n(device 2) and a digital fluoroscopy device (device 3) were included in the IRB \napproved retrospective study (1926 men, 1886 women; 61.5±16.5 years, range \n18–107 years). Dose area product (DAP), cumulative air karma (CAK), \nfluoroscopy time (FT), patient information, and procedure information were \nextracted using the institutional dose monitoring system. IDRLs were defined \naccording to the recommendations of the International Commission on \nRadiological Protection (ICRP) as the median dose and calculated for the three \nmost frequent procedures per device. When available national DRLs were \ncompared with these iDRLs. \nResults or Findings: IDRLs (DAP/CAK/FT) for device 1 were 1603 cGycm²/ \n74 mGy/ 14.4 min for lower limb angiography (n=216), 11444/635/19.4 for \nabdominal vessel intervention (n=155), and 14587/942/24.5 for transarterial \nchemoembolization (TACE, n=84). For device 2 iDRLs were 9994/632/25.2 for \ncerebral and cervical thrombectomy (n=387), 7924/398/8.9 for cerebral \ndiagnostic angiography (n=298) and 3113/195/5.5 for diagnostic angiography \nof the carotid arteries (n=122). For device 3 iDRLs were 638/31/0.6 for iod \nswallow (n=452), 409/15/0.9 for colon contrast enema (n=123) and 414/16/0.8 \nfor upper gastrointestinal fluoroscopy (n=95). All iDRLs were lower than the \nnational DRLs ranging from 13.6% for colon contrast enema to 63.4% for \nTACE. \nConclusion: We implemented iDRLs for fluoroscopic diagnostic and \ninterventional procedures which enable a comprehensive dose analysis and \ncomparison with national DRLs. \nLimitations: The retrospective study design did not allow a complexity \nanalysis of the procedures. \nEthics Committee Approval: Ethics committee approval was granted by the \ninstitutional review board. \nFunding for this study: None \nAuthor Disclosures: \nJohannes Boos: Nothing to disclose \nChristoph Thomas: Nothing to disclose \nJuliana Tristram: Nothing to disclose \nFeride Kröpil: Nothing to disclose \nGerald Antoch: Nothing to disclose \nAndrea Steuwe: Nothing to disclose \n \nRPS 200-15 \nExposure of the population to ionising radiation from diagnostic medical \nimaging procedures in France in 2017 \n*S. Dreuil*, C. Michel; Fontenay-aux-Roses Cedex/FR \n(serge.dreuil@irsn.fr) \n \nPurpose: This study aims to establish data on the exposure of the French \npopulation to ionising radiation from medical imaging for diagnosis purposes \n(conventional, dental and interventional radiology, computed tomography and \nnuclear medicine) for the year 2017 and to analyse variation in such data. \nMethods or Background: The study was performed based on diagnostic \nimaging procedures taken from the \"échantillon généraliste des bénéficiaires\", \na sample on a 1/97th scale of the healthcare consumption of the population \ncovered by the main French health insurance schemes. \nResults or Findings: 45.4% of the French population underwent one or more \ndiagnostic imaging procedure in 2017 (43.8% in 2012), this percentage falling \nto 32.7% when dental radiology procedures are excluded. The evolution \nobserved on the mean frequency of imaging procedures and the average per \ncaput annual effective dose was generally minor, the latter stabilising at 1.53 \nmSv per caput (vs. 1.56 mSv in 2012). Nuclear medicine, the third contribution \nto the collective effective dose (11.3%) behind conventional radiology (11.8%), \nrecorded the greatest increase over the 2012-2017 period (+44%). However, \ncomputed tomography remained the most significant contribution to the \nexposure faced by the population (74.2 %) by far. Only a small percentage of \npatients - but representing several hundreds of thousands of patients \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 315  \nthroughout France - combined multiple computed tomography examinations, \nleading to high effective doses, potentially exceeding 100 mSv over 3 years. \nConclusion: The strong increase recorded between 2002 and 2012 for the \naverage per caput annual effective dose due to diagnostic medical imaging is \nno longer observed between 2012 and 2017. Nevertheless, attention should be \npaid to patients undergoing multiple imaging procedures over a short period of \ntime. \nLimitations: Not applicable. \nEthics Committee Approval: Not applicable. \nFunding for this study: Not applicable. \nAuthor Disclosures: \nSerge Dreuil: Nothing to disclose \nCélian Michel: Nothing to disclose \n \nRPS 200-16 \nEvaluation of possible effectiveness and detriment of using patient lead \npad for reducing staff dose in interventional radiology \n*T. Viana Miranda Lima*, T. Reyes Del Castillo, M. Heinrich, S. Zihlmann,  \nR. Lopez Benitez, J. E. Roos; Luzern/CH \n(thiago.lima@luks.ch) \n \nPurpose: To evaluate the usefulness of commercially available scatter \nreduction lead pads on staff radiation exposures in interventional radiology. \nMethods or Background: For this study an Alderson radiation therapy \nphantom, was irradiated in our Siemens Artis Icono angiograph device in three \nscenarios of protective pad usage (no use of the protective pad, correct use of \nthe pad and incorrect use of pad). Different levels of incorrect pad positioning \n(pad covering the FOV) were also evaluated: 5%, 15% and 50% of the FOV. A \nRaysafe i3 real-time dosimeter system was used to evaluate accumulative \ndose (mSv) and dose rates (mSv/h). Dosimeters positions simulated operator's \nleft eye (closer to the x-ray tube), over the lead apron, and thyroid. Doses and \ndose rates were compared in respect to its usefulness (dose reduction) or \ndetriment (higher dose). Additionally, patient exposure was evaluated by the \nprocedure DAP. \nResults or Findings: Operator doses ranged from 3.15 ± 0.04 μSv to 67.89 ± \n2.92 μSv (over the lead apron); from 0.43 ± 0.01 to 16.43 ± 0.91 (thyroid); and \nfrom 1.52 ± 0.08 to 44.77 ± 1.83 μSv (left eye). In terms of dose, at the perfect \npositioning of the pad (no FOV obstruction) we obtained in average 68% dose \nreduction compared to 67% (5% FOV obstruction), 63% (15% obstruction) and \nan average dose increase of 779% (50% obstruction). This pattern was \nobserved for all dosimetry locations. Similar order of magnitude was observed \nto the patient exposure. \nConclusion: Our results showed that exposure reduction (around 60%) for the \noperator is possible when these protective pads are used, however, the \nincorrect use may introduce a detriment in both operator and patient exposure. \nLimitations: Our results cover a limited number or devices. \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nStefanie Zihlmann: Nothing to disclose \nJustus Erasmus Roos: Nothing to disclose \nMirjam Heinrich: Nothing to disclose \nTomas Reyes Del Castillo: Nothing to disclose \nThiago Viana Miranda Lima: Nothing to disclose \nRuben Lopez Benitez: Nothing to disclose \n \nRPS 200-18 \nSee the Invisible: an augmented reality simulation of scatter radiation \nembedded in endovascular simulator as a game changer in the \nphysician's awareness \n*G. Bartal*, S. Fargun, I. Gal, N. Conway, A. Porat; Tel Aviv-Yafo/IL \n(gbartal@gmail.com) \n \nPurpose: State of the art angiography systems are an integral part of \nInterventional Radiology (IR), yet they come with a price of significant radiation \nexposure to the patients and personnel. Intelligent and safe use of this \nhardware improves performance and minimizes radiation exposure. Our aim \nwas to develop and evaluate performance of “See-the-Invisible”, radiation \nawareness application. \nMethods or Background: “See the Invisible” is a radiation alertness software \npackage add-on, connected to the ANGIO Mentor endovascular simulator \n(Simbionix, 3D Systems Healthcare). Based on published exposure data on \ndistance and angulation, four 3D models were created for each C-Arm \nangulation. The four 3D models represent scatter from 1000 mGy\\min, 150-\n1000 mGy\\min, 50-15 mGy\\min, <50 mGy\\min, and outer layer <1 mGy\\min \nrespectively. \nResults or Findings: The simulator launches an external TCP server \napplication, activating the Augmented Reality add-on, receiving synchronized \nscatter data as four layers of exposure. The 3D models shape, color and size \nare modified based on data interpolation corresponding to the simulation \ncase’s current C-Arm movement and other imaging parameters. The radiation \nscatter is a combination of four 3D models pre-loaded by the simulation, \nrepresenting the four layers of the radiation exposure. The room’s simulated \nscatter radiation is displayed using real-time deformation of the 3D models. \nThe server sends the information received from simulator client to any display \ndevices clients (phones/tablets) and they render for pre-calculated meshes in \nthe simulated 3D environment. \nConclusion: Real time augmented reality simulation of scatter radiation during \nsimulation of endovascular interventions creates virtual environment expected \nto improve the interventionist’s skills in a better procedure performance with \nlowest possible radiation exposure. Further evaluation using validated \nquestionnaires is underway. \nLimitations: Laboratory Investigation \nEthics Committee Approval: Not required \nFunding for this study: Not required \nAuthor Disclosures: \nShani Fargun: Employee: Simbionix 3DSystems \nIdan Gal: Employee: Simbionix 3DSystems \nAmir Porat: Employee: Simbionix 3DSystems \nGabriel Bartal: Consultant: Simbionix 3DSystems \nNeithan Conway: Employee: Simbionix 3DSystems \n \nRPS 200-19 \nChild protection beyond gender-based violence in crisis and \nhumanitarian settings of northeast Nigeria: a radiation protection \nperspective \n*A. A. C. Igwegbe *¹, L. R. Owoade², K. Kwaji¹, M. Abubakar¹, F. B. Nkubli ¹,  \nC. Chukwuemeka Nzotta³, A. Ali¹, U. Mohammed Sani ຾; ¹Maiduguri/NG, \n²Ibadan/NG, ³Awka/NG, ຾Kano/NG \n(igwegbea@gmail.com) \n \nPurpose: To determine radiation doses received by school-aged female \nchildren and to establish diagnostic reference levels (DRLs) \nMethods or Background: Fifty (50) school – aged female children,< 18 years \nof age were recruited from a tertiary hospital in Northeast Nigeria for this study. \nDemographic data such as age and gender; anthropometric data such as \nweight, height, Body Mass Index, and anteroposterior chest thickness and \ntechnical exposure parameters were obtained. Calibrated thermoluminescent \ndosimeter chips (TLD 100) were used to measure entrance skin dose. \nDescriptive statistics were used to summarise the data while percentiles were \nused to establish DRLs. Pearson’s correlation was used to determine the \nrelationship between doses received with anthropometric and technical \nparameters. DRL was set at the 75th percentile of the median patient dose \ndistributions for the various age groups studied. Statistical significance was set \nat p < 0.05. \nResults or Findings: The results of the established DRLs for the various age \ngroups in this study were;4Years - <10Year, 1.56 mGy; 10Years - <14Years, \n1.23 mGy; 14Years - <18Years, 2.12 mGy. Pearson correlation shows \nstatistically significant (p = 0.044) moderate positive relationship (r = 0.353) \nbetween weight with entrance skin dose among the 10 Years - <14 Years age \ngroup. A significant (p = 0.035) strong negative relationship (r = - 0.703) was \nalso observed between entrance skin dose with kVp among the 14 Years - < \n18 Years age group. \nConclusion: Age specific DRL for plain chest radiography marked by \nvariations in measured entrance skin doses was established for school aged \nfemale children. A statistically significant strong positive relationship between \nkVp and entrance skin dose was observed in this study. \nLimitations: Only chest radiography examination was considered \nEthics Committee Approval: Ethics committee approval was obtained for this \nstudy \nFunding for this study: n/a \nAuthor Disclosures: \nKafuli Kwaji: Author: Author \nAiman Amin Chidera Igwegbe : Author: speaker \nUmar Mohammed Sani: Author: Author \nChristian Chukwuemeka Nzotta: Author: Author \nAlhaji Ali: Author: Author \nFlavious Bobuin Nkubli : Author: Author \nLatifat Ronke Owoade: Author: Author \nMathew Abubakar: Author: Author \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 316  \n \nResearch Presentation Session: Education \n& Professional issues \nRPS 100 \nProfessional issues: education and \ntraining \nRPS 100-1 \nRadioimmunotherapy with yttrium-90 ibritumomab tiuxetan for relapsed \nor refractory B-cell non-Hodgkin's lymphoma: a single institution \nexperience in Japan \n*K. Maruyama*, K. Utsunomiya, Y. Kono, Y. Ueno, N. Tanigawa; Osaka/JP  \n(maruyamk@hirakata.kmu.ac.jp) \n \nPurpose: Yttrium-90 ibritumomab tiuxetan therapy (90Y-IT) was approved for \ntreating relapsed or refractory B-cell non-Hodgkin's lymphoma (NHL). As yet \nhowever, how long survive after 90Y-IT and what kind of factor affect the \nefficacy remains uncertain. Objective: We investigated the efficacy of 90Y-IT \nfor NHL. \nMethods or Background: Methods: We retrospectively examined 65 patients \n(mean age 68, range 45-87 years) with relapsed or refractory NHL who \nreceived 90Y-IT between October 2012 and September 2017. NHL included 46 \nFollicular lymphoma (FL),13 Mucosa associated lymphoid tissue lymphoma \n(MALT), and 6 Mantle cell lymphoma (MCL). Response rates (complete \nresponse, CR; partial response, PR; stable disease, SD; progressive disease, \nPD), overall survival (OS), and progression-free survival (PFS) were analyzed. \nThe correlations between OS and baseline variables such as age and F-18 \nfluorodeoxyglucose (FDG) uptake were analyzed. \nResults or Findings: Results: The overall response rate to 90Y-IT was 86% \n(CR 63%; PR 23%). The median follow-up between 90Y-IT and the latest \nclinical record was 51 months (range 0.9 to 95 months). The median OS was \nnot reached. For evaluable patients excluding who were censored (lost to \nfollow-up) the OS and PFS rates were 77% and 28% at 5 years, respectively. \nOf a total of 65 patients 10 patients died. 5 FL and 2 MALT died after 1 year \nfrom 90Y-IT. Three (50%) of the six patients with MCL did not respond and \ndied within 1 year in PD. The baseline variables were not significantly \ncorrelated with OS. \nConclusion: Radioimmunotherapy is active against relapse or refractory FL \nand MALT. On the other hand, efficacy data for 90Y-IT in MCL are limited. \nLimitations: Time limits. Longer follow-up needs. \nEthics Committee Approval: This study was conducted according to the \nprinciples of the Declaration of Helsinki. \nFunding for this study: No funding. \nAuthor Disclosures: \nKaoru Maruyama: Nothing to disclose \nKeita Utsunomiya: Nothing to disclose \nNoboru Tanigawa: Nothing to disclose \nYasuhiro Ueno: Nothing to disclose \nYumiko Kono: Nothing to disclose \n \nRPS 100-2 \nA novel online training platform for improving the accuracy of frontline \nclinicians in suspected COVID-19 chest x-ray interpretation \n*S. Ather*, F. Gleeson, A. Novak, J. Bahra, A. Acharya; Oxford/UK  \n(msarim@hotmail.com) \n \nPurpose: The incidence of coronavirus disease 2019 (COVID-19) continues to \nrise in the UK. Identification of COVID-19 using conventional radiography \n(chest X-rays) in the Emergency Department (ED) is a crucial skill for frontline \nclinicians. Report and Image Quality Control (RAIQC) is an original web-based \ntool designed to improve the image reporting ability of clinicians. We set out to \nevaluate the use of this platform for improving the accuracy of COVID-19 \nidentification on chest X-rays via a multicentre service improvement study. \nMethods or Background: 112 clinicians working in EDs across five regional \nhospitals were recruited over a six-month period. Participants completed online \ntraining in interpreting sixty anonymised chest X-rays. Accuracy of X-ray \nreporting was assessed before and after training. \nResults or Findings: All recruits completed the initial assessment. 56 recruits \ncompleted all three training components. The initial mean accuracy of \nclinicians in identifying COVID-19 on chest X-rays was 43%. The mean \naccuracy was 57% amongst recruits who completed all three online training \ncomponents. Participants who completed all training components had an \nimproved reporting speed. \nConclusion: Online training can improve the accuracy of frontline clinicians in \nidentifying COVID-19 on chest X-rays. \nLimitations: This study assessed participant reporting accuracy in a virtual \nlearning environment. Further work is required to evaluate the real-life \naccuracy rates of ED COVID-19 X-ray detection following the completion of \nonline training. \nEthics Committee Approval: - Permission was sought from the OUH \nCaldicott Guardian and information governance team to use anonymised \npatient imaging for the study. - Study participants were informed that their \nanonymised performance data would be used for service improvement \npurposes. \nFunding for this study: - Oxford Hospitals Charity - Innovate UK - Pfizer Ltd. \nFunding provided for the development and creation of the online learning \nplatform. Funders did not have any editorial influence. \nAuthor Disclosures: \nSarim Ather: Research/Grant Support: Innovate UK Research/Grant Support: \nPfizer Ltd Research/Grant Support: Oxford Hospitals Charity \nFergus Gleeson: Nothing to disclose \nAlex Novak: Nothing to disclose \nJasdeep Bahra: Nothing to disclose \nAnita Acharya: Nothing to disclose \n \nRPS 100-3 \nAirway, breathing, COVID-19? Adapting resuscitation training in the \nradiology department to ensure patient and staff safety in the COVID-19 \npandemic \n*S. Memarian*, W. Pettit, M. Naik, G. Treanor, M. Cooper, J. Danin,  \nA. J. Jameel; London/UK \n \nPurpose: The creation of the 2019 Radiology Specific Resus Training (RSR), \nwas to aid radiology staff in responding to a deteriorating patient and perform \neffective resuscitation. As safety to staff and patients is paramount, where \npatients in the radiology department often have unknown Covid status, we \nhave adapted the course to meet the unique challenges of the Covid-19 \npandemic. \nMethods or Background: Following discussion with key stakeholders \nincluding resuscitation, paediatric and imaging teams (specifically MR safety) \nthe previous RSR course now incorporates Covid-19 into each original \nscenario: anaphylaxis and contrast reactions, paediatric basic life support, \nmaternal collapse and resuscitation of an adult in the MR scanner (adult basic \nlife support) with special reference to staff safety and personal protective \nequipment (PPE). \nResults or Findings: This two hour course consists of an 'e-component' and a \npractical RSR component, which provides 'hands on' learning from the \nscenarios presented in the e-learning module. This “e-RSR” encompasses all \nof the above scenarios with the following aims: 1. Provide key knowledge prior \nto the practical session, using modern distance learning platforms. 2. Ensure \nthe practical session is effective and time focused - reducing any potential \nexposure to staff. We audited the effectiveness of the new e-RSR course at \ndelivering resuscitation training with a pre- and post course questionnaire. \nConclusion: Due to Covid-19 we amended the successful roll out of the \nradiology specific resuscitation (RSR) training programme, demonstrating the \nability of our department to swiftly adapt resuscitation training to the Covid-19 \npandemic. The new e-RSR course provides our radiology staff with the skills \nand confidence to manage acutely unwell paediatric and adult patients with a \nvariety of Covid status. \nLimitations: Covid-19 imposed restrictions and limited resus teams availability \nimpacting sample size for audit. \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nMehrengise Cooper: Nothing to disclose \nGillian Treanor: Nothing to disclose \nWilliam Pettit: nothing to disclose \nMitesh Naik: Nothing to disclose \nJoanna Danin: Nothing to disclose \nSabrina Memarian: Nothing to disclose \nAyesha Juvairia Jameel: Nothing to disclose \n \nRPS 100-4 \nThe effects of multidisciplinary team meetings on clinical practice for \ncolorectal, lung, breast, and prostate cancer: a systematic review \n*L. Koco*, H. Weekenstroo, R. Mann; Nijmegen/NL \n(lejla.koco@radboudumc.nl) \n \nPurpose: The aim of this systematic review is to identify the effects and value \nof multidisciplinary team meetings (MDTM) for lung, breast, colorectal and \nprostate cancer. \nMethods or Background: For this systematic review, performed following \nPRISMA guidelines, studies examining the impact of MDTMs on breast, \ncolorectal, lung, and prostate cancer care pathways were included. Endpoints \ninclude impact on management plan and survival. Electronic databases \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 317  \nPUBMED, EMBASE, Cochrane Library and Web of Science were searched for \narticles published between 2000-2019. Screening and data extraction were \nperformed by two independent researchers. Risk of bias and level of evidence \nwere assessed using ROBINS-I tool and GRADE scale. \nResults or Findings: 35 of 11,875 articles were selected; evaluating colorectal \n(20), lung (8), prostate (6) and breast (1) cancer. Risk of Bias was scored \nserious to critical and reported results are heterogeneous. Results showed that \nmanagement plans were changed in 1.6%-58% of cases after MDTMs; 10 of \n14 studies showed an increase of more than 20%. All studies evaluating \nsurgery showed a significant impact of MDTMs on surgery type; most studies \nshowed a significant reduction of overall performed surgery after MDTM. Most \nstudies showed a significant increase in CT and MRI imaging in the MDT \ncohorts. No significant impact on colonoscopy and ultrasound diagnostics was \nidentified. Nine studies assessed survival, of which six studies showed survival \nrate increased significantly with MDTM discussions and three studies did not \nshow significant differences. \nConclusion: Despite heterogeneous data, MDTMs commonly change the \nmanagement plan, decreasing surgery and increasing imaging. Survival seems \nto be increased in patients discussed in MDTMs. To further explore the impact \nof MDTMs on the quality of healthcare, high-quality research is needed. \nLimitations: Meta-analysis wasn't possible due to the heterogeneity of data. \nEthics Committee Approval: Not necessary \nFunding for this study: None \nAuthor Disclosures: \nHarm Weekenstroo: Nothing to disclose \nRitse Maarten Mann: Nothing to disclose \nLejla Koco: Nothing to disclose \n \nRPS 100-5 \nStaff radiologists' experience and subspecialisation: how does it affect \nproofreading behaviour when reviewing resident preliminary reports? \n*J. Vosshenrich*, P. Brantner, J. Cyriac, D. Boll, E. M. Merkle, T. Heye; \nBasel/CH \n(jan.vosshenrich@usb.ch) \n \nPurpose: To investigate if level of experience and subspecialization of \nattendings impact the report review process using a data mining approach. \nMethods or Background: 131,397 radiology reports dictated from 07/2017-\n08/2020 in our tertiary care radiology department were included. Reports were \nautomatically analyzed by a custom-developed report comparison tool. It \nquantifies the amount of edits on residents’ preliminary reports by attendings \nduring proofreading using the Jaccard Index (range: 0-1). A Jaccard index of \n0.85 e.g. equals an edit distance of 15%. Years/months of post-fellowship \nexperience as staff radiologist at the time of review were allocated to each \nreport. Three levels of experience were defined: (1) ” 5 years, (2) 6-10 years \n(3) >10 years. Welch ANOVA was used to compare groups overall, per \nmodality and subspecialty section. Relationship of Jaccard distance and \nexperience was assessed with linear regression analysis. \nResults or Findings: With increasing experience, staff radiologists performed \nless edits during review of resident reports overall (Jaccard distance: 18% [ ”5 \nyears’ experience] vs. 14% [6-10 years’ experience] vs. 9% [>10 years’ \nexperience]; p<.001). Similar decreases were seen for all distinct radiology \nsubspecialty sections (e.g. MSK: 28% [ ”5 years] vs. 20% [6-10 years] vs. 9% \n[>10 years]; p<.001) and imaging modalities (e.g. CT: 15% [ ”5 years] vs. 11% \n[6-10 years] vs. 9% [>10 years]; p<.001). Linear regression analysis confirmed \na strong negative relationship between experience and Jaccard distance (r=-\n0.79 [95%-CI: -0.72,-0.84]; p<.001). Attendings performed more edits on \nreports from their personal subspecialty compared to reports of imaging \nstudies outside their field of expertise (Jaccard distance: 15% vs. 11%; \np<.001). \nConclusion: Staff radiologists’ level of experience and subspecialization seem \nto impact proofreading behavior when reviewing resident reports significantly. \nFurther investigation how this affects radiology report quality are needed. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nPhilipp Brantner: Nothing to disclose \nTobias Heye: Nothing to disclose \nJoshy Cyriac: Nothing to disclose \nDaniel Boll: Nothing to disclose \nElmar M. Merkle: Nothing to disclose \nJan Vosshenrich: Nothing to disclose \n \n \n \n \n \n \n \nRPS 100-6 \nHow COVID-19 kick-started online learning in medical education: the \nDigiMed study \n*F. Stoehr*¹, L. Müller¹, A. Brady², F. Hahn¹, A. Mähringer-Kunz¹, C. Düber¹,  \nT. Emrich¹, D. Pinto³, R. Kloeckner¹; ¹Mainz/DE, ²Cork/IE, ³Cologne/DE \n \nPurpose: The coronavirus disease 2019 (COVID-19) pandemic led to far-\nreaching restrictions of social and professional life. Medical schools had to \nrestructure their curriculum by switching to online learning. We aimed to \nevaluate students’ attitudes to online learning to guide future development of \nmedical education. \nMethods or Background: 3286 medical students from 12 different countries \nparticipated in this cross-sectional study. On a 7-point Likert scale, participants \nrated the online learning situation before and during the pandemic at their \nmedical schools, technical and social aspects, and the current and future role \nof online learning in medical education. \nResults or Findings: Most medical schools managed the rapid switch to \nonline learning (78%). Online learning led to unchanged or higher attendance \nof courses (70%). Possible downsides included motivational problems (42%) \nand the risk of social isolation (64%). Most were convinced that medical \neducation lags behind current capabilities regarding online learning (78%) and \nestimated the proportion of online learning before the pandemic at only 14%. \nFor the future, they wished for a more prominent role, involving around 42% of \nonline learning. \nConclusion: This study demonstrates the positive attitude of medical students \ntowards online learning. It reveals a discrepancy between what students \ndemand and what the curriculum offers. The pandemic might be the long-\nawaited catalyst for a new “online era” in medical education. \nLimitations: - selection bias, meaning that interested students are more likely \nto complete the questionnaire. - social desirability, meaning that participants \nchoose the answer that they assume is favourable. - cross-sectional study \ndesign. Thus, results may not necessarily translate into long-term opinions. \nEthics Committee Approval: Institutional review board approval was waived \nby the Ethics Committee of the Medical Association of Rhineland-Palatinate. \nFunding for this study: FS is supported by the Clinician Scientist Fellowship \n“Else Kröner Research College: 2018_Kolleg.05”. \nAuthor Disclosures: \nRoman Kloeckner: Nothing to disclose \nLukas Müller: Nothing to disclose \nFabian Stöhr: Grant Recipient: Fabian Stoehr is supported by the Clinician \nScientist Fellowship “Else Kröner Research College: 2018_Kolleg.05”.This \nfunding source had no role in the design, data collection, analysis, \ninterpretation, writing, or decision to submit the results of this study. \nChristoph Düber: Nothing to disclose \nAline Mähringer-Kunz: Nothing to disclose \nFelix Hahn: Nothing to disclose \nTilman Stephan Emrich: Nothing to disclose \nDaniel Pinto: Nothing to disclose \nAdrian Brady: Nothing to disclose \n \nRPS 100-7 \nHow to operate proton therapy in the pandemic environment: a single \ncenter experience \n*M. Cherkashin*, N. Berezina, N. Vorobyov, A. Mikhaylov, A. Nikolaev,  \nN. Kataev; Saint Petersburg/RU \n(mikhail.a.cherkashin@gmail.com) \n \nPurpose: To discuss organizational practices for proton therapy delivery in \nCOVID-19 pandemic environment \nMethods or Background: Novel coronavirus pandemic has affected on \ndifferent therapeutic areas and patient access for cancer treatment this year \nwas restricted. We've tried to organize processes for proton and external beam \nradiation therapy for COVID-positive cancer patients. Due to local regulations, \nverified SARS-CoV-2 patient should be isolated, and we've organized \ndedicated observational inpatient department. 2 infected patients (moderate \npneumonia confirmed by CT and good respiratory function) were involved - \nprostate cancer and esophageal tumor. Prostate was treated by \nhypofractionation (5 fractions with endorectal balloons), esophageal cancer - \nby standard fractionation. Patients has isolated in wards and before each \nradiation treatment were disinfected in disinfection area and covered with PPE. \nMedical physicists and radiotherapists also use PPE level 2. Proton therapy \ntreatment gentry was sanitized after each fraction. \nResults or Findings: Radiation proton therapy for cancer in COVID patients \nwas completed with standard clinical effect and good local control. Also both \npatients has positive respiratory status and were dismisses hospital for home \ntreatment. After 3 months we haven't detected cancer progression (by MRI) \nand patients has reconvalescence for COVID with positive IgG antibodies and \ngood clinical performance. Medical staff and other non-infected patients \nhaven't any infection exposure and still COVID-free. \nConclusion: New pandemic environment in oncology hospitals demands to \nreassess infection control practices. Standard radiation cancer treatment is \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 318  \npossible for coronavirus infected patients. Clear practices should be \nimplemented - patient isolation in case of infection, disinfection before \ntreatment, personal protective equipment usage for patient and involved \nhealthcare providers. \nLimitations: This is the ongoing case study in pandemic environment \nEthics Committee Approval: Study was approved by LEC \nFunding for this study: Funded by Hospital \nAuthor Disclosures: \nNikita Kataev: Nothing to disclose \nMikhail Cherkashin: Nothing to disclose \nNatalia Berezina: Nothing to disclose \nAleksey Nikolaev: Nothing to disclose \nAlexey Mikhaylov: Nothing to disclose \nNikolay Vorobyov: Nothing to disclose \n \nRPS 100-8 \nChallenges encountered by radiologists during the COVID-19 pandemic \nin a limited-resource third-world setting \n*M. E. Abd El Bagi*¹, M. Mustafa¹, H. Khalil², M. Altahir¹, S. Alhassan¹,  \nS. Mohammed³, O. Elamin຾, H. Ahmed¹, T. Abdalhadi³; ¹Khartoum/SD, \n²Omdurman/SD, ³Khartoum North/SD, ຾Shargelneel/SD \n(drm_bagi@hotmail.com) \n \nPurpose: COVID19 impact on radiologists in a limited resource setting. \nMethods or Background: COVID19 hit Sudan on 13th March 2020. Access to \nadvanced imaging is limited to those who can pay. Sudanese radiology \nresidents and their supervisors were asked by an online questionnaire about \ntheir experience during the pandemic. This paper reports the actual challenges \nencountered by radiologists during the pandemic. \nResults or Findings: The weekly meeting attendance varied from 70-100. 89 \nparticipants responded. 55 (61.8%) of the respondents were residents. \n35(39.3%) of participants were affiliated with the private sector. Most \ndepartments 61 (68.5%) were partly shutdown.11(12.4%) of participants were \nnot given a pass during the care few. 32(36%) could not find transport. \nPersonal protective equipment (PPEs) was totally lacking for 34 (38.2%) of the \nparticipants. Turn-around times of radiology reports were normal in only \n30(33.7%). Delay of swab results has caused unnecessary isolation for 59 \n(66.3%) of the participants. 76 (85.4%) of the 89 respondents did not get any \ntraining for COVID19. 45 (50.6%) of the respondents have sometimes suffered \nintimidation or aggression by co-patients or the forces. Only 27 (30.3%) of the \nparticipants expected their departments would do better in the future. 21 \n(23.6%) of the participants had their rent refused by landlords due to phobia. \nConclusion: There were many encountered challenges. Most serious was lack \nof training and shortage of PPE which lead to departments shut down. Though \nwell equipped, the private sector is not the best set up for training and \nresearch. It is hoped that this report would help future preparedness and attract \ninternational logistic support to bridge the widening gap of global health \ninequalities. \nLimitations: The results were not gendered specific. \nEthics Committee Approval: The study was approved by the Sudan Medical \nSpecialities Board \nFunding for this study: None. \nAuthor Disclosures: \nSomia Mohammed: Nothing to disclose \nHiba Khalil: Nothing to disclose \nTarteel Abdalhadi: Nothing to disclose \nMohammed Altahir: Nothing to disclose \nMohamed Elmutasim Abd El Bagi: Nothing to disclose \nHanaa Ahmed: Nothing to disclose \nMadina Mustafa: Nothing to disclose \nSuzan Alhassan: Nothing to disclose \nOsman Elamin: Nothing to disclose \n \nRPS 100-9 \nContrast media in the water supply system: how to reduce the use of \ncontrast media in CT scans \n*H. Dekker*, M. Prokop; Nijmegen/NL \n(heleen.dekker@radboudumc.nl) \n \nPurpose: To understand the environmental impact of iodinated contrast \nagents. To learn which measures can be taken to reduce the amount of \ncontrast material in waste water. To understand the impact of these measures \non contrast use and waste. \nMethods or Background: For radiologists, contrast media are essential for \ndiagnostic and interventional procedures. Data from The Netherlands shows \nthat these contrast media are found in sewage water, surface water and \ndrinking water. Contrast media cannot be removed from the water with current \npurification techniques and therefore pose a problem for drinking water \npreparation that has not been solved yet. \nResults or Findings: At Radboudumc we have implemented the following \napproach: 1. Individually adjustment of the amount of intravascular iodinated \ncontrast medium in CT to the weight of the patient and the clinical question. 2. \nMulti-patient injection system using bottle sizes of 50 – 500 ml adjusted to the \nexpected aggregated use towards the upcoming scan hours. 3. Oral contrast \nmedia for abdominal CT largely replaced by water. 4. Collection of residues of \ncontrast medium separately and dispose of them via the specific hospital \nwaste. The following effects have been achieved by these measures: 1. The \nuse of intravenous iodinated contrast medium is reduced by more than 10% 2. \nThe use of oral contrast medium is reduced by more than 80% 3. Awareness \nand active anticipation has arisen among technicians. \nConclusion: Reducing the use of contrast media, both for intravenous and \noral use, is a first step to limit the environmental impact of contrast media. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nMathias Prokop: nothing to disclose \nHelena Dekker: nothing to disclose \n \nRPS 100-10 \nPatient-centred care in diagnostic radiography: perceptions of service \nusers, service deliverers, students, and educators \n*E. Hyde*¹, M. Hardy²; ¹Derby/UK, ²Bradford/UK \n(e.hyde@derby.ac.uk) \n \nPurpose: To elicit the meaning of patient centred care (PCC) from the \nperspectives of service users (patients), service deliverers (radiographers and \nmanagers), radiography students and educators and determine whether these \nare aligned in terms of attached importance. \nMethods or Background: A 2 stage approach was adopted. Stage 1 was a \nweb-based attitudinal survey to explore understanding of PCC. Respondents \nwere asked to indicate their level of agreement to paired (positive and negative \nphrasing) statements. Survey content was the same across participant groups \nbut phrasing was tailored to respondent group. Pre-distribution piloting ensured \nsuitability on survey language and questions. Data were analysed using \ndescriptive statistics with impact of statement phrasing analysed \nusingௗWilcoxon signed rank test. Stage 2 ௗwas focus groupsௗand telephone \ninterviewsௗwith volunteer particpants from Stage 1. Situational vignettes ௗwere \ndeveloped from Stage 1 responses and participants were asked to ௗdiscuss \nthese to elicit deeper understanding of PCC priorities from the differing \nperspectives. The interviewsௗwere audio-recorded and transcribed verbatim \nbefore being analysed thematically to draw out key themes. These were \ncompared and contrasted across participant groups. ௗௗ \nResults or Findings: While the core components of PCC identified by all \ngroups were: technical competence; dignity and privacy; and human \ninteraction, the interpretation and meaning placed on these and their reltive \nimportance within PCC varied. Importantly, only patients identified the \nenvironment as important to PCC. Similarly only radiographers and \nradiography managers identified efficiency as important. \nConclusion: Patient centred care does not hold the same meaning for the \ndifferent participant groups. In order to truly deliver PCC, the differing values \nand interpretations need to be aligned. \nLimitations: None \nEthics Committee Approval: Ethical approval was granted by the University \nof Derby. \nFunding for this study: This research was funded by the UK College of \nRadiographers Industry Partnership scheme. \nAuthor Disclosures: \nEmma Hyde: Nothing to disclose \nMaryann Hardy: Nothing to disclose \n \nRPS 100-11 \nRadiological \"SATs\" monitor: the use of \"study ascribable times\" to \nassess the impact of clinical workload on resident training in a resource-\nlimited setting \n*C. E. Le Roux*; Cape Town/ZA \n(camilla.leroux@gmail.com) \n \nPurpose: Globally, increasing clinical demands threaten postgraduate \nradiology training programmes. Time-based assessment of clinical workload is \noptimal in the academic environment, where an estimated 30% of consultant \ntime should ideally be devoted to non-reporting activities. There has been \nlimited analysis of the academic radiologist workload in low- and middle-\nincome countries. \nMethods or Background: Departmental staffing and clinical statistics were \nreviewed for 2008 and 2017. The Royal Australian and New Zealand College \nof Radiologists ‘study ascribable times’ (RANZCR-SATs) for primary consultant \nreporting were used with the Royal College of Radiologists (RCR) 2012 \nguidelines for secondary review of resident reports, to estimate the total \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 319  \nconsultant-hours required for each year’s clinical workload. Analyses were \nstratified by type of investigation (plain-film vs. special) and expressed as a \nproportion of the total annual available consultant working hours. \nResults or Findings: Reporting all investigations required 90% and 100%, \nwhile reporting special investigations alone, demanded 53% and 69% of \nannual consultant working hours in 2008 and 2017, respectively. Between \n2008 and 2017, the proportion of consultant time available for plain-film \nreporting decreased from 17% to 1%, while preserving 30% for non-reporting \nactivities. \nConclusion: A time-based analysis of the academic radiologist’s clinical \nworkload, utilising the RANZCR-SATs and RCR 2012 guidelines for primary \nand secondary reporting, respectively, provides a reasonably accurate \nreflection of the service pressures in resource-constrained environments and \nhas potential international applicability. \nLimitations: A retrospective study was conducted and it is not possible to \ninvoke a completely accurate and all-encompassing method of measuring \nradiologist workload and productivity. \nEthics Committee Approval: Granted \nFunding for this study: None \nAuthor Disclosures: \nCamilla Engela Le Roux: Nothing to disclose \n \nRPS 100-12 \nThe COVID-19 outbreak on healthcare workers: survey on the perception \nof phase 1 of the HealthCare system: Italian radiographers' experience \n*C. Martini*¹, A. Devetti², M. Nicolò³, C. Risoli ຾, A. Tombolesi຿, O. Brazzo๤,  \nD. Di Feoເ, W. Antonucciແ, M. Migliorini๥; ¹Parma/IT, ²Udine/IT, ³Brescia/IT, \n຾Piacenza/IT, ຿Torino/IT, ๤Bari/IT, ເFlorence/IT, ແBarletta/IT, ๥Ferrara/IT \n(martinic@ao.pr.it) \n \nPurpose: To evaluate the Italian radiographers experience during the Phase 1 \nCOVID-19 Outbreak. \nMethods or Background: The COVID-19 (C19) outbreak had since spread \nrapidly worldwide. Many patients even with and without symptoms, underwent \nradiological examinations, with an high risk of infection for radiology \ndepartment’s staff. The first-hit European country to face the outbreak of C19 \nwas Italy and the impact on radiographers (RT) was huge. It was a cross-\nsectional study consisting of a web-based survey to investigate the attitudes \nand the level of awareness of Healthcare Workers (HCW) during first wave \nC19 pandemic. The survey was administered via social media by the Italian \nAssociation of CT and Pediatric RT, Italian Risk Management Group, Italian \nAssociation of System and Telehealth Administrators, and Italian Federation of \nScientific RT Societies, respectively. The survey was available anonymously \nonline from March 7 th 2020 to May 31. The questions concerned: \ndemographics, working environment, knowledge on Covid-19/SARS/MERS, \nradiological equipment for X-ray and CT, presence of dedicated \npaths/protocols, PPE, sanification and disinfection. \nResults or Findings: A total of 1.109 responded to the survey. Of these, 35% \nwere women. HCW were mostly RT (95%), from high-prevalence regions \n(68%). 73% worked in a public hospital getting defined protocol for generical \ninfection, and pathway for COVID-19. While only 38% was aware to \nSARS/MERS protocol. 55% had a dedicated both X-ray and CT for COVID-19 \npatients, without exhaustive guidelines. Among the tested population, 40% \nperformed a radiological exam in pairs. Only 21% of HCW considered PPE \nadequate for quality and quantity. \nConclusion: Healthcare institutions should have ongoing training for HCWs \nand discussions around protocol for infection transmission. Management \nstrategies should be promptly undertaken to enhance safety and optimize \nresource allocation. \nLimitations: Nothing to declare \nEthics Committee Approval: Nothing to declare \nFunding for this study: Nothing to declare \nAuthor Disclosures: \nCamilla Risoli: Nothing to disclose \nAlessandro Tombolesi: Nothing to disclose \nWalter Antonucci: Nothing to disclose \nAngie Devetti: Nothing to disclose \nMarco Nicolò: Nothing to disclose \nOscar Brazzo: Nothing to disclose \nChiara Martini: Nothing to disclose \nMatteo Migliorini: nothing to disclose \nDaniele Di Feo: Nothing to disclose \n \nRPS 100-13 \nRadiology residents' feedback on initial training by social media in a \nlimited resource sub-Saharan setting during the COVID-19 pandemic \n*M. E. Abd El Bagi*, A. Jabir, K. Tia, M. M. Fadol, W. Almansoori,  \nI. Abd Elgadir, T. Nori, E. Eltayeb, R. Abugsaisa; Khartoum/SD \n(profmutasim@gmail.com) \n \nPurpose: Residents' evaluation of training by social media. \nMethods or Background: Radiology residents in limited-resource settings of \nSub-Saharan Africa compete for the same British Fellowships and European \nDiploma exams with their privileged western counterparts. There is a lack of \nliterature about radiology-infrastructure in Africa. Little is known about the use \nof social media in radiology training. The choice of the most suitable social \nmedia at the local circumstances was not studied before. This paper reports \nthe hurdles facing local trainees and their evaluation of an initial voluntary \ntraining program using social media. Methods A quantitative questionnaire was \nposted on google forms software. Sudanese radiology residents were invited to \nparticipate via their What’s App group. Expatriates and those trapped outside \nthe country were excluded. Participants were asked about their experience \nduring the first 3month peak of COVID19 spread in the country. \nResults or Findings: There were 91 residents in the town of whom 53(59%) \nresponded. 47 (88.7%) suffered difficulties related to the care few. Onsite \ntraining stopped completely for24(45.3%) of residents due to the pandemic. \nThe most practical platform was What’s App according to 27(50.9%) of the \nresidents. 9( 17%) recommended virtual learning full time but 12(22.6%) \nindicated that virtual teaching should not replace onsite activities.34(64.7%) of \nresidents reported technical internet inaccessibility due to a weak district \ninternet signal or interrupted electric power supply. The care few procedures \nwere restrictive. \nConclusion: The pandemic has challenged the training program with \nunparalleled hurdles. Social media use is unavoidable albeit privacy risk and \ndiscontinuity. WhatsApp was the most favored. A need exists for a booster \nexternal attachment training programs, perhaps sponsored by ECR and RCR. \nLimitations: The results were not gender-specific. \nEthics Committee Approval: Sudan Medical Specialisation Board approval. \nFunding for this study: None \nAuthor Disclosures: \nTsabeeh Nori: Nothing to disclose \nEman Eltayeb: Nothing to disclose \nRanda Abugsaisa: Nothing to disclose \nWeam Almansoori: Nothing to disclose \nKhalid Tia: Nothing to disclose \nAbdallah Jabir: Nothing to disclose \nMohamed Elmutasim Abd El Bagi: Nothing to disclose \nIman Abd Elgadir: Nothing to disclose \nMuhammed Mustafa Fadol: Nothing to disclose \n \nRPS 100-14 \nDoes levosimendan prevent contrast medium nephrotoxicity in rats? \n*I. Durur Subasi*¹, D. Kose², M. Yayla³, B. Sirin², A. Karaman², I. Calik²,  \nF. Alper²; ¹Istanbul/TR, ²Erzurum/TR, ³Kars/TR \n(irmakdurur@yahoo.com) \n \nPurpose: To study the possible nephroprotective influences of levosimendan \nfor contrast medium nephrotoxicity in the kidney of rat. \nMethods or Background: With the permissions of IRB, the experiment \nconsisted of 8 rat groups having 6 rats in each cage. Nephrotoxicity was \nprovoked by one-day water withdrawal and injection of glycerol. Contrast \nmedium nephrotoxicity was encouraged by IV delivery of iohexol. The first \ngroup was not given any medications as the control group. The other groups \nwere given some medications as follows: Glycerol for the second group; \ncontrast medium (iohexol 10 ml/kg) for third; glycerol and contrast medium for \nfourth; contrast medium and levosimendan 0.25 mg/kg for fifth; glycerol, \ncontrast medium and levosimendan 0.25 mg/kg for sixth:, contrast medium and \nlevosimendan 0.5 mg/kg for seventh; glycerol, contrast medium and \nlevosimendan 0.5 mg/kg for eight groups. \nResults or Findings: The serum blood urea nitrogen and creatinine levels, \nsuperoxide dismutase activity, glutathione, and malondialdehyde levels were \nconsiderably developed by levosimendan direction. Levosimendan significantly \ndown-regulated the values of tumor necrosis factor- Į, nuclear factor-kappa ß, \nand interleukin 6 mRNA. The histopathological marks of hyaline and \nhemorrhagic casts and tubular necrosis were improved in the levosimendan \nadministered ones. \nConclusion: Levosimendan has nephroprotective properties attributable to its \npossessions falling oxidative distress and preventing the secretion of pro-\ninflammatory cytokines against contrast medium nephrotoxicity in rats. \nLimitations: A limited number of rats. \nOnly two different (not multiple) dose administration. \nEthics Committee Approval: Exists. \nFunding for this study: No funding. \nAuthor Disclosures: \nDuygu Kose: Nothing to disclose \nBusra Sirin: Nothing to disclose \nMuhammed Yayla: Nothing to disclose \nAdem Karaman: Nothing to disclose \nFatih Alper: Nothing to disclose \nIrmak Durur Subasi: Nothing to disclose \nIlknur Calik: Nothing to disclose \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 320  \nRPS 100-15 \nMedical devices in the abdominal x-ray: what the radiologist needs to \nknow \n*D. C. Carvalho*, F. L. Ferreira, M. Morgado, A. T. Vilares, S. C. Dias,  \nA. J. Madureira; Porto/PT \n \nPurpose: To review and illustrate many of the abdominal and pelvic devices \nthat a radiologist may encounter in X-ray studies, going through how to \nrecognize them, as well as their indications and related complications. \nMethods or Background: Due to technology advancements and the \nincreasing number of imaging studies, it's getting more common for radiologists \nto find devices on abdominal X-rays, some of which they might not be familiar \nwith. This can complicate the interpretation of the images. Failing to recognize \nthe device(s) present in a certain X-ray study might compromise the accuracy \nof the diagnosis, and lead the radiologist to miss an incorrectly placed device \nor a related complication. It’s very important for the radiologist to become \nfamiliar with the radiologic appearance of medical devices, and their evaluation \nshould be considered as important as any other aspect in a radiologic \nexamination. \nResults or Findings: Medical devices in abdominal x-rays can be divided into \na few major groups for simplification purposes, namely gastrointestinal, \ngenitourinary, surgical and neurologic devices. Some of them are more \ncommonly seen, such as nasogastric tubes, gastric banding, gastrostomy and \njejunostomy, Foley catheters, ureteric stents, intrauterine contraceptive devices \nou tubal sterilization devices, surgical clips or drains and endoprosthetic stents, \njust to name a few. Others are seen more rarely, such as neurostimulators, \nsuprapubic cystotomies or nephrostomy tubes, embolization material, penile \nprostheses or a vaginal pessaries. \nConclusion: Since there is a wide variety of devices that can be found during \nan X-ray study of the abdomen and pelvis, it is important for the radiologist to \nbe familiar with them, not only with their accurate placement, but also with \ncomplications that might be associated, so that he can timely inform the \nreferring clinician. \nLimitations: n/a \nEthics Committee Approval: n/a \nFunding for this study: n/a \nAuthor Disclosures: \nAna Teresa Vilares: Nothing to disclose \nAntónio J. Madureira: Nothing to disclose \nSílvia Costa Dias: Nothing to disclose \nFábio Lopes Ferreira: Nothing to disclose \nMargarida Morgado: Nothing to disclose \nDiogo Costa Carvalho: Nothing to disclose \n \nRPS 100-16 \nGender trends in authorships and publication impact \n*I. Molwitz*; Hamburg/DE \n \nPurpose: To investigate publication numbers of female authors in 10 high to \nlow impact radiological journals between 2007/8 and 2017/18. \nMethods or Background: In this retrospective bibliometric analysis original \nresearch articles and reviews published in 2007/8 and 2017/18 in high, \nmedium, and low impact journals according to Clarivate analytics web of \nscience’s journal citation reports were reviewed with regards to the gender of \nthe first (FA) and senior author (SA). The adjusted event rate (AER) and \nadjusted odds ratio (AOR) were calculated by mixed logistic and multinomial \nlogistic regression models to assess likelihood of female publications according \nto impact factor, journal, author position and combination. \nResults or Findings: The proportion of female FA and female SA in N=6979 \n(2007/8) and N=7383 (2017/18) articles, increased by 58% and 61%, \nrespectively. While most female authorships were continuously observed in \nmedium impact journals, the strongest increase occurred for both female FA \n(AOR 2.0; P <.0001) and SA (AOR 2.1; P <.0001) in low impact journals. \nFemale SA were significantly more likely to publish in a low (AOR 1.5) or \nmedium ranking journal (AOR 1.8) than in a high ranking one. Same-sex male \ncollaborations were more likely than female SA collaborations across journals \nof all impact spates. \nConclusion: A ten-year positive trend in the development of female \nauthorships was observed in all impact areas. Gender disparities however still \nexist, particularly with regard to female senior positions and high impact factor. \nLimitations: The analysis was focused on FA and SA and does not provide \ninformation about co-authors. Statistical analysis was corrected for authors of \nunclear gender. \nEthics Committee Approval: Institutional review board exemption was \nobtained. \nFunding for this study: This work has not received any funding. \nAuthor Disclosures: \nIsabel Molwitz: Nothing to disclose \n \n \nRPS 100-17 \nEverything you always wanted to know about contrast media (but were \nafraid to ask) \n*J. M. Felices Farias*, M. D. Abellan-Rivero, P. P. Ortuño-Lopez,  \nV. Martinez-Jimenez, A. Perez-Ballesta, F. Barqueros Escuer,  \nD. San Leandro Pardo, A. Puerta-Sales; El Palmar/ES \n(jmfelicesfarias@gmail.com) \n \nPurpose: - To learn the main information to know about the patient before \ncontrast media use - To know the complications related to contrast media use \nand how to prevent them - To review which patients should be premedicated \nand how to premedicate. \nMethods or Background: Contrast media is broadly used in Radiology \ndepartments. Nowadays they are mostly safe and complications related to \ncontrast media are rare. The most common complications related to contrast \nmedia are the anafilactoid reactions and the acute kidney injury but there is not \nenough known which patients could develop them and how to properly prevent \nthese kinds of complications. \nResults or Findings: In clinical practice it is common to doubt if an image \nstudy might or not be performed because of potential complications, which \ncould lead to infradiagnosis. Most of these situations could be avoided through \nan optimal premedication, but it is main to know which patients get benefit of \nthe premedication and how to set it. An algorithm to recognize patients in risk \nto develop contrast media related complications is shown according to a review \nof the relevant risk factors. It is also purposed the suitable management of \nthese patients in risk, based on potential adverse anafilactoid reactions or \ndevelopment of an acute kidney injury. \nConclusion: To use an algorithm to check the relevant information due to \npremedicate the patients in risk of contrast media related complications will \nallow clinicians and radiologists to avoid infradagnosis and to perform safer \nimage studies. \nLimitations: It is based on retrospective study. \nEthics Committee Approval: No need of ethics committee approval \nFunding for this study: No funding received \nAuthor Disclosures: \nJosé Manuel Felices Farias: Speaker: Hospital Clinico Universitario Virgen de \nla Arrixaca Author: Hospital Clinico Universitario Virgen de la Arrixaca \nAna Perez-Ballesta: Author: Hospital Clinico Universitario Virgen de la Arrixaca \nMaria Dolores Abellan-Rivero: Author: Hospital Clinico Universitario Virgen de \nla Arrixaca \nDavid San Leandro Pardo: Author: Hospital Clinico Universitario Virgen de la \nArrixaca \nVictor Martinez-Jimenez: Author: Hospital Clinico Universitario Virgen de la \nArrixaca \nPedro Pablo Ortuño-Lopez: Author: Hospital Clinico Universitario Virgen de la \nArrixaca \nFrancisco Barqueros Escuer: Author: Hospital Clinico Universitario Virgen de la \nArrixaca \nAlejandro Puerta-Sales: Author: Hospital Clinico Universitario Virgen de la \nArrixaca \n \nRPS 100-18 \nOptimising patient and staff safety during a pandemic: practical infection \ncontrol measures for MRI scanning \n*B. J. Nugent*; Edinburgh/UK \n(bnugent@btopenworld.com) \n \nPurpose: Lockdown measures such as postponing elective MRI scans were \ndesigned to ensure capacity for an expected surge in COVID-19 cases and to \nreduce the likelihood of nosocomial spread. With the easing of restrictions \ncomes pressure to resume routine scanning and process the backlog of \nexaminations. As criteria for infection control during this pandemic evolves, \nestablishing current infection control processes and sharing expertise may \nencourage best practice. \nMethods or Background: A snapshot survey, via email, asked UK MRI \nprofessionals what strategies were in place to try to protect against contracting \nCOVID-19 in the workplace. The results led to a collaborative project to \ndevelop a series of infection control measures to consider. \nResults or Findings: A learning resource developed providing practical and \ninnovative steps, within an outpatient MRI patient pathway, to try to reduce the \nrisk of infection emphasising the importance of: • Health surveillance checks • \nEye protection for staff if a patient is not wearing a mask • Regular COVID-19 \ntesting of staff • Tools/workflow intervention to ensure physical distancing • \nCleaning/disinfection/decontamination guidance • Workplace/personal risk \nassessments • MRI safety labelling/classification of respiratory personal \nprotective equipment (PPE) \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 321  \nConclusion: Many of the proposals could be introduced into any outpatient \nsetting and may assist in promoting a benchmark of infection control standards \nto follow, as further evidence about COVID-19 emerges. Maintaining \nrecommended safe distances isn't possible when scanning. Identifying infected \ncases is problematic. A multitiered approach, which filters out the potentially \ninfected before they reach the unit is required. The complex nature of MRI \npresents challenges to cleaning, disinfecting and decontamination with \nrespiratory PPE not labelled for MRI safety conditions. These interventions \nmay help reduce such risks and optimise service efficiency. \nLimitations: Limited number of responses \nEthics Committee Approval: Not applicable \nFunding for this study: Not applicable \nAuthor Disclosures: \nBarbara J. Nugent: Nothing to disclose \n \n \nE³ - Advanced Courses: Artificial \nIntelligence \nE³ 122 \nArtificial intelligence (AI) in radiology: the \nbasics you need to know \nE³ 122-1 \nA. Conventional machine learning vs deep learning \nMarleen de Bruijne; Rotterdam/NL  \n \nLearning Objectives: \n1. To understand the difference between machine learning and deep learning. \n2. To learn about the various conventional machine learning techniques. \n3. To learn about pros and cons of conventional machine learning vs deep \nlearning. \nAuthor Disclosures: \nMarleen de Bruijne: Research Grant/Support: NWO, TTW, Intel, Quantib \n \nE³ 122-2 \nB. Training data for deep learning: what is needed? \nThomas Weikert; Basle/CH  \n(thomasjohannes.weikert@usb.ch) \n \nLearning Objectives: \n1. To learn about what is needed to train neural networks in radiology. \n2. To learn about the sources of training data for radiology projects as well as \ntheir pros and cons. \n3. To learn about the peculiarities of data in radiology and what they mean for \nthe training of algorithms. \n \nE³ 122-3 \nC. Clinical applications of artificial intelligence (AI) in medical imaging \nNickolas Papanikolaou; Lisbon/PT \n(nickolas.papanikolaou@research.fchampalimaud.org) \n \nLearning Objectives: \n1. To learn about the current state of the art of AI applications in medical \nimaging. \n2. To focus on the current challenges related to AI development and \ndeployment in clinical conditions. \n3. To understand how AI will transform medical imaging in the long term. \nAuthor Disclosures: \nNickolas Papanikolaou: Owner: MRIcons LTD \n \n \n \n \n \n \n \n \n \nE³ - Advanced Courses: Artificial \nIntelligence \nE³ 222 \nArtificial intelligence for image \nreconstruction: towards deep imaging? \nE³ 222-1 \nA. Deep learning for MRI reconstruction \nKerstin Hammernik; London/UK  \n \nLearning Objectives: \n1. To demonstrate how with deep learning we can learn the entire MRI \nreconstruction procedure. \n2. To understand the advantages and disadvantages of using deep learning in \nMRI reconstruction. \n3. To demonstrate the application of deep learning in the reconstruction of MRI \nmusculoskeletal images. \n \nE³ 222-2 \nB. Deep learning in cardic MRI acquisition and reconstruction \nDaniel Rueckert; London/UK  \n(D.Rueckert@imperial.ac.uk) \n \nLearning Objectives: \n1. To understand how MRI acquisition time can be reduced with deep learning. \n2. To understand the potential artefacts related to deep learning-based image \nreconstruction. \n3. To demonstrate the applications of deep learning in the reconstruction of \ncardiovascular MRI data. \nAuthor Disclosures:  \nDaniel Rueckert: Consultant: Heartflow, IXICO, Circle Cardiovascular Imaging \n \nE³ 222-3 \nC. Deep learning in CT image acquisition and reconstruction \nMathias Prokop; Nijmegen/NL \n(mathias.prokop@radboudumc.nl) \n \nLearning Objectives: \n1. To learn how deep learning can be used to improve CT image quality. \n2. To understand how deep learning can be used to speed up CT image \nacquisition. \n3. To learn about clinical applications of deep learning-based CT \nreconstruction. \nAuthor Disclosures:  \nMathias Prokop: Patent Holder: 4D noise suppresion, licensed to Canon \nMedical Systems; Research Grant/Support: Canon Medical Systems, Siemens \nHealthineers; Speaker: Canon Medical Systems, Siemens Healthineers \n \n \nE³ - Advanced Courses: Artificial \nIntelligence \nE³ 322 \nArtificial intelligence and translations to \nclinical practice \nE³ 322-1 \nA. Artificial intelligence (AI) use cases \nBibb Allen, Jr.; Birmingham, AL/US  \n(bibb@mac.com) \n \nLearning Objectives: \n1. To introduce the audience to the AI use cases developed by the American \nCollege of Radiology. \n2. To learn about an ecosystem for developing AI algorithms that can be \ntranslated into clinical practice. \n3. To discuss the hurdles and proposed solutions to getting regulatory approval \nfor AI techniques. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 322  \nE³ 322-2 \nB. Challenges to objectively compare performance of AI applications \nLena Maier-Hein; Heidelberg/DE  \n \nLearning Objectives: \n1. To learn about the outcomes of a review of more than 150 challenges in \nmedical imaging. \n2. To learn about the metrics allowing the objective evaluation of AI algorithm \nperformance. \n3. To understand how new developments in AI challenges help to objectively \nevaluate the performance of algorithms. \n \nE³ 322-3 \nC. How far are we in getting AI into clinical practice? \nLuis Martí-Bonmatí; Valencia/ES \n(marti_lui@gva.es) \n \nLearning Objectives: \n1. To critically review the current level of AI adoption in clinical practice. \n2. To understand the need of data scientists working in radiology departments. \n3. To discuss what next steps need to be taken in order to increase take-up in \nclinical practice. \nAuthor Disclosures: \nLuis Martí-Bonmatí: Advisory Board: QUIBIM \n \n \nE³ - Advanced Courses: Artificial \nIntelligence \nE³ 422 \nRadiomics: principles and applications \nE³ 422-1 \nA. Radiomics: images are data! \nGiuseppe Cicchetti; Rome/IT  \n(cicchetti.giuseppe88@gmail.com) \n \nLearning Objectives: \n1. To understand the design of a pipeline to develop a radiomics signature. \n2. To learn about the current state of the art in radiomics. \n3. To learn about the impact of radiomics for precision medicine. \n \nE³ 422-2 \nB. Radiomics applications \nTobias Penzkofer; Berlin/DE  \n \nLearning Objectives: \n1. To learn about the state of the art of radiomics in prostate cancer. \n2. To learn about the state of the art of radiomics in gliomas. \n3. To learn about other promising application areas of radiomics. \nAuthor Disclosures:  \nTobias Penzkofer: Employee: Charité Universitätsmedizin Berlin; Research \nGrant/Support: Berlin Institute of Health, AGO, Aprea AB, ARCAGY-GINECO, \nAstellas Pharma Global Inc. (APGD), Astra Zeneca, Clovis Oncology, Inc., \nDohme Corp, Elsevier, Holaira, Incyte Corporation, Karyopharm, Lion \nBiotechnologies, Inc., MedImmune, Merck Sharp, Millennium Pharmaceuticals, \nInc., Morphotec Inc., NovoCure Ltd., PharmaMar S.A. and PharmaMar USA, \nInc., Roche, Siemens Healthineers, and TESARO Inc. \n \nE³ 422-3 \nC. Multicentre studies for more robust radiomics signatures \nMartijn Starmans; Rotterdam/NL \n(m.starmans@erasmusmc.nl) \n \nLearning Objectives: \n1. To introduce a framework for the rapid development of radiomics signatures. \n2. To explain how the parameters of a radiomics pipeline can be automatically \noptimised. \n3. To show the performance of the framework for a number of applications. \n \n \nE³ - Advanced Courses: Artificial \nIntelligence \nE³ 522 \nArtificial intelligence and clinical decision \nsupport \nE³ 522-1 \nA. Clinical decision support workflow improved by artificial intelligence \n(AI) \nErik R. Ranschaert; Tilburg/NL  \n \nLearning Objectives: \n1. To learn how a decision support workflow can be supported and improved \nby AI. \n2. To understand the different workflow parts in which AI can play a role. \n3. To discuss how to evaluate the clinical value of AI in decision support. \nAuthor Disclosures:  \nErik R. Ranschaert: Advisory Board: Osimis, Diagnose.me; Consultant: Barco, \nRobovision; Share holder: Osimis, Diagnose.me \n \nE³ 522-2 \nB. Data mining and machine learning for integrated clinical decision \nsupport \nGiles Boland; Boston, MA/US  \n(gboland@partners.org) \n \nLearning Objectives: \n1. To understand how data mining can help in clinical decision support. \n2. To learn about the needs and limitations of standardisation for AI-assisted \nclinical decision support. \n3. To learn about the state of the art in AI-assisted clinical decision support. \nAuthor Disclosures: \nGiles Boland: Other: royalities Elsevier \n \nE³ 522-3 \nC. AI to predict treatment response \nNandita M. deSouza; Sutton/UK \n \nLearning Objectives: \n1. To understand the role of AI in moving towards precision medicine. \n2. To understand the current potential of AI for monitoring response. \n3. To understand how to manage AI in a clinical workflow as a decision support \ntool. \n \n \nE³ - Advanced Courses: Artificial \nIntelligence \nE³ 622 \nChallenges and solutions for introducing \nartificial intelligence (AI) in daily clinical \nworkflow \nE³ 622-1 \nA. Implementation of AI algorithms in picture archiving and \ncommunication systems (PACS) \nWouter B. Veldhuis; Utrecht/NL  \n \nLearning Objectives: \n1. To learn about how to start experimenting with AI in daily clinical routine. \n2. To learn about the developments of integrating multiple AI tools within one \nframework. \n3. To learn about the processes to evaluate AI algorithms for clinical use \ncases. \nAuthor Disclosures: \nWouter B. Veldhuis: Other: CoFounder of QuantibU \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 323  \nE³ 622-2 \nB. How to best complement human intelligence with AI \nChristian J. Herold; Vienna/AT  \n(Christian.Herold@meduniwien.ac.at) \n \nLearning Objectives: \n1. To understand the current and emerging concept for AI and machine \nlearning in imaging. \n2. To explore whether it is possible to successfully integrate AI into clinical \npractice today. \n3. To learn how radiologists can be assisted by AI. \nAuthor Disclosures:  \nChristian J. Herold: Advisory Board: Siemens Healthineers; Board Member: \nContext Flow; Research Grant/Support: Siemens Healthineers, Bracco, Bayer \nHealthcare and 115 other companies; Share holder: Hologic Inc. \n \nE³ 622-3 \nC. AI, ethics, and radiology \nAdrian Brady; Cork/IE \n(adrianbrady@me.com) \n \nLearning Objectives: \n1. To understand the ethical aspects related to data use in AI. \n2. To learn about possible bias in AI algorithms. \n3. To learn how to prepare radiology policies for AI. \n \nE³ 622-4 \nD. AI in radiology: culture change \nHoward Fleishon; Atlanta, GA/US \n(hfleishon@outlook.com) \n \nLearning Objectives: \n1. To review the possible changes in radiology practices and departments due \nto the implementation of AI workflows. \n2. To present the possible impact of AI on radiology macroeconomics. \n3. To discuss the educational innovations in introducing AI into radiology \nresident training. \n \n \nE³ - Advanced Courses: Artificial \nIntelligence \nJointly organised by the ESR and EIBALL \nE³ 722 \nMaking the invisible visible: pushing the \nboundaries in multimodality radiomic \nquantification \nE³ 722-1 \nA. Unravelling the mysteries of the black box: does radiomics enhance or \ncomplement biomarker data? \nAna Jiménez-Pastor; Valencia/ES  \n(anajimenez@quibim.com) \n \nLearning Objectives: \n1. To learn what radiomic analyses add to current biomarker evaluation. \n2. To appreciate the limitations and pitfalls of such analyses. \n3. To understand the most robust statistical methods for carrying out the \nanalyses. \nAuthor Disclosures:  \nAna Jiménez-Pastor: Employee: QUIBIM SL \n \nE³ 722-2 \nB. Working across modalities: how do we progress from redundant to \nrelevant data? \nPhilippe Lambin; Maastricht/NL  \n \nLearning Objectives: \n1. To learn how radiomic outputs differ across modalities. \n2. To appreciate the variability of the method and how to ensure data is robust. \n3. To understand the relevance of the findings. \n \n \nE³ 722-3 \nC. Using radiomics in the clinic: a decision support tool? \nMarius E. Mayerhöfer; Vienna/AT \n(marius.mayerhoefer@meduniwien.ac.at) \n \nLearning Objectives: \n1. To learn the clinical scenarios where radiomic analyses may be helpful. \n2. To appreciate the place of these analyses in the context of other quantifiable \nbiomarkers. \n3. To understand the implications of using these analyses in the clinic. \nAuthor Disclosures: \nMarius E. Mayerhöfer: Speaker: Siemens, BMS \n \n \nE³ - Advanced Courses: How to Improve \nYour Expertise in Cardiothoracic Imaging \nE³ 919 \nLow-dose thoracic CT: only screening for \nlung cancer? \nE³ 919-1 \nA. Overview of lung cancer screening activities in European countries \nMario Silva; Parma/IT  \n(mariosilvamed@gmail.com) \n \nLearning Objectives: \n1. To be aware of the latest results of lung cancer screening trials. \n2. To learn about the best technical standards for lung cancer screening. \n3. To learn about the performance of artificial intelligence algorithms for lung \ncancer prediction. \n \nE³ 919-2 \nB. Lung nodule management \nAnna Rita Larici; Rome/IT  \n(annarita.larici@unicatt.it) \n \nLearning Objectives: \n1. To be aware of the common causes of solitary pulmonary nodules. \n2. To learn about key radiological features suggesting a benign cause. \n3. To learn about the methods allowing identifying malignant nodules. \n \nE³ 919-3 \nC. Coronary artery disease assessment as part of a lung cancer \nscreening programme: how to do it? \nRozemarijn Vliegenthart; Groningen/NL \n(r.vliegenthart@umcg.nl) \n \nLearning Objectives: \n1. To become familiar with the importance and predictive power of coronary \ncalcium assessment. \n2. To discuss the possibilities of combining coronary calcium assessment and \nlung cancer screening. \n3. To learn about the practical implementation of coronary calcium assessment \nin the routine chest. \nAuthor Disclosures:  \nRozemarijn Vliegenthart: Grant Recipient: Institutional Research grant, \nSiemens Healthineers; Other: honorarium as Associate Editor, Eur J Radiology \n \n \nE³ - Advanced Courses: How to Improve \nYour Expertise in Cardiothoracic Imaging \nE³ 1219 \nInfections of the chest \nE³ 1219-1 \nA. Pulmonary infections \nJiri Neuwirth; Prague/CZ  \n(neuwirthj@gmail.com) \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 324  \n \nLearning Objectives: \n1. To review the role and limitations of chest-x ray for diagnosing community-\nacquired pneumonia. \n2. To learn about pulmonary infections in immunocompromised hosts. \n3. To become familiar with CT signs suggesting fungal infection. \n \nE³ 1219-2 \nB. Tuberculosis (TB) \nIgor E. Tyurin; Moscow/RU  \n \nLearning Objectives: \n1. To evaluate the imaging patterns of thoracic tuberculosis. \n2. To review the different imaging features of the disease in immune \ncompromised patients. \n3. To discuss the current role of imaging in nontuberculous mycobacterial \ndisease. \n \nE³ 1219-3 \nC. Infectious endocarditis \nHatem Alkadhi; Zurich/CH \n \nLearning Objectives: \n1. To review the valvular consequences of untreated infections. \n2. To become familiar with the CT signs of endocarditis in native valves. \n3. To learn about the typical appearance of infectious complications after \nvalvular surgery. \n \n \nE³ - Advanced Courses: How to Improve \nYour Expertise in Cardiothoracic Imaging \nE³ 1519 \nMediastinal and cardiac tumours in adults \nE³ 1519-1 \nA. Prevascular compartment of the mediastinum \nJosé Vilar; Valencia/ES  \n(vilarsamper@gmail.com) \n \nLearning Objectives: \n1. To become familiar with the main causes of prevascular tumours. \n2. To review the CT features of thymic malignancies. \n3. To learn when to suspect lymphoma and when to suggest percutaneous \nbiopsy. \n \nE³ 1519-2 \nB. Paravertebral space \nMariaelena Occhipinti; Florence/IT  \n \nLearning Objectives: \n1. To become familiar with the posterior mediastinal pathology. \n2. To review the typical and atypical features of neurogenic tumours. \n3. To learn about less frequent causes of paravertebral space masses. \n \nE³ 1519-3 \nC. Cardiac masses: a survival guide \nValentin E. Sinitsyn; Moscow/RU \n(vsini@mail.ru) \n \nLearning Objectives: \n1. To learn how to differentiate thrombi from tumours of the cardiac cavities. \n2. To review the main differential diagnosis of cardiac tumours. \n3. To learn about the role of US, CT, and MRI for diagnosis and \ncharacterisation. \nAuthor Disclosures:  \nValentin E. Sinitsyn: Advisory Board: Comany Botkin AI (Russia); Consultant: \nComany PET-Technology (Russia); Speaker: GE healthcare Satellite \nSymposium at ECR 2021 \n \n \nE³ - Advanced Courses: How to Improve \nYour Expertise in Cardiothoracic Imaging \nE³ 1619 \nPulmonary embolism/pulmonary \nhypertension \nE³ 1619-1 \nA. Diagnosis of acute pulmonary embolism (PE) \nMarie-Pierre Revel; Paris/FR  \n(marie-pierre.revel@aphp.fr) \n \nLearning Objectives: \n1. To review the role of clinical probability scores and D-dimer assessment. \n2. To learn about tips and tricks to optimise arterial opacification on CT. \n3. To learn about key features to report in acute PE. \nAuthor Disclosures:  \nMarie-Pierre Revel: Speaker: Lecture fees from MSD; Other: Travel support \nfrom GUERBET \n \nE³ 1619-2 \nB. Pulmonary hypertension \nAnagha P. Parkar; Bergen/NO  \n \nLearning Objectives: \n1. To become familiar with the causes of pulmonary hypertension. \n2. To learn about the radiological presentation of pulmonary artery \nhypertension. \n3. To understand how imaging helps patient management. \n \nE³ 1619-3 \nC. The heart in pulmonary hypertension \nKarl-Friedrich Kreitner; Mainz/DE \n(Karl-Friedrich.Kreitner@unimedizin-mainz.de) \n \nLearning Objectives: \n1. To learn about cardiac causes of pulmonary hypertension. \n2. To become familiar with cardiac assessment in pulmonary hypertension. \n3. To recognise the prognostic importance of right ventricle dysfunction in \npulmonary hypertension. \n \n \nE³ - Advanced Courses: Interactive \nTeaching Sessions for Young (and not so \nYoung) Radiologists \nE³ 121 \nMusculoskeletal tumours \nE³ 121-1 \nA. Soft tissue tumours \nFilip M.H.M. Vanhoenacker; Antwerp/BE  \n(filip.vanhoenacker@telenet.be) \n \nLearning Objectives: \n1. To describe the imaging findings of soft tissue tumours. \n2. To review the differential diagnosis of soft tissue tumours and tumour-like \nconditions. \n \nE³ 121-2 \nB. Bone tumours \nF. Bilge Ergen; Ankara/TR  \n(bergen@delta-eur.com) \n \nLearning Objectives: \n1. To describe imaging findings of musculoskeletal tumours and tumour-like \nconditions. \n2. To recognise imaging pitfalls of musculoskeletal tumours and tumour-like \nconditions. \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 325  \n \nE³ - Advanced Courses: Interactive \nTeaching Sessions for Young (and not so \nYoung) Radiologists \nE³ 221 \nEmergency and chest radiology \nE³ 221-1 \nA. Dyspnoea in oncologic patients: how to approach it \nCornelia M. Schaefer-Prokop; Amersfoort/NL  \n(cornelia.schaeferprokop@gmail.com) \n \nLearning Objectives: \n1. To learn about the role of imaging in oncologic patients with dyspnoea. \n2. To understand the importance of clinical data for narrowing the differential \ndiagnosis \n \nE³ 221-2 \nB. Blunt thoracic trauma: from the plain film to CT \nAnastasia Oikonomou; Toronto, ON/CA  \n(anastasia.oikonomou@sunnybrook.ca) \n \nLearning Objectives: \n1. To learn about the spectrum of radiological findings in blunt thoracic trauma. \n2. To emphasise the importance of CT reformations for the detection of severe \ncomplex traumatic injuries. \n \n \nE³ - Advanced Courses: Interactive \nTeaching Sessions for Young (and not so \nYoung) Radiologists \nE³ 321 \nImaging of the liver \nE³ 321-1 \nA. CT and MRI liver imaging reporting and data system (LI-RADS): how to \nuse it and what to expect \nAnna Darnell; Barcelona/ES  \n \nLearning Objectives: \n1. To become familiar with LI-RADS categories, definitions and algorithms. \n2. To discuss the confusing features of LI-RADS with examples. \n3. To understand what the probability of hepatocellular carcinoma is for each \nLI-RADS category. \n \nE³ 321-2 \nB. Focal lesions in non-cirrhotic liver: how to diagnose, differentiate and \nmanage \nGiuseppe Brancatelli; Palermo/IT  \n(gbranca@yahoo.com) \n \nLearning Objectives: \n1. To learn how to differentiate focal liver lesions in non-cirrhotic patients with \nCT and MRI. \n2. To know how to manage non-cirrhotic patients with focal liver lesions. \nAuthor Disclosures:  \nGiuseppe Brancatelli: Consultant: Bayer; Speaker: Bayer, GE Healthcare \n \n \nE³ - Advanced Courses: Interactive \nTeaching Sessions for Young (and not so \nYoung) Radiologists \nE³ 421 \nSmall bowel imaging \nE³ 421-1 \nA. CT and MR enterography: my technical tips for preparation and \nscanning \nAntónio J.B.S. Madureira; Porto/PT  \n(ajbmadureira@gmail.com) \n \nLearning Objectives: \n1. To understand the importance of proper preparation for enterography. \n2. To be familiar with technical details that ensures high imaging quality. \n \nE³ 421-2 \nB. Detection of small bowel involvement in patients with peritoneal \ncarcinomatosis before hyperthermic intraperitoneal chemotherapy \n(HIPEC)? \nMichael R. Torkzad; Stockholm/SE  \n(michael.torkzad@gmail.com) \n \nLearning Objectives: \n1. To understand how to optimise imaging techniques to detect peritoneal \ninvolvement of the small bowel. \n2. To be familiar the various imaging characteristics of peritoneal involvement \nof the small bowel. \n \n \nE³ - Advanced Courses: Interactive \nTeaching Sessions for Young (and not so \nYoung) Radiologists \nE³ 521 \nMusculoskeletal radiology: arthropathies \nE³ 521-1 \nA. Extremities \nÜstün Aydingöz; Ankara/TR  \n(uaydingo@hacettepe.edu.tr) \n \nLearning Objectives: \n1. To explain the key points in the differential diagnosis of common \narthropathies in the extremities. \n2. To describe the imaging findings of common arthropathies in the extremities \nas they relate to pathophysiology. \n \nE³ 521-2 \nB. The axial skeleton \nApostolos H. Karantanas; Iraklion/GR  \n(akarantanas@gmail.com) \n \nLearning Objectives: \n1. To explain the key points in the differential diagnosis of arthropathies in the \naxial skeleton. \n2. To describe the imaging findings of arthropathies in the axial skeleton as \nthey relate to pathophysiology. \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 326  \n \nE³ - Advanced Courses: Interactive \nTeaching Sessions for Young (and not so \nYoung) Radiologists \nE³ 621 \nNeuroradiology: paediatric and adult \nE³ 621-1 \nA. Imaging in epilepsy: how to scan and find the suspect \nMichael Okujava; Tbilisi/GE  \n \nLearning Objectives: \n1. To describe best imaging protocols when considering the patient's age. \n2. To review common epileptogenic lesions and their imaging features. \n3. To define contributions from advanced imaging. \n \nE³ 621-2 \nB. Imaging in movement disorders: keeping up with the neurologist \nKader Karli Oguz; Ankara/TR  \n(karlioguz@yahoo.com) \n \nLearning Objectives: \n1. To review common movement disorders and basic mechanisms. \n2. To define the role of radiologic examinations and review ideal imaging \nprotocols. \n3. To review diagnostic radiologic patterns in classified movement disorders. \n \n \nE³ - Advanced Courses: Interactive \nTeaching Sessions for Young (and not so \nYoung) Radiologists \nE³ 721 \nCardiac imaging: an update \nE³ 721-1 \nA. Coronary artery disease - reporting and data system (CAD-RADS): a \nnew tool for reporting coronary CT angiograms (CTAs) \nBálint Szilveszter; Budapest/HU  \n(szilveszter.balint@gmail.com) \n \nLearning Objectives: \n1. To be familiar with standardised reporting of coronary CTA findings. \n2. To know the impact of CAD-RADS in management and treatment. \n \nE³ 721-2 \nB. Athlete's heart \nJan Bogaert; Leuven/BE  \n(Jan.Bogaert@uz.kuleuven.ac.be) \n \nLearning Objectives: \n1. To learn about the different entities that cause left ventricular thickening. \n2. To understand the role of the different techniques in the study of this \npatients. \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nE³ - Advanced Courses: Interactive \nTeaching Sessions for Young (and not so \nYoung) Radiologists \nE³ 821 \nGynecological cancer imaging \nE³ 821-1 \nA. Cervical cancer \nTeresa Margarida Cunha; Lisbon/PT  \n(tmargarida@gmail.com) \n \nLearning Objectives: \n1. To describe the imaging findings of cervical cancer. \n2. To learn about the new International Federation of Gynecology and \nObstretrics (FIGO) classification and its implications. \n3. To define the role of radiologic examinations and review ideal imaging \nprotocols. \n4. To recognise imaging pitfalls in cervical cancer. \n \nE³ 821-2 \nB. Ovarian cancer: new challenges \nStephanie Nougaret; Montpellier/FR  \n \nLearning Objectives: \n1. To be familiar with the histological subtype of the epithelial ovarian cancer. \n2. To become familiar with the revised FIGO staging system. \n3. To learn about the role of imaging in recognising \"difficult to resect\" disease. \n \n \nE³ - Advanced Courses: Interactive \nTeaching Sessions for Young (and not so \nYoung) Radiologists \nE³ 921 \nImaging of the face \nE³ 921-1 \nA. Facial infections and complications \nMartin G. Mack; Munich/DE  \n(m.mack@radiologie-muenchen.de) \n \nLearning Objectives: \n1. To become familiar with the key concepts and imaging features of facial \ninfections. \n2. To learn how to integrate clinical findings with radiological features. \n \nE³ 921-2 \nB. Facial pain \nAlexandra Borges; Lisbon/PT  \n(borgalexandra@gmail.com) \n \nLearning Objectives: \n1. To become familiar with the key concepts and imaging features of facial \npain. \n2. To learn how to integrate clinical findings with radiological features. \n \n \n \n \n \n \n \n \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 327  \n \nE³ - Advanced Courses: Interactive \nTeaching Sessions for Young (and not so \nYoung) Radiologists \nE³ 1021 \nFocal testicular lesions: challenging \nconditions \nE³ 1021-1 \nA. Acutely painful lesions \nVikram S. Dogra; Rochester, NY/US  \n(Vikram_Dogra@URMC.Rochester.Edu) \n \nLearning Objectives: \n1. To describe the imaging findings of tumours and tumour-like testicular \nlesions presenting clinically with acute scrotal pain. \n2. To learn how to integrate clinical and imaging findings for the differential \ndiagnosis between benign and malignant lesions. \n \nE³ 1021-2 \nB. The small, incidentally detected lesion \nPaul S. Sidhu; London/UK  \n(paulsidhu@btinternet.com) \n \nLearning Objectives: \n1. To learn about the prevalence of small testicular lesions incidentally \ndetected at US. \n2. To learn how to improve characterisation of small incidentally detected \ntesticular lesions. \n3. To discuss how to manage the patient with small incidentally detected \ntesticular lesions. \nAuthor Disclosures: \nPaul S. Sidhu: Advisory Board: Samsung Inc; Consultant: ITREAS; Speaker: \nBracco, Siemens \n \n \nE³ - Advanced Courses: Interactive \nTeaching Sessions for Young (and not so \nYoung) Radiologists \nE³ 1121 \nImaging of head and neck manifestations \nof systemic disease \nE³ 1121-1 \nA. Autoimmune disorders: IgG, Sjogren's syndrome and others \nMinerva Becker; Geneva/CH  \n \nLearning Objectives: \n1. To become familiar with the imaging characteristics of autoimmune disease \nmanifestations in the head and neck. \n2. To learn how to avoid interpretation pitfalls on CT, US and MRI. \n \nE³ 1121-2 \nB. Lymphatic and haematopoietic neoplasms \nFrank Pameijer; Utrecht/NL  \n(f.a.pameijer@umcutrecht.nl) \n \nLearning Objectives: \n1. To become familiar with the imaging characteristics of lymphatic and \nhaematopoietic neoplasms affecting the head and neck. \n2. To learn how to avoid interpretation pitfalls on CT, US and MRI. \n \n \nE³ - Advanced Courses: Interactive \nTeaching Sessions for Young (and not so \nYoung) Radiologists \nE³ 1221 \nBreast lesions of uncertain malignant \npotential (B3 lesions): the management \nconundrum \nE³ 1221-1 \nA. Imaging appearance of B3 lesions \nPascal A.T. Baltzer; Vienna/AT  \n \nLearning Objectives: \n1. To understand the entire spectrum of the lesions with uncertain malignant \npotential (B3). \n2. To learn how B3 lesions appear on mammography, tomosynthesis, contrast-\nenhanced mammography, ultrasound, non-contrast and contrast-enhanced \nMRI. \n3. To discuss their different biological behaviour in relation to contrast-\nenhanced imaging modalities. \n \nE³ 1221-2 \nB. The clinical management of B3 lesions \nSimone Schiaffino; Milan/IT  \n(schiaffino.simone@gmail.com) \n \nLearning Objectives: \n1. To distinguish between low and high-risk B3 lesions. \n2. To know the impact of needle size and imaging guidance on exclusion of \nassociated malignancy. \n3. To learn how to discuss the clinical management of B3 lesions in the \nmultidisciplinary meeting. \nAuthor Disclosures:  \nSimone Schiaffino: Speaker: GE Healthcare; Bracco Imaging \n \n \nE³ - Advanced Courses: Interactive \nTeaching Sessions for Young (and not so \nYoung) Radiologists \nE³ 1321 \nImaging of the retroperitoneum \nE³ 1321-1 \nA. Retroperitoneal lesions \nSubramaniyan Ramanathan; Doha/QA  \n(drrmsubbu@gmail.com) \n \nLearning Objectives: \n1. To illustrate the spectrum of primary retroperitoneal tumours and non-\nneoplastic disease. \n2. To explain the key points in the differential diagnosis. \n3. To learn how to avoid interpretation pitfalls. \n \nE³ 1321-2 \nB. Subperitoneal, perirectal and deep pelvic lesions \nMustafa Secil; Izmir/TR  \n(mustafa.secil@deu.edu.tr) \n \nLearning Objectives: \n1. To illustrate the spectrum of benign and malignant perirectal and deep pelvic \nlesions. \n2. To discuss the imaging features of these lesions. \n3. To understand how to narrow the differential diagnosis. \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 328  \n \nE³ - Advanced Courses: Interactive \nTeaching Sessions for Young (and not so \nYoung) Radiologists \nE³ 1421 \nCross-sectional imaging of bone \nmetastases \nE³ 1421-1 \nA. Is it a bone metastasis (incidental lesions)? \nSabine Weckbach; Heidelberg/DE  \n(sabine.weckbach@med.uni-heidelberg.de) \n \nLearning Objectives: \n1. To illustrate the imaging appearance of bone metastases. \n2. To review the imaging protocols for evaluation of bone metastases. \n3. To illustrate how to differentiate between metastases and other focal bone \nlesions.  \n4. To illustrate the pitfalls and limitations of imaging in assessment of \nmetastatic bone disease. \n \nE³ 1421-2 \nB. Dedicated whole-body staging for bone metastases \nGiuseppe Petralia; Milan/IT  \n(giuseppe.petralia@ieo.it) \n \nLearning Objectives: \n1. To review current image acquisition and interpretation for whole-body MRI. \n2. To illustrate the clinical applications for whole-body MRI in assessment of \nmetastatic bone disease.  \n3. To illustrate the potential and limitations of whole-body MRI in assessment \nof metastatic bone disease. \n \n \nE³ - Advanced Courses: Interactive \nTeaching Sessions for Young (and not so \nYoung) Radiologists \nE³ 1521 \nPelvic pain in female patients \nE³ 1521-1 \nA. Acute pain \nFrancesca Iacobellis; Naples/IT  \n(iacobellisf@gmail.com) \n \nLearning Objectives: \n1. To become familiar with different uterine and adnexal pathologies presenting \nacute pelvic pain. \n2. To learn about integrating clinical findings with imaging features before \nestablishing a diagnosis. \n \nE³ 1521-2 \nB. Chronic pain \nMarcia C. Javitt; Haifa/IL  \n(m_javitt@rambam.health.gov.il) \n \nLearning Objectives: \n1. To become familiar with different uterine and adnexal pathologies presenting \nchronic pelvic pain. \n2. To learn about integrating clinical findings with imaging features before \nestablishing a diagnosis. \n \n \nE³ - Advanced Courses: Neuro \nE³ 118 \nMetabolic disorders: common and \ncomplex \nE³ 118-1 \nA. Posterior reversible encephalopathy syndrome (PRES): still no name \nchange? \nSven Haller; Geneva/CH  \n \nLearning Objectives: \n1. To discuss the pathophysiology and new insights of PRES. \n2. To give an overview of imaging findings in PRES. \n3. To learn how to recognise PRES differentials. \nAuthor Disclosures: \nSven Haller: Advisory Board: EPAD; Consultant: Spineart, Wyss \n \nE³ 118-2 \nB. Acquired metabolic diseases \nJasmina Boban; Novi Sad/RS  \n(jasmina.konstantinovic@gmail.com) \n \nLearning Objectives: \n1. To learn about the most important acquired metabolic diseases affecting the \nbrain. \n2. To understand the underlying pathology of intoxications. \n3. To become familiar with drugs-related neurotoxicity. \n \nE³ 118-3 \nC. Prognostication of hypoxic-ischaemic injury (HII) \nSeamus Looby; Dublin/IE \n \nLearning Objectives: \n1. To explain imaging findings in HII. \n2. To learn how to evaluate the prognosis. \n3. To discuss the diagnosis of brain death. \n \n \nE³ - Advanced Courses: Neuro \nE³ 218 \nInflammation: the burning brain \nE³ 218-1 \nA. Vessel wall imaging: how to do it \nJeroen Hendrikse; Utrecht/NL  \n(J.Hendrikse@umcutrecht.nl) \n \nLearning Objectives: \n1. To understand vessel wall imaging. \n2. To learn when and how to use vessel wall imaging. \n3. To learn about the possible pitfalls in using vessel wall imaging. \n \nE³ 218-2 \nB. Vasculitis: what can we see with new MRI techniques? \nHans Rolf Jäger; London/UK  \n(r.jager@ucl.ac.uk) \n \nLearning Objectives: \n1. To discuss the imaging findings in CNS vasculitis. \n2. To understand the value of each MRI technique in the evaluation of \nvasculitis. \n3. To discuss the pathological findings and their clinical relevance. \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 329  \nE³ 218-3 \nC. Autoimmune diseases: new pandemia? \nPhilippe Demaerel; Leuven/BE \n \nLearning Objectives: \n1. To learn about the rising incidence of autoimmune mediated diseases. \n2. To discuss the imaging findings suggestive of autoimmune encephalitis. \n3. To understand the clinical scenarios and indications for imaging. \n \n \nE³ - Advanced Courses: Neuro \nE³ 318 \nBrain tumours: new classification, new \nnames, new challenges \nE³ 318-1 \nA. Glioblastoma: what is really important? \nSotirios Bisdas; London/UK  \n(s.bisdas@ucl.ac.uk) \n \nLearning Objectives: \n1. To become familiar with the current classifications of glioblastoma. \n2. To learn how to distinguish between glioblastoma and lymphoma. \n3. To understand the value of advanced techniques in evaluating. \n \nE³ 318-2 \nB. Child with posterior fossa tumour: what next? \nZoltán Patay; Memphis, TN/US  \n \nLearning Objectives: \n1. To learn about the most common posterior fossa tumours in children. \n2. To understand the challenges in the interpretation of images. \n3. To appreciate the new classifications and genetic insights. \n \nE³ 318-3 \nC. Tumour or therapy-induced changes \nPia C. Maly Sundgren; Lund/SE \n \nLearning Objectives: \n1. To learn about therapy-induced phenomena. \n2. To appreciate diagnostic strategy in the differentiation between recurrence \nand therapy-induced changes. \n3. To understand how to use advanced techniques in treatment monitoring. \n \n \nE³ - Advanced Courses: Neuro \nE³ 418 \nVascular disorders beyond stroke: small \narteries and veins \nE³ 418-1 \nA. Cerebral amyloid angiopathy (CAA) and other small vessel diseases \nFabrice Bonneville; Toulouse/FR  \n(bonneville.f@chu-toulouse.fr) \n \nLearning Objectives: \n1. To learn about imaging findings in CAA. \n2. To discuss vascular dementia. \n3. To review imaging findings in small vessel disease. \n \n \n \n \n \n \n \n \n \nE³ 418-2 \nB. Not every black dot on susceptibility weighted imaging (SWI) is a \nmicrobleed \nPaul M. Parizel; Perth, WA/AU  \n \nLearning Objectives: \n1. To review differential diagnosis of multiple black dots on SWI. \n2. To understand how to use SWI in neurological diseases. \n3. To appreciate the value of SWI in routine brain protocols. \nAuthor Disclosures:  \nPaul M. Parizel: Advisory Board: Agfa, icometrix, SmartReporting, Incepto \nMedical; Consultant: Gold Standard Phantoms; Share holder: icometrix, \nSmartReporting, Incepto Medical, Gold Standard Phantoms, GE, Siemens \nHealthineers \n \nE³ 418-3 \nC. Veins are different \nPedro Vilela; Almada/PT \n(ferrovilela@sapo.pt) \n \nLearning Objectives: \n1. To learn about venous diseases. \n2. To review the imaging findings in venous sinus thrombosis. \n3. To become familiar with venous infarcts. \n \n \nE³ - Advanced Courses: Neuro \nE³ 518 \nSeizures: disrupted connections \nE³ 518-1 \nA. Imaging in seizures: how to identify the epileptogenic focus \nChristopher Hess; San Francisco, CA/US  \n \nLearning Objectives: \n1. To discuss the \"perfect\" protocol in patients with seizures. \n2. To learn about the structural MRI in seizures. \n3. To discuss the value of functional MRI. \n \nE³ 518-2 \nB. Temporal lobe epilepsy (TLE) \nNúria Bargalló; Barcelona/ES  \n(bargallo@clinic.ub.es) \n \nLearning Objectives: \n1. To learn the anatomy of the temporal lobe necessary for the evaluation of \nTLE. \n2. To adopt the \"temporal lobe epilepsy protocol\". \n3. To review the underlying causes of temporal lobe epilepsy. \n \nE³ 518-3 \nC. Status epilepticus \nPaolo Vitali; Milan/IT \n \nLearning Objectives: \n1. To learn about the definition and clinical presentation of status epilepticus. \n2. To understand CT and MRI findings in status epilepticus. \n3. To discuss postictal imaging findings. \n \n \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 330  \n \nEFOMP Workshop: New European Quality \nControls for State-of-the-Art Innovations in \nRadiology and Artificial intelligence: The \nRole of the Medical Physicist \nEF 2 \nEuropean quality controls (QC) in \ninnovation, safety, and artificial \nintelligence (AI) \nEF 2-1 \nArtificial intelligence: which role for the medical physicist? \nFederica Zanca; Leuven/BE  \n(federica.zanca@palindromo.consulting) \n \nLearning Objectives: \n1. To understand the rationale and challenges for building a European \nCurricular and Professional Programme on AI for medical physicists. \n2. To learn about a guideline curriculum covering theoretical and practical \naspects of education and training for medical physicists in AI within Europe. \n3. To become familiar with AI challenges and activities of medical physicists, \nthrough worked out examples. \n \nEF 2-2 \nA universal model for breast dosimetry \nIoannis Sechopoulos; Nijmegen/NL \n(ioannis.sechopoulos@radboudumc.nl) \n \nLearning Objectives: \n1. To learn why a Europe wide consistent approach is necessary for medical \nphysicists involved in clinical trials and where they fit in the multidisciplinary \nteam. \n2. To understand the rationale and challenges for the new guidances and its \nrelevance to diagnostic accuracy and safety. \n3. To become familiar with how the new guidances can be implemented in a \npractical manner. \nAuthor Disclosures:  \nIoannis Sechopoulos: Research Grant/Support: Siemens Healthcare, \nScreenPoint, Sectra Benelux, Volpara Solutions, Canon Medical; Speaker: \nSiemens Healthcare \n \nEF 2-3 \nThe role of medical physics experts in clinical trials \nNatalie Abbott; Cardiff/UK \n(natalie.abbott@wales.nhs.uk) \n \nLearning Objectives: \n1. To learn why a Europe wide consistent approach is necessary for medical \nphysicists involved in clinical trials and where they fit in the multidisciplinary \nteam. \n2. To understand the rationale and challenges for the new guidance and its \nrelevance to diagnostic accuracy and safety. \n3. To become familiar with how the new guidances can be implemented in a \npractical manner. \n \n \nEuroSafe Imaging Session \nJointly organised by the ESR and WHO \nEU 1 \nEthics and radiation protection of the \npatient: a focus on medical imaging \nEU 1-1 \nEthics and radiation protection of the patient: the WHO perspective \nJim Malone; Dublin/IE  \n(jifmal@gmail.com) \nLearning Objectives: \n1. To learn about the distinction between ethical behaviour and compliance \nwith guidelines/the law. \n2. To become familiar with a widely accepted set of ethical values and how to \ndiscern them in medicine and radiation protection (RP). \n3. To understand that a personal moral compass alone is not acceptable when \nacting as a professional. \n \nEU 1-2 \nEthics in the context of EuroSafe Imaging \nGuy Frija; Paris/FR  \n \nLearning Objectives: \n1. To learn the evolving position of ethics in radiation protection in medicine. \n2. To identify ethical challenges for the implementation of the radiation \nprotection system in medical imaging.  \n3. To appreciate the EuroSafe response to these developments. \n \nEU 1-3 \nEthics in radiation protection of patients: ICRP activities \nFrancois Bochud; Lausanne/CH \n \nLearning Objectives: \n1. To learn about the existence of ICRP-138, a report setting out the ethics \nfoundation of radiation protection. \n2. To appreciate why ICRP is developing a new report on ethics of radiation \nprotection in medical diagnosis/treatment.  \n3. To understand the concepts and values that will be introduced in the new \nICRP report. \n \nEU 1-4 \nEthics in radiological practice \nDina Husseiny Salama; Cairo/EG \n(drdinahusseiny@yahoo.com) \n \nLearning Objectives: \n1. To learn about the importance of ethics for radiology in day-to-day practice. \n2. To become familiar with ethical dilemmas that may arise when implementing \nthe system of radiation protection in radiology. \n3. To understand the importance of information for, and personal contact with, \npatients in day-to-day practice. \n \n \nEuroSafe Imaging Session \nEU 3 \nEssential requirements for dose \nmanagement systems (DMS): what do we \nreally need? \nEU 3-1 \nDosimetric parameters of x-ray modalities as an input source for DMS \nEliseo Vaño; Madrid/ES  \n(eliseov@med.ucm.es) \n \nLearning Objectives: \n1. To learn about the option of dosimetric quantities to be used for the different \nimaging modalities. \n2. To appreciate the advantages to auditing the typical patient dose values \ncompared to DRLs. \n3. To understand the need to periodically validate the dosimetric values \ntransferred to the DMS. \n \nEU 3-2 \nExperience and problems with the implementation of DMS in clinical \nroutine \nVirginia Tsapaki; Athens/GR  \n  \n\n \n \n \n2Q\u0010'HPDQG\u00033URJUDPPH\u0003\n \n A \nB \nC \n 331  \nLearning Objectives: \n1. To learn about the practical steps to follow to facilitate the process of \nprocurement to installation. \n2. To appreciate the importance of various DMS technical characteristics and \nhow they can affect the clinical practice. \n3. To understand the challenges related to the practical implementation of \nDMS into the daily clinical practice. \n \nEU 3-3 \nRequirements and workflow of DMS in the clinical context of HIS, RIS, \nand PACS \nPeter Mildenberger; Mainz/DE \n(mildenbe@uni-mainz.de) \n \nLearning Objectives: \n1. To learn about the requirements for standardised dose reporting. \n2. To appreciate the integration profiles for interoperability between different \nvendors. \n3. To understand the value of the integration of DMS into clinical information \nsystems. \n \nEU 3-4 \nNetworking of individual dose management systems to create a \ncentralised dose repository for benchmarking and national dose \ncollection \nSebastian T. Schindera; Aarau/CH \n(sschindera@aol.com) \n \nLearning Objectives: \n1. To learn about the main objectives of a centralised dose repository. \n2. To appreciate the requirements of establishing a centralised dose repository. \n3. To understand the main challenges of a centralised dose repository. \n \n \nEuroSafe Imaging Session \nEU 4 \nA historical overview of CT dose \nexposure: past, present, and future \nEU 4-1 \nFrom past to present: how have advances in CT technology impacted \nradiation doses? \nMahadevappa Mahesh; Baltimore, MD/US  \n(mmahesh@jhmi.edu) \n \nLearning Objectives: \n1. To understand how CT dose-reduction technology evolves. \n2. To become familiar with modern CT dose-reduction technology. \n3. To learn how advances in CT technology have impacted radiation doses. \nAuthor Disclosures:  \nMahadevappa Mahesh: Board Member: American College of Radiology, \nAmerican Association of Physicists in Medicine \n \nEU 4-2 \nYear 2021: what still needs to be done to reduce doses for CT? \nVirginia Tsapaki; Athens/GR  \n \nLearning Objectives: \n1. To propose new strategies that should be implemented for CT dose \nreduction. \n2. To become familiar with the tools available for CT dose management. \n3. To learn what still needs to be done to reduce doses for CT. \n \nEU 4-3 \nThe road ahead: how can we overcome hurdles towards reliable clinical \nCT dosimetry? \nJohn Damilakis; Iraklion/GR \n \nLearning Objectives: \n1. To appreciate the value of personalised dosimetry in CT. \n2. To understand how artificial intelligence can support the CT dose-reduction \nprocess. \n3. To learn how to overcome obstacles towards reliable clinical CT dosimetry. \n \n \nEuroSafe Imaging Session \nJointly organised by EuroSafe Imaging and ECR \nSubcommittee on Physics in Medical Imaging \nEU 7 \nMedical radiation exposure of patients \nEU 7-1 \nMedical radiation exposure of patients in the United States: methodology, \ndata sources, and results \nMahadevappa Mahesh; Baltimore, MD/US  \n(mmahesh@jhmi.edu) \n \nLearning Objectives: \n1. To learn how different data sources can be used to estimate the number of \nimaging procedures. \n2. To appreciate the difficulties in estimating radiation doses per imaging \nprocedure. \n3. To understand the method to estimate medical radiation exposure per \nperson. \nAuthor Disclosures:  \nMahadevappa Mahesh: Board Member: American College of Radiology, \nAmerican Association of Physicists in Medicine \n \nEU 7-2 \nMedical radiation exposure of the paediatric population \nDonald P. Frush; Durham, NC/US  \n(donald.frush@duke.edu) \n \nLearning Objectives: \n1. To become familiar with the various imaging procedures performed in the \npaediatric population. \n2. To appreciate how size matters and that imaging protocols are key to dose \noptimisation. \n3. To understand the status of paediatric imaging in the Unites States as per \nNCRP 184. \nAuthor Disclosures:  \nDonald P. Frush: Author: NCRP Report 184 \n \nEU 7-3 \nUNSCEAR's global report on radiation exposure of patients \nPeter Thomas; Yallambie, VIC/AU \n(peter.thomas@arpansa.gov.au) \n \nLearning Objectives: \n1. To learn about the survey results of the global radiation exposure of \npatients. \n2. To appreciate the challenges in coordinating data regarding the number of \nimaging procedures from various countries. \n3. To understand how the model can be utilised to estimate radiation exposure. \n \n\n \n A B \nC \n332  \n \n \n\u0003\nScientific and Educational \nExhibits (C) \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nFull EPOS\nTM presentations are published at epos.myESR.org \nand can be cited by a Digital Object Identifier (DOI) if the \npresenter has chosen to publish the work.","source_license":"CC-BY-4.0","license_restricted":false}